Introducing Pharmaceutical Care to Primary Care in Iceland—An Action Research Study

Directory of Open Access Journals (Sweden)

Anna Bryndis Blondal

2017-04-01

Full Text Available Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient’s medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher’s notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125 before and between general practitioners’ interviews. The study setting was a primary care clinic in the Reykjavik area and the patients’ homes. Results showed that the GPs’ knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space

Pharmaceutical care in smoking cessation.

Science.gov (United States)

Marín Armero, Alicia; Calleja Hernandez, Miguel A; Perez-Vicente, Sabina; Martinez-Martinez, Fernando

2015-01-01

As a determining factor in various diseases and the leading known cause of preventable mortality and morbidity, tobacco use is the number one public health problem in developed countries. Facing this health problem requires authorities and health professionals to promote, via specific programs, health campaigns that improve patients' access to smoking cessation services. Pharmaceutical care has a number of specific characteristics that enable the pharmacist, as a health professional, to play an active role in dealing with smoking and deliver positive smoking cessation interventions. The objectives of the study were to assess the efficacy of a smoking cessation campaign carried out at a pharmaceutical care center and to evaluate the effects of pharmaceutical care on patients who decide to try to stop smoking. The methodology was an open, analytical, pre-post intervention, quasi-experimental clinical study performed with one patient cohort. The results of the study were that the promotional campaign for the smoking cessation program increased the number of patients from one to 22, and after 12 months into the study, 43.48% of the total number of patients achieved total smoking cessation. We can conclude that advertising of a smoking cessation program in a pharmacy increases the number of patients who use the pharmacy's smoking cessation services, and pharmaceutical care is an effective means of achieving smoking cessation.

Pharmaceutical care in the Netherlands. History, definition and projects

NARCIS (Netherlands)

van Mil, J.W F

1996-01-01

The evolving concept of Pharmaceutical Care knows different interpretations in a different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical care is tested in the TOM and

Emerging pharmaceutical therapies for COPD

Directory of Open Access Journals (Sweden)

Lakshmi SP

2017-07-01

Full Text Available Sowmya P Lakshmi,1,2 Aravind T Reddy,1,2 Raju C Reddy1,2 1Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, 2Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA Abstract: COPD, for which cigarette smoking is the major risk factor, remains a worldwide burden. Current therapies provide only limited short-term benefit and fail to halt progression. A variety of potential therapeutic targets are currently being investigated, including COPD-related proinflammatory mediators and signaling pathways. Other investigational compounds target specific aspects or complications of COPD such as mucus hypersecretion and pulmonary hypertension. Although many candidate therapies have shown no significant effects, other emerging therapies have improved lung function, pulmonary hypertension, glucocorticoid sensitivity, and/or the frequency of exacerbations. Among these are compounds that inhibit the CXCR2 receptor, mitogen-activated protein kinase/Src kinase, myristoylated alanine-rich C kinase substrate, selectins, and the endothelin receptor. Activation of certain transcription factors may also be relevant, as a large retrospective cohort study of COPD patients with diabetes found that the peroxisome proliferator-activated receptor γ (PPARγ agonists rosiglitazone and pioglitazone were associated with reduced COPD exacerbation rate. Notably, several therapies have shown efficacy only in identifiable subgroups of COPD patients, suggesting that subgroup identification may become more important in future treatment strategies. This review summarizes the status of emerging therapeutic pharmaceuticals for COPD and highlights those that appear most promising. Keywords: pulmonary, PPAR, phosphodiesterase, emphysema, cigarette, mucus 

Provision of pharmaceutical care by community pharmacists across Europe

DEFF Research Database (Denmark)

Costa, Filipa A; Scullin, Claire; Al-Taani, Ghaith

2017-01-01

RATIONALE, AIMS, AND OBJECTIVES: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully...... implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. METHOD: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS......) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. RESULTS: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being...

Capacity to deliver pharmaceutical care by community pharmacies ...

African Journals Online (AJOL)

Pharmacy practice has transcended from largely a dispensary practice to pharmaceutical care practice. The capacity of community pharmacies to deliver pharmaceutical care was studied using pretested self survey methods. Ninety five percent (95%) of the respondents always educated customers on drug related needs, ...

Public awareness of Pharmaceutical care availability in community ...

African Journals Online (AJOL)

Furthermore, the awareness of availability of pharmaceutical care services in community pharmacies was 3% while 75% of the respondents believed a community pharmacy was just a place drugs can be obtained. As the profession and pharmacists endeavour to improve knowledge and skill to deliver pharmaceutical care ...

Pharmaceutical care as a historical, normative-legal and social-economic category in the system of the population health and pharmaceutical care

Directory of Open Access Journals (Sweden)

G. L. Panfilova

2014-08-01

Full Text Available Aim. Terminological vagueness of the term «pharmaceutical care» in domestic legislative framework and scientific environment makes it impossible to introduce new forms and methods of providing pharmaceutical population in Ukraine effectively. In order to form the unified methodological approach to identify and order the use of the mentioned term, the results of organizational-economic studies in pharmacy and the existing legal framework have been analyzed. Methods and results. Using dialectical, historical, logical-semantic and other methods the basic stages in the development of pharmaceutical care have been established and definitions tree of the concept have been constructed. Conclusion. The results of these studies indicate the need for recognition and regulatory mapping integration (organizational and economic of the definition «pharmaceutical care» in domestic legislation and public health practice.

Technology-dependent children and the demand for pharmaceutical care.

Science.gov (United States)

Okido, Aline Cristiane Cavicchioli; Cunha, Suelen Teles da; Neves, Eliane Tatsch; Dupas, Giselle; Lima, Regina Aparecida Garcia de

2016-01-01

to understand the experience of mothers of technology-dependent children as regards pharmaceutical care. this was a qualitative, descriptive-exploratory study developed based on open interviews using a structured characterization tool, and applied during home visits to 12 mothers caring for technology-dependent children. The data was submitted to inductive content analysis. this study is split into two themes: (i) maternal overload during pharmaceutical care, demonstrating the need to administer drugs continuously and the repercussions of this exhaustive care on the caregivers; (ii) the ease or difficulty of access to the medicines required, showing informal strategies and support networks. pharmaceutical care is a daily challenge expressed in maternal overload and difficulty accessing the drugs, made worse by failures in the care network and coordinated care.

Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

NARCIS (Netherlands)

Geurts, Marlies M E; Ivens, Martijn; van Gelder, Egbert; de Gier, Johan J

2013-01-01

BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs)

Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

Science.gov (United States)

Monroe, C Douglas; Chin, Karen Y

2013-05-01

The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

Active methodology and blended learning: An experience in pharmaceutical care.

Science.gov (United States)

Czepula, Alexandra Ingrid Dos Santos; Bottacin, Wallace Entringer; Júnior, Edson Hipólito; Pontarolo, Roberto; Correr, Cassyano Januário

The aim of this study was to analyze the implementation of an active methodology in a blended model of education in the teaching-learning processes of students enrolled in two disciplines: Pharmaceutical Care I and Pharmaceutical Care II, both part of the undergraduate Bachelor of Pharmacy program at the Federal University of Paraná. The study design was quasi-experimental, prospective, comparative, following a pre/posttest format, where Pharmaceutical Care classes were the intervention. Identical pre- and post-intervention tests were designed based on Anderson and Krathwohl's (2001) revision of Bloom's taxonomy, and according to the three levels of the cognitive domain: remember and understand; apply and analyze; evaluate and create. Participants were 133 students enrolled in the two Pharmaceutical Care classes. A significant difference between pre- and posttest results was observed, showing an increase in students' performance in the applied tests at all cognitive levels. This is the first study of its kind involving Pharmaceutical Care and Blended Learning. By comparing the results of the diagnostic and summative assessments based on Bloom's taxonomy at all levels of the cognitive domain, positive results were observed regarding the students' performance in the two disciplines (Pharmaceutical Care I and II). Copyright © 2017 Elsevier Inc. All rights reserved.

Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial.

Science.gov (United States)

Obreli-Neto, Paulo Roque; Marusic, Srecko; Guidoni, Camilo Molino; Baldoni, André de Oliveira; Renovato, Rogério Dias; Pilger, Diogo; Cuman, Roberto Kenji Nakamura; Pereira, Leonardo Régis Leira

2015-01-01

Most diabetic and hypertensive patients, principally the elderly, do not achieve adequate disease control and consume 5%-15% of annual health care budgets. Previous studies verified that pharmaceutical care is useful for achieving adequate disease control in diabetes and hypertension. To evaluate the economic cost and the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) of pharmaceutical care in the management of diabetes and hypertension in elderly patients in a primary public health care system in a developing country. A 36-month randomized controlled clinical trial was performed with 200 patients who were divided into a control group (n = 100) and an intervention group (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultations). The intervention group received the usual care plus a pharmaceutical care intervention. The intervention and control groups were compared with regard to the direct costs of health services (i.e., general practitioner, specialist, nurse, and pharmacist appointments; emergency room visits; and drug therapy costs) and the ICER per QALY. These evaluations used the health system perspective. No statistically significant difference was found between the intervention and control groups in total direct health care costs ($281.97 ± $49.73 per patient vs. $212.28 ± $43.49 per patient, respectively; P = 0.089); pharmaceutical care added incremental costs of $69.60 (± $7.90) per patient. The ICER per QALY was $53.50 (95% CI = $51.60-$54.00; monetary amounts are given in U.S. dollars). Every clinical parameter evaluated improved for the pharmaceutical care group, whereas these clinical parameters remained unchanged in the usual care group. The difference in differences (DID) tests indicated that for each clinical parameter, the patients in the intervention group improved more from pre to post than the control group (P < 0.001). While pharmaceutical

Knowledge and attitude of Iranian community pharmacists about the pharmaceutical care for epileptic females

International Nuclear Information System (INIS)

Sabzghabaee, A.M.; Zolfaghari, B.; Ebrahimabadi, M.H.

2012-01-01

This study was designed to evaluate the knowledge and attitude of a cohort of Iranian community pharmacists about the pharmaceutical care indexes and drug therapy in female epileptic patients. Methodology: This cross-sectional study was conducted in Iran (2011) and one hundred and twenty two community pharmacists were randomly selected using clustering method for sampling. A self-administered questionnaire which was originally made by a clinical pharmacy focus group was used. This questionnaire had 10 true/false questions for knowledge assessing (Spearman-Brown coefficient, 0.65) and 19 attitude statements (with Likert scale) about the intention of pharmacists for providing pharmaceutical care for epileptic females (Croanbach's alpha, 0.802). Face and content validity for both parts of the questionnaire were performed before the study. Results: There was a significant inverse relationship between pharmacists' knowledge on pharmaceutical care for epileptic females and the time elapsed from their graduation date. Considering the minimum passing score of 5, 85% of pharmacists did not have enough knowledge. The range of pharmacists' attitude scores was 35 to 64 and its mean was 46.09. Regarding the minimum passing score of 45, 63.3% of pharmacists had positive attitude to AEDs in epileptic females. Conclusion: It seems that the pharmaceutical care for epileptic females is a missing part of Pharmacy education. It is highly recommended to pay special attention to this topic in continuing education programs for Iranian pharmacists. (author)

Pharmaceutical Care and the Role of a Pharmacist in Space Medicine

Science.gov (United States)

Bayuse, Tina

2007-01-01

Space medicine is primarily preventative medicine Outcomes of space medicine pharmaceutical care are: a) Elimination or reduction of a patient's symptomatology; b) Arresting or slowing of long term effects from microgravity; and c) Preventing long term effects or symptomatology as a result of microgravity. Space medicine pharmaceutical care is about both the patient and the mission. Pharmaceutical care in the area of space medicine is evolving. A pharmacist serves a critical role in this care. Commercial space travel will require pharmacist involvement.

Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy.

Science.gov (United States)

Dreischulte, Tobias; Fernandez-Llimos, Fernando

2016-12-01

Background The definitions that are being used for the terms 'clinical pharmacy' and 'pharmaceutical care' seem to have a certain overlap. Responsibility for therapy outcomes seems to be especially linked to the latter term. Both terms need clarification before a proper definition of clinical pharmacy can be drafted. Objective To identify current disagreements regarding the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care' and to assess to which extent pharmacists with an interest in Clinical Pharmacy are willing to accept responsibility for drug therapy outcomes. Setting The membership of the European Society of Clinical Pharmacy. Methods A total of 1,285 individuals affiliated with the European Society of Clinical Pharmacy were invited by email to participate in an online survey asking participants to state whether certain professional activities, providers, settings, aims and general descriptors constituted (a) 'Clinical Pharmacy only', (b) 'Pharmaceutical Care only', (c) 'both' or (d) 'neither'. Further questions examined pharmacists' willingness to accept ethical or legal responsibility for drug therapy outcomes, under current and ideal working conditions. Main outcome measures Level of agreement with a number of statements. Results There was disagreement (responsibility under current/ideal working conditions were: safety (32.7%/64.3%), effectiveness (17.9%/49.2%), patient-centeredness (17.1%/46.2%), cost-effectiveness (20.3%/44.0%). Conclusions The survey identified key disagreements around the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care', which future discussions around a harmonised definition of 'Clinical Pharmacy' should aim to resolve. Further research is required to understand barriers and facilitators to pharmacists accepting responsibility for drug therapy outcomes.

Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings.

Science.gov (United States)

Chua, Siew Siang; Kok, Li Ching; Yusof, Faridah Aryani Md; Tang, Guang Hui; Lee, Shaun Wen Huey; Efendie, Benny; Paraidathathu, Thomas

2012-11-12

The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. This study demonstrates the importance of pharmacists working in

Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings

Directory of Open Access Journals (Sweden)

Chua Siew

2012-11-01

Full Text Available Abstract Background The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. Methods This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Results Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%, insufficient awareness and knowledge about disease condition and medication (20.4%, adverse drug reactions (15.6%, therapeutic failure (13.9%, drug-choice problems (9.5% and dosing problems (3.4%. Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52% were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2% was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. Conclusions This study

Patients\\' Perception of the Benefits of Pharmaceutical Care ...

African Journals Online (AJOL)

Patients\\' Perception of the Benefits of Pharmaceutical Care Services in the Management of Hypertension in a Tertiary Health Care Facility in Benin City. ... effects, exercises, weight and blood pressure control were rated as “not beneficial”.

Pharmaceutical management in ProCare Health Limited.

Science.gov (United States)

Malcolm, L; Barry, M; MacLean, I

2001-06-22

To review pharmaceutical budget holding and management in ProCare Health Limited by; describing budget holding strategies implemented in 1995/6, identifying prescribing savings achieved, analysing variation in prescribing behaviour and comparing the findings with experience elsewhere. With 340 members, ProCare is one of the largest and most progressive of New Zealand's independent practitioner associations (IPAs). Data were obtained for the three years 1994 to 1996 to determine pharmaceutical expenditure against budget and against national trends, by member and general medical services (GMS) consultations. ProCare has established a classical, quality focussed pharmaceutical management strategy. Savings against the agreed budget was 9.5% comparing 1996 with 1995 but 5.7% compared, with national trends. Wide variation in per capita and per consultation costs was not reduced and was entirely explained by prescribing volumes not drug prices. The most important finding is that general practitioners (GPs), working collaboratively, can establish a strategy of clinical and corporate governance which may be exerting a wide ranging influence over clinical behaviour. Although there may be doubts about the actual levels of saving these appeared to be well in excess of the financial investment in the strategy. Greater savings appear possible with a focus on addressing the large and apparently inappropriate per capita prescribing volume variation between practices. Understanding and successfully addressing this variation will be one of the key issues facing the implementation of the government's primary health care strategy.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada.

Science.gov (United States)

Romain, Sandra J

2013-01-01

Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requiring that all public and private sector essential services offer verbal and written communication in Inuit languages (Inuktitut and Inuinnaqtun) by 2012. While the legislation mandates compliance, policy implementation for pharmaceutical services is problematic. Not a single pharmacist in Nunavut is fluent in either of the Inuit languages. Pharmacists have indicated challenges in formally translating written documentation into Inuit languages based on concerns for patient safety. These challenges of negotiating the joint requirements of language legislation and patient safety have resulted in pharmacies using verbal on-site translation as a tenuous solution regardless of its many limitations. The complex issues of pharmaceutical health care and communication among the Inuit of Nunavut are best examined through multimethod research to encompass a wide range of perspectives. This methodology combines the richness of ethnographic data, the targeted depth of interviews with key informants and the breadth of cross-Canada policy and financial analyses. The analysis of this information would provide valuable insights into the current relationships between health care providers, pharmacists and Inuit patients and suggest future directions for policy that will improve the efficacy of pharmaceuticals and health care spending for the Inuit in Canada.

Pharmaceutical health care and Inuit language communications in Nunavut, Canada

Directory of Open Access Journals (Sweden)

Sandra J. Romain

2013-08-01

Full Text Available Background. Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requiring that all public and private sector essential services offer verbal and written communication in Inuit languages (Inuktitut and Inuinnaqtun by 2012. Methods. While the legislation mandates compliance, policy implementation for pharmaceutical services is problematic. Not a single pharmacist in Nunavut is fluent in either of the Inuit languages. Pharmacists have indicated challenges in formally translating written documentation into Inuit languages based on concerns for patient safety. These challenges of negotiating the joint requirements of language legislation and patient safety have resulted in pharmacies using verbal on-site translation as a tenuous solution regardless of its many limitations. Results. The complex issues of pharmaceutical health care and communication among the Inuit of Nunavut are best examined through multimethod research to encompass a wide range of perspectives. This methodology combines the richness of ethnographic data, the targeted depth of interviews with key informants and the breadth of cross-Canada policy and financial analyses. Conclusions. The analysis of this information would provide valuable insights into the current relationships between health care providers, pharmacists and Inuit patients and suggest future directions for policy that will improve the efficacy of pharmaceuticals and health care spending for the Inuit in Canada.

Pharmaceutical Care Implementation: A Survey of Attitude ...

African Journals Online (AJOL)

International Journal of Health Research ... Purpose: To assess the attitude, perception and practice of pharmacists in Ogun State towards pharmaceutical care implementation. Methods: Pre-tested and validated structured questionnaire was ...

Assessment of satisfaction with pharmaceutical services in patients receiving antiretroviral therapy in outpatient HIV treatment setting.

Science.gov (United States)

Agu, Kenneth Anene; Oqua, Dorothy; Agada, Peter; Ohiaeri, Samuel I; Adesina, Afusat; Abdulkareem, Mohammed Habeeb; King, Rosalyn C; Wutoh, Anthony K

2014-06-01

The patient's perception and satisfaction are increasingly considered as a useful factor in the assessment of competency of health care providers and quality of care. However, these patient focused assessments are largely ignored when assessing health care outcomes. The study assessed the perception and satisfaction of patients receiving antiretroviral therapy (ART) with pharmaceutical services received in outpatient HIV treatment settings. Seventeen HIV treatment centres in Nigeria. This cross-sectional survey included 2,700 patients randomly selected from 26,319 HIV patients on ART, who received pharmaceutical services in the study setting. A study-specific Likert-type instrument was administered to the participants at point of exit from the pharmacy. Midpoint of the 5-point scale was computed and scores above it were regarded as positive while below as negative. Chi-square was used for inferential statistics. All reported p values were 2-sided at 95 % confidence interval (CI). Patient satisfaction with pharmaceutical services. Of 2,700 patients sampled, data from 1,617 (59.9 %) were valid for analysis; 62.3 % were aged 26-40 years and 65.4 % were females. The participants had received pharmaceutical services for a mean duration of 25.2 (95 % CI 24.3-26.1) months. Perception of participants regarding the appearance of pharmacy was positive while that regarding the pharmacists' efforts to solve patients' medication related problems was negative. The participants' rating of satisfaction with the waiting time to access pharmaceutical services was negative; the satisfaction decreases with increasing waiting time. However, the satisfaction with the overall quality of pharmaceutical services received was rated as positive; 90.0 % reported that they got the kind of pharmaceutical services they wanted; 98.2 % would come back to the pharmacy if they were to seek help again and would recommend services to others. The level of satisfaction was found to be associated with

Pharmaceutical health care and Inuit language communications in Nunavut, Canada

OpenAIRE

Romain, Sandra J.

2013-01-01

Background. Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requ...

Public perceptions of health care professionals' participation in pharmaceutical marketing.

Science.gov (United States)

Crigger, Nancy J; Courter, Laura; Hayes, Kristen; Shepherd, K

2009-09-01

Trust in the nurse-patient relationship is maintained not by how professionals perceive their actions but rather by how the public perceives them. However, little is known about the public's view of nurses and other health care professionals who participate in pharmaceutical marketing. Our study describes public perceptions of health care providers' role in pharmaceutical marketing and compares their responses with those of a random sample of licensed family nurse practitioners. The family nurse practitioners perceived their participation in marketing activities as significantly more ethically appropriate than did the public responders. Further research is warranted before conclusions can be drawn, but these early findings suggest that nurse practitioners should consider a conservative approach to participating in pharmaceutical marketing.

Perceived needs of pharmaceutical care services among healthcare professionals in South Korea: a qualitative study.

Science.gov (United States)

Lee, Iyn-Hyang; Rhie, Sandy Jeong; Je, Nam Kyung; Rhew, Ki Yon; Ji, Eunhee; Oh, Jung Mi; Lee, Euni; Yoon, Jeong-Hyun

2016-10-01

Purpose To explore the need for pharmaceutical care services, key features of desirable pharmacy services, and perceived barriers for advancing the services in hospital environments with doctors and nurses who are key co-workers of the interdisciplinary team care services.Methods Semi-structured, in-depth interviews with eighteen doctors and fifteen nurses employing purposive and snowballing sampling strategies were conducted in ten hospitals in South Korea. Results The level of pharmaceutical care was varied across regions or institutions in South Korea. The concept of pharmaceutical care was insufficiently defined, and tended to be limited to some parts of medication counseling. Through pharmaceutical care services, doctors desired to acquire comprehensive drug information from and to share clinical responsibilities with pharmacists. Nurses wished to lower their burdens of medication counseling services from their daily practices. Doctors and nurses asked for pharmacists providing essential and carefully selected medication information to their patients in a patient-centered manner. The listed barriers to pharmaceutical care included the lack of appropriate systems for reward, insufficient accessibility to patient records by pharmacists, ambiguous role descriptions of pharmacist, and absence of effective communication among professionals. Conclusion A successful pharmaceutical care service model should allow efficient exchange of information among healthcare professionals to build inter-professional trust and to provide a continuity of care both in terms of time and setting. As prerequisites of such system, it was warranted to develop clinical evidence and an appropriate reward system for pharmaceutical care services.

Emerging pharmaceutical therapies for COPD

Science.gov (United States)

Lakshmi, Sowmya P; Reddy, Aravind T; Reddy, Raju C

2017-01-01

COPD, for which cigarette smoking is the major risk factor, remains a worldwide burden. Current therapies provide only limited short-term benefit and fail to halt progression. A variety of potential therapeutic targets are currently being investigated, including COPD-related proinflammatory mediators and signaling pathways. Other investigational compounds target specific aspects or complications of COPD such as mucus hypersecretion and pulmonary hypertension. Although many candidate therapies have shown no significant effects, other emerging therapies have improved lung function, pulmonary hypertension, glucocorticoid sensitivity, and/or the frequency of exacerbations. Among these are compounds that inhibit the CXCR2 receptor, mitogen-activated protein kinase/Src kinase, myristoylated alanine-rich C kinase substrate, selectins, and the endothelin receptor. Activation of certain transcription factors may also be relevant, as a large retrospective cohort study of COPD patients with diabetes found that the peroxisome proliferator-activated receptor γ (PPARγ) agonists rosiglitazone and pioglitazone were associated with reduced COPD exacerbation rate. Notably, several therapies have shown efficacy only in identifiable subgroups of COPD patients, suggesting that subgroup identification may become more important in future treatment strategies. This review summarizes the status of emerging therapeutic pharmaceuticals for COPD and highlights those that appear most promising. PMID:28790817

Unlicensed pharmaceutical preparations for clinical patient care: Ensuring safety.

Science.gov (United States)

de Wilde, Sofieke; de Jong, Maria G H; Le Brun, Paul P H; Guchelaar, Henk-Jan; Schimmel, Kirsten J M

2018-01-01

Most medicinal products dispensed to patients have marketing authorization (MA) to ensure high quality of the product, safety, and efficacy. However, in daily practice, to treat patients adequately, there is a medical need for drugs that do not hold MA. To meet this medical need, medicinal products are used in clinical care without MA (unlicensed), such as products prepared by (local) pharmacies: the pharmaceutical preparations. Three types of pharmaceutical preparations are distinguished: (i) reconstitution in excess of summary of product characteristics; (ii) adaptation of a licensed medicinal product (outside its official labeling); (iii) medicinal products from an active pharmaceutical ingredient. Although unlicensed, patients may expect the same quality for these unlicensed pharmaceutical preparations as for the licensed medicinal products. To assure this quality, a proper risk-benefit assessment and proper documentation in (centralized) patient registries and linking to a national pharmacovigilance database should be in place. Based on a risk assessment matrix, requirements for quality assurance can be determined, which has impact on the level of documentation of a pharmaceutical preparation. In this paper, the approach for good documentation including quality assurance and benefit-risk assessment will be discussed and possibilities for patient registries are described to make these crucial preparations available for regular patient care. KEY POINTS Ensuring pharmaceutical quality and performing a proper benefit-risk assessment will guarantee safe use of pharmaceutical preparations. Good documentation of (ultra-)orphan treatments can be collected in centralized patient registries and should be combined with existing information in (inter)national databases and self-reflection of patients. Linking patient registries to a centralized database for adverse drug events is highly recommended as it increases safety control of the (ultra) orphan pharmaceutical

Quality of pharmaceutical care at the pharmacy counter : Patients’ experiences versus video observation

NARCIS (Netherlands)

Koster, Ellen S.; Blom, Lyda; Overbeeke, Marloes R.; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

2016-01-01

Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods: Pharmaceutical

Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation.

NARCIS (Netherlands)

Koster, E.S.; Blom, L.; Overbeeke, M.R.; Philbert, D.; Vervloet, M.; Koopman, L.; Dijk, L. van

2016-01-01

Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods: Pharmaceutical

[Pharmaceutical care of patients with rheumatoid and psoriatic arthritis receiving etanercept].

Science.gov (United States)

Romero Crespo, I; Antón Torres, R; Borrás Blasco, J; Navarro Ruiz, A

2005-01-01

To evaluate a pharmaceutical care protocol for patients with rheumatoid arthritis (RA) or psoriatic arthritis who begin treatment with etanercept with the objective of identifying potential medication-related problems and implementing therapeutic measures to improve the way this drug is used. An observational, prospective, 3-month study of patients with RA receiving etanercept therapy from March to December 2003 was conducted and a pharmaceutical care protocol was set up. During the first visit, a pharmacotherapeutic record was initiated for each patient, including socio-demographic data, personal history, diagnosis, DMARDs (disease-modifying anti-rheumatic drugs) previously received, and concomitant therapies for other underlying conditions. Patients were briefed on dosage, administration route, and potential adverse events both orally and in writing. Correct drug administration and preservation were verified during the second visit, where potential adverse effects were identified, treatment adherence was confirmed, and, if needed, potential drug interactions with other ongoing medications were disclosed. During the third visit, adherence was assessed, adverse events were recorded, and patients evaluated their response to treatment. Fifty patients were included, 40 with a diagnosis of rheumatoid arthritis (80%) and 10 diagnosed with psoriatic arthritis (20%). In all, 72% had received previous treatment with methotrexate (MTX), 40% with leflunomide, 20% with infliximab, 56% with corticoids, 2% with analgesics, 56% with NSAIDs, and 30% with other DMARDs. No significant drug interactions were found. Regarding adherence to treatment, 7.7% of patients skipped one or more doses, with travelling being the most common reason. Adverse events reported included: injection site reaction (27%), headache (7.7%) and nausea (7.7%). At 3 months after treatment onset, a reduction of MTX doses was seen in 18% of patients, of leflunomide dosage in 8%, of corticoids in 18%, of

Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients

DEFF Research Database (Denmark)

Olesen, Charlotte; Harbig, Philipp; Buus, Kirsten Marie

2014-01-01

= 315) was designed. It involved patients aged 65+ years living in Aarhus, Denmark who used five drugs or more without assistance. Pharmacists visited the pharmaceuticalcare patients at home, once only, and followed them during the subsequent year with three telephone calls. Non-adherence was measured......, hospitalisation and mortality. Results The final analyses included 517 patients (median age 74 years; females 52 %). Dropouts were more frequent for the pharmaceutical-care group than for controls. Pharmacists encountered drug-related problems amongst 72 % of pharmaceutical-care patients. Pharmaceutical...

Pharmaceutical care in community pharmacies: practice and research in the US.

Science.gov (United States)

Christensen, Dale B; Farris, Karen B

2006-01-01

To describe the state of community pharmacy, including patient care services, in the US. Chain pharmacies, including traditional chains, mass merchandisers, and supermarkets, comprise more than 50% of community pharmacies in the US. Dispensing of drugs remains the primary focus, yet the incidence of patients being counseled on medications appears to be increasing. More than 25% of independent community pharmacy owners report providing some patient clinical care services, such as medication counseling and chronic disease management. Most insurance programs pay pharmacists only for dispensing services, yet there are a growing number of public and private initiatives that reimburse pharmacists for cognitive services. Clinical care opportunities exist in the new Medicare prescription drug benefit plan, as it requires medication therapy management services for specific enrollees. The private market approach to healthcare delivery in the US, including pharmacy services, precludes national and statewide strategies to change the basic business model. To date, most pharmacies remain focused on dispensing prescriptions. With lower dispensing fees and higher operating costs, community pharmacies are focused on increasing productivity and efficiency through technology and technicians. Pharmacists remain challenged to establish the value of their nondispensing-related pharmaceutical care services in the private sector. As the cost of suboptimal drug therapy becomes more evident, medication therapy management may become a required pharmacy benefit in private drug insurance plans. Pharmacy school curricula, as well as national and state pharmacy associations, continually work to train and promote community pharmacists for these roles. Practice research is driven primarily by interested academics and, to a lesser degree, by pharmacy associations. Efficient dispensing of prescriptions is the primary focus of community pharmacies in the US. Some well designed practice-based research

Assessment of pharmaceutical care practices of community ...

African Journals Online (AJOL)

We undertook to assess the pharmaceutical care practices of community pharmacists in patients with co-morbidity of hypertension and diabetes in Delta State. A seventeen item questionnaire consisting of 5 points response scale was developed and administered to pharmacists in the community setting. The questionnaire ...

Patient satisfaction with pharmaceutical care delivery in community pharmacies

Directory of Open Access Journals (Sweden)

Kassam R

2012-04-01

Full Text Available Rosemin Kassam1, John B Collins2, Jonathan Berkowitz31School of Population and Public Health, Faculty of Medicine, 2Department of Educational Studies, Faculty of Education, 3Sauder School of Business, University of British Columbia, Vancouver, British Columbia, CanadaBackground: The purpose of this study was to validate previously published satisfaction scales in larger and more diversified patient populations; to expand the number of community pharmacies represented; to test the robustness of satisfaction measures across a broader demographic spectrum and a variety of health conditions; to confirm the three-factor scale structure; to test the relationships between satisfaction and consultation practices involving pharmacists and pharmacy students; and to examine service gaps and establish plausible norms.Methods: Patients completed a 15-question survey about their expectations regarding pharmaceutical care-related activities while shopping in any pharmacy and a parallel 15 questions about their experiences while shopping in this particular pharmacy. The survey also collected information regarding pharmaceutical care consultation received by the patients and brief demographic data.Results: A total of 628 patients from 55 pharmacies completed the survey. The pilot study’s three-factor satisfaction structure was confirmed. Overall, satisfaction measures did not differ by demographics or medical condition, but there were strong and significant store-to-store differences and consultation practice advantages when pharmacists or pharmacists-plus-students participated, but not for consultations with students alone.Conclusion: Patient satisfaction can be reliably measured by surveys structured around pharmaceutical care activities. The introduction of pharmaceutical care in pharmacies improves patient satisfaction. Service gap details indicated that pharmacy managers need to pay closer attention to various consultative activities involving patients

PHARMACEUTICALS AND PERSONAL CARE PRODUCTS ...

Science.gov (United States)

Modern sanitary practices result in large volumes of human waste, as well as domestic and industrial sewage, being collected and treated at common collection points, wastewater treatment plants (WWTP). In recognition of the growing use of sewage sludges as a fertilizers and as soilamendments, and the scarcity of current data regarding the chemical constituents in sewage sludges, the United States National Research Council (NRC) in 2002 produced a report on sewage sludges. Among the NRC's recommendations was the need for investigating the occurrence of pharmaceuticals and personal care products (PPCPs) in sewage sludges. PPCPsare a diverse array of non-regulated contaminants that had not been studied in previous sewage sludges surveys but which are likely to be present. The focus of this paper will be to review the current analytical methodologies available for investigating whether pharmaceuticals are present in WWTP-produced sewage sludges, to summarize current regulatory practices regarding sewage sludges, and to report on the presence of pharmaceuticals in sewage sludges. The research focused on in the subtasks is the development and application of state-of the-art technologies to meet the needs of the public, Office of Water, and ORD in the area of Water Quality. Located In the subtasks are the various research projects being performed in support of this Task and more in-depth coverage of each project. Briefly, each project's objective is stated below.Subta

Billing third party payers for pharmaceutical care services.

Science.gov (United States)

Poirier, S; Buffington, D E; Memoli, G A

1999-01-01

To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.

The need for pharmaceutical care in an intensive care unit at a teaching hospital in South Africa

Directory of Open Access Journals (Sweden)

N Shellack

2014-11-01

Full Text Available Background. The role of the pharmacist has evolved over the last 2 decades beyond traditional functions such as stock control and dispensing. Objectives. To describe the functions performed by a clinical pharmacist while based in a surgical and trauma intensive care unit of a teaching hospital. Methods. An operational research study that included indications of programme success was conducted. Interventions to assess therapy and achieve definite outcomes to satisfy patients’ medicine needs were documented for 51 patients over a study period of 8 weeks.Results. A total of 181 interventions were suggested by the pharmacist, with 127 (70% accepted and implemented by the medical and nursing staff of the unit. The most frequent interventions were related to: untreated medical conditions (15.5%, appropriate therapy or course (13.8%, investigations indicated or outstanding (12.2%, and inappropriate doses and dosing frequency (11%. Interventions were also made regularly to address system errors or non-compliance and factors hindering therapeutic effect. Of the 250 h the pharmacist spent in the ward, most time was used for pharmaceutical care (28% and ward rounds (21% with members of the multidisciplinary team.Conclusions. The study results demonstrated that a clinical pharmacist’s contribution to patient care at ward level resulted in improved monitoring of pharmacotherapy. Medicine-related problems were identified and addressed.

Beyond the Pharmacists’ Patient Care Process: Cultivating Patient Care Practitioners by Utilizing the Pharmaceutical Care Framework

Directory of Open Access Journals (Sweden)

Claire Kolar

2017-08-01

Full Text Available The adoption of a standard pharmacists’ patient care process (PPCP for the profession, and inclusion of the PPCP in the ACPE Standards 2016, are positive steps for pharmacy education and creates consistency among pharmacy practitioners, regardless of practice setting. The PPCP, and its implications for practice, needs to continue to be embraced by educators and emphasized with students. The PPCP should be the patient care process taught to students and integrated throughout didactic courses and experiential experiences. However, teaching the PPCP or a particular service, such as Medication Therapy Management (MTM or Comprehensive Medication Management (CMM, is not enough. The patient care process must be taught as one component of pharmaceutical care. Without also learning the philosophy of practice and practice management systems, student pharmacists will not be prepared for the realities of practice. Pharmacists are taking on new roles, getting paid in new ways, and in positions to take responsibility for a patient’s medication-related needs. Student pharmacists need to be in a position to take advantage of these opportunities as they progress throughout their careers. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received, employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.   Type: Idea Paper

Computer-assisted detection (CAD) methodology for early detection of response to pharmaceutical therapy in tuberculosis patients

Science.gov (United States)

Lieberman, Robert; Kwong, Heston; Liu, Brent; Huang, H. K.

2009-02-01

The chest x-ray radiological features of tuberculosis patients are well documented, and the radiological features that change in response to successful pharmaceutical therapy can be followed with longitudinal studies over time. The patients can also be classified as either responsive or resistant to pharmaceutical therapy based on clinical improvement. We have retrospectively collected time series chest x-ray images of 200 patients diagnosed with tuberculosis receiving the standard pharmaceutical treatment. Computer algorithms can be created to utilize image texture features to assess the temporal changes in the chest x-rays of the tuberculosis patients. This methodology provides a framework for a computer-assisted detection (CAD) system that may provide physicians with the ability to detect poor treatment response earlier in pharmaceutical therapy. Early detection allows physicians to respond with more timely treatment alternatives and improved outcomes. Such a system has the potential to increase treatment efficacy for millions of patients each year.

The effect of active learning methodologies on the teaching of pharmaceutical care in a Brazilian pharmacy faculty.

Directory of Open Access Journals (Sweden)

Alessandra R Mesquita

Full Text Available In recent years, pharmacists have been involved in expanded patient care responsibilities, for example patient counseling in self-medication, medication review and pharmaceutical care, which require graduates to develop the necessary competences. Consequently, reorientation of pharmacy education has become necessary. As such, active learning strategies have been introduced into classrooms to increase problem-solving and critical thinking skills of students. The objective of this study was to evaluate the performance and perceptions of competency of students in a new pharmaceutical care course that uses active learning methodologies.This pharmaceutical care course was conducted in the first semester of 2014, in the Federal University of Sergipe. In the pharmaceutical care course, active learning methods were used, consisting of dialogic classroom expository, simulation and case studies. Student learning was evaluated using classroom tests and instruments that evaluated the perception of competency in pharmaceutical care practice. Furthermore, students' satisfaction with the course was evaluated.Thirty-three students completed the four evaluations used in the course (i.e., a discursive written exam, seminars, OSCE, and virtual patient; 25 were female (75.75%, and the median age was 23.43 (SD 2.82 years. The overall mean of student scores, in all evaluation methods was 7.97 (SD 0.59 on a scale of 0 to 10 points, and student performance on the virtual patient method was statistically superior to other methods. With respect to the perception of competency in pharmaceutical care practice, a comparison of pre- and post-test scores revealed statistically significant improvement for all evaluated competences. At the end of the semester, the students presented positive opinions of the pharmaceutical care course.The results suggest that an active learning course can enhance the learning of pharmaceutical care competences. In future studies it will be

The effect of active learning methodologies on the teaching of pharmaceutical care in a Brazilian pharmacy faculty.

Science.gov (United States)

Mesquita, Alessandra R; Souza, Werlissandra M; Boaventura, Thays C; Barros, Izadora M C; Antoniolli, Angelo R; Silva, Wellington B; Lyra Júnior, Divaldo P

2015-01-01

In recent years, pharmacists have been involved in expanded patient care responsibilities, for example patient counseling in self-medication, medication review and pharmaceutical care, which require graduates to develop the necessary competences. Consequently, reorientation of pharmacy education has become necessary. As such, active learning strategies have been introduced into classrooms to increase problem-solving and critical thinking skills of students. The objective of this study was to evaluate the performance and perceptions of competency of students in a new pharmaceutical care course that uses active learning methodologies. This pharmaceutical care course was conducted in the first semester of 2014, in the Federal University of Sergipe. In the pharmaceutical care course, active learning methods were used, consisting of dialogic classroom expository, simulation and case studies. Student learning was evaluated using classroom tests and instruments that evaluated the perception of competency in pharmaceutical care practice. Furthermore, students' satisfaction with the course was evaluated. Thirty-three students completed the four evaluations used in the course (i.e., a discursive written exam, seminars, OSCE, and virtual patient); 25 were female (75.75%), and the median age was 23.43 (SD 2.82) years. The overall mean of student scores, in all evaluation methods was 7.97 (SD 0.59) on a scale of 0 to 10 points, and student performance on the virtual patient method was statistically superior to other methods. With respect to the perception of competency in pharmaceutical care practice, a comparison of pre- and post-test scores revealed statistically significant improvement for all evaluated competences. At the end of the semester, the students presented positive opinions of the pharmaceutical care course. The results suggest that an active learning course can enhance the learning of pharmaceutical care competences. In future studies it will be necessary to

Knowledge and practice of pharmaceutical care by community ...

African Journals Online (AJOL)

There is a global strategy to improve health through prompt identification and treatment of diseases. The pharmacy profession has remodelled its roles in an attempt to meet these global expectations through pharmaceutical care. The objective of this study was therefore to assess the knowledge and practice of ...

Pharmaceutical care in Brazil’s primary health care

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Patricia Sodré Araújo

2017-11-01

Full Text Available ABSTRACT OBJECTIVE To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015, a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285 were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. RESULTS From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were “pharmaceutical guidance” and “pharmaceutical care.” The registration of activities is mainly made in the users’ medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. CONCLUSIONS Activities of clinical nature

Effectiveness of pharmaceutical care at discharge in the emergency department: study protocol of a randomized controlled trial.

Science.gov (United States)

Kuhmmer, Regina; Lima, Karine Margarites; Ribeiro, Rodrigo Antonini; Hammes, Luciano Serpa; Bastos, Gisele Alsina Nader; Cotta de Souza, Maria Claudia Schardosim; Polanczyk, Carisi Anne; Soares Rollin, Guilherme Alcides Flores; Caon, Suhelen; Guterres, Cátia Moreira; Araújo Leite, Leni Everson; Delabary, Tássia Scholante; Falavigna, Maicon

2015-02-25

Patient education on pharmacological therapy may increase medication adherence and decrease hospitalizations. Our aim is to evaluate the effectiveness of pharmaceutical care at emergency department discharge in patients with hypertension and/or diabetes. This is a randomized controlled trial. Participants will be recruited from a public emergency department at Restinga district in Porto Alegre, southern Brazil. A total of 380 patients will be randomly assigned into 2 groups at the moment of emergency department discharge after receiving medical orientations: an intervention group, consisting of a structured individual counseling session by a pharmacist in addition to written orientations, or a control group, consisting only of written information about the disease. Outcomes will be assessed in an ambulatory visit 2 months after the randomization. The primary outcome is the proportion of patients with high medication adherence assessed using the Morisky-Green Test and the Brief Medication Questionnaire. The secondary outcomes are reduction of blood pressure, glycated hemoglobin, fasting plasma glucose, quality of life and number of visits to the emergency department. Pharmaceutical care interventions have shown to be feasible and effective in increasing medication adherence in both hospital outpatient and community pharmacy settings. However, there have been no previous assessments of the effectiveness of pharmacy care interventions initiated in patients discharged from emergency departments. Our hypothesis is that pharmaceutical counseling is also effective in this population. ClinicalTrials.gov registration number: NCT01978925 (11 November 2013) and Brazilian Registry of Clinical Trials U1111-1149-8922 (5 November 2013).

Management of pharmaceutical services in the Brazilian primary health care.

Science.gov (United States)

Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

2017-11-13

To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

Development of Organizational Technologies for Pharmaceutical Care to Outpatients (on the Example of Diabetes Mellitus

Directory of Open Access Journals (Sweden)

A.D. Semionova

2014-11-01

Full Text Available Taking into account global trends in the development of healthcare, there were scientifically grounded conceptual model of pharmaceutical care to outpatients with diabetes mellitus and the integrated technology of managing processes of pharmaceutical care on the basis of personalization in pharmaceutical care, specialization of pharmacies, modeling procedures of information exchange between medical institutions and pharmacies, optimization of prescription and providing drugs, providing information and consulting services with the use of methods and means of modern information technologies, the development of step-by-step guides for the implementation of control technologies, the creation of a system of continuous professional education of pharmacy specialists in the field of diabetes mellitus.

Practice of pharmaceutical care in community pharmacies in Jordan ...

African Journals Online (AJOL)

Purpose: To describe the current role played by pharmacists in delivering pharmaceutical care (PC) in community pharmacies in Jordan (current activities and practices undertaken in the community and extent of provision of PC standards), pharmacists' perspectives on PC implementation and barriers to implementing PC ...

Population health management guiding principles to stimulate collaboration and improve pharmaceutical care.

Science.gov (United States)

Steenkamer, Betty; Baan, Caroline; Putters, Kim; van Oers, Hans; Drewes, Hanneke

2018-04-09

Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate. Design/methodology/approach The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes. Findings In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem. Practical implications The guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes. Originality/value This is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.

Complex pharmaceutical care intervention in pulmonary care Part B. Patient opinion and process survey

NARCIS (Netherlands)

Stuurman-Bieze, A.GG; Kokenberg, M.E.A.P.; Tobi, H; de Boer, W.O.; van Doormaal, Jasperien E.; de Jong-van den Berg, Lolkje Theodora Wilhelmina; Tromp, Th.F.J.

2005-01-01

Objective: The IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigates and describes the results of complex pharmaceutical care interventions provided to selected pulmonary patients to improve their drug use. This paper describes the patients' opinions about the

Intensified pharmaceutical care is improving immunosuppressive medication adherence in kidney transplant recipients during the first post-transplant year: a quasi-experimental study.

Science.gov (United States)

Joost, Robert; Dörje, Frank; Schwitulla, Judith; Eckardt, Kai-Uwe; Hugo, Christian

2014-08-01

Medication adherence is critical for transplant patients because the consequences of non-adherence can result in allograft loss and may be life threatening. A prospective study with 74 renal transplant recipients using a sequential control group design was performed to investigate the impact of a pharmaceutical intensified care programme led by a clinical pharmacist on daily drug adherence during the first year after renal transplantation. Thirty-nine patients of the control group received the already established standardized drug and transplant training, while 35 patients of the intensified care group (ICG) received additional inpatient and outpatient pharmaceutical care and counselling by a dedicated clinical pharmacist. Applied interventions were clustered and classified using the behaviour change technique taxonomy according to Michie. Adherence to immunosuppressive drug therapy was monitored up to 1 year using a medication event monitoring system, pill count (PC), drug holiday (DH) occurrence, Morisky questionnaire and self-report. Sixty-seven patients (35 of the standard care and 32 of the ICG) were analysed. Implementation of DA was significantly (P = 0.014) improved in patients of the ICG (91%) compared with SCG (75%) during the first year after transplantion. Daily adherence measures were already improved within 30-40 days after start of intensified patient care and continued throughout the study period. Intensified care patients also showed significantly better results for taking adherence (P = 0.006), PC (P = 0.008) and DHs (P = 0.001). The additional, intensified pharmaceutical care improved patients' medication adherence remarkably, suggesting that the applied additional care programme has the potential to improve outcomes after organ transplantation. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Using design science research to develop online enhanced pharmaceutical care services.

Science.gov (United States)

Lapão, Luís Velez; Gregório, João; Mello, Diogo; Cavaco, Afonso; Mira Da Silva, Miguel; Lovis, Christian

2014-01-01

The ePharmaCare project aims at assessing the potential of eHealth services for the provision of pharmaceutical services interacting actively with patients. The results presented here focus on the first three steps of Design Science Research Methodology. A mixed methods approach was used with an online survey to collect data on use of information technologies in community pharmacy, followed by an exploratory observational time and business processes study, which use the shadowing method to identify and assess the opportunity to lunch online services. Combining this with the Service Experiment Blueprint and the Dáder method an enhanced pharmaceutical service was designed. Next, an artifact is developed and a prototype is implemented to demonstrate the value of online pharmaceutical services' delivery. This new service could represent a new perspective for pharmaceutical services integration within the health system.

Identification of Standards for Pharmaceutical Care in Benin City

African Journals Online (AJOL)

The goal of this study is to identify practice standards that can be effectively ... Pharmaceutical care evolved from clinical ... The specific objectives ..... The pharmacist should regularly run reports on their patients to see if they are ... Each pharmacist shall procure a certain amount of hours of continuing education on topics to.

[Steps aimed at upgrading a pharmaceutical care sector: the case of surgery].

Science.gov (United States)

Guérin, A; Thibault, M; Nguyen, C; Lebel, D; Bussières, J-F

2014-07-01

While the concept of clinical pharmacy was developed in the 1960s, clinical programs are characterized by their great variety and disparity when it comes to the presence of pharmacists in healthcare sectors. This article aims to describe a method in which pharmaceutical care sectors in healthcare facilities can be upgraded. This is a descriptive study supporting the upgrade of pharmaceutical care practiced in the surgery sector of a 500-bed mother-child university hospital center, the CHU Sainte-Justine. The pharmacy department employs more than 70 healthcare professionals. The study involved these proposed upgrading steps: firstly, a review of the literature; secondly, a description of the profile of the sector; thirdly, a description of the upgrading of pharmacist practice in surgery. A total of 137 articles were compiled, seven of which were selected to evaluate the impact and eight a description of the pharmacist's role in surgery. The authors did not identify any particular pharmaceutical activity based on very good quality data (A). However, there were five based on good quality data (B) and seven that lacked adequate proof (C, D) in relation to the practice of surgery. Nevertheless, a number of other authors described the development of the pharmacist's clinical role in surgery. There are few data on the impact of pharmacists in surgery. This descriptive study proposes a number of steps aimed at upgrading pharmaceutical care within a Quebec university hospital center. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

What variables should be considered in allocating Primary health care Pharmaceutical budgets to districts in Uganda?

Science.gov (United States)

Mujasi, Paschal N; Puig-Junoy, Jaume

2015-01-01

A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.

Pharmaceutical market in Serbia

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Veselin Tima Dickov

2012-02-01

Full Text Available Marketing concept formed around the focus on the consumers, their needs, wants and demands, evolves in the case of pharmaceutical into a care of the complex interest of constituents generating demand on this market and #8211; pres scribers whose role is to select therapies, pharmacists who dispense drugs within a specialized distribution channel to the final consumer -patient, alongside the payers and #8211; the state and or insurance companies refund a part of or total costs of the pharmaceutical product. A special challenge that the subject raises is the existence of controversy generated from two sources. Marketing controversy stems from criticism leveled at the effectiveness and efficiency of marketing activities and the debatable ethical code of conduct. [J Intercult Ethnopharmacol 2012; 1(1.000: 44-51

Using peer teaching to introduce the Pharmaceutical Care Model to incoming pharmacy students.

Science.gov (United States)

Kolar, Claire; Hager, Keri; Janke, Kristin K

2018-02-01

The aim of this initiative was to design and evaluate a peer teaching activity where pairs of second-year pharmacy students introduced the Pharmaceutical Care Model and discussed success in the broader first-year pharmacy curriculum with pairs of first year students. Second-year pharmacy students individually created concept maps illustrating the main components of pharmaceutical care to be used as teaching tools with first-year students. First-year students were given a brief introduction to pharmaceutical care by faculty and prepared questions to ask their second-year colleagues. Two second-year students were then matched with two first-year students for a two-part peer teaching event. Each student completed documentation of the peer experience, which included questions about the effectiveness of the teaching, changes to be made in the future, and the usefulness of the exercise. The documentation was analyzed via content analysis and instructors evaluated the concept maps based on their effectiveness as a teaching tool for novices. A rubric was used to evaluate 166 concept maps of which 145 were rated good, 18 were rated as better, and 3 as best. Themes emerging from the content analysis included: positive impact of teaching and learning pharmaceutical care, value of broader curriculum discussion, and beneficial first- and second-year connections. A structured peer teaching event outside the traditional classroom setting can create a space for: teaching and learning to occur, student-student connections to be made, and advice on the curriculum to be shared. Copyright © 2017 Elsevier Inc. All rights reserved.

PHARMACEUTICAL CARE IN THE TREATMENT OF PATIENTS WITH INFECTIONS OF THE LOWER URINARY TRACT

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Moroz V.A.

2013-06-01

Full Text Available In order to monitor changes in the recommendations for drug treatment of lower urinary tract infections (UTI and pharmaceutical care of patients analyzed resolution and related publications of American Urological Association at the end of 2012. Marked improvement of detail factors of chronicity UTI and allocation of roles pharmacist to prevent its recurrence. In the arsenal of treatments for uncomplicated disease (about 80% left Co-trimoxazole, but exclude the scheme of its single administration. In complicated UTI the use of recommended combinations of antibiotics extended to 14 days, introduced the scheme extended use of Co-trimoxazole or fluoroquinolones in bacterial prostatitis and epididymitis. Formulated the principles of pharmaceutical care of patients with UTI and stated that this pathology are results from the interaction of several biomedical factors that must be considered for the rational choice of treatment strategy. Implementation of pharmaceutical care of patients with UTI is an important component of the treatment success and prevention of disease recurrence.

Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation

Directory of Open Access Journals (Sweden)

Koster ES

2016-03-01

Full Text Available Ellen S Koster,1 Lyda Blom,1 Marloes R Overbeeke,1 Daphne Philbert,1 Marcia Vervloet,2 Laura Koopman,2,3 Liset van Dijk2 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands; 2Netherlands Institute of Health Services Research (NIVEL, Utrecht, the Netherlands; 3National Health Care Institute, Diemen, the Netherlands Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences.Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations.Methods: Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients’ experiences regarding information provision, medication counseling, and pharmacy staff’s communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients’ experiences was calculated.Results: In total, 109 encounters were included for analysis. For the domains “medication counseling” and “communication style”, agreement between patients’ experiences and observations was very high (>90%. Less agreement (45% was found for “information provision”, which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients’ questioning behavior.Conclusion: A questionnaire is useful to assess the quality of medication counseling and pharmacy staff’s communication style, but might be less suitable to evaluate information provision and pharmacy staff’s encouragement of patients’ questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

NARCIS (Netherlands)

F. Karapinar-Çarkit (Fatma); R. van der Knaap (Ronald); Bouhannouch, F. (Fatiha); S.D. Borgsteede (Sander); M.J.A. Janssen (Marjo); Siegert, C.E.H. (Carl E. H.); T.C.G. Egberts (Toine C.G.); P.M.L.A. van den Bemt (Patricia); M.F. van Wier (Marieke); J.E. Bosmans (Judith)

2017-01-01

textabstractBackground To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective.

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

NARCIS (Netherlands)

Karapinar-Çarkıt, Fatma; van der Knaap, Ronald; Bouhannouch, Fatiha; Borgsteede, Sander D; Janssen, Marjo J A; Siegert, Carl E H; Egberts, Toine C G; van den Bemt, Patricia M L A; van Wier, Marieke F; Bosmans, Judith E

2017-01-01

BACKGROUND: To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. METHODS: A

[Logistics in the pharmaceutical service].

Science.gov (United States)

Stanko, P; Fulmeková, M

2005-11-01

The conception of the field of pharmaceutical service defines pharmaceutical service as the basic part of pharmacy, the principal task of which is to provide pharmaceutical care as an inseparable part of providing health care. It represents a set of professional activities of the pharmacist oriented to securing human and veterinary pharmaceutical products and health care products and to optimising effective, safe and quality pharmacotherapy. Technically, pharmaceutical service is an applied discipline, as it makes use of knowledge gained in other pharmaceutical, medical, psychological, social, and economic sciences. Because of its interdisciplinary character it is necessary to extend the theory of pharmaceutical service in such a way so that it may reflect all aspects of its sphere of activity. One of the possibilities is to define the pharmacy premises as an independent functional unit which operates on the basis of valid legal standards in such a way that on the one hand it secures the provision of health (pharmaceutical) care, and on the other hand it maintains its cost-effectiveness. To keep the quality of care of the patient and the economic aspect in balance, it is necessary to define the term pharmaceutical logistics also under the conditions of Slovak (Czech) pharmacy as early satisfaction of the requirements of the patient (client) in the pharmacy premises, which means that the appropriate pharmaceutical product or health care product and the appropriate information must be at the right time in the required amount and required quality in the right place.

Pharmaceutical Care for hypertensive patients provided within the Family Health Strategy in Goiânia, Goiás, Brazil

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Bárbara Posse Reis Martins

2013-09-01

Full Text Available The aim of Pharmaceutical Care programs is to improve patients' quality of life, and such programs are particularly effective in the case of chronic diseases such as hypertension. The objective of this longitudinal study was to analyze a Pharmaceutical Care model for hypertensive patients receiving care within the Family Health Strategy (FHS. All patients were being seen by an FHS team affiliated to a primary healthcare unit in Goiânia, Goiás, Brazil. Fourteen patients participated in the study, with each patient receiving six home visits during the Pharmaceutical Care. Overall, 142 drug-related problems were reported, the most common concerning the ineffectiveness of treatment (33.8%. A total of 135 pharmaceutical interventions were performed, 92.6% of which involved pharmacist-patient communication, with 48.8% of these interventions being implemented. Cardiovascular risk decreased in three patients and remained unchanged in nine. In hypertensive patients with diabetes, fasting glucose levels were reduced in six out of nine cases. The Pharmaceutical Care model proposed here was effective in detecting drug-related problems and in proposing interventions to resolve or prevent these problems. Consequently, this may have contributed towards improving clinical parameters, such as fasting glucose levels and cardiovascular risk in hypertensive patients receiving care within the FHS.

Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential.

Science.gov (United States)

Sarikaya, Ozlem; Civaner, Murat; Vatansever, Kevser

2009-12-01

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.

Developing a Model for Pharmaceutical Palliative Care in Rural Areas—Experience from Scotland

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Gazala Akram

2017-02-01

Full Text Available Palliative care is increasingly delivered in the community but access to medicines, particularly ‘out of hours’ remains problematic. This paper describes the experience of developing a model to deliver pharmaceutical palliative care in rural Scotland via the MacMillan Rural Palliative Care Pharmacist Practitioner (MRPP project. The focus of the service was better integration of the MRPP into different care settings and professional teams, and to develop educational resources for the wider MDT including Care Home and Social Care staff on medicine related issues in palliative care. A variety of integration activities are reported in the paper with advice on how to achieve this. Similarly, many resources were developed, including bespoke training on pharmaceutical matters for Care Home staff. The experience allowed for a three step service and sustainability model for community pharmacy palliative care services to be developed. Moving through the steps, the key roles and responsibilities of the MRPP gradually shift towards the local Community Pharmacist(s, with the MRPP starting from a locality-based hands-on role to a wider supportive facilitating role for local champions. It is acknowledged that successful delivery of the model is dependent on alignment of resources, infrastructure and local community support.

[Legal Framework of Autologous Fat Usage in Point-of-Care Treatments in Plastic and Aesthetic Surgery - Risks of Criminal Prosecution and Infringement of Medical Law Due to Pharmaceutical Regulations].

Science.gov (United States)

Faltus, T

2016-08-01

The use of autologous fat, especially for (stem) cell-assisted lipotransfer in plastic and aesthetic surgery, has regularly been regarded as the manufacture and application of so called Advanced Therapy Medicinal Products (ATMP). However, the in-house production of such pharmaceuticals at the point-of-care (PoC) in the surgeon's practice is not permitted without an official manufacturing license. Therefore, before beginning such treatments, a pharmaceutical manufacturing license has to be granted to the surgeon to avoid criminal prosecution and negative consequences due to infringement of professional regulations. Because such a license is linked to compliance with GMP standard, in-house manufacturing of such pharmaceuticals also implies extra technical and personnel expenses. The surgeon is obliged to check that the available autologous fat based applications are in compliance with pharmaceutical legislation. Repeated infringements of pharmaceutical regulations are incompatible with medical reliability - a prerequisite for the license to practice medicine. © Georg Thieme Verlag KG Stuttgart · New York.

Therapeutic outcomes monitoring: application of pharmaceutical care guidelines to community pharmacy.

Science.gov (United States)

Grainger-Rousseau, T J; Miralles, M A; Hepler, C D; Segal, R; Doty, R E; Ben-Joseph, R

1997-01-01

To design a pharmaceutical care model, and develop and field test a set of community pharmacy guidelines and practice support materials--Therapeutic Outcomes Monitoring (TOM) modules. Concept interviews with pharmacists, physicians, and patients; development and field testing of practice guidelines. Community pharmacies. Five independent, five chain, and two clinic site pharmacies. A prototype TOM module for asthma was developed through a seven-step process. Concept interviews were held with pharmacists, physicians, and patients to determine the desirability and feasibility of the TOM concept, prototype, and materials. Two field tests were completed and modifications made. Results were gathered through further concept interviews at the completion of the second field tests. Participants' opinions and experiences. Pharmacists, physicians, and patients expressed favorable attitudes about community pharmacists' participation in this pharmaceutical care model. Of the 12 participating pharmacists, 7 successfully implemented TOM in their practice sites and participated in the project throughout the testing; 49 patients were recruited into the study; and 22 patients remained in the program at the end of the second field test. In providing TOM services to these patients, the two most problematic areas for the pharmacists were in documenting care and reporting to physicians. A final phase of the TOM project has not been conducted in the United States because of insufficient numbers of patients for evaluating patient outcomes. The TOM project was successful from a technical but not a marketing perspective. Useful practice guidelines can be written and taught to pharmacists. Enrollment of patients was difficult, and the concept is not likely to spread spontaneously within the existing market for pharmaceutical services.

Population health management guiding principles to stimulate collaboration and improve pharmaceutical care

NARCIS (Netherlands)

B. Steenkamer (Betty); C.A. Baan (Caroline); K. Putters (Kim); H.A.M. Oers (Hans); H.W. Drewes (Hanneke W.)

2018-01-01

markdownabstractPurpose: A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying

Population health management guiding principles to stimulate collaboration and improve pharmaceutical care

NARCIS (Netherlands)

Steenkamer, B.M.; Baan, C.A.; Putters, Kim; van Oers, J.A.M.; Drewes, Hanneke

2018-01-01

Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative

Population health management guiding principles to stimulate collaboration and improve pharmaceutical care.

NARCIS (Netherlands)

Steenkamer, Betty; Baan, Caroline; Putters, Kim; van Oers, Hans; Drewes, Hanneke

2018-01-01

Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative

Pharmaceuticals and personal care products in environmental waters

OpenAIRE

Pedrouzo Lanuza, Marta

2010-01-01

En la presente Tesis Doctoral se han desarrollado diferentes métodos analíticos para la determinación de pharmaceuticals and personal care products (PPCPs) en aguas medioambientales. El término PPCPs engloba todos los fármacos, drogas de abuso, hormonas y los excipientes activos incluidos en productos de uso personal, así como los metabolitos, conjugados y sub-productos de transformación. Los métodos desarrollados han estado basados en extracción en fase sólida o extracción con barras magnéti...

Pharmaceuticals and personal care products in waters: occurrence, toxicity, and risk

OpenAIRE

Cizmas, Leslie; Sharma, Virender K.; Gray, Cole M.; McDonald, Thomas J.

2015-01-01

Pharmaceuticals and personal care products (PPCP) are compounds with special physical and chemical properties that address the care of animal and human health. PPCP have been detected in surface water and wastewater in the ng/L to ��g/L concentration range worldwide. PPCP ecotoxicity has been studied in a variety of organisms, and multiple methods have been used to assess the risk of PPCP in the environment to ecological health. Here we review the occurrence, effects, and risk assessment of P...

Quality of pharmaceutical care at the pharmacy counter: patients' experiences versus video observation.

Science.gov (United States)

Koster, Ellen S; Blom, Lyda; Overbeeke, Marloes R; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

2016-01-01

Consumer Quality Index questionnaires are used to assess quality of care from patients' experiences. To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients' experiences regarding information provision, medication counseling, and pharmacy staff's communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients' experiences was calculated. In total, 109 encounters were included for analysis. For the domains "medication counseling" and "communication style", agreement between patients' experiences and observations was very high (>90%). Less agreement (45%) was found for "information provision", which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients' questioning behavior. A questionnaire is useful to assess the quality of medication counseling and pharmacy staff's communication style, but might be less suitable to evaluate information provision and pharmacy staff's encouragement of patients' questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments.

Drugs - Do we need them? Applications of non-pharmaceutical therapy in anterior eye disease: A review.

Science.gov (United States)

Mandal, Priyanka; Khan, Mohammad A; Shah, Sunil

2017-12-01

Natural products have been in use long before the introduction of modern drug therapies and are still used in various communities worldwide for the treatment of anterior eye disease. The aim of this review is to look at the current non-pharmaceutical modalities that have been tried and assess the body of existing evidence behind them. This includes alternative medicine, existing non-pharmaceutical therapy and more recent low and high tech solutions. A detailed search of all available databases including MEDLINE, Pubmed and Google was made to look for English-language studies for complementary and alternative treatment modalities (CAM), natural therapies and new modalities for anterior eye disease such as blepharitis, dry eye and microbial keratitis. We have included a broad discussion ranging from traditional treatments like honey and aloe vera which have been used for centuries, to the more recent technological advances like Intense Pulsed Light (IPL), LipiFlow and photoactivated chromophore for corneal cross linking in infectious keratitis (PACK-CXL). Alternative management strategies may have a role in anterior eye diseases and have a potential in changing the way we currently approach them. Some of the available CAM could play a role if incorporated in to current management practices of not only chronic diseases like blepharitis and dry eye, but also acute conditions with significant morbidity like microbial keratitis. Further large-scale randomized control trials stratified by disease severity are required to improve our understanding and to evaluate the use of non-pharmaceutical therapy against current practice. Copyright © 2017. Published by Elsevier Ltd.

Online Pharmaceutical Care Provision: Full-Implementation of an eHealth Service Using Design Science Research.

Science.gov (United States)

Gregório, João; Pizarro, Ângela; Cavaco, Afonso; Wipfli, Rolf; Lovis, Christian; Mira da Silva, Miguel; Lapão, Luís Velez

2015-01-01

Chronic diseases are pressing health systems to introduce reforms, focused on primary care and multidisciplinary models. Community pharmacists have developed a new role, addressing pharmaceutical care and services. Information systems and technologies (IST) will have an important role in shaping future healthcare provision. However, the best way to design and implement an IST for pharmaceutical service provision is still an open research question. In this paper, we present a possible strategy based on the use of Design Science Research Methodology (DSRM). The application of the DSRM six stages is described, from the definition and characterization of the problem to the evaluation of the artefact.

Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation

Science.gov (United States)

Koster, Ellen S; Blom, Lyda; Overbeeke, Marloes R; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

2016-01-01

Introduction Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients’ experiences regarding information provision, medication counseling, and pharmacy staff’s communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients’ experiences was calculated. Results In total, 109 encounters were included for analysis. For the domains “medication counseling” and “communication style”, agreement between patients’ experiences and observations was very high (>90%). Less agreement (45%) was found for “information provision”, which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients’ questioning behavior. Conclusion A questionnaire is useful to assess the quality of medication counseling and pharmacy staff’s communication style, but might be less suitable to evaluate information provision and pharmacy staff’s encouragement of patients’ questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments. PMID:27042025

Occurrence of pharmaceuticals and personal care products in fish: results of a national pilot study in the United States.

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Ramirez, Alejandro J; Brain, Richard A; Usenko, Sascha; Mottaleb, Mohammad A; O'Donnell, John G; Stahl, Leanne L; Wathen, John B; Snyder, Blaine D; Pitt, Jennifer L; Perez-Hurtado, Pilar; Dobbins, Laura L; Brooks, Bryan W; Chambliss, C Kevin

2009-12-01

Pharmaceuticals and personal care products are being increasingly reported in a variety of biological matrices, including fish tissue; however, screening studies have presently not encompassed broad geographical areas. A national pilot study was initiated in the United States to assess the accumulation of pharmaceuticals and personal care products in fish sampled from five effluent-dominated rivers that receive direct discharge from wastewater treatment facilities in Chicago, Illinois; Dallas, Texas; Orlando, Florida; Phoenix, Arizona; and West Chester, Pennsylvania, USA. Fish were also collected from the Gila River, New Mexico, USA, as a reference condition expected to be minimally impacted by anthropogenic influence. High performance liquid chromatography-tandem mass spectrometry analysis of pharmaceuticals revealed the presence of norfluoxetine, sertraline, diphenhydramine, diltiazem, and carbamazepine at nanogram-per-gram concentrations in fillet composites from effluent-dominated sampling locations; the additional presence of fluoxetine and gemfibrozil was confirmed in liver tissue. Sertraline was detected at concentrations as high as 19 and 545 ng/g in fillet and liver tissue, respectively. Gas chromatography-tandem mass spectrometry analysis of personal care products in fillet composites revealed the presence of galaxolide and tonalide at maximum concentrations of 2,100 and 290 ng/g, respectively, and trace levels of triclosan. In general, more pharmaceuticals were detected at higher concentrations and with greater frequency in liver than in fillet tissues. Higher lipid content in liver tissue could not account for this discrepancy as no significant positive correlations were found between accumulated pharmaceutical concentrations and lipid content for either tissue type from any sampling site. In contrast, accumulation of the personal care products galaxolide and tonalide was significantly related to lipid content. Results suggest that the detection of

[Hospital pharmaceutical practice in prison].

Science.gov (United States)

Harcouët, L

2010-09-01

Since 1994, hospital pharmaceutical teams have been in charge of pharmaceutical tasks in "unités de consultation et de soins ambulatoires" (UCSA), which are hospital consulting care units in French prisons. In 2008, pharmaceutical team in Parisian prisons received 6500 prescriptions and prepared 85,000 nominative bags containing drugs. Prisoners were 1.3% to receive treatments against HIV, 8.2% cardiovascular drugs, 7.2% opioid substitution treatments, and 52.9% psychoactive drugs, including 39.3% hypnotics, 40.5% anxiolytics, 11.3% antidepressants and 12.2% neuroleptics. In prison, the dichotomy between somatic and mental care is marked, attitudes of prisoners about their medicines are complex (important claims, embezzlement, etc.) and it is difficult for law defendants to maintain treatment confidentiality and to prepare prison outing in terms of health. To attenuate the heterogeneity of drug distribution systems in French prisons, we propose pharmaceutical analysis of prescriptions and nominative dispensation, computerization in UCSA in coordination with hospitals, a better contribution of prison medical and pharmaceutical staff in hospital "drug committees" and the redaction of pharmaceutical guidelines. Acting in concert with multidisciplinary medical staff in UCSA, pharmaceutical teams have to develop epidemiological studies to improve knowledge in prisoner's health and also prevention and health care in prison. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Effectiveness of the Dader Method for Pharmaceutical Care on Patients with Bipolar I Disorder: Results from the EMDADER-TAB Study.

Science.gov (United States)

Salazar-Ospina, Andrea; Amariles, Pedro; Hincapié-García, Jaime A; González-Avendaño, Sebastián; Benjumea, Dora M; Faus, Maria José; Rodriguez, Luis F

2017-01-01

Bipolar I disorder (BD-I) is a chronic illness characterized by relapses alternating with periods of remission. Pharmacists can contribute to improved health outcomes in these patients through pharmaceutical care in association with a multidisciplinary health team; however, more evidence derived from randomized controlled trials (RCTs) is needed to demonstrate the effect of pharmaceutical care on patients with BD-I. To assess the effectiveness of a pharmaceutical intervention using the Dader Method on patients with BD-I, measured by the decrease in the number of hospitalizations, emergency service consultations, and unscheduled outpatient visits from baseline through 1 year of follow-up. This study is based on the EMDADER-TAB trial, which was an RCT designed to compare pharmaceutical care with the usual care given to outpatients with BD-I in a psychiatric clinic. The main outcome was the use of health care services, using Kaplan-Meier methods and Cox regression. The trial protocol was registered in ClinicalTrials.gov (Identifier NCT01750255). 92 patients were included in the EMDADER-TAB study: 43 pharmaceutical care patients (intervention group) and 49 usual care patients (control group). At baseline, no significant differences in demographic and clinical characteristics were found across the 2 groups. After 1 year of follow-up, the risk of hospitalizations and emergencies was higher for the control group than for the intervention group (HR = 9.03, P = 0.042; HR = 3.38, P = 0.034, respectively); however, the risk of unscheduled outpatient visits was higher for the intervention group (HR = 4.18, P = 0.028). There was no "placebo" treatment, and patients in the control group might have produced positive outcomes and reduced the magnitude of differences compared with the intervention group. Compared with usual care, pharmaceutical care significantly reduced hospitalizations and emergency service consultations by outpatients with BD-I. This study received funding from

Impact of an educational program on knowledge and practice of health care staff toward pharmaceutical waste management in Gaza, Palestine.

Science.gov (United States)

Tabash, Mohammed I; Hussein, Rim A; Mahmoud, Aleya H; El-Borgy, Mohamed D; Abu-Hamad, Bassam A

2016-04-01

In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. Poor knowledge about their potential downstream impacts may be a primary factor for improper disposal behavior. The objective of this study was to determine the impact of an intervention program on knowledge and practice of health care staff regarding pharmaceutical waste management. The study was designed as a pre/posttest intervention study. Total sample size was 530 in the pre-intervention phase, and then a subsample of 69 individuals was selected for the intervention and the post-intervention phases. Paired-sample t test was used to assess the difference between pretest and follow-up test results. A statistically significant improvement in knowledge and practice was achieved (Ppharmaceutical waste management. In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. A lack of knowledge about the potential impacts of this type of waste may be a leading factor in improper disposal behavior. Following an educational program, statistically significant improvement in knowledge and practice of health care staff as regards to pharmaceutical waste management (PWM) was achieved. It is thus recommended that authorities implement training-of-trainers (TOT) programs to educate health care staff on PWM and organize refreshment workshops regularly.

International scientists’ priorities for research on pharmaceutical and personal care products in the environment

Science.gov (United States)

Pharmaceuticals and personal care products (PPCPs) are widely discharged into the environment via diverse pathways. The effects of PPCPs in the environment have potentially important human and ecosystem health implications, so credible, salient, and legitimate scientific evidence...

Music therapy for palliative care: A realist review.

Science.gov (United States)

McConnell, Tracey; Porter, Sam

2017-08-01

Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation. We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works. A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation. Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.

Pharmaceuticals and Personal Care Products in the Environment: What are the Big Questions?

Science.gov (United States)

Over the past 10-15 years, a significant amount of work has been done by the scientific, regulatory and business communities into effects and risks of pharmaceuticals and personal care products (PPCPs) in the environment. It is now timely to review the current knowledge and to...

Pharmaceuticals and Personal-Care Products in Plants.

Science.gov (United States)

Bartrons, Mireia; Peñuelas, Josep

2017-03-01

Pharmaceuticals and personal-care products (PPCPs) derived from agricultural, urban, and industrial areas accumulate in plants at concentrations (ng to μg kg -1 ) that can be toxic to the plants. Importantly, the dietary intake of these PPCP-contaminated plants may also pose a risk to human health, but currently little is known about the fate of PPCPs in plants and their effect on or risk to the ecosystem. In this Opinion article we propose that in-depth research on the use of plants as a monitoring device for assessing the use and environmental presence of PPCPs is warranted. The toxicity of PPCPs to plants and their microbiota needs to be established, as well as any toxic effects on herbivores including humans. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pharmaceutical policy and the pharmacy profession

DEFF Research Database (Denmark)

Traulsen, Janine Marie; Almarsdóttir, Anna Birna

2005-01-01

In this article, the authors look at the relationship between pharmaceutical policy and the pharmacy profession with focus on pharmacy practice and pharmacists in the health care sector. Pharmaceutical policy encompasses three major policy inputs: public health policy, health care policy and indu......In this article, the authors look at the relationship between pharmaceutical policy and the pharmacy profession with focus on pharmacy practice and pharmacists in the health care sector. Pharmaceutical policy encompasses three major policy inputs: public health policy, health care policy...... and industrial policy. In order to analyse and understand pharmaceutical policy, it is important to know how policymakers view pharmacy and pharmacists. The authors look at the issues that arise when policy regulates pharmacy as a business, and what this means for the profession. The perspective of pharmacy...... in managerialism, and how the division of labour with other health professionals such as physicians and pharmacy assistants is affecting the pharmacy profession's position in the labour market. Next the authors look at ways in which the pharmacy profession has affected policy. Pharmacists have been instrumental...

[Effect of Environmental Factors on the Ecotoxicity of Pharmaceuticals and Personal Care Products].

Science.gov (United States)

Sugihara, Kazumi

2018-01-01

　In recent years, pharmaceuticals and personal care products (PPCPs) have emerged as significant pollutants of aquatic environments and have been detected at levels in the range of ng/L to μg/L. The source of PPCPs is humans and livestock that have been administered pharmaceuticals and subsequently excreted them via urine and feces. Unlike agricultural chemicals, the environmental dynamics of PPCPs is not examined and they would undergo structural transformation by environmental factors, e.g., sunlight, microorganisms and treatments in sewage treatment plants (STPs). Processing at STPs can remove various PPCPs; however, they are not removed completely and some persist in the effluents. In this study, we examined the degradation of 9 pharmaceuticals (acetaminophen, amiodarone, dapsone, dexamethasone, indomethacin, raloxifene, phenytoin, naproxen, and sulindac) by sunlight or UV, and investigated the ecotoxicological variation of degradation products. Sunlight (UVA and UVB) degraded most pharmaceuticals, except acetaminophen and phenytoin. Similar results were obtained with UVB and UVA. All the pharmaceuticals were photodegraded by UVC, which is used for sterilization in STPs. Ecotoxicity assay using the luminescent bacteria test (ISO11348) indicated that UVC irradiation increased the toxicity of acetaminophen and phenytoin significantly. The photodegraded product of acetaminophen was identified as 1-(2-amino-5-hydroxyphenyl)ethanone and that of phenytoin as benzophenone, and the authentic compounds showed high toxicity. Photodegraded products of PPCPs are a concern in ecotoxicology.

Pharmaceuticals and personal care products alter the holobiome and development of a medically important mosquito

International Nuclear Information System (INIS)

Pennington, Marcus J.; Rivas, Nicholas G.; Prager, Sean M.; Walton, William E.; Trumble, John T.

2015-01-01

The increasing demand for fresh water has forced many countries to use reclaimed wastewater for agricultural purposes. This water contains pharmaceuticals and personal care products (PPCPs) that remain biologically active following passage through wastewater treatment plants. Run-off from farms and contaminated water from treatment facilities exposes aquatic ecosystems to PPCPs. This study examined the effects of PPCPs on a lower trophic organism. Culex quinquefasciatus larvae were reared in water contaminated with environmentally relevant concentrations of common PPCPs. Acetaminophen alone and a mixture of contaminants were found to increase developmental time of larvae. Susceptibility to Bti increased in larvae exposed to antibiotics, acetaminophen, or a mixture of PPCPs. Antibiotics, hormones, and the mixture altered the mosquito bacterial microbiome. Overall, the results indicate that at environmentally relevant concentrations, PPCPs in reclaimed water can have biologically important effects on an ecologically and medically important lower trophic level insect. - Highlights: • Effects of Pharmaceuticals and Personal Care Products on mosquitoes were examined. • Three PPCP treatments increase susceptibility to a common larvicide (Bti). • Acetaminophen and the mixture of PPCPs caused an increase in developmental time. • The holobiome of mosquitoes treated with PPCPs were sequenced. • Three PPCP regimes changed the holobiome of the mosquitoes. - Pharmaceuticals and personal care products, common to reclaimed wastewater, alter the development of mosquitoes. They also alter the whole-body bacterial microbiome

Pharmaceutical product cross-contamination: industrial and clinical ...

African Journals Online (AJOL)

problems. Pharmaceutical product cross-contamination is a serious problem which has been detected as an obstacle ... In the pharmaceutical care of patients in developed countries, cross-contamination ..... neonatal intensive care units.

Seminar: Music Therapy in Dementia Care

DEFF Research Database (Denmark)

Ridder, Hanne Mette Ochsner

2009-01-01

This seminar presents music therapy in person centered dementia care. In the first part focus is on research and documentation. How can short term music therapy document changes in symptoms of depression? Is Dementia Care Mapping a valid assessment tool for documenting group music therapy......? In the next part focus is on clinical music therapy – in group work as well as in individual work – and how the music therapist works in the interdisciplinary field....

Occupational Therapy experience in family care in a primary health care service

Directory of Open Access Journals (Sweden)

Gisele Baissi

2013-08-01

Full Text Available Occupational therapy is presented as the core knowledge involved in the remodeling and strengthening of Primary Health Care in the Brazilian Unified Health Care System (Sistema Único de Saúde – SUS. In this study, we aimed to describe the interventions in the process of occupational therapy in supervised family care in a primary health care service in the municipality of Várzea Paulista, São Paulo state. In this case study, the moments of care were described and analyzed in light of narratives on the supervised practice of occupational therapy with a family. The results showed forms of intervention that characterize the process of occupational therapy focused on family health needs in favor of creativity and the role for changes in health practices in everyday life. Through the accomplishment of occupational activities directed to self-care, Occupational Therapy can aid families to cope with daily life adversity.

Pharmaceutical drug detailing in primary care: extent and methods

DEFF Research Database (Denmark)

Schramm, Jesper

The dimension and methods of pharmaceutical marketing towards 47 danish general practitioners is described. Conclusions: Pharmaceutical drug detailing possesses a huge potential to influence the prescription pattern of GP's.......The dimension and methods of pharmaceutical marketing towards 47 danish general practitioners is described. Conclusions: Pharmaceutical drug detailing possesses a huge potential to influence the prescription pattern of GP's....

The need for pharmaceutical care in an intensive care unit at a ...

African Journals Online (AJOL)

Interventions to assess therapy ... and trauma intensive care unit (ICU) at Steve Biko Academic Hospital. ... of programme success, such as improving the quality of service by .... saving and extra quality assurance opportunity for the unit.[11].

Developing anchored measures of patient satisfaction with pharmaceutical care delivery: Experiences versus expectations

Directory of Open Access Journals (Sweden)

Rosemin Kassam

2009-04-01

Full Text Available Rosemin Kassam1, John B Collins2, Jonathan Berkowitz31Structured Practice Education Program, Faculty of Pharmaceutical Sciences; 2Department of Educational Studies; 3Sauder School of Business, University of British Columbia, Vancouver, BC, CanadaBackground: A pilot study was undertaken to evaluate patients’ satisfaction with pharmaceutical care (PC activities delivered at community pharmacies. The objectives of the study were to: (1 operationalize patient satisfaction in terms of the advanced pharmacy practice experience (APPE PC activities, (2 conduct psychometric analysis of the satisfaction instrument, and (3 assess the sensitivity of the instrument to detect any differences that may exist between what patients expect to receive versus what is actually experienced.Methods: Pharmacies affiliated with two national chains were recruited to participate. Asthma patients at each of these sites were invited to complete a survey designed to assess their expectations of and their experiences with PC at the respective site.Results: One hundred forty-seven surveys were completed from patients in 19 community pharmacies. Psychometric analysis confirmed the survey’s internal reliability and sensitivity to be very high. Data analysis suggested that most patients expect more from PC services than they actually experienced.Conclusion: Unlike other PC satisfaction surveys, this instrument allows patient experiences to be anchored against their expectations. The results suggest that most patients would be willing to engage in PC activities outlined in the survey.Keywords: satisfaction survey, pharmaceutical care, community-APPE

Where and how does physical therapy fit? Integrating physical therapy into interprofessional HIV care.

Science.gov (United States)

deBoer, Heather; Andrews, Matthew; Cudd, Stephanie; Leung, Ellie; Petrie, Alana; Chan Carusone, Soo; O'Brien, Kelly K

2018-03-13

To investigate the role of physical therapy in HIV care from the perspective of people living with HIV and health care professionals with expertise in HIV care. We conducted a qualitative descriptive study using semistructured interviews (with health care professionals) and focus groups (with people living with HIV). We purposively sampled health care professionals and recruited people living with HIV in collaboration with an HIV-specialty hospital. We asked participants about their knowledge of and experiences with physical therapy, and perceptions of the physical therapy role in interprofessional HIV care. We analyzed data using content analytical techniques. Thirteen people living with HIV and 12 health care professionals conceptualized physical therapy as positively influencing independence and social participation, and as a valuable ally in interprofessional collaboration. The Framework of Physical Therapy Role in HIV Care consists of two components: (1) multidimensional and client-centered roles of physical therapy addressing physical, psychological and social health domains; and (2) contextual factors important to consider for the role of physical therapy: aging, episodic nature of HIV, multimorbidity, competing priorities, continuity of care, stigma, resource security and social isolation. The interaction between contextual factors and health domains can influence the role of physical therapy. The role of physical therapy in HIV is multidimensional and client-centered. This Framework can be used by rehabilitation professionals working with people living with HIV. Implications for Rehabilitation Participants living with HIV in this study experienced physical therapy as a means of addressing rehabilitation goals that positively influenced physical health and social participation. The role of physical therapy in HIV care is multidimensional and client-centered and can address health challenges in physical, social and psychological health domains. The presence

Music Therapy in Palliative Care.

Science.gov (United States)

Warth, Marco; Keßler, Jens; Hillecke, Thomas K; Bardenheuer, Hubert J

2015-11-13

Music therapy has been used successfully for over 30 years as part of palliative care programs for severely ill patients. There is nonetheless a lack of high-quality studies that would enable an evidence-based evaluation of its psychological and physiological effects. In a randomized controlled trial, 84 hospitalized patients in palliative care were assigned to one of two treatment arms--music therapy and control. The music therapy intervention consisted of two sessions of live music-based relaxation exercises; the patients in the control group listened to a verbal relaxation exercise. The primary endpoints were self-ratings of relaxation, well-being, and acute pain, assessed using visual analog scales. Heart rate variability and health-related quality of life were considered as secondary outcomes. The primary data analysis was performed according to the intention-to-treat principle. Analyses of covariance revealed that music therapy was more effective than the control treatment at promoting relaxation (F = 13.7; p Music therapy did not differ from control treatment with respect to pain reduction (F = 0.4; p = 0.53), but it led to a significantly greater reduction in the fatigue score on the quality-of-life scale (F = 4.74; p = 0.03). Music therapy is an effective treatment with a low dropout rate for the promotion of relaxation and well-being in terminally ill persons undergoing palliative care.

Multicomponent Pharmaceutical Cocrystals: A Novel Approach for Combination Therapy.

Science.gov (United States)

Fatima, Zeeshan; Srivastava, Dipti; Kaur, Chanchal Deep

2018-03-05

Cocrystallization is a technique for modifying the physicochemical and pharmacokinetic properties of an active pharmaceutical ingredient (API) embodying the concept of supramolecular synthon. Most of the examples cited in the literature are of cocrystals formed between an API and a coformer chosen from the generally recognized as safe (GRAS) substance list, however, few examples exist where a cocrystal consists of two or more APIs. These cocrystals are commonly known as multi API, multi drug or drug- drug cocrystals. The formation of such cocrystals is feasible by virtue of non covalent interactions between the APIs, which help them in retaining their biologic activity. In addition, drug- drug cocrystals also offer the potential solution to the limitations such as solubility, stability differences and chemical interaction between the APIs which is often faced during the traditional combination therapy. Cocrystallization of two or more APIs can be employed for delivery of combination drugs for the better and efficacious management of many complex disorders where existing monotherapies do not furnish the desired therapeutic effect. This review on the existing drug-drug cocrystals is to gain insight for better designing of multi API cocrystals with improved physicochemical and pharmacokinetic profile and its application in multiple target therapy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Music therapy in palliative care: current perspectives.

Science.gov (United States)

O'Kelly, Julian

2002-03-01

As the music therapy profession has developed internationally over the last 25 years, so has its role in palliative care. Music is a highly versatile and dynamic therapeutic modality, lending itself to a variety of music therapy techniques used to benefit both those living with life-threatening illnesses and their family members and caregivers. This article will give a broad overview of the historical roots of music therapy and introduce the techniques that are employed in current practice. By combining a review of mainstream music therapy practice involving musical improvisation, song-writing and receptive/recreational techniques with case material from my own experience, this article aims to highlight the potential music therapy holds as an effective holistic practice for palliative care, whatever the care setting.

Pharmaceutical Sponsorship Bias Influences Thrombolytic Literature in Acute Ischemic Stroke

Directory of Open Access Journals (Sweden)

Ryan P Radecki

2011-05-01

Full Text Available Background: The efficacy of thrombolytic therapy for acute ischemic stroke remains controversial in Emergency Medicine and has not been fully endorsed by either the American College of Emergency Physicians or the American Academy of emergency medicine. A growing recognition exists of the influence of pharmaceutical sponsorship on the reported findings of published clinical trials. Sponsorship bias has been suggested as a potential criticism of the literature and guidelines favoring thrombolytic therapy. Objective: The objective of this study is to review the most influential literature regarding thrombolytic therapy for acute ischemic stroke and document the presence or absence of pharmaceutical sponsorship. Methods: A publication-citation analysis was performed to identify the most frequently cited articles pertaining to thrombolytic therapy for acute ischemic stroke. Identified articles were reviewed for disclosures of pharmaceutical funding. Results: Of the 20 most-cited articles pertaining to thrombolytic therapy for acute stroke, 17 (85% disclosed pharmaceutical sponsorship. These disclosures range from general sponsorship to direct employment of authors by pharmaceutical companies. Conclusion: An overwhelming predominance of the most influential literature regarding thrombolytic therapy for acute ischemic stroke is susceptible to sponsorship bias. This potential bias may provide a basis for physician concern regarding the efficacy and safety of thrombolytic therapy. Further, large, independent, placebo-controlled studies may be required to guide therapy and professional guidelines definitively for acute ischemic stroke. [West J Emerg Med. 2011;12(4:435–441.

CAM therapies among primary care patients using opioid therapy for chronic pain

OpenAIRE

Fleming, Sara; Rabago, David P; Mundt, Marlon P; Fleming, Michael F

2007-01-01

Abstract Background Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. Method A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to as...

[Effectiveness of Team-Based Learning (TBL) as a new teaching approach for pharmaceutical care education].

Science.gov (United States)

Suno, Manabu; Yoshida, Toshiko; Koyama, Toshihiro; Zamami, Yoshito; Miyoshi, Tomoko; Mizushima, Takaaki; Tanimoto, Mitsune

2013-01-01

The concept of Team-Based Learning (TBL) was developed in the late 1970s by Larry Michaelsen, who wanted students to enjoy the benefits of small group learning within large classes in the business school environment. In contrast to problem-based learning (PBL), which is student centered, TBL is typically instructor centered. Recently, TBL is being used as a teaching method in over 60 health science professional schools in the US and other countries. In the present study, the impact of adopting TBL in teaching pharmaceutical care practices to students was evaluated. Students were required to answer a set of multiple-choice questions individually in individual readiness assessment test (IRAT) before the TBL sessions to assess their level of preparation. The same set of questions was then reattempted by the group readiness assessment test (GRAT) during TBL. Comparing the scores obtained in the GRAT and IRAT before the first TBL session, the scores from the GRAT were always higher than those of the IRAT, indicating that TBL has encouraged active learning. In addition, students were surveyed about their level of satisfaction with TBL and written comments about TBL were solicited. The results of the questionnaire showed that 87.3±9.3% of the students were satisfied. Moreover, no student commented that TBL was in any way inferior to the PBL. Implementation of a TBL approach was successfully integrated into the pharmaceutical care education course. In order to further improve the usefulness of TBL in teaching pharmaceutical care, a hybrid teaching approach that also comprises PBL and a lecture-based course is desirable.

Pharmaceutical intervention in menopausal patients with hormone replacement therapy in a community pharmacy from Antofagasta

Directory of Open Access Journals (Sweden)

Alejandrina Alucema

2015-02-01

Full Text Available Context: Hormone replacement therapy (HRT is the most widely used treatment for controlling the effects of menopause. This type of therapy causes some drug-related problems (DRP, which requires monitoring to control the negative effects and ensure patient adherence to therapy. Aims: Perform a pharmacotherapeutic monitoring and educate to menopausal patients in HRT of a community pharmacy from the city of Antofagasta. Methods: A 98-menopausal patients underwent a pharmaceutical intervention to identify the PRM and its resolution. It was applied to them a survey before and after educational activities about this disease and HRT to determine the knowledge on the subject. Results: During the pharmacotherapeutic monitoring was determined that 55% of patients using combined HRT. 62 DRPs were detected, of which 43 were resolved (69%; the most were Patient-Pharmacist (73%. The better resolution DRP were DRP 4(b “frequency of inadequate administration” and DRP 2(a “no medical indication”. At baseline, 90% had an inadequate level of knowledge about the disease and THR, 8% intermediate, and only 2% adequate. After the implementation of the education strategy, the level of knowledge increased, achieving at the end of the study only intermediate (10% and adequate (90% levels. Conclusions: The results confirm the importance of pharmaceutical intervention for the identification and resolution of DRP and the requirement to establish educational strategies to increase the knowledge about menopause and HRT in menopausal patients.

Investigating the relationship between the practice of pharmaceutical care, construed external image, organizational identification, and job turnover intention of community pharmacists.

Science.gov (United States)

O'Neill, Jessica L; Gaither, Caroline A

2007-12-01

Pharmacy employers are being challenged to recruit and retain qualified employees. Our study hypothesized that pharmacists who practice pharmaceutical care have an attractive construed external image (how employees think outsiders view their organization), which strengthens their organizational identification (perceptions of oneness with or belongingness to the organization) and decreases job turnover intention (thoughts of quitting/searching for another job). A 7-page questionnaire was mailed to the homes of a random sample of 759 licensed pharmacists practicing in the United States. Participants had the option of returning the completed survey via postal mail or a Web site. The study variables were measured with previously validated scales. Structural equation modeling with latent variables evaluated the hypothesized relationships. Several demographic variables were included. Responses were received from 252 subjects (33%); 121 were community pharmacists. As hypothesized, organizational identification and job turnover intention were significantly related (B=-0.24) as well as construed external image and organizational identification (B=0.41). The practice of pharmaceutical care and construed external image were not significantly correlated (B=0.10). Although not hypothesized, construed external image was directly related to job turnover intention (B=-0.25). The effects of the practice of pharmaceutical care on job turnover intention were mediated through organizational identification. Position had significant effects. One additional benefit to the practice of pharmaceutical care may be strengthened organizational identification. Pharmacists' perception of the image of their employer may increase organizational identification and decrease job turnover intention. An understanding of the organizational identification of pharmacists would be useful in decreasing job turnover intention. Given the current demand for pharmacists, this is a worthwhile endeavor. Future

Occupational Therapy and Primary Care: Updates and Trends

Science.gov (United States)

Mroz, Tracy M.; Fogelberg, Donald J.; Leland, Natalie E.

2018-01-01

As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care. PMID:29689169

Looking at CER from the pharmaceutical industry perspective.

Science.gov (United States)

Dubois, Robert W

2012-05-01

Comparative effectiveness research (CER) is increasing as an element of health care reform in the United States. By comparing drugs against other drugs or other therapies instead of just to placebo, CER has the potential to improve decisions about the appropriate treatment for patients. But the growth of CER also brings an array of questions and decisions for purchasers and policy makers that will not be easy to answer and which require significant dialogue to fully understand and address. To describe some of the impact, both positive and negative, that comparative effectiveness research (CER) may have on the pharmaceutical industry. As CER data proliferate, questions are being raised about who can access the data, who can discuss it, and in what forums. Regulations place different communication restrictions on the pharmaceutical industry than on other health care stakeholders, which creates a potential inequality. Another CER consideration will be the tendency to apply average results to individuals, even if not every individual experiences the average result. Policy makers should implement CER findings carefully with a goal toward accommodating flexibility. A final impact to consider is whether greater expectations for CER will have a negative or positive effect on incentives for drug innovation. In some cases, CER may increase development costs or decrease market size. In other cases, better targeting of trial populations could result in lower development costs. The rising expectations and growth in CER raise questions about information access, communication restrictions, flexible implementation policies, and incentives for innovation. Members of the pharmaceutical industry should be cognizant of the questions and should be participating in dialogues now to pave the way for future solutions.

[Opinion of primary care physicians from Ourense on various features of the pharmaceutical prescription].

Science.gov (United States)

Díaz Grávalos, G J; Palmeiro Fernández, G; Núnñez Masid, E; Casado Górriz, I

2001-01-01

To learn the opinion of the primary care Physicians of Ourense (Spain) with respect to certain aspects of their prescription of medicines, such as their awareness of the price of drugs, the induced prescribing perceived, their relationship with the pharmaceutical industry and their opinions concerning possible measures for reducing the expenditure on medicines. In this transversal descriptive study, all of the primary care physicians in the province of Ourense (243) were surveyed by means of a previously-approved questionnaire sent to them by post. The questionnaire included demographic characteristics of the physicians, the influence of cost when prescribing medicines, their estimate of the price of 15 drugs routinely prescribed and their opinion on different aspects relating to induced prescription, the pharmaceutical industry and different strategies in order to curtail the expenditure on medicines. In order to analyze the results, the chi 2 and Student's t tests and an analysis of the variance were used, together with the Spearman correlation coefficient with alpha = 0.05. The level of participation of the physicians surveyed was 42.8% (104). The average daily duration of visits by pharmaceutical company representatives was 13.6 minutes, with new specialities being the topic of greatest interest. Close to 27% admitted to having participated in clinical testing sponsored by the industry. 23% considered the price to be a priority when prescribing. Induced prescription accounted for 39.7% of the total. The majority of physicians chose co-payment as the means for reducing expenditure on medicines. In the estimate of prices, the overall percentage of error was 45.7%, underestimating the more expensive medicines and overestimating the less expensive. There is a significant lack of awareness of the price of drugs among the primary care physicians. Most of the physicians do not feel that the price of a drug should be a priority when prescribing medicines. There is a

Present Conditions and Problems of Home Care Education in Pharmaceutical Education: Through the Activities of "the Working Group to Create Home Clinical Cases for Education".

Science.gov (United States)

Kobuke, Yuko

2017-01-01

In the pharmaceutical education model core curriculums revision, "basic qualities required as a pharmacist" are clearly shown, and "the method based on learning outcomes" has been adopted. One of the 10 qualities (No. 7) is "Practical ability of the health and medical care in the community". In the large item "F. Pharmaceutical clinical" of the model core curriculums, "participation in the home (visit) medical care and nursing care" is written in "participation in the health, medical care, and welfare of the community", and it is an important problem to offer opportunities of home medical care education at university. In our university, we launched a working group to create "home clinical cases for education" from the educational point of view to pharmacy students to learn home medical care, in collaboration with university faculty members and pharmacists, who are practitioners of home care. Through its working group activities, we would like to organize the present conditions and problems of home care education in pharmaceutical education and to examine the possibility of using "home clinical case studies" in home care education at university.

The pharmaceutics used in medicine, using fields and discarding of wastes

International Nuclear Information System (INIS)

Oezyurt, M.

2009-01-01

Radioisotopes are being used in medicine, industry, environmental pollution, agriculture, hydrology etc. The medical diagnosis by radiation is the main source of synthetic radiation exposure source of public. Radioisotopes are used in different topics both for diagnosis and therapy. Naturally as a result of the usage of these radioactive elements, radioactive wastes are formed and discarding rules of these wastes must be applied very carefully. Solid or liquid all the radioactive medical wastes are subject to utmost care of disposing process under control of the health physics authorities. Pharmaceutics used in humans are consumed at high amounts in the world. Pharmaceutical compounds discharged into surface waters threaten the water life and reenter the water cycle. At a thesis work, it was showed that the medical drugs were absorbed by the active sludge in specific ratios. Therefore, the waters and treated sludges discharged from wastewater treatment plants must never be used for agricultural purposes without the necessary analysis. The receptor media where wastewaters are discharged , also at the places where advanced treatment technologies are not used, presence of medical drug residues cause potential risk for the livings and human health. At this work, the characteristics of radio pharmaceutics, the using places and also discarding ways are told.

Cardiovascular risk rate in hypertensive patients attended in primary health care units: the influence of pharmaceutical care

Directory of Open Access Journals (Sweden)

Paulo Yuri Milen Firmino

2015-09-01

Full Text Available Cardiovascular complications are relevant due to their frequency and severity on the hypertension scenario. Studies refer Pharmaceutical Care (PC as capable of decreasing cardiovascular risk rate (%CVR on hypertensive patients. This study aimed to investigate, through a randomized clinical assay, the influence of PC service on the %CVR of hypertensive patients assisted in a health primary care unit from Fortaleza-Ceará. Two study groups were formed: i. Intervention Group (IG, which received orientation about taking medicines, actions aiming to prevent/solve medicine interactions and adverse effects and non-pharmacological interventions for 9 months and, ii. Control Group (CG, which received traditional assistance of the unit and was monitored during the same period. It was observed a statistically significant reduction on %CVR (10.76 to 7.86; p=0.04 and systolic blood pressure levels (SBP (137.69 to 131.54; p<0.01 in the IG, while, in the CG, there was no significant alteration. 151 Drug Related Problem (DRP were identified and it was realized 124 pharmaceutical interventions, with 89.2% of them resulting on solution/prevention of the problem. Our findings indicated that the inclusion of the PC service in the hypertensive health assistance was more effective at the %CVR and the SBP reduction in comparison to the traditional assistance offered.

Reiki therapy: a nursing intervention for critical care.

Science.gov (United States)

Toms, Robin

2011-01-01

Complementary and alternative medicine (CAM) is not generally associated with the complexity and intensity of critical care. Most CAM therapies involve slow, calming techniques that seem to be in direct contrast with the fast-paced, highly technical nature of critical care. However, patients in critical care often find themselves coping with the pain and stress of their illness exacerbated by the stress of the critical care environment. Complementary and alternative medicine-related research reveals that complementary therapies, such as Reiki, relieve pain and anxiety and reduce symptoms of stress such as elevated blood pressure and pulse rates. Patients and health care professionals alike have become increasingly interested in complementary and alternative therapies that do not rely on expensive, invasive technology, and are holistic in focus. Reiki is cost-effective, noninvasive, and can easily be incorporated into patient care. The purpose of this article is to examine the science of Reiki therapy and to explore Reiki as a valuable nursing intervention.

Pharmacist-perceived barriers to pharmaceutical care of chronic and end-stage kidney disease patients in Saudi Arabia

Directory of Open Access Journals (Sweden)

Amal K Suleiman

2016-01-01

Conclusion: The contribution of pharmacists in CKD and ESRD will continue to grow as their clinical knowledge improves. Saudi pharmacists believe that the pharmaceutical care is an essential component of managing CKD and ESRD patients.

Pharmaceutical care for patients with hypertension: a new methodology and the importance of this practice in home care

OpenAIRE

Valdomiro Vagner de Souza; Ana Lúcia Francisco Bertoncin

2008-01-01

Objective: To evaluate and increase the knowledge of patients about hypertension trying to guide and motivate them for the correct use of medication and for the adherence to adequate health styles, pointing out the importance of pharmaceutical home care in the treatment of the illness. Methods: A prospective, experimental and longitudinal study held with 10 randomly selected patients from a municipal pharmacy. Data on life style, information concerning the used drugs and results after the acc...

Application of Emerging Pharmaceutical Technologies for Therapeutic Challenges of Space Exploration Missions

Science.gov (United States)

Putcha, Lakshmi

2011-01-01

An important requirement of therapeutics for extended duration exploration missions beyond low Earth orbit will be the development of pharmaceutical technologies suitable for sustained and preventive health care in remote and adverse environmental conditions. Availability of sustained, stable and targeted delivery pharmaceuticals for preventive health of major organ systems including gastrointestinal, hepato-renal, musculo-skeletal and immune function are essential to offset adverse effects of space environment beyond low Earth orbit. Specifically, medical needs may include multi-drug combinations for hormone replacement, radiation protection, immune enhancement and organ function restoration. Additionally, extended stability of pharmaceuticals dispensed in space must be also considered in future drug development. Emerging technologies that can deliver stable and multi-therapy pharmaceutical preparations and delivery systems include nanotechnology based drug delivery platforms, targeted-delivery systems in non-oral and non-parenteral formulation matrices. Synthetic nanomaterials designed with molecular precision offer defined structures, electronics, and chemistries to be efficient drug carriers with clear advantages over conventional materials of drug delivery matricies. Nano-carrier materials like the bottle brush polymers may be suitable for systemic delivery of drug cocktails while Superparamagnetic Iron Oxide Nanoparticles or (SPIONS) have great potential to serve as carriers for targeted drug delivery to a specific site. These and other emerging concepts of drug delivery and extended shelf-life technologies will be reviewed in light of their application to address health-care challenges of exploration missions. Innovations in alternate treatments for sustained immune enhancement and infection control will be also discussed.

Internet pharmaceutical sales: attributes, concerns, and future forecast.

Science.gov (United States)

Bruckel, Katy; Capozzoli, Ernest A

2003-01-01

Internet pharmaceutical sales continue to skyrocket as healthcare providers and consumers are increasingly relying on the efficiencies and convenience that is available via such transactions. Managed care companies, increasing demands to reduce healthcare inefficiencies while maximizing the quality of patient care is a significant contributing factor to the expanding utilization and success of online pharmaceutical sales. However, with the expansion of Internet pharmaceutical sales, healthcare providers, pharmacy benefit management and insurance companies, and consumers realize new opportunities and risks. This paper will review the attributes and concerns associated with online pharmaceutical sales, discussing current and pending legislation intended to more effectively manage these parameters.

An ecological perspective on medical care: environmental, occupational, and public health impacts of medical supply and pharmaceutical chains.

Science.gov (United States)

Vatovec, Christine; Senier, Laura; Bell, Michael

2013-09-01

Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.

Pharmaceutical regulation in 15 European countries review.

Science.gov (United States)

Panteli, Dimitra; Arickx, Francis; Cleemput, Irina; Dedet, Guillaume; Eckhardt, Helen; Fogarty, Emer; Gerkens, Sophie; Henschke, Cornelia; Hislop, Jennifer; Jommi, Claudio; Kaitelidou, Daphne; Kawalec, Pawel; Keskimaki, Ilmo; Kroneman, Madelon; Lopez Bastida, Julio; Pita Barros, Pedro; Ramsberg, Joakim; Schneider, Peter; Spillane, Susan; Vogler, Sabine; Vuorenkoski, Lauri; Wallach Kildemoes, Helle; Wouters, Olivier; Busse, Reinhard

2016-10-01

In the context of pharmaceutical care, policy-makers repeatedly face the challenge of balancing patient access to effective medicines with affordability and rising costs. With the aim of guiding the health policy discourse towards questions that are important to actual and potential patients, this study investigates a broad range of regulatory measures, spanning marketing authorization to generic substitution and resulting price levels in a sample of 16 European health systems (Austria, Belgium, Denmark, England, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Portugal, Scotland, Spain and Sweden). All countries employ a mix of regulatory mechanisms to contain pharmaceutical expenditure and ensure quality and efficiency in pharmaceutical care, albeit with varying configurations and rigour. This variation also influences the extent of publicly financed pharmaceutical costs. Overall, observed differences in pharmaceutical expenditure should be interpreted in conjunction with the differing volume and composition of consumption and price levels, as well as dispensation practices and their impact on measurement of pharmaceutical costs. No definitive evidence has yet been produced on the effects of different cost-containment measures on patient outcomes. Depending on the foremost policy concerns in each country, different levers will have to be used to enable the delivery of appropriate care at affordable prices. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Impact of a pharmaceutical care program on clinical evolution and antiretroviral treatment adherence: a 5-year study

Directory of Open Access Journals (Sweden)

Hernández Arroyo MJ

2013-08-01

Full Text Available María Jesús Hernández Arroyo,1 Salvador Enrique Cabrera Figueroa,2 Rosa Sepúlveda Correa,3 María de la Paz Valverde Merino,1 Alicia Iglesias Gómez,4 Alfonso Domínguez-Gil Hurlé5 On behalf of the Tormes Team 1Pharmacy Service, University Hospital of Salamanca, Salamanca, Spain; 2Pharmacy Institute, University Austral of Chile, Valdivia, Chile; 3Department of Statistics, University of Salamanca, Salamanca, Spain; 4Infectious Disease Service, University Hospital of Salamanca, Salamanca, Spain; 5Department of Pharmacy and Pharmaceutical Technology, University of Salamanca, Salamanca, Spain Background: Antiretroviral treatments (ART form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1 to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2 to detect possible correlations between different adherence evaluation measurements. Methods: A 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR. The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February–May, 2005–2010. Results: A total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01. Improvement was observed in the mean adherence level (P < 0.001, and there was a

Introduction of pharmaceutical expertise in a palliative care team in Sweden.

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Norrström, Barbro; Cannerfelt, Ing-Britt; Frid, Helen; Roos, Kim; Ramström, Helena

2010-12-01

This paper presents for the first time the inclusion of dispensing pharmacists, a special group of pharmacy professionals, in a Swedish palliative care team. It also presents the drug stock management in the medication room of the clinical area and the improvement of drug logistics. In addition to a dispensing pharmacist, a pharmacist was included in this part of the project as well. The palliative care team at ASIH Långbro Park, Sweden. The intervention with the dispensing pharmacists as new members of the interdisciplinary palliative team was evaluated by a questionnaire to the staff. An inventory of the different drugs in stock was performed in March 2006 and in April 2007, respectively. The inventory turnover rate was determined and the drug consumption for the last 6 months of 2005 and 2006, respectively, was also analysed. The questionnaire used rating scales allowing participants to rate the questions/statements. The number of different drugs and drug packages in stock were recorded during the inventories. Drug costs were calculated and the inventory turnover rate was determined by dividing the annual cost of drugs by the value of the inventory. Drug consumption was analysed using the Xplain statistical programme, a statistical tool from Apoteket AB. The overall impression of the dispensing pharmacists was positive. The staff reported advantages in having a dispensing pharmacist present at ASIH not only for the drug logistics, but also for drug-related queries. The inventory of the drug stock and the drug-handling process resulted in a 14% reduction of product numbers and a 36% reduction in the tied-up capital for drugs in stock. The inventory turnover rate increased from 6.7 to 9.5. A 7% reduction of medication costs was also observed when comparing the last 6 months of 2006 with the costs in 2005. The principal result of this project is that inclusion of pharmaceutical expertise on a palliative care team can be a valuable asset for the team in

Expectation and satisfaction of HIV/AIDS patients toward the pharmaceutical care provided at Gondar University Referral Hospital, Northwestern Ethiopia: a cross-sectional study

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Abebe TB

2016-10-01

provided at Gondar University Referral Hospital was found to be low, while the overall respondents’ expectation from the pharmaceutical services were exceedingly high. The hospital should implement good dispensing practice systems in relation to the services and continuing professional development to professionals in order to improve the satisfaction of patients. Keywords: pharmaceutical care, Ethiopia, HIV/AIDS, antiretroviral therapy

[Impact of pharmaceutical interventions on antibiotic therapy of urinary tract infections in rehabilitation center].

Science.gov (United States)

Rochefolle, A; Maison, O; Chazaud, C; Rioufol, C; Rode, G; Luaute, J; Jacquin-Courtois, S; Guinet-Lacoste, A; Carré, E

2017-06-01

The aim of this study was to assess the impact of medico-pharmaceutical partnership on the quality of antibiotic treatment in urinary tract infection (UTI) within rehabilitation center. All antibiotic prescriptions were validated by the pharmacist at the start of treatment and twice a week. All patients with symptomatic urinary tract infection between January 1, 2014 to December 31, 2015 were included in this study. Addition to awareness among specifiers to promoting the appropriate use of antibiotics, the pharmacist suggested pharmaceutical interventions (PI) in order to improve the quality of antibiotic treatments. At the same time, 3 quality indicators (QI) were followed: duration, dosage, antibiotic susceptibility. The compliance rates of this 3 QI allowed to assess the quality of the antibiotic treatment in urinary tract infection. The study population included 154 patients corresponding to 252 UTI. Sixty-eight PI were made by pharmacist about urinary tract infection treatment (overdosage or under-dosing, duration unknown, inadequate route of administration). These QI achieved 96.4% compliance with duration, 98.8% compliance with dosage and 99.2% with the antibiotic susceptibility. This study allowed showing the medico-pharmaceutical impact on the quality of antibiotic treatments in UTI. The awareness among specifiers with a daily validation of prescription by the pharmacist allowed to improve urinary tract infections care in rehabilitation center. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Supply Chain Management in Zhendong Pharmaceutical Company

OpenAIRE

Li, Yan

2011-01-01

Medicines are special commodity related to people’s lives and health, therefore, pharmaceutical distribution is an industry affecting the national economy and the people's livelihood. With health care reform, changeable pharmaceutical policy and fiercely increasing competition in the medical industry, pharmaceutical distribution companies should improve their level of logistics operations and reduce overall logistics management costs in order to gain a leading position in the competition. In ...

PHARMACEUTICAL CARE IN THE TREATMENT OF PATIENTS WITH INFECTIONS OF THE LOWER URINARY TRACT

OpenAIRE

Moroz V.A.

2013-01-01

In order to monitor changes in the recommendations for drug treatment of lower urinary tract infections (UTI) and pharmaceutical care of patients analyzed resolution and related publications of American Urological Association at the end of 2012. Marked improvement of detail factors of chronicity UTI and allocation of roles pharmacist to prevent its recurrence. In the arsenal of treatments for uncomplicated disease (about 80%) left Co-trimoxazole, but exclude the scheme of its single administr...

Implementation of a comprehensive pharmaceutical care program for an underserved population.

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Mascardo, Lisa A; Spading, Kimberly A; Abramowitz, Paul W

2012-07-15

The implementation of a prescription benefit program for low-income patients emphasizing clinical pharmacist services and strict formulary control is described, with a review of program expenditures and cost avoidance. In 2006, University of Iowa Hospitals and Clinics (UIHC) launched a program to provide a limited prescription benefit to indigent patients under the IowaCare Medicaid demonstration waiver. Sudden dramatic growth in IowaCare enrollment, combined with sharp budget cuts, forced UIHC pharmacy leaders to implement creative cost-control strategies: (1) the establishment of an ambulatory care clinic staffed by a clinical pharmacy specialist, (2) increased reliance on an almost exclusively generic formulary, (3) collaboration with social services staff to help secure medication assistance for patients requiring brand-name drugs, (4) optimized purchasing through the federal 340B Drug Pricing Program, and (5) the imposition of medication copayments and mailing fees for prescription refills. Now in its seventh year, the UIHC pharmacy program has expanded indigent patients' access to pharmaceutical care services while reducing their use of hospital and emergency room services and lowering program medication costs by an estimated 50% (from $2.6 million in fiscal year 2009 to $1.3 million in fiscal year 2010). The UIHC ambulatory care pharmacy implemented a prescription program in collaboration with social service workers to address the medication needs of the state's low-income and uninsured patients in a fiscally responsible manner by managing purchasing contracts, revising a generic formulary, implementing copayments and mailing fees, and reviewing medication profiles.

Rational Use of Medicines in Relation to Pharmaceutical Supply ...

African Journals Online (AJOL)

Pharmaceutical management involves a set of practices aiming at ensuring timely availability and appropriate use of safe, effective and quality pharmaceuticals and services in any health care setting. Rational use of medicines is often associated with efficiency of pharmaceutical supply system that operates in the health ...

Effect of pharmaceutical care intervention on blood pressure of elderly outpatients with hypertension Efeito de intervenções de atenção farmacêutica na pressão arterial de pacientes idosos com hipertensão

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Divaldo Pereira de Lyra Júnior

2008-09-01

Full Text Available The purpose of this study was to evaluate the effect of pharmacist intervention on the prevention and solution of drug therapy-problems (DTP, Body Mass Index (BMI, and blood pressure control in elderly outpatients with hypertension. The instruments were applied to 30 elderly outpatients assisted at the pharmacy of a primary health care unit in Ribeirão Preto (SP, Brazil. The group of patients received follow-up during a period of 12 months. It was observed that Pharmaceutical Care intervention optimized the medication use; reduced symptoms caused by drug therapy and improved the elderly patients' health conditions. The Pharmaceutical Care intervention influenced the care given to elderly people as well as the achievement of positive health outcomes. After this study, the researcher gave training about practice of Pharmaceutical Care to 38 dispensing pharmacists from the Public Health-System of Ribeirão Preto. Nowadays, these pharmacists are perpetuating the practice introduced in the region.O objetivo deste estudo foi avaliar o efeito das intervenções farmacêuticas na prevenção e solução de problemas relacionados à farmacoterapia, ao índice de massa corporal e ao controle da pressão arterial de um grupo de pacientes idosos portadores de hipertensão arterial. O grupo de 30 pacientes assistidos na farmácia de uma unidade básica de saúde, em Ribeirão Preto (SP, Brasil, foi acompanhado por 12 meses. No estudo foi observado que as intervenções do programa de Atenção Farmacêutica otimizaram o uso dos medicamentos, reduziram os problemas de saúde causados pelos medicamentos e melhoraram as condições de saúde dos pacientes. As intervenções influenciaram tanto no cuidado prestado aos idosos como na obtenção de resultados de saúde positivos. Depois deste estudo, o pesquisador ministrou um curso de capacitação sobre a prática da Atenção Farmacêutica para 38 farmacêuticos da Secretaria Municipal de Saúde de Ribeir

Integrating medical humanities into a pharmaceutical care seminar on dementia.

Science.gov (United States)

Zimmermann, Martina

2013-02-12

Objective. To design, integrate, and assess the effectiveness of a medical humanities teaching module that focuses on pharmaceutical care for dementia patients.Design. Visual and textual dementia narratives were presented using a combination of teacher and learner-centered approaches with the aim being to highlight patients' and caregivers' needs for empathy and counselling.Assessment. As gauged from pre- and post-experience questionnaires, students highly rated this approach to teaching medical humanities. In-class presentations demonstrated students' increased sensitivity to patient and caregiver needs, while objective learning outcomes demonstrated students' increased knowledge and awareness.Conclusions. Pharmacy students were open to and successfully learned from reading and discussing patient and caregiver narratives, which furthers the discussion on the value of integrating the medical humanities into the curricula of pharmacy and other health sciences.

Pharmaceutical policy and the lay public

DEFF Research Database (Denmark)

Traulsen, Janine Marie; Almarsdóttir, Anna Birna

2005-01-01

Almost every national and supranational health policy document accords high importance to the need to listen to and 'empower' patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisati......Almost every national and supranational health policy document accords high importance to the need to listen to and 'empower' patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient...... organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry....... The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation...

Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings.

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O'Donoghue, Amie C; Boudewyns, Vanessa; Aikin, Kathryn J; Geisen, Emily; Betts, Kevin R; Southwell, Brian G

2015-01-01

The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program.

The duty of the pharmacist and the pharmaceutical industry.

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Dwyer, Peter

2003-01-01

The common law duty of care, an essential element of the tort of negligence, focuses on conduct. Accordingly, any discussion of the existence, nature and content of the duty of care of a pharmaceutical manufacturer and of a pharmacist, requires analysis of their respective functions. Also relevant are the special nature and effects of drug products and their approval for and acceptance in, human therapy based upon a balancing of risks and benefits. Critical to a manufacturer's potential tortuous liability is the so-called 'learned intermediary, role of pharmacists, prescribers and other health professionals and whether they have current and accurate drug product information. Manufacturers are not necessarily the only source of drug information available to health professionals. These responsibilities serve patients who also need to be adequately informed so as to achieve optimal safety and efficacy when using prescribed medications.

[Influence of pharmaceutical advertising on the physician. A contribution to ethics in medicine].

Science.gov (United States)

Kalb, Stefanie

2004-01-01

Physicians who prescribe medicaments to patients are the preferred target group of sales promotion by pharmaceutical industry. As studies show, pharmaceutical advertising actually exerts some influence on a physician's knowledge and habit of prescribing medicine, to the point of even inducing him to give preference to a special drug. Information on pharmaceuticals given by advertisements may contain some potential of bias, instead of offering the physician a chance of objectives additional training. Free gifts from the pharmaceutical industry may easily plunge a physician into a conflict of interest while giving therapy with drugs. The gift relationship established between him and pharmaceutical enterprises is apt to mutate to some sort of commitment he owes to the givers. Favouring a drug which has come about through he influence of advertising, can thus violate the principles of "good prescribing". For a treatment which contains potential for bias and a conflict of interest cannot possibly match the profession's principles of responsibility, fostering informed choice (autonomy), protecting the patient from harm (nonmaleficence), acting in a patient's best interest (beneficence), and promoting equity in health care (justice). Each physician should therefore be aware of possibly belonging to a preferred target group pharmaceutical sales promotion is aiming at. He should take an independent attitude while acquiring knowledge, and critically view the adequateness of free gifts he is offered. Even students of medicine should be encouraged to critically reflect on the necessary and essential relationship to pharmaceutical industries so that it may be moulded according to the benefit of the patients.

Decision Makers' Allocation of Home-Care Therapy Services: A Process Map

Science.gov (United States)

Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine

2013-01-01

ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

Pharmaceutical industry marketing: understanding its impact on women's health.

Science.gov (United States)

Sufrin, Carolyn B; Ross, Joseph S

2008-09-01

The delivery of modern health care entails significant involvement from the pharmaceutical industry, including developing and manufacturing drugs. However, the industry also has tremendous influence on the practice of medicine through its considerable marketing efforts, both to patients through direct to consumer advertising, and to physicians through detailing, providing samples, continuing medical education, and other efforts. This article will review the role that pharmaceutical marketing plays in health care, and the substantial evidence surrounding its influence on patient and physician behaviors, with additional discussion of the medical device industry, all with particular attention to women's health. Understanding the effects of pharmaceutical marketing on women's health, through discussion of relevant examples-including oral contraceptive pills, drugs for premenstrual dysphoric disorder, Pap smear cytology techniques, and neonatal herpes prophylaxis-will help ensure that women receive unbiased, evidenced-based care. We will conclude with a discussion of guidelines that have been proposed by professional organizations, policy makers, and universities, to assist physicians in managing exposure to pharmaceutical marketing.

Removal of pharmaceuticals and personal care products in aquatic plant-based systems: A review

International Nuclear Information System (INIS)

Zhang, Dongqing; Gersberg, Richard M.; Ng, Wun Jern; Tan, Soon Keat

2014-01-01

Pharmaceuticals and personal care products (PPCPs) in the aquatic environment are regarded as emerging contaminants and have attracted increasing concern. The use of aquatic plant-based systems such as constructed wetlands (CWs) for treatment of conventional pollutants has been well documented. However, available research studies on aquatic plant-based systems for PPCP removal are still limited. The removal of PPCPs in CWs often involves a diverse and complex set of physical, chemical and biological processes, which can be affected by the design and operational parameters selected for treatment. This review summarizes the PPCP removal performance in different aquatic plant-based systems. We also review the recent progress made towards a better understanding of the various mechanisms and pathways of PPCP attenuation during such phytoremediation. Additionally, the effect of key CW design characteristics and their interaction with the physico-chemical parameters that may influence the removal of PPCPs in functioning aquatic plant-based systems is discussed. -- Highlights: • Investigation of the removal performance of PPCPs in CW systems. • Investigation of the mechanisms and pathways contributing to PPCP removal in CWs. • Investigation of the effect of CW design parameters on PPCP removal. • Investigation of the correlation between physico-chemical parameters and PPCP removal. -- This review gives an overview of the present state of research on the removal of pharmaceutical and personal care products by means of constructed wetlands

The argument for pharmaceutical policy.

Science.gov (United States)

Traulsen, Janine Morgall; Almarsdóttir, Anna Birna

2005-02-01

Pharmaceutical policy is a global concern. It has become a hot political topic in most countries--developed as well as developing--and can be found on the agenda of international organizations such as WHO, OECD, EU, WTO and even the World Bank. Pharmaceutical policy affects everyone in the world of pharmacy and it is therefore imperative that it be understood, discussed and debated within the pharmacy profession and included in the curriculum of schools of pharmacy. This, the first article in a series, argues for the importance of the academic discipline of pharmaceutical policy analysis and the involvement of pharmacists in this endeavour. The aim of the authors is to stimulate an informed and critical appreciation of this field. The authors begin with an introduction to the field of pharmaceutical policy, introducing several important concepts and current trends including: medicines regulation; how pharmaceutical policy is made; pharmaceutical policy as a dynamic process; and the new public health as a global issue. The article ends with a short description of the remaining five articles in the series which will deal with important aspects of pharmaceutical policy. The topics include: economic pressures on health care systems; drug utilization from the clinical viewpoint (rational use of medicines); the impact of pharmaceutical policy on patients and the patient impact on pharmaceutical policy; the professional perspective; and finally the last article which deals with studying and evaluating pharmaceutical policy.

Occupational therapy practice in emergency care: Occupational therapists' perspectives.

Science.gov (United States)

Spang, Lisa; Holmqvist, Kajsa

2015-01-01

Emergency care takes place in a complex work environment that is characterized by critically ill patients, short hospital stays, and a wide variety of different healthcare professionals. Studies of occupational therapists' (OTs) experiences of working within emergency care have shown that they often experience difficulties in explaining the essence of occupational therapy and have to justify their approaches. Much effort has been made in Sweden to help OTs dispel the notion that occupational therapy is difficult to explain, and the aim of this study was to describe how Swedish OTs perceive their work in emergency care. A qualitative descriptive approach was taken, and 14 interviews were conducted with OTs working in emergency care. Qualitative content analysis was used to analyse the data. The overall theme that emerged was "Feeling established through deliberate occupation-based work". The underlying categories showed different strategies used by the OTs to provide occupational therapy in an emergency care context. Deliberate strategies were used to demonstrate the effectiveness of occupational therapy and its approaches to patients and other health care professionals, and this resulted in the OTs feeling both established and needed. Unlike the OTs in previous studies, the Swedish OTs experienced no difficulties in explaining occupational therapy and could make convincing arguments for their interventions. Parallel to their clinical work, the OTs worked with on-going development to find ways to improve their approaches. In summary, these Swedish OTs seem to have been provided with a professional language and the knowledge required to establish themselves in an emergency care setting.

A Comparison of Health Care Resource Utilization and Costs for Patients with Allergic Rhinitis on Single-Product or Free-Combination Therapy of Intranasal Steroids and Intranasal Antihistamines.

Science.gov (United States)

Harrow, Brooke; Sedaghat, Ahmad R; Caldwell-Tarr, Amanda; Dufour, Robert

2016-12-01

Allergic rhinitis (AR) is a common condition that can be treated with a number of different therapies. Treatments such as intranasal antihistamines (INAs) and intranasal steroids (INSs) are widely used by AR patients. For some allergy sufferers, a combination of therapies, specifically an INA and an INS, is required to address their symptoms. A new treatment, the formulation of azelastine hydrochloride and fluticasone pro-pionate used as a single spray (MP-AzeFlu), has become available for AR patients who need both types of treatment. In this regard, the comparison with the alternative concomitant use of INAs and INSs is of interest. The current study examines the health care resource utilization and costs for each cohort. To examine the resource utilization and costs associated with AR for patients treated with MP-AzeFlu or concurrent therapy with single-ingredient INA and INS sprays (free-combination therapy). A retrospective administrative claims study for commercially insured patients from a large U.S. health plan was performed. Patients with an AR diagnosis and a prescription claim for MP-AzeFlu or free-combination therapy between September 1, 2012, and September 30, 2013, were identified. Patients were aged at least 12 years at index date (first prescription fill for intranasal therapy) and were required to have 12 months pre-index and 6 months post-index of continuous enrollment. Health care resource utilization and costs were assessed for the post-index period. The cohorts were adjusted on baseline demographic and clinical characteristics using inverse propensity treatment weights. Other covariates, prescriber specialty, product switching during the post-index period, and pre-index total costs were included in the regression models measuring outcomes. One clinical characteristic of interest was the presence of asthma as comorbidity. A subset analysis of AR patients with asthma was also performed. All-cause-related pharmacy fills as well as pharmacy, medical

[Actual medical care situation and therapeutic needs in multiple sclerosis: Impact of the Pharmaceutical Market Restructuring Act (AMNOG)].

Science.gov (United States)

Bittner, S; Meuth, S G

2016-04-01

The treatment of patients with multiple sclerosis (MS) is associated with constantly rising costs for the healthcare system and pharmaceuticals constitute 60 % of the direct medical costs. The Pharmaceutical Market Restructuring Act (Arzneimittelmarkt-Neuordnungsgesetz, AMNOG) came into force on 1 January 2011 with the aim of limiting the costs of pharmaceuticals by obligating newly approved products to be subjected to an early evaluation of the additional benefits by the Federal Joint Committee (FJC, Gemeinsamer Bundesausschuss, G‑BA). The majority of products evaluated up to October 2015 in neurology (5 out of 8) were approved for treatment of MS. Has the AMNOG been able to fulfill the original aims? Analysis of available information on MS therapies evaluated by the FJC between December 2010 and October 2015. For various reasons an additional benefit could be shown in only 2 out of 5 assessment procedures for MS drugs. It is obvious that some methodological shortcomings of the process have to be improved. Additionally requirements for pivotal clinical trials have to be harmonized with AMNOG requirements taking the best available evidence and real-life data into consideration (e.g. non-interventional studies) and a closer collaboration between the FJC, healthcare providers and the neurological societies is necessary. The AMNOG procedure currently only partially fulfills the original aims, which could be the reason why guidelines play a more important role for therapy decision-making than FJC decisions. As the early evaluation procedure is an adaptive process methodological shortcomings might be overcome in the future; however, this requires a much closer collaboration between the FJC and neurological societies.

Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review.

Science.gov (United States)

Schmid, W; Rosland, J H; von Hofacker, S; Hunskår, I; Bruvik, F

2018-02-20

The use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy's potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users' and providers' perspectives on music therapy in palliative care within one research article. A systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy's impact in palliative care to forward a comprehensive understanding of it's effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data. Twelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy. Both quantitative as well as qualitative research showed positive changes in

Status of the structure, process and outcoms of pharmaceutical care to HIV patient in Spain. Origen study

Directory of Open Access Journals (Sweden)

R. Morillo-Verdugo

2014-03-01

Full Text Available Objectives: To describe the structure, process and outcomes with which hospital pharmacist performs health care activity, teaching and research about Pharmaceutical Care (PC in HIV patients in Spain. Methods: Observational, cross-sectional and multicenter study carried out between November 2011-February 2012 in spanish hospitals. The inclusion criteria were: hospitals pharmacy services that dispensed antiretroviral medication to HIV patients. The questionnaire had 41 questions structured in 9 groups: hospital type and person conducting the survey, structure and resources, health care activities, interventions, communication with the rest of the multidisciplinary team, adherence, and quality records, management and pharmacoeconomy and teaching and research. Descriptive analysis was performed. To analyze the existence of statistically significant relationships, we applied fisher test, chi-square or logistic regression Results: 86 hospitals completed the survey. In 93%, PC consultation was not classified by pathologies. 27.9% provided continuing PC to all patients. Adherence was determined regularly or when pharmacist suspected poor adherence (57.5 %. 20% of hospital s teaching had a program that allowed a high level of training in PC to HIV patient. 52,3% of participating centers had published scientific articles related to HIV. Conclusions: Pharmaceutical care to HIV patients in Spain need to adapt to a new situation. For this, hospital pharmacists have to consider several issues such as chronicity, comorbidity, incorporation of new technologies and the stratification of patients in order to make it more efficient.

Multidisciplinary perspectives of music therapy in adult palliative care.

Science.gov (United States)

O'Kelly, Julian; Koffman, Jonathan

2007-04-01

Music therapy aims to provide holistic support to individuals through the sensitive use of music by trained clinicians. A recent growth in music therapy posts in UK palliative care units has occurred despite a paucity of rigorous research. To explore the role of music therapy within multidisciplinary palliative care teams, and guide the future development of the discipline. In-depth qualitative interviews with 20 multidisciplinary colleagues of music therapists, based in five UK hospices. Analysis of interview material revealed a number of themes relevant to the study aims. Music therapy was valued by most interviewees; however there exists some lack of understanding of the role of the music therapist, particularly amongst nurses. Emotional, physical, social, environmental, creative and spiritual benefits of music therapy were described, with some benefits perceived as synergistic, arising from collaborations with other disciplines. Interviewees found experiencing or witnessing music therapy is effective in developing an understanding of the discipline. Music therapy is an appropriate therapeutic intervention for meeting the holistic needs of palliative care service users. More understanding and integration of music therapy could be encouraged with collaborative work, educational workshops, and the utilization of environmentally focused techniques. The study merits further research to explore and develop these findings.

Electroconvulsive therapy: Promoting awareness among primary care physicians.

Science.gov (United States)

Sicher, Sarah; Gedzior, Joanna

2016-04-01

This article aims to promote awareness among primary care providers and support electroconvulsive therapy as a generally well-tolerated, effective therapeutic modality to treat specific psychiatric conditions in appropriately selected patients. There seem to be several potential barriers to treatment with electroconvulsive therapy including stigma, lack of providers who preform it, and lack of awareness among providers referring patients who may be appropriate candidates. The article provides a brief overview of electroconvulsive therapy principles and topics and includes a case report to illustrate clinical utility. The article proposes the concept that a potential way to overcome barriers to treatment with electroconvulsive therapy may be to promote education and awareness of it as a viable treatment modality among primary care providers. © The Author(s) 2016.

Comparison of Iran’s and World’s Leading Faculties Approved Curriculum in the Field of Pharmacy, in terms of Pharmaceutical Care Education

Directory of Open Access Journals (Sweden)

Kaveh Eslami

2018-02-01

Full Text Available Background: Following the changes in the basic concepts of pharmaceutical science, the main opinion in pharmacy practice changed from “drug-oriented pharmacy” to “patient-oriented pharmacy”, leading to changes in the pharmacy education in many aspects.Methods: In the presented study, we compare Iran’s Pharm.D education system and the four of high ranking systems available in the world in term of pharmaceutical care related educations and how much is the portion of this type educations in the curriculum. The University of California, San Francisco (UCSF with a rank of 2, The University of Michigan with a rank of 7, and the Universities of Pittsburgh and Purdue with ranks of almost under 50 in the world ranking have been selected.Results: The results showed, in the United States (US colleges about 60.5% of educational program was related to the pharmaceutical care concept. This calculation for the University of Waterloo was about 74%. The Saudi University compared, had about 47% related units. Regarding the Iranian program, when the specialized units after basic science were considered as the professional course, about 24% of them had a relationship with the pharmaceutical care. However, this was in the case that a student chooses the hospital internship instead of industry internship in the final year; otherwise, the percentage would reduce to 22.7%.Conclusion: Based on the results of this study, and regarding internationally accepted standards, we strongly recommend to change the structure of pharmacy curriculum in Iran to improve the ability of students for patient-oriented services.

Environmental stewardship practices of veterinary professionals and educators related to use and disposal of pharmaceuticals and personal care products.

Science.gov (United States)

Lam, Jennifer; Chan, Samuel S; Conway, Flaxen D L; Stone, David

2018-03-01

OBJECTIVE To document the environmental stewardship practices (decisions and actions regarding use and disposal) of pet and human pharmaceuticals and personal care products (PPCPs) among pet-owning veterinary-care professionals (practicing veterinarians, veterinary students, and veterinary technicians and trainees) and environmental educators. DESIGN Internet-based cross-sectional survey. SAMPLE 191 pet owners (103 veterinary-care professionals and 88 environmental educators). PROCEDURES Study participants were recruited by means of a 2-part internet survey distributed to veterinary-care professional and environmental educator networks of individuals residing in Washington state, Oregon, and southern California. Survey questions addressed motivators for environmental stewardship practices (ie, decisions and actions regarding use and disposal of pet and human PPCPs). RESULTS Data were collected from 191 respondents; the response rate for individuals who self-selected to opt in was 78% (191/246). Of the 191 respondents, 42 (22%) stored pet pharmaceuticals indefinitely. The most common disposal method was the garbage (88/191 [46%]). Veterinary-care professionals counseled clients infrequently regarding environmental stewardship practices for PPCPs. Fifty-five percent (105/191) of all respondents preferred more environmentally friendly and clinically effective PPCPs. CONCLUSIONS AND CLINICAL RELEVANCE Results of the present survey emphasized the urgent need for improved educational resources to minimize environmental contamination from improper disposal of PPCPs. Environmental and economic motivations among pet owners in the veterinary-care and education professions indicate further opportunities for outreach and institutional support.

Code of ethics for the national pharmaceutical system: Codifying and compilation.

Science.gov (United States)

Salari, Pooneh; Namazi, Hamidreza; Abdollahi, Mohammad; Khansari, Fatemeh; Nikfar, Shekoufeh; Larijani, Bagher; Araminia, Behin

2013-05-01

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conduct was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conduct is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended.

CAM therapies among primary care patients using opioid therapy for chronic pain

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Mundt Marlon P

2007-05-01

Full Text Available Abstract Background Complementary and alternative medicine (CAM is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. Method A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. Results Patients were treated for a variety of pain problems including low back pain (38.4%, headaches (9.9%, and knee pain (6.5%; the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248, chiropractic treatment (17.8%, n = 162, acupuncture (7.6%, n = 69, yoga (6.1%, n = 55, herbs and supplements (6.8%, n = 62, and prolotherapy (5.9%, n = 54. CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8% and prolotherapy (87.7%, whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. Conclusion This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied.

CAM therapies among primary care patients using opioid therapy for chronic pain.

Science.gov (United States)

Fleming, Sara; Rabago, David P; Mundt, Marlon P; Fleming, Michael F

2007-05-16

Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. Patients were treated for a variety of pain problems including low back pain (38.4%), headaches (9.9%), and knee pain (6.5%); the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248), chiropractic treatment (17.8%, n = 162), acupuncture (7.6%, n = 69), yoga (6.1%, n = 55), herbs and supplements (6.8%, n = 62), and prolotherapy (5.9%, n = 54). CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8%) and prolotherapy (87.7%), whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied.

Eudemonic Care: A Future Path for Occupational Therapy?

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Charlotte l. Royeen

2017-03-01

Full Text Available The core tenets of occupational therapy date to ancient Greece. Philosophers and physicians alike promulgated that quality of life, or “eudemonia,” is at the center of both ethical and medical concern and can be attained through healthful engagement in meaningful occupation. In more recent times, there has been a strong call to return to the powerful implementation of the eudemonic moral philosophy in health care practice, especially in occupational therapy. Searches of recent occupational therapy research show that integration of wellness initiatives into rehabilitative treatment sessions can have a profound impact on the physical and emotional healthfulness of people with a wide variety of ailments. Accordingly, we put forth three self-reflection questions and 10 client-centered questions to use in occupational therapy assessment to promote eudemonic care.

[Coordination between pharmaceutical services for integrated pharmacotherapy: the case of Catalonia].

Science.gov (United States)

Costa, Karen Sarmento; Goldbaum, Moisés; Guayta-Escolies, Rafel; Modamio, Pilar; Mariño, Eduardo Luis; Tolsá, José Luis Segú

2017-08-01

Pharmaceutical policies have been considered strategies to contribute to the guarantee of care coordination and clinical integration. This study sought to describe the pharmaceutical services developed at different levels of care in the health network in Catalonia, as well as to identify and analyze the mechanisms and instruments that act as facilitators and/or barriers to the coordination of pharmacotherapy. This is a descriptive study of 12 cases of hospital pharmacy services, primary care and community pharmacies. Advances related to the perception, formalization and clinical and assistance coordination of the pharmaceutical services were identified. However, weaknesses and potential improvements in coordination were observed. The conclusion drawn was that the different tools and instruments implemented appear to facilitate a greater possibility of integration between pharmaceutical services and the latter with the health services network to contribute to integrated pharmacotherapy.

[Case Study - A Successful Outpatient Design of Cross-Professional Pharmaceutical Cooperation in Home Health Care - Reduction of Financial and Care-Related Burden by Shifting to R-Compound Enteral Semisolid Formulation].

Science.gov (United States)

Takeda, Namihiro; Hamana, Tomoko; Oka, Toyoka; Matsuyama, Narihisa; Hirohara, Masayoshi; Kushida, Kazuki

2015-12-01

Among patients who receive enteral nutrition through a gastric fistula, some are concomitantly administered viscosity modifiers to avoid aspiration pneumonitis caused by gastroesophageal reflux. These patients(and families)often bear the high economic and care burdens associated with enteral nutritional management. We developed an outpatient-based pharmacy service through multidisciplinary cooperation, facilitating a shift from enteral nutrition to semi-solid formula. This shift is expected to reduce the economic burden by approximately 120 thousand yen, and the hours of care by about 550 hours annually. Owing to family circumstances or economic conditions, some patients(and families)do not receive at-home guidance of pharmaceutical management by pharmacists. The family members of such patients visit the pharmacy to obtain the prescribed medications. Such patients and families could be supported within the outpatient-based pharmacy services, through proactively participating in home health care daily(collaborative relationship with the local community)and re-counting experiences of providing home guidance of pharmaceutical management.

The ecological disruptive and bioaccumulative potentials of PPCPs (pharmaceuticals and personal care products) in freshwater streams

OpenAIRE

ERINN KATE RICHMOND

2017-01-01

Pharmaceuticals and Personal Care Products (PPCPs) are now detected in waterways around the world, and are most commonly discharged into waterways via wastewater treatment plants. The effects of PPCPs on aquatic plants and animals including fish and insects within these environments are largely unknown. This research examines the ecological impacts of PPCPs on vital processes like photosynthesis, and assesses the potential exposure risks to aquatic animals, including platypus and fish, living...

Toward a Broader Role for Occupational Therapy in Supportive Oncology Care.

Science.gov (United States)

Sleight, Alix G; Duker, Leah I Stein

2016-01-01

Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. Copyright © 2016 by the American Occupational Therapy Association, Inc.

Brazilian scientific production on pharmaceutical care from 1990 to 2009

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Maria Denise Ricetto Funchal-Witzel

2011-06-01

Full Text Available Brazilian scientific production on pharmaceutical care was identified based on articles indexed on the Medline, Embase, Lilacs, Web of Science and International Pharmaceutical Abstracts databases. Sixty-three articles published in both national and international journals were retrieved. With regard to authors, 72.3% were from the Southeast and South Regions, and 60.8% were affiliated to public universities. In relation to the type of studies, 85.7% were descriptive, and the most frequently researched fields were community pharmacies, hospitals and primary health care units. Articles were original in 65.1% of cases, updates in 20.6%, and reviews in 7.9%. An increase in publications commenced in 2006. In 31.7% of cases, authors had adopted a bibliographical study design, 28.6% qualitative study, 23.8% intervention, and 15.9% observational study design. The most researched subjects were elderly with chronic diseases. The importance of stimulating the conducting of experimental and qualitative studies, as well as amplifying authorship affiliated with the service area, foreign authors and with research in a wide variety of practice settings were highlighted. Despite the limited quantity of articles, an increase in their number as well as in their scope and quality is expected, so as to create further knowledge that contributes to the recognition of pharmacists' actions by patient healthcare teams.Identificam-se características da produção científica brasileira sobre atenção farmacêutica, a partir de artigos indexados nas bases Medline, Embase, Lilacs, Web of Science e International Pharmaceutical Abstracts. Foram localizados 63 artigos em revistas nacionais e internacionais. Em relação aos autores, 72,3% pertenciam as Regiões Sudeste e Sul e 60,8% estavam vinculados a universidades públicas. Quanto ao tipo de pesquisa, 85,7% foram descritivas, sendo campos mais pesquisados: farmácias comunitárias, hospitais e unidades básicas de sa

Capitated chronic disease management programs: a new market for pharmaceutical companies.

Science.gov (United States)

Cave, D G

1995-01-01

With corporatism of the medical care delivery system, the pharmaceutical industry is searching for new ways to market prescription drug product lines. A new strategy focuses on developing chronic disease management programs. In doing so, pharmaceutical companies work with clinical leaders of HMOs or large physician groups on disease management guidelines to reduce practice pattern variations and improve the quality of patient care. In addition, pharmaceutical companies capitate payment to physicians treating chronic disease patients to give them financial incentives to comply with the disease management guidelines.

Characterisation and comparison of the uptake of ionizable and polar pesticides, pharmaceuticals and personal care products by POCIS and Chemcatchers

NARCIS (Netherlands)

Kaserzon, S.L.; Hawker, D.W.; Kennedy, K.; Bartkow, M.; Carter, S.; Booij, K.; Mueller, J.F.

2014-01-01

Growing concern about the environmental impact of ionizable and polar organic chemicals such as pesticides, pharmaceuticals and personal care products has lead to the inclusion of some in legislative and regulatory frameworks. It is expected that future monitoring requirements for these chemicals in

Nursing care update: Internal radiation therapy

International Nuclear Information System (INIS)

Lowdermilk, D.L.

1990-01-01

Internal radiation therapy has been used in treating gynecological cancers for over 100 years. A variety of radioactive sources are currently used alone and in combination with other cancer treatments. Nurses need to be able to provide safe, comprehensive care to patients receiving internal radiation therapy while using precautions to keep the risks of exposure to a minimum. This article discusses current trends and issues related to such treatment for gynecological cancers.20 references

Pain, music creativity and music therapy in palliative care.

Science.gov (United States)

O'Callaghan, C C

1996-01-01

An analysis of the music therapy literature yields numerous reports to support the role of music in the alleviation of pain in palliative care. Four theoretical perspectives that support why many patients report reduced pain sensation after music therapy include: the psychological relationship between music and pain; the psychophysiological theory; spinal mechanisms involved in pain modulation; and the role of endorphins. Considerations significant to the use of music in pain relief include how music, used inappropriately, can aggravate pain sensation. Case studies, which include the use of creative music therapy techniques, point to the efficacy of music therapy in alleviating the pain experiences of both palliative care patients and their significant others.

Music therapy for end-of-life care: An updated systematic review.

Science.gov (United States)

McConnell, Tracey; Scott, David; Porter, Sam

2016-10-01

Music therapy during palliative and end-of-life care is well established and positive benefits for patients have been reported. Assess the effectiveness of music therapy versus standard care alone or standard care in combination with other therapies for improving psychological, physiological and social outcomes among adult patients in any palliative care setting. In order to update an existing Cochrane systematic review, we searched MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, ClinicalTrials.gov register and Current Controlled Trials register to identify randomised or quasi-randomised controlled trials published between 2009 and April 2015. Nine electronic music therapy journals were searched from 2009 until April 2015, along with reference lists and contact was made with key experts in music therapy. Only studies published in English were eligible for inclusion. Two reviewers independently screened titles, abstracts, assessed relevant studies for eligibility, extracted data and judged risk of bias for included studies. Disagreements were resolved through discussion with a third reviewer. Data were synthesised in Revman using the random effects model. Heterogeneity was assessed using I(2). Three studies were included in the review. Findings suggest that music therapy may be effective for helping to reduce pain in palliative care patients (standard mean deviation = -0.42, 95% confidence interval = -0.68 to -0.17, p = 0.001). Available evidence did not support the use of music therapy to improve overall quality of life in palliative care. While this review suggests that music therapy may be effective for reducing pain, this is based on studies with a high risk of bias. Further high-quality research is required. © The Author(s) 2016.

Development and efficacy of music therapy techniques within palliative care.

Science.gov (United States)

Clements-Cortés, Amy

2016-05-01

Music therapy is increasingly becoming an intervention used in palliative care settings around the globe. While the specialty of palliative care music therapy is relatively young having emerged in the late 1980s, there is a strong and growing body of evidence demonstrating its efficacy in assisting a variety of issues common at end-of-life. There are multiple music therapy techniques that are implemented with clients in palliative care and they can be categorized in four broad areas: receptive, creative, recreative and combined. These techniques will be presented with respect to their development by clinicians as supported by the descriptive and research literature. Information is also provided on the use of music therapy in facilitating the grieving and bereavement process. Copyright © 2015 Elsevier Ltd. All rights reserved.

Perspectives on music therapy in adult cancer care: a hermeneutic study.

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Olofsson, Anne; Fossum, Bjöörn

2009-07-01

To explore perspectives on music therapy as a nursing intervention in adult cancer care and to expand and integrate knowledge and understanding about music therapy as an adjunctive intervention in adult cancer nursing care. Published nursing articles. Medical and nursing journals have reported on research related to music and its effect as a nursing intervention. However, this research often lacks a musical context (i.e., knowledge and understanding from a musical perspective). Music therapy is not a consistent concept. Perspectives on the meanings of music therapy vary according to knowledge and scientific orientation. The perspective may influence the character and methodology of the music therapy intervention as well as the understanding of its results. To fully develop music therapy as an adjunct intervention in adult cancer care, interdisciplinary cooperation between nurses and music therapists should be supported on clinical and educational levels.

Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey.

Science.gov (United States)

Eva, Gail; Morgan, Deidre

2018-05-01

Occupational therapists play an integral role in the care of people with life-limiting illnesses. However, little is known about the scope of occupational therapy service provision in palliative care across Europe and factors influencing service delivery. This study aimed to map the scope of occupational therapy palliative care interventions across Europe and to explore occupational therapists' perceptions of opportunities and challenges when delivering and developing palliative care services. A 49-item online cross-sectional survey comprised of fixed and free text responses was securely hosted via the European Association for Palliative Care website. Survey design, content and recruitment processes were reviewed and formally approved by the European Association for Palliative Care Board of Directors. Descriptive statistics and thematic analysis were used to analyse data. Setting/respondents: Respondents were European occupational therapists whose caseload included palliative care recipients (full-time or part-time). In total, 237 valid responses were analysed. Findings demonstrated a consistency in occupational therapy practice in palliative care between European countries. Clinician time was prioritised towards indirect patient care, with limited involvement in service development, leadership and research. A need for undergraduate and postgraduate education was identified. Organisational expectations and understanding of the scope of the occupational therapy role constrain the delivery of services to support patients and carers. Further development of occupational therapy in palliative care, particularly capacity building in leadership and research activities, is warranted. There is a need for continuing education and awareness raising of the role of occupational therapy in palliative care.

A review of wastewater handling in the Arctic with special reference to Pharmaceuticals and Personal Care Products (PPCPs) and microbial pollution

DEFF Research Database (Denmark)

Gunnarsdottir, Ragnhildur; Jenssen, Petter Deinboll; Jensen, Pernille Erland

2013-01-01

Treatment of wastewater is often inadequate or completely lacking in Arctic regions. Wastewater contains different kinds of substances that can be harmful for the environment and human health, including residues of pharmaceuticals and personal care products. Bioaccumulation and biomagnifications ...

Pharmaceutical packaging handbook

National Research Council Canada - National Science Library

Bauer, Edward J

2009-01-01

... of the modern world. Pharmaceutical products and health care in developing countries and remote parts of the world seems like magic. Diseases that were once fatal and chronic conditions that destroyed lives have slowly been conquered by modern medicine. Views of the body, unimaginable for most of the last century with X rays, are now possible with new i...

Nanomaterials for the Abatement of Pharmaceuticals and Personal Care Products from Wastewater

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Francesca Stefania Freyria

2018-01-01

Full Text Available In this short-review, the most common types of both pharmaceutical and personal care products (PPCP, a class of “emerging pollutants” are considered, as well as some of the most frequent methods for their removal that envisage the use of nanomaterials. The nanomaterials used in conservative methods (namely, reverse osmosis, nanofiltration and adsorption are basically nanoporous solids. Non-conservative methods, which include photocatalysis and Fenton reaction, are currently considered more promising than conservative ones, as the former allow the (at least partial degradation of the original molecules into more biodegradable by-products, which can be further abated by subsequent biological treatments, whereas the former are not efficient for the removal of small quantities of pollutants and have to be regenerated.

Integrative Care Therapies and Physiological and Pain-related Outcomes in Hospitalized Infants

OpenAIRE

Hathaway, Elizabeth E.; Luberto, Christina M.; Bogenschutz, Lois H.; Geiss, Sue; Wasson, Rachel S.; Cotton, Sian

2015-01-01

Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcome...

[Outcomes after a 2-year pharmaceutical care program for patients taking vitamin K antagonist therapy? Community pharmacist's perception].

Science.gov (United States)

Mongaret, C; Lepage, C; Aubert, L; Lestrille, A; Slimano, F

2018-03-01

Since 2013 French community pharmacist are involved in pharmaceutical care program (PCP) for patients treated with vitamin K antagonist (VKA). While PCPs are now extending to other patient populations, we aimed to evaluate pharmacists' perception after 2-years implementation and leading of PCP. A prospective investigational survey from 1st August to 31st December, 2015 from 400 community pharmacies in Champagne-Ardenne Region. Survey focuses on 3 points: first about implementation and leading of PCP; secondly about patient's population description; finally on the global perception by CP about new tasks. Among n=47, 72% of pharmacists performed VKA PCP. Almost all received appropriate training (96%). Remuneration appears to be insufficient given the time spent for 73%. Ninety-five percent met patient's refusal mainly because of interest lacking or time lacking (54% and 22%, respectively). Pharmacists reported 3 main lacks of knowledges of patients: drugs, which increase drug-drug interaction risk (28%), VKA overdose effects (27%) and VKA-food interactions (23%). Overall view of pharmacist for PCP appears to be positive (81%) in part because of improvement of pharmacist-patient relationship perception for 66%. Community pharmacists' perception for PCP for patients treated by VKA is broadly positive. However, organizational or economic constraints can lead to a decreasing adherence by pharmacists to PCPs. A global issue about amount of compensation and communications campaigns to patients and others health professionals will be useful in order to reinforced PCP implementation and leading taxonomy. Copyright © 2017. Published by Elsevier Masson SAS.

Systematic review: treatment pattern and clinical effectiveness and safety of pharmaceutical therapies for Crohn’s disease in Europe

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Lelli F

2016-10-01

Full Text Available Filippo Lelli,1 Solomon Nuhoho,2 Xin Ying Lee,3 Weiwei Xu4 1EMEA Hemar, Janssen, Milan, Italy; 2Health Economics, Market Access and Reimbursement, Johnson & Johnson Middle East FZ LLC, Dubai, United Arab Emirates; 3EMEA Hemar, Janssen, Birkerød, Denmark; 4Pharmerit International, Rotterdam, the Netherlands Background: Although many clinical trials have been conducted in treatments of Crohn’s ­disease (CD, whether the trial results were representative of daily practice needs to be supported by studies conducted in real-world settings. Aim: This study aims to identify how CD is treated and what are the clinical effectiveness and safety of the pharmaceutical therapies of CD in real-world settings. Methods: A systematic literature review was conducted based on Medline®, Embase®, and Cochrane. All publications were assessed for title/abstract and full-text according to a predefined study protocol. Data were extracted and reported.Results: A total of 1,998 publications were identified. Fifty studies including six publications reporting treatment pattern and 44 studies reporting clinical effectiveness and safety of pharmaceutical therapies in CD management in Europe were included. 5-Aminosalicylic acid and corticosteroids were reported to be used among 14%–74% of CD patients. Immunomodulators were used by 14%–25% and 29%–31% of CD patients as an initial and follow-up treatment, respectively. Biological therapies were used by 25%–33% of CD patients. A trend toward an increasing use of immunomodulators and biological therapies in Europe has been reported in recent years. Approximately 50% of patients achieved remission on immunomodulator or biologic treatment, although a relapse rate of up to 23% has been reported.Conclusion: There is a trend of treatment shift to immunomodulators and biologics in CD management. Clinical effectiveness of immunomodulators and biologics has been demonstrated, though with a lack of sustainability of the

75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

Science.gov (United States)

2010-09-08

... at very low concentrations. EPA has been studying unused pharmaceutical disposal practices at health... avoiding pharmaceutical waste; Practices for identifying and managing types of unused pharmaceuticals; and...: September 1, 2010. Ephraim S. King, Director, Office of Science and Technology. [FR Doc. 2010-22325 Filed 9...

Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer.

Science.gov (United States)

Leung, Henry W C; Chan, Agnes L F; Leung, Matthew S H; Lu, Chin-Li

2013-04-01

To systematically review and assess the quality of cost-effectiveness analyses (CEAs) of pharmaceutical therapies for metastatic colorectal cancer (mCRC). The MEDLINE, EMBASE, Cochrane, and EconLit databases were searched for the Medical Subject Headings or text key words quality-adjusted, QALY, life-year gained (LYG), and cost-effectiveness (January 1, 1999-December 31, 2009). Original CEAs of mCRC pharmacotherapy published in English were included. CEAs that measured health effects in units other than quality-adjusted life years or LYG and letters to the editor, case reports, posters, and editorials were excluded. Each article was independently assessed by 2 trained reviewers according to a quality checklist created by the Panel on Cost-Effectiveness in Health and Medicine. Twenty-four CEA studies pertaining to pharmaceutical therapies for mCRC were identified. All studies showed a wide variation in methodologic approaches, which resulted in a different range of incremental cost-effectiveness ratios reported for each regimen. We found common methodologic flaws in a significant number of CEA studies, including lack of clear description for critique of data quality; lack of method for adjusting costs for inflation and methods for obtaining expert judgment; no results of model validation; wide differences in the types of perspective, time horizon, study design, cost categories, and effect outcomes; and no quality assessment of data (cost and effectiveness) for the interventions evaluation. This study has shown a wide variation in the methodology and quality of cost-effectiveness analysis for mCRC. Improving quality and harmonization of CEA for cancer treatment is needed. Further study is suggested to assess the quality of CEA methodology outside the mCRC disease state.

Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin.

Science.gov (United States)

Edoh, Thierry Oscar; Teege, Gunnar

2011-10-01

One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems.

Assistência farmacêutica no sistema público de saúde no Brasil Pharmaceutical assistance in the Brazilian public health care system

Directory of Open Access Journals (Sweden)

Fabiola Sulpino Vieira

2010-02-01

Full Text Available This article deals with the organization of pharmaceutical assistance within the Brazilian Public Unified Health System (Sistema Único de Saúde, SUS by analyzing the progress made so far and the challenges that still must be faced to ensure the right to universal therapeutic and pharmaceutical coverage in Brazil. Among the improvements, the article discusses the National List of Essential Drugs and its role to guide the supply, prescription, and dispensing of drugs within SUS. The structure of federal funding and the existing pharmaceutical programs are described, as well as the responsibilities of the Federal Government, states, and municipalities concerning allocation of financial resources. Despite the progress made, the model of access to SUS drugs has not been successful in securing universal therapeutic assistance. It is essential to consider a type of funding and organization of pharmaceutical assistance that is driven by a notion of regionalization, with financing based on health care flows rather than on the population circumscribed to a given territory. It is also essential to qualify pharmaceutical management by hiring pharmacists and support personnel, professionalizing workers, and setting up facilities with appropriate information systems and equipment.

Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

Science.gov (United States)

Duker, Leah I. Stein

2016-01-01

Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. PMID:27295001

Toxicity and Treatment of Pharmaceutical and Personal Care Products Using Exotic Plants - A Laboratory Scale Experiment

DEFF Research Database (Denmark)

Ramírez Vargas, Carlos Andrés; Paredes, Diego; Cubillos, Janneth

Pharmaceuticals and personal care products (PPCPs) detected in the environment belong to a large and diverse group of organic substances (analgesics, antibiotics, anticonvulsants, soaps, lotions, toothpaste, etc.). PPCPs reach aquatic ecosystems through point and diffuse discharges (unused....../expired products, excretion of people and animals, application of fertilizers, direct delivery of veterinary products etc. Santos et al., 2010). Conventional technologies for water treatment (potable and sewage) fail to remove efficiently these compounds (Dordio et al., 2010), hence it is desirable to implement...

[PHARMACEUTICAL CARE FOR HEALTHY BREAKFAST PROMOTION IN COMMUNITY PHARMACIES].

Science.gov (United States)

Marín Rives, Fátima; Morales Marin, Fatima; Marín Rives, Luz Virtudes; Gastelurrutia Garralda, Miguel Ángel

2015-09-01

a healthy breakfast is the one that includes a balanced portion of every nutrient qualitatively and quantitatively. Although it should supply the 20-25% calories of the day, it is usually insufficient or even absent. to study the food habits of schoolchildren and to participate in a health educational intervention of a Pharmaceutical Care Program with them. only the 36.6% of students have a healthy breakfast every day. The health education achieves favorable changes in the behavior and opinions of the schoolchildren participating. the percentage of students that have C group food is higher than in other studies. We can consider the fact that the School is located in a rural area with many vegetable gardens, and that can help students to eat more fruits. Another remarkable data is that the percentage of alumni that achieve a healthy breakfast is also higher than in other researchers. the breakfast of students of Fifth and Six Degree of Primary School is imbalanced. Health education by an educative and practical intervention benefits positive changes in the students' breakfast. It supports the effort of promoting Heath Education in Primary Schools. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Animal-Assisted Therapy in Pediatric Palliative Care.

Science.gov (United States)

Gilmer, Mary Jo; Baudino, Marissa N; Tielsch Goddard, Anna; Vickers, Donna C; Akard, Terrah Foster

2016-09-01

Animal-assisted therapy is an emerging complementary strategy with an increasing presence in the literature. Limited studies have been conducted with children, particularly those with life-threatening and life-limiting conditions. Although outcomes show promise in decreasing suffering of children receiving palliative care services, more work is needed to validate evidence to support implementation of animal-assisted therapy with this vulnerable population. Copyright © 2016 Elsevier Inc. All rights reserved.

Are doctor of pharmacy curricula in developing countries adequate to train graduates to provide pharmaceutical care?

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Ramalingam Peraman

2017-01-01

Full Text Available Doctor of Pharmacy (PharmD program is a new dimension of pharmacy education in developing countries. The PharmD graduates are expected to participate in patient health care by providing pharmaceutical care. The graduates should have enough necessary clinical knowledge, competitiveness and skills in community, hospital and clinical pharmacy related services. There is a need of curriculum that fit into the program outcome that helps to attain graduate competency. Programs in India, Pakistan, Iran and Nepal were reviewed based on the available literature. Even though it is evident that the PharmD curriculum in developing countries has made an attempt to provide patient-oriented approach for pharmacists, the existing curriculum, training and orientation have several pitfalls. It needs assessment, evaluation and improvement.

Electrochemical treatment of pharmaceutical and industrial wastewater by anodic oxidation

International Nuclear Information System (INIS)

Menapace, H. M.; Fellerer, M.; Treschnitzer, M.

2009-01-01

In modern medicine pharmaceuticals play a decisive role: because of an increased life expectancy and intensive care medicine an increasing amount of pharmaceuticals is produced. thus these substances are consumed in a mass of tons per year in industrialized countries. Wastewater effluents from sewage treatment plants (STP) are important point sources for residues of pharmaceuticals and complexing agents in the aquatic environment. For this reason a research project, which started in December 2006, was established to eliminate pharmaceutical substances and complexing agents found in wastewater as micropollutants. (Author)

Use of subatmospheric (VAC) therapy to improve bioengineered tissue grafting in diabetic foot wounds.

Science.gov (United States)

Espensen, Eric H; Nixon, Brent P; Lavery, Lawrence A; Armstrong, David G

2002-01-01

The use of bioengineered tissue and topical subatmospheric pressure therapy have both been widely accepted as adjunctive therapies for the treatment of noninfected, nonischemic diabetic foot wounds. This article describes a temporally overlapping method of care that includes a period of simultaneous application of bioengineered tissue (Apligraf, Novartis Pharmaceuticals Corp, East Hanover, New Jersey) and subatmospheric pressure therapy delivered through the VAC (Vacuum Assisted Closure) system (KCI, Inc, San Antonio, Texas). Future descriptive and analytic works may test the hypothesis that combined therapies used at different and often overlapping periods during the wound-healing cycle may be more effective than a single modality.

Cleaner production at pharmaceutical industry: first steps assessment

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Edilaine Conceição Rezende

2015-12-01

Full Text Available The Cleaner Production (CP is an environmental management system effective to comply the environmental obligations and promote sustainable development of enterprises. In this study, the implementing possibilities of CP practices were evaluated to pharmaceutical industry, through prior identification procedures for Pharmaceutical Manufacturing Practices. The study was conducted in a scientific and health care institution, which produces pharmaceutical drugs and makes assistance for public health. The production process was evaluated and made a survey of the main points of waste and sewage generations in each stage, in order to diagnose the measures of CP established and propose new actions. Thus, by using this tool, it was possible to demonstrate the reduction of environmental impacts associated with pharmaceutical production. The Pharmaceutical Manufacturing Practices also contributed to the implementation of measures CP, preserving the final product quality, and generating environmental and economic benefits.

Design of an instrument to measure the quality of care in Physical Therapy.

Science.gov (United States)

Cavalheiro, Leny Vieira; Eid, Raquel Afonso Caserta; Talerman, Claudia; Prado, Cristiane do; Gobbi, Fátima Cristina Martorano; Andreoli, Paola Bruno de Araujo

2015-01-01

To design an instrument composed of domains that would demonstrate physical therapy activities and generate a consistent index to represent the quality of care in physical therapy. The methodology Lean Six Sigma was used to design the tool. The discussion involved seven different management groups staff. By means of brainstorming and Cause & Effect Matrix, we set up the process map. Five requirements composed the quality of care index in physical therapy, after application of the tool called Cause & Effect Matrix. The following requirements were assessed: physical therapist performance, care outcome indicator, adherence to physical therapy protocols, measure whether the prognosis and treatment outcome was achieved and Infrastructure. The proposed design allowed evaluating several items related to physical therapy service, enabling customization, reproducibility and benchmarking with other organizations. For management, this index provides the opportunity to identify areas for improvement and the strengths of the team and process of physical therapy care.

The 'ripple effect': Towards researching improvisational music therapy in dementia care homes.

Science.gov (United States)

Pavlicevic, Mercédès; Tsiris, Giorgos; Wood, Stuart; Powell, Harriet; Graham, Janet; Sanderson, Richard; Millman, Rachel; Gibson, Jane

2015-09-01

Increased interest in, and demand for, music therapy provision for persons with dementia prompted this study's exploration of music therapists' strategies for creating musical communities in dementia care settings, considering the needs and resources of people affected by dementia. Focus group discussions and detailed iterative study of improvisational music therapy work by six experienced practitioners clarify the contextual immediacy and socio-musical complexities of music therapy in dementia care homes. Music therapy's 'ripple effect', with resonances from micro (person-to-person musicking), to meso (musicking beyond 'session time') and macro level (within the care home and beyond), implies that all who are part of the dementia care ecology need opportunities for flourishing, shared participation, and for expanded self-identities; beyond 'staff', 'residents', or 'being in distress'. On such basis, managers and funders might consider an extended brief for music therapists' roles, to include generating and maintaining musical wellbeing throughout residential care settings. © The Author(s) 2013.

Review: Pharmaceutical and personal care products (PPCPs) as ...

African Journals Online (AJOL)

... under constant threat of being polluted by a diverse range of man-made chemicals, ... at South African wastewater treatment works (WWTWs) are also highlighted. ... Keywords: pharmaceutical, endocrine disruption, wastewater, sewage water ... Algeria (5); Benin (2); Botswana (3); Burkina Faso (3); Cameroon (8); Congo, ...

Curing the disobedient patient: medication adherence programs as pharmaceutical marketing tools.

Science.gov (United States)

Lamkin, Matt; Elliott, Carl

2014-01-01

Pharmaceutical companies have long focused their marketing strategies on getting doctors to write more prescriptions. But they lose billions in potential sales when patients do not take their prescribed drugs. Getting patients to "adhere" to drug therapies that have unpleasant side effects and questionable efficacy requires more than mere ad campaigns urging patients to talk to their doctors. It requires changing patients' beliefs and attitudes about their medications through repeated contact from people patients trust. Since patients do not trust drug companies, these companies are delivering their marketing messages through nurses, pharmacists, and even other patients--leveraging patients' trust in these intermediaries to persuade them to consume more brand name drugs. Armed with the premise that better adherence improves patients' health, drug companies justify manipulating patients by reframing reasonable decisions to decline therapy as pathological, and promote brand loyalty in the guise of offering medical care. © 2014 American Society of Law, Medicine & Ethics, Inc.

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital.

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Fatma Karapinar-Çarkıt

Full Text Available To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective.A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping.In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51, and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001. Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847. Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained.The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519.

Pharmaceutical pricing policy in Greece: towards a different path.

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Kyriakos Souliotis

2016-08-01

Full Text Available Background: Affordable, accessible and innovation-promoting pharmaceutical care is essential to the operation of a sustainable health system. External reference pricing (ERP, a common pharmaceutical policy in Europe, suffers today from indigenous weaknesses that may cause market distortions and barriers to care, burdening mostly the weak economies, and hence, raising ethical and political worrying. Objectives and Methods: A non-randomized experiment was conducted, in order to examine the influence of flexible and adaptable to health systems’ affordability ERP structures. Outcomes were assessed by measuring deviations from Greek prices’ level ex ante, as well as effects on pharmaceutical markets affiliated to the European ERP system. Results and Conclusions: Pharmaceutical pricing models that fit prices to income and affordability are better in all aspects, as they produce fairer results, while resulting in low external costs for the European ERP network as a whole. Small sets of reference countries are preferred to large baskets, as they produce similar results, while presenting better qualities by increasing the flexibility of the reimbursement system and the transparency of the market.

Code of Ethics for Pharmacists – Pharmaceutical Chamber of Macedonia

OpenAIRE

Angelovska, Bistra

2015-01-01

Code of ethics represents the principles that form the fundamental basis of the roles and responsibilities of pharmacists in pharmaceutical practice. According to pharmacy practice, pharmacists are confirmed as healthcare professionals with unique knowledge, skills and responsibilities for safe and efficient medication therapy management in order to optimize therapeutic outcomes. The scope of pharmacy practice includes technical aspects of pharmaceutical services, the preparation of p...

Pharmaceuticals and personal care products (PPCPs in the freshwater aquatic environment

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Anekwe Jennifer Ebele

2017-03-01

Full Text Available Pharmaceuticals and personal care products (PPCPs are a unique group of emerging environmental contaminants, due to their inherent ability to induce physiological effects in human at low doses. An increasing number of studies has confirmed the presence of various PPCPs in different environmental compartments, which raises concerns about the potential adverse effects to humans and wildlife. Therefore, this article reviews the current state-of-knowledge on PPCPs in the freshwater aquatic environment. The environmental risk posed by these contaminants is evaluated in light of the persistence, bioaccumulation and toxicity criteria. Available literature on the sources, transport and degradation of PPCPs in the aquatic environment are evaluated, followed by a comprehensive review of the reported concentrations of different PPCP groups in the freshwater aquatic environment (water, sediment and biota of the five continents. Finally, future perspectives for research on PPCPs in the freshwater aquatic environment are discussed in light of the identified research gaps in current knowledge.

Improving the well-being of elderly patients via community pharmacy-based provision of pharmaceutical care - A multicentre study in seven European countries

NARCIS (Netherlands)

Bernsten, C; Bjorkman, [No Value; Caramona, M; Crealey, G; Frokjaer, B; Grundberger, E; Gustafsson, T; Henman, M; Herborg, H; Hughes, C; McElnay, J; Magner, M; van Mil, F; Schaeffer, M; Silva, S; Sondergaard, B; Sturgess, [No Value; Tromp, D; Vivero, L; Winterstein, A

2001-01-01

Objective: This study aimed to measure the outcomes of a harmonised, structured pharmaceutical care programme provided to elderly patients: (greater than or equal to 65 years of age) by community pharmacists in a multicentre international study performed in 7 European countries. Design and setting:

A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal.

Science.gov (United States)

Upadhyay, Dinesh Kumar; Mohamed Ibrahim, Mohamed Izham; Mishra, Pranaya; Alurkar, Vijay M

2015-02-12

Patient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided. Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients' satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal. An interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (n = 54), test 1 group (n = 54) and test 2 group (n = 54)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient's satisfaction scores at baseline, three, six, nine and, twelve months' follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05). There were significant (p patients' satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (p = 0.008), (p satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients' related outcomes and their

Pharmaceutical marketing research and the prescribing physician.

Science.gov (United States)

Greene, Jeremy A

2007-05-15

Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

Mitigating pharmaceutical waste exposures: policy and program considerations.

Science.gov (United States)

Amster, Eric D

2016-01-01

Pharmaceutical disposal and the environmental fate of medication metabolites directly impacts the public's health in two significant ways: accidental medication ingestion of pharmaceuticals that were not disposed of properly results in inadvertent toxicity; and environmental health consequences of pharmaceuticals that were inappropriately disposed and which contaminate municipal water supply. In reviewing the effectiveness of medication disposal policy globally, it is crucial to not only determine which policies are effective but also to assess why they are effective. By assessing the root causes for a specific policy's effectiveness it can be determined if those successes could be translated to another country with a different health care system, unique culture and divergent policy ecosystem. Any intervention regarding pharmaceutical disposal would require a multifaceted approach beyond raising awareness and coordinating pharmaceutical disposal on a national level. While consumer participation is important, effective primary prevention would also include research on drug development that is designed to biodegrade in the environment as opposed to medications that persist and accumulate in the natural environment even when properly disposed. Countries that lack a nationalized disposal policy should leverage the resources and infrastructure already in place in the national health care system to implement a unified policy to address medication disposal in the short-term. In tandem, efforts should be made to recruit the biotechnology sector in high-tech and academia to develop new technologies in medication design and water filtration to decrease exposures in the long-term.

Fate of pharmaceuticals and personal care products in wastewater treatment plants - Conception of a database and first results

International Nuclear Information System (INIS)

Miege, C.; Choubert, J.M.; Ribeiro, L.; Eusebe, M.; Coquery, M.

2009-01-01

We created a database in order to quantitatively assess the occurrence and removal efficiency of pharmaceuticals and personal care products (PPCPs) in wastewater treatment plants (WWTPs). From 117 scientific publications, we compiled 6641 data covering 184 PPCPs. Data included the concentrations of PPCPs in WWTP influents and effluents, their removal efficiency and their loads to the aquatic environment. The first outputs of our database allowed to identify the most investigated PPCPs in WWTPs and the most persistent ones, and to obtain reliable and quantitative values on their concentrations, frequency of detection and removal efficiency in WWTPs. We were also able to compare various processes and pointed out activated sludge with nitrogen treatment and membrane bioreactor as the most efficient ones. - By means of a database including information from 117 international scientific papers, we present quantitative conclusions on the concentrations, frequencies of detection and removals of pharmaceutical products in wastewater treatment plants.

A critical realist evaluation of a music therapy intervention in palliative care.

Science.gov (United States)

Porter, Sam; McConnell, Tracey; Clarke, Mike; Kirkwood, Jenny; Hughes, Naomi; Graham-Wisener, Lisa; Regan, Joan; McKeown, Miriam; McGrillen, Kerry; Reid, Joanne

2017-12-08

Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK). Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy's impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention. Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients' responses helped identify specific benefits for different types of patients. There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective.

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care.

Science.gov (United States)

Souza, Gisélia Santana; Costa, Ediná Alves; Barros, Rafael Damasceno de; Pereira, Marcelo Tavares; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

2017-11-13

To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees' answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of pautonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization were positively highlighted in all dimensions; however, it is necessary to conduct new studies to evaluate the institutionalization of pharmaceutical services' finalistic activities.

Norwegian physicians' knowledge of the prices of pharmaceuticals: a survey.

Science.gov (United States)

Eriksen, Ida Iren; Melberg, Hans Olav; Bringedal, Berit

2013-01-01

The objectives of this study are to measure physicians' knowledge of the prices of pharmaceuticals, and investigate whether there are differences in knowledge of prices between groups of physicians. This article reports on a survey study of physicians' knowledge of the prices of pharmaceuticals conducted on a representative sample of Norwegian physicians in the autumn of 2010. The importance of physicians' knowledge of costs derives from their influence on total spending and allocation of limited health-care resources. Physicians are important drivers in the effort to contain costs in health care, but only if they have the knowledge needed to choose the most cost-effective treatment options. A survey was sent to 1543 Norwegian physicians, asking them for price estimates and their opinions on the importance of considering the cost of treatment to society as a decision factor when treating their patients. This article deals with a subsection in which the physicians were asked to estimate the price of five pharmaceuticals: simvastatin, alendronate (Fosamax), infliximab (Remicade), natalizumab (Tysabri) and escitalopram (Cipralex). The response rate was 65%. For all the five pharmaceuticals, more than 50% and as many as 83% gave responses that differed more than 50% from the actual drug price. The price of more expensive pharmaceuticals was underestimated, while the opposite was the case for less expensive medicines. The data show that physicians in general have poor knowledge of the prices of the pharmaceuticals they offer their patients. However, the physicians who frequently deal with a drug have better knowledge of its price than those who do not handle a medication as often. The data also suggest that those physicians who agree that cost of care to society is an important decision factor have better knowledge of drug prices.

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care

Directory of Open Access Journals (Sweden)

Gisélia Santana Souza

2017-11-01

Full Text Available ABSTRACT OBJECTIVE To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines, a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%, partial (35.0%-69.0%, and advanced (70.0%-100%, estimated based on the interviewees’ answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05. RESULTS Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the “organization, structure, and financing” dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. CONCLUSION The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional

Marketing concepts for pharmaceutical service development.

Science.gov (United States)

Grauer, D W

1981-02-01

Marketing concepts as a mechanism to help pharmacy develop, communicate, and sell future pharmaceutical services to consumers are discussed. Pharmacy as a profession must define itself broadly to take advantage of future growth opportunities. These growth opportunities will be realized from unmet health-care needs and changing consumer life style trends and values. New services must therefore be oriented toward consumers (i.e., patients, health professionals, and third-party agencies) to gain acceptance. Dispensing and drug-knowledge-distribution pharmaceutical services are reviewed by a product life cycle analysis of sales profits versus time. A marketing mix for new pharmaceutical services is developed consisting of service, price, distribution, and promotion strategies. Marketing can encompass those key elements necessary to meet the organizational goals of pharmacy and provide a systematic, disciplined approach for presenting a new service to consumers.

Music therapy perspectives in palliative care education.

Science.gov (United States)

Porchet-Munro, S

1993-01-01

Major strides have been made in expanding the content of professional education in palliative care to include a focus on attitudes which nurture compassionate care as well as on knowledge and skills. However, accessing the emotional spheres--for instance the fear and helplessness of caregivers--remains a challenge. The inclusion of music therapy techniques as a teaching modality, with an emphasis on emotional experience and nonverbal expression, is suggested to address the latter and to enhance affective growth and learning.

The pharmaceutical care and the rejected constitutional reform: what might have been and what is.

Science.gov (United States)

Siracusa, Margherita; Grappasonni, Iolanda; Petrelli, Fabio

2017-10-23

This study analyzes the current state of legislation pertaining to pharmaceutical/health care in a period of normative ferment characterized by continuous changes, after countless discussions that have been held on a proposed constitutional reform (rejected by the will of the people at the end of 2016). After a general reflection on the division of legislative powers between the State and its Regions, in the light of attempts to bring about a reform, we will analyse specific problems: from the recent, but in some ways already defined as historic, approval of the new Essential Levels of Care (LEC), the approval of the 2017 Budget Law (concerning important items such as the purchase of drugs), until we reach the Draft Law on competition which is in the process of being approved. All this is taking place in the context of loyal, unavoidable cooperation between State, Regions and local institutions, in the spirit of the ascendancy of the right to health over economic/financial interests in the country.

The integration of occupational therapy into primary care: a multiple case study design

Science.gov (United States)

2013-01-01

Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group

Cell-Based Veterinary Pharmaceuticals - Basic Legal Parameters Set by the Veterinary Pharmaceutical Law and the Genetic Engineering Law of the European Union.

Science.gov (United States)

Faltus, Timo; Brehm, Walter

2016-01-01

Cell-based therapies have been in use in veterinary medicine for years. However, the legal requirement of manufacturing, placing on the market and use of cell-based veterinary pharmaceuticals are not as well developed as the respective requirements of chemical pharmaceuticals. Cell-based veterinary pharmaceuticals are medicinal products in the sense of the pharmaceutical law of the European Union (EU). For that reason, such medicinal products principally require official approval for their manufacture and an official marketing authorization for their placement on the market before being used by the veterinarian. The manufacture, placing on the market, and use of cell-based veterinary pharmaceuticals without manufacturing approval and marketing authorization is permitted only in certain exceptional cases determined by EU and individual Member State law. Violations of this requirement may have consequences for the respective veterinarian under criminal law and under the code of professional conduct in the respective Member State. The regular use of cell-based veterinary pharmaceuticals within the scope of a therapeutic emergency as well as the import of such veterinary pharmaceuticals from non-European countries for use in the EU are currently out of the question in the EU because of a lack of legal bases. Here, we review the general legal requirement of manufacturing, placing on the market, and use of cell-based veterinary pharmaceuticals within the EU and point out different implementations of EU law within the different Member States.

Using the New Postacute Care Quality Measures to Demonstrate the Value of Occupational Therapy.

Science.gov (United States)

Sandhu, Sharmila; Furniss, Jeremy; Metzler, Christina

As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy's distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection. Copyright © 2018 by the American Occupational Therapy Association, Inc.

Music therapy in pediatric palliative care: family-centered care to enhance quality of life.

Science.gov (United States)

Lindenfelser, Kathryn J; Hense, Cherry; McFerran, Katrina

2012-05-01

Research into the value of music therapy in pediatric palliative care (PPC) has identified quality of life as one area of improvement for families caring for a child in the terminal stages of a life-threatening illness. This small-scale investigation collected data in a multisite, international study including Minnesota, USA, and Melbourne, Australia. An exploratory mixed method design used the qualitative data collected through interviews with parents to interpret results from the PedsQL Family Impact Module of overall parental quality of life. Parents described music therapy as resulting in physical improvements of their child by providing comfort and stimulation. They also valued the positive experiences shared by the family in music therapy sessions that were strength oriented and family centered. This highlighted the physical and communication scales within the PedsQL Family Impact Module, where minimal improvements were achieved in contrast to some strong results suggesting diminished quality of life in cognitive and daily activity domains. Despite the significant challenges faced by parents during this difficult time, parents described many positive experiences in music therapy, and the overall score for half of the parents in the study did not diminish. The value of music therapy as a service that addresses the family-centered agenda of PPC is endorsed by this study.

Family focused grief therapy: The therapy of choice in palliative care

Directory of Open Access Journals (Sweden)

Klikovac Tamara

2017-01-01

Full Text Available Palliative care refers to offering physical, psychosocial and spiritual care to patients who are suffering from life threatening diseases. It also includes providing psychological support for family members and other close relations during the period of illness (anticipatory grief and in the period of bereavement and mourning after the patient's death. The choice of therapy during the process of bereavement and mourning is Family Focused Grief Therapy (FFGT. FFGT is a brief, focused and time-limited psychotherapeutic model of intervention belonging to family psychotherapy which is specified for the families that face a life threatening disease of a family member. FFGT, with some modifications, can be applied in work with the families who are facing a terminal illness of younger family members - a child or an adolescent. FFGT typically comprises of 7 to 9 sessions lasting for 90 minutes, which are arranged flexibly across 9 to 18 months, depending on the needs of each family individually. It is important to emphasize that the frequency and number of sessions in each phase depend on the specific features and needs of each particular family. The intervention aim of FFGT is to prevent the complications of bereavement by enhancing the functioning of the family, through exploration of its cohesion, communications (of thoughts and feelings, and handling of conflict. The story of illness and the related grief is shared in the process. The creator of this model is Dr David Kissane, a psychiatrist and a family psychotherapist from Melbourne, Australia, who also worked at the Memorial Sloan Kettering Cancer Centre in New York. The main aims of this article are, on the one hand, to introduce this very useful model of the family therapy to the professional community in Serbia and, on the other, to introduce a conceptual and practical frame of palliative care.

Pressure ulcer care: nutritional therapy need not add to costs.

NARCIS (Netherlands)

Schols, J.M.G.A.; Kleijer, C.N.; Lourens, C.

2003-01-01

Fewer patients with pressure ulcers in Dutch nursing homes receive nutritional therapy via sip feeds, possibly because of cost concerns. But this therapy would not cost more if it reduced the duration of nursing care by even one day, this paper argues.

Implementing US-style anti-fraud laws in the Australian pharmaceutical and health care industries.

Science.gov (United States)

Faunce, Thomas A; Urbas, Gregor; Skillen, Lesley

2011-05-02

This article critically analyses the prospects for introducing United States anti-fraud (or anti-false claims) laws in the Australian health care setting. Australian governments spend billions of dollars each year on medicines and health care. A recent report estimates that the money lost to corporate fraud in Australia is growing at an annual rate of 7%, but that only a third of the losses are currently being detected. In the US, qui tam provisions - the component of anti-fraud or anti-false claims laws involving payments to whistleblowers - have been particularly successful in providing critical evidence allowing public prosecutors to recover damages for fraud and false claims made by corporations in relation to federal and state health care programs. The US continues to strengthen such anti-fraud measures and to successfully apply them to a widening range of areas involving large public investment. Australia still suffers from the absence of any comprehensive scheme that not only allows treble damages recovery for fraud on the public purse, but crucially supports such actions by providing financial encouragement for whistleblowing corporate insiders to expose evidence of fraud. Potential areas of application could include direct and indirect government expenditure on health care service provision, pharmaceuticals, medical devices, defence, carbon emissions compensation and tobacco-related illness. The creation in Australia of an equivalent to US anti-false claims legislation should be a policy priority, particularly in a period of financial stringency.

Discharge inventory of pharmaceuticals and personal care products in Beijing, China

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Zhixia Zhang

2016-09-01

Full Text Available Pharmaceuticals and personal care products (PPCPs are emerging environmental contaminants, whose potential risk for the ecological environment has caused wide attention in recent years. In China, quite a large amount of PPCPs were annually emitted into the environment. Their existence in different matrix has been reported frequently, including river water, sediment and soil. However, the contribution from different sources was seldom reported and still unclear in China. Wastewater treatment plant (WWTP was usually considered to be the main source to the urban river, but livestock and aquaculture farms were also reported as significant pollution sources of PPCPs due to poor environmental management in China. This study summarized environmental discharges of different PPCPs from various sources and obtained the discharge data through different environment media in Beijing, the statistical source of PPCPs was analyzed in detail. The sources comprised WWTPs, excess sludge, hospital wastewater, municipal untreated wastewater, aquaculture wastewater and landfill leachate. This article helps understand the general situation and the potential risk of PPCPs in Beijing.

Oral care of the cancer patient receiving radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Holtzhausen, T [Medical Univ. of Southern Africa, Pretoria (South Africa). Dept. of Community Dentistry

1982-07-01

Radiation therapy is frequently being used for the patient with oral cancer. The survival rate is increasing, due to more effective treatment technique. The question of whether any teeth should be extracted, the mode of therapy and the side effects of radiation like Xerostomia, caries, stomatitis, trismus and osteo-radionecrosis and also post radiation care are discussed.

Irradiation treatment of pharmaceutical and personal care products (PPCPs) in water and wastewater: An overview

International Nuclear Information System (INIS)

Wang, Jianlong; Chu, Libing

2016-01-01

Pharmaceutical and personal care products (PPCPs), especially the pharmaceutically active compounds (PhACs) such as antibiotics and hormones have attracted great concerns worldwide for their persistence and potential threat to ecosystem and public health. This paper presents an overview on the ionizing irradiation-induced degradation of PPCPs in aqueous solution. Parameters that affect PPCPs degradation, such as the absorbed dose, solution pH, dose rate, water matrices and the presence of some inorganic ions and humic acid are evaluated. The mechanism and pathways of radiolytic degradation of PPCPs are reviewed. In many cases, PPCPs such as antibiotics and X-ray contrast agent could be removed completely by radiation, but a higher absorbed dose was needed for their mineralization and toxicity reduction. The combination of ionizing irradiation with other methods such as H 2 O 2 , ozonation and TiO 2 nanoparticles could improve the degradation efficacy and reduce the cost. Ionizing irradiation is a promising alternative for degradation of PPCPs in aqueous solution. - Highlights: • This paper presents an overview on radiation-induced degradation of PPCPs. • Parameters that affect PPCPs degradation were evaluated. • The mechanism and pathways of PPCPs degradation are reviewed. • Ionizing irradiation is a promising alternative for degradation of PPCPs in aqueous solution.

The ethics of the medical-pharmaceutical relationship.

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Vashi, Neelam A; Latkowski, Jo-Ann M

2012-01-01

Physician interaction with the pharmaceutical industry raises many ethical concerns. This relationship is complex, owing to a pluralism of beliefs held by physicians, patients, and third parties. As a result, determining whether physicians fulfill their responsibilities to both the professional and public communities is an arduous endeavor. In an effort to clarify the situation and provide transparency to this complex relationship, medical and pharmaceutical organizations have enacted their own respective codes and guidelines. Even with adherence to these guidelines, questions remain regarding the codependent relationship that interweaves the pharmaceutical industry with the medical community. Owing to the ever-changing landscape enmeshing product development, scientific advancement, corporate realities and patient care, the proper choice for physicians is rarely obvious; however, to operate to the highest standards, those in the medical community must be candid about relations with the pharmaceutical industry and transparent in their financial interests. Further undertakings should focus not on the eradication of physician-pharmaceutical interaction, but instead on the education of physicians about industry marketing strategies and the delineation of boundaries of these interactions to benefit not the individual physician, but our patients. Copyright © 2012. Published by Elsevier Inc.

Emerging contaminants (pharmaceuticals, personal care products, a food additive and pesticides) in waters of Sydney estuary, Australia.

Science.gov (United States)

Birch, G F; Drage, D S; Thompson, K; Eaglesham, G; Mueller, J F

2015-08-15

The current investigation of marine water from 30 sites adjacent to stormwater outlets across the entire Sydney estuary is the first such research in Australia. The number of analytes detected were: 8/59 pharmaceutical compounds (codeine, paracetamol, tramadol, venlafaxine, propranolol, fluoxetine, iopromide and carbamazepine), 7/38 of the pesticides (2,4-dichlorophenoxyacetic acid (2,4-D), 3,4-dichloroaniline, carbaryl, diuron, 2-methyl-4-chlorophenoxyacetic acid (MCPA), mecoprop and simazine) and 0/3 of the personal care products (PCPs) analysed. An artificial sweetener (acesulfame) was detected, however none of the nine antibiotics analysed were identified. Sewage water is not discharged to this estuary, except infrequently as overflow during high-precipitation events. The presence of acesulfame (a recognised marker of domestic wastewater) and pharmaceuticals in water from all parts of the estuary after a dry period, suggests sewage water is leaking into the stormwater system in this catchment. The pesticides are applied to the environment and were discharged via stormwater to the estuary. Copyright © 2015 Elsevier Ltd. All rights reserved.

Analysis of Pharmaceutical and Personal Care Compounds in Wastewater Sludge and Aqueous Samples using GC-MS/MS

Energy Technology Data Exchange (ETDEWEB)

Zhong, Lirong [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mitroshkov, Alexandre V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gilmore, Tyler J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2016-03-15

The Bioenergy Program at Pacific Northwest National Laboratory (PNNL) is evaluating the feasibility of converting wastewater sludge materials to fuels. Wastewater sludge from various municipalities will be used in the evaluation process and as with any municipal waste, there is the potential for residual contaminates to remain in the sludge following wastewater treatment. Many surveys and studies have confirmed the presence of pharmaceuticals in municipal wastewater and effluents (World Health Organization, 2011). Determination of the presence and concentrations of the contaminants is required to define the proper handling of this sludge. A list of targeted compounds was acquired from the literature and an analytical method was developed for the pharmaceutical and personal care compounds. The presence of organics complicated the analytical techniques and, in some cases, the precision of the results. However, residual concentrations of a range of compounds were detected in the wastewater sludge and the presence and concentrations of these compounds will be considered in identifying the appropriate handling of this material in conduct of research.

Pharmacists' views on the development of asthma pharmaceutical care model in Indonesia: A needs analysis study.

Science.gov (United States)

Widayati, Aris; Virginia, Dita Maria; Setiawan, Christianus Heru; Fenty, Fenty; Donowati, Maria Wisnu; Christasani, Putu Dyana; Hartayu, Titien Siwi; Suhadi, Rita; Saini, Bandana; Armour, Carol

2018-01-30

Over recent years the pharmacy profession in Indonesia has adopted a stance of pharmaceutical care to expand their scope of practice. Asthma management presents a key opportunity for pharmacists to test expanded roles in health service provision. There is however no exploratory work on the willingness, experience or future practice needs of Indonesian pharmacists in the realm of specialised asthma service provision. The objectives of this study were to explore Indonesian pharmacists' experiences, perspectives, and needs regarding the provision of pharmaceutical care for asthma patients in Indonesia. The study utilised conventional qualitative content analyses with two stages, i.e.: deductive analyses and inductive concept development. Data were collected using Focus Group Discussion (FGD) Method. FGDs were conducted using a topic guide and by facilitators trained in FGD conduct. FGDs were audio-recorded and transcribed verbatim prior to analysis. A maximum variation sampling methods targeted pharmacist across various settings of practice within Yogyakarta Indonesia. Nine focus groups with 103 pharmacist participants were conducted, with an average of 11 participants in each group. Inductively derived concepts that emerged included: willingness to adopt asthma service provision roles, pragmatism in recognising essential barriers/facilitators in adopting such roles, reflections regarding practice gaps and barriers to interprofessional collaboration mainly in relation to doctors. Inductive data analysis indicated clear differences in responses between hospital and non-hospital pharmacists. Key barriers to service provision included lack of training, lack of supportive professional frameworks, time and lack of reimbursement channels for services. Participants urged for a visionary leadership to facilitate pharmacists' role expansion into health services provision in Indonesia. Indonesian pharmacists were willing to adopt change and reported universally recognised

Attitude and practice of dental surgeons towards pharmaceutical companies' marketing gifts.

Science.gov (United States)

Tahir, Shaila; Rafique, Adeela; Ghafoor, Farkhanda; Saleem, Akif; Khan, Amanullah

2013-01-01

Interaction of pharmaceutical companies (PC) with healthcare services has been a reason for concern. In medicine, awareness of the ethical implications of these interactions have been emphasized upon, while this issue has not been highlighted in dentistry. This study undertook a cross-sectional rapid assessment procedure to gather views of dentists in various institutions towards unethical practices in health care and pharmaceutical industry. The purpose of this study was to assess the need for the formulation and implementation of guidelines for the interaction of dentists with the pharmaceutical and device industry in the best interest of patients. A group of 209 dentists of Lahore including faculty members, demonstrators, private practitioners and fresh graduates responded to a questionnaire to assess their attitudes and practices towards pharmaceutical companies' marketing gifts. The study was conducted during 2011 and provided interesting data that showed the pharmaceutical industry is approaching private practitioners more frequently than academicians and fresh graduates. Private practioners accepted the gifts but mostly recognized them as unethical (over 65%). Both groups considered sponsoring of on-campus lectures as acceptable (over 70%). Respondents are not fully aware of the ethical demands which are imperative for all health care industries, and there is a dire need of strict guidelines and code of ethics for the dentist's interaction with the pharmaceutical and device industry so that patient interest is protected.

Chitosan Modification and Pharmaceutical/Biomedical Applications

Directory of Open Access Journals (Sweden)

Jiali Zhang

2010-06-01

Full Text Available Chitosan has received much attention as a functional biopolymer for diverse applications, especially in pharmaceutics and medicine. Our recent efforts focused on the chemical and biological modification of chitosan in order to increase its solubility in aqueous solutions and absorbability in the in vivo system, thus for a better use of chitosan. This review summarizes chitosan modification and its pharmaceutical/biomedical applications based on our achievements as well as the domestic and overseas developments: (1 enzymatic preparation of low molecular weight chitosans/chitooligosaccharides with their hypocholesterolemic and immuno-modulating effects; (2 the effects of chitin, chitosan and their derivatives on blood hemostasis; and (3 synthesis of a non-toxic ion ligand—D-Glucosaminic acid from Oxidation of D-Glucosamine for cancer and diabetes therapy.

Current Care and Investigational Therapies in Achondroplasia.

Science.gov (United States)

Unger, Sheila; Bonafé, Luisa; Gouze, Elvire

2017-04-01

The goal of this review is to evaluate the management options for achondroplasia, the most common non-lethal skeletal dysplasia. This disease is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications. Achondroplasia is the most common non-lethal skeletal dysplasia. It is characterized by short stature and a variety of complications, some of which can be quite severe. Despite several attempts to standardize care, there is still no widely accepted consensus. This is in part due to absence of concrete data on the incidence of sudden unexplained death in infants with achondroplasia and the best investigation for ascertaining which individuals could benefit from foramen magnum decompression surgery. In this review, we identify the different options of care and management for the various orthopedic, neurologic, and respiratory complications. In parallel, several innovative or drug repositioning therapies are being investigated that would restore bone growth but may also prevent complications.

Pharmaceutical cocrystals, salts and polymorphs: Advanced characterization techniques.

Science.gov (United States)

Pindelska, Edyta; Sokal, Agnieszka; Kolodziejski, Waclaw

2017-08-01

The main goal of a novel drug development is to obtain it with optimal physiochemical, pharmaceutical and biological properties. Pharmaceutical companies and scientists modify active pharmaceutical ingredients (APIs), which often are cocrystals, salts or carefully selected polymorphs, to improve the properties of a parent drug. To find the best form of a drug, various advanced characterization methods should be used. In this review, we have described such analytical methods, dedicated to solid drug forms. Thus, diffraction, spectroscopic, thermal and also pharmaceutical characterization methods are discussed. They all are necessary to study a solid API in its intrinsic complexity from bulk down to the molecular level, gain information on its structure, properties, purity and possible transformations, and make the characterization efficient, comprehensive and complete. Furthermore, these methods can be used to monitor and investigate physical processes, involved in the drug development, in situ and in real time. The main aim of this paper is to gather information on the current advancements in the analytical methods and highlight their pharmaceutical relevance. Copyright © 2017 Elsevier B.V. All rights reserved.

Cell-Based Veterinary Pharmaceuticals – Basic Legal Parameters Set by the Veterinary Pharmaceutical Law and the Genetic Engineering Law of the European Union

Science.gov (United States)

Faltus, Timo; Brehm, Walter

2016-01-01

Cell-based therapies have been in use in veterinary medicine for years. However, the legal requirement of manufacturing, placing on the market and use of cell-based veterinary pharmaceuticals are not as well developed as the respective requirements of chemical pharmaceuticals. Cell-based veterinary pharmaceuticals are medicinal products in the sense of the pharmaceutical law of the European Union (EU). For that reason, such medicinal products principally require official approval for their manufacture and an official marketing authorization for their placement on the market before being used by the veterinarian. The manufacture, placing on the market, and use of cell-based veterinary pharmaceuticals without manufacturing approval and marketing authorization is permitted only in certain exceptional cases determined by EU and individual Member State law. Violations of this requirement may have consequences for the respective veterinarian under criminal law and under the code of professional conduct in the respective Member State. The regular use of cell-based veterinary pharmaceuticals within the scope of a therapeutic emergency as well as the import of such veterinary pharmaceuticals from non-European countries for use in the EU are currently out of the question in the EU because of a lack of legal bases. Here, we review the general legal requirement of manufacturing, placing on the market, and use of cell-based veterinary pharmaceuticals within the EU and point out different implementations of EU law within the different Member States. PMID:27965965

Patterns of clinical care in radiation therapy in the United States

International Nuclear Information System (INIS)

Kramer, S.

1984-01-01

Results of the first nationwide evaluation of radiation therapy in the United States with respect to its quality and accessibility are presented. The Patterns of Care Study (PCS) is financially supported by the National Cancer Institute and has served as a model for other oncology-related disciplines. The PCS has determined criteria by which to evaluate radiation therapy care in 10 disease sites in which curative radiation therapy plays a major role. The sampling design identified the institution to be surveyed and included all types of practice in the U.S. This paper examines results related to carcinomas of the cervix, larynx and prostate

Practice of pharmaceutical care in community pharmacies in Jordan

African Journals Online (AJOL)

Tropical Journal of Pharmaceutical Research February 2017; 16 (2): 463-470 ... 2Royal Medical Services, Amman, 11821 Jordan, 3Faculty of Pharmacy, Applied Science Private University, Amman, 11942 ... Results: 163 pharmacists agreed to participate in the study (response rate was 90.5 %). ... For example, courses of.

Pharmaceuticals: pharmaceutical cost controls--2005. End of Year Issue Brief.

Science.gov (United States)

Seay, Melicia; Varma, Priya

2005-12-31

The enactment of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) gave states the option of offering pharmaceutical benefits within their Medicaid programs. But the law placed restrictions on states' flexibility to control what prescriptions they would cover and required the states to reimburse outpatient prescription drugs from manufacturers that signed rebate agreements with the U.S. Department of Health and Human Services. Forty-nine states--Arizona is excluded, based on its program structure--and the District of Columbia currently offer prescription drug coverage under the Medicaid Drug Rebate Program. During the past four years, states all over the country have been plagued with revenue shortfalls in their state Medicaid budgets. While the fiscal situation improved for most states in the 2004 legislative session, many states still face budget pressures in 2005. Compounding existing budget pressures are threats from the Bush Administration to shift increased costs of the Medicaid program on to the states. All things considered, the economic pressure of funding Medicaid is at the top of legislative agendas in 2005. As in previous years, states are attempting to reduce costs to their Medicaid programs by seeking savings in their pharmaceutical programs. Prescription drug costs are highly attributed as a contributing factor to the fiscal climate of state Medicaid programs. Currently, prescription drug spending outpaces that of every other category of health care and drug prices are rising faster than inflation. In response, states are instituting a variety of pharmaceutical cost control measures such as creating preferred drug lists (PDLs), negotiating supplemental rebates, forming bulk purchasing pools, promoting generic drug substitution and implementing price controls. As prescription drug cost containment tools have gained acceptance and momentum, they continue to be controversial. This issue brief explores the debate, history, methodology, utilization

ENVIRONMENTAL STEWARDSHIP OF PHARMACEUTICALS - THE GREEN PHARMACY

Science.gov (United States)

The occurrence of pharmaceuticals and personal care products (PPCPS) as environmental pollutants is a multifaceted issue whose scope continues to become better delineated since the escalation of conceited attention beginning in the 1980s. PPCPs typically occur as trace environme...

Comparison of health care resource utilization and costs among patients with GERD on once-daily or twice-daily proton pump inhibitor therapy

Directory of Open Access Journals (Sweden)

Mody R

2013-04-01

Full Text Available Reema Mody,1 Debra Eisenberg,2 Likun Hou,2 Siddhesh Kamat,2 Joseph Singer,2 Lauren B Gerson3 1Takeda Pharmaceuticals International Inc, Deerfield, IL, 2HealthCore Inc, Wilmington, DE, 3Stanford University School of Medicine, Stanford, CA, USA Background: The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI therapy. Most patients with gastroesophageal reflux disease (GERD achieve symptom control on once-daily PPI therapy, but approximately 20%–30% require twice-daily dosing. Methods: Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRDSM during 2004–2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim. Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply, patients were classified as once-daily (dose ≤ 1.5 pills per day or twice-daily (≥1.5 PPI users. Results: The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05. More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001 than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%, outpatient visit (60% versus 49%, and office visit (48% versus 38% versus once-daily patients (P < 0.0001. Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001. Conclusion: Patients receiving twice-daily PPI therapy were likely to have more

The service blueprint as a tool for designing innovative pharmaceutical services.

Science.gov (United States)

Holdford, D A; Kennedy, D T

1999-01-01

To describe service blueprints, discuss their need and design, and provide examples of their use in advancing pharmaceutical care. Service blueprints are pictures or maps of service processes that permit the people involved in designing, providing, managing, and using the service to better understand them and deal with them objectively. A service blueprint simultaneously depicts the service process and the roles of consumers, service providers, and supporting services. Service blueprints can be useful in pharmacy because many of the obstacles to pharmaceutical care are a result of insufficient planning by service designers and/or poor communication between those designing services and those implementing them. One consequence of this poor design and communication is that many consumers and third party payers are uninformed about pharmacist roles. Service blueprints can be used by pharmacists to promote the value of pharmaceutical care to consumers and other decision makers. They can also assist in designing better pharmaceutical services. Blueprints are designed by identifying and mapping a process from the consumer's point of view, mapping employee actions and support activities, and adding visible evidence of service at each consumer action step. Key components of service blueprints are consumer actions, "onstage" and "backstage" employee actions, and support processes. Blueprints can help pharmacy managers identify and correct problems with the service process, provide pharmacy employees an opportunity to offer feedback in the planning stages of services, and demonstrate the value of pharmaceutical services to consumers. Service blueprints can be a valuable tool for designing, implementing, and evaluating pharmacy services.

Music therapy in dementia care and neuro-rehabilitation

DEFF Research Database (Denmark)

Ridder, Hanne Mette Ochsner

2017-01-01

medication. Music therapists,who play a role in staff training and supervision, and not only in direct music therapy practice, bring new important dimensions to how music therapy discipline is understood and how it is integrated in interdisciplinary work........ Then she turns her head away and wipes away a tear, clearly moved by his singing. In line with the increasing interest in applying music in medical care, the healing power of music has been recently highlighted in journals such as the Scientific American (Thompson & Schlaug 2015) and Musicae Scientiae...... (Croom 2015). In an article published in the journal Nature, the “surprising preservation of musical memory” in persons with Alzheimer’s Disease is explained (Jacobsen et al. 2015: 2439). The common goal for the dementia field is to advance and develop the culture of care. The music therapist may engage...

Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies.

Science.gov (United States)

Einstein, David J; DeSanto-Madeya, Susan; Gregas, Matthew; Lynch, Jessica; McDermott, David F; Buss, Mary K

2017-09-01

Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model's implementation. Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P 7 days before death-a core Quality Oncology Practice Initiative metric-was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

Pharmaceutical costs of assisted reproduction in Spain.

Science.gov (United States)

Lorente, Maria-Reyes; Hernández, Juana; Antoñanzas, Fernando

2013-11-01

Assisted reproduction is one of the health services currently being considered for possible limitation or exclusion from the public health services portfolio in Spain. One of the main reasons claimed for this is the impact on the budget for pharmaceutical expenditure. The objective of this study was to assess the significance of the pharmaceutical costs of assisted reproduction in Spain. This study focused on medical practice in Spain, and is based on the opinions of experts in assisted reproduction and the results provided by professional societies' publications. The reference year is 2012 and the setting was secondary care. We have included all existing pharmaceutical modalities for assisted reproduction, as well as the most common drug for each modality. We have considered the pharmaceutical cost per cycle for artificial insemination, in vitro fertilisation with or without intracytoplasmic sperm injection (IVF_ICSI), and cryotransfer and donated fresh oocytes reception. In Spain, artificial insemination has a pharmaceutical cost per cycle of between €69.36 and €873.79. This amounts to an average cycle cost of €364.87 for partner's sperm and €327.10 for donor sperm. The pharmaceutical cost of IVF_ICSI ranges between €278.16 and €1,902.66, giving an average cost per cycle of €1,139.65. In the case of cryotransfer and donated fresh oocytes reception, the pharmaceutical cost per cycle is between €22.61 and €58.73, yielding an average cost of €40.67. The budgetary impact of pharmaceutical expenditure for assisted reproduction in Spain for the year 2012 was estimated at €98.7 million. In Spain, the total pharmaceutical cost of assisted reproduction is substantial. According to our results, we can say that about 29% of the total pharmaceutical expenditure for assisted reproduction techniques is funded by the National Health System and the rest represents 2.4% of the total annual out-of-pocket family expenditure on drugs.

Use of health care services and pharmaceutical agents in coeliac disease: a prospective nationwide study

Directory of Open Access Journals (Sweden)

Ukkola Anniina

2012-09-01

Full Text Available Abstract Background Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet. Methods A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed. Results Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month and painkillers (6.8-5.5 pills/month and the number of antibiotic courses (0.6-0.5 prescriptions/year was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment. Conclusions Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease. Trial registration ClinicalTrials.gov NCT01145287

Use of health care services and pharmaceutical agents in coeliac disease: a prospective nationwide study.

Science.gov (United States)

Ukkola, Anniina; Kurppa, Kalle; Collin, Pekka; Huhtala, Heini; Forma, Leena; Kekkonen, Leila; Mäki, Markku; Kaukinen, Katri

2012-09-27

Approximately 1% of the population suffer from coeliac disease. However, the disease is heavily underdiagnosed. Unexplained symptoms may lead to incremented medical consultations and productivity losses. The aim here was to estimate the possible concealed burden of untreated coeliac disease and the effects of a gluten-free diet. A nationwide cohort of 700 newly detected adult coeliac patients were prospectively evaluated. Health care service use and sickness absence from work during the year before diagnosis were compared with those in the general population; the data obtained from an earlier study. Additionally, the effect of one year on dietary treatment on the aforementioned parameters and on consumption of pharmaceutical agents was assessed. Untreated coeliac patients used primary health care services more frequently than the general population. On a gluten-free diet, visits to primary care decreased significantly from a mean 3.6 to 2.3. The consumption of medicines for dyspepsia (from 3.7 to 2.4 pills/month) and painkillers (6.8-5.5 pills/month) and the number of antibiotic courses (0.6-0.5 prescriptions/year) was reduced. There were no changes in hospitalizations, outpatient visits to secondary and tertiary care, use of other medical services, or sickness absence, but the consumption of nutritional supplements increased on treatment. Coeliac disease was associated with excessive health care service use and consumption of drugs before diagnosis. Dietary treatment resulted in a diminished burden to the health care system and lower use of on-demand medicines and antibiotic treatment. The results support an augmented diagnostic approach to reduce underdiagnosis of coeliac disease. ClinicalTrials.gov NCT01145287.

Alternative therapies for the holistic care of the HIV / AIDS patient ...

African Journals Online (AJOL)

Alternative therapies that can be used for the holistic nursing care of HIV / AIDS infection include psychological, mental and emotional therapies, therapeutic touch, nutrition, vitamins, minerals and nutritional supplements, herbal medicine, Chinese medicine and homeopathy, traditional medicine, lifestyle changes and ...

Occupational Therapy in the Intensive Care Unit: A Systematic Review.

Science.gov (United States)

Weinreich, Mark; Herman, Jennifer; Dickason, Stephanie; Mayo, Helen

2017-07-01

This paper is a synthesis of the available literature on occupational therapy interventions performed in the adult intensive care unit (ICU). The databases of Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and CINAHL databases were systematically searched from inception through August 2016 for studies of adults who received occupational therapy interventions in the ICU. Of 1,938 citations reviewed, 10 studies met inclusion criteria. Only one study explicitly discussed occupational therapy interventions performed and only one study specifically tested the efficacy of occupational therapy. Future research is needed to clarify the specific interventions and role of occupational therapy in the ICU and the efficacy of these interventions.

Occupational therapy for care home residents with stroke

NARCIS (Netherlands)

C. Sackley; M. Walker; E. Steultjens; M. Feltham; J. Fletcher-Smith

2012-01-01

In this systematic review we aim to measure the effects of occupational therapy interventions (provided directly by an occupational therapist or under the supervision of an occupational therapist) targeted at improving, restoring and maintaining independence in ADL (to include both self-care and

Randomized Controlled Trial of Problem-Solving Therapy for Minor Depression in Home Care

Science.gov (United States)

Gellis, Zvi D.; McGinty, Jean; Tierney, Lynda; Jordan, Cindy; Burton, Jean; Misener, Elizabeth

2008-01-01

Objective: Data are presented from a pilot research program initiated to develop, refine, and test the outcomes of problem-solving therapy that targets the needs of older adults with minor depression in home care settings. Method: A pilot randomized clinical trial compares the impact of problem-solving therapy for home care to treatment as usual…

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain: a randomized, controlled trial.

NARCIS (Netherlands)

Hoving, J.L.; Koes, B.W.; Vet, H.C.W. de; Windt, D.A.W.M. van der; Assendelft, W.J.J.; Mameren, H. van; Devillé, W.L.J.M.; Pool, J.J.M.; Scholten, R.J.P.M.; Bouter, L.M.

2002-01-01

BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled

Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial

NARCIS (Netherlands)

Hoving, Jan Lucas; Koes, Bart W.; de Vet, Henrica C. W.; van der Windt, Danielle A. W. M.; Assendelft, Willem J. J.; van Mameren, Henk; Devillé, Walter L. J. M.; Pool, Jan J. M.; Scholten, Rob J. P. M.; Bouter, Lex M.

2002-01-01

BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled

Nursing care of patients receiving interventional therapy for hepatic artery stenosis after liver transplantation

International Nuclear Information System (INIS)

Wei Lin; Liu Shiguang

2009-01-01

Objective: To discuss the perioperative nursing care of patients who is going to receive interventional therapy for hepatic artery stenosis after liver transplantation and to provide useful reference for reducing surgery-related complication and for improving the prognosis of patients. Methods: Based on the patient's condition and operative requirement,we provided effective nursing care for 20 patients who were admitted to receive the interventional therapy for hepatic artery stenosis after liver transplantation. The nursing care included preoperative preparation,postoperative nursing and medical guidance at the time of discharge. Results: Interventional therapy was successfully performed in all 20 cases, and no hemorrhagic tendency or acute thrombosis occurred. Marked symptomatic improvement was obtained in all patients. Conclusion: The interventional therapy is an effective treatment for hepatic artery stenosis after liver transplantation. Intensive perioperative nursing care can well prevent the occurrence of surgery-related complications and can surely improve the therapeutic results. (authors)

Palliative care and use of animal-assisted therapy.

Science.gov (United States)

Engelman, Suzanne R

2013-01-01

A growing body of research and clinical reports support the benefits of utilizing animal-assisted therapy (AAT) as a complementary, transdisciplinary treatment intervention in medical settings. However, fewer articles are found demonstrating AAT's use in palliative care settings. This article is a study of the effects of AAT in palliative care situations, presenting one anecdotal clinical vignette. In this way, the efficacy of this technique in decreasing patient pain, thereby increasing patient quality of life, and lowering staff stress levels may be illustrated.

Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

Directory of Open Access Journals (Sweden)

Annemarije L Kruis

Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

Self-care under the perspective of Occupational Therapy: analysis of scientific production

Directory of Open Access Journals (Sweden)

Regina Célia Titotto Castanharo

2014-04-01

Full Text Available This is an exploratory descriptive study aiming to explain how self-care has been addressed by Occupational Therapy (OT. Data collection was carried out by consulting LILACS, SciELO databases and national journals of Occupational Therapy. From 1994 to 2012, twelve articles published by occupational therapists were selected considering the following keywords on abstracts or full texts: occupational therapy, self-care, daily activities or daily life activities. The results were submitted to integrative review and thematic analysis. The categories evidenced were self-care and activities of daily life; autonomy and independence for self-care; and intervention of OT favoring self-care by the individual. The results showed different dimensions of self-care when associated with the individual and private autonomy as well as with professional interdisciplinary practices of OT. The intervention in this area is directed to human performance in the cycles of life, faced with situations of vulnerability, such as disease and social exclusion. Adaptations, modifications, assistive technology resources and/or functional rehabilitation are used to promote the independence of individuals, favoring autonomy and recovery routines. We observed similarities between the conceptions of self-care found in the scientific production of OT and in the Orem’s concepts (1971-2001. In general, health professionals can achieve benefits to the systematization of knowledge that underlie their practice when they articulate them with the knowledge systematized by other areas.

Home iv Antibiotic Therapy through a Medical Day Care Unit

Directory of Open Access Journals (Sweden)

Marie Gourdeau

1993-01-01

Full Text Available An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%. The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days. Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days. Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system.

Science.gov (United States)

Grande, David; Shea, Judy A; Armstrong, Katrina

2012-03-01

Pharmaceutical industry gifts to physicians are common and influence physician behavior. Little is known about patient beliefs about the prevalence of these gifts and how these beliefs may influence trust in physicians and the health care system. To measure patient perceptions about the prevalence of industry gifts and their relationship to trust in doctors and the health care system. Cross sectional random digit dial telephone survey. African-American and White adults in 40 large metropolitan areas. Respondents' beliefs about whether their physician and physicians in general receive industry gifts, physician trust, and health care system distrust. Overall, 55% of respondents believe their physician receives gifts, and 34% believe almost all doctors receive gifts. Respondents of higher socioeconomic status (income, education) and younger age were more likely to believe their physician receives gifts. In multivariate analyses, those that believe their personal physician receives gifts were more likely to report low physician trust (OR 2.26, 95% CI 1.56-3.30) and high health care system distrust (OR 2.03, 95% CI 1.49-2.77). Similarly, those that believe almost all doctors accept gifts were more likely to report low physician trust (OR 1.69, 95% CI 1.25-2.29) and high health care system distrust (OR 2.57, 95% CI 1.82-3.62). Patients perceive physician-industry gift relationships as common. Patients that believe gift relationships exist report lower levels of physician trust and higher rates of health care system distrust. Greater efforts to limit industry-physician gifts could have positive effects beyond reducing influences on physician behavior.

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Directory of Open Access Journals (Sweden)

Patrice K. Nicholas

2014-01-01

Full Text Available Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013. Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013. This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n=775 that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care.

Access to essential medicines for sexual and reproductive health care: the role of the pharmaceutical industry and international regulation.

Science.gov (United States)

Cottingham, Jane; Berer, Marge

2011-11-01

The range of medicines and technologies that are essential for sexual and reproductive health care is well established, but access to them is far from universally assured, particularly in less developed countries. This paper shows how the pharmaceutical industry plays a major role in the lack of access to essential medicines for sexual and reproductive health care, by a) investing in products for profit-making reasons despite their negative health impact (e.g. hormone replacement therapy), b) marketing new essential medicines at prices beyond the reach of countries that most need them (e.g. HPV vaccines), and c) failing to invest in the development of new products (e.g. microbicides and medical abortion pills). Small companies, some of them non-profit-making, struggle to fill some of that demand (e.g. for female condoms). International patent protection contributes to high prices of medicines, and while international agreements such as compulsory licensing under TRIPS and the Medicines Patent Pool allow for mechanisms to enable poorer countries to get access to essential medicines, the obstacles created by "big pharma" are daunting. All these barriers have fostered a market in sub-standard medicines (e.g. fake medical abortion pills sold over the internet). An agenda driven by sexual and reproductive health needs, based on the right to health, must focus on universal access to essential medicines at prices developing countries can afford. We call for greater public investment in essential medicines, expanded production of affordable generic drugs, and the development of broad strategic plans, that include affordable medicines and technologies, for addressing identified public health problems, such as cervical cancer. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

Science.gov (United States)

Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

2014-10-01

Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

Pharmaceutical and personal care products in domestic wastewater and their removal in anaerobic treatment systems: septic tank - upflow anaerobic filter

OpenAIRE

Arrubla, Juan Pablo; Cubillos, Janneth A.; Ramírez Vargas, Carlos Andrés; Arredondo, Jhon Alexander; Arias, Carlos A.; Paredes, Diego

2016-01-01

In several countries around the world, Pharmaceutical and Personal Care Products (PPCPs) exist in aquatic environments, a fact that increases the awareness within the scientific community with respect to their possible fate and environment effects. This research presents a preliminary monitoring of use, consumption and presence of PPCPs in wastewater from a treatment plant in a rural area of Pereira (Colombia). Domestic sewage is treated in a septic tank followed by an Up-Flow Anaerobic Filte...

Exposure of Medical Students to Pharmaceutical Marketing in Primary Care Settings: Frequent and Influential

Science.gov (United States)

Sarikaya, Ozlem; Civaner, Murat; Vatansever, Kevser

2009-01-01

It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts.…

Chapter 5. Essential equipment, pharmaceuticals and supplies. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

NARCIS (Netherlands)

Sprung, Charles L.; Kesecioglu, Jozef; Christian, Michael D.; Camargo, Ruben; Ceraso, Daniel; Azoulay, Elie; Duguet, Alexandre; Guery, Benoit; Reinhart, Konrad; Adini, Bruria; Barlavie, Yaron; Benin-Goren, Odeda; Cohen, Robert; Klein, Motti; Leoniv, Yuval; Margalit, Gila; Rubinovitch, Bina; Sonnenblick, Moshe; Steinberg, Avraham; Weissman, Charles; Wolff, Donna; de Jong, Menno; Moreno, Rui; An, Youzhong; Du, Bin; Joynt, Gavin M.; Colvin, John; Loo, Shi; Richards, Guy; Artigas, Antonio; Pugin, Jerome; Amundson, Dennis; Devereaux, Asha; Beigel, John; Danis, Marion; Farmer, Chris; Hick, John L.; Maki, Dennis; Masur, Henry; Rubinson, Lewis; Sandrock, Christian; Talmor, Daniel; Truog, Robert; Zimmerman, Janice; Brett, Steve; Montgomery, Hugh; Rhodes, Andrew; Sanderson, Frances; Taylor, Bruce

2010-01-01

To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on essential equipment, pharmaceuticals and supplies. Based on a literature review and expert opinion, a Delphi process was

PHARMACEUTICAL COMPANIES BETWEEN CRISIS AND COMPETITIVENESS - SECTORAL DIAGNOSIS

Directory of Open Access Journals (Sweden)

Mihaela\tBÎRSAN

2015-06-01

Full Text Available The evolution of the pharmaceutical industry was a positive constant with the indicators of industrial production even in years of crisis. Although the economic crisis in Romania decreased average growth rate of pharmaceutical companies, market value is expected to increase. The explanation comes from the fact that in order to boost productivity, pharmaceutical companies are turning to emerging countries with aging populations such as open new markets for future development. Add to this the recent health policies implemented by newly industrialized countries that are aimed at ensuring increased access to care. Analysts see the field phenomenon called "Farma-merger" a good chance for European pharmaceutical companies oriented to developing countries where drug sales should record a double-digit annual growth until 2017. In Erste Group reports stated that the impact of the crisis on the pharmaceutical industry should be limited markets for EU only their economic slowdown. This will be possible because the external indebtedness of pharmaceutical companies in the EU remains at a minimum, they are able to finance their investment plans without tapping financial markets, are not adversely affected by the current limited availability of credit resources. Therefore major pharmaceutical companies in the EU will remain a solid investment on the long term, the negative developments are limited due to high resistance to the crisis their business model segment "generic". The consequence of these developments is reflected in the recognition for the first time, the pharmaceutical sector as a strategic sector for the Romanian economy. In the context of public debate launching the National Strategy for Competitiveness 2014-2020, Generic Medicines Industry Association of Romania (APMGR local pharmaceutical industry reminds the Government proposals on correcting the current fiscal and operational regulatory framework, to allow unlocking investments in facilities

Primary health care to elderly people: Occupational Therapy actions perspectives

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Cassio Batista Alves

2015-09-01

Full Text Available In Brazil, Occupational Therapy (OT was legislated in 1969, and was introduced into the Primary Health Care (PHC in the 90s. At this level of care, the OT serves various stages of human development, including aging, in a perspective of care and active aging line, seeks to optimize opportunities for health, participation and safety, using clinical reasoning in order to plan, guide, conduct and reflect their actions in producing the line of care. This career considers human activities as part of the construction of the man himself as an expertise area and seeks to understand the relationships that the active human establishes in its life and health. This study aimed to verify the actions and identify the occupational therapy line of care with the elderly in APS. This is a qualitative study that used a semi-structured interview applied during April to May 2013 with six occupational therapists that cared for older people in the APS at Uberaba-MG. The data was analyzed using the Collective Subject Discourse (CSD technique. We observed that the OT actions to produce line of care for the elderly happen according to the general public care, whether individual or group, with the team during case discussions, referrals or work management and the territory during the territorial diagnosis and networks formation, all permeated by the principles of fairness, integrity, intersectoriality and clinical reasoning in OT.

Pharmaceutical care in community pharmacies: practice and research in Denmark

DEFF Research Database (Denmark)

Herborg, Hanne; Sørensen, Ellen Westh; Frøkjaer, Bente

2007-01-01

% offer inhalation counseling, a reimbursed service. Research in pharmacy practice is well established and conducted primarily at universities and at Pharmakon A/S, which is owned by the Danish Pharmaceutical Association. DISCUSSION: Extended services in clinical pharmacy are priorities for all Danish...

Burn patient care lost in good manufacturing practices?

Science.gov (United States)

Dimitropoulos, G.; Jafari, P.; de Buys Roessingh, A.; Hirt-Burri, N.; Raffoul, W.; Applegate, L.A.

2016-01-01

Summary Application of cell therapies in burn care started in the early 80s in specialized hospital centers world-wide. Since 2007, cell therapies have been considered as “Advanced Therapy Medicinal Products” (ATMP), so classified by European Directives along with associated Regulations by the European Parliament. Consequently, regulatory changes have transformed the standard linear clinical care pathway into a more complex one. It is important to ensure the safety of cellular therapies used for burn patients and to standardize as much as possible the cell sources and products developed using cell culture procedures. However, we can definitely affirm that concentrating the bulk of energy and resources on the implementation of Good Manufacturing Practice (GMP) alone will have a major negative impact on the care of severely burned patients world-wide. Developing fully accredited infrastructures and training personnel (required by the new directives), along with obtaining approval for clinical trials to go ahead, can be a lengthy process.We discuss whether or not these patients could benefit from cell therapies provided by standard in-hospital laboratories, thus avoiding having to meet rigid regulations concerning the use of industrial pharmaceutical products. “Hospital Exemption” could be a preferred means to offer burn patients a customized and safe product, as many adaptations may be required throughout their treatment pathway. Patients who are in need of rapid treatment will be the ones to suffer the most from regulations intended to help them. PMID:28149232

Mindfulness-based cognitive therapy for recurrent major depression: A 'best buy' for health care?

Science.gov (United States)

Shawyer, Frances; Enticott, Joanne C; Özmen, Mehmet; Inder, Brett; Meadows, Graham N

2016-10-01

While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up. Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost-utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost-utility acceptability curves. Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness

Transport and deposition of cohesive pharmaceutical powders in human airway

Directory of Open Access Journals (Sweden)

Wang Yuan

2017-01-01

Full Text Available Pharmaceutical powders used in inhalation therapy are in the size range of 1-5 microns and are usually cohesive. Understanding the cohesive behaviour of pharmaceutical powders during their transportation in human airway is significant in optimising aerosol drug delivery and targeting. In this study, the transport and deposition of cohesive pharmaceutical powders in a human airway model is simulated by a well-established numerical model which combines computational fluid dynamics (CFD and discrete element method (DEM. The van der Waals force, as the dominant cohesive force, is simulated and its influence on particle transport and deposition behaviour is discussed. It is observed that even for dilute particle flow, the local particle concentration in the oral to trachea region can be high and particle aggregation happens due to the van der Waals force of attraction. It is concluded that the deposition mechanism for cohesive pharmaceutical powders, on one hand, is dominated by particle inertial impaction, as proven by previous studies; on the other hand, is significantly affected by particle aggregation induced by van der Waals force. To maximum respiratory drug delivery efficiency, efforts should be made to avoid pharmaceutical powder aggregation in human oral-to-trachea airway.

Transport and deposition of cohesive pharmaceutical powders in human airway

Science.gov (United States)

Wang, Yuan; Chu, Kaiwei; Yu, Aibing

2017-06-01

Pharmaceutical powders used in inhalation therapy are in the size range of 1-5 microns and are usually cohesive. Understanding the cohesive behaviour of pharmaceutical powders during their transportation in human airway is significant in optimising aerosol drug delivery and targeting. In this study, the transport and deposition of cohesive pharmaceutical powders in a human airway model is simulated by a well-established numerical model which combines computational fluid dynamics (CFD) and discrete element method (DEM). The van der Waals force, as the dominant cohesive force, is simulated and its influence on particle transport and deposition behaviour is discussed. It is observed that even for dilute particle flow, the local particle concentration in the oral to trachea region can be high and particle aggregation happens due to the van der Waals force of attraction. It is concluded that the deposition mechanism for cohesive pharmaceutical powders, on one hand, is dominated by particle inertial impaction, as proven by previous studies; on the other hand, is significantly affected by particle aggregation induced by van der Waals force. To maximum respiratory drug delivery efficiency, efforts should be made to avoid pharmaceutical powder aggregation in human oral-to-trachea airway.

Mitochondrial Replacement Therapy: Halachic Considerations for Enrolling in an Experimental Clinical Trial

Science.gov (United States)

Tendler, Rabbi Moshe D.; Loike, John D.

2015-01-01

The transition of new biotechnologies into clinical trials is a critical step in approving a new drug or therapy in health care. Ethically recruiting appropriate volunteers for these clinical trials can be a challenging task for both the pharmaceutical companies and the US Food and Drug Administration. In this paper we analyze the Jewish halachic perspectives of volunteering for clinical trials by focusing on an innovative technology in reproductive medicine, mitochondrial replacement therapy. The halachic perspective encourages individuals to volunteer for such clinical trials under the ethical principles of beneficence and social responsibility, when animal studies have shown that health risks are minimal. PMID:26241230

Mitochondrial Replacement Therapy: Halachic Considerations for Enrolling in an Experimental Clinical Trial

Directory of Open Access Journals (Sweden)

Rabbi Moshe D. Tendler

2015-07-01

Full Text Available The transition of new biotechnologies into clinical trials is a critical step in approving a new drug or therapy in health care. Ethically recruiting appropriate volunteers for these clinical trials can be a challenging task for both the pharmaceutical companies and the US Food and Drug Administration. In this paper we analyze the Jewish halachic perspectives of volunteering for clinical trials by focusing on an innovative technology in reproductive medicine, mitochondrial replacement therapy. The halachic perspective encourages individuals to volunteer for such clinical trials under the ethical principles of beneficence and social responsibility, when animal studies have shown that health risks are minimal.

The Pharmaceutical Industry Beamline of Pharmaceutical Consortium for Protein Structure Analysis

International Nuclear Information System (INIS)

Nishijima, Kazumi; Katsuya, Yoshio

2002-01-01

The Pharmaceutical Industry Beamline was constructed by the Pharmaceutical Consortium for Protein Structure Analysis which was established in April 2001. The consortium is composed of 22 pharmaceutical companies affiliating with the Japan Pharmaceutical Manufacturers Association. The beamline is the first exclusive on that is owned by pharmaceutical enterprises at SPring-8. The specification and equipments of the Pharmaceutical Industry Beamline is almost same as that of RIKEN Structural Genomics Beamline I and II. (author)

Using portable negative pressure wound therapy devices in the home care setting

Directory of Open Access Journals (Sweden)

Burke JR

2014-12-01

Full Text Available Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy

[Horus: technological innovation in pharmaceutical assistance within the Brazilian unified health system].

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Costa, Karen Sarmento; Nascimento, José Miguel do

2012-12-01

To analyze results of the Horus Information System, comparing elements of this system with some international experiences. Horus is a technological innovation introduced in 2009 in the Pharmaceutical management information system of the Sistema Único de Saúde (Brazilian Unified Health System). In 2011, local managers and health professionals of 1,247 municipalities (16 states) that adhered to Horus answered questionnaires on pharmaceutical assistance in primary care and about the Horus system. This is a descriptive and exploratory study, developed with the use of quantitative and qualitative methods of research. Multivariate tools were used for data collection and interpretative support of the statistical inference and thematic analysis. The main changes identified after the implementation of this system were: improvement on technical and scientific quality control of Pharmaceutical Assistance, improvement on the supply of medications and health care; training of human resources and knowledge management; improvement on the relationship health managers/users; development in the administrative management and greater inter-state management; and improvement on the technological infrastructure. In terms of health information systems, these categories are consistent with programs and obstacles observed in international experiences. The biggest gap identified was the fact that Horus was not included in a national policy of health information systems, which is in a process of consolidation in Brazil. The national database of actions and services within the Pharmaceutical Assistance will enable the collection, analysis and dissemination of information regarding integrated pharmaceutical assistance in the Brazilian context. The Horus System is a technological innovation that enables the management of the Pharmaceutical Assistance. The national base will enable the definition and agreement on national indicators of Pharmaceutical Assistance, aiming to produce evidence of

Seeking optimal renal replacement therapy delivery in intensive care units.

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Kocjan, Marinka; Brunet, Fabrice P

2010-01-01

Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.

Removal of pharmaceuticals in WWTP effluents by ozone and ...

African Journals Online (AJOL)

2013-02-12

Feb 12, 2013 ... discharge of effluents by wastewater treatment plants (WWTPs) that are not ... The efficiency of ozone in removing pharmaceuticals and personal care ...... assessment and modeling of an ozonation step for full-scale munic-.

Horticultural therapy in dementia care: a literature review.

Science.gov (United States)

Blake, Marianne; Mitchell, Gary

2016-01-20

Aim To present a narrative review of the empirical literature on the use of horticultural therapy in dementia care. Method A comprehensive literature search, conducted in December 2014, resulted in the selection of 15 primary research articles for review. Of these, three used qualitative methods, five used quantitative methods and seven used mixed methodology. The articles were critically appraised, and the narrative synthesis used a thematic approach whereby prominent themes from the articles were grouped to form representative themes. Findings Three main themes emerged from the narrative synthesis: the emotional health of people living with dementia, their perceived self-identity and their levels of engagement. Conclusion Horticultural therapy can be beneficial. At a macro-level, it is an inexpensive therapy that does not require specialist training to deliver. At a micro-level, it enhances the wellbeing of people living with dementia. Recommendations are made to promote access to appropriate horticultural therapy for people living with dementia, and for further research in this area.

On-Year Study on Pattern of Acute Pharmaceutical and Chemical Poisoning Cases Admitted to a Tertiary Care Hospital in Thrissur, India

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Padmakumar Krishnankutty Nair

2015-06-01

Full Text Available Background: Identification of regional pattern of poisoning is essential for health care authorities for proper planning on prevention programs and optimized management of antidote stockpiles. This study was designed to evaluate one-year epidemiologic pattern of acute poisoning cases treated at a tertiary care hospital in Thrissur, India. Methods: In this retrospective cross sectional study, medical records of patients with the diagnosis of acute pharmaceutical and chemical poisoning admitted to Jubilee Mission Hospital (JMH, during 1st October 2012 to 30th September 2013 were reviewed. Results: During the study period, 168 poisoned patients (59.5% women were treated at emergency department of JMH. Married patients outnumbered unmarried ones (55.4% vs. 44.6%. The highest number of patients aged 21 to 30 years (31.5% followed by patients with 11-20 years of age (17.3%. Most of the poisonings occurred following suicidal ideation (72.6%. Familial disharmony (14.3% was the most common reason behind suicidal ingestions, followed by mental disorders (11.3%. Drug poisoning made up the largest proportion of poisoning-related admissions (43.5% followed by pesticide poisoning (37.5%. Among poisoning with pharmaceutical agents, most cases were due to paracetamol (13.7% followed by anti-psychotics and sedatives (5.4%. In pesticide poisonings, the most common classes ingested by the patients were rodenticides and organophosphates. The most common household items ingested by the patients were petroleum products. The average length of hospital stay was 5.5 days. Seven patients (4.2% died, of which 4 were due to organophosphates followed by 2 due to carbamates and one due to rodenticide ingestion. Conclusion: Pharmaceutical and pesticide products were identified as the main cause of poisoning. This finding warrants educational programs for adequate safety measures on storage and use of these substances.

Coming Soon to a Physician Near You: Medical Neoliberalism and Pharmaceutical Clinical Trials.

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Fisher, Jill A

2007-01-01

This paper aims to expand standard conceptions of current ethical issues by discussing pharmaceutical clinical trials in terms of the broader political economy. Specifically, it explores one important characteristic of the political economy in the United States: the trend towards the neoliberalization of health care. First, it provides an overview of neoliberalism and its manifestations in the health care sector. Then, it applies this perspective to pharmaceutical drug development. The paper argues that federal regulation must attend to the context of clinical research to protect human subjects more fully.

Production cost structure in US outpatient physical therapy health care.

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Lubiani, Gregory G; Okunade, Albert A

2013-02-01

This paper investigates the technology cost structure in US physical therapy care. We exploit formal economic theories and a rich national data of providers to tease out implications for operational cost efficiencies. The 2008-2009 dataset comprising over 19 000 bi-weekly, site-specific physical therapy center observations across 28 US states and Occupational Employment Statistics data (Bureau of Labor Statistics) includes measures of output, three labor types (clinical, support, and administrative), and facilities (capital). We discuss findings from the iterative seemingly unrelated regression estimation system model. The generalized translog cost estimates indicate a well-behaved underlying technology structure. We also find the following: (i) factor demands are downwardly sloped; (ii) pair-wise factor relationships largely reflect substitutions; (iii) factor demand for physical therapists is more inelastic compared with that for administrative staff; and (iv) diminishing scale economies exist at the 25%, 50%, and 75% output (patient visits) levels. Our findings advance the timely economic understanding of operations in an increasingly important segment of the medical care sector that has, up-to-now (because of data paucity), been missing from healthcare efficiency analysis. Our work further provides baseline estimates for comparing operational efficiencies in physical therapy care after implementations of the 2010 US healthcare reforms. Copyright © 2012 John Wiley & Sons, Ltd.

Pharmaceutical counseling: Between evidence-based medicine and profits.

Science.gov (United States)

Egorova, S N; Akhmetova, T

2015-01-01

The number of pharmacies, which produce drug formulations locally, has recently considerably reduced in Russia. Pharmacies mainly operate as retailers of industrially manufactured drugs.Pharmaceutical consultation of customers at pharmacies aimed at responsible self-medication is the most popular and accessible feature of pharmaceutical care. In Russia there is a significant list of medicines approved for sale in pharmacies on a non-prescription basis that is specified in the product label. In this regard, the role of pharmacists in public health in Russia increases. Pharmacist, working directly with population, is an important figure for the rational use of medicines. This type of work requires high level of professional training and appropriate ethics. To explore the current status of pharmaceutical counseling in Russia. Situation analysis, surveys of pharmacists. Our experience in the system of postgraduate professional education, the results of the survey of pharmacists, and the long-term dialogue with pharmacists allowed us to identify several unresolved issues in the work of a pharmacist selling non-prescription drugs.Lack of differentiation in the functions of a pharmacist with a higher education and pharmaceutical technologist: In production/industrial pharmacy technicians are engaged in manufacturing of pharmaceutical formulations. However, due to the loss of production functions technologists had to move away from production laboratories of apothecaries to the sales area. Currently, the apothecary's assignment to receive prescriptions and dispense medications can be fulfilled by either a pharmacist or a pharmaceutical technician. It significantly discerns the pharmacy from the medical organization with clearly delineated functions of doctors and nurses. Russian regulations should consider the level of education required for high-quality pharmaceutical counseling.Contradiction between the pharmacist's special functions and trade procedure with the lack of

Parents' Voices Supporting Music Therapy within Pediatric Palliative Care

OpenAIRE

Kathryn Lindenfelser

2005-01-01

It has been my experience that parents are willing and open to express their voices to promote and advocate for music therapy services for their terminally ill children. By listening to parents' voices when providing care for terminally ill children, much can be done to ease the suffering of children and families at the end of life (Widger & Wilkins, 2004). My music therapy masters research at the University of Melbourne with Dr. Katrina McFerran will investigate bereaved parents' experie...

Pharmaceutical cost control in primary care: opinion and contributions by healthcare professionals

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Oliván-Blázquez Bárbara

2009-11-01

Full Text Available Abstract Background Strategies adopted by health administrations and directed towards drug cost control in primary care (PC can, according to earlier studies, generate tension between health administrators and healthcare professionals. This study collects and analyzes the opinions of general practitioners (GPs regarding current cost control measures as well as their proposals for improving the effectiveness of these measures. Methods A qualitative exploratory study was carried out using 11 focus groups composed of GPs from the Spanish regions of Aragon, Catalonia and the Balearic Islands. A semi-structured guide was applied in obtaining the GPs' opinions. The transcripts of the dialogues were analyzed by two investigators who independently considered categorical and thematic content. The results were supervised by other members of the team, with overall responsibility assigned to the team leader. Results GPs are conscious of their public responsibility with respect to pharmaceutical cost, but highlight the need to spread responsibility for cost control among the different actors of the health system. They insist on implementing measures to improve the quality of prescriptions, avoiding mere quantitative evaluations of prescription costs. They also suggest moving towards the self-management of the pharmaceutical budget by each health centre itself, as a means to design personalized incentives to improve their outcomes. These proposals need to be considered by the health administration in order to pre-empt the feelings of injustice, impotence, frustration and lack of motivation that currently exist among GPs as a result of the implemented measures. Conclusion Future investigations should be oriented toward strategies that involve GPs in the planning and management of drug cost control mechanisms. The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns

Incorporating Yoga Therapy into Primary Care: The Casey Health Institute.

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Ross, Alyson; Williams, Laurie; Pappas-Sandonas, Mary; Touchton-Leonard, Katharine; Fogel, David

2015-01-01

Individuals seek complementary and alternative medicine (CAM) for a variety of health conditions, and yoga is a popular CAM modality. Over the past few decades, yoga has become incorporated into hundreds of healthcare facilities, most commonly in large university medical centers. While research has shown yoga to be effective in reducing symptoms and improving outcomes in chronic health conditions, most patients seek yoga therapy on their own, as few primary care practitioners have incorporated yoga therapy into their practices. The purpose of this article is to describe the efforts of the Casey Health Institute to incorporate yoga therapy into their primary care integrative medicine center. At Casey Health, a full-time Clinical Yoga Specialist works alongside the physicians, nurses, and CAM providers in delivering care to a wide variety of patients. The majority of referrals to yoga therapy have been for pain-related musculoskeletal conditions, as well as hypertension, headaches, anxiety, depression, and sleep disturbances. Most patients attend weekly 60-minute individual sessions, and the Clinical Yoga Specialist stays in touch with the patient between appointments via telephone and email. T h e Clinical Yoga Specialist has become an integral part of Casey Health, participating in collaborative medical appointments in which two CAM practitioners provide simultaneous treatments to a patient. She also participates in the clinic's ongoing weight loss program. The Clinical Yoga Specialist spends one morning each week "floating" in the clinic, when she is on-call to the practitioners to assist in treatment and/or to introduce a yoga therapy experience to the patients. These brief interventions introduce the patients to the therapeutic benefits of yoga, while simultaneously demonstrating yoga's effectiveness to the healthcare providers. Casey Health has developed a unique teacher training program whose faculty includes senior Iyengar yoga teachers as well as physicians

[AIDS and social justice: pharmaceutical industry and economics].

Science.gov (United States)

López Guzmán, José

2008-01-01

This article takes a broad look at the complicated framework of relationships between the third world and pharmaceutical companies. In the first part of the work reference is made to the poverty of these countries, their lack of education in terms of health, the scarcity of basic hygiene, and their greatly limited access to medicines, especially those for treating AIDS. The article then proceeds to the issue of the pharmaceutical companies' degree of responsibility for the reduced availability of medicines in certain areas of the world. One of the factors that most limits access to medicines is their price, and many sectors of society propose taking action on the patents of drugs (rescinding or limiting them) in order to lower their price. However, the problem of patent exemption is more complicated than it seems at first glance, and comes with its own risks. If, for lack of funds or the uncertainty concerning a return on the capital invested, pharmaceutical companies discontinue research and development of new drugs, AIDS therapy would worsen. It is imperative and urgent to develop new drugs against the AIDS because of its resistance to the drugs currently available. The article concludes with the pharmaceutical industry's effort to look for possible forms of collaboration with developing countries.

Nurse attitudes towards the use of complementary and alternative therapies in critical care.

Science.gov (United States)

Tracy, Mary Fran; Lindquist, Ruth; Watanuki, Shigeaki; Sendelbach, Sue; Kreitzer, Mary Jo; Berman, Brian; Savik, Kay

2003-01-01

There is increasing demand for complementary/alternative therapies (CAT) in critical care, however, critical care nurses' perspectives regarding CAT are unknown. This study was conducted to determine critical care nurses' knowledge, attitudes, and use of CAT. A total of 348 critical care registered nurses working at least 40% in medical, surgical, cardiac, neurological, and pediatric ICUs at 2 tertiary-level hospitals in a large Midwestern city were surveyed. One hospital is a 926-bed private, urban hospital and the second is an 1868-bed academic-affiliated medical center. A survey was distributed to all critical care nurses described above. The level of knowledge reported by 138 nurse respondents was greatest for diet, exercise, massage, prayer, and music therapy. Use of therapies was related to knowledge and training and consistent with beliefs of legitimacy and perceptions of beneficial effects. Despite barriers including lack of knowledge, time, and training, 88% of respondents were open or eager to use CAT, and 60% reported moderate or greater desire to use CAT. Critical care nurses are open to CAT use and many use them in their own practice. Because use was associated with knowledge, recommendations for future research include increasing the scientific base and enhancing knowledge to promote evidence-based incorporation of CAT in practice.

Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status.

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Maniadakis, N; Kourlaba, G; Shen, J; Holtorf, A

2017-05-25

Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country's income status. A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Pharmaceutical policies are linked to a country's socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price-cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries.

Pharmaceuticals and personal care products in waters: occurrence, toxicity, and risk.

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Cizmas, Leslie; Sharma, Virender K; Gray, Cole M; McDonald, Thomas J

2015-12-01

Pharmaceuticals and personal care products (PPCP) are compounds with special physical and chemical properties that address the care of animal and human health. PPCP have been detected in surface water and wastewater in the ng/L to µg/L concentration range worldwide. PPCP ecotoxicity has been studied in a variety of organisms, and multiple methods have been used to assess the risk of PPCP in the environment to ecological health. Here we review the occurrence, effects, and risk assessment of PPCP in aquatic systems, as well as the sustainability of current methods for managing PPCP contamination in aquatic systems. The major points are the following: (1) a number of PPCP present potential concerns at environmentally relevant concentrations. PPCP mixtures may produce synergistic toxicity. (2) Various methods have been used for the ecological risk assessment of PPCP in aquatic systems. There are similarities in these methods, but no consensus has emerged regarding best practices for the ecological risk assessment of these compounds. (3) Human health risk assessments of PPCP contamination in aquatic systems have generally indicated little cause for concern. However, there is a lack of information regarding whether antibiotic contamination in wastewater and aquatic systems could lead to an increase in clinically relevant antibiotic-resistant bacteria and antibiotic-resistant genes. (4) Over the next century, the combination of increasing global population size and potential droughts may result in reduced water availability, increased need for water reuse, and increasing concentrations of PPCP in wastewaters. The current wastewater treatment methods do not remove all PPCP effectively. This, coupled with the possibility that antibiotics may promote the development of antibiotic-resistant bacteria and antibiotic-resistant genes, leads to concerns about the sustainability of global water supplies.

Methodological substantiation of the professional functions of Responsible persons of pharmaceutical and hospital institutions

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N. O. Vetiutneva

2018-03-01

Full Text Available The aim of the work is the content analysis and methodological justification of the professional functions of the Responsible persons for quality assurance of medicines in pharmaceutical and hospital institutions. Materials and methods. The following research methods were used: system and comparative analysis, generalization, systematization, graphic modeling, observation. Research materials: normative legal acts, normative documents, recommendations of international organizations, information of wholesale and retail pharmaceutical companies, pharmaceutical and hospital institutions, professional non-governmental organizations, placed on official web-sites and collected in the process of direct observation. Results. The personnel and qualification aspects of professional activity of Responsible persons of pharmaceutical and hospital institutions were discussed. On the basis of analysis of the modern legal and regulatory framework, a general list of professional functions of the Responsible persons of health care institutions had been formed. The content analysis and comparison of the number of the functions of Responsible persons performed in health care institutions of different types is carried out. The new functions of the Responsible persons of health care institutions are considered. The managerial nature of the professional functions of the Responsible persons and the expediency of their complementing with the leadership functions are substantiated. On the basis of international management standards, requirements of GPP and GPEP, systematization of the functions of the Responsible persons of health care institutions in the groups and subgroups was performed. Conclusions. The generalization and systematization of the professional functions of the Responsible persons of health care institutions had been carried out for five classification groups of functions, namely: leadership, planning, organizational, control and information, of which the

Patterns of care in radiation therapy of adenocarcinoma of the endometrium

International Nuclear Information System (INIS)

Luk, K.H.; Fuller, D.E.; Kramer, S.; Davis, L.W.; Herring, D.F.; Delclos, L.; Dobelbower, R.R.; Lustig, R.

1980-01-01

In 1974 the Patterns of Care Study began investigating radiation therapy of endometrial cancers in the United States. This endeavor required development of a methodology to survey the care of patients who had similar disease and who were treated at various institutions. Analysis of 919 questionnaires revealed a substantial difference nationwide in treatment approaches to this site. Outcome studies and ongoing research projects, combined with this survey of Patterns of Care, can provide a sound base for educational efforts to improve patient care

Wound care matrices for chronic leg ulcers: role in therapy

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Sano H

2015-07-01

Full Text Available Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed “extracellular matrix replacement therapies”. The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use

An evaluation of the adequacy of pharmaceutical services for the ...

African Journals Online (AJOL)

Background: With the introduction of nurse-initiated and -managed antiretroviral therapy (NIMART), new challenges have emerged with regard to the prescribing and dispensing of ART by nurses. One of the key challenges is ensuring adequate pharmaceutical services at PHC clinics. Objective: The objective of the study ...

APPLICATION OF U.S. EPA METHODS TO THE ANALYSIS OF PHARMACEUTICALS AND PERSONAL CARE PRODUCTS IN THE ENVIRONMENT: DETERMINATION OF CLOFIBRIC ACID IN SEWAGE EFFLUENT BY GC-MS

Science.gov (United States)

An emerging area of research concerns pharmaceuticals and personal care products in the environment and their possible impact on biota and ecosystems. The long term effects of constant perfusion of PPCPs into the aquatic environment are presently unknown. Some compoun...

Tropical Journal of Pharmaceutical Research - Vol 16, No 1 (2017)

African Journals Online (AJOL)

Tropical Journal of Pharmaceutical Research. ... in vitro evaluation of their biocompatibility with rheumatoid arthritis macrophages (RAW 264.7) ... impact of returned intravenous medications at a tertiary care hospital in Riyadh, Saudi Arabia ...

Clinical Impact of a Pharmaceutical Care Programme Developed in a Family Health Unit: Results of a Pharmacist-Physician Collaboration in the Treatment of Hypertensive Patients

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Mónica Condinho

2016-07-01

Full Text Available Introduction: The positive impact of pharmacist-physician collaborative care has been reported in the international literature, although examples of this impact are limited in Portugal. We aim to underline the clinical added value for hypertensive patients that results from pharmacist-physician collaborations. Methods: A community trial was conducted at a Portuguese family health unit for 19 months. The intervention group was randomly selected from the global records and members of the group received pharmaceutical care in addition to physician care. The comparison group received only physician care. Both groups were comparable at the beginning of the study. In the intervention group, we analysed the hypertensive patients to evaluate the impact of pharmacist-physician collaboration on the patients’ blood pressure levels. This evaluation was performed by comparing the obtained blood pressure levels with the levels at baseline and between the groups. Results: A total of 17 patients with hypertension were enrolled in the pharmaceutical care programme, 12 of whom were female. The mean age was 68.50±3.26 years and, on average, each patient consumed 6.06±0.93 medicinal products. Thirteen patients were uncontrolled. Compared with the baseline, the intervention group achieved mean reductions of 28.85±5.90 mmHg (p < 0.0005 and 11.23±2.75 mmHg (p < 0.005 in their systolic and diastolic blood pressure, respectively. Considering the comparison group, improvements of 18.63±6.44 mmHg (p = 0.011 in systolic blood pressure and 9.03±2.63 mmHg ( p < 0.005 in diastolic blood pressure were observed. Conclusion: Pharmacist-physician collaborative care adds clinical value to the typical physician care provided to hypertensive patients within the context of a Portuguese family health unit.

Basic pharmaceutical technology

OpenAIRE

Angelovska, Bistra; Drakalska, Elena

2017-01-01

The lecture deals with basics of pharmaceutical technology as applied discipline of pharmaceutical science, whose main subject of study is formulation and manufacture of drugs. In a broad sense, pharmaceutical technology is science of formulation, preparation, stabilization and determination of the quality of medicines prepared in the pharmacy or in pharmaceutical industry

A evolução da Atenção Farmacêutica e a perspectiva para o Brasil The evolution of pharmaceutical care and the prospect for the Brazil

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Leonardo Régis Leira Pereira

2008-12-01

Full Text Available Atenção Farmacêutica, prática recente da atividade farmacêutica, prioriza a orientação e o acompanhamento farmacoterapêutico e a relação direta entre o farmacêutico e o usuário de medicamentos. Na maioria dos países desenvolvidos a Atenção Farmacêutica já é realidade e tem demonstrado ser eficaz na redução de agravamentos dos portadores de patologias crônicas e de custos para o sistema de saúde. No Brasil, esta atividade ainda é incipiente e alguns fatores dificultam sua implantação, entre outros, a dificuldade de acesso ao medicamento por parte dos usuários do Sistema Único de Saúde (SUS, Unidades Básicas de Saúde sem farmacêutico e a ausência de documentação científica que possibilite demonstrar aos gestores do sistema público e privado que a implementação da Atenção Farmacêutica representa investimento e não custo. Por outro lado, sendo nova atividade do profissional farmacêutico, torna-se primordial que as instituições de ensino farmacêutico promovam adaptações curriculares, de modo a fornecer o conhecimento formal necessário ao desempenho desta atividade. Esta revisão discute a Atenção Farmacêutica nos países em que esta se encontra mais evoluída e teve como base a busca de artigos publicados nos periódicos indexados no MedLine/Pubmed (www.ncbi.nlm.nih.gov/PubMed até 31/12/2007. Com a revisão bibliográfica foi possível comparar com outros países as dificuldades encontradas no Brasil, para a implantação e implementação da Atenção Farmacêutica e as perspectivas para a sedimentação dessa prática no futuro.The Pharmaceutical Care, recent practice of the pharmaceutical activity, prioritizes the orientation and the pharmacotherapeutic follow up, besides direct relation among the pharmacist and the medicine's user. In most developed countries the Pharmaceutical Care is already a reality and has demonstrated efficacy in the reduction of aggravation in the chronical diseases and

Uptake of pharmaceutical and personal care products by soybean plants from soils applied with biosolids and irrigated with contaminated water.

Science.gov (United States)

Wu, Chenxi; Spongberg, Alison L; Witter, Jason D; Fang, Min; Czajkowski, Kevin P

2010-08-15

Many pharmaceuticals and personal care products (PPCPs) are commonly found in biosolids and effluents from wastewater treatment plants. Land application of these biosolids and the reclamation of treated wastewater can transfer those PPCPs into the terrestrial and aquatic environments, giving rise to potential accumulation in plants. In this work, a greenhouse experiment was used to study the uptake of three pharmaceuticals (carbamazepine, diphenhydramine, and fluoxetine) and two personal care products (triclosan and triclocarban) by an agriculturally important species, soybean (Glycine max (L.) Merr.). Two treatments simulating biosolids application and wastewater irrigation were investigated. After growing for 60 and 110 days, plant tissues and soils were analyzed for target compounds. Carbamazepine, triclosan, and triclocarban were found to be concentrated in root tissues and translocated into above ground parts including beans, whereas accumulation and translocation for diphenhydramine and fluoxetine was limited. The uptake of selected compounds differed by treatment, with biosolids application resulting in higher plant concentrations, likely due to higher loading. However, compounds introduced by irrigation appeared to be more available for uptake and translocation. Degradation is the main mechanism for the dissipation of selected compounds in biosolids applied soils, and the presence of soybean plants had no significant effect on sorption. Data from two different harvests suggest that the uptake from soil to root and translocation from root to leaf may be rate limited for triclosan and triclocarban and metabolism may occur within the plant for carbamazepine.

Care of the patient receiving radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Yasko, J.M.

1982-12-01

External radiation therapy, or teletherapy, is the use of ionizing radiation to destroy cancer cells. Clinical use of ionizing radiation as treatment for cancer began with the discovery of x-rays in 1895, the identification of natural radioactivity (radium) in 1896, and the first reported cure of cancer, a basal cell epithelioma, induced by radiation in 1899. Initially, radiation was administered as a single large dose and produced severe, life-threatening side effects. The basis for the use of ionizing radiation in daily increments for a period of weeks was provided by Regaud in 1922; ten years later, Coutard clinically developed the method of dose fractionation, which remains in use today. Although the use of ionizing radiation as a treatment is over eighty years old, only in recent years have advancements in its clinical application been based on research related to the biologic effect of radiation on human cells. To effectively care for the patient prior to, during, and at the completion of external radiation therapy, the nurse must know the physical and biologic basis of external radiation therapy and its clinical application.

Care of the patient receiving radiation therapy

International Nuclear Information System (INIS)

Yasko, J.M.

1982-01-01

External radiation therapy, or teletherapy, is the use of ionizing radiation to destroy cancer cells. Clinical use of ionizing radiation as treatment for cancer began with the discovery of x-rays in 1895, the identification of natural radioactivity (radium) in 1896, and the first reported cure of cancer, a basal cell epithelioma, induced by radiation in 1899. Initially, radiation was administered as a single large dose and produced severe, life-threatening side effects. The basis for the use of ionizing radiation in daily increments for a period of weeks was provided by Regaud in 1922; ten years later, Coutard clinically developed the method of dose fractionation, which remains in use today. Although the use of ionizing radiation as a treatment is over eighty years old, only in recent years have advancements in its clinical application been based on research related to the biologic effect of radiation on human cells. To effectively care for the patient prior to, during, and at the completion of external radiation therapy, the nurse must know the physical and biologic basis of external radiation therapy and its clinical application

Pharmaceuticals and personal care products (PPCPs): a review on environmental contamination in China.

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Liu, Jin-Lin; Wong, Ming-Hung

2013-09-01

Pharmaceuticals and personal care products (PPCPs) which contain diverse organic groups, such as antibiotics, hormones, antimicrobial agents, synthetic musks, etc., have raised significant concerns in recently years for their persistent input and potential threat to ecological environment and human health. China is a large country with high production and consumption of PPCPs for its economic development and population growth in recent years. This may result in PPCP contamination in different environmental media of China. This review summarizes the current contamination status of different environment media, including sewage, surface water, sludge, sediments, soil, and wild animals, in China by PPCPs. The human body burden and adverse effects derived from PPCPs are also evaluated. Based on this review, it has been concluded that more contamination information of aquatic environment and wildlife as well as human body burden of PPCPs in different areas of China is urgent. Studies about their environmental behavior and control technologies need to be conducted, and acute and chronic toxicities of different PPCP groups should be investigated for assessing their potential ecological and health risks. © 2013.

Pharmaceuticals and personal care products in the aquatic environment in China: a review.

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Bu, Qingwei; Wang, Bin; Huang, Jun; Deng, Shubo; Yu, Gang

2013-11-15

Pharmaceuticals and personal care products (PPCPs) have been detected as contaminants of emerging concern ubiquitously in the aquatic environment in China and worldwide. A clear picture of PPCP contamination in the Chinese aquatic environment is needed to gain insight for both research and regulatory needs (e.g. monitoring, control and management). The occurrence data of 112 PPCPs in waters and sediments in China has been reviewed. In most cases, the detected concentration of these PPCPs in waters and sediments were at ng/L and ng/g levels, which were lower than or comparable to those reported worldwide. A screening level risk assessment (SLERA) identified six priority PPCPs in surface waters, namely erythromycin, roxithromycin, diclofenac, ibuprofen, salicylic acid and sulfamethoxazole. The results of SLERA also revealed that the hot spots for PPCP pollution were those river waters affected by the megacities with high density of population, such as Beijing, Tianjin, Guangzhou and Shanghai. Limitations of current researches and implications for future research in China were discussed. Some regulatory issues were also addressed. Copyright © 2013 Elsevier B.V. All rights reserved.

Effects of three pharmaceutical and personal care products on natural freshwater algal assemblages.

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Wilson, Brittan A; Smith, Val H; deNoyelles, Frank; Larive, Cynthia K

2003-05-01

Treated wastewaters in the United States contain detectable quantities of surfactants, antibiotics, and other types of antimicrobial chemicals contained in pharmaceutical and personal-care products (PPCPs) that are released into stream ecosystems. The degradation characteristics of many of these chemicals are not yet known, nor are the chemical properties of their byproducts. They also are not currently mandated for removal under the U.S. Clean Water Act. Three representative PPCPs were individually tested in this study using a series of laboratory dilution bioassays: Ciprofloxacin (an antibiotic), Triclosan (an antimicrobial agent), and Tergitol NP 10 (a surfactant), to determine their effects on natural algal communities sampled both upstream and downstream of the Olathe, KS wastewater treatment plant (WWTP). There were no significant treatment effects on algal community growth rates during the exponential phase of growth, but significant differences were observed in the final biomass yields (p WWTP effluents. These changes could result in shifts in both the nutrient processing capacity and the natural food web structure of these streams.

Unhealthy marketing of pharmaceutical products: An international public health concern.

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Mulinari, Shai

2016-05-01

I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care.

Music Therapy as a Caring Intervention: Swedish Musicians Learning a New Professional Field

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Petersson, Gunnar; Nystrom, Maria

2011-01-01

The question of competence in providing music therapy has rarely been the focus of interest in empirical research, as most music therapy research aims at measuring outcomes. Therefore, the aim of this study is to analyse and describe musicians' learning processes when they study music therapy as a caring intervention. An initial presumption is…

Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

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Fogelberg, Donald J.; Halle, Ashley D.; Mroz, Tracy M.

2017-01-01

One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system. PMID:28027031

Eva between anxiety and hope: integrating anthroposophic music therapy in supportive oncology care

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Eran Ben-Arye

2015-11-01

Full Text Available Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient’s involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients’ supportive care.

Pharmaceuticals, political money, and public policy: a theoretical and empirical agenda.

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Jorgensen, Paul D

2013-01-01

Why, when confronted with policy alternatives that could improve patient care, public health, and the economy, does Congress neglect those goals and tailor legislation to suit the interests of pharmaceutical corporations? In brief, for generations, the pharmaceutical industry has convinced legislators to define policy problems in ways that protect its profit margin. It reinforces this framework by selectively providing information and by targeting campaign contributions to influential legislators and allies. In this way, the industry displaces the public's voice in developing pharmaceutical policy. Unless citizens mobilize to confront the political power of pharmaceutical firms, objectionable industry practices and public policy will not change. Yet we need to refine this analysis. I propose a research agenda to uncover pharmaceutical influence. It develops the theory of dependence corruption to explain how the pharmaceutical industry is able to deflect the broader interests of the general public. It includes empirical studies of lobbying and campaign finance to uncover the means drug firms use to: (1) shape the policy framework adopted and information used to analyze policy; (2) subsidize the work of political allies; and (3) influence congressional voting. © 2013 American Society of Law, Medicine & Ethics, Inc.

A project investigating music therapy referral trends within palliative care: an Australian perspective.

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Horne-Thompson, Anne; Daveson, Barbara; Hogan, Bridgit

2007-01-01

The purpose of this project is to analyze music therapy (MT) referral trends from palliative care team members across nine Australian inpatient and community-based palliative care settings. For each referral 6 items were collected: referral source, reason and type; time from Palliative Care Program (PCP) admission to MT referral; time from MT referral to death/discharge; and profile of referred patient. Participants (196 female, 158 male) were referred ranging in age from 4-98 years and most were diagnosed with cancer (91%, n = 323). Nurses (47%, n = 167) referred most frequently to music therapy. The mean average time in days for all referrals from PCP admission to MT referral was 11.47 and then 5.19 days to time of death. Differences in length of time to referral ranged from 8.19 days (allied health staff) to 43.75 days (families). Forty-eight percent of referrals (48.5%, n = 172) were completed when the patient was rated at an Eastern Cooperative Oncology Group Performance (ECOG) of three. Sixty-nine percent (n = 244) were living with others at the time of referral and most were Australian born. Thirty-six percent (36.7%, n = 130) were referred for symptom-based reasons, and 24.5% (n = 87) for support and coping. Implications for service delivery of music therapy practice, interdisciplinary care and benchmarking of music therapy services shall be discussed.

Pharmaceutical services cost analysis using time-driven activity-based costing: A contribution to improve community pharmacies' management.

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Gregório, João; Russo, Giuliano; Lapão, Luís Velez

2016-01-01

The current financial crisis is pressing health systems to reduce costs while looking to improve service standards. In this context, the necessity to optimize health care systems management has become an imperative. However, little research has been conducted on health care and pharmaceutical services cost management. Pharmaceutical services optimization requires a comprehensive understanding of resources usage and its costs. This study explores the development of a time-driven activity-based costing (TDABC) model, with the objective of calculating the cost of pharmaceutical services to help inform policy-making. Pharmaceutical services supply patterns were studied in three pharmacies during a weekday through an observational study. Details of each activity's execution were recorded, including time spent per activity performed by pharmacists. Data on pharmacy costs was obtained through pharmacies' accounting records. The calculated cost of a dispensing service in these pharmacies ranged from €3.16 to €4.29. The cost of a counseling service when no medicine was supplied ranged from €1.24 to €1.46. The cost of health screening services ranged from €2.86 to €4.55. The presented TDABC model gives us new insights on management and costs of community pharmacies. This study shows the importance of cost analysis for health care services, specifically on pharmaceutical services, in order to better inform pharmacies' management and the elaboration of pharmaceutical policies. Copyright © 2016 Elsevier Inc. All rights reserved.

Idea management in support of pharmaceutical front end innovation

DEFF Research Database (Denmark)

Aagaard, Annabeth

2012-01-01

The pharmaceutical industry faces continuing pressures from rising R&D costs and depreciating value of patents, as patent lives is eroded by testing procedures and pressures from public authorities to cut health care costs. These challenges have increased the focus on shortening development times......, which again put pressure on the efficiency of front end innovation (FEI). In the attempt to overcome these various challenges pharmaceutical companies are looking for new models to support FEI. This paper explores in what way idea management can be applied as a tool in facilitation of front end...... innovation in practice. First I show through a literature study, how idea management and front end innovation are related and may support each other. Hereafter I apply an exploratory case study of front end innovation in eight medium to large pharmaceutical companies in examination of how idea management...

Integrative therapies for low back pain that include complementary and alternative medicine care: a systematic review.

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Kizhakkeveettil, Anupama; Rose, Kevin; Kadar, Gena E

2014-09-01

Systematic review of the literature. To evaluate whether an integrated approach that includes different Complementary and Alternative Medicine (CAM) therapies combined or CAM therapies combined with conventional medical care is more effective for the management of low back pain (LBP) than single modalities alone. LBP is one of the leading causes of disability worldwide, yet its optimal management is still unresolved. The PRISMA Statement guidelines were followed. The Cochrane Back Review Group scale was used to rate the quality of the studies found. Twenty-one studies were found that met the inclusion criteria. The CAM modalities used in the studies included spinal manipulative therapy, acupuncture, exercise therapy, physiotherapy, massage therapy, and a topical ointment. Twenty studies included acupuncture and/or spinal manipulative therapy. Nine high quality studies showed that integrative care was clinically effective for the management of LBP. Spinal manipulative therapy combined with exercise therapy and acupuncture combined with conventional medical care or with exercise therapy appears to be promising approaches to the management of chronic cases of LBP. There is support in the literature for integrated CAM and conventional medical therapy for the management of chronic LBP. Further research into the integrated management of LBP is clearly needed to provide better guidance for patients and clinicians.

Developing relationships between care staff and people with dementia through Music Therapy and Dance Movement Therapy: A preliminary phenomenological study.

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Melhuish, Ruth; Beuzeboc, Catherine; Guzmán, Azucena

2017-04-01

Background There is an increasing focus on providing effective psychosocial interventions to improve quality of life in dementia care. This study aims to explore the attitudes and perceptions of staff who participated regularly in Music Therapy (MT) and Dance Movement Therapy (DMT) groups for residents with dementia in a nursing home. Method In-depth interviews were conducted with seven members of care home staff. Data were analysed using interpretative phenomenological analysis. Results A representation modelling the impact of MT and DMT in a nursing care home. Three main themes were identified. 1) Discovering residents' skills and feelings; 2) Learning from the therapists to change approaches to care practice with subthemes: time, space and pace, choice, following the residents' lead; 3) Connection between staff and residents. Conclusion The model indicated that both interventions performed in parallel helped staff to discover residents' skills and feelings. Although it is a small sample size, this study strongly suggests that MT and DMT can have a positive influence in helping care staff to provide a meaningful care environment.

Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression

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Cape John

2010-06-01

Full Text Available Abstract Background Psychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders. Methods Meta-analysis and meta-regression of randomized controlled trials of brief psychological therapies of adult patients with anxiety, depression or mixed common mental health problems treated in primary care compared to primary care treatment as usual. Results Thirty-four studies, involving 3962 patients, were included. Most were of brief cognitive behaviour therapy (CBT; n = 13, counselling (n = 8 or problem solving therapy (PST; n = 12. There was differential effectiveness between studies of CBT, with studies of CBT for anxiety disorders having a pooled effect size [d -1.06, 95% confidence interval (CI -1.31 to -0.80] greater than that of studies of CBT for depression (d -0.33, 95% CI -0.60 to -0.06 or studies of CBT for mixed anxiety and depression (d -0.26, 95% CI -0.44 to -0.08. Counselling for depression and mixed anxiety and depression (d -0.32, 95% CI -0.52 to -0.11 and problem solving therapy (PST for depression and mixed anxiety and depression (d -0.21, 95% CI -0.37 to -0.05 were also effective. Controlling for diagnosis, meta-regression found no difference between CBT, counselling and PST. Conclusions Brief CBT, counselling and PST are all effective treatments in primary care, but effect sizes are low compared to longer length treatments. The exception is brief CBT for anxiety, which has comparable effect sizes.

New strategies for innovation in global health: a pharmaceutical industry perspective.

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Witty, Andrew

2011-01-01

Diseases that disproportionately affect developing countries play a large role in stalling economic and social development. Pharmaceutical companies are driving crucial research into new vaccines and medicines; however, although there is an imperative for industry to research new therapies for diseases of the poor, the financial returns are often seen as limited. This is beginning to change. The pharmaceutical industry and the public sector are thinking differently than before about how to improve access to medicines and advance research and development for neglected diseases. The public and private sectors must work together to develop a wide range of innovative tools, partnerships, and approaches.

The culture of massage therapy: valued elements and the role of comfort, contact, connection and caring.

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Smith, Joanna M; Sullivan, S John; Baxter, G David

2009-08-01

To explore the attributes of the therapy encounter valued by repeat users of health-related massage therapy. A qualitative design with telephone focus group methodology was used. A total of 19 repeat users of massage therapy participated in three telephone focus groups where audiotaped semi-structured interviews were conducted. Telephone focus group with massage clients from a range of provincial and urban regions in New Zealand. Summary of reported themes of the massage experience. Data were thematically analysed using the general inductive approach. Six valued elements of the massage encounter (time for care and personal attention, engaging and competent therapist, trust partnership, holism and empowerment, effective touch and enhancing relaxation), four modulators (comfort, contact, connection and caring) and two themes relating to adding experiential value (enjoyment, escapism) characterize the massage therapy culture. The culture of massage therapy care incorporates a number of characteristics that are congruent with the complementary and alternative medicine approach to health. In addition, massage specific factors were identified. The humanistic aspects of the therapy encounter valued by clients offer insight into the growing use of massage therapy and the success of massage therapy outcomes.

Methods for the comparative evaluation of pharmaceuticals

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Busse, Reinhard

2005-11-01

preferred to surrogate parameters. Following the concept of community effectiveness, drug review institutions also explicitly favour RCT in a "natural" design, i.e. in daily routine and country specific care settings. The countries' requirements for pharmacoeconomic studies are similar despite some methodological inconsistencies, e.g. concerning cost calculation. Outcomes of clinical and pharmacoeconomic analyses are largely determined by the choice of comparator. Selecting an appropriate comparative treatment is therefore crucial. In theory, the best or most cost effective therapy is regarded as appropriate comparator for clinical and economic studies. Pragmatically however, institutions accept that the drug is compared to the treatment of daily routine or to the least expensive therapy. If a pharmaceutical offers several approved indications, in some countries all of them are assessed. Others only evaluate a drug's main indication. Canada is the only country which also considers a medicine's off-label use. It is well known that clinical trials and pharmacoeconomic studies directly comparing a drug with adequate competitors are lacking - in quantitative as well as in qualitative terms. This is specifically the case before or shortly after marketing authorisation. Yet there is the need to support reimbursement or pricing decisions by scientific evidence. In this situation review bodies are often forced to rely on observational studies or on other internally less valid data (including expert and consensus opinions. As a second option they use statistical approaches like indirect adjusted comparisons (in Australia and the United Kingdom and, commonly, economic modelling. However, there is consensus that results provided by these techniques need to be verified by valid head-to-head comparisons as soon as possible.ConclusionsIn the majority of countries reimbursement and pricing decisions are based on systematic and evidence-based evaluation comparing a drug's clinical and

Methods for the comparative evaluation of pharmaceuticals.

Science.gov (United States)

Zentner, Annette; Velasco-Garrido, Marcial; Busse, Reinhard

2005-11-15

of community effectiveness, drug review institutions also explicitly favour RCT in a "natural" design, i.e. in daily routine and country specific care settings. The countries' requirements for pharmacoeconomic studies are similar despite some methodological inconsistencies, e.g. concerning cost calculation. Outcomes of clinical and pharmacoeconomic analyses are largely determined by the choice of comparator. Selecting an appropriate comparative treatment is therefore crucial. In theory, the best or most cost effective therapy is regarded as appropriate comparator for clinical and economic studies. Pragmatically however, institutions accept that the drug is compared to the treatment of daily routine or to the least expensive therapy. If a pharmaceutical offers several approved indications, in some countries all of them are assessed. Others only evaluate a drug's main indication. Canada is the only country which also considers a medicine's off-label use. It is well known that clinical trials and pharmacoeconomic studies directly comparing a drug with adequate competitors are lacking - in quantitative as well as in qualitative terms. This is specifically the case before or shortly after marketing authorisation. Yet there is the need to support reimbursement or pricing decisions by scientific evidence. In this situation review bodies are often forced to rely on observational studies or on other internally less valid data (including expert and consensus opinions). As a second option they use statistical approaches like indirect adjusted comparisons (in Australia and the United Kingdom) and, commonly, economic modelling. However, there is consensus that results provided by these techniques need to be verified by valid head-to-head comparisons as soon as possible. In the majority of countries reimbursement and pricing decisions are based on systematic and evidence-based evaluation comparing a drug's clinical and economic characteristics to daily treatment routine. However

Atenção farmacêutica no contexto da estratégia de saúde da família Pharmaceutical care in the context of the family health strategy

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Aline Aparecida Foppa

2008-12-01

Full Text Available A assistência farmacêutica, no âmbito do Sistema Único de Saúde (SUS, é muitas vezes realizada com o objetivo primordial de garantir o abastecimento dos medicamentos nas Unidades Locais de Saúde. Freqüentemente, os cuidados com os pacientes e a promoção do uso racional dos medicamentos são marginalizados. Contudo, durante o desenvolvimento do seguimento farmacoterapêutico, são identificados problemas relacionados aos medicamentos (PRM e dificuldades na adesão ao tratamento farmacológico, os quais estão relacionados a questões familiares e sociais, e têm contribuído para o não-sucesso terapêutico, portanto pontos-chave a serem considerados durante a Atenção Farmacêutica. Foi realizado o seguimento farmacoterapêutico de quatro pacientes atendidos em uma unidade de saúde do município de Florianópolis. Para a resolução dos PRMs, adotou-se abordagem que inclui os contextos familiar e social e, que utiliza ferramentas como o genograma e o ecomapa, além do trabalho interdisciplinar. Observou-se a importância da família e dos grupos de apoio para a resolução dos PRMs e a necessidade do farmacêutico de aprimorar a prática de atenção farmacêutica mediante a utilização de tais ferramentas. Percebeu-se, ainda, a importância das visitas domiciliares para conhecer melhor o ambiente familiar e a necessidade de trabalho interdisciplinar para melhorar a qualidade do atendimento.The main objective of pharmaceutical policy management within the scope of SUS (Brazilian National Health System is to guarantee the supply of drugs to local health centers, therefore displacing patient care When drug-related problems (DRP and difficulties in adhering to the prescribed treatment are identified during the development of pharmaceutical follow-up, family and social issues have been shown to be reasons for unsuccessful treatment. They are key points to be considered during Pharmaceutical Care. The methodology chosen for this study

Connecting pills and people: an ethnography of the pharmaceutical nexus in Odisha, India.

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Seeberg, Jens

2012-06-01

This article explores the impact of intensive competition within the pharmaceutical industry and among private providers on health care in an Indian city. In-depth interviewing and clinical observation were used over a period of 18 months. Private practitioners and chemists who provided regular services to inhabitants of a poor neighborhood in central Bhubaneswar were included. Fierce competition in private health in Odisha, India, reduced quality of care for the poor. The pharmaceutical industry exploited weak links in the health system to push drugs aggressively, including through illegal channels. The private health market is organized in small "network molecules" that maximize profit at the cost of health. The large private share of health care in India and stiff competition are detrimental for primary care in urban India. Free government services are urgently needed and a planned health insurance scheme should be linked to quality control measures.

Mixing Online and Face-to-Face Therapy: How to Benefit From Blended Care in Mental Health Care.

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Wentzel, Jobke; van der Vaart, Rosalie; Bohlmeijer, Ernst T; van Gemert-Pijnen, Julia E W C

2016-02-09

Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of "blend" works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The "Fit for Blended Care" instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) "blends" of online and

Innovating cystic fibrosis clinical trial designs in an era of successful standard of care therapies.

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VanDevanter, Donald R; Mayer-Hamblett, Nicole

2017-11-01

Evolving cystic fibrosis 'standards of care' have influenced recent cystic fibrosis clinical trial designs for new therapies; care additions/improvements will require innovative trial designs to maximize feasibility and efficacy detection. Three cystic fibrosis therapeutic areas (pulmonary exacerbations, Pseudomonas aeruginosa airway infections, and reduced cystic fibrosis transmembrane conductance regulator [CFTR] protein function) differ with respect to the duration for which recognized 'standards of care' have been available. However, developers of new therapies in all the three areas are affected by similar challenges: standards of care have become so strongly entrenched that traditional placebo-controlled studies in cystic fibrosis populations likely to benefit from newer therapies have become less and less feasible. Today, patients/clinicians are more likely to entertain participation in active-comparator trial designs, that have substantial challenges of their own. Foremost among these are the selection of 'valid' active comparator(s), estimation of a comparator's current clinical efficacy (required for testing noninferiority hypotheses), and effective blinding of commercially available comparators. Recent and future cystic fibrosis clinical trial designs will have to creatively address this collateral result of successful past development of effective cystic fibrosis therapies: patients and clinicians are much less likely to accept simple, placebo-controlled studies to evaluate future therapies.

Essencialidade e assistência farmacêutica: considerações sobre o acesso a medicamentos mediante ações judiciais no Brasil Essential drugs and pharmaceutical care: reflection on the access to drugs through lawsuits in Brazil

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João Maurício Brambati Sant'Ana

2011-02-01

Full Text Available A garantia do direito à assistência farmacêutica no ordenamento jurídico brasileiro a partir da Constituição de 1988 deu vazão a um aumento das demandas judiciais para efetivação desse direito. Esse fenômeno vem sendo chamado de judicialização da assistência farmacêutica. Estudos sobre o tema têm revelado tanto deficiências no acesso dos usuários do Sistema Único de Saúde aos medicamentos das listas oficiais de assistência farmacêutica como dificuldades do sistema de justiça e do próprio procedimento judicial para lidar com a temática. Este artigo discute essas questões considerando o arcabouço conceitual que informa a política de medicamentos e a política de assistência farmacêutica brasileiras, sobretudo os conceitos de medicamentos essenciais e de alocação de recursos escassos.The guarantee of pharmaceutical care as a legal right established by the Brazilian federal constitution of 1988 led to an increase in lawsuits to put that right into practice. This phenomenon has been dubbed the judicialization of pharmaceutical care. Studies on this topic have revealed, on the one hand, deficiencies in the access of Unified Health Care (SUS users to drugs included in Ministry of Health pharmaceutical care lists, and, on the other hand, limitations of the legal system to deal with the situation. The present article addresses these issues in the context of the conceptual framework that supports the Brazilian drug policy and pharmaceutical care policy, especially the notions of essential drugs and allocation of scarce resources.

Laser therapy in cardiovascular disease

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Rindge, David

2009-02-01

Cardiovascular disease is the number one cause of death worldwide. It is broadly defined to include anything which adversely affects the heart or blood vessels. One-third of Americans have one or more forms of it. By one estimate, average human life expectancy would increase by seven years if it were eliminated. The mainstream medical model seeks mostly to "manage" cardiovascular disease with pharmaceuticals or to surgically bypass or reopen blocked vessels via angioplasty. These methods have proven highly useful and saved countless lives. Yet drug therapy may be costly and ongoing, and it carries the risk of side effects while often doing little or nothing to improve underlying health concerns. Similarly, angioplasty or surgery are invasive methods which entail risk. Laser therapy1 regenerates tissue, stimulates biological function, reduces inflammation and alleviates pain. Its efficacy and safety have been increasingly well documented in cardiovascular disease of many kinds. In this article we will explore the effects of laser therapy in angina, atherosclerosis, coronary artery disease, hypertension, hyperlipidemia, myocardial infarction, stroke and other conditions. The clinical application of various methods of laser therapy, including laserpuncture and transcutaneous, supravascular and intravenous irradiation of blood will be discussed. Implementing laser therapy in the treatment of cardiovascular disease offers the possibility of increasing the health and wellbeing of patients while reducing the costs and enhancing safety of medical care.

Herbal remedy clinical trials in the media: a comparison with the coverage of conventional pharmaceuticals

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Caulfield Timothy

2008-11-01

Full Text Available Abstract Background This study systematically compares newspaper coverage of clinical trials for herbal remedies, a popular type of complementary and alternative medicine, with clinical trials for pharmaceuticals using a comparative content analysis. This is a timely inquiry given the recognized importance of the popular press as a source of health information, the complex and significant role of complementary and alternative medicine in individual health-care decisions, and the trend toward evidence-based research for some complementary and alternative medical therapies. We searched PubMed for clinical trials, Lexis/Nexis for newspaper articles in the UK, US, Australia/New Zealand, and Factiva for Canadian newspaper articles from 1995 to 2005. We used a coding frame to analyze and compare 48 pharmaceutical and 57 herbal remedy clinical trials as well as 201 pharmaceutical and 352 herbal remedy newspaper articles. Results Herbal remedy clinical trials had similar Jadad scores to pharmaceutical trials but were significantly smaller and of shorter duration. The trials were mostly studies from Western countries and published in high-ranking journals. The majority of pharmaceutical (64% and herbal remedy (53% clinical trials had private sector funding involvement. A minority declared further author conflicts of interest. Newspaper coverage of herbal remedy clinical trials was more negative than for pharmaceutical trials; a result only partly explained by the greater proportion of herbal remedy clinical trials reporting negative results (P = 0.0201; χ2 = 7.8129; degrees of freedom = 2. Errors of omission were common in newspaper coverage, with little reporting of dose, sample size, location, and duration of the trial, methods, trial funding, and conflicts of interest. There was an under-reporting of risks, especially for herbal remedies. Conclusion Our finding of negative coverage of herbal remedy trials is contrary to the positive trends in most

A strategy to improve skills in pharmaceutical supply management in East Africa: the regional technical resource collaboration for pharmaceutical management

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Minzi Omary

2008-12-01

Full Text Available Abstract Background International initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative have significantly increased availability and access to medicines in some parts of the developing world. Despite this, however, skills remain limited on quantifying needs for medications and ordering, receiving and storing medications appropriately; recording medications inventories accurately; distributing medications for use appropriately; and advising patients on how to use medications appropriately. The Regional Technical Resource Collaboration for Pharmaceutical Management (RTRC has been established to help address the problem of skills shortage in pharmaceutical management in East Africa. Methods The initiative brings together academic institutions from four East African countries to participate in skills-building activities in pharmaceutical supply management. The initiative targeted the institutions' ability to conduct assessments of pharmaceutical supply management systems and to develop and implement effective skills-building programmes for pharmaceutical supply chain management. Results Over a two-year period, the RTRC succeeded in conducting assessments of pharmaceutical supply management systems and practices in Kenya, Rwanda, Tanzania and Uganda. In 2006, the RTRC participated in a materials-development workshop in Kampala, Uganda, and contributed to the development of comprehensive HIV/AIDS pharmaceutical management training materials; these materials are now widely available in all four countries. In Tanzania and Uganda the RTRC has been involved with the training of health care workers in HIV/AIDS pharmaceutical management. In Kenya, Tanzania and Uganda the RTRC has been conducting operations research to find solutions to their countries' skills-shortage problems. Some of the interventions tested include applying and evaluating the

Contamination sources and distribution patterns of pharmaceuticals and personal care products in Alpine rivers strongly affected by tourism.

Science.gov (United States)

Mandaric, Ladislav; Diamantini, Elena; Stella, Elisa; Cano-Paoli, Karina; Valle-Sistac, Jennifer; Molins-Delgado, Daniel; Bellin, Alberto; Chiogna, Gabriele; Majone, Bruno; Diaz-Cruz, M Silvia; Sabater, Sergi; Barcelo, Damia; Petrovic, Mira

2017-07-15

Knowledge regarding the impact of tourism on the emergence of pharmaceuticals and personal care products (PPCPs) in Alpine river waters is limited and scarce. Therefore, a study on the occurrence patterns and spatiotemporal variability of 105 PPCPs in an Alpine river basin located in the Trentino-Alto Adige region (North-Eastern Italy) has been conducted. We observed that the total concentration of analyzed PPCPs was generally higher in all sampling sites during winter than in the summer. The analysis of tourist data revealed that during both sampling campaigns the number of tourists was lower in the downstream sites in comparison with the upstream area of the basin (Val di Sole). Particularly, sampling sites located near important tourist resorts have shown the highest abundance of the PPCPs during winter, being analgesics/anti-inflammatories, antihypertensives and antibiotics the most abundant pharmaceutically active compounds (PhACs). Diclofenac showed the highest concentration amongst PhACs, reaching concentrations up to 675ngL -1 in the sampling site situated downstream of the Tonale wastewater treatment plant (WWTP). Antihypertensives were found at concentrations >300ngL -1 , while antibiotics were quantified up to 196ngL -1 , respectively. Amongst personal care products (PCPs), the most abundant compound was octyl-dimethyl-p-aminobenzoic acid (ODPABA) with concentrations reaching up to 748ngL -1 in the sampling site situated within the Rotaliana district. In general, concentrations and detection frequencies were higher in water than in the sediment samples. The most frequently detected PhACs in sediments from both sampling campaigns were antibiotics, while amongst PCPs in sediments, octocrylene (OC) showed the highest concentration in both sampling campaigns. As a result, this study highlights the potential impact of tourism on the water quality of the Alpine aquatic ecosystems. Copyright © 2017 Elsevier B.V. All rights reserved.

The effects of massage therapy on pain management in the acute care setting.

Science.gov (United States)

Adams, Rose; White, Barb; Beckett, Cynthia

2010-03-17

Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona-a nonprofit community hospital serving a large rural area of northern Arizona. A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 - 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t(52) = 12.43, r = .67, d = 1.38, p massage therapy into the acute care setting creates overall positive results in the patient's ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process.

Professional learning of pharmaceutical care in a virtual world

Directory of Open Access Journals (Sweden)

Ana MARTÍN SUÁREZ

2011-12-01

Full Text Available 0 0 1 141 776 Instituto Universitario de Ciencias de la Educación 6 1 916 14.0 Normal 0 21 false false false ES JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-ansi-language:ES; mso-fareast-language:EN-US;} The learning of professional skills at University suffers from the drawback of how to reproduce a context similar to reality that with allow students to perform the tasks set them in a “living” way. Here we trained 54 students following the subject entitled Pharmaceutical Care of the Pharmacy degree in Second Life (an immersive virtual world in 3D, simulating common situations in the dispensation of anti-asthmatic agents in the context of a Community Pharmacy. The results of the study indicated that the students had no difficulty in adapting to the virtual platform and they reported a high degree of satisfaction (the mean score obtained was 2.36 on a scale of 0-3. The assessment of professional competencies revealed the high global performance of the group. The activity was hard for the professors, but they considered it an enrichening experience able to open new possibilities in teaching and research.

Expanding perspective on music therapy for symptom management in cancer care.

Science.gov (United States)

Potvin, Noah; Bradt, Joke; Kesslick, Amy

2015-01-01

Symptom management is a frequently researched treatment topic in music therapy and cancer care. Representations in the literature of music interventions for symptom management, however, have often overlooked the human experiences shaping those symptoms. This may result in music therapy being perceived as a linear intervention process that does not take into account underlying experiences that contribute to symptom experiences. This study explored patient experiences underlying symptoms and symptom management in cancer care, and examined the role of music therapy in that clinical process. This study analyzed semi-structured, open-ended exit interviews obtained from 30 participants during a randomized controlled trial investigating the differential impact of music therapy versus music medicine interventions on symptom management in participants with cancer. Interviews were conducted by a research assistant not involved with the clinical interventions. Exit interview transcripts for 30 participants were analyzed using an inductive, latent, constructivist method of thematic analysis. Three themes-Relaxation, Therapeutic relationship, and Intrapersonal relating-capture elements of the music therapy process that (a) modified participants' experiences of adjustments in their symptoms and (b) highlighted the depth of human experience shaping their symptoms. These underlying human experiences naturally emerged in the therapeutic setting, requiring the music therapist's clinical expertise for appropriate support. Symptom management extends beyond fluctuation in levels and intensity of a surface-level symptom to incorporate deeper lived experiences. The authors provide recommendations for clinical work, entry-level training as related to symptom management, implications for evidence-based practice in music therapy, and methodology for future mixed methods research. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Uptake and Accumulation of Pharmaceuticals in Lettuce Under Surface and Overhead Irrigations

Science.gov (United States)

Bhalsod, G.; Chuang, Y. H.; Jeon, S.; Gui, W.; Li, H.; Guber, A.; Zhang, W.

2015-12-01

Pharmaceuticals and personal care products are being widely detected in wastewater and surface waters. As fresh water becomes scarcer, interests in using reclaimed water for crop irrigation is intensified. Since reclaimed waters often carry trace levels of pharmaceuticals, accumulation of pharmaceuticals in food crops could increase the risk of human exposure. This study aims to investigate uptake and accumulations of pharmaceuticals in greenhouse-grown lettuce under contrasting irrigation practices (i.e., overhead and surface irrigations). Lettuce was irrigated with water spiked with 11 commonly used pharmaceuticals (acetaminophen, caffeine, carbamazepine, sulfadiazine, sulfamethoxazole, carbadox, trimethoprim, lincomycin hydrochloride, oxytetracycline hydrochloride, monensin sodium, and tylosin). Weekly sampling of lettuce roots, shoots, and soils were continued for 5 weeks, and the samples were freeze dried, extracted for pharmaceuticals and analyzed by LC-MS/MS. Preliminary results indicate that higher concentrations of pharmaceuticals were found in overhead irrigated lettuce compared to surface irrigated lettuce. For carbamezapine, sulfadiazine, trimethoprim, oxytetracycline, and monensin sodium, their concentrations generally increased in lettuce shoots in the overhead treatment over time. However, acetaminophen was found at higher concentrations in both shoots and roots, indicating that acetaminophen can be easily transported in the plant system. This study provides insight on developing better strategies for using reclaimed water for crop irrigations, while minimizing the potential risks of pharmaceutical contamination of vegetables.

Doll Therapy in Dementia Care Mitchell Gary Doll Therapy in Dementia Care 136pp £17.99 Jessica Kingsley 9781849055703 184905570X [Formula: see text].

Science.gov (United States)

2017-06-30

This book is an engaging read from the beginning to end. It explains the needs of people with advanced dementia, particularly that for attachment, and how doll therapy is one of many approaches to engaging in person-centred care.

Palliative care in Parkinson′s disease: Role of cognitive behavior therapy

Directory of Open Access Journals (Sweden)

Samput Mallick

2009-01-01

Full Text Available Background : Parkinson′s disease (PD is a chronic, progressive, neurodegenerative disorder that leads to the classic features of akinesia (encompassing hypokinesia and bradykinesia, tremor, rigidity and postural instability. Other non-motor complications include depression, fatigue, pain, and sleep disturbances. For the management of these complications, non-pharmacological techniques, such as Cognitive-behavioral therapy (CBT can be used. This can focus on overt behavior and underlying cognitions and train the patient in coping strategies to obtain better symptom control. Objectives: To review studies on CBT as palliative care in PD patients. Materials and Methods: A survey was conducted for all available English-language studies by means of a MEDLINE search. Keywords in the searches included Parkinson′s disease, palliative care, and cognitive behavior therapy. All articles that reported the cognitive behavior therapy and palliative care in a group of PD patients regardless of the method used by the researchers were identified and analyzed. Result and Conclusion: CBT has a strong evidence base for its use and has proven to be an effective treatment in management of people with chronic pain, fatigue syndrome, depression and sleep disturbances, with efficacy that lasts beyond the duration of treatment. Although PD patients suffer from these complications, there are only a few studies on administration of CBT on them. Considering its effectiveness, CBT can be used as an option for palliative care for PD patients, directed toward improving the patient′s functional status, clinical disability and quality of life. Further studies are required in this area.

A Study of Comparative Advantage and Intra-Industry Trade in the Pharmaceutical Industry of Iran.

Science.gov (United States)

Yusefzadeh, Hassan; Rezapour, Aziz; Lotfi, Farhad; Ebadifard Azar, Farbod; Nabilo, Bahram; Abolghasem Gorji, Hassan; Hadian, Mohammad; Shahidisadeghi, Niusha; Karami, Atiyeh

2015-04-23

Drug costs in Iran accounts for about 30% of the total health care expenditure. Moreover, pharmaceutical business lies among the world's greatest businesses. The aim of this study was to analyze Iran's comparative advantage and intra-industry trade in pharmaceuticals so that suitable policies can be developed and implemented in order to boost Iran's trade in this field. To identify Iran's comparative advantage in pharmaceuticals, trade specialization, export propensity, import penetration and Balassa and Vollrath indexes were calculated and the results were compared with other pharmaceutical exporting countries. The extent and growth of Iran's intra-industry trade in pharmaceuticals were measured and evaluated using the Grubel-Lloyd and Menon-Dixon indexes. The required data was obtained from Iran's Customs Administration, Iran's pharmaceutical Statistics, World Bank and International Trade Center. The results showed that among pharmaceutical exporting countries, Iran has a high level of comparative disadvantage in pharmaceutical products because it holds a small share in world's total pharmaceutical exports. Also, the low extent of bilateral intra-industry trade between Iran and its trading partners in pharmaceuticals shows the trading model of Iran's pharmaceutical industry is mostly inter-industry trade rather than intra-industry trade. In addition, the growth of Iran's intra-industry trade in pharmaceuticals is due to its shares of imports from pharmaceutical exporting countries to Iran and exports from Iran to its neighboring countries. The results of the analysis can play a valuable role in helping pharmaceutical companies and policy makers to boost pharmaceutical trade.

[Pharmaceutical care for patients of the third age in pharmacy organizations as a significant aspect of social gerontology].

Science.gov (United States)

Krivosheev, S A; Kartashova, O V; Tikhonova, U A; Zakharova, O V

2017-01-01

There are questions in the article that study mutual relations of patients of elderly and senile age with pharmaceutical experts. It was revealed that pharmacy organizations are an important element in the life of patients of the third age and noted the high role of the pharmaceutical specialist in their social environment. The article shows the need to focus on the psychosomatic features of elderly patients with proper pharmaceutical counseling and professional communication. It was noted that interaction of patients of the third age with pharmaceutical specialists and their confidence in them has high importance.

Nursing care for patients with local recurrent rectal cancer after CT-guided 125I seed implantation therapy

International Nuclear Information System (INIS)

Yuan Li; Wei Fan; Ren Caifeng; Tu Mingmei; Qian Guixiang

2010-01-01

Objective: To discuss the nursing care strategy for patients with local recurrent rectal cancer who has been treated with CT-guided 125 I seed implantation therapy. Methods: Twenty patients with local recurrent rectal cancer received a series of nursing interventions, including comfort care and pain care. The clinical results were observed and analyzed. Results: The therapy was smoothly accomplished in all patients. The pain was remarkably relived and the anxiety was alleviated. No displacement of implanted 125 I seed occurred. Conclusion: For patients with local recurrent rectal cancer occurred after CT-guided 125 I seed implantation therapy, careful nursing can effectively relieve the pain and anxiety feeling,and the living quality can also be markedly improved. (authors)

Assessing the diurnal variability of pharmaceutical and personal care products in a full-scale activated sludge plant

International Nuclear Information System (INIS)

Salgado, R.; Marques, R.; Noronha, J.P.; Mexia, J.T.; Carvalho, G.; Oehmen, A.; Reis, M.A.M.

2011-01-01

An intensive sampling campaign has been carried out in a municipal wastewater treatment plant (WWTP) to assess the dynamics of the influent pharmaceutical active compounds (PhAC) and musks. The mass loadings of these compounds in wastewater influents displayed contrasting diurnal variations depending on the compound. The musks and some groups of PhACs tended to follow a similar diurnal trend as compared to macropollutants, while the majority of PhACs followed either the opposite trend or no repeatable trend. The total musk loading to the WWTP was 0.74 ± 0.25 g d -1 , whereas the total PhAC mass loading was 84.7 ± 63.8 g d -1 . Unlike the PhACs, the musks displayed a high repeatability from one sampling day to the next. The range of PhAC loadings in the influent to WWTPs can vary several orders of magnitude from one day or week to the next, representing a challenge in obtaining data for steady-state modelling purposes. - Highlights: → Investigated the variations in influent wastewater pharmaceutical and musk loadings. → A high number of different pharmaceutical and musk compounds was analysed. → Many pharmaceutical groups displayed different characteristic patterns. → A representative steady-state pattern was observable for musks, not pharmaceuticals. → The results are relevant to the design of sampling campaigns for modelling purposes. - The diurnal variations of pharmaceuticals and musks were studied in an activated sludge plant, where the loadings of the musks were more repeatable than the pharmaceuticals.

Brief cognitive behavioral therapy compared to general practitioners care for depression in primary care: a randomized trial

Science.gov (United States)

2010-01-01

Background Depressive disorders are highly prevalent in primary care (PC) and are associated with considerable functional impairment and increased health care use. Research has shown that many patients prefer psychological treatments to pharmacotherapy, however, it remains unclear which treatment is most optimal for depressive patients in primary care. Methods/Design A randomized, multi-centre trial involving two intervention groups: one receiving brief cognitive behavioral therapy and the other receiving general practitioner care. General practitioners from 109 General Practices in Nijmegen and Amsterdam (The Netherlands) will be asked to include patients aged between 18-70 years presenting with depressive symptomatology, who do not receive an active treatment for their depressive complaints. Patients will be telephonically assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to ascertain study eligibility. Eligible patients will be randomized to one of two treatment conditions: either 8 sessions of cognitive behavioral therapy by a first line psychologist or general practitioner's care according to The Dutch College of General Practitioners Practice Guideline (NHG- standaard). Baseline and follow-up assessments are scheduled at 0, 6, 12 and 52 weeks following the start of the intervention. Primary outcome will be measured with the Hamilton Depression Rating Scale-17 (HDRS-17) and the Patient Health Questionnaire-9 (PHQ-9). Outcomes will be analyzed on an intention to treat basis. Trial Registration ISRCTN65811640 PMID:20939917

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers.

Science.gov (United States)

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M; Karanikas, Alexia T; Oyeniyi, Blessing; Holcomb, John B; Cap, Andrew P; Rasmussen, Todd E

2015-12-01

Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military-civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a "state of the science" review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients.

Pharmaceutical lobbying in Brazil: a missing topic in the public health research agenda.

Science.gov (United States)

Paumgartten, Francisco José Roma

2016-12-22

In the US, where registration of lobbyists is mandatory, the pharmaceutical industry and private health-care providers spend huge amounts of money seeking to influence health policies and government decisions. In Brazil, where lobbying lacks transparency, there is virtually no data on drug industry expenditure to persuade legislators and government officials of their viewpoints and to influence decision-making according to commercial interests. Since 1990, however, the Associação da Indústria Farmacêutica de Pesquisa (Interfarma - Pharmaceutical Research Industry Association), Brazilian counterpart of the Pharmaceutical Research and Manufacturers of America (PhRMA), main lobbying organization of the US pharmaceutical industry, has played a major role in the advocacy of interests of major drug companies. The main goals of Interfarma lobbying activities are: shortening the average time taken by the Brazilian regulatory agency (ANVISA) to approve marketing authorization for a new drug; making the criteria for incorporation of new drugs into SUS (Brazilian Unified Health System) more flexible and speeding up technology incorporation; changing the Country's ethical clearance system and the ethical requirements for clinical trials to meet the need of the innovative drug industry, and establishing a National Policy for Rare Diseases that allows a prompt incorporation of orphan drugs into SUS. Although lobbying affects community health and well-being, this topic is not in the public health research agenda. The impacts of pharmaceutical lobbying on health policies and health-care costs are of great importance for SUS and deserve to be investigated.

A validated high performance thin layer chromatography method for determination of yohimbine hydrochloride in pharmaceutical preparations

OpenAIRE

Jihan M Badr

2013-01-01

Background: Yohimbine is an indole alkaloid used as a promising therapy for erectile dysfunction. A number of methods were reported for the analysis of yohimbine in the bark or in pharmaceutical preparations. Materials and Method: In the present work, a simple and sensitive high performance thin layer chromatographic method is developed for determination of yohimbine (occurring as yohimbine hydrochloride) in pharmaceutical preparations and validated according to International Conference of Ha...

Home iv antibiotic therapy through a medical day care unit

OpenAIRE

Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

1993-01-01

An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-pa...

Occurrence and fate of pharmaceuticals and personal care products in drinking water in southern China.

Science.gov (United States)

Qiao, Tiejun; Yu, Zhengrong; Zhang, Xihui; Au, Doris W T

2011-11-01

Occurrence and fate of pharmaceuticals and personal care products (PPCPs) in drinking water was investigated in southern China. Fifteen and twelve PPCPs were detected with concentrations of 0-36 ng L(-1) in source water and of 0-20 ng L(-1) in treated water, respectively. Four PPCPs were detected with concentrations of approximately 1 ng L(-1) in drinking water of distribution network. Conventional water treatment processes removed the types and average concentrations of PPCPs by 30% and above 50%, respectively. Advanced water treatment processes were more efficient in the removal of most PPCPs, with the types and concentrations reduced by 50% and approximately 90%, respectively. Molecular properties of PPCPs had an important influence on their behaviors during water treatment. pK(a) (acidity coefficient) and K(oc) (organic carbon partition coefficient) of PPCPs appeared to have a combined effect on PPCPs removal during coagulation and oxidation. Adsorption and biodegradation were two possible mechanisms responsible for PPCPs removal during sand filtration.

Occurrence, sources and fate of pharmaceuticals and personal care products in the groundwater: A review

Directory of Open Access Journals (Sweden)

Qian Sui

2015-11-01

Full Text Available The presence of pharmaceuticals and personal care products (PPCPs in the aquatic environment may pose potential threat to the ecosystem and human health, hence PPCPs have aroused much concern over the world. The contamination of PPCPs in the groundwater, the main source of drinking water supply in many countries and regions, has been extensively studied in the last decade. This paper reviews the occurrence of frequently detected PPCPs, including antibiotics, anti-inflammatories, lipid-regulators, carbamazepine, caffeine, and N,N-diethyl-m-toluamide in groundwater, with special concern to the progress made over the past three years. Possible emission sources for PPCPs in groundwater, such as wastewater and contaminated surface water, landfills, septic systems, livestock breeding and sewer leakage, are summarized. Besides, adsorption, migration and degradation, the dominant mechanisms in the subsurface transport and fate of PPCPs, are discussed, and the insights into the future study of PPCPs in the groundwater are provided.

Reiki Therapy for Symptom Management in Children Receiving Palliative Care: A Pilot Study.

Science.gov (United States)

Thrane, Susan E; Maurer, Scott H; Ren, Dianxu; Danford, Cynthia A; Cohen, Susan M

2017-05-01

Pain may be reported in one-half to three-fourths of children with cancer and other terminal conditions and anxiety in about one-third of them. Pharmacologic methods do not always give satisfactory symptom relief. Complementary therapies such as Reiki may help children manage symptoms. This pre-post mixed-methods single group pilot study examined feasibility, acceptability, and the outcomes of pain, anxiety, and relaxation using Reiki therapy with children receiving palliative care. A convenience sample of children ages 7 to 16 and their parents were recruited from a palliative care service. Two 24-minute Reiki sessions were completed at the children's home. Paired t tests or Wilcoxon signed-rank tests were calculated to compare change from pre to post for outcome variables. Significance was set at P Reiki therapy did decrease pain, anxiety, heart, and respiratory rates, but small sample size deterred statistical significance. This preliminary work suggests that complementary methods of treatment such as Reiki may be beneficial to support traditional methods to manage pain and anxiety in children receiving palliative care.

Gestalt therapy approaches with aggressive children in a day care setting

OpenAIRE

Maxey, Win

1987-01-01

This research study was designed to evaluate whether or not Gestalt therapy approaches could be used effectively when intervening with aggressive acts in a day care setting. Five focus children were observed at timed intervals as to whether or not they were aggressive, how the caretaker intervened, and how the children responded to the caretaker intervention. After a baseline of aggressive acts was established, caretakers were trained to use Gestalt therapy interventio...

Structural changes in the German pharmaceutical market: price setting mechanisms based on the early benefit evaluation.

Science.gov (United States)

Henschke, Cornelia; Sundmacher, Leonie; Busse, Reinhard

2013-03-01

In the past, free price setting mechanisms in Germany led to high prices of patented pharmaceuticals and to increasing expenditures in the pharmaceutical sector. In order to control patented pharmaceutical prices and to curb increasing pharmaceutical spending, the Act for Restructuring the Pharmaceutical Market in Statutory Health Insurance (AMNOG) came into effect on 1st January 2011. In a structured dossier, pharmaceutical manufacturers have to demonstrate the additional therapeutic benefit of the newly approved pharmaceutical compared to its appropriate comparator. According to the level of additional benefit, pharmaceuticals will be subject to price negotiations between the Federal Association of Statutory Health Insurance Funds and the pharmaceutical company concerned (or assigned to a reference price group in case of no additional benefit). Therefore, the health care reform is a first step to decision making based on "value for money". The process of price setting based on early benefit evaluation has an impact on the German as well as the European pharmaceutical markets. Therefore, these structural changes in Germany are of importance for pricing decisions in many European countries both from a political point of view and for strategic planning for pharmaceutical manufacturers, which may have an effect on insured patients' access to pharmaceuticals. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Virtual patient care: an interprofessional education approach for physician assistant, physical therapy and occupational therapy students.

Science.gov (United States)

Shoemaker, Michael J; Platko, Christina M; Cleghorn, Susan M; Booth, Andrew

2014-07-01

The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: benefits of collaborative care, role clarification and relevance of the IPE experience for future practice. A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.

Is Bobath-based therapy used by physiotherapists in the care of stroke patients?

NARCIS (Netherlands)

Nico L.U. Meeteren; Maria H.F. Grypdonck; Thóra Hafsteinsdóttir

2005-01-01

The aim of this study was to investigate if physiotherapists had knowledge and skills in applying Bobath-based therapy (BB), also referred to as Neurodevelopmental Treatment, in the care of stroke patients and if they generally used the therapy in daily practice. This is because of the important

Music therapy applied to complex blast injury in interdisciplinary care: a case report.

Science.gov (United States)

Vaudreuil, Rebecca; Avila, Luis; Bradt, Joke; Pasquina, Paul

2018-04-24

Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community. Implications for Rehabilitation Music therapy in stand-alone sessions and in co-treatment with traditional disciplines can enhance treatment outcomes in functional domains of motor, speech, cognition, social integration, and quality of life for military populations. Music therapists can help ease discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. Music therapy assists treatment processes from clinic to community, making it highly valued by the patient, family, and interdisciplinary team members in military

Pharmaceutical industry's corporate social responsibility towards HIV/AIDS.

Science.gov (United States)

Khanna, Arun Kumar

2006-01-01

The pharmaceutical industry has a corporate social responsibility (CSR) towards HIV/AIDS. Measures taken to increase awareness of HIV/AIDS, availability and accessibility of potent and patient-friendly FDCs / Kits for adults and children will go a long way in increasing awareness and acceptance of this disease and its therapy. This will improve adherence, lower resistance and facilitate better disease management. This article discusses some of the CSR initiatives and their scope.

Withholding or withdrawing therapy in intensive care units: improving interdisciplinary cooperation

DEFF Research Database (Denmark)

Jensen, Hanne Irene; Ammentorp, Jette; Ørding, Helle

INTRODUCTION. Decisions regarding withholding or withdrawing therapy are common in the intensive care units. The health care professionals involved in the decision-making process do not always assess the situation identically, leading to potential conflicts. Studies have suggested that improving...... (conducted at two hospitals) with participation of primary care physicians, anaesthesiologists (both with and without ICU as their main workplace) and intensive care nurses. A total of 29 participated in the audits. The participants received beforehand three complicated cases (borrowed from other hospitals...... unit conflicts: the conflicus study. Am J Respir Crit Care Med180:853-860. (2) Halvorsen K, Forde R, Nortvedt P (2009) Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 53:10-17 GRANT ACKNOWLEDGMENT. The study was supported...

A Study of Comparative Advantage and Intra-Industry Trade in the Pharmaceutical Industry of Iran

Science.gov (United States)

Yusefzadeh, Hassan; Rezapour, Aziz; Lotfi, Farhad; Azar, Farbod Ebadifard; Nabilo, Bahram; Gorji, Hassan Abolghasem; Hadian, Mohammad; Shahidisadeghi, Niusha; Karami, Atiyeh

2015-01-01

Background: Drug costs in Iran accounts for about 30% of the total health care expenditure. Moreover, pharmaceutical business lies among the world’s greatest businesses. The aim of this study was to analyze Iran’s comparative advantage and intra-industry trade in pharmaceuticals so that suitable policies can be developed and implemented in order to boost Iran’s trade in this field. Methods: To identify Iran’s comparative advantage in pharmaceuticals, trade specialization, export propensity, import penetration and Balassa and Vollrath indexes were calculated and the results were compared with other pharmaceutical exporting countries. The extent and growth of Iran’s intra-industry trade in pharmaceuticals were measured and evaluated using the Grubel-Lloyd and Menon-Dixon indexes. The required data was obtained from Iran’s Customs Administration, Iran’s pharmaceutical Statistics, World Bank and International Trade Center. Results: The results showed that among pharmaceutical exporting countries, Iran has a high level of comparative disadvantage in pharmaceutical products because it holds a small share in world’s total pharmaceutical exports. Also, the low extent of bilateral intra-industry trade between Iran and its trading partners in pharmaceuticals shows the trading model of Iran’s pharmaceutical industry is mostly inter-industry trade rather than intra-industry trade. In addition, the growth of Iran’s intra-industry trade in pharmaceuticals is due to its shares of imports from pharmaceutical exporting countries to Iran and exports from Iran to its neighboring countries. Conclusions: The results of the analysis can play a valuable role in helping pharmaceutical companies and policy makers to boost pharmaceutical trade. PMID:26153184

Deep pharma: psychiatry, anthropology, and pharmaceutical detox.

Science.gov (United States)

Oldani, Michael

2014-06-01

Psychiatric medication, or psychotropics, are increasingly prescribed for people of all ages by both psychiatry and primary care doctors for a multitude of mental health and/or behavioral disorders, creating a sharp rise in polypharmacy (i.e., multiple medications). This paper explores the clinical reality of modern psychotropy at the level of the prescribing doctor and clinical exchanges with patients. Part I, Geographies of High Prescribing, documents the types of factors (pharmaceutical-promotional, historical, cultural, etc.) that can shape specific psychotropic landscapes. Ethnographic attention is focused on high prescribing in Japan in the 1990s and more recently in the Upper Peninsula of Michigan, in the US. These examples help to identify factors that have converged over time to produce specific kinds of branded psychotropic profiles in specific locales. Part II, Pharmaceutical Detox, explores a new kind of clinical work being carried out by pharmaceutically conscious doctors, which reduces the number of medications being prescribed to patients while re-diagnosing their mental illnesses. A high-prescribing psychiatrist in southeast Wisconsin is highlighted to illustrate a kind of med-checking taking place at the level of individual patients. These various examples and cases call for a renewed emphasis by anthropology to critically examine the "total efficacies" of modern pharmaceuticals and to continue to disaggregate mental illness categories in the Boasian tradition. This type of detox will require a holistic approach, incorporating emergent fields such as neuroanthropology and other kinds of creative collaborations.

Implementing cognitive therapies into routine psychosis care: organisational foundations.

Science.gov (United States)

Dark, Frances; Whiteford, Harvey; Ashkanasy, Neal M; Harvey, Carol; Crompton, David; Newman, Ellie

2015-08-05

Treatment outcomes for people diagnosed with psychosis remain suboptimal due in part to the limited systematic application of evidence based practice (Adm Policy Ment Health, 36: 1-7, 2009) [1]. The Implementation science literature identifies a number of factors organisationally that need to be considered when planning to introduce a particular EBP. Profiling these organisational characteristics at baseline, prior to commencement of service reform can determine the focus of a subsequent implementation plan. This study examined the organisational baseline factors existing in two services promoting the routine use of cognitive interventions for psychosis. One of the services studied has since undertaken organisational structural reform to facilitate the greater uptake of Evidence Based Practice (EBP). The results of this study were used to design an implementation strategy to make cognitive therapies a part of routine psychosis care. One hundred-and-six mental health staff from two metropolitan mental health services in Australia was surveyed to ascertain their attitudes, competencies and interest in Cognitive Behavioural Therapy for psychosis (CBTp) and Cognitive Remediation Therapy (CRT). In addition perceptions of organisational values were profiled using the Organisational Culture Profile (OCP). Fifty five participants were excluded because they completed less than 50% of the survey. The final sample consisted of 51 participants. 48.1% of surveys were completed. Over 50% of staff were interested in CBTp and CRT approaches to psychosis. Staff were aware of existing CBTp and CRT programs but these were not uniformly available throughout the services. Fourteen percent of staff identified as CBT therapist and 35% were trained CRT facilitators. Only 12% of staff were receiving therapy specific supervision. The Organisational Culture Profile (OCP) at baseline revealed highest scores amongst leadership, planning, and humanistic workplace domains, with communication

A first screening and risk assessment of pharmaceuticals and additives in personal care products in waste water, sludge, recipient water and sediment from Faroe Islands, Iceland and Greenland.

Science.gov (United States)

Huber, Sandra; Remberger, Mikael; Kaj, Lennart; Schlabach, Martin; Jörundsdóttir, Hrönn Ó; Vester, Jette; Arnórsson, Mímir; Mortensen, Inge; Schwartson, Richard; Dam, Maria

2016-08-15

A screening of a broad range of pharmaceuticals and additives in personal care products (PPCPs) in sub-arctic locations of the Faroe Islands (FO), Iceland (IS) and Greenland (GL) was conducted. In total 36 pharmaceuticals including some metabolites, and seven additives in personal care products were investigated in influent and effluent waters as well as sludge of waste water treatment plants (WWTPs) and in water and sediment of recipients. Concentrations and distribution patterns for PPCPs discharged via sewage lines (SLs) to the marine environment were assessed. Of the 36 pharmaceuticals or metabolites analysed 33 were found close to or above the limit of detection (LOD) in all or a part of the samples. All of the seven investigated additives in personal care products were detected above the LOD. Some of the analysed PPCPs occurred in every or almost every sample. Among these were diclofenac, ibuprofen, lidocaine, naproxen, metformin, citalopram, venlafaxine, amiloride, furosemide, metoprolol, sodium dodecyl sulphate (SDS) and cetrimonium salt (ATAC-C16). Additionally, the study encompasses ecotoxicological risk assessment of 2/3 of the analysed PPCPs in recipient and diluted effluent waters. For candesartan only a small margin to levels with inacceptable risks was observed in diluted effluent waters at two locations (FO). Chronical risks for aquatic organisms staying and/or living around WWTP effluent pipe-outlets were indicated for 17β-estradiol and estriol in the three countries. Additives in PCPs were found to pose the largest risk to the aquatic environment. The surfactants CAPB and ATAC-C16 were found in concentrations resulting in risk factors up to 375 for CAPB and 165 for ATAC-C16 in recipients for diluted effluents from Iggia, Nuuk (GL) and Torshavn (FO) respectively. These results demonstrates a potentially high ecological risk stemming from discharge of surfactants as used in household and industrial detergents as well as additives in personal care

Laughter therapy as an intervention to promote psychological well-being of volunteer community care workers working with HIV-affected families.

Science.gov (United States)

Hatzipapas, Irene; Visser, Maretha J; Janse van Rensburg, Estie

2017-12-01

The study explores the experiences of volunteer community care workers working with HIV-affected families, participating in laughter therapy. Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of emotional distress. Community care workers play a vital role in the support of the HIV/AIDS-infected and -affected members in communities. The nature of this type of work and their limited training contributes to high levels of secondary trauma and emotional exhaustion. The purpose of the study was firstly, to explore the effects of working with orphans and vulnerable children (OVC) on the community care workers and secondly, to establish the impact that laughter therapy has to positively combat stresses of working within the care workers' environment. All the community care workers from a community-based organisation that provides care for HIV/AIDS-infected and -affected OVC and their families in the greater region of Soweto, South Africa, took part in daily laughter therapy sessions for one month. To assess the experiences of participants of laughter therapy, seven community care workers agreed to participate in a mixed method assessment. Interviews were conducted before and after the intervention using the Interpretative Phenomenological Analysis as framework. As supportive data, a stress and anxiety and depression scale were added in the interview. Participants reported more positive emotions, positive coping, improved interpersonal relationships and improvement in their care work after exposure to laughter therapy. Quantitative results on stress, anxiety and depression for each participant confirmed observed changes. Laughter therapy as a self-care technique has potential as a low-cost intervention strategy to reduce stress and counteract negative emotions among people working in highly emotional environments.

Pharmaceutical policies: effects of financial incentives for prescribers.

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

2015-08-04

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

Pharmaceutical and biomedical applications of lipid-based nanocarriers.

Science.gov (United States)

Carbone, Claudia; Leonardi, Antonio; Cupri, Sarha; Puglisi, Giovanni; Pignatello, Rosario

2014-03-01

Increasing attention is being given to lipid nanocarriers (LNs) as drug delivery systems, due to the advantages offered of a higher biocompatibility and lower toxicity compared with polymeric nanoparticles. Many administration routes are being investigated for LNs, including topical, oral and parenteral ones. LNs are also proposed for specific applications such as cancer treatment, gene therapy, diagnosis and medical devices production. However, the high number of published research articles does not match an equal amount of patents. A recent Review of ours, published in Pharmaceutical Patent Analyst, reported the patents proposing novel methods for the production of LNs. This review work discusses recent patents, filed in 2007-2013 and dealing with the industrial applications of lipid-based nanocarriers for the vectorization of therapeutically relevant molecules, as well as biotech products such as proteins, gene material and vaccines, in the pharmaceutical, diagnostic and biomedical areas.

Does brand differentiate pharmaceuticals?

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Bednarik, Josef

2005-12-01

Role of marketing in pharmaceutical industry is increasing and inspiration by successful brands known from consumer goods market influenced pharmaceutical companies enough to switch their attention to branding initiatives. Still there is little evidence that pharmaceutical brands represent anything more than product only. This study aims to explore the area of branding in pharmaceutical industry. Central hypothesis of the research has been that brand and its emotional content differentiate pharmaceuticals as well as rational data derived from clinical studies. It has been tested by extensive review of available literature as well as by primary research focused on drivers of physicians' attitudes towards products and their influence on prescribing behavior. The research has been conducted in the sample of psychiatrists in the Czech Republic. No evidence about pharmaceutical brand exceeding value of product has been found in reviewed literature. Nevertheless, the primary research conducted in the sample of Czech psychiatrists indicates that emotional brand in pharmaceutical industry exists and enables author to draw a model of Customer/product life cycle that describes likely impact of functional, emotional and self-expressive benefits throughout pharmaceutical product's market presence. Pharmaceutical brand is likely to develop differently than the same of consumer goods products--it seems to be built predominantly on long-term positive experience. Marketing role in this process should lie in finding relevant product position and building brand identity compliant with real product capabilities.

Pharmaceutical manufacturing facility discharges can substantially increase the pharmaceutical load to U.S. wastewaters

Science.gov (United States)

Scott, Tia-Marie; Phillips, Patrick J.; Kolpin, Dana W.; Colella, Kaitlyn M.; Furlong, Edward T.; Foreman, William T.; Gray, James L.

2018-01-01

Discharges from pharmaceutical manufacturing facilities (PMFs) previously have been identified as important sources of pharmaceuticals to the environment. Yet few studies are available to establish the influence of PMFs on the pharmaceutical source contribution to wastewater treatment plants (WWTPs) and waterways at the national scale. Consequently, a national network of 13 WWTPs receiving PMF discharges, six WWTPs with no PMF input, and one WWTP that transitioned through a PMF closure were selected from across the United States to assess the influence of PMF inputs on pharmaceutical loading to WWTPs. Effluent samples were analyzed for 120 pharmaceuticals and pharmaceutical degradates. Of these, 33 pharmaceuticals had concentrations substantially higher in PMF-influenced effluent (maximum 555,000 ng/L) compared to effluent from control sites (maximum 175 ng/L). Concentrations in WWTP receiving PMF input are variable, as discharges from PMFs are episodic, indicating that production activities can vary substantially over relatively short (several months) periods and have the potential to rapidly transition to other pharmaceutical products. Results show that PMFs are an important, national-scale source of pharmaceuticals to the environment.

Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care.

Science.gov (United States)

Helmes, Edward; Ward, Bradley G

2017-03-01

Anxiety in older people is under-diagnosed and poorly treated despite significant impairments that arise from anxiety. Mindfulness-based cognitive therapy (MBCT) has been shown to be a promising treatment for anxiety. The aim of this study was to determine the effect of an MBCT program on anxiety symptoms in older people living in residential care. Fifty-two participants (34 females) were randomly allocated into therapy and control groups using a 2 × 3 mixed design. The average age of participants was 83 years. The group effect showed significant improvements on all measures at the end of the seven-week program in the therapy group, while the control group did not show significant changes. This study represents one of the first studies of the effectiveness of an MBCT program on anxiety symptoms for older people using a randomized controlled trial. The study has implications for future research that include the effectiveness of MBCT for the treatment of anxiety symptoms in older people, the utility of group therapy programs in residential care and the benefits of using specialized instruments for older populations.

Prescribers and pharmaceutical representatives: why are we still meeting?

Science.gov (United States)

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

2009-07-01

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

A joint research protocol for music therapy in dementia care

DEFF Research Database (Denmark)

Ridder, Hanne Mette Ochsner; Stige, Brynjulf

2011-01-01

Agitation is a major challenge within institutions of care for the elderly. The effect of music therapy on agitation and quality of live is investigated in a practice-relevant research combined with a Randomized Controlled Trial and multicentre research. The research protocol is developed...... in dialogue with practicing music therapists....

Physical and occupational therapy utilization in a pediatric intensive care unit.

Science.gov (United States)

Cui, Liang R; LaPorte, Megan; Civitello, Matthew; Stanger, Meg; Orringer, Maxine; Casey, Frank; Kuch, Bradley A; Beers, Sue R; Valenta, Cynthia A; Kochanek, Patrick M; Houtrow, Amy J; Fink, Ericka L

2017-08-01

To characterize the use of physical therapy (PT) and occupational therapy (OT) consultation in our pediatric intensive care unit (PICU). We studied children aged 1week-18years admitted to a tertiary care PICU for ≥3days. Patient characteristics, details of PT and OT sessions and adverse events were collected. A multivariable logistic regression was performed to determine factors associated with receipt of PT and OT consultation with propensity analysis followed by a regression for factors associated with outcome. Of 138 children studied, 40 (29%) received PT and OT consultation. Services were initiated 6.9±10.0 (mean±standard deviation) days after PICU admission. Range of motion (83%) was the most common therapy provided and 28% of patients were ambulated. Sixty-four of 297 (21.5%) sessions were deferred and 7 (2.4%) sessions were terminated early due to physiologic instability with no serious adverse events. Children who received PT and OT were older, more likely to require neuromuscular blocking agents, and had lower pre-PICU POPC scores (all ptherapies initiated in the ICU to improve outcome for critically ill children. Copyright © 2017 Elsevier Inc. All rights reserved.

[Translational/regulatory science researches of NIHS for regenerative medicine and cellular therapy products].

Science.gov (United States)

Sato, Yoji

2014-01-01

In 2013, the Japanese Diet passed the Regenerative Medicine Promotion Act and the revisions to the Pharmaceutical Affairs Act, which was also renamed as the Therapeutic Products Act (TPA). One of the aims of the new/revised Acts is to promote the development and translation of and access to regenerative/cellular therapies. In the TPA, a product derived from processing cells is categorized as a subgroup of "regenerative medicine, cellular therapy and gene therapy products" (RCGPs), products distinct from pharmaceuticals and medical devices, allowing RCGPs to obtain a conditional and time- limited marketing authorization much earlier than that under the conventional system. To foster not only RCGPs, but also innovative pharmaceuticals and medical devices, the Ministry of Health, Labour and Welfare recently launched Translational Research Program for Innovative Pharmaceuticals, Medical Devices and RCGPs. This mini-review introduces contributions of the National Institute of Health Sciences (NIHS) to research projects on RCGPs in the Program.

[Increasing cost of insulin therapy in Belgium. From a critical analysis of the situation to a search for practical solutions].

Science.gov (United States)

Scheen, A J

2006-09-01

Cost related to insulin therapy is markedly increasing in Belgium, as in other Eucopean countries. In the present paper, we will briefly analyze the main reasons for such aa increase, integrate such observation withIn the global context of diabetes management and suggest some solutions to provide best care to insulin-treated diabetic patients at a reasonable cost. The rise of the cost of insulin therapy has a multifactorial origin. It mainly results from an increase in the number of diabetic patients, a more intensive management, In both type 1 and type 2 diabetes, and a greater use of more expansive insulin analogues. It is important to analyze the increase of the cost of insulin therapy within the global burden of diabetes melitus. Only a better responsibility of all health care partners, patients, physicians, pharmaceutical companies, public health authorities, could provide solutions allowing diabetic people to profit from best treatments they should receive in order to prevent diabetic complications, by far the main cause of expenses.

Brief Cognitive Behavioural Therapy compared to optimised general practitioners’ care for depression : A randomised trial

NARCIS (Netherlands)

Schene, A.H.; Baas, K.D.; Koeter, M.W.J.; Lucassen, P.; Bockting, C.L.H.; Wittkampf, K.A.; Huyser, J.; van Weert, H.C.

2014-01-01

Background: How to treat Major Depressive Disorder (MDD) in primary care? Studies that compared (brief) Cognitive Behavioural Therapy (CBT) with care as usual by the General Practitioner (GP) found the first to be more effective. However, to make a fair comparison GP care should be optimised and

Brief Cognitive Behavioural Therapy Compared to Optimised General Practitioners? Care for Depression: A Randomised Trial

NARCIS (Netherlands)

Schene, A. H.; Baas, K. D.; Koeter, M.; Lucassen, P.; Bockting, C. L. H.|info:eu-repo/dai/nl/258267992; Wittkampf, K. F.; van Weert, H. C.; Huyser, J.

2014-01-01

Background: How to treat Major Depressive Disorder (MDD) in primary care? Studies that compared (brief) Cognitive Behavioural Therapy (CBT) with care as usual by the General Practitioner (GP) found the first to be more effective. However, to make a fair comparison GP care should be optimised and

Application of Orem self-care theory on injection of interferon antiviral therapy in patients with

Directory of Open Access Journals (Sweden)

Xiujuan Tao

2015-01-01

Full Text Available Guided by Orem self-care theory, the nursing staff evaluate the injection of interferon antiviral therapy in patients, finding that patients with the presence of self-care was insufficient, so effective nursing care in different periods of application of different nursing system was necessary.

[Pharmaceutical logistic in turnover of pharmaceutical products of Azerbaijan].

Science.gov (United States)

Dzhalilova, K I

2009-11-01

Development of pharmaceutical logistic system model promotes optimal strategy for pharmaceutical functioning. The goal of such systems is organization of pharmaceutical product's turnover in required quantity and assortment, at preset time and place, at a highest possible degree of consumption readiness with minimal expenses and qualitative service. Organization of the optimal turnover chain in the region is offered to start from approximate classification of medicaments by logistic characteristics. Supplier selection was performed by evaluation of timeliness of delivery, quality of delivered products (according to the minimum acceptable level of quality) and time-keeping of time spending for orders delivery.

Structural-functional and parametric analysis of the social function of pharmaceutical industry

Directory of Open Access Journals (Sweden)

N. O. Tkachenko

2016-12-01

Full Text Available Pharmacy has always had a special (social value and was sensitive to the new social changes in the society and the state. These changes allow better understand the issues associated with increasing the efficiency of pharmaceutical care to the population. The aim of the work: identify, justify and to summarize the main elements of the social function of pharmacy, as a component of health care system, to further evaluate the properties of the pharmaceutical industry as a system. Materials and methods. To achieve this goal the principle of a systematic approach and the complex of research methods such as structural, functional and parametric analysis, logical knowledge and comparison, ad also generalization have been used. As materials of research, we used the results of fundamental and applied research of national and foreign experts on the issue. Results and discussion. The basic principles of the welfare state and pharmacy as socially oriented sectors of the economy have been determined. We have found that the pharmaceutical industry is an agent, which implements a number of elements of the social function, such as pharmaceutical assistance to the population, the production of social goods (drugs, medical products, medical cosmetics, etc., creating and providing of working places, paying taxes (replenishment of the state budget, the formation and development of human capital, research and innovation activities, charity and sponsorship, environmental protection. Ukraine formally acceded to United Nations document, «Agenda for the XXI Century». This agreement commits our government to implement development and implementation of sustainable development strategies. Its main components are the social responsibility, social integration, an efficient worker and effective owner. Social responsibility acts as a reverse reaction on realization of social policy through the main sectors of the economy. Conclusions. We have summarized the information and

Methods for handling uncertainty within pharmaceutical funding decisions

Science.gov (United States)

Stevenson, Matt; Tappenden, Paul; Squires, Hazel

2014-01-01

This article provides a position statement regarding decision making under uncertainty within the economic evaluation of pharmaceuticals, with a particular focus upon the National Institute for Health and Clinical Excellence context within England and Wales. This area is of importance as funding agencies have a finite budget from which to purchase a selection of competing health care interventions. The objective function generally used is that of maximising societal health with an explicit acknowledgement that there will be opportunity costs associated with purchasing a particular intervention. Three components of uncertainty are discussed within a pharmaceutical funding perspective: methodological uncertainty, parameter uncertainty and structural uncertainty, alongside a discussion of challenges that are particularly pertinent to health economic evaluation. The discipline has focused primarily on handling methodological and parameter uncertainty and a clear reference case has been developed for consistency across evaluations. However, uncertainties still remain. Less attention has been given to methods for handling structural uncertainty. The lack of adequate methods to explicitly incorporate this aspect of model development may result in the true uncertainty surrounding health care investment decisions being underestimated. Research in this area is ongoing as we review.

The role of health technology assessment on pharmaceutical reimbursement in selected middle-income countries.

Science.gov (United States)

Oortwijn, Wija; Mathijssen, Judith; Banta, David

2010-05-01

Middle-income countries are often referred to as developing or emerging economies and face multiple challenges of severe financial stresses in their health care sectors, and high disease burden. The objective of this study is to provide an overview of how health technology assessment (HTA) is used and organized in selected middle-income countries and its role in the process of pharmaceutical coverage. We selected middle-income countries where HTA activities are evident: Argentina, Brazil, China, Colombia, Israel, Mexico, Philippines, Korea, Taiwan, Thailand, and Turkey. We collected and reviewed relevant information to describe the health care and reimbursement systems and how HTA relates to coverage decision-making of pharmaceuticals. This was supplemented by information from a structured survey among professionals working in public and private health insurance, industry, regulatory authorities, ministries of health, academic units or HTA. All countries require market authorization for pharmaceuticals to be sold and most countries have a national plan defining which pharmaceuticals can be reimbursed. However, the use of HTA in reimbursement decisions is still in its early stages with varying levels of HTA guidance implementation. The study provides evidence of the development of HTA in coverage decision-making in middle-income countries. Increased health care spending and the resulting access to modern technology give a strong impetus to HTA. However, HTA is developing with uneven speed in middle-income countries and many countries are building on the organisational and methodological experience from established HTA agencies. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality

National Research Council Canada - National Science Library

Mossialos, Elias; Mrazek, M. F; Walley, T; Mossialos, E

2004-01-01

... Breckenridge, Chairman of the Medicines and Healthcare Products Regulatory Agency, United Kingdom The rising cost of pharmaceutical expenditures in many European countries is of concern to governments required to make effective use of health care budgets. Taking a broad perspective that encompasses institutional, political and supranational aspects of ...

Risk-based prioritization of pharmaceuticals in the natural environment in Iraq.

Science.gov (United States)

Al-Khazrajy, Omar S A; Boxall, Alistair B A

2016-08-01

Numerous studies have demonstrated the occurrence of pharmaceuticals in the natural environment, raising concerns about their impact on non-target organisms or human health. One region where little is known about the exposure and effects of pharmaceuticals in the environment is Iraq. Due to the high number of pharmaceuticals used by the public health sector in Iraq (hospitals and care centres) and distributed over the counter, there is a need for a systematic approach for identifying substances that should be monitored in the environment in Iraq and assessed in terms of environmental risk. In this study, a risk-based prioritization approach was applied to 99 of the most dispensed pharmaceuticals in three Iraqi cities, Baghdad, Mosul and Basrah. Initially, information on the amounts of pharmaceuticals used in Iraq was obtained. The top used medicines were found to be paracetamol, amoxicillin and metformin with total annual consumption exceeding 1000 tonnes per year. Predicted environmental concentrations (PECs) and predicted no-effect concentrations (PNECs), derived from ecotoxicological end-points and effects related to the therapeutic mode of action, were then used to rank the pharmaceuticals in terms of risks to different environmental compartments. Active pharmaceutical ingredients used as antibiotics, antidepressants and analgesics were identified as the highest priority in surface water, sediment and the terrestrial environment. Antibiotics were also prioritized according to their susceptibility to kill or inhibit the growth of bacteria or to accelerate the evolution and dissemination of antibiotic-resistant genes in water. Future work will focus on understanding the occurrence, fate and effects of some of highly prioritized substances in the environment.

Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals

DEFF Research Database (Denmark)

Johansen, Jens B; Mortensen, Peter T; Videbæk, Regitze

2011-01-01

Aims The aim of this study was to examine health-care professionals attitudes towards implantable cardioverter-defibrillator (ICD) therapy and issues discussed with patients. Methods and results Survey of 209 health-care professionals providing specialized treatment and care of ICD patients......-physicians. Physicians were less likely to believe that their personal attitude towards ICD treatment has no influence on how they deal professionally with patients (27.8 vs. 43.6%; P = 0.04). Physicians and non-physicians were equally positive towards ICD therapy as primary prophylaxis in ischaemic cardiomyopathy (87...... discussing ICD treatment with candidate patients. At the same time, physicians are more aware that their attitude towards ICD treatment may influence how they deal professionally with patients compared with non-physicians....

Factors affecting the choice of treatment in occupational therapy practices in hospital-based care.

NARCIS (Netherlands)

Driessen, M.J.; Dekker, J.; Lankhorst, G.; Zee, J. van der

1996-01-01

The aim of this article was twofold: to describe the occurrence of treatment goals, health-care programmes and type of interventions chosen by occupational therapists; and to investigate relationships between treatment goals, health-care programmes and interventions. A survey on occupational therapy

THz spectroscopy: An emerging technology for pharmaceutical development and pharmaceutical Process Analytical Technology (PAT) applications

Science.gov (United States)

Wu, Huiquan; Khan, Mansoor

2012-08-01

As an emerging technology, THz spectroscopy has gained increasing attention in the pharmaceutical area during the last decade. This attention is due to the fact that (1) it provides a promising alternative approach for in-depth understanding of both intermolecular interaction among pharmaceutical molecules and pharmaceutical product quality attributes; (2) it provides a promising alternative approach for enhanced process understanding of certain pharmaceutical manufacturing processes; and (3) the FDA pharmaceutical quality initiatives, most noticeably, the Process Analytical Technology (PAT) initiative. In this work, the current status and progress made so far on using THz spectroscopy for pharmaceutical development and pharmaceutical PAT applications are reviewed. In the spirit of demonstrating the utility of first principles modeling approach for addressing model validation challenge and reducing unnecessary model validation "burden" for facilitating THz pharmaceutical PAT applications, two scientific case studies based on published THz spectroscopy measurement results are created and discussed. Furthermore, other technical challenges and opportunities associated with adapting THz spectroscopy as a pharmaceutical PAT tool are highlighted.

Music therapy in cardiac health care: current issues in research.

Science.gov (United States)

Hanser, Suzanne B

2014-01-01

Music therapy is a service that has become more prevalent as an adjunct to medical practice-as its evidence base expands and music therapists begin to join the cardiology team in every phase of care, from the most serious cases to those maintaining good heart health. Although applications of music medicine, primarily listening to short segments of music, are capable of stabilizing vital signs and managing symptoms in the short-term, music therapy interventions by a qualified practitioner are showing promise in establishing deeper and more lasting impact. On the basis of mind-body approaches, stress/coping models, the neuromatrix theory of pain, and entrainment, music therapy capitalizes on the ability of music to affect the autonomic nervous system. Although only a limited number of randomized controlled trials pinpoint the efficacy of specific music therapy interventions, qualitative research reveals some profound outcomes in certain individuals. A depth of understanding related to the experience of living with a cardiovascular disease can be gained through music therapy approaches such as nonverbal music psychotherapy and guided imagery and music. The multifaceted nature of musical responsiveness contributes to strong individual variability and must be taken into account in the development of research protocols for future music therapy and music medicine interventions. The extant research provides a foundation for exploring the many potential psychosocial, physiological, and spiritual outcomes of a music therapy service for cardiology patients.

Bee venom therapy: Potential mechanisms and therapeutic applications.

Science.gov (United States)

Zhang, Shuai; Liu, Yi; Ye, Yang; Wang, Xue-Rui; Lin, Li-Ting; Xiao, Ling-Yong; Zhou, Ping; Shi, Guang-Xia; Liu, Cun-Zhi

2018-04-11

Bee venom is a very complex mixture of natural products extracted from honey bee which contains various pharmaceutical properties such as peptides, enzymes, biologically active amines and nonpeptide components. The use of bee venom into the specific points is so called bee venom therapy, which is widely used as a complementary and alternative therapy for 3000 years. A growing number of evidence has demonstrated the anti-inflammation, the anti-apoptosis, the anti-fibrosis and the anti-arthrosclerosis effects of bee venom therapy. With these pharmaceutical characteristics, bee venom therapy has also been used as the therapeutic method in treating rheumatoid arthritis, amyotrophic lateral sclerosis, Parkinson's disease, Alzheimer's disease, liver fibrosis, atherosclerosis, pain and others. Although widely used, several cases still reported that bee venom therapy might cause some adverse effects, such as local itching or swelling. In this review, we summarize its potential mechanisms, therapeutic applications, and discuss its existing problems. Copyright © 2018 Elsevier Ltd. All rights reserved.

Metabolism of pharmaceutical and personal care products by carrot cell cultures.

Science.gov (United States)

Wu, Xiaoqin; Fu, Qiuguo; Gan, Jay

2016-04-01

With the increasing use of treated wastewater and biosolids in agriculture, residues of pharmaceutical and personal care products (PPCPs) in these reused resources may contaminate food produce via plant uptake, constituting a route for human exposure. Although various PPCPs have been reported to be taken up by plants in laboratories or under field conditions, at present little information is available on their metabolism in plants. In this study, we applied carrot cell cultures to investigate the plant metabolism of PPCPs. Five phase I metabolites of carbamazepine were identified and the potential metabolism pathways of carbamazepine were proposed. We also used the carrot cell cultures as a rapid screening tool to initially assess the metabolism potentials of 18 PPCPs. Eleven PPCPs, including acetaminophen, caffeine, meprobamate, primidone, atenolol, trimethoprim, DEET, carbamazepine, dilantin, diazepam, and triclocarban, were found to be recalcitrant to metabolism. The other 7 PPCPs, including triclosan, naproxen, diclofenac, ibuprofen, gemfibrozil, sulfamethoxazole, and atorvastatin, displayed rapid metabolism, with 0.4-47.3% remaining in the culture at the end of the experiment. Further investigation using glycosidase hydrolysis showed that 1.3-20.6% of initially spiked naproxen, diclofenac, ibuprofen, and gemfibrozil were transformed into glycoside conjugates. Results from this study showed that plant cell cultures may be a useful tool for initially exploring the potential metabolites of PPCPs in plants as well as for rapidly screening the metabolism potentials of a variety of PPCPs or other emerging contaminants, and therefore may be used for prioritizing compounds for further comprehensive evaluations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Multi-residue determination of pharmaceutical and personal care products in vegetables.

Science.gov (United States)

Wu, Xiaoqin; Conkle, Jeremy Landon; Gan, Jay

2012-09-07

Treated wastewater irrigation and biosolid amendment are increasingly practiced worldwide and contamination of plants, especially produces that may be consumed raw by humans, by pharmaceutical and personal care products (PPCPs), is an emerging concern. A sensitive method was developed for the simultaneous measurement of 19 frequently-occurring PPCPs in vegetables using high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS) for detection, combined with ultrasonic extraction and solid phase extraction (SPE) cleanup for sample preparation. Deuterated standards were used as surrogates to quantify corresponding analytes. The corrected recoveries ranged between 87.1 and 123.5% for iceberg lettuce, with intra- and inter-day variations less than 20%, and the method detection limits (MDLs) in the range of 0.04-3.0 ng g⁻¹ dry weight (dw). The corrected recoveries were equally good when the method was used on celery, tomato, carrot, broccoli, bell pepper and spinach. The method was further applied to examine uptake of PPCPs by iceberg lettuce and spinach grown in hydroponic solutions containing each PPCP at 500 ng L⁻¹. Twelve PPCPs were detected in lettuce leaves with concentrations from 0.2 to 28.7 ng g⁻¹ dw, while 11 PPCPs were detected in spinach leaves at 0.04-34.0 ng g⁻¹ dw. Given the diverse chemical structures of PPCPs considered in this study, this method may be used for screening PPCP residues in vegetables and other plants impacted by treated wastewater or biosolids, and to estimate potential human exposure via dietary uptake. Copyright © 2012 Elsevier B.V. All rights reserved.

LEARNING ORGANISATION CHALLENGE FOR ROMANIAN PHARMACEUTICAL SMEs

Directory of Open Access Journals (Sweden)

Otilia-Maria BORDEIANU

2014-04-01

Full Text Available The concept of the learning organization has gone through many changes both theoretically and also as practical implementation. Learning organizations do not appear automatically, they require a strong commitment for developing the skills needed in the workplace, and this commitment should start from the top of the organization. The learning process should be managed at different levels within the organization. Learning, therefore, is made up of several different components and requires a special management. Successful companies are the result of carefully cultivated attitudes, commitments and management processes. This paper investigates the learning organization dimensions analysed in case of pharmaceutical SMEs from Romania. The results obtained in this study allow us to draw relevant conclusions, constituting a practical starting point for businesses. The paper highlights the fact that SMEs pharmaceutical companies have taken important steps toward learning organization model, but reaching different levels from one key dimension to another.

Pharmaceuticals and personal care products in the aquatic environment as a new issue of environmental health

Directory of Open Access Journals (Sweden)

Aneta Koszowska

2015-03-01

Full Text Available Pharmaceuticals and Personal Care Products PPCPs are different chemical substances biologically active. They are part of drugs, supplements and cosmetics. An increasing interest in the field of PPCPs is observed recently. High sensitivity analysis methods allowed to detect PPCPs in natural environment in the world . Because of their complex chemical structure these compounds are not completely removed and discharged into the sewage for treatment and as such unchanged or intermediate metabolites may cause pollution of surface and deep water. It is estimated that they may accumulate in living organisms. PPCPs problem becomes a serious challenge for many scientific disciplines. The aim of the study is to present the problem of the occurrence of PPCPs in water environment as a new environmental health hazard. This study presents selected groups of PPCPs as the examples of research in the field of PPCPS and their presence in the environment. Moreover new prospects of removing these substances from water are shown.

Occupational Therapy Predischarge Home Visits in Acute Hospital Care: A Randomized Trial.

Science.gov (United States)

Clemson, Lindy; Lannin, Natasha A; Wales, Kylie; Salkeld, Glenn; Rubenstein, Laurence; Gitlin, Laura; Barris, Sarah; Mackenzie, Lynette; Cameron, Ian D

2016-10-01

To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Randomized controlled trial. Acute and medical wards. Individuals aged 70 and older (N = 400). Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Occupational therapist recommendations differed significantly between groups (P occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

What Aspects of Personal Care Are Most Important to Patients Undergoing Radiation Therapy for Prostate Cancer?

International Nuclear Information System (INIS)

Foley, Kimberley A.; Feldman-Stewart, Deb; Groome, Patti A.; Brundage, Michael D.; McArdle, Siobhan; Wallace, David; Peng, Yingwei; Mackillop, William J.

2016-01-01

Purpose/Objective: The overall quality of patient care is a function of the quality of both its technical and its nontechnical components. The purpose of this study was to identify the elements of nontechnical (personal) care that are most important to patients undergoing radiation therapy for prostate cancer. Methods and Materials: We reviewed the literature and interviewed patients and health professionals to identify elements of personal care pertinent to patients undergoing radiation therapy for prostate cancer. We identified 143 individual elements relating to 10 aspects of personal care. Patients undergoing radical radiation therapy for prostate cancer completed a self-administered questionnaire in which they rated the importance of each element. The overall importance of each element was measured by the percentage of respondents who rated it as “very important.” The importance of each aspect of personal care was measured by the mean importance of its elements. Results: One hundred eight patients completed the questionnaire. The percentage of patients who rated each element “very important” ranged from 7% to 95% (mean 61%). The mean importance rating of the elements of each aspect of care varied significantly: “perceived competence of caregivers,” 80%; “empathy and respectfulness of caregivers,” 67%; “adequacy of information sharing,” 67%; “patient centeredness,” 59%; “accessibility of caregivers,” 57%; “continuity of care,” 51%; “privacy,” 51%; “convenience,” 45%; “comprehensiveness of services,” 44%; and “treatment environment,” 30% (P<.0001). Neither age nor education was associated with importance ratings, but the patient's health status was associated with the rating of some elements of care. Conclusions: Many different elements of personal care are important to patients undergoing radiation therapy for prostate cancer, but the 3 aspects of care that most believe are most important are these: the perceived

What Aspects of Personal Care Are Most Important to Patients Undergoing Radiation Therapy for Prostate Cancer?

Energy Technology Data Exchange (ETDEWEB)

Foley, Kimberley A. [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Feldman-Stewart, Deb [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Groome, Patti A. [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Brundage, Michael D. [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Cancer Centre of Southeastern Ontario, Kingston, Ontario (Canada); McArdle, Siobhan [Cancer Centre of Southeastern Ontario, Kingston, Ontario (Canada); Wallace, David [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Peng, Yingwei [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Mathematics and Statistics, Queen' s University, Kingston, Ontario (Canada); Mackillop, William J., E-mail: William.mackillop@krcc.on.ca [Cancer Care and Epidemiology, Queen' s Cancer Research Institute, Kingston, Ontario (Canada); Department of Public Health Sciences, Queen' s University, Kingston, Ontario (Canada); Department of Oncology, Queen' s University, Kingston, Ontario (Canada); Cancer Centre of Southeastern Ontario, Kingston, Ontario (Canada)

2016-02-01

Purpose/Objective: The overall quality of patient care is a function of the quality of both its technical and its nontechnical components. The purpose of this study was to identify the elements of nontechnical (personal) care that are most important to patients undergoing radiation therapy for prostate cancer. Methods and Materials: We reviewed the literature and interviewed patients and health professionals to identify elements of personal care pertinent to patients undergoing radiation therapy for prostate cancer. We identified 143 individual elements relating to 10 aspects of personal care. Patients undergoing radical radiation therapy for prostate cancer completed a self-administered questionnaire in which they rated the importance of each element. The overall importance of each element was measured by the percentage of respondents who rated it as “very important.” The importance of each aspect of personal care was measured by the mean importance of its elements. Results: One hundred eight patients completed the questionnaire. The percentage of patients who rated each element “very important” ranged from 7% to 95% (mean 61%). The mean importance rating of the elements of each aspect of care varied significantly: “perceived competence of caregivers,” 80%; “empathy and respectfulness of caregivers,” 67%; “adequacy of information sharing,” 67%; “patient centeredness,” 59%; “accessibility of caregivers,” 57%; “continuity of care,” 51%; “privacy,” 51%; “convenience,” 45%; “comprehensiveness of services,” 44%; and “treatment environment,” 30% (P<.0001). Neither age nor education was associated with importance ratings, but the patient's health status was associated with the rating of some elements of care. Conclusions: Many different elements of personal care are important to patients undergoing radiation therapy for prostate cancer, but the 3 aspects of care that most believe are most important are these: the

Effects of Improvisational Music Therapy vs Enhanced Standard Care on Symptom Severity Among Children With Autism Spectrum Disorder

Science.gov (United States)

Bieleninik, Łucja; Geretsegger, Monika; Mössler, Karin; Assmus, Jörg; Thompson, Grace; Gattino, Gustavo; Elefant, Cochavit; Gottfried, Tali; Igliozzi, Roberta; Muratori, Filippo; Suvini, Ferdinando; Kim, Jinah; Crawford, Mike J.; Odell-Miller, Helen; Oldfield, Amelia; Casey, Órla; Finnemann, Johanna; Carpente, John; Park, A-La; Grossi, Enzo

2017-01-01

Importance Music therapy may facilitate skills in areas affected by autism spectrum disorder (ASD), such as social interaction and communication. Objective To evaluate effects of improvisational music therapy on generalized social communication skills of children with ASD. Design, Setting, and Participants Assessor-blinded, randomized clinical trial, conducted in 9 countries and enrolling children aged 4 to 7 years with ASD. Children were recruited from November 2011 to November 2015, with follow-up between January 2012 and November 2016. Interventions Enhanced standard care (n = 182) vs enhanced standard care plus improvisational music therapy (n = 182), allocated in a 1:1 ratio. Enhanced standard care consisted of usual care as locally available plus parent counseling to discuss parents’ concerns and provide information about ASD. In improvisational music therapy, trained music therapists sang or played music with each child, attuned and adapted to the child’s focus of attention, to help children develop affect sharing and joint attention. Main Outcomes and Measures The primary outcome was symptom severity over 5 months, based on the Autism Diagnostic Observation Schedule (ADOS), social affect domain (range, 0-27; higher scores indicate greater severity; minimal clinically important difference, 1). Prespecified secondary outcomes included parent-rated social responsiveness. All outcomes were also assessed at 2 and 12 months. Results Among 364 participants randomized (mean age, 5.4 years; 83% boys), 314 (86%) completed the primary end point and 290 (80%) completed the last end point. Over 5 months, participants assigned to music therapy received a median of 19 music therapy, 3 parent counseling, and 36 other therapy sessions, compared with 3 parent counseling and 45 other therapy sessions for those assigned to enhanced standard care. From baseline to 5 months, mean ADOS social affect scores estimated by linear mixed-effects models decreased from 14

Uptake and Tissue Distribution of Pharmaceuticals and Personal Care Products in Wild Fish from Treated-Wastewater-Impacted Streams.

Science.gov (United States)

Tanoue, Rumi; Nomiyama, Kei; Nakamura, Haruna; Kim, Joon-Woo; Isobe, Tomohiko; Shinohara, Ryota; Kunisue, Tatsuya; Tanabe, Shinsuke

2015-10-06

A fish plasma model (FPM) has been proposed as a screening technique to prioritize potential hazardous pharmaceuticals to wild fish. However, this approach does not account for inter- or intraspecies variability of pharmacokinetic and pharmacodynamic parameters. The present study elucidated the uptake potency (from ambient water), tissue distribution, and biological risk of 20 pharmaceutical and personal care product (PPCP) residues in wild cyprinoid fish inhabiting treated-wastewater-impacted streams. In order to clarify the uncertainty of the FPM for PPCPs, we compared the plasma bioaccumulation factor in the field (BAFplasma = measured fish plasma/ambient water concentration ratio) with the predicted plasma bioconcentration factor (BCFplasma = fish plasma predicted by use of theoretical partition coefficients/ambient water concentration ratio) in the actual environment. As a result, the measured maximum BAFplasma of inflammatory agents was up to 17 times higher than theoretical BCFplasma values, leading to possible underestimation of toxicological risk on wild fish. When the tissue-blood partition coefficients (tissue/blood concentration ratios) of PPCPs were estimated, higher transportability into tissues, especially the brain, was found for psychotropic agents, but brain/plasma ratios widely varied among individual fish (up to 28-fold). In the present study, we provide a valuable data set on the intraspecies variability of PPCP pharmacokinetics, and our results emphasize the importance of determining PPCP concentrations in possible target organs as well as in the blood to assess the risk of PPCPs on wild fish.

Future wastewater solutions: removal of pharmaceuticals in conventional wastewater treatment plants

DEFF Research Database (Denmark)

Jensen, Thomas

Residues of pharmaceuticals, personal care products and industrial chemicals find their way into the environment mainly through incomplete removal in the conventional urban wastewater treatment plants (WWTPs) and appear as micro-pollutants at pg L-1 to μg L-1 concentrations. WWTPs were designed...

Nursing care for patients with pulmonary malignancy after radiofrequency ablation therapy

International Nuclear Information System (INIS)

Ren Caifeng; Gong Yunzhen; Li Huiqian; Ge Lei; Zhao Fang

2009-01-01

Objective: To discuss the nursing care strategy for patients with pulmonary malignancy who were treated with CT-guided radiofrequency ablation (RFA) therapy. Methods CT-guided RFA was performed in 21 patients with pulmonary malignancy, the sum total of ablated lesions was 31. Results: RFA procedure was successfully accomplished in all patients. The operation-related complications included minor pneumothorax, hydropneumothorax, bloody sputum, pain and mild fever. The clinical symptoms were soon relieved after medication according to indications. No death or serious complications occurred. Conclusion: For patients with pulmonary malignancy who were treated with CT-guided RFA, esponsible nursing care and serious, careful observation after operation are very helpful for patient's recovery. (authors)

Monitoring of emerging contaminants (pharmaceuticals, Personal Care Products, surfactants and heavy metals) in a quaternary detritic aquifer

Science.gov (United States)

Candela, L.; Valdes-Abellan, J.; Jiménez-Martínez, J.

2012-04-01

The presence of 209 emerging compounds, surfactants, priority substances according to the 2008/105/EC Directive, 10 heavy metals and microbiological organisms in blended water and aquifer samples was investigated in a quaternary aquifer. The effects of these compounds over the environment are not clear in many cases, but many of them have been classified as endocrine disruptor compounds, EDC. Their presence in the media is controlled in one hand by their transformation and/or removal rates and, on the other hand, by their continuous release into the media, due to the broad use of these in many human activities (pharmaceuticals, personal care products, pesticides, heavy metals, LAS and others). The attention of this work focusses on the presence and fate of these substances in the vadose zone and the aquifer. The aquifer catchment (81km2) located in SE Spain presents a high natural salinity (with EC values of ~7,500 μS cm-1, and high concentrations of chloride, sulphate and sodium), making it unsuitable to be used as drinking water or irrigation. Two sampling campaigns (February and June 2011) in wells and springs have been carried out top characterize physic-chemical, microbiological and emerging contaminants presence in the aquifer. A total of 209 emerging pollutants grouped into the following classes were analysed: 125 pharmaceutical compounds (Phs), 20 polyaromatic hydrocarbons (PAHs) and Dioxins, 46 pesticides, 3 volatile priority pollutants as well as the most commonly used anionic surfactants were identified for further analysis. Heavy metals included: Cu, Cd, Pb, Hg, Ni, Zn, Sn, Pt, Pd and Tl. Results showed that 39 out of all compounds were detected: 11 pharmaceuticals, 9 PAHs, 19 pesticides, 4 surfactants and 4 heavy metals. Two of the compounds, endosulfan-α and Ni, were detected in concentrations above the allowed regulation. Although results are limited to 2 sampling campaigns, it is important to note that surfactants (LAS), pesticides PAHs and

Development of Taiwan's strategies for regulating nanotechnology-based pharmaceuticals harmonized with international considerations.

Science.gov (United States)

Guo, Jiun-Wen; Lee, Yu-Hsuan; Huang, Hsiau-Wen; Tzou, Mei-Chyun; Wang, Ying-Jan; Tsai, Jui-Chen

2014-01-01

Nanotechnology offers potential in pharmaceuticals and biomedical developments for improving drug delivery systems, medical imaging, diagnosis, cancer therapy, and regenerative medicine. Although there is no international regulation or legislation specifically for nanomedicine, it is agreed worldwide that considerably more attention should be paid to the quality, safety, and efficacy of nanotechnology-based drugs. The US Food and Drug Administration and the European Medicines Agency have provided several draft regulatory guidance and reflection papers to assist the development of nanomedicines. To cope with the impact of nanotechnology and to foster its pharmaceutical applications and development in Taiwan, this article reviews the trends of regulating nanotechnology-based pharmaceuticals in the international community and proposes strategies for Taiwan's regulation harmonized with international considerations. The draft regulatory measures include a chemistry, manufacturing, and controls (CMC) review checklist and guidance for CMC review of liposomal products. These have been submitted for discussion among an expert committee, with membership comprised of multidisciplinary academia, research institutions, the pharmaceutical industry, and regulators, and are currently approaching final consensus. Once a consensus is reached, these mechanisms will be recommended to the Taiwan Food and Drug Administration for jurisdiction and may be initiated as the starting point for regulating nanotechnology-based pharmaceuticals in Taiwan.

Evaluation of P-Listed Pharmaceutical Residues in Empty Pharmaceutical Containers

Science.gov (United States)

Under the Resource Conservation and Recovery Act (RCRA), some pharmaceuticals are considered acute hazardous wastes because their sole active pharmaceutical ingredients are P-listed commercial chemical products (40 CFR 261.33). Hospitals and other healthcare facilities have stru...

A study on monitoring of pharmaceuticals and personal care products (PPCPs) in livestock wastewater and treatment by radiation techniques

Energy Technology Data Exchange (ETDEWEB)

Myung, Seung Woon [KAERI, Daejeon (Korea, Republic of)

2010-05-15

In this study, and effective monitoring and the investigation of treatment efficiency of pharmaceuticals from the influent and effluent of livestock wastewater treatment plant (WWTPs) and by-product with radiation processing by LC/ESI-MS/MS was performed. Thirteen pharmaceuticals including antibiotics, growth promoters and disinfectants were assayed from twelve WWTPs in South Korea. The established method could be used to determine low concentration levels of pharmaceuticals in environmental samples. From few influents of live-stock WWTPs, chlortetracycline and acetaminophen were detected with the highest concentration among the monitoring pharmaceuticals. And also lincomycin, sufathiazole, sulfamethazine, trimethoprim, acetyl salicylic acid, tylosin, glutaraldehyde and formaldehyde were detected from the influents of WWTPs

A study on monitoring of pharmaceuticals and personal care products (PPCPs) in livestock wastewater and treatment by radiation techniques

International Nuclear Information System (INIS)

Myung, Seung Woon

2010-05-01

In this study, and effective monitoring and the investigation of treatment efficiency of pharmaceuticals from the influent and effluent of livestock wastewater treatment plant (WWTPs) and by-product with radiation processing by LC/ESI-MS/MS was performed. Thirteen pharmaceuticals including antibiotics, growth promoters and disinfectants were assayed from twelve WWTPs in South Korea. The established method could be used to determine low concentration levels of pharmaceuticals in environmental samples. From few influents of live-stock WWTPs, chlortetracycline and acetaminophen were detected with the highest concentration among the monitoring pharmaceuticals. And also lincomycin, sufathiazole, sulfamethazine, trimethoprim, acetyl salicylic acid, tylosin, glutaraldehyde and formaldehyde were detected from the influents of WWTPs

The pharmaceutical corporation and the 'good work' of managing women's bodies.

Science.gov (United States)

Padamsee, Tasleem Juana

2011-04-01

Pharmaceutical companies are intricately intertwined with every aspect of contemporary medical reality, and they increasingly drive the social process of medicalization in order to establish and dominate markets for their drugs and devices. In addition to funding the majority of clinical research, organizing it to generate an evidence base that favors their innovations, and influencing the regulation of pharmaceutical drugs and devices, companies still spend substantial resources on direct attempts to shape the attitudes, dispositions, and prescribing behavior of physicians. This article sheds new light on our picture of the relationship between the pharmaceutical industry and physicians by examining a novel form of physician-directed communication produced by one prominent corporation. An interpretive, thematic analysis of ORGYN - the unique, full-length magazine published by the Organon Corporation between 1990 and 2003 - reveals two overarching messages it communicated to physicians during that period. First, it offered a compelling picture of the "good work" obstetricians and gynecologists do, which involves enabling women of reproductive age to control their fertility through contraception and infertility treatment, and providing symptom relief and preventive benefits to older women by increasing compliance with hormone therapy regimes. Second, it included pharmaceutical technology in every aspect of the doctor's work, portraying pharmaceutical corporations as the physician's "natural partner", and women patients as passive, disempowered objects of medical practice. Through these consistent messages, the print magazine ORGYN represented one important set of mechanisms by which a pharmaceutical corporation helped drive and sustain medicalization. The article ends with a consideration of the implications of ORGYN's messages for companies, doctors, women patients, and the study of medicalization. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pharmacy specialists' attitudes toward pharmaceutical service quality at community pharmacies.

Science.gov (United States)

Urbonas, Gvidas; Jakušovaitė, Irayda; Savickas, Arūnas

2010-01-01

The main objective of this study was to analyze pharmacy specialists' attitudes toward the quality of pharmaceutical services at Lithuanian community pharmacies. Between April and June 2009, a total of 471 Lithuanian community pharmacy specialists completed a questionnaire designed to evaluate their attitudes toward the quality of pharmaceutical services at community pharmacies. The main dimensions of pharmaceutical service quality were extracted by principal component analysis. Two main dimensions of pharmaceutical service quality were extracted: pharmacotherapeutic aspects (provision of information about drug therapy, possible side effects, health promotion, the amount of time spent with a patient, and the ascertainment that a patient understood the provided information) and socioeconomic aspects (considering patient's needs and financial capabilities, making a patient confident with the services provided). Pharmacy specialists evaluated the quality of both dimensions positively, but the quality of the first dimension was rated significantly worse than that of the second dimension. The attitudes of pharmacy specialists working at independent pharmacies were more positive toward pharmacotherapeutic aspects as compared to the specialists working at chain or state pharmacies. Pharmacotherapeutic aspects were rated better by pharmacy specialists, aged ≥ 55 years, than those younger than 45 years. Moreover, the attitudes of 45-54-year-old pharmacy specialists toward the socioeconomic aspects were more positive as compared with those of 35-44-year olds. Pharmacists rated the socioeconomic aspects of pharmaceutical service quality worse as compared with pharmacy technicians. The attitudes of pharmacy specialists working at pharmacies with 6-9 specialists were more negative toward pharmacotherapeutic aspects than those of the pharmacies with 1-2 specialists. Pharmacy specialists working at pharmacies with ≥ 10 specialists reported lower scores of socioeconomic

Clinical profile of newborns undergoing physical therapy in a neonatal intensive care unit

Directory of Open Access Journals (Sweden)

Graziela Ferreira Biazus

Full Text Available Abstract Introduction: In neonatal therapy units, physical therapy is directed toward integral baby care. Objective: To describe the profile of newborns (NBs hospitalized in a Neonatal Intensive Care Unit (NICU. Methods: Retrospective documentary study with data collection from medical records from July 2011 to July 2013. The sample consisted of NBs who performed motor and respiratory therapy. Data were grouped into five categories according to birth weight (≤ 1000g, 1001-1500g, 1501-2000g, 2001-2500g, ≥ 2501g. Results: total of 1,884 newborns were admitted to the NICU within the stipulated period, 168 (13.9% underwent physical therapy. Of the 168 NBs who underwent physical therapy, 137 were born in the hospital (81.5% and 31 were transferred there (18.5%; 17 of these babies died during the neonatal hospital stay (10.1%. All newborns of the extremely low birth weight group (≤ 1000g required mechanical ventilation, 72.7% non-invasive ventilation and 16.6% high-frequency oscillatory ventilation. The occurrence of pneumothorax in the extremely low birth weight group was 13.8% and 16% in the group with birth weight 1001-1500g. Conclusion: Infants with low birth weight (<2500g constituted the profile of NBs who underwent physical therapy, which was directly related to higher incidence of death and pneumothorax, as well as increased use of mechanical and non-invasive ventilation.

Systemic therapy in men with metastatic castration-resistant prostate cancer:American Society of Clinical Oncology and Cancer Care Ontario clinical practice guideline.

Science.gov (United States)

Basch, Ethan; Loblaw, D Andrew; Oliver, Thomas K; Carducci, Michael; Chen, Ronald C; Frame, James N; Garrels, Kristina; Hotte, Sebastien; Kattan, Michael W; Raghavan, Derek; Saad, Fred; Taplin, Mary-Ellen; Walker-Dilks, Cindy; Williams, James; Winquist, Eric; Bennett, Charles L; Wootton, Ted; Rumble, R Bryan; Dusetzina, Stacie B; Virgo, Katherine S

2014-10-20

To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 ((223)Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or (223)Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to evaluate optimal sequences or

Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary

Directory of Open Access Journals (Sweden)

Senthil P Kumar

2011-01-01

Full Text Available Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification-based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective are explained with recent evidence for physical therapy treatments for each of the mechanisms.

Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial

Directory of Open Access Journals (Sweden)

Severens Johan L

2008-06-01

Full Text Available Abstract Background Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost- effectiveness of online computerised cognitive behavioural therapy for depression in primary care. Methods/Design In a randomised trial we will compare (a computerised cognitive behavioural therapy with (b treatment as usual by a GP, and (c computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65 will be recruited in the general population by means of a large-scale Internet-based screening (N = 200,000. Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life

Application of ozonation for pharmaceuticals and personal care products removal from water.

Science.gov (United States)

Gomes, João; Costa, Raquel; Quinta-Ferreira, Rosa M; Martins, Rui C

2017-05-15

Due to the shortening on natural water resources, reclaimed wastewater will be an important water supply source. However, suitable technologies must be available to guaranty its proper detoxification with special concern for the emerging pharmaceutical and personal care products that are continuously reaching municipal wastewater treatment plants. While conventional biological systems are not suitable to remove these compounds, ozone, due to its interesting features involving molecular ozone oxidation and the possibility of generating unselective hydroxyl radicals, has a wider range of action on micropollutants removal and water disinfection. This paper aims to review the studies dealing with ozone based processes for water reuse by considering municipal wastewater reclamation as well as natural and drinking water treatment. A comparison with alternative technologies is given. The main drawback of ozonation is related with the low mineralization achieved that may lead to the production of reaction intermediates with toxic features. The use of hydrogen peroxide and light aided systems enhance ozone action over pollutants. Moreover, scientific community is focused on the development of solid catalysts able to improve the mineralization level achieved by ozone. Special interest is now being given to solar light catalytic ozonation systems with interesting results both for chemical and biological contaminants abatement. Nowadays the integration between ozonation and sand biofiltration seems to be the most interesting cost effective methodology for water treatment. However, further studies must be performed to optimize this system by understanding the biofiltration mechanisms. Copyright © 2017 Elsevier B.V. All rights reserved.

Exploring the role of occupational therapy in caring for cancer survivors in Australia: A cross sectional study.

Science.gov (United States)

Buckland, Nicole; Mackenzie, Lynette

2017-10-01

With increasing rates of cancer survival in Australia, more people are living with long-term side effects of cancer and its treatment, and cancer survivorship is now considered a distinct phase of cancer care. While occupational therapists play an integral role in multidisciplinary care for people with chronic conditions, there is little evidence documenting the occupational therapy role for people living with chronic cancer-related conditions. This study aimed to explore the views of Australian occupational therapists about current practice and what constitutes best practice for cancer survivors. A cross-sectional online survey was developed and distributed via emailed invitations to the Occupational Therapy Australia membership to collect responses from occupational therapists in a range of locations and practice settings around Australia. A total of 204 completed surveys were returned (response rate of 4%). More than 70% (n = 143) of respondents worked with people with cancer at least sometimes and most worked in acute (13.8%, n = 28) or community (11.2%, n = 23) settings. Participants rated equipment provision as the most common intervention (94%, n = 192), followed by energy conservation (91%, n = 185) and pressure care (78%, n = 160). Lack of funding for occupational therapy positions and a lack of recognition of the role of occupational therapy by health professionals and consumers were identified as key barriers to survivorship care. Research is needed to provide evidence supporting the role and practice of occupational therapy with cancer survivors. Collaborative work with multidisciplinary teams is needed to develop long-term routine treatment pathways that include occupational therapy interventions. © 2017 Occupational Therapy Australia.