Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship.

Objective: To investigate and describe how an acute care, multi-site teaching hospital implements a new technology called the Automated Medication Dispensing Cabinet (ADC) that will be used by nurses. Design and methods: Qualitative, descriptive, single-case study method using the Ottawa Model of Research Use as a framework to guide data collection and analysis. The project was evaluated from the beginning, through the planning stages until a cabinet vendor was chosen. Results: A multidisciplinary committee was created to implement the ADCs across the organization. Clinical nurses, the intended users, were not directly involved in the implementation; usability testing was not done; they were not prepared for all the needed training costs and no evaluation was planned. Conclusions: An implementation framework was not used to guide the ADC project and several key area surrounding implementation were missed. Recommendations were made to improve future implementation projects in heath organizations.

Fluid dispensing is a method by which fluid materials are delivered to the targeted boards in a controlled manner and has been extensively applied in various packaging processes in the electronics assembly industry. In these processes, the flow rate of the fluid dispensed and/or the fluid amount transferred onto a board are two important performance indexes. Due to the involvement of the compressibility and non-Newtonian behaviour of the fluid being dispensed, modeling the fluid dispensing process has proven to be a challenging task. This thesis presents a study on the modeling of the positive displacement dispensing process, in which the linear displacement of a piston is used to dispense fluid. Also, this thesis presents an evaluation of different designs of the fluid dispensing system based on the axiomatic design principles. <p>At first, the characterization of the flow behaviour of fluids used in the electronic packaging industry is addressed. Based on the previous experiments conducted in the authors lab, a 3-parameter Carreau model for the fluid Hysol FP4451 is derived for use in the present study. Then, taking into account fluid compressibility and flow behaviour, a model is developed to represent the dynamics of the flow rate of the fluid dispensed. The resulting model suggests that the dynamics of the flow rate in the positive displacement dispensing process is equivalent to that of a second order system. Based on the model developed, the influences of the fluid compressibility and the process parameters such as the dispensing time and needle temperature are investigated by simulations. <p>In the positive dispensing process, it is noticed that the fluid amount dispensed out of needle is different from the fluid amount finally transferred to the board, if the fluid amount dispensed is very small. This difference is considered one major problem affecting dispensing performance. In order to determine the fluid amount transferred to the board, a 3-step method is developed in the present study, based on existing theories of liquid bridges and Laplaces equation. Simulations are conducted based on the developed method to study the influence of surface tension and initial fluid amount on the final fluid amount transferred onto the board. <p> Finally, this thesis presents a new approach to evaluate and compare different designs of the fluid dispensing system, namely air-pressure, rotary-crew, and positive- displacement. In this approach, the axiomatic design principles, i.e., the Independence Axiom and the Information Axiom, are employed. This approach can be used not only to evaluate existing dispensing systems, but also to design new dispensing systems.

Tissue engineering is a multidisciplinary subject aimed at producing the immunologically tolerant artificial tissues/organs to repair or replace damaged ones. In this field, tissue scaffold plays a key role to support cell growth and new tissue regeneration. For fabrication of tissue scaffolds with individual external geometry and predefined inner structure, rapid prototyping (RP) systems based on fluid dispensing techniques have proved to be very promising. The present research conducted a comprehensive study on the dispensing-based fabrication process. <p>First of all, the scaffold materials are characterized in terms of their biocompatibility and flow behaviour. The biocompatibility of biomaterials of PLLA, PCL, collagen, chitosan, and gelatine is evaluated in terms of supporting neuron cells adhesion and outgrowth. Chitosan solution (2% w/v) in acetic acid is shown to be the most promising among the examined biomaterials for the fabrication of nerve tissue scaffolds. Its non-Newtonian flow behaviour is identified by using a commercial rheometer. <p>In the fabrication process, the flow rate of biomaterials dispensed, the profile of strand cross-sections, and the scaffold porosity are very important and must be precisely controlled. A model is developed to represent the flow rate of biomaterials dispensed under the assumptions that the flow is incompressible, steady, laminar, and axisymmetric. Also, the profile and size of line strands at different layers and portions are modeled based on the Young-Laplace equation. Thus the dispensing-based fabrication process can be predicted in terms of the flow rate and the scaffold porosity. <p>The effects of operation conditions on the fabrication result are identified theoretically and experimentally. Simulation result shows that a higher driving pressure, a higher temperature, and a larger needle diameter will result in a larger size of the strand cross-sections and lower scaffold porosity. The change pattern, however, is nonlinear, which is affected by the fluid surface tension and non-Newtonian flow behaviour of scaffold biomaterials. <p>To verify the effectiveness of the developed models, experiments were carried out on a commercial dispensing system (C-720, Asymtek, USA). To avoid the possible error derived from the temperature difference between the dispensing system and the rheometer, a new method is presented to characterize the fluid properties used for model predictions. Experimental results illustrate that the developed models, combined with the new identification method, are very promising to predict the dispensing-based fabrication process.

This thesis for the Master of Science degree was performed at Oppunda Electronics AB. The assignment was to further develop an existing prototype of a dispensing equipment. The dispensing equipment doses a kind of glue, bonding which dentist use to mend teeth. The dispensing equipment is adjusted to dose 12 micro litres of bonding. With the dispensing equipment SafeBond Electronic the user can reduce the bonding consumption with approximately 50 percent. Furthermore will the handling of the bonding be more hygienic, because the photoelectric sensor allows the user to start a dosage without touching any part of the dispensing equipment. The main requirements for the development was to reduce the size of the existing prototype and implement functions to makeit possible to change the dose time and display the current dose time. Some parts and components have been replaced and reorganized to reduce the size of the dispenser. The choice of a steep motor, which makes the rotation when a dosage is performed, is the largest contribution to shrink the size of the equipment. Also the new designed circuit board makes it possible to reduce the size of the dispensing equipment. A LCD is used to show the current dose time. The LCD is a part of a LCD module. To change the dosing time two push buttons are being used. A microcontroller is controlling the steep motor. The microcontroller is a PIC16F877A from Microchip. The microcontroller in the dispensing equipment is controlling all the functions. The program code is designed to function in an interrupt routine. This makes it possible to set the processor in a sleep mode when the dispenser is not in use and decrease the power consumption. More functions have been implemented in the dispenser and it is now more suitable for itsassignment. In the mean time it has been possible to reduce the size of the equipment. The chosen parts andcomponents make a good price function ratio. During the product development a lot of documentations have been done. Which make the dispensing equipment ready to be implemented in production.

Tissue engineering is a multidisciplinary subject aimed at producing the immunologically tolerant artificial tissues/organs to repair or replace damaged ones. In this field, tissue scaffold plays a key role to support cell growth and new tissue regeneration. For fabrication of tissue scaffolds with individual external geometry and predefined inner structure, rapid prototyping (RP) systems based on fluid dispensing techniques have proved to be very promising. The present research conducted a comprehensive study on the dispensing-based fabrication process. <p>First of all, the scaffold materials are characterized in terms of their biocompatibility and flow behaviour. The biocompatibility of biomaterials of PLLA, PCL, collagen, chitosan, and gelatine is evaluated in terms of supporting neuron cells adhesion and outgrowth. Chitosan solution (2% w/v) in acetic acid is shown to be the most promising among the examined biomaterials for the fabrication of nerve tissue scaffolds. Its non-Newtonian flow behaviour is identified by using a commercial rheometer. <p>In the fabrication process, the flow rate of biomaterials dispensed, the profile of strand cross-sections, and the scaffold porosity are very important and must be precisely controlled. A model is developed to represent the flow rate of biomaterials dispensed under the assumptions that the flow is incompressible, steady, laminar, and axisymmetric. Also, the profile and size of line strands at different layers and portions are modeled based on the Young-Laplace equation. Thus the dispensing-based fabrication process can be predicted in terms of the flow rate and the scaffold porosity. <p>The effects of operation conditions on the fabrication result are identified theoretically and experimentally. Simulation result shows that a higher driving pressure, a higher temperature, and a larger needle diameter will result in a larger size of the strand cross-sections and lower scaffold porosity. The change pattern, however, is nonlinear, which is affected by the fluid surface tension and non-Newtonian flow behaviour of scaffold biomaterials. <p>To verify the effectiveness of the developed models, experiments were carried out on a commercial dispensing system (C-720, Asymtek, USA). To avoid the possible error derived from the temperature difference between the dispensing system and the rheometer, a new method is presented to characterize the fluid properties used for model predictions. Experimental results illustrate that the developed models, combined with the new identification method, are very promising to predict the dispensing-based fabrication process.

Fluid dispensing is a method by which fluid materials are delivered to the targeted boards in a controlled manner and has been extensively applied in various packaging processes in the electronics assembly industry. In these processes, the flow rate of the fluid dispensed and/or the fluid amount transferred onto a board are two important performance indexes. Due to the involvement of the compressibility and non-Newtonian behaviour of the fluid being dispensed, modeling the fluid dispensing process has proven to be a challenging task. This thesis presents a study on the modeling of the positive displacement dispensing process, in which the linear displacement of a piston is used to dispense fluid. Also, this thesis presents an evaluation of different designs of the fluid dispensing system based on the axiomatic design principles. <p>At first, the characterization of the flow behaviour of fluids used in the electronic packaging industry is addressed. Based on the previous experiments conducted in the authors lab, a 3-parameter Carreau model for the fluid Hysol FP4451 is derived for use in the present study. Then, taking into account fluid compressibility and flow behaviour, a model is developed to represent the dynamics of the flow rate of the fluid dispensed. The resulting model suggests that the dynamics of the flow rate in the positive displacement dispensing process is equivalent to that of a second order system. Based on the model developed, the influences of the fluid compressibility and the process parameters such as the dispensing time and needle temperature are investigated by simulations. <p>In the positive dispensing process, it is noticed that the fluid amount dispensed out of needle is different from the fluid amount finally transferred to the board, if the fluid amount dispensed is very small. This difference is considered one major problem affecting dispensing performance. In order to determine the fluid amount transferred to the board, a 3-step method is developed in the present study, based on existing theories of liquid bridges and Laplaces equation. Simulations are conducted based on the developed method to study the influence of surface tension and initial fluid amount on the final fluid amount transferred onto the board. <p> Finally, this thesis presents a new approach to evaluate and compare different designs of the fluid dispensing system, namely air-pressure, rotary-crew, and positive- displacement. In this approach, the axiomatic design principles, i.e., the Independence Axiom and the Information Axiom, are employed. This approach can be used not only to evaluate existing dispensing systems, but also to design new dispensing systems.

Abstract The unstable policies of both pubic health and payment by National Health Insurance¡]NHI¡^in Taiwan cause great difficulties in the management of clinics since the separation of dispensing practice from medical practice since 1997.In order to survival from the tough circumstance, the managers of clinics must adapt different strategies to increasing income, enlarging size of organization, or gaining the competition advantage. One of the most important strategies is the institution of clinic pharmacies by themselves or cooperating with another pharmacist. Right now the theses about the clinic pharmacies was few. But the name, so called ¡¨ doorway drugstore ¡§, which was considered to against the spirit of the policies of separation of dispensing practice from medical practice and global budget is called by some scholars and the NHI. In order to reducing the payment for the clinic pharmacies, the NIH is planning to set up 3 criteria for further management of the ¡§doorway drugstores¡¨. And if the new rules come true in the future, the managers of clinic pharmacies and the owners of clinics will meet more challenges. In this study, main focus would be the 6 clinic pharmacies at Kaohsiung city and by the means of face to face interview with the managers of these drugstores in order to gathering the primary data about the motivation for selling OTC merchandise, and the situations of merchandise profile, pricing strategy, promotion activity and the situations of human resource etc. The study result revealed that there are two clinic pharmacies have no selling of OTC merchandise because of small space, lack of salesman, or worry about the conflict between the doctor and the pharmacist. The percentage of the OTC income at another four clinic pharmacies is below the level of 20%, and the reasons of difficulties for selling these products were too expensive, not famous, and lack of in job training for salesmen. Further analysis of the needs of the main consumers , whom were the patients of the clinics, of these drugstores were the treatments for their disease and the maintenance of their health. So the health food or function food will play the import roles of OTC merchandise profile. The reasons of success of selling OTC products in the clinic pharmacies were choosing proper merchandies, which were good for these patients` health or some help for control their disease, and were recommoned by the doctor, and with reasonable price. The weakness of the management of clinic pharmacies were lack of salesmen and few investment of I.T. equipments, lack of promotion activity and in job training. According the primary data from the interview with the managers of clinical pharmacies and biotech functional food suppliers, there are some important conclusions from this study¡G¡]1¡^clinical pharmacies now are selling some OTC merchandise and functional food¡]2¡^clinical pharmacies provide the service for the patients whom came from not only one clinic¡]3¡^the owners of the clinical pharmacies would be the physician of clinic or the pharmacist and the ownership status could be sole or partnership¡]4¡^the percentage of income from selling OTC merchandise is still low in these pharmacies¡]5¡^the managers of clinical pharmacies wish to joint chain pharmacy in the future ,but right now they are not urgent ¡]6¡^the major reason of joint chain pharmacy is cost down and the clinical pharmacies managers will share the management data and use the logo of chain pharmacy, but there are tremendous disagreements between them about the franchising fee¡]7¡^clinical pharmacies had the potential of transforming to become retail channels of biotech functional food because of patients may need them to keep their health and they trust their physician and pharmacist, and the successful selling for biotech functional foods need professional explain ,which can provided by the doctor and pharmacist both are available in clinical pharmacies.

Medicine cures and kills people. In some advanced nations, prescription transparency is achieved through the separation of prescribing and dispensing, which further leads to public examination of prescriptions. Such an operation results in a restriction mechanism to prevent misuse and abuse of drugs and to guarantee the safety of consumers. Taiwan initiated the separation of prescribing and dispensing on March 1, 1997; however, most people do not recognize the significance of the system and conclude the issue to be an interest dispute between doctors and pharmacists. In the separation of prescribing and dispensing, disputes over the right of dispensation between doctors and pharmacists are commonly seen, but literatures are rarely found to review from consumers' position. This study plans to investigate consumers' viewpoints in respect of prescription transparency and understand its effect on satisfaction. Consequently, this study would be the benchmark for the government and health care sectors in promoting the separation of prescribing and dispensing. The study found the followings: 1. The discrepancy between satisfaction and attention to drug information is 0.88. Most people are used to nontransparent prescriptions, so such non-transparency does not cause significant dissatisfaction. 2. Among the people interviewed, the prescription transparency service they receive is 100% in academic medical centers, 66% in hospitals, and 23% in clinics. 3. 52.3% of the interviewees pays strong attention to drug information, 31.8% pays attention, 11.4% pays little attention, 2.8% pays very little attention and 1.7% do not pay attention at all. 4. The results show the diversity of demand to prescription transparency. Public displays different recognition to the importance of the list of medications: 82.5% thinks listing medication titles for easy reference. 81.9% considers the list represents a sense of responsibility from doctors and their prescriptions. 65.0% keeps the list for later use or for resolving medical disputes. 35.6% uses the list to enrich knowledge in medication. And 1.1% considers the list insignificant in all aspects. 5. Under the condition of non-transparent prescriptions, the educational level will influence the newly-developed factor in satisfaction. In other words, highly educated people tend to care more about prescription transparency

Objective: To investigate and describe how an acute care, multi-site teaching hospital implements a new technology called the Automated Medication Dispensing Cabinet (ADC) that will be used by nurses. Design and methods: Qualitative, descriptive, single-case study method using the Ottawa Model of Research Use as a framework to guide data collection and analysis. The project was evaluated from the beginning, through the planning stages until a cabinet vendor was chosen. Results: A multidisciplinary committee was created to implement the ADCs across the organization. Clinical nurses, the intended users, were not directly involved in the implementation; usability testing was not done; they were not prepared for all the needed training costs and no evaluation was planned. Conclusions: An implementation framework was not used to guide the ADC project and several key area surrounding implementation were missed. Recommendations were made to improve future implementation projects in heath organizations.