Title: Analysis of pharmacotherapy and drug related problems in patients with arterial hypertension in Greece Student: Zisis Papadopoulos Tutor: Jiri Vlcek Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Background: Arterial hypertension or high blood pressure is a chronic medical condition which is characterized by elevated blood pressure in the arteries and is an important risk factor for future development of cardiovascular disease. Also belongs to asymptomatic diseases because it usually does not cause symptoms for years until a vital organ is damaged. Moreover is a major cause of morbidity and mortality, due to its association with some other serious diseases like coronary heart disease, cerebrovascular disease, atherosclerosis, renal disease, dyslipidemia, diabetes, obesity and metabolic syndrome. Arterial hypertension for adults, who don't suffer from any other kind of diseases, is defined by an elevation of blood pressure to 140 / 90 mm Hg or to higher values. Aim: In the theoretical part the main aim is to analyze information regarding etiopathogenesis, diagnostic methods and treatment strategies of arterial hypertension, as well as classification and causes of drug-related-problems to antihypertensive agents. In the...

The methodology for investigation of drug-related crime is the topic of this thesis. There are a few reasons why I have chosen this topic. The issue of drugs, drug-related crime, drug addiction and also illegal drug traffic has become recently the worldwide problem which intervenes into many areas of human life and therefore we must constantly pay attention to it. Especially this fact, together with other reasons as my personal connection with drug issue (few-year-long involvement in the program focused on the primary prevention from drugs at secondary schools) made me to choose this topic. My thesis is divided into 6 parts. In the first two chapters I define the general notions related to the drug issue and I provide with the division of drugs into groups under chosen criteria. For the better orientation in this issue I have listed the most common types of drugs with the description of their effect on the organism of humans. In the third part of my thesis I focus on the criminal prosecution of drug offences and the historical development of the legal regulation of this issue. More deeply I analyze the Act No. 140/1961 Coll., the Criminal Act, as amended and the actual legal regulation governing the prosecution of drug offences, the Act No. 40/20096 Coll., the Criminal Code, as amended. The forth...

Class of 2015 Abstract / Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

Criminological Aspects of Drug-Related Crime The thesis deals with the topic of criminological aspects of drug-related crime. Due to the breadth of the issue, the work is focused only on the so-called primary drug crime, which is understood as a criminal activity consisting in violating the regulations governing the handling of narcotic drugs and psychotropic substances. Specifically, it deals with crime associated with the unauthorized handling of cannabis. The main goal of this work is to answer the question whether the criminal law regulation of unauthorized handling of cannabis chosen by the legislator is appropriate and respects in a reasonable way the specific criminological aspects related to cannabis. The first part focuses on explaining some basic terms that are used in the work. The second part deals with the interpretation of terms that are specifically related to the issue of illicit handling of cannabis. Also it includes the issue of the harmfulness of cannabis use and describes the state and trends of crime associated with cannabis use. The third part deals with the international treaties by which the Czech Republic is bound in terms of regulation of cannabis handling. For legislators, key international agreements are a starting point and at the same time a limit in the creation of...

Background: Drugs are one of the cornerstones in the management of many diseases. In general, drugs are used for diagnosis, prevention, mitigation of symptoms, and, sometimes, to cure disease. However, drug treatment in elderly people, especially those with dementia and cognitive impairments, may involve significant risk of adverse drug events.  The aim of this thesis was to identify the extent of potentially inappropriate drug treatment among people with dementia and cognitive impairment and to assess the occurrence and character of drug-related problems that lead to acute hospital admissions. Another aim was to assess the potential impact of a comprehensive medication review conducted by clinical pharmacists as part of a health care team on quality of patients’ drug therapy and drug-related hospital readmission rates. Method: Long-term use of antipsychotic/psychotropic drugs and associated factors were investigated among 344 and 278 people respectively with dementia living in specialized care units. Trends in the prescribing of potentially inappropriate drugs between 2007 and 2013, comprising 2772 and 1902 people, living in nursing homes in the county of Västerbotten, were assessed using six national quality indicators. Data on drug use, function in the activities of daily living, cognitive function and behavioral and psychological symptoms were collected using the Multi-Dimensional Dementia Assessment Scale. Further, an investigation of a separate corresponding population from 2012 was done, where potentially inappropriate drug use was measured before and after a total of 895 medication reviews. Finally, a randomized, controlled trial was carried out among people 65 years or older with dementia or cognitive impairment in internal medicine and orthopedic wards at two hospitals in northern Sweden. The proportion of hospital admissions that were drug-related were estimated, and also whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team could affect the risk of drug-related hospital readmissions. Results: Antipsychotic and other psychotropic drugs were frequently prescribed to people with dementia living in specialized care units for prolonged periods. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. The extent of potentially inappropriate drug use declined between 2007 and 2013. In the separate corresponding population from 2012, the frequency of potentially inappropriate drug use was significantly reduced among people who underwent medication reviews. Hospitalizations due to drug-related problems among old people with dementia or cognitive impairment were prevalent. We found that inclusion of a clinical pharmacist in the health care team significantly reduced the risk of drug-related 30-day and 180-day readmissions. However, in a subset of patients with concomitant heart failure no effect was seen. Conclusion: Among patients with dementia or cognitive impairment long-term treatment with antipsychotic and other psychotropic drugs is common. The results indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals, despite limited evidence of their efficacy and the high risk of adverse effects. Drug-related problems, such as adverse drug reactions, constituted a major cause of hospital admissions. By reducing potentially inappropriate drug use and optimizing overall drug therapy, inclusion of clinical pharmacists in a health care team might improve the quality of patient care and reduce the risk of hospital readmissions among people with dementia.

Thesis (MSc)--Stellenbosch University, 2015 / ENGLISH ABSTRACT : In this study we look at the syndemic of substance abuse and drug-related crime in the Western Cape province of South Africa. The intent of this study is to provoke critical thinking about the possibilities systems thinking and system dynamics posses for social and health challenges in a diverse and complex environment like that of South Africa, especially the Western Cape. This study ventures into cross-discipline work between Epidemiology, Biomathematics and System Dynamics, with the hope of encouraging researchers from different fields to collaborate in order to curb the scourge of substance abuse and drug-related crime in South Africa. Substance abuse and the associated health and social hazards such as drug-related crime is a major problem in the Western Cape. Drug-related crime cases reported by the South African Police Services (SAPS) for the Western Cape exhibited a 311.5% growth in the past decade. This highlights how the reduction of substance abuse and drug-related crime within theWestern Cape province, will be an elixir for the safety and development of the communities. The fight against substance abuse has been driven by a multi-sectorial approach involving several government departments, non-governmental organisations and communities. With systems thinking the assumption is that the world is systemic, which means that phenomena is understood to be an emergent property of the interrelated whole. Firstly, using non-linear ordinary differential equations, we formulate a deterministic mathematical model for the substance abuse and drug-related crime syndemic, evaluate the threshold number and use sensitivity analysis to analyze the model. Secondly, a dynamic system, called the Substance Abuse and Drug-related Crime in theWestern Cape (SADC-WC) system is constructed using the STELLA in order to explore and classify the underlying relationships and structures within the substance abuse and drug-related crime system. Both the sensitivity analysis, and the simulations of the SADC-WC system indicate that an increase of successful convictions will have a significant influence on the syndemic, and promise to reduce drug-related crime cases. / AFRIKAANSE OPSOMMING : In hierdie studie ondersoek on die syndemie (‘syndemic’) van dwelmmisbruik en dwelmverwante misdaad in die Wes-Kaap provinsie, in Suid-Afrika. Die moontlikhede wat sistemiese denke en dinamiese sisteme inhou vir sosiale en gesondheid kwale in ’n diverse en komplekse omgewing soos Suid-Afrika, word ondersoek. Hierdie studie waag interdisiplinêre werk tussen Epidemiologie, Biowiskunde en Dinamiese sisteme, met die hoop om navorsers van verskillende velde aan te moedig om saam te werk om die plaag van dwelmmisbruik en dwelm-verwante misdaad in Suid-Afrika te bekamp. Dwelmmisbruik en die gepaardgaande gesondheid en maatskaplike gevare soos dwelmverwante misdaad is ’n groot probleem in dieWes-Kaap. Die SAPD se vermelde dwelmverwante midaad het ’n groei van 311,5% ondergaan in die afgelope dekade, en is aanduidend vir hoe die beheer en beperking van dwelmmisbruik en dwelm-verwante misdaad in die Wes-Kaap provinsie bevordering van beide die veiligheid en ontwikkeling van die gemeenskap sal verseker. Dit beklemtoon hoe die vermindering van dwelmmisbruik en dwelm-verwante misdaad in dieWes-Kaapland, sal ’n elikser vir die veiligheid en ontwikkeling van die gemeenskappe. Die stryd teen dwelmmisbruik is gedryf deur ’n multi-sektorale benadering waarby verskeie regeringsdepartemente, nie-regerings organisasies en gemeenskappe. Stelsels denke en dinamiese sisteme is gebasseur op die aanname, dat die wÃłreld is sistemiese en dat verskynsels verstaan word ten opsigte van die ontluikende eienskap van die omvattende geheel. Eerstens stel ons ’n kompartementele model op wat deur nie-liniêre gewone differensiële vergelykings beskryf kan word vir die dwelmmisbruik en dwelm-verwante misdaad epidemies. Ons evalueer die drumpel getal en gebruik sensitiwiteitsanalise om die parameters van die model te analiseer. Tweedens, is ’n dinamiese sisteem genaamd die Middelmisbruik en dwelmverwante misdaad in dieWes-Kaap (SADC-WC) stelsel gebou met behulp van die STELLA platform om te verken en klassifiseer die onderliggende verhoudings en strukture binne die dwelmmisbruik en dwelm-verwante misdaad stelsel. Beide die sensitiwiteitsanalise, en die simulasies van die SADC-WC stelsel dui aan dat ’n toename in suksesvolle vonisse ’n beduidende invloed op die epidemies sal hê; en beloof om sake van dwelmverwante misdaad te verminder.

The European Monitoring Centre for Drugs and Drug Addiction reports that drug-related deaths have almost tripled in Sweden between year 2006 and 2015. The aim of this study is to elucidate in which ways drug-related mortality is produced and conceptualized as a problem within policy discourse by critically analyzing The National Board of Health and Welfare’s policy proposal “Nationellt utvecklingsarbete för att motverka narkotikarelaterad dödlighet” (2017). Using Bacchi’s poststructural approach to policy analysis “What’s the problem represented to be?”, two problem representations are identified, namely that drug-related mortality is conceptualized as a problem with drugs and drug use in general as well as a problem due to lack of knowledge and information. This is based on underlying assumptions that all illegal drug use is hazardous and that the solution to the drug problem can be obtained by objective knowledge production thus leaving both the practice of gaining knowledge as well as current Swedish drug laws unproblematized. The effects are, to name a few, that proposed policies mainly targets “all people who use drugs” with a focus on providing “more of the same” which in extension overrides the group of high-risk drug users along with a structural understanding of drug-related mortality.

Analysis of the Effect of Pharmacotherapy on the Risk of a Fall I. Author: Klára Šturcová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Pague Introduction: Falls of hospitalized patients are one of the most common problems in health institutions. In terms of prevention of falls it is necessary to analyze all the factors that might have contributed to the emergence of a fall and subsequently minimize these risk factors. Objectives: The aim of the thesis was to analyze the possible drugs and other causes of falls of patients hospitalized in a certain rehabilitation institution. Methods: The data were collected from 21 March to 31 July 2014 in an institution providing rehabilitation care. The evaluated group consisted of patients who fell during the hospitalization in this period. The data about the fall, personal and drug anamnesis were transferred to an electronic form and subsequently evaluated by means of the frequency analysis, converted into graphs and tables and discussed. Results: 67 patients experienced 79 falls. Women experienced 53 % of falls; men experienced 47 % of falls. 87 % of the patients fell once, 9 % of the patients fell twice, 4 % of the patients fell three times. 58 % of all falls were experienced by...

Analysis of drug-related problems in a health facility I. Author: Michaela Bahnerová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Intoduction: Drug-related problems (DRPs) lower the quality of health care and present a risk factor in patient's safety. Objectives: The aim of this thesis is identification, classification and further analysis of DRPs in health care facility. Methods: Revision of pharmacotherapy was performed in health care facility in term 6. 8. - 10. 8. 2012. The pharmaceutical team which contained two pharmacists and diplomant examined health documentation of patients hospitalized in the facility. We collected information from personal, allergic, family, and labor-social anamnesis of patients. This data were noted into electronical database and after revision were DRPs classified and evaluated. The results of DRPs identification were evaluated by frequency analysis. In ten randomly selected patients was described DRPs resolution. Results: In total we noticed medical therapy in 175 patients (61 % women). Average patient's age was 58 years. 482 DRPs were identified. Of the patients, 84 % had DRPs and an average of 2,75 DRPs were recorded per patient. Conclusion: Appearance of DRPs is very frequent and...

95 Summary - Crime Related to Substance Abuse This diploma thesis deals with the phenomena of drugs from the criminal law point of view. This topic represents a danger for a lot of domains, eg. criminality, therefore it is necessary to pay appropriate attention to it. The first chapter is introductory and it defines the basic terminology concerning drug problem. The next chapter looks at the drugs in international dimension. It focuses on international treaties handling narcotic drugs and psychotropic substances, which affected legislation in the Czech republic, especially by those adopted in the United Nations. I briefly mention overall situation in the Czech republic after 1989. The third chapter describes the evolution of legislation from the time of Austro- Hungarian empire until the times of new criminal code. The principal part of my diploma thesis concerns primary and secondary aspects of drug-related crime. The fourth chapter is a detailed analysis of drug crimes according to criminal code Nř 40/2009 Coll. Analysis of the individual merits follows after defining common features of these crimes. This chapter also reflects the Constitutional court decision. This decision cancels part of criminal code that enabled government to determine in its regulation the quantity of the drug which is to be treated...