Läkemedelshanteringen är ett av sjuksköterskans ansvarsområden inom hälso- och sjukvården. Utifrån kunskap och lagar skall den bedrivas på ett patientsäkert sätt men trots det sker läkemedelshanteringsfel vilket innebär risker i patientsäkerheten. Syftet med studien var att beskriva faktorer som påverkar säkerheten i samband med sjuksköterskans läkemedelshantering. Studien genomfördes som en litteraturstudie. Resultatet visade att vanliga läkemedelshanteringsfel är utebliven dos, fel administreringstid, fel dos, fel administreringssätt, fel läkemedel och läkemedel till fel patient. Faktorer som påverkar sjuksköterskans läkemedelshantering är felaktiga och dåligt skrivna läkemedelsordinationer, distraktion under läkemedelshanteringen, bristande rutiner samt införande av ny teknologi. Sjuksköterskor upplever mer problem kring läkemedelsordinationer än läkarna. Annan vårdpersonal stod för den största orsaken till sjuksköterskans distraktion men vid införande av ett säkerhetssystem från flygindustrin reducerades distraktionen. Att följa rätt patient, rätt läkemedel, rätt dos, rätt administreringssätt och rätt tid (5 R) är en bra rutin för att läkemedelshanteringen kan bli säkrare. För att göra läkemedelshanteringen säkrare införs ny teknologi som datoriserade läkemedelsordinationer och då är rätt utbildning viktig för att det ska bli ett säkert hjälpmedel. Vidare forskning och utveckling bör bedrivas på sjukhusen i Sverige samt inom den teknologiska industrin med hjälp av sjuksköterskan för att utveckla säkrare läkemedelshantering och hjälpmedel till dem. A central part of nursing is the drug administration. This administration is to be carried out in a manner which is conducive to patient safety. This science is the product both of knowledge and of legal provisions, yet errors still occur within the drug administration that create considerable risk for patient safety. The purpose of this literary study has been to indicate factors that affect the safety of nurses’ drug administration. The results indicate that common errors in medicines administration are the result of the following: missed dosage, dosage at wrong time, wrong dosage, wrong method of administration, wrong medicine and giving medicine to the wrong patient. Factors contributing to these errors include erroneous or poorly written ordination, distraction during drug administration, poor routines as well as the introduction of new technology. Nurses’ consider the problems relating to ordination as being greater than doctors generally perceive them to be. Other healthcare personnel are seen to contribute to nurses’ distraction and this was greatly reduced in cases where security routines were adapted from the airline industry. The routine of right patient, right drug, right dosage, right administration and right time (5 R) is effective in creating greater safety in the drug administration. New technology is used to this end, computers being used, for example, for writing ordinations. In order for these methods truly to contribute to safety it is important that appropriate training is provided. In order to develop safer drug administration together with necessary tools and facilities it is recommended that more research is carried out, with the assistance of nurses, in hospitals here in Sweden as well as within the technology industries.

To study the decision-making model behind how physicians making prescribing decisions, we studied the effects of the introduction of Medicare Part D in 2006 on numbers and characteristics of medications prescribed by physicians. We identified a significant increase in overall number of medications prescribed due to Medicare Part D but did not find any effects on the number of antibiotics. The result suggests there exist factors distinguishing antibiotics from other medications that led to a change in incentives to prescribe antibiotics, such as costs of antibiotics resistances. . We also identified the heterogeneity responses to Medicare Part D with respect to physician’s employment status, primary care relationship and patient’s gender and diagnostic categories.

More than half of the women aged from 45-55 suffer from menopausal symptoms which can seriously affect the quality of life of the midlife women. The menopause transition has become a very active research area in healthy aging in the last several decades. In recent years, more and more women have turned to traditional Chinese medicine (TCM) to manage their menopausal symptoms. Among various Chinese medicine formulae, Er-Xian Decoction (EXD) is one of the most acceptable Chinese medicine formulae to relieve menopausal symptoms. Although EXD is popular in the management of menopausal symptoms, its effectiveness has not been evaluated by strictly designed clinical study. A systematic review was conducted to evaluate the current evidence to assess the efficacy and safety of EXD as a basic formula for menopausal symptoms. A total of 12 randomized controlled trials (RCTs) were included for further analysis. The results of these studies suggested that EXD was more effective than the control interventions, which included various HRT and other Chinese herbal medicine. Seven of the studies compared EXD with HRT and the meta-analysis seemed to suggest that EXD as a basic formula was superior to hormone replacement therapy. However, the included studies were insufficient in methodological quality and had a high probability of bias. A double-blind randomized controlled clinical trial was then conducted to assess the efficacy and safety of EXD for menopausal symptoms. Of 557 recruited women, 108 subjects were eligible to participate in the study and 101 subjects finished the study. Comparisons between placebo and EXD groups were conducted by using an analysis of covariance (ANCOVA) with baseline as covariate. EXD granules when compared with placebo significantly reduced the frequency and severity of hot flushes and night sweats. EXD compared with placebo significantly reduced the frequency of hot flushes (P=0.041) and the hot flush severity score (P=0.016). Superiority of EXD over placebo was also observed in greater improvement in total scores of MRS (P=0.028) and MENQOL questionnaires (P=0.021). There were no differences between EXD and placebo group in serum hormones and bone markers. There were no serious adverse events and the safety indices of whole blood counts, renal and liver functions were normal before and after the treatment. Both EXD and placebo were well tolerated. In summary, this Chinese herbal formula EXD was found to be superior to placebo in reducing hot flushes and improving menopausal symptoms in Hong Kong perimenopausal women. It was well tolerated, with no serious adverse events noted during the study period. / published_or_final_version / Chinese Medicine / Doctoral / Doctor of Philosophy

No description available.

No description available.

Tikslas: Įvertinti visuomenės vaistinę pasiekiančių gydytojų išrašytų receptų klaidas. Uždaviniai: 1. Nustatyti klaidingų receptų (RP) pasitaikymo dažnį; 2. Įvertinti visuomenės vaistinę pasiekiančių RP klaidų pobūdį ir dažnį; 3. Palyginti RP pasitaikančių klaidų dažnį pagal recepto formą. Metodika: Tyrimas buvo atliktas nuo 2013 m. birželio mėn. iki 2013 m. spalio mėn. Tyrimo metodas – dokumentų analizė. Standartizuotoje analizės formoje buvo vertinamas RP išrašymo atitikimas Lietuvos Respublikos (LR) teisės aktuose (TA) nustatytiems reikalavimams, bet nefiksuojami asmenis identifikuoti galintys duomenys. Tyrime dalyvavo visi atsitiktinai pasirinktomis dienomis į tiriamą visuomenės vaistinę patekę 1 ir 3 formos RP Iš viso tirti 1174 1 ir 3 formos RP (1 formos – 806; 3 formos 368). Duomenys analizuoti taikant statistinę programą SPSS 17.00. Rezultatai: Tyrimas parodė, kad net 38% visų tirtų RP neatitinka LR TA nustatytų reikalavimų. Dažniausios klaidos - atskiros struktūrinės recepto dalys neteisingai ar visai neužpildytos. 1 formos receptuose klaidų pasitaikė dažniau nei 3 formos (p<0,05). Klaidingi buvo 43% 1 formos RP ir atitinkamai 26% 3 formos RP 1 formos receptuose daugiausiai klaidų pasitaikė informacijos apie pacientą dalyje (26% - nepabraukta, suaugusiajam ar vaikui skirtas vaistinis preparatas (VP) , 2% - su trūkstamais vardo, pavardės ar gimimo metų duomenimis bei 2% - su trūkstamu ambulatorinės kortelės nr. arba adresu). Informacijos apie vaistą dalyje:... [toliau žr. visą tekstą] / Aim: To evaluate prescribing errors made by doctors in prescriptions in community pharmacy. Tasks: 1. Identify frequency of incorrect prescriptions. 2. Estimate the nature and frequency of prescription errors. 3. Compare 1st and 3rd form frequency of incorrect prescriptions. Methodology: The study conducted between June 2013 and October 2013 in the community pharmacy of Lithuania and based on methodology - analysis of documents. The compliance of Legal Acts of the Republic of Lithuania of prescriptions was assessed in standardized analysis form, but the data which may identify a person were not recorded. The study included all randomly 1st and 3rd form prescriptions partaking in community pharmacy of selected days. Total 1174 1st and 3rd form prescription were analyzed. (1st form – 806, 3rd form - 368). The statistical analysis of the quantitative findings was performed using the data accumulation and analysis software package SPSS version 17.0 for Windows. P-values less than 0.05 were considered to be significant. Results: The study showed that 38% of all investigated prescriptions were not met the requirements of Legal Acts of the Republic of Lithuania. The most common mistake – the individual structural components of prescriptions were incorrect or incompletely filled. Errors were occurred more often in 1st form prescriptions (43%) than in 3rd form (26%) (p<0,05). The most of errors were related with information about patients in 1st form prescriptions (26% were not... [to full text]

Thesis (M.H.A.)--University of Michigan, 1962.

Thesis (M.H.A.)--University of Michigan, 1962.

目的：通过对柴胡桂枝汤从古至今文献的整理，了解柴胡桂枝汤的应用规律，并对其方证应用做出归纳、总结。 方法：在充分收集资料的基础上，对各类相关文献进行整理、归类，分为方论类文献、医论类文献、本草类文献、临床观察类文献和医案类文献。根据不同文献特点提取相共不同信息。其中前三类文献以文义阐释和解读为主进行归纳总结；余下两类文献则以数据统计为主进行频次分析，从统计数据中提取疾病谱、典型指征等信息。 结果：一. 通过文献阐释方药含义，对柴胡桂枝汤病机、方义、适应证进行了初步归纳、总结；二．通过文献数据统计、分析，对柴胡桂枝汤疾病谱、适应证、适应体质作了详细归纳。 结论：一．柴胡桂枝汤病机：太少两感、营卫不和 适应证型：太少两枝轻证 偏虚证 二．从典型指征、患者体质状态和疾病谱对柴胡桂枝汤方证作如下 表述： （一） 1.王证（典型指征）：恶寒、肢节烦疼、发热、喜呕、腹痛、胸闷气短； 2.兼证（重要指征）：纳呆、神疲乏力、口干、口苦脇痛、往来寒热、汗出。 （二）适合体质：体虚、气郁之人 （三）疾病谱： 1.外感类疾病：如小儿外感热病、产后发热等 2.体痛类疾病：如坐骨神经痛、颈椎病等 3.心腹痛类疾病：冠心病、慢性胃炎、膜腺炎等。 4.神志相关类疾病：如更年期综合征、癫痫等。 關鍵詞：柴胡桂枝汤 方证研究 太少两戚 医案文献

This thesis examines the writings of second generation Japanese Canadian women in the newspaper, The New Canadian between 1938 and 1949. Nisei women lived in a dual world containing different messages of appropriate female behaviour. Although there were similarities between Japanese and North American notions of womanhood, female Nisei writers advocated acculturation to the dominant society. In The New Canadian three major themes emerge from their writings that centre around social acceptance. The first theme is prescriptions of masculinity and femininity. They openly advocated popular North American gender roles, deportment, etiquette and courting customs. The second theme concerns the Issei-Nisei relationship and the conflicts that arose over different notions of femininity. The third examines how Nisei women responded to Anglo-Canadian prejudice, by denouncing racism and advocating acculturation to mainstream society. These articles offer one image of how some Nisei women actively defined themselves, their male counterparts and their future roles. These female voices suggest the deep seeded ambivalent feelings many Nisei women had about their dual identity, their Issei parents, and their status in Canadian society. The women in The New Canadian offered one solution to this uncertainty--acculturation. / Graduate