Introduction: Potentially inappropriate prescriptions (PIPs) have been defined as the prescribing of medications where the risk of adverse outcomes outweighs the benefit to patients. Some medications pose a greater risk than others. Nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelets, and anticoagulants are among the top offenders for preventable drug-related ER visits, hospitalizations and deaths. Methods: Data were collected through a retrospective electronic/paper chart review for all patients prescribed a target medication in two family medicine clinics in Winnipeg, Manitoba from June 2012 to June 2013. Results: The presence of at least one PIP was identified in 198 of 567 patients (35%). The most common PIP was the use of an oral NSAID with one or more gastrointestinal bleed risk factor without adequate gastro-protection. Conclusion: With over one-third of patients using NSAIDs, antiplatelets, and anticoagulants potentially inappropriately, a greater focus on improving prescribing practices with these higher-risk medications is warranted.

The University of ManchesterEsther NelsonDoctorate in Educational and Child Psychology Exploring professional action around sexually inappropriate behaviour and children in schools2013Background: Sexually inappropriate behaviour (SIB) displayed by children and young people often results in pupil school exclusions and, at present, a national intervention pathway is not available (DfE, 2010). School staff feel ill equipped to recognise and respond to SIB (Flanagan, 2010), and within the present research context, they may be placed in ‘out of city’ specialist settings, with attendant social, emotional and financial implications. Participants: From Local Authority (LA) with local SIB pathway: 2 Educational Psychologists (EPs). From non-pathway LA: 2 EPs and 6 school professional participants with SIB case experience.Methods: A qualitative mixed methods investigation, consisting of surveys, semi-structured interviews and a focus group. A documentary analysis of the existing regional LA policies and pathways was completed. Semi-structured interviews were completed with EPs; a focus group with professionals with experience of children displaying SIB to discuss the knowledge, thoughts and feelings of these staff members in relation SIB, and the current processes and pathways in use within the school and the LA. Analysis/ Findings: Content analysis of the existing policies reveals much variation between LAs in how incidents of SIB are managed in schools. Thematic analysis of interview data with EPs reveals both facilitators and potential barriers for managing incidents of SIB. Thematic analysis of interview data with school staff reveals practical approaches and strategies which if included in a pathway would be beneficial in dealing with incidents of SIB.Conclusion/ Implications: Procedures for managing incidents of SIB vary widely within LAs in the region. Pathways and procedures should include practical advice for managing these incidents and would benefit from being designed through a bottom up approach, focusing on the approaches and strategies that teaching staff at the front line would find beneficial.

Thesis (doctoral)--University of Geneva, 1979. / "Thèse No. 3753." Includes bibliographical references (p. 17-19).

Introduction: Proportion of seniors in the world population is growing and substantial attention is given to population aging worldwide. Geriatric patients present very heterogenous group of patients with high interindividual differences. With increasing age number of chronic and degenerative disorders increases, drug consumption raises and consequently also polypharmacy. The more medications a senior consume, the higher probability of prescription of high-risk medications he/she has. With the aim to rationalize drug prescribing in geriatric patients, significant number of explicit criteria of medications/medication procedures potentially inappropriate in older age has been published. The aim of this diploma thesis was to evaluate prevalence of potentially inappropriate prescribing in geriatric population in studies published between 1991 and 2015 years and to further evaluate the most frequently prescribed potentially inappropriate medications (PIMs) in these studies. Methods: Detailed literature search has been conducted with the use of PubMed and Web of Science databases. Studies dealing with potentially inappropriate prescribing that have been published from 1st January 1991 to 31st December 2015 were included. Data from scientific articles were summarized in the first part of the diploma...

Class of 2014 Abstract / Specific Aims: To assess appropriate use or cessation of metformin therapy in the presence of renal impairment. Methods: A retrospective chart review was conducted on 785 charts of patients at El Rio Community Health Center between June 2011 and December 2012. Eligibility criteria were adults aged 18 years or older with a diagnosis of Type 2 Diabetes Mellitus (DM), a history of metformin therapy, and renal function data. Data was accessed through the electronic medical record (EMR) at El Rio and metformin history, presence of contraindications, renal function, weight, age, gender, and race/ethnicity were collected. Group 1 were patients who were currently taking metformin and Group 2 were patients with a history of taking metformin. Main Results: A larger proportion of patients had renal impairment (eGFR 30-60 ml/min/1.73 m2) in Group 1 than Group 2 (Yates’ p = 0.002). Only one patient in the entire study had severe renal impairment (eGFR < 30 ml/min/1.73 m2). There was a greater proportion of inappropriate cessation in Group 2 than inappropriate use or cessation in Group 1 (Yates’ p < 0.001). Conclusion: Most patients were found to have normal renal function. Group 2 had a greater proportion of inappropriate metformin cessation than inappropriate use or cessation in Group 1.

Bribery is a concept which has appeared quite frequently in the media recently, but what constitutes a bribe and what factors can be used in determining if an individual case is actually a bribe? The purpose of this essay is to try and answer these questions through a study in which respondents were presented with different scenarios and were asked to determine whether a bribe had occurred and explain their reasoning. In the study, it was evident that the amount of money involved in a given case had a large impact on respondents’ determination of whether a bribe had occurred or not. The grey area that seems to exist between what is appropriate and inappropriate most likely stems from ambiguousness in Swedish law.

<p>Bribery is a concept which has appeared quite frequently in the media recently, but what constitutes a bribe and what factors can be used in determining if an individual case is actually a bribe? The purpose of this essay is to try and answer these questions through a study in which respondents were presented with different scenarios and were asked to determine whether a bribe had occurred and explain their reasoning. In the study, it was evident that the amount of money involved in a given case had a large impact on respondents’ determination of whether a bribe had occurred or not. The grey area that seems to exist between what is appropriate and inappropriate most likely stems from ambiguousness in Swedish law.</p>

Potentially Inappropriate Prescribing (PIP) is common in Canada yet little is known about its health system costs or which PIPs have the greatest cost impact. This thesis examined the health system costs from hospitalizations, emergency department (ED) visits and medications from all PIP, and for distinct PIP. PIPs were identified in a cohort of older adults in Ontario using a subset of the STOPP/START criteria applicable to health administrative databases, and all analyses were conducted by comparing participants with and without PIP. In study one, the costs from hospitalization, ED visits and newly prescribed medications were identified using population attributable fractions. PIP was identified as responsible for a sizeable portion of all three cost categories, with hospitalization and ED visits costs most highly impacted. Study two compared the incremental costs due to PIP among four distinct PIP criteria selected based on differing frequency and crude costs to validate the use of such characteristics for priority-setting. The crude healthcare costs, as well as the cost of the drug causing the PIP and the frequency of the PIP were identified as likely key characteristics of high-impact PIP. Combined, these studies provide evidence on the overall burden of PIP, while also identifying likely characteristics of high-impact PIP. They suggest interventions at the health system level may be needed to address medication appropriateness and provide information which may be helpful to decision-makers when identifying which PIPs should be targeted for intervention, given no health system level interventions for PIP are currently in place.

No description available.

Introduction: Older persons represent a quickly growing segment of the population worldwide and more vulnerable population to various adverse drug reactions and adverse outcomes. Many explicit criteria of potentially inappropriate medications (PIMs) have been developed in different countries in order to improve the quality and safety of geriatric prescribing and to reduce the risk of drugs in older adults. The aim of this diploma thesis was to summarize (using narrative literature review) the negative outcomes of potentially inappropriate medications documented in pharmacoepidemological studies published by 2016 year. The outputs of diploma thesis create a part of the effort of the research subgroup "Aging and Changes in the Therapeutic Value of Medications in the Aged" and EU COST Action initiative IS1402 (2015-2018). Methods: The literature review using PubMed and Web of Science datasets during the period 10/2015 - 1/2017 was conducted. 421 studies were identified during the primary literature search and after thorough consideration of abstracts 67 (16%) of studies were selected for works on summary tables (354 of studies were excluded because in these studies only prevalence of PIMs, no negative outcomes were documented, or PIMs were defined based on implicit criteria or full text of articles...