Medication safety is a key contribution to patient safety in health care settings. Health care researchers and scholars frequently report and discuss nurses medication administration practices or medication errors associated with patients safety in hospitals. Yet there are gaps in published reports about how practitioners view the larger phenomenon of medication safety as it unfolds on a hospital unit. Research is needed to advance our understanding of medication safety as it comes together amidst the interrelated elements in a complex hospital environment, and what practitioners identify and associate with medication safety in this context. In this study, medication safety was explored with participants from nursing and pharmacy departments on one Canadian hospital unit. Using a restorative theoretical approach and citizen science methodology, the researcher engaged in critical conversations with practitioner and decision-maker participants (n=68) to explore elements that support and those that present barriers to medication safety through focus groups, photo walkabouts, on-unit observations, and photo elicitation. Themes from the data revealed that (1) unit structures shape medication safety, (2) medication system design affects medication safety, (3) practitioners embed accountability for medication safety into their practice and processes, (4) unit culture influences medication safety, (5) practitioners devise and employ workarounds to circumvent ongoing barriers to medication safety, and (6) participants envisioned, and in some cases implemented, restorations to improve medication safety on their unit. Findings highlight a range of contextual, interrelated supports for and barriers to medication safety that participants discovered and shared knowledge about on their unit. Participants envisioned medication safety improvements that could be implemented at present and in the future. Workarounds, power, and possibilities for medication safety improvements related to current medication system design in health care systems are discussed.

Objectives:<br>1. Describe patient-related and hospice-related characteristics such as gender, average length of hospice stay, primary diagnoses, average daily census, number of admissions per year, net operating revenues, inpatient unit (IPU) operating costs, and medication expenditures of hospices in Ohio and compare it with NHPCO data.<br>2. Identify and analyze therapeutic drug classes and medications with the most frequent utilization rates and largest percentage of expenditures in hospice care.<br><br>Method:<br>Hospice Pharmacy Benefit Managers (PBM) employ pharmacists to provide comprehensive pharmaceutical care services for patients under hospice care and one component of pharmacist provided services include comprehensive medication review. To study the impact of pharmacist-led medication review on hospice costs and medication utilization, PBM claims data for year 2007 were obtained from five hospices in Ohio. The data included information on utilization and costs of medications, patient-related (gender, average length of hospice service, and primary diagnoses) and hospice-related (number of admissions per year, average daily census, net operating revenues, inpatient unit [IPU] operating costs and pharmacy costs) characteristics. Claims data were analyzed to identify the most frequently used therapeutic drug classes and those classes which contributed to the largest percentage of pharmacy expenditures. Prescription drug count and total cost for medications under the identified therapeutic drug classes were also obtained. For benchmarking purposes, analysis was conducted to compare patient and hospice-related data obtained from the five hospices to the 2007 NHPCO data.<br><br>Results:<br>The average number of admissions per hospice for the year 2007 was 627 patients. Average daily census (136 patients) and total patient days (51,350 days) in these five hospices were 1.5 times higher as compared to that of NHPCO data (90 patients and 31,300 days, respectively.). Annual drug expenditures per hospice ranged from $67,580 to $763,413 while average hospice medication cost per patient per day (PPPD) was $11.12 ($12.43 PPPD for home care and $8.5 PPPD for nursing care). Average PPPD excluding outliers such as enoxaparin was $10.72 ($12.05 PPPD for home care and $8.25 PPPD for nursing care).<br>Approximately 1,020 different drugs under 246 therapeutic classes were utilized in the five hospices. The most frequently utilized therapeutic class of drugs, based on prescription drug volume included analgesic-narcotics (15.6%) followed by laxatives-cathartics (7.5%), and anti-anxiety drugs (7%). Therapeutic classes contributing to the majority of drug expenditures, included analgesics-narcotics (16.5%), SSRIs (4.7%), and anti-anxiety drugs (4.5%). Medications whose frequency of use accounted for high expense included morphine sulfate (5.3% - utilization, 4.4% - expenditure), lorazepam (4.4%, 3.1%), furosemide (4%, 0.6%), methadone (3%, 0.9%), and prednisone (3.1%, 0.5%). Medications such as enoxaparin injections whose frequency of utilization was low (0.01%), contributed to 3.1% of total medication expenditure. Likewise, fentanyl and oxycodone contributed to 3.5% and 3.7%, respectively to the total medication expenditure, but their frequency of utilization was only 0.9% and 1.9%, respectively.<br><br>Conclusion:<br>The five hospices in Ohio utilized preferred drugs recommended by pharmacists following a medication review to identify potential drug related problems (DRPs) and encourage cost-effective drug utilization. As a result of these interventions, the utilization of expensive medications is low. Pharmacists specializing in hospice and palliative care are able to recommend preferred medications in end-of-life care thus producing cost-savings. More importantly, hospice pharmacists frequently identify DRP's which can improve patient outcomes. Hospices should consider interventions made by pharmacists and place emphasis on the utilization of cost effective drugs that can be used among terminally ill patients to provide a high level of quality care with fiscal responsibility. / Mylan School of Pharmacy and the Graduate School of Pharmaceutical Sciences; / Pharmacy Administration; / MS; / Thesis;

Disparities in medication adherence (MA) associated with African American (AA) adults may be related to a dynamic interplay between personal factors, behavioral capability, and environmental factors. The purpose of the study was to examine this relationship in AA adults with metabolic syndrome (MetS). A cross-sectional, correlational analysis was conducted from baseline data from a larger intervention study. Constructs from the Social Cognitive Theory were used to predict MA. The sample of 91 AA adults with MetS was primarily middle-aged (age range 45-70 years old; M 53, SD 6.3), female (79%), relatively well-educated, and married. Despite being on antihypertensive medications, 53% of the participants presented with uncontrolled high blood pressure (≥130/90 mmHg). Although the vast majority (95%) of the sample displayed adequate health literacy (HL), 30% of the sample was non-adherent to their medication regimen. A positive significant relationship was found between age and MA [χ2 (1, n = 90) = 6.71, p = .01)]. Stress [χ2 (1, n = 90) = 6.28, p = .012)] and social support (SS) [χ2 (1, n = 90) = 4.10, p = .04)] were the only significant relationships among environmental factors, barriers and hypertension MA. Highly stressed AA adults were significantly more likely to be non-adherent or had a 15% reduction in the odds of hypertension MA. Similarly, adults with a low income were 5.8 times more likely to be non-adherent (OR 5.828, 95% CI, 1.014-33.493, p= .0482), while those with low SS had a 9% reduction in the odds of MA; SS trended toward significance (OR.914. 95% CI .823-1.016, p =.09). With increasing age, AA adults were more likely to be non-adherent (OR 1.12, 95% CI 1.028-1.220, p =.0096). Most of the participants reported a high degree of autonomy, satisfaction with their health care climate, and the availability of SS. Although increasing age, adequate SS, high stress, and adequate HL appeared to influence MA in AA adults with MetS, the research questions were only partially answered. Further investigation of the relationships and potential mediating pathways between personal characteristics, environmental factors, behavioral capability and hypertension MA in AA adults with MetS is needed.

Background: Self-medication with antibiotics is a global phenomenon and potentialcontributor to human pathogen resistance to antibiotics. Amongst Pakistanis, antibioticself-medication rates are high. At present, no data is available on prevalence and practicesof self-medication with antibiotics among Pakistani students abroad. Aim: The aim of this study was to assess prevalence and comparative practices ofPakistani students in Sweden and Finland regarding self-medication with antibiotics. Methods: The study used an anonymous cross-sectional Web-based questionnaire surveywith convenience census sampling targeted to Pakistani students in Sweden and Finland.Questionnaire asking use of antibiotics and six-month recall of antibiotic self-medicationbefore the survey was administered to the 9333 potential respondents. Data was analyzedusing statistical software R version 2.8.1. Descriptive statistic was used to analyze theresults. Associations were tested using Pearson's Chi-squared test. Findings: Response rate was 2.3% after five reminders. Of 213 participants (mean age27.9 years), 151 were from Sweden and 57 were from Finland. One hundred eleven(52.1%) reported antibiotic self-medication in their life time and forty two percent knewthat it could be injurious to health. Sixty-eight participants (31.9%) did self-medicationwith antibiotics during their stay in the study countries and almost all used oral antibiotics.Unrestricted pharmacy sale was the commonest source (37%) of such antibiotics.Common symptoms triggering antibiotic self-medication were respiratory (42.6%) andoro-dental (13.2%). Preferred antibiotics were broad spectrum Penicillin (41.2%),Macrolides (23.5%) and Quinolones (6.2%). Almost all (98.8%) antibiotics for suchmedication were obtained from Pakistan. About 27% reported that they would considerself-medication with antibiotics in future. The most common reason for antibiotic selfmedicationwas affordability of health care consultation and antibiotics (23.9%). Therewas no significant difference between the self-medication practices of participants basedon country of studentship (p=0.6). Self-medication rates were not significantly lower instudents who were aware that it may harm (p=0.2) and is unsafe (p=0.2). Conclusion: High prevalence of self-medication with antibiotics among participants is amatter of concern from individual and public health perspective. There is need to augmentawareness and implement legislations to promote judicious and safe practices. Furtherstudies are needed concerning resistance impact of antibiotic self-medication. Key wards: self-medication, antibiotics, Pakistani students, abroad, practices

Syfte: Syftet med denna studie är att beskriva patienters inställning till sin antipsykotiska medicinering och orsaker till varför läkemedelsordinationer inte följs. Metod: Enkätstudie med kvalitativ innehållsanalys. Resultat: Två teman och 13 kategorier framkom för att beskriva patienters inställning till läkemedlet. Dessa teman är Läkemedel som hjälp och Läkemedel som belastning. Antalet kategorier under temat läkemedel som hjälp är nio stycken och antalet kategorier under temat läkemedel som belastning är fyra. För att beskriva varför ordinationer inte följts framkom fyra kategorier. Slutsats: Huvudresultaten i denna studie är de två teman som framkom, Läkemedel som hjälp och Läkemedel som belastning. Deltagarna i denna studie uppgav både positiva och negativa attityder till sin antipsykotiska medicin. Medicinen förbättrade sjukdomsbilden och ökade deras välbefinnande, men den var också förknippad med biverkningar och att man var bunden till att äta ett läkemedel. Inställningen till antipsykotiska läkemedel var dock övervägande positiv i denna studie. Deltagare som någon gång valt att sluta med medicinen uppgav att de gjort det på grund av glömska, biverkningar och en önskan om att få vara frisk. / Objective: The purpose of this study is to describe patients’ attitude to their medication and reasons why they may not be compliant to the medical treatment. Method: Data was collected using questionnaires and the data was analysed using qualitative content analysis. Results: Two themes and 13 categories emerged to describepatients’ attitude to their medication. The themes are Medication as an aid and Medication as a burden. There were nine categories describing the theme Medication as an aid and four to describe Medication as a burden. For reasons why patients did not adhere to medication treatment four categories emerged. Conclusion: The main results in this study are the two themes that emerged, Medication as an aid and Medication as a burden. The participants in this study expressed both positive and negative attitudes towards their antipsychotic medication. The medicine improved the clinical picture and their well-being, but it was also associated with side effects and that they were tied to a drug. Participants who stated that they had quit taking their medication one time or another had done so because of forgetfulness, side effects and a desire to be healthy.

No description available.

The skin serves as a semi-permeable barrier that protects the body from pathogens and water loss. The stratum corneum, the upper 10-15 µm layer of skin, is the primary barrier layer. Due to its structure, only drugs that are lipophilic and with a low molecular weight (<500 Da) can penetrate intact skin. This study examines the use of microdermabrasion as a method of removing the stratum corneum to increase the skin's permeability to hydrophilic molecules, proteins, and vaccines. Microdermabrasion is a FDA-approved cosmetic skin resurfacing procedure that removes the stratum by bombarding it with abrasive particles under vacuum. The aims of this thesis are focused on optimizing the microdermabrasion conditions that will selectively remove stratum corneum, evaluating the transport of different sized molecules through abraded skin in vitro, examining drug efficacy in vivo by delivering insulin to diabetic rats, and examining the rate of skin healing after treatment. Microdermabrasion can be used as a non-invasive transdermal drug technique to safely remove stratum corneum to make the skin more permeable to waters soluble drugs and proteins.

Thesis (Ph. D.)--School of Chemical Engineering, Georgia Institute of Technology, 2004. Directed by Mark R. Prausnitz. / Vita. Includes bibliographical references (leaves 151-158).

Thesis (M.S.)--Mississippi State University. Department of Industrial Engineering. / Title from title screen. Includes bibliographical references.

Thesis (M.S.)--Worcester Polytechnic Institute. / Keywords: mass balance approach; bioavailability; drug delivery; dynamic modeling; partial differential equations; sensitivity analysis; dynamic simulations. Includes bibliographical references (p. 62-67).