Thesis (M.Phil.)--Hong Kong University of Science and Technology, 2007. / Includes bibliographical references (leaves 70-80). Also available in electronic version.

Thesis (Ph. D.)--University of Rhode Island, 2002. / "... presents a comprehensive analysis of the classification of nonprescription medicines and Rx-to-OTC switch criteria policy in the United States, United Kingdom, Canada, Japan and Australia."--abstract. Includes bibliographical references (leaves 245-251). Also available on the internet.

Poor adherence is common in patients with diabetes mellitus and other chronic diseases that require extensive self-management. This behavior has been linked to increased complications, mortality rate, and health care costs. Although much effort has been put into studying the barriers to adherence and ways to improve both patient self-care and clinical outcomes, little success can be observed in the long run. Literature review of studies related to medication adherence in diabetes has shown a lack of uniformity in study parameters and statistical analysis making the juxtaposition of studies difficult and unreliable. Intervention studies in the field have shown general improvement in adherence rate in a short period of time, but rarely making any significant differences in clinical outcomes. Since diabetes mellitus is a chronic disease, it would be important to design studies measuring long term effects of interventions in the future.

Background - Mobile health (mHealth) interventions to promote medication adherence have shown promise; among patients primarily diagnosed with Coronary Heart Disease (CHD), however, there is a lack of evidence for nurse-led mHealth interventions, in this particular group in Iran. Aim - To refine and evaluate a pre-developed nurse-led mHealth intervention to promote cardiovascular medication adherence in Iranian adult, male and female Cardiac Rehabilitation (CR) outpatients. Methods - A quantitative-dominant mixed methods study was conducted drawing upon the Medical Research Council’s (MRC) Framework on the development and evaluation of complex interventions. Phase 1 comprised of a self-completion CHD patients’ survey (n=123) and three focus groups with cardiac nurses (n=23) within three public university-affiliated hospitals in Tehran, which in turn informed Phase 2 (the exploratory trial phase). The automated Short Message Service (SMS) medication reminder was designed based on the dimensions of adherence suggested by the World Health Organisation (WHO) and Bandura’ Self-efficacy Theory. The intervention was refined according to the findings from Phase 1 and then piloted in an Iranian CR setting. Seventy eight CHD patients who were 18 years or older, and had mobile phone access were recruited and randomised to receive either daily SMS reminders (n=39) or usual care (n=39) for 12 weeks. The primary outcome was the effect on cardiovascular medication adherence as measured by the self-reported Morisky Medication Adherence Scale; secondary outcomes explored the feasibility of the mHealth intervention, intervention effect on medication adherence selfefficacy, cardiac ejection fraction, cardiac functional capacity, hospital readmission/ death rate and health-related quality of life. Patient acceptability was assessed through completion of a post-intervention survey. Results - Feasibility was evidenced by high ownership of mobile phones in CHD patients, high application of SMS messaging, positive patients’ perception about the intervention, suboptimal cardiovascular medication adherence and patients’ high interest in receiving SMS reminders for their medications. Participants in the intervention group showed higher self-reporting of medication adherence compared to the usual care group χ2 (2) = 23.447; P < 0.001. The Relative Risk (RR) was indicated that it was 2.19 times more likely for the control group to be less adherent to their medications than the intervention group (RR = 2.19; 95% Confidence Interval (CI) 1.5 - 3.19). All secondary outcomes improved in the intervention group at the end of the study. Acceptability was evidenced by participants who received the intervention reporting that they perceived the SMS reminders useful. Conclusion - The SMS medication reminder intervention was well accepted and feasible with significantly higher reporting of medication adherence in Iranian CHD patients. Effect sizes were established for use in future follow-up evaluations of the mHealth intervention.

Magister Curationis - Mcur / Clinical experiences have always been an integral part of nursing education, and the value thereof to the nursing students is widely demonstrated in research. The purpose of clinical supervision is bridging the gap between theory and practice and ensuring that nursing students are prepared to be competent in their professional duties upon completion of their studies. However, clinical supervision focuses mainly on clinical skills and seems to neglect policies and protocols that govern care delivery, often impacting negatively on the expected quality of service. This problem is more so prominent in policies and protocols pertaining to medication. The Essential Drug List (EDL), which is a useful tool in the South African public health facilities, is one such protocol. Supervision on Essential Drug List as a medication protocol seems to be non-existent in the nursing field despite the expectations that nursing students should be able to implement its contents upon completing their studies. The nursing students' views regarding supervision in this regard are often not sourced despite their importance as stakeholders. However, if positive changes that will serve as a solution to the current problem are to be achieved, the students need to be heard. The study aimed to explore the perceptions of nursing students at a university in the Western Cape regarding clinical supervision on EDL medication protocol.

abstract: The treatment of individuals with multiple chronic conditions represents the single largest driver of Medicare costs. The use of prescription drugs is a major component in the treatment/management of chronic disease in the United States. Medication nonadherence, however, is a common problem among older adults and leads to significant morbidity and mortality. Whereas, the problem of medication nonadherence has been a primary focus of research for the last thirty years, much is still unknown about which older adults are most at risk for medication nonadherence, as well as what are effective theory-based interventions to improve a person's medication self-management. The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2014

nÃo hà / A seguranÃa relacionada ao sistema de medicaÃÃo tem sido objeto de pesquisas recentes, principalmente, em relaÃÃo aos antibacterianos que possuem alta especificidade farmacolÃgica e podem ter sua aÃÃo prejudicada em detrimento de erros associados Ãs fases de preparo e administraÃÃo. Assim, o estudo teve como objetivo geral: Analisar os fatores comportamentais e ambientais envolvidos na ocorrÃncia de erros durante as etapas de preparo de administraÃÃo de antibacterianos. Trata-se de um estudo observacional, exploratÃrio e transversal, de natureza quantitativa, realizado entre agosto a dezembro de 2014 em Hospital da Rede Sentinela em Fortaleza. A amostra compreendeu 44% das doses de antibiÃticos das clÃnicas mÃdicas A e B, 108 e 157, respectivamente. A coleta de dados se deu em duas fases: a primeira para caracterizar o perfil sÃcio ocupacional dos profissionais de enfermagem; e a segunda para identificar as adequaÃÃes e inadequaÃÃes comportamentais e ambientais nas fases de preparo e administraÃÃo. Os dados foram organizados em tabelas e analisados por meio da estatÃstica descritiva e analÃtica. Todos os princÃpios bioÃticos foram respeitados, conforme aprovaÃÃo da pesquisa pelo Comità de Ãtica da Universidade Federal do CearÃ, protocolo nÃmero 660.897. Os resultados permitiram realizar as seguintes inferÃncias: a concretizaÃÃo do preparo e administraÃÃo dos antibacterianos foi realizada por tÃcnicos de enfermagem (100%), predominantemente do sexo feminino, na faixa etÃria de 31 a 40 anos, que concluÃram a formaÃÃo entre os Ãltimos dez a 20 anos e atuam na Ãrea por um perÃodo semelhante, no entanto, hà menos de dez anos na instituiÃÃo onde a pesquisa foi realizada. Sobre a influÃncia de fatores ambientais verificou-se que durante o preparo houve inadequaÃÃo em 136 observaÃÃes na variÃvel limpeza e em 187 na organizaÃÃo. A dimensÃo para o preparo foi inadequada na ClÃnica MÃdica A (3,8m2), e os itens iluminaÃÃo, temperatura e ruÃdo foram extremamente oscilantes nos trÃs turnos e nas duas clÃnicas, com mÃdias geralmente acima do recomendado. Quanto Ãs variÃveis comportamentais observou-se: fontes produtoras de interrupÃÃes em 145 doses durante o preparo, e, no entanto, nÃo foram estatisticamente significativas para aumentar o tempo de preparo dos antibiÃticos (p=0,776). Houve maior frequÃncia de nÃo-conformidades respectivamente nas clÃnicas A e B quanto ao itens: comportamento de utilizaÃÃo da prescriÃÃo 86 (79,6%) e 157 (100%); confirmaÃÃo do nome do paciente 68 (62,9%) e 142 (90,4%); e, monitoramento 84 (77,7%) e 82 (52,2%). Jà a ClÃnica MÃdica B apresentou maiores Ãndices de conformidade no controle do tempo de infusÃo 84 (53,5%) e checagem imediata 93 (59,2%). Fator que contribuiu para aumentar as chances de interaÃÃo medicamentosa foi a ausÃncia de diretrizes com informaÃÃes sobre o medicamento (p=0,003). A principal categoria de erro encontrada foi o erro de dose (157). Jà o antibiÃtico mais comumente utilizado foi a Piperaciclina + Tazobactan com 51 doses. Conclui-se que o ambiente de trabalho e o comportamento adotado pelos profissionais de enfermagem sÃo condiÃÃes que podem favorecer a ocorrÃncia de erros com antibiÃticos.

Class of 2014 Abstract / Specific Aims: To assess older adults’ knowledge of medications associated with an increased risk of falls and to evaluate the impact of pharmacist counseling on knowledge of medication-related fall risk. Subjects: Community-dwelling adults 60 and older. Methods: Data were collected using an online questionnaire consisting of 15 knowledge-based items to determine awareness of medication-related fall risk, four items to determine pharmacist counseling experience, fall history, and number of medications taken, and two items to collect demographic information (age and gender). Main Results: Two hundred and six community-dwelling older adults (mean age = 69.07 years, SD = 5.59) participated in the study by completing all or part of the questionnaire. The number of older adults who reported having fallen within the last five years was 90 (43.7%). The knowledge-based portion of the questionnaire was completed in its entirety by 162 older adults (80 males, 81 females, one unreported gender; mean age = 68.7 years, SD = 5.12). One hundred and nineteen of 162 (73.5%) questionnaire respondents scored below 70% on the knowledge assessment (mean score 49.3%, SD = 26.8). The 12 respondents (7.6%) who reported having received counseling from a pharmacist regarding medication-related fall risk scored significantly higher on the knowledge assessment compared to the 145 respondents who did not (mean score 61.66% versus 48.09%, p = 0.01). Conclusion: A majority of community-dwelling older adults lacked knowledge of medications associated with an increased risk of falling. However, those who had been counseled by a pharmacist demonstrated greater awareness of medication-related fall risk. Thus, pharmacist counseling of older adults regarding medications and fall risk should be promoted.

Class of 2015 Abstract / Objectives: There is limited information regarding medication use during in-hospital cardiac arrest (IHCA). The purpose of this study was to characterize medication use during IHCA, and determine the association between medications used and survival to hospital discharge. Methods: This was a retrospective cohort study conducted in an academic medical center looking at IHCA between October 2009 and December 2013. Data regarding medication use during IHCA and other pertinent predictors of survival were collected. The primary objective was to characterize medications used during IHCA and to assess the relationship between medications used and survival to hospital discharge. Results: There were 171 patients who were included in the study and 44 (26%) survived to hospital discharge. The medications most commonly used were epinephrine, sodium bicarbonate, calcium chloride or gluconate, atropine, amiodarone, vasopressin, magnesium sulfate, and lidocaine. Patients who died were more likely to receive total epinephrine ≥3 mg (53% versus 27%, p=0.005), sodium bicarbonate (73% versus 55%, p=0.025), and calcium (59% versus 27%, p<0.001), compared to survivors, respectively. After adjusting for duration of resuscitation, total epinephrine ≥3 mg (OR 0.38, 95% CI 0.18 to 0.83, p=0.015) and calcium (OR 0.30, 95% CI 0.14 to 0.64, p=0.002) was associated with decreased survival. Conclusions: This study found that 3 mg or more of epinephrine, calcium salts and sodium bicarbonate are linked to decreased survival to hospital discharge. Further research should be done to define the cause of this link.

Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.