Thesis (M.H.A.)--University of Michigan, 1975.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1976.

Abstract Background and Objective: An accurate medication history list is an integral part of the patient assessment at hospital admission. The objective of the study was to describe the frequency, type, and predictors of unintentional medication errors and to evaluate the quality of the clinical pharmacy services focusing on the acceptance of the recommendations made by the clinical pharmacist. Setting and methods: A descriptive study was conducted at two internal medicine wards at Baghdad Teaching Hospital in Iraq using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. The study pharmacist conducted medication interviews for patients shortly after hospital admission to obtain the most accurate pre-admission medication history list. This list was compared with the medication list in the patient’s medical chart. Intended addition, withdrawal of a drug, or changes to the dose/ dosage form in the patient’s medical list was considered as medication discrepancies. However, medication discrepancies were considered as medication errors based on no identified clinical reason. Results: A total of 114 patients were included in this study. Over two-thirds of the study patients (73.7%) experienced 215 medication errors identified by a clinical pharmacist conducting medication reconciliation. Most errors were omission (87.9%). Cardiovascular agents followed by NSAID were commonly in error (53%) and (10.2%) respectively. In a logistic regression model, age (odds ratio (OR), 1.055: 95% confidence interval (CI) 1.010 - 1.102), female gender (OR, 3.468: 95% CI 1.232- 9.761) and number of medications at admission (OR, 0.810: 95% CI 0.681-0.963) were predictors for medication history errors at admission. Conclusions: Medication errors at the time of hospital admission are common and undetected.  A structured approach like the LIMM-based medication reconciliation at Iraqi hospital is needed to detect these errors.

Orientador: Patrícia Moriel / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T03:57:40Z (GMT). No. of bitstreams: 1 Carvalho_IndiraValade_M.pdf: 1267534 bytes, checksum: de03a91e0914a3ff437fe44fca10a9e9 (MD5) Previous issue date: 2013 / Resumo: A segurança na utilização de medicamentos tornou-se um tema altamente discutido nas políticas de saúde, em parte devido a pesquisas que demonstram a ocorrência de importantes eventos adversos aos medicamentos (EAM) causados por fármacos comumente utilizados. Poucos estudos em pediatria quantificam os EAM, o que demonstra a necessidade da condução de mais estudos com esta faixa etária. O objetivo deste trabalho foi realizar uma análise prospectiva sobre a incidência de EAM e estabelecer o perfil de adesão à farmacoterapia de uso contínuo em pacientes pediátricos admitidos em uma unidade de emergência. Trata-se, portanto, de um estudo transversal, com duração de um ano (julho/2011 a junho/2012), conduzido na Unidade de Emergência Referenciada Pediátrica do Hospital de Clínicas da (HC) da Universidade Estadual de Campinas (UNICAMP). Os EAM foram identificados, quantificados e caracterizados em 7 categorias (reação adversa ao medicamento; não adesão; inefetividade terapêutica; uso inadequado do medicamento; interação medicamentosa; intoxicação e queixa técnica) e classificados segundo a gravidade obedecendo aos critérios do CTCAE (Common Terminology Criteria for Adverse Events). As reações adversas aos medicamentos foram classificadas pela causalidade, segundo Algoritmo de Naranjo. Para os pacientes em tratamento medicamentoso em regime contínuo, foi avaliado o grau de adesão à terapia proposta utilizando o Teste de Morisky-Green. No período de estudo foram admitidos na unidade de emergência 20.441 pacientes e 1723 (8,4%) foram atendidos pela farmacêutica responsável pelo projeto. Destes, 199 (11,5%) foram admitidos em decorrência de pelo menos um EAM e fazem parte da "População EAM" e 226 (13,2%) relataram o uso de pelo menos um medicamento em regime contínuo e por isso foram incluídos na "População Adesão". O evento de maior frequência foi uso inadequado do medicamento, identificado em 39,3% dos casos. O principal medicamento envolvido nos casos de reação adversa ao medicamento, não adesão e uso inadequado foi a Amoxicilina (26,0%). Nos casos em que mais de um medicamento estava envolvido em um ou mais eventos, notou-se que a maioria dos medicamentos causadores dos EAM provinha de medicamentos prescritos (85,8%). Foi observada maior ocorrência de EAM de gravidade leve (62,9%) e, ao estudo da causalidade das reações adversas, apenas 1 caso foi classificado como definido (2,4%). Quanto às características do perfil de adesão à farmacoterapia prescrita, houve predomínio de alta adesão (62,2%) principalmente entre crianças de 0 a 9 anos. Este trabalho demonstra uma alta incidência de EAM relacionados à admissão de pacientes pediátricos em unidade de emergência. A carência de informações e de estudos publicados na área demonstra a necessidade de estímulo a pesquisas nos grandes pólos de saúde no Brasil os quais poderão demonstrar o real problema de eventos adversos aos medicamentos na pediatria, podendo com isso estabelecer propostas de ações mais efetivas para o uso racional de medicamentos nesta faixa etária o que ressalta a importância da atuação do farmacêutico clínico através da atenção farmacêutica, para orientar e intervir no uso correto dos medicamentos / Abstract: The safety drug utilization has became a highly visible topic in health politics, due in part to research suggesting that there are important adverse drug events (ADE) caused by commonly used medications. Few pediatric studies quantify the ADE; this fact demonstrates the necessity of conducting further research with this age group. The objective of this study was to realize a prospective analysis on the incidence of ADE and to establish the profile of adherence to pharmacotherapy of continuous use in pediatric patients admitted to an emergency unit. This study was transversal with lasting one year (July/2011 to June/2012), conducted at the Emergency Pediatric Unit, Hospital de Clinicas (HC), State University of Campinas (UNICAMP). The ADE were identified, quantified and characterized in seven categories: (adverse drug reaction, non-compliance, and treatment ineffectiveness, inappropriate use of medication, drug interactions, toxicity, and technical defect) and classified by severity according to the criteria of the CTCAE (Common Terminology Criteria for Adverse Events). The adverse drug reactions were classified by causality, second to Naranjo algorithm, and type (organ involved). For patients under treatment in continuous, the degree of adherence to therapy proposal was evaluated using the Morisky-Green test. During the study period 20,441 patients were admitted and 1,723 (8.4%) were attended by the pharmaceutical responsible for the project. Of these, 199 (11.5%) were admitted with at least one ADE and form part of the "Population ADE"; and 226 (13.2%) were evaluated because of administering at least one drug in continuous and so were included in the "Population Adherence". The most frequent event was inappropriate use of the drug, identified in 39.3% of cases. The main drug involved in cases of adverse reaction to medication, non-compliance and inappropriate use was Amoxicillin (26.0%). In cases where more than one drug was involved in one or more events, it was noted that most of the drugs that cause ADE came from prescription drugs (85.8%). There was higher occurrence of ADE mild severity (62.9%), and the study of causality of adverse events, only 1 case was classified as definite (2.4%). Regarding the characteristics of the profile of adherence to pharmacotherapy prescribed, were higher in adherence (62.2%) mainly children aged 0 to 9 years. This work demonstrates a high incidence of ADE related to admission of pediatric patients in emergency unit. The lack of information and studies published in the area demonstrates the need to stimulate research in major health centers in Brazil which will demonstrate the real problem of adverse drug events in pediatric, and this may establish proposals for more effective actions for rational drug use in this age group which emphasizes the importance of the role of the clinical pharmacist through pharmaceutical care to guide and intervene in the correct use of medicines / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Orientador: Priscila Gava Mazzola / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T11:39:26Z (GMT). No. of bitstreams: 1 Costa_LarissaSaitoda_M.pdf: 1703771 bytes, checksum: cad484500b66f36f1f44735876ed798f (MD5) Previous issue date: 2014 / Resumo: Durante tratamentos oncológicos, ginecológicos e obstétricos, a mulher pode desenvolver complicações que requerem a sua admissão em uma Unidade de Terapia Intensiva (UTI). Neste contexto, a atuação do farmacêutico clínico nas reuniões à beira leito da equipe intensivista e a realização de intervenções farmacêuticas contribui para a otimização da terapia medicamentosa, a redução de erros de prescrição e consequentemente, para a segurança da paciente. Este estudo objetivou avaliar o impacto que a incorporação da Farmácia Clínica à equipe multidisciplinar de uma UTI especializada em saúde da mulher pode gerar na terapia medicamentosa de sujeitos internados neste local. Foram realizadas intervenções farmacêuticas por meio da análise de prescrições e da discussão de casos clínicos durante as visitas à beira leito junto à equipe multidisciplinar. Estas intervenções, bem como os erros de prescrição identificados, foram documentados, quantificados e classificados. Foram acompanhados 222 sujeitos ao longo do estudo, com uma média de 5,89 ± 6,44 prescrições por sujeito. Foram identificados 101 erros de prescrição, dos quais 87 foram prevenidos. Os mais prevalentes foram dosagem maior que a correta (22[21,78%]), medicamento não seguro por presença de interação medicamentosa (IM) (20[19,80%]) e medicamento não seguro na lactação (15[14,85%]). Foram realizadas 127 intervenções, das quais 113 foram aceitas, 5 parcialmente aceitas e 9 não aceitas. As mais prevalentes foram ajuste de dose (30[23,62%]), interações medicamentosas (20[15,74%]) e informações sobre medicamentos (17[13,39%]). Pode-se concluir que a implementação da Farmácia Clínica contribuiu para a redução de riscos provenientes da terapia medicamentosa na área de terapia intensiva na saúde da mulher / Abstract: During gynecological, oncological and obstetrical treatments, a woman may develop complications requiring her admission to an Intensive Care Unit (ICU). In this context, the role of the clinical pharmacist in multidisciplinary meetings at bedside visits contributes to patient safety by performing pharmacy interventions. This study aimed to evaluate the impact that the incorporation of Clinical Pharmacy in the multidisciplinary team of a specialized ICU in women¿s health can generate in drug therapy of hospitalized subjects in that place. Pharmacy interventions were performed through the analysis of patient¿s prescriptions and clinical case discussions during bedside visits. These interventions and prescription errors found in prescriptions were documented, quantified and classified. We followed 222 subjetcs throughout the study, with an average of 5,89 ± 6,44 prescriptions.The most prevalent were dosage higher than the correct (22 [21.78%]), unsafe medicine for the presence of drug interaction (IM) (20 [19.80%]) and unsafe medication during lactation (15 [14 dosage 85%]). A total of 127 interventions were performed, of which 113 were accepted, 5 partially accepted and 9 not accepted. The most prevalent were dose adjustment (30 [23.62%]), drug interactions (20 [15.74%]) and drug information (17 [13.39%]). We can conclude that Clinical Pharmacy implementation contributed to reduce risks from drug therapy in intensive care in women¿s health area / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Chung, Jennifer Siu Toye. / "June 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 145-157). / Abstracts in English and Chinese, some text in appendix also in Chinese. / Abstract of Thesis in English --- p.i / Abstract of Thesis in Chinese --- p.iii / Acknowledgments --- p.v / List of Tables --- p.xi / List of Figures --- p.xiii / List of Abbreviations --- p.xiv / List of Publications and Presentations related to Thesis --- p.xvi / Contributions related to Thesis --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Introduction of the Thesis --- p.1 / Chapter 1.2 --- Review on Coronary Heart Disease --- p.3 / Chapter 1.2.1 --- Definition of Coronary Heart Disease --- p.3 / Chapter 1.2.2 --- Risk factors for the development of Coronary Heart Disease --- p.3 / Chapter 1.2.3 --- Worldwide Figures for Coronary Heart Disease --- p.9 / Chapter 1.2.4 --- Coronary Heart Disease in Asia Pacific --- p.10 / Chapter 1.2.5 --- Coronary Heart Disease in Hong Kong --- p.11 / Chapter 1.3 --- Dyslipidaemia --- p.14 / Chapter 1.3.1 --- Lipid Transport and Lipoprotein Metabolism --- p.14 / Chapter 1.3.2 --- Definition and Classification of Dyslipidaemia --- p.16 / Chapter 1.3.3 --- Coronary Heart Disease and Dyslipidaemia --- p.17 / Chapter 1.3.4 --- Lifestyle Modifications for the Management of Dyslipidaemia --- p.19 / Chapter 1.3.4.1 --- Dietary Measures --- p.20 / Chapter 1.3.4.2 --- Cigarette Smoking --- p.23 / Chapter 1.3.4.3 --- Physical Activity --- p.24 / Chapter 1.3.4.4 --- Weight Control --- p.25 / Chapter 1.3.5 --- Lipid-lowering Drug Therapy for Dyslipidaemia --- p.29 / Chapter 1.3.5.1 --- Statins --- p.31 / Chapter 1.3.5.2 --- Bile Acid Sequestrants --- p.35 / Chapter 1.3.5.3 --- Fibrates --- p.36 / Chapter 1.3.5.4 --- Ezetimibe --- p.37 / Chapter 1.3.5.5 --- Nicotinic Acid Group --- p.38 / Chapter 1.4 --- International Guidelines for Dyslipidaemic Management --- p.39 / Chapter 1.4.1 --- National Service Framework for Coronary Heart Disease (UK) --- p.39 / Chapter 1.4.1.1 --- National Service Framework Lipid-lowering Goals --- p.40 / Chapter 1.4.1.2 --- The Joint British Societies' Guidelines --- p.41 / Chapter 1.4.1.3 --- Achievement of the NSF Lipid Profile Targets --- p.42 / Chapter 1.4.2 --- National Cholesterol Education Program (United States) --- p.43 / Chapter 1.4.2.1 --- The Third Report of the National Cholesterol Education Program --- p.43 / Chapter 1.4.2.2 --- Review of Clinical Trials --- p.43 / Chapter 1.4.2.3 --- Low-Density Lipoprotein Cholesterol Goal Targets --- p.46 / Chapter 1.4.2.4 --- Compliance with the NCEP ATP III Guidelines --- p.48 / Chapter 1.4.3 --- Dyslipidaemic Guidelines for Study --- p.51 / Chapter 1.5 --- Clinical Pharmacy Services --- p.52 / Chapter 1.5.1 --- The Healthcare System in Hong Kong --- p.52 / Chapter 1.5.2 --- Clinical Pharmacy Services in Hong Kong --- p.54 / Chapter 1.5.3 --- Examples of successful Clinical Pharmacy Services --- p.55 / Chapter 1.5.3.1 --- Hypertension Clinic --- p.55 / Chapter 1.5.3.2 --- Diabetes Mellitus Clinic --- p.56 / Chapter 1.5.3.3 --- Smoking Cessation Clinic --- p.57 / Chapter 1.5.3.4 --- Anticoagulation Clinic --- p.57 / Chapter 1.5.3.5 --- Haematology-oncology Clinic --- p.57 / Chapter 1.5.4 --- Pharmacist-managed Lipid Clinics --- p.58 / Chapter 1.6 --- Objective & General Aims of the Study --- p.60 / Chapter 1.6.1 --- Objectives --- p.60 / Chapter 1.6.2 --- Study Hypothesis --- p.60 / Chapter 1.6.3 --- General Aims of the Study --- p.60 / Chapter Chapter 2 --- Methodology of Study --- p.62 / Chapter 2.1 --- Background Setting --- p.62 / Chapter 2.2 --- Subject Selection and Recruitment --- p.62 / Chapter 2.3 --- Intervention and Control Groups --- p.63 / Chapter 2.4 --- Validation of Survey --- p.67 / Chapter 2.5 --- Data Collection --- p.67 / Chapter 2.6 --- Outcome Measures --- p.68 / Chapter 2.6.1 --- Lipid value changes --- p.68 / Chapter 2.6.2 --- Compliance rate with medications --- p.68 / Chapter 2.6.3 --- Patient satisfaction survey assessment --- p.69 / Chapter 2.6.4 --- Time spent and Cost of clinical pharmacist --- p.69 / Chapter 2.7 --- Statistical Analysis --- p.70 / Chapter 2.7.1 --- Sample Size Calculation --- p.70 / Chapter 2.7.2 --- Methods of Statistical Analysis --- p.71 / Chapter Chapter 3 --- Results of Study --- p.72 / Chapter 3.1 --- Recruitment Details --- p.72 / Chapter 3.2 --- Demographic Characteristics of Patients --- p.73 / Chapter 3.3 --- Drug Therapy of Patients during Study Period --- p.75 / Chapter 3.4 --- LDL-C Lowering Potency of Statin Doses Prescribed --- p.80 / Chapter 3.5 --- Coronary Heart Disease Risk Category of Patients --- p.84 / Chapter 3.6 --- Lipid Profile Changes --- p.85 / Chapter 3.7 --- NCEP ATP III LDL-C Goal Attainment --- p.87 / Chapter 3.8 --- Relationship between Patient Characteristics and LDL-C Goal Attainment --- p.91 / Chapter 3.9 --- Compliance with Medications --- p.94 / Chapter 3.10 --- Pharmacist Intervention --- p.98 / Chapter 3.10.1 --- Range of Pharmacist Intervention --- p.98 / Chapter 3.10.2 --- Time spent by Pharmacist --- p.100 / Chapter 3.10.2.1 --- Time spent on Documentation --- p.100 / Chapter 3.10.2.2 --- Time spent on Direct Communication with Patients --- p.101 / Chapter 3.10.3 --- Cost of Clinical Pharmacy Service at the Lipid Clinic --- p.102 / Chapter 3.10.3.1 --- Cost of Pharmacist Involvement --- p.102 / Chapter 3.10.3.2 --- Potential Healthcare Cost Saving --- p.103 / Chapter 3.11 --- Clinical Pharmacy Service Satisfaction Survey --- p.105 / Chapter 3.11.1 --- Validation of Survey --- p.105 / Chapter 3.11.2 --- Questionnaire Survey for Intervention and Control Groups --- p.107 / Chapter 3.11.3 --- Physician Questionnaire Survey on Clinical Pharmacy Service --- p.110 / Chapter Chapter 4 --- Discussion --- p.111 / Chapter 4.1 --- Clinical Outcomes of Study --- p.111 / Chapter 4.1.1 --- Changes in Lipid Parameters --- p.111 / Chapter 4.1.2 --- Reduction in CHD risk --- p.113 / Chapter 4.1.3 --- Attainment in NCEP ATP III LDL-C goals --- p.114 / Chapter 4.1.4 --- Predictors for LDL-C Goal Attainment --- p.117 / Chapter 4.2 --- Drug-related Problems --- p.119 / Chapter 4.2.1 --- Statin Dosing and LDL-C Lowering Potency --- p.119 / Chapter 4.2.2 --- Adherence to Drug Therapy --- p.121 / Chapter 4.2.3 --- Polypharmacy --- p.126 / Chapter 4.2.4 --- Adverse Drug Events and Drug Interactions --- p.129 / Chapter 4.2.5 --- Patient Busy Lifestyle --- p.131 / Chapter 4.3 --- Role of Clinical Pharmacist --- p.133 / Chapter 4.3.1 --- Role of Pharmacist --- p.133 / Chapter 4.3.2 --- Multidisciplinary Team --- p.135 / Chapter 4.3.3 --- Healthcare Cost Saving --- p.137 / Chapter 4.4 --- Limitations of Study --- p.139 / Chapter 4.5 --- Further Study --- p.142 / Chapter Chapter 5 --- Conclusion --- p.144 / Chapter 5.1 --- Conclusion of Study --- p.144 / Bibliography --- p.145 / Appendices --- p.158 / Appendix I Data collection form --- p.158 / Appendix II Information sheet on study protocol to patient --- p.160 / Appendix III Patient consent form for study --- p.164 / Appendix IV Framingham risk scoring system for male --- p.165 / Appendix V Framingham risk scoring system for female --- p.166 / Appendix VI Patient educational leaflet --- p.167 / Appendix VII Physician-pharmacist communication sheet --- p.169 / Appendix VIII Telephone checklist --- p.170 / Appendix IX Questionnaire survey provided to Intervention Group --- p.172 / Appendix X Questionnaire survey provided to Control Group --- p.174 / Appendix XI Questionnaire survey provided to Physicians --- p.176

Objetivos: Conhecer a satisfação e a percepção da equipe de enfermagem usuária dos dispensários eletrônicos com relação a estes equipamentos e adaptar transculturalmente o instrumento ISMP Medication Safety Self Assessment® for Automated Dispensing Cabinets para a realidade brasileira. Métodos: O estudo foi realizado em duas etapas. A primeira etapa consistiu de um estudo qualitativo, do tipo exploratório, através da realização de grupos focais com os técnicos de enfermagem e enfermeiros das unidades que possuem dispensários eletrônicos. Na segunda etapa foi realizado um estudo metodológico para tradução e validação do instrumento ISMP Medication Safety Self Assessment® for Automated Dispensing Cabinets através da realização das etapas de tradução por dois tradutores independentes, síntese das traduções, retrotradução, síntese da retrotradução, avaliação por especialistas e pré-teste. Resultados: Durante a realização dos grupos focais a equipe de enfermagem demonstrou estar satisfeita com o uso dos dispensários eletrônicos, necessitando de algumas adequações e melhorias no processo. As etapas de adaptação transcultural do instrumento foram realizadas obtendo-se um instrumento adaptado para a realidade brasileira que pode auxiliar no planejamento da implantação de dispensários eletrônicos. Faz-se necessária a realização de validação externa deste instrumento para utilização na realidade nacional. Conclusões: Neste estudo ficou evidente a satisfação dos usuários dos dispensários eletrônicos com o uso destes equipamentos e a importância de um planejamento adequado para a implantação de novas tecnologias. Demonstra-se a importância de um trabalho conjunto entre as equipes de farmácia e enfermagem na implantação e utilização de dispensários eletrônicos com foco na segurança do paciente. / Objectives: To know the satisfaction and perception of the user nursing staff of automated dispensing cabinets about this equipment and cross-culturally adapt the instrument ISMP Medication Safety Self Assessment® for Automated Dispensing Cabinets for the Brazilian reality. Methods: The study was conducted in two stages. The first stage consisted of a qualitative study, exploratory, by conducting focus groups with nursing technicians and nurses of the units that use automated dispensing cabinets. In the second stage it was carried out a methodological study for the translation and validation of the instrument ISMP Medication Safety Self Assessment® for Automated Dispensing Cabinets by performing the translation stages by two independent translators, synthesis of translations, back translation, synthesis of back translation, evaluation by experts and pretest. Results: During the course of the focus groups the nursing staff proved to be satisfied with the use of automated dispensing cabinets, requiring some adjustments and improvements in the process. The steps of cross-cultural adaptation of the instrument were carried out obtaining a tool that can assist in planning the implementation of automated dispensing cabinets adapted to the Brazilian reality. Conducting external validation of this instrument for use at the national reality is necessary. Conclusions: In this study it was evident the satisfaction of users of automated dispensing cabinets with the use of this equipment and the importance of proper planning for the deployment of new technologies. It demonstrates the importance of joint work between the pharmacy and nursing staff in the implementation and use of automated dispensing cabinets with a focus on patient safety.

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.H.A.)--University of Michigan, 1967.