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Självständig och effektiv vård - distriktssköterskans erfarenhet av läkemedelsförskrivning : En systematisk litteraturstudie / Independent and effective care - The district nurse experience of prescribing medicines : A systematic literature reviewArslan, Aysel, Hammarberg, Christina January 2021 (has links)
Bakgrund: Distriktssköterskan har med sin breda kompetens en viktig roll inom primärvården. Distriktssköterskan besitter goda ämneskunskaper i omvårdnad, vårdpedagogik, medicin, och folkhälsovetenskap. Många länder i världen har valt att tillåta läkemedelsförskrivning till distriktssköterskor, vilket leder till en effektivare vård. Syfte: Litteraturstudiens syfte var att belysa distriktssköterskans erfarenhet av läkemedelsförskrivning inom primärvården. Metod: En systematisk litteraturstudie med kvalitativ induktiv design har genomförts. Till datainsamlingen gjordes systematisk litteratursökning i databaserna CINAHL och Pubmed. Totalt användes 11 artiklar som svarade på studiens syfte. Kvalitativ innehållsanalys enligt Graneheim och Lundman (2004) med manifest analys användes. Resultat: Dataanalysen mynnade ut i tre huvudkategorier. 1. Ökad självständighet och ansvar, 2. Förbättrad omvårdnad genom förskrivningsrätten med följande underkategorier: effektivare vård med kostnadseffektivitet och personcentrerad och holistisk vård. 3. Orsaker som påverkar hur förskrivningsrätten används i praxis med tre underkategorier: Viljan att hålla sig uppdaterad, behov av tillgång till stöd och begränsad förskrivning. Konklusion: Även om vården har förändrats har distriktssköterskans förskrivningsrätt inte utvecklats i samma utsträckning i Sverige som i andra länder. Litteraturstudiens resultat bekräftas av tidigare forskning att distriktssköterskornas läkemedelsförskrivning gav ökad självständighet, ökad status och ökad respekt bland kollegor och patienter. Resultatet visar att distriktssköterskorna önskar mer utbildning, fortbildning och träning för att öka kompetensen inom läkemedelsförskrivning.
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Drug prescribing and administration changes in hospitalized geriatric patients : analysis of three drug utilization review programsElzarian, Edward James 01 January 1978 (has links)
Elderly people, or those over 65 years of age, are known to comprise 10% of the United States population today and are projected to reach nearly 12% by the year 2000. Further, 5% of this population is reported to be institutionalized resulting in approximately 1.1 million chronic care patients or 0.5% of the population. The use of drugs in this population comprises approximately 25% of the prescription drug market in the United States which is directly related to the greater occurrence of pathological problems associated with the aging process. While it is evident that the beneficial outcome of drug therapies is partially related to the increased longevity observed in these elderly people, this population is also well-known to be the most prone to adverse drug reactions. Factors complicating drug use in the elderly include high usage, chronic therapy, long-term hospitalization, inappropriate and multiple prescribing of drugs, inadequate monitoring of adverse drug effects, susceptibility to physical deterioration and senility.
Therefore, the objective of this project is to test the hypothesis that the quality and cost of drug therapy in SNF patients can be significantly improved by implementing measures to improve the utilization of drugs.
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Providing behavioral data to physicians for enhancing medication treatment for chronically mentally disabled individualsPatterson, Nona L. 01 January 1987 (has links)
Physicians are often unaware of mentally disabled outpatients' symptomatic behaviors that are relevant to their medication prescriptions. Such information is available to the clients' residential care providers . The present study trained clients' residential care providers in data collection and provided these data to physicians. It was predicted that these data would improve medication treatment for these clients and consequently lead to a decrease in client's symptomatic behaviors . The results did not confirm the predictions; the data provided to physicians on clients' between- visit behaviors had no measured effect on the physicians' treatment of these clients, although the physicians reported positive attitudes about the helpfulness and utility of ·the system .
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Stárnutí populace a specifické aspekty lékové preskripce hypnotik ve stáří (II.) / Ageing of the population and specific aspects of prescribing of hypnotics in older adults (II.)Puldová, Karolína January 2020 (has links)
Title: Ageing of the population and specific aspects of prescribing of hypnotics in older adults (II.) Student: Karolína Puldová, Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Czech Republic Supervisor: Assoc. Prof. Daniela Fialová, PharmD, Ph.D., Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové and Department of Geriatrics and Gerontology, 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic Introduction: World population is ageing and rational geriatric pharmacotherapy receives increasing attention. In seniors, rational pharmacotherapy is complicated by many risk factors, especially by physiological and pathological changes accompanying ageing, polymorbidity, polypharmacy, higher risk of adverse drug events, drug interactions and other risk factors. Particularly psychotropics belong to drug classes where rational prescribing in seniors often requires respecting of different rules. This diploma thesis focuses on specific aspects of irrational prescribing of hypnosedatives in ambulatory geriatric patients, particularly in the area of use of nongeriatric doses and nongeriatric lenght of therapy. Methodology: Data collection for this diploma thesis has been conducted between 2019-2020 years in the...
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Kardiovaskulární rizikové faktory a komplikace související s aterosklerózou - jejich výskyt a kontrola u seniorů v projektu EUROAGEISM H2020 / Cardiovascular risc factors and complications associated with atherosclerosis - their prevalence and control in seniors in the EUROAGEISM H2020 projectKubíková, Veronika January 2019 (has links)
INTRODUCTION Cardiovascular diseases (CVD) are currently on the first place among the causes of death worldwide and also in the Czech Republic (CR). The most common causes of death among CVDs are disorders associated with atherosclerosis (ATS) and the prevalence of atherosclerosis and their complications increases with increasing age. The aim of this diploma thesis was to document CVS morbidity in geriatric patients in the sample of FIP7 program of the EUROAGEISM H2020 project, mainly the prevalence of CVS disorders associated with ATS, and to evaluate the controll of risk factors associatedwith general risks of progression of ATS. METHODS The data collection for this theses was carried out in the CR from September 2018 to January 2019 in patients in acute care at the age of 65 and older at geriatric wards in Hradec Králové (HK) and Brno. Patients involved in the study were those admitted to hospitalization at the time of data collection, were complying with inclusion criteria and undersigned the informed consent. The Ethics committee of the Faculy of Pharmacy, Charles University and ethics committee of participating healthcare facilities approved the project. Information have been obtained using the questionnaire for comprehensive geriatric assessment which is the secured instrument of the...
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Vybrané aspekty racionality užití diuretik u seniorů ambulantní péče v projektu EUROAGEISM H2020 / Selected aspects of the racionality of use of diuretics in ambulatory care seniors in the EUROAGEISM H2020 projectGruberová, Natálie January 2019 (has links)
INTRODUCTION: In the world population, the number of seniors with very heterogeneous health care is increasing. Because of the aging of the organism they are much more sensitive to adverse effects of drugs, therefore geriatric care is more visitors and safety pharmacotherapy. It thus seeks to prevent risky medicines available in geriatric patients. Many explicit targets have been disclosed that can be reserved for the potentially endangered by the elderly. Diuretics are among the classes of drugs that are often prescribed in the geriatric population but which pose significant risks to the geriatric patient. Problems with their unpleasant effects, but also poor indication or combination with minimal drugs. OBJECTIVE: The main aim of this thesis was to describe the frequency and rationality of prescribing diuretics in seniors treated in geriatric outpatient clinics. The use of diuretics in appropriate and potentially inappropriate indications, the occurrence of changes accompanying adverse reactions (including laboratory changes in electrolytes and metabolic parameters) and whether these problems are controlled were monitored. The risks of hyponatraemia associated with diuretic therapy and the use of SIADH-inducing drugs were also assessed in more detail. METHODICS: This thesis was based on the...
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Analýza užití potencionálně nevhodných kardiovaskulárních léčiv u seniorů v akutní péči v projektu EUROAGEISM H2020 / Analysis of the use of potentially inappropriate cardiovascular drugs in seniors in acute care in the project EUROAGEISM H2020Gajdošová, Petra January 2019 (has links)
Title: Analysis of the use of potentially inappropriate cardiovascular drugs in seniors in acute care in the project EUROAGEISM H2020 Author: Petra Gajdošová Department: Department of Social and Clinical Pharmacy Supervisor: Assoc. Prof. PharmDr. Daniela Fialová PhD. ABSTRACT INTRODUCTION: Population aging is a global problem for which all health and social systems of all countries needs be prepared, including the Czech Republic. It is assumed that in 2050 every third citizen of the Czech Republic will be 65 years and older. The group of seniors is characterized by high polymorbidity and polypharmacotherapy. Prescription of drugs is also very complicated in seniors due to changes accompanying aging (at the level of pharmacokinetics, pharmacodynamics and homeostasis). The aim of this diploma thesis was to determinate the prevalence of potentially inappropriate medications (PIMs) from the cardiovascular system (CVS) using the best-known explicit criteria of PIMs in the Czech sample of seniors in acute care assessed during the FIP7 program of the EUROAGEISM H2020 project. METHODOLOGY: Data collection was held during the FIP7 program of the EUROAGEISM H2020 project in acute care in seniors aged 65 years and over in two health facilities in Brno and Hradec Králové (HK) in the Czech Republic from August 2018 to...
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Analýzy racionality užívání hypnotik u seniorů v akutní péči v českém souboru projektu Euroageism H2020 / Analyses of the rationality of hypnotics use in acute care geriatrics in the czech set of the Euroageism H2020 projectZelinková, Andrea January 2019 (has links)
Introduction: As the population is aging and the number of the seniors is rising, the importance of knowledge and methods of geriatry and gerontology grows bigger. The seniors represent highly specified group of patients whose health care and treatment should be paid especial attention. Multimorbidity, polypharmacotherapy and an enlarged risk of adverse drug events often make such treatment more complicated. Complex geriatric assessment and acceptance of principals of geriatric prescription both represent key values of rational treatment. This thesis is dedicated to the issue of insomnia and rating of sedative/hypnotic treatment in the czech sample of seniors in acute care. Methodology: The data for this thesis were collected between the years 2018-2019 within EUROAGEISM H2020 project. They include information on 438 patients 65 years of age and older which was collected from three geriatric medical acute care centres in Czech republic (Prague, Brno, Hradec Králové) and gained from the medical documentation combined with the information from patient and medical staff themselves, which were interviewed with use of standardized questionnaire of the EUROAGEISM H2020 research project. The questionnaire was composed from sociodemographic characteristics, assesment of functional ability, nutrition state...
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Rizika gastrotoxicity a racionalita užití inhibitorů protonové pumpy u seniorů v akutní péči v projektu EUROAGEISM H2020 / Risks of gastrotoxicity and rationality of presribing of proton pump inhibitors in seniors in acute care in the EUROAGEISM H2020 projectMasaryková, Petra January 2019 (has links)
INTRODUCTION The deepening process of demographic aging has a significant impact on all areas of the society. With increasing age, the presence of illness, as well as the amount of used drugs increases. The most commonly prescribed drugs are often proton pump inhibitors, which play an irreplaceable role in the treatment of many gastrointestinal diseases. The trend of the overuse of proton pump inhibitors as the main antisecretory drugs is mainly related to their long-term administration in the prophylaxis of concurrent use of gastrotoxic drugs. The aim of this work was to evaluate the rationality of use of proton pump inhibitors including indications, administered dosages and duration of treatment. METHODS The data collected and used in this work are a part of the FIP7 project of the EUROAGEISM H2020 program. The study involved 438 geriatric patients in acute care institutions in Brno, Prague, and Hradec Králové, who were hospitalized between August 2018 and January 2019. The inclusion criteria were age over 65 years and adherence to inclusion criteria of the study. Seniors with severe cognitive impairment (MMSE < 10 points), memory impairment, speech or hearing impairment, patients hospitalized in the intensive care unit and in the terminal stage of the disease were excluded from the study. Data...
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Prescription patterns and drug duplication in specialist outpatient clinics at a tertiary hospital in the greater Tshwane metropolitan areaNcube, Musawenkosi Genius January 2020 (has links)
Background: Tertiary hospitals have multiple specialist outpatient clinics attended by
patients suffering from various comorbid diseases. This results in individuals attending
more than one clinic per month, since dedicated clinic days are seldom on the same day.
As patients attend discrete clinics, they have separate encounters with various
prescribers, increasing the potential for irrational drug use. In addition, multiple clinic visits
have a negative socio-economic impact on health care users from poorer communities
where financial resources are limited due to transport expenses and days of work missed.
The aim of this study was to determine the prescribing pattern of drugs to chronic disease
outpatients, and find possible solutions to provide a system that would reduce
overprescribing of chronic medication at Steve Biko Academic Hospital (SBAH) in one
measure namely drug duplication.
Methods: A retrospective descriptive cross-sectional study with the use of convenience
sampling was employed to determine the medication prescribing practises to comorbid
chronic disease patients attending multiple specialist clinics at SBAH from February 1,
2018-May 31, 2018. Participants were selected according to their appearance in the
hospital records, with sample saturation reached when each participant had visited all the
different clinics. Chronic disease outpatients attending the SBAH clinics had reviews
every three months. The reviews were controlled by issuing patients with medication for
a three-month period, where after a follow up visit was mandatory in order to ensure
prescription and medication renewal. Therefore, each patient visited all the clinics
rendering a service relating to a specific chronic condition within a four-month period that
determined the study period chosen. Hospital records of patients attending the most
frequently visited clinics as reported by the SBAH Pharmacy and Therapeutics committee
(PTC) were evaluated. These clinics included outpatient departments of diabetes,
haematology, internal medicine, neurology, oncology and psychiatry. Each drug
prescription observed was evaluated using guidelines of World Health Organization (WHO) titled, “How to investigate drug use in health facilities: selected drug use
indicators.” Prescribing indicators relevant to this study were used from the WHO
guidelines.
Results: One hundred and six patients were multiple clinic-attendees during the study
period. Of the 106 patients retained, 103 (97.17%) patients attended two clinics and three
(2.83%) patients attended three clinics. Regarding the WHO prescribing indicators, the
average number of visits to SBAH by the comorbid chronic disease outpatients observed
was 3.03 visits during the four-month study period. Prescription analysis included 80
(75.47%) patients out of 106 patients attending multiple clinics at the same time. The
average number of drugs prescribed per encounter was 4.97. The results also showed
that 45.45% of the 187 prescriptions observed contained five or more drugs. Most
frequently prescribed drugs were tramadol 51 (5.49%), followed by simvastatin 48
(5.17%) and enalapril 45 (4.84%). Drug duplication occurred in 68 individual cases in the
80 patients observed. In total, drug duplication affected 39 patients (48.75%) [95% CI =
37.80%: 59.70%]. The most duplicated drug classes were analgesics 18 (26.47%),
followed by anti-depressants 14 (20.59%) cases recorded.
Conclusion: The results from this study support findings from similar studies at different
institutions. The study confirmed multiple clinic visits are prevalent in the medical
disciplines, often prescribing drugs from the same class. Clinical implications from these
frequent and separate encounters may result in irrational prescribing, adverse drug
events, drug-drug interactions and polypharmacy. The establishment of polypharmacy to
comorbid chronic disease patients indicates the high risk of drug-drug interactions and
adverse drug events. A prospective study would have provided more data for analysis to
determine the level of polypharmacy and drug duplication. Thus, supplementation of this
study with further studies could provide conclusions on whether the patients suffered from
problematic or had appropriate polypharmacy. Physicians treating multiple clinicattendees should be equipped to monitor rationality of prescribing encounters. Installation
of an advanced electronic Hospital Information System (HIS) could aid in improving drug
prescribing in tertiary hospitals. Use of electronic prescribing tools as shown in previous studies is a requirement to improve tertiary hospitals in developing countries such as
SBAH. The incidence of drug duplication at SBAH builds on existing evidence of
unnecessary healthcare costs because of medication errors. / Dissertation (MSc)--University of Pretoria, 2020. / Pharmacology / MSc (Pharmacology) / Unrestricted
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