<p> <b>BACKGROUND:</b> The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act created meaningful use (MU) incentive program to promote the nationwide adoption of certified electronic health record (EHR) systems. Computerized physician order entry (CPOE) system is a part of the EHR system and a cornerstone of the MU incentive program, which helps to reduce prescribing errors and enhance care coordination for treatment between providers. </p><p> <b>OBJECTIVES:</b> The main objective of this study was to investigate trends in the adoption of CPOE system for medication orders and determine factors associated with meeting the meaningful use criteria for health information technology. </p><p> <b>METHODS:</b> A cross-sectional analysis was conducted using 10 years of data from the 2006&ndash;2015 National Ambulatory Medical Care Survey (NAMCS), 10 years of 2006&ndash;2015 data from the National Hospital Ambulatory Medical Care Survey (NHAMCS)&mdash;emergency department (ED) component, the 2016 American Hospital Association (AHA) Annual Survey Database, and the 2016 AHA Annual Survey Information Technology (IT) Supplement. The outcomes of the study included the adoption of CPOE for medication orders, drug-drug interaction alerts (DDI), guideline reminders, electronic prescribing (eRx), health information exchange (HIE), and compliance with the MU criteria. Descriptive statistics were calculated for all study variables. Bivariate analysis using the chi-square test was used to determine if there is a significant relationship between the adoption of CPOE for medication orders and timing (pre-post meaningful use). Chi-square test for trend was used to determine the significance of the change in the adoption of several EHR functionalities between 2006 and 2015. Logistic regression analyses were performed to identify factors that influence the adoption of several EHR functionalities. All analyses were performed using SAS 9.3 at an alpha of 0.05. </p><p> <b>RESULTS:</b> In NAMCS 2006&ndash;2015, the weighted surveyed physicians&rsquo; responses were weighted to represent 325,070 ambulatory based physicians throughout the U.S. The majority (66%) of respondents worked in group practices, and 34% worked as solo practitioners. The overall AHA annual survey sample had 6,239 hospitals. Of these, a total of 3,656 hospitals responded to the AHA IT supplement survey, representing a response rate of 59%. Primary care physicians&rsquo; adoption of CPOE systems for medication orders was significantly higher than specialists (p &lt; 0.0001). The adoption of CPOE for medication orders was higher in the Post-MU incentive payments period (2012&ndash;2015) compared to pre-MU incentive payments period (2006&ndash;2011) in both the ambulatory care and ED settings (p &lt; 0.0001). From 2006 through 2015 there was a statistically significant increase in the percent of ambulatory care practices adopting CPOE medication ordering system with clinical decision support (CDS) tools and eRx in the ambulatory care setting (p-trend &lt; 0.001). In the same period, group practices compared to solo practices were significantly more likely to adopt these EHR functionalities (p &lt; 0.0001). From 2013 to 2015, physician offices that generated > 50% of their revenue from Medicaid in the ambulatory care setting were less likely to adopt EHR systems that meet the MU criteria compared those generate &le; 50% (p &lt; 0.01). </p><p> <b>CONCLUSION:</b> Findings indicate that physician specialty, practice size, and percentage of revenue from Medicaid are significantly associated with the adoption of selected EHR functionalities. The CPOE for medication orders adoption rates significantly increased post-MU incentive payments. No significant association was found between for-profit hospitals and sending electronic notification to the patient&rsquo;s primary care physician upon ED visit. These results may be important to design interventions to improve EHR adoption.</p><p>

Thesis (M.S.)--University of Wisconsin. / A bibliography on tablets: p. 67-144. "December 1928"--Cover.

Diss. Nr. 7990 Naturwiss. ETH Zürich.

Thesis (M.S.)--University of Wisconsin. / A bibliography on tablets: p. 67-144. "December 1928"--P. [1] of cover.

Liu Hua. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 139-143). / Abstracts in English and Chinese. / Table of Contents --- p.I / Acknowledgement --- p.VII / Abstract --- p.VIII / Abstract (Chinese) --- p.X / List of Tables --- p.XV / List of Figures --- p.XXIV / List Symbols and Abbreviations / Chapter Chapter One --- Introduction / Chapter 1.1. --- Rationale of study --- p.2 / Chapter 1.2. --- Drug Delivery to the lungs --- p.5 / Chapter 1.3. --- Particle transport and deposition mechanisms --- p.8 / Chapter 1.4. --- Factors affecting particulate interactions --- p.9 / Chapter 1.4.1. --- Particle size --- p.9 / Chapter 1.4.2. --- Particle shape --- p.10 / Chapter 1.4.3. --- Surface texture --- p.10 / Chapter 1.4.4. --- Surface energy --- p.11 / Chapter 1.4.5. --- Contact area --- p.12 / Chapter 1.4.6. --- Relative humidity --- p.12 / Chapter 1.4.7. --- Electrical properties --- p.13 / Chapter 1.5. --- Fine powder production technologies applicable to dry powder inhalation formulations --- p.13 / Chapter 1.5.1. --- Batch crystallization and micronization --- p.14 / Chapter 1.5.2. --- Spray drying --- p.15 / Chapter 1.5.3. --- Supercritical fluid crystallization --- p.17 / Chapter 1.6. --- Physical characterization of aerosol powders --- p.18 / Chapter 1.6.1. --- Microscopy and particle size analysis --- p.19 / Chapter 1.6.2. --- Powder X-ray diffractometry --- p.19 / Chapter 1.6.3. --- Thermal analysis --- p.20 / Chapter 1.6.4. --- In-vitro deposition assessment --- p.20 / Chapter 1.6.5. --- Surface energy measurement by inverse gas chromatography (IGC) --- p.21 / Chapter 1.7. --- Scope of study --- p.22 / Chapter Chapter Two --- Materials and Methods / Chapter 2.1. --- Materials --- p.25 / Chapter 2.2. --- Equipment --- p.25 / Chapter 2.3. --- Methods --- p.27 / Chapter 2.3.1. --- Determination of aqueous solubility of salbutamol sulphate in water --- p.27 / Chapter 2.3.2. --- Preparation of spray-dried salbutamol sulphate powders under different operating conditions --- p.27 / Chapter 2.3.3. --- Preparation of spray-dried salbutamol sulphate powders at various lecithin concentrations --- p.30 / Chapter 2.3.4. --- Preparation of spray-dried salbutamol sulphate powders at various oleic acid concentrations --- p.32 / Chapter 2.3.5. --- Physical characterization of spray-dried salbutamol sulphate powders --- p.34 / Chapter 2.3.5.1. --- Scanning electron microscopy --- p.34 / Chapter 2.3.5.2. --- Specific surface area determination --- p.34 / Chapter 2.3.5.3. --- Particle size distribution measurements --- p.35 / Chapter 2.3.5.4. --- Water content determination --- p.36 / Chapter 2.3.5.5. --- Isothermal water vapour sorption studies --- p.37 / Chapter 2.3.5.6. --- Powder X-ray diffraction --- p.37 / Chapter 2.3.5.7. --- Thermal analysis --- p.38 / Chapter 2.3.5.8. --- Surface energy measurement by inverse gas chromatography --- p.39 / Chapter 2.3.5.8.1. --- Calculation of surface thermodynamic parameters --- p.40 / Chapter 2.3.5.8.1.1. --- Standard Free Energy of Adsorption and Related Thermodynamic Parameters --- p.40 / Chapter 2.3.5.8.1.2. --- Dispersive Component of Surface Free Energy and Related Thermodynamic Parameters --- p.41 / Chapter 2.3.5.8.1.3. --- Specific Interactions and Associated Acid-Base Properties --- p.42 / Chapter 2.3.5.9. --- In-vitro deposition measurement by multi-stage liquid impinger --- p.43 / Chapter Chapter Three --- Results and discussion / Chapter 3.1. --- Influence of spray drying operating parameters --- p.46 / Chapter 3.1.1. --- Drying temperature --- p.46 / Chapter 3.1.1.1. --- "Particle size, particle morphology, and specific surface area" --- p.46 / Chapter 3.1.1.2. --- "Crystallinity, moisture sorption and thermal behaviour" --- p.53 / Chapter 3.1.1.3. --- Surface thermodynamic properties --- p.60 / Chapter 3.1.1.4. --- Aerodynamic properties and in-vitro deposition --- p.64 / Chapter 3.1.2. --- Feed solution concentration --- p.67 / Chapter 3.1.2.1. --- "Particle size, particle morphology and specific surface area" --- p.69 / Chapter 3.1.2.2. --- "Crystallinity, moisture sorption and thermal behaviour" --- p.69 / Chapter 3.1.2.3. --- Surfacethermodynamicproperties --- p.70 / Chapter 3.1.2.4. --- Aerodynamic properties and in-vitro deposition --- p.70 / Chapter 3.1.3. --- Feed speed --- p.72 / Chapter 3.1.3.1. --- "Particle size, particle morphology, and specific surface area" --- p.72 / Chapter 3.1.3.2. --- "Crystallinity, moisture sorption and thermal behaviour" --- p.73 / Chapter 3.1.3.3. --- Surfacethermodynamicproperties --- p.73 / Chapter 3.1.3.4. --- Aerodynamic properties and in-vitro deposition --- p.73 / Chapter 3.2. --- Influence of formulation additives --- p.78 / Chapter 3.2.1. --- Influence of lecithin as additive --- p.78 / Chapter 3.2.1.1. --- "Particle morphology, particle size and specific surface area" --- p.79 / Chapter 3.2.1.2. --- "Crystallinity, moisture sorption and thermal behaviour" --- p.84 / Chapter 3.2.1.3. --- Surfacethermodynamicproperties --- p.90 / Chapter 3.2.1.4. --- Aerodynamic properties and in-vitro deposition --- p.94 / Chapter 3.2.2. --- Influence of oleic acid as additive --- p.101 / Chapter 3.2.2.1. --- "Particle morphology, particle size and specific surface area" --- p.101 / Chapter 3.2.2.2. --- "Crystallinity, moisture sorption and thermal behaviour" --- p.106 / Chapter 3.2.2.3. --- Surfacethermodynamicproperties --- p.123 / Chapter 3.2.2.4. --- Aerodynamic properties and in-vitro deposition --- p.127 / Chapter Chapter Four --- Conclusion and Future Work / Chapter 4.1. --- Conclusion --- p.134 / Chapter 4.1.1. --- Influence of spray drying operating parameters --- p.134 / Chapter 4.1.2. --- Influence of formulation additives --- p.135 / Chapter 4.2. --- Future Work --- p.137 / References --- p.139

引子: 共晶技術和納米沉澱技術於近年被廣泛討論能改進藥物性質和提高體內性能。本論文研究旨在將該兩種技術嘗試應用於五種模型藥物中，分別是薑黃素(CUR)，氟比洛芬(FLU)，布洛芬(IBU)，酮洛芬(KET) 和環氧洛芬(LOX)。這些藥物均難溶於水，擁有較差機械性質，相對高的親油性和潛在治療腦退化症的功用。在共晶技術中，藥物將會與煙酰胺(NCT)先溶於在溶劑中，透過蒸發以誘發共晶產生。另一方面，瞬時納米沉澱(FNP)技術會將藥物溶液(包含穩定劑)與反溶劑在封閉衝擊射流混合器(CIJM)或多入口渦旋混合器(MIVM)快速混合，生成納米藥物。 / 方法: 將藥物和NCT溶於乙醇中，應用旋轉蒸發或簡單蒸發生成共晶。透過不同的檢測方法，包括X射線衍射，差示掃描量熱法，熱重分析，吸濕分析，傅立葉變化紅外線光譜，特性溶出速率量度法和壓實分析將共晶檢定。另一方面，利用CIJM或MIVM，藥物在不同的混合速率，溶劑性質，聚乙二醇-聚乳酸(穩定劑)分子重量或藥物對聚合物比的工藝環境下載入於納米粒子中。生產出來的納米藥物會利用動態光散射測定粒徑; 電泳光散射法測定zeta電位; 掃描電子顯微鏡和原子力顯微鏡測定粒子形貌和其表面性質; X-射線光電子能譜測定表面成分; 高效液相色層分析測定載藥量和包封率。 / 結果: 利用旋轉蒸發，高純度的1:1 IBU-NCT 和FLU-NCT 的共晶能成功生成，但KET-NCT和LOX-NCT 共晶則不能獲得。低純度的CUR-NCT 共晶可根據相同技術取得。相比原來藥物而言，IBU-NCT 和FLU-NCT 共晶均有較好的機械性質，抗吸水性和溶解速度。而在FNP研究中，証實了混合速率，溶劑性質，聚乙二醇-聚乳酸(穩定劑)分子重量或藥物對聚合物比均對生產出來的納米粒子的粒徑有重要影響。另外，納米粒子的穩定性可籍添加輔助穩定劑(如PVA)大幅提高。XPS分析証實輔助穩定劑能與在粒子表面的聚乙二醇起相互作用，更佳地保護粒子。而在一系列對四種不同的洛芬藥物的實驗中，多次線性回歸分析指出三種有關藥物的溶液性質(即溶解度，分配係數和酸度系數)會對生成的納米粒子的粒徑和包封率有顯著影響。 / 結論: 將IBU和FLU與NCT結成共晶能同時提高其機械性質，抗吸水性和溶解速度。而在FNP中，優化不同工藝參數能有效控制納米藥物的粒徑，形態，表面性質和穩定性。 / Introduction: In recent years, cocrystallization and nanoprecipitation have gained increasing popularity as viable strategies for improving the pharmaceutical properties and in vivo performance of drugs. The present thesis was aimed at assessing these two approaches for potential applications in pharmaceutical formulation and manufacture with five model drugs, viz. curcumin (CUR), flurbiprofen (FLU), ibuprofen (IBU), ketoprofen (KET) and loxoprofen (LOX). Selection of these drugs for the study was guided mainly by their poor water solubility, poor compactibility, typical drug‘s lipophilicity (log P =3-5), and potential for treatment of Alzheimer‘s disease. Cocrystallization was induced by the attainment of a sufficient supersaturation level through rapid solvent removal from a solution containing the drug and the coformer, nicotinamide (NCT), while flash nanoprecipitation (FNP) was achieved by rapid and homogenous mixing of drug solution (with stabilizer and co-stabilizer if required) with antisolvent in the mixing chamber of a specially designed confined impinging jet mixer (CIJM) or multi-inlet vortex mixer (MIVM). / Methods: Cocrystals were prepared by rotary solvent evaporation or slow evaporation of a solution of drug and NCT in ethanol, and characterized by powder X-ray diffraction, differential scanning calorimetry, thermogravimetry, moisture sorption analysis, Fourier transform infrared spectroscopy, intrinsic dissolution rate (IDR) measurement and compaction analysis. Polymer-stabilized drug nanoparticles were prepared by FNP using a two-stream CIJM or four-stream MIVM under defined conditions of varying flowrate, solvent type, molecular weight of amphiphilic diblock (PEG-PLA) copolymer (stabilizer), or drug-to-copolymer ratio. The resulting nanoparticles were characterized for particle size by dynamic light scattering; zeta potential by electrophoretic light scattering; particle morphology and surface properties by scanning electron microscopy and atomic force microscopy; surface composition by X-ray photoelectron spectroscopy (XPS); and drug loading and encapsulation efficiency (EE) by high performance liquid chromatography. / Results: Phase-pure 1:1 cocrystals of IBU and FLU with NCT were obtainable by rotary solvent evaporation, but not slow evaporation. Similar solvent removal failed to cause any cocrystal formation for KET and LOX while inducing partial cocrystal conversion for CUR. Both IBU-NCT and FLU-NCT cocrystals displayed enhanced IDR, reduced moisture sorption and improved tabletability compared with the individual profen crystals. FNP studies using the MIVM confirmed the flowrate, solvent type, molecular weight of PEG-PLA copolymer, and drug-to-copolymer mass ratio being important process variables for controlling particle size and particle stability. Particle stability could be enhanced with a hydrophilic co-stabilizer (e.g., PVA). Such co-stabilizers possibly act by binding to the PEG corona at the particle surface to reinforce the protective steric barrier, as substantiated by XPS data. Comparative studies on nanoparticle production by FNP for the four profens indicated that three structure-related intrinsic solution properties of the profens, namely, water solubility, log P and pKa, were important determinants of the particle size and EE of nanoparticles, as determined by multiple linear regression analysis. / Conclusion: Cocrystallization with NCT can simultaneously improve the tableting behavior, hygroscopicity, and dissolution performance of IBU and FLU. Proper optimization of the process variables in FNP is critical to the controlled production of polymer-stabilized drug nanoparticles with consistent properties and storage stability. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chow, Shing Fung. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 224-247). / Abstracts also in Chinese.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

As terapias integrativas e complementares têm sido utilizadas há tempos para o tratamento e prevenção de diversos males. A fitoterapia utiliza plantas para estes tratamentos e, dentre estas, destacamos a Chamomilla recutita (L.) rauschert, conhecida popularmente como camomila. Trata-se de uma planta muito utilizada popularmente com finalidades terapêuticas, que possui propriedades anti-inflamatórias, digestivas, calmantes e cicatrizantes. Frente a estas propriedades e em conjunto com a tecnologia farmacêutica para elaboração de micropartículas com liberação controlada, este estudo teve como objetivo desenvolver uma formulação tópica de micropartículas de quitosana com camomila e realizar estudos preliminares de seu uso considerando aplicações futuras para prevenção de lesões de pele. Para alcançar o objetivo proposto, este trabalho foi realizado em três partes. A primeira parte consistiu no desenvolvimento da formulação tópica a ser testada. Para isso, foi realizada a caracterização farmacognóstica do material vegetal adquirido, a extração da planta, a microencapsulação deste extrato e o teste com incorporação destas em diversas formulações. Nesta etapa, o material vegetal apresentou características recomendadas pela Farmacopeia Brasileira, o extrato e a microencapsulação apresentaram resultados positivos e ao final foram selecionadas três formulações para testes preliminares. Estes testes consistiram em um ensaio de permeação em célula de Franz e estudos de estabilidade preliminar, acelerada e de longa duração. Nestes testes das três formulações previamente escolhidas, apenas uma foi eleita para as demais etapas. Na segunda parte do estudo as micropartículas desenvolvidas foram testadas quanto à sua citotoxicidade em fibroblastos e queratinócitos de pele humana e também quanto ao seu efeito frente à exposição à radiação ionizante. Nestes ensaios as micropartículas demonstraram citotoxicidade apenas nas maiores concentrações. Observa-se que a toxicidade celular do extrato é maior quando comparado as microcápsulas. Ainda neste estudo, o maior efeito protetor para a radiação nas três soluções em teste foi observado na faixa de dose entre 1:1000000 e 1:10000 nos queratinócitos e entre as concentrações 1:1000000 e 1:10000 nos fibroblastos. Na última parte deste estudo foi desenvolvido um ensaio clínico fase I para verificar a segurança e eficácia preliminar da formulação em voluntários saudáveis. Participaram deste ensaio 35 voluntários que utilizaram a formulação teste em um antebraço e uma formulação sem as micropartículas para controle no outro antebraço durante 28 dias. De acordo com os resultados a formulação não causou eritema, descamação, ardor, prurido ou dor dentro de um período de quatro semanas de uso. Houve um aumento do conteúdo aquoso no local de aplicação da formulação com as micropartículas e no controle do mesmo braço. Na avaliação da função barreira houve um aumento da perda transepidérmica de água após o uso do produto, mas este aumento também foi encontrado nos controles. Conclui-se que a formulação é estável e segura para o uso na pele íntegra e seus efeitos na hidratação da pele e na função barreira devem ser melhor estudados / Integrative and complementary therapies have long been used in treatment and prevention of diverse problems. Phytotherapy uses plants for these treatments and, among these, we highlight the Chamomilla recutita (L.) Rauschert, popularly known as chamomile. This is a very commonly plant, which is used for therapeutic purposes and has anti-inflammatory, digestive, soothing and healing properties. Considering these properties and the pharmaceutical technology for preparation of microparticles, this study aimed to develop a topical formulation with chitosan-chamomile microparticles and conduct preliminary studies of their use, taking into account future applications for the prevention of skin lesions. To achieve the proposed objective, this study was performed in three parts. The first part was the development of topical formulation to be tested. To do so, a number of actions were carried out, namely pharmacognostic characterization of plant material, the extraction of the plant, the microencapsulation of the test extract and its incorporation in various formulations. In this step, the plant material showed characteristics recommended by the Brazilian Pharmacopeia: the extract microencapsulation showed positive results and three final formulations were selected for preliminary testing. These tests consisted of a permeation test using Franz cell; and preliminary, short-time and long-time stability studies. In these tests, only one of these three formulations was selected for the remaining steps. In the second part of the study, the microparticles were tested for both their cytotoxicity in fibroblasts and keratinocytes from human skin, and for the effect of being exposed to ionizing radiation. These tests revealed cytotoxicity only at higher concentrations. The cellular toxicity of the extract is higher when compared to the microcapsules. The best protective effect of tested formulations varies between 1:1000000 and 1:10000 in keratinocytes and between 1:1000000 and 1:10000 in fibroblasts. In the last part of this study, a clinical trial phase I was conducted to check the safety and preliminary efficacy of the formulation in healthy volunteers. Thirty-five volunteers participated by using the formulation in test on a forearm, and a formulation without the microparticles to control on the the other forearm for 28 days. According to results, the formulation did not cause erythema, peeling, burning, itching or pain within the aforementioned period. There was an improvement in aqueous content of stratum corneum in the application site with the microparticles and in the control of the same arm. When assessing the barrier function, there was an increase in transepidermal water loss after using the product, but this increase was also found in the controls. We concluded that the formulation is stable and safe for use in healthy skin, and its effects on skin hydration and barrier function should be better studied

Thesis (Ph.D.)--Pardee Rand Graduate School, 2009. / Title from PDF t.p. Includes bibliographical references.

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 173 pages. Includes Vita. Includes bibliographical references.