Class of 2012 Abstract / Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e-prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology, in the Department of Chiropractic at the Durban University of Technology, 2009. / Introduction: National Olympic Committees (NOCs) select medical personnel to support their athletes at the Olympic Games. To best support athletes the knowledge, perception and utilisation of all medical professions is assumed to be high, however literature seems to indicate that this is not so. Objective: To determine the knowledge, perception and utilisation of Chiropractic by NOCs in order to develop a better relationship so that more athletes can benefit from Chiropractic care. Methods: A questionnaire was emailed to the 205 NOCs worldwide. Respective executive committee and medical commission members were asked to complete the questionnaires. Results: 76 NOCs responded (37%), returning 27 questionnaires. 30% of the respondents were high ranking members. 93% were highly educated with a bachelor’s degree or higher and 33% had represented their country as an athlete. Both committees agreed on the importance of a post-graduate sports qualification and perceived the profession to be one of spinal care specialists. Overall knowledge of Chiropractic was poor. A trend was observed among the medical commissions in their choice of Medical Doctors or Physiotherapists over Chiropractors and other professionals. The executive committees in contrast seemed more open-minded in their choice of professionals. No association was found between the knowledge and perception of Chiropractic and use of Chiropractic Conclusion: There is confusion regarding the role and scope of practice of Chiropractic by NOCs. In order to achieve a greater level of acceptance and utilisation of Chiropractic in international sports medical teams the profession needs to clarify their role, better educate NOC members on the benefits of Chiropractic, and obtain sports specific post-graduate programmes that are recognised internationally.

Malaria is more prevalent today and the death toll is on the increase annually. It is one of the leading causes of morbidity and mortality worldwide and most of these deaths are in the poorest regions of the world. About 500 million cases are reported annually with more than 2 million deaths, and most are children. It is the major killer in the tropics and a major public health problem in developing countries and Papua New Guinea (PNG) is no exception. Resistant strains have been reported. This may be enhanced by inappropriate human behaviour in the use of anti-malarial drugs. Human factors include inappropriate prescribing and patient behaviour in using anti-malarial drugs. Despite the establishment of the standard treatment guidelines for malaria in PNG, three out of every four patients have chloroquine-resistant falciparum malaria and malaria remains a major health problem. The aim of this study was to evaluate the influence of an education program on patients carers' understanding and effective use of anti-malarial drugs for the treatment of uncomplicated malaria in children in general health clinics in PNG. The trial design involved a pre-post intervention study with a control group. The study was undertaken in the National Capital District. Papua New Guinea using one Clinic as the intervention site and another as the control site. The two clinics were similar in characteristics as confirmed in the study by demographic data where there were no significant differences observed. The data collection took placed over the period February to April 2002. It included observation of drug provision at study sites and interviews of patient carers on the first day at the clinic and a follow up seven days later. Three questionnaires were developed to evaluate the process and outcomes of malaria drug treatment in the above health facilities. / Prescribing data were collected from prescriptions and patient carers' interviewed prior to the intervention program. Following the provision of drug information to patient carers. similar drug information and compliance questioning was undertaken. Differences in the pre-post elements of the study and in the control group over the study period were evaluated using Chi-Squared, Kruskal-Wallis, Fisher's Exact or Student's t-tests as appropriate. In excess of 100 patients in the pre- and in the post intervention phases were evaluated for their understanding and effective use of the anti-malarial drugs. In addition, 100 clients were in the control group at another clinic. Patients had attended the clinic up to 8 times in the previous year with a median of 2 visits. Amodiaquine, Fansidar, albendazole and paracetamol made up a total of 60% of the drugs prescribed. The use of medicines was strongly supported with 94.4% indicating no problems with the medication. Only 3% of patients received herbal or local remedies for malaria treatment. 1n patients 10 years or less or their carers, it was found, there was a significant improvement in the carers understanding of the medications. There was a statistically significant improvement in patient outcomes from 57.9% to 92.3% reported as cured following the intervention program. The study has also identified low levels of appropriate administration of antibiotic suspensions in children by patient carers. / For example, incorrect responses recorded for amoxycillin suspension were 80.8% (143). Septrim tablets 92% (23), Septrim suspension 86% (123), erythromycin suspension 100% (26), and chloramphenicol suspension 84.4% (38). In this study the face to face (one-to-one) education program was used to influence patient carers understanding and effective use of drugs. The intervention program involved advising, informing, encouraging, and counselling the patient carers verbally on the appropriate and effective use of medicines. The verbal message was reinforced by a suitable label typed in English and Pidgin-English where instructions were clear, simple and unambiguous. The label was then attached to the envelopes or containers containing the drugs. On feedback, the information on the understanding and effective use of drugs was re-emphasized to the carers to reinforce their understanding for future references. Results showed that the intervention program made an impact in improved patient carers understanding and effective use of drugs and children's health outcomes. In conclusion, it is evident that a patient intervention program designed to improve the dosages and frequency of administration of anti-malarial drugs in PNG had no statistically significant outcome. This may be because the current level of understanding was quite high (>70%) and the study experienced a ceiling effect. However, as shown in the results, the patient carers understanding on the appropriate and effective use of drugs was lower during the pre-intervention and control group. / When compared clinic-pre with clinic-post, there was a significant difference (P < 0.05) in the cured group and the improved cure rate increases from 57.9% to 92.3%. When compared control pre with control post groups, there was no significant difference (P > 0.05) in the cured group. Therefore, the study identified an improvement in patient outcomes with respect to malaria. Hence. the simple intervention program in influencing patient carers understanding of the appropriate and effective use of medications led to a marked improvement in patient outcomes.

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology, in the Department of Chiropractic at the Durban University of Technology, 2009. / Introduction: National Olympic Committees (NOCs) select medical personnel to support their athletes at the Olympic Games. To best support athletes the knowledge, perception and utilisation of all medical professions is assumed to be high, however literature seems to indicate that this is not so. Objective: To determine the knowledge, perception and utilisation of Chiropractic by NOCs in order to develop a better relationship so that more athletes can benefit from Chiropractic care. Methods: A questionnaire was emailed to the 205 NOCs worldwide. Respective executive committee and medical commission members were asked to complete the questionnaires. Results: 76 NOCs responded (37%), returning 27 questionnaires. 30% of the respondents were high ranking members. 93% were highly educated with a bachelor’s degree or higher and 33% had represented their country as an athlete. Both committees agreed on the importance of a post-graduate sports qualification and perceived the profession to be one of spinal care specialists. Overall knowledge of Chiropractic was poor. A trend was observed among the medical commissions in their choice of Medical Doctors or Physiotherapists over Chiropractors and other professionals. The executive committees in contrast seemed more open-minded in their choice of professionals. No association was found between the knowledge and perception of Chiropractic and use of Chiropractic Conclusion: There is confusion regarding the role and scope of practice of Chiropractic by NOCs. In order to achieve a greater level of acceptance and utilisation of Chiropractic in international sports medical teams the profession needs to clarify their role, better educate NOC members on the benefits of Chiropractic, and obtain sports specific post-graduate programmes that are recognised internationally.

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / Includes bibliographical references (p. 155-163). Also available on the Internet.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2005.

Thesis (M.P.H.M. ( Primary Health Care Management))--Mahidol University, 2006. / LICL has E-Thesis 0011 ; please contact computer services.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0039 ; please contact computer services.

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