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

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1998. / Bibliography: leaves 99-107.

Thesis (D.P.H.)--University of Oklahoma. / Bibliography: leaves 52-53.

Thesis (Ph.D.)--University of Wisconsin--Madison, 2006. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 155-163).

Background Drug utilization review (DUR) is a central role of the pharmacist, especially within the community pharmacy setting. Previous literature has shown risk of “alert fatigue”, supporting the necessity of pharmacists to utilize a step-wise approach in evaluation of drug therapy during the verification process. Many students are intimidated by this process, and may lack verification practice or experience until their first day as a licensed pharmacist. Educational Activity and Setting An innovative skills-based laboratory exercise was developed for third-year pharmacy students to develop DUR skills. Through simulation of patient prescriptions, profiles, and drug information resources, students were tasked with completing a DUR for each patient case. Students were expected evaluate the clinical significance of various drug-related problems, determine if they would or would not dispense the prescription, and were required to provide rationale for their decision. Findings This learning activity was well-received by the student population; however, students struggled with the volume of cases along with identifying a solution to the clinical scenario. On average, students required nine minutes per case, which is likely longer than community pharmacists can devote to a single DUR in practice. Discussion In response, to student challenges with the activity, the number of cases was condensed to highlight key concepts and cases that facilitated strong discussion. To improve students’ approach to the DUR process, faculty developed a vodcast to watch prior to the activity explaining a systematic approach to the DUR process as well as considerations a pharmacist should have. Summary Development and integration of an active-learning, simulated dispensing activity allowed students to gain valuable experience completing the DUR process, a foundational community pharmacy practice skill; however, repeated experience should be provided to ensure competency.

If knowledge has been gathered by the practitioners’ community in the area of health data warehousing evaluation, it is mostly relying on anecdotal evidence instead of academic research. Isolated dimensions have received more attention and benefit from definitions and performance measures. However, very few cases can be found in the literature which describe how the assessment of the technology can be made, and these cases do not provide insight on how to systematize such assessment. The research in this dissertation is aimed at bridging this knowledge gap by developing an evaluation framework, and conducting an empirical study to further investigate the state of health data warehousing evaluation and the use of the technology to improve healthcare efficiency, as well as to compare these findings with the proposed framework. The empirical study involved an exploratory approach and used a qualitative method, i.e. audio-taped semi-structured interviews. The interviews were conducted in collaboration with the Healthcare Data Warehousing Association and involved 21 participants who were members of the Association working in a mid- to upper-level management capacity on the development and implementation of health data warehousing. All audio-taped interviews were transcribed and transcripts were coded using a qualitative analysis software package (NVivo, QSR International). Results were obtained in three areas. First, the study established that current health data warehousing systems are typically not formally evaluated. Systematic assessments relying on predetermined indicators and commonly accepted evaluation methods are very seldom performed and Critical Success Factors are not used as a reference to guide the system’s evaluation. This finding appears to explain why a literature review on the topic returns so few publications. Second, from patient throughput to productivity tracking and cost optimization, the study provided evidence of the contribution of data warehousing to the improvement of healthcare systems’ efficiency. Multiple examples were given by participants to illustrate the ways in which the technology contributed to streamlining the care process and increase healthcare efficiency in their respective organizations. Third, the study compared the proposed framework with current practices. Because formal evaluations were seldom performed, the empirical study offered limited feedback on the framework’s structure and rather informed its content and the assessment factors initially defined. / Graduate

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

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

The high use and often inappropriate antimicrobial is the main factor related to increased incidence of multiresistant microorganisms . This fact highlights the need to promote rational use through actions , such as monitoring the use of these drugs . The present study aimed to characterize the pattern and trends of antimicrobial use , comparing pediatric intensive care units ( ICU -PED ) and adult ( AD - ICU ) between July 2006 and June 2011 , in a public hospital high complexity of the state of Sergipe . This is a study of time series using data collected prospectively by the Office of Infection Control ( HICS ) hospital study on the use of antimicrobials . To measure the use of these drugs , we calculated the percentage and density and incidence rates per 1,000 patient-days , by means of measurement units : days of treatment ( DOT ) and treatment period (LOT ) . As a result it was observed that the percentage of use of these drugs was greater than 80 % in both units , with greater frequency among pediatric patients . During the study were recorded incidence density of 1,530.8 DOT/1.000 patient-days of all antimicrobials in the ICU and ICU -PED -AD DOT/1.000 1,344.4 patient-days . The most frequently used were cephalosporins , carbapenems and glycopeptides . By analyzing the temporal trend of the use of these drugs was observed that cefepime and ceftriaxone showed a downward trend , with increased use of carbapenems in the two ICUs . The drugs were more likely to increase over time were : polymyxin B ICU -AD and antifungal ICU -PED . The median antibiotic use differed between the two ICUs ( p < 0.005 ) , except for : ceftriaxone , carbapenems , ciprofloxacin , however the median LOT were equivalent . The use of antimicrobials by DOT and LOT demonstrated trend towards increasing in both units and different usage pattern , showing the relevance of this monitoring as part of the programs for the rational use of antimicrobials and control multiresistant microorganisms . / O uso elevado e muitas vezes inadequado de antimicrobianos é o principal fator relacionado ao aumento da incidência de microrganismos multiresistentes. Tal fato evidencia a necessidade de se promover uso racional por meio de ações, como o monitoramento da utilização destes fármacos. O presente estudo teve o objetivo de caracterizar o padrão e tendências do uso de antimicrobianos, comparando unidades de terapia intensiva pediátrica (UTI-PED) e adulta (UTI-AD), entre julho de 2006 e junho de 2011, em um hospital público de alta complexidade do Estado de Sergipe. Trata-se de um estudo de série temporal com utilização de dados coletados de forma prospectiva pelo Serviço de Controle de Infecção Hospitalar (SCIH) do hospital em estudo, acerca da utilização de antimicrobianos. Para mensurar o uso destes fármacos, foi calculado o percentual e taxas de densidade e incidência por 1.000 pacientes-dia, por meio das unidades de medida: dias de tratamento (DOT) e período de tratamento (LOT). Como resultado foi observado que o percentual de uso desses fármacos foi superior a 80% em ambas as unidades, com maior frequência entre os pacientes pediátricos . Durante o estudo foram registrados a densidade de incidência de 1.530,8 DOT/1.000 pacientes-dia de todos os antimicrobianos na UTI-PED e na UTI-AD 1.344,4 DOT/1.000 pacientes-dia. As classes mais utilizadas foram as cefalosporinas, os carbapenêmicos e os glicopeptídeos. Ao analisar a tendência temporal do uso destes fármacos observou-se que o cefepime e a ceftriaxone apresentaram tendência de queda, com aumento do uso dos carbapenêmicos nas duas UTI. Os fármacos que apresentaram maior tendência de aumento ao longo do tempo foram: a polimixina B na UTI-AD e os antifúngicos na UTI-PED. As medianas de uso de antimicrobianos diferiram entre as duas unidades intensivas (p< 0,005), exceto para: ceftriaxone, carbapenêmicos, ciprofloxacina, entretanto as medianas de LOT foram equivalentes. A utilização de antimicrobianos por DOT e LOT demostrou tendência de aumento crescente nas duas unidades e padrão de uso diferenciado, mostrando a relevância deste monitoramento como parte dos programas de uso racional de antimicrobianos e controle de microrganismos multirresistentes.

<p>Zbog visoke stope morbiditeta i mortaliteta od kardiovaskularnih bolesti, udeo lekova za terapiju kardiovaskularnih bolesti značajno učestvuje u ukupno utro&scaron;enoj količini lekova u svetu. Evidentan je porast potro&scaron;nje lekova za kardiovaskularne bolesti. Radi postizanja &scaron;to je moguće vi&scaron;eg stepena racionalizacije terapije u većini zemalja stručna tela donose farmakoterapijske smernice kako bi se mogućnost pogre&scaron;nog lečenja svela na najmanju moguću meru. Na ovaj način lekaru-praktičaru pružena je sigurnost pravilnog izbora i najadekvatnijeg postupka u datim okolnostima. Ciljevi ovog istraživanja bili su: 1) izračunavanje ukupne vanbolničke potro&scaron;nje lekova za lečenje kardiovaskularnih bolesti na teritoriji Novog Sada i njeno poređenje sa propisivanjem u Republici Srbiji i u zemljama sa razvijenom farmakoterapijskom praksom; 2) analiza strukture propisanih lekova za lečenje kardiovaskularnih bolesti (grupa C prema ATC klasifikaciji) po grupama i njeno poređenje sa propisivanjem u Republici Srbiji i u zemljama sa razvijenom farmakoterapijskom praksom; 3) analiza strukture propisanih lekova po dijagnozama i provera usklađenosti sa farmakoterapijskim smernicama; 4) komparacija propisanih lekova sa morbiditetnom statistikom kardiovaskularnih bolesti; 5) analiza farmakoekonomskih aspekata propisivanja lekova za kardiovaskularne bolesti. Sprovedeno istraživanje spada u IV fazu kliničkih ispitivanja-farmakoepidemiolo&scaron;ko, retrospektivno, opservaciono. Podaci su prikupljeni na osnovu izve&scaron;taja iz elektronske baze podataka za period od 6 meseci (01. 01. 2012 &minus; 01. 07. 2012), na teritoriji grada Novog Sada. Na osnovu ovih podataka na teritoriji grada Novog Sada analizirana je upotreba lekova za kardiovaskularne bolesti na 100% uzorku stanovnika. Ispitivanje se sastojalo iz dva dela. Prvi deo obuhvata prikupljanje, obradu i analizu podataka o ukupno propisanoj količni lekova za kardiovaskularne bolesti na teritoriji grada Novog Sada. U drugom delu istraživanja kori&scaron;ćenjem podataka dobijenih iz državne &bdquo;Apoteke Novi Sad&ldquo; detaljnije je analizirana upotreba lekova za lečenje kardiovaskularnih bolesti izdatih na recept. Upotreba lekova analizirana je: prema uzrastu i polu pacijenata, prema dijagnozama za koje su lekovi propisani i prema ceni. Sruktura upotrebe lekova po indikacijama za dijagnoze kod kojih je ukupna upotreba propisanih lekova bila veća od 1 DDD/1000stanovnika/dan upoređena je sa postojećim nacionalnim vodičima i sa upotrebom u zemljama sa razvijenom farmakoterapijskom praksom, odnosno sa međunarodnim vodičima. Ovi podaci upoređeni su sa morbiditetnom statistikom na teritoriji grada Novog Sada. Ukupno propisana količina lekova za kardiovaskularne bolesti u posmatranom periodu iznosila je 399,79 DDD/1000st/dan. Od te količine, preko polovine (201,11DDD/1000st/dan) propisivanih lekova za kardiovaskularne bolesti su lekovi koji deluju na sistem renin-angiotenzin, slede blokatori kalcijumskih kanala, zatim blokatori beta-adrenergičkih receptora, a na četvrtom mestu po ukupno propisanoj količini su lekovi za terapiju bolesti srca. Od najče&scaron;ćih dijagnoza za koje su propisivani lekovi za kardiovaskularne bolesti, najzastupljenije su bile arterijska hipertenzija, a potom ishemijska bolest srca. Upotreba lekova za kardiovaskularne bolesti u vanbolničkoj sredini na teritoriji grada Novog Sada (399,79 DDD/1000st/dan) vi&scaron;a je u odnosu na zemlje u okruženju (Hrvatsku, Crnu Goru), a niža u odnosu na zemlje sa razvijenom farmakoterapijskom praksom. U odnosu na zemlje sa razvijenom farmakoterapijskom praksom postoje odstupanja u pogledu strukture propisivanja. Struktura propisivanja lekova za kardiovaskularne bolesti odstupa od važećih nacionalnih vodiča o racionalnoj upotrebi lekova za kardiovaskularne bolesti u Republici Srbiji. Istovremeno struktura propisanih lekova nije u skladu sa morbiditetnom statistikom kardiovaskularnih bolesti prema zvaničnim podacima. Među 10 najče&scaron;će propisanih lekova nalaze se i skupi lekovi, koji imaju adekvatne, a mnogo jeftinije paralele. Nedovoljno i neracionalno lečenje kardiovaskularnih bolesti verovatno su jedan od značajnih razloga za visoku smrtnost od kardiovaskularnih bolesti u Srbiji.</p> / <p>Due to high rates of morbidity and mortality from cardiovascular diseases, the share drugs for the treatment of cardiovascular diseases significantly contributes to a total utilization among drugs in the world. There is an evident increase in the consumption of drugs for cardiovascular diseases. In order to achieve as much as possible a higher level of rationalization of therapy in most countries the professional bodies making pharmacotherapeutic guidelines to the possibility of the wrong treatment was reduced to a minimum. In this way, the physician-practitioner provided the security proper selection and the most appropriate procedure in the circumstances. The objectives of this study were: 1) the calculation of the total outpatient consumption of drugs for the treatment of cardiovascular diseases on the territory of Novi Sad and its comparison with the prescribing in the Republic of Serbia and the countries with developed pharmacotherapeutical practice; 2) analysis of the structure of prescribed drugs for the treatment of cardiovascular diseases (group C according to the ATC classification) by the groups and its comparison with the prescribing in the Republic of Serbia and the countries with developed pharmacotherapeutical practice 3) analysis of the structure of prescribed drugs per diagnosis and verification of compliance with pharmacotherapeutic guidelines; 4) comparison of prescribed drugs with morbidity statistics cardiovascular diseases; 5) analysis of pharmacoeconomic aspects of prescribing drugs for cardiovascular diseases. A research conducted among the phase IV clinical trials-pharmacoepidemiological, retrospective observational. Data were collected on the basis of a report from the electronic database for the period of 6 months (01. 01. 2012 - 01. 07. 2012), on the territory of the city of Novi Sad. Based on these data on the territory of the city of Novi Sad analyzed the use of drugs for cardiovascular diseases at 100% sample of the population. The research consisted of two parts. The first part comprises the collection, processing and analysis of data on the total quantity of the prescribed cardiovascular drugs on the territory of the city of Novi Sad. In the second part of this research using data from the public &quot;Pharmacy Novi Sad&quot; is a more detailed analysis of the utilization of drugs for the treatment of cardiovascular diseases of prescription. The utilization of drugs is analyzed: according to the age and sex of patients, in diagnosis for which the drugs prescribed and to the cost. Structure of the use of drugs by indications for diagnosis in which the total utilization of prescribed drugs was greater than 1 DDD/1000inhabitants/day was compared with the existing national guidelines and use in countries with developed pharmacotherapeutical practice, and with international guidelines. These data were compared with morbidity statistics on the territory of the city of Novi Sad. Total amount of prescribed drugs for cardiovascular diseases in the examined period was 399.79 DDD/1000inh/day. Of this amount, more than half (201.11 DDD/1000inh/day) were drugs acting on the renin-angiotensin system, followed by calcium channel blockers, beta adrenergic receptor blockers, and fourth in total prescribed quantity drugs for treatment of heart diseases. Of the most common diagnosis for which drugs for cardiovascular diseases were prescribed, the most common were arterial hypertension, and then ischemic heart disease. The use of drugs for cardiovascular diseases in outpatient environment on the territory of the city of Novi Sad (399.79 DDD/1000inh/day) is higher compared to neighboring countries (Croatia, Montenegro), and lower than in countries with developed pharmacotherapeutical practice. Compared to countries with developed pharmacotherapeutical practice there are variations in terms of the structure of prescribing. Structure of prescribing of drugs for cardiovascular diseases deviates from the existing national guidelines on rational use of drugs for cardiovascular diseases in the Republic of Serbia. At the same time the structure of prescribed drugs is not in compliance with morbidity statistics cardiovascular diseases according to official data. Among the 10 most commonly prescribed drugs are costly drugs, that have adequate, and much cheaper parallels. Insufficient and irrational treatment of cardiovascular diseases are probably one of the major reasons for the high mortality from cardiovascular diseases in Serbia.</p>