Made available in DSpace on 2014-06-11T19:23:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-23Bitstream added on 2014-06-13T18:09:21Z : No. of bitstreams: 1 silva_dmsl_me_botfm.pdf: 811732 bytes, checksum: b7af16d051df1c13aff67359d5fcc98b (MD5) / Fundação Amaral Carvalho / A Farmácia hospitalar é uma unidade técnico-administrativa e científica, dirigida por profissionais de Farmácia, sendo desenvolvidas várias atividades, entre elas a dispensação de medicamentos. O enfoque deste trabalho foi à análise de dispensação de medicamentos de uma Farmácia Hospitalar que possui o sistema de dispensação de medicamentos por dose individualizada diferenciada com prescrição eletrônica. O objetivo foi verificar a incidência de divergências ocorridas durante o processo de dispensação, através da análise do processo realizado e de informações obtidas dos profissionais atuantes no setor, bem como da verificação de prescrições, identificando as causas que levaram a tal e propondo estratégias ao hospital, visando melhorias para o sistema e para segurança do paciente. Após a observação das atividades, a análise dos fluxogramas existentes e a verificação de prescrições, foi possível constatar que ocorreram divergências em 2% das dispensações verificadas, sendo a principal causa dessas divergências a falta de conferência após a dispensação. Outras possíveis causas de divergências são: ambiente de trabalho, falta de treinamento e falta de capacitação dos envolvidos com o sistema informatizado. As propostas para melhoria são: implantação da conferência final após os medicamentos estarem aguardando a retirada, adequação física do ambiente de trabalho e maior capacitação e treinamento dos profissionais na utilização do sistema. Em longo prazo a implantação da dose unitária / The Hospital pharmacy is a technical-administrative and scientific unit, directed by pharmacy professionals, being developed several activities, including the dispensing of drugs. The focus of this study was to examine the dispensing of drugs from a hospital pharmacy which has a system of dispensing drugs with individual differentiated dose using electronic prescription. The objective was to check the incidence of occurred differences during the dispensing process, through the conducted process analysis and from obtained information of the professionals working in the department, as well as the verification requirements, identifying the causes that led to this and proposing strategies to the hospital, looking for improvements to the system and patient’s safety. Following the observation of the activities, the analysis of the existing flowcharts and the checking of the prescriptions, it was possible to establish that there were differences in 2% of the verified dispensations, and the main cause of these differences was the lack of conference after dispensation. Other possible causes of differences are: work environment, lack of training and lack of training of those involved with the computerized system. The proposals for improvement are: implementation of the final conference after the drugs are waiting for removal, physical adequacy of the working environment and a better capacity and training of the professionals in the utilization of the system. In a long term the implementation of unit dose

Resumo: A Farmácia hospitalar é uma unidade técnico-administrativa e científica, dirigida por profissionais de Farmácia, sendo desenvolvidas várias atividades, entre elas a dispensação de medicamentos. O enfoque deste trabalho foi à análise de dispensação de medicamentos de uma Farmácia Hospitalar que possui o sistema de dispensação de medicamentos por dose individualizada diferenciada com prescrição eletrônica. O objetivo foi verificar a incidência de divergências ocorridas durante o processo de dispensação, através da análise do processo realizado e de informações obtidas dos profissionais atuantes no setor, bem como da verificação de prescrições, identificando as causas que levaram a tal e propondo estratégias ao hospital, visando melhorias para o sistema e para segurança do paciente. Após a observação das atividades, a análise dos fluxogramas existentes e a verificação de prescrições, foi possível constatar que ocorreram divergências em 2% das dispensações verificadas, sendo a principal causa dessas divergências a falta de conferência após a dispensação. Outras possíveis causas de divergências são: ambiente de trabalho, falta de treinamento e falta de capacitação dos envolvidos com o sistema informatizado. As propostas para melhoria são: implantação da conferência final após os medicamentos estarem aguardando a retirada, adequação física do ambiente de trabalho e maior capacitação e treinamento dos profissionais na utilização do sistema. Em longo prazo a implantação da dose unitária / Abstract: The Hospital pharmacy is a technical-administrative and scientific unit, directed by pharmacy professionals, being developed several activities, including the dispensing of drugs. The focus of this study was to examine the dispensing of drugs from a hospital pharmacy which has a system of dispensing drugs with individual differentiated dose using electronic prescription. The objective was to check the incidence of occurred differences during the dispensing process, through the conducted process analysis and from obtained information of the professionals working in the department, as well as the verification requirements, identifying the causes that led to this and proposing strategies to the hospital, looking for improvements to the system and patient's safety. Following the observation of the activities, the analysis of the existing flowcharts and the checking of the prescriptions, it was possible to establish that there were differences in 2% of the verified dispensations, and the main cause of these differences was the lack of conference after dispensation. Other possible causes of differences are: work environment, lack of training and lack of training of those involved with the computerized system. The proposals for improvement are: implementation of the final conference after the drugs are waiting for removal, physical adequacy of the working environment and a better capacity and training of the professionals in the utilization of the system. In a long term the implementation of unit dose / Orientador: Paulo Eduardo de Abreu Machado / Coorientador: Kátia Milena Gonçalves Meira Gonçalves / Banca: Natália Mayumi Inada / Banca: Maria Justina Dalla Bernardino Felippe / Mestre

The first part of our study introduces a new method for rapidly generating an "improved" Stribeck curve (i.e. Stribeck+ curve) that, compared to traditional Stribeck curves, shows a more complete tribological picture of the chemical mechanical planarization (CMP) process. The method significantly reduces the consumables and time required to obtain the curve compared to traditional means. Results of the Stribeck+ curve are consistent with individual tests using several different consumables combinations. All copper CMP Stribeck+ examples clearly indicate the lubrication mechanism and transitions thereof between different polishing conditions. Variability in COF as well as a much wider range in U/P are also explored. In the second part of our study, the Stribeck+ curve is successfully applied to silicon dioxide CMP processes to characterize the tribology of such processes under different process conditions and consumables. Results show our Stribeck+ curve methodology to be capable of rapidly determining and differentiating the tribological mechanism among all cases studied. The Stribeck+ curve helps indicate process stability as shown by the spread of the COF vertical clusters. The Stribeck+ curve also confirms a previously known effect that the greater the ratio of pad’s up-features to the total pad area, the greater the probability of wafer hydroplaning. As the third part of our study, we investigate the effect of different pad surface micro-textures on the tribological, thermal and kinetic attributes during copper CMP. Different micro-textures are generated by two different chemical vapor deposited (CVD) diamond-coated conditioner discs (i.e. Disc A and Disc B). Results show that while pad temperature and removal rate increase with polishing pressure and sliding velocity on both discs, Disc B generates consistently lower removal rates and COF than Disc A. To fundamentally elucidate the cause(s) of such differences, pad surface contact area and topography are analyzed using laser confocal microscopy. The comparison of the pad surface micro-texture analysis indicates that Disc A causes a pad surface with a smaller abruptness (λ) and much more solid contact area which results in a higher removal rate. In contrast, Disc B generates less contact areas and COF. A two-step modified Langmuir–Hinshelwood model is employed to simulate copper removal rates as well as chemical and mechanical rate constants. The simulated chemical to mechanical constant ratios indicate that Disc A produces a more mechanically limited process under all conditions tested. In the fourth part of our study, the position of a slurry injection system (SIS) is optimized to achieve a more cost-effective and environmentally benign CMP process using a widely-adopted ceria-based "reverse slurry". Here, SIS is configured with different angles in order to investigate slurry dilution characteristics caused by residual pad rinsing with ultrapure water (UPW) that is known to affect silicon dioxide removal. UPW dilution effect on removal rate, coefficient of friction and pad surface temperature is explained by maintaining a constant dilution ratio for each of the SIS configuration tests. Results indicate that SIS negative rotation angles increase the actual slurry dilution ratio on top of the polishing pad. This generates more Ce3+ which boosts removal rates. Application of negatively rotated SIS allows significantly lower slurry flow rates and/or shorter polishing times leading to more environmental friendly semiconductor manufacturing processes. Finally, it is confirmed that variations in SIS configuration has no impact on silicon dioxide to silicon nitride removal rate selectivity. In the fifth and final part of our study, the silicon dioxide removal rate using a "reverse" ceria-based slurry is investigated under four different combinations of conditioning modes and slurry application methods. In a “reverse” slurry, addition of water acts to promote material removal. Overall, the process using ex-situ conditioning with the SIS results in the highest removal rate, while the process using in-situ conditioning with the conventional point application (PA) generates the lowest removal rate. This study explains the differences in silicon dioxide removal rate based on the variations of the actual slurry dilution ratio on the pad associated with conditioning and slurry application methods. Frictional analysis and Stribeck+ curves are employed to elucidate the tribological characteristics. Results show that the conditioning modes and the slurry application methods vary the extent of the polishing vibrations. Silicon dioxide removal rate is found to linearly correlate with the extent of COF fluctuation. The work underscores the importance of optimum slurry flow dynamics and injection geometry to obtain a more cost-effective and environmentally benign CMP process.

Class of 2014 Abstract / Specific Aims: To compare two groups of automated dispensing technology and their impact on medication safety and costs at an inpatient pharmacy. Methods: A total of 784 medications were audited for Pyxis refill errors, 352 prior to and 432 post implementation of Boxpicker and the ATP High Speed Tablet Packager. Data were collected by obtaining refill reports for automated dispensing. Every other medication on the refill report was audited for errors in the corresponding location of the automated dispensing cabinet. The rate of reported errors was obtained from a self-reported error program, Patient Safety Net (PSN). Analysis related to costs included automated dispensing cabinet related inventory and costs associated with bulk repackaging. All data associated with costs were obtained from pharmacy financial records. Main Results: There was no significant difference in the Pyxis refill error rate between Pyxis PARx and Boxpicker (0.00284% versus 0.00231%, respectively, p =0.88). The total number of automated dispensing cabinet problems reported through Patient Safety Net transiently increased during and after implementation of new automated technology. Value of pharmacy inventory costs associated with automation was $674,460 prior to and $594,789 post implementation of technology. Bulk repackaging with the ATP High Speed Automatic Tablet Packager resulted in an estimated cost savings of $203,400 annually. Conclusion: Implementation of Boxpicker and ATP High Speed Tablet Packager resulted in no significant change in Pyxis refill error rates, a transient increase in reported automated dispensing cabinet problems, a decrease in inventory costs, and savings associated with bulk repackaging.

Magister Public Health - MPH / Background: South African medical scheme members needlessly purchase high cost originator prescription medicines which attract out of pocket co-payments at pharmacies. This is despite availability of low priced generic medicines that are paid for in full by medical schemes. Co-payments result from misalignment between prices of the dispensed medicine and that of the alternative medicine which appears on the medical scheme's formulary list and for which the scheme is prepared to pay for in full. To establish what factors caused such misalignment, perspectives of medical scheme members and key informants which included pharmacists, regulators and representatives of medical schemes were explored. The study focused on co-payments for prescription medicines dispensed at private sector retail pharmacies in Pretoria, South Africa. Aim: The aim of the study was to explore views about co-payments and identify factors that motivate and influence Pretoria medical scheme members to co-pay when purchasing prescription medicines at pharmacies, despite being insured by medical scheme insurance organizations. Methodology: An exploratory qualitative research study was performed. Semi-structured interviews were conducted among purposefully selected medical scheme members (12) and 9 key informants. Key informants consisted of dispensing pharmacists (6), regulators of health professionals and medical schemes (2) and a senior official (1) with experience in the regulation of medicines and operations within medical scheme organizations. From a total of twelve interviewed medical scheme members, eight were interviewed at preselected retail pharmacies after they had made a co-payment and the other four selected because they did not make a co-payment. To ensure diversity in views about co-payments and related factors, dispensing pharmacists, co-paying and non co-paying medical scheme members were accessed from six pharmacies that are located in two separate locations of different socioeconomic status in Pretoria, that is, the Pretoria East suburban area and Pretoria city centre which is close to Pretoria central station and taxi routes. Three pharmacies were identified from each of the two different geographical locations, one independent and two corporate pharmacies per socioeconomic area. One pharmacist was interviewed from each of the selected pharmacies and medical scheme members were accessed from across the six pharmacies. The remainder of the key informants such as the regulators, were interviewed during office hours at venues of their choice which included areas of work. A pilot study was conducted among medical scheme members and pharmacists to test the applicability of interview tools. All interviews were conducted face-to-face by the researcher and recorded. The electronic record was independently compared with the researcher's enhanced notes for data accuracy. Codes identified during data analysis were derived from the interview notes and recordings and translated into organized text for theme development in a manner that referenced them to each study objective. Themes were arrived at after combining similar codes which were noted as representing a particular description for use during data interpretation and report writing. Ethics: Ethical clearance was sought from the UWC Senate Research Committee and granted. Prior to conducting interviews, written consent was obtained from all participants. Research details were explained and also provided on the participant information sheet wherein voluntary participation was emphasized. Anonymity and confidentiality was maintained throughout. Results: All patients and pharmacists expressed confusion about the medical scheme rules and related co-payments. There were differing co-payment perspectives among scheme members depending on socioeconomic status, with affordability being a key factor among those of lower socio-economic status whilst convenience and lack of comprehensible information about co-payments was prioritised amongst those members of higher socioeconomic status. Key influences on patient's purchasing decisions were health professionals (both doctors and pharmacists), with friends, family members and advertisements less influential. Patients and medical schemes generally preferred to utilise large chain pharmacies and patients, in particular, had a poor perception of the quality of generics. In general, the first prescribed medicine was highly favoured by patients and this influenced medicine preferences during subsequent prescriptions, especially for non communicable disease (NCD) medicines. Pharmacists did not apply the generic substitution policy in a manner that benefited the consumer because the lowest priced generic was frequently not kept as pharmacy stock. Co-payments appeared to create a divide between corporate and independent pharmacies. Some regulators tended to blame patients, pharmacists and medical schemes rather than the lack of adequate enforcement of national policies and regulations. Inadequate monitoring and enforcement of pro-consumer policies were found to be the main factors that contributed to co-payments. Conclusions and Recommendations: The introduction of regulations on minimum requirements for stock available at private sector retail pharmacies should be considered to ensure availability of the lowest priced generic at all times. This would ensure that co-payments are reduced and the desired consumer benefits that should accrue from the existing generic substitution policy are realized and maximized. To prevent perception-based and self-initiated co-payment behavior among consumers, vigorous and continued education about the value and equivalence of generics should be championed at the highest level of government with the execution of this critical responsibility not left to those with profit driven motives. Consumers might benefit from extensive education about the purchasing choices made at pharmacies and, in particular, the negative financial consequences associated with choosing a preferred but highly priced originator versus a low cost generic medicine which is used to treat the same ailment. Enforcement of policies by dedicated government agencies could further protect consumers from preventable high cost of healthcare and of medicines in particular.

Objective: To investigate and describe how an acute care, multi-site teaching hospital implements a new technology called the Automated Medication Dispensing Cabinet (ADC) that will be used by nurses. Design and methods: Qualitative, descriptive, single-case study method using the Ottawa Model of Research Use as a framework to guide data collection and analysis. The project was evaluated from the beginning, through the planning stages until a cabinet vendor was chosen. Results: A multidisciplinary committee was created to implement the ADCs across the organization. Clinical nurses, the intended users, were not directly involved in the implementation; usability testing was not done; they were not prepared for all the needed training costs and no evaluation was planned. Conclusions: An implementation framework was not used to guide the ADC project and several key area surrounding implementation were missed. Recommendations were made to improve future implementation projects in heath organizations.

Doctor Educationis / Background: Since 2005 the Chronic Dispensing Unit (CDU) has been part of the Western Cape Government’s strategy to address increasing demand for chronic medication for patients with non-communicable diseases. However, some patients are unable to collect their pre-packed chronic medication parcels from health care facilities on the due date. Recent research reported that some patients utilise collectors or medicine agents to collect their prepacked chronic medication parcels. Currently little is known about this phenomenon of collectors. Aim and Objectives: This study explored the acceptability of collectors of CDU chronic medication parcels to improve access to medicines for patients with non-communicable diseases at Lotus River Community Day Centre (LRCDC). Methodology: An exploratory descriptive qualitative study using semi-structured interviews in English and Afrikaans was conducted with six purposively selected collectors, three patients who use collectors and three key informants who have intimate knowledge of the collectors and system at the health facility. Interviews were recorded, transcribed, translated into English (where applicable) and thematically coded to derive themes from the data. Ethical approval was provided by the University of the Western Cape Bio-Medical Research Ethics Committee and informed consent was obtained from all study participants. Results: Patients reported that their collectors exhibited positive characteristics such as trust, patience and reliability, as well as, a passion for helping the community and organisational skills. All patients acknowledged the benefits of utilising a collector and found them to be highly acceptable. Key informants, however, had some reservations about the characteristics of collectors and their role in medication distribution and were sceptical as to whether collectors were suitably equipped to perform this function. Patients were grateful when their collector had some knowledge about their condition and were able to converse with them regarding their medication. Key informants suggested that with sufficient training and skills development, collectors could potentially improve access to chronic medication parcels and impart basic knowledge about chronic medication adherence to patients. iv Conclusion: The collector system that has emerged at LRCDC is highly acceptable to patients, but health facility staff were more measured in their assessments. Health facility staff, however, acknowledged the potential of collectors to improve access to chronic medication parcels for patients with chronic conditions and the benefit of upskilling collectors to perform this function. Recommendations: As a short-term measure, collectors should be formally accepted at facilities as medicine agents. They should receive basic education about safe medication distribution practices. Patients should screen collectors to ensure that they have the desired positive attributes. Furthermore, future research is necessary to comprehensively understand the current scope of practice of collectors within communities

Objective. To examine the extent to which theory of planned behavior (TPB) constructs and demographic characteristics explain pharmacy students’ dispensing intentions in ethically or legally gray areas involving potential substance misuse or abuse. Methods. Two cohorts of third-year Doctor of Pharmacy (PharmD) students (n5159) were provided with five written cases describing common “gray area” dispensing scenarios in community practice involving medications and devices with potential for misuse or abuse (eg, long-term buprenorphine maintenance prescription without evidence of tapering, early refill of a narcotic for an out-of-town patient, non-prescription sale of pseudoephedrine). Students completed a 12-item survey instrument for each case. Items assessed whether the student would dispense the medication or device in the given scenario, how many times in 10 similar scenarios the student would dispense the medication or device, attitudes regarding dispensing, and subjective norm and perceived behavioral control beliefs. Results. Wide variation in the percentages of students who would dispense the medications or devices was noted across the five scenarios (14% in the buprenorphine scenario to 61% in the pseudoephedrine scenario). Attitude scores significantly predicted dispensing decisions in all scenarios (p,.001), whereas subjective norm and perceived behavioral control beliefs were significant predictors of dispensing only in select case scenarios. Gender and community pharmacy work experience did not consistently predict dispensing intentions. Conclusion. Student attitudes consistently predicted intent to dispense across five gray practice scenarios. These findings can be used to inform development of educational interventions that influence students’ attitudes and self-awareness in community practice decision-making scenarios involving potential substance misuse or abuse.

No description available.

The purpose of this thesis is to investigate the possibilities of automating a gluing process in the optical manufacturing industry. Aimpoint, a Swedish company that manufactures red-dot sights was the industrial partner in this thesis. Since the optical quality of their products is of the highest importance and the lenses and protective glass are for the most part glued using traditional, manual methods, the company aims to find improvements and methods to ensure the qualityof their products by automating this process. A number of requests were submitted, including the ability of such an improved process to be able to glue lenses of more complex geometries than the mostly round lenses currently used. To allow precise adhesive dispensing around the lens of a sight with a complex geometry, Aimpoint has two Cartesian tabletop dispensing robots. This kind of robot servesas a baseline for the comparisons in this thesis. A Franka Emika articulating robot arm was used to test the possibilities of au-tomating the process using such a robot system. Firstly, a motion was generatedbased on the CAD model of the product. The motion generation and manipulation was performed in MATLAB where the Peter Corke robotics toolbox was used for initial simulations. Unfortunately, the robot model in the toolbox was not able to take joint limitations into account and a migration to ROS was in order. Since there was no implementation for Cartesian control in the simulation software for Franka Emika, a decision was made to start physical tests using the robot pre-maturely. As for the adhesive dispensing, tests were conducted to investigate the parameters that affect the termination of a glue joint such as the retract setup and timings. A repeatability test was also conducted to test the performance of dis-pensing using a direct pressure fed adhesives syringe versus using a dispensingvalve. With the knowledge and data from these tests, the experimental setup was built at the robot lab in Lund where a computer ran the controller implementation, controlling the robot and an Arduino was utilized to actuate the dispenser. Several details were glued on this setup, both with vertical and angled nozzle. Asa reference for gluing, a detail was glued using the Cartesian dispensing robotat Aimpoint with the same limited path as previously described. To analyse the performance of the glued joint, a push-out test was conducted at Aimpoint usinga tensile strength machine. The results from this test showed that a glue joint glued with an angled nozzle was stronger and a higher force was required to deform the joint compared to one glued with a vertical nozzle. On average, the joint glued with an angled nozzle required 721 N and the vertical required 395 N. It is concluded that keeping the nozzle angled during the dispensing operation yield a stronger glue joint and makes the system less sensitive to positionand orientation errors. As for the impedance controller used in this thesis, it is concluded to not be suitable for the considered application and its requirements. Regarding the robotic solution investigated in this thesis, it was observed to bebeneficial to utilize a high number of axes when generating the motion for the gluing operation. However, case-consistent inverse kinematics is a requirementto further investigate this claim.