The topic of the thesis is inappropriate behavior in organizations. The aim of the thesis is a deeper understanding of the issue through qualitative research and finding assumptions for further quantitative research. The introduction is providing comprehensive information on the topic of inappropriate behavior in organizations. Attention is given to the definition of inappropriate behavior, its phases, actors - offender and victim, as well as possibilities of defending and resolving these problematic situations. The practical part is based on an analysis of interviews with victims of inappropriate behavior and also analyzes the stories of the victims. The findings point to the specific characteristics of the offender, the victim's characteristics, signs of inappropriate behavior, inappropriate behaviors impact on the victim and ways to deal with the situation. For each of the above categories are summarizes the differences and similarities of individual aspects. Generalizations were made based on the findings and assumptions that can become the basis for further quantitative research were set.

Orientador: Paulo José Fortes Villas Boas / Resumo: Introdução: A prescrição de Medicamentos Potencialmente Inapropriados (MPIs) possuem aspectos relevantes em idosos juntamente com a prevalência de automedicação, interações medicamentosas, reações adversas e polifarmácia, sendo, portanto, necessário utilizar medidas que proporcionem o uso racional destes medicamentos nessa população, além de elaborar medidas que possibilitem a diminuição de custos relacionados à essa prática para as Instituições de Saúde. Objetivo: Analisar os custos diretos das prescrições medicamentosas de idosos internados em enfermaria de Clínica Médica e comparar os custos das prescrições com e sem medicamentos potencialmente inapropriados (MPI) para idosos. Metodologia: Estudo observacional retrospectivo descritivo, realizado em enfermaria de Clínica Médica de hospital universitário público de nível terciário. Foram analisadas as prescrições de 124 idosos com 60 anos ou mais, internados por condições clínicas. Os dados das prescrições foram coletados por meio do sistema de prontuário eletrônico da instituição. Os custos das prescrições foram obtidos junto à Seção Técnica de Farmácia de acordo com a tabela de preço unitário do ano vigente de 2018, sendo realizada a somatória total dos custos de toda internação. Os medicamentos foram considerados MPI segundo critérios de Beers de 2019 da American Geriatrics Society. Resultados: Foram avaliadas prescrições de 124 pacientes com mediana de idade de 74,6 (percentil 25 – 75: 69 – 81) anos, sendo 60,5% do sexo ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Prescription of Potentially Inappropriate Medications (PIMs) have relevant aspects in the elderly along with the prevalence of self-medication, drug interactions, adverse reactions and polypharmacy, therefore, it is necessary to use measures that provide rational use of these drugs in this population, besides to elaborate measures that allow the reduction of costs related to this practice for the Health Institutions. Objective: To analyze the direct costs of the prescriptions of elderly patients hospitalized in a Clinical Medical ward and to compare the costs of prescriptions with and without potentially inappropriate medications (PIM) for the elderly. Methodology: Descriptive retrospective observational study, carried out in a Clinical Medical ward of a tertiary-level public university hospital. The prescriptions of 124 elderly patients 60 years of age or older hospitalized for clinical conditions were analyzed. Prescribing data were collected through the institution's electronic medical record system. Prescription costs were obtained from the Technical Section of Pharmacy according to the unit price table of the current year of 2018, and the total sum of the costs of all hospitalization was made. The drugs were considered PIM according to the 2015 Beers criteria of the American Geriatrics Society. Results: Prescriptions of 124 patients with a median age of 74.6 (25 - 75: 69 - 81 percentile) years were evaluated, with 60.5% being male. The median number of medi... (Complete abstract click electronic access below) / Mestre

Antibiotics are commonly prescribed and requested for viral illnesses despite evidence-based research studies and societal guidelines that advise against this practice. Literature has indicated that antibiotic decision-making comes from a provider's experience or exposure to illness, uncertainty of illness, or from being pressured by the patient. Nurses and advanced practice nurses are important participants in the antibiotic stewardship initiative. The purpose of this project was to examine potential knowledge deficits responsible for inappropriate antibiotic prescribing at a rural urgent care clinic in the southeastern United States, which when addressed could promote an educational in-service to decrease the number of antibiotics prescribed during a high-volume cough, cold, and flu months. The health belief model was used as a foundational model and a knowledge, attitude, and practice survey to collect data. Antibiotic prescribing habits were evaluated in the preintervention group (n = 250) and a year later in the postintervention group (n = 265). Antibiotic prescribing decreased positively from 80% to 70% and watchful waiting also increased positively from 4% to 30%; X-² (1) = 12.302, p = .000. The increase in educational awareness from these results can support a decrease in inappropriate antibiotic prescriptions, which prevents the emergence of antibiotic-resistant bacteria, contributing to positive social change.

Yes / Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated. To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty. A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions. Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model. Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.

Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: Evaluation of the rationality of prescribing of selected potentially inappropriate medications in ambulatory geriatric patients Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Roman Lestina Introduction: Rational therapy in the geriatric population is an essential area due to the ever-increasing percentage of geriatric patients in the population. Due to the frequent polypharmacotherapy in these patients, including possible polypragmatism, it is important to constantly monitor potential drug problems and address potential drug risks in a timely manner. As an auxiliary tool in rational geriatric pharmacotherapy, expert groups have defined many potentially inappropriate medications (PIMs), which often contribute to drug reactions in the elderly, and which should be given more attention in clinical practice. This diploma thesis focused on 10 selected, most frequently used PIMs in the geriatric outpatient clinic of the University Hospital in Hradec Králové, and its aim was to monitor how often these drugs are prescribed in high-risk situations in geriatric patients (i.e., in the presence of symptoms, laboratory results and diseases, which...

Améliorer la qualité de la prise en charge des personnes âgées vivant en EHPAD est un impératif. L'influence des caractéristiques organisationnelles des EHPAD sur la qualité de la prise en charge des résidents est mal connue. Nos travaux de recherche ont porté sur trois objectifs : 1) Rechercher les facteurs organisationnels en EHPAD qui ont un impact sur les prescriptions potentiellement inappropriées de neuroleptiques, ces médicaments faisant l'objet d'une attention particulière chez les personnes âgées en EHPAD ; 2) Déterminer la valeur ajoutée de l'intervention d'un gériatre au sein d'EHPAD pendant 18 mois par rapport à la restitution simple d'un audit qualité, sur les prescriptions potentiellement inappropriées de neuroleptiques ; 3) Proposer des actions concrètes d'amélioration de la prise en charge globale des résidents d'EHPAD concernant notamment les transferts inappropriées des résidents d'EHPAD vers les urgences, et la prévention du déclin fonctionnel des résidents. Pour répondre aux deux premiers objectifs, nous avons utilisé les données de l'étude IQUARE (Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en EHPAD) un essai multicentrique comparatif ayant pour objectif d'évaluer l'impact d'une intervention globale d'éducation gériatrique pour le personnel d'EHPAD sur des indicateurs de qualité. Pour le troisième objectif, nous proposons d'une part la structuration d'un hôpital de jour ayant pour vocation de ne recevoir que des résidents d'EHPAD avec la possibilité de les prendre en charge dans des délais courts afin de limiter les transferts inappropriés des résidents d'EHPAD vers les urgences. D'autre part, nous avons participé à une task force d'experts composée de médecins gériatres cliniciens et chercheurs dont l'objectif était de proposer des actions de prévention du déclin fonctionnel des résidents d'EHPAD. Sur les 6275 résidents inclus dans IQUARE, 1532 (24.4%) avaient au moins une prescription de neuroleptique parmi lesquels 1019 (66.5%) étaient potentiellement inappropriées. Nous avons montré que les résidents d'EHPAD dans lesquels intervenait un nombre important de médecins généralistes différents (plus de 30 pour 100 lits), étaient plus à risque de recevoir une prescription inappropriée de neuroleptiques que ceux vivant dans des EHPAD avec moins de 10 médecins généralistes pour 100 lits. Dans cette même étude IQUARE, nous n'avons pas mis en évidence d'effet positif de l'intervention d'un gériatre au sein d'EHPAD pendant 18 mois par rapport à la restitution simple d'un audit qualité, sur la réduction des prescriptions inappropriées de neuroleptiques 18 mois plus tard. [...] / Improving the quality of care for nursing home residents is a real concern. A better understanding of the factors determining a good quality of care in nursing homes (NH) is necessary. This thesis deals with three aims: 1) Determining whether facility characteristics - and in particular the number of attending general practitioners (GPs) in NH - are associated with inappropriate neuroleptic prescribing ; 2) Studying the effect of a quality assurance approach in a NH, with or without the intervention of a geriatrician, on potentially inappropriate neuroleptics prescription at 18 months (T18); 3) Offering practical actions improving medical care in NH in order to reduce potentially avoidable transfers to emergency rooms and to prevent disability and functional decline for NH residents. To meet the two first objectives, we used the data from the Impact of a QUAlity exercise study on the change in practices and the functional decline of Residents in EHPAD (IQUARE), a comparative multicenter trial aiming at assessing the impact of a global education intervention for NH staff based on quality indicators. As for the third objective, on the one hand, we implemented a new day hospital characterized by its being exclusively dedicated to NH residents and its ability to provide patient care within a short period of time. On the other hand, we took part in a Task Force discussion of experts in NH care and research, to implement strategies to prevent or to slow disability and functional decline for NH residents.Among the 6275 residents included in IQUARE study, 1532 (24.4%) had at least one prescription for a neuroleptic drug. Compared with nursing homes with <10 GPs/100 beds, nursing homes with more than 30 GPs/100 beds were exposed to a greater risk of potentially inappropriate neuroleptic prescribing. We have not shown the added benefit of geriatrician intervention in a global effort to decrease potentially inappropriate neuroleptic prescribing. This result can be explained by the strong impact of the quality assurance audit restoration at each NH with a 20% decrease of the potentially inappropriate neuroleptic prescribing for the two study groups. Over this thesis, we have opened a responsive day hospital dedicated to NH residents. This day hospital could be a practical response to the problem of inappropriate and avoidable transfers of NH residents to emergency rooms. Improving the quality of care for nursing home residents also means preventing and/or slowing the functional decline of residents. A Task Force of experts emphasized the need for cultural change to incorporate physical activity for nursing home residents and implement multidomain interventions to delay disability. To conclude, this work has identified factors having an influence on potentially inappropriate care and suggests simple areas to improve the quality of care.

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs. Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach. Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p&lt;0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p&lt;0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS. Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

The study relates to road management in Nigeria, on one (land locked) state out of the 36 that comprise the country. The state (Sokoto) has a population of over four million people, and the acute shortage of road connections to the majority of its rural inhabitants necessitated the research. The practice of road management in Sokoto is broadly representative of other Nigerian States. Sokoto like all the northern states, is distant from the coast, and its main asset is an abundant supply of cheap labour. Roads provide the principal mode of access, and are a key factor to trade, industry and social development. An intensive literature review was carried out to determine the existing state of knowledge on the problems encountered by practitioners in the field. The review (desk study) occupied the first stage of the research. It rapidly became clear that the topic is seriously under-researched, both internationally and specifically in the study area. The review has also drawn upon a variety of published and unpublished sources, drawing upon the limited amount of quantified and rigorous data that is available, but also assessing the more substantial quantity of partially quantified or impressionistic information to be found in project reports and case studies. For research to be successful, observable indicators must be found for at least some of the abstract concepts used in the theory. In this regard, six months field work (data collection) was carried out in Nigeria as the study's second stage. This translates the research hypothesis into an operational hypothesis. The third stage of the research covers the analysis and validation of data. This includes an interpretation, which serves as a bridge between the theoretical and practical data. The thesis describes how the empirical data has been used in analysis, to spell out parameters that affect rural road management in Nigeria as in many Sub-Saharan Africa. The research revealed the inappropriate use of technology to be the major factor hindering performance. The study suggests some workable operating methods as possible alternatives that can simplify the difficulties of road maintenance under different operating conditions.

Functional analysis is a method of behavioural assessment used to determine the environmental variables maintaining a specific behaviour. While functional analysis is often used with individuals with developmental and intellectual disabilities, problem behaviours in people with dementia are rarely assessed using functional analysis methodology. The purpose of the present study was to conduct descriptive and functional analyses of problem behaviours among individuals with dementia to determine: (a) if a descriptive assessment would identify a function of the challenging behaviour assessed; (b) the extent to which stimuli identified in the descriptive assessment were needed to conduct a functional analysis; and (c) if a standard functional analysis is an effective assessment method for this population. The participants were two individuals with dementia who exhibited inappropriate vocalizations, consisting of swearing and delusional speech. For both participants, the results of the descriptive assessments suggested that the function of the behaviour was positive reinforcement in the form of attention from staff members. The findings of the descriptive analyses were confirmed in the functional analyses. The results suggest that a functional analysis informed by a descriptive analysis can identify the function of problem behaviour in individuals with dementia in a residential setting. / May 2016

Les sujets âgés sont souvent atteints de nombreuses comorbidités. Leur prise en charge thérapeutique selon les recommandations en vigueur peut être à l’origine d’une polymédication. La prescription de psychotropes est fréquemment retrouvée dans les traitements des sujets âgés. Cette classe thérapeutique est à haut risque iatrogène potentiel dans cette population vulnérable. Les effets indésirables médicamenteux les plus notables sont les chutes, les fractures et les troubles confusionnels. L’identification des psychotropes potentiellement inappropriés (PPI) chez les sujets âgés à l’aide de la liste de Beers a fait l’objet de peu de travaux.Les objectifs de cette thèse étaient d’identifier les prescriptions de psychotropes potentiellement inappropriés (PPI) à l’aide des listes de Beers actualisées dans les traitements de sujets hospitalisés ou vivant en Etablissement d’hébergement pour personnes âgées dépendantes (EHPAD). Les facteurs liés à ces prescriptions ont aussi été recherchés.La polymédication, ainsi que les troubles neuropsychiatriques du sujet âgé doivent rendre le prescripteur de psychotropes particulièrement vigilant dans cette population particulièrement vulnérable.L’usage des listes de médicaments potentiellement inappropriés (MPI) pourrait permettre d’identifier les psychotropes au rapport bénéfice risque défavorable chez les sujets âgés. Et orienter le choix du prescripteur vers des traitements plus favorables au patient. / Elderly people often have many comorbidities. Therapeutic management according to the recommendations in force may be at the origin of a polymedication. The prescription of psychotropic drugs is frequently found in the treatment of elderly patients. This therapeutic class is at high potential iatrogenic risk in this vulnerable population. The most notable adverse drug reactions are falls, fractures and confusion. The identification of potentially inappropriate psychotropic medications (PIP) in elderly subjects using the Beers list has received little attention.The objective of this thesis was to identify the prescriptions of potentially inappropriate psychotropic drugs (PIP) using the updated Beers lists in the treatment of subjects hospitalized or living in the nursing home. Factors related to these treatment s were also investigated.Polymedication, as well as neuropsychiatric disorders in the elderly, should make the prescriber of psychotropic drugs particularly vigilant in this particularly vulnerable population.The use of lists of potentially inappropriate medications (PIM) could identify psychotropic drugs with an unfavorable risk-benefit ratio in elderly subjects. And direct the choice of the prescriber towards treatments more favorable to the patient.