Understanding the philosophy of a different culture and integrating this understanding into the provision of pharmaceutical care is challenging and complex. This thesis argues the importance for community pharmacists to acknowledge that culture, religion, family and community dynamics can impact on patients' health, health seeking behaviour and medicines adherence. The perceptions of members of the South Asian population, general practitioners, and community pharmacists about how these factors are viewed in relation to community pharmacy services were explored in this study. It was conducted in Leicester City, which has a South Asian minority ethnic population of more than 25%. Participants' views of the role of extended community pharmacy services in the wider government agenda were explored. South Asians attitudes to healthcare, self care and the management of minor ailments were discussed. A qualitative methodology approach was adopted, which used constructivist and interpretive principles. Data collection for the study was conducted in two phases. In Phase 1, one to one semi-structured interviews were conducted separately with six local GPs and five community pharmacists from both 'white' (European) and South Asian backgrounds. In Phase 2, six gender specific focus groups were convened comprising of fifty five participants in total from the Sikh, Moslem and Hindu communities. Bi-lingual community workers were used in this study which allowed a more 'sensitive' exploration of the sociological aspects of health seeking behaviour and the impact of 'cultural' influences on medicines adherence. The need for 'cultural competence' of community pharmacists is discussed as one of the major contributions to the evidence base for pharmacy practice. Such initiatives would require pharmacists to acquire more effective consultation skills in the first instance. South Asians expressed views that community pharmacists need to be more knowledgeable, responsive and flexible in their professional practice by assessing their pharmaceutical needs and being aware of particular cultural sensitivities when planning their services in line with the new pharmaceutical contract. More specifically, South Asian participants illustrated the need for community pharmacists and their staff to be more 'culturally knowledgeable' about the communities in which they practice. It is argued that the provision of a more culturally sensitive and pro-active service is needed to develop a better patient-practitioner professional relationship that promotes trust. South Asians illustrated how certain behavioural, religious and cultural beliefs impact on medicines adherence, such as compliance issues whilst on holiday to their homeland, the impact of religious pilgrimage and fasts. Many South Asian participants had limited understanding about 'generic' medicines and considered these to be 'inferior' or 'less effective' than 'branded' medication. Participants' views of 'sharing' of medicines and medicines waste were also illustrated. Factors such as 'stress', 'fate' and 'karma' and their impact on health of the participants were discussed. Many of these factors could not be solely attributable to a South Asian 'culture'. However, the findings illustrate a need for a Medicines Use Review (MUR) service to include more 'targeted' exploration of medicines adherence and medicines optimisation for this population. The findings also highlighted why South Asians rarely consult the community pharmacist about sensitive or stigmatised issues such as depression, and how some conditions and symptoms were perceived to have negative impact on the 'social acceptance' of South Asian individuals within their own communities. South Asians suggested that community pharmacists needed to be more pro-active and 'responsive' to their pharmaceutical needs and respect confidentiality through use of private consultation areas for routine counselling, health promotion and medicines information. All participants endorsed a need for more 'professional' recognition of the pharmacist not only as an autonomous health care professional, but as one integral to providing NHS services relating to medicines and public health. The findings illustrated a lack of professional collaboration between community pharmacists and GPs, confounded by community pharmacists being 'subordinate' to GPs and portraying more of a 'shopkeeper' image. South Asians were well informed about the lack of shared medical records and relied heavily on a doctor's definitive 'diagnosis' for somatic symptoms related common ailments. South Asians pro-actively engaged with 'community action' based approaches in health education and health promotion, and an opportunity for community pharmacists to become more involved with social initiatives was inferred from the findings. Candid and animated discussions explored their understanding of exercise as part of weight management and their interpretation of effects of the use of herbal products, alternative practitioners and the importance of collaboration with religious and community leaders in promoting medicines adherence. Participants desired alternative communication methods other than leaflets (translated or otherwise), including the use of audio-visual means and use of media. Communication difficulties were still prevalent, and trained interpreters were rarely used. By embracing some of these challenges, community pharmacists could enhance the value of their services and provide a more meaningful, 'culturally' competent and responsive services based on the needs of their local populations and nurture a better trusting and professional relationship with their service users and healthcare colleagues.

The intense modifications in the global business environment has been turning the hospital atmosphere competitive, demanding a new organization with the adhesion in concepts that turn the productive process turned to the client and may reach better levels of productivity. The managers became, so, to be responsibles for the initiative of the expenses control on all levels, because every year noticed an increase of the hospital costs and a depreciation of physical and technological resources, increasing a view where financial resources to the sector are smaller and smaller. This assignment aims to achieve a study of case on managing of supplies sector of Hospital School of Taubaté University on which refers to distribution of medicines and clinical materials. It was made a diagnosis of the real situation about the hospital storeroom and pharmacy, analyzing the procedures adapted at supplies sectors as regards to the products exit control. It was suggested improvement at the new control process that aims to reduce the waste of clinical sectors, starting from the distribution, aiming corrective actions along with the whole process of distribution of the medical and clinical materials. / As intensas modificações no ambiente empresarial globalizado têm tornado o ambiente hospitalar competitivo, exigindo uma nova organização com a adesão a conceitos que tornem o processo produtivo mais direcionado ao cliente e possibilitem atingir níveis de produtividade mais elevados. Os gestores passaram, então, a serem responsáveis pelas iniciativas de controle de gastos em todos os níveis, pois a cada ano observa-se um aumento dos custos hospitalares e uma depreciação dos recursos físicos e tecnológicos, incrementando um cenário onde os recursos financeiros ao setor são cada vez menores. Este trabalho objetiva realizar um estudo de caso do gerenciamento do setor de suprimentos do Hospital Escola da Universidade de Taubaté no que se refere à distribuição de medicamentos e materiais clínicos. Realizou-se um diagnóstico da situação real do almoxarifado e da farmácia do hospital, analisando-se os procedimentos adotados nos setores de suprimento quanto ao controle de saída de produtos. Foram sugeridas melhorias no processo de controle, buscando reduzir o desperdício de material e medicamento partindo da dispensação e visando ações corretivas e preventivas ao longo de todo o processo de distribuição.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-05T00:17:16Z No. of bitstreams: 1 Disserta??o_Diego_Carneiro_Ramos.pdf: 1919158 bytes, checksum: fcbe830160413909e9172b507eba619c (MD5) / Made available in DSpace on 2016-10-05T00:17:16Z (GMT). No. of bitstreams: 1 Disserta??o_Diego_Carneiro_Ramos.pdf: 1919158 bytes, checksum: fcbe830160413909e9172b507eba619c (MD5) Previous issue date: 2014-03-31 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: Nutrition goes beyond the physiological need. Nutrition is part of a symbolic universe that gives different meanings to food and nurturing. Among the maternal responsibilities, the nutrition occupies a special place in care. This maternal task makes the mothers feel apprehensive when the children do not reach the expectations of nutrition they have, either rejecting or selecting foods too eat and what to eat. These factors combined with the relationship between child health and corporeality makes mothers seek for drugs that can intervene in appetite or weight children. Objective: This study aims to ascertain the reasons mothers manage appetite stimulants to children and what senses are involved in this act of care. Methodology: The object of this study pointed to the necessity of using methodological principles of qualitative research. The theory of Social representations was used as theoretical support. The study was conducted through semi - structured interviews with 15 mothers living in a neighbourhood in Concei??o do Coit? (Bahia). The selected mothers should have administered drugs to stimulate appetite in their under five years old children or have related any general use of stimulant medications appetite. Data were analysed based on the technique of content analysis. Results: These medicines were used for various purposes. The main reason was to increase the amount of food eaten. To direct interest of the child to foods that mothers understand are better was another reason , along with the desire that the child gain more weight and eat at set times. To provoke disinterest in breast milk and cause sedation in children were other findings. The use of these medicines often occurred as a self-medication, stimulated and guided by nearby people and other mothers who have made the same practice. Conclusion: This research reveals a variety of reasons for the use of medicines, regulated by social representations that mothers do appetite, eating habits of the children and the pharmaceutical product classified as an appetite stimulant. / Introdu??o: A alimenta??o vai al?m da necessidade fisiol?gica. Ela se insere em um universo simb?lico que d? significados diferentes ? comida e ao nutrir. Dentro das responsabilidades maternas a alimenta??o do filho ocupa espa?o especial no cuidado. Essa tarefa materna deixa as m?es apreensivas quando os filhos n?o atendem ?s expectativas de alimenta??o esperada, seja rejeitando os alimentos ou selecionando demasiadamente o que come e como come. Esses fatores aliados a rela??o ainda existente entre corporalidade infantil e sa?de faz com que m?es busquem por medicamentos que possam intervir no apetite ou peso das crian?as Objetivo: este trabalho objetiva conhecer as raz?es das m?es administrarem estimulantes de apetite em crian?as e quais os sentidos envolvidos neste ato de cuidado. Metodologia: O objeto deste estudo apontou para a necessidade de se usar os preceitos metodol?gicos da pesquisa qualitativa. Como suporte te?rico foi utilizada a teoria das Representa??es Sociais. O estudo foi realizado por meio de entrevistas semiestruturadas com 15 m?es residentes de um bairro de Concei??o do Coit?-BA. As m?es selecionadas deveriam ter administrado em seus filhos menores de cinco anos medicamentos para estimular o apetite dos filhos ou o uso de medicamentos estimulantes do apetite. Os dados foram analisados com base na t?cnica de an?lise de conte?do. Resultados: Os medicamentos foram utilizados em empregos diversos. A principal raz?o era aumentar a quantidade de alimentos ingeridos. Direcionar o interesse da crian?a para alimentos que as m?es entendiam como melhor era outra raz?o, juntamente com o desejo que o filho ganhasse mais peso e que comesse em hor?rios pr?-estabelecidos. Despertar o desinteresse pelo leite materno e provocar a seda??o nos filhos foram outros resultados encontrados. O consumo dos medicamentos frequentemente dava-se por automedica??o, estimulado e orientado por pessoas pr?ximas e outras m?es que fizeram a mesma pr?tica. Conclus?o: A presente pesquisa revela uma diversidade de motivos para o uso dos medicamentos, regulado pelas representa??es sociais que as m?es fazem do apetite, dos h?bitos alimentares dos filhos e do produto farmac?utico classificado como estimulante do apetite.

El proyecto de rediseño del sistema se ha realizado para mantener la operación activa y el flujo de medicamentos en la empresa. Si bien la farmacia o el almacén principal representa el 10% de los ingresos netos de la organización, es la principal área de apoyo para los principales servicios ofrecidos por la clínica a los clientes, ya que es responsable del suministro médico al consumidor interno y externo donde se interactúa con las actividades de la empresa. La implementación del proyecto consistió en calcular los lotes óptimos para cada línea de productos que se agruparon para un mejor tratamiento de los medicamentos: 700 artículos a 50 familias. Las líneas de productos para aquellos con características similares se definieron y se pudieron comprar a un proveedor en particular. Además, se establecieron descuentos para reducir los niveles de precios en la farmacia. En relación con el control de stock, se estableció el Plan Cíclico basado en el análisis Multicriterio ABC. Como parte del alcance del proyecto, se tomó una muestra con un nivel de confianza del 90% de la implementación del tipo de producto "A" total para aplicar durante 3 meses. En efecto, los pedidos de productos elegidos en el Plan Piloto cayeron del 80% al 12.5% de las ventas no atendidas por la falta de disponibilidad de existencias y los altos precios. Los resultados se lograron con la implementación de nuevos procedimientos de POES que involucran a los responsables de las áreas de la Clínica. / The System redesign project has been done in order to maintain active operation and flow of medicines in the company. Although Pharmacy - or main warehouse - accounts for 10% of net income in the organization, it is the main area of support for the main services offered by the clinic to the customers, because it is responsible for the medical supply to consumer internal and external interacting with the activities of the company. The implementation of the project was to calculate the optimal batch order for each product line, which were grouped for better treatment of medicines - 700 items to 50 families. Product lines for those with similar characteristics were defined and could be purchased from a particular vendor. Also, discounts were established to reduce the levels of prices in the pharmacy. In relation to stock control, counting Cyclical Plan based on analysis Multicriteria ABC was established. As part of the project scope, a sample at 90% confidence level of total product type “A” implementation to apply for 3 months was taken. In effect, orders for products chosen in the Pilot Plan fell from 80% to 12.5% of sales not served by non-availability of stock and high prices. The results were achieved with the implementation of new POES procedures involving those responsible for the areas in the Clinic. / Tesis

Concern beliefs in medicines are patients' anxieties about the harmful effects of a specific prescribed medication. Three papers examined the importance of concern beliefs in medicine, specifically its relationship to patient outcomes such as self-reported adverse drug events (ADEs) and symptom attribution, and the factors that might drive a change in concern beliefs over time. For the first and second paper, a cross-sectional internet survey of Medicare enrollees who were English speakers, 65 years and older and enrolled in the Medicare Part D program was done. In the third paper, a longitudinal internet survey of the same sample was done before Medicare Part D in 2005 and after Medicare Part D in 2007, and adults 40 years and older with physical limitations were interviewed using telephone. Multiple logistic regressions showed that having stronger concern beliefs in medicine and more symptoms was related to self-reported ADE, rather than using an inappropriate medicine or the number of inappropriate medicines used. Using independent sample t-tests, concern beliefs in medicine were found to be unrelated to symptom attribution for any causal reason, irrespective of whether there was patient-clinician agreement on attribution. Multiple linear regressions showed that concern beliefs changed over time for some older adults and having an ADE in the past year was related to this change. Among adults with physical limitations, though concern beliefs changed for some individuals; only one factor included in this study, changes in number of medicines, was related to this change. Establishing the importance of concern beliefs in medicines as a socio-psychological variable to consider in medication use outcomes will enhance the understanding of clinical researchers and practitioners concerning the mechanism of ADEs and symptom reporting.

My diploma thesis mainly deals with monitoring Ayurveda and description of this phenomena in specific situations and contexts. Ayurveda is understood as an entity based on the actor network theory and the symmetrical anthropology which has been constructed in a process of mutual relationships of actors alleging of various natures (material, social, discursive). The main focus is on the ways of setting and redefining of boundaries of Ayurveda as such which have been realized through identification of significant parts related to this process. It was decided to define the key actors as the Teacher, the Doctrine, the Ayurveda Institution, approaches to human body by alimentation, yoga and breath exercise and Ayurvedic medicines. Each chapter is dedicated to both elements and practices influencing these key actors and different ways of their realization. Ayurveda in its entirety is intervened by members of the community, canonical Ayurvedic texts, biomedicine, national and EUs legislative, climate, politics of Institution, individual daily routines and collective scope of interpretation. 1

Over the last few years, significant immune system changes have been observed in tumor patients exposed to different treatments. Moreover, evaluation and prediction of the responses of treatments given to these patients can become a key component. Therefore, it is critical to develop a pipeline for a systematic approach where complete monitoring of the immune system and interpretation of data from different assaysare involved in predicting treatment effects. Most of the children in the study involved were diagnosed with neuroblastoma, osteosarcoma, wilms tumor, and brain tumor. In this study,whole blood samples from children with solid tumors were used. The analysis was done on cells, proteins, and genes to gather comprehensive information on the immune system's composition and function. This study extracts cell-specific signatures with modern mass cytometry technology, proteins with a proximity extension assay, and mRNA whole blood sequencing. These assays were analyzed with different statistical models such as multivariate, mixed effect model, and multi-omics factor analysis. These assay signatures provided information about the contribution of specific immune cells, plasma proteins, and genes associated with a tumor. The use of these signatures in diagnosing and treating solid tumors has been discussed in the form of a shared trajectory of recovery among tumor patients / <p>Presentation was approved with Instructions of additional information in the report.</p>

En Perú el gasto de bolsillo es el principal financiamiento de los servicios de salud (MINSA, 2018), siendo la botica el principal punto de contacto. Lima Metropolitana tiene un 22.5% de la población con hipertensión arterial (INEI, 2019), 5.1% con diabetes (INEI, 2019) y 33% con triglicéridos y colesterol total elevados (INS, 2020), quienes requieren tratamiento con medicamentos y el uso de dispositivos médicos. Adicionalmente, el volumen de ventas del 2020 de medicamentos creció entre 2% y 3%, y el canal online aumentó un 42%, mostrando un importante cambio en las tendencias de compra (Gestión.pe, 2021). Una Botica digital con entrega por delivery mejoraría el acceso a medicamentos y dispositivos médicos requeridos para estas enfermedades; los pacientes podrían solicitar su tratamiento desde la comodidad de su hogar, recibiéndolos de manera oportuna y mejorando la adherencia al tratamiento, evitando las complicaciones de las distancias, tiempos de traslados y riesgos de acudir personalmente. Lima moderna tiene más población de los niveles socioeconómicos A, B y C, quienes mayormente compran productos por internet (APEIM, 2020). Pharma Place, presenta una estrategia de enfoque debido a la especialización de los productos, la venta por canal digital y la entrega por delivery. Dentro de las ventajas competitivas se consideran la innovación tecnológica y ser la primera botica digital especializada en Lima. La inversión requerida es S/ 325,000.00 los cuales serán financiados por los socios y entidades bancarias, el análisis de factibilidad financiera muestra un VAN de S/ 329,491.90 y TIR de 46.10% en un escenario conservador. / In Peru, the health out-of-pocket spending is the main financing for health services (MINSA, 2018), with the drugstore being the main point of contact. Metropolitan Lima has 22.5% of the population with arterial hypertension (INEI, 2019), 5.1% with diabetes (INEI, 2019) and 33% with high triglycerides and total cholesterol (INS, 2020), who require drug treatment and the use of medical devices. Additionally, the 2020 sales volume of medicines grew between 2% and 3%, and the online channel increased by 42%, showing an important change in purchasing trends (Gestión.pe, 2021). A digital drugstore with the supply by delivery would improve access to medicines and medical devices required for these diseases; patients could request their treatment from the comfort of their home, receiving them in a timely manner and improving adherence to treatment; thus avoiding the complications of distances, travel times and risks of going in person. Modern Lima has a larger population of socioeconomic levels A, B and C, who mostly purchase products through the internet. Pharma Place presents a focus strategy due to the specialization of the products and the sale through the digital channel; the main competitive advantages are technological innovation and being the first specialized digital drugstore in Lima. The required investment is S/ 325,000.00 which will be financed by the associates and banks; the financial feasibility analysis shows an NPV of S/ 329,491.90 and IRR of 46.10% in a conservative scenario. / Trabajo de investigación

La circulation en ligne des médicaments est une réalité de notre monde numérique. Elle s’exprime entre autres à travers la circulation des informations, des services, des idées, des produits. Au regard du rôle du médicament dans le cadre de la thérapie de soins, ce nouveau mode de distribution ne peut être régi uniquement par le cadre juridique d’ordre général applicable au commerce électronique. Le médicament, avant d’être un produit du commerce, est un produit de santé publique ; et l’accès à ce dernier un « droit humain ». En raison de cet ensemble d’éléments, l’entrée du médicament dans le « marché numérique » soulève plusieurs enjeux juridiques ; et justifie la réticence du législateur (au sens classique) qu’il soit national ou international. Cette réticence qui remet en cause le principe de libre circulation des biens et des services, est due à un certain nombre de défis que pose la création d’un circuit de distribution fiable dans le cyberespace. Ces défis sont liés à la définition des normes devant régir la création d’une architecture au sein de laquelle il est facile d’effectuer les contrôles qui garantissent la qualité des produits pharmaceutiques. En outre, la création du « marché électronique » du médicament suppose la définition des acteurs aptes à assurer le bon fonctionnement de cette architecture. Bien plus, il s’agit de la capacité de nos systèmes juridiques à définir un corpus normatif capable de réguler les incidences de la numérisation du circuit de distribution sur les pratiques et les relations entre les différents acteurs. L’objectif visé est de favoriser la disponibilité du « bon médicament pour le bon patient et au bon moment ». Or dans une analyse pragmatique et à l’heure actuelle du développement de la connaissance du cyberespace, la définition d’un tel corpus normatif n’est pas aisée en raison du caractère sans cesse changeant du « marché électronique » qui ne permet pas d’avoir des cadres de références stables. L’idée que nous avons partagée dans le cadre de cette analyse est celle selon laquelle ces défis ne devraient pas nous empêcher de travailler à la création d’un système légal de distribution en ligne qui définit le statut juridique des différents acteurs intervenant dans le circuit de distribution. En bref, un système qui fixe les cadres de références qui régissent l’architecture au sein duquel se font les opérations en ligne; et qui protège les cyberpatients tout en les transformant en « actients ». Pour ainsi dire, des « cyberconsommateurs » outillés sur les procédures de contrôle et de recours possibles en cas de préjudice subi, car dans le déni de construire un système de distribution légal, on laisse la place à la prolifération d’un réseau illégal de distribution en ligne. / The online circulation of medicines is a reality of our digital environment. It is a fact in our digital world through the flow of information, services, ideas, and products. It cannot be governed only to the general legal scope applicable to the e-commerce because of the function of drug within the framework of care therapy. Since, before being a commercial product, the drug is a public health product and access to it is part of the right to health. That is the reason why its insertion into the digital market raises several legal issues; and justifies the reluctance of the legislator (in the classical sense), whether national or international, to promote its entry into the “electronic market”. This reluctance, even if it calls into questions the principles of free movement of goods and services, is due to a number of challenges raised by the establishment of a trustable distribution channel in cyberspace. The challenges are linked to defining the standards that should govern the creation of an architecture within which it is easy to perform the necessary control useful to ensure the quality of pharmaceutical products. The creation of the “electronic market” of drug equally suppose, the definition of actors capable to sustain the good functioning of that architecture and having well legal defined status. Besides, it takes to the capacity of our legal systems to define a nominative corpus able to regulate the issues of the digitization of the distribution process over the practices and relations between actors. However, in a pragmatic analysis and at the current time of the development of the cyberspace, the definition of such a normative corpus is not that easy due to the fast changing character of the cyberspace that does not allow to have stables framework of references necessary to define the normative corpus. The idea shared in this analysis is that these challenges should not prevent us from working to create a legal online distribution system. A system that defines the different actors who intervene in the distribution and sets the frames of reference that govern the architecture within which online operations take place. But above all, which protects cyber patients, while transforming them into real “active patient” capable of making informed choices online. Cyber consumers equipped with the control procedures and possible recourse in the event of damage suffered. Because, in the denial of building a legal distribution system, there is space for the proliferation of an illegal network.

In this thesis, the aim is to address the persistent challenges posed by differing perspectives despite the establishment of the TRIPS agreement, which serves as a shared foundation for addressing legal and practical gaps among jurisdictions worldwide. The focus is on analyzing the Bolar exemptions within TRIPS Flexibilities for pharmaceutical patents in three specific regions: the Republic of Finland, the People's Republic of China (China), and the United States (the US). By employing a hierarchical approach that incorporates deductive theory, examination of legal cases, and literature review, this research aims to identify and resolve disparities between these jurisdictions. Both international law and national legal systems are scrutinized to ensure comparability across the three continents. Ultimately, the study presents a comprehensive assessment of the advantages and disadvantages associated with implementing Bolar provisions in each country, particularly in the context of facilitating access to vaccines during the COVID-19 pandemic.