Yes / ackground Patient access to medicines in the community at end-of-life (pertaining to the last year of life) is vital for symptom control. Supply of such medicines is known to be problematic, but despite this, studies have failed to examine the issues affecting community pharmacy access to palliative medicines. Objective To identify community pharmacists' and pharmaceutical wholesalers'/distributors' views on supply chain processes and challenges in providing access to medicines during the last year of life, to characterise supply in this UK context. Methods Qualitative design, with telephone interviews analysed using Framework Analysis. Coding frames were developed iteratively with data analysed separately and then triangulated to examine differences in perspectives. Findings Thirty-two interviews (24 community pharmacists and 8 wholesalers/distributors) were conducted. To ensure appropriate palliative medicines were available despite occasional shortages, community pharmacists worked tirelessly. They navigated a challenging interface with wholesalers/distributors, the Drug Tariff to ensure reimbursement, and multiple systems. IT infrastructures and logistics provided by wholesalers/distributors were often helpful to supply into community pharmacies resulting in same or next day deliveries. However, the inability of manufacturers to predict operational issues or accurately forecast demand led wholesalers/distributors to encounter shortages with manufactured stock levels, reducing timely access to medicines. Conclusions The study identifies for the first time how palliative medicines supply into community pharmacy, can be improved. A conceptual model was developed, illustrating how influencing factors affect responsiveness and speed of medicines access for patients. Work is required to strengthen this supply chain via effective relationship-building and information-sharing, to prevent patients facing disruptions in access to palliative medicines at end-of-life.

This thesis deals with the role of nurses in the administration of drugs in the intensive care unit. The goal is to find consistency between the legal and factual state of drug administration, ie analyze, what are the non-medical healthcare professionals authorized in accordance with applicable legislation and internal regulations of the medical device to do and what they are actually able to perform safely. The theoretical part defines the terms related to the administration of medicines. I deal with the skills of paramedical staff, indications of medicines, their administration, pharmacotherapy, mistakes and evaluation of the quality and safety of health services. The theoretical part deals with the current status of this issue and also provides insight into the history of drug administration. In the empirical part of the thesis I work with the results that I received questionnaires. Respondents are nurses, paramedics, nurses of leading nursing management and physicians. Individual items are analyzed and used to answer defined research questions. The research implies that the nurse of nursing management are able to organize an intensive care unit activities and maintain procedures, to ensure quality and safe administration of medicines. General nurses and paramedics are able to meet the doctor's...

Equitable access to essential medicines is a major challenge for policy-makers world-wide, including Central and Eastern European countries. This study analyses whether socioeconomic determinants influence the use of prescribed and non-prescribed medicines in eight Central and Eastern European countries (Bulgaria, Czech Republic, Hungary, Latvia, Poland, Romania, Slovenia, Slovakia). Further, the study discusses observed (in)equalities in medicine use in the context of the pharmaceutical policy framework and the implementation in these countries. The study is based on cross-sectional data from the first wave of the European Health Interview Survey (2007-2009). Multivariate logistic regression analyses were carried out to determine the association between socioeconomic status and medicine use (prescribed and non-prescribed medicines). This was supplemented by a pharmaceutical policy analysis based on indicators in four policy dimensions (sustainable funding, affordability, availability and accessibility, and rational selection and use of medicines). Overall, the analysis showed a gradient favouring individuals from higher socioeconomic groups in the consumption of non-prescribed medicines in the eight surveyed countries, and for prescribed medicines in three countries (Latvia, Poland, Romania). The pharmaceutical systems in the eight countries were, to varying degrees, characterized by a lack of (public) funding, thus resulting in high and growing shares of private financing (including co-payments for prescribed medicines), inefficiencies in the selection of medicines into reimbursement and limitations in medicines availability. Pharmaceutical policies aiming at reducing inequalities in medicine use require not only a consideration of the role of co-payments and other private expenditure but also adequate investment in medicines and transparent and clear processes regarding the inclusion of medicines into reimbursement. (authors' abstract)

<p>The underlying rational behind the protection of intellectual property rights is to strike a balance between the interests of intellectual property rights holders on the one hand and users of protected knowledge on the other hand. This thesis sought to achieve the following objectives: to create a good understanding of the historical development of the primary and secondary legal instruments related to the intellectual property rights/public health debate / to determine to what extent a balance is struck by the Agreement on Trade Related Aspects of Intellectual Property Rights with reference to the flexibilities provided for in the Treaty, read together with the subsequent World Trade Organization Ministerial Declarations and TRIPS Council Decisions / to evaluate the extent to which selected developing and least developed country members of the World Trade Organization have taken measures to implement the said flexibilities, taking cognizance of their relevant strengths and weaknesses / to suggest ways in which select countries in the developing world specifically India and Zambia can take greater advantage of the flexibilities to promote better access to medicines which taking into consideration various opportunities and threats that are foreseeable / to identify public health aspects of TRIPS that the developing country and least developed countries World Trade Organization members would do well to address in further negotiations.</p>

Le médicament propose de concilier sa finalité sanitaire et la maîtrise budgétaire en empruntant la voie concurrentielle par laquelle le paysage des antagonismes ne cesse de défiler. Convoquant le droit dans son dessein, le médicament lui présente des conditions semblant indépassables ; surtout lorsque dans l'équation s'invite un autre objet paradoxal : le marché. La rencontre d'une demande irrationnelle, insensibilisée à la dépense qui, de surcroit, ne détermine pas seule son besoin, avec une offre naturellement monopolistique oblige l'intrusion de l'État dans les mécanismes de marché. La détermination du marché pertinent, outil économique converti au droit, en devient un précieux outil politique. Offrant d'expliquer le marché en identifiant sa réalité concurrentielle, il oblige à l'analyse de ses structures, des déterminants comportementaux des agents s'y confrontant et, plus que de révéler des pouvoirs de marché qui manquent d'être équilibrés, renseigne sur l'état du marché : son équilibre concurrentiel, sa finalité naturelle ; son équilibre social, sa finalité culturelle. Délimitant le champ d'application du droit de la concurrence, le marché pertinent conditionne la stratégie concurrentielle des opérateurs et cristallise les tensions entre le droit et l'économie. Cette thèse démontre que malgré les typicités du médicament, la méthodologie traditionnelle de définition du marché pertinent demeure opérationnelle dans le secteur pharmaceutique. / The definition of the relevant market aims at identifying the competitive constraints that an undertaking faces and, thus, defines the scope of competition law enforcement. Given the antagonisms that characterise the pharmaceutical sector, defining the relevant market in this industry seems to disqualify the classic methodology and points out the tensions between law and economy. The interaction of an irrational demand - one which is insensitive to the expenditures and that doesn't define its needs on its own - with an offer naturally monopolistic, makes the involvement of the State in the market mechanisms strictly necessary to ensure its equilibrium. This thesis demonstrates how the conventional tools used to define relevant product markets remain operational inspite of the idiosyncrasies of the pharmaceutical sector.

This was a two phase study exploring lay perspectives of medicines for dementia. In phase one, participants were recruited from 4 local branches of the Alzheimer's Society in the southwest to take part in a single focus group or interview. In total 5 people with dementia and 23 carers participated. The aim was to explore perceptions of medicines on day-to-day life. Findings fell into 3 superordinate themes: On Being a Carer; Interacting with Healthcare Professionals and Living with a Degenerative Illness. Participants described great variability in access to medicines and in outcomes of consultations with healthcare professionals. Ageism and therapeutic nihilism were commonly encountered. Phase Two was a longitudinal study exploring the impact of medicines for dementia in early stage disease using a case study approach. Seven case studies were recruited via memory clinics; with four receiving a medicine for dementia and three not. Case study participants were followed over a 13-month period. The superordinate themes were: Living with a Memory Problem or Dementia; Interacting with Healthcare Professionals and Medicines for Dementia. Even in the early stages of a dementia spousal relationships were negatively affected. Medicines for dementia enabled renegotiation of spousal relationships and adjustment and acceptance to take place. The Mini-Mental State Examination was perceived to tell only half the story and was insensitive to improvements in alertness, initiative, engagement with the individuals' lifeworld and ability to maintain and engage in social relationships. Overall both phases found access to medicines for dementia a complicated and long procedure. The methods for assessing response were perceived as threatening and unrealistic. There was a perceived need for greater education about dementia and its treatment for healthcare professionals, people with dementia and their carers. It was identified that pharmacists could take a more proactive role in providing a pharmaceutical care service.

O uso prolongado de medicamentos ácidos na cavidade bucal de crianças com desordens crônicas causam preocupação, devido ao risco de erosão dental. O objetivo deste estudo foi avaliar, in situ, o efeito de um medicamento antiasmático de uso prolongado (Sulfato de Salbutamol) no esmalte e dentina de dentes decíduos. Molares decíduos foram seccionados, de forma a obter fragmentos de esmalte e de dentina (3 x 3 x 2 mm) da porção coronária. Os espécimes foram esterilizados, incluídos em resina epóxica, planificados, polidos sob refrigeração, e inspecionados em microscópio ótico quanto à presença de trincas. Vinte e oito espécimes de esmalte e 28 de dentina foram selecionados e armazenados. A microdureza Knoop, a morfologia microscópica e a rugosidade das superfícies iniciais foram avaliadas. Quatorze voluntários usaram dispositivos palatinos, contendo dois fragmentos de dentina e dois de esmalte, posicionados dos lados direito e esquerdo, em nichos 1 mm abaixo da superfície palatina. Neste experimento split mouth, os voluntários realizaram o tratamento das superfícies três vezes ao dia (às 8 h, 12 h e 17 h) por 5 dias consecutivos, gotejando ex vivo 5 ml de Sulfato de Salbutamol, por 1 min, somente nos espécimes de um dos lados do aparelho, definido por sorteio. Os espécimes contralaterais do dispositivo palatino não foram submetidos ao desafio erosivo (Controle). Após o término do experimento, os espécimes foram removidos dos aparelhos e verificou-se a morfologia microscópica, a rugosidade, o perfil de desgaste e a microdureza das superfícies. Os resultados foram avaliados pelo teste estatístico não paramétrico de Friedman, utilizando a mediana da diferença dos valores finais e iniciais para todas as variáveis de resposta. Nas superfícies de esmalte expostas ao medicamento, observou-se erosão nas imagens de microscopia, aumento significativo da rugosidade (p=0,0325) e do perfil de desgaste (p=0,03251) e diminuição da microdureza Knoop (p=0,0325), em relação ao Controle. Nas superfícies de dentina foi observada erosão apenas nas imagens de microscopia. Não foi constatado aumento significativo na rugosidade (p=0,593), no perfil de desgaste (p=0,285), tampouco diminuição da microdureza Knoop (p=0,1088). Pode se concluir que o Sulfato de Salbutamol teve efeito erosivo in situ no esmalte de dentes decíduos e na dentina de dentes decíduos este efeito foi observado apenas morfologicamente. / Prolonged use of acidic drugs in the oral cavity of children with chronic disorders cause concern, because of the risk of dental erosion. The aim of this study was to evaluate the in situ effect of a long term relief anti-asthmatic drug (salbutamol sulphate) on enamel and dentin of primary teeth. Deciduous molars were sectioned to obtain slabs of enamel and dentin (3 x 3 x 2 mm) of the crowns. The slabs were sterilized, embedded in epoxy resin and polished planned under refrigeration and inspected by an optical microscope for the presence of cracks. Twenty-eight specimens of enamel and dentin 28 were selected and stored. The Knoop microhardness, roughness and 3D morphology of the baseline surfaces were examined. Fourteen volunteers wore palatal appliances containing two specimens of dentin and two specimens of enamel, positioned in niches 1 mm below the surface on the right and left sides. In this split mouth experiment, the subjects underwent surface treatment 3 times per day (8 h, 12 h and 17 h) for 5 days, dripping ex vivo 5 ml of salbutamol sulphate for 1 min in only one side of the palatal device, defined by lottery. After the end of the experiment, the specimens were removed from the palatal device and were verified the microscopic morphology, roughness, confocal profilometry and Knoop microhardness of the dentin and enamel surfaces. The results were evaluated by the nonparametric Friedman test using the median difference of the final and initial values for all analyses. For the primary enamel surfaces exposed to the drug were observed erosion on microscopy images, the mean increase in roughness (p = 0.0325) and tooth surface loss (p = 0.03251) and a significant decrease in microhardness (p = 0.0325) compared to the control group. Dentin erosion was observed only in microscopy images. There was not observed a significant increase of dentin roughness (p = 0.593) and tooth surface loss (p = 0.285) or microhardness decrease (p = 0.1088). It can be concluded that the salbutamol sulphate had an in situ erosive effect on enamel of primary teeth and on dentin of primary teeth this effect was observed only morphologically.

O uso prolongado de medicamentos ácidos na cavidade bucal de crianças com desordens crônicas causam preocupação, devido ao risco de erosão dental. O objetivo deste estudo foi avaliar, in situ, o efeito de um medicamento antiasmático de uso prolongado (Sulfato de Salbutamol) no esmalte e dentina de dentes decíduos. Molares decíduos foram seccionados, de forma a obter fragmentos de esmalte e de dentina (3 x 3 x 2 mm) da porção coronária. Os espécimes foram esterilizados, incluídos em resina epóxica, planificados, polidos sob refrigeração, e inspecionados em microscópio ótico quanto à presença de trincas. Vinte e oito espécimes de esmalte e 28 de dentina foram selecionados e armazenados. A microdureza Knoop, a morfologia microscópica e a rugosidade das superfícies iniciais foram avaliadas. Quatorze voluntários usaram dispositivos palatinos, contendo dois fragmentos de dentina e dois de esmalte, posicionados dos lados direito e esquerdo, em nichos 1 mm abaixo da superfície palatina. Neste experimento split mouth, os voluntários realizaram o tratamento das superfícies três vezes ao dia (às 8 h, 12 h e 17 h) por 5 dias consecutivos, gotejando ex vivo 5 ml de Sulfato de Salbutamol, por 1 min, somente nos espécimes de um dos lados do aparelho, definido por sorteio. Os espécimes contralaterais do dispositivo palatino não foram submetidos ao desafio erosivo (Controle). Após o término do experimento, os espécimes foram removidos dos aparelhos e verificou-se a morfologia microscópica, a rugosidade, o perfil de desgaste e a microdureza das superfícies. Os resultados foram avaliados pelo teste estatístico não paramétrico de Friedman, utilizando a mediana da diferença dos valores finais e iniciais para todas as variáveis de resposta. Nas superfícies de esmalte expostas ao medicamento, observou-se erosão nas imagens de microscopia, aumento significativo da rugosidade (p=0,0325) e do perfil de desgaste (p=0,03251) e diminuição da microdureza Knoop (p=0,0325), em relação ao Controle. Nas superfícies de dentina foi observada erosão apenas nas imagens de microscopia. Não foi constatado aumento significativo na rugosidade (p=0,593), no perfil de desgaste (p=0,285), tampouco diminuição da microdureza Knoop (p=0,1088). Pode se concluir que o Sulfato de Salbutamol teve efeito erosivo in situ no esmalte de dentes decíduos e na dentina de dentes decíduos este efeito foi observado apenas morfologicamente. / Prolonged use of acidic drugs in the oral cavity of children with chronic disorders cause concern, because of the risk of dental erosion. The aim of this study was to evaluate the in situ effect of a long term relief anti-asthmatic drug (salbutamol sulphate) on enamel and dentin of primary teeth. Deciduous molars were sectioned to obtain slabs of enamel and dentin (3 x 3 x 2 mm) of the crowns. The slabs were sterilized, embedded in epoxy resin and polished planned under refrigeration and inspected by an optical microscope for the presence of cracks. Twenty-eight specimens of enamel and dentin 28 were selected and stored. The Knoop microhardness, roughness and 3D morphology of the baseline surfaces were examined. Fourteen volunteers wore palatal appliances containing two specimens of dentin and two specimens of enamel, positioned in niches 1 mm below the surface on the right and left sides. In this split mouth experiment, the subjects underwent surface treatment 3 times per day (8 h, 12 h and 17 h) for 5 days, dripping ex vivo 5 ml of salbutamol sulphate for 1 min in only one side of the palatal device, defined by lottery. After the end of the experiment, the specimens were removed from the palatal device and were verified the microscopic morphology, roughness, confocal profilometry and Knoop microhardness of the dentin and enamel surfaces. The results were evaluated by the nonparametric Friedman test using the median difference of the final and initial values for all analyses. For the primary enamel surfaces exposed to the drug were observed erosion on microscopy images, the mean increase in roughness (p = 0.0325) and tooth surface loss (p = 0.03251) and a significant decrease in microhardness (p = 0.0325) compared to the control group. Dentin erosion was observed only in microscopy images. There was not observed a significant increase of dentin roughness (p = 0.593) and tooth surface loss (p = 0.285) or microhardness decrease (p = 0.1088). It can be concluded that the salbutamol sulphate had an in situ erosive effect on enamel of primary teeth and on dentin of primary teeth this effect was observed only morphologically.

Submitted by FERNANDA DE CASTRO NAKAMURA null (jkr.nanda@hotmail.com) on 2017-03-06T18:10:38Z No. of bitstreams: 1 FERNANDA DISSERTAÇÃO.pdf: 896591 bytes, checksum: c674cad38f560727036c1313e3d8f742 (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-03-10T16:28:16Z (GMT) No. of bitstreams: 1 nakamura_fc_me_fran.pdf: 896591 bytes, checksum: c674cad38f560727036c1313e3d8f742 (MD5) / Made available in DSpace on 2017-03-10T16:28:16Z (GMT). No. of bitstreams: 1 nakamura_fc_me_fran.pdf: 896591 bytes, checksum: c674cad38f560727036c1313e3d8f742 (MD5) Previous issue date: 2017-02-16 / Este trabalho tem como foco a análise da atuação do Ministério Público no âmbito do processo de judicialização da saúde na região de Ribeirão Preto. A pesquisa toma como referência o tema da Repercussão Geral nº262 no STF, que trata sobre a propositura de ações civis públicas em benefício de um grupo de pessoas com determinadas doenças. O objetivo é, portanto, a análise da dinâmica da judicialização da saúde por meio da atuação do Ministério Público do Estado de São Paulo, do processo de expansão da Instituição e da sua inserção na esfera da política pública de fornecimento gratuito de medicamentos. Para tanto, a sua realização se deu mediante levantamento bibliográfico, com a utilização de fontes que tratam sobre temas relacionados à judicialização da saúde e à atuação do Poder Judiciário e Instituições paralelas nas políticas públicas. Do mesmo modo, foi realizada uma investigação sobre os pedidos realizados nas ações civis públicas visando o fornecimento de medicamentos propostas pelo Ministério Público de São Paulo nos anos de 2010 e 2011 na região de Ribeirão Preto. A pesquisa teve, ainda, como papel complementar a análise e comparação da Relação Nacional de Medicamentos Essenciais e da Lista de Medicamentos Essenciais do Estado de São Paulo, com os dados coletados nas ações civis públicas, o que permitiu aferir que a judicialização influencia de maneira virtual na reorganização das listas de medicamentos federal e estadual dos anos posteriores aos do recorte temporal da pesquisa. Em conclusão, chegou-se à delimitação de alguns parâmetros que se perfazem na adoção de critérios que atendam as necessidades regionais, por meio de um estudo epidemiológico a ser feito pelo Poder Público, bem como, da eventual elaboração de uma política específica para os insumos, com a utilização dos dados obtidos pela judicialização; o que, consequentemente, acarretaria em uma economia de recursos materiais e institucionais tanto para o Poder Judiciário e Ministério Público como para os entes federativos, por conta da readequação do sistema de fornecimento gratuito de medicamentos. / This work focuses on the analysis of the role of the Public Prosecutor within the process of judicialisation of health in the region of Ribeirão Preto. The research take as reference the issue of the general repercussion nº262 on Brazilian´s Supreme Court, which deals on the filing of public civil actions on behalf of a group of people with certain diseases. The objective is, therefore, the analysis of the dynamics of the judicialisation of health through the perfomance of the São Paulo State Prosecutor's Office, the expansion process of the Institution and its insertion in the sphere of the public policies of free supply of medicines. For this purpose, its realization took place through bibliographical research, with the use of sources that deal on issues related to health litigation and the role of the Judiciary and parallel institutions in public policies. In the same way, it was performed a research on the requests made in public civil actions aiming at the provision of drugs proposed by the São Paulo State Prosecutor's Office in 2010 and 2011 in the region of Ribeirão Preto. The research had as additional role the analysis and comparison of the National List of the Essential Drugs and the list of essential medicines of the State of São Paulo, with data collected in the public civil actions, which has allowed the measurement, in a virtual way, of the judicialisation influences in the reorganization of the lists of medicines, in federal and state governments, of the later years of the temporal cut of the search. In conclusion, some parameters, that are related to the adoption of criteria that meet regional needs, through an epidemiological study to be done by Public Power, as well as, the eventual elaboration of a specific policy for inputs, with the use of the data obtained by judicialisation, were delimited; which, consequently, could result in a saving of material and institutional resources, for the Judiciary Branch, Public Prosecution, and federal entities, because of the revision of the system of free supply of medicines.

No description available.