published_or_final_version / Community Medicine / Master / Master of Public Health

This dissertation evaluated the provision of two different one-to-one educational interventions, randomly assigned, to two separate groups of medical practitioners at a health maintenance organization (HMO), Cigna Healthplan of Tucson, Arizona. A control group received no intervention. Each group consisted of seven physicians and one nurse practitioner. The intervention was aimed at improving the prescribing of the anti-ulcer drugs, cimetidine, ranitidine, and sucralfate. The theoretical basis for the study involved the cognitive principle of vividness, which implies that more vivid information has greater effect on decisions. For this research, the vivid intervention included case scenarios, while the non-vivid intervention included statistical information of the results of a drug use review. Prescribing data, consisting of percentages and cost of inappropriate prescriptions, were collected for one month prior to and for two months after the intervention. Analysis of covariance was employed with the pre-intervention measures of prescribing as the covariate in each test and post-intervention measures as the dependent variables. No differences were found between the two interventions, but the control group was significantly different from the intervention groups. For the first post-intervention month, it was found that the interventions resulted in significantly lower percentages of prescriptions written inappropriately for indication, dose, or duration (P = 0.001). These percentages decreased by 36% for the intervention groups, while increasing by 14% for the control group. Costs of inappropriate prescribing per study prescription and per patient encounter were also significantly lower for the intervention groups than for the control group (P = 0.001 and P = 0.019, respectively). In the second post-intervention month, inappropriate prescribing increased slightly in the intervention groups and were no longer significantly different from the control group. The research demonstrated the effectiveness of a one-to-one educational intervention in improving drug prescribing at an HMO. The lack of differences between the two interventions may have been due to the overall effectiveness of the one-to-one educational discussion, the interpretation of the statistical information as prescribing feedback by the practitioners, or the inadequate presentation of vividness in the case scenarios.

No description available.

<p>Infusions, decoctions, alcoholic preparations and other dosage forms of Artemisia afra are frequently used in South African traditional medicine. Generally when these preparations are made without applying good manufacturing practices they do not meet microbial quality control standards, safety and toxicity criteria and encourage poor patients compliance. To overcome the aforementioned disadvantages of traditional dosage forms a sold dosage form, i.e. a table might be recommended. The first objective of this study was to formulate and manufacture a rapid release tablet dosage of Artemisia afra that would contain an amount of plant material equivalent to that found in its traditional liquid dosage forms and that would meet conventional pharmaceutical standards. The second objective was to conduct a pilot study to obtain a preliminary profile of the bioavailability of select flavonoids presents in both the tablet and traditional liquid preparation of Artemisia afra in humans.</p>

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

MEDICAL PRESCRIPTIONS IN CYPRUS Author: Papadopoulos V. Philippos Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis is to get: current knowledge about medical prescriptions (MP) in Cyprus and rules of their use their basic division according their kinds, formal look, practical handle, payment knowledge of the current Health system of Cyprus Results: The Health system of Cyprus is a unique arrangement in the EU since is a simultaneous participation of public and the private sector which has many phenomena of inequality and non- accessibility mainly from the economically weaker. In the future plans of Ministry of Health is the complete redesign of entire Health System in a direction of electronic services for all the parts of health system chain including doctors, pharmacists and insured patients. The basic and significant informations about medical prescriptions in Cyprus according aim of diploma thesis are demonstrated in the Summary Table at chapter 11. All prescriptions in Cyprus are in common form for all type of drugs and there is no rule for size and color of the paper. Pharmacist is checking the signature of the doctor as well as name of the patient and...

MEDICAL PRESCRIPTIONS IN GREECE Author: Naoum I. Panagiotis Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: The aim of diploma thesis is: to get current knowledge about medical prescriptions (MP) in Greece and rules of their use; to prepare its basic division according their kinds, formal look, practical handle with them and their payment; to get sample of different MP and finally to describe the current Greek health, pension and insurance system as a secondary aim. Results: In this diploma thesis it has been described the existing model of medical prescriptions in Greece and have been given adequate information about their basic divisions, their kinds, their formal look, and their compensation. Also it is described the course of the prescription, from the doctor to the pharmacist, harmonized with modern electronic prescribing. In the recent years (from 2009), Greece started the pilot implementation of e-prescribing for the modernization of public administration. This reform was established in order to fight against impunity and seemingly anti-ethical actions. The measure was certified by the laws of the Greek State, whereas the first results are starting to show...

Medical praescriptions in the Czech Republic Author: Petra Pečivová Tutor: RNDr. Jana Kotlářová, Ph.D. Department of social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: Was detailed analyze of the medical prescriptions in the Czech Republic, their requirements, and manipulation with that. Prescriptions for medicines (LP) were analyzed in detail, their elements and handling were also described in detail, e-prescription, and current issues were discussed, eg. forgery of prescriptions or cross- border patient pharmaceutical care. Methods: Legislation of the Czech Republic were the starting basis as at 31 5th 2014 legislation were obtained from the website of the official institutions. From there comes the economic data, augmented by specific examples of smaller public pharmacies. Publications and magazines for pharmacists and health professionals were part of the sources, as well as similar websites. Knowledge at work, including discussion is also based on the author's own experience working in a pharmacy. Results: Medical prescriptions for medicines were distributed to recipes and order forms, vouchers and orders for medical devices were described only a bit. Each of the prescriptions were explained in detail....

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.

Na atualidade, a questão dos eventos adversos a medicamentos nos idosos apresenta grande importância, dada a expansão populacional deste grupo e o impacto negativo destes eventos, que muitas vezes apresenta associação com o uso de medicamentos potencialmente inapropriados (MPI). Tendo em vista que os resultados dos estudos sobre o impacto do uso de MPI na mortalidade de idosos, ainda são inconclusivos, o objetivo foi identificar e analisar na literatura científica as evidências de que o uso de MPI em idosos, segundo critério de Beers, encontra-se associado a mortalidade. Trata-se de uma revisão sistemática finalizada em 20 de Julho de 2012, cujos procedimentos metodológicos seguiram as recomendações do Joanna Briggs Institutte e Systematic Reviews Centre for Reviews and Dissemination guidance for undertaking reviews in health care. Na busca das publicações foram utilizadas as bases de dados Pubmed/Medline, Lilacs, Scopus, Embase, International Pharmaceutical Abstracts, Web of science, Sciencedirect; CINAHL, Current contents connect, Proquest Dissertation and Theses, Banco de teses-CAPES. A seleção das publicações e extração das informações dos estudos foi realizada por dois investigadores de forma independente. A qualidade metodológica dos estudos foi avaliada pela lista de verificação Newcastle-Ottawa. A amostra da RS foi constituída por 17 estudos, sendo que destes, oito publicações compuseram a metanálise. Na síntese descritiva observou-se que a maioria dos estudos apresentou nível de evidência IV (94,1%), cujo delineamento foi coorte (94,1%), usou técnica de amostragem não probabilística (64,7%), coletou dados de modo prospectivo (64,7%), utilizou amostra superior a 1.000 idosos (64,7%), realizou seguimento de 12 a 24 meses (52,9%) e a obtenção do desfecho mortalidade ocorreu em bases de dados (64,7%). A metanálise que totalizou a participação de 90.611 participantes apontou que idosos que utilizaram MPI apresentaram maior risco relativo para o desfecho de mortalidade (RR=1,11; IC 95% 1,01 1,22; p = 0,023), de acordo com os critérios de Beers, independente do cenário do estudo, da existência de comorbidades, de polifarmácia ou do tipo de MPI usado. / Currently, the issue of adverse drug events in the elderly presents great importance, given the expansion of this population group and the negative impact of these events, which often presents association with the use of Potentially Inappropriate Medications (PIM). Having in mind that the results of studies on the impact of using MPI elderly mortality are still inconclusive, the aim was to identify and analyze the evidences in the scientific literature that the use of PIM in the elderly, according to the Beers criteria, is associated with mortality. This is a Systematic Review finalized in July 20, 2012, whose methodological procedures followed the recommendations of the Joanna Briggs Institutte and Systematic Reviews - Centre for Reviews and Dissemination Guidance for Undertaking Reviews in Health Care. In the search of the publications were used databases Pubmed / Medline, Lilacs, Scopus, Embase, International Pharmaceutical Abstracts, Web of science, Sciencedirect, CINAHL, Current Contents Connect, Proquest Dissertation and Theses database-CAPES. The selection of publications and extraction of the information of the studies was conducted by two researchers independently. The methodological quality of studies was assessed by checklist Newcastle-Ottawa. The sample was composed of RS 17 studies, of which eight publications were included in the meta-analysis. In the synthesis descriptive observed that most studies showed level of evidence IV (94.1%), whose design was cohort (94.1%) used non-probability sampling technique (64.7%), collected data from prospectively (64.7%) used sample of more than 1,000 elderly (64.7%), realized during 12 to 24 months (52.9%) and obtaining of outcome mortality occurred in databases (64.7% ). The meta-analysis which totaled the participation of 90,611 participants pointed out that the elderly who have used PIM had higher relative risk for the outcome of mortality (RR = 1.11, 95% CI 1.01 to 1.22, p = 0.023), according to Beers criteria, regardless of the setting of the study, the existence of co-morbidities, polypharmacy, or the type of PIM used.