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Dissertations / Theses on the topic 'Clinical pharmacy'

Author: Grafiati

Published: 4 June 2021

Last updated: 20 July 2024

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1

Reilly, Paul Matthew 1955. "Assessing decision-making by hospital pharmacy directors in implementing clinical pharmacy services." Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276575.

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Decision-making by hospital pharmacy directors when deciding which clinical pharmacy services to implement and/or continue to provide was assessed. Also examined was how these decision-making activities, hospital characteristics, pharmacy characteristics, and pharmacy director demographics might be associated with the number and quality of clinical pharmacy services provided, as well as the number of clinical services implemented under the current pharmacy director. Hospital pharmacy directors reported considering a relatively large number of perceived goals for a clinical service and also indicated they use a rather broad range of decision-making methodologies in evaluating those goals when determining clinical services. Numerous variables were found to be significantly associated with the number of clinical services provided by the pharmacy department and the number of clinical services implemented under the current pharmacy director. However, relatively few variables were found to be significantly related to the quality of clinical pharmacy services being provided.

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2

Luo, R. "Evaluation of an enhanced clinical pharmacy services." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517405.

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3

Clark, Monica, and Ryan Burgess. "Evaluating Research Designs of Clinical Pharmacy Services." The University of Arizona, 2011. http://hdl.handle.net/10150/623556.

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Class of 2011 Abstract
OBJECTIVES: To design a tool to assess for bias in studies for pharmacy services. METHODS: This study will involve reviewing published reports of studies comparing pharmacists’ services to usual services to identify the key study design components and methods for addressing study design limitations. We will then design a tool to assess further such studies for bias. RESULTS: The aspects of a good pharmacy services study that can be controlled include: large study population, equivalence of population at baseline, experimental mortality, multi-centered study, adequate adherence to treatment, and independence from study staff/manufacturer influence. If these things are controlled and/or accounted for it increases the strength of the study. CONCLUSION: The tool we have designed can successfully evaluate the quality of studies of pharmacy services.

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4

Cai, Yan. "Clinical and pre-clinical pharmacokinetics of green tea polyphenols." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280157.

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Tea consumption has been suggested to have beneficial effects for human health, especially in cancer prevention. At present, epidemiological evidence of the protective effect of tea consumption against the development of human cancer is not conclusive. Interpretation of epidemiological data and extrapolation of rodent data to humans are generally hampered by inadequate information on the bioavailability and pharmacokinetics of tea constituents. We have performed studies to determine the pharmacokinetics of green tea in humans after single and multiple oral dose administration of tea polyphenols and the contribution of hepatic first-pass elimination to the low oral bioavailability of green tea catechins in animals. EGCG was present in the systemic blood in the unchanged form in humans after oral administration of two green tea polyphenol products, EGCG and Polyphenon E (a mixture of major green tea polyphenols). Oral administration of EGCG and Polyphenon E resulted in similar systemic exposure of EGCG. EGC and EC were present in glucuronic acid/sulfate conjugates in blood and urine samples after the Polyphenon E administration. Large inter-subject variations in the systemic levels of green tea catechins were observed following oral administration of green tea polyphenols. We found that it is safe for healthy human subjects to take green tea polyphenols for four weeks in amounts equivalent to those contained in 8 to 16 cups of green tea once a day or in divided doses twice a day. Systemic availability of EGCG increased more than 60% after chronic green tea polyphenol administration at high doses once a day. Oral administration of green tea polyphenols at the selected doses and dosing schedules did not elicit overall changes in the selected pharmacodynamic measurements. Oral bioavailability of green tea catechins was demonstrated to be low in animals and possibly in humans. Based on our pre-clinical study, we found that first-pass hepatic elimination of green tea catechins didn't play a significant role in the presystemic elimination of orally administered catechins. Factors within the gastrointestinal tract such as limited membrane permeability, transporter mediated intestinal secretion, or gut wall metabolism may contribute more significantly to the low oral bioavailability of green tea catechins.

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5

Akhatova, Elena. "Do clinical pharmacy servicesimprove outcomes for patientswith heart failure (HF)? : Do clinical pharmacy servicesimprove outcomes for patientswith heart failure (HF)?" Thesis, Umeå universitet, Kemiska institutionen, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-106301.

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6

Alahdab, Albannay O. G. A. "Role of pharmacoeconomics in clinical pharmacy service development." Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.501231.

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7

Hellström, Lina. "Clinical pharmacy services within a multiprofessional healthcare team." Doctoral thesis, Linnéuniversitetet, Institutionen för naturvetenskap, NV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-18293.

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Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital. Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate. Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated. Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen

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8

Vinterflod, Charlotta. "Physicians’ perceptions on clinical pharmacy services : A qualitative study." Thesis, Umeå universitet, Kemiska institutionen, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-101887.

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9

Polaha, Jodi, McKenzie Highsmith, William Lusenhop, Deepu George, and Adrian Sandoval. "Clinical Evaluators Take Your Mark." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6881.

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Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting. Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work.

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10

Hajji, Feras Walid Darwish El. "Applications of risk assessment measures within enhanced clinical pharmacy provision." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546039.

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11

Hawksworth, Gillian Mary. "Pharmaceutical care - clinical community pharmacy services in primary care : an evaluation of drug monitoring, clinical interventions, domiciliary visiting and other unremunerated clinical pharmacy services which could be provided by a community pharmacist." Thesis, University of Bradford, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.559095.

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12

Stokes, Julie Anne. "Introducing clinical pharmacy as a quality use of medicines intervention in residential aged care /." [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16923.pdf.

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13

Abdi, Yasin. "The appropriateness of clinical microbiology laboratory investigations : a retrospective study of the cost and clinical relevance of specimen management and processing." Thesis, University of Portsmouth, 2011. https://researchportal.port.ac.uk/portal/en/theses/the-appropriateness-of-clinical-microbiology-laboratory-investigations(b1f5faea-580b-4dad-b033-8ecc2407ff97).html.

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Each year, NHS clinical laboratories carry out more than 700 million laboratory tests, of which 50 million are microbiology investigations. Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary, and up to 46% of ordered microbiology tests are inappropriate. In light of these accounts, the present study was undertaken to evaluate the process of microbiology specimen management in order to assess microbiology test utilisation and the appropriateness of the test ordering processes. The study focussed on respiratory tract specimens using sputum microbiology as a model for the microbiology service inappropriate test utilisation. The overall main aim of this study was to determine the appropriateness of clinical microbiology test utilisation, its clinical relevance and cost-effectiveness, hence recommend better utilisation strategies. A total of 15,941 respiratory tract samples from Barts and The London NHS Trust were randomly selected from the years 2004/05 and analysed retrospectively. Seven hundred microbiology laboratory request forms from patients for whom respiratory tract cultures were requested over a three month period were examined in detail. These requests were derived from 511 sputum specimens, 100 throat swabs, 63 ear swabs and 76 samples from other respiratory tract sites. 641 (91%) of microbiology test requisition forms were completed, provided all requested details by the service users and were therefore considered as appropriate microbiology test requisitions. 660 (94%) of those examined stated the patient’s clinical diagnosis and only in 65 (13%) of these patients was the stated diagnosis as respiratory tract infection. Sixty percent of sputum specimens examined were considered as poor quality. Forty percent of respiratory specimens were reported as culture positive, based on the local hospital criteria of microbiology test reporting. In sputum culture, 39% was reported as culture positive; however, less than 18% were positive with recognised respiratory pathogens, whilst 27% of throat swabs were reported as culture positive, of which 67% had throat pathogens. From the beginning of this study and before, there were no microbiology test comments and interpretation of test results provided with the test result reporting. The test turnaround time of respiratory microbiology results reported within three days in 2004/2005 was only 20%. The total inappropriate respiratory specimens processed locally were 9,575. Extrapolating from our results, this suggests that 2,153,977 nationally were inappropriate in NHS hospitals in 2004/2005. The total cost of inappropriate respiratory microbiology test use was approximately £152,000 in local NHS hospitals. Extrapolating from our results, this suggests that £23,900, 000 nationally was the total cost of inappropriate tests in the NHS hospitals. Following implementation of this study, follow up studies in 2006 and onwards indicated that there has been an improvement in the quality of the microbiology service. The number of good quality sputum specimens was 69% compared to 40% in 2004/2005. While the total microbiology test turnaround time that was reported within three days in 2009/2010 was more than 94%. From mid 2006 onwards, test interpretation comments have been used in all microbiology test result reporting. The total workload of respiratory tract microbiology activity decreased from 18,915/year to 16,651/year over the years 2004/2005 to 2007/2008, which is down nearly 8%. Analysis of the findings showed that the usefulness of culture results was limited by the collection of inappropriate specimens, and lack of clinical information on the microbiology request form. The crucial importance of the role of clinical and nursing staff is stressed if the clinical relevance of sputum culture is to be maximised. The increasing introduction of electronic pathology test requests gives new opportunities to restrict the collection of inappropriate specimens and make substantial savings in resources, both in the ward and the laboratory. This type of study and audit can give invaluable information about the rationale behind testing, and the appropriateness of sampling and transport time. Appropriate measures for corrective actions can be identified.

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14

Parsons, Laura B., and John B. Bossaer. "Differences in the Hyper-CVAD Regimen throughout Clinical Trials." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/2355.

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15

Ridge, Helen E. "A multi-method study to investigate whether the pharmacist has a role on the neonatal unit." Thesis, King's College London (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.323152.

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16

Baker, D. J. "The clinical neurophysiology of organophosphate poisoning." Thesis, University of Southampton, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.259652.

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17

Darwish, Mona. "Computer modelling of clinical pharmacokinetic data." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335515.

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18

Silva, Diana Rocha Lopes. "Clinical research in community pharmacies : trying to find a way." Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/12946.

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Mestrado em Biomedicina Farmacêutica
This project aims to promote the involvement of community pharmacists in clinical research. In the last years, the pharmaceutical profession has gone through various challenges. At the same time, pharmacists have sought to develop a more active role in the community. The skills that pharmacists have allow them a more active role in clinical research, either cooperating with health units, either as researchers. The proximity to the patient and the placing in the community, allows community pharmacies to have an important role in the disclosure of clinical research. The Portuguese reality, so far, does not seem to reflect the reality of other countries in this field. However, Portugal has the necessary conditions for this situation to change. The growing importance of real world data and the placement of pharmacies in the community leave space for its involvement in clinical research to be improved. Thus, in the near future it would be important that community pharmacies are called upon to this reality. This project suggests the application of a questionnaire to Portuguese community pharmacies in order to assess the feasibility of this project, evaluating their interest in clinical research and identifying the possible barriers to their participation.
Este projeto propõe-se promover o envolvimento dos farmacêuticos de farmácia comunitária em investigação clínica. Nos últimos anos, a profissão farmacêutica tem passado por vários desafios. Ao mesmo tempo, os farmacêuticos têm procurado desenvolver um papel mais interventivo na comunidade. As competências que os farmacêuticos têm permitem-lhes um papel mais interventivo em investigação clínica, quer cooperando com as unidades de saúde, quer como investigadores. A proximidade ao utente e a inserção na comunidade, permite às farmácias comunitárias terem um papel importante em investigação clínica. A realidade portuguesa, até ao momento, não parece acompanhar a realidade doutros países neste âmbito. No entanto, Portugal reúne as condições necessárias para que essa realidade se altere. A crescente importância dos dados de vida real e o posicionamento das farmácias na comunidade deixam espaço para que a sua intervenção em investigação clínica possa ser melhorada. Assim, num futuro próximo será importante que as farmácias comunitárias sejam chamadas para esta realidade. Este projeto sugere a aplicação futura de um questionário de modo a avaliar a sua exequibilidade, avaliando o interesse das farmácias comunitárias portuguesas em investigação clínica e as possíveis barreiras à sua participação.

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19

Suggett, Emma Lucy. "Risk assessment of patients as a means of directing a clinical pharmacy service." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7336/.

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The aim of this research was to develop a new work model for hospital pharmacists based on risk assessment of patients using an electronic prescribing and administration system (EPMA). Systematic review was performed to identify risk factors associated with clinical pharmacy intervention. Those factors which can be measured by the EPMA in a UK teaching hospital were subsequently identified. Data was extracted from the EPMA relating to risks in intervention recipients on medical and surgical wards and those patients present concurrently. Univariable and multivariable analysis was performed and a risk score calculated. Receiver operating curves (ROCs) determined predictability of the score. Risk factors for pharmacist intervention were: age, female gender, patient compliance, unavailable stock, prescription of warfarin, number of allergies, comorbidities, regular prescriptions, anti-epileptics, thrombolytics/anticoagulants, central nervous system agents, and chemotherapy / immunosuppressants. The area under the ROC for the risk score was 0.61. Multiple factors were significantly and independently associated, with an increased intervention rate. However, it was not possible to generate a useful model for directing clinical pharmacy services. Inverse relationships were demonstrated between some risk factors usually associated with problems with medicines use.

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20

Al-Taani, Ghaith Mohammed Yousef. "Challenges in the provision of clinical pharmacy services to overcome medication-related problems." Thesis, Queen's University Belfast, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.669539.

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Pharmaceutical care and medicines management are terms which are often used interchangeably to describe the patient-centred services provided by pharmacists. The programme of research presented within this thesis evaluated a range of topics within this area of endeavour. The extent of pharmaceutical care provision within the community pharmacy setting was examined in a cross-sectional survey in N. Ireland and across 15 European countries. The findings indicated that community pharmacists' provision of comprehensive pharmaceutical care can be deemed as limited in Northern Ireland (mean score 41.4% of the total achievable score) and across Europe (scores ranged from 56.6% in England to 29.4% in Moldova). To inform the development of a definitive RCT for novel post-discharge medicines management clinic (MMC), a feasibility study was carried out, and identified a number of methodological challenges, in particular, challenges around patient recruitment, attrition rates and clinic scheduling. A series of risk assessment models was developed to help with the targeting of patients to be recruited for the RCT referred to above. These models were designed to forecast the likelihood of patient early readmission to hospital (within 30 and 8 to 30 days) and high-cost readmissions. Important risk factors for readmission identified included the Charlson age-adjusted co-morbidity score, respiratory- and genitourinary-related primary diagnoses and number of medications prescribed on discharge, and new patient targeting criteria for the RCT to explore the impact of the MMC was developed. A systematic content analysis revealed that the print media coverage of medicine-related adverse effects requires significant improvement in order to properly inform the public on this matter. Specifically, the reporting of adverse effects, in terms of medicines implicated and organ systems affected, did not correspond with those commonly cited in scientific journal articles. Findings from the present research help contextualise and provide evidence based advice on a number of issues which need to be addressed in pharmaceutical care / medicines management practice and research.

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21

Al-Mehsen, Fahad A. "Clinical pharmacokinetics of antibiotics in cystic fibrosis." Thesis, Queen's University Belfast, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336044.

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22

Choonara, I. A. "Clinical pharmacology of warfarin and vitamin K." Thesis, University of Liverpool, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.383440.

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23

Vincent, J. "Clinical and experimental studies with alpha1Ì² adrenoceptor anatagonists." Thesis, University of Glasgow, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.374541.

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24

Harrison, I. H. "Effect of legislation on the safety, quality and efficacy of medicines." Thesis, Cardiff University, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.374734.

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25

Aziz, Zoriah. "Herbal medicines: Physician's recommendation and clinical evaluation of St.John's Wort for depression." Thesis, Aston University, 2003. http://publications.aston.ac.uk/10950/.

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Why some physicians recommend herbal medicines while others do not is not well understood. We undertook a survey designed to identify factors which predict recommendation of herbal medicines by physicians in Malaysia. About a third (206 out of 626) of the physicians working at the University of Malaya Medical Centre were interviewed face-to-face, using a structured questionnaire. Physicians were asked about their personal use of, recommendation of, perceived interest in, and usefulness and safety of herbal medicines. Using logistic regression modelling we identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of recommendation. St. John's wort is one of the most widely used herbal remedies. It is also probably the most widely evaluated herbal remedy with no fewer than 57 randomised controlled trials. Evidence from the depression trials suggests that St. John's wort is more effective than placebo while its comparative efficacy to conventional antidepressants is not well established. We updated previous meta-analyses of St. John's wort, described the characteristics of the included trials, applied methods of data imputation and transformation for incomplete trial data and examined sources of heterogeneity in the design and results of those trials. Thirty randomised controlled trials, which were heterogeneous in design, were identified. Our meta-analysis showed that St. John's wort was significantly more effective than placebo [pooled RR 1.90 (1.54-2.35)] and [Pooled WMD 4.09 (2.33 to 5.84)]. However, the remedy was similar to conventional antidepressant in its efficacy [Pooled RR I. 0 I (0.93 -1.10)] and [Pooled WMD 0.18 (- 0.66 to 1.02). Subgroup analyses of the placebo-controlled trials suggested that use of different diagnostic classifications at the inclusion stage led to different estimates of effect. Similarly a significant difference in the estimates of efficacy was observed when trials were categorised according to length of follow-up. Confounding between the variables, diagnostic classification and length of trial was shown by loglinear analysis. Despite extensive study, there is still no consensus on how effective St. lohn's wort is in depression. However, most experts would agree that it has some effect. Our meta-analysis highlights the problems associated with the clinical evaluation of herbal medicines when the active ingredients are poorly defined or unknown. The problem is compounded when the target disease (e.g. depression) is also difficult to define and different instruments are available to diagnose and evaluate it.

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26

Liva, Sophia G. "Preclinical and clinical investigations of a novel histone deacetylase inhibitor: AR-42 (REC-2282)." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586338257085974.

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27

Smith, Fraser. "How physicians decide : a regulatory compliance perspective from clinical research." Thesis, Edinburgh Napier University, 2015. http://researchrepository.napier.ac.uk/Output/8852.

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The central aim of this thesis is to investigate how physicians, working for Pharmaceutical Product Development (PPD), a clinical research organisation (CRO), make decisions for a new industry standard for good clinical practice in medical device trials. This topic is introduced via review of decision theory and decision-making (DM) in contextual environments. Physician's career experiences, insights and perceptions of how they make regulatory compliance decisions, and how they think these new requirements should be met, are explored in the main study. The research rationale relates to the author's experience of physician DM in non-medical settings during 25 years working in the field, with a desire to ascertain how compliance influences are identified, assessed and synthesized into decisions within the workplace. Furthermore PPD physicians hold senior positions and new industry regulations require regulatory compliance decisions to be made at the highest level. In this study an interpretive phenomenological paradigm was used to ascertain how physicians make sense of industry regulation then make compliance decisions based on their roles, experiences, cues and sources of data available. Literature review identified 4 core themes (decision-making, errors, situation awareness and new requirements) that guided qualitative data collection via 2 mini-focus groups (n=3 per group) and semi-structured interviews (n=12). Review of 18 physicians' data occurred via framework analysis then comparing between contrasting positions presented. The findings found 4-5 dimensions under each core theme from which 2 frameworks were constructed: firstly, using DM tenets to guide physicians' DM in context and, secondly, identifying how to comply with new industry requirements. This research contributes to academia and practice via framework generation for DM in context. It is unique in its contextual exploration, analysis and interpretation of physicians' impressions, from departmental heads to company board members, in relation to their everyday working lives and the decision approaches used to ensure regulatory compliance within their organisational area of responsibility. The thesis ends by considering potential areas for further research such as deploying each framework, applying the framework concepts with other industry legislation changes or exploring alternative research paradigms in PPD.

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28

Boadi, Samuel. "Assessment of methods for the diagnosis of Giardia infection in a clinical laboratory." Thesis, University of Portsmouth, 2013. https://researchportal.port.ac.uk/portal/en/theses/assessment-of-methods-for-the-diagnosis-of-giardia-infection-in-a-clinical-laboratory(7fb64882-ddb5-4f35-9593-57c4b43b6290).html.

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Background: Giardiasis is an intestinal diarrhoeal illness caused by the flagellate protozoan parasite Giardia intestinalis (synonymous with Giardia lamblia and Giardia duodenalis). Traditionally, giardiasis has been diagnosed in patients using faecal concentration and microscopy techniques. Non-microscopy based tests available for the laboratory diagnoses of giardiasis include recent innovations in polymerase chain reaction (PCR) and immunoassays with increased sensitivity. The laboratory diagnosis of giardiasis is complicated by the intermittent excretion of the parasite and asymptomatic presentation that sometimes occurs with this infection. Clinicians may on occasion treat patients for giardiasis on clinical suspicion alone when diagnostic tests have failed to identify Giardia intestinalis and some of the patients do get better putting into question the performance of the diagnostic test used. At the Hospital for Tropical Diseases (HTD) in London the ova, cysts and parasite microscopy (OCP-M) is the front line test for diagnosing giardiasis. Aim: The aim of this study was to critically analyse the performance of a commercial and a published real-time PCR diagnostic tests for their potential use as front line tests for the diagnosis of giardiasis in the clinical parasitology diagnostic laboratory at the HTD. Storage conditions that will allow the best yield of Giardia intestinalis DNA from stored faecal samples were also investigated in this study. Methods: In the absence of a gold standard, a composite reference standard (CRS) of enzyme immunoassay (EIA) and rapid membrane test (RMT) was used to evaluate the performance of Primerdesign Ltd. real-time PCR kit for Giardia intestinalis (which detects only assemblages A and B subtypes) and a real-time PCR assay using Verweij et al published primers (Verweij realtime PCR) which targeted the (SSU) rRNA gene. The two tests were compared with the OCP-M test in a diagnostic accuracy study using a nonprobability sampling technique with consecutive samples. Results: The Verweij real-time PCR which targeted the (SSU) rRNA gene showed a diagnostic sensitivity of 93.4 % (95 % CI: 86.2 to 97.5%) and a specificity of 74.7% (95% CI: 63.6 to 83.8%) with a limit of detection (LOD) of < 5 cysts/ml. The Primerdesign Ltd. real-time PCR which also targeted the gdh gene showed a diagnostic sensitivity of 61.5% (95% CI: 50.8 to 71.6%) and specificity of 98.7% (95% CI: 93.2 to 99.8%) with a limit of detection (LOD) of ≤ 114 cysts/ml. Also, with a serially diluted 1 in 10 dilutions of a known concentration Giardia intestinalis DNA solution, the Verweij real-time PCR produced efficiency (E) of 96% (the slope was - 3.414) with a correlation coefficient (R2) of 0.99 and a copy number variance predominantly less than 10% (< 10%). The Primerdesign Ltd. had E = 100% (the slope was -3.342), R2 = 0.95, and a copy number variance predominantly greater than 10% (> 10%). In this study, the OCP-M missed 16.5% Giardia positive stool samples contrasted with 6.6% missed by the Verweij real-time PCR. The Verweij real-time PCR therefore showed approximately 10% increase (i.e. 16.5% - 6.6%) in detection rate over the OCP-M and with an estimated detection limit of < 5 cysts/ml of stool, it also correctly identified 70% (14/20) of the discrepant cases as true positives. OCP-M identified 10% (2/20). When sensitivities were adjusted for the Verweij real-time PCR as a result of enhancement in the detection rate of the CRS, 19.3% (94.3% - 75% = 19.3%) more positive cases were noted. The Verweij real-time PCR proved to be more robust than the OCP-M and the Primerdesign Ltd. PCR and has therefore been shown to be more suited for deployment as a first line diagnostic test than the other two index tests. Even in combination with the OCP-M, the sensitivity remained unchanged at 93.4%. With its high specificity, the Primerdesign Ltd. Giardia PCR kit may be useful for partitioning clinical history for epidemiological studies but with LOD of ≤ 114 cysts/ml of stool and R2 < 0.99 when faecal samples are involved, it will require further optimisation for use on clinical samples. Up to the end of April 2013, a literature search showed no independent evaluation of this Giardia real-time PCR kit. Storage affects molecular analyses and from the findings of this study stool samples are best stored in industrial methylated spirit and kept at 4-6°C if they are to be used for real-time PCR for Giardia intestinalis detection. Alternatively they can be stored in the freezer at -20°C without industrial methylated spirit. Samples should however be tested within three months of storage. Conclusion: The reason why some patients get better when they are treated empirically following microscopy negative results for Giardia intestinalis may be found in the fact that, in this study, the OCP-M failed to detect 16.5% of positive cases. The Verweij real-time PCR performed better than the OCP-M and showed an improvement of 10% in Giardia intestinalis detection rate. The Primerdesign Ltd. Giardia PCR kit requires further optimisation for use on clinical samples. The Verweij real-time PCR was more robust than the OCP-M and the Primerdesign Ltd. PCR and therefore is more suited for use as a first line diagnostic test with best results obtained when stool samples are first treated with industrial methylated spirit, stored in the fridge at 4-6°C and tested within three months of storage. The Verweij real-time PCR assay may be used as a standalone test for in combination with the OCP-M, there was no improvement in the 93.4% sensitivity when it was used alone. The OCP-M, however, has the advantage of identifying the presence of other parasites.

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Bradley, Victoria. "Determining sub-arachnoid haemorrhage in the clinical biochemistry laboratory utilising cerebrospinal fluid samples." Thesis, University of Portsmouth, 2013. https://researchportal.port.ac.uk/portal/en/theses/determining-subarachnoid-haemorrhage-in-the-clinical-biochemistry-laboratory-utilising-cerebrospinal-fluid-samples(b68c29d7-afbe-4e20-9c26-a293df652963).html.

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Introduction: Sub-arachnoid haemorrhage (SAH) occurs when cerebral artery ruptures and blood leaks out into the sub-arachnoid space. This is often a catastrophic event for the individual and morbidity and mortality rates are significantly influenced by early intervention. This makes the role of the clinical biochemistry laboratory in early diagnosis vitally important, as delays in diagnosis can have a major clinical impact. The cerebrospinal fluid (CSF) of healthy individuals is optically clear. It has, however, been recognised for over a century that it can become coloured (xanthochromia) following a cerebrovascular incident such as a SAH. This has made the main role of the clinical biochemistry laboratory in SAH diagnosis that of detecting xanthochromia in the CSF. The majority of laboratories which offer a xanthochromia screening service use the national guidelines that are based upon ultra-violet scanning spectrophotometry (350 nm to 600 nm). This analytical technique is not without its problems: it is subjective, has a possibility of inter-operator variability and due to the specialised nature of the test can take many hours or even days for a result to be issued. This project aimed to improve the current laboratory service by investigating: turnaround times, users opinions of the current service and potential alternative analytical methods. Methods: An audit of the current analytical provision was used to assess its effectiveness and in order to elucidate the service users’ perception. This was effected by a questionnaire that was distributed to service users across three different NHS Trusts in England and Wales. In an attempt to improve the laboratory service, alternatives to scanning spectrophotometry were investigated. These were selected through consideration of the nature of SAH i.e. blood is released into the subarachnoid space and the brain is damaged. Laboratory analysis therefore needed to focus on detecting the presence of blood and/or its breakdown products, any change in CSF constituents that arise as a direct consequence of blood being introduced in to the subarachnoid space or a specific analyte which would only be present if brain damage occurred. Investigation of current research into subarachnoid haemorrhage identified the following analytes as potential alternatives: CSF diazo bilirubin, CSF Ferritin, CSF protein S100 and serum protein S100. Results: The audit revealed the average turnaround time for reporting xanthochromia results to be 26 hours, with almost 20% of samples being reported as equivocal. The service user’s questionnaire revealed a general lack of awareness of current United Kingdom National External Quality Assurance Scheme (UKNEQAS) guidelines for the ‘Analysis of cerebrospinal fluid for bilirubin in suspected Subarachnoid haemorrhage’ and a lack of understanding regarding the timing of lumbar punctures. Additionally, one third of users felt that the turnaround time for results was inadequate. CSF protein S100 was found to be unsuitable due to the difficulty in achieving a suitable balance between sensitivity and specificity; at a cut-off of 0.40 μg/l sensitivity is 80% and specificity is 4%, at a cut-off of 1.60 μg/l sensitivity is 40% and specificity is 94%. Serum protein S100 was found to be unsuitable due to the difficulty in achieving a suitable balance between sensitivity and specificity at appropriate cut-offs (66 % and 73%, respectively, at a cut-off of 0.09 μg/l). When the CSF diazo bilirubin and CSF ferritin were compared to current laboratory practises using pre-defined criteria then CSF diazo bilirubin was found to be the analyte of choice to base new guidelines upon. CSF diazo bilirubin was then used as an initial ‘rule-out’ step in a new set of guidelines for the determination of SAH utilising CSF analysis. Conclusion: The new guidelines employ CSF diazo bilirubin analysis as a ‘rule-out’ step with all samples that are above the cut-off (300 nmol/l) being processed through the UKNEQAS guidelines. In order for the guidelines to be introduced and accepted, local training and education programmes for laboratory and clinical staff will need to be developed and implemented and they will need to be disseminated through publication of articles in journals relevant to both the clinical biochemistry community and requesting clinicians.

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30

Kirresh, Tatian. "Clinical and genetic determinants of tacrolimus pharmacokinetics and pharmacodynamics in the transplant population." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/1662.

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Calcineurin inhibitors (CNIs) are the cornerstone of immunosuppressive therapy following transplantation; however, immunosuppressive drug regimens consist of multiple medications with narrow therapeutic indices and substantial inter-patient variability. Despite intensive therapeutic monitoring, considerable time can elapse before the desired therapeutic concentration is achieved, which increases the risk of graft rejection or drug-related toxicities. In addition, maintaining therapeutic concentrations of CNIs does not prevent the development of toxicities, such as nephrotoxicity. Pharmacogenomics can greatly benefit solid organ transplant recipients through individualized drug therapy; tacrolimus is a widely used CNI and a substrate of cytochrome P450 3A (CYP3A) metabolizing enzymes and the efflux transporter p-glycoprotein (PGP) encoded by the ATP-binding cassette subfamily B member 1(ABCB1) gene. This dissertation describes work conducted in order to examine the effect of genetic variability in the above mentioned genes on the pharmacokinetics of tacrolimus and their contribution to a predisposition to adverse events or drug interactions in the transplant population. Our retrospective study investigating the effect of genetic polymorphisms on the risk of CNI-induced renal dysfunction identified a time-sensitive effect for the CYP3A5 expressor genotype, which predicts increased renal tubular CYP3A5 expression, in modifying the risk for renal dysfunction in liver transplant patients. This dissertation also examines the hypothesis that local tissue levels of tacrolimus and/or its major metabolite may be an improved indicator of nephrotoxicity, and through development of a robust and sensitive liquid chromatography/ mass spectrometry (LC/MS) analytical method to co-determine tacrolimus and its major metabolite, 13-O-demethyl tacrolimus (13-ODMT), in rat kidney tissues, we identified a possible relationship between tacrolimus dose and the extent of metabolite accumulation in the kidneys of rats receiving tacrolimus intra-peritoneally, paving the way for examining this relationship in kidney transplant recipients with calcineurin inhibitor-induced nephrotoxicity (CNIT). Overall, my research aims to identify biomarkers that might assist in early prediction of optimal tacrolimus starting and maintenance doses. Importantly, these studies provide the foundation for prospectively identifying patients at higher risk for adverse effects or drug interactions, with the ultimate goal of improving treatment outcome and quality of life for the transplant recipient receiving tacrolimus.

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31

Fox, Brent Irby Berger Bruce A. Felkey Bill G. "Explaining pharmacists' intentions to use personal digital assistants as clinical resources during patient care interventions." Auburn, Ala., 2005. http://repo.lib.auburn.edu/EtdRoot/2005/SPRING/Pharmacy_Care_Systems/Dissertation/FOX_BRENT_19.pdf.

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32

McLoughlin, Cormac Coburn. "Clinical and experimental aspects of suxamethonium induced muscle damage." Thesis, Queen's University Belfast, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334537.

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33

Thompson-Coon, J. "Clinical studies on interactions between #beta#-agonists and glucocorticoids." Thesis, University of Nottingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285776.

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34

Mansor, Sharif Mahsufi. "Malaria infection and drug disposition : clinical and experimental studies." Thesis, University of Liverpool, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.306571.

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35

Rimoy, Gerald Herman. "Studies on the clinical pharmacology of kappa opioid receptor agonists." Thesis, University of Nottingham, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.305134.

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36

Woodruffe-Peacock, Charlotte Anne. "Clinical trials on over-the-counter medicines in community pharmacies." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299861.

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37

Gibson, Fiona Mary. "Some aspects of the clinical pharmacology of nondepolarising neuromuscular blocking drugs." Thesis, Queen's University Belfast, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484217.

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38

Isah, Ambrose Ohumagho. "Clinical pharmacology of antiemetic agents : a study on prochlorperazine and metoclopramide." Thesis, University of Newcastle Upon Tyne, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308762.

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39

Urquhart, D. Rennie. "Clinical studies with the antiprogesterone Mifepristone (RU486) in human pregnancy termination." Thesis, University of Aberdeen, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.277383.

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Mifepristone in combination with prostaglandin was given to 135 women requesting legal termination, with up to 63 days of amenorrhoea. Various dosage regimes were employed. A 600mg dose of Mifepristone followed forty eight hours later by a prostaglandin vaginal pessary was as effective as more complex regimes given over a longer period. Complete abortion rates of greater than 90% were achieved (approaching the efficacy of the surgical alternative). The outcome of treatment was not gestation dependent. Treatment was well tolerated, acceptable to women, and associated with a low incidence of psychological morbidity. The only serious complication encountered was a 2.5% incidence of heavy bleeding requiring blood transfusion and emergency curettage. Mifepristone is also a useful cervical priming agent prior to late first trimester surgical termination. In a double blind placebo controlled study, forty women received either placebo or 600mg Mifepristone forty eight hours prior to surgery. In the treated group significant cervical dilatation was induced and significantly less force was required to dilate the cervix to allow the passage of a number 8 Karman curette. Blood loss was also significantly reduced. The treatment was well tolerated by patients. No serious complications were noted. In the second trimester, Mifepristone was given at various time intervals prior to prostaglandin induced abortion. The induction to abortion interval and doses of prostglandin required was significantly reduced in Mifepristone treated patients. There was no apparent advantage in an exposure time to Mifepristone of longer than twenty four hours. Serum hormone changes and the development of uterine activity and increased sensitivity to prostaglandins (as measured by intrauterine pressure recordings) after Mifepristone administration are presented. The results are discussed and incorporated into our understanding of the mechanisms of action of Mifepristone in human pregnancy termination.

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40

Challenor, Vivian Francis. "Plasma nifedipine concentrations in cardiovascular disease : influencing factors and clinical applications." Thesis, University of Southampton, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316429.

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41

Allen, M. C. "Some studies of the clinical pharmacology of drugs used in anaesthesia." Thesis, University of Sussex, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.372067.

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42

Abercrombie, Caroline, Leonard B. Cross, Sandra Alicia Williams, and Jodi Polaha. "Developing a Blueprint for Incorporating Clinical Environments Into IPE." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6550.

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East Tennessee State University has successfully integrated clinical environments into its IPE curriculum, providing over 200 students from several different health professions training programs with first hand experiences in team based care. Seven partner sites host IPE groups comprised of entry-level students, providing opportunities to interact with members of the health care team, tour the active facility and interact with a patient. Our team will discuss how we navigated complex logistics and partnerships to build these experiences into our paradigm. Attendees will be challenged to think creatively about working with clinical sites outside the university setting and provided with guidance for their program. At least 40 minutes of the workshop will utilize active learning techniques. This workshop will consist of four sections, three similarly structured followed by a final reflective section. The first three sections (Building the Framework, Faculty Facilitators, and Clinical Partners) will be structured similarly. A brief introduction will prompt participants to identify potential barriers, helpful resources, and/or logistical concerns associated with each topic. This will be a small group activity where attendees share and record their discussion on a provided template. This will be followed by a brief overview of how the topic was approached for implementation of the ETSU IPE curriculum, while incorporating group responses to create a large group discussion. Our team brings the value of each representing the perspective of the various roles involved in the implementation: faculty, site leader, and director.In the fourth section, attendees will use content from the prior sections to develop a blue print for their program’s opportunities in clinical environments. Our team will answer specific questions and provide consultations with the draft of attendees’ individualized blue print. The blue print can then serve as a tool to spark the development of a strategic plan for the integration of clinical environments at their program. Learner Outcomes:At the end of this workshop, attendees are expected to be able to:1) identify potential barriers, helpful resources and logistical details for partnering with clinical sites to create IPE experiences in clinical environments;2) identify barriers and helpful resources to assist faculty in facilitating IPE groups in the clinical environment;3) create a blueprint as a guide to incorporating clinical environments into the IPE curriculum.

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43

Bennett, David M. "Effectiveness of clinical practice guidelines for treating asthma in the Department of Defense: A comparison of clinical and economic outcomes between the Army, Air Force, and Navy." Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280138.

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The purpose of this research was to evaluate the strategy of the military health service (MHS) to improve asthma outcomes through the use of clinical practice guidelines (CPGs). Outcomes were evaluated at the patient level and included inpatient/outpatient visits, prescriptions dispensed, number of exacerbations, number of beddays and direct cost of therapy. In addition, provider compliance to CPG recommendations was evaluated by measuring the proportion of subjects dispensed long-acting controller medications. A nonrandomized control-group before-after design with retrospective matched-pair DoD data was used for this research. The intervention used in this research was the formal asthma CPG-use process implemented by the Army in September of 2000. Compared to baseline measures, all outcomes improved significantly (p < 0.05) in the after period for both the subjects exposed, and not exposed, to the CPG-use process. Other than the improvement noted in the number of asthma exacerbations, which was greater in the exposed group than the non-exposed group (p < 0.001), there was no other difference between groups in the amount that outcomes improved. The proportion of subjects prescribed long-term controller medications increased significantly for subjects exposed to the CPG-use process (0.30 to 0.66, p < 0.001), and for those not exposed to the CPG-use process (0.30 to 0.66, p < 0.001). Although the findings of this research suggested that a formal CPG-use process to standardize asthma therapy was associated with decreased costs, this was not supported by results regarding the clinical outcomes. To further evaluate the effect of asthma CPGs on economic and clinical outcomes, additional research is needed.

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44

Black, Kirsten. "Emergency contraception as a sexual health intervention : access and clinical outcomes through pharmacy and community provision." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497774.

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45

Ashby, Jade. "Academic and Training Requirements in Advertisements for Pharmacy Management and Clinical Director Positions: A Follow up." The University of Arizona, 2008. http://hdl.handle.net/10150/624295.

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Class of 2008 Abstract
Objectives: A follow-up analysis of academic and training requirements found in advertisements for pharmacy management, assistant director, and clinical pharmacy director positions. Methods: Advertisements appearing in the American Journal of Hospital Pharmacy (AJHP) were analyzed for academic and training criteria that were either preferred or required for pharmacy management, assistant director, or clinical pharmacy director positions. Included advertisements were for pertinent positions found in AJHP between January 2002 and December 2007. Some of the requirements or preferences that appeared in the advertisements that were analyzed included the type of pharmacy or other degree, postgraduate training including residencies and/or fellowships, board certification, and experience qualifications. Results: There was a total of 426 advertisements that met inclusion criteria. Results were listed in percentages of advertisements either requiring or preferring a certain qualification. A significant portion of ads sought applicants who had completed a residency (24% - pharmacy manager/director, 50% - clinical director, 47% - assistant/associate manager). Preferences and requirements of the PharmD or MS degree qualification decreased in percent from a previous study. However there was an increase in the relative number of ads pertaining to the MBA preference (9%, n=27). Conclusions: Many of the results from this study were similar to previous studies which looked at job qualifications in pharmacy manager and clinical directors. It remains evident that education, training, and experience play a major role in meeting the qualifications associated with obtaining a job as a pharmacy manager, clinical director, or associate director.

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46

Potvin, Kenneth A. "Use of an administrative database to develop and test a model to predict the allocation of clinical pharmacy human resources." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0021/MQ57158.pdf.

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47

Brogden, Nicole K. "CLINICAL EVALUATION OF NOVEL METHODS FOR EXTENDING MICRONEEDLE PORE LIFETIME." UKnowledge, 2012. http://uknowledge.uky.edu/pharmacy_etds/8.

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Microneedles are a minimally invasive method for delivering drugs through the impermeable skin layers, and have been used to deliver a variety of compounds including macromolecules, vaccines, and naltrexone. Microneedles can be applied to the skin once, creating micropores that allow for drug delivery into the underlying circulation from a drug formulation. The utility of this technique, however, is blunted by rapid micropore closure. This research project sought to: 1) characterize micropore lifetime and re-sealing kinetics, and 2) prolong micropore lifetime via inhibition of the skin’s barrier restoration processes. Impedance spectroscopy was used as a surrogate technique in animals and humans to measure micropore formation and lifetime. A proof of concept study in humans, using impedance spectroscopy, demonstrated that diclofenac (a topical anti-inflammatory) applied to microporated skin resulted in slower re-sealing kinetics compared to placebo, in agreement with previous animal studies. The clinical feasibility of prolonging micropore lifetime with diclofenac was confirmed via 7-day delivery of naltrexone through microneedle treated skin in humans (compared to 72 hour delivery with placebo). Lastly, naltrexone gels with calcium salts were applied to microneedle treated skin (hairless guinea pigs) to restore the altered epidermal calcium gradient; this method did not significantly extend micropore lifetime.

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48

Cooper, Andrew Ronald. "Rocuronium (ORG-9426) : clinical and pharmacological studies on a new neuromuscular blocking agent." Thesis, Queen's University Belfast, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336733.

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49

McVeigh, Gary Eugene. "An assessment of the antihypertensive efficacy and clinical pharmacology of low dose cyclopenthiazide." Thesis, Queen's University Belfast, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317053.

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50

Bell, Paul. "The use of saccadic eye movements in the clinical psychopharmacology of psychotropic drugs." Thesis, Queen's University Belfast, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261766.

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