Dissertations / Theses: 'Drug related problems (DRPs)'

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Ibrahim, N. "Drug-related problems (DRPs) in children with kidney disease." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1448344/.

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Introduction: Medicines are used with the intention of benefitting from their effect. The effects of medicines can also be undesirable and potentially lead to harm. A drug-related problem (DRP) is a term used to describe problem(s) that exist in the use of medicines. There remains a distinct paucity of data on the epidemiology of DRPs in children with kidney disease. Aim: To investigate the epidemiology of DRPs in children with kidney disease in clinical practice at tertiary Paediatric Nephrology units. Methods: Study 1: Prospective observational study on the characteristics of DRPs in hospitalised children with kidney disease. Study 2: Randomised control trial on clinical pharmacist (CP) interventions in resolving DRPs on the renal outpatient clinic. Results: Study 1: A total of 127 patients were recruited and a total of 203 DRPs were identified. The incidence of DRP was 51.2% (95% CI 43.2-60.6%) of patients reviewed by the CPs. The number of medicines prescribed per child was the only significant risk factor for the occurrence of DRPs (OR 1.06, 95% CI 1.02-1.10, p=0.002). The majority of DRPs were minor in clinical significance (68%, n=138/203). The predominant DRPs were sub-optimal drug effect. These DRPs were associated with drug selections and dosage errors. Study 2: A total of 100 patients were recruited (Control n=53, Intervention n=47). The trial showed no effect of intervention in the resolution of active DRPs (p=0.96) between the Control and Intervention arms. Conclusion: DRPs are common in children with kidney disease and necessitate a comprehensive approach to their identification and resolution. Their characteristics in both settings are different even though the majority of them shared a similar level of clinical significance. Further research is required to evaluate the effectiveness of pharmacists’ intervention in resolving DRPs at the outpatient clinics.

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Malfará, Marcia Regina Medeiros. "Avaliação do impacto das intervenções do farmacêutico clínico na prevenção de problemas relacionados à farmacoterapia em um centro de terapia intensiva pediátrico de hospital de ensino." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17144/tde-24042018-165341/.

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Erros de medicação e eventos adversos relacionados a medicamentos são comuns em pacientes hospitalizados. O risco de ocorrer problemas com a população pediátrica é cerca de três vezes maior do que com a população adulta, especialmente em unidades de terapia intensiva, onde os pacientes são submetidos a grande número de prescrições de medicamentos intravenosos, com baixo índice terapêutico e formas farmacêuticas adaptadas. A farmácia clínica tem como objetivo introduzir o farmacêutico clínico junto à equipe multidisciplinar de saúde no sentido de intervir, prevenindo problemas relacionados a medicamentos à farmacoterapia (PRF), otimizando-a e contribuindo para a segurança do paciente. O presente estudo teve como objetivo avaliar a implantação e o impacto das intervenções da farmácia clínica no Centro de Terapia Intensiva-Pediátrico (CTIP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Trata-se de estudo prospectivo, observacional e descritivo que incluiu crianças de zero a dezoito anos, no período de um ano. Foi aplicada a ferramenta Failure Mode and Effects Analysis (FMEA - Análise dos Modos de Falha e seus Efeitos) no início do estudo para avaliar os riscos relacionados aos medicamentos no CTIP e orientar a atuação da farmácia clínica, em que o farmacêutico avaliou as prescrições diárias e realizou intervenções junto à equipe multidisciplinar. Foram acompanhadas 162 crianças e avaliadas 1586 prescrições com uma taxa de PRF de 12,42% (IC95% 10,50-14,04). Foram realizadas 197 intervenções com custo salvo de R$15.118,73. Os principais tipos de intervenções foram relacionados à indicação e necessidade do medicamento. A partir destas, os grupos foram divididos em pacientes com PRF e sem PRF. Foram detectadas diferenças significativas nas seguintes variáveis: peso, idade, tempo de internação, tempo de acompanhamento, custo total, custo salvo pelas intervenções, gravidade dos pacientes avaliada pelo escore PRISM e PELOD, quantidade total de medicamentos utilizados e quantidade de medicamentos potencialmente perigosos e endovenosos contínuos. Além disso, houve diferenças significativas na taxa de óbito e nas categorias diagnósticas entre os grupos. A implantação do serviço de farmácia clínica no CTIP mostrou impacto positivo na redução de riscos relacionados a todo o processo de utilização de medicamentos. As intervenções do farmacêutico clínico identificaram e preveniram PRF, promovendo o uso racional de medicamentos e contribuindo para a redução de custos associados à prescrição médica.
Medication errors and adverse events related to drugs are common in hospitalized patients. The potential risk for medication errors in pediatric patients is about three times higher than in adults, especially in intensive care units, where patients are subjected to a large number of intravenous drug prescriptions, with low therapeutic index and adapted pharmaceutical forms. Clinical pharmacy aims to introduce the clinical pharmacist in a multidisciplinary health team in order to intervene, preventing drug-related problems (DRPs) and optimize pharmacotherapy, contributing to patient safety. This study aimed to assess the implementation and the impact of clinical pharmacy interventions in the Pediatric Intensive Care Unit (PICU) of Hospital das Clinicas of Ribeirao Preto Medical School, University of São Paulo (HCFMRP-USP). This was a prospective, observational and descriptive study which included children from zero to eighteen years of age, over a one year period. Failure Mode and Effects Analysis Tool (FMEA) was applied at the beginning of the study to assess the risks related to medicines in the PICU and to guide clinical pharmacy work, where the pharmacist evaluated daily prescriptions and made interventions along with a multidisciplinary team. One thousand five hundred and eighty-six prescriptions of 162 children were assessed, and a DRPs rate of 12.42% (95% CI - 10.50 to 14.04) was found. One hundred ninety-seven interventions were performed, with a cost saving of R$ 15,118.73. The main types of interventions were related to indication and necessity of the drug. From these, the groups were divided in patients with DRPs and without DRPs. Significant differences were found in weight, age, time of hospitalization, time of follow-up, total cost, costs saved by interventions, severity of patients assessed by PRISM and PELOD scores, total amount of medications used, and number of potentially dangerous and continuous intravenous medications. In addition, there were significant differences in mortality rate and diagnostic categories between groups. The implementation of clinical pharmacy service in the PICU showed a positive impact on patients\' treatment. The clinical pharmacist interventions identified and prevented DRPs, promoting the rational use of medications and contributing to the reduction of costs associated with medical prescription.

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Mannheimer, Buster. "Drug-related problems with special emphasis on drug-drug interactions." Stockholm : Department of Clinical Science and Education, Karolinska Institutet, 2009. http://diss.kib.ki.se/2009/978-91-7409-602-6/.

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Al-Deagi, Fawzi A. A. "Drug-related problems in elderly patients." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318951.

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Easton-Carter, Kylie 1973. "The consequences of drug related problems in paediatrics." Monash University, Dept. of Pharmacy Practice, 2001. http://arrow.monash.edu.au/hdl/1959.1/8988.

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Gordon, Karen Joyale. "Drug related problems in cardiovascular patients in primary care." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269639.

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Abramsson, Linnea. "PREVALENCE OF DRUG RELATED PROBLEMS STOPP/START in elderly people with dementia." Thesis, Umeå universitet, Farmakologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-157692.

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Petropulos, Anthony J. A. (Anthony John Alexander). "Understanding the dynamics of drug-related problems in public housing and its surrounding neighborhood." Thesis, Massachusetts Institute of Technology, 1996. http://hdl.handle.net/1721.1/69362.

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Koubaity, Majda. "Drug-Related Problems in Belgium: From community pharmacies to hospital: State of the situation and Impact." Doctoral thesis, Universite Libre de Bruxelles, 2019. https://dipot.ulb.ac.be/dspace/bitstream/2013/294510/3/TM.doc.

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IntroductionDepuis plusieurs décennies, la pratique et les soins pharmaceutiques sont soumis à plusieurs changements en partie en raison de l’évolution de la société, des progrès de la recherche et de la mise sur le marché de nouveaux médicaments. La pratique du pharmacien a passée d’une délivrance centrée sur le médicament vers la délivrance centrée sur le patient notamment par la détection, l’intervention et la résolution des Problèmes Liés aux Médicaments (PLM).Certains patients atteints d’une condition médicale particulière, tels que les patients cancéreux, peuvent être soumis à des traitements lourds qui leurs sont nécessaires mais qui peuvent les rendre plus vulnérable à l’apparition d’un PLMObjectifsL'objectif de cette thèse était de mettre en évidence la proportion des PLM dans les pharmacies d’officines ainsi qu’à l'hôpital et d’évaluer les potentielles conséquences en milieu hospitalier.La première partie était composée de deux projets ;1) Traduction et adaptation de la classification du PCNE V6.2 à la pratique et au cadre juridique pharmaceutique belge en intégrant la validation du contenu et la fiabilité inter-évaluateur de la classification adaptée. 2) Étude pilote visant à évaluer la proportion de PLM des antidouleurs les plus utilisés en Belgique.La deuxième partie de cette thèse était composée de trois projets. 1) Quantification et classification des réadmissions des PLM des patients cancéreux réadmis dans les 30 jours et mise en évidence des facteurs de risque liés à ces réadmissions ;2) Évaluation des coûts liés aux réadmissions dues aux PLM et les potentielles économies de PLM évitables ;3) Détection des interactions médicamenteuses à partir de différentes sources disponibles au sein de la population cancéreuse réadmise lors du premier projet et évaluation de l’impact de ces interactions sur la survie des patients.MéthodeLa classification du PCNE V6.2 a été adaptée et traduite pour le contexte belge. Afin d’évaluer la validité du contenu, les pharmaciens académiques et d’officines ont évalué six critères, deux qui ciblaient le mode d’emploi (compréhensibilité, utilité) et quatre le formulaire d’encodage (pertinence, logique d’agencement, exhaustivité et redondance). Lors de leur pratique quotidienne, les pharmaciens ont appliqué l'outil adapté du PCNE afin d’évaluer si les instructions avaient été respectées et de quantifier le temps nécessaire pour résoudre un PLM. Par la suite, l’analyse des encodages des pharmaciens a permis d’estimer la fiabilité inter-évaluateurs. Le second projet était une étude pilote qui a permis aux étudiants de Master 2 d’encoder avec l’outil adapté du PCNE V6.2 les PLM détectés en officine par leur maître de stage. Les PLM impliquant les antidouleurs ont été extraits de la base de données initiale et ont été analysés.La deuxième partie s’est basée sur une étude rétrospective observationnelle de six mois dans deux établissements de soins Bruxellois :un hôpital général universitaire et un centre de référence en oncologie. Afin d’évaluer les PLM, une revue de médication de type 2b a été appliquée pour chaque patient réadmis aux urgences ou suite à une consultation médicale. La probabilité d’implication d’un PLM dans la réadmission a été évaluée à l’aide du système du Centre de surveillance de l'organisation mondiale de la santé d'Uppsala (OMS-UMC). La réception de la base de données des différents coûts liés à ces réadmissions a permis une estimation des coûts de réadmission de ces PLM pour chacun des deux établissements impliqués. Le caractère évitable d’un PLM a pu être évalué par l’utilisation du questionnaire de Schumock et al. Le dernier projet à évaluer les potentielles interactions médicamenteuses à l'aide des bases de données en ligne Lexicomp® et Epocrates®. Une analyse de survie de Kaplan-Meier et une analyse de Cox ont été effectuées pour évaluer le lien entre les variables interaction et survenue du décès.RésultatsL'adaptation de l’outil a permis l'ajout de 16 items. Une bonne validation du contenue a été obtenue suite à l’évaluation des pharmaciens académiques et des pharmaciens d’officine. Un total de 109 PLM a été encodé, avec un temps de résolution moyen de 5 min. Concernant la fiabilité inter-évaluateur, 74 items sur un ensemble de 83 ont montré une fiabilité élevée. L’étude pilote a permis de recueillir 15 952 PLM, dont 1 832 pour les antidouleurs, 3 200 interventions ont été produites afin de résoudre les PLM. La majorité des PLM ont été totalement ou partiellement résolus (77,2%).Lors de la seconde partie de la thèse, l’analyse des dossiers de patients cancéreux réadmis dans les 30 jours a révélé que 123 patients avaient été réadmis pour un PLM certain (4,9%), probable (49,6%) ou possible (45,5%). Les facteurs de risque mis en évidence étaient un faible score de Charlson, la polymédication et certaines chimiothérapies (préparations à base de Platine, les anthracyclines ou les vinca-alcaloides). Un montant total de 495 869,10 € a été mis en évidence pour les réadmissions dues aux PLM, avec une durée médiane d’hospitalisation de 7 jours. Les cancers prédominants liés à ces réadmissions étaient le poumon (19,5%) et le sein (17,9%). En se basant sur les diagnostiques des médecins, une part importante (71,5%) des réadmissions du aux PLM était liée aux effets indésirables de la chimiothérapie.Le troisième projet de la seconde partie de ce travail a inclus une population finale de 299 patients réadmis 30 jours après la sortie de l'hôpital en raison d’un PLM. Selon les bases de données en ligne, entre 78,9% et 80,9% des patients étaient réadmis avec au moins une interaction. En moyenne entre 1,6 et 2,3 interactions par patient ont été détectés pour Lexicomp® et Epocrates®. Les opioïdes (29,9%) suivis des anxiolytiques (15,8%) étaient les médicaments les plus souvent impliqués. Les effets indésirables les plus prédominants étaient les dépressions du système nerveux central (SNC) et les dépressions respiratoires. Des analyses de Kaplan-Meier ont montré une différence statistiquement significative sur la survenue du décès, entre les patients avec et sans interactions. Néanmoins, le décès ne semble pas être directement lié à la présence d'une interaction.ConclusionLa première partie a pu montrer que l’adaptation de l’outil au contexte francophone belge était fiable et avait une validité suffisante pour une utilisation quotidienne. La participation de 6 facultés belges a permis une implication nationale permettant d’obtenir une grande proportion de PLM (15 952) ;parmi eux, plus de 10% concernaient les antidouleurs dont la quasi-totalité ont été complètement résolus.Concernant la deuxième partie, environ 10% des réadmissions de patients cancéreux dans les 30 jours suivant leur dernier soin étaient liées à un PLM, parmi ces réadmissions 71,5% étaient liées à un effet indésirable. Le coût médian par réadmission était de 2 406,10 €. Les PLM évitables représentaient 7,3% dont le coût s’élevait à un total 27 938,61 €. L’évaluation des interactions a pu mettre en évidence une forte proportion de potentielles interactions liées aux traitements de patients cancéreux, néanmoins cela ne semble pas être lié à la survenue du décès.Ce travail a pu mettre en évidence la présence importante de PLM en officine et la volonté des pharmaciens d’officines belges à améliorer leur pratique. Néanmoins l’intégration d’un outil plus spécifique à la pratique officinale sur le terrain permettrait une adhésion plus complète et potentiellement une meilleure détection. La deuxième partie de ce travail a montré quelques facteurs de risque intéressants et l’importante présence d'interactions, qui demandent une potentielle vigilance chez les patients cancéreux afin de réduire les risques de réadmission dues aux PLM et les coûts associés. Cependant, une meilleure communication entre les professionnels de santé au sein de l’hôpital mais également avec les prestataires extérieurs tels que les médecins de famille et les pharmaciens d’officine, pourrait permettre un meilleur suivi et une diminution de ces réadmissions avec pour objectif d'améliorer la qualité de vie des patients.
Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie)
info:eu-repo/semantics/nonPublished

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Morningstar, Bridget A. "Examination of drug-related problems in Nova Scotia seniors with diabetes using the Pharmacare Database, 1993-1995." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0021/MQ49412.pdf.

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Wallace, RIcky Reanell. "The study of the effects of religiosity on adolescent alcohol and drug use and alcohol-related problems." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007. http://digitalcommons.auctr.edu/dissertations/1164.

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The purpose of this study is to examine the effect of religiosity as a central feature on juvenile delinquents, ages 12-17, who are chronically involved with drugs and alcohol. An estimated 400,000 adolescents sought treatment for substance abuse, which does not include those who failed to come to the attention of parents, school officials, treatment providers, or researchers (Adger, 1991). It is hypothesized that religiosity will have minima] statistical significance in the lives of substance abuse adolescents. Secondly, a positive relationship between several dimensions of parental and family religiosity is also predictive of adolescent substance use. Thirdly, a positive relationship exist between religiosity and violation of social norms and laws. Its findings suggest that despite drug abusing adolescents delusional ways of thinking about the world, they continue to embrace a sense of hope that something other than themselves [God, Allah, Buddha] can help them re-establish an intrinsic sense of equilibrium in their lives. Relationships with religious oriented friends as role models is found to have had a 1 protective impact on juvenile adolescents who are involved with substance use in this study. This study further highlights the need for more empirical-based treatment strategies in working with this target population that incorporates religiosity as a intervention strategy. Key Terms: Religiosity- supernatural power or spirit [God, Buddha, or Allah] who is the center of the universe and controls all natural and living organisms. Spirituality- innate feeling of connectiveness to something greater than oneself that invokes a sense of serenity and peace of mind.

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Cunningham, Gillian. "An assessment of drug related problems in the elderly in the community and methodology for their prevention." Thesis, Robert Gordon University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296171.

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Ghaswalla, Parinaz K. "Medication-Related Problems in Older Adults: A Focus on Underuse of Warfarin and Warfarin-Antibiotic Interactions." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2631.

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The work presented in this dissertation focuses on two important medication-related problems in older adults, that is, untreated indication and drug-drug interactions, specifically with respect to a high-risk medication such as warfarin. Warfarin is a challenge to use in clinical practice due to its narrow therapeutic index, variability in dose-response and its interactions with numerous foods and drugs. This dissertation presents the research from two projects. In the first project the prevalence and predictors of warfarin use in nursing home (NH) residents with atrial fibrillation (AF), and use of secondary stroke prevention strategies was determined, in order to understand the patterns of anticoagulant use in frail NH residents and to identify patient characteristics associated with warfarin use. In the second project the effect of oral antibiotics on anticoagulation outcomes, when prescribed concomitantly with warfarin, was determined, in order to provide evidence on the clinical significance of warfarin-antibiotic interactions in older adults. In the first project a cross-sectional analysis of the prescription and resident files from the 2004 National Nursing Home Survey was done to determine the prevalence of AF and rates of use of warfarin and other anti-platelet agents, such as aspirin and clopidogrel. A multiple logistic regression model was used to determine factors associated with warfarin use. In this sample of older NH residents, 13% of residents had a diagnosis of AF, with indications for warfarin use and no contraindications to warfarin. From these patients, 30% received anticoagulant therapy with warfarin and 23% of the remaining patients received either aspirin or clopidogrel, suggesting that more than 50% of residents with AF did not receive any form of anticoagulant therapy. Non-white race, history of bleeding, and use of anti-platelet medications were associated with reduced odds of receiving warfarin. The second project was a retrospective medical record review of older patients from an outpatient anticoagulation clinic at a Veterans Affairs medical center. Results of the repeated measures ANOVA suggested a significant increase in post-antibiotic INR values with fluoroquinolones, azithromycin and amoxicillin. In addition, the percentage of patients with warfarin dose adjustments was significantly greater with fluoroquinolones and azithromycin as compared to cephalexin. No bleeding events were reported for any of these patients. In conclusion, the results of the projects suggest that there is underuse of warfarin in NH settings. Furthermore, antibiotics may be safely prescribed with warfarin in older adults as long as the INR is monitored closely.

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Tse, Brittany, Jill Augustine, and Kevin Boesen. "Impact of a Nationwide Medication Therapy Management Program on Drug-Related Problems at the Medication Management Center in 2012." The University of Arizona, 2015. http://hdl.handle.net/10150/614023.

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Class of 2015 Abstract
Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

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Gustafsson, Maria. "Optimizing drug therapy among people with dementia : the role of clinical pharmacists." Doctoral thesis, Umeå universitet, Geriatrik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118309.

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Background: Drugs are one of the cornerstones in the management of many diseases. In general, drugs are used for diagnosis, prevention, mitigation of symptoms, and, sometimes, to cure disease. However, drug treatment in elderly people, especially those with dementia and cognitive impairments, may involve significant risk of adverse drug events. The aim of this thesis was to identify the extent of potentially inappropriate drug treatment among people with dementia and cognitive impairment and to assess the occurrence and character of drug-related problems that lead to acute hospital admissions. Another aim was to assess the potential impact of a comprehensive medication review conducted by clinical pharmacists as part of a health care team on quality of patients’ drug therapy and drug-related hospital readmission rates. Method: Long-term use of antipsychotic/psychotropic drugs and associated factors were investigated among 344 and 278 people respectively with dementia living in specialized care units. Trends in the prescribing of potentially inappropriate drugs between 2007 and 2013, comprising 2772 and 1902 people, living in nursing homes in the county of Västerbotten, were assessed using six national quality indicators. Data on drug use, function in the activities of daily living, cognitive function and behavioral and psychological symptoms were collected using the Multi-Dimensional Dementia Assessment Scale. Further, an investigation of a separate corresponding population from 2012 was done, where potentially inappropriate drug use was measured before and after a total of 895 medication reviews. Finally, a randomized, controlled trial was carried out among people 65 years or older with dementia or cognitive impairment in internal medicine and orthopedic wards at two hospitals in northern Sweden. The proportion of hospital admissions that were drug-related were estimated, and also whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team could affect the risk of drug-related hospital readmissions. Results: Antipsychotic and other psychotropic drugs were frequently prescribed to people with dementia living in specialized care units for prolonged periods. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. The extent of potentially inappropriate drug use declined between 2007 and 2013. In the separate corresponding population from 2012, the frequency of potentially inappropriate drug use was significantly reduced among people who underwent medication reviews. Hospitalizations due to drug-related problems among old people with dementia or cognitive impairment were prevalent. We found that inclusion of a clinical pharmacist in the health care team significantly reduced the risk of drug-related 30-day and 180-day readmissions. However, in a subset of patients with concomitant heart failure no effect was seen. Conclusion: Among patients with dementia or cognitive impairment long-term treatment with antipsychotic and other psychotropic drugs is common. The results indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals, despite limited evidence of their efficacy and the high risk of adverse effects. Drug-related problems, such as adverse drug reactions, constituted a major cause of hospital admissions. By reducing potentially inappropriate drug use and optimizing overall drug therapy, inclusion of clinical pharmacists in a health care team might improve the quality of patient care and reduce the risk of hospital readmissions among people with dementia.

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Gillespie, Ulrika. "Effects of Clinical Pharmacists' Interventions : on Drug-Related Hospitalisation and Appropriateness of Prescribing in Elderly Patients." Doctoral thesis, Uppsala universitet, Institutionen för farmaceutisk biovetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-167343.

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The overall aim of this thesis was to evaluate clinical pharmacist interventions with the focus on methods aiming to improve the quality of drug therapy and increase patient safety. Adverse drug events caused by medication errors, suboptimal dosages and inappropriate prescribing are common causes of drug-related morbidity and mortality. Clinical pharmacists integrated in multi-professional health-care teams are increasingly addressing these issues. A randomised controlled trial (RCT) was conducted to investigate the effectiveness of clinical pharmacists’ interventions in reducing morbidity and use of hospital care for patients 80 years or older. The results showed that the intervention group had fewer visits to hospital and that the intervention was cost-effective. In a subsequent study based on the population in the RCT, the appropriateness of prescribing was assessed using three validated tools. The results indicated improved appropriateness of prescribing for the intervention group as a result of the intervention. The tools and the number of drugs at discharge were then tested for validity in terms of causal links between the scores at discharge and hospitalisation. No clear correlations between high scores for the tools or a high number of drugs and increased risk of hospitalisation could be detected. During the inclusion period of the RCT a survey based study was conducted where the perceived value of ward-based clinical pharmacists, from the perspective of hospital-based physicians and nurses as well as from general practitioners (GPs) was evaluated. The respondents were positive to the new collaboration to a high degree and stated increased patient safety and improvements in patients’ drug therapy as the main advantages. In the last study the frequency and severity of prescription and transcription errors, when patients enrolled in the multidose-dispensed medications (MDD) system are discharged from hospital, was investigated. The results showed that errors frequently occur when MDD patients are hospitalised.

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Peterson, Cecilia. "Characterization of drugrelated problems and associated factors at a clinical pharmacy-naïve hospital in the northern part of Sweden." Thesis, Umeå universitet, Farmakologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-131902.

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Mdege, Noreen D. "Reducing substance misuse and related problems : how can unhealthy alcohol users and problem drug users be effectively intervened with in general hospital settings?" Thesis, University of York, 2015. http://etheses.whiterose.ac.uk/10655/.

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Background: There is a high prevalence of unhealthy alcohol use and problem drug use among patients presenting to general hospital settings. However, many unhealthy alcohol users and problem drug users in these settings are not even aware, or do not acknowledge that they have such problems. Their presentation to hospital for the treatment of other conditions offers an opportunity to engage with them. However, there is uncertainty over how best to identify, assess and intervene with this population. Aim: To investigate how unhealthy alcohol users or problem drug users can be effectively identified, assessed and intervened with when they present to general hospital settings for the treatment of other conditions. Methods: This thesis is based on six published papers that used systematic review, meta-regression and Delphi methods. Main findings: To date, research on interventions for unhealthy alcohol use in general hospital settings has focused on brief interventions (BIs). Multiple session BIs are likely to be beneficial for unhealthy alcohol use in these settings. Where targeted screening and intervention is the strategy of choice, a focus on gastroenterology and emergency medicine is a promising way to target resources for unhealthy alcohol use. There is lack of evidence on how to effectively identify and intervene with problem drug users. The available evidence favours the ASSIST as the problem drug use screening instrument of choice. There is also lack of evidence to inform which comprehensive substance misuse assessment package to use in these settings. Conclusions: There is still need for robustly designed research on how to effectively identify, assess and intervene with unhealthy alcohol users and problem drug users within general hospital settings. It is to be hoped that the body of work presented in this thesis will, effectively, contribute to the development stage for other primary research in the future.

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Goodin, William John, and bgoodin@nursing usyd edu au. "AN INVESTIGATION OF FACTORS THAT DETERMINE SELF-REPORTED KNOWLEDGE, ATTITUDES, AND CLINICAL BEHAVIOURS OF PRACTISING REGISTERED NURSES TOWARDS PEOPLE WITH ALCOHOL, TOBACCO, AND OTHER DRUG-RELATED PROBLEMS." Flinders University. Nursing and Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061110.120239.

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There is an enduring and prevailing disparity between the clinical prevalence of alcohol, tobacco and other drug-related problems and the frequency that nurses recognise and intervene in these common problems. The extant nursing literature has long determined an urgent need for further investigation into why nurses do not respond to patients with ATOD-related problems in the consistent and effective manner that the prevalence of these costly health problems require, or in a manner that reflects the opportunities that nurses have to offer brief and timely intervention. This thesis reports and discusses the investigation of factors that determine identification, assessment and interventions of patients with alcohol, tobacco and other drug-related problems by a randomly selected sample of Registered Nurses [n=1281] in practice in New South Wales, Australia. Of particular interest was the relationship between nurses' ATOD knowledge, therapeutic attitudes and clinical activity. Multiple quantitative and qualitative methods were used, firstly to systematically investigate factors within the nurse and their clinical setting that might predict desired clinical behaviour towards addressing ATOD-related problems, and secondly, to analyse and describe nurses' self-reported perceptions, views and experiences of the issue and what aids or impedes it. The research instrument - a 72 item self-completed questionnaire was developed and refined within a process of three (3) pilot studies and test-retest method. A multiple regression model was developed to establish the predictors of key clinical behaviours. Thematic coding was used to analyse the perceptions of these nurses as to the factors that affect their ability to intervene with patients who have ATODrelated problems. Convergent and divergent concerns between quantitative and qualitative findings became apparent. Thematic analysis of open-ended responses demonstrated that nurses report a complex of factors that affect their ability and capacity to intervene with patients who have ATOD-related problems. Among these are factors located within nurses themselves, within their patient(s), within their workplace, within other health professionals and within the broader social/cultural context. The latter part of the thesis systematically considers the relationships between the quantitative and qualitative findings within this large sample of registered nurses. From this comprehensive level of analysis, workforce implications for ATOD education, training and organisational support for nurses, the most numerous group of health care workers, have been readily identified. The major empirical finding of this investigation is that there is a significant difference between positive attitudinal sets and motivation of practicing registered nurses to perform desired ATOD-related clinical activities, and the lower reported frequency at which this occurs. The qualitative findings are highly convergent with the empirical ones. It is the nurse's self-identified lack of knowledge, skills, experience and confidence that is now reported as having the greatest effect on their ability to assess, identify and offer brief and timely intervention for patients with ATOD-related problems, rather than any prevailing beliefs and attitudes that these patients were not worthy of their care, or outside the legitimate framework of their nursing role.

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Wittchen, Hans-Ulrich, Silke Behrendt, Michael Höfler, Axel Perkonigg, Jürgen Rehm, Roselind Lieb, and Katja Beesdo. "A typology of cannabis-related problems among individuals with repeated illegal drug use in the first three decades of life: Evidence for heterogeneity and different treatment needs." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-111264.

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Background: Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and young adults. We aim to identify clinically meaningful latent classes of users of cannabis and other illegal substances with distinct problem profiles. Methods: N= 3021 community subjects aged 14–24 at baseline were followed-up over a period ranging up to 10 years. Substance use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N= 1089 subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders. Results: Four latent classes were identified: “Unproblematic CU” (class 1: 59.2%), “Primary alcohol use disorders” (class 2: 14.4%), “Delinquent cannabis/alcohol DSM-IV-abuse” (class 3: 17.9%), “CUD with multiple problems” (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2–4. Conclusion: While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders.

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Wittchen, Hans-Ulrich, Silke Behrendt, Michael Höfler, Axel Perkonigg, Jürgen Rehm, Roselind Lieb, and Katja Beesdo. "A typology of cannabis-related problems among individuals with repeated illegal drug use in the first three decades of life: Evidence for heterogeneity and different treatment needs." Technische Universität Dresden, 2009. https://tud.qucosa.de/id/qucosa%3A26837.

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Background: Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and young adults. We aim to identify clinically meaningful latent classes of users of cannabis and other illegal substances with distinct problem profiles. Methods: N= 3021 community subjects aged 14–24 at baseline were followed-up over a period ranging up to 10 years. Substance use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N= 1089 subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders. Results: Four latent classes were identified: “Unproblematic CU” (class 1: 59.2%), “Primary alcohol use disorders” (class 2: 14.4%), “Delinquent cannabis/alcohol DSM-IV-abuse” (class 3: 17.9%), “CUD with multiple problems” (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2–4. Conclusion: While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders.

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Odenwald, Michael. "The use of the stimulant khat, war-related trauma and psychosis in Somalia how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace /." [S.l. : s.n.], 2006. http://nbn-resolving.de/urn:nbn:de:bsz:352-opus-23510.

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Hammar, Tora. "eMedication – improving medication management using information technology." Doctoral thesis, Linnéuniversitetet, Institutionen för medicin och optometri (MEO), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-37167.

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Medication is an essential part of health care and enables the prevention andtreatment of many conditions. However, medication errors and drug-relatedproblems (DRP) are frequent and cause suffering for patients and substantial costsfor society. eMedication, defined as information technology (IT) in themedication management process, has the potential to increase quality, efficiencyand safety but can also cause new problems and risks.In this thesis, we have studied the employment of IT in different steps of themedication management process with a focus on the user's perspective. Sweden isone of the leading countries when it comes to ePrescribing, i.e. prescriptionstransferred and stored electronically. We found that ePrescribing is well acceptedand appreciated by pharmacists (Study I) and patients (Study II), but that therewas a need for improvement in several aspects. When the pharmacy market inSweden was re-regulated, four new dispensing systems were developed andimplemented. Soon after the implementation, we found weaknesses related toreliability, functionality, and usability, which could affect patient safety (StudyIII). In the last decade, several county councils in Sweden have implementedshared medication lists within the respective region. We found that physiciansperceived that a regionally shared medication list generally was more complete butoften not accurate (Study IV). Electronic expert support (EES) is a decisionsupport system which analyses patients´ electronically-stored prescriptions in orderto detect potential DRP, i.e. drug-drug interactions, therapy duplication, highdose, and inappropriate drugs for geriatric or pediatric patients. We found thatEES detected potential DRP in most patients with multi-dose drug dispensing inSweden (Study V), and that the majority of alerts were regarded as clinicallyrelevant (Study VI).For an improved eMedication, we need a holistic approach that combinestechnology, users, and organization in implementation and evaluation. The thesissuggests a need for improved sharing of information and support for decisionmaking, coordination, and education, as well as clarification of responsibilitiesamong involved actors in order to employ appropriate IT. We suggestcollaborative strategic work and that the relevant authorities establish guidelinesand requirements for IT in the medication management process.
Läkemedel förbättrar och förlänger livet för många och utgör en väsentlig del av dagens hälso- och sjukvård men om läkemedel tas i fel dos eller kombineras felaktigt med varandra kan behandlingen leda till en försämrad livskvalitet, sjukhusinläggningar och dödsfall. En del av dessa problem skulle kunna förebyggas med rätt information till rätt person vid rätt tidpunkt och i rätt form. Informationsteknik i läkemedelsprocessen har potentialen att öka kvalitet, effektivitet och säkerhet genom att göra information tillgänglig och användbar men kan också innebära problem och risker. Det är dock en stor utmaning att i läkemedelsprocessen föra in effektiva och användbara IT-system som stödjer och inte stör personalen inom sjukvård och på apotek, skyddar den känsliga informationen för obehöriga och dessutom fungerar tillsammans med andra system. Dagens IT-stöd i läkemedelsprocessen är otillräckliga. Till exempel saknar läkare, farmaceuter och patienter ofta tillgång på fullständig och korrekt information om en patients aktuella läkemedel; det händer att fel läkemedel blir utskrivet eller expedierat på apotek; och bristande eller långsamma system skapar frustration hos användarna. Dessutom är det flera delar av läkemedelsprocessen som fortfarande är pappersbaserade. Därför är det viktigt att utvärdera IT-system i läkemedelsprocessen. Vi har studerat IT i olika delar av läkemedelsprocessen, före eller efter införandet, framför allt utifrån användarnas perspektiv. Sverige har lång erfarenhet och tillhör de ledande länderna i världen när det gäller eRecept, det vill säga recept som skickas och lagras elektroniskt. I två studier fann vi att eRecept är väl accepterat och uppskattat av farmaceuter (Studie I) och patienter (Studie II), men att det finns behov av förbättringar. När apoteksmarknaden omreglerades 2009 infördes fyra nya receptexpeditionssystem på apoteken. Vi fann att det efter införandet uppstod problem med användbarhet, tillförlitlighet och funktionalitet som kan ha inneburit en risk för patientsäkerheten (Studie III). I Sverige har man inom flera sjukvårdsregioner infört gemensamma elektroniska läkemedelslistor. I en av studierna kunde vi visa att detta har inneburit en ökad tillgänglighet av information, men att en gemensam lista inte alltid blir mer korrekt och kan innebära en ökad risk att känslig information nås av obehöriga (Studie IV). I två av studierna undersöktes beslutsstödssystemet elektroniskt expertstöd (EES):s potential som stöd för läkare att upptäcka läkemedelsrelaterade problem till exempel om en patient har två olika läkemedel som inte passar ihop, eller ett läkemedel som kanske är olämpligt för en äldre person. Studierna visade att EES gav signaler för potentiella problem hos de flesta patienter med dosdispenserade läkemedel i Sverige (Studie V), och läkarna ansåg att majoriteten av signalerna är kliniskt relevanta och att några av signalerna kan leda till förändringar i läkemedelsbehandlingen (Studie VI). Sammantaget visar avhandlingen att IT-stöd har blivit en naturlig och nödvändig del i läkemedelsprocessen i Sverige men att flera problem är olösta. Vi fann svagheter med användbarhet, tillförlitlighet och funktionalitet i de använda IT-systemen. Patienterna är inte tillräckligt informerade och delaktiga i sin läkemedelsbehandling. Läkare och farmaceuter saknar fullständig och korrekt information om patienters läkemedel, och de har i dagsläget inte tillräckliga beslutsstöd för att förebygga läkemedelsrelaterade problem. Eftersom läkemedelsprocessen är komplex med många aspekter som påverkar utfall behöver vi ett helhetstänkande när vi planerar, utvecklar, implementerar och utvärderar IT-lösningar där vi väger in både tekniska, sociala och organisatoriska aspekter. Avhandlingens resultat visar på ett behov av ökad koordination och utbildning samt förtydligande av ansvaret för inblandade aktörer. Vi föreslår gemensamt strategiskt arbete och att inblandade myndigheter tar fram vägledning och krav för IT i läkemedelsprocessen.

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Cavaco, Margarida Isabel Mendes Guerreiro. "Resultados clínicos negativos da farmacoterapia como motivo de atendimento no serviço de urgência." Master's thesis, Universidade de Évora, 2009. http://hdl.handle.net/10174/18345.

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O estudo foi efectuado no Hospital de Faro EPE usando um questionário específico, semifechado, aplicado a 213 utentes admitidos no Serviço de Urgência. Os dados recolhidos indicam que 53% dos doentes acedem à urgência devido a resultados clínicos negativos da farmacoterapia, sendo 82% potencialmente evitáveis pelo Acompanhamento Farmacoterapêutico. A falta de efectividade (46,2%) e a necessidade de terapêutica (37,2%) são as causas mais frequentes. Os principais motivos de acesso à Urgência relacionam-se com problemas digestivos, músculo-esqueléticos e urinários. Os sinais e sintomas mais referidos são cefaleias, febre e epigastralgias. Em média 70% tomam dois ou três medicamentos diariamente. Os grupos terapêuticos mais representados são psicoléticos, anti-inflamatórios não-esteroides e anti-reumatismais e as substâncias activas paracetamol, furosemida, ibuprofeno, pantoprazol e alprazolam (nenhuma claramente relacionada com os resultados negativos). Uma nova chave dicotómica, com oito questões, é proposta para antecipar potenciais resultados clínicos negativos da farmacoterapia, antes da consulta médica (probabilidade de 92%). ABSTRACT; The study was performed at Hospital de Faro EPE, using a specific semi-opened survey of 213 patients, on the reasons to procure the Urgency. Around 53% of responders accessed the urgency due to a clinical negative result of pharmacotherapy, being 82% potential avoidable by pharmacotherapy follow-up service. The ineffectivity (46.2%) and the need for medication (37.2%) were the most frequent causes. The main reasons for attendance the urgency were problems related with digestive, muscle-skeletal and urinary systems. The most frequent signs and symptoms: headache, fever and stomach pain. Over 70% used two or three medicinal products per day. The main therapeutic groups: psicoletics and non-steroidal anti-inflammatory and anti-rheumatic drugs. The active substances most used were paracetamol, furosemide, ibuprofen, pantoprazole and alprazolam (no one clearly related with negative outcomes). A new algorithm, containing eight questions, is proposed to predict pharmacotherapy clinical negative results before physician consultation, with 92% of probability.

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Costa, Caroline de Godoi Rezende 1985. "Papel da intervenção farmacêutica na evolução dos parâmetros clínicos e na resolução de problemas farmacoterapêuticos em pacientes HIV-positivos." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311650.

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Orientadores: Priscila Gava Mazzola, Patricia Moriel
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-21T18:32:30Z (GMT). No. of bitstreams: 1 Costa_CarolinedeGodoiRezende_M.pdf: 3126877 bytes, checksum: 97128de773972dad8f95a4242353e863 (MD5) Previous issue date: 2012
Resumo: Muitos fatores contribuem para a resposta do paciente à terapia antirretroviral (TARV), incluindo adesão, efetividade farmacológica e tolerância. A TARV é complexa e longa, e o risco de falha virológica, comumente associada à resistência antirretroviral, aumenta quando a adesão diminui. Neste contexto, a presença do farmacêutico, como o profissional capaz de orientar o paciente em relação à terapia medicamentosa e realizar o acompanhamento farmacoterapêutico, estimula os pacientes a estarem familiarizados com seus próprios esquemas terapêuticos, tornando mais simples a compreensão da importância do uso correto do medicamento, aumentando a adesão à terapia, efetividade e tolerância. Este trabalho teve como objetivo avaliar a efetividade da Intervenção Farmacêutica (IF) na resolução dos Problemas Farmacoterapêuticos (PFTs) e na melhora dos parâmetros clínicos dos pacientes com HIV/AIDS. Foi realizado um estudo prospectivo controlado intervencionista, com amostra consecutiva e de conveniência com controles de reposição emparelhados segundo gênero e valores iniciais de linfócitos T CD4+. Do total de pacientes selecionados para o estudo (n=143), 57 (39,86%) pacientes foram descontinuados e 86 pacientes finalizaram o estudo de 1 ano, sendo 43 pacientes do controle (GC) e 43 do grupo intervenção (GI). Os pacientes do GI receberam acompanhamento farmacoterapêutico por meio de método próprio baseado no método Pharmacotherapy workup. Durante o período de 1 ano foram realizadas 202 Intervenções ou Orientações Farmacêuticas no GI, com uma redução de 38,43% (p=0,0001) do total de PFTs. O GI apresentou aumento médio da variação de CD4 1,84 vezes maior que o aumento observado GC, com média de 154,66 para o GI e 83,80 para o GC. Apesar da carga viral média final do GI ser maior do que aquela observada no GC (17394,51 e 12921,53 cópias/mL, respectivamente), para o GI foi observada uma redução 3 vezes maior da carga viral do que para o GC: GI variou em média 23517,67 e GC, 6226,51. Os resultados deste estudo indicam que as Intervenções Farmacêuticas proporcionaram redução PFTs principalmente aqueles relacionados às reações adversas e interações medicamentosas, promoveram a adesão, aumentaram a efetividade da terapia antirretroviral, constatada com maior elevação da contagem de CD4 e redução da carga viral em comparação com o grupo controle
Abstract: Many factors contribute to the patient's response to antiretroviral therapy (ARVT), including adhesion, drug effectiveness and tolerance. Antiretroviral therapy is complex and lengthy, and the risk of virologic failure commonly associated with antiretroviral resistance increases when adhesion decreases. In this context, the presence of the pharmacist as a professional capable of guiding the patient in relation to drug therapy and follow up drug use, encourages patients to be familiar with their own therapeutic regimens, making it easier to understand the importance of using correct medicine, increasing adherence to therapy, effectiveness and tolerance. This study aimed to evaluate the effectiveness of pharmaceutical intervention (PI) in solving drug related problems (DRPs) and improvement of HIV/ AIDS patients clinical parameters. We conducted a prospective controlled intervention study, with a consecutive and convenience sampling with replaced controls paired by gender and initial T CD4+ lymphocytes values. Out of the total patients enrolled in the study (n=143), 57 (39,86%) patients were discontinued and 86 patients completed the 1-year study, with 43 patients in the control group (CG) and 43 in the intervention group (IG). Patients from de IG received pharmacotherapeutic follow up through a method developed in this work and some Pharmacotherapy workup method features. Over the period of 1 year were performed 202 interventions or counselling on Pharmaceutical IG, with a decrease of 38.43% (p = 0.0001) of total PFTs. The IG showed a mean improvement variation of 1.84 times CD4 greater than the increase observed CG with an average of 154.66 for IG and 83.80 for CG. Although the final viral load mean of IG found were greater than that observed in the CG (17394.51 and 12921.53 copies / mL, respectively), IG presented a reduction of three times greater than that in the CG: IG had mean range of 23517.67 and CG, 6226.51. The results of this study indicate that pharmacist interventions led to lower DRPs especially those related to adverse reactions and drug interactions, promoted adherence, increased the effectiveness of antiretroviral therapy, verified with greater elevation of CD4 count and viral load reduction compared with the control group
Mestrado
Ciencias Biomedicas
Mestra em Ciências Médicas

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Leite, Celina Luís Ferreira da Costa. "Comunicação com o doente em farmácia clínica." Master's thesis, [s.n.], 2014. http://hdl.handle.net/10284/4871.

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Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências Farmacêuticas
O papel do Farmacêutico evoluiu de modo considerável ao longo das últimas décadas, passando de uma prática focada no medicamento para a de uma relação com o doente que abrange, entre outros aspetos, a monitorização da medicação. É sabido que a maioria dos doentes, particularmente, os crónicos, idosos, deficientes e polimedicados, apresentam baixos níveis de adesão ou de cumprimento do tratamento. A profissão farmacêutica aceitou a responsabilidade de proporcionar a informação, a educação, o aconselhamento e a orientação do doente no contexto da assistência farmacêutica, para motivar e melhorar a adesão do doente à terapêutica, reduzir os problemas relacionados com medicamentos e, desse modo, prestar uma melhor qualidade na prestação dos cuidados de saúde. Nesta dissertação pretende-se, através de uma revisão bibliográfica, relacionar as competências da comunicação clínica do Farmacêutico com a intervenção farmacêutica no seguimento do tratamento farmacológico do doente, através da realização da entrevista clínica, conducente à melhoria da saúde dos doentes. Neste trabalho relacionam-se as competências de comunicação com a intervenção farmacêutica, uma vez que a comunicação é um elemento chave na prestação de cuidados de saúde. A comunicação com o doente em Farmácia Clínica é uma área a desenvolver e a expandir na prestação de cuidados farmacêuticos, centrando no doente toda a intervenção que possa repercutir-se no seu benefício clínico. O desenvolvimento deste conhecimento no ensino deve ser objeto de implementação na carreira universitária, considerando a sua repercussão no desempenho profissional do Farmacêutico e na melhoria dos cuidados de saúde prestados em Portugal. Community pharmacist’s work has evolved greatly over the last decades, moving from a practice essentially based on preparing and dispensing medicines to patients towards to a clinically based relationship, which compromises monitoring of patient’s conditions and concomitant medication use. It is known that most patients, particularly those with chronic illnesses, elderly and deficient people or with multiple medications have low levels of adherence to the therapy. The pharmacy profession has accepted the responsibility for providing patient information, education and counselling in the context of pharmaceutical care to improve adherence to therapy and minimize drug related problems. This dissertation is intended, through a literature review, to relate the skills of clinical communication of the pharmacist with a pharmaceutical intervention to follow up the pharmacologic effects by conducting clinical interviews, leading to improved health-related outcomes of the patients. Communication skills have a relationship with the pharmaceutical intervention, considering it as a key element in the delivery of health care. Patient communication in Pharmacy is a developing area to be considered and expanding in health care, concentrating on the patient the intervention to maximize the clinical benefit. The development of this knowledge in the educational institution must be implemented, considering its impact in the professional performance of the Pharmacist and in the health care benefits in Portugal.

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Andersson, Johanna, and Andersson Jennifer Landin. "Too Cool for School : En kvantitativ studie om studierelaterad problematik bland gymnasieelever och deras inställning inför studierna - ur ett helhetsperspektiv." Thesis, Uppsala universitet, Centrum för socialt arbete - CESAR, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-385202.

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Studiens syfte är att undersöka gymnasieelever i årskurs tre och deras motivation till att prioritera sina studier och prestera väl i skolan, samt undersöka vad som kan bidra till problematiken kring att vissa gymnasieelever inte är motiverade till att prioritera sina studier och prestera väl i skolan. Ett visst fokus riktas mot gymnasieelevers alkohol- och narkotikaanvändning, med syftet att undersöka huruvida detta samspelar med bristande studiemotivation. Studien utgår från tidigare forskning på området, vilken fastslår att det existerar ett samband mellan studierelaterad problematik och alkohol- och narkotikaanvändning, samt att andra omkringliggande aspekter i elevers liv kan vara avgörande för studierelaterad problematik och ungas användning av alkohol och narkotika. Tidigare forskning har, tillsammans med vårt teoretiska ramverk hjälpt oss att analysera och diskutera studiens resultat. Det teoretiska ramverket består av ett helhetsperspektiv och andra teoretiska begrepp som KASAM (känsla av sammanhang), gruppkultur, subkultur och avvikande beteende. För att uppnå studiens syfte har vi antagit en kvantitativ ansats och inhämtat vårt empiriska material via en webbaserad enkätundersökning. Vår data har genomgått sambandsanalyser med hjälp av Chi2-test, t-test och variansanalys (ANOVA). Studiens resultat visar att de flesta gymnasieelever sällan är motiverade att gå till skolan på morgonen och spenderar under 30 minuter om dagen på studier utöver skoltid. Samtidigt är det övervägande många som anser att det är av vikt att prestera väl i skolan. De flesta elever skolkar minst någon gång per termin och då på grund av en allmän skoltrötthet. Resultatet visar även att det finns ett samband mellan elevers omgivning och deras studiesituation. Vänners vanor kring skolk återspeglas exempelvis i hur ofta eleven själv skolkar. Detsamma gäller för elevens användning av alkohol och narkotika. Avslutningsvis visar också studiens resultat att det finns samband mellan alkoholanvändning (i vissa fall), cannabisanvändning (i de flesta fallen) och studierelaterad problematik.

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Abdul, Hadi Roza. "Avvikelser i receptlistan : En intervjustudie med patienter på apotek." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-101940.

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Background: Medications are used to treat, cure, or relieve symptoms of diseases, but there is a risk with the use of medications. Drug-related-problems are known to increase morbidity and mortality. Incorrect medical list and discrepancies in these lists can lead to drug-related problems as side effects, hospitalization, non-compliance, drug interactions and overtreated or undertreated patients. Discrepancies can be for example: more prescriptions than necessary, outdated prescriptions, i.e., medicines that will not be used, prescriptions with incorrect dosing and missing prescriptions i.e., medicines used by patients that cannot be seen in the medication list. Purpose: The aim of this study was to investigate discrepancies in the Swedish prescription list "My saved prescriptions at the pharmacy". The secondary aim was to investigate how common it is to use this prescription list or the dosage label on the medicine packaging to know which medicines to use and which dosage. Methods: The data collection was performed by four pharmacy students at seven pharmacies in Sweden over a period of three weeks during Jan-Feb. 2021 where the prescription list was investigated together with patients to identify any discrepancies. The study included patients who was over 18 years old, spoke Swedish, had three or more prescribed drugs, and agreed to participate. Results A total of 215 patients were interviewed, where 61% had one or more discrepancies in their medication list. A total of 1717 prescriptions were analyzed, of which 10% were double prescriptions (n = 167), 8% outdated prescriptions (n = 141) and 3% prescriptions with the wrong dosage (n = 42). When analyzing the primary sources of information used by patients to know which medicine to use, the printout of the list "my saved prescriptions at the pharmacy” dominated (n = 72). Most used information source to know drug dosage was the dosage label on the medicine packaging (n = 112). Conclusions: It is important to have an updated and correct information in the medication list, to prevent drug-related-problems caused by discrepancies. It becomes even more important when we see that the medication list "My saved prescriptions at the pharmacy" and dosage label (containing the same information in the medication list), are the most used primary sources by patients to know which drug to use and in what dosage. Finally, results show a relationship between the number of prescribed drugs and the number of discrepancies that occur, and therefore we see more discrepancies in elderly patients who are usually ill and are being treated for several diseases. There are opportunities for further research to study e.g., which drug-related-problems are caused by discrepancies in the medication list as well as the degree of danger in these problems.
Användning av läkemedel som avses behandla, lindra eller bota sjukdomar kan i vissa fall utgöra en risk för patientens hälsa. Läkemedelsrelaterade problem p.g.a. felmedicinering står för en stor andel av morbiditeten och mortaliteten bland patienter. En bidragande orsak är ofullständig information i patientens läkemedelslista. Syftet med studien var att undersöka antalet avvikelser som förekommer i receptlistan ”Mina sparade recept på apoteket”. Studiens sekundära syfte var att undersöka vilka informationskällor som användes av patienter för att veta vilka läkemedel som ska adminstreras och i vilken dos dosering. Studiens metod var att intervjua patienter som kom till apoteket för att hämta ut läkemedel till sig själva och uppfyllde inklusionskriterierna för att delta i studien. Studien utfördes av fyra farmaceutstudenter på sju olika apotek i fyra olika städer i Sverige som tillsammans med patienter gick igenom receptlistan för att identifiera avvikelser. Resultatet blev totalt 1717 recept som studerades varav 21% hade avvikelser. Av recepten var 10% dubbla recept (n = 167), 8% inaktuella recept (n = 141) och 3% recept med fel dosering (n = 42). Vid analys av primära informationskällor som används dominerade utskrift av listan ”Mina sparade recept på apoteket” (n = 72) resp. doseringsetiketten på läkemedelsförpackningen (n = 112). Resultaten visade även ett samband mellan ökade antal läkemedel och antalet avvikelser. Avvikelser i läkemedelslistan Mina sparade recept är vanligt förekommande därmed är listan inte alltid aktuell. Det är vanligt att denna lista och doseringsetikett på läkemedels-förpackningar används som primära källor av patienter under deras behandlingstid vilket kan innebära en risk för läkemedelsrelaterade problem. En gemensam nationell läkemedelslista är en möjlig lösning till att förebygga läkemedelsrelaterade problem orskade av infromationsbrist i läkemedelslistor. Det är dock nödvändigt med läkemedelsgenomgångar för att bibehålla uppdateringen av listan.

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Carvalho, Felipe Dias. "Avaliação econômica do impacto da atividade de atenção farmacêutica na assistência à saúde: aspectos metodológicos." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/17/17139/tde-06032008-160915/.

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A atenção farmacêutica (ATENFAR) é uma nova prática clínica, inerente ao profissional farmacêutico, que tem como principais objetivos a prevenção de doenças, a promoção e a recuperação da saúde de usuários de serviços sanitários, através do fomento ao uso racional de medicamentos. Vários estudos realizados no Brasil e no exterior mostram que a atividade de ATENFAR pode propiciar muitos benefícios aos tratamentos de saúde que fazem uso de farmacoterapia, resultando no aumento da efetividade do tratamento e na melhoria da qualidade de vida dos pacientes. Além disso, alguns estudos mostram que a ATENFAR exerce influência sobre os custos assistenciais, sendo esta informação de grande importância para que se discuta a inserção desta prática em programas de saúde coletiva. Devido à escassez de estudos econômicos sobre serviços de ATENFAR, este trabalho visou, através de pesquisa bibliográfica, levantar informações acerca dos temas Economia da Saúde, Atenção Farmacêutica e Avaliação em Saúde e discutir criticamente a aplicabilidade e adequação dessas informações aos referidos estudos. A análise das publicações encontradas através da revisão bibliográfica realizada permitiu concluir que: o As análises econômicas tipo custo-minimização, tipo custo-efetividade, tipo custo-utilidade e tipo custo-benefício são aplicáveis a serviços de ATENFAR; o Os custos relativos aos salários dos farmacêuticos, dos auxiliares e dos demais membros da equipe de saúde; ao transporte do paciente ou da equipe de saúde; aos materiais de consumo; aos medicamentos; às internações hospita lares; aos atendimentos médicos de urgência; às sensações de dor, de tristeza, de mal estar; aos dias de trabalho perdidos; à necessidade de um cuidador; ao aluguel do espaço desti nado ao serviço; são custos que devem ser levantados em uma avaliação econômica de serviços de ATENFAR; o A melhoria em parâmetros clínicos e na qualidade de vida de pacientes atendidos por serviços de ATENFAR e a economia de recursos financeiros, são possíveis resultados gerados por esses serviços; o As análises econômicas de serviços de ATENFAR podem ser realizadas sob a perspectiva do paciente, da instituição de saúde, do plano de saúde, do sistema de saúde, da sociedade ou de qualquer outro agente que tenha inte resse em realizar uma avaliação econômica de tais serviços; o Os modelos de estudos epidemiológicos mais indicados para serem utilizados em análises econômicas de serviços de ATENFAR são o modelo experimental e o modelo observacional longitudinal tipo coorte prospectivo.
The pharmaceutical care is a new practical clinic, inherent to the pharmaceutical professional, who has as main objectives the prevention of illnesses, the promotion and recovery of health of sanitary services users, through the fomentation of rational drug use. Several studies accomplished in Brazil and the exterior show that the pharmaceutical care activity can propitiate many benefits to the health treatments which use the pharmacotherapy, resulting in the increase of treatment effectiveness and in the improvement of life quality of patients. Moreover, some studies show that the pharmaceutical care exerts influence on the assistance costs, being this information of great importance to discuss the insert of this practical in collective health programs. Due to scarcity of economic studies on pharmaceutical care services, the present work aimed at, through bibliographical research, raise information about the topics Health Economics, Pharmaceutical Care and Health Evaluation and to critically discuss the applicability and adequacy of this information to the related studies. The analysis of publications found by means of bibliographic revision lead to the conclusion that: o The economic analyses type cost-minimization, type cost-effectiveness, type costutility and type cost-benefit are applicable to pharmaceutical care services; o The cost concerning to the wages of the pharmacist, the assistant and others members of the health team; to the patients or health team transport; to the consumption materials; to medicines; to the hospital internments; to the medical attends of urgency; to the sensations of pain, sadness and badly being; to the lost days of work; to the necessity of attendant; to the rent of the space destined to the service; they are costs that must be raised in a economic evaluation of pharmaceutical care services; o The improvement in clinical parameters and the life quality of patients taken care for pharmaceutical care services and the economy of financial resources are possible results from these services; o The system of assumption of costs by absorption or traditional and the system of activity based costs (ABC) are the most indicated to be established in health units that offer pharmaceutical care services; o The economic analyses of pharmaceu tical care services might be carried through under the patient perspective, the health institution, the health plan, the health system, the society or any other agent who has interest in realize an economic evaluation of such services; o The most indicated models of epidemiological studies to be used in economic analyses of pharmaceutical care services are the experimental model and the longitudinal observational model type prospective cohort.

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30

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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31

Sperottová, Šárka. "Analýza lékových problémů ("drug-related problems) v ambulanci lékaře II." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-382840.

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Analysis of drug-related problems in general practitioners office II. Author: Šárka Sperottová Supervisor of the thesis: PharmDr. Martin Doseděl, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Background: A Drug-Related Problem - DRP - is according to Pharmaceutical Care Network Europe - PCNE - an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. We can encounter DRP in every general practitioner's - GPs - office all around the world. But with proper cooperation between practitioners and pharmacists we could reduce the number of problems. That would be big benefit for patients and health system as well. This thesis is focused on anticoagulant drugs, mainly on DOAC group - direct oral anticoagulants - and their DRP in it's theoretical part. Practical part of thesis is analysis of DRP in GPs office itself. Aim: Theoretical part - describe the process of haemostasis and the possibilities of influencing this process by drugs. Discuss DRP of anticoagulants, especially oral anticoagulants and heparins. Practical part - identify and describe DRP. Sort them by PCNE Classification for DRP V5.01. Analyse and describe the most frequent drug-related problems occurring in general...

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32

Truongová, Thu Thao. "Analýza lékových problémů ("drug-related problems") ve zdravotnickém zařízení V." Master's thesis, 2020. http://www.nusl.cz/ntk/nusl-435810.

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ANALYSIS OF DRUG-RELATED PROBLEMS IN A HEALTHCARE FACILITY V. Author: Thu Thao Truongová Supervisor of the diploma thesis: PharmDr. Martin Doseděl, Ph.D. Consultant: PharmDr. Veronika Měrková Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy INTRODUCTION Medication errors are one of the most frequent medicinal errors. They affect patient's safety from the long-term point of view.1 The great part of medication errors occurs on the level of drug administration.2 In healthcare facilities mostly nurses are responsible for medication administration.3 AIM To obtain and evaluate medication errors during drug administration by nurses in a healthcare facility. METHODICS A prospective observational study was conducted in the facility Hamzova léčebna for children and adults focusing on medical rehabilitation. Data collection was performed in May 2019 three consecutive days on each ward, where drugs were administrated by nurse. Direct observation was done in morning, noon and evening drug administrations. Obtained data were recorded into prepared form and were compared with physician's medication order on the patient's record. Afterwards, the forms were transcripted into online database, data were transfered to MS Excel software programme and evaluated by...

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Gajdošová, Vanesa. "Analýza lékových problémů ("drug-related problems") ve zdravotnickém zařízení IV." Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-356020.

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(english) ANALYSIS OF DRUG-RELATED PROBLEMS IN HEALTHCARE FACILITY IV. Author: Vanesa Gajdošová Supervisor: PharmDr. Martin Doseděl, Ph.D. Introduction Drug-Related Problems (DRPs) occure in lots of clinical areas.1 They are defined as pharmacotherapy related events, which actually or prospectively interfere with a therapeutic purpose.2 Aims The goal of the teoretical part of the work is to become familiar with the problem of DRPs and analyze in detail the problems of benzodiazepines and atipsychotics. The practical part of the work is focused on obtaining and evaluating of DRPs in the specific healthcare facility. Methods The data was obtained in Hamzova odborná léčebna pro děti a dospělé (Luže-Košumberk) which is the important center of rehabilitation in the Czech Republic. The audit was taking place from February 13, 2017 to February 16, 2017. The data of 94 patients from the three departments of the rehabilitation center was analyzed. The all necessary information was obtained from the medical documentation. The data was collected using the special online application and finally was statistically evaluated by the descriptive statistic. The most occurred DRPs were discussed with physicians. Results Patients used together 672 drugs (i.e. 7.15 drugs per patient). Overall, 272 DRPs were registered...

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34

"Drug related problems causing admissions to a medical unit in Hong Kong." Chinese University of Hong Kong, 1995. http://library.cuhk.edu.hk/record=b5888524.

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Wen Er Ya Jane.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1995.
Includes bibliographical references (leaves 130-134).
Table of contents --- p.ii
List of tables --- p.iv
List of figures --- p.vi
Abstract --- p.vii
Glossary of abbreviations --- p.ix
Acknowledgments --- p.x
Chapter CHAPTER 1 --- INTRODUCTION --- p.1
Chapter 1.1 --- DEFINITIONS AND CLASSIFICATIONS...............................Error! Bookmark not defined
Chapter 1.1.1 --- Classification of drug-related problems --- p.2
Chapter 1.1.2 --- Adverse drug reactions (ADRs) --- p.2
Chapter 1.1.3 --- Drug interactions (DI) --- p.7
Chapter 1.1.4 --- Therapeutic failures (TF) --- p.8
Chapter 1.1.5 --- Non-compliance --- p.10
Chapter 1.1.6 --- Drug overdoses (DO) or drug poisonings --- p.11
Chapter 1.1.7 --- Drug-related hospitalizations (DRH) --- p.12
Chapter 1.1.8 --- Other relevant definitions --- p.13
Chapter 1.2 --- LITERATURE REVIEW --- p.16
Chapter 1.2.1 --- Adverse drug reactions --- p.16
Chapter 1.2.2 --- Hospital admission due to ADRs --- p.18
Chapter 1.2.3 --- Drug-related hospitalizations (DRH) --- p.22
Chapter 1.2.4 --- Discussion --- p.24
Chapter 1.3 --- PURPOSE OF THIS STUDY --- p.27
Chapter CHAPTER 2 --- METHODS --- p.30
Chapter 2.1 --- BACKGROUND --- p.30
Chapter 2.2 --- DATA COLLECTION --- p.31
Chapter 2.2.1 --- The patients --- p.31
Chapter 2.2.2 --- The drug history --- p.31
Chapter 2.2.3 --- Patients knowledge of drugs they were taking --- p.33
Chapter 2.2.4 --- Compliance --- p.33
Chapter 2.2.5 --- Previous episodes of adverse drug reactions --- p.34
Chapter 2.2.6 --- Diagnosis and outcome --- p.34
Chapter 2.2.7 --- Laboratory Results --- p.34
Chapter 2.2.8 --- Demographic characteristics of the patients --- p.35
Chapter 2.2.9 --- The data sheet --- p.36
Chapter 2.3. --- CASE REVIEW (REASSESSMENT) --- p.41
Chapter 2.4 --- CODING OF DATA --- p.41
Chapter 2.4.1 --- Coding of general data except diagnoses and drugs --- p.41
Chapter 2.4.2 --- Coding of diagnoses --- p.42
Chapter 2.4.3 --- Coding of drugs --- p.42
Chapter 2.5 --- STATISTICAL ANALYSIS --- p.42
Chapter CHAPTER 3 --- RESULTS --- p.43
Chapter 3.1 --- THE PATIENTS --- p.43
Chapter 3.1.1 --- Age and sex distributions --- p.43
Chapter 3.1.2 --- Patients' ADL and living environments --- p.47
Chapter 3.1.3 --- Baseline liver and renal function tests --- p.50
Chapter 3.1.4 --- Diagnoses --- p.52
Chapter 3.2 --- DRUG USE PRIOR TO ADMISSION --- p.54
Chapter 3.2.1 --- Overview --- p.54
Chapter 3.2.2 --- Consumption patterns for the prescribed drugs --- p.61
Chapter 3.2.3 --- Sources and durations for the prescribed drugs --- p.69
Chapter 3.2.4 --- Consumption patterns for self-medications --- p.71
Chapter 3.2.5 --- Source and duration of the self-medications --- p.73
Chapter 3.2.6 --- Drug overdose patterns --- p.75
Chapter 3.3 --- PATIENTS' KNOWLEDGE OF THE EFFECTS AND SIDE-EFFECTS OF DRUGS --- p.74
Chapter 3.3.1 --- Overview --- p.74
Chapter 3.3.2 --- Patients' knowledge of the effects of their prescribed drugs --- p.74
Chapter 3.3.3 --- Patients' knowledge of the side-effects of their prescribed drugs --- p.77
Chapter 3.4 --- COMPLIANCE --- p.79
Chapter 3.5 --- DRUG-RELATED HOSPITALIZATIONS (DRH) --- p.82
Chapter 3.5.1 --- Overview --- p.82
Chapter 3.5.2 --- Adverse drug reactions (ADRs) --- p.84
Chapter 3.5.3 --- Outcome of ADRs --- p.98
Chapter 3.5.4 --- "Therapeutic failures (Non-compliance, Inappropriate dose reduction)" --- p.100
Chapter 3.5.5 --- Drug overdoses --- p.104
Chapter CHAPTER 4 --- DISCUSSION --- p.106
Chapter 4.1 --- ABOUT THE PATIENTS --- p.106
Chapter 4.2 --- DISEASE PATTERNS AND DRUG CONSUMPTION PATTERNS --- p.107
Chapter 4.2.1 --- Diagnoses on admission --- p.107
Chapter 4.2.2 --- Drug consumption patterns --- p.109
Chapter 4.2.3 --- About the sources and durations of the prescribed drugs --- p.112
Chapter 4.2.4 --- About the self-medications --- p.113
Chapter 4.3 --- ABOUT PATIENTS' KNOWLEDGE OF THE DRUGS --- p.114
Chapter 4.4 --- ABOUT COMPLIANCE --- p.116
Chapter 4.5 --- ABOUT ADRS AND DRUGS INTERACTIONS --- p.118
Chapter 4.5.1 --- The incidence of ADRs --- p.118
Chapter 4.5.2 --- The patterns of ADRs --- p.119
Chapter 4.5.3 --- The drugs and ADRs --- p.119
Chapter 4.5.4 --- Self-medications and ADRs --- p.121
Chapter 4.5.5 --- The risk factors for ADRs --- p.122
Chapter 4.5.6 --- Drug interactions --- p.125
Chapter 4.6 --- ABOUT THERAPEUTIC FAILURES --- p.126
Chapter 4.7 --- ABOUT DRUG OVERDOSES --- p.127
Chapter 4.8 --- CONCLUSIONS --- p.128
BIBLIOGRAPHY --- p.130

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35

曾彥閔. "Economic Impact of Drug Related Problems in Long Term Care Facilities." Thesis, 2003. http://ndltd.ncl.edu.tw/handle/98084271895255391827.

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碩士
臺北醫學大學
藥學系
91
Taiwan has been an “aging society” since 1994.Aging of population bring new medical problems, raising the requirement of chronic disease treatment and long term care substantially. Raising medical insurance cost has become a problem in every health care system since 1980,so it become an important issue to manage the cost in the world. In this retrospective study, we reviewed 44 residents’ medical charts in a metropolitan hospital to realize the degree of the medical insurance cost consumed by the residents, and the economic impact of drug related problems due to residents’ drug therapy. Residents in average was 75.6 years old, taking 4.8 medications with 3.4 disease. In one year, 73.7% of residents elder than 65 years old received as least one inappropriate drug for elderly, and 27.3% of total 44 resident suffered drug related problems. We found 14.6 outpatient services used per resident in one year when their medical care is taken by a family physician. Comparing with people elder than 65 years old in Taiwan, the outpatient service uses were reduced by 10.4 times, and cost reduced by NT 10,140 dollars. However, the cost induced by drug related problems is up to 11.1% of the medical insurance cost consumed by all the residents in one year. To use medical resources rationally is very important today, we hope the result of this study could call attention to the drug therapy of residents in long term care facilities for all the health care provider.

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Lee, Yi-Ting, and 李怡婷. "Drug History Taking and Identification of Drug-Related Problems by Pharmacists: Experience in A Nephrology Ward." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/86001599491170662957.

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碩士
臺灣大學
臨床藥學研究所
95
Background: In Taiwan, most patients are not aware about what drugs they are taking and medication safety policies are important. Currently, the prevalence of end-stage renal disease in Taiwan is ranked as the second highest in the world. These patients are at high risk of having drug-related problems (DRPs). Thus, to identify DRPs is an important issue. However, with insufficient human resources, inpatient pharmacists in Taiwan can hardly have time to take drug history and assess the DRPs. Objective: To estimate the human resources of pharmacist required for drug history taking, and to evaluate the contribution of identifying DRPs on admission Method: All patients in the nephrology ward were included in the study except those who were quarantined. Those who were admitted for primary aldosteronism, belonged to other specialties, had been interviewed by the study pharmacist during last admission, or could not provide drug history were excluded. The patients’ basic and clinical information were recorded on a questionnaire, and used as a guide to interview the patients. After interview, each patient’s DRPs were identified, and the time spent on all the above activities was also recorded. To compare pharmacy records and medical records, the continuous variables were analyzed by Wilcoxon signed rank test or paired t test, and the test of agreement was Kappa test. Predictive factors of DRPs were analyzed with multiple logistic regression. Results: During the study period, 207 patients met the inclusive criteria. Among them, 108 were interviewed by pharmacist. There were no significant difference in the demographic data of the patients who were interview and those who were not, except in length of stay, and incidence of renal and cardiovascular disease. We also found that drug histories taken by the pharmacist vary from which taken by physicians, which included histories of allergy/adverse drug reaction, the number of medications prescribed before admission, and their ingredients/dosage/strengths noted, records of self-medications and alternative medications. Sixty-six of 108 patients interviewed, DRPs were assessed. Among these patients and those who DRPs were not assessed, only length of stay was significantly different. The number of DRPs documented by pharmacists and by physicians was 149 and 22 respectively, which were significantly different. The average time spent on recording and interview was 36 minutes, while it took the pharmacist 62 minutes to complete the DRPs assessment and wrote a pharmacy note on the medical record. In this study, the most common DRPs were improper drug selection (30.9%), adverse drug reactions (18.1%), failure to receive drugs (13.4%), and drug interactions (13.4%). The most common drugs that involved DRPs were psycholeptics (7.4%), diuretics (6.9%), mineral supplement (6.3%), and agents acting on the renin-angiotensin system (5.3%). Pharmacists identified at least 1 DRP in each patient with liver disease, which was overseen by physicians. Pharmacists observed that patients with more medications prescribed before admissions tend to have DRPs. It was also found that patients with liver disease, malignancy, non-metabolic/endocrine disease, and females were more vulnerable to DRPs. Conclusion: In this study, pharmacists were able to get more comprehensive drug history from patients in the nephrology ward and to identify DRPs. However, because of time-strait, pharmacist may not be able to take drug history of all inpatients. Drug history may render taken by intern pharmacists and availability of good computerized information. To identify the most DRPs in limited time, we suggest that pharmacists identify DRPs of patients on drugs commonly associated with DRPs, those who receive many drugs before admission, those with liver disease/malignancy, those with non-metabolic/endocrine disease, or female gender.

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Moodley, Pathma. "Drug-related problems among geriatric outpatients at a public sector hospital : an intervention study." Thesis, 2000. http://hdl.handle.net/10413/7570.

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Introduction: Although drug-related problems (DRPs) are known to be prevalent in elderly patients, there are not many studies that have been performed in geriatric outpatients at public health facilities in South Africa. Thus, the prevalence of DRPs in elderly outpatients attending Addington Hospital was investigated and suitable preventive intervention strategies to overcome or minimise these DRPs were developed. Research Methodology: The study was conducted in two phases. Phase 1 was conducted in March and April 1998, during which 281 elderly patients on chronic medical treatment were chosen for the study by systematic random sampling, according to specific inclusion criteria. Data collection was via a retrospective review of the elderly patient's medical notes and by personally interviewing the patient. Two research instruments were used in this phase. The customised Patient Profile (PF) form helped to delineate DRPs in the elderly patients. A Prescription Intervention Form (PIF) was used to inform the prescriber of the DRP and to make recommendations to change the drug therapy in order to overcome the DRP. In phase 2 of the study, intervention strategies were devised to address some of the major DRPs identified in phase 1 of the study. A patient counselling leaflet, prescribing guidelines for geriatric patients and a protocol for counselling of in-patients were developed. In addition, two DRP reporting systems were developed for surveillance of adverse drug reactions and medication errors during dispensing. Results and Discussions: Most geriatric subjects suffered from multiple, chronic conditions, these being hypertension (64.8%) followed by ischaemic heart disease (43.8%), musculoskeletal disorders (arthritis or gout) (42.7%), diabetes (29.2%), chronic obstructive airways disease (13.2%), hypercholesteremia (11.7%) and arrythmias (atrial fibrillation) (11.0%). The 281 patients were taking 1730 prescribed drugs, with a mean of 6.2 (range 3 to 15) prescribed drugs per patient. An astounding 45.6% of the total geriatric patients were taking or using between 7 to 9 medicines and 10.3% were taking or using between 10 to 15 medicines. The antihypertensives (15.9%) were the most widely prescribed drugs followed by medicines acting on CNS (10.9%), coronary vasodilators (9.1%), diuretics (9.1%) and medicines acting on the musculoskeletal system (8.7%). A total of 856 actual DRPs experienced by 262 geriatric patients (93.2%) ranged from 1 to 11 DRPs. The greater the number of prescribed drugs the greater the actual DRPs experienced by geriatric patients (p = 0.000). The most common DRPs were those involved in drug safety (56.6%); effectiveness of the drug therapy (20.8%); compliance (7.8%) and indication of drug therapy (7.6%). 159 elderly patients (56.6%) experienced 223 adverse effects either with their current or past prescribed medicines. The most common ADRs were as follows: gastro-intestinal ulceration (11.0%), cough (9.3%), diuretic side effects (dehydration, fatigue, hypotension, etc) (7.1%), constipation (6.8%), equilibrium problems (6.4%) and headaches (6.4%). For those DRPs warranting interventions, the mean number of prescription interventions in the entire sample population of 281 elderly patients was 0.65 ± 1.16. 87 elderly patients (30.1 %) had from 1 to 4 interventions on their current prescription. The most common prescription interventions were on problems involving drug therapy monitoring (26.9%), safety of drug therapy (26.5%), indication of drug therapy (17.5%), prescribing errors (15.3%) and prescription information omission (11.1 %). The three intervention strategies and DRPs surveillance reporting systems were successfully devised and developed. Conclusions: A profile related to the elderly patient's medical history and pharmacotherapy was completed for each of the 281 patients. General trends of prescribing pattern prevalence of DRPs and the prescribed inappropriate medication was established. The interventions of problem prescriptions were based on a newly developed PIF. The development and implementation of suitable intervention strategies to minimise DRPs were as follows: a compliance information leaflet, prescribing guidelines and the protocol for counselling in-patients. A medication error form as well as an adverse drug reaction reporting forms was developed for surveillance of DRPs. The recommendations for clinical practice and directions for future research that are presented should help to make drug therapy in the elderly safer and more effective.
Thesis (M.Pharm.)-University of Durban-Westville, 2000.

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Papadopoulos, Zisis. "ANALYSIS OF PHARMACOTHERAPY AND DRUG RELATED PROBLEMS IN PATIENT WITH ARTERIAL HYPERTENSION IN GREECE." Master's thesis, 2014. http://www.nusl.cz/ntk/nusl-333038.

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Title: Analysis of pharmacotherapy and drug related problems in patients with arterial hypertension in Greece Student: Zisis Papadopoulos Tutor: Jiri Vlcek Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Background: Arterial hypertension or high blood pressure is a chronic medical condition which is characterized by elevated blood pressure in the arteries and is an important risk factor for future development of cardiovascular disease. Also belongs to asymptomatic diseases because it usually does not cause symptoms for years until a vital organ is damaged. Moreover is a major cause of morbidity and mortality, due to its association with some other serious diseases like coronary heart disease, cerebrovascular disease, atherosclerosis, renal disease, dyslipidemia, diabetes, obesity and metabolic syndrome. Arterial hypertension for adults, who don't suffer from any other kind of diseases, is defined by an elevation of blood pressure to 140 / 90 mm Hg or to higher values. Aim: In the theoretical part the main aim is to analyze information regarding etiopathogenesis, diagnostic methods and treatment strategies of arterial hypertension, as well as classification and causes of drug-related-problems to antihypertensive agents. In the...

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Lau, Hong Sang. "Drug related problems in the elderly : Studies on occurence and interventions = Geneesmiddel gerelateerde problemen bij ouderen /." 1998. http://www.gbv.de/dms/bs/toc/310441285.pdf.

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Lin, Chia-Hui, and 林嘉慧. "Possible Strategy to Improve Olanzapine-related Problems: Approaches by Therapeutic Drug Monitoring and Traditional Chinese Medicine." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/60893703394477851650.

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碩士
臺北醫學大學
藥學研究所
97
Inter- or intra-individual variability of second-generation antipsychotics in therapeutic outcomes has been reported. Olanzapine (OLZ) exerts its benefits in therapeutic action; however, they can lead to metabolic complications. Drugs, such as metformin and topiramate, activates AMP-activated protein kinase (AMPK) were reported to ameliorate weight gain induced by OLZ. Here, we aimed to establish an analytical system to undergo OLZ therapeutic drug monitoring (TDM). Effects of OLA, N-Desmethyl-olanzapine (DMO) or Rehmannia dride rhizome crude extracts on AMPK were investigated. Methods: First, a high performance liquid chromatography with electrochemical detector (HPLC-ECD), was set up for OLZ and DMO serum concentration determinations, and further applied for patients (June 2007 to October 2008) who were diagnosed with schizophrenia and schizoaffective disorder and have been taking OLZ for 3 months. The determined OLZ and DMO serum concentrations were used to calculate OLZ, DMO concentration-dose ratio (C/D ratio). The correlations between dose or C/D ratios and various parameters will be examined. C2C12 myoblasts cell culture system was used to test effects of OLZ, DMO or Rehmannia dride rhizome crude extracts on AMPK. Results: (I) the HPLC-ECD system condition such as guard cell was set at +400 mV, the analytical cells was set at -200 mV (channel I) and +300 mV (channel II). Analytical C18 column with 15 cm length was used while eluted with mobile phase containing 50 mM phosphate salt buffer: acetonitrile: methanol=67:22:11. The flow rate was set at 1.0 ml/min to complete one sample for OLZ, DMO, and internal standard within 30 minutes. The detection limitation of OLZ or DMO was 1 ng/ml. (II) seventy-nine patients with 99 samples were included in this study. There are correlations between OLZ daily dose and patients’ weight, BMI, waist, BUN, progesterone [r=0.228 (p=0.022), r=0.230 (p=0.021), r=0.260 (p=0.009), r=0.227 (p=0.022), r=-0.153 (p=0.018)]. OLZ serum concentrations correlate with OLZ daily dose [r=0.311 (p=0.002)]. In this study, OLZ C/D ratios, but not DMO or DMO C/D ratio, of patients who were female (50.5%) or non-smokers (67.68%) were higher than male or smokers significantly (p<0.05). There are negative correlations between OLZ serum concentration and progesterone, testosterone [r=-0.220 (p=0.028), r=-0.213 (p=0.033)]. OLZ C/D ratio correlates negatively with waist [r=-0.207 (p=0.038)]. The mean and median of DMO C/D ratio were 0.54 and 0.43 ng/ml/mg (n=99). There are negative correlations between DMO C/D ratio and systolic blood pressure, waist [r=-0.238 (p=0.018), r=-0.247 (p=0.014)]. There are correlations between DMO serum concentration and prolactin, BUN, creatinine [r=0.488 (p<0.001), r=0.299 (p=0.002), r=0.606 (p<0.001)]. The serum concentrations of OLZ and DMO obtained from adults showed inter- and intra-individual variability. Pearson’s correlation was used to analyze the correlation between the intra-individual differences of OLZ and DMO serum concentration or C/D ratio with the factors among 11 patients. There are negative correlations between the difference of OLZ serum concentration and patients’ height, C-peptide, uric acid, triglyceride, testosterone [r=-0.558 (p=0.016), r=-0.539 (p=0.021), r=-0.506 (p=0.032), r=-0.470 (p=0.049), r=-0.629 (p=0.005)]. There are correlations between the differences of DMO serum concentration and age, creatinine [r=0.503 (p=0.033), r=0.671 (p=0.002)]. (III) C2C12 treated with OLZ or DMO（0.2, 2, 10, 20μM）did not change phosphate-AMPK at 120 minutes significantly. Rehmannia dride rhizome crude extracts (3, 10, 30 μg/ml) had dose-dependent activity to increase phosphated-AMPK, significantly (30 μg/ml, 2.02 ± 0.33 fold, p<0.05). Conclusions: Our results suggest that obese patients may need higher OLZ daily doses and higher OLZ serum concentration may also observed in patients who have higher OLZ daily doses. TDM is suggested for patient who is on OLZ including its metabolite DMO since serum concentration may provide possible prediction on metabolic syndrome, even though there are inter- or intra-individual variability in C/D ratio present in this adult patient study group. OLZ (0.2~20μM) did not cause phosphated-AMPK changes and future study on establishing OLZ-induced metabolic dysregulation study model is needed in order to identify potential modulation roles for Rehmannia dride rhizome.

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"Psychosocial determinants of motivation for abstinence among persons with substance use problems in Hong Kong." 2014. http://library.cuhk.edu.hk/record=b6116189.

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缺乏變革動機被廣泛地視為治療藥物濫用的其中一個主要障礙，本研究旨在針對以上問題，了解影響香港藥物濫用者斷藥動機的心理社會因素。跨理論模式 (Transtheoretical Model) 的轉變階段概念被用作斷藥動機的指標。而計劃行為理論 (Theory of Planned Behavior)，因為可以有效預測廣泛的健康相關行為，故被採納為研究斷藥動機的主要理論架構。本文研究計畫行為理論中的構念（即態度、主觀規範和自我意識行為控制）如何影響人的斷藥動機。本文也調查了在研究初始時的斷藥動機與其他心理社會因素，如何影響受訪者在三個月後的斷藥狀態及濫藥的頻率。影響行為抑制及情緒不穩的性格因素也會被探討，以了解它們如何影響斷藥動機及藥物濫用。
本文中的受訪者來自醫院管理局的藥物濫用診所，康復機構轄下的中途宿舍或社會服務中心。共有183位過去或現在有濫用藥物背景的受訪者參與研究，當中有87位受訪者(47.5%)完成了三個月後的跟進電話訪問。
本文使用路徑分析，發現計劃行為理論裡中的態度、主觀規範及自我意識行為控制，會透過行為意欲影響斷藥的轉變階段。此外，研究亦部份支持結合了計劃行為理論與轉變階段概念的修正綜合斷藥動機模型，可以預測受訪者在三個月後的濫藥頻率。斷藥的自我效能被發現為影響硏究初始時的斷藥動機及三個月後濫藥頻率的重要因素。另外，研究亦証明斷藥動機是預測三個月後的斷藥狀態及濫藥頻率的關鍵因素。影響行為抑制的性格因素透過斷藥的自我效能和轉變階段對濫藥頻率有輕微的間接影響。本文會闡述以上發現對藥物濫用治療的影響。
Since lack of motivation for change has been generally regarded as one of the major obstacles in treating substance use problems, the present study aimed to address this issue by investigating the psychosocial factors in determining motivation for abstinence among persons with substance use problems in Hong Kong. The stage of change construct of the Transtheoretical Model (TTM) was used as an indicator of motivation for abstinence. The Theory of Planned Behavior (TPB) with its well established usefulness for the prediction of a wide-range of health-related behaviors was adopted as a major theoretical framework. The present study investigated whether the constructs of TPB (i.e. attitude, subjective norm, and perceived behavioral control) influenced one's motivation to abstain from substance use. It also examined how motivation for abstinence and other psychosocial variables at baseline influenced drug abstinence status and drug use frequency at 3 month follow-up. The potential influences of personality factors of behavioral disinhibition and emotional instability in influencing motivation for drug absitnence and drug use behavior were also examined.
Participants were recruited from substance abuse treatment clinics, halfway houses and social services centres run by rehabilitation organisations. 183 participants with past or current history of substance use problems participated in the main study. 87 of them (47.5%) completed the follow-up phone survey 3 months later.
The applicability of the TPB variables of attitude, subjective norm, and preceived behavioral control in predicting stage of change through the mediation of behavioral intention was supported in a series of path analyses. In addition, the applicability of a revised integrated model on motivation for drug abstinence, which integrated the TPB model with the stage of change construct, in the prediction of drug use frequency at follow-up was partially supported in path analyses. Drug abstinence self-efficacy was found to be a very important factor in predicting both motivation for abstinence at baseline and drug use frequency at follow-up. In addition, the pivotal role of motivation for abstinence in the prediction of drug abstinence status and drug use frequency at follow-up was supported. Among the 2 personality variables, only behavioral disinhibition showed weak indirect effect on drug use frequency at follow-up through the mediation of drug abstinence self-efficacy and stage of change. The implications of the findings for intervention were discussed.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Wong, Sau Ying.
Thesis (Ph.D.) Chinese University of Hong Kong, 2014.
Includes bibliographical references (leaves 115-145).
Abstracts also in Chinese; appendix in Chinese.

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Goodin, William John. "An investigation of factors that determine self-reported knowledge, attitudes, and clinical behaviours of practising registered nurses towards people with alcohol, tobacco, and other drug-related problems." 2006. http://catalogue.flinders.edu.au/local/adt/public/adt-SFU20061110.120239/index.html.

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Šturcová, Klára. "Analýza vlivu farmakoterapie na riziko vzniku pádu I." Master's thesis, 2015. http://www.nusl.cz/ntk/nusl-332592.

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Analysis of the Effect of Pharmacotherapy on the Risk of a Fall I. Author: Klára Šturcová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Pague Introduction: Falls of hospitalized patients are one of the most common problems in health institutions. In terms of prevention of falls it is necessary to analyze all the factors that might have contributed to the emergence of a fall and subsequently minimize these risk factors. Objectives: The aim of the thesis was to analyze the possible drugs and other causes of falls of patients hospitalized in a certain rehabilitation institution. Methods: The data were collected from 21 March to 31 July 2014 in an institution providing rehabilitation care. The evaluated group consisted of patients who fell during the hospitalization in this period. The data about the fall, personal and drug anamnesis were transferred to an electronic form and subsequently evaluated by means of the frequency analysis, converted into graphs and tables and discussed. Results: 67 patients experienced 79 falls. Women experienced 53 % of falls; men experienced 47 % of falls. 87 % of the patients fell once, 9 % of the patients fell twice, 4 % of the patients fell three times. 58 % of all falls were experienced by...

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Moczygemba, Leticia Rae 1978. "The impact of pharmacist provision of medication therapy management (MTM) on medication and health-related problems, medication knowledge, and medication adherence among Medicare beneficiaries." 2008. http://hdl.handle.net/2152/17883.

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This study used the Andersen Model for Health Services Utilization to examine a pharmacist-provided telephone MTM program among Medicare Part D beneficiaries. Predisposing (age, gender, race) and need factors (number of medications, number of chronic diseases, medication regimen complexity) were assessed. The health behavior, MTM utilization, distinguished the intervention and control groups. The health outcomes were change in number of medication-related problems, change in medication adherence [using the medication possession ratio (MPR)], and change in total drug costs. Medication knowledge, medication adherence (using the Morisky Scale), and patient satisfaction were also measured in the intervention group. The intervention and control groups were not significantly different in age (71.2 ± 7.5 vs. 73.9 ± 8.0 years), number of medications (13.0 ± 3.2 vs. 13.2 ± 3.4), number of chronic diseases (6.5 ± 2.3 vs. 7.0 ± 2.1), and medication regimen complexity [21.5 (range 8 – 43) vs. 22.8 (range 9 – 42.5)], respectively. For the subset of problems that was evaluated in the intervention and control groups, 4.8 (± 2.7) and 9.2 (± 2.9) problems were identified at baseline and 2.7 (± 2.3) and 8.6 (± 2.9) problems remained at the 3-month follow-up, respectively. Cost-related and preventative care needs and drug-drug interactions were the three most common problems identified. Multivariate regression analysis revealed that the intervention group had significantly more problems resolved (p < 0.0001) when compared to the control group, while controlling for predisposing and need factors. Significantly fewer problems were resolved (p = 0.01) as number of diseases increased and significantly more problems were resolved (p = 0.01) as medication regimen complexity increased. There were no significant predictors of change in MPR or total drug costs from baseline to the 3-month follow-up. Medication knowledge and medication adherence measured by the Morisky scale did not change significantly from baseline to the 2-week follow-up. However, patients were very satisfied with the service. A pharmacist-provided telephone MTM program was an effective method for identifying and resolving medication and health-related problems. A longer follow-up period may be necessary to detect the impact of pharmacist provision of MTM on adherence, total drug costs, and knowledge.
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Šubrtová, Linda. "Analýza lékových problémů ve zdravotnickém zařízení IV." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-382843.

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Analysis of drug-related problems in a health facility IV. Author: Linda Šubrtová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Increasing use of drugs leads to a growing risk of occurence of drug-related problems. These problems can often endanger patient's health and increase the economic cost of the treatment. However, many of these problems can be prevented by controls and collaboration of all health care subjects. Objective: The aim of this work was to carry out a revision of pharmacotherapy in a rehabilitation health facility and to analyse acquired drug-related problems. Methodology: The collection of data took place from 13 to 15 February 2017 in health facility in the Czech Republic. The review of pharmacotherapy was performed by a three-member team (clinical pharmacist, pharmacist, work researcher). The data obtained from the provided medical records were recorded into the database, which was prepared for the purpose of the pharmacotherapy review. Recorded were: the patient's age and sex, allergic, family, work, social and personal history, physical and laboratory examinations and complete pharmacotherapy, which included over-the-counter drugs and dietary supplements, including dosage...

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Bahnerová, Michaela. "Analýza lékových problémů ve zdravotnickém zařízení I." Master's thesis, 2014. http://www.nusl.cz/ntk/nusl-339704.

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Analysis of drug-related problems in a health facility I. Author: Michaela Bahnerová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Intoduction: Drug-related problems (DRPs) lower the quality of health care and present a risk factor in patient's safety. Objectives: The aim of this thesis is identification, classification and further analysis of DRPs in health care facility. Methods: Revision of pharmacotherapy was performed in health care facility in term 6. 8. - 10. 8. 2012. The pharmaceutical team which contained two pharmacists and diplomant examined health documentation of patients hospitalized in the facility. We collected information from personal, allergic, family, and labor-social anamnesis of patients. This data were noted into electronical database and after revision were DRPs classified and evaluated. The results of DRPs identification were evaluated by frequency analysis. In ten randomly selected patients was described DRPs resolution. Results: In total we noticed medical therapy in 175 patients (61 % women). Average patient's age was 58 years. 482 DRPs were identified. Of the patients, 84 % had DRPs and an average of 2,75 DRPs were recorded per patient. Conclusion: Appearance of DRPs is very frequent and...

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Odenwald, Michael [Verfasser]. "The use of the stimulant khat, war related trauma and psychosis in Somalia : how changed use patterns of a traditional drug are related to psychiatric problems in a country in the transition from war to peace / Michael Odenwald." 2007. http://d-nb.info/983478139/34.

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Keegan, Vanessa. "Facteurs de risque des problèmes attribuables à la consommation de drogues et d'alcool à l'adolescence." Thèse, 2009. http://hdl.handle.net/1866/7442.

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Kalaitzidis, Georgios. "The analysis of pharmacotherapy by patients suffering with DM in Greece I." Master's thesis, 2015. http://www.nusl.cz/ntk/nusl-334853.

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The analysis of pharmacotherapy by patients suffering with DM in Greece I Author: Georgios Kalaitzidis Tutor: Professor RNDr.Jiri Vlcek,CSc. Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove. Introduction: The diabetes in developed countries concerns 11% of people over 70 years and is the cause of 3% of total deaths in general population. Aim: The aim of the study was to assess the Pharmacotherapy of Diabetes mellitus type II in a pharmacy of a small town of Greece, Veria. Methods: It is retrospective cross-sectional study, which was conducted in a pharmacy in a small town of Greece, Veria. The study population consists of 60 patients with known Type II diabetes Melitus. The data collection was performed by a self-reported questionnaire, which was created and developed by the researcher and filled by the respondents. Results: The mean age of the sample was 56.5±17.5 years. Most of them were females (n=40). Most of the patients knew their fasting glucose level (93.3%,n=56).Of the patients who knew their fasting glucose level, 36 (64.3%) patients had high fasting glucose level and 20 (35.7%) had physiological fasting glucose level. From all the patients(n=60), some of them visited their physician every 6 months (n=24), and every 3 months...

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Maithya, Redempta W. "Drug abuse in the secondary school in Kenya : developing a programme for prevention and intervention." Thesis, 2009. http://hdl.handle.net/10500/3433.

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Drug abuse is becoming an increasing problem in Kenya. A number of studies carried out in the country show that almost every Kenyan youngster at one time or another experiments with drugs, especially beer and cigarettes. The major cause of concern is that a significant proportion of these young people eventually get addicted posing a threat to their own health and safety, while creating difficulties for their families and the public at large into difficulties. This study sought to establish the current trend of drug abuse among students in Kenyan secondary schools, and to analyze the strategies used to address the problem. The ultimate aim was to propose a programme for prevention and intervention. The study is a descriptive survey. In view of this, the field survey method was adopted to collect quantitative and qualitative data, using questionnaires and interviews. Both qualitative and quantitative approaches were used in data analysis, thus there was a mixed model research design approach to data analysis. The analysis of structured items was mainly done using the Statistical Package for Social Sciences (SPSS). The key findings from the study were that drug abuse among students is common; both boys and girls have abused drugs with the majority being in boys‟ schools; the greatest ratio of drug abusers to non-abusers among the sampled schools are aged between 20 and 22 years; there is a significant relationship between drug abuse and age, use of drugs by other family members and easy access to drugs. A variety of factors contribute to drug abuse with the majority of students citing curiosity, acceptance by peers and ignorance as to the dangers of drug abuse as the main reasons. Both the school administrators and teachers face a number of challenges in an attempting to curb drug abuse in schools. The study makes a number of recommendations for policy and further research. A number of guidelines are proposed for developing a programme for prevention and intervention.
Educational Studies
D. Ed. (Socio-Education)

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