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At least 991 records · Page 55Linked to original sources

Pandemics, antiviral stockpiles and biosecurity in Australia: what about the generic option?

In view of the possibility of a human pandemic of avian influenza, a first-line strategy for many countries is stockpiling of antiviral neuraminidase inhibitors (oseltamivir [Tamiflu] and zanamivir [Relenza]), which can reduce mortality, morbidity and influenza transmission. However, global supply of the antivirals is controlled by the European-based patent owners, Roche and GlaxoSmithKline. This prevents competition in the manufacturing and distribution of antivirals and has reduced global supply capacity and affordability. The Australian Government has acknowledged that, in the event of a pandemic, its own stockpile of antivirals will be limited and reserved for those on a confidential rationing list. Pharmacies are running out of stocks, limiting opportunities for individuals to secure supplies privately. Compulsory licensing provisions, permitted under domestic patent law, would allow Australian generic manufacturers to start producing antivirals locally or import them from generic producers at affordable prices. Australia also has an opportunity and a responsibility to promote compulsory licensing and generic antiviral production in the Asian region, to ensure our neighbours can establish pandemic stockpiles in a timely and affordable manner.

Antiviral Agents↗

The impact of computerization on medication discrepancies in a centralized unit dose drug distribution system.

A missing dose audit was conducted to evaluate the impact of computerization of a centralized unit dose drug distribution system on the number and source of medication discrepancies. The methodology used was the same as that used for a previous audit done before computerization. The cardiology and coronary care nursing units participated in the 12 day study. The pharmacy auditor and the nurse compared the contents of each patient's medication bin to the nursing profile daily. All discrepancies were documented, investigated, and resolved. All missing dose phone calls were recorded and evaluated. The results were compared to the results of the previous audit. The results of this audit showed that after computerization there was a 17% reduction in medication discrepancies and a 41% decrease in the number of phone calls received for missing doses. The audit uncovered additional areas where further change may be beneficial.

Centralized Hospital Services↗

Insecticide-treated nets and treatment service: a trial using public and private sector channels in rural United Republic of Tanzania.

The Rotary Net Initiative, implemented in Kilombero District, southern United Republic of Tanzania, allowed us to explore different sales channels for the distribution of insecticide-treated nets (ITNs) and the insecticide treatment service in a rural area of very high malaria transmission. Several types of ITNs were promoted and sold through different channels in the public and private sector, i.e. hospital pharmacy, mother and child health (MCH) clinic, net committee, village health workers and retail shops. The ITNs were sold for US$ 5.0-9.2, with profit margins of 9-16%. Net treatment cost US$ 0.33, with commission fees of 75%. Net transport and treatment were partially subsidized. Some outlets established their own fund by ITN sales. Sales of nets and treatments were seasonal, and certain net types were preferred. Demand for insecticide treatment was generally low. Changes in net coverage were assessed in two villages. A range of outlet features were compared qualitatively. Our experience supports suggestions that ITN technology should be delivered through MCH care services and demonstrates that specific promotion and innovation are necessary to achieve substantial net treatment levels. A large-scale ITN project in the same area and other ITN studies should lead to better understanding of ITN implementation at the population level.

Child, Preschool↗

Charting accuracy of scheduled medications in the medication administration record.

This study was designed by the pediatric clinical pharmacy service to evaluate the accuracy of the nursing Medication Administration Record (MAR). Medications returned to the pharmacy in the exchanged medication carts were compared to those charted in the computer-generated MAR for 10 working days. Fourteen percent of the doses studied were categorized as charting errors. Charting inconsistencies were summarized in a personalized memorandum distributed to the nursing staff on the pediatric unit. A subsequent evaluation revealed a 10% charting discrepancy rate. The nursing memo did not effect a statistically significant change in the error rates between the two phases of the study. Inaccurate charting poses problems for therapeutic decision making and for methods of reimbursement that use the MAR. This problem should be assessed in individual institutions. Corrective measures should be implemented and evaluated.

Documentation↗

Justification and operation of a critical-care satellite pharmacy.

Development and implementation of a pharmacy satellite for critical-care areas in a 700-bed community hospital are described. Before the satellite, central-pharmacy personnel filled 70% of critical-care orders; the remainder of medications were floor stock. Large-volume admixtures were prepared by nurses on the critical-care units. In planning for a satellite pharmacy, turn-around time and lost drug charges were studied. Workload and staffing projections and potential expenses and revenues associated with the proposed satellite were presented to the hospital administration. The satellite was approved and serves 82 beds including the critical-care areas. It is open 16.5 hours/day and provides all i.v. admixtures. Drug distribution is computerized, and pharmacists participate on the CPR team and on physician rounds. Data collected four months after the satellite opened showed shorter turnaround time, decreased floor stock inventory, fewer lost charges, and additional revenue from preparation of i.v. admixtures. Ten months after the satellite was opened, a unit dose system was implemented. Through implementation of the satellite, shorter turnaround time for medication orders and i.v. admixtures, improved drug control, and greater control over billing were achieved.

Hospital Bed Capacity, 500 and over↗

Development and preliminary testing of a patient decision aid to assist pharmaceutical care in the prevention of cardiovascular disease.

STUDY OBJECTIVE: To develop and test a decision aid for patients with hypertension and/or dyslipidemia because a decision aid may assist in pharmaceutical care by providing relevant evidence-based information. DESIGN: Before and after use of a decision aid. SETTING: Hypertension clinic of a university hospital and a specialized coronary heart disease-prevention clinic. PATIENTS: A convenience sample of 16 patients receiving pharmacologic treatment for hypertension and/or dyslipidemia. INTERVENTION: A face-to-face interview was conducted before using the decision aid. This was followed by a telephone interview after the patient used the decision aid to assess the acceptability of the decision aid to the patient, as well as the patient's knowledge, risk perception, and decisional conflict. MEASUREMENTS AND MAIN RESULTS: The decision aid consists of a booklet containing general, evidence-based information and a personal worksheet. The worksheet provides information on patient risk factors, personal estimates of cardiovascular disease (CVD) risk, the benefits of treatment options, and values clarification exercise. It invites patients to specify an action plan and follow their own progress over time. Most patients (86-93%) rated the presentation of the information as excellent or very good, 80% judged the information about lifestyle changes and drug therapy to be balanced, 93% rated the amount of information "just right," and 100% found the decision aid useful. After using the decision aid, patients had higher knowledge scores for general risk factors (before, 91%; after, 100%, p=0.014), personal risk factors (73%, 92%, p=0.016), and treatment options (68%, 99%, p<0.001). More patients were able to estimate correctly their CVD risk category (50%, 93%, p=0.03) and their absolute 10-year CVD risk (0%, 93%, p<0.001), whereas the overall decisional conflict score decreased (p=0.007). CONCLUSION: The decision aid was acceptable to patients and improved their knowledge, risk perception, and decisional conflict. Therefore, the feasibility and impact of using the decision aid in community pharmacies and medical clinics should be assessed.

Cardiovascular Diseases↗

A prototype generalized network technology for hospitals: initial implementation.

A demonstration implementation of a distributed data-processing hospital information system using an intelligent local area communications network (LACN) technology is described. This system is operational at the UCSF Medical Center and integrates four heterogeneous, stand-alone minicomputers. The applications systems are PID/Registration, Outpatient Pharmacy, Clinical Laboratory, and Radiology/Medical Records. Functional autonomy of these systems has been maintained, and no operating system changes have been required. The LACN uses a fiber-optic communications medium and provides extensive communications protocol support within the network, based on the ISO/OSI Model. The architecture is reconfigurable and expandable. This paper describes system architectural issues, the applications environment, and the local area network.

California↗

Prescribing amphetamines to drug misusers: data from the 1995 national survey of community pharmacies in England and Wales.

Results from the 1995 survey of community pharmacy services for drug misusers provide data on 177 amphetamine prescriptions dispensed by pharmacists; this extrapolates to an estimated 900-1000 patients receiving amphetamine for the treatment of addiction in England and Wales, at any one time. Seventy-three per cent and 24% of prescriptions were for dexamphetamine tablets and oral liquid, respectively, and 3% for injectables amphetamines. Fifty-seven per cent of prescriptions were from doctors working in hospital/clinics and 92% in NHS practice. Hospital/clinic-based prescribers tended to prescribe lower daily doses and were more likely to instruct daily pickups than general practitioners, as did those in NHS compared with private practice. Major regional variations were noted in the overall distribution of prescriptions and for the different dosage forms. In conclusion, we find that there is a disturbing lack of consistency nationally and a lack of safeguards against diversion into the black market.

Amphetamines↗

Management stretegy for the diffusion of innovation: unit dose drug distribution.

The concepts of the change agent and opinion leader are explored as means to aid the pharmacists in affecting the diffusion of an innovation such as unit dose. A four-part model which describes one possible management strategy for the diffusion of innovation into the organization is presented. The effect of changes in the environment of hospital pharmacy, which may result in the recognition of performance gaps and thus stimulate the introduction of innovation, is discussed. Aspects of diffusion of an innovation--supplying the appropriate information, the knowledge function; creating a positive attitude toward the implementation of the innovation, the persuasion function; the adoption or rejection of the innovation, the decision function--are explained. The successful diffusion of an innovation requires a conscious management strategy, such as the four-component model discussed in this paper.

Decision Making↗

Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s.

BACKGROUND: The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. OBJECTIVES: To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. METHODS: Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million. RESULTS: The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. CONCLUSION: The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.

Adolescent↗

Injecting equipment sharing among injecting drug users in Togliatti City, Russian Federation: maximizing the protective effects of syringe distribution.

OBJECTIVE: To compare risk factors for injecting equipment sharing among injecting drug users (IDUs) in Togliatti City, Russia. DESIGN: Unlinked, anonymous, cross-sectional community-recruited survey with oral fluid sample collection. METHODS: Between September and October 2001, 426 IDUs completed an interviewer-administered questionnaire and oral fluid samples were tested for HIV. Univariate and multivariate analyses compared potential risk factors for injecting equipment sharing. RESULTS: More than half (56% [234/418]) of the sample were positive for antibodies to HIV. A third (36%) had injected with used needles and syringes in the last 4 weeks. IDUs who reported syringe exchanges or outreach workers as their main sources of new needles and syringes in the last 4 weeks had 0.3 times the odds of sharing compared with those obtaining them from a pharmacy or shop, whereas those whose main source was buying them from the streets or obtaining them from friends, sexual partners, or other drug users had 12 times the odds of receptive needle and syringe sharing. IDUs who reported being last arrested or detained by the police for a drug-related offense had higher odds of sharing. CONCLUSIONS: Findings highlight the delicate balance in HIV prevention between potentially competing strategies of law enforcement and syringe distribution.

Analysis of Variance↗

Language barriers surrounding medication use among older Latinos.

Limited English language proficiency forms a significant challenge for many Latinos in clinical settings. Although medications are commonly used by older individuals as a means of maintaining good health and managing health problems, the extent to which English proficiency is related to medication use among older Latinos is not known. Focus groups were conducted with Latino, community-residing individuals aged 50 and over in eastern Massachusetts. Qualitative evaluation of the group interviews suggests that language is a barrier in dealing with medication for these individuals. Limited English proficiency appears to be related to feelings of being discriminated against in clinical and pharmacy settings. As well, communicating directly with health professionals in a common language is associated with level of trust and confidence in medical settings. Use of formal and informal interpreters, as well as seeking Spanish-speaking physicians and pharmacies with Spanish-speaking staff, are identified as strategies for overcoming health-related obstacles surrounding language.

Age Distribution↗

Preinduction cervical ripening with commercially available prostaglandin E2 gel: a randomized, double-blind comparison with a hospital-compounded preparation.

OBJECTIVE: Our purpose was to compare the efficacy, safety, and cost of commercially available dinoprostone cervical gel 0.5 mg with a hospital-compounded formulation. STUDY DESIGN: One hundred thirty-four patients undergoing labor induction were randomly assigned to one of two cervical ripening groups. Commercially available dinoprostone gel 0.5 mg or a compounded formulation of 0.5 mg of prostaglandin E2 gel was administered endocervically. On the basis of cervical scores, gel was reapplied at 6-hour intervals for a maximum of three doses. Physicians managing labor were blinded as to treatment group allocation. RESULTS: Among 134 patients evaluated, 70 were allocated to the commercially available gel and 64 to the compounded gel. No statistically significant differences were noted between the treatment groups with respect to start-to-delivery interval, number of doses, amount of oxytocin, or neonatal adverse outcomes. However, cesarean delivery was performed less frequently in patients in the group receiving the commercially available gel (12.9%) than in the group receiving the compounded gel (28.1%) (p = 0.03). Because of the higher cesarean delivery rate in the compound group, use of this formulation was not associated with cost savings. CONCLUSIONS: The two prostaglandin E2 formulations appeared equivalent with respect to efficacy. An unexplained higher cesarean section rate, however, was associated with the use of the compounded preparation.

Adolescent↗

Hypothetical versus real willingness to pay in the health care sector: results from a field experiment.

We conducted a field experiment comparing hypothetical and real purchase decisions for a pharmacist provided asthma management program among 172 subjects with asthma. Subjects received either a dichotomous choice contingent valuation question or were given the opportunity to actually enroll in the program. Three different prices were used: US$ 15, 40, and 80. In the hypothetical group, 38% of subjects said that they would purchase the good at the stated price, but only 12% of subjects in the real group purchased the good (p = 0.000). We cannot, however, reject the null hypothesis that "definitely sure" hypothetical yes responses, as identified in a follow-up question, correspond to real yes responses. We conclude that the dichotomous choice contingent valuation method overestimates willingness to pay, but that it may be possible to correct for this overestimation by sorting out "definitely sure" yes responses.

Adolescent↗

Productivity and medical costs of diabetes in a large employer population.

OBJECTIVE: The purpose of this study was to assess the economic burden of diabetes from an employer's perspective. We analyzed the costs of diabetes, using claims data for an employed population and the prevalence of selected comorbid conditions. RESEARCH DESIGN AND METHODS: The data source is a claims database from a national Fortune 100 manufacturer. It includes medical, pharmacy, and disability claims for all beneficiaries (n >100,000). Both medical and work productivity costs of diabetes patients are compared by age with those of matched control subjects from the overall beneficiary population. Out-of-pocket and intangible costs are excluded. RESULTS: In 1998, the employer's mean annual per capita costs were higher for all diabetes beneficiaries than for control subjects ($7,778 +/- 16,176 vs. $3,367 +/- 8,783; P < 0.0001), yielding an incremental cost of $4,410 +/- 18,407 associated with diabetes. The medical and productivity costs for employees with diabetes were significantly (P < 0.0008) higher than for control subjects. The incremental cost of diabetes among employees ranged from $4,671 (aged 18-35 years) to $4,369 (aged 56-64 years). CONCLUSIONS: Diabetes imposes a significant economic burden on employers, particularly when including productivity costs. Employers should select health plans that provide enriched benefits to diabetes patients, including ready access to medical and pharmacy services as well as aggressive diabetes management programs.

Adolescent↗

Cardioplegia solutions.

The mechanism of action, characteristics and components, dosage and administration, and adverse effects of cardioplegia solution are described. The pharmacist's role in the formulation, preparation, and quality control of cardioplegia solution is also discussed. The use of cardioplegia solution has substantially increased the safety of cardiac surgery. It protects the myocardium by inducing a rapid and complete diastolic arrest, minimizing myocardial energy requirements and preventing ischemic damage during the arrest phase, and minimizing or preventing reperfusion injury once coronary blood flow is restored. Chemical components added to the cardioplegia solution, such as potassium and glucose, are largely responsible for this protective effect. Basic characteristics of cardioplegia solutions include temperature, osmolarity, and pH. Crystalloid solution has traditionally been used as a vehicle for cardioplegia solution; however, laboratory and clinical studies have demonstrated favorable effects of blood-based cardioplegia solution. Single-pass and recirculating delivery systems can be used to administer either crystalloid or blood cardioplegia solutions. Pharmacists can play a major role in the formulation, preparation, distribution, and quality control of cardioplegia solutions; these solutions prevent myocardial injury during the arrest and reperfusion phases of cardiac surgery.

Cardioplegic Solutions↗