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Dispensing
Terms modified by Dispensing Selected AbstractsSystem for Ophthalmic Dispensing, 3rd editionCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 6 2008Article first published online: 10 OCT 200 No abstract is available for this article. [source] Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependenceADDICTION, Issue 1 2010Marie Longo ABSTRACT Aim To investigate the safety and efficacy of once-daily supervised oral administration of sustained-release dexamphetamine in people dependent on methamphetamine. Design Randomized, double-blind, placebo-controlled trial. Participants Forty-nine methamphetamine-dependent drug users from Drug and Alcohol Services South Australia (DASSA) clinics. Intervention Participants were assigned randomly to receive up to 110 mg/day sustained-release dexamphetamine (n = 23) or placebo (n = 26) for a maximum of 12 weeks, with gradual reduction of the study medication over an additional 4 weeks. Medication was taken daily under pharmacist supervision. Measurements Primary outcome measures included treatment retention, measures of methamphetamine consumption (self-report and hair analysis), degree of methamphetamine dependence and severity of methamphetamine withdrawal. Hair samples were analysed for methamphetamine using liquid chromatography-mass spectrometry. Findings Treatment retention was significantly different between groups, with those who received dexamphetamine remaining in treatment for an average of 86.3 days compared with 48.6 days for those receiving placebo (P = 0.014). There were significant reductions in self-reported methamphetamine use between baseline and follow-up within each group (P < 0.0001), with a trend to a greater reduction among the dexamphetamine group (P = 0.086). Based on hair analysis, there was a significant decrease in methamphetamine concentration for both groups (P < 0.0001). At follow-up, degree of methamphetamine dependence was significantly lower in the dexamphetamine group (P = 0.042). Dexamphetamine maintenance was not associated with serious adverse events. Conclusions The results of this preliminary study have demonstrated that a maintenance pharmacotherapy programme of daily sustained-release amphetamine dispensing under pharmacist supervision is both feasible and safe. The increased retention in the dexamphetamine group, together with the general decreases in methamphetamine use, degree of dependence and withdrawal symptom severity, provide preliminary evidence that this may be an efficacious treatment option for methamphetamine dependence. [source] Gold Nanoparticle-Based Mediatorless Biosensor Prepared on Microporous ElectrodeELECTROANALYSIS, Issue 3 2006Fenghua Zhang Abstract A mediatorless biosensor was fabricated with a double-sided microporous gold electrode by successively immobilizing a mixed self-assembled monolayer (SAM) comprising carboxylic-acid- and thiol-terminated thiolate (dl -thiorphan and 1,8-octanedithiol), glucose oxidase (GOx) and finally gold nanoparticle (Au NP) on one working side. The double-sided microporous gold electrodes were formed by plasma sputtering of gold on a porous nylon substrate, yielding a face-to-face type two-electrode electrochemical cell. While the straight chain molecule 1,8-octanedithiol forms a dense insulating monolayer, the side armed dl -thiorphan forms a low density layer for the diffusion of redox couples to the electrode surface. The mixed SAM not only provided the linking functional groups for both enzyme and Au NP but also resulted in the appropriately spaced monolayer for direct electron tansfer (ET) process from the center of the redox enzyme to the electrode surface. After covalently immobilizing GOx onto the carboxylic-acid-terminated monolayer, Au NP was easily immobilized to both enzyme and nearby thiols by simple dispensing of the colloidal gold solution. It was observed that the resulting amperometric biosensor exhibited quantitatively the same response to glucose in the presence and in the absence of dissolved oxygen, which evidence that the Au NPs immobilized on and around the GOx promote direct ET from the enzymes to the electrode, assuming the role of a common redox mediator. [source] Cover Picture: Electrophoresis 8'2010ELECTROPHORESIS, Issue 8 2010Article first published online: 20 APR 2010 Issue no. 8 is a regular issue comprising19 manuscripts distributed over four distinct parts. Part I is on proteins and proteomics and has 5 articles; Part II is on nucleic acids with 5 articles on DNA purification, sequencing, genotyping and differential gene expression; Part III has 4 articles on droplet dispensing and particle separation; Part IV is on various methodologies and applications assembling 5 articles on improved sample preparation method for glycan analysis by CE, measurement of intracellular accumulation chemotherapeutic drugs in cancerous cells, metabolic monitoring in microfluidic cell arrays, microchip electrophoresis for continuous monitoring of microdialysis samples, and determination of glyphosate and its metabolites in plant materials by CE. Featured articles include: Delta2D and Proteomweaver: Performance evaluation of two different approaches for two-dimensional electrophoresis analysis. ((10.1002/elps.200900766)) A Multidimensional Electrophoretic System of Separation for the Analysis of Gene Expression (MESSAGE). ((10.1002/elps.200900624)) Particle trapping using dielectrophoretically patterned carbon nanotubes. ((10.1002/elps.200900717)) [source] Does prescribing for opiate addiction change after national guidelines?ADDICTION, Issue 5 2007Methadone, buprenorphine prescribing to opiate addicts by general practitioners, hospital doctors in England ABSTRACT Aim To assess changes in opiate prescribing (1995,2005) following a decade of national guidelines to address substandard opiate substitution prescribing for heroin addiction. Design A repeat national survey (1995 and 2005) using random one-in-four samples of all community pharmacies in England, achieving response rates of 75% (1847/2475) in 1995 and 95% (2349/2473) in 2005. Data were obtained on 3732 (1995 data) and 9620 (2005 data) prescriptions dispensed in the preceding month from the 936 and 1463 pharmacies who were currently dispensing. Measurements We have measured impact on practice for seven specific recommended changes. Findings Between 1995 and 2005 the number of substitute opiate prescriptions doubled (×2.03). By 2005, methadone still dominated (down from 97% to 83%), buprenorphine increased (from 1% to 16%) and other opiate medications virtually disappeared. Changes in the direction of national guidelines included: increased daily dose of methadone (from 47.3 mg to 56.3 mg), more frequent dispensing (from 38% to 60% as daily instalments), more supervised consumption (from 0% to 36%) and fewer methadone tablets (from 10.9% to 1.8%). Nevertheless, despite the increased mean daily dose, only 41.0% of prescriptions for methadone were for daily doses in the recommended 60,120 mg dose range. Only one change was not in the direction of the national guidelines,the proportion of prescriptions from GPs fell from 41% to 30%, although this still represented an approximate 50% increase in the extent of GP prescribing. Conclusion Doubling in provision of opiate substitute treatment has occurred, alongside significant improvements in the nature of this treatment. These positive changes have occurred in the direction of six out of seven of the UK national guidelines. [source] Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?HEALTH ECONOMICS, Issue 5 2007Adam Wagstaff Abstract The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system , the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals , rapid cost and price inflation, a race for the best technology, and so on , illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more ,rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists. Copyright © 2006 John Wiley & Sons, Ltd. [source] Strategies to reduce medication errors with reference to older adultsINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2006Brent Hodgkinson BSc (Hons) MSc GradCertPH GradCertEcon(Health) Abstract Background, In Australia, around 59% of the general population uses prescription medication with this number increasing to about 86% in those aged 65 and over and 83% of the population over 85 using two or more medications simultaneously. A recent report suggests that between 2% and 3% of all hospital admissions in Australia may be medication related with older Australians at higher risk because of higher levels of medicine intake and increased likelihood of being admitted to hospital. The most common medication errors encountered in hospitals in Australia are prescription/medication ordering errors, dispensing, administration and medication recording errors. Contributing factors to these errors have largely not been reported in the hospital environment. In the community, inappropriate drugs, prescribing errors, administration errors, and inappropriate dose errors are most common. Objectives, To present the best available evidence for strategies to prevent or reduce the incidence of medication errors associated with the prescribing, dispensing and administration of medicines in the older persons in the acute, subacute and residential care settings, with specific attention to persons aged 65 years and over. Search strategy, Bibliographic databases PubMed, Embase, Current contents, The Cochrane Library and others were searched from 1986 to present along with existing health technology websites. The reference lists of included studies and reviews were searched for any additional literature. Selection criteria, Systematic reviews, randomised controlled trials and other research methods such as non-randomised controlled trials, longitudinal studies, cohort or case,control studies, or descriptive studies that evaluate strategies to identify and manage medication incidents. Those people who are involved in the prescribing, dispensing or administering of medication to the older persons (aged 65 years and older) in the acute, subacute or residential care settings were included. Where these studies were limited, evidence available on the general patient population was used. Data collection and analysis, Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data where possible. All other data were presented in a narrative summary. Results, Strategies that have some evidence for reducing medication incidents are: ,,computerised physician ordering entry systems combined with clinical decision support systems; ,,individual medication supply systems when compared with other dispensing systems such as ward stock approaches; ,,use of clinical pharmacists in the inpatient setting; ,,checking of medication orders by two nurses before dispensing medication; ,,a Medication Administration Review and Safety committee; and ,,providing bedside glucose monitors and educating nurses on importance of timely insulin administration. In general, the evidence for the effectiveness of intervention strategies to reduce the incidence of medication errors is weak and high-quality controlled trials are needed in all areas of medication prescription and delivery. [source] Medication errors in older people with mental health problems: a reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2008Ian D Maidment Abstract Objective To review and summarise published data on medication errors in older people with mental health problems. Methods A systematic review was conducted to identify studies that investigated medication errors in older people with mental health problems. MEDLINE, EMBASE, PHARMLINE, COCHRANE COLLABORATION and PsycINFO were searched electronically. Any studies identified were scrutinized for further references. The title, abstract or full text was systematically reviewed for relevance. Results Data were extracted from eight studies. In total, information about 728 errors (459 administration, 248 prescribing, 7 dispensing, 12 transcribing, 2 unclassified) was available. The dataset related almost exclusively to inpatients, frequently involved non-psychotropics, and the majority of the errors were not serious. Conclusions Due to methodology issues it was impossible to calculate overall error rates. Future research should concentrate on serious errors within community settings, and clarify potential risk factors. Copyright © 2007 John Wiley & Sons, Ltd. [source] Community pharmacy services to drug misusers in the south west of England: results of the 2003,2004 postal surveyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2006Rachel M Britton research pharmacist Objectives To quantify current levels of methadone dispensing and supervised consumption for the treatment of drug misuse in community pharmacies in the south west of England. To compare 2003,2004 data to estimates made in 1995. Setting All community pharmacies in the strategic health authority areas of Avon, Gloucestershire and Wiltshire; Dorset and Somerset; and South West Peninsula (n = 903). Method A self-completion postal questionnaire was addressed to the ,pharmacist in charge', with up to three reminders. Descriptive data were collected on demography and drug misuse services provided by the pharmacist. Key findings An overall response rate of 78.3% (707/903) was achieved. Of all respondents, 69.2% (n = 489) dispensed methadone for the treatment of drug misuse, and 70.1% of these pharmacies (n = 343) reported providing a supervised methadone consumption service. The total number of clients receiving methadone through pharmacies in the south west was 3427, with a mean number of 7.0 clients per pharmacy; 49.5% of all clients receiving methadone had their daily doses supervised by the pharmacist. The majority of prescriptions issued for methadone (72.9%, n = 2503) were from general practice. Conclusions The majority of pharmacies (69.2%) in south west England dispense methadone and other drugs to drug misusers with just under half of the clients (49.5%) receiving their methadone by supervised consumption. [source] Pilot randomised controlled trial of community pharmacy administration of buprenorphine versus methadoneINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2006Isobel M Cameron research fellow Objectives The established regime for opiate substitute prescribing for drug misusers is daily methadone administered under supervision in community pharmacies. Buprenorphine has recently been introduced as an alternative. However there is a lack of evidence of the effectiveness of buprenorphine maintenance therapy (BMT) in the UK treatment setting. This study aimed to assess methods for a randomised controlled trial (RCT) and the feasibility of pharmacy-based supervised self-administration (SSA) of buprenorphine compared to methadone. Setting Specialist substance misuse service, general practices and community pharmacies in Aberdeen, Scotland. Method The design was a pilot RCT. Opiate-dependent drug misusers, newly referred for maintenance treatment were randomised to receive BMT or methadone maintenance therapy (MMT). Clients and pharmacists were interviewed at baseline and at the end of a 12-week intervention period. Clients completed the quality of life measure EQ-5D. Pharmacy activities were timed. Key findings Twenty-one opiate-dependent clients were recruited (BMT = 11, MMT = 10). Recruitment levels improved as the trial progressed. Clients' treatment preferences were evident. Withdrawals occurred early with BMT. Clients found SSA of buprenorphine acceptable, but found daily administration more manageable than three times weekly. Pharmacists found the dispensing of buprenorphine to be an acceptable role, but felt less certain of ensuring against diversion with buprenorphine than they were with methadone. Pharmacy activities associated with buprenorphine took longer than those associated with methadone (mean = 7 min 25 s versus mean = 3 min 27 s, respectively). Conclusion Recruitment to a trial comparing MMT to BMT for opiate-dependent clients within a UK treatment setting is feasible. Clients and pharmacists found buprenorphine acceptable. [source] Repeat dispensing of prescriptions in community pharmacies: a systematic review of the UK literatureINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2006Charles W. Morecroft Research associate Objective To identify, review and evaluate the published literature that focused on the impact of repeat dispensing in community pharmacies in the United Kingdom. Method Electronic databases (e.g. Medline, Embase and CINAHL) were searched from 1992 to May 2005. This was supplemented by searching PJ-online, IJPP online conference abstracts and the bibliographies of retrieved articles. Analysis of the findings explored the quality of the assessed papers, stakeholders' perceptions of repeat dispensing, the impact on professional relationships and workload, quality of care and prescription cost savings. Key findings Four randomised controlled trials (RCTs) and one before-and-after study were identified; most studies also incorporated a qualitative component. The findings indicated that patients' satisfaction with repeat dispensing was high, mainly as the service was seen as more convenient and time saving. While pharmacists considered that their relationship with patients had improved, one study found that patients did not necessarily agree and considered that pharmacists still remained in their dispensaries. Quality of care was considered in two RCTs, which indicated that more adverse reactions and compliance issues were identified in the intervention group. However, no direct comparisons were reported in differences in rates between intervention and control groups. Likewise, it was not possible to determine if any of the reported cost savings were solely attributable to repeat dispensing, as direct comparisons between groups were not reported. Conclusions Definitive conclusions about the effectiveness and impact of repeat dispensing are difficult to draw given a lack of transparency and systematicity when reporting these studies. Nevertheless, the findings suggest that there are high levels of patient satisfaction with the service. Likewise, it was not possible to draw conclusions about the possible savings on the NHS drug budget. Important policy decisions are being made about the implementation of repeat dispensing; however they are currently been made in a vacuum of adequate information. [source] Lead-Time Reduction Utilizing Lean Tools Applied to Healthcare: The Inpatient Pharmacy at a Local HospitalJOURNAL FOR HEALTHCARE QUALITY, Issue 1 2010Omar Al-Araidah Abstract: The healthcare arena, much like the manufacturing industry, benefits from many aspects of the Toyota lean principles. Lean thinking contributes to reducing or eliminating nonvalue-added time, money, and energy in healthcare. In this paper, we apply selected principles of lean management aiming at reducing the wasted time associated with drug dispensing at an inpatient pharmacy at a local hospital. Thorough investigation of the drug dispensing process revealed unnecessary complexities that contribute to delays in delivering medications to patients. We utilize DMAIC (Define, Measure, Analyze, Improve, Control) and 5S (Sort, Set-in-order, Shine, Standardize, Sustain) principles to identify and reduce wastes that contribute to increasing the lead-time in healthcare operations at the pharmacy understudy. The results obtained from the study revealed potential savings of >45% in the drug dispensing cycle time. [source] Scheduling dispensing and counting in secondary pharmaceutical manufacturingAICHE JOURNAL, Issue 5 2009Michele Ciavotta Abstract In this article, we describe a general methodology for operations scheduling in dispensing and counting departments of pharmaceutical manufacturing plants. The departments are modeled as a multiobjective parallel machines scheduling problem under a number of both standard and realistic constraints, such as release times, due dates and deadlines, particular sequence-dependent setup times, machine unavailabilities, and maximum campaign size. Main characteristics of the methodology are the modularity of the solution algorithms, the adaptability to different objectives and constraints to fulfill production requirements, the easiness of implementation, and the ability of incorporating human experience in the scheduling algorithms. Computational experience carried out on two case studies from a real pharmaceutical plant shows the effectiveness of this approach. © 2009 American Institute of Chemical Engineers AIChE J, 2009 [source] Biofunctional rapid prototyping for tissue-engineering applications: 3D bioplotting versus 3D printing,JOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 3 2004Andreas Pfister Abstract Two important rapid-prototyping technologies (3D Printing and 3D Bioplotting) were compared with respect to the computer-aided design and free-form fabrication of biodegradable polyurethane scaffolds meeting the demands of tissue-engineering applications. Aliphatic polyurethanes were based on lysine ethyl ester diisocyanate and isophorone diisocyanate. Layer-by-layer construction of the scaffolds was performed by 3D Printing, that is, bonding together starch particles followed by infiltration and partial crosslinking of starch with lysine ethyl ester diisocyanate. Alternatively, the 3D Bioplotting process permitted three-dimensional dispensing and reactive processing of oligoetherurethanes derived from isophorone diisocyanate, oligoethylene oxide, and glycerol. The scaffolds were characterized with X-ray microtomography, scanning electron microscopy, and mechanical testing. Osteoblast-like cells were seeded on such scaffolds to demonstrate their potential in tissue engineering. © 2003 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 42: 624,638, 2004 [source] BSAVA's evidence to the dispensing reviewJOURNAL OF SMALL ANIMAL PRACTICE, Issue 3 2001Article first published online: 28 JUN 200 The Independent Review Group (IRG) is currently considering evidence relating to the dispensing of prescription-only medicines for veterinary use, and is due to report its findings to the Minister of Agriculture by March 31. The BSAVA has been actively involved in submitting evidence to the review. Following its written submission in October, it has given oral evidence and has taken part in two public workshops organised by the IRG. Here, Harvey Locke, the BSAVA's Senior Vice-President, provides details [source] A patient follow-up survey programme for alosetron: assessing compliance to and effectiveness of the risk management programmeALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2006D. MILLER Summary Background In November 2002, alosetron HCl (Lotronex, GlaxoSmithKline Research Triangle Park, NC, USA) was re-introduced to the US marketplace for women with severe diarrhoea-predominant irritable bowel syndrome. In support of the re-introduction, a risk management programme was implemented, which included a patient follow-up study in which all users of alosetron could participate. Aim We report on the methods used and the effectiveness of key elements of the risk management programme. Methods Patients voluntarily enroled in the study and completed questionnaires at baseline, after 5 and 10 weeks, and quarterly thereafter. Questions focussed on patient eligibility, knowledge of risks and benefits, and adherence to the recommended programme elements for education, prescribing and dispensing. Results Between December 2002 and 2004, 4803 patients enrolled in the study, and <3% were lost to follow-up. The average follow-up time was approximately 6 months, and the response rate for each assessment was >95%. A total of 90% of patients at baseline met the full clinical criteria recommended for the treatment. Patient adherence to the risk management programme was >87%. Conclusions Using the Lotronex risk management programme, patients met clinical criteria, were knowledgeable about treatment risks and benefits, and were adherent to the process elements of the programme. These patients seemed to engage in active dialogue with their physicians about symptoms and use of alosetron. [source] The ChromaGen contact lens system: colour vision test results and subjective responsesOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2001Helen A. Swarbrick Summary The ChromaGen lens system is designed to enhance colour perception in colour vision deficiency (CVD). To investigate its efficacy, 14 CVD subjects were prescribed ChromaGen contact lenses. Colour vision tests (Ishihara, Farnsworth Munsell D-15, Farnsworth Lantern) were administered at baseline, lens dispensing, and after a 2-week lens-wearing trial during which subjective responses were recorded daily using visual analogue scales. ChromaGen lenses significantly reduced Ishihara error rates(p<0.001; ANOVA), particularly for deutan subjects. There was also a significant reduction in errors(p<0.005) on the D-15 test. Conversely, lens wear had no significant effect on Farnsworth Lantern test performance. Subjectively, subjects reported enhanced colour perception, but poor vision in dim light. Judgement of distance and motion were only slightly affected. We conclude that ChromaGen lenses may enhance subjective colour experience and assist in certain colour-related tasks, but are not indicated as an aid for CVD in occupations with colour vision-related restrictions. [source] Population stress and the Swedish sex ratioPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 6 2005Ralph Catalano Summary Well-developed theory implies that the human secondary sex ratio moves inversely over time with the level of anxiety and depression in the population. Few tests of this hypothesis, however, appear in the voluminous literature concerned with the sex ratio. These tests, moreover, employ designs that allow only weak inference. We contribute to the literature by applying time-series methods to Swedish data for the 276 months beginning January 1974 to detect a relationship between the sex ratio and defined daily doses of antidepressants and anxiolytics dispensed to women. Consistent with theory, we find the drug variable inversely related to the sex ratio. We argue that the discovered association cannot be attributed to shared trends, cycles, or other forms of autocorrelation in the data, or to the problem of endogeneity that necessarily plagues studies based on samples of individual women and births. Implications include that surveillance systems might monitor dispensing of anxiolytics and antidepressants as a marker for population stress thought to be a risk factor for adverse pregnancy outcomes such as preterm delivery. [source] Increased risk of hip fracture in the elderly associated with prochlorperazine: is a prescribing cascade contributing?,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2010Gillian E. Caughey Abstract Purpose To examine the prescribing of prochlorperazine secondary to the prescribing of a medicine which could lead to symptoms for which prochlorperazine is indicated and commonly used. Given the range of potential hypotensive, sedative, dystonic and other extra-pyramidal side effects associated with prochlorperazine, its association with hip fracture was also examined. Methods Prescription/event sequence symmetry analyses were undertaken from 1st January 2003 to 31st December 2006, using administrative claims data from the Department of Veterans' Affairs, Australia. This method assesses asymmetry in the distribution of an incident event (either prescription of another medicine or hospitalization) before and after the initiation of prochlorperazine. Crude and adjusted sequence ratios (ASR) with 95% confidence intervals (CI) were calculated. Results A total of 34,235 persons with incident use of prochlorperazine were identified during the study period. Statistically significant positive associations were found for a number of commonly used medicines, including cardiovascular medicines, NSAIDs, opioids and sedatives and the subsequent initiation of prochlorperazine that ranged from 1.07 (95%CI 1.01,1.14) for diuretics to 1.50 (95%CI 1.40,1.61) for statins. Prescription event analysis showed a 49% (95%CI 1.19,1.86) increased risk of hospitalisation for hip fracture following dispensing of prochlorperazine. Conclusions Prescribers should consider the possible contributing role of newly initiated medicines with the potential to cause of dizziness, and where possible address this through dose reduction or cessation of the medicine, rather than prescribing prochlorperazine. Copyright © 2010 John Wiley & Sons, Ltd. [source] COX-2 inhibitors: complex association with lower risk of hospitalization for gastrointestinal events compared to traditional NSAIDs plus proton pump inhibitors,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2009Michiel W. van der Linden MDPhD Abstract Purpose To compare hospitalization rates for serious upper and lower gastrointestinal (GI) events between chronic and acute users of a traditional non-steroidal anti-inflammatory drugs (tNSAID),+,proton pump inhibitor (PPI) and users of a COX-2 selective inhibitor (Coxib). Methods The PHARMO Record Linkage System, including linked drug-dispensing and hospital records of approximately 3 million individuals in the Netherlands was used. We selected new Coxib or tNSAID users (01/01/2000,31/12/2004) with ,1,year history before the first NSAID dispensing and ,1,year follow-up ending at the first hospitalization for GI event (the outcome), last dispensing, or end of the study period. Chronic users were patients who used any NSAIDs for ,60,days during the first year (n,=,58,770); others were acute users (n,=,538,420). Multivariate analysis was performed by Poisson regression adjusted for gender, age, and duration of follow-up, tNSAID and Coxib dose, NSAID/PPI adherence, use of other gastroprotective agents, anticoagulants, acetaminophen, corticosteroids, and cardiovascular disease. Results The cohort included 23,999 new tNSAIDs,+,PPI users and 25,977 new Coxib users, with main characteristics: mean,±,SD age 58.1,±,15.5 vs. 56.7,±,17.5; female 55.3% vs. 62.2%; duration of treatment (days): 137,±,217 vs. 138,±,179, respectively. Among acute users, adjusted hazard ratios (95% Confidence Interval) were 0.21 (0.14,0.32) for upper and 0.26 (0.16,0.42) for lower GI events, for Coxib versus tNSAIDs,+,PPI users. Among chronic users, these were 0.35 (0.22,0.55) for upper GI and 0.43 (0.25,0.75) for lower GI events. Conclusions Coxib users had significantly lower rates of GI events. Further research should elucidate the possible impact of selection bias. Copyright © 2009 John Wiley & Sons, Ltd. [source] Treatment with inhaled corticosteroids in asthma is too often discontinued,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Nancy S. Breekveldt-Postma PhD Abstract Purpose To study persistence with inhaled corticosteroids (ICS) and its determinants in asthma-patients. Methods From the PHARMO database, asthma-patients (age,<,35 years) with a first dispensing for ICS in 1999,2002 and,,,2 dispensings in the first year were included. Persistence during the first year was defined as the number of days from start to time of first failure to continue renewal of the initial ICS. Potential determinants of persistence were assessed at ICS-start and 1 year before. Results The study-cohort included 5563 new users of single ICS and 297 of fixed-combined ICS. Less than 10% of patients using single ICS and 15% of patients using fixed-combined ICS were persistent at 1 year. Similar persistence-rates were observed when stratified for age (children/adolescents: 0,18 years and adults: 19,34 years). Increased persistence with single ICS was observed with the type of ICS (budesonide), prescriber (specialist), prior use of long-acting beta-agonists, previous hospitalization for asthma, metered-dose inhaler, low starting-dose and once-daily dosing regimen at start. Persistence with fixed combined ICS-treatment increased with younger age and was decreased in patients having high starting-dose of ICS and prior use of antibiotics. Conclusion New users of both single and fixed combined ICS have alarming low persistence rates with ICS-treatment in the first year of follow-up. Persistence was mainly related to patient factors, such as severity of disease, and to treatment-related factors, such as once-daily dosing frequency. Copyright © 2008 John Wiley & Sons, Ltd. [source] What happened to the prescribing of other COX-2 inhibitors, paracetamol and non-steroidal anti-inflammatory drugs when rofecoxib was withdrawn in Australia?,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 11 2007Nadia Barozzi Abstract Objectives To analyse how the prescribing of cyclooxygenase-2 (COX-2) inhibitors, non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) and paracetamol (acetaminophen) changed when rofecoxib was withdrawn in 2004. Method COX-2 inhibitors, paracetamol and ns-NSAID's use was measured using dispensing data for concession beneficiaries subsidized by the Australian Pharmaceutical Benefit Scheme (PBS) for the period of 1997,2005. Data were downloaded from the Medicare Australia website and converted, according to the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) (2005), to DDD/1000 concession beneficiaries/day. Results In the period 2000,2004, the use of COX-2 inhibitors was progressively increased. Overall NSAID's use changed from approximately 80 to 105,DDD/1000 concession beneficiaries/day while a decrease of ns-NSAIDs from about 70 to 40,DDD/1000 concession beneficiaries/day was observed. Following rofecoxib withdrawal, the overall NSAIDs use declined. In 2005, celecoxib prescription declined (23%) while prescription of meloxicam increased by 62%. Use of paracetamol was steady over the period 1997,2004 (around 40,DDD/1000 concession beneficiaries/day). In April 2005, a slight increase in paracetamol use was observed. Conclusion Our analysis showed that COX-2 inhibitors prescribing markedly influenced the overall NSAIDs prescribing in Australia. When COX-2 inhibitors were introduced their uptake was rapid and extensive. Following rofecoxib withdrawal, the total overall dispensing of NSAIDs returned to a similar value as before COX-2 inhibitors' introduction. The decrease was due both to rofecoxib withdrawal and to a reduction in celecoxib prescribing. However, meloxicam use increased. Paracetamol prescribing was steady, between 1997 and 2005 and was not affected when the COX-2 inhibitors were introduced on to the market and after rofecoxib withdrawal, rather than increasing as might have been anticipated after rofecoxib withdrawal. Copyright © 2007 John Wiley & Sons, Ltd. [source] Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care populationPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 11 2006DrPH, John D. Seeger Pharm D Abstract Background Case reports and observational studies have implicated fluoroquinolone antibiotic exposure as a risk factor for Achilles tendon rupture (ATR), an uncommon condition for which there are few formal studies. We sought to quantify the strength of association between exposure to fluoroquinolone antibiotics and the occurrence of ATR, accounting for other risk factors. Methods This was a case-control study nested within a health insurer cohort. Cases of ATR were identified and confirmed using patterns of health insurance claims that were validated through sampled medical record review. Information on risk factors, including fluoroquinolone exposure, came from health insurance claims. Results There were 947 cases of ATR and 18,940 controls. A dispensing of a fluoroquinolone antibiotic in the past 6 months was more common among ATR cases than controls, although not significantly so (odds ratio (OR),=,1.2; 95% confidence interval (CI),=,0.9,1.7), and exposure to a higher cumulative fluoroquinolone dose was more strongly associated (OR,=,1.5, 95%CI,=,1.0,2.3). Other risk factors for ATR were trauma (OR,=,17.2, 95%CI,=,14.0,20.2), male sex (OR,=,3.0, 95%CI,=,2.6,3.5), injected corticosteroid administration (OR,=,2.2, 95%CI,=,1.6,2.9), obesity (OR,=,2.0, 95%CI,=,1.2,3.1), rheumatoid arthritis (OR,=,1.9, 95%CI,=,1.0,3.7), skin or soft tissue infections (OR,=,1.5, 95%CI,=,0.9,2.3), oral corticosteroids (OR,=,1.4, 95%CI,=,1.0,1.8), and non-fluoroquinolone antibiotics (OR,=,1.2, 95%CI,=,1.1,1.5). Conclusions The elevation in ATR risk associated with fluoroquinolones was similar in magnitude to that associated with oral corticosteroids or non-fluoroquinolone antibiotics. Trauma and male sex were more strongly associated with ATR, as were obesity and injected corticosteroids. Copyright © 2006 John Wiley & Sons, Ltd. [source] Use of prescription medications with a potential for fetal harm among pregnant women,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2006Susan E. Andrade ScD Abstract Purpose To estimate the prevalence of use of prescription drugs with a potential for fetal harm among pregnant women in the United States. Methods A retrospective study was conducted using the automated databases of eight health maintenance organizations involved in the HMO Research Network Center for Education and Research on Therapeutics (CERT). Women who delivered an infant from January 1996 to December 2000 were identified. The frequency of use of prescription drugs with a potential for fetal harm was based upon the expert review of a clinical teratologist and the U.S. Food and Drug Administration (FDA) risk classification system, assuming a gestational duration of 270 days. Results Among the 114,165 women with no documentation of a diagnosis suggesting potential pre-term birth or dispensing of ovulation stimulants in the 270 days before delivery, 1305 (1.1%) received a teratogenic drug during the 270 days before delivery, based upon the expert review of a clinical teratologist. A larger proportion of women received U.S. FDA category D or X drugs (5.8%; N,=,6600). However, the general patterns of use were similar, with higher use in early pregnancy compared to later trimesters. The proportion of women dispensed a teratogen during pregnancy was substantially higher among women who received a teratogen in the 90 days before pregnancy compared to women who did not (adjusted RR,=,38.9, 95%CI, 33.5, 45.3). Conclusions Our results suggest that further efforts directed at physicians to counsel women or at the women themselves about the potential risks of particular medications appear warranted. Copyright © 2006 John Wiley & Sons, Ltd. [source] Impact of the Minimum Pricing Policy and introduction of brand (generic) substitution into the Pharmaceutical Benefits Scheme in AustraliaPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2001Peter McManus Abstract Purpose To describe the effects of introducing the Minimum Pricing Policy (MPP) and generic (brand) substitution in 1990 and 1994 respectively on the dispensing of Pharmaceutical Benefits Scheme (PBS) prescriptions both at the aggregate and individual patient level. Methods The relative proportion of prescriptions with a brand premium and those at benchmark was examined 4 years after introduction of the MPP and again 5 years later after generic substitution by pharmacists was permitted. To determine the impact of a price signal at the individual level, case studies involving a patient tracking methodology were conducted on two drugs (fluoxetine and ranitidine) that received a brand premium. Results From a zero base when the MPP was introduced in 1990, there were 5.4 million prescriptions (17%) dispensed for benchmark products 4 years later in 1994. At this stage generic (brand) substitution by pharmacists was then permitted and the market share of benchmark brands increased to 45% (25.2 million) by 1999. In the patient tracking studies, a significantly lower proportion of patients was still taking the premium brand of fluoxetine 3 months after the introduction of a price signal compared with patients taking paroxetine which did not have a generic competitor. This was also the case for the premium brand of ranitidine when compared to famotidine. The size of the price signal also had a marked effect on dispensing behaviour with the drug with the larger premium (fluoxetine) showing a significantly greater switch away from the premium brand to the benchmark product. Conclusions The introduction in 1990 of the Minimum Pricing Policy without allowing generic substitution had a relatively small impact on the selection of medicines within the Pharmaceutical Benefits Scheme. However the effect of generic substitution at the pharmacist level, which was introduced in December 1994, resulted in a marked increase in the percentage of eligible PBS items dispensed at benchmark. Case studies showed a larger premium resulted in a greater shift of patients from drugs with a brand premium to the benchmark alternative. Copyright © 2001 John Wiley & Sons, Ltd. [source] Light-induced immobilisation of biomolecules as an attractive alternative to micro-droplet dispensing-based arraying technologiesPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 5 2008Meg Duroux No abstracts. [source] Light-induced immobilisation of biomolecules as an attractive alternative to microdroplet dispensing-based arraying technologiesPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 19 2007Meg Duroux Abstract The present work shows how UV ,light-induced molecular immobilisation' (LIMI) of biomolecules onto thiol reactive surfaces can be used to make biosensors, without the need for traditional microdispensing technologies. Using ,LIMI,' arrays of biomolecules can be created with a high degree of reproducibility. This technology can be used to circumvent the need for often expensive nano/microdispensing technologies. The ultimate size of the immobilised spots is defined by the focal area of the UV beam, which for a diffraction-limited beam can be less than 1,,m in diameter. LIMI has the added benefit that the immobilised molecules will be spatially oriented and covalently bound to the surface. The activity of the sensor molecules is retained. Antibody sensor arrays made using LIMI demonstrated successful antigen binding. In addition, the pattern of immobilised molecules on the surface is not restricted to conventional array formats. The ultimate consequence of the LIMI is that it is possible to write complex protein patterns using bitmaps at high resolution onto substrates. Thus, LIMI of biomolecules provides a new technological platform for biomolecular immobilisation and the potential for replacing present microdispensing arraying technologies. [source] Study to support the standardization of the prescribing, dispensing and labeling of etoposide formulations in AustraliaASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Christine CARRINGTON Abstract Aim: Etoposide is used in a wide variety of solid and hematological tumors. It is available in Australia in two intravenous formulations; etoposide base and the etoposide phosphate salt with 113.6 mg of etoposide phosphate being equivalent to 100 mg of the etoposide base. Variances between the etoposide dose prescribed and that actually given have been reported recently in Australia with patients receiving either too much or too little of the intended dose of etoposide. We carried out a review of national practices of prescribing, dispensing and labeling of etoposide and etoposide phosphate. Methods: Cancer care clinicians and pharmacists, identified through their membership of the Clinical Oncological Society of Australia (COSA), were asked to complete an online survey or participate in a telephone interview, about their etoposide prescribing and dispensing practices. Results: Nineteen pharmacists and 11 prescribers provided responses suitable for analysis. The most common reason for using the etoposide phosphate formulation was its shorter infusion time. The most common reason provided for preferring the base formulation over the phosphate formulation was that the original clinical trial data supported its use. There were a variety of methods identified that a prescriber might use to indicate the formulation of etoposide required and a variety of methods used for the labeling of etoposide formulations. Conclusion: Prescribing, ordering and dispensing practices for etoposide base and etoposide phosphate are inconsistent across Australia, which could lead to dosing errors. We recommend that a national standard is adopted with etoposide phosphate preparations prescribed and labeled as "Etoposide (as the PHOSPHATE) x mg. Where x is the number of milligrams of etoposide base required." This would move towards minimizing the risk of dosage errors occurring with these formulations. [source] Development of guidelines for the safe prescribing, dispensing and administration of cancer chemotherapyASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Christine CARRINGTON Abstract Aim: The issue of medication safety is highly significant when anti-cancer therapy is used due to the high potential for harm from these agents and the disease context in which they are being used. This article reports on the development of multidisciplinary consensus guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy undertaken by a working group of the Clinical Oncological Society of Australia (COSA). Methods: A working group of pharmacists, nurses and medical oncologists was convened from the COSA membership. A draft set of guidelines was proposed and circulated to the COSA council and the wider membership of COSA for comment. The final version of the guidelines was then distributed to 25 key stakeholders in Australia for feedback and endorsement. Results: An initial draft was developed based on existing standards, evidence from the literature and consensus opinion of the group. It was agreed that published case studies would be used as evidence for a particular statement where related processes had resulted in patient harm. The group defined 13 areas where a guidance statement was applicable to all professional disciplines and three individual sections based on the processes and the professionals involved in the provision of cancer therapy. Conclusion: The guidelines development represents a multidisciplinary collaboration to standardize the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. They should be seen as a point of reference for practitioners providing chemotherapy services. [source] The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapyASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Christine CARRINGTON Abstract The issue of medication safety is highly significant when anti-cancer therapy is used as a treatment modality due to the high potential for harm from these agents and the disease context in which they are being used. These guidelines provide recommendations on the safe prescribing, dispensing and administration of chemotherapy and related agents used in the treatment of cancer. The guidelines represent a multidisciplinary collaboration to standardise the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. The aim of these guidelines is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer. This guidance is intended for a multi-disciplinary audience and will have most relevance for medical, nursing and pharmacy staff involved in the complex processes of delivering chemotherapy and associated treatment. The scope of the guidelines includes; all patients and age groups receiving chemotherapy and targeted therapy for the treatment of cancer and cancer therapy administered by any route in both the hospital and home setting. These guidelines should be seen as point of reference for practitioners providing cancer chemotherapy services. [source] | |||||||||||||||||||||||||||||||