Modification Of Prescription Research Articles

OHP-002 Accessibility, Availability, Affordability of Prescription Drugs, Aretaieio University Hospital, Athens Greece

BackgroundTime is that wherein there is opportunity, and opportunity is that wherein there is no great time. Healing is a matter of time, but it is sometimes also a matter...

Parallel retrieval of correlated patterns: From Hopfield networks to Boltzmann machines

In this work, we first revise some extensions of the standard Hopfield model in the low storage limit, namely the correlated attractor case and the multitasking case recently introduced by the authors. The former case is based on a modification of the Hebbian prescription, which induces a coupling between consecutive patterns and this effect is tuned by a parameter a. In the latter case, dilution is introduced in pattern entries, in such a way that a fraction d of them is blank. Then, we merge these two extensions to obtain a system able to retrieve several patterns in parallel and the quality of retrieval, encoded by the set of Mattis magnetizations {mμ}, is reminiscent of the correlation among patterns. By tuning the parameters d and a, qualitatively different outputs emerge, ranging from highly hierarchical to symmetric. The investigations are accomplished by means of both numerical simulations and statistical mechanics analysis, properly adapting a novel technique originally developed for spin glasses, i.e. the Hamilton–Jacobi interpolation, with excellent agreement. Finally, we show the thermodynamical equivalence of this associative network with a (restricted) Boltzmann machine and study its stochastic dynamics to obtain even a dynamical picture, perfectly consistent with the static scenario earlier discussed.

Le traitement hormonal de la ménopause : aspects pratiques

Menopause is a total follicular depletion leading to menstruation cessation. Climacterics symptoms are linked to estrogen decrease. Hormonal replacement therapy (HRT) was developed in 1940s in order to control these signs and to improve women's quality of life. In United States, conjugated equine estrogen, first estrogens developed, are the most common. In France, customs are different with the transdermic estrogen use. The progesterone use is also different between both countries: in USA, medroxyprogesteron acetate is the most common, whereas this treatment does not exist anymore in France. Indeed, lot of different progestagen is available in France: progesterone, dydrogesterone others progestin. Publication of randomized trials, as the Women's Health Initiative, had shown a long-term unfavorable HRT risk/benefit ratio, as prescribed in USA. These studies have led to prescription modification. Due to these results, recent trials, closers to French customs, allowed a new evaluation of HRT risk/benefit ratio. Today, clinical practices are based on these results and new trials are necessary.

Implications of High-Frequency Cochlear Dead Regions for Fitting Hearing Aids to Adults With Mild to Moderately Severe Hearing Loss

A cochlear dead region (DR) occurs at a given frequency when there is a loss of normal functioning of inner hair cells tuned to that frequency. It has been suggested that existence of high-frequency DRs has implications for hearing aid fitting, and that the optimal amount of high-frequency gain is reduced for these patients. However, the data supporting this suggestion has been obtained using listeners with severe or profound hearing loss. It is uncertain whether these results would apply for listeners with the mild to moderately severe hearing loss that is more typical of hearing aid users. This investigation used laboratory and field measurements to examine the effects of reduced high-frequency gain in typical hearing aid users with high-frequency DRs compared with matched users without DRs. The study was a double-blinded, nonrandomized intervention design with 18 matched pairs of adult subjects. In each pair, one subject had high-frequency DRs (usually at one or two test frequencies) and the other subject had no DR. Each subject was fitted unilaterally with a hearing aid having two active programs. One program used a National Acoustics Laboratories (NAL) prescription target for average speech (NAL condition). The other program was identical to NAL except for reduced gain in the high frequencies (low-pass [LP] condition). Outcomes included aided speech recognition in quiet and noise measured in the laboratory, ratings of speech understanding in daily life, and final preference for the NAL or LP program. In laboratory testing, speech recognition in quiet was significantly better when using the NAL program. This result was seen for subjects with DRs and without DRs. When listening in noise, speech recognition was significantly better when using the NAL program for subjects without DRs. For subjects with DRs, results were equivalent for the NAL and LP programs. In daily life, the NAL program received significantly higher ratings for speech understanding, and this result was seen for subjects with and without DRs. When asked about their preference for using the NAL or LP program in daily life, subjects did not always choose the program they had rated as giving better speech understanding, but their preference was not associated with having DRs. About one-third of subjects preferred the LP program. The reason most frequently given for preferring the LP program was that the NAL was too loud. Overall, adult hearing aid wearers with mild to moderately severe hearing loss benefitted from high-frequency gain whether or not they had DRs. In laboratory testing, but not in daily life, subjects with DRs tended to obtain less benefit than those without DRs. However, provision of NAL high-frequency gain never resulted in poorer performance in either group. These results suggest that identification of high-frequency DRs at one or two frequencies does not call for any a priori modification of the target hearing aid prescription for listeners with mild to moderately severe hearing loss.

Spike-triggered covariance: geometric proof, symmetry properties, and extension beyond Gaussian stimuli

The space of sensory stimuli is complex and high-dimensional. Yet, single neurons in sensory systems are typically affected by only a small subset of the vast space of all possible stimuli. A proper understanding of the input–output transformation represented by a given cell therefore requires the identification of the subset of stimuli that are relevant in shaping the neuronal response. As an extension to the commonly-used spike-triggered average, the analysis of the spike-triggered covariance matrix provides a systematic methodology to detect relevant stimuli. As originally designed, the consistency of this method is guaranteed only if stimuli are drawn from a Gaussian distribution. Here we present a geometric proof of consistency, which provides insight into the foundations of the method, in particular, into the crucial role played by the geometry of stimulus space and symmetries in the stimulus–response relation. This approach leads to a natural extension of the applicability of the spike-triggered covariance technique to arbitrary spherical or elliptic stimulus distributions. The extension only requires a subtle modification of the original prescription. Furthermore, we present a new resampling method for assessing statistical significance of identified relevant stimuli, applicable to spherical and elliptic stimulus distributions. Finally, we exemplify the modified method and compare it to other prescriptions given in the literature.

How great is the clinical impact of pharmacist interventions on prescriptions?

BackgroundThe public hospital of Aubagne (South of France) records about 15 000 patients each year. New prescriptions are scrupulously examined by pharmacists every day. This routine analysis leads to pharmaceutical...

Prescriptions analysis by clinical pharmacists in the post‐operative period: a 4‐year prospective study

Clinical pharmacists can help prevent medication errors. However, data are scarce on their role in preventing medication prescription errors in the post-operative period, a high-risk period, as at least two prescribers can intervene, the surgeon and the anesthetist. We aimed to describe and quantify clinical pharmacist' intervention (PIs) during validation of drug prescriptions on a computerized physician order entry system in a post-surgical and post-transplantation ward. We illustrate these interventions, focusing on one clearly identified recurrent problem. In a prospective study lasting 4 years, we recorded drug-related problems (DRPs) detected by pharmacists and whether the physician accepted the PI when prescription modification was suggested. Among 7005 orders, 1975 DRPs were detected. The frequency of PIs remained constant throughout the study period, with 921 PIs (47%) accepted, 383 (19%) refused and 671 (34%) not assessable. The most frequent DRP concerned improper administration mode (26%), drug interactions (21%) and overdosage (20%). These resulted in a change in the method of administration (25%), dose adjustment (24%) and drug discontinuation (23%) with 307 drugs being concerned by at least one PI. Paracetamol was involved in 26% of overdosage PIs. Erythromycin as prokinetic agent, presented a recurrent risk of potentially severe drug-drug interactions especially with other QT interval-prolonging drugs. Following an educational seminar targeting this problem, the rate of acceptation of PI concerning this DRP increased. Pharmacists detected many prescription errors that may have clinical implications and could be the basis for educational measures.

Pretreatment Staging Positron Emission Tomography/Computed Tomography in Patients With Inflammatory Breast Cancer Influences Radiation Treatment Field Designs

Positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for staging of inflammatory breast cancer (IBC). The purpose of this study was to define how pretreatment PET/CT studies affected postmastectomy radiation treatment (PMRT) planning decisions for IBC. We performed a retrospective analysis of 62 patients diagnosed with IBC between 2004 and 2009, who were treated with PMRT in our institution and who had a staging PET/CT within 3 months of diagnosis. Patients received a baseline physical examination, staging mammography, ultrasonographic examination of breast and draining lymphatics, and chest radiography; most patients also had a bone scan (55 patients), liver imaging (52 patients), breast MRI (46 patients), and chest CT (25 patients). We compared how PET/CT findings affected PMRT, assuming that standard PMRT would target the chest wall, level III axilla, supraclavicular fossa, and internal mammary chain (IMC). Any modification of target volumes, field borders, or dose prescriptions was considered a change. PET/CT detected new areas of disease in 27 of the 62 patients (44%). The areas of additional disease included the breast (1 patient), ipsilateral axilla (1 patient), ipsilateral supraclavicular (4 patients), ipsilateral infraclavicular (1 patient), ipsilateral IMC (5 patients), ipsilateral subpectoral (3 patients), mediastinal (8 patients), other distant/contralateral lymph nodes (15 patients), or bone (6 patients). One patient was found to have a non-breast second primary tumor. The findings of the PET/CT led to changes in PMRT in 11 of 62 patients (17.7%). These changes included additional fields in 5 patients, adjustment of fields in 2 patients, and higher doses to the supraclavicular fossa (2 patients) and IMC (5 patients). For patients with newly diagnosed IBC, pretreatment PET/CT provides important information concerning involvement of locoregional lymph nodes, mediastinal lymph nodes, and unsuspected sites of distant metastasis. This information is important in the design of radiotherapy treatment fields and, therefore, we recommend that PET/CT be a component of initial staging for IBC.

The importance of medical monitoring and modification of exercise prescription in physical therapy for patients with anorexia nervosa: a case report.

The importance of medical monitoring and modification of exercise prescription in physical therapy for patients with anorexia nervosa: a case report.

Prevention of sudden cardiac arrest in dialysis patients: can we do more to improve outcomes?

Sudden cardiac arrest (SCA) is a leading cause of cardiac-associated mortality in dialysis patients. Risk factors unique to hemodialysis patients include abnormal electrolytes, large-volume ultrafiltration, and prior history of cardiac disease. Few randomized controlled trials of standard cardiac interventions have been completed in dialysis patients. Observational studies suggest that modification of the dialysis prescription may be one place to intervene. Prospective research is needed to determine mechanisms of SCA in hemodialysis patients.

136 Nature, Frequency and Determinants of Clinical Pharmacy Interventions in Electronic Medication Prescriptions for Pediatric Inpatients

Background and aims: All electronically ordered prescriptions for pediatric patients are checked and if necessary corrected by the hospital pharmacy. This study examined the frequency, nature and determinants of electronic prescription interventions by a children's hospital pharmacy in a pediatric inpatient population. Methods: Case-control study. All intervened electronic prescriptions (cases) were compared to a sample of non-intervened electronic prescriptions (controls) of children between 0-18 years hospitalized from 01/03/2004 - 31/12/2007. An intervention was defined as a contact of the pharmacy with the prescriber in order to clarify, correct or complete the prescription. Determinants evaluated were prescription-, patient- and medication-related. Results: 1577 (1.1%) of 138,449 prescriptions were intervened for one or more reasons, leading to 829 (53%) prescription modifications. 45% of the corrections concerned dose discrepancies. 9% of the interventions was about technically impossible/impractical prescriptions, explained by the complexity of pediatric dispensing. The 1577 cases were compared to 1983 controls. Children from 1 month-2 years were at higher risk for an intervention than 12-18 year olds (OR 1.97 [1.63-2.38]). Free text prescriptions had a five times higher (OR 4.71 [3.61-6.13]) intervention risk than pre-standardized prescriptions. No significant differences were found between day-, evening- and night shifts. Significantly more interventions occurred in summer than spring (OR 1.34 [1.12-1.61]). The oral dosage form (OR 1.63 [1.41-1.88]) and oral administration route (OR 1.80 [1.55-2.09]) stood out. Conclusions: Pediatric prescribing is complex, even when computerized. Prescription-related clinical decision support in computerized prescribing can improve the quality and efficiency in drug prescribing.

Characteristics of Antihypertensive Medication and Change of Prescription Over 1 Year of Follow Up in Japan: Fukushima Research of Hypertension (FRESH)

The relationship between achieving target blood pressures and medication modification among hypertensive patients in Japan is relatively unknown. We examined the incidence of prescription changes and how the prescription changes influence success rates in achieving target blood pressures in a group of patients with uncontrolled hypertension. This prospective observational cohort study (July 2006 to May 2007) examined the association between blood pressure control and antihypertensive medication among 2,735 Japanese hypertensive patients who completed four seasonal follow-ups and whose medications were verified. The primary outcome was "therapeutic failure" at the third follow-up survey. Logistic regression analyzed how prescription changes may influence therapeutic failure risk. Common medication changes were estimated using follow-up data. Median ages and proportion of males were 73 years and 43.8% vs. 69 years and 45.6% in those with controlled and those with uncontrolled hypertension at baseline, respectively. At baseline, 1,496 patients were uncontrolled, and 296 (18.0%) changed prescriptions during the follow-up period. Among patients with diabetes mellitus, renal disease, or organ damage and vascular complications, who were uncontrolled at baseline, prescription changes during the year significantly increased therapeutic failures at the third follow-up after adjusting for related variables. About half of the changes at each follow-up visit remained in the same class or combination category. This study identified infrequent changes in prescription and minor modifications of medication even among uncontrolled hypertension. We highlight the importance of reviewing prescription content to maintain or improve blood pressure levels to achieve recommended treatment goals.

Non-local conserved charges from defects in perturbed conformal field theory

Perturbing a Virasoro minimal model by the (1,3) primary bulk field results in an integrable field theory. In this paper, an infinite set of commuting conserved charges is obtained by considering defects: a one-parameter family of perturbed defect operators is given, and it is shown that these operators mutually commute, they commute with the Hamiltonian of the perturbed conformal field theories and they satisfy a T-system functional relation. The formulation in terms of perturbed defects is a modification of the original prescription for such charges by Bazhanov, Lukyanov and Zamolodchikov.

Use of Bangerter filters with adults having intractable diplopia

Purpose The aim of this study was to describe the use of Bangerter filters in adults having intractable diplopia. Methods/Case Reports A series of adults having intractable diplopia caused by either cyclotorsion, retinal disease, monocular diplopia, or rapid alternating fixation who were treated with Bangerter filters is reported. Detailed case reports on 4 of the 10 patients are included. Conclusion Bangerter filters can be used to mitigate diplopia that cannot be eliminated with either prism, modification of the spectacle prescription, vision therapy, or extraocular muscle surgery. The weakest density filter that eliminates the diplopia should be prescribed. Prospective studies reporting the long-term efficacy and quality of life with the filters are needed.

Design Features That Affect the Maneuverability of Wheelchairs and Scooters

Koontz AM, Brindle ED, Kankipati P, Feathers D, Cooper RA. Design features that affect the maneuverability of wheelchairs and scooters. Objective To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space. Design Case series. Setting University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event. Participants The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14). Intervention A mock environment was constructed to create passageways to form an L-turn, 360°-turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests. Main Outcome Measure Minimum passageway widths for the 4 maneuverability tasks. Results Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs ( P<.05). Mid-wheel-drive PWCs required the least space for the 360°-turn in place compared with front-wheel-drive and rear-wheel-drive PWCs ( P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks. Conclusions Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas.

Effect of position and alteration in synergist muscle force contribution on hip forces when performing hip strengthening exercises

Background Understanding the magnitude and direction of joint forces generated by hip strengthening exercises is essential for appropriate prescription and modification of these exercises. The purpose of this study was to evaluate hip joint forces created across a range of hip flexion and extension angles during two hip strengthening exercises: prone hip extension and supine hip flexion. Methods A musculoskeletal model was used to estimate hip joint forces during simulated prone hip extension and supine hip flexion under a control condition and two altered synergist muscle force conditions. Decreased strength or activation of specific muscle groups was simulated by decreasing the modeled maximum force values by 50%. For prone hip extension, the gluteal muscle strength was decreased in one condition and the hamstring muscle strength in the second condition. For supine hip flexion, the strength of the iliacus and psoas muscles was decreased in one condition, and the rectus femoris, tensor fascia lata, and sartorius muscles in the second condition. Findings The hip joint forces were affected by hip joint position and partially by alterations in muscle force contribution. For prone hip extension, the highest net resultant force occurred with the hip in extension and the gluteal muscles weakened. For supine hip flexion, the highest resultant forces occurred with the hip in extension and the iliacus and psoas muscles weakened. Interpretation Clinicians can use this information to select exercises to provide appropriate prescription and pathology-specific modification of exercise.

On a worldsheet dual of the Gaussian matrix model

We discuss a modification of Gopakumar's prescription for constructing string theory duals of free gauge theories. We use this prescription to construct an unconventional worldsheet dual of the Gaussian matrix model.

Practical evaluation of the drug-related problem management process in Swiss community pharmacies

To develop and evaluate a coding system integrated into pharmaceutical software to routinely report and assess the process of community pharmacists' interventions related to medical prescriptions. A convenient sample of 20 Swiss community pharmacies. Pharmacists documented their interventions concerning all drug-related problems (DRPs) related to medical prescriptions during four consecutive weeks in 2005. The coding system assesses each step of the DRP management process; that is, the type of problem, possible negative outcomes, pharmaceutical decisions, and individuals involved. In order to be comprehensive, the management process of technical problems related to prescriptions and clinical DRPs was analysed separately. DRP intervention rate and characterization of each step of the process. Of 38,663 prescriptions, 287 clinical DRPs required interventions. This corresponds to a mean intervention rate of 0.77% per pharmacy (SD = 0.61%). There was a large variability among pharmacies (0-2.6%). Most of the clinical DRPs were associated with dosage problems (n = 91) and drug-drug interactions (n = 45). The most frequent potential negative outcomes reported were quantitative inefficacy (n = 101) and quantitative safety (n = 94). Two-thirds of clinical DRPs required a prescription modification (n = 186), the most frequent being a change in dosage or drug regimen. In 110 interventions (38%), physicians were immediately contacted to take part in the decision. In 122 interventions (43%), pharmacists managed the interventions alone. However, in 55 interventions (19%), pharmacists managed the DRPs with the patient. From these 287 clinical interventions, 134 different codes were reported. Seven hundred and thirty-six technical problems related to prescriptions required intervention, which corresponded to a mean intervention rate of 1.90% per pharmacy. The main type of problem was a discrepancy with the medication record (n = 208). There were 494 instances that required a prescription modification. Pharmacists resolved 45% of all technical problems by themselves. The developed coding system could describe the management process for DRPs. The observed intervention rate and the frequency of steps involved were comparable to those previously observed for pharmacists' interventions. Data regarding the entire process used to manage drug-related problems can be useful in improving medication safety, education, and collaborative care.

Rehabilitation and exercise prescription in Australian intensive care units

Objectives To identify methods of exercise prescription by physiotherapists across Australian intensive care units (ICUs), including the most commonly used activities for both mechanically ventilated and spontaneously breathing patients; and to determine the outcome measures used for the evaluation of exercise intervention. Design Postal questionnaire. Setting One hundred and sixty-seven adult ICUs across all Australian states and territories. Participants Australian intensive care physiotherapists. Results In total, 126 questionnaires were returned from all states and territories of Australia except the Northern Territory. Almost half of the ICUs (49%, 20/41) that did not return a questionnaire lacked a permanent physiotherapy service. Seventy-eight percent (87/111) of respondents were senior staff, and 49% (54/111) of respondents had worked in ICUs for longer than 5 years. Almost all (94%, 104/111) physiotherapists prescribed exercise routinely for ICU patients, with active and active-assisted exercise techniques along with mobilisation being the most common activities utilised. Heart rate, oxygen saturation and respiratory rate were the most important factors used in modification of exercise prescription. Seventy-one percent (79/111) of respondents prescribed exercise routinely for mechanically ventilated patients, but altered the type of exercise prescription for these patients compared with spontaneously breathing patients. Only one-third (34%, 38/111) of physiotherapists used outcome measures routinely in ICU exercise prescription. Conclusions Although a large majority of ICU physiotherapists prescribed exercise routinely in ICU patients (including those on mechanical ventilation), practice varies widely throughout Australia. No validated, functional exercise outcome measures were used, highlighting that further research is required to enable adequate evaluation of exercise prescription and rehabilitation in ICUs.

The Medical-Spending Debate Continues

The Medical-Spending Debate Continues