Professional practice following regulatory change: An evaluation using principles of "Better Regulation"

BackgroundThe provisions in place internationally to regulate the practice of healthcare professionals have undergone significant change. However, this changing regulatory environment as experienced by healthcare professionals in the practice setting has not to date been widely researched.ObjectiveTo describe the “lived experience” of pharmacists in community practice in Ireland of the model of regulation introduced by the Pharmacy Act 2007 and their perception of it as fulfilling the seven principles of “better regulation”: Necessity; Effectiveness/Targeted; Proportionality; Transparency; Accountability; Consistency and Agility.Method20 community pharmacists purposively selected, shared their lived experiences of the Act, as implemented in a semi-structured interview. A qualitative content analysis incorporating a framework analysis based on the seven principles of better regulation was used to analyze the data.ResultsThe Act and its implementation by the Pharmaceutical Society of Ireland (PSI) was not perceived by community pharmacists overall as fulfilling the principles of better regulation. While there was agreement that the Act was necessary, its implementation by the PSI was not viewed as being effective, targeted, proportional and consistent. The PSI was considered to act as a deterrence regulator that is not adequately transparent or accountable. The Act is not sufficiently agile to respond to changes in pharmacy practice.ConclusionCommunity pharmacists acknowledge the need for the Pharmacy Act but perceive that the PSI needs to adopt a more responsive approach to implementation if the Act is to be considered a model of better regulation. The study findings are of interest as there is little published research on how regulation is experienced by healthcare professionals who are subject to its provisions. The principles of better regulation provide an effective qualitative methodology to examine models of professional regulation based on the “lived experience” of regulatees.     

使用锐器专用箱前后医护人员针刺伤的调查分析

目的调查医疗废物锐器专用回收箱使用前后我院医护人员刺伤的情况.方法在医疗废物锐器专用回收箱使用前半年及使用后半年,对我院急诊科、注射室及内科病房的医护人员进行每月一次锐器刺伤人次进行记录.结果三个科室共22位医师和63住护士,使用医疗废物锐器回收箱前半年共12人次发生过针刺伤,而使用专用回收箱半年共有2人发生刺伤,发生锐器刺伤的频率明显减少(P＜0.05).结论使用医疗废物锐器专用箱对减少医护人员针刺伤有重要作用.     

论药品集中招标采购制度的再度“异化”与因应之道

目的:讨论我国药品集中招标采购制度再度被“异化”的现象、原因和解决方案。方法:从药品集中招标采购制度再度被“异化”的原因出发,通过借鉴美国集中采购组织的经验,提出我国药品集中招标采购制度改革的方案。结果与结论:应当借助互联网,进一步完善与深化药品集中招标采购制度,并配合相关的医疗卫生体制改革措施,正确处理好政府、医疗机构与中介服务机构的关系。     

Advances in the generation of mouse models to elucidate the pathways of drug metabolism in rodents and man

Clinical pharmacologists have three distinct contributions to make in the economic evaluation of new and existing pharmaceutical products: they should play a significant role in promoting the principles of “opportunity costs” in healthcare; they need to have a broad understanding of the methodology of economic evaluation in healthcare; they have a critical role in bringing their specialist knowledge, skills and experience in decision-making. In fulfilling these essential roles clinical pharmacologists may find themselves outside their conventional “comfort zones”. Nevertheless, clinical pharmacologists need to rise to the occasion if they are to meet their obligations to patients and to society as a whole.     

静配中心危害药品废物与一般医疗废物处置原则与流程——《静脉用药调配中心建设与管理指南》系列解读(四)

通过对《静脉用药调配中心建设与管理指南(试行)》关于危害药品与医疗废物处置规定的解读,明确静配中心危害药品与医疗废物的潜在危害,加强静配中心危害药品与医疗废物的规范处置。通过对危害药品与医疗废物定义、分类及危害的具体认识,明确其规范处置的必要性和基本原则。通过对工作各环节危害药品与医疗废物的产生方式和处置流程的阐述,明确规范处置的具体操作。作为静配中心日常工作中的重要环节,危害药品与医疗废物的规范处置在维持静配中心洁净工作环境、减少污染方面发挥着不可忽视作用。通过对危害药品与医疗废物处置原则和流程的明确,增强工作人员对危害药品与医疗废物规范处置的意识和能力,规范标准操作,降低危害影响。     

Role of Exhaled Breath Biomarkers in Environmental Health Science

As a discipline of public health, environmental health science is the study of the linkage from environmental pollution sources to eventual adverse health outcome. This progression may be divided into two components, (1) “exposure assessment,” which deals with the source terms, environmental transport, human exposure routes, and internal dose, and (2) “health effects,” which deals with metabolism, cell damage, DNA changes, pathology, and onset of disease. The primary goal of understanding the linkage from source to health outcome is to provide the most effective and efficient environmental intervention methods to reduce health risk to the population. Biomarker measurements address an individual response to a common external environmental stressor. Biomarkers are substances within an individual and are subdivided into chemical markers, exogenous metabolites, endogenous response chemicals, and complex adducts (e.g., proteins, DNA). Standard biomarker measurements are performed in blood, urine, or other biological media such as adipose tissue and lavage fluid. In general, sample collection is invasive, requires medical personnel and a controlled environment, and generates infectious waste. Exploiting exhaled breath as an alternative or supplement to established biomarker measurements is attractive primarily because it allows a simpler collection procedure in the field for numerous individuals. Furthermore, because breath is a gas-phase matrix, volatile biomarkers become more readily accessible to analysis. This article describes successful environmental health applications of exhaled breath and proposes future research directions from the perspective of U.S. Environmental Protection Agency (EPA) human exposure research.     

Ensuring rigour and trustworthiness of qualitative research in clinical pharmacy

The use of qualitative research methodology is well established for data generation within healthcare research generally and clinical pharmacy research specifically. In the past, qualitative research methodology has been criticized for lacking rigour, transparency, justification of data collection and analysis methods being used, and hence the integrity of findings. Demonstrating rigour in qualitative studies is essential so that the research findings have the “integrity” to make an impact on practice, policy or both. Unlike other healthcare disciplines, the issue of “quality” of qualitative research has not been discussed much in the clinical pharmacy discipline. The aim of this paper is to highlight the importance of rigour in qualitative research, present different philosophical standpoints on the issue of quality in qualitative research and to discuss briefly strategies to ensure rigour in qualitative research. Finally, a mini review of recent research is presented to illustrate the strategies reported by clinical pharmacy researchers to ensure rigour in their qualitative research studies.     

病理科加强感染性标本的管理对控制医院感染的影响及其解决措施

目的:探究病理科加强感染性标本的管理对控制院内感染的影响及其解决措施,为感染性标本导致院内感染制定防范措施提供合理化的建议和改善方法。方法:通过分析病理科感染性标本接收方式、标本处理流程及医疗垃圾处理等方面存在的污染防控点,详细剖析感染性标本导致院内感染发生环节,为摸索建立可行性改善方案提供依据。结果:从管理到执行,从医院到科室再到责任人,均存在薄弱环节,应进一步加强规范化管理、完善感染性标本的管理措施。结论:建立健全规范管理制度和操作规章,改变感染性标本的处置程序对预防和控制病理科院内感染已迫在眉睫。     

Health and Social Difficulties in High School Students using High Amounts of Alcohol and Drugs: Implications for Screening

The use of frequency-based criteria to detect harmful substance use in adolescents is rare despite its potential to identify young people at risk. We compared high school students who use high amounts of substances to students with lower levels (or nil) of use across health and well-being indicators to explore the feasibility of this kind of categorization. Based on survey questions from Youth'12, a cross-sectional adolescent health survey involving 3% (8,500) of New Zealand high school students, we selected criteria indicative of substance use that would warrant specialist alcohol and other drugs (AOD) treatment. Two sets of “high-use” criteria (e.g., drinking “alcohol most days a week or more”) for both older and younger adolescents were selected. Eleven percent of students met criteria for “high use,” with higher rates in males and older students. Rates of high use were similar across high-, medium- and low-deprivation neighborhoods. Binge alcohol use (9.2%) was the predominant form of “high use.” Students with “high use” reported poorer health outcomes across numerous areas including mental health, physical health, risk behaviors, and access to health care. Only 5% of “high-use” students had accessed an AOD service. The wide range of negative health outcomes associated with a high level of substance use suggests that brief screening focusing on the level of substance use may help in identifying young people at risk. Simple and brief processes may improve the uptake and implementation of screening in primary care and other settings, and further research in this area is recommended.     

Are cannabis prevalence estimates comparable across countries and regions? A cross-cultural validation using search engine query data

BackgroundPrevalence estimation of cannabis use is usually based on self-report data. Although there is evidence on the reliability of this data source, its cross-cultural validity is still a major concern. External objective criteria are needed for this purpose. In this study, cannabis-related search engine query data are used as an external criterion.MethodsData on cannabis use were taken from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). Provincial data came from three Italian nation-wide studies using the same methodology (2006–2008; ESPAD-Italia). Information on cannabis-related search engine query data was based on Google search volume indices (GSI). (1) Reliability analysis was conducted for GSI. (2) Latent measurement models of “true” cannabis prevalence were tested using perceived availability, web-based cannabis searches and self-reported prevalence as indicators. (3) Structure models were set up to test the influences of response tendencies and geographical position (latitude, longitude). In order to test the stability of the models, analyses were conducted on country level (Europe, US) and on provincial level in Italy.ResultsCannabis-related GSI were found to be highly reliable and constant over time. The overall measurement model was highly significant in both data sets. On country level, no significant effects of response bias indicators and geographical position on perceived availability, web-based cannabis searches and self-reported prevalence were found. On provincial level, latitude had a significant positive effect on availability indicating that perceived availability of cannabis in northern Italy was higher than expected from the other indicators.ConclusionAlthough GSI showed weaker associations with cannabis use than perceived availability, the findings underline the external validity and usefulness of search engine query data as external criteria. The findings suggest an acceptable relative comparability of national (provincial) prevalence estimates of cannabis use that are based on a common survey methodology. Search engine query data are a too weak indicator to base prevalence estimations on this source only, but in combination with other sources (waste water analysis, sales of cigarette paper) they may provide satisfactory estimates.     

Biological testing—development,application, and trends in canadian environmental protection laboratories

Past and present Canadian experiences with biological tests for controlling the quality of wastewaters are discussed. Test use has evolved from data acquisition on acute toxicities, to physicochemical and biological parameters being regulated and monitored by industrial sector in the 1970s, and hazard assessments conducted by the 1980s. At a time when Environment Canada is reviewing its ecotoxicological procedures, new opportunities for waste assessment with “second generation” biotests are emerging. Recent experiences suggest that small-scale, sensitive, biological tests can be employed for environmentally and economically effective control of effluents entering aquatic environments. It is also expected that biotesting activities will increase because of new environmental strategies and regulations. These will stimulate biological research and development, and promote a partnership between ecotoxicology, environmental chemistry, and biotechnology.     

How to engage healthcare providers in preventing medication waste through individualized prescribing and dispensing: A qualitative study

BackgroundMedication waste is a threat to healthcare's sustainability. To prevent medication waste in patients' homes, medication quantities prescribed and dispensed to patients could be individualized. Perspectives of healthcare providers on engaging in this strategy however remain unclear.Objective(s)To identify factors influencing healthcare providers in preventing medication waste through individualized prescribing and dispensing.MethodsIndividual semi-structured interviews were conducted via conference calls with pharmacists and physicians prescribing and dispensing medication to outpatients of eleven Dutch hospitals. An interview guide based on the Theory of Planned Behaviour was developed. Questions related to participant's view on medication waste, current prescribing/dispensing behaviour and intention to personalising prescribing/dispensing quantities. Data was thematically analysed, following a deductive approach based on the Integrated Behavioural Model.ResultsNineteen out of 45 (42%) healthcare providers were interviewed, of whom eleven were pharmacists and eight physicians. Factors influencing individualized prescribing and dispensing by healthcare providers were identified and categorized in seven themes: (1) attitude: beliefs about consequences of waste, as well as perceived benefits and concerns of the intervention; (2) perceived norm: professional and social responsibilities; (3) personal agency: available resources; (4) knowledge and skills: intervention complexity; (5) salience of behaviour: perceived need from past experiences and evaluation of actions; (6) habit: prescribing and dispensing habits; and (7) situational factors: support for change, momentum for sustainable actions, need for guidance, triad collaboration and information provision.ConclusionsHealthcare providers perceive a strong professional and social responsibility to prevent medication waste yet feel bound by limited resources available to engage in individualized prescribing and dispensing. Situational factors, including leadership, organizational awareness and strong collaborations, could help healthcare providers to engage in individualized prescribing and dispensing. Through the identified themes, this study offers directions for designing and implementing an individualized prescribing and dispensing program to prevent medication waste.     

Aqueous extracts of biomass ash as an alternative class of Green Solvents for organic transformations: A review update

The minimization of generation of wastes or their eradication is a crucial aspect of Green Chemistry. As such, the design of processes that involve any or both the two, is of utmost concern. In addition, the elimination of hazardous materials and the utilization of safer alternatives are important. The use of agricultural waste biomass ash, in the form of their aqueous extracts, excludes the need of harmful volatile organic compounds (VOCs) in a number of organic transformations, thereby enhancing the greener aspect. Herein, we highlight the utility of aqueous extracts of agricultural waste in some significant organic transformations. Majority of them are sourced from the peels of fruits and seeds which normally fall under the category of “Household Waste”.     

Drug shortages in hospitals: Actors’ perspectives

BackgroundDespite an increasing focus on drug shortages, no standardized global definition of a drug shortage seems to exist. This raises the question of whether healthcare actors are discussing the same phenomenon, which may influence their actions when managing, solving and preventing drug shortages. Further, the literature reports a lack of national contingency plans for managing drug shortages in hospitals.ObjectiveTo explore national-level communication, decision-making and collaboration on drug shortage management carried out in Denmark by secondary healthcare actors.MethodsSeven semi-structured interviews were conducted with actor representatives from Amgros, the procurement department of the hospital pharmacy in the Capital Region of Denmark, two medicine suppliers, two pharmaceutical wholesalers and distributors, and the Danish Medicines Agency. Data was analyzed using a social constructivist approach.ResultsNo common definition of a drug shortage exists among the actors, but referential definitions related to “contract” and delivered “as expected” were identified. Additionally, actors initiate drug shortage procedures differently, and, as efforts are minimally coordinated, the work procedures are often needlessly duplicated. Further, discrepancies in available drug shortage information arise, as information is distributed through different electronic systems, unavailable to all actors. Besides, Amgros (a national organization responsible for tendering and procuring medicines in hospitals) and the procurement department of the hospital pharmacy in the Capital Region of Denmark make joint decisions regarding the choice of alternative drugs. However, the study found that actors had diverse collaborative relationships, especially those with the Danish Medicines Agency, and that these were limited to contact regarding medicine regulations and unlicensed medicine.ConclusionThe study provided insight into national-level communication, decision-making and collaboration on drug shortage management by different actors in hospitals. This knowledge is useful in the development of a national contingency plan for drug shortage management.     

Olive-mill and grape-mill waste as a substitute growing media component for unexploded vegetables production

Olive tree and grapevine cultivations are the main crops in the Mediterranean area, resulting to high yields but also a great amount of wastes after processing, with environmental and human health concerns, after their disposal. The present study was conducted in order to evaluate the potential use of olive-mill wastes (OMW) and grape-mill wastes (GMW) in different ratios (0-5-10-20-40% v/v) with peat, as a peat substitute material, for the production of Portulaca oleracea (purslane) and Sonchus oleraceus (sowthistle) plants. Both GMW and OMW addition in the substrate mixture affected purslane's and sowthistle growth and disturb plant's physiological metabolism at ≥20% and ≥10% of the waste, respectively. Sowthistle plants that grew with GMW up to 10% on the substrate, had increased growth indicators (or remained unaffected) compared to the control. Leaf stomatal conductance was decreased proportionally with the increase of the ratios the tested materials into the growing mixtures. The antioxidant status of both plants was significantly affected by the addition of the waste materials into the growing media. Plants in cases appeared to be under stress conditions, as this was revealed by the increment in stress indicators as the lipid peroxidation and the internal concentration of hydrogen peroxide, and as a consequence, antioxidative (catalase, superoxide dismutase, peroxidase) enzyme metabolism was found increased. It can be concluded, that both GMW and OMW have the potential to be used in the growing media at low ratios of 10% and 5%, respectively, providing healthy plants, with increased antioxidant and mineral value.     

Healthcare expenditures and patient satisfaction: cost and quality from the consumer's perspective in the US*

ABSTRACT

Background: Both cost and quality of healthcare are major concerns in the United States. Using patient satisfaction as a quality indicator, we seek to identify the relationship between healthcare cost and quality from the perspective of the community-dwelling population in the United States.

Methods: We examined a nationally representative sample of 13?980 adults (age?≥?18 years) in the 2003 Medical Expenditure Panel Survey (MEPS). Given the idiosyncrasies of the cost data distribution, a recently developed extended estimating equation (EEE) model was employed to identify the relationship between patient satisfaction and healthcare expenditure, after controlling for individual demographic covariates, co-morbidity profile, and functional and activity limitations. A series of sensitivity analyses were conducted, in addition, to verify the identified relationship. All statistics were adjusted using the proper sampling weight from the MEPS data.

Results: Average annual healthcare expenditures for 2003 ranged between $3923 and $6073 when grouped by patient satisfaction ratings with a mean value $4779 for all individuals who rated perceived satisfaction of their healthcare. We found that there is no statistically signif­icant relationship between patient satisfaction and total healthcare expenditure (?p?=?0.60) and a non-monotonic relationship is not identified either. All sensitivity analyses results revealed a lack of relationship between patient satisfaction and healthcare expenditures.

Limitations: Patient satisfaction might not reflect the quality of healthcare from an objective clinical standpoint. The identified cost–satisfaction relationship may not be extrapolated to other quality indicators. Due to the cross-sectional study design, no causal relationship could be inferred between patient satisfaction and healthcare expenditure.

Conclusions: Our study adds to the literature on health­care cost and quality by suggesting that the improvement of patient satisfaction may not require additional health­care spending.     

Effective integration of pharmacovigilance systems at public health facilities in resource-limited settings: A qualitative study

BackgroundPharmacovigilance systems increase access to safe medicines and healthcare, but their integration in public healthcare remains a challenge in many countries. The main barriers to pharmacovigilance integration are attributed to high patient load and limited capacities.ObjectiveTo explore the challenges associated with the effective integration of pharmacovigilance systems in public healthcare in a developing country such as Namibia.MethodsA nationwide qualitative assessment of integration of pharmacovigilance systems particularly spontaneous adverse drug reaction (ADR) reporting at public health facility level was conducted. Key informant interviews were conducted among pivotal healthcare professionals involved in pharmacovigilance. The main outcomes were themes on challenges and strategies for effective integration of PV services at the facility level. Qualitative data were collected over a one-month period (i.e., March 2019), and thematically analysed.ResultsEight (8) key informants were recruited; the majority were pharmacists (n = 7) and male (n = 5). The main challenges affecting the effective integration of pharmacovigilance systems reporting at public health facilities were “weak pharmacovigilance policies and structures”, “negative attitude of healthcare workers towards pharmacovigilance”, and “limited capacity and support for implementation of pharmacovigilance activities”. The main strategies for effective integration of PV systems at facilities included local capacity-building through continuing profession education and support, advocacy, stakeholder engagement, facility/region based pharmacovigilance champions, and facility-based policies for universal and inclusive reporting, (i.e. patients and health workers at all levels) as well as development of workable standard operational procedures.ConclusionsThe pharmacovigilance systems at healthcare facilities in Namibia were observed to have sub-optimal policies, structures and support systems, and lack health care worker buy-in. There is a need for a policy framework to ensure effective and sustainable integration of pharmacovigilance activities at public healthcare facilities.     

“Trip-Sitting” in the Black Hole: A Netnographic Study of Dissociation and Indigenous Harm Reduction

An array of dissociative novel psychoactive substances, including “methoxetamine,” “3-MeO-PCP,” and “methoxphenidine,” have emerged as substitutes for the illicit substance “ketamine.” A netographic research methodology aimed to describe online, dissociative novel psychoactive substance users’ perceptions of risk, informed knowledge around use, and indigenous harm-reduction practices as advocated within online drug fora, so as to provide credible information which can be used to inform public online health education and drug prevention. Systematic Internet searches were performed using the terms “synthetic dissociative,” “methoxetamine,” “methoxphenidine,” “diphenidine,” “3-MeO-PCP,” “4-MeO-PCP,” “2-MDP,” and “dissociative research chemical” in combination with “forum.” Following screening of 3,476 forum threads with removal of duplicates and exclusion criteria, 90 user trip reports and 115 fora threads from seven drug fora websites were analyzed by conducting content analysis. Five themes emerged with 43 categories. The findings illustrated how forum activity within the cyber drug user community disseminated and exchanged “communal folk pharmacology” relating to the use of dissociative novel psychoactive substances. Further research and consistent monitoring of Internet drug fora are advised to explore variations in harm-reduction tactics throughout dissociative NPS populations, and to consider how existing harm-reduction initiatives are influencing these hard-to-reach groups.     

论我国现阶段医疗保险个人账户存在的必要性

目的:探讨我国现阶段医疗保险个人账户存在的必要性。方法:比较医疗保险个人账户设计初衷与实际运行效果,分析其有必要存在的原因。结果:医疗保险个人账户约束和积累作用不佳且在一定程度上抑制了老年人和慢性病患者的医疗需要,但从我国国民的心理承受力、国民素质及人口老龄化等方面原因考虑,现阶段其有存在的必要。结论:为完善医疗保险个人账户,应扩大医疗保险覆盖对象,调整使用范围,取消退休人员个人账户,加强对供方的管理以及其他配套措施的完善。     

Toxicity analysis of leachates from hazardous wastes via microtox and daphnia magna

One of the most common ways of surface and ground water contamination from hazardous wastes is through its leachates. Toxicity is a meaningful parameter allowing an integrated evaluation of the potential danger of leachates. Two bioassays were considered for measuring toxicity: Microtox and Daphnia magna. The toxicity was measured on leachates obtained, using different leaching procedures, from wastes of a pesticide manufacturing industry and sludge from electroplating wastewater. Twenty-two tests were carried out, measuring IC50 for D. magna and EC50 for Microtox. Both bioassays were compared using three toxicity criteria. The first criterium is classification on toxic/non-toxic at 25 and 50% leachate concentration. The second criterium is classification on percent ranks, and the third on log ranks. Considering these criteria, the agreement between both bioassays is within a 75–85%. It is shown that both, Microtox and D. magna assays could be used as toxicity indicators for the wastes considered. The sensitivity of the bioassays is different depending on leachate composition. In all samples, the leachate concentration of chemicals was measured.