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At least 487 records · Page 27Linked to original sources
PubMed2005

Prescription audit adjunct to rational pharmacotherapy education improves prescribing skills of medical students.

OBJECTIVE: To assess the impact of a rational pharmacotherapy (RP) teaching program during clinical pharmacology clerkship by analyzing the results of prescription audits (PAs) of the medical students. Collectively, we intended to observe the possible improvement of the students in their prescribing, problem solving and self-directed learning skills. DESIGN: At the beginning and end of the clerkship, the students were presented with cases of uncomplicated osteoarthritis to assess their prescribing skills; format and rationality were scored. SETTING: A medical school in Turkey that teaches RP to the fourth-year students in clinical pharmacology clerkship. PARTICIPANTS: There were 94 students of the 2002-2003 academic year in three groups and a single group of students belonging to the previous academic year tested. Of those students from the previous academic year, 26 were also analyzed a year later to demonstrate the long-term impact of the training. MAIN OUTCOME MEASURES: Prescribing skills of medical students and their opinions about PA. RESULTS: Direct assessment via PA demonstrated that the scores for post-clerkship prescriptions were far better than those for pre-clerkship prescriptions in terms of format and rationality. Long-term assessment showed that the scores declined within a year following clerkship, but they were still higher than those of their pre-clerkship scripts. Analysis of the questionnaires revealed that the students were satisfied with PA. The majority of the students stated they had learned the general principles of RP and gained better prescribing skills, and they intended to apply most of the principles learned to their future professional lives. The script format scores of a retrospectively created PA-exempted group were significantly lower than those of the students to whom an established PA education was given. CONCLUSION: PA sessions were shown to be an easy and a useful method of both evaluating and reinforcing prescribing skills gained though problem-based RP education.

Analgesics↗
PubMedDate not supplied

The impact of problem-based pharmacotherapy training on the competence of rational prescribing of Yemen undergraduate students.

OBJECTIVE: This study aims to reveal whether a short training course of problem-based pharmacotherapy teaching, based on the World Health Organization's (WHO's) Guide to Good Prescribing and the Yemen Essential Drug List and Standard Treatment Guidelines, will improve the competence of rational prescribing among medical and health assistant students in Yemen. DESIGN: In a controlled pre/post-test study, 111 students from universities and health institutes participated on a voluntary basis. They were randomly separated into a study and a control group. Students of the study group were taught to generate standard first-choice drugs for asthma or diarrhoea. The students were then taught how to apply this set of first-choice drugs to specific patient problems, using the WHO six-step problem-solving approach. RESULTS: Students from the study group performed significantly better than those from control in all problems presented and also when compared with the results of the pre-test. The results of the pre-test also show that teaching students all basic knowledge about drugs does not guarantee rational prescribing in Yemen. CONCLUSION: It can be concluded from this study that proper training, i.e. 'immunising' future doctors using problem-based pharmacotherapy teaching, is an efficient way of teaching rational prescribing in Yemen.

Analysis of Variance↗
PubMed1997

Adequacy of food rations in soldiers during exercise in hot, day-time conditions assessed by doubly labelled water and energy balance methods.

The energy requirements of people doing physical work in hot climates are not clearly understood. In particular, we know little about the combined effects of heat stress and muscular work on energy requirements. During military exercises in the African bush, soldiers are supplied with standard rations, the adequacy of which is unknown. We have now assessed the adequacy of these food and water rations in 12 male Zimbabwean soldiers during 12 days of strenuous, heat-stress exercise in the field. We used two methods to measure energy expenditure: the double-labelled water method (DLW) and the energy balance method (i.e. comparing dietary energy with changes, if any, in body energy stores). Two groups were studied: one group (eight subjects) carried out field exercises; the control group consisted of four soldiers doing normal work. Mean daily energy expenditure as assessed by the DLW method was [mean (SE)] 23 (1.5) MJ x day(-1) for the field group and 14 (0.5) MJ x day(-1) for the control group (P < 0.001). By the energy balance method, daily energy expenditure was calculated to be 26 (0.7) MJ x day(-1) and 15.5 (0.4) MJ x day(-1) for the field group and control group, respectively. Body mass loss was 3 (0.1) kg [4.6 (0.3)% of body mass] for the field group, but the control group gained 1.1 (0.1) kg. Mean daily fluid intake was 11 (0.5) 1 x day(-1), suggesting that the standard ration supplied was inadequate. Body mass loss was caused by both the energy deficit and total body water loss. These results suggest strenuous work in hot, dry field conditions imposes extra energy requirements.

Adipose Tissue↗
PubMed2005

Rational design of thermostable lactate oxidase by analyzing quaternary structure and prevention of deamidation.

Our current knowledge of protein unfolding is overwhelmingly related to reversible denaturation. However, to engineer thermostable enzymes for industrial applications and medical diagnostics, it is necessary to consider irreversible denaturation processes and/or the entire quaternary structure. In this study we have used lactate oxidase (LOD), which is employed in lactic acid sensors, as a model example to design thermostable variants by rational design. Twelve mutant proteins were tested and one of them displayed a markedly greater thermostability than all the mutants we had previously obtained by random mutagenesis. This mutant was designed so as to strengthen the interaction between the subunits and stabilize the quaternary structure. Since LOD is difficult to crystallize, its three-dimensional structure remains unknown. This study shows that it is possible to carry out rational design to improve thermostability using a computer-aided quaternary structure model based on the known tertiary structure of a related protein. Critical factors required for increasing the thermal stability of proteins by rational design, where the 3-D structure is not available, are discussed.

Amides↗
PubMed2005

Rational use of medicines--an important issue in pharmaceutical policy.

In this article the authors deal with issues of drug utilisation from a clinical and policy perspective. They address the difficulties of managing drug therapy on a population level, which is known among professionals, as the problem of rational use of medicines. Various definitions and interpretations are presented and compared. This is followed by a presentation of the concerns associated with pharmaceutical marketing from a policy perspective, including the fear that the dominance of information produced by industry may lead to irrational drug use. Next, the authors review the tools for policy making including educational, managerial, and regulatory interventions. The (often overlapping) concepts of medicines management, clinical pharmacy and pharmaceutical care are then discussed to show how professionals, sometimes in collaboration with policymakers, have tackled the problem of nonrational use of medicines. The authors address the question as to whether the rational use of medicines a universal concept, whether it can be and whether it should be? They argue that, as with most concepts, the rational use of medicines must always be viewed in context. They conclude that pharmacy needs to adapt its way of thinking to include the issue of context. They point out that clinical pharmacists today already adapt their decisons to each patient and patient group. Policy-makers are encouraged to adopt a similar approach because populations as well as particular market situations vary and therefore policy solutions cannot be considered universal.

Drug Utilization Review↗
PubMed1989

Rationality and antiemotionality as a risk factor for cancer: concept differentiation.

Control and repression of emotions may be coping styles or personality characteristics found more often in patients with cancer than in other patients and healthy subjects. Previous research indicated a possible relationship between high scores on a 'rationality and antiemotionality' scale and cancer. In the two studies reported, the psychometric properties of this scale and the meaning of the concept as a personality variable related to the control of emotions were investigated. It was found that the internal consistency of the scale could be improved by re-designing it into a personality inventory. Factor analysis repeatedly yielded more than one factor, indicating the complexity of the concept. 'Rationality and antiemotionality' seems related to the control, suppression or repression of anger. Our findings tentatively support the view that rationality and antiemotionality may be an important distinctive personality characteristic in patients with cancer.

Adult↗
PubMed1984

Accounting and the celebration of rationality in human service delivery organizations.

Emerging perspectives of control in human service delivery organizations are facilitated by rational accountability formulations whose tenets and assumptions remain basically unquestioned in organizational and accounting literature. This paper critiques the underpinnings of rational accountability formulations and their appropriateness for human service delivery organizations. In turn, a non-rational metaphor of the role of management accounting information is proposed which recognizes uncertainty for what it is rather than assuming the very certainties that cannot be found in the delivery of human services.

Accounting↗
PubMed1979

Psychiatry's identity crisis: a critical rational remedy.

Psychiatry has several partial identities reflecting its biologic, psychoanalytic, and social subspecialities. It has, however, no encompassing professional identity. This identity requires three features: (a) a common language and procedure for assessing psychopathology, (b) a common method for evaluation and use of knowledge from outside psychiatry, and (c) a common set of values regarding clinical and research activities. The authors discuss the clinical, biologic, and sociocultural psychiatric traditions to identify the roots and consequences of psychiatry's fragmented state. Psychiatry's identity problems cannot be solved by ignoring them or simply becoming more "medical." Rather, the authors propose a remedy--critical rationality--to help resolve the crisis. Critical rationality requires a discimplined approach to psychiatric knowledge that underscores the necessity of methodologic rigor, practicality, and mid-range theorizing (rationality); and the equal necessity for systematic self-criticism, reform, self-awareness, and attention to the ethical dimensions in teaching, practice, and research (critical).

Cultural Characteristics↗
PubMed1991

Informed consent, competency, and the illusion of rationality.

Since the advent of informed consent, patients have become more involved in treatment decisions than ever before. To give an informed consent or refusal a patient must be competent to understand the information being presented. Although most authors agree on the need for a structured format for assessing competency, in practice this step is often omitted if the patient's decision "makes sense." In this paper we present two cases in which acutely ill patients gave apparently rational refusals of potentially life-prolonging treatment. Following their recovery, both viewed their earlier decisions as irrational. These cases demonstrate some of the difficulties in assessing competency and rationality in gravely ill patients, and the need for careful evaluation regardless of the apparent rationality of expressed desires.

Activities of Daily Living↗
PubMed2026

Sugar rationing during the first 1000 days and early onset cancer: a natural experiment.

BACKGROUND: The "first 1000 days" of life is a critical window for metabolic programming, while the long-term oncological consequences of nutritional exposures during this period remain understudied. OBJECTIVES: We aimed to evaluate whether restricted sugar intake in utero and during early childhood reduces risk of early onset cancer diagnosis and mortality in adulthood, utilizing a natural experiment. METHODS: We analyzed 63,819 United Kingdom Biobank participants born between October 1951 and March 1956, spanning the end of United Kingdom sugar rationing (September 1953). Leveraging a quasi-experimental birth cohort design, we compared participants exposed to sugar rationing in utero and during infancy with those unexposed. Early onset cancer incidence (&#x2264;50 y) and mortality were ascertained via integrated national Cancer Registry and hospital inpatient records. Multivariable Cox proportional hazards models (including Gompertz distribution) were used to estimate hazard ratios (HRs), with exploratory site-specific analyses. RESULTS: Among 63,819 participants (56.3% female), 40,397 were exposed to rationing and 23,422 were unexposed. Early life sugar restriction significantly reduced early onset cancer risk (HR: 0.66; 95% confidence interval: 0.53, 0.81; P < 0.001). A dose-response relationship was observed, with peak protection in individuals exposed for &#x2264;24 mo postnatally. This protection was observed systemically across solid tumors, independent of specific cancer sites. Specificity was corroborated by null associations with negative controls (herpes zoster and cataract). No significant difference was found for cancer-specific mortality. CONCLUSIONS: Restricting sugar intake during the first 1000 days is associated with a reduced risk of early onset cancer, extending the disease-free lifespan. The divergence between reduced incidence and unchanged mortality suggests early life metabolic environments primarily influence tumor latency rather than biological aggressiveness. These findings highlight the potential long-term public health implications of early life dietary guidelines against the rising burden of early onset cancer.

Humans↗
PubMed2004

Effects of food attributes and feeding environment on acceptance, consumption and body weight: lessons learned in a twenty-year program of military ration research US Army Research (Part 2).

Twenty years of testing in the field has consistently revealed that food intake is inadequate when packaged military rations are fed as the sole source of food. Food intake is much lower and there is a loss of body weight. Conversely when these rations are fed to students or military personnel for periods ranging from 3 to 42 days in a cafeteria-like setting, food intake is comparable to levels of a control group provided with freshly prepared food. Under these conditions, body weight is maintained. In this review, the consumption pattern is considered in terms of characteristics of the food (acceptability, variety, portion size, beverages, serving temperature, appropriateness for time of day, monotony, and novelty) and the eating milieu (social interactions, time, ease of preparing and consuming a meal). The twenty-year program of military ration research has led us to conclude that both the food and the context must be considered in understanding and controlling food intake.

Eating↗
PubMed2005

Rational polynomial equation helps to select among homeomorphic kinetic models for cholinesterase reaction mechanism.

The hydrolysis of substrates by cholinesterases does not follow the Michaelis-Menten reaction mechanism. In addition to the inhibition by excess substrate, these enzymes often show an unexpectedly high activity at low substrate concentrations. It seems that these deviations are the consequence of an unusual architecture of the active site, buried deep inside the core of the molecule. Kinetic data and structural evidence allow for a detailed prediction of the events during a very fast substrate turnover. Recently, we presented a procedure which provides an unbiased framework for mathematical modelling of the complex cholinesterase reaction [J. Stojan, M. Golicnik, D. Fournier, Rational polynomial equation as an unbiased approach for the kinetic studies of Drosophila melanogaster acetylcholinesterase reaction mechanism, Biochim. Biophys. Acta 1703 (2004) 53-61]. It is based on regression analysis of a rational polynomial using classical initial rate data. Here, we extend the use of the rational polynomial rate equation for finding and comparing some selected homeomorphic reaction schemes useful for the mechanistic interpretation of cholinesterase kinetic data.

Acetylcholine↗
PubMed2004

The effects of diet composition and ration on biotransformation enzymes and stress parameters in rainbow trout, Oncorhynchus mykiss.

Juvenile rainbow trout (Oncorhynchus mykiss) were fed one of three isoenergetic diets varying in protein (35-55%) and lipid content (8-18%), at full satiation levels or half rations for 6 weeks in order to investigate the effects of diet on baseline stress parameters and biotransformation enzyme activity. Growth was greatest in fish fed to satiation on a low protein and high lipid diet. Stress parameters, including plasma lactate, glucose and cortisol concentrations were not significantly affected by dietary treatment or ration. Basal biotransformation enzymes, including glutathione S-transferase (GST) and ethoxyresorufin O-deethylase (EROD) activity, were also unaffected by dietary treatment. Fish exposed to the biotransformation enzyme inducer beta-naphthoflavone did not exhibit an alteration in stress indicators or GST activity; however, EROD activity was increased (87- to 210-fold) in fish receiving all diets and rations. The results of the present study indicate that, unlike mammals, fish may be more recalcitrant to different levels of ingestion of isoenergetic diets varying in protein and lipid concentration with respect to stress responses and the maintenance of basal titers of biotransformation enzymes and their induction.

Animals↗
PubMed2006

Last night I had the strangest dream: Varieties of rational thought processes in dream reports.

From the neurophysiological perspective, thinking in dreaming and the quality of dream thought have been considered hallucinatory, bizarre, illogical, improbable, or even impossible. This empirical phenomenological research concentrates on testing whether dream thought can be defined as rational in the sense of an intervening mental process between sensory perception and the creation of meaning, leading to a conclusion or to taking action. From 10 individual dream journals of male participants aged 22-59 years and female participants aged 25-49 years, we delimited four dreams per journal and randomly selected five thought units from each dream for scoring. The units provided a base for testing a hypothesis that the thought processes of dream construction are rational. The results support the hypothesis and demonstrate that eight fundamental rational thought processes can be applied to the dreaming process.

Adult↗
PubMed2005

Towards the rational design of cereal starches.

A major challenge in cereal biotechnology is to achieve the rational design of renewable polymers to meet specific requirements for improving human health, nutrition, and food quality, to increase the energy supply, and to provide safer and more profitable industrial inputs. The field of starch synthesis research has advanced at a rapid pace over the past decade, and many core observations about the pathway are well established over a range of species. Owing to the complexity of the starch-synthesis process, in which suites of enzymes act at the interface between soluble and insoluble phases, the rational design of starch granules with specific functionality is still in its infancy. Our fundamental biochemical knowledge of starch biosynthesis has recently advanced, and this new information could be exploited to create novel variability in carbohydrate polymers in cereal grains. We propose two strategies for moving more rapidly towards truly rational design of starch. First, the focusing of fundamental research on processes that are involved in the regulation of starch synthesis and granule assembly. Second, the development of iterative strategies, exploiting new molecular genetics tools, to screen for desired properties in high-throughput systems.

Biotechnology↗
PubMed2006

Can we rationally design promiscuous drugs?

Structure-based drug design is now used widely in modern medicinal chemistry. The application of structural biology to medicinal chemistry has heralded the "rational drug design" vision of discovering exquisitely selective ligands. However, recent advances in post-genomic biology are indicating that polypharmacology may be a necessary trait for the efficacy of many drugs, therefore questioning the "one drug, one target" assumption of current rational drug design. By combining advances in chemoinformatics and structural biology, it might be possible to rationally design the next generation of promiscuous drugs with polypharmacology.

Cluster Analysis↗
PubMed2005

Integrating research and development: the emergence of rational drug design in the pharmaceutical industry.

Rational drug design is a method for developing new pharmaceuticals that typically involves the elucidation of fundamental physiological mechanisms. It thus combines the quest for a scientific understanding of natural phenomena with the design of useful technology and hence integrates epistemic and practical aims of research and development. Case studies of the rational design of the cardiovascular drugs propranolol, captopril and losartan provide insights into characteristics and conditions of this integration. Rational drug design became possible in the 1950s when theoretical knowledge of drug-target interaction and experimental drug testing could interlock in cycles of mutual advancement. The integration does not, however, diminish the importance of basic research for pharmaceutical development. Rather, it can be shown that still in the 1990s, linear processes of innovation and the close combination of practical and epistemic work were interdependent.

Biomedical Research↗
PubMed2004

Time course of the GH/IGF axis response to fasting and increased ration in chinook salmon (Oncorhynchus tshawytscha).

Body growth in vertebrates is chiefly regulated by the GH/IGF axis. Pituitary growth hormone (GH) stimulates liver insulin-like growth factor-I (IGF-I) production. During fasting, plasma IGF-I levels decline due to the development of liver GH resistance, while GH levels generally increase. In mammals, decreased insulin during fasting is thought to cause liver GH resistance. However, the sequence of events in the GH/IGF axis response to fasting is not well characterized, especially in non-mammalian vertebrates. We assessed the time course of the GH/IGF axis response to fasting and increased ration in chinook salmon. Fish were placed on Fasting, Increased, or Control rations, and sampled daily for 4 days and at more widely spaced intervals through 29 days. Plasma IGF-I, GH, insulin, and 41 kDa IGF binding protein (putative salmon IGFBP-3), and liver IGF-I gene expression were measured. Control and Increased ration fish did not differ strongly. Plasma IGF-I and 41 kDa IGFBP were significantly lower in Fasted versus Control fish from day 4 onward, and liver IGF-I gene expression was significantly lower from day 6 onward. Liver IGF-I gene expression and plasma IGF-I levels were correlated. Plasma insulin was lower in Fasted fish from day 6 onward. There was a trend toward increased GH in Fasted fish on days 1-2, and GH was significantly increased Fasted fish from day 3 onward. Fasted GH first increased (days 1-3) to a plateau of 10-20 ng/ml (days 4-12) and then increased dramatically (days 15-29), suggesting that the GH response to fasting had three phases. The early increase in GH, followed by the decrease in plasma IGF-I after 4 days, suggests that GH resistance developed within 4 days.

Animals↗