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PubMedDate not supplied

Music thanatology: prescriptive harp music as palliative care for the dying patient.

Music thanatology represents an emerging area in which the raw materials of music, usually harp and/or voice, assist and comfort the dying patient. During prescriptive "music vigils, " the clinician-musician carefully observes physiological changes, cues, and breathing patterns, thereby synchronizing the music to reflect or support the patient's physiology and overall condition. Using data collected from 65 patients, this study was designed to assess the effectiveness of prescriptive harp music on selected palliative care outcomes using a sample of de-identified data forms from past music vigils. Patients were administered a 25- to 95-minute intervention of prescriptive harp music. Data collected included vital signs and observational indicators before (Ti) and after (T2) the vigil. Patients were more likely to experience decreased levels of agitation and wakefulness while also breathing more slowly and deeply with less effort at the conclusion of the music vigil. Results from this study suggest that a prescriptive vigil conducted by a trained music thanatologist could provide an effective form of palliative care for dying patients.

Aged↗
PubMed2004

Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns.

BACKGROUND: Since the introduction of antipsychotics, especially the so called atypicals, the treatment of schizophrenia has shown important improvements. At the present time, it is preferred to label clozapine and other antipsychotics sharing similar profiles as second-generation antipsychotics (SGAs). These medications have been proposed by some experts as a first line treatment for schizophrenia. It is critical to have reliable data about antipsychotic prescription in Mexico and to create management guidelines based on expert meetings and not only on studies carried out by the pharmaceutical industry. Only this approach will help to make the right decisions for the treatment of schizophrenia. METHODS: A translated version of Rabinowitz's survey was used to evaluate antipsychotic prescription preferences and patterns in Mexican psychiatrists. The survey questionnaire was sent by mail to 200 psychiatrists from public institutions and private practice in Mexico City and Guadalajara, Mexico. RESULTS: Recommendations for antipsychotics daily doses at different stages of the treatment of schizophrenia varied widely. Haloperidol was considered as the first choice for the treatment of positive symptoms. On the contrary, risperidone was the first option for negative symptoms. For a patient with a high susceptibility for developing extrapyramidal symptoms (EPS), risperidone was the first choice. It was also considered that SGAs had advantages over typical antipsychotics in the management of negative symptoms, cognitive impairment and fewer EPS.Besides, there was a clear tendency for prescribing typical antipsychotics at higher doses than recommended and inadequate doses for the atypical ones. CONCLUSIONS: Some of the obstacles for the prescription of SGAs include their high cost, deficient knowledge about their indications and dosage, the perception of their being less efficient for the treatment of positive symptoms and the resistance of some Mexican physicians to change their prescription pattern. It is necessary to reach a consensus, in order to establish and standardize the treatment of schizophrenia, based on the information reported in clinical trials and prevailing economic conditions in Mexico.

Antipsychotic Agents↗
PubMed1995

Inhibitory effect of rikkunshi-to, a traditional Chinese herbal prescription, on tumor promotion in two-stage carcinogenesis in mouse skin.

We report the inhibitory effect of topical application of extracts of a traditional Chinese herbal prescription on 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced inflammation in mice. Methanol and water extracts obtained from 22 traditional Chinese herbal prescriptions were assayed and their inhibition ratios calculated. In general, the methanol extracts produced more effective inhibition than the water extracts. Of the various traditional Chinese herbal prescriptions, the methanol extract of Rikkunshi-to was more effective than other prescriptions as far as inhibition of TPA-induced inflammation was concerned. Hoelen, Glycyrrhizae Radix, Atractylodis Rhizoma, components of Rikkunshi-to markedly inhibited the inflammatory activity involved by TPA in mice. Furthermore, topical application of the methanol extract of Rikkunshi-to markedly inhibited TPA-induced tumor promotion in two-stage carcinogenesis in mouse skin.

Animals↗
PubMed1998

Effects of preparations of Chinese medicinal prescriptions on digestive enzymes in vitro and in vivo.

The effects of preparations of Chinese medicinal prescriptions on the activities of digestive enzymes were investigated. The starch dextrinizing activity of pancreatin was inhibited by Keishi-bukuryo-gan, Sho-seiryu-to, Hachimi-jio-gan, Unsei-in and Keishi-ka-shakuyaku-to to below 40% of the control activity. Hachimi-jio-gan and Sho-seiryu-to, in particular, lowered the activity to 4% and 24% of the control activity, respectively. The protein digestive activity of pancreatin was lowered by Keishi-bukuryo-gan, Oren-gedoku-to, Ryutan-shakan-to, Tokaku-joki-to, Yokuinin-to and Hange-shashin-to, to 56 to 70% of the control activity. To investigate the effects of the preparations of Chinese medicinal prescriptions on digestive enzymes in vivo, 600 mg (185 kBq) of 125I-egg white albumin were administered orally to rats 30 min before the administration of 100 mg of Tokaku-joki-to or Oren-gedoku-to. The radioactivity which transferred to the blood was less in the animals pre-fed these prescriptions than in the control animals, indicating that the digestion of egg white albumin was delayed in the presence of the prescriptions.

Albumins↗
PubMed2001

Inhibitory potential of herbal medicines on human cytochrome P450-mediated oxidation: properties of umbelliferous or citrus crude drugs and their relative prescriptions.

To investigate the possible drug interaction with herbal medicine, hot water decoctions or 40% ethanol infusions of several Umbelliferous or Citrus crude drugs and their prescriptions were examined in vitro for their abilities to inhibit human cytochrome P450 3A (CYP3A). Addition of each decoction or infusion from Baizhi (Angelica dahurica and varieties), Qianghuo (Notopterygium incisum or N. forbesii), Duhuo (Angelica biserrata), Fangfeng (Saposhnikovia divaricata), Danggui (Angelicasinensis), Zhishi or Zhiqiao (Citrus aurantium) resulted in various degrees of human CYP3A inhibition as determined by microsomal testosterone 6beta-hydroxylation. The inhibitory potency was consistent with the abundance of the hydrophobic components for each sample. Experiments on the infusion of a Japanese Baizhi (BZ1) showed the major role of furanocoumarins on human CYP3A inhibition. Some of the crude drugs and a related prescription showed increased inhibition after the preincubation, suggesting the involvement of a mechanism-based inhibition. Some formulated prescriptions, however, showed intense inhibition with their hydrophobic fractions rather than with their hydrophobic fractions, suggesting that components other than furanocoumarins in herbal prescriptions may also cause CYP3A inhibition. These results indicate the necessity of intensive investigations on the possible drug interaction with traditional medicines.

Aryl Hydrocarbon Hydroxylases↗
PubMed2002

Prescription of binaural hearing aids in the United Kingdom: a knowledge, attitude and practice (KAP) study.

The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.

Attitude of Health Personnel↗
PubMed2006

A study of the prescription of radiographs for children by a group of general dental practitioners in the South West of England.

OBJECTIVE: This study aimed to assess the familiarity of general dental practitioners (GDPs) in the South West of England with the guidelines in the first edition of the then Faculty of General Dental Practitioners (UK) "good practice guidelines" publication Selection Criteria for Dental Radiography (henceforth referred to as "the guidelines") by studying the prescription of radiographs for children in two case scenarios. METHOD: A single mailshot of questionnaires containing questions relating to the guidelines and the two case scenarios was sent to 136 GDPs in the South West of England. Their recommendations for the prescription of radiographs for the children in the two scenarios were then compared with the guidelines. RESULTS: There was a 60% response rate. Of the respondents, 48% reported that they had access to the guidelines. Of those who responded to the question, 66% said that they found the guidelines easy to use. Seventy per cent of respondents reported that they preferred the concept of guidelines to that of protocols. The results from the case scenarios revealed an under-prescription of radiographs for patients presenting with developmental problems or trauma when compared to the recommendations in the guidelines. There was good correlation for the prescription of radiographs for caries but little consensus on radiographic review times. CONCLUSIONS: The study highlighted (a) areas within the guidelines that require further clarification and research and (b) that in the group studied half did not have access to the guidelines.

Child↗
PubMedDate not supplied

Evaluation of written prescription information provided in community pharmacies: a study in eight states.

OBJECTIVES: To develop three tools for assessing the quality of written information provided with new prescriptions in community pharmacies and to identify pharmacy, pharmacist, and patient characteristics associated with the dissemination and quality of that information. DESIGN: Observational study. Regression techniques were used to analyze the influence of pharmacy, pharmacist, and shopper (acting as patient) characteristics on outcome measures. PARTICIPANTS: Trained shoppers (acting as patients) visited 306 randomly selected pharmacies in 8 states. Each shopper presented three prescriptions, answered questions according to a standard scenario, accepted the information offered, and paid for the prescriptions. MAIN OUTCOME MEASURES: Percentage of shoppers receiving any written information; quality of written information as judged by an expert panel using explicit criteria. RESULTS: Shoppers received an information leaflet with 87% of the 918 prescriptions dispensed. Although most leaflets provided unbiased information, leaflet length and quality of information varied greatly. A majority of leaflets did not include adequate information about contraindications, precautions, and how to avoid harm. Shoppers were more likely to receive leaflets in chain pharmacies and pharmacies with more staff. Information quality also was higher in chain pharmacies. Shopper and pharmacist demographic characteristics were unrelated to the level or quality of written information after controlling for other factors. CONCLUSION: The provision of patient leaflets is becoming a routine practice in the states studied. However, most leaflets do not meet quality criteria. It is important for pharmacists to become familiar with criteria for evaluating these leaflets and to take necessary action to improve their quality.

Adult↗
PubMedDate not supplied

Medicaid cost containment and access to prescription drugs.

States have been intensifying their efforts to control rising prescription drug costs in their Medicaid programs. This study examines the effects of five Medicaid cost containment policies on enrollees' perceptions of their ability to get prescription drugs. The results show that enrollees in states that have implemented all or almost all of these five policies have greater problems getting prescription drugs than enrollees in other states encounter. In terms of specific policies, prior authorization and mandatory generic substitutions had the largest effects on access to prescription drugs.

Adolescent↗
PubMed2005

Warrants for prescription: analytically and empirically based approaches to improving decision making.

Efforts to improve decision making must appeal to some source of warrant - that is, specific criteria or models for guiding and evaluating decision-making performance. We examine and compare the warrants for two approaches to decision aids, decision training, and consulting: analytically based prescription, which obtains warrant from formal models, and empirically based prescription, which obtains warrant from descriptive models of successful performance. We argue that empirically based warrants can provide a meaningful and valid basis for prescriptive intervention without committing the naturalistic fallacy (i.e., confusing what is with what ought to be) and without the use of formal deduction from first principles. We describe points of divergence as well as convergence in the types of warrant appealed to by naturalistic decision making and decision analysis, letting each approach shed light on the other, and explore the application of empirically based prescription to cognitive engineering. Actual or potential applications of this research include the development of training programs to improve various aspects of naturalistic decision making.

Awareness↗
PubMed1996

Relationships between ambient sounds and the accuracy of pharmacists' prescription-filling performance.

Associations between ambient sounds and accuracy of pharmacists' prescription-filling performance in a pharmacy was studied. Pharmacists were videotaped as they filled prescriptions each workday for 23 days. Each filled prescription was inspected by the investigator. Deviations from the physician's written order were considered errors. Videotape analysis was used to detect unpredictable, predictable, uncontrollable, and controllable sounds. A within-subjects case control study design was employed to determine whether the frequency of ambient sounds was significantly different when prescriptions with errors, compared with those without errors, were filled. Loudness, in terms of equivalent sound levels (Leq) for each half hour, was analyzed for a relationship to dispensing error rate. A mean dispensing error rate of 3.23% was found. Unpredictable sounds, controllable sounds, and noise had a significant effect on pharmacists which resulted in a decreased dispensing error rate. These results suggest that the quality of pharmacists' performance is not adversely affected by ambient sound. As equivalent sound levels increased, the error rate increased to a point, then decreased.

Case-Control Studies↗
PubMed1981

Do prescriptions adversely affect doctor-patient interactions?

The purpose of this study was to assess the impact of the prescription on the doctor-patient interaction. Data were collected during ongoing quality assessment studies at a prepaid group practice of about 19,000 enrollees. Adult patients and their providers completed forms on all visits to the Department of Medicine and Urgent Care Center during a two-week period. A 50 percent random sample of patients was interviewed by telephone one week after the index visit. Patients who did not receive prescriptions reported more satisfaction with the communicative aspects of their visits to physicians than patients who did receive prescriptions. We suggest that prescriptions may hinder patient satisfaction with the doctor-patient interaction by substituting for other, more "meaningful" communication between patient and provider.

Adolescent↗
PubMed2003

Bedside rapid flu test and zanamivir prescription in healthy working adults: a cost-benefit analysis.

BACKGROUND: Zanamivir, a neuraminidase inhibitor, reduces the number of days of illness in influenza-positive patients. New bedside rapid flu tests (RFT) should increase the number of influenza-positive patients whom receive zanamivir appropriately. OBJECTIVE: To estimate the economic effects of implementing RFT and zanamivir among unvaccinated healthy working adults who consult within 2 days of the onset of influenza-like symptoms. METHODS: We constructed a decision tree to perform a cost-benefit analysis from a societal perspective. Clinical outcome, i.e. number of influenza days averted, and societal costs were compared for three strategies: RFT and conditional zanamivir prescription;systematic zanamivir prescription; and no zanamivir. A two-way sensitivity analysis was performed including the proportion of influenza-positive patients. RESULTS: During influenza epidemics, systematic zanamivir prescription provided the best health outcome (0.81 influenza days averted) and minimised societal costs (reduced by 29.80 US dollars per person compared with no zanamivir; 1999 values). RFT with conditional zanamivir averted 0.65 influenza days and saved 14.40 US dollars per person. When the proportion of influenza-positive patients was under 39%, the no zanamivir strategy yielded the greatest societal savings; otherwise, systematic zanamivir was the dominant strategy. Medical costs associated with no zanamivir were 88.70 US dollars per patient consulting with influenza-like illness, and increased to 125.50 US dollars with systematic zanamivir and to 127.60 US dollars with RFT and conditional zanamivir. CONCLUSIONS: Due to poor sensitivity of current RFT, systematic zanamivir prescription without RFT for unvaccinated healthy working adults should be recommended during influenza epidemics.

Adult↗
PubMed2003

[Protective effects and mechanisms of serial TCM "Huoxuehuayu" prescriptions on cerebral ischemia-reperfusion injury in rats].

OBJECTIVE: To determine effects and mechanisms of traditional Chinese medicine serial "Huoxuehuayu" (activating blood flow and removing blood stasis) prescriptions on cerebral ischemia-reperfusion injury in rats. METHODS: Focal cerebral ischemia was induced by 60 min of middle cerebral artery occlusion (MCAO) and followed by 3 d reperfusion. Drugs were orally administered 1 h before MCAO and 4 h after reperfusion and the following 2 d. The neurological scores were evaluated 3 d after reperfusion. Then the animals were sacrificed, the infarct volumes, right and left areas of brain section, the pathologic changes and the normal neurons in hippocampal CA1 and cortex were determined by using an image analyzer. Nitric oxide synthase (NOS), superoxide dismutase (SOD) activities and malondialdehyde (MDA) content in brain tissue were evaluated by spectrophotography. The expression of NMDA R1 subunit (NR1) and endothelial NOS (eNOS) was determined by immunoblotting technique. RESULT: Serial "Huoxuehuayu" prescriptions and nimodipine improved neuronal dysfunction, and reduced infarct size and brain edema. Serial Huoxuehuayu prescriptions and nimodipine reduced MDA content and NOS activity, and increased SOD activity. Western blotting analysis demonstrated induction of NR1. CONCLUSION: Serial Huoxuehuayu prescriptions have a protective effect on cerebral ischemia-reperfusion injury by reducing NOS activity, MDA content, expression of NR1 and increasing SOD activity.

Animals↗
PubMed1985

Prescription options for the below knee amputee. A review.

In 1973 a workshop sponsored by the National Academy of Sciences recommended that "efforts to develop prescription criteria for use of the numerous variants of the BK prosthesis should be intensified." This paper provides a review of the important considerations in the prescription of a below-knee prosthesis. It is intended that this information would assist the physician to make better informed decisions regarding the specific type of prosthesis for a particular patient. No attempt has been made to describe all prosthetic options since a majority of amputees are fit with only a few prescriptions. Thus, socket design, suspension, shank type, and foot specification may be optimized for individual patients through mutual agreement of the prosthetist and the knowledgeable physician. This paper will present some of the more difficult prescription solutions to the various fitting problems that are representative of our nation's amputee population. This is done with the knowledge that there may be other and equally successful solutions to these problems. Several illustrative examples are provided.

Adult↗
PubMedDate not supplied

[Evaluation model of the effect of Rofecoxib on the co-prescription of gastroprotective agents observed during the treatment of osteoarthritis].

OBJECTIVE: This study was conducted to define an evaluation model to estimate changes in the co-prescription of gastroprotective agents (GPAs) induced by rofecoxib in the treatment of osteoarthritis (OA). METHODS: On the basis of a cross-linking information, which were stored in different administrative and clinical databases, a multivariate regression analysis was used to develop the model. Data were collected by 30 general practitioners of the Local Health Unit of Ravenna (middle-north of Italy). RESULTS: The study population consisted of 2,944 patients treated with non-steroidal anti-inflammatory drugs (NSAIDs) and 487 treated with rofecoxib. Patients treated with rofecoxib generally presented a higher number of gastrointestinal damage risk factors and also a lower level of GPAs co-prescription compared to those treated with NSAIDs. Including in the model variables such as type of anti-inflammatory treatment (NSAIDs or rofecoxib), gender, age by class, previous hospital admissions due to gastrointestinal complications, number of different NSAIDs used, and prescription of corticosteroids, the regression equation and its coefficients were identified. A non-linear relationship between the percentage of patients treated with rofecoxib and the relative reduction of GPAs co-prescription was found. It has been estimated the basis of the registered percentage of patients treated with rofecoxib (17,6%) adjusting for gastrointestinal damage risk factors, and on a 63% (CI95%: 55%-70%) relative reduction of GPA use with rofecoxib with respect to NSAIDs was estimated. CONCLUSIONS: Based on data collected in the clinical practice after the introduction of rofecoxib, a model evaluating the relationship between the frequency of its use in the OA population and the expected reduction of GPAs, has been developed.

Aged↗
PubMed2003

Conventional, atypical, and combination antipsychotic prescriptions: a 2-year comparison.

BACKGROUND: The purpose of this study was to determine if there is a relationship between the type of antipsychotic prescribed (conventional, atypical, or a combination) and patients' use of psychiatric services and prescription of adjuvant medications. METHOD: A chart review of 83 outpatients with long-term psychiatric disorders recorded the type and dosage of psychiatric medications prescribed in 1997-1998 (T1) and 2 years later, in 1999-2000 (T2). Psychiatric service use was also noted during the 2-year follow-up. RESULTS: Atypical prescriptions increased from 27% (N = 22) to 45% (N = 37) 2 years later. At T2, 35% of patients (N = 29) were prescribed conventionals, and 19% (N = 16) were prescribed a combination of conventionals and atypicals. The mean antipsychotic dosage in chlorpromazine equivalents (546.5 mg/day) increased significantly (p <.05). There was no difference between the 3 groups in their use of psychiatric services or the prescription of adjuvant medications, with the exception of less common prescription of anticholinergics. There was also no difference in psychiatric service use between patients who remained on treatment with combined antipsychotics at T1 and T2 (11%; N = 9) and the rest of the sample. Patients who were switched from one type of antipsychotic to another made more use of psychiatric services, however. CONCLUSION: Contrary to our expectations, patients prescribed combined antipsychotic types did not make more use of psychiatric services or use more adjuvant medications. The high percentage of patients prescribed a combination may be due to antipsychotic polypharmacy preferences and may represent a very slow crossover from one antipsychotic to another.

Adult↗
PubMed1994

Utilization effects of prescription drug benefits in an aging population.

In this article, the effects of prescription drug coverage on use are analyzed for beneficiaries of a large retiree health benefit fund in a quasi-experiment comparing new and established enrollees. Newer enrollees show an 18-percentage point greater increase in prescription drug expenditures per capita than established enrollees during the 3-year period following enrollment. This differential is interpreted as the insurance effect of prescription coverage. The impact was greater among high-cost drugs than among low-cost drugs, and also greater among low users of prescription drugs than among high users. No clear patterns were discerned across therapeutic categories.

Aged↗