17 CFR 269.2 - Form T-2, for statement of eligibility and qualification for individual trustees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 3 2012-04-01 2012-04-01 false Form T-2, for statement of... SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE TRUST INDENTURE ACT OF 1939 § 269.2 Form T-2, for statement of eligibility and qualification for individual trustees. This form shall be...

48 CFR 53.205-1 - Paid advertisements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Paid advertisements. 53.205-1 Section 53.205-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS Prescription of Forms 53.205-1 Paid advertisements. SF 1449, prescribed in 53.212, shall be used to place orders for paid...

Non-medical prescribing in New Zealand: an overview of prescribing rights, service delivery models and training.

PubMed

Raghunandan, Rakhee; Tordoff, June; Smith, Alesha

2017-11-01

In this paper, we aim to provide an updated source of information for nonmedical prescribing (NMP) in New Zealand (NZ). A variety of NZ sources were used to collect data: legislation, policy documents and information from professional and regulatory organizations, and education providers. In NZ, the legal categories for prescribers include authorized, designated, and delegated prescribers. Authorized prescribers include dentists, midwives, nurse practitioners, and optometrist prescribers. Designated prescribers include pharmacist prescribers, registered nurse prescribers, and dietitian prescribers. There are no delegated prescribers in NZ at this time. There is variation in the regulation, educational programmes and prescribing competencies used by the different prescribing health professionals involved in NMP in NZ. This update collates relevant information relating to NMP in NZ into one consolidated document and provides policy makers with a current overview of prescribing rights, service delivery models, training requirements, and prescribing competencies used for NMP in NZ. As NMP in NZ continues to expand and evolve, this paper will form a baseline for future NMP research in NZ. NZ needs to develop overarching NMP policy to enable consistency in the various aspects of NMP, thereby delivering a safe and sustainable NMP service in NZ.

76 FR 69330 - Proposed Collection; Comment Request for Form

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

.../or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law... program involving certain issuers of tax exempt advance refunding bonds. Revenue Procedure 96-41 established this voluntary compliance program and prescribed the filing of this form as a cover sheet to...

17 CFR 274.201 - Form N-MFP, portfolio holdings of money market funds.

Code of Federal Regulations, 2010 CFR

2010-04-01

... EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE INVESTMENT COMPANY ACT OF 1940 Forms for Other... registered open-end management investment companies that are regulated as money market funds under § 270.2a-7... GPO Access. Effective Date Note: At 75 FR 10118, Mar. 4, 2010, § 274.201 was added, effective May 5...

17 CFR 269.1 - Form T-1, for statement of eligibility and qualification for corporate trustees.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 3 2012-04-01 2012-04-01 false Form T-1, for statement of eligibility and qualification for corporate trustees. 269.1 Section 269.1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE TRUST INDENTURE ACT OF 1939 § 269.1...

17 CFR 269.1 - Form T-1, for statement of eligibility and qualification for corporate trustees.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Form T-1, for statement of eligibility and qualification for corporate trustees. 269.1 Section 269.1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE TRUST INDENTURE ACT OF 1939 § 269.1...

17 CFR 269.1 - Form T-1, for statement of eligibility and qualification for corporate trustees.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 4 2014-04-01 2014-04-01 false Form T-1, for statement of eligibility and qualification for corporate trustees. 269.1 Section 269.1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE TRUST INDENTURE ACT OF 1939 § 269.1...

17 CFR 269.1 - Form T-1, for statement of eligibility and qualification for corporate trustees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Form T-1, for statement of eligibility and qualification for corporate trustees. 269.1 Section 269.1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE TRUST INDENTURE ACT OF 1939 § 269.1...

17 CFR 269.1 - Form T-1, for statement of eligibility and qualification for corporate trustees.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 17 Commodity and Securities Exchanges 3 2013-04-01 2013-04-01 false Form T-1, for statement of eligibility and qualification for corporate trustees. 269.1 Section 269.1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE TRUST INDENTURE ACT OF 1939 § 269.1...

17 CFR 274.11 - Form N-1, registration statement of open-end management investment companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... statement of open-end management investment companies. 274.11 Section 274.11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE INVESTMENT COMPANY ACT...(b) of the Investment Company Act of 1940 by open-end management investment companies that are...

Non-medical prescribing in New Zealand: an overview of prescribing rights, service delivery models and training

PubMed Central

Raghunandan, Rakhee; Tordoff, June; Smith, Alesha

2017-01-01

Aim: In this paper, we aim to provide an updated source of information for nonmedical prescribing (NMP) in New Zealand (NZ). Methods: A variety of NZ sources were used to collect data: legislation, policy documents and information from professional and regulatory organizations, and education providers. Results: In NZ, the legal categories for prescribers include authorized, designated, and delegated prescribers. Authorized prescribers include dentists, midwives, nurse practitioners, and optometrist prescribers. Designated prescribers include pharmacist prescribers, registered nurse prescribers, and dietitian prescribers. There are no delegated prescribers in NZ at this time. There is variation in the regulation, educational programmes and prescribing competencies used by the different prescribing health professionals involved in NMP in NZ. Conclusion: This update collates relevant information relating to NMP in NZ into one consolidated document and provides policy makers with a current overview of prescribing rights, service delivery models, training requirements, and prescribing competencies used for NMP in NZ. As NMP in NZ continues to expand and evolve, this paper will form a baseline for future NMP research in NZ. NZ needs to develop overarching NMP policy to enable consistency in the various aspects of NMP, thereby delivering a safe and sustainable NMP service in NZ. PMID:29090084

24 CFR 969.104 - Continuing eligibility for operating subsidy.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in accordance with an ACC amendment providing for extension of the term of the ACC provisions related to project operation, pursuant to § 969.105 or § 969.106. The ACC amendment shall be in the form prescribed by HUD and shall specify the particular provisions of the ACC which relate to continued project...

24 CFR 969.104 - Continuing eligibility for operating subsidy.

Code of Federal Regulations, 2011 CFR

2011-04-01

... in accordance with an ACC amendment providing for extension of the term of the ACC provisions related to project operation, pursuant to § 969.105 or § 969.106. The ACC amendment shall be in the form prescribed by HUD and shall specify the particular provisions of the ACC which relate to continued project...

50 CFR 86.52 - What information must I include in my grant proposals?

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF THE INTERIOR (CONTINUED) FINANCIAL ASSISTANCE-WILDLIFE SPORT FISH RESTORATION PROGRAM BOATING... and Tier Two) (see § 86.53): (a) Standard Form 424 series as prescribed by the Office of Management...

50 CFR 86.52 - What information must I include in my grant proposals?

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF THE INTERIOR (CONTINUED) FINANCIAL ASSISTANCE-WILDLIFE SPORT FISH RESTORATION PROGRAM BOATING... and Tier Two) (see § 86.53): (a) Standard Form 424 series as prescribed by the Office of Management...

50 CFR 86.52 - What information must I include in my grant proposals?

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF THE INTERIOR (CONTINUED) FINANCIAL ASSISTANCE-WILDLIFE SPORT FISH RESTORATION PROGRAM BOATING... and Tier Two) (see § 86.53): (a) Standard Form 424 series as prescribed by the Office of Management...

Incorporating assessment and prescribing for ambulatory ailments skills into practice: An environmental scan of continuing education for pharmacist prescribing in Canada

PubMed Central

Habicht, Dana; Ng, Sheila; Dunford, Drena; Shearer, Brenna; Kuo, I fan

2017-01-01

Objectives: Pharmacists in Canadian provinces are at different stages of applying prescribing legislation into practice. The purpose of this environmental scan was to examine differences in legislation, remuneration, professional uptake, continuing education requirements and continuing education resources relating to pharmacist prescribing for ambulatory ailments, with a focus on continuing education. Methods: Data were collected between May and December 2016 using websites and communication with provincial professional regulatory bodies, advocacy bodies, drug coverage programs and other organizations that offer continuing education for pharmacists. Results: Training requirements to prescribe for ambulatory ailments vary provincially, including no training requirements, online tutorials and a comprehensive application process. Government-funded remuneration for prescribing services is absent in most provinces. Pharmacist uptake of the training required to obtain prescribing authority ranges from 30% to 100% of pharmacists. Continuing education programs on the topic of prescribing across the country include online courses, in-person courses, webinars, panel discussions and preparation courses. Conclusion: Many aspects of pharmacist prescribing for ambulatory ailments, including the style and content of continuing education resources, vary from province to province. Further research on this topic would help to determine the effect of these differences on the success of incorporating pharmacist prescribing into practice. PMID:28894501

Incorporating assessment and prescribing for ambulatory ailments skills into practice: An environmental scan of continuing education for pharmacist prescribing in Canada.

PubMed

Habicht, Dana; Ng, Sheila; Dunford, Drena; Shearer, Brenna; Kuo, I Fan

2017-01-01

Pharmacists in Canadian provinces are at different stages of applying prescribing legislation into practice. The purpose of this environmental scan was to examine differences in legislation, remuneration, professional uptake, continuing education requirements and continuing education resources relating to pharmacist prescribing for ambulatory ailments, with a focus on continuing education. Data were collected between May and December 2016 using websites and communication with provincial professional regulatory bodies, advocacy bodies, drug coverage programs and other organizations that offer continuing education for pharmacists. Training requirements to prescribe for ambulatory ailments vary provincially, including no training requirements, online tutorials and a comprehensive application process. Government-funded remuneration for prescribing services is absent in most provinces. Pharmacist uptake of the training required to obtain prescribing authority ranges from 30% to 100% of pharmacists. Continuing education programs on the topic of prescribing across the country include online courses, in-person courses, webinars, panel discussions and preparation courses. Many aspects of pharmacist prescribing for ambulatory ailments, including the style and content of continuing education resources, vary from province to province. Further research on this topic would help to determine the effect of these differences on the success of incorporating pharmacist prescribing into practice.

45 CFR 602.41 - Financial reporting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM... under this part. (5) Federal agencies may provide computer outputs to grantees to expedite or contribute... machine usable format or computer printouts instead of prescribed forms. (6) Federal agencies may waive...

45 CFR 602.41 - Financial reporting.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM... under this part. (5) Federal agencies may provide computer outputs to grantees to expedite or contribute... machine usable format or computer printouts instead of prescribed forms. (6) Federal agencies may waive...

45 CFR 602.41 - Financial reporting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM... under this part. (5) Federal agencies may provide computer outputs to grantees to expedite or contribute... machine usable format or computer printouts instead of prescribed forms. (6) Federal agencies may waive...

45 CFR 602.41 - Financial reporting.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM... under this part. (5) Federal agencies may provide computer outputs to grantees to expedite or contribute... machine usable format or computer printouts instead of prescribed forms. (6) Federal agencies may waive...

45 CFR 602.41 - Financial reporting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM... under this part. (5) Federal agencies may provide computer outputs to grantees to expedite or contribute... machine usable format or computer printouts instead of prescribed forms. (6) Federal agencies may waive...

Continuous Venovenous Hemofiltration in Severely Burned Patients with Acute Kidney Injury: A Cohort Study

DTIC Science & Technology

2009-05-01

to result in any extra- renal effects. In the CVVH group the initial prescribed dose was variable based on hemo- dynamic compromise and perceived...associated with a decrease in 28-day and hospital mortality when compared with a historical control group, which largely did not receive any form of renal ...BUN: blood urea nitrogen; CVVH: continuous venovenous hemofiltration; CVVHDF: continuous venovenous hemodiafiltration; ESRD: end-stage renal disease

5 CFR 841.202 - Applications required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) FEDERAL EMPLOYEES RETIREMENT SYSTEM-GENERAL ADMINISTRATION Applications for Benefits § 841.202 Applications required. (a) No benefit is payable under FERS, until after the claimant has applied for the benefit in the form prescribed by OPM. (b) An employee, Member, or survivor may exercise any option or...

17 CFR 274.53 - Form N-54A, notification of election to be subject to sections 55 through 65 of the Investment...

Code of Federal Regulations, 2010 CFR

2010-04-01

... section 54(a) of the Investment Company Act of 1940 [15 U.S.C. 80a-53(a)] by a company of the type defined... election to be subject to sections 55 through 65 of the Investment Company Act of 1940 filed pursuant to... COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE INVESTMENT COMPANY ACT OF 1940 Registration Statements...

32 CFR Appendix A to Part 516 - References

Code of Federal Regulations, 2010 CFR

2010-07-01

... Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY AID OF CIVIL AUTHORITIES AND PUBLIC RELATIONS LITIGATION Pt. 516, App. A Appendix A to Part 516—References Publications referenced in this part... the Army Personnel. AR 690-700, Personnel Relations and Services. (Cited in § 516.70.) Prescribed Form...

17 CFR 270.8b-11 - Number of copies; signatures; binding.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Number of copies; signatures... (CONTINUED) RULES AND REGULATIONS, INVESTMENT COMPANY ACT OF 1940 § 270.8b-11 Number of copies; signatures... manner prescribed by the appropriate form. Unsigned copies shall be conformed. If the signature of any...

27 CFR 46.22 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CIGARETTE PAPERS AND TUBES Administrative Provisions § 46.22 Forms prescribed. (a) The appropriate TTB officer is authorized to prescribe all forms required by this part. You must furnish all of the..., and as required by this part. You must file each form in accordance with its instructions. (b) Forms...

27 CFR 5.3 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE TREASURY LIQUORS LABELING AND ADVERTISING OF DISTILLED SPIRITS Scope § 5.3 Forms prescribed. (a...) Forms prescribed by this part are available for printing through the TTB Web site (http://www.ttb.gov...

Evaluating nurse prescribers' education and continuing professional development for independent prescribing practice: findings from a national survey in England.

PubMed

Latter, Sue; Maben, Jill; Myall, Michelle; Young, Amanda

2007-10-01

The number of nurses able to independently prescribe medicines in England has risen steadily in recent years. To evaluate the adequacy of nurses' educational preparation for independent prescribing and to describe nurses' experiences of their continuing professional development as prescribers in practice. Postal questionnaire survey. Random sample of 246 nurses registered as nurse independent prescribers with the Nursing and Midwifery Council. The majority of nurses considered that the initial taught course element of their education programme met their needs, either to some extent (61% 151/246), or completely (22% 54/246). Most nurses (77% 190/246) received the specified 12 days support from their supervising medical practitioner and most were satisfied and positive about this experience. Nearly all of the nurses (>95%) reported that they were able to maintain a range of specified prescribing competencies in practice. Two thirds (62% 152/246) of the sample reported that they were receiving support/supervision for prescribing. Ninety five per cent (233/246) of the sample also reported that they engaged in self-directed informal continuing professional development, but only half of the sample had experience of formally provided professional development opportunities. Approximately half (52% 127/246) of the sample identified needs for continuing professional development. This first national survey of the education and professional development experiences of nurse independent prescribers in England provides evidence which highlights areas in which national policy is working well, and also points up issues which may need addressing as the roll out of nurse prescribing continues. The study also highlights characteristics and issues that health care policy makers and nurse educationalists internationally may wish to consider in developing and refining their own nurse prescriber education programmes.

Closed-form solution for Eshelby's elliptic inclusion in antiplane elasticity using complex variable

NASA Astrophysics Data System (ADS)

Chen, Y. Z.

2013-12-01

This paper provides a closed-form solution for the Eshelby's elliptic inclusion in antiplane elasticity. In the formulation, the prescribed eigenstarins are not only for the uniform distribution, but also for the linear form. After using the complex variable and the conformal mapping, the continuation condition for the traction and displacement along the interface in the physical plane can be reduced to a condition along the unit circle. The relevant complex potentials defined in the inclusion and the matrix can be separated from the continuation conditions of the traction and displacement along the interface. The expressions of the real strains and stresses in the inclusion from the assumed eigenstrains are presented. Results for the case of linear distribution of eigenstrain are first obtained in the paper.

27 CFR 25.3 - Forms prescribed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate TTB...

27 CFR 25.3 - Forms prescribed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate TTB...

27 CFR 25.3 - Forms prescribed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate TTB...

27 CFR 25.3 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate TTB...

27 CFR 25.3 - Forms prescribed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Forms prescribed. 25.3 Section 25.3 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Scope of Regulations § 25.3 Forms prescribed. (a) The appropriate TTB...

27 CFR 4.3 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE TREASURY LIQUORS LABELING AND ADVERTISING OF WINE Scope § 4.3 Forms prescribed. (a) The... prescribed by this part are available for printing through the TTB Web site (http://www.ttb.gov) or by...

Independent extended and supplementary nurse prescribing practice in the UK: a national questionnaire survey.

PubMed

Courtenay, Molly; Carey, Nicola; Burke, Joanna

2007-09-01

Nurses are able to prescribe independently from a list of nearly 250 prescription only medicines for a range of over 100 medical conditions or, from the whole British National Formulary as a supplementary prescriber. There is some evidence available on the prescribing practices of district nurses and health visitors and early independent extended prescribers. Little or no attention has focussed on supplementary nurse prescribing. To provide an overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing. National questionnaire survey. United Kingdom. A convenience sample of 868 qualified independent extended/supplementary nurse prescribers self-completed a written questionnaire. A total of 756 (87%) used independent extended prescribing; 304 (35%) used supplementary prescribing to treat a range of chronic conditions (including asthma, diabetes and hypertension); 710 (82%) nurses worked in primary care. Nurses in general practice reported the largest number of reasons preventing prescribing. Reasons included the inability to computer generate prescriptions and to implement the Clinical Management Plan. Nurses in primary care reported more continuing professional development needs. These needs included update on prescribing policy and the treatment management of conditions. A total of 277 (32%) nurses were unable to access continuing professional development. Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. These nurses are highly qualified and have many years clinical experience. Supplementary prescribing is used by a minority of nurses. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing. The continuing professional development needs of independent extended/supplementary nurse prescribers are frequently unmet. It will become increasingly important that these needs are met once nurses are able to prescribe the full range of medicines included in the British National Formulary, limited only by their area of competence.

27 CFR 7.3 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE TREASURY LIQUORS LABELING AND ADVERTISING OF MALT BEVERAGES Scope § 7.3 Forms prescribed. (a) The... prescribed by this part are available for printing through the TTB Web site (http://www.ttb.gov) or by...

Prescribing Errors Involving Medication Dosage Forms

PubMed Central

Lesar, Timothy S

2002-01-01

CONTEXT Prescribing errors involving medication dose formulations have been reported to occur frequently in hospitals. No systematic evaluations of the characteristics of errors related to medication dosage formulation have been performed. OBJECTIVE To quantify the characteristics, frequency, and potential adverse patient effects of prescribing errors involving medication dosage forms . DESIGN Evaluation of all detected medication prescribing errors involving or related to medication dosage forms in a 631-bed tertiary care teaching hospital. MAIN OUTCOME MEASURES Type, frequency, and potential for adverse effects of prescribing errors involving or related to medication dosage forms. RESULTS A total of 1,115 clinically significant prescribing errors involving medication dosage forms were detected during the 60-month study period. The annual number of detected errors increased throughout the study period. Detailed analysis of the 402 errors detected during the last 16 months of the study demonstrated the most common errors to be: failure to specify controlled release formulation (total of 280 cases; 69.7%) both when prescribing using the brand name (148 cases; 36.8%) and when prescribing using the generic name (132 cases; 32.8%); and prescribing controlled delivery formulations to be administered per tube (48 cases; 11.9%). The potential for adverse patient outcome was rated as potentially “fatal or severe” in 3 cases (0.7%), and “serious” in 49 cases (12.2%). Errors most commonly involved cardiovascular agents (208 cases; 51.7%). CONCLUSIONS Hospitalized patients are at risk for adverse outcomes due to prescribing errors related to inappropriate use of medication dosage forms. This information should be considered in the development of strategies to prevent adverse patient outcomes resulting from such errors. PMID:12213138

Use of prescribed fire to reduce wildfire potential

Treesearch

Robert E. Martin; J. Boone Kauffman

1989-01-01

Fires were a part of our wildlands prehistorically. Prescribed burning reduces fire hazard and potential fire behavior primarily by reducing fuel quantity and continuity. Fuel continuity should be considered on the micro scale within stands, the mid-scale among, and the macro-scale among watersheds or entire forests. Prescribed fire is only one of the tools which can...

"Under the radar": nurse practitioner prescribers and pharmaceutical industry promotions.

PubMed

Ladd, Elissa C; Mahoney, Diane Feeney; Emani, Srinivas

2010-12-01

To assess nurse practitioners' interactions with pharmaceutical industry promotional activities and their perception of information reliability and self-reported prescribing behaviors. Self-administered online survey. A nationally randomized sample of nurse practitioner prescribers was surveyed. Eligibility criteria included current clinical practice and licensure to prescribe medications in their state of practice. A total of 263 responses were analyzed. Almost all respondents (96%) reported regular contact with pharmaceutical sales representatives, and most (71%) reported receiving information on new drugs directly from pharmaceutical sales representatives some or most of the time. A large portion (66%) dispensed drug samples regularly to their patients, and 73% believed that samples were somewhat or very helpful in learning about new drugs. Eighty-one percent of respondents thought that it was ethically acceptable to give out samples to anyone, and 90% believed that it was acceptable to attend lunch and dinner events sponsored by the pharmaceutical industry. Almost half (48%) stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event. Most respondents stated that it was ethically acceptable for speakers to be paid by industry. Nurse practitioner prescribers had extensive contact with pharmaceutical industry promotional activities such as pharmaceutical representative contact, receipt of drug samples, and regular attendance at industry-sponsored meal events and continuing education programs. They reported that industry interface with nurse practitioner prescribers in the form of sponsored meals, education events, and paid speakers was ethically acceptable.

Seventeen years' experience of a voluntarily based drug rationalisation programme in hospital.

PubMed Central

Baker, J. A.; Lant, A. F.; Sutters, C. A.

1988-01-01

A study was carried out analysing the operation of a drug rationalisation programme in a central London teaching district that had evolved from experience over 17 years. Creation of a limited list of about 700 drugs had been achieved by local consensus. Drug selection was based on appraisal of efficacy, safety, and cost and was undertaken by means of collaborative participation of most consultant specialists in the district. Educative and other non-restrictive strategies for reinforcing the rationalisation policy had achieved a consistently high rate of compliance in prescribing recommended drugs. The concept of selectivity in drug use and its continuous local reappraisal had a beneficial impact on the prescribing habits of doctors at all levels of seniority as well as on the training of medical undergraduates and nurses in the therapeutic use of medicines. Peer review and self audit were encouraged by use of an extensive monitoring system which incorporated continuous "facilitative" dialogue between ward pharmacists and prescribers. Two models of drug rationalisation programme were studied, the second of which together with other local initiatives had been associated with substantial and sustained reductions in drug spending each year over nine years since 1978. It is concluded that the second drug rationalisation programme model substantially improves the cost effective use of drugs in hospital and furthermore has the potential of being extended to general practice, especially in types of prescribing that are common to both forms of patient care. PMID:3139150

The impact of a general practice group intervention on prescribing costs and patterns.

PubMed Central

Walker, Jane; Mathers, Nigel

2002-01-01

BACKGROUND: The formation of primary care groups (PCGs) and trusts (PCTs) has shifted the emphasis from individual practice initiatives to group-based efforts to control rising prescribing costs. However, there is a paucity of literature describing such group initiatives. We report the results of a multilevel group initiative, involving input from a pharmaceutical adviser, practice comparison feedback, and peer review meetings. AIM: To determine the impact of a prescribing initiative on the prescribing patterns of a group of general practices. DESIGN OF STUDY: A comparative study with non-matched controls. SETTING: Nine semi-rural/rural practices forming a commissioning group pilot, later a PCG, in Southern Derbyshire with nine practices as controls. METHOD: Practice data were collated for overall prescribing and for therapeutic categories, between the years 1997/1998 and 1998/1999 and analysed statistically. Prescribing expenditure trends were also collated. RESULTS: Although both groups came well within their prescribing budgets, in the study group this was for the first time in five years. Their rate of increase in expenditure slowed significantly following the initiative compared with that of the comparison group, which continued to rise (median practice net ingredient cost/patient unit (nic/PU) increase: Pound Sterling0.69 and Pound Sterling3.80 respectively; P = 0.03). The study group's nic/PU dropped below, and stayed below, that of the comparison group one month after the start of the initiative. For most therapeutic categories the study group had lower increases in costs and higher increases in percentage of generic items than the comparison group. Quality markers were unaffected. CONCLUSION: We suggest that practices with diverse prescribing patterns can work together effectively within a PCT locality to control prescribing costs. PMID:12030659

Two Years of the STEREO Heliospheric Imagers: Invited Review

DTIC Science & Technology

2009-01-01

impact of CMEs and CIRs on planets. The very nature of this area of research—which brings together aspects of solar physics, space -environmentphysics...Include area code) Standard Form 298 (Rev 8/98) Prescribed by ANSI Sid Z39 18 13. SUPPLEMENTARY NOTES (Continued) 1. Space Science and Technology...Department, STFC Rutherford Appleton Laboratory, Chilton, Didcot, Oxfordshire, 0X11OQX UK. 2. Space Environment Physics Group, School of Physics

Military Training: DOD’s Annual Sustainable Ranges Report Addressed Statutory Reporting Requirements

DTIC Science & Technology

2015-06-01

electromagnetic spectrum, (5) continued growth in domestic use of Unmanned Aerial Systems, (6) early coordination with renewable energy industry, and (7...unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 United States Government...challenges; (4) manage increasing military demand for range space; (5) address effects from new energy infrastructure and renewable energy effects; (6

[Measures to reduce costs for prescriptions in Vienna--preliminary analysis].

PubMed

Tönies, Hans

2009-01-01

To increase the rate of prescriptions for generic drugs in Vienna an information campaign was started in 2004 and quality circles for prescribing doctors were organized. Since the result of this initiative is not yet known publicly this report aims to present a preliminary analysis. The prescription statements kindly provided by the health insurance fund of Vienna could be analysed. Data from the Chamber of Viennese Physicians were used for compiling a report about the quality circles. A total of 17 quality circles with an average of 15 participants were formed; they met four times yearly. Participants were paid for their attendance. The rate of prescribed generic drugs in Vienna has continuously improved, with the major increase in the first year of the activities. In the year 2006 a rate of over 40% generic prescriptions was reached by 80% of general practitioners. This cooperation between the health insurance fund and doctors apparently resulted in both an increase in the rate of generic drugs prescribed and in a good acceptance among physicians.

32 CFR 811.8 - Forms prescribed and availability of publications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... FORCE SALES AND SERVICES RELEASE, DISSEMINATION, AND SALE OF VISUAL INFORMATION MATERIALS § 811.8 Forms prescribed and availability of publications. (a) AF Form 833, Visual Information Request, AF Form 1340, Visual Information Support Center Workload Report, DD Form 1995, Visual Information (VI) Production...

Independent and supplementary prescribing and PGDs.

PubMed

Baird, A

Types of prescribing for non-medical staff are discussed and clarifications made regarding the current overlap in six forms of prescribing and administration of medication. Differences between independent and supplementary prescribing are explored and the distinction between patient group directions and extended formulary nurse prescribing outlined.

Continuous opioid treatment for chronic noncancer pain: a time for moderation in prescribing.

PubMed

Colameco, Stephen; Coren, Joshua S; Ciervo, Carman A

2009-07-01

Physicians have embraced the concept of long-term opioid treatment for chronic noncancer pain (CNCP), as evidenced by increased prescribing. Many patients have benefited from more liberal opioid prescribing, but many have not, and prescription opioid abuse has risen significantly coincident with increased prescribing. Because of the potentially serious adverse effects of opioids, physicians must balance potential benefits against risks, especially in individuals at risk for opioid misuse, abuse, or dependence. This article reviews long-term, continuous opioid treatment of CNCP, current treatment guidelines, addiction risk stratification, opioid-induced hyperalgesia, and endocrine dysfunction.

The Great Boundary Crossing: Perceptions on Training Pharmacists as Supplementary Prescribers in the UK

ERIC Educational Resources Information Center

Tann, Jennifer; Blenkinsopp, Alison; Grime, Janet; Evans, Amanda

2010-01-01

Objective: To explore the perceptions of General Medical Practitioners and pharmacist supplementary prescribers of the training provided for qualification as a pharmacist supplementary prescriber, and the experience of pharmacist supplementary prescribers of subsequent continuing professional development in practice. Design: A qualitative study of…

8 CFR 299.1 - Prescribed forms.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Prescribed forms. 299.1 Section 299.1 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS IMMIGRATION FORMS § 299.1... forms can also be viewed on its Internet Web site. [76 FR 53797, Aug. 29, 2011] ...

8 CFR 299.1 - Prescribed forms.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Prescribed forms. 299.1 Section 299.1 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS IMMIGRATION FORMS § 299.1... forms can also be viewed on its Internet Web site. [76 FR 53797, Aug. 29, 2011] ...

8 CFR 299.1 - Prescribed forms.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Prescribed forms. 299.1 Section 299.1 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS IMMIGRATION FORMS § 299.1... forms can also be viewed on its Internet Web site. [76 FR 53797, Aug. 29, 2011] ...

20 CFR 422.527 - Private printing and modification of prescribed applications, forms, and other publications.

Code of Federal Regulations, 2010 CFR

2010-04-01

... prescribed applications, forms, and other publications. 422.527 Section 422.527 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES Applications and Related Forms § 422.527 Private..., institution, or organization wishing to reproduce, reprint, or distribute any application, form, or...

Total Quality Management Implementation Plan for Military Personnel Management

DTIC Science & Technology

1989-09-01

2050.. )ATE 3. REPORT TYPE AND DATES CO VERED 4. TITLE AND SUBTITLE 5,rrmir18 . FUNDING NUMBERS Total Quality Management Implementation Plan for...SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Military Personnel Management, Continuous Process Improvement 16. PRICE CODE 17. SECURITY...UNCLASSIFIED UNCLASSIFIED UL NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Prescribed by ANSI Std Z39-16 296-102 TOTAL QUALITY MANAGEMENT I

The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey.

PubMed

Carey, Nicola; Courtenay, Molly; Stenner, Karen

2013-07-01

To explore the practice of nurses who prescribe medication for patients with skin conditions. Nurses have lead roles in dermatology services. In the United Kingdom, nurses in primary care frequently prescribe medicines for skin conditions, but there are concerns about role preparation and access to continuing professional development. The prescribing practices of nurse independent supplementary prescribers who care for patients with skin conditions are under-researched. Cross-sectional survey. An online questionnaire was used to survey 186 nurses who prescribed for skin conditions from May-July 2010. Data were analysed using descriptive statistics and nonparametric tests. The majority worked in primary care (78%) and general practice (111, 59.7%). Twenty (10.8%) had specialist modules (at diploma, degree or master's level), 104 (55.9%) had dermatology training (e.g. study days), 44 (23.7%) had no training, and a further 18 (9.6%) did not respond. Oral antibiotics, topical antifungal and antibacterial drugs were frequently prescribed. Nurses with specialist dermatology training used their qualification in a greater number of ways, prescribed the broadest range of products and prescribed more items per week. Over 70% reporting on continuing professional development had been able to access it. A large number of nurses in primary care prescribe medicines for skin conditions and are involved in medicines management activities. Lack of specialist dermatology training is a concern and associated with lower prescribing-related activities. Access to dermatology training and continuing professional development are required to support nurse development in this area of practice and maximise benefits. Nurse prescribers' involvement in medicines management activities has important implications in terms of improving access to services, efficiency and cost savings. To maximise their contribution, improved provision of specialist dermatology training is required. This will be of interest to education providers and service planners in the UK and countries around the world. © 2013 John Wiley & Sons Ltd.

Provision of continued professional development for non-medical prescribers within a South of England Strategic Health Authority: a report on a training needs analysis.

PubMed

Green, Anita; Westwood, Olwyn; Smith, Pam; Peniston-Bird, Fiona; Holloway, David

2009-07-01

This paper reports on a Training Needs Analysis for Non-Medical Prescribers commissioned by a south of England Strategic Health Authority. The aim of the TNA was to inform future policy, educational provision and practice development and provide nurse managers with significant information on the perceived Continuing Professional Development (CPD) needs of the non-medical prescribers. Data were collected from a sample of 270 non-medical prescribers using an in-depth questionnaire, and telephone interviews with a purposive sample of 11 key stakeholders. The findings report: * The qualifications that non-medical prescribers possess. * The level of confidence described by the non-medical prescribers in their role. * What non-medical prescribers identify as their present and future CPD requirements in relation to prescribing. * What education and training provision non-medical prescribers have attended in relation to their prescribing role since qualifying. The findings suggest, first that short courses that were specific to the non-medical prescribers role were considered to be the most popular and useful. However, courses needed to be advertised well in advance. Second, training gaps were identified. Pharmacology and prescribing are rapidly changing and require regular CPD in order to keep up to date with the latest developments. Non-medical prescribing is a comparatively new innovation to the NHS, therefore those who are not medically qualified need mentorship from experienced prescribers, as well as the encouragement from nurse managers to be confident prescribers themselves and enhance patient care.

Rational drug use in Cambodia: study of three pilot health centers in Kampong Thom Province.

PubMed

Chareonkul, Chanin; Khun, Va Luong; Boonshuyar, Chaweewon

2002-06-01

This study obtained baseline information for the design of a strategy to address irrational prescribing practices in three health centers in Kampong Thom Province, Cambodia. Indicators of rational drug use have been measured and compared with Standard Guidelines. Data were collected from patients' registers and by interviewing patients immediately after patient-prescriber and patient-dispenser encounters. Checklists and pre-designed forms were used to collect data regarding the World Health Organization drug use indicators and some additional indices. Of the 330 prescriptions analyzed, the results showed that the average number of drugs per prescription was 2.35 and that a large proportion of the prescriptions contained two or more drugs that could result in adverse drug interactions. Prescribing by generic names (99.8%) was encouraging. The exposure of patients to antibiotics (66% to 100%) was high, and injection use (2.4%) was often unnecessary. Prescribing from the Essential Drugs List (99.7%) was satisfactory. The average consultation and dispensing times were short and not sufficient for patients to get health information. All the prescribed drugs were supplied, but all were inadequately labeled. Some 55% of patients knew the correct dosage of their drugs. The availability of key essential drugs (86.6%) was below the Standard. The percentages of appropriate prescriptions for treating malaria, diarrhea and acute respiratory infection treatment were 68.3%, 3.3%, and 45%, respectively. Inappropriate prescriptions were mostly due to unsuitable dosages, incorrect drugs, and the improper duration of treatment. The results suggest a need for intervention to curb the irrational use of drugs in prescribing at the three pilot health centers. Continuing education of prescribers and healthcare providers, monitoring, supervision, public education would be beneficial.

20 CFR 422.525 - Where applications and other forms are available.

Code of Federal Regulations, 2014 CFR

2014-04-01

... available. 422.525 Section 422.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND... applications and related forms prescribed for use in the programs administered by the Social Security... described therein. All prescribed forms can be obtained upon request from any social security district...

20 CFR 422.525 - Where applications and other forms are available.

Code of Federal Regulations, 2010 CFR

2010-04-01

... available. 422.525 Section 422.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND... applications and related forms prescribed for use in the programs administered by the Social Security... described therein. All prescribed forms can be obtained upon request from any social security district...

20 CFR 422.525 - Where applications and other forms are available.

Code of Federal Regulations, 2011 CFR

2011-04-01

... available. 422.525 Section 422.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND... applications and related forms prescribed for use in the programs administered by the Social Security... described therein. All prescribed forms can be obtained upon request from any social security district...

20 CFR 422.525 - Where applications and other forms are available.

Code of Federal Regulations, 2012 CFR

2012-04-01

... available. 422.525 Section 422.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND... applications and related forms prescribed for use in the programs administered by the Social Security... described therein. All prescribed forms can be obtained upon request from any social security district...

20 CFR 422.525 - Where applications and other forms are available.

Code of Federal Regulations, 2013 CFR

2013-04-01

... available. 422.525 Section 422.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND... applications and related forms prescribed for use in the programs administered by the Social Security... described therein. All prescribed forms can be obtained upon request from any social security district...

7 CFR 75.7 - Inspection in accordance with methods prescribed or approved.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 3 2012-01-01 2012-01-01 false Inspection in accordance with methods prescribed or approved. 75.7 Section 75.7 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE...

7 CFR 75.7 - Inspection in accordance with methods prescribed or approved.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 3 2014-01-01 2014-01-01 false Inspection in accordance with methods prescribed or approved. 75.7 Section 75.7 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE...

7 CFR 75.7 - Inspection in accordance with methods prescribed or approved.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 3 2013-01-01 2013-01-01 false Inspection in accordance with methods prescribed or approved. 75.7 Section 75.7 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE...

7 CFR 75.7 - Inspection in accordance with methods prescribed or approved.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Inspection in accordance with methods prescribed or approved. 75.7 Section 75.7 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE...

7 CFR 75.7 - Inspection in accordance with methods prescribed or approved.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Inspection in accordance with methods prescribed or approved. 75.7 Section 75.7 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) REGULATIONS AND STANDARDS UNDER THE...

Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis.

PubMed

Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

2014-12-08

To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. All healthcare settings. Medical and non-medical prescribers of medicines to adults. Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. 21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the risk of iatrogenic harm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Synthesis of feedback systems with large plant ignorance for prescribed time domain tolerances

NASA Technical Reports Server (NTRS)

Horowitz, I. M.; Sidi, M.

1971-01-01

There is given a minimum-phase plant transfer function, with prescribed bounds on its parameter values. The plant is imbedded in a two-degree-of freedom feedback system, which is to be designed such that the system time response to a deterministic input lies within specified boundaries. Subject to the above, the design should be such as to minimize the effect of sensor noise at the input to the plant. This report presents a design procedure for this purpose, based on frequency response concepts. The time-domain tolerances are translated into equivalent frequency response tolerances. The latter lead to bounds on the loop transmission function in the form of continuous curves on the Nichols chart. The properties of the loop transmission function which satisfy these bounds with minimum effect of sensor noise, are derived.

Did the new French pay-for-performance system modify benzodiazepine prescribing practices?

PubMed

Rat, Cédric; Penhouet, Gaëlle; Gaultier, Aurélie; Chaslerie, Anicet; Pivette, Jacques; Nguyen, Jean Michel; Victorri-Vigneau, Caroline

2014-07-11

French general practitioners (GPs) were enrolled in a new payment system in January 2012. As part of a national agreement with the French National Ministry of Health, GPs were asked to decrease the proportion of patients who continued their benzodiazepine treatment 12 weeks after its initiation and to decrease the proportion of patients older than 65 who were prescribed long half-life benzodiazepines. In return, GPs could expect an extra payment of up to 490 euros per year. This study reports the evolution of the corresponding prescribing practices of French GPs during that period regarding patients who were prescribed a benzodiazepine for the first time. The national healthcare system's administrative database was used to report the longitudinal follow-up of two historical cohorts of French patients from the Pays de la Loire area. The "2011" and "2012" cohorts included all patients who initiated benzodiazepine regimens from April 1 to June 30 in 2011 and 2012, respectively.The primary outcomes were the proportion of those study patients who continued benzodiazepine treatment after 12 weeks and the proportion of study patients >65 years who were prescribed long half-life benzodiazepines.Analyses were performed using a multi-level regression. In total, 41,436 and 42,042 patients initiated benzodiazepine treatment in 2011 and 2012, respectively. A total of 18.97% of patients continued treatment for more than 12 weeks in 2012, compared with 18.18% in 2011. In all, 27.43% and 28.06% of patients >65 years continued treatment beyond 12 weeks in 2011 and 2012, respectively. The proportion of patients >65 years who were prescribed long half-life benzodiazepines decreased from 53.5% to 48.8% (p < 0.005) due to an increase in short half-life benzodiazepine prescriptions. Patients >65 years who were prescribed short half-life benzodiazepines were more likely to continue treatment after 12 weeks (p < 0.005). Despite the pay-for-performance strategy, the number of short half-life benzodiazepine prescriptions increased between 2011 and 2012, and the number of long half-life benzodiazepine initiations remained unchanged. Reducing the proportion of long half-life benzodiazepine prescriptions might be counterproductive because prescribing short half-life benzodiazepines was associated with higher rates of continuation beyond the recommended duration.

Prescribed and self-reported seasonal training of distance runners.

PubMed

Hewson, D J; Hopkins, W G

1995-12-01

A survey of 123 distance-running coaches and their best runners was undertaken to describe prescribed seasonal training and its relationship to the performance and self-reported training of the runners. The runners were 43 females and 80 males, aged 24 +/- 8 years (mean +/- S.D.), training for events from 800 m to the marathon, with seasonal best paces of 86 +/- 6% of sex- and age-group world records. The coaches and runners completed a questionnaire on typical weekly volumes of interval and strength training, and typical weekly volumes and paces of moderate and hard continuous running, for build-up, pre-competition, competition and post-competition phases of a season. Prescribed training decreased in volume and increased in intensity from the build-up through to the competition phase, and had similarities with 'long slow distance' training. Coaches of the faster runners prescribed longer build-ups, greater volumes of moderate continuous running and slower relative paces of continuous running (r = 0.19-0.36, P < 0.05), suggesting beneficial effects of not training close to competition pace. The mean training volumes and paces prescribed by the coaches were similar to those reported by the runners, but the correlations between prescribed and reported training were poor (r = 0.2-0.6). Coaches may therefore need to monitor their runners' training more closely.

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

PubMed

Smith, Samuel G; Foy, Robbie; McGowan, Jennifer A; Kobayashi, Lindsay C; DeCensi, Andrea; Brown, Karen; Side, Lucy; Cuzick, Jack

2017-06-01

The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk. To investigate GPs' attitudes towards prescribing tamoxifen. In an online survey, GPs in England, Northern Ireland, and Wales ( n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription. In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164. Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, P <0.001). The GP prescribers reported less comfort discussing tamoxifen (53.4% versus 62.5%, P = 0.01). GPs willing to prescribe were more likely to be aware of the NICE guideline ( P = 0.039) and to have acknowledged the benefits of tamoxifen ( P <0.001), and were less likely to have considered its off-licence status ( P <0.001). Initiating tamoxifen prescriptions for preventive therapy in secondary care before asking GPs to continue the patient's care may overcome some prescribing barriers. © British Journal of General Practice 2017.

Research Today Volume 3, Issue 2 April 2017 Newsletter

DTIC Science & Technology

2017-05-05

for your study [ e.g., 59 MDW CRD Graduate Health Sciences Education (GHSE) (SG5 O&M); SG5 R&D; Tri-Service Nursing Research Program (TSNRP); Defense...DATE 59 MOW FORM 3039 20160628 Prescribed by 59 MDWl41.~08 PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 3 Pages VOLUME 2, ISSUE 2 PAGE 2 NURSE SCIENTISTS...ATTENDS GATEWAY ACADEMY CONTINUED ••• Regarding the return on the investment of time, Col Brenda Morgan, Director of Nursing Research said, "With the

How is medication prescribing ceased? A systematic review.

PubMed

Ostini, Remo; Jackson, Claire; Hegney, Desley; Tett, Susan E

2011-01-01

Medication prescribing is a complex process where the focus tends to be on starting new medication, changing a drug regimen, and continuing a drug regimen. On occasion, a prudent approach to prescribing may necessitate ending an ongoing course of medication, either because it should not have been started in the first place; because its continued use would cause harm; or because the medication is no longer effective. To identify effective strategies for stopping pre-existing prescribing in situations where continued prescribing may no longer be clinically warranted. Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951-November 2009), EMBASE (1966-September 2008), and International Pharmaceutical Abstract b (1970-September 2008). A manual search for relevant review articles and a keyword search of a local database produced by a previous systematic search for prescribing influence and intervention research were also conducted. Following initial title screening for relevance 2 reviewers, using formal assessment and data extraction tools, independently assessed abstracts for relevance and full studies for quality before extracting data from studies selected for inclusion. Of 1306 articles reviewed, 12 were assessed to be of relevant, high-quality research. A variety of drugs were examined in the included studies with benzodiazepines the most common. Studies included in the review tested 9 different types of interventions. Effective interventions included patient-mediated interventions, manual reminders to prescribers, educational materials given to patients, a face-to-face intervention with prescribers, and a case of regulatory intervention. Partially effective interventions included audit and feedback, electronic reminders, educational materials alone sent to prescribers, and distance communication combined with educational materials sent to prescribers. It appears possible to stop the prescribing of a variety of medications with a range of interventions. A common theme in effective interventions is the involvement of patients in the stopping process. However, prescribing at the level of individual patients was rarely reported, with data often aggregated to number of doses or number of drugs per unit population, attributing any reduction to cessation. Such studies are not measuring the actual required outcome (stopping prescribing), and this may reflect the broader ambiguity about when or why it might be important to end a prescription. Much more research is required into the process of stopping pre-existing prescribing, paying particular attention to improving the outcomes that are measured.

Solid oral forms availability in children: a cost saving investigation

PubMed Central

Lajoinie, Audrey; Henin, Emilie; Kassai, Behrouz; Terry, David

2014-01-01

Aim To assess the suitability and potential cost savings, from both the hospital and community perspective, of prescribed oral liquid medicine substitution with acceptable solid forms for children over 2 years. Method Oral liquid medicines dispensed from a paediatric hospital (UK) in 1 week were assessed by screening for existence of the solid form alternative and evaluating the acceptability of the available solid form, firstly related to the prescribed dose and secondly to acceptable size depending on the child's age. Costs were calculated based on providing treatment for 28 days or prescribed duration for short term treatments. Results Over 90% (440/476) of liquid formulations were available as a marketed solid form. Considering dosage acceptability (maximum of 10% deviation from prescribed dosage or 0% for narrow therapeutic range drugs, maximum tablet divisions into quarters) 80% of liquids could be substituted with a solid form. The main limitation for liquid substitution would be solid form size. However, two-thirds of prescribed liquids could have been substituted with a suitable solid form for dosage and size, with estimated savings being of £5K and £8K in 1 week, respectively based on hospital and community costs, corresponding to a projected annual saving of £238K and £410K (single institution). Conclusion Whilst not all children over 2 years will be able to swallow tablets, drug cost savings if oral liquid formulations were substituted with suitable solid dosage forms would be considerable. Given the numerous advantages of solid forms compared with liquids, this study may provide a theoretical basis for investing in supporting children to swallow tablets/capsules. PMID:24965935

Continuing professional development needs of nursing and allied health professionals with responsibility for prescribing.

PubMed

Weglicki, Robert S; Reynolds, Julie; Rivers, Peter H

2015-01-01

Continuing professional development (CPD) for non-medical prescribers is recognised as being pivotal in maintaining up -to -date knowledge and skills influencing prescribing competence. This study was, therefore, designed to ascertain the aspirations, priorities and preferred mode of CPD for non-medical prescribers. Qualitative data were derived from semi-structured in-depth interviews and a focus group given by 16 allied health professionals working in primary and secondary care settings. A topic guide was used to cover clinical decision-making (including difficult decisions), legal aspects of prescribing and diagnostic issues. A content analysis of the verbatim transcripts enabled four key emerging themes to be identified, thus offering a basis for developing a greater understanding of the CPD needs of non-medical prescribers. The four key emerging themes identified are the following: Theme 1: "Personal anxiety undermining confidence to prescribe", Theme 2: "External barriers and other factors that exacerbate anxiety", Theme 3: "Need for support identified through coping strategies", and Theme 4: "Preferred mode or style of learning". The findings suggest that anxiety and lack of confidence in non-medical prescribing pose a significant challenge for CPD. Strategies that are most likely to improve prescribing confidence are through a blended learning approach. Local higher education and workplace employer collaboration is an appropriate step forward to achieve this. Copyright © 2014 Elsevier Ltd. All rights reserved.

Magnetic-saturation zone model for two semipermeable cracks in magneto-electro-elastic medium

NASA Astrophysics Data System (ADS)

Jangid, Kamlesh

2018-03-01

Extension of the PS model (Gao et al. [1]) in piezoelectric materials and the SEMPS model (Fan and Zhao [2]) in MEE materials, is proposed for two semi-permeable cracks in a MEE medium. It is assumed that the magnetic yielding occurs at the continuation of the cracks due to the prescribed loads. We have model these crack continuations as the zones with cohesive saturation limit magnetic induction. Stroh's formalism and complex variable techniques are used to formulate the problem. Closed form analytical expressions are derived for various fracture parameters. A numerical case study is presented for BaTiO3 - CoFe2O4 ceramic cracked plate.

A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia.

PubMed

Harrow, Martin; Jobe, Thomas H; Faull, Robert N; Yang, Jie

2017-10-01

To assess the long-term effectiveness of antipsychotic medications in facilitating work functioning in patients with schizophrenia we conducted longitudinal multifollowup research on 139 initially psychotic patients. The 70 patients with schizophrenia and 69 initially psychotic mood disordered control patients were followed up 6 times over 20 years. We compared the influence on work functioning of patients with schizophrenia continuously prescribed antipsychotics with patients with schizophrenia not prescribed antipsychotics, using statistical controls for inter-subject differences. While antipsychotics reduce or eliminate flagrant psychosis for most patients with schizophrenia at acute hospitalizations, four years later and continually until the 20 year followups, patients with schizophrenia not prescribed antipsychotics had significantly better work functioning. The work performance of the patients who were continuously prescribed antipsychotics was at a low rate and did not improve over time. Multiple other factors also interfere with work functioning. The data suggest that some patients with schizophrenia not prescribed antipsychotics for prolonged periods can function relatively well. Multiple other factors are associated with poor post-hospital work performance. The longitudinal data raise questions about prolonged treatment of schizophrenia with antipsychotic medications. Copyright © 2017 Elsevier B.V. All rights reserved.

Multidimensional Sexual Perfectionism and Female Sexual Function: A Longitudinal Investigation.

PubMed

Stoeber, Joachim; Harvey, Laura N

2016-11-01

Research on multidimensional sexual perfectionism differentiates four forms: self-oriented, partner-oriented, partner-prescribed, and socially prescribed. Self-oriented sexual perfectionism reflects perfectionistic standards people apply to themselves as sexual partners; partner-oriented sexual perfectionism reflects perfectionistic standards people apply to their sexual partner; partner-prescribed sexual perfectionism reflects people's beliefs that their sexual partner imposes perfectionistic standards on them; and socially prescribed sexual perfectionism reflects people's beliefs that society imposes such standards on them. Previous studies found partner-prescribed and socially prescribed sexual perfectionism to be maladaptive forms of sexual perfectionism associated with a negative sexual self-concept and problematic sexual behaviors, but only examined cross-sectional relationships. The present article presents the first longitudinal study examining whether multidimensional sexual perfectionism predicts changes in sexual self-concept and sexual function over time. A total of 366 women aged 17-69 years completed measures of multidimensional sexual perfectionism, sexual esteem, sexual anxiety, sexual problem self-blame, and sexual function (cross-sectional data). Three to six months later, 164 of the women completed the same measures again (longitudinal data). Across analyses, partner-prescribed sexual perfectionism emerged as the most maladaptive form of sexual perfectionism. In the cross-sectional data, partner-prescribed sexual perfectionism showed positive relationships with sexual anxiety, sexual problem self-blame, and intercourse pain, and negative relationships with sexual esteem, desire, arousal, lubrication, and orgasmic function. In the longitudinal data, partner-prescribed sexual perfectionism predicted increases in sexual anxiety and decreases in sexual esteem, arousal, and lubrication over time. The findings suggest that partner-prescribed sexual perfectionism contributes to women's negative sexual self-concept and female sexual dysfunction.

27 CFR 478.21 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Forms prescribed. 478.21 Section 478.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.21 - Forms prescribed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Forms prescribed. 478.21 Section 478.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.21 - Forms prescribed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Forms prescribed. 478.21 Section 478.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.21 - Forms prescribed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Forms prescribed. 478.21 Section 478.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 478.21 - Forms prescribed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Forms prescribed. 478.21 Section 478.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION COMMERCE IN FIREARMS AND AMMUNITION Administrative...

27 CFR 479.21 - Forms prescribed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

27 CFR 479.21 - Forms prescribed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

27 CFR 479.21 - Forms prescribed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

27 CFR 479.21 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

27 CFR 479.21 - Forms prescribed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Forms prescribed. 479.21 Section 479.21 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION MACHINE GUNS, DESTRUCTIVE DEVICES, AND CERTAIN...

Governmental oversight of prescribing medications: history of the US Food and Drug Administration and prescriptive authority.

PubMed

Plank, Linda S

2011-01-01

The evolution of drug regulation and awarding of prescriptive authority is a complex and sometimes convoluted process that can be confusing for health care providers. A review of the history of how drugs have been manufactured and dispensed helps explain why this process has been so laborious and complicated. Because the federal and state governments have the responsibility for protecting the public, most regulations have been passed with the intentions of ensuring consumer safety. The current system of laws and regulations is the result of many years of using the legal system to correct drug marketing that had adverse health consequences. Government oversight will continue as prescribing medications transitions to an electronic form and as health care professionals in addition to physicians seek to gain prescriptive authority. © 2011 by the American College of Nurse-Midwives.

76 FR 68766 - Draft Blueprint for Prescriber Education for Long-Acting/Extended-Release Opioid Class-Wide Risk...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-07

...] Draft Blueprint for Prescriber Education for Long-Acting/ Extended-Release Opioid Class-Wide Risk... announcing the availability of a draft document entitled ``Blueprint for Prescriber Education for the Long... intended for use by continuing education (CE) providers to develop educational materials to train...

Focusing on changing clinical practice to enhance rational prescribing--collaboration and networking enable comprehensive approaches.

PubMed

Helin-Salmivaara, Arja; Huupponen, Risto; Klaukka, Timo; Hoppu, Kalle

2003-10-01

Most western societies are enhancing rational pharmacotherapy to get best value for the constantly increasing expenditure on drugs. Government bodies and the medical profession took joint responsibility for the education programme for rational prescribing, launched in Finland at the end of the 1990s. The goals were to enhance critical thinking, and when appropriate, change prescribing behaviour. Various approaches that included evidence-based continuing medical education (CME), implementing clinical guidelines, delivering information, and providing prescribing feedback were used simultaneously. The commitment of the stakeholders and participants has been strong and the approaches have succeeded even though there is no clear outcome measure. The Government has recently decided to continue and widen the process, which started as a pilot programme, on a tight budget.

Academic detailing.

PubMed

Shankar, P R; Jha, N; Piryani, R M; Bajracharya, O; Shrestha, R; Thapa, H S

2010-01-01

There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations.

27 CFR 447.35 - Forms prescribed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2012-04-01 2010-04-01 true Forms prescribed. 447.35 Section 447.35 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION IMPORTATION OF ARMS, AMMUNITION AND IMPLEMENTS OF...

27 CFR 447.35 - Forms prescribed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2011-04-01 2010-04-01 true Forms prescribed. 447.35 Section 447.35 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION IMPORTATION OF ARMS, AMMUNITION AND IMPLEMENTS OF...

27 CFR 447.35 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Forms prescribed. 447.35 Section 447.35 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION IMPORTATION OF ARMS, AMMUNITION AND IMPLEMENTS OF...

27 CFR 447.35 - Forms prescribed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2013-04-01 2013-04-01 false Forms prescribed. 447.35 Section 447.35 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION IMPORTATION OF ARMS, AMMUNITION AND IMPLEMENTS OF...

27 CFR 447.35 - Forms prescribed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 3 2014-04-01 2014-04-01 false Forms prescribed. 447.35 Section 447.35 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL, TOBACCO, FIREARMS, AND EXPLOSIVES, DEPARTMENT OF JUSTICE FIREARMS AND AMMUNITION IMPORTATION OF ARMS, AMMUNITION AND IMPLEMENTS OF...

27 CFR 18.16 - Forms prescribed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative and...

27 CFR 18.16 - Forms prescribed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative and...

27 CFR 18.16 - Forms prescribed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative and...

27 CFR 18.16 - Forms prescribed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative and...

27 CFR 18.16 - Forms prescribed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Forms prescribed. 18.16 Section 18.16 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS PRODUCTION OF VOLATILE FRUIT-FLAVOR CONCENTRATE Administrative and...

8 CFR 248.3 - Application.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 212(d)(3) of the Act and 8 CFR 212.15(n). [36 FR 9001, May 18, 1971, as amended at 48 FR 14593, Apr. 5... the fee prescribed in 8 CFR 103.7(b) and in accordance with the form instructions. (a) Petition by... forms designated by USCIS with the fee prescribed in 8 CFR 103.7(b)(1) and in accordance with the form...

8 CFR 248.3 - Application.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 212(d)(3) of the Act and 8 CFR 212.15(n). [36 FR 9001, May 18, 1971, as amended at 48 FR 14593, Apr. 5... the fee prescribed in 8 CFR 103.7(b) and in accordance with the form instructions. (a) Petition by... forms designated by USCIS with the fee prescribed in 8 CFR 103.7(b)(1) and in accordance with the form...

8 CFR 248.3 - Application.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 212(d)(3) of the Act and 8 CFR 212.15(n). [36 FR 9001, May 18, 1971, as amended at 48 FR 14593, Apr. 5... the fee prescribed in 8 CFR 103.7(b) and in accordance with the form instructions. (a) Petition by... forms designated by USCIS with the fee prescribed in 8 CFR 103.7(b)(1) and in accordance with the form...

Tolcapone

MedlinePlus

... carbidopa to treat the signs and symptoms of Parkinson's disease.This medication is sometimes prescribed for other uses; ... prescribed by your doctor.Tolcapone controls symptoms of Parkinson's disease but does not cure it. Continue to take ...

Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients.

PubMed

Hedman, S; Nydahl, M; Faxén-Irving, G

2016-06-01

Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal. This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients. The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff. Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

A Continued Study of Polymeric Materials for Protection Against Chemical and Biological Contaminants and Halogen Oxidants for Immobilization in Protective Materials and Coatings

DTIC Science & Technology

2013-03-01

household bleach in water at a pH controlled at 7–10, or in a dilute solution of bromine. The loading of the halogen on the coatings was determined using ...or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, apparatus, product, or process...disclosed, or represents that its use would not infringe privately owned rights. Standard Form 298 (Rev. 8/98) REPORT DOCUMENTATION PAGE Prescribed

Low fidelity, high quality: a model for e-learning.

PubMed

Gordon, Morris; Chandratilake, Madawa; Baker, Paul

2013-08-01

E-learning continues to proliferate as a method to deliver continuing medical education. The effectiveness of e-learning has been widely studied, showing that it is as effective as traditional forms of education. However, most reports focus on whether the e-learning is effective, rather than discussing innovations to allow clinical educators to ask 'how' and 'why' it is effective, and to facilitate local reproduction. Previous work has set out a number of barriers to the introduction of e-learning interventions. Cost, the time to produce interventions, and the training requirements for educators and trainees have all been identified as barriers. We set out to design an e-learning intervention on paediatric prescribing that could address these issues using a low-fidelity approach, and report our methods so as to allow interested readers to use a similar approach. Using low-cost, readily accessible tools and applying appropriate educational theory, the intervention was produced in a short period of time. As part of a randomised controlled trial, long-term retention of prescribing skills was demonstrated, with significantly higher prescribing skill scores in the e-learning group at 4 and 12 weeks (p < 0.0001). Feedback was universally positive, with Likert responses suggesting that it was useful, convenient and easy to use. A low-fidelity approach to designing can successfully overcome many of the barriers to the introduction of e-learning. The design model described is simple and can be used by clinical teachers to support local development. Further research could investigate the experiences of these clinicians using this method of instructional design. © 2013 John Wiley & Sons Ltd.

Continuing Versus New Prescriptions for Sedative-Hypnotic Medications: United States, 2005–2012

PubMed Central

Spira, Adam P.; Depp, Colin A.; Mojtabai, Ramin

2016-01-01

Objectives. To assess trends in continuing and new prescriptions for sedative-hypnotic medications, including benzodiazepines (BZDs) and non-BZD receptor agonists (nBZRAs). Methods. Data came from the National Ambulatory Medical Care Survey and comprised 287 288 randomly sampled patient visits. Physicians reported medications prescribed and whether they were “continuing” or “new” prescriptions. We assessed trends in continuing BZD, new BZD, continuing nBZRA, and new nBZRA prescriptions from 2005 to 2012. Results. Proportions of visits with continuing prescriptions increased from 3.4% in 2005 to 4.7% in 2012 (P < .01) for BZDs, and from 1.0% to 1.7% (P < .01) for nBZRAs. We noted no changes in new prescriptions. We observed the same patterns across patient age and physician specialties, except psychiatry. Despite no growth over time, the prevalence of visits involving continuing and new BZD and nBZRA prescriptions was much higher in psychiatry than in primary care and other specialties. Conclusions. Increased sedative-hypnotic prescribing in recent years may be attributable to long-term growth in continuing prescriptions, rather than new prescriptions. Public Health Implications. Findings call for renewed efforts to limit continuing prescribing of sedative-hypnotics to reduce their use in the population. PMID:27631754

30 CFR 210.151 - What reports must I submit to claim an excess allowance?

Code of Federal Regulations, 2010 CFR

2010-07-01

... MINERALS REVENUE MANAGEMENT FORMS AND REPORTS Special-Purpose Forms and Reports-Oil, Gas, and Geothermal... approval from MMS to exceed prescribed transportation and processing allowance limits on Federal oil and gas leases and prescribed transportation allowance limits on Indian oil and gas leases under part 206...

31 CFR 128.2 - Manner of reporting.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (a) Methods of reporting—(1) Prescribed forms. (i) Except as provided in § 128.2(a)(2), reports... 20220. (2) Alternative methods of reporting. In lieu of reporting on forms prescribed by the Secretary pursuant to this part, reports may be filed on magnetic tape or other media acceptable to, and approved in...

46 CFR 14.307 - Entries on certificate of discharge.

Code of Federal Regulations, 2012 CFR

2012-10-01

... them on the prescribed form with permanent ink or generating them from computer in the prescribed format; and shall sign them with permanent ink. The prescribed format for a certificate of discharge is...) Each mariner being discharged shall sign the certificate and both copies with permanent ink. (c) When...

46 CFR 14.307 - Entries on certificate of discharge.

Code of Federal Regulations, 2010 CFR

2010-10-01

... them on the prescribed form with permanent ink or generating them from computer in the prescribed format; and shall sign them with permanent ink. The prescribed format for a certificate of discharge is...) Each mariner being discharged shall sign the certificate and both copies with permanent ink. (c) When...

46 CFR 14.307 - Entries on certificate of discharge.

Code of Federal Regulations, 2014 CFR

2014-10-01

... them on the prescribed form with permanent ink or generating them from computer in the prescribed format, and must sign them with permanent ink. The prescribed format for a certificate of discharge is.... (b) Each mariner being discharged must sign the certificate and both copies with permanent ink. (c...

46 CFR 14.307 - Entries on certificate of discharge.

Code of Federal Regulations, 2011 CFR

2011-10-01

... them on the prescribed form with permanent ink or generating them from computer in the prescribed format; and shall sign them with permanent ink. The prescribed format for a certificate of discharge is...) Each mariner being discharged shall sign the certificate and both copies with permanent ink. (c) When...

46 CFR 14.307 - Entries on certificate of discharge.

Code of Federal Regulations, 2013 CFR

2013-10-01

... them on the prescribed form with permanent ink or generating them from computer in the prescribed format; and shall sign them with permanent ink. The prescribed format for a certificate of discharge is...) Each mariner being discharged shall sign the certificate and both copies with permanent ink. (c) When...

Predicting fire scars in Ozark timber species following prescribed burning

Treesearch

Aaron P. Stevenson; Richard P. Guyette; Rose-Marie Muzika

2009-01-01

A potential consequence of using prescribed fire is heat-related injury to timber trees. Scars formed following fire injuries are often associated with extensive decay in hardwoods. The ability to predict scarring caused by prescribed fire is important when multiple management goals are incorporated on a single forest site.

20 CFR 418.3210 - What is a prescribed application for a subsidy?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What is a prescribed application for a subsidy? 418.3210 Section 418.3210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES... prescribed application may include a printed form, an application our employees complete on computer screens...

20 CFR 418.3210 - What is a prescribed application for a subsidy?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What is a prescribed application for a subsidy? 418.3210 Section 418.3210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES... prescribed application may include a printed form, an application our employees complete on computer screens...

20 CFR 418.3210 - What is a prescribed application for a subsidy?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What is a prescribed application for a subsidy? 418.3210 Section 418.3210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES... prescribed application may include a printed form, an application our employees complete on computer screens...

20 CFR 418.3210 - What is a prescribed application for a subsidy?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What is a prescribed application for a subsidy? 418.3210 Section 418.3210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES... prescribed application may include a printed form, an application our employees complete on computer screens...

20 CFR 418.3210 - What is a prescribed application for a subsidy?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What is a prescribed application for a subsidy? 418.3210 Section 418.3210 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES... prescribed application may include a printed form, an application our employees complete on computer screens...

Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists

PubMed Central

Lim, Jamie K.; Bratberg, Jeffrey P.; Davis, Corey S.; Green, Traci C.; Walley, Alexander Y.

2016-01-01

In March of 2015, the United States Department of Health and Human Services identified 3 priority areas to reduce opioid use disorders and overdose, which are as follows: opioid-prescribing practices; expanded use and distribution of naloxone; and expansion of medication-assisted treatment. In this narrative review of overdose prevention and the role of prescribers and pharmacists in distributing naloxone, we address these priority areas and present a clinical scenario within the review involving a pharmacist, a patient with chronic pain and anxiety, and a primary care physician. We also discuss current laws related to naloxone prescribing and dispensing. This review was adapted from the Prescribe to Prevent online continuing medical education module created for prescribers and pharmacists (http://www.opioidprescribing.com/naloxone_module_1-landing). PMID:27261669

Patient perceptions of antibiotic use and resistance at a single university dermatology clinic.

PubMed

Goettsche, Lainee S; Weig, Emily A; Chung, Jina; Hoff, Brian M; Ince, Dilek; Wanat, Karolyn A

2018-05-21

Antibiotic resistance is an important problem that requires continued patient education and important prescribing stewardship. Dermatologists prescribe the most antibiotics per provider in comparison to other specialties and have an important role to play in the campaign of mindful prescribing. Data on the dermatology patients' knowledge and perception regarding antibiotic resistance is lacking and could play a role in providers' continuation of medications. We conducted a single institution survey of 512 dermatology clinic patients to understand patient's knowledge and potential gaps. Overall, our results demonstrated an overall higher level of knowledge than expected, there were still several knowledge gaps identified. Ninety-one percent of respondents were aware of the term 'antibiotic resistance'. However, 65% of participants believed that a short course of antibiotics could not cause resistance. While our patients have awareness of antibiotic resistance, it is imperative to continue to assess patients' knowledge about antibiotic resistance and provide education whenever possible in order to continue to practice antibiotic stewardship.

Assessing clinicians' management of first episode schizophrenia using clinical case vignettes.

PubMed

Huffman, Jeff C; Freudenreich, Oliver; Romeo, Sarah; Baer, Lee; Sutton-Skinner, Kelly; Petersen, Tim; Fromson, John A; Birnbaum, Robert J

2010-02-01

Patients with first episode schizophrenia may present in a variety of clinical settings to providers who have a range of knowledge and skills. A thoughtful workup of patients with new-onset psychosis is critical, and the treatment of first episode schizophrenia differs from that of chronic psychotic disorders. Clinical case vignettes with free-form responses can be used to carefully assess whether front line practitioners provide guideline-adherent management of first episode psychosis. A clinical case vignette, presenting a patient with first episode schizophrenia, was created and administered to the attendees of a continuing medical education programme. Free-form responses to questions regarding differential diagnosis, workup, treatment and treatment duration were scored based on published practice guidelines. Response frequencies were tabulated and performance was compared among professional disciplines. Sixty-two attendees completed the vignette. Though the attendees typically considered a broad differential diagnosis and appropriately initiated treatment with antipsychotics, the respondents' proposed medical workup was limited, and they prescribed antipsychotics at higher doses and for a shorter duration than recommended in the literature. The prescribers outperformed the non-prescribers on treatment questions (P = 0.006), but the two groups' performance did not significantly differ on the assessment questions (P = 0.08). The front line clinicians who encounter patients with first episode schizophrenia may have significant practice gaps in the initial and follow-up care of these patients. Given the preliminary nature of this study and the debate about the optimal care for first episode psychosis, further study is needed. If such gaps are confirmed, additional educational interventions are required to align clinical management with published practice guidelines.

Assessment of nonsteroidal anti-inflammatory drug use pattern using World Health Organization indicators: A cross-sectional study in a tertiary care teaching hospital of Chhattisgarh.

PubMed

R Vaishnavi, P R; Gaikwad, Nitin; Dhaneria, S P

2017-01-01

The objective of this study is to assess drug utilization pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in a tertiary care teaching hospital, Raipur, Chhattisgarh. A prospective, cross-sectional observational study was conducted in the outpatient department during 2-month period. After informed consent, the patients visiting pharmacy shop with a prescription were enrolled in the study. Their demographic details and prescription data were recorded in a case record form. The data were analyzed to determine the drug utilization pattern of NSAIDs, using the World Health Organization (WHO) prescribing indicators. A total of 600 prescriptions were analyzed. Of them, NSAIDs were prescribed in 30.83% encounters. In general, nonselective COX inhibitors were most commonly prescribed. The most commonly prescribed form of NSAID was paracetamol (39.45%). The percentage of NSAIDs prescribed with generic names were almost identical (91.15%), whereas the percentage of NSAIDs prescribed from the National List of Essential Medicine (India) - 2015 (49.72%) was not identical with the WHO standard (100%) which serves as an ideal. In 13.51% encounters, a fixed-dose combination (FDC) of NSAIDs was prescribed. Co-administration of gastroprotective agent with NSAIDs was observed in 24.32% encounters. The prescribing practices of NSAIDs indicate some deviation from the WHO standard. In addition, FDCs of NSAIDs with gastroprotective agents as well as other NSAIDs was also prescribed, which are irrational. This baseline data will be useful to plan further targeted research and to improve prescribing practices at the center. Various strategies such as face-to-face periodic training programs of prescribers, establishing drug and therapeutic committee; drug information centers; and drug bulletins can serve beneficial in improving prescribing practices.

Antibiotics for URTI and UTI -- prescribing in Malaysian primary care settings.

PubMed

Teng, Cheong Lieng; Tong, Seng Fah; Khoo, Ee Ming; Lee, Verna; Zailinawati, Abu Hassan; Mimi, Omar; Chen, Wei Seng; Nordin, Salleh

2011-05-01

Overprescription of antibiotics is a continuing problem in primary care. This study aims to assess the antibiotic prescribing rates and antibiotic choices for upper respiratory tract infections (URTI) and urinary tract infections (UTI) in Malaysian primary care. Antibiotic prescribing data for URTI and UTI was extracted from a morbidity survey of randomly selected primary care clinics in Malaysia. Analysis was performed of 1,163 URTI and 105 UTI encounters. Antibiotic prescribing rates for URTI and UTI were 33.8% and 57.1% respectively. Antibiotic prescribing rates were higher in private clinics compared to public clinics for URTI, but not for UTI. In URTI encounters, the majority of antibiotics prescribed were penicillins and macrolides, but penicillin V was notably underused. In UTI encounters, the antibiotics prescribed were predominantly penicillins or cotrimoxazole. Greater effort is needed to bring about evidence based antibiotic prescribing in Malaysian primary care, especially for URTIs in private clinics.

Building a state prescribed fire program: experiences and lessons learned in Ohio

Treesearch

Michael Bowden

2009-01-01

Science continues to show the need for the use of prescribed fire in oak-dominated forests of the eastern United States. Fire is necessary to reduce competition by thin-barked species, allowing for the development of oak advance regeneration. Many agencies are beginning to apply this science by using prescribed fire to manage their oak forests. This paper examines the...

Responses of hardwood advace regeneration to seasonal prescribed fires in oak-dominated shelterwood stands

Treesearch

Patrick H. Brose; David H. Van Lear

1998-01-01

Effects of seasonal prescribed fires of varying intensities on density, mortality, stem form, height, and height growth of hardwood advance regeneration were investigated. Three mixed-hardwood stands on productive upland sites were cut using a shelterwood technique, each forming a block of spring burn, summer burn, winter burn, and control treatments. Advance...

Use of Exogenous Testosterone for the Treatment of Male Factor Infertility: A Survey of Nigerian Doctors.

PubMed

Omisanjo, Olufunmilade Akinfolarin; Ikuerowo, Stephen Odunayo; Abdulsalam, Moruf Adekunle; Ajenifuja, Sheriff Olabode; Shittu, Khadijah Adebisi

2017-01-01

Though exogenous testosterone is known for its contraceptive effects in men, it is sometimes prescribed by medical practitioners for the treatment of male factor infertility in the mistaken belief that exogenous testosterone improves sperm count. The aim of this study was to evaluate the scope of testosterone use in the treatment of male factor infertility by medical practitioners in Lagos, Nigeria. A survey using a structured questionnaire was carried out amongst doctors attending a regular Continuing Medical Education (CME) programme in Lagos, Nigeria. There were 225 respondents. Most of the respondents (69.8%, n = 157) indicated that exogenous testosterone increases sperm count. Only 22 respondents (9.8%) indicated (correctly) that exogenous testosterone decreases sperm count. Seventy-seven respondents (34.2%) had prescribed some form of exogenous testosterone in the treatment of male factor infertility. The vast majority of respondents who had prescribed testosterone (81.8%, n = 63) thought exogenous testosterone increases sperm count. There was no statistically significant difference in the pattern of prescription across the respondents' specialty ( p = 0.859) or practice type ( p = 0.747). The misuse of exogenous testosterone for the treatment of male infertility was common amongst the respondents, with most of them wrongly believing that exogenous testosterone increases sperm count.

20 CFR 702.418 - Procedure for requesting medical care; employee's duty to notify employer.

Code of Federal Regulations, 2013 CFR

2013-04-01

... becomes aware, or in the exercise of reasonable diligence should be aware, of the relationship between an... to the employer. If a form has been prescribed for such purpose it shall be used, if available and practicable under the circumstances. Notices filed under subpart B of this part, if on the form prescribed by...

20 CFR 702.418 - Procedure for requesting medical care; employee's duty to notify employer.

Code of Federal Regulations, 2012 CFR

2012-04-01

... becomes aware, or in the exercise of reasonable diligence should be aware, of the relationship between an... to the employer. If a form has been prescribed for such purpose it shall be used, if available and practicable under the circumstances. Notices filed under subpart B of this part, if on the form prescribed by...

48 CFR 653.219-70 - DOS form DS-1910, Small Business Agency Review-Actions Above the Simplified Acquisition Threshold.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false DOS form DS-1910, Small Business Agency Review-Actions Above the Simplified Acquisition Threshold. 653.219-70 Section 653.219-70... Threshold. As prescribed in 619.501(c), DS-1910 is prescribed for use in documenting set-aside decisions...

Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications.

PubMed

Fadare, Joseph O; Oshikoya, Kazeem A; Ogunleye, Olayinka O; Desalu, Olufemi O; Ferrario, Alessandra; Enwere, Okezie O; Adeoti, Adekunle; Sunmonu, Taofiki A; Massele, Amos; Baker, Amanj; Godman, Brian

2018-04-01

Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits. Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria. 176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients' clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry. Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns.

14 CFR Appendix A to Part 33 - Instructions for Continued Airworthiness

Code of Federal Regulations, 2013 CFR

2013-01-01

... degree of complexity requiring specialized maintenance techniques, test equipment, or expertise. The... Limitations section must also prescribe the mandatory post-flight inspections and maintenance actions... adequacy of the instructions for mandatory post-flight inspections and maintenance actions prescribed under...

14 CFR Appendix A to Part 33 - Instructions for Continued Airworthiness

Code of Federal Regulations, 2014 CFR

2014-01-01

... degree of complexity requiring specialized maintenance techniques, test equipment, or expertise. The... Limitations section must also prescribe the mandatory post-flight inspections and maintenance actions... adequacy of the instructions for mandatory post-flight inspections and maintenance actions prescribed under...

14 CFR Appendix A to Part 33 - Instructions for Continued Airworthiness

Code of Federal Regulations, 2010 CFR

2010-01-01

... degree of complexity requiring specialized maintenance techniques, test equipment, or expertise. The... Limitations section must also prescribe the mandatory post-flight inspections and maintenance actions... adequacy of the instructions for mandatory post-flight inspections and maintenance actions prescribed under...

The need for a prescribing competency framework to address the burden of complex polypharmacy among multiple long-term conditions.

PubMed

Picton, Catherine; Loughrey, Claire; Webb, Andrew

2016-10-01

The original requirement for a competency framework for prescribers was to identify the essential skills for non-medical prescribers. However, core prescribing competencies are relevant to any prescriber. The new, revised version is especially relevant for doctors/physicians. Doctors are the most frequent prescribers - prescribing is the most common therapeutic intervention. The quantity and complexity of medicine use is increasing through multiple treatment strategies/pathways for multiple comorbidities, resulting in polypharmacy - especially with long-term conditions. This is against a background of the ongoing introduction of new drugs with novel mechanisms of action with increased risks of adverse effects, compounded by drug-drug and disease-drug interactions. This has increased the need for monitoring and follow-up, including identification and management of poor adherence. It is challenging for doctors to maintain safe and effective prescribing and train other doctors and non-medical prescribers within the multidisciplinary team. The prescribing competency framework provides a systematic approach to support doctors to prescribe safely and effectively. It can be used by medical schools to teach prescribing, including preparation for the prescribing safety assessment; by F1/F2 doctors to support prescribing in early years; as part of prescribing quality improvement initiatives and as a continuing professional development framework in general practice or acute care settings. © Royal College of Physicians 2016. All rights reserved.

"I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study.

PubMed

Strandberg, Eva Lena; Brorsson, Annika; Hagstam, Charlotta; Troein, Margareta; Hedin, Katarina

2013-09-01

To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Primary health care in two counties in southern Sweden. Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Exploration of categories, determination of themes, construction of models. The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

42 CFR 423.160 - Standards for electronic prescribing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Standards for electronic prescribing. 423.160 Section 423.160 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality...

47 CFR 32.13 - Accounts-general.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accounting system with respect to such subsidiary records: (1) Subsidiary records shall be reconciled to the... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES UNIFORM SYSTEM OF ACCOUNTS... prescribed in this system. (1) A company may subdivide any of the accounts prescribed. The titles of all such...

Antibiotic Prescribing Patterns in Outpatient Emergency Clinics at Queen Rania Al Abdullah II Children's Hospital, Jordan, 2013.

PubMed

Al-Niemat, Sahar I; Aljbouri, Tareq M; Goussous, Lana S; Efaishat, Rania A; Salah, Rehab K

2014-07-01

To investigate antibiotics prescribing patterns in the outpatient pediatric emergency clinic at Queen Rania Al Abdullah II Children's Hospital at Royal Medical Services in Amman, Jordan. The data was collected from the emergency pharmacy over the period of a -five consecutive months. The methodology recommended by the World Health Organization for investigating drug use in a health facility was followed. The study measures the percentage of encounter with a prescribed antibiotic and the percentage share of each antibiotic category. The distribution of diagnostic categories that accounted for all antibiotics being prescribed and the distribution of each antibiotic being prescribed for upper respiratory tract infections (URTIs) were also measured. Antibiotic prescribing was frequent during pediatric visits to the outpatient pediatric emergency clinic resulting in a high percentage of encounters (85%) when compared to appropriate. Emergency physicians continue to frequently prescribe broad spectrum antibiotics which accounted for approximately (60%) of the total prescribed antibiotics and (83%) of prescribed antibiotics for upper respiratory tract infections and macrolides (primarily azithromycin) were the leading class among them. Our results showed high consumption of antibiotics by emergency department pediatricians which highlight the importance for interventions to promote rational and judicious prescribing. An insight into factors influencing antibiotics prescribing patterns by military prescribers is required.

Knowledge Claims, Jurisdictional Control and Professional Status: The Case of Nurse Prescribing

PubMed Central

Kroezen, Marieke; van Dijk, Liset; Groenewegen, Peter P.; Francke, Anneke L.

2013-01-01

Over the past decades, professional boundaries in health care have come under pressure, and the expansion of prescriptive authority to include nurses touches on issues of professional domains and interprofessional competition. Knowledge claims play an important role in achieving jurisdictional control. Knowledge can take on multiple forms, ranging from indeterminate to technical (I/T ratio) and from everyday to exclusive knowledge. To investigate the interrelatedness of jurisdiction, knowledge claims and professional status, we examine which knowledge claims were made by the medical and nursing professions in the Netherlands to secure or obtain, respectively, jurisdictional control over prescribing, and which form this knowledge took. The study is based on thirteen semi-structured stakeholder interviews and an extensive document analysis. We found that the nursing profession in its knowledge claims strongly emphasized the technicality and everyday knowledge character of the prescribing task, by asserting that nurses were already prescribing medicines, albeit on an illegal basis. Their second claim focused on the indeterminate knowledge skills of nurses and stated that nurse prescribing would do justice to nurses’ skills and expertise. This is a strong claim in a quest for (higher) professional status. Results showed that the medical profession initially proclaimed that prescribing should be reserved for doctors as it is a task requiring medical knowledge, i.e. indeterminate knowledge. Gradually, however, the medical profession adjusted its claims and tried to reduce nurse prescribing to a task almost exclusively based on technicality knowledge, among others by stating that nurses could prescribe in routine cases, which would generate little professional status. By investigating the form that professional knowledge claims took, this study was able to show the interconnectedness of jurisdictional control, knowledge claims and professional status. Knowledge claims are not mere rhetoric, but actively influence the everyday realities of professional status, interprofessional competition and jurisdictional division between professions. PMID:24124613

29 CFR 4003.4 - Extension of time.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION GENERAL RULES FOR ADMINISTRATIVE REVIEW... an extension shall stop the running of the prescribed period of time. When a request for an extension... writing, and the prescribed period of time shall resume running from the date of denial. (b) Disaster...

Advantages and disadvantages of interdisciplinary consultation in the prescription of assistive technologies for mobility limitations.

PubMed

de Laat, Fred A; van Heerebeek, Bart; van Netten, Jaap J

2018-03-28

To explore the advantages and disadvantages experienced by professionals in interdisciplinary consultation involving the user, prescriber and technician in the prescription of assistive technologies for mobility limitations. Cross-sectional study. Prescribers (N = 39) and orthopaedic technicians (N = 50), who were regularly involved in an interdisciplinary consultation completed a questionnaire about advantages and disadvantages of the interdisciplinary consultation. Advantages of the interdisciplinary consultation were mentioned within all CanMEDS areas of medical practice, including better and quicker prescription of the assistive technology, shared knowledge of medical diagnosis and device possibilities, shared decision making of the device prescription and clear communication rules. Disadvantages were mentioned in the CanMEDS areas management and collaboration, including planning problems (financial) reimbursement of this type of consultation, and time efficiency. On a 10-point scale, mean (standard deviation) rates of interdisciplinary consultations were 7.9 (0.6) according to prescribers, and 7.8 (0.9) by technicians. All participants wanted to continue the interdisciplinary consultation. Prescribers and technicians in the field of assistive technologies for walking mobility limitations appreciate an interdisciplinary consultation. Advantages are found in all CanMEDS areas, whereas disadvantages only concern coordination. It should be encouraged to realize this kind of consultation in all situations where such technologies are prescribed. Implications for rehabilitation Interdisciplinary consultation involving the user, prescriber and technician to prescribe assistive technologies for mobility limitations has many advantages in all CanMEDS areas of medical practice, and few disadvantages, related to management and collaboration only. The disadvantages of interdisciplinary consultation, such as (financial) reimbursement by health insurance companies, have to be taken into account. Professionals in the field of ankle-foot-orthoses and orthopaedic shoes (medical specialist as prescriber and orthopaedic technician) who are involved in interdisciplinary consultation appreciate it and want to continue.

Initial results of the use of prescription order change forms to achieve dose form optimization (consolidation and tablet splitting) of SSRI antidepressants in a state Medicaid program.

PubMed

Hamer, Ann M; Hartung, Daniel M; Haxby, Dean G; Ketchum, Kathy L; Pollack, David A

2006-01-01

One method to reduce drug costs is to promote dose form optimization strategies that take advantage of the flat pricing of some drugs, i.e., the same or nearly the same price for a 100 mg tablet and a 50 mg tablet of the same drug. Dose form optimization includes tablet splitting; taking half of a higher-strength tablet; and dose form consolidation, using 1 higher-strength tablet instead of 2 lower-strength tablets. Dose form optimization can reduce the direct cost of therapy by up to 50% while continuing the same daily dose of the same drug molecule. To determine if voluntary prescription change forms for antidepressant drugs could induce dosing changes and reduce the cost of antidepressant therapy in a Medicaid population. Specific regimens of 4 selective serotonin reuptake inhibitors (SSRIs)- citalopram, escitalopram, paroxetine, and sertraline- were identified for conversion to half tablets or dose optimization. Change forms, which served as valid prescriptions, were faxed to Oregon prescribers in October 2004. The results from both the returned forms and subsequent drug claims data were evaluated using a segmented linear regression. Citalopram claims were excluded from the cost analysis because the drug became available in generic form in October 2004. A total of 1,582 change forms were sent to 556 unique prescribers; 9.2% of the change forms were for dose consolidation and 90.8% were for tablet splitting. Of the 1,118 change forms (70.7%) that were returned, 956 (60.4% of those sent and 85.5% of those returned) authorized a prescription change to a lower-cost dose regimen. The average drug cost per day declined by 14.2%, from Dollars 2.26 to Dollars 1.94 in the intervention group, versus a 1.6% increase, from Dollars 2.52 to Dollars 2.56, in the group without dose consolidation or tablet splitting of the 3 SSRIs (sertraline, escitalopram, and immediate-release paroxetine). Total drug cost for the 3 SSRIs declined by 35.6%, from Dollars 333,567 to Dollars 214,794, as a result of a 24.8% decline in the total days of SSRI drug therapy and the 14.2% decline in average SSRI drug cost per day. The estimated monthly cost avoidance from this intervention, based on pharmacy claims data, was approximately Dollars 35,285, about 2% of the entire spending on SSRI drugs each month, or about Dollars 0.09 per member per month. Program administration costs, excluding costs incurred by prescribers and pharmacy providers, were about 2% of SSRI drug cost savings. Voluntary prescription change forms appear to be an effective and well-accepted tool for obtaining dose form optimization through dose form consolidation and tablet splitting, resulting in reduction in the direct costs of SSRI antidepressant drug therapy with minimal additional program administration costs.

A 5-year retrospective audit of prescribing by a critical care outreach team.

PubMed

Wilson, Mark

2018-05-01

UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

Psychotropic Medications and Substances of Abuse Interactions in Youth

ERIC Educational Resources Information Center

Kaminer, Yifrah; Goldberg, Pablo; Connor, Daniel F.

2010-01-01

The majority of youth with substance use disorders (SUDs) manifest one or more co-occurring psychiatric disorders. Consequently, many of these youths are being prescribed with psychotropic medications. As prescribing rates continue to increase for early-onset psychiatric disorders, potential risk for substance of abuse-psychiatric medication…

The effect of advertising in clinical software on general practitioners' prescribing behaviour.

PubMed

Henderson, Joan; Miller, Graeme; Pan, Ying; Britt, Helena

2008-01-07

To assess the effect of pharmaceutical advertising embedded in clinical software on the prescribing behaviour of general practitioners. Secondary analysis of data from a random sample of 1336 Australian GPs who participated in Bettering the Evaluation and Care of Health, a national continuous cross-sectional survey of general practice activity, between November 2003 and March 2005. The prescribing behaviour of participants who used the advertising software was compared with that of participants who did not, for seven pharmaceutical products advertised continually throughout the study period. Prescription for advertised product as a proportion (%) of prescriptions for all pharmaceutical products in the same generic class or group. GP age, practice location, accreditation status, patient bulk-billing status and hours worked were significantly associated (P < 0.05) with use of advertising software. We found no significant differences, either before or after adjustment for these confounders, in the prescribing rate of Lipitor (adjusted odds ratio [AOR], 0.90; P = 0.26); Micardis (AOR, 0.98; P = 0.91); Mobic (AOR, 1.02; P = 0.89); Norvasc (AOR, 1.02; P = 0.91); Natrilix (AOR, 0.80; P = 0.32); or Zanidip (AOR, 0.88; P = 0.47). GPs using advertising software prescribed Nexium significantly less often than those not using advertising software (AOR, 0.78; P = 0.02). When all advertised products were combined and compared with products that were not advertised, no difference in the overall prescribing behaviour was demonstrated (AOR, 0.96; P = 0.42). Exposure to advertisements in clinical software has little influence on the prescribing behaviour of GPs.

Commentary on the Federal Government's Role in Influencing E-prescribing Use and Research

PubMed Central

Odukoya, Olufunmilola K; Chui, Michelle A

2012-01-01

Electronic prescribing (e-prescribing) is one of the most studied areas of health information technology due to advocacy for its use by influential organizations such as the Institute of Medicine (IOM). In the United States, the federal government has played a significant role in encouraging use of e-prescribing technology and in stimulating associated research nationwide. The federal government has increased e-prescribing research initiatives through agencies such as the Agency for Healthcare Research and Quality (AHRQ) and the Health Resources and Services Administration (HRSA). Initial initiatives focused on the development of standards for e-prescribing systems and implementation. In recent times, e-prescribing research initiatives have become more focused on identifying unintended consequences of using this technology and identifying new possibilities of use that were previously not envisioned. Continuous studies of how healthcare professionals are interfacing with this new technology, how systems have been implemented, and the impact of this technology on healthcare processes and outcomes are crucial. PMID:22737095

Renal function monitoring in patients prescribed dabigatran in the Compass Health Primary Health Organisation: a quality improvement audit.

PubMed

McBain, Lynn; Kyle, Anna

2018-03-09

To assess annual renal function monitoring and clinical indications for use in patients prescribed dabigatran. A quality improvement activity included all patients in the Compass Health Primary Health Organisation (PHO) prescribed dabigatran. Information recorded: demographics; indication for use; daily dose; height; weight; serum creatinine; and estimated glomerular filtration rate (eGFR). The first audit occurred during July 2013 - May 2014, the second during May 2014 - October 2016. Across the PHO, all patients prescribed dabigatran were reviewed: 941 patients and 1,564 respectively. At the time of the second pass audit, renal function monitoring improved from 88% to 90%, and 96% were prescribed dabigatran for an approved indication. Results showed a continuing high level of renal function monitoring across the PHO in 90% of patients prescribed dabigatran. Practitioners were reminded to use creatinine clearance as a marker of renal function. Dabigatran was prescribed for an approved indication in 96% of patients. Our results are in line with recommended best practice and clinical guidelines.

Childhood Attention-Deficit/Hyperactivity Disorder Prescribing by Prescriber Type and Specialty in Oregon Medicaid.

PubMed

Klein, Tracy A; Panther, Shannon; Woo, Teri; Odom-Maryon, Tamara; Daratha, Kenn

2016-08-01

This study compares nurse practitioner (NP) and physician (MD/DO) prescribing patterns for treatment of children with an attention-deficit/hyperactivity disorder (ADHD)-related diagnosis covered by Oregon Medicaid from 2012 to 2013. This study is a limited data set review of Oregon pharmacy claims for youth aged 3-18 at time of prescription fill, who were continuously enrolled for at least 10 months of the index year. Claims with selected ICD-9 codes (n = 197,364) were further defined by 30-day prescriptions and prescription drug events (PDE) linked to each prescriber type of interest. Descriptive statistical analysis of variables included prescriber type (NP vs. physician) and specialty (generalist vs. specialist), child age, and controlled versus noncontrolled drug type. A total of 82,754 complete 30-day prescriptions for 10,753 children from 1785 unique prescribers (78 NP specialists; 303 NP generalists; 162 physician specialists; and 1242 physician generalist prescribers) and 16,669 PDE were analyzed. Physicians prescribed more than 81% of all ADHD medications, and physician generalists prescribed nearly 60% of all prescriptions. Sixty-four percent of 30-day supply prescriptions (n = 52,678) were controlled substances. Generalists, both NPs and physician prescribers, prescribed controlled medications more often than specialists. Physician specialists consistently prescribed controlled substances for all age groups, while NP specialists prescribed more controlled substances as child age increased. Rates of controlled medications prescribed generally increased, as children got older, regardless of provider type. NPs overall prescribe in a similar pattern to physicians when given the authority to prescribe controlled substances for ADHD. Comparisons between prescriber types for controlled substance prescribing by age should be explored further to identify possible variance from national guidelines.

Duration of fuels reduction following prescribed fire in coniferous forests of U.S. national parks in California and the Colorado Plateau

USGS Publications Warehouse

van Mantgem, Phillip J.; Lalemand, Laura; Keifer, MaryBeth; Kane, Jeffrey M.

2016-01-01

Prescribed fire is a widely used forest management tool, yet the long-term effectiveness of prescribed fire in reducing fuels and fire hazards in many vegetation types is not well documented. We assessed the magnitude and duration of reductions in surface fuels and modeled fire hazards in coniferous forests across nine U.S. national parks in California and the Colorado Plateau. We used observations from a prescribed fire effects monitoring program that feature standard forest and surface fuels inventories conducted pre-fire, immediately following an initial (first-entry) prescribed fire and at varying intervals up to >20 years post-fire. A subset of these plots was subjected to prescribed fire again (second-entry) with continued monitoring. Prescribed fire effects were highly variable among plots, but we found on average first-entry fires resulted in a significant post-fire reduction in surface fuels, with litter and duff fuels not returning to pre-fire levels over the length of our observations. Fine and coarse woody fuels often took a decade or longer to return to pre-fire levels. For second-entry fires we found continued fuels reductions, without strong evidence of fuel loads returning to levels observed immediately prior to second-entry fire. Following both first- and second-entry fire there were increases in estimated canopy base heights, along with reductions in estimated canopy bulk density and modeled flame lengths. We did not find evidence of return to pre-fire conditions during our observation intervals for these measures of fire hazard. Our results show that prescribed fire can be a valuable tool to reduce fire hazards and, depending on forest conditions and the measurement used, reductions in fire hazard can last for decades. Second-entry prescribed fire appeared to reinforce the reduction in fuels and fire hazard from first-entry fires.

REVIEW OF INDEPENDENT NURSE PRESCRIBING IN A PAEDIATRIC CYSTIC FIBROSIS (CF) AND RESPIRATORY POPULATION.

PubMed

Chana, Gabis; Tabberner, Michelle; Nixon, Wendy; Frost, Sue; Barrett, Leslie; Desai, Maya; Paskin, Lucy

2016-09-01

With pressures on junior doctors' availability in the NHS, non-medical prescribing is topical. Independent Nurse Prescribers (INPs) can prescribe any licensed medicine for any medical condition within their level of competence.1 An audit was undertaken of the four INPs employed by the Respiratory Department evaluating current prescribing practices. The requirement for this audit was identified by the multidisciplinary team (MDT) and Trust approval was obtained. A data collection form was designed capturing patient demographics and full details of prescribed items.Over a 3 month period (August to October 2014) outpatient cystic fibrosis (CF) and respiratory prescriptions were studied using cluster sampling. Over a 6 week period prescription requests by CF INPs faxed to General Practitioners (GPs) were reviewed. INPs also prescribe via telephone, documenting advice on trust forms; these were preliminarily audited. All data was analysed using Microsoft Excel. Legality of prescriptions and adherence to national and local guidelines were evaluated. Reference keys were used to designate non-adherence post-application of exclusion criteria. A total of 77 outpatient prescriptions (45 CF and 32 respiratory) were completed by the 4 INPs, containing 122 items (72 CF and 50 respiratory). Of the CF prescribed items 21 were oral antibiotics (29%). Respiratory INPs mainly prescribed 14 inhaler devices (28%) and 12 inhaled bronchodilators (24%).All INP prescriptions met legal requirements. Basic details of medicinal products (drug name and dose) were documented for all items. A key finding was that duration/quantity was not indicated for 27 (54%) respiratory items.After applying exclusion criteria, of the CF prescribed items, 56/59 (95%) adhered to national guidelines and 47/66 (71%) followed local guidelines. The leading reason for not following local guidelines was not documenting allergy status. Of the respiratory prescribed items, 34 (100%) adhered to national guidelines and 31/32 (97%) followed local guidelines.A total of 33 faxes (with 38 items) were completed and 35 items (92%) were oral antibiotics. Drug name, dose and frequency were stated for all items. From the faxed items, 38 (100%) adhered to national guidelines and 32/33 (97%) followed local guidelines.Over 5 days, CF INPs provided telephone advice for 12 patients. Of these, 6 patients had respiratory exacerbation. Telephone advice led to faxes being sent to GPs for 9 patients. This was preliminary data with a re-audit planned after amendment of trust form. Overall INP prescribing was found to be safe and effective. This review enabled education of the respiratory team of prescribing practices via a local audit meeting. The positive contribution that INPs provide to patient care was highlighted as they improve the patient journey and support the MDT. The demand for INP prescribing in particular with CF has provided opportunity for a pharmacist prescriber to join the CF MDT. It is recommended medical and pharmacist prescribing to be reviewed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Non-circulatory fluid forces on porous bodies with application to panel flutter

NASA Astrophysics Data System (ADS)

Hajian, Rozhin; Jaworski, Justin W.

2017-11-01

The non-circulatory fluid forces acting on an oscillating porous panel or airfoil in uniform incompressible flow are derived from linearized potential theory. The fundamental integral equation for Holder-continuous porosity distributions is formulated and solved numerically for the special cases of non-porous and uniformly-porous panels with prescribed structural deformations. The new unsteady aerodynamic forces are then applied to aeroelastic stability predictions for porous panels or liners. Results from this analysis aim to form the basis of a complete unsteady aerodynamic theory for porous airfoils and their acoustic emissions based upon the unique attributes of natural fliers and swimmers.

The effect of prescribed burning on plant rarity in a temperate forest.

PubMed

Patykowski, John; Holland, Greg J; Dell, Matt; Wevill, Tricia; Callister, Kate; Bennett, Andrew F; Gibson, Maria

2018-02-01

Rare species can play important functional roles, but human-induced changes to disturbance regimes, such as fire, can inadvertently affect these species. We examined the influence of prescribed burns on the recruitment and diversity of plant species within a temperate forest in southeastern Australia, with a focus on species that were rare prior to burning. Floristic composition was compared among plots in landscapes before and after treatment with prescribed burns differing in the extent of area burnt and season of burn (before-after, control-impact design). Floristic surveys were conducted before burns, at the end of a decade of drought, and 3 years postburn. We quantified the effect of prescribed burns on species grouped by their frequency within the landscape before burning (common, less common, and rare) and their life-form attributes (woody perennials, perennial herbs or geophytes, and annual herbs). Burn treatment influenced the response of rare species. In spring-burn plots, the recruitment of rare annual herbs was promoted, differentiating this treatment from both autumn-burn and unburnt plots. In autumn-burn plots, richness of rare species increased across all life-form groups, although composition remained statistically similar to control plots. Richness of rare woody perennials increased in control plots. For all other life-form and frequency groups, the floristic composition of landscapes changed between survey years, but there was no effect of burn treatment, suggesting a likely effect of rainfall on species recruitment. A prescribed burn can increase the occurrence of rare species in a landscape, but burn characteristics can affect the promotion of different life-form groups and thus affect functional diversity. Drought-breaking rain likely had an overarching effect on floristic composition during our study, highlighting that weather can play a greater role in influencing recruitment and diversity in plant communities than a prescribed burn.

10 CFR 170.41 - Failure by applicant or licensee to pay prescribed fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Failure by applicant or licensee to pay prescribed fees. 170.41 Section 170.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.41 - Failure by applicant or licensee to pay prescribed fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Failure by applicant or licensee to pay prescribed fees. 170.41 Section 170.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.51 - Right to review and appeal of prescribed fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 2 2012-01-01 2012-01-01 false Right to review and appeal of prescribed fees. 170.51 Section 170.51 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.41 - Failure by applicant or licensee to pay prescribed fees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 2 2012-01-01 2012-01-01 false Failure by applicant or licensee to pay prescribed fees. 170.41 Section 170.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.51 - Right to review and appeal of prescribed fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Right to review and appeal of prescribed fees. 170.51 Section 170.51 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.51 - Right to review and appeal of prescribed fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 2 2013-01-01 2013-01-01 false Right to review and appeal of prescribed fees. 170.51 Section 170.51 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.51 - Right to review and appeal of prescribed fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Right to review and appeal of prescribed fees. 170.51 Section 170.51 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.41 - Failure by applicant or licensee to pay prescribed fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Failure by applicant or licensee to pay prescribed fees. 170.41 Section 170.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.41 - Failure by applicant or licensee to pay prescribed fees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 2 2013-01-01 2013-01-01 false Failure by applicant or licensee to pay prescribed fees. 170.41 Section 170.41 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

10 CFR 170.51 - Right to review and appeal of prescribed fees.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Right to review and appeal of prescribed fees. 170.51 Section 170.51 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) FEES FOR FACILITIES, MATERIALS, IMPORT AND EXPORT LICENSES, AND OTHER REGULATORY SERVICES UNDER THE ATOMIC ENERGY ACT OF 1954, AS AMENDED...

Microsite and time since prescribed fire's influence on soil microbiology in a pinyon woodland

Treesearch

Benjamin M. Rau; Robert R. Blank; Tye Morgan

2008-01-01

Pinyon-juniper (Pinus monophylla Torr. & Frém.? Juniperus osteosperma Torr.) encroachment into sagebrush grasslands is a continuing problem in the Western United States. Prescribed burning has been suggested to slow woodland encroachment. We examined surface soil microbial community structure using Phospholipid Fatty Acid (PLFA...

Using Standardized Patients in Continuing Medical Education Courses on Proper Prescribing of Controlled Substances

ERIC Educational Resources Information Center

Swiggart, William H.; Ghulyan, Marine V.; Dewey, Charlene M.

2012-01-01

Controlled prescription drug (CPD) abuse is an increasing threat to patient safety and health care providers (HCPs) are not adequately prepared nor do they routinely employ proper screening techniques. Using standardized patients (SPs) as an instructional strategy, the trained physicians on proper prescribing practices and SBIRT (Screening, Brief…

Influencing prescribing in English primary care: the views of primary care organisations.

PubMed

Mason, Anne; Drummond, Michael; Towse, Adrian; Cooke, Jonathan

2004-07-01

The rapid rise of prescribing expenditure is a concern in many industrialised countries and methods to manage medicines are widely employed. The purpose of this study was to identify the approaches to improve primary care prescribing by primary care organisations (PCOs) in the National Health Service (NHS) in England. A questionnaire (Management of Medicines, MANMED) was mailed to prescribing advisers and prescribing leads in 332 PCOs. A response rate of 66% (220/332) was achieved. Most PCOs report the improvement of the quality of prescribing as their top priority, followed by budget adherence at both practice and PCO levels. Prescribing advisers typically offer several forms of support: practice visits, prescribing reviews, indicators of prescribing, prescribing newsletters, hands-on support, seminars and local formularies. PCOs are pursuing a wide range of prescribing initiatives, covering, on average, seven different therapeutic areas. National targets are the main driver for prescribing initiatives but other key influences include inappropriate prescribing and clinical governance. Although cost considerations are important, improving the quality of prescribing is perceived as the overriding principle on which PCO prescribing strategy is based. Multifaceted prescribing support is widespread and national targets are the largest single factor influencing choice of therapeutic area for prescribing initiatives. Diversity in approaches presents the opportunity to improve the evidence base for medicines management. Not only could such research inform PCOs in their central aim of improving the quality of prescribing within the NHS, but it may also offer insights of relevance to other countries if the influence of process and context upon the effectiveness of medicines management is systematically explored.

Adherence to multiple, prescribed medications in diabetic kidney disease: A qualitative study of consumers' and health professionals' perspectives.

PubMed

Williams, Allison F; Manias, Elizabeth; Walker, Rowan

2008-12-01

Individuals are adherent to approximately 50% of their prescribed medications, which decreases when multiple, chronic conditions are involved. To examine factors affecting adherence to multiple prescribed medications for consumers with co-existing diabetes and chronic kidney disease (diabetic kidney disease) from the time of prescription to the time they took their medications. A descriptive exploratory design was used incorporating in-depth interviews and focus groups. The diabetes and nephrology departments of two metropolitan, public hospitals in Melbourne, Australia. A convenience sample of 23 consumers with diabetic kidney disease participated in an in-depth interview. Inclusion criteria involved English-speaking individuals, aged > or =18 years, with co-existing diabetes and chronic kidney disease, and who were mentally competent. Exclusion criteria included impending commencement on dialysis, pregnancy, an aggressive form of cancer, or a mental syndrome that was not stabilised with medication. Sixteen health professionals working in diabetes and nephrology departments in Melbourne, Australia also participated in one of two focus groups. In-depth structured interviews and focus groups were conducted and analysed according to a model of medication adherence. Consumers were not convinced of the need, effectiveness and safety of all of their medications. Alternatively, health professionals focussed on the importance of consumers taking their medications as prescribed and believed that the risk of medication-related adverse effects was over-rated. Accessing prescribed medications and difficulties surrounding continuity of care contributed to consumers' unintentional medication non-adherence. In particular, it was hard for consumers to persist taking their ongoing medication prescriptions. Healthcare system inadequacies were highlighted, which affected relationships between consumers with diabetic kidney disease and health professionals. Acknowledging the barriers as perceived by consumers with diabetic kidney disease can facilitate effective communication and partnerships with health professionals necessary for medication adherence and medication safety.

Introducing management principles into the supply and distribution of medicines in Tunisia.

PubMed Central

Garraoui, A.; Le Feuvre, P.; Ledoux, M.

1999-01-01

A number of strategies have been proposed by various organizations and governments for rationalizing the use of drugs in developing countries. Such strategies include the use of essential drug lists, generic prescribing, and training in rational prescribing. None of these require doctors to become actively involved in the management of the drug supply to their health centres. In 1997, in the Kasserine region of Tunisia, the regional health authorities piloted a radically different strategy. This involved the theoretical allocation of a proportion of the regional drug budget to each district and subsequently to each health centre according to estimated demand. Medical staff were given responsibility for the management of these budgets, allowing them to control the nature and quantities of drugs supplied to the health centres in which they worked. This paper outlines the process by which this strategy was successfully implemented in the Foussana district of Kasserine region, and explores the problems encountered. It describes now the theoretical budgets were allocated to each district and how the costs of individual drugs and the consumption of drugs in the previous year were calculated. It then continues by giving an account of the training of the staff of the health centres, the preparation of a drug order form and the method of allocation of the theoretical budgets to each of the health centres. The results give an account of how the prescribing habits of doctors were changed as a result of the strategy, in order to take into account the costs of the drugs that they prescribed. They show how the health centres were able to manage their budgets, spending overall 99.8% of the budget allocated to the district. They outline some of the changes in the prescribing habits that took place, demonstrating a greater use of appropriate and essential drugs. The paper concludes that doctors and paramedical staff can successfully manage a theoretical drug budget, and that their involvement in this process leads to more rational prescribing within existing resource constraints. This has a consequence of benefiting patients, satisfying doctors and pleasing administrators. PMID:10427939

Investigation of antimicrobial use at a tertiary care hospital in Southern Punjab, Pakistan using WHO methodology.

PubMed

Atif, Muhammad; Azeem, Muhammad; Saqib, Anum; Scahill, Shane

2017-01-01

Globally, between 20 to 50% of antimicrobial consumption is inappropriate, causing significant impact on the quality of care, cost of therapy and incidence of adverse drug reactions. The purpose of this study was to investigate the prescribing patterns and utilization of antimicrobials in ten selected wards at Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. A descriptive cross-sectional study was designed using the World Health Organization (WHO) indicators for antimicrobial use. Standard data collection forms were used in ten wards and the Pharmacy Department at BVH. Antimicrobial utilization patterns in terms of frequency and percentage were also determined. Systematic random sampling techniques were used to collect data from 1,000 prescription records out of 21,115 prescriptions written for the six months January to June 2016. For the hospital indicators, a formulary list or essential medicines list (FL/EML) was available, but standard treatment guidelines (STGs) for infectious diseases was not. The average number of days that key antimicrobials were out of stock was 3.3 days per month. The expenditure on antimicrobials as a percentage of the total medicines costs was 12.2%. For the prescribing indicators, the percentage of hospitalizations with antimicrobial(s) prescribed was 82.3%, and the average number of antimicrobials per hospitalization was 1.4 (SD = 0.6). The average duration of antimicrobial treatment per hospitalization was 5.4 days (SD = 3.2). The average cost of antimicrobials prescribed per hospitalization was USD 5.4 (SD = 6.7). None of the patients who were prescribed antimicrobials, received AM according to the STGs (pneumonia and cesarean section cases). Among the patient-care and supplemental indicators, the average duration of hospital stay of patients who received antimicrobials was 6.4 (SD = 4.3) days. The drug sensitivity testing was almost non-existent, with only 0.24% prescription records having drug sensitivity tests. Ceftriaxone (39.6%), metronidazole (23.4%) and cefotaxime (23.1%) were the top most frequently prescribed antimicrobials. The results of the current study revealed less than optimal antimicrobial prescribing and utilization patterns of selected wards at BVH. Continuous education and training of physicians, and cost-effective policies could play an important role in promoting the rational use of antimicrobials in this setting.

Prescribing practices amid the OxyContin crisis: examining the effect of print media coverage on opioid prescribing among physicians.

PubMed

Borwein, Alexandra; Kephart, George; Whelan, Emma; Asbridge, Mark

2013-12-01

The pain medication OxyContin (hereafter referred to as oxycodone extended release) has been the subject of sustained, and largely negative, media attention in recent years. We sought to determine whether media coverage of oxycodone extended release in North American newspapers has led to changes in prescribing of the drug in Nova Scotia, Canada. An interrupted time-series design examined the effect of media attention on physicians' monthly prescribing of opioids. The outcome measures were, for each physician, the monthly proportions of all opioids prescribed and the proportion of strong opioids prescribed that were for oxycodone extended release. The exposure of interest was media attention defined as the number of articles published each month in 27 North American newspapers. Variations in media effects by provider characteristics (specialty, prescribing volume, and region) were assessed. Within-provider changes in the prescribing of oxycodone extended release in Nova Scotia were observed, and they followed changes in media coverage. Oxycodone extended release prescribing rose steadily prior to receiving media attention. Following peak media attention in the United States, the prescribing of oxycodone extended release slowed. Likewise, following peak coverage in Canadian newspapers, the prescribing of oxycodone extended release declined. These patterns were observed across prescriber specialties and by prescriber volume, though the magnitude of change in prescribing varied. This study demonstrates that print media reporting of oxycodone extended release in North American newspapers, and its continued portrayal as a social problem, coincided with reductions in the prescribing of oxycodone extended release by physicians in Nova Scotia. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program

PubMed Central

Zisblatt, Lara; Ng, Pamela; Hayes, Sean M.; Peloquin, Sophie; Hardesty, Ilana; White, Julie L.

2016-01-01

Objective. Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Method. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. Subjects. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Results. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. Conclusions. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. PMID:26304703

Managing smoke at the wildland-urban interface

Treesearch

Dale Wade; Hugh Mobley

2007-01-01

When prescribed burning is conducted at the wildland-urban interface (WUI), the smoke that is produced can sometimes inconvenience people, but it can also cause more serious health and safety problems. The public is unlikely to continue to tolerate the use of prescribed fire, regardless of the benefits, if burn managers cannot keep smoke out of smoke-sensitive areas....

Estimating fuel consumption for the upper coastal plain of South Carolina

Treesearch

S.L. Goodrick; D. Shea; J. Blake

2010-01-01

Recent changes in air quality regulations present a potential obstacle to continued use of prescribed fire as a land management tool. towering of the acceptable daily concentration of particulate matter from 6510 35 jig/m' will bring much closer scrutiny of prescribed burning practices from the air quality community. To work within this narrow window, land...

Effects of prescribed fire on wildlife and wildlife habitat in selected ecosystems of North America

Treesearch

William M. Block; L. Mike Conner; Paul A. Brewer; Paulette Ford; Jonathan Haufler; Andrea Litt; Ronald E. Masters; Laura R. Mitchell; Jane Park

2016-01-01

Prescribed fire is applied widely as a management tool in North America to meet various objectives such as reducing fuel loads and fuel continuity, returning fire to an ecosystem, enhancing wildlife habitats, improving forage, preparing seedbeds, improving watershed conditions, enhancing nutrient cycling, controlling exotic weeds, and enhancing resilience from...

Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis.

PubMed

Elsaid, K; Truong, T; Monckeberg, M; McCarthy, H; Butera, J; Collins, C

2013-12-01

To evaluate the impact of electronic standardized chemotherapy templates on incidence and types of prescribing errors. A quasi-experimental interrupted time series with segmented regression. A 700-bed multidisciplinary tertiary care hospital with an ambulatory cancer center. A multidisciplinary team including oncology physicians, nurses, pharmacists and information technologists. Standardized, regimen-specific, chemotherapy prescribing forms were developed and implemented over a 32-month period. Trend of monthly prevented prescribing errors per 1000 chemotherapy doses during the pre-implementation phase (30 months), immediate change in the error rate from pre-implementation to implementation and trend of errors during the implementation phase. Errors were analyzed according to their types: errors in communication or transcription, errors in dosing calculation and errors in regimen frequency or treatment duration. Relative risk (RR) of errors in the post-implementation phase (28 months) compared with the pre-implementation phase was computed with 95% confidence interval (CI). Baseline monthly error rate was stable with 16.7 prevented errors per 1000 chemotherapy doses. A 30% reduction in prescribing errors was observed with initiating the intervention. With implementation, a negative change in the slope of prescribing errors was observed (coefficient = -0.338; 95% CI: -0.612 to -0.064). The estimated RR of transcription errors was 0.74; 95% CI (0.59-0.92). The estimated RR of dosing calculation errors was 0.06; 95% CI (0.03-0.10). The estimated RR of chemotherapy frequency/duration errors was 0.51; 95% CI (0.42-0.62). Implementing standardized chemotherapy-prescribing templates significantly reduced all types of prescribing errors and improved chemotherapy safety.

The impact of nurse prescribing on the clinical setting.

PubMed

Creedon, Rena; Byrne, Stephen; Kennedy, Julia; McCarthy, Suzanne

To investigate the impact nurse prescribing has on the organisation, patient and health professional, and to identify factors associated with the growth of nurse prescribing. Systematic search and narrative review. Data obtained through CINAHL, PubMed, Science direct, Online Computer Library Centre (OCLC), databases/websites, and hand searching. English peer-reviewed quantitative, qualitative and mixed-method articles published from September 2009 through to August 2014 exploring nurse prescribing from the perspective of the organisation, health professional and patient were included. Following a systematic selection process, studies identified were also assessed for quality by applying Cardwell's framework. From the initial 443 citations 37 studies were included in the review. Most studies were descriptive in nature. Commonalities addressed were stakeholders' views, prescribing in practice, jurisdiction, education and benefits/barriers. Prescriptive authority for nurses continues to be a positive addition to clinical practice. However, concerns have emerged regarding appropriate support, relationships and jurisdictional issues. A more comprehensive understanding of nurse and midwife prescribing workloads is required to capture the true impact and cost-effectiveness of the initiative.

48 CFR 53.200 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... to, the parts of the FAR in which the form usage requirements are addressed. For example, forms...; forms addressed in FAR part 43, Contract Modifications, are treated in this subpart in section 53.243... AND FORMS FORMS Prescription of Forms 53.200 Scope of subpart. This subpart prescribes standard forms...

Some Sleep Drugs Can Impair Driving

MedlinePlus

... prescribed sleep medications. Some sleep drugs contain an extended-release form of zolpidem that stays in the ... the regular form. FDA is particularly concerned about extended-release forms of zolpidem. They are sold as ...

48 CFR 453.108 - Recommendations concerning forms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Recommendations concerning... AND FORMS FORMS General 453.108 Recommendations concerning forms. Contracting officers shall submit recommendations for new forms or to revise, eliminate, or consolidate forms prescribed by FAR part 53 and part 453...

The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain.

PubMed

Stenner, Karen; Courtenay, Molly

2008-08-01

This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain. Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses. A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain. Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning. Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing.

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey.

PubMed

Courtenay, Molly; Carey, Nicola; Stenner, Karen

2012-06-01

Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA. NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011. The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001). NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This workforce is contributing to medicines management activities in a range of care settings. If non-medical prescibers are to maximise their contribution, robust governance and support from healthcare organisations is essential. The continued use of supplementary prescribing is questionable if maximum efficiency is sought. These are important points that need to be considered by those responsible for developing non-medical prescribing in the United Kingdom and other countries around the world.

Consultations between nurse prescribers and patients with diabetes in primary care: A qualitative study of patient views.

PubMed

Stenner, Karen L; Courtenay, Molly; Carey, Nicola

2011-01-01

There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients' views about their consultations with a nurse prescriber. To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management. A qualitative study involving semi-structured interviews and thematic analysis. Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009. Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers. Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment. The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses' interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients' requirements. Copyright © 2010 Elsevier Ltd. All rights reserved.

PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique

PubMed Central

Barry, Emma; O'Brien, Kirsty; Cooper, Janine; Redmond, Patrick; Hughes, Carmel M; Bennett, Kathleen; Fahey, Tom; Smith, Susan M

2016-01-01

Objective There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings. Design Two-round modified Delphi consensus method. Setting Irish and UK general practice. Participants A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel. Results 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2). Conclusions The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases. PMID:27601499

PIPc study: development of indicators of potentially inappropriate prescribing in children (PIPc) in primary care using a modified Delphi technique.

PubMed

Barry, Emma; O'Brien, Kirsty; Moriarty, Frank; Cooper, Janine; Redmond, Patrick; Hughes, Carmel M; Bennett, Kathleen; Fahey, Tom; Smith, Susan M

2016-09-06

There is limited evidence regarding the quality of prescribing for children in primary care. Several prescribing criteria (indicators) have been developed to assess the appropriateness of prescribing in older and middle-aged adults but few are relevant to children. The objective of this study was to develop a set of prescribing indicators that can be applied to prescribing or dispensing data sets to determine the prevalence of potentially inappropriate prescribing in children (PIPc) in primary care settings. Two-round modified Delphi consensus method. Irish and UK general practice. A project steering group consisting of academic and clinical general practitioners (GPs) and pharmacists was formed to develop a list of indicators from literature review and clinical expertise. 15 experts consisting of GPs, pharmacists and paediatricians from the Republic of Ireland and the UK formed the Delphi panel. 47 indicators were reviewed by the project steering group and 16 were presented to the Delphi panel. In the first round of this exercise, consensus was achieved on nine of these indicators. Of the remaining seven indicators, two were removed following review of expert panel comments and discussion of the project steering group. The second round of the Delphi process focused on the remaining five indicators, which were amended based on first round feedback. Three indicators were accepted following the second round of the Delphi process and the remaining two indicators were removed. The final list consisted of 12 indicators categorised by respiratory system (n=6), gastrointestinal system (n=2), neurological system (n=2) and dermatological system (n=2). The PIPc indicators are a set of prescribing criteria developed for use in children in primary care in the absence of clinical information. The utility of these criteria will be tested in further studies using prescribing databases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

14 CFR Sec. 19-2 - Maintenance of data.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Classifications Sec. 19-2 Maintenance of data. (a) Each air carrier required to file Form 41 Schedule T-100 data... classifications prescribed. Codes are prescribed for each operating element and service class. All traffic... that the enplanement/deplanement information be broken out into separate units called “on-flight market...

14 CFR Sec. 19-2 - Maintenance of data.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Classifications Sec. 19-2 Maintenance of data. (a) Each air carrier required to file Form 41 Schedule T-100 data... classifications prescribed. Codes are prescribed for each operating element and service class. All traffic... that the enplanement/deplanement information be broken out into separate units called “on-flight market...

[Beautiful girls' ugly malady--selected passages from the history of guilty sex and syphilis].

PubMed

Forrai, Judit

2008-10-05

In Budapest at the end of the 19th century, visiting brothels was an important part of night life, including the risk of some venereal disease (v.d.) like syphilis, the in-vogue illness of the age. The expansion of prostitution could be explained with the continuous growth of economy and social development as a consequence of urbanization. Prostitution has grown in innumerable forms, levels and places in order to meet all requirements since this was the only tolerated form of sexuality "out of homes". The police headquarters' duty was to control the observation of rules prescribed for prostitutes. Data and information were available only on registered "professional" prostitutes because references on hidden prostitution were hard to find. Liberalization of the strict rules and regalements on brothels and "staff" began at the time when the increase of prostitution and simultaneously, of syphilis overreached the capacity of the Police and the Health Care System.

27 CFR 46.107 - Penalty for failure to file return or to pay tax.

Code of Federal Regulations, 2010 CFR

2010-04-01

... before the date for filing prescribed in § 46.103 must pay, in addition to the tax, a delinquency penalty....109). The delinquency penalty for failure to file the return on or before the last date prescribed... during which the delinquency continues, but not more than 25 percent in the aggregate. (b) Failure to pay...

Laser-Heated Floating Zone Production of Single-Crystal Fibers

NASA Technical Reports Server (NTRS)

Ritzert, Frank; Westfall, Leonard

1996-01-01

This report describes how a laser-heated floating zone apparatus can be used to investigate single-crystal fibers of various compositions. A feedrod with a stoichiometric composition of high-purity powders was connected to a pedestal and fed into a laser scan where it combined with a single-crystal fiber seed. A molten zone was formed at this junction. As the feedrod was continuously fed into the laser scan, a single-crystal fiber of a prescribed orientation was withdrawn from the melt. The resultant fibers, whose diameters ranged from 100 to 250 gm, could then be evaluated on the basis of their growth behavior, physical properties, mechanical properties, and fiber perfection.

Conclusions: the future of antimicrobial therapy - Augmentin and beyond.

PubMed

Ball, Peter

2007-12-01

Since most infectious microorganisms inevitably develop resistance to any agents used to combat them, there has been a constant need to produce improved, more potent, antimicrobials. At least in part, the emergence and spread of resistant organisms has been provoked by inappropriate over-use of antibacterials. In the last decade, many fewer new antibacterials have been developed but overall prescribing has continued to increase. Consensus prescribing principles have now been defined with the aim of optimising therapy and preventing further increases in, or even to prompt a reduction in, the prevalence of resistance to antibacterial agents. Whilst it is important to encourage continued development of new classes of antibacterials, it is also vital to make the best use of available agents. The development of new dosages and formulations of amoxicillin/clavulanate allows this agent to continue to fill the important role in therapy which it has occupied, and continues to occupy, 25 years after it was launched.

Secondary preventive medication persistence and adherence 1 year after stroke.

PubMed

Bushnell, C D; Olson, D M; Zhao, X; Pan, W; Zimmer, L O; Goldstein, L B; Alberts, M J; Fagan, S C; Fonarow, G C; Johnston, S C; Kidwell, C; Labresh, K A; Ovbiagele, B; Schwamm, L; Peterson, E D

2011-09-20

Data on long-term use of secondary prevention medications following stroke are limited. The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry assessed patient, provider, and system-level factors influencing continuation of prevention medications for 1 year following stroke hospitalization discharge. Patients with ischemic stroke or TIA discharged from 106 hospitals participating in the American Heart Association Get With The Guidelines-Stroke program were surveyed to determine their use of warfarin, antiplatelet, antihypertensive, lipid-lowering, and diabetes medications from discharge to 12 months. Reasons for stopping medications were ascertained. Persistence was defined as continuation of all secondary preventive medications prescribed at hospital discharge, and adherence as continuation of prescribed medications except those stopped according to health care provider instructions. Of the 2,880 patients enrolled in AVAIL, 88.4% (2,457 patients) completed 1-year interviews. Of these, 65.9% were regimen persistent and 86.6% were regimen adherent. Independent predictors of 1-year medication persistence included fewer medications prescribed at discharge, having an adequate income, having an appointment with a primary care provider, and greater understanding of why medications were prescribed and their side effects. Independent predictors of adherence were similar to those for persistence. Although up to one-third of stroke patients discontinued one or more secondary prevention medications within 1 year of hospital discharge, self-discontinuation of these medications is uncommon. Several potentially modifiable patient, provider, and system-level factors associated with persistence and adherence may be targets for future interventions.

'It's showed me the skills that he has': pharmacists' and mentors' views on pharmacist supplementary prescribing.

PubMed

Lloyd, Fran; Parsons, Carole; Hughes, Carmel M

2010-02-01

Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers. The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n = 47) were invited to participate in focus groups, while mentors (n = 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison. Nine pharmacist focus groups were convened (number per group ranging from three to six; total n = 40) and 31 semi-structured interviews with mentors were conducted. The six main themes that emerged were optimal practice setting, professional progression for prescribing pharmacists, outcomes for prescribing pharmacists, mentors and patients, relationships, barriers to implementation and the future of pharmacist prescribing. Where practised, pharmacist prescribing had been accepted, worked best for chronic disease management, was perceived to have reduced doctors' workload and improved continuity of care for patients. However, three-quarters of pharmacists qualified to practise as supplementary prescribers were not actively prescribing, largely due to logistical and organisational barriers rather than inter-professional tensions. Independent prescribing was seen as contentious by mentors, particularly because of the diagnostic element. Supplementary prescribing has been successful where it has been implemented but a number of barriers remain which are preventing the wider acceptance of this practice innovation.

48 CFR 1353.200 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... keyed to the parts of the CAR in which the form usage requirements are addressed. ... Section 1353.200 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CLAUSES AND FORMS FORMS Prescription of Forms 1353.200 Scope of subpart. This subpart prescribes or references DOC forms for use in...

Heroin and methadone prescriptions from a London drug clinic over the first 15 years of operation (1968-1983): old records examined.

PubMed

Strang, John; Sheridan, Janie

2006-01-01

We charted changes in the prescriptions issued to opiate addicts in treatment at a London clinic over the first 15 years of operation of one of the new National Health Service (NHS) drug clinics established in 1968. Having located the original handwritten ledger records of prescriptions issued by the drug addict treatment clinic, an SPSS data file was created of the prescriptions given to each of the clinic patients each month over the period 1968-1983 to permit examination of changes over this 15-year period in the drugs prescribed (e.g., heroin, methadone), the form (e.g., injectable or oral), the daily doses, and the extent of multiple items for single patients (e.g., both injectable ampule and oral forms). For each month, a list was available of all current patients detailing which drug(s) they had received during that month, in what form(s) and what dose(s). These items were the basic units of study. We report changes over the 15-year period for which the data were available. For the first 5 years, more than half of the prescriptions were for heroin (diamorphine hydrochloride), with the remainder of the prescriptions mostly comprising oral methadone. After 1973, methadone ampules for injection were increasingly commonly prescribed and thereafter remained at about a quarter of the prescriptions for the remaining 10 years for which data are available, whereas heroin prescriptions declined over the mid-1970s to only 20%. From 1973 onward, oral methadone was increasingly prescribed, rising from approximately one third of prescriptions in the early 1970s to more than two thirds by the early 1980s. Individual patients often received more than one drug or form of drug: From 1969 onward, oral methadone was commonly prescribed as a supplement to heroin prescriptions. This same practice was widespread with prescriptions for methadone ampules prescribed as a supplement to heroin prescriptions. Daily doses of heroin were at a mean of from 160 to 540 mg, in contrast with means of 20 to 40 mg and 25 to 50 mg daily for the injectable methadone ampules and the oral methadone solution, respectively. Major changes occurred in the prescribing practices of this London drug clinic over the first 15 years of operation of the new NHS clinics. However, these changes did not occur overnight and can be seen to have been gradual evolutions of practice with the preservation of heroin prescription through the first 5 years and the subsequent move to increased prescribing of injectable methadone, with both these practices being overtaken by the subsequent increased prominence of oral methadone syrup as the main drug prescribed. Reference to the original records reveals a more interesting picture than might be evident from the potentially selective recall of contemporary or historical commentators.

7 CFR 1955.51 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE... REGULATIONS (CONTINUED) PROPERTY MANAGEMENT Management of Property § 1955.51 Purpose. This subpart delegates authority and prescribes policies and procedures for the Rural Housing Service (RHS), Rural Business...

Attitudes of physicians and pharmacists towards International Non-proprietary Name prescribing in Belgium.

PubMed

Van Bever, Elien; Elseviers, Monique; Plovie, Marijke; Vandeputte, Lieselot; Van Bortel, Luc; Vander Stichele, Robert

2015-03-01

International Non-proprietary Name (INN) prescribing is the use of the name of the active ingredient(s) instead of the brand name for prescribing. In Belgium, INN prescribing began in 2005 and a major policy change occurred in 2012. The aim was to explore the opinions of Dutch-speaking general practitioners (GPs) and pharmacists. An electronic questionnaire with 39 five-point Likert scale statements and one open question was administered in 2013. Multivariate analysis was performed with multiple linear regression on a sum score for benefit statements and for drawback statements. Answers to the open question were qualitatively analysed. We received 745 valid responses with a representable sample for both subgroups. Participants perceived the motives to introduce INN prescribing as purely economic (to reduce pharmaceutical expenditures for the government and the patient). Participants accepted the concept of INN prescribing, but 88% stressed the importance of guaranteed treatment continuity, especially in older, chronic patients, to prevent patient confusion, medication non-adherence and erroneous drug use. In conclusion, the current way in which INN prescribing is applied in Belgium leads to many concerns among primary health professionals about patient confusion and medication adherence. Slightly adapting the current concept of INN prescribing to these concerns can turn INN prescribing into one of the major policies in Belgium to reduce pharmaceutical expenditures and to stimulate rational drug prescribing. © 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Pharmacoepidemiology of testosterone: Curbing off-label prescribing.

PubMed

Handelsman, David J

2017-10-01

To estimate the impact of the first year of new Pharmaceutical Benefits Scheme (PBS) prescribing criteria that dictate eligibility for national health scheme subsidy of testosterone prescribing. Analysis of cumulative PBS data. Retrospective analysis of testosterone prescribing from PBS data. Nil MAIN OUTCOME MEASURES: PBS expenditure analysed by total expenditure, by state, and by product type as well as the age, indication, and prescriber type for new testosterone treatment. Total PBS expenditure continued to exceed $20 million in 2014 before declining from 2015 with changes that were uniform by state and product type. Prior to 2015, over 80% were for men aged over 40 years of age for low circulating testosterone in the absence of reproductive system disorders ("Low T") initiated by GPs. From 2015, these features were markedly reduced without changing the numbers of new prescriptions for pathological reproductive disorders or specialist initiations. The short-term impact of 2015 PBS criteria showed highly effective and well-targeted curbing of off-label testosterone prescribing. The findings indicate that the main driver for the recent upsurge in testosterone prescribing was treatment of middle-aged men for "Low T" initiated by GPs. © 2017 Government of New South Wales. Pharmacoepidemiology & Drug Safety © 2017 John Wiley & Sons Ltd.

49 CFR 191.19 - Report forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... forms. Copies of the prescribed report forms are available without charge upon request from the address... 49 Transportation 3 2010-10-01 2010-10-01 false Report forms. 191.19 Section 191.19 Transportation... size and kind of paper. In addition, the information required by these forms may be submitted by any...

48 CFR 453.200 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... same order as, and keyed to, the parts of the AGAR in which the form usage requirements are addressed. ... Section 453.200 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE CLAUSES AND FORMS FORMS Prescription of Forms 453.200 Scope of subpart. This subpart prescribes USDA (AD) forms for use in acquisition...

48 CFR 653.200 - Scope of subpart.

Code of Federal Regulations, 2010 CFR

2010-10-01

... same order as and keyed to the parts of the DOSAR in which the form usage requirements are addressed. ... Section 653.200 Federal Acquisition Regulations System DEPARTMENT OF STATE CLAUSES AND FORMS FORMS Prescription of Forms 653.200 Scope of subpart. This subpart prescribes or references optional and DOS forms...

77 FR 61400 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-09

... military imagery as part of their standard operating procedure. The completed form allows the respondents... and equipment for commercial purposes. The form prescribes processes/standards that have been...

Antimicrobial use in paediatric patients in a teaching hospital in Ethiopia

PubMed Central

Kebede, Hafte Kahsay; Gesesew, Hailay Abrha; Woldehaimanot, Tewodros Eyob; Goro, Kabaye Kumela

2017-01-01

Background Antibiotics use in in children are different from adults due to a lack of data on pharmacokinetics, pharmacodynamics, efficacy and safety of drugs, different physiological spectrum, pediatrics populations being vulnerable to the majority of the illnesses, and the adverse effect of their irrational use is more serious. However, antibiotic use is not explored much in a paediatric population. The current study focused on antibiotic use among pediatric population using data from a tertiary hospital in Ethiopia. Methods A retrospective cross-sectional study collated data from 614 pediatrics patients admitted in pediatrics ward at Jimma University Teaching Hospital, Southwest Ethiopia. Descriptive analyses were performed to describe the type and pattern of antibiotics. The number of prescriptions per a patient was also compared with the WHO standard. Data analysis was carried out using SPSS version 20 for mackintosh. Results Antimicrobials were prescribed for 407(86.4%) patients of which 85.9% were in the form of injectables. A total of 1241 (90%) medicines were administered parenterally followed by oral 110 (8%). The maximum number of medicines per prescription was eight for all types of drugs in general, and five for antimicrobials in particular. All antimicrobials were prescribed empirically without any microbiological evidence. Pneumonia, sepsis and meningitis were the main reasons for antimicrobial use in the ward. Out of the total of 812 antibiotics prescribed; Penicillin G crystalline was the most (20%) frequently prescribed, followed by gentamicin (19%) and ampicillin (16). Conclusions Majority of the prescribed antibiotics were antimicrobials, and was in the form of injectables. Antimicrobials were over prescribed and the number of drugs per prescription was also far from WHO recommendation. Strict prescribing standard guidelines and treatment habits should be developed in the country, to prevent antimicrobial resistance. PMID:28264021

48 CFR 53.236-1 - Construction.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Construction. 53.236-1... AND FORMS FORMS Prescription of Forms 53.236-1 Construction. The following forms are prescribed, as stated below, for use in contracting for construction, alteration, or repair, or dismantling, demolition...

48 CFR 53.236-1 - Construction.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Construction. 53.236-1... AND FORMS FORMS Prescription of Forms 53.236-1 Construction. The following forms are prescribed, as stated below, for use in contracting for construction, alteration, or repair, or dismantling, demolition...

48 CFR 53.236-1 - Construction.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Construction. 53.236-1... AND FORMS FORMS Prescription of Forms 53.236-1 Construction. The following forms are prescribed, as stated below, for use in contracting for construction, alteration, or repair, or dismantling, demolition...

48 CFR 53.236-1 - Construction.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Construction. 53.236-1... AND FORMS FORMS Prescription of Forms 53.236-1 Construction. The following forms are prescribed, as stated below, for use in contracting for construction, alteration, or repair, or dismantling, demolition...

48 CFR 53.236-1 - Construction.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Construction. 53.236-1... AND FORMS FORMS Prescription of Forms 53.236-1 Construction. The following forms are prescribed, as stated below, for use in contracting for construction, alteration, or repair, or dismantling, demolition...

48 CFR 53.245 - Government property.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Government property. 53...) CLAUSES AND FORMS FORMS Prescription of Forms 53.245 Government property. The following forms are prescribed, as specified in this section, for use in reporting, reutilization, and disposal of Government...

48 CFR 53.245 - Government property.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Government property. 53...) CLAUSES AND FORMS FORMS Prescription of Forms 53.245 Government property. The following forms are prescribed, as specified in this section, for use in reporting, reutilization, and disposal of Government...

48 CFR 53.245 - Government property.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Government property. 53...) CLAUSES AND FORMS FORMS Prescription of Forms 53.245 Government property. The following forms are prescribed, as specified in this section, for use in reporting, reutilization, and disposal of Government...

48 CFR 53.245 - Government property.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Government property. 53...) CLAUSES AND FORMS FORMS Prescription of Forms 53.245 Government property. The following forms are prescribed, as specified in this section, for use in reporting, reutilization, and disposal of Government...

48 CFR 53.245 - Government property.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Government property. 53...) CLAUSES AND FORMS FORMS Prescription of Forms 53.245 Government property. The following forms are prescribed, as specified in this section, for use in reporting, reutilization, and disposal of Government...

Medication prescription: a pilot survey of Bernese doctors of chiropractic practicing in Switzerland.

PubMed

Wangler, Martin; Zaugg, Beatrice; Faigaux, Eric

2010-01-01

The purpose of this survey was to assess the use of and the attitude toward prescribing medication among doctors of chiropractic in 1 of 26 Swiss cantons. A Likert scale electronic questionnaire was sent to licensed doctors of chiropractic of the canton of Berne (n = 47). Percentages, mean values, and standard deviations were calculated. A follow-up survey was used to assess comments from the main survey. A probability value of P < .05 indicated a statistically significant difference. The response rate was 77%. Forty-one percent of the respondents stated that medications are a necessary component of the chiropractic treatment. Although 92% actively prescribe medication at least once a week, this is significantly less than asked for by their patients (P < .01). Seventy-two percent of the doctors of chiropractic rated the present privilege to prescribe nonprescription medications as an advantage for chiropractic care. Fifty-eight percent thought that chiropractic should aim at expanding the options of nonsteroidal anti-inflammatory drugs, analgesics, and muscle relaxants that can be prescribed. Ninety-one percent agreed on continuing education in pharmacology. Despite prescribing medication at least once a week, less than half of Bernese doctors of chiropractic perceived medications as a necessary component of their treatment, mainly using them to help patients who cannot sleep because of pain and to speed up recovery. When asked if they would be allowed to prescribe medications of the "B-list," the majority would want structured continuing education. Limited medication prescription was judged as an advantage for the chiropractic profession by this group of survey participants. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Relationship Between Medication Adherence and Distance to Dispensing Pharmacies and Prescribers Among an Urban Medicaid Population with Diabetes Mellitus.

PubMed

Syed, Samina T; Sharp, Lisa K; Kim, Yoonsang; Jentleson, Adam; Lora, Claudia M; Touchette, Daniel R; Berbaum, Michael L; Suda, Katie J; Gerber, Ben S

2016-06-01

To determine whether a relationship exists between medication adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and distance to dispensing pharmacies and prescribers among an urban public aid population with diabetes mellitus. Retrospective cohort study using claims data. Illinois Department of Healthcare and Family Services database. A total of 6532 patients aged 18-64 years with diabetes who had at least one prescription fill for an ACEI or ARB and had continuous Medicaid coverage in the greater Chicago area in 2009. We assessed medication adherence, defined as proportion of days covered (PDC) of 0.8 or higher, to ACEIs and ARBs and its association with distances between patients and their pharmacies and prescribers. Of the 6532 patients included in the analyses, 2930 (45%) had PDC levels of 0.8 or higher. No significant differences were observed between patients who were adherent versus those who were nonadherent in distance to pharmacy (median 1.39 vs 1.35 miles, p=0.15) or distance to prescriber (median 4.39 vs 4.48 miles, p=0.80). In a multivariate regression model including age, sex, race/ethnicity, number of pharmacies, number of prescribers, distance to pharmacy, and distance to prescriber, a greater number of prescribers was associated with higher adherence (two prescribers vs one prescriber: odds ratio [OR] 1.396, 95% confidence interval [CI] 1.233-1.580; three or more prescribers vs one prescriber: OR 2.208, 95% CI 1.787-2.727). ACEI or ARB adherence was not associated with distances to pharmacies and prescribers. © 2016 Pharmacotherapy Publications, Inc.

Simvastatin prescribing patterns before and after FDA dosing restrictions: a retrospective analysis of a large healthcare claims database.

PubMed

Tuchscherer, Rhianna M; Nair, Kavita; Ghushchyan, Vahram; Saseen, Joseph J

2015-02-01

Muscle-related events, or myopathies, are a commonly reported adverse event associated with statin use. In June 2011, the US FDA released a Drug Safety Communication that provided updated product labeling with dosing restrictions for simvastatin to minimize the risk of myopathies. Our objective was to describe prescribing patterns of simvastatin in combination with medications known to increase the risk of myopathies following updated product labeling dosing restrictions in June 2011. A retrospective observational analysis was carried out, in which administrative claims data were utilized to identify prescribing patterns of simvastatin in combination with calcium channel blockers (CCBs) and other pre-specified drug therapies. Prescribing patterns were analyzed on a monthly basis 24 months prior to and 9 months following product label changes. Incidence of muscle-related events was also analyzed. In June 2011, a total of 60% of patients with overlapping simvastatin-CCB claims and 94% of patients with overlapping simvastatin-non-CCB claims were prescribed an against-label combination. As of March 2012, a total of 41% and 93% of patients continued to be prescribed against-label simvastatin-CCB and simvastatin-non-CCB combinations, respectively. The most commonly prescribed dose of simvastatin was 20 mg (39%). Against-label combinations were most commonly prescribed at a simvastatin dose of 40 mg (56%). Amlodipine was the most commonly prescribed CCB in combination with simvastatin (70%) and the most common CCB prescribed against-label (67%). Despite improvements in prescribing practices, many patients are still exposed to potentially harmful simvastatin combinations. Aggressive changes in simvastatin prescribing systems and processes are needed to improve compliance with FDA labeling to improve medication and patient safety.

26 CFR 1.410(b)-1 - Minimum coverage requirements (before 1994).

Code of Federal Regulations, 2011 CFR

2011-04-01

... (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus Plans, Etc... the minimum age and service requirements (if any) prescribed by the plan, as of the date coverage is... employees (including employees who do not satisfy the minimum age or service requirements of the plan) are...

Audits of antibiotic prescribing in a Bristol hospital.

PubMed Central

Swindell, P J; Reeves, D S; Bullock, D W; Davies, A J; Spence, C E

1983-01-01

Audits of antibiotic prescribing were done for periods of up to eight weeks in two successive years on medical, surgical, orthopaedic, gynaecology, obstetric, and urology wards and in an accident and emergency department. Clinical details were matched with antibiotic prescribing, and the appropriateness of the latter was judged independently by two medical microbiologists. Only when they agreed was an individual prescription included in the analysis. Overall, 28% of prescriptions in 1979 and 35% in 1980 were judged as unnecessary, with 17% and 16%, respectively, being for inappropriate choices of antibiotic. An educational programme about antibiotic prescribing carried out between the audits had no beneficial effect overall. Though the results compared favourably with those of audits published, prescribing could still be much improved. To judge by the failure of education, however, this might be difficult to achieve. Most prescriptions were written by junior staff, who in the absence of guidance from their seniors and because of their frequent moves would require a widespread and continual education programme. Published concern about the quality of antibiotic prescribing appears to be justified. PMID:6401484

Nurse prescribing: reflections on safety in practice.

PubMed

Bradley, Eleanor; Hynam, Brian; Nolan, Peter

2007-08-01

This qualitative study explores how recently qualified nurse prescribers describe, and rate, the safety of their prescribing. Internationally, the costs of drug errors are enormous and they can have serious implications for staff and patients. Nurses are now undertaking extended prescribing practice throughout the UK. Nurse prescribers work across different work settings and although safe prescribing is a priority in all of them, it is essential to ascertain the conditions that foster the highest levels of safety and how nurses can be supported in practice. Thirty-one nurses form the West Midlands area of England agreed to participate in an in-depth interview which sought to elicit their responses to various aspects of their prescribing work. They came from a variety of specialities and from hospital, community and general practice backgrounds. On completion of their training nurses were acutely aware of the responsibility that prescribing imposed on them. Although this awareness was thought to encourage caution and safety, it may also account for the fact that 26% of the nurses (n=8) had not prescribed since qualifying. Nurses felt that the multidisciplinary team had a vital role to play in supporting their prescribing practice as did collaborative working. It is concluded that those working in specialty areas that are less well-defined in terms of scope of practice (e.g. older adult nursing and learning disability) would benefit in particular from ongoing mentoring relationships with experienced prescribers and the development of individual formularies.

7 CFR 1724.70 - Standard forms of contracts for borrowers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC ENGINEERING, ARCHITECTURAL SERVICES AND DESIGN POLICIES AND... construction, procurement, engineering services, and architectural services financed by a loan made or... prescribes RUS procedures in promulgating electric program standard contract forms and identifies those forms...

Can we influence prescribing patterns?

PubMed

Sbarbaro, J A

2001-09-15

A variety of programming techniques and methods of training have been employed to change physician behavior. Didactic continuing medical education lectures and clinical guidelines have had minimal impact, although endorsement of national professional guidelines by local opinion leaders appears to have a positive influence on the impact of professional guidelines. Interactive, hands-on workshops, performance reporting, and peer/patient feedback are also effective. Changing prescribing habits has been equally difficult. Drug utilization letters involving both pharmacist and physician have more impact than do letters sent only to the physician. Academic detailing, when properly executed, has been consistently effective. When combined with these strategies, closed formularies become a powerful tool in changing prescribing behavior.

Use pattern for contraceptive implants in Norway.

PubMed

Øvre-Eide, Vigdis; Skjeldestad, Finn Egil

2016-11-01

Knowledge about global use patterns of contraceptive implants is limited. This study aims to describe implant use patterns from a user and a prescriber perspective. In a cross-sectional design, we estimated the annual number of users by calculating doses sold per 1000 women-years in the Norwegian Prescription Database for 2006-2012. For each contraceptive method, we calculated on an annual basis a proportion of defined daily doses of all hormonal contraceptives in five-year age groups. Data were analyzed in SPSS version 22, using chi-square test, t-test, and survival analysis. Sales from pharmacies for contraceptive implants more than doubled over the study years and were consistently higher in the younger age groups. The collection rate was 9.3 per 1000 women in 2012, when implant sales amounted to 2.4% of all daily doses of hormonal contraceptives sold. General practitioners and doctors with no specialty were the major prescribers to those starting to use contraceptive implants (starters), whereas gynecologists prescribed nearly 12% of the volume, with a higher proportion to women >35 years of age than younger women. The cumulative proportions of continued users at 6, 12, 24, and 36 months were 96.1, 78.6, 51.9, and 34.9%, respectively, significantly lower for users who had prescribing doctors with no specialty. At end of the first expiration period, 21% of starters continued using implants. Implants play a minor role in the overall use of hormonal contraception in Norway. One in five starters continue as long-term users. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program.

PubMed

Alford, Daniel P; Zisblatt, Lara; Ng, Pamela; Hayes, Sean M; Peloquin, Sophie; Hardesty, Ilana; White, Julie L

2016-01-01

Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

47 CFR 69.310 - Capital leases.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Capital leases. 69.310 Section 69.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES... prescribed for similar plant costs or shall be apportioned in the same manner as Account 2001. ...

47 CFR 69.310 - Capital leases.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Capital leases. 69.310 Section 69.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES... prescribed for similar plant costs or shall be apportioned in the same manner as Account 2001. ...

32 CFR 631.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Purpose. 631.1 Section 631.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL....1 Purpose. This part prescribes uniform policies and procedures for the establishment, and operation...

40 CFR 142.22 - Review of State variances, exemptions and schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Review of...) Not later than 18 months after the effective date of the interim national primary drinking water... (and schedules prescribed pursuant thereto) by the States with primary enforcement responsibility...

48 CFR 1553.209-71 - EPA Form 1900-27, Project Officer's Evaluation of Contractor Performance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Officer's Evaluation of Contractor Performance. 1553.209-71 Section 1553.209-71 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY CLAUSES AND FORMS FORMS Prescription of Forms 1553.209-71 EPA Form 1900-27, Project Officer's Evaluation of Contractor Performance. As prescribed in 1509.170-4...

Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

PubMed

Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

2009-11-01

Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

Safe prescribing: a titanic challenge

PubMed Central

Routledge, Philip A

2012-01-01

The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

Pediatricians' beliefs and prescribing patterns of adolescent contraception: a provider survey.

PubMed

Swanson, K J; Gossett, D R; Fournier, M

2013-12-01

Teen pregnancy and sexually transmitted infection (STI) rates continue to be significant public health problems in the United States. While general pediatricians are in a unique position to improve these issues by addressing contraception with their adolescent patients, there are no data describing their current prescribing patterns. This study sought to elucidate the beliefs and prescribing patterns of general pediatricians and pediatrics residents and to distinguish whether these were affected by practice setting, level of training, or gender. General pediatricians and pediatrics residents affiliated with Lurie Children's Hospital in Chicago, IL, were asked to complete a survey regarding adolescent contraception. Questions were related to obtaining information about contraception, contraceptive counseling, knowledge of contraceptive methods, prescribing patterns of contraceptives, and concerns about individual contraceptive methods. 120 physicians of an eligible 411 physicians participated in this study (29%). 79% of participants had prescribed at least 1 contraceptive method. The most commonly prescribed method was oral contraceptive pills at 72%. We noted few differences in prescribing patterns based on above criteria. Numerous misconceptions existed among participants, including a high rate of concern about infertility with IUD use (29% among physicians who prescribed at least 1 method of contraception). General pediatricians can improve their rates of prescribing contraception to adolescents, and could utilize more of the approved methods. One way to do so may be to implement educational interventions among general pediatricians. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Dispatch from the non-HITECH-incented Health IT world: electronic medication history adoption and utilization.

PubMed

Gabriel, Meghan Hufstader; Smith, Jaime Y; Sow, Max; Charles, Dustin; Joseph, Seth; Wilkins, Tricia Lee

2016-05-01

To document national trends of electronic medication history use in the ambulatory setting and describe the characteristics and predicting factors of providers who regularly use medication history transaction capabilities through their e-prescribing systems. The study used provider-initiated medication history data requests, electronically sent over an e-prescribing network from all 50 states and the District of Columbia. Data from 138,000 prescribers were evaluated using multivariate analyses from 2007 to 2013. Medication history use showed significant growth, increasing from 8 to 850 million history requests during the study period. Prescribers on the network for <5 years had a lower likelihood of requests than those on the network for 5 or more years. Although descriptive analyses showed that prescribers in rural areas were alongside e-prescribing, and requesting medication histories more often than those in large and small cities, these findings were not significant in multivariate analyses. Providers in orthopedic surgery and internal medicine had a higher likelihood of more requests than family practice prescribers, with 12% and 7% higher likelihood, respectively. Early adopters of e-prescribing have remained medication history users and have continually increased their volume of requests for medication histories. Despite the fact that the use of medication histories through e-prescribing networks in the ambulatory care setting has not been encouraged through federal incentive programs, there has been substantial growth in the use of medication histories offered through e-prescribing networks. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Evaluation of a medication order writing standards policy in a regional health authority.

PubMed

Raymond, Colette B; Sproll, Barbara; Coates, Jan; Woloschuk, Donna M M

2013-09-01

The Winnipeg Regional Health Authority (WRHA) implemented a medication order writing standards (MOWS) policy (including banned abbreviations) to improve patient safety. Widespread educational campaigns and direct prescriber feedback were implemented. We audited orders within the WRHA from 2005 to 2009 and surveyed all WRHA staff in 2011 about the policy and suggestions for improving education and compliance. Overall, orders containing banned abbreviations, acronyms or symbols numbered 2261/8565 (26.4%) preimplementation. After WRHA-wide didactic education, the proportion declined to 1358/5461 (24.9%) (p = 0.043) and then, with targeted prescriber feedback, to 1186/6198 (19.1%) (p < 0.0001). A survey of 723 employees showed frequent violations of the MOWS, despite widespread knowledge of the policy. Respondents supported ongoing efforts to enforce the policy within the WRHA. Nonprescribers were significantly more likely than prescribers to agree with statements regarding enhancing compliance by defining prescriber/transcriber responsibilities and placing sanctions on noncompliant prescribers. Education, raising general awareness and targeted feedback to prescribers alone are insufficient to ensure compliance with MOWS policies. WRHA staff supported ongoing communication, improved tools such as compliant preprinted orders and reporting and feedback about medication incidents. A surprising number of respondents supported placing sanctions on noncompliant prescribers. Serial audits and targeted interventions such as direct prescriber feedback improve prescription quality in inpatient hospital settings. Education plus direct prescriber feedback had a greater impact than education alone on improving compliance with a MOWS policy. Future efforts at the WRHA to improve compliance will require an expanded focus on incentives, resources and development of action plans that involve all affected staff, not just prescribers. Plans include continued advertising, MOWS summaries in all charts, all-staff education, reminders and exploration of sustainable interventions for targeted feedback for prescribers.

Utility of routinely acquired primary care data for paediatric disease epidemiology and pharmacoepidemiology

PubMed Central

Helms, Peter J; Daukes, Suzie Ekins; Taylor, Michael W; Simpson, Colin R; McLay, James S

2005-01-01

Background The majority of medicines prescribed for children are prescribed in primary care for common acute and chronic conditions. This is in contrast to prescribing in secondary care where the population of children admitted is small but where a large number of different medicines are prescribed to treat more serious and less common conditions. Methods Data on prescribing was extracted from the General Practice Administration System for Scotland (GPASS) for the year November 1999 to October 2000 and prescribing patterns for children aged 0–16 years expressed as percentages. A comparison of age specific consultations for asthma, as an example of a common paediatric condition, was also made between two separate general practice data sets, the General Practice Research Database (GRPD) and the continuous morbidity recording (CMR) subset of GPASS. Results Of 214 medicines investigated for unlicensed and off-label prescribing no unlicensed prescribing was identified. Off-label prescribing due to age was most common among younger and older children. The most common reasons for off-label prescriptions were, in order of frequency, lower than recommended dose, higher than recommended dose, below the recommended age, and unlicensed formulation. Age and gender specific consultations for asthma were similar in the two representative databases, GPRD and CMR, both showing disappearance of the male predominance in the teenage years. Conclusions Large primary care data sets available within a unified health care system such as the UK National Health Service (NHS) are likely to be broadly compatible and produce similar results. The prescribing of off-label medicines to children is common in primary care, most commonly due to prescribing out with the recommended dosage regimen. PMID:15948933

Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

PubMed Central

Johnson, Chris F; Macdonald, Hector J; Atkinson, Pauline; Buchanan, Alasdair I; Downes, Noreen; Dougall, Nadine

2012-01-01

Background Antidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses. Aim To review general practice patients prescribed the same antidepressant long-term (≥2 years) and evaluate prescribing and management pre and post-review. Design and setting Prospective observational cohort study using routine data from 78 urban general practices, Scotland. Method All patients prescribed antidepressants (excluding amitriptyline) for ≥2 years were identified from records November 2009 to March 2010. GPs selected patients for face-to-face review of clinical condition and medication, December 2009 to September 2010. Pre- and post-review data were collected; average antidepressant doses and changes in prescribed daily doses were calculated. Onward referral to support services was recorded. Results 8.6% (33 312/388 656) of all registered patients were prescribed an antidepressant, 47.1% (15 689) were defined as long-term users and 2849 (18.2%) were reviewed. 811 (28.5%) patients reviewed had a change in antidepressant therapy: 7.0% stopped, 12.8% reduced dose, 5.3% increased dose, and 3.4% changed antidepressant, resulting in 9.5% (95% CI = 9.1% to 9.8% P<0.001) reduction in prescribed daily dose and 8.1% reduction in prescribing costs. 6.3% were referred onwards, half to NHS Mental Health Services. Pre-review SSRI doses were 10–30% higher than previously reported. Conclusion Almost half of all people prescribed antidepressants were long-term users. Appropriate reductions in prescribing can be achieved by reviewing patients. Higher SSRI doses may be contributing to current antidepressant growth. PMID:23211181

Influence of Qualification and Practice Settings of Dental Practitioners on Antimicrobial Prescribing in Delhi and National Capital Region, India

PubMed Central

Wasan, Himika; Gupta, Pooja; Mathur, Apoorva; Mutneja, Ekta; Mathur, Vijay Prakash; Gupta, Yogendra Kumar

2017-01-01

Background and Objectives: Inappropriate antimicrobial prescribing is highly reported in dentistry. The objective of the study was to see the effect of dental qualification and practice settings on antimicrobial prescribing practices among dental practitioners in Delhi and National Capital Region (NCR) of India. Materials and Methods: A self-designed and pretested questionnaire was given to 667 dental practitioners holding degrees of graduation, postgraduation, and those pursuing postgraduation, working in academic institutions and private clinics in NCR of India. Data were analyzed using statistical software Stata version 12.0. Chi-square and logistic regression tests were used for analysis. Results: Out of total 539 responded, 66.4% of the practitioners prescribed by brand name and 27.8% by generic name. Amoxicillin + clavulanic acid (27.4%) was the first choice. Only 26% of the practitioners asked for antimicrobial susceptibility testing. Space infections (91.9%), impacted third molar extractions (89.7%), and periodontal abscess (88.1%) were the conditions where antimicrobials were most frequently prescribed. However, 60.9% and 53.3% of the practitioners also prescribed antimicrobials for acute pulpitis and dry socket, respectively. For prophylaxis in medical conditions, amoxicillin was the first choice. In case of history of allergy to penicillin, 52.3% of the practitioners prescribe erythromycin whereas 14.6% prescribe amoxicillin. The adverse drug reporting culture was negligible, and only 14.3% of the practitioners were aware of the Pharmacovigilance Program of India. Level of qualification had a significant effect on prescribing (P < 0.05). Interpretation and Conclusion: Frequent irrational prescribing of antimicrobials used in odontogenic conditions warrants an urgent and continued need for guidelines as well as educational intervention programs in dentistry. This will improve the quality of antimicrobial prescribing practices in dentistry. PMID:28781493

Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine

PubMed Central

Acheampong, Paul; Cooper, Gill; Khazaeli, Behshad; Lupton, David J; White, Sue; May, Margaret T; Thomas, Simon H L

2013-01-01

Aims To ascertain the effects of the Medicines and Healthcare products Regulatory Agency's (MHRA) safety update in June 2010 on the volume of prescribing of quinine and on indices of quinine toxicity. Methods We analysed quarterly primary care total and quinine prescribing data for England and quinine prescribing volume for individual Primary Care Trusts in the North East of England from 2007/8 to 2011/12 obtained from the ePACT.net database. We also analysed quinine toxicity enquiries to the National Poisons Information Service (NPIS) via Toxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and Pearson's correlation tests were used to ascertain changes in trends in prescribing and indices of toxicity and associations between prescribing and indices of toxicity, respectively. Results Total prescribing continued to increase, but annual growth in quinine prescribing in England declined from 6.0 to −0.6% following the MHRA update [difference −0.04 (95% confidence interval −0.07 to −0.01) quinine prescriptions per 100 patients per quarter, P = 0.0111]. Much larger reductions were observed in Primary Care Trusts that introduced comprehensive prescribing reviews. The previously increasing trend in Toxbase® quinine searches was reversed [difference −19.76 (95% confidence interval −39.28 to −9.20) user sessions per quarter, P = 0.0575]. Telephone enquiries to NPIS for quinine have declined, with stabilization of the proportion of moderate to severe cases of quinine poisoning since the update. Conclusions The MHRA advice was followed by limited reductions in the growth in quinine prescribing and in indicators of quinine overdose and toxicity. Quinine prescribing, however, remains common, and further efforts are needed to reduce availability and use. PMID:23594200

48 CFR 452.228-70 - Alternative Forms of Security.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Alternative Forms of Security. 452.228-70 Section 452.228-70 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE... Alternative Forms of Security. As prescribed in 428.204-2, insert the following provision: Alternative Forms...

48 CFR 1253.245-70 - Report of Government property.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Report of Government... TRANSPORTATION CLAUSES AND FORMS FORMS Prescription of Forms 1253.245-70 Report of Government property. The following form is prescribed for use by contractors to report Government property, as specified in (TAR) 48...

48 CFR 1253.245-70 - Report of Government property.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Report of Government... TRANSPORTATION CLAUSES AND FORMS FORMS Prescription of Forms 1253.245-70 Report of Government property. The following form is prescribed for use by contractors to report Government property, as specified in (TAR) 48...

48 CFR 1253.245-70 - Report of Government property.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Report of Government... TRANSPORTATION CLAUSES AND FORMS FORMS Prescription of Forms 1253.245-70 Report of Government property. The following form is prescribed for use by contractors to report Government property, as specified in (TAR) 48...

17 CFR 301.0-1 - Availability of forms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... A to Part 285 FORMS, SECURITIES INVESTOR PROTECTION CORPORATION § 301.0-1 Availability of forms. The forms prescribed for use under the Securities Investor Protection Act of 1970, as amended, (the “Act... may be obtained upon request to, as appropriate, the Securities Investor Protection Corporation (“SIPC...

49 CFR 387.313 - Forms and procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... BMC 90, with the specific amounts of underlying and limits of coverage shown thereon or appended thereto, and Form BMC 91X certificate is required of each insurer. **Note: See Note for Rule 387.311. Also... (b)(2), a separate Department of Transportation prescribed form endorsement and Form BMC 91X...

17 CFR 239.0-1 - Availability of forms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... F Street, NE, Washington, DC 20549. Any persons may inspect the forms at this address and at the... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Availability of forms. 239.0-1 Section 239.0-1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED...

Physicians' medication prescribing in primary care . in Riyadh City, Saudi Arabia. Literature review, part 3: prescribing errors.

PubMed

Qureshi, N A; Neyaz, Y; Khoja, T; Magzoub, M A; Haycox, A; Walley, T

2011-02-01

Medication errors are globally huge in magnitude and associated with high morbidity and mortality together with high costs and legal problems. Medication errors are caused by multiple factors related to health providers, consumers and health system, but most prescribing errors are preventable. This paper is the third of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews the etiology, prevention strategies, reporting mechanisms and the myriad consequences of medication errors.

The Need for Specialty Curricula Based on Core Competencies: A White Paper of the Conjoint Committee on Continuing Medical Education

ERIC Educational Resources Information Center

Jackson, Marcia J.; Gallis, Harry A.; Gilman, Stuart C.; Grossman, Michael; Holzman, Gerald B.; Marquis, Damon; Trusky, Sandra K.

2007-01-01

At present there is no curriculum to guide physician lifelong learning in a prescribed, deliberate manner. The Conjoint Committee on Continuing Medical Education, a group representing 16 major stakeholder organizations in continuing medical education, recommends that each specialty society and corresponding board reach consensus on the…

Genetics Home Reference: warfarin sensitivity

MedlinePlus

... it thins the blood, preventing blood clots from forming . Warfarin is often prescribed to prevent blood clots ... much drug to prevent clots because their clot forming process is already slower than average and can ...

48 CFR 53.105 - Computer generation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Computer generation. 53...) CLAUSES AND FORMS FORMS General 53.105 Computer generation. (a) Agencies may computer-generate the... be computer generated by the public. Unless prohibited by agency regulations, forms prescribed by...

48 CFR 53.105 - Computer generation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Computer generation. 53...) CLAUSES AND FORMS FORMS General 53.105 Computer generation. (a) Agencies may computer-generate the... be computer generated by the public. Unless prohibited by agency regulations, forms prescribed by...

Biogenic Aldehydes as Therapeutic Targets for Cardiovascular Disease

PubMed Central

Nelson, Margaret-Ann M; Baba, Shahid P; Andersonc, Ethan J

2017-01-01

Aldehydes are continuously formed in biological systems through enzyme-dependent and spontaneous oxidation of lipids, glucose, and primary amines. These highly reactive, biogenic electrophiles can become toxic via covalent modification of proteins, lipids and DNA. Thus, agents that scavenge aldehydes through conjugation have therapeutic value for a number of major cardiovascular diseases. Several commonly-prescribed drugs (e.g., hydralazine) have been shown to have potent aldehyde-conjugating properties which may contribute to their beneficial effects. Herein, we briefly describe the major sources and toxicities of biogenic aldehydes in cardiovascular system, and provide an overview of drugs that are known to have aldehyde-conjugating effects. Some compounds of phytochemical origin, and histidyl-dipeptides with emerging therapeutic value in this area are also discussed. PMID:28528297

32 CFR 45.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... RELEASE OR DISCHARGE FROM ACTIVE DUTY (DD FORM 214/5 SERIES) § 45.1 Purpose. (a) This document revises 32 CFR part 45. (b) Prescribes procedures concerning the preparation and distribution of revised DD Form...

Early experiences with E-prescribing.

PubMed

Halamka, John

2006-01-01

Most physicians understand that e-prescribing will reduce medical errors and will be perceived by patients as making the prescription process easier. However, they are skeptical about a number of things. They worry whether their office processes will be improved or streamlined; e-prescribing will interface seamlessly with their existing practice management software; training and support will be available; e-prescribing data will be seamlessly transferable to an electronic health record when they implement a more advanced clinical record system for their practice; and if they will achieve a return on investment. Early adopting clinicians in Massachusetts can convince the majority of clinicians to adopt e-prescribing by sharing their motivations for adopting e-prescribing, the challenges that they needed to overcome, the hardware and software requirements, and integration into their office workflow. Finally, interaction with the physicians and practice managers in the audience makes the adoption of e-prescribing seem both reasonable and exciting. Resources such as vendor lists, questions to ask, and hardware and software requirements also need to be readily available and in a form that non-technical staff can read and understand. Physicians who know the "why" would also like to know

29 CFR 516.1 - Form of records; scope of regulations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Form of records; scope of regulations. 516.1 Section 516.1... RECORDS TO BE KEPT BY EMPLOYERS Introductory § 516.1 Form of records; scope of regulations. (a) Form of records. No particular order or form of records is prescribed by the regulations in this part. However...

77 FR 65233 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

..., DC 20549-0213. Extension: Form N-8A; OMB Control No. 3235-0175, File No. 270-135. Notice is hereby... in such form as the Commission prescribes. Form N-8A (17 CFR 274.10) is the form for notification of... registration provided on Form N-8A is to notify the Commission of the existence of investment companies...

20 CFR 702.214 - Notice; form and content.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Notice; form and content. 702.214 Section 702... Procedures Notice § 702.214 Notice; form and content. Notice shall be in writing on a form prescribed by the Director for this purpose; such form shall be made available to the employee or beneficiary by the employer...

20 CFR 703.110 - Other forms of endorsements and policies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Other forms of endorsements and policies. 703... Insurance Carriers § 703.110 Other forms of endorsements and policies. Where the form of endorsement prescribed by § 703.109 is not appropriate when used in conjunction with a form of policy approved for use by...

Nurse-led management of contraceptive services.

PubMed

Wilson, Emma

2014-07-01

This article discusses the role of the practice nurse (PN) in the provision of health assessment for contraceptive choices. PNs who have an extended role as an independent nurse prescriber must demonstrate the principles of safe prescribing practice, with appropriate and informed assessment of the patient's needs and risk within the limited time of a general practice appointment. With continued professional development, PNs are well placed to provide comprehensive, independent nurse-led contraceptive services.

19 CFR 191.157 - Landing certificates.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Landing certificates. 191.157 Section 191.157... TREASURY (CONTINUED) DRAWBACK Merchandise Exported From Continuous Customs Custody § 191.157 Landing certificates. When required, a landing certificate shall be filed within the time prescribed in § 191.76 of...

19 CFR 191.157 - Landing certificates.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Landing certificates. 191.157 Section 191.157... TREASURY (CONTINUED) DRAWBACK Merchandise Exported From Continuous Customs Custody § 191.157 Landing certificates. When required, a landing certificate shall be filed within the time prescribed in § 191.76 of...

48 CFR 252.237-7023 - Continuation of Essential Contractor Services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prescribed in 237.7603, use the following clause: Continuation of Mission Essential Functions (Date) (a) The... contractor services in support of mission-essential functions. The contractor-provided services that have been determined to be essential contractor services in support of mission-essential functions are...

5 CFR 720.101 - Federal Equal Opportunity Recruitment Program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Program. 720.101 Section 720.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) AFFIRMATIVE EMPLOYMENT PROGRAMS Principal Statutory Requirements § 720.101....” 5 U.S.C. 7201(c) requires under regulations prescribed by the Office of Personnel Management: “(1...

21 CFR 174.5 - General provisions applicable to indirect food additives.

Code of Federal Regulations, 2013 CFR

2013-04-01

... additives. 174.5 Section 174.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: GENERAL § 174.5 General provisions applicable to indirect food additives. (a) Regulations prescribing conditions under...

21 CFR 174.5 - General provisions applicable to indirect food additives.

Code of Federal Regulations, 2010 CFR

2010-04-01

... additives. 174.5 Section 174.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: GENERAL § 174.5 General provisions applicable to indirect food additives. (a) Regulations prescribing conditions under...

21 CFR 174.5 - General provisions applicable to indirect food additives.

Code of Federal Regulations, 2011 CFR

2011-04-01

... additives. 174.5 Section 174.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: GENERAL § 174.5 General provisions applicable to indirect food additives. (a) Regulations prescribing conditions under...

21 CFR 174.5 - General provisions applicable to indirect food additives.

Code of Federal Regulations, 2012 CFR

2012-04-01

... additives. 174.5 Section 174.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) INDIRECT FOOD ADDITIVES: GENERAL § 174.5 General provisions applicable to indirect food additives. (a) Regulations prescribing conditions under...

17 CFR 209.0-1 - Availability of forms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... may inspect the forms at this address and at the Commission's regional offices. (See § 200.11 of this... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Availability of forms. 209.0-1 Section 209.0-1 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED...

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature.

PubMed

Kroezen, Marieke; van Dijk, Liset; Groenewegen, Peter P; Francke, Anneke L

2011-05-27

A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights.

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature

PubMed Central

2011-01-01

Background A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. Methods A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. Results One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Conclusions Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights. PMID:21619565

A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

PubMed

Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

2017-08-01

Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use "If-Then" plans for patient management. Technology, as opposed to other methods of learning (eg, traditional "paper based" learning), was seen as a positive advancement for continued learning. MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers' training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented. ©Chris Keyworth, Jo Hart, Hong Thoong, Jane Ferguson, Mary Tully. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 01.08.2017.

Changing the Antibiotic Prescribing of general practice registrars: the ChAP study protocol for a prospective controlled study of a multimodal educational intervention.

PubMed

van Driel, Mieke L; Morgan, Simon; Tapley, Amanda; McArthur, Lawrie; McElduff, Patrick; Yardley, Lucy; Dallas, Anthea; Deckx, Laura; Mulquiney, Katie; Davis, Joshua S; Davey, Andrew; Henderson, Kim; Little, Paul; Magin, Parker J

2016-06-06

Australian General Practitioners (GPs) are generous prescribers of antibiotics, prompting concerns including increasing antimicrobial resistance in the community. Recent data show that GPs in vocational training have prescribing patterns comparable with the high prescribing rate of their established GP supervisors. Evidence-based guidelines consistently advise that antibiotics are not indicated for uncomplicated upper respiratory tract infections (URTI) and are rarely indicated for acute bronchitis. A number of interventions have been trialled to promote rational antibiotic prescribing by established GPs (with variable effectiveness), but the impact of such interventions in a training setting is unclear. We hypothesise that intervening while early-career GPs are still developing their practice patterns and prescribing habits will result in better adherence to evidence-based guidelines as manifested by lower antibiotic prescribing rates for URTIs and acute bronchitis. The intervention consists of two online modules, a face-to-face workshop for GP trainees, a face-to-face workshop for their supervisors and encouragement for the trainee-supervisor dyad to include a case-based discussion of evidence-based antibiotic prescribing in their weekly one-on-one teaching meetings. We will use a non-randomised, non-equivalent control group design to assess the impact on antibiotic prescribing for acute upper respiratory infections and acute bronchitis by GP trainees in vocational training. Early-career GPs who are still developing their clinical practice and prescribing habits are an underutilized target-group for interventions to curb the growth of antimicrobial resistance in the community. Interventions that are embedded into existing training programs or are linked to continuing professional development have potential to increase the impact of existing interventions at limited additional cost. Australian New Zealand Clinical Trials Registry, ACTRN12614001209684 (registered 17/11/2014).

The effect of regulatory advisories on maternal antidepressant prescribing, 1995–2007: an interrupted time-series study of 228,876 pregnancies

PubMed Central

Bobo, William V.; Epstein, Richard A.; Hayes, Rachel M.; Shelton, Richard C.; Hartert, Tina V.; Mitchel, Ed; Horner, Jeff; Wu, Pingsheng

2013-01-01

Purpose To assess whether antidepressant prescribing during pregnancy decreased following release of U.S. and Canadian public health advisory warnings about the risk of perinatal complications with antidepressants. Methods We analyzed data from 228,876 singleton pregnancies among women (aged 15–44 years) continuously enrolled in Tennessee Medicaid with full pharmacy benefits (1995–2007). Antidepressant prescribing was determined through outpatient pharmacy dispensing files. Information on sociodemographic and clinical factors was obtained from enrollment files and linked birth certificates. An interrupted time-series design with segmented regression analysis was used to quantify the impact of the advisory warnings (2002–2005). Results Antidepressant prescribing rates increased steadily from 1995–2001, followed by sharper increases from 2002–late 2004. Overall antidepressant prescribing prevalence was 34.51 prescriptions (95% CI 33.37–35.65) per 1,000 women in January 2002, and increased at a rate of 0.46 (95% CI 0.41–0.52) prescriptions per 1,000 women per month until the end of the pre-warning period (May 2004). During the post-warning period (October 2004 – June 2005), antidepressant prescribing decreased by 1.48 (95% CI 1.62-1.35) prescriptions per 1,000 women per month. These trends were observed for both SSRI and non-SSRI antidepressants, although SSRI prescribing decreased at a greater rate. Conclusion Antidepressant prescribing to pregnant women in Tennessee Medicaid increased from 1995–late 2004. U.S. and Canadian public health advisories about antidepressant-associated perinatal complications were associated with steady decreases in antidepressant prescribing from late 2004 until the end of the study period, suggesting that the advisory warnings were impactful on antidepressant prescribing in pregnancy. PMID:24196827

The effect of regulatory advisories on maternal antidepressant prescribing, 1995-2007: an interrupted time series study of 228,876 pregnancies.

PubMed

Bobo, William V; Epstein, Richard A; Hayes, Rachel M; Shelton, Richard C; Hartert, Tina V; Mitchel, Ed; Horner, Jeff; Wu, Pingsheng

2014-02-01

The purpose of this study was to assess whether antidepressant prescribing during pregnancy decreased following release of U.S. and Canadian public health advisory warnings about the risk of perinatal complications with antidepressants. We analyzed data from 228,876 singleton pregnancies among women (aged 15-44 years) continuously enrolled in Tennessee Medicaid with full pharmacy benefits (1995-2007). Antidepressant prescribing was determined through outpatient pharmacy dispensing files. Information on sociodemographic and clinical factors was obtained from enrollment files and linked birth certificates. An interrupted time series design with segmented regression analysis was used to quantify the impact of the advisory warnings (2002-2005). Antidepressant prescribing rates increased steadily from 1995 to 2001, followed by sharper increases from 2002 to late 2004. Overall antidepressant prescribing prevalence was 34.51 prescriptions [95 % confidence interval (CI) 33.37-35.65] per 1,000 women in January 2002, and increased at a rate of 0.46 (95 % CI 0.41-0.52) prescriptions per 1,000 women per month until the end of the pre-warning period (May 2004). During the post-warning period (October 2004-June 2005), antidepressant prescribing decreased by 1.48 (95 % CI 1.62-1.35) prescriptions per 1,000 women per month. These trends were observed for both selective serotonin reuptake inhibitors (SSRI) and non-SSRI antidepressants, although SSRI prescribing decreased at a greater rate. We conclude that antidepressant prescribing to pregnant women in Tennessee Medicaid increased from 1995 to late 2004. U.S. and Canadian public health advisories about antidepressant-associated perinatal complications were associated with steady decreases in antidepressant prescribing from late 2004 until the end of the study period, suggesting that the advisory warnings were impactful on antidepressant prescribing in pregnancy.

How should teaching of undergraduates in clinical pharmacology and therapeutics be delivered and assessed?

PubMed Central

Maxwell, Simon R J

2012-01-01

Clinical pharmacology and therapeutics is the academic discipline that informs rational prescribing of medicines. There is accumulating evidence that a significant minority of prescriptions in the UK National Health Service contain errors. This comes at a time when the approach to and success of undergraduate education in this area has been called into question. Various stakeholders are now in agreement that this challenging area of undergraduate education needs to be strengthened. The principles that should form the basis of future educational strategy include greater visibility of clinical pharmacology and therapeutics in the curriculum, clear learning outcomes that are consistent with national guidance, strong and enthusiastic leadership, a student formulary, opportunities to practice prescribing, a robust assessment of prescribing competencies and external quality control. Important new developments in the UK are Prescribe, a repository of e-learning materials to support education in clinical pharmacology and prescribing, and the Prescribing Skills Assessment, a national online assessment designed to allow medical students to demonstrate that they have achieved the core competencies required to begin postgraduate training. PMID:22360965

Variation in antibiotic prescribing and its impact on recovery in patients with acute cough in primary care: prospective study in 13 countries

PubMed Central

Hood, K; Verheij, T; Little, P; Melbye, H; Nuttall, J; Kelly, M J; Mölstad, S; Godycki-Cwirko, M; Almirall, J; Torres, A; Gillespie, D; Rautakorpi, U; Coenen, S; Goossens, H

2009-01-01

Objective To describe variation in antibiotic prescribing for acute cough in contrasting European settings and the impact on recovery. Design Cross sectional observational study with clinicians from 14 primary care research networks in 13 European countries who recorded symptoms on presentation and management. Patients followed up for 28 days with patient diaries. Setting Primary care. Participants Adults with a new or worsening cough or clinical presentation suggestive of lower respiratory tract infection. Main outcome measures Prescribing of antibiotics by clinicians and total symptom severity scores over time. Results 3402 patients were recruited (clinicians completed a case report form for 99% (3368) of participants and 80% (2714) returned a symptom diary). Mean symptom severity scores at presentation ranged from 19 (scale range 0 to 100) in networks based in Spain and Italy to 38 in the network based in Sweden. Antibiotic prescribing by networks ranged from 20% to nearly 90% (53% overall), with wide variation in classes of antibiotics prescribed. Amoxicillin was overall the most common antibiotic prescribed, but this ranged from 3% of antibiotics prescribed in the Norwegian network to 83% in the English network. While fluoroquinolones were not prescribed at all in three networks, they were prescribed for 18% in the Milan network. After adjustment for clinical presentation and demographics, considerable differences remained in antibiotic prescribing, ranging from Norway (odds ratio 0.18, 95% confidence interval 0.11 to 0.30) to Slovakia (11.2, 6.20 to 20.27) compared with the overall mean (proportion prescribed: 0.53). The rate of recovery was similar for patients who were and were not prescribed antibiotics (coefficient −0.01, P<0.01) once clinical presentation was taken into account. Conclusions Variation in clinical presentation does not explain the considerable variation in antibiotic prescribing for acute cough in Europe. Variation in antibiotic prescribing is not associated with clinically important differences in recovery. Trial registration Clinicaltrials.gov NCT00353951. PMID:19549995

Rational Risk-Benefit Decision-Making in the Setting of Military Mefloquine Policy.

PubMed

Nevin, Remington L

2015-01-01

Mefloquine is an antimalarial drug that has been commonly used in military settings since its development by the US military in the late 1980s. Owing to the drug's neuropsychiatric contraindications and its high rate of inducing neuropsychiatric symptoms, which are contraindications to the drug's continued use, the routine prescribing of mefloquine in military settings may be problematic. Due to these considerations and to recent concerns of chronic and potentially permanent psychiatric and neurological sequelae arising from drug toxicity, military prescribing of mefloquine has recently decreased. In settings where mefloquine remains available, policies governing prescribing should reflect risk-benefit decision-making informed by the drug's perceived benefits and by consideration both of the risks identified in the drug's labeling and of specific military risks associated with its use. In this review, these risks are identified and recommendations are made for the rational prescribing of the drug in light of current evidence.

Safe prescribing: a titanic challenge.

PubMed

Routledge, Philip A

2012-10-01

The challenge to achieve safe prescribing merits the adjective 'titanic'. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the 'Seven C's'. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

Sorafenib prescribed by gastroenterologists and hepatologists for hepatocellular carcinoma

PubMed Central

Kaplan, David E.; Mehta, Rajni; D’Addeo, Kathryn; Valderrama, Adriana; Taddei, Tamar H.

2018-01-01

Abstract Sorafenib is the only Food and Drug Administration (FDA)-approved first-line therapy shown to have survival benefit for patients with advanced hepatocellular carcinoma (HCC). Patients with advanced HCC are often but not exclusively transferred from non-oncologists to oncologists to initiate systemic therapy. The objective of this study was to assess whether sorafenib prescribing by non-oncologists has any impact on utilization, adverse effects, cost or outcome. This was a retrospective cohort study utilizing data from patients prescribed sorafenib for HCC within Veterans Health Administration hospitals with 100% chart abstraction to confirm HCC diagnosis, identify prescribing provider specialty (oncology versus gastroenterology/hepatology), and obtain data required for cancer staging by the Barcelona Clinic Liver Cancer (BCLC) system. The primary outcome was overall survival from the time of sorafenib prescription. A total of 4903 patients who prescribed sorafenib for HCC were identified, for whom 340 patients (6.9%) were prescribed drug by a non-oncologist (Onc). BCLC Stage, age, Child–Turcotte–Pugh score, and comorbidity indices were similar between patients prescribed sorafenib by oncologists and non-oncologists. Oncologists more often discontinued sorafenib due to progression, whereas non-oncologists were more likely to continue sorafenib until death resulting in greater pill utilization and cost. Overall survival in both unadjusted and multivariable models showed no significant impact of prescriber type on survival (222 vs 217 days, P = .96), confirmed with propensity-matched subcohorts. Similar survival outcomes were observed for patients with HCC prescribed sorafenib by non-oncologists and oncologists, suggesting that non-oncologists with expertise in the management of HCC can safely and effectively administer sorafenib. PMID:29369224

48 CFR 1228.106-1 - Bonds and bond-related forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... GENERAL CONTRACTING REQUIREMENTS BONDS AND INSURANCE Bonds and Other Financial Protections 1228.106-1 Bonds and bond-related forms. (b) Standard Form (SF) 25, Performance Bond, prescribed at (FAR) 48 CFR 28...) shall not be used by contractors when a performance bond is required. ...

Mental health pharmacists as interim prescribers

PubMed Central

2017-01-01

Introduction: Turnover leading to fluctuations in prescriber availability presents many challenges, most notably in access to and continuity of care. In 2015, the Veterans Affairs Eastern Colorado Healthcare System (VA ECHCS) experienced a period of significant mental health prescriber turnover leading to patient utilization of psychiatric emergency services (PES) for nonemergent medication management. The resulting increase in volume placed excessive stress on PES prescribers. Mental health pharmacists have opportunities to provide interim medication management while patients are between prescribers. Methods: This study was a retrospective, cohort study of patients unassigned to an outpatient mental health prescriber due to prescriber turnover, receiving care at VA ECHCS between October 1, 2015, and February 28, 2016. The primary outcome was the number of pharmacist interventions performed. Secondary outcomes characterize the interventions performed and describe the change in the mean monthly volume of patients presenting to PES. Results: In this veteran population, 152 interventions were performed in 81 unique patients. The most common intervention was prescription renewals (80%). Interventions most commonly involved antidepressants (28%), antipsychotics (10%), and mood stabilizers (10%). Before initiation of the clinic, Denver VA PES experienced a mean of 300 monthly visits. After clinic implementation, PES visits decreased significantly to a mean of 237 visits per month (P = .041). Discussion: The pharmacist interim prescriber clinic was associated with a significant decrease in mean number of patients seen per month in PES. The success of the clinic also contributed to interest by the mental health service to expand clinical pharmacy services.

49 CFR 195.300 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pressure Testing § 195.300 Scope. This subpart prescribes minimum requirements for the pressure...

49 CFR 195.300 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pressure Testing § 195.300 Scope. This subpart prescribes minimum requirements for the pressure...

49 CFR 195.300 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pressure Testing § 195.300 Scope. This subpart prescribes minimum requirements for the pressure...

49 CFR 195.300 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pressure Testing § 195.300 Scope. This subpart prescribes minimum requirements for the pressure...

49 CFR 195.300 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Pressure Testing § 195.300 Scope. This subpart prescribes minimum requirements for the pressure...

32 CFR 634.2 - References.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true References. 634.2 Section 634.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) LAW ENFORCEMENT AND CRIMINAL INVESTIGATIONS MOTOR VEHICLE TRAFFIC SUPERVISION Introduction § 634.2 References. Required and related publications along with prescribed and reference...

26 CFR 1.1494-2 - Effective date.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Tax on Transfers to Avoid Income Tax § 1.1494-2 Effective date. Chapter 5 (section 1491 and following) of the Internal Revenue Code of 1954 and the regulations prescribed thereunder apply with respect...

A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe

PubMed Central

Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

2017-01-01

Background Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Objective Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Methods Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. Results MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors’ e-portfolio). The participants were able to provide examples of how they would use “If-Then” plans for patient management. Technology, as opposed to other methods of learning (eg, traditional “paper based” learning), was seen as a positive advancement for continued learning. Conclusions MyPrescribe was perceived as an acceptable and feasible learning tool for changing prescribing practices, with participants suggesting that it would make an important addition to medical prescribers’ training in reflective practice. MyPrescribe is a novel theory-based technological innovation that provides the platform for doctors to create personalized implementation intentions. Applying the COM-B model allows for a more detailed understanding of the perceived mechanisms behind prescribing practices and the ways in which interventions aimed at changing professional practice can be implemented. PMID:28765104

Pezizalean mycorrhizas and sporocarps in ponderosa pine (Pinus ponderosa) after prescribed fires in eastern Oregon, USA.

Treesearch

K.E. Fujimura; J.E. Smith; T.R. Horton; N.S. Weber; J.W. Spatafora

2005-01-01

Post-fire Pezizales fruit commonly in many forest types after fire. The objectives of this study were to determine which Pezizales appeared as sporocarps after a prescribed fire in the Blue Mountains of eastern Oregon, and whether species of Pezizales formed mycorrhizas on ponderosa pine, whether or not they were detected from sporocarps. Forty-two sporocarp...

The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents.

PubMed

Kistler, Christine E; Zimmerman, Sheryl; Scales, Kezia; Ward, Kimberly; Weber, David; Reed, David; McClester, Mallory; Sloane, Philip D

2017-08-01

Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship. Chart review of 260 randomly-selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NHs in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work-up and subsequent clinical events including emergency department use, hospitalization, and death. Analyses described the decision-making processes and outcomes and compared decisions made with Loeb criteria for initiation of antibiotics. Of 260 cases, 60% had documented signs/symptoms of the presenting illness and 15% met the Loeb criteria. Acute mental status change was the most commonly documented sign/symptom (24%). NH providers (81%) were the most common prescribers and ciprofloxacin (32%) was the most commonly prescribed antibiotic. Fourteen percent of presumed UTI cases included a white blood cell count, 71% included a urinalysis, and 72% had a urine culture. Seventy-five percent of cultures grew at least one organism with ≥100,000 colony-forming units/milliliter and 12% grew multi-drug resistant organisms; 28% of antibiotics were prescribed for more than 7 days, and 7% of cases had a subsequent death, emergency department visit, or hospitalization within 7 days. Non-specific signs/symptoms appeared to influence prescribing more often than urinary tract-specific signs/symptoms. Prescribers rarely stopped antibiotics, and a minority prescribed for overly long periods. Providers may need additional support to guide the decision-making process to reduce antibiotic overuse and antibiotic resistance. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

A qualitative study of GPs' and PCO stakeholders' views on the importance and influence of cost on prescribing.

PubMed

Prosser, Helen; Walley, Tom

2005-03-01

With prescribing expenditure rising and evidence of prescribing costs variation, general practitioners (GPs) in the UK are under increasing pressure to contain spending. The introduction of cash-limited, unified budgets and increased monitoring of prescribing within Primary Care Organizations (PCO) are intended to increase efficiency and enhance GPs financial responsibility. Whilst GPs regularly receive data on the costs of their prescribing and also performance against a set prescribing budget, little is known about the extent to which GPs take cost into account in their prescribing decisions. This study undertook a qualitative exploration of the attitudes of various stakeholders on the relative importance and influence of cost on general practice prescribing. In order to explore a plurality of perspectives, data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key PCO stakeholders. The data suggest that although almost all GPs believed costs should be taken into account when prescribing, there was great variation in the extent to which this was applied and to how sensitive GPs were to costs. Cost was secondary to clinical effectiveness and safety, whilst individual patient need was emphasized above other forms of rationality or notions of opportunity costs. Conflict was apparent between a PCO policy of cost-containment and GPs' resistance to cost-cutting. GPs largely applied simple cost-minimization while cost-consideration was undermined by contextual factors. Implications for research and policy are discussed.

KINK AND SAUSAGE MODES IN NONUNIFORM MAGNETIC SLABS WITH CONTINUOUS TRANSVERSE DENSITY DISTRIBUTIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, Hui; Li, Bo; Chen, Shao-Xia

2015-11-20

We examine the influence of a continuous density structuring transverse to coronal slabs on the dispersive properties of fundamental standing kink and sausage modes supported therein. We derive generic dispersion relations (DRs) governing linear fast waves in pressureless straight slabs with general transverse density distributions, and focus on cases where the density inhomogeneity takes place in a layer of arbitrary width and in arbitrary form. The physical relevance of the solutions to the DRs is demonstrated by the corresponding time-dependent computations. For all profiles examined, the lowest order kink modes are trapped regardless of longitudinal wavenumber k. A continuous density distribution introducesmore » a difference to their periods of ≲13% when k is the observed range relative to the case where the density profile takes a step function form. Sausage modes and other branches of kink modes are leaky at small k, and their periods and damping times are heavily influenced by how the transverse density profile is prescribed, in particular the length scale. These modes have sufficiently high quality to be observable only for physical parameters representative of flare loops. We conclude that while the simpler DR pertinent to a step function profile can be used for the lowest order kink modes, the detailed information on the transverse density structuring needs to be incorporated into studies of sausage modes and higher order kink modes.« less

40 CFR 720.80 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... manner prescribed on the notice form. (ii) When a person submits information in an attachment, the claim(s) must be asserted in the attachment as described on the notice form. (2) If any information is... sanitized copy of the notice form (or electronic submission) and any attachments. (i) The notice and...

48 CFR 49.502 - Termination for convenience of the Government.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the Government (Services) (Short Form) is appropriate, (ii) in contracts for research and development... Government (Services) (Short Form), is appropriate (see 49.502(c)), or one of the clauses prescribed or cited... Convenience of the Government (Services) (Short Form), in solicitations and contracts for services, regardless...

40 CFR 720.80 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... manner prescribed on the notice form. (ii) When a person submits information in an attachment, the claim(s) must be asserted in the attachment as described on the notice form. (2) If any information is... sanitized copy of the notice form (or electronic submission) and any attachments. (i) The notice and...

48 CFR 52.253-1 - Computer Generated Forms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Computer Generated Forms....253-1 Computer Generated Forms. As prescribed in FAR 53.111, insert the following clause: Computer... by the Federal Acquisition Regulation (FAR) may be submitted on a computer generated version of the...

48 CFR 52.253-1 - Computer Generated Forms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Computer Generated Forms....253-1 Computer Generated Forms. As prescribed in FAR 53.111, insert the following clause: Computer... by the Federal Acquisition Regulation (FAR) may be submitted on a computer generated version of the...

48 CFR 52.253-1 - Computer Generated Forms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Computer Generated Forms....253-1 Computer Generated Forms. As prescribed in FAR 53.111, insert the following clause: Computer... by the Federal Acquisition Regulation (FAR) may be submitted on a computer generated version of the...

48 CFR 52.253-1 - Computer Generated Forms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Computer Generated Forms....253-1 Computer Generated Forms. As prescribed in FAR 53.111, insert the following clause: Computer... by the Federal Acquisition Regulation (FAR) may be submitted on a computer generated version of the...

48 CFR 52.253-1 - Computer Generated Forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Computer Generated Forms....253-1 Computer Generated Forms. As prescribed in FAR 53.111, insert the following clause: Computer... by the Federal Acquisition Regulation (FAR) may be submitted on a computer generated version of the...

Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records—REDUCE Trial study original protocol

PubMed Central

Juszczyk, Dorota; Charlton, Judith; McDermott, Lisa; Soames, Jamie; Sultana, Kirin; Ashworth, Mark; Fox, Robin; Hay, Alastair D; Little, Paul; Moore, Michael V; Yardley, Lucy; Prevost, A Toby; Gulliford, Martin C

2016-01-01

Introduction Respiratory tract infections (RTIs) account for about 60% of antibiotics prescribed in primary care. This study aims to test the effectiveness, in a cluster randomised controlled trial, of electronically delivered, multicomponent interventions to reduce unnecessary antibiotic prescribing when patients consult for RTIs in primary care. The research will specifically evaluate the effectiveness of feeding back electronic health records (EHRs) data to general practices. Methods and analysis 2-arm cluster randomised trial using the EHRs of the Clinical Practice Research Datalink (CPRD). General practices in England, Scotland, Wales and Northern Ireland are being recruited and the general population of all ages represents the target population. Control trial arm practices will continue with usual care. Practices in the intervention arm will receive complex multicomponent interventions, delivered remotely to information systems, including (1) feedback of each practice's antibiotic prescribing through monthly antibiotic prescribing reports estimated from CPRD data; (2) delivery of educational and decision support tools; (3) a webinar to explain and promote effective usage of the intervention. The intervention will continue for 12 months. Outcomes will be evaluated from CPRD EHRs. The primary outcome will be the number of antibiotic prescriptions for RTIs per 1000 patient years. Secondary outcomes will be: the RTI consultation rate; the proportion of consultations for RTI with an antibiotic prescribed; subgroups of age; different categories of RTI and quartiles of intervention usage. There will be more than 80% power to detect an absolute reduction in antibiotic prescription for RTI of 12 per 1000 registered patient years. Total healthcare usage will be estimated from CPRD data and compared between trial arms. Ethics and dissemination Trial protocol was approved by the National Research Ethics Service Committee (14/LO/1730). The pragmatic design of the trial will enable subsequent translation of effective interventions at scale in order to achieve population impact. Trial registration number ISRCTN95232781; Pre-results. PMID:27491663

20 CFR 422.510 - Applications and related forms used in the health insurance for the aged program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... health insurance for the aged program. 422.510 Section 422.510 Employees' Benefits SOCIAL SECURITY... forms used in the health insurance for the aged program. (a) Application forms. The following forms are prescribed for use in applying for entitlement to benefits under the health insurance for the aged program...

48 CFR 52.249-1 - Termination for Convenience of the Government (Fixed-Price) (Short Form).

Code of Federal Regulations, 2010 CFR

2010-10-01

... Convenience of the Government (Fixed-Price) (Short Form). 52.249-1 Section 52.249-1 Federal Acquisition... (Fixed-Price) (Short Form). As prescribed in 49.502(a)(1), insert the following clause: Termination for Convenience of the Government (Fixed-Price) (Short Form) (APR 1984) The Contracting Officer, by written notice...

78 FR 2699 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

..., DC 20549-0213. Extension: Form N-8A, OMB Control No. 3235-0175, File No. 270-135. Notice is hereby... Commission of a notification of registration in such form as the Commission prescribes. Form N-8A (17 CFR 274...). The purpose of such notification of registration provided on Form N-8A is to notify the Commission of...

18 CFR 357.4 - FERC Form No. 6-Q, Quarterly report of oil pipeline companies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false FERC Form No. 6-Q... No. 6-Q, Quarterly report of oil pipeline companies. (a) Prescription. The quarterly financial report form of oil pipeline companies, designated as FERC Form No. 6-Q, is prescribed for the reporting...

18 CFR 357.4 - FERC Form No. 6-Q, Quarterly report of oil pipeline companies.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false FERC Form No. 6-Q... No. 6-Q, Quarterly report of oil pipeline companies. (a) Prescription. The quarterly financial report form of oil pipeline companies, designated as FERC Form No. 6-Q, is prescribed for the reporting...

18 CFR 357.4 - FERC Form No. 6-Q, Quarterly report of oil pipeline companies.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false FERC Form No. 6-Q... No. 6-Q, Quarterly report of oil pipeline companies. (a) Prescription. The quarterly financial report form of oil pipeline companies, designated as FERC Form No. 6-Q, is prescribed for the reporting...

18 CFR 357.4 - FERC Form No. 6-Q, Quarterly report of oil pipeline companies.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false FERC Form No. 6-Q... No. 6-Q, Quarterly report of oil pipeline companies. (a) Prescription. The quarterly financial report form of oil pipeline companies, designated as FERC Form No. 6-Q, is prescribed for the reporting...

18 CFR 357.4 - FERC Form No. 6-Q, Quarterly report of oil pipeline companies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false FERC Form No. 6-Q... No. 6-Q, Quarterly report of oil pipeline companies. (a) Prescription. The quarterly financial report form of oil pipeline companies, designated as FERC Form No. 6-Q, is prescribed for the reporting...

Improvements on a non-invasive, parameter-free approach to inverse form finding

NASA Astrophysics Data System (ADS)

Landkammer, P.; Caspari, M.; Steinmann, P.

2017-08-01

Our objective is to determine the optimal undeformed workpiece geometry (material configuration) within forming processes when the prescribed deformed geometry (spatial configuration) is given. For solving the resulting shape optimization problem—also denoted as inverse form finding—we use a novel parameter-free approach, which relocates in each iteration the material nodal positions as design variables. The spatial nodal positions computed by an elasto-plastic finite element (FE) forming simulation are compared with their prescribed values. The objective function expresses a least-squares summation of the differences between the computed and the prescribed nodal positions. Here, a recently developed shape optimization approach (Landkammer and Steinmann in Comput Mech 57(2):169-191, 2016) is investigated with a view to enhance its stability and efficiency. Motivated by nonlinear optimization theory a detailed justification of the algorithm is given. Furthermore, a classification according to shape changing design, fixed and controlled nodal coordinates is introduced. Two examples with large elasto-plastic strains demonstrate that using a superconvergent patch recovery technique instead of a least-squares (L2 )-smoothing improves the efficiency. Updating the interior discretization nodes by solving a fictitious elastic problem also reduces the number of required FE iterations and avoids severe mesh distortions. Furthermore, the impact of the inclusion of the second deformation gradient in the Hessian of the Quasi-Newton approach is analyzed. Inverse form finding is a crucial issue in metal forming applications. As a special feature, the approach is designed to be coupled in a non-invasive fashion to arbitrary FE software.

Improvements on a non-invasive, parameter-free approach to inverse form finding

NASA Astrophysics Data System (ADS)

Landkammer, P.; Caspari, M.; Steinmann, P.

2018-04-01

Our objective is to determine the optimal undeformed workpiece geometry (material configuration) within forming processes when the prescribed deformed geometry (spatial configuration) is given. For solving the resulting shape optimization problem—also denoted as inverse form finding—we use a novel parameter-free approach, which relocates in each iteration the material nodal positions as design variables. The spatial nodal positions computed by an elasto-plastic finite element (FE) forming simulation are compared with their prescribed values. The objective function expresses a least-squares summation of the differences between the computed and the prescribed nodal positions. Here, a recently developed shape optimization approach (Landkammer and Steinmann in Comput Mech 57(2):169-191, 2016) is investigated with a view to enhance its stability and efficiency. Motivated by nonlinear optimization theory a detailed justification of the algorithm is given. Furthermore, a classification according to shape changing design, fixed and controlled nodal coordinates is introduced. Two examples with large elasto-plastic strains demonstrate that using a superconvergent patch recovery technique instead of a least-squares (L2)-smoothing improves the efficiency. Updating the interior discretization nodes by solving a fictitious elastic problem also reduces the number of required FE iterations and avoids severe mesh distortions. Furthermore, the impact of the inclusion of the second deformation gradient in the Hessian of the Quasi-Newton approach is analyzed. Inverse form finding is a crucial issue in metal forming applications. As a special feature, the approach is designed to be coupled in a non-invasive fashion to arbitrary FE software.

Eflornithine

MedlinePlus

... than prescribed by your doctor.Eflornithine cream slows hair growth but does not prevent it. You should continue to use your current method of hair removal (e.g., shaving, plucking, cutting) or treatment ...

18 CFR 34.4 - Required exhibits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Cash Flows and Computation of Interest Coverage on an actual basis and a pro forma basis for the most... Cash Flows must be in the form prescribed for the “Statement of Cash Flows” of the FERC Form No. 1...

18 CFR 34.4 - Required exhibits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Cash Flows and Computation of Interest Coverage on an actual basis and a pro forma basis for the most... Cash Flows must be in the form prescribed for the “Statement of Cash Flows” of the FERC Form No. 1...

18 CFR 34.4 - Required exhibits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Cash Flows and Computation of Interest Coverage on an actual basis and a pro forma basis for the most... Cash Flows must be in the form prescribed for the “Statement of Cash Flows” of the FERC Form No. 1...

18 CFR 34.4 - Required exhibits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Cash Flows and Computation of Interest Coverage on an actual basis and a pro forma basis for the most... Cash Flows must be in the form prescribed for the “Statement of Cash Flows” of the FERC Form No. 1...

18 CFR 34.4 - Required exhibits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Cash Flows and Computation of Interest Coverage on an actual basis and a pro forma basis for the most... Cash Flows must be in the form prescribed for the “Statement of Cash Flows” of the FERC Form No. 1...

77 FR 73053 - Comment Request for Information Collection on Administrative Procedures Including Form MA 8-7...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... prescribes the use of Form MA 8-7, Transmittal for Unemployment Insurance Materials. This simple check off... particularly interested in comments which: Evaluate whether the proposed collection of information is necessary...

E-Prescribing: History, Issues, and Potentials

PubMed Central

Salmon, J. Warren; Jiang, Ruixuan

2012-01-01

Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform. PMID:23569654

How Physician Perspectives on E-Prescribing Evolve over Time

PubMed Central

Patel, Vaishali; Pfoh, Elizabeth R.; Kaushal, Rainu

2016-01-01

Summary Background Physicians are expending tremendous resources transitioning to new electronic health records (EHRs), with electronic prescribing as a key functionality of most systems. Physician dissatisfaction post-transition can be quite marked, especially initially. However, little is known about how physicians’ experiences using new EHRs for e-prescribing evolve over time. We previously published a qualitative case study about the early physician experience transitioning from an older to a newer, more robust EHR, in the outpatient setting, focusing on their perceptions of the electronic prescribing functionality. Objective Our current objective was to examine how perceptions about using the new HER evolved over time, again with a focus on electronic prescribing. Methods We interviewed thirteen internists at an academic medical center-affiliated ambulatory care clinic who transitioned to the new EHR two years prior. We used a grounded theory approach to analyze semi-structured interviews and generate key themes. Results We identified five themes: efficiency and usability, effects on safety, ongoing training requirements, customization, and competing priorities for the EHR. We found that for even experienced e-prescribers, achieving prior levels of perceived prescribing efficiency took nearly two years. Despite the fact that speed in performing prescribing-related tasks was highly important, most were still not utilizing system short cuts or customization features designed to maximize efficiency. Alert fatigue remained common. However, direct transmission of prescriptions to pharmacies was highly valued and its benefits generally outweighed the other features considered poorly designed for physician workflow. Conclusions Ensuring that physicians are able to do key prescribing tasks efficiently is critical to the perceived value of e-prescribing applications. However, successful transitions may take longer than expected and e-prescribing system features that do not support workflow or require constant upgrades may further prolong the process. Additionally, as system features continually evolve, physicians may need ongoing training and support to maintain efficiency. PMID:27786335

What do providers want to know about opioid prescribing? A qualitative analysis of their questions.

PubMed

Cushman, Phoebe A; Liebschutz, Jane M; Hodgkin, Joseph G; Shanahan, Christopher W; White, Julie L; Hardesty, Ilana; Alford, Daniel P

2017-01-01

In 2012, the US Food and Drug Administration (FDA) responded to the opioid crisis with a Risk Evaluation and Mitigation Strategy, requiring manufacturers of extended-release/long-acting opioids to fund continuing medical education based on the "FDA Blueprint for Prescriber Education." Topics in the Blueprint are "Assessing Patients for Treatment," "Initiating Therapy, Modifying Dosing, and Discontinuing Use," "Managing Therapy," "Counseling Patients and Caregivers about Safe Use," "General Drug Information," and "Specific Drug Information." Based on the FDA Blueprint, Boston University School of Medicine's "Safe and Competent Opioid Prescribing Education" (SCOPE of Pain) offers live trainings for physicians and other prescribers. During trainings, participants submit written questions about the curriculum and/or their clinical experiences. The objective was to compare themes that arose from questions asked by SCOPE of Pain participants with content of the FDA Blueprint in order to evaluate how well the Blueprint answers prescribers' concerns. The authors conducted qualitative analyses of all 1309 questions submitted by participants in 29 trainings across 16 states from May 2013 to May 2015, using conventional content analysis to code the questions. Themes that emerged from participants' questions were then compared with the Blueprint. Most themes fell into the topic categories of the Blueprint. Five main themes diverged: Participants sought information on (1) safe alternatives to opioids, (2) overcoming barriers to safe opioid prescribing, (3) government regulations of opioid prescribing, (4) the role of marijuana in opioid prescribing, and (5) maintaining a positive provider-patient relationship while prescribing opioids. In addition to learning the mechanics of safe opioid prescribing, providers want to understand government regulations and effective patient communication skills. Aware of the limitations of opioids in managing chronic pain, providers seek advice on alternatives therapies. Future updates to the FDA Blueprint and other educational guidelines on opioid prescribing should address providers' additional questions.

Steady/unsteady aerodynamic analysis of wings at subsonic, sonic and supersonic Mach numbers using a 3D panel method

NASA Astrophysics Data System (ADS)

Cho, Jeonghyun; Han, Cheolheui; Cho, Leesang; Cho, Jinsoo

2003-08-01

This paper treats the kernel function of an integral equation that relates a known or prescribed upwash distribution to an unknown lift distribution for a finite wing. The pressure kernel functions of the singular integral equation are summarized for all speed range in the Laplace transform domain. The sonic kernel function has been reduced to a form, which can be conveniently evaluated as a finite limit from both the subsonic and supersonic sides when the Mach number tends to one. Several examples are solved including rectangular wings, swept wings, a supersonic transport wing and a harmonically oscillating wing. Present results are given with other numerical data, showing continuous results through the unit Mach number. Computed results are in good agreement with other numerical results.

Biogenic Aldehydes as Therapeutic Targets for Cardiovascular Disease.

PubMed

Nelson, Margaret-Ann M; Baba, Shahid P; Anderson, Ethan J

2017-04-01

Aldehydes are continuously formed in biological systems through enzyme-dependent and spontaneous oxidation of lipids, glucose, and primary amines. These highly reactive, biogenic electrophiles can become toxic via covalent modification of proteins, lipids and DNA. Thus, agents that scavenge aldehydes through conjugation have therapeutic value for a number of major cardiovascular diseases. Several commonly-prescribed drugs (e.g., hydralazine) have been shown to have potent aldehyde-conjugating properties which may contribute to their beneficial effects. Herein, we briefly describe the major sources and toxicities of biogenic aldehydes in cardiovascular system, and provide an overview of drugs that are known to have aldehyde-conjugating effects. Some compounds of phytochemical origin, and histidyl-dipeptides with emerging therapeutic value in this area are also discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Can volunteering in later life reduce the risk of dementia? A 5-year longitudinal study among volunteering and non-volunteering retired seniors.

PubMed

Griep, Yannick; Hanson, Linda Magnusson; Vantilborgh, Tim; Janssens, Laurens; Jones, Samantha K; Hyde, Martin

2017-01-01

We propose that voluntary work, characterized by social, physical and cognitive activity in later life is associated with fewer cognitive problems and lower dementia rates. We test these assumptions using 3-wave, self-reported, and registry data from the 2010, 2012, and 2014 Swedish National Prescribed Drug Register. We had three groups of seniors in our data: 1) no volunteering (N = 531), 2) discontinuous volunteering (N = 220), and 3) continuous volunteering (N = 250). We conducted a path analysis in Mplus to investigate the effect of voluntary work (discontinuously and continuously) on self-reported cognitive complaints and the likelihood of being prescribed an anti-dementia treatment after controlling for baseline and relevant background variables. Our results indicated that seniors, who continuously volunteered, reported a decrease in their cognitive complaints over time, whereas no such associations were found for the other groups. In addition, they were 2.44 (95%CI [1.86; 3.21]) and 2.46 (95%CI [1,89; 3.24]) times less likely to be prescribed an anti-dementia treatment in 2012 and 2014, respectively. Our results largely support the assumptions that voluntary work in later life is associated with lower self-reported cognitive complaints and a lower risk for dementia, relative to those who do not engage, or only engage episodically in voluntary work.

Can volunteering in later life reduce the risk of dementia? A 5-year longitudinal study among volunteering and non-volunteering retired seniors

PubMed Central

Hanson, Linda Magnusson; Vantilborgh, Tim; Janssens, Laurens; Jones, Samantha K.; Hyde, Martin

2017-01-01

We propose that voluntary work, characterized by social, physical and cognitive activity in later life is associated with fewer cognitive problems and lower dementia rates. We test these assumptions using 3-wave, self-reported, and registry data from the 2010, 2012, and 2014 Swedish National Prescribed Drug Register. We had three groups of seniors in our data: 1) no volunteering (N = 531), 2) discontinuous volunteering (N = 220), and 3) continuous volunteering (N = 250). We conducted a path analysis in Mplus to investigate the effect of voluntary work (discontinuously and continuously) on self-reported cognitive complaints and the likelihood of being prescribed an anti-dementia treatment after controlling for baseline and relevant background variables. Our results indicated that seniors, who continuously volunteered, reported a decrease in their cognitive complaints over time, whereas no such associations were found for the other groups. In addition, they were 2.44 (95%CI [1.86; 3.21]) and 2.46 (95%CI [1,89; 3.24]) times less likely to be prescribed an anti-dementia treatment in 2012 and 2014, respectively. Our results largely support the assumptions that voluntary work in later life is associated with lower self-reported cognitive complaints and a lower risk for dementia, relative to those who do not engage, or only engage episodically in voluntary work. PMID:28301554

Ten Common Questions (and Their Answers) About Off-label Drug Use

PubMed Central

Wittich, Christopher M.; Burkle, Christopher M.; Lanier, William L.

2012-01-01

The term off-label drug use (OLDU) is used extensively in the medical literature, continuing medical education exercises, and the media. Yet, we propose that many health care professionals have an underappreciation of its definition, prevalence, and implications. This article introduces and answers 10 questions regarding OLDU in an effort to clarify the practice's meaning, breadth of application, acceptance, and liabilities. Off-label drug use involves prescribing medications for indications, or using a dosage or dosage form, that have not been approved by the US Food and Drug Administration. Since the Food and Drug Administration does not regulate the practice of medicine, OLDU has become common. It occurs in every specialty of medicine, but it may be more common in areas of medicine in which the patient population is less likely to be included in clinical trials (eg, pediatric, pregnant, or psychiatric patients). Pharmaceutical companies are not allowed to promote their medications for an off-label use, which has lead to several large settlements for illegal marketing. To limit liability, physicians should prescribe medications only for indications that they believe are in the best interest of the patient. In addition, health care professionals should educate themselves about OLDU to weigh the risks and benefits and provide the best possible care for their patients. PMID:22877654

Prescription of opioid analgesics for nontraumatic dental conditions in emergency departments.

PubMed

Okunseri, Christopher; Dionne, Raymond A; Gordon, Sharon M; Okunseri, Elaye; Szabo, Aniko

2015-11-01

Opioid analgesics prescribed for nontraumatic dental conditions (NTDCs) by emergency physicians continue to receive attention because of the associated potential for misuse, abuse and addiction. This study examined rates of prescription of opioid analgesics and types of opioid analgesics prescribed for NTDC visits in U.S. emergency departments. Data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2010 were analyzed. Descriptive statistics and logistic regression analysis were performed and adjusted for the survey design. NTDCs made up 1.7% of all ED visits from 2007 to 2010. The prescription of opioid analgesics was 50.3% for NTDC and 14.8% for non-NTDC visits. The overall rate of opioid analgesics prescribed for NTDCs remained fairly stable from 2007 through 2010. Prescription of opioids was highest among patients aged 19-33 years (56.8%), self-paying (57.1%), and non-Hispanic Whites (53.2%). The probability of being prescribed hydrocodone was highest among uninsured patients (68.7%) and for oxycodone, it was highest among private insurance patients (33.6%). Compared to 34-52 year olds, children 0-4 years were significantly more likely to be prescribed codeine and less likely to be prescribed oxycodone. Compared to non-Hispanic Whites, non-Hispanic Blacks had significantly higher odds of been prescribed codeine and somewhat lower odds of been prescribed oxycodone, but it was not statistically significant. There was no significant change in the rates of opioid analgesics prescribed over time for NTDC visits to EDs. Age, payer type and race/ethnicity were significant predictors for the prescription of different opioid analgesics by emergency physicians for NTDC visits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Antibiotic Use in 2016 by Members of the American Association of Endodontists: Report of a National Survey.

PubMed

Germack, Mark; Sedgley, Christine M; Sabbah, Wael; Whitten, Brian

2017-10-01

This study surveyed the antibiotic prescribing practices of endodontists, and data were compared with previous surveys conducted in 1994 and 1999. A 17-question survey was sent via www.surveymonkey.com to 3000 active members of the American Association of Endodontists for responses about antibiotic prescribing practices and demographics. The data were analyzed using descriptive statistics, chi-square tests, and linear regression analyses. Six hundred eighty-six participants (22.86%) completed the survey. The most frequently prescribed antibiotics were amoxicillin (60.71%) followed by penicillin V (30.43%) and clindamycin for patients with allergies (95.4%). Respondents reported prescribing antibiotics for irreversible pulpitis with mild symptoms (1.75%), irreversible pulpitis with moderate symptoms (6.41%), necrotic pulp with symptomatic apical periodontitis (43.59%), chronic apical abscess without (10.50%) or with symptoms (29.74%), acute apical abscess (95.92%), avulsion (70.26%), endodontic surgery (41.69%), retreatment (silver point [23.76%] or gutta-percha [15.60%]), postoperative pain after instrumentation or obturation (12.39%), and perforation repair (5.98%). The type of practice (solo/group) and geographic region (Southeast) were significant predictors of increased antibiotic prescribing; 36.89% of respondents reported prescribing antibiotics that are not necessary, most commonly because of patient expectations. Since 1999, there has been a significant shift from prescribing penicillin V to amoxicillin as endodontists' first choice of antibiotic and a significant increase in the use of clindamycin for penicillin-allergic patients. Antibiotics continue to be prescribed in clinical situations for which they are typically not indicated, most commonly because of patient expectations. Regional differences in antibiotic prescribing practices by endodontists exist in the United States. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden.

PubMed

Strandberg, Eva Lena; Brorsson, Annika; André, Malin; Gröndal, Hedvig; Mölstad, Sigvard; Hedin, Katarina

2016-07-18

Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners' audit registrations. Qualitative data were collected through observations and semi-structured interviews. From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioner's diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses' triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.

17 CFR 239.500 - Form D, notice of sales of securities under Regulation D and section 4(5) of the Securities Act...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Form D, notice of sales of... Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED UNDER THE SECURITIES ACT OF 1933 Forms Pertaining to Exemptions § 239.500 Form D, notice of sales of securities under...

17 CFR 239.500 - Form D, notice of sales of securities under Regulation D and section 4(6) of the Securities Act...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Form D, notice of sales of... Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED UNDER THE SECURITIES ACT OF 1933 Forms Pertaining to Exemptions § 239.500 Form D, notice of sales of securities under...

17 CFR 239.500 - Form D, notice of sales of securities under Regulation D and section 4(6) of the Securities Act...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Form D, notice of sales of... Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED UNDER THE SECURITIES ACT OF 1933 Forms Pertaining to Exemptions § 239.500 Form D, notice of sales of securities under...

17 CFR 239.500 - Form D, notice of sales of securities under Regulation D and section 4(5) of the Securities Act...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Form D, notice of sales of... Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED UNDER THE SECURITIES ACT OF 1933 Forms Pertaining to Exemptions § 239.500 Form D, notice of sales of securities under...

48 CFR 653.219-71 - DOS form DS-4053, Department of State Mentor-Protégé Program Application.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., Department of State Mentor-Protégé Program Application. 653.219-71 Section 653.219-71 Federal Acquisition...-4053, Department of State Mentor-Protégé Program Application. As prescribed in 619.102-70(i), DS-4053 is prescribed for use in applying for an agreement under the Department of State Mentor-Protégé...

26 CFR 1.642(c)-5 - Definition of pooled income fund.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Definition of pooled income fund. 1.642(c)-5...) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Estates, Trusts, and Beneficiaries § 1.642(c)-5 Definition of pooled income fund. (a) In general—(1) Application of provisions. Section 642(c)(5) prescribes...

32 CFR Appendix to Part 383a - Delegations of Authority

Code of Federal Regulations, 2011 CFR

2011-07-01

... National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED..., “Federal Advisory Committee Act”; and DoD Directive 5105.4 1 “Department of Defense Federal Advisory... thereto, pursuant to the policies and procedures prescribed in DoD 5025.1-M 6 “Department of Defense...

32 CFR Appendix to Part 383a - Delegations of Authority

Code of Federal Regulations, 2010 CFR

2010-07-01

... National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED..., “Federal Advisory Committee Act”; and DoD Directive 5105.4 1 “Department of Defense Federal Advisory... thereto, pursuant to the policies and procedures prescribed in DoD 5025.1-M 6 “Department of Defense...

32 CFR Appendix to Part 383a - Delegations of Authority

Code of Federal Regulations, 2013 CFR

2013-07-01

... National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED..., “Federal Advisory Committee Act”; and DoD Directive 5105.4 1 “Department of Defense Federal Advisory... thereto, pursuant to the policies and procedures prescribed in DoD 5025.1-M 6 “Department of Defense...

32 CFR Appendix to Part 383a - Delegations of Authority

Code of Federal Regulations, 2012 CFR

2012-07-01

... National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED..., “Federal Advisory Committee Act”; and DoD Directive 5105.4 1 “Department of Defense Federal Advisory... thereto, pursuant to the policies and procedures prescribed in DoD 5025.1-M 6 “Department of Defense...

32 CFR Appendix to Part 383a - Delegations of Authority

Code of Federal Regulations, 2014 CFR

2014-07-01

... National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED..., “Federal Advisory Committee Act”; and DoD Directive 5105.4 1 “Department of Defense Federal Advisory... thereto, pursuant to the policies and procedures prescribed in DoD 5025.1-M 6 “Department of Defense...

Adolescents' Commitment to Continuing Psychotropic Medication: A Preliminary Investigation of Considerations, Contradictions, and Correlates

ERIC Educational Resources Information Center

Moses, Tally

2011-01-01

This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed "medication commitment"); (2) their general subjective experiences with…

21 CFR 170.15 - Adoption of regulation on initiative of Commissioner.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) FOOD ADDITIVES General Provisions § 170.15... propose the issuance of a regulation prescribing, with respect to any particular use of a food additive... 21 Food and Drugs 3 2013-04-01 2013-04-01 false Adoption of regulation on initiative of...

21 CFR 170.15 - Adoption of regulation on initiative of Commissioner.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) FOOD ADDITIVES General Provisions § 170.15... propose the issuance of a regulation prescribing, with respect to any particular use of a food additive... 21 Food and Drugs 3 2011-04-01 2011-04-01 false Adoption of regulation on initiative of...

21 CFR 170.15 - Adoption of regulation on initiative of Commissioner.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) FOOD ADDITIVES General Provisions § 170.15... propose the issuance of a regulation prescribing, with respect to any particular use of a food additive... 21 Food and Drugs 3 2012-04-01 2012-04-01 false Adoption of regulation on initiative of...

Cost implication of irrational prescribing of chloroquine in Lagos State general hospitals.

PubMed

Aina, Bolajoko A; Tayo, Fola; Taylor, Ogori

2008-02-01

A major share of the hospital budget is spent on drugs. Irrational use of these drugs is a waste of financial and human resources that could have been deployed for another use within the hospital setting especially in cases where such drugs are provided free to patients. Also there is increased morbidity and progression of severity with irrational use. The objective of this study was to determine the irrational use of chloroquine and the subsequent cost implications in Lagos State general hospitals. A retrospective study period of one year (January to December, 2000) was selected. A total of 18,781 prescription forms of "Free Eko Malaria" were sampled for children and adults from all the Lagos State general hospitals. Drug costs in each prescription form were identified. Cost effectiveness analysis of chloroquine tablet and intramuscular injection was undertaken. The average cost of medicine per prescription was 132.071 ($1.03) which should have been 94.22 ($0.73) if prescribed rationally. The total cost of prescriptions for malaria under study was 2,480,425.00 ($19,348.09). About 68% {(1,679,444.00) ($13,100.19)} of the total cost was lost to irrational prescribing. This is a waste of scarce resources. When the prescriptions were differentiated into the different dosage forms prescribed, the prescriptions containing intramuscular injections only had over 90% of the cost lost to irrational prescribing. Cost effectiveness analysis showed that chloroquine tablet was 17 times more cost effective than chloroquine injection (intramuscular) from a health care system perspective while it was 14 times more cost effective from a patient perspective. There is waste of scarce resources with irrational dispensing of drugs and these resources could have been deployed to other uses or areas within the hospitals. The tablet chloroquine was more cost effective than injection chloroquine (intramuscular). Increasing the cost of tablets, decreasing effectiveness of tablets, decreasing the cost of injections and increasing the effectiveness of injections did not change the cost effectiveness conclusion.

48 CFR 1553.209-70 - EPA Form 1900-26, Contracting Officer's Evaluation of Contractor Performance.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., Contracting Officer's Evaluation of Contractor Performance. 1553.209-70 Section 1553.209-70 Federal... 1553.209-70 EPA Form 1900-26, Contracting Officer's Evaluation of Contractor Performance. As prescribed... evaluation of Contractor performance. ...

Drug prescribing during pregnancy in a central region of Italy, 2008-2012.

PubMed

Ventura, Martina; Maraschini, Alice; D'Aloja, Paola; Kirchmayer, Ursula; Lega, Ilaria; Davoli, Marina; Donati, Serena

2018-05-15

Drug consumption during pregnancy is a matter of concern, especially regarding drugs known or suspected to be teratogens. Little is known about drug use in pregnant women in Italy. The present study is aimed at examining the prevalence, and to detect potential inappropriateness of drug prescribing among pregnant women in Latium, a region of central Italy. This retrospective study was conducted on a cohort of women aged 18-45 years who delivered between 2008 and 2012 in public hospitals. Women were enrolled through the Regional Birth Register. After linking the regional Health Information Systems and the Regional Drug Claims Register, women's clinical data and prescribed medications were analyzed. Italian Medicine Agency (AIFA) and US Food and Drug Administration (FDA) evidence were used to investigate inappropriate prescribing and teratogenic risk. Excluding vitamins and minerals, 80.6% (n = 153,079) of the women were prescribed at least one drug during pregnancy, with an average of 4.6 medications per pregnancy. Drugs for blood and hematopoietic organs were the most commonly prescribed (53.0%,), followed by anti-infectives for systemic use (50.7%). Among the inappropriate prescriptions, progestogen supplementation was given in 20.1% of pregnancies; teratogen drugs were prescribed in 0.8%, mostly angiotensin co-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) (0.3%). In Latium, drugs are widely used in pregnancy. Prescriptions of inappropriate drugs are observed in more than a fifth of pregnancies, and teratogens are still used, despite their known risk. Continuous updates of information provided to practitioners and an increased availability of information to women might reduce inappropriate prescribing.

Is Customization in Antidepressant Prescribing Associated with Acute-Phase Treatment Adherence?

PubMed

Merrick, Elizabeth L; Hodgkin, Dominic; Panas, Lee; Soumerai, Stephen B; Ritter, Grant

2012-03-01

OBJECTIVES: The objective was to explore whether prescribing variation is associated with duration of antidepressant use during the acute phase of treatment. Improving quality of care and increasing the extent to which treatment is patient-centered and customized are interrelated goals. Prescribing variation may be considered a marker of customization, and could be associated with better antidepressant treatment adherence. METHODS: A cross-sectional secondary data analysis examining the association between providers' antidepressant prescribing variation and patient continuity of antidepressant treatment. The data source was two states' Medicaid claims for dual-eligible Medicaid/Medicare patients. The sample included 383 patients with new episodes of antidepressant treatment, representing 70 providers with at least four patients in the sample. We tested two alternate measures of prescribing concentration: 1) share of prescriber's initial antidepressant prescribing accounted for by the two most common regimens, and 2) Herfindahl index. The HEDIS performance measure of effective acute-phase treatment (at least 84 out of 114 days with antidepressant) was the dependent variable. KEY FINDINGS: In multivariate analyses, the concentration measure based on the top two regimens was significant and inversely related to duration adequacy (p <.05). The Herfindahl index measure showed a trend towards a similar inverse relationship (p<.10). CONCLUSIONS: The findings provide some support for the hypothesized relationship between prescribing variation and adequate antidepressant treatment duration during the acute phase of treatment. Future work with more detailed, clinical longitudinal data could extend this inquiry to better understand the causal mechanisms using a more direct measure of customized care.

Is Customization in Antidepressant Prescribing Associated with Acute-Phase Treatment Adherence?

PubMed Central

Merrick, Elizabeth L.; Hodgkin, Dominic; Panas, Lee; Soumerai, Stephen B.; Ritter, Grant

2012-01-01

Objectives The objective was to explore whether prescribing variation is associated with duration of antidepressant use during the acute phase of treatment. Improving quality of care and increasing the extent to which treatment is patient-centered and customized are interrelated goals. Prescribing variation may be considered a marker of customization, and could be associated with better antidepressant treatment adherence. Methods A cross-sectional secondary data analysis examining the association between providers' antidepressant prescribing variation and patient continuity of antidepressant treatment. The data source was two states' Medicaid claims for dual-eligible Medicaid/Medicare patients. The sample included 383 patients with new episodes of antidepressant treatment, representing 70 providers with at least four patients in the sample. We tested two alternate measures of prescribing concentration: 1) share of prescriber's initial antidepressant prescribing accounted for by the two most common regimens, and 2) Herfindahl index. The HEDIS performance measure of effective acute-phase treatment (at least 84 out of 114 days with antidepressant) was the dependent variable. Key Findings In multivariate analyses, the concentration measure based on the top two regimens was significant and inversely related to duration adequacy (p <.05). The Herfindahl index measure showed a trend towards a similar inverse relationship (p<.10). Conclusions The findings provide some support for the hypothesized relationship between prescribing variation and adequate antidepressant treatment duration during the acute phase of treatment. Future work with more detailed, clinical longitudinal data could extend this inquiry to better understand the causal mechanisms using a more direct measure of customized care. PMID:22707982

9 CFR 325.16 - Official seals; forms, use, and breaking.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Official seals; forms, use, and... AND VOLUNTARY INSPECTION AND CERTIFICATION TRANSPORTATION § 325.16 Official seals; forms, use, and breaking. (a) The official seals required by this part shall be those prescribed in § 312.5(a) of this...

9 CFR 325.16 - Official seals; forms, use, and breaking.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Official seals; forms, use, and... AND VOLUNTARY INSPECTION AND CERTIFICATION TRANSPORTATION § 325.16 Official seals; forms, use, and breaking. (a) The official seals required by this part shall be those prescribed in § 312.5(a) of this...

48 CFR 1852.223-72 - Safety and Health (Short Form).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Safety and Health (Short... and Clauses 1852.223-72 Safety and Health (Short Form). As prescribed in 1823.7001(e), insert the following clause: Safety and Health (Short Form) (APR 2002) (a) Safety is the freedom from those conditions...

48 CFR 1852.223-72 - Safety and Health (Short Form).

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Safety and Health (Short... and Clauses 1852.223-72 Safety and Health (Short Form). As prescribed in 1823.7001(e), insert the following clause: Safety and Health (Short Form) (APR 2002) (a) Safety is the freedom from those conditions...

48 CFR 1852.223-72 - Safety and Health (Short Form).

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Safety and Health (Short... and Clauses 1852.223-72 Safety and Health (Short Form). As prescribed in 1823.7001(e), insert the following clause: Safety and Health (Short Form) (APR 2002) (a) Safety is the freedom from those conditions...

48 CFR 1852.223-72 - Safety and Health (Short Form).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Safety and Health (Short... and Clauses 1852.223-72 Safety and Health (Short Form). As prescribed in 1823.7001(e), insert the following clause: Safety and Health (Short Form) (APR 2002) (a) Safety is the freedom from those conditions...

48 CFR 1852.223-72 - Safety and Health (Short Form).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Safety and Health (Short... and Clauses 1852.223-72 Safety and Health (Short Form). As prescribed in 1823.7001(e), insert the following clause: Safety and Health (Short Form) (APR 2002) (a) Safety is the freedom from those conditions...

26 CFR 31.3406(h)-3 - Certificates.

Code of Federal Regulations, 2013 CFR

2013-04-01

... other instrument, or one Form W-9 for all the payee's obligations or relationships with the payor or... Income Tax at Source § 31.3406(h)-3 Certificates. (a) Prescribed form to furnish information under penalties of perjury—(1) In general. Except as provided in paragraph (c) of this section, the Form W-9 is...

26 CFR 31.3406(h)-3 - Certificates.

Code of Federal Regulations, 2014 CFR

2014-04-01

... other instrument, or one Form W-9 for all the payee's obligations or relationships with the payor or... Income Tax at Source § 31.3406(h)-3 Certificates. (a) Prescribed form to furnish information under penalties of perjury—(1) In general. Except as provided in paragraph (c) of this section, the Form W-9 is...

26 CFR 31.3406(h)-3 - Certificates.

Code of Federal Regulations, 2012 CFR

2012-04-01

... other instrument, or one Form W-9 for all the payee's obligations or relationships with the payor or... Income Tax at Source § 31.3406(h)-3 Certificates. (a) Prescribed form to furnish information under penalties of perjury—(1) In general. Except as provided in paragraph (c) of this section, the Form W-9 is...

43 CFR 12.912 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

43 CFR 12.912 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

43 CFR 12.912 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

22 CFR 518.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

43 CFR 12.912 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

22 CFR 518.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

22 CFR 518.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

43 CFR 12.912 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

22 CFR 518.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

22 CFR 518.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SPOC for a particular State can be obtained from the Federal awarding agency or the Catalog of Federal... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal...

26 CFR 1.6015-5 - Time and manner for requesting relief.

Code of Federal Regulations, 2014 CFR

2014-04-01

... equitable relief under § 1.6015-4, a requesting spouse must file Form 8857, “Request for Innocent Spouse Relief” (or other specified form); submit a written statement containing the same information required on Form 8857, which is signed under penalties of perjury; or submit information in the manner prescribed...

26 CFR 1.6015-5 - Time and manner for requesting relief.

Code of Federal Regulations, 2011 CFR

2011-04-01

... equitable relief under § 1.6015-4, a requesting spouse must file Form 8857, “Request for Innocent Spouse Relief” (or other specified form); submit a written statement containing the same information required on Form 8857, which is signed under penalties of perjury; or submit information in the manner prescribed...

48 CFR 52.246-9 - Inspection of Research and Development (Short Form).

Code of Federal Regulations, 2010 CFR

2010-10-01

... Clauses 52.246-9 Inspection of Research and Development (Short Form). As prescribed in 46.309, insert the following clause: Inspection of Research and Development (Short Form) (APR 1984) The Government has the... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Inspection of Research and...

Form reconciles meds, but doctor buy-in difficult.

PubMed

2006-02-01

One ED has developed a medication reconciliation form to meet the National Patient Safety Goal of reconciling medications across the continuum of care. The form does require additional staff time to complete. Staff and physicians need training so they understand the importance of meeting the safety goal. Physicians may resist giving orders on previously prescribed meds and may see the form as redundant.

A scoping review of research on the prescribing practice of Canadian pharmacists

PubMed Central

Faruquee, Chowdhury Farhana; Guirguis, Lisa M.

2015-01-01

Background: Pharmacists in Canada have been prescribing since 2007. This review aims to explore the volume, array and nature of research activity on Canadian pharmacist prescribing and to identify gaps in the existing literature. Methods: We conducted a scoping review to examine the literature on prescribing by pharmacists in Canada according to methodological trends, research areas and key findings. We searched for peer-reviewed research articles and abstracts in the Ovid MEDLINE, Ovid EMBASE and International Pharmaceutical Abstracts databases without any date limitations. A standardized form was used to extract information. Results: We identified 156 articles; of these, 26 articles and 12 abstracts met inclusion criteria. One-half of the research studies (20) used quantitative methods, including surveys, trials and experimental designs; 11 studies used qualitative methods and 7 used other methods. Research on pharmacist prescribing demonstrated an improvement in patient outcomes (13 studies), varied stakeholder perceptions (10 studies) and factors that influence this practice change (11 studies). Pharmacist prescribing was adopted when pharmacists practised patient-centred care. Stakeholders held contrasting perceptions of pharmacist prescribing. Discussion: Canadian research has demonstrated the benefit of pharmacist prescribing on patient outcomes, which is not present in the international literature. Future research may consider a meta-analysis addressing the impact on patient health. Gaps in research include comparisons between provinces, effects on physicians’ services, overall patient safety and access to health care systems and economic implications for society. Conclusion: A growing body of research on pharmacist prescribing has captured the early impact of prescribing on patient outcomes, perceptions of practice and practice change. Opportunities exist for pan-Canadian research that examines the system impact. PMID:26600824

Prescribing pattern of analgesics in orthopedic in-patient department at tertiary care hospital in Guwahati, Assam, Northeast India

PubMed Central

Choudhury, Dwijen Kumar; Bezbaruah, Babul Kumar

2016-01-01

Objectives: The aim of this study is to evaluate the prescribing pattern of analgesics and analyze the rational use of analgesic in orthopedic in-patient department of tertiary care teaching hospital, Guwahati, Assam. Subjects and Methods: An observational and cross-sectional study was carried out for 1 month from April to May 2014. Collected data included age, sex, diagnosis and line of management during the study. The generic name and the average cost of treatment per patient were evaluated using Indian Drug Review, 2014. The prescribed drugs were assessed with respective National Model List of Essential Medicines (NLEM), 2011 and the rationality of prescriptions was determined using the World Health Organization indicators of drug utilization. The patients’ details were recorded in a predeigned data collection form and results were analyzed by descriptive statistics. Results: Out of 200 patients, 123 were male and 77 were female. The average number of analgesic per prescription was 1.46. In this study, 55.5% of patients had received single analgesic. Diclofenac was the most commonly prescribed analgesic (43.49%). During hospitalization, majority of the patients have received parenteral preparation. Gastroprotective agents and antimicrobials were frequently prescribed along with analgesics. Out of 292 analgesics prescribed, 183 (62.67%) were from the NLEM, India. Furthermore, 176 (57.19%) analgesics were prescribed by generic name. The average cost of treatment per patient was 2151.72 INR. Utilization of analgesic in terms of defined daily dose/100 bed-days was 104.01. Conclusion: The percentages of analgesics prescribing from NLEM and the use of analgesic by generic name were found satisfactory. Regular educational interventions to improve prescribing practices among physicians at different levels may further promote rational prescribing. PMID:27756947

TU-G-BRB-01: Continuous Path Optimization for Non-Coplanar Variant SAD IMRT Delivery Using C-Arm Machines.

PubMed

Ruan, D; Dong, P; Low, D; Sheng, K

2012-06-01

To develop and investigate a continuous path optimization methodology to traverse prescribed non-coplanar IMRT beams with variant SADs, by orchestrating the couch and gantry movement with zero-collision, minimal patient motion consequence and machine travel time. We convert the given collision zone definition and the prescribed beam location/angles to a tumor-centric coordinate, and represent the traversing path as a continuous open curve. We proceed to optimize a composite objective function consisting of (1) a strong attraction energy to ensure all prescribed beams are en-route, (2) a penalty for patient-motion inducing couch motion, and (3) a penalty for travel-time inducing overall path-length. Feasibility manifold is defined as complement to collision zone and the optimization is performed with a level set representation evolved with variational flows. The proposed method has been implemented and tested on clinically derived data. In the absence of any existing solutions for the same problem, we validate by: (1) visual inspecting the generated path rendered in the 3D tumor-centric coordinates, and (2) comparing with a traveling-salesman (TSP) solution obtained from relaxing the variant SADs and continuous collision-avoidance requirement. The proposed method has generated delivery paths that are smooth and intuitively appealing. Under relaxed settings, our results outperform the generic TSP solutions and agree with specially tuned versions. We have proposed a novel systematic approach that automatically determines the continuous path to cover non-coplanar, varying SAD IMRT beams. The proposed approach accommodates patient-specific collision zone definition and ensures its avoidance continuously. The differential penalty to couch and gantry motions allows customizable tradeoff between patient geometry stability and delivery efficiency. This development paves the path to achieve safe, accurate and efficient non-coplanar IMRT delivery with the advanced robotic controls in new-generation C-arm systems, enabling practical harvesting of the dose benefit offered by non-coplanar, variant SAD IMRT treatment. © 2012 American Association of Physicists in Medicine.

Barriers to the delivery of diabetes care in the Middle East and South Africa: a survey of 1,082 practising physicians in five countries.

PubMed

Assaad-Khalil, S H; Al Arouj, M; Almaatouq, M; Amod, A; Assaad, S N; Azar, S T; Belkhadir, J; Esmat, K; Hassoun, A A K; Jarrah, N; Zatari, S; Alberti, K G M M

2013-11-01

Developing countries face a high and growing burden of type 2 diabetes. We surveyed physicians in a diverse range of countries in the Middle East and Africa (Egypt, Kingdom of Saudi Arabia, United Arab Emirates, South Africa and Lebanon) with regard to their perceptions of barriers to type 2 diabetes care identified as potentially important in the literature and by the authors. One thousand and eighty-two physicians completed a questionnaire developed by the authors. Most physicians enrolled in the study employed guideline-driven care; 80-100% of physicians prescribed metformin (with lifestyle intervention, where there are no contraindications) for newly diagnosed type 2 diabetes, with lifestyle intervention alone used where metformin was not prescribed. Sulfonylureas were prescribed widely, consistent with the poor economic status of many patients. About one quarter of physicians were not undertaking any form of continuing medical education, and relatively low proportions of practices had their own diabetes educators, dieticians or diabetic foot specialists. Physicians identified the deficiencies of their patients (unhealthy lifestyles, lack of education and poor diet) as the most important barriers to optimal diabetes care. Low-treatment compliance was not ranked highly. Access to physicians did not appear to be a problem, as most patients were seen multiple times per year. Physicians in the Middle East and South Africa identified limitations relating to their patients as the main barrier to delivering care for diabetes, without giving high priority to issues relating to processes of care delivery. Further study would be needed to ascertain whether these findings reflect an unduly physician-centred view of their practice. More effective provision of services relating to the prevention of complications and improved lifestyles may be needed. © 2013 John Wiley & Sons Ltd.

[Public health service prescriptions of vaccines not included in systematic vaccination programs in Valencian community, Spain, during the period 2004-2009].

PubMed

Ruiz Palacio, Ana; Pastor Villalba, Eliseo; Martín Ivorra, Rosa; Alguacil Ramos, Ana María; Portero Alonso, Antonio; Lluch Rodrigo, José Antonio

2011-06-01

In the context of the policies of rational use of medicine, and in order to achieve an efficient management of the vaccinations programs, we expect to know the number of packings and cost of prescribed vaccines not included in the vaccination programs of Valencian Community and its departments during 2009 and to analyze its evolution since 2004, focusing on an analysis of Heptavalent pneumococcal conjugate vaccine in children under two years old. Retrospective descriptive study to analyze the prescriptions of vaccines in Valencian Community during 2009 and its evolution since 2004. vaccine availability, number of packings, group of beneficiary (actives/pensioners), department, and cost of prescriptions. Gestor de Prestación Farmacéutica (GAIA) and Sistema Información Poblacional (SIP). In 2009 prescribed vaccines on official national health system prescription forms that are not included in vaccination programs, supposed a cost of 683.445,71 € corresponding to 17.353 packings (87% of the total prescribed vaccines). Heptavalent pneumococcal conjugate vaccine generated 72% of the total cost of vaccines not included in the vaccination programs. The trend from 2004 to 2009 shows an increase in expenditure of 735.334 € (24,66%) in 2005 from which there takes place a marked and gradual decrease that reaches 1.562.650,67 € (-228.64%). The cost by departments of prescriptions per 1000 children under two years old of pneumococcal conjugate vaccine ranges between 17.377 and 324 €. The declining trend of prescriptions, mainly of pneumococcal conjugate vaccines, continues during 2009. A great interdepartmental variability is observed, nevertheless, in rates of prescription that should be corrected.

Impact of computerized order entry and pre-mixed dialysis solutions for continuous veno-venous hemodiafiltration on selection of therapy for acute renal failure.

PubMed

Saadulla, Lawand; Reeves, W Brian; Irey, Brittany; Ghahramani, Nasrollah

2012-02-01

To investigate the impacts of availability of pre-mixed solutions and computerized order entry on nephrologists' choice of the initial mode of renal replacement therapy in acute renal failure. We studied 898 patients with acute renal failure in 3 consecutive eras: era 1 (custom-mixed solution; n = 309), era 2 (pre-mixed commercial solution; n = 324), and era 3 (post-computerized order entry; n = 265). The proportion of patients treated with renal replacement therapy and the time from consult to initiation of continuous renal replacement therapy was similar in the 3 eras. Following introduction of the pre-mixed solution, the proportion of patients treated with continuous renal replacement therapy increased (20% vs. 33%; p < 0.05), it was initiated at a lower serum creatinine (353 ± 123 μmol/L vs. 300 ± 80 μmol/L; p < 0.05) and in older patients (53 ± 12 vs. 61 ± 14 years; p < 0.05). There was a progressive increase in the use of continuous veno-venous hemodialysis (18% vs. 79% vs. 100%; p < 0.05) and in the total prescribed flow rate (1,382 ± 546 vs. 2,324 ± 737 vs. 2,900 ± 305 mL/hr 3; p < 0.05). There was no significant impact on mortality. The availability of a pre-mixed solution increases the likelihood of initiating continuous renal replacement therapy in acute renal failure, initiating it at a lower creatinine and for older patients, use of continuous veno-venous hemodialysis and higher prescribed continuous renal replacement therapy dose. Computerized order entry implementation is associated with an additional increase in the use of continuous veno-venous hemodialysis, higher total prescribed dialysis dose, and use of CRRT among an increasing number of patients not on mechanical ventilation. The effect of these changes on patient survival is not significant.

Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits.

PubMed

Molina, Kyle C; Fairman, Kathleen A; Sclar, David A

2018-01-01

Opioids are not recommended for routine treatment of migraine because their benefits are outweighed by risks of medication overuse headache and abuse/dependence. A March 2016 US Food and Drug Administration (FDA) safety communication warned of the risk of serotonin syndrome from using opioids concomitantly with 5-hydroxytryptamine receptor agonists (triptans) or serotonergic antidepressants: selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Epidemiological information about co-prescribing of these medications is limited. The objective of this study was to estimate the nationwide prevalence of co-prescribing of an opioid with a serotonergic antidepressant and/or triptan in US office-based physician visits made by 1) all patients and 2) patients diagnosed with migraine. National Ambulatory Medical Care Survey (NAMCS) data were obtained for 2013 and 2014. Physician office visits that included the new or continued prescribing of ≥1 opioid medication with a triptan or an SSRI/SNRI were identified. Co-prescribed opioids were stratified by agent to determine the proportion of co-prescriptions with opioids posing a higher risk of serotonergic agonism (meperidine, tapentadol, and tramadol). Of an annualized mean 903.6 million office-based physician visits in 2013-2014, 17.7 million (2.0% of all US visits) resulted in the prescribing of ≥1 opioid medication with a triptan or an SSRI/SNRI. Opioid-SSRI/SNRI was co-prescribed in 16,044,721 visits, while opioid-triptan was co-prescribed in 1,622,827 visits. One-fifth of opioid co-prescribing was attributable to higher-risk opioids, predominantly tramadol (18.6% of opioid-SSRI/SNRI, 21.8% of opioid-triptan). Of 7,672,193 visits for patients diagnosed with migraine, 16.3% included opioid prescribing and 2.0% included co-prescribed opioid-triptan. During a period approximately 2 years prior to an FDA warning about the risk of serotonin syndrome from opioid-SSRI/SNRI or opioid-triptan co-prescribing, use of these combinations was common in the USA. Studies on prescribing patterns following the March 2016 warning, and on the risk of serotonin syndrome associated with these co-prescriptions, are needed.

Stem Cell Transplant

MedlinePlus

... prevent infections. You may also be prescribed antifungal, antibacterial or antiviral medications. Doctors continue to study and develop several new medications, including new antifungal medications, antibacterial medications, antiviral medications and immunosuppressive medications. Diet and ...

27 CFR 40.232 - Experimental purposes.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... after their use for experimental purposes. (e) Record of use. In addition to the records prescribed by...

27 CFR 40.232 - Experimental purposes.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... after their use for experimental purposes. (e) Record of use. In addition to the records prescribed by...

27 CFR 40.232 - Experimental purposes.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... after their use for experimental purposes. (e) Record of use. In addition to the records prescribed by...

27 CFR 40.232 - Experimental purposes.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... after their use for experimental purposes. (e) Record of use. In addition to the records prescribed by...

77 FR 59456 - Proposed Collection; Comment Request for Form 8281

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-27

... 8281, Information Return for Publicity Offered Original Issue Discount Instructions. DATES: Written... Offered Original Issue Discount Instruments. OMB Number: 1545-0887. Form Number: 8281. Abstract: Internal... publicity offered debt instruments having original issue discount. Regulations section 1.1275- 3 prescribes...

7 CFR 3052.320 - Report submission.

Code of Federal Regulations, 2010 CFR

2010-01-01

... audit shall be completed and the data collection form and reporting package shall be submitted within... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...

7 CFR 3052.320 - Report submission.

Code of Federal Regulations, 2011 CFR

2011-01-01

... audit shall be completed and the data collection form and reporting package shall be submitted within... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...

7 CFR 3052.320 - Report submission.

Code of Federal Regulations, 2013 CFR

2013-01-01

... audit shall be completed and the data collection form and reporting package shall be submitted within... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...

7 CFR 3052.320 - Report submission.

Code of Federal Regulations, 2012 CFR

2012-01-01

... audit shall be completed and the data collection form and reporting package shall be submitted within... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...

7 CFR 3052.320 - Report submission.

Code of Federal Regulations, 2014 CFR

2014-01-01

... audit shall be completed and the data collection form and reporting package shall be submitted within... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...

Pharmacological treatments for alleviating agitation in dementia: a systematic review and network meta-analysis.

PubMed

Kongpakwattana, Khachen; Sawangjit, Ratree; Tawankanjanachot, Itthipol; Bell, J Simon; Hilmer, Sarah N; Chaiyakunapruk, Nathorn

2018-04-10

To determine the most efficacious and acceptable treatments of agitation in dementia. MEDLINE, EMBASE, PsycINFO, CENTRAL and clinicaltrials.gov were searched up to 7 February 2017. Two independent reviewers selected randomized controlled trials (RCTs) of treatments to alleviate agitation in people with all-types dementia. Data were extracted using standardized forms and study quality was assessed using the revised Cochrane Risk of Bias Tool for RCTs. Data were pooled using meta-analysis. The primary outcome, efficacy, was 8-week response rates defined as a 50% reduction in baseline agitation score. The secondary outcome was treatment acceptability defined as treatment continuation for 8 weeks. Thirty-six RCTs comprising 5585 participants (30.9% male; mean ± standard deviation age, 81.8 ± 4.9 years) were included. Dextromethorphan/quinidine [odds ratio (OR) 3.04; 95% confidence interval (CI), 1.63-5.66], risperidone (OR 1.96; 95% CI, 1.49-2.59) and selective serotonin reuptake inhibitors as a class (OR 1.61; 95% CI, 1.02-2.53) were found to be significantly more efficacious than placebo. Haloperidol appeared less efficacious than nearly all comparators. Most treatments had noninferior treatment continuation compared to placebo, except oxcarbazepine, which was inferior. Findings were supported by subgroup and sensitivity analyses. Risperidone, serotonin reuptake inhibitors as a class and dextromethorphan/quinidine demonstrated evidence of efficacy for agitation in dementia, although findings for dextromethorphan/quinidine were based on a single RCT. Our findings do not support prescribing haloperidol due to lack of efficacy, or oxcarbazepine due to lack of acceptability. The decision to prescribe should be based on comprehensive consideration of the benefits and risks, including those not evaluated in this meta-analysis. © 2018 The British Pharmacological Society.

18 CFR 260.300 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false FERC Form No. 3-Q... ENERGY APPROVED FORMS, NATURAL GAS ACT STATEMENTS AND REPORTS (SCHEDULES) § 260.300 FERC Form No. 3-Q... as FERC Form No. 3-Q, is prescribed for the reporting quarter ending March 31, 2004, and each quarter...

18 CFR 260.300 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false FERC Form No. 3-Q... ENERGY APPROVED FORMS, NATURAL GAS ACT STATEMENTS AND REPORTS (SCHEDULES) § 260.300 FERC Form No. 3-Q... as FERC Form No. 3-Q, is prescribed for the reporting quarter ending March 31, 2004, and each quarter...

18 CFR 260.300 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false FERC Form No. 3-Q... ENERGY APPROVED FORMS, NATURAL GAS ACT STATEMENTS AND REPORTS (SCHEDULES) § 260.300 FERC Form No. 3-Q... as FERC Form No. 3-Q, is prescribed for the reporting quarter ending March 31, 2004, and each quarter...

18 CFR 260.300 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false FERC Form No. 3-Q... ENERGY APPROVED FORMS, NATURAL GAS ACT STATEMENTS AND REPORTS (SCHEDULES) § 260.300 FERC Form No. 3-Q... as FERC Form No. 3-Q, is prescribed for the reporting quarter ending March 31, 2004, and each quarter...

Use of the Screening Tool of Older Persons' Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) in hospitalised older people.

PubMed

Manias, Elizabeth; Kusljic, Snezana; Lam, Di-Luu

2015-12-01

To determine the prevalence and nature of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in patients aged 65 years and over. A retrospective clinical audit was undertaken (N = 200) in an Australian metropolitan teaching hospital. The prevalence of at least one PIM was 51% (n = 101) whereas the prevalence of at least one PPO was 74% (n = 147). The most common PIM was prescribing aspirin to patients with no history of coronary, cerebral or peripheral arterial disease or occlusive arterial events. The most commonly detected PPO was the failure to prescribe statins to patients with a documented history of coronary, cerebral or peripheral vascular disease. Overall, 80 (24%) of the 335 PIMs identified were possibly associated with an adverse clinical outcome experienced by patients. Inappropriate prescribing continues to be a problem as shown by complexities associated with the risk-benefit trade-offs of managing medications in older patients. © 2014 AJA Inc.

Translating Patient Safety Research Into Clinical Practice

DTIC Science & Technology

2005-01-01

AIM approach is being used to evaluate a pharmacy alert intervention designed to detect and correct medication prescribing errors for all patients ...Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Advances in Patient Safety: Vol. 2 164 patients .6, 9 Medication use in the ambulatory care...subjects and patients with chronic illnesses) and settings (e.g., schools, worksites, and medical clinics).32 We illustrate each of the RE-AIM dimensions

Long-term prescribing of antidepressants in the older population: a qualitative study

PubMed Central

Dickinson, Rebecca; Knapp, Peter; House, Allan O; Dimri, Vandana; Zermansky, Arnold; Petty, Duncan; Holmes, John; Raynor, David K

2010-01-01

Background High rates of long-term antidepressant prescribing have been identified in the older population. Aims To explore the attitudes of older patients and their GPs to taking long-term antidepressant therapy, and their accounts of the influences on long-term antidepressant use. Design of study Qualitative study using in-depth semi-structured interviews. Setting One primary care trust in North Bradford. Method Thirty-six patients aged ≥75 years and 10 GPs were interviewed. Patients were sampled to ensure diversity in age, sex, antidepressant type, and home circumstances. Results Participants perceived significant benefits and expressed little apprehension about taking long-term antidepressants, despite being aware of the psychological and social factors involved in onset and persistence of depression. Barriers to discontinuation were identified following four themes: pessimism about the course and curability of depression; negative expectations and experiences of ageing; medicine discontinuation perceived by patients as a threat to stability; and passive (therapeutic momentum) and active (therapeutic maintenance) decisions to accept the continuing need for medication. Conclusion There is concern at a public health level about high rates of long-term antidepressant prescribing, but no evidence was found of a drive for change either from the patients or the doctors interviewed. Any apprehension was more than balanced by attitudes and behaviours supporting continuation. These findings will need to be incorporated into the planning of interventions aimed at reducing long-term antidepressant prescribing in older people. PMID:20353660

Monitoring of Recommended Metabolic Laboratory Parameters Among Medicaid Recipients on Second-Generation Antipsychotics in Federally Qualified Health Centers.

PubMed

Uzal, Natalia E; Chavez, Benjamin; Kosirog, Emily R; Billups, Sarah J; Saseen, Joseph J

2018-02-01

In 2004, a consensus statement outlining recommended metabolic monitoring for patients prescribed second-generation antipsychotics (SGAs) was published. More than a decade later, suboptimal adherence rates to these recommendations continue to be reported, which could lead to long-term and costly complications. To define the prevalence of appropriately monitored Medicaid patients receiving care at federally qualified health centers (FQHCs) prescribed SGAs. This was a retrospective study examining electronic health record and Medicaid claims data to assess the rates of glucose and lipid monitoring for patients prescribed SGAs from January 2014 to August 2016 in a FQHC. Prescription and laboratory claims for patients receiving care at 4 FQHCs were reviewed. Descriptive statistics were used to evaluate the primary outcome. A total of 235 patients were included in the analysis. Patients initiated on SGA therapy (n = 92) had baseline glucose and lipid monitoring rates of 50% and 23%, respectively. The 3-month monitoring rates were 37% for glucose and 26% for lipids, whereas annual rates were 71% and 40%, respectively. Patients continuing SGA therapy (n = 143) had annual glucose and lipid monitoring rates of 67% and 44%. Medicaid patients at FQHCs initially prescribed SGAs have low baseline and 3-month metabolic monitoring, whereas annual monitoring was comparable to previously published studies. Adults receiving chronic care at a FQHC were more likely to receive glucose monitoring. Those with type 2 diabetes mellitus and/or hyperlipidemia were more likely to receive glucose and lipid monitoring.

Medication apprehension and compliance among dialysis patients--a comprehensive guidance attitude.

PubMed

Katzir, Ze'ev; Boaz, Mona; Backshi, Irena; Cernes, Relu; Barnea, Zvi; Biro, Alexander

2010-01-01

Compliance with treatment regimens is a continuing challenge for chronic dialysis patients and their medical caregivers. Poor patient adherence to prescribed medications can adversely affect treatment outcome. In this pre- versus post-intervention study, 89 chronic dialysis patients [75 hemodialysis (HD), 14 continuous ambulatory peritoneal dialysis (CAPD); mean age 62.7 +/- 12.39 years, 34 females] responded to a written questionnaire designed to assess knowledge about and compliance with 5 groups of prescribed medications: metabolic drugs, antihypertensives, cardiac-supporting agents, peptic disease therapy and hematological replacement therapy. Mode of intake, storage, means of supply and source of information for each class of drug were also assessed. Patients then received both oral and written instructions regarding their prescribed medications (intervention). This information was repeated 3 months later. Six months after the intervention, patients were re-administered the questionnaires. Response to the questionnaires and laboratory data were compared prior to and following the intervention. Overall, compliance with prescribed medications significantly improved following the intervention, from 89 to 95.7%, p = 0.0007. This relative improvement was greater in HD than CAPD patients (27 vs. 2%, p < 0.0001). Improvement in compliance was associated with lower initial scores, fewer years of education, and longer dialysis vintage. Compared to baseline values, post-intervention blood hemoglobin, hematocrit, mean corpuscular volume, ferritin and Ca levels were significantly improved. Dialysis patients appear to benefit from receiving comprehensive guidance about medications, in terms of compliance with medications and blood chemistry and hematology measures. (c) 2009 S. Karger AG, Basel.

Current opinions and recommendations of paediatric healthcare professionals – The importance of tablets: Emerging orally disintegrating versus traditional tablets

PubMed Central

Alyami, Hamad; Koner, Jasdip; Terry, David; Mohammed, Afzal R.

2018-01-01

The appropriate prescribing of paediatric dosage forms is paramount in providing the desired therapeutic effect alongside successful medication adherence with the paediatric population. Often it is the opinion of the healthcare practitioner that dictates which type of dosage form would be most appropriate for the paediatric patient, with liquids being both the most commonly available and most commonly used. Orally disintegrating tablets (ODTs) are an emerging dosage form which provide many benefits over traditional dosage forms for paediatric patients, such as rapid disintegration within the oral cavity, and the reduction in the risk of choking. However the opinion and professional use of healthcare practitioners regarding ODT’s is not known. This study was designed to assess the opinions of several types of healthcare professionals (n = 41) regarding ODTs, using a survey across two hospital sites. Results reaffirmed the popularity of liquids for prescribing in paediatrics, with 58.0% of participants preferring this dosage form. ODTs emerged as the second most popular dosage form (30.0%), with healthcare practitioners indicating an increasing popularity amongst patients in the hospital setting, belief with 63.0% of practitioners agreeing that many liquid formulations could be substituted with a suitable ODT. The desired properties of an ideal ODT were also identified by healthcare practitioners preferring a small, fast disintegrating tablet (90.2% and 95.1% respectively), with the taste, disintegration time and flavour being the three most important attributes identified (29.5%, 28.7% and 21.7% respectively). This study provided a pragmatic approach in assessing healthcare professional’s opinions on ODTs, highlighting the ideas and thoughts of practitioners who are on the frontline of paediatric prescribing and treatment and gave an indication to their preference for ODT properties. PMID:29489871

50 CFR 18.24 - Taking incidental to commercial fishing operations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... THE INTERIOR (CONTINUED) TAKING, POSSESSION, TRANSPORTATION, SALE, PURCHASE, BARTER, EXPORTATION, AND... until October 21, 1974: Provided, That such taking is by means of equipment and techniques prescribed in...

Abortion - medical

MedlinePlus

... several hours. Your provider may prescribe medicine for pain and nausea if needed to ease your discomfort during this process. ... Risks of medical abortion include: Continued bleeding Diarrhea ... body, making surgery necessary Infection Nausea Pain Vomiting

Prescribing Clinicians’ Perspectives on Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

PubMed Central

Barnett, Erin R.; Bernardy, Nancy C.; Jenkyn, Aaron B.; Parker, Louise E.; Lund, Brian C.; Alexander, Bruce; Friedman, Matthew J.

2014-01-01

Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians’ knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs. PMID:25431445

12 CFR 238.53 - Prescribed services and activities of savings and loan holding companies.

Code of Federal Regulations, 2014 CFR

2014-01-01

... reasons and the date by which the Board expects to act. (3)(i) Required time limit for System action. The... and loan holding companies. 238.53 Section 238.53 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) SAVINGS AND LOAN HOLDING COMPANIES...

12 CFR 238.53 - Prescribed services and activities of savings and loan holding companies.

Code of Federal Regulations, 2012 CFR

2012-01-01

... reasons and the date by which the Board expects to act. (3)(i) Required time limit for System action. The... and loan holding companies. 238.53 Section 238.53 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) SAVINGS AND LOAN HOLDING COMPANIES...

12 CFR 238.53 - Prescribed services and activities of savings and loan holding companies.

Code of Federal Regulations, 2013 CFR

2013-01-01

... reasons and the date by which the Board expects to act. (3)(i) Required time limit for System action. The... and loan holding companies. 238.53 Section 238.53 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) SAVINGS AND LOAN HOLDING COMPANIES...

26 CFR 1.641(a)-1 - Imposition of tax; application of tax.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Imposition of tax; application of tax. 1.641(a... (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Estates, Trusts, and Beneficiaries § 1.641(a)-1 Imposition of tax; application of tax. For taxable years beginning after December 31, 1970, section 641 prescribes...

Treating Wisely: The Surgeon's Role in Antibiotic Stewardship.

PubMed

Leeds, Ira L; Fabrizio, Anne; Cosgrove, Sara E; Wick, Elizabeth C

2017-05-01

: Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of "superbugs," bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

18 CFR 141.400 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false FERC Form No. 3-Q... AND REPORTS (SCHEDULES) § 141.400 FERC Form No. 3-Q, Quarterly financial report of electric utilities..., licensees, and natural gas companies, designated as FERC Form No. 3-Q, is prescribed for the reporting...

18 CFR 141.400 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false FERC Form No. 3-Q... AND REPORTS (SCHEDULES) § 141.400 FERC Form No. 3-Q, Quarterly financial report of electric utilities..., licensees, and natural gas companies, designated as FERC Form No. 3-Q, is prescribed for the reporting...

18 CFR 141.400 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false FERC Form No. 3-Q... AND REPORTS (SCHEDULES) § 141.400 FERC Form No. 3-Q, Quarterly financial report of electric utilities..., licensees, and natural gas companies, designated as FERC Form No. 3-Q, is prescribed for the reporting...

18 CFR 141.400 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false FERC Form No. 3-Q... AND REPORTS (SCHEDULES) § 141.400 FERC Form No. 3-Q, Quarterly financial report of electric utilities..., licensees, and natural gas companies, designated as FERC Form No. 3-Q, is prescribed for the reporting...

20 CFR 422.512 - Applications and related forms used in the black lung benefits program.

Code of Federal Regulations, 2011 CFR

2011-04-01

... black lung benefits program. 422.512 Section 422.512 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... black lung benefits program. (a) Application forms. The following forms are prescribed for use in... Act of 1969, as amended by the Black Lung Benefits Act of 1972: SSA-46—Application for Benefits Under...

49 CFR 19.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal... name and address of the SPOC for a particular State can be obtained from the Federal awarding agency or...

49 CFR 19.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal... name and address of the SPOC for a particular State can be obtained from the Federal awarding agency or...

49 CFR 19.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal... name and address of the SPOC for a particular State can be obtained from the Federal awarding agency or...

49 CFR 19.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal... name and address of the SPOC for a particular State can be obtained from the Federal awarding agency or...

49 CFR 19.12 - Forms for applying for Federal assistance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Paperwork Burdens on the Public,” with regard to all forms used by the Federal awarding agency in place of... series or those forms and instructions prescribed by the Federal awarding agency. (c) For Federal... name and address of the SPOC for a particular State can be obtained from the Federal awarding agency or...

48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in 836...

48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in 836...

17 CFR 239.34 - Form F-4, for registration of securities of foreign private issuers issued in certain business...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Form F-4, for registration of securities of foreign private issuers issued in certain business combination transactions. 239.34 Section 239.34 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION FORMS PRESCRIBED UNDER THE...

77 FR 36018 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

..., Washington, DC 20549-0213. Extension: Form TH; OMB Control No. 3235-0425; SEC File No. 270-377. Notice is... request for extension of the previously approved collection of information discussed below. Form TH (17... prescribed by Rule 201(a) of Regulation S-T. (17 CFR 232.201(a)). Form TH is a public document and is filed...

77 FR 22004 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-12

..., Washington, DC 20549-0213 Extension: Form TH, OMB Control No. 3235-0425, SEC File No. 270-377. Notice is... Management and Budget for extension and approval. Form TH (17 CFR 239.65, 249.447, 269.10 and 274.404) under... otherwise be required to be filed electronically as prescribed by Rule 201(a) of Regulation S-T. Form TH...

Simulating Full-Waveform LIDAR

DTIC Science & Technology

2009-09-01

WAVEFORM LIDAR by Angela M. Kim September 2009 Thesis Co-Advisors: Carlos F. Borges Richard C. Olsen i REPORT DOCUMENTATION PAGE Form ... Form 298 (Rev. 2-89) Prescribed by ANSI Std. 239-18 ii THIS PAGE INTENTIONALLY LEFT BLANK iii Approved for public release; distribution is...and various forms of vegetated landscapes” from the SLA-02 instrument (From NASA, 1997

Self-transcendence and medication adherence in older adults with hypertension.

PubMed

Thomas, Nezbile F; Dunn, Karen S

2014-12-01

The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication. Descriptive, correlational research design. Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed's Self-Transcendence Scale. No significant relationship was found between medication adherence and self-transcendence (r = -.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers. Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population. © The Author(s) 2014.

Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts.

PubMed

Yeh, James S; Franklin, Jessica M; Avorn, Jerry; Landon, Joan; Kesselheim, Aaron S

2016-06-01

Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed. Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol. Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011. The exposure variable was a physician's industry payments as listed in the Massachusetts database. The outcome was the physician's rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians' industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments. Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P < .001). Payments for educational training were associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not. Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to rein in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

Impact of Technological Advancement on Pedagogy

ERIC Educational Resources Information Center

Abik, Mounia; Ajhoun, Rachida; Ensias, Lerma

2012-01-01

To improve the quality of learning, pedagogues have prescribed different pedagogical approaches (constructivist, cognitivist...). However, the effective implementation of the majority of these approaches has not been possible only after the advent of new forms of learning (E_learning, M-learning...). These forms are closely related to…

7 CFR 1205.520 - Procedure for obtaining reimbursement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... application forms may be filed. In any such case, the reimbursement application shall show the names... Cotton Board shall make reimbursement to the importer. For joint applications, the reimbursement shall be... procedures prescribed in this section. (a) Application form. An importer shall obtain a reimbursement...

75 FR 22637 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-29

... the form prescribed for use by registered investment companies in certain circumstances to request orders of the Commission declaring that the registration of that investment company cease to be in effect. The form requests, from investment companies seeking a deregistration order, information about (i) the...

38 CFR 41.320 - Report submission.

Code of Federal Regulations, 2013 CFR

2013-07-01

... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...) General. The audit shall be completed and the data collection form described in paragraph (b) of this...

38 CFR 41.320 - Report submission.

Code of Federal Regulations, 2011 CFR

2011-07-01

... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...) General. The audit shall be completed and the data collection form described in paragraph (b) of this...

38 CFR 41.320 - Report submission.

Code of Federal Regulations, 2012 CFR

2012-07-01

... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...) General. The audit shall be completed and the data collection form described in paragraph (b) of this...

38 CFR 41.320 - Report submission.

Code of Federal Regulations, 2010 CFR

2010-07-01

... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...) General. The audit shall be completed and the data collection form described in paragraph (b) of this...

38 CFR 41.320 - Report submission.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is limited to the data elements prescribed by OMB. (c) Reporting package. The reporting package shall... not submitted the required data collection forms and reporting packages. (i) Clearinghouse address...) General. The audit shall be completed and the data collection form described in paragraph (b) of this...

7 CFR 61.36 - Cause for suspension or revocation.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) has violated or evaded any provision of the Act, these regulations, or the sampling methods prescribed... (CONTINUED) COTTONSEED SOLD OR OFFERED FOR SALE FOR CRUSHING PURPOSES (INSPECTION, SAMPLING AND CERTIFICATION...

Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study.

PubMed

Newlands, Rumana; Duncan, Eilidh M; Prior, Maria; Elouafkaoui, Paula; Elders, Andrew; Young, Linda; Clarkson, Jan E; Ramsay, Craig R

2016-01-29

General dental practitioners (GDPs) regularly prescribe antibiotics to manage dental infections although most infections can be treated successfully by local measures. Published guidance to support GDPs to make appropriate prescribing decisions exists but there continues to be wide variation in dental antibiotic prescribing. An interview study was conducted as part of the Reducing Antibiotic Prescribing in Dentistry (RAPiD) trial to understand the barriers and facilitators of using local measures instead of prescribing antibiotics to manage bacterial infections. Thirty semi-structured one-to-one telephone interviews were conducted using the Theoretical Domains Framework (TDF). Responses were coded into domains of the TDF and sub-themes. Priority domains (high frequency: ≥50 % interviewees discussed) relevant to behaviour change were identified as targets for future intervention efforts and mapped onto 'intervention functions' of the Behaviour Change Wheel system. Five domains (behavioural regulation, social influences, reinforcement, environmental context and resources, and beliefs about consequences) with seven sub-themes were identified as targets for future intervention. All participants had knowledge about the evidence-based management of bacterial infections, but they reported difficulties in following this due to patient factors and time management. Lack of time was found to significantly influence their decision processes with regard to performing local measures. Beliefs about their capabilities to overcome patient influence, beliefs that performing local measures would impact on subsequent appointment times as well as there being no incentives for performing local measures were also featured. Though no knowledge or basic skills issues were identified, the participants suggested some continuous professional development programmes (e.g. time management, an overview of published guidance) to address some of the barriers. The domain results suggest a number of intervention functions through which future interventions could change GDPs' antibiotic prescribing for bacterial infections: imparting skills through training, providing an example for GDPs to imitate (i.e. modelling) or creating the expectation of a reward (i.e. incentivisation). This is the first theoretically informed study to identify barriers and facilitators of evidence-based management of patients with bacterial infections among GDPs. A pragmatic approach is needed to address the modifiable barriers in future interventions intended to change dentists' inappropriate prescribing behaviour.

Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study.

PubMed

McCrorie, Carolyn; Closs, S José; House, Allan; Petty, Duncan; Ziegler, Lucy; Glidewell, Liz; West, Robert; Foy, Robbie

2015-09-11

The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain. We held semi-structured interviews with patients and focus groups with general practitioners (GPs). Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford, United Kingdom (UK). We used a grounded approach to the analysis of transcripts. Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality of life. GPs' responses are shaped by how UK general practice is organised, available therapeutic choices and their expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is at odds with the patient's wishes. Four features of the resulting transaction between patients and doctors influence prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient relationship; and mutuality and trust. Problematic prescribing occurs when patients experience repeated consultations that do not meet their needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans of action. Apart from commissioning improved access to appropriate specialist services, general practices should also consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients.

National Health Models and the Adoption of E-Health and E-Prescribing in Primary Care - New Evidence from Europe.

PubMed

Brennan, James; McElligott, Annette; Power, Norah

2015-11-25

Recent research from the European Commission (EC) suggests that the development and adoption of eHealth in primary care is significantly influenced by the context of the national health model in operation. This research identified three national health models in Europe at this time - the National Health Service (NHS) model, the social insurance system (SIS) model and the transition country (TC) model, and found a strong correlation between the NHS model and high adoption rates for eHealth. The objective of this study is to establish if there is a similar correlation in one specific application area - electronic prescribing (ePrescribing) in primary care. A review of published literature from 2000 to 2014 was undertaken covering the relevant official publications of the European Union and national government as well as the academic literature. An analysis of the development and adoption of ePrescribing in Europe was extracted from these data. The adoption of ePrescribing in primary care has increased significantly in recent years and is now practised by approximately 32% of European general practitioners. National ePrescribing services are now firmly established in 11 countries, with pilot projects underway in most others. The highest adoption rates are in countries with the NHS model, concentrated in the Nordic area. The electronic transmission of prescriptions continues to pose a significant challenge, especially in SIS countries and TCs. There is a strong correlation between the NHS model and high adoption rates for ePrescribing similar to the EC findings on the adoption of eHealth. It may be some time before many SIS countries and TCs reach the same adoption levels for ePrescribing and eHealth in primary care as most NHS countries.

Systematic Review of Factors Associated with Antibiotic Prescribing for Respiratory Tract Infections

PubMed Central

Mah, Allison; McGrail, Kimberlyn; Patrick, David M.

2016-01-01

Antibiotic use is a modifiable driver of antibiotic resistance. In many circumstances, antibiotic use is overly broad or unnecessary. We systematically assessed factors associated with antibiotic prescribing for respiratory tract infections (RTI). Studies were included if they used actual (not self-reported or intended) prescribing data, assessed factors associated with antibiotic prescribing for RTIs, and performed multivariable analysis of associations. We searched Medline, Embase, and International Pharmaceutical Abstracts using keyword and MeSH (medical subject headings) search terms. Two authors reviewed each abstract and independently appraised all included texts. Data on factors affecting antibiotic prescribing were extracted. Our searches retrieved a total of 2,848 abstracts, with 97 included in full-text review and 28 meeting full inclusion criteria. Compared to other factors, diagnosis of acute bronchitis was associated with increased antibiotic prescribing (range of adjusted odds ratios [aOR], 1.56 to 15.9). Features on physical exam, such as fever, purulent sputum, abnormal respiratory exam, and tonsillar exudate, were also associated with higher odds of antibiotic prescribing. Patient desire for an antibiotic was not associated or was modestly associated with prescription (range of aORs, 0.61 to 9.87), in contrast to physician perception of patient desire for antibiotics, which showed a stronger association (range of aORs, 2.11 to 23.3). Physician's perception of patient desire for antibiotics was strongly associated with antibiotic prescribing. Antimicrobial stewardship programs should continue to expand in the outpatient setting and should emphasize clear and direct communication between patients and physicians, as well as signs and symptoms that do and do not predict bacterial etiology of upper respiratory tract infections. PMID:27139474

ORACLS: A system for linear-quadratic-Gaussian control law design

NASA Technical Reports Server (NTRS)

Armstrong, E. S.

1978-01-01

A modern control theory design package (ORACLS) for constructing controllers and optimal filters for systems modeled by linear time-invariant differential or difference equations is described. Numerical linear-algebra procedures are used to implement the linear-quadratic-Gaussian (LQG) methodology of modern control theory. Algorithms are included for computing eigensystems of real matrices, the relative stability of a matrix, factored forms for nonnegative definite matrices, the solutions and least squares approximations to the solutions of certain linear matrix algebraic equations, the controllability properties of a linear time-invariant system, and the steady state covariance matrix of an open-loop stable system forced by white noise. Subroutines are provided for solving both the continuous and discrete optimal linear regulator problems with noise free measurements and the sampled-data optimal linear regulator problem. For measurement noise, duality theory and the optimal regulator algorithms are used to solve the continuous and discrete Kalman-Bucy filter problems. Subroutines are also included which give control laws causing the output of a system to track the output of a prescribed model.

77 FR 9889 - Black Hills National Forest Advisory Board Public Meeting Dates Announced

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-21

... vegetation management (wild and prescribed fire, fuels reduction, controlling insect epidemics, invasive species), travel management (off highway vehicles, the new OHV rule, and related topics), and continuing...

Emtricitabine

MedlinePlus

... HIV in the blood. Although emtricitabine does not cure HIV, it may decrease your chance of developing acquired ... often than prescribed by your doctor.Emtricitabine controls HIV infection but does not cure it. Continue to take emtricitabine even if you ...

Abacavir

MedlinePlus

... HIV in the blood. Although abacavir does not cure HIV, it may decrease your chance of developing acquired ... prescribed by your doctor.Abacavir helps to control HIV infection but does not cure it. Continue to take abacavir even if you ...

50 CFR 20.23 - Shooting hours.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PLANTS (CONTINUED) MIGRATORY BIRD HUNTING Taking § 20.23 Shooting hours. No person shall take migratory game birds except during the hours open to shooting as prescribed in subpart K of this part and subpart...

7 CFR 656.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-01-01

... of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... ENCOUNTERED IN NRCS-ASSISTED PROGRAMS § 656.1 Purpose. This part prescribes Natural Resources Conservation... laws and appropriate executive orders for administering NRCS programs. ...

7 CFR 656.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-01-01

... of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... ENCOUNTERED IN NRCS-ASSISTED PROGRAMS § 656.1 Purpose. This part prescribes Natural Resources Conservation... laws and appropriate executive orders for administering NRCS programs. ...

7 CFR 656.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-01-01

... of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... ENCOUNTERED IN NRCS-ASSISTED PROGRAMS § 656.1 Purpose. This part prescribes Natural Resources Conservation... laws and appropriate executive orders for administering NRCS programs. ...

7 CFR 656.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... ENCOUNTERED IN NRCS-ASSISTED PROGRAMS § 656.1 Purpose. This part prescribes Natural Resources Conservation... laws and appropriate executive orders for administering NRCS programs. ...

7 CFR 656.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-01-01

... of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF... ENCOUNTERED IN NRCS-ASSISTED PROGRAMS § 656.1 Purpose. This part prescribes Natural Resources Conservation... laws and appropriate executive orders for administering NRCS programs. ...

M-matrices with prescribed elementary divisors

NASA Astrophysics Data System (ADS)

Soto, Ricardo L.; Díaz, Roberto C.; Salas, Mario; Rojo, Oscar

2017-09-01

A real matrix A is said to be an M-matrix if it is of the form A=α I-B, where B is a nonnegative matrix with Perron eigenvalue ρ (B), and α ≥slant ρ (B) . This paper provides sufficient conditions for the existence and construction of an M-matrix A with prescribed elementary divisors, which are the characteristic polynomials of the Jordan blocks of the Jordan canonical form of A. This inverse problem on M-matrices has not been treated until now. We solve the inverse elementary divisors problem for diagonalizable M-matrices and the symmetric generalized doubly stochastic inverse M-matrix problem for lists of real numbers and for lists of complex numbers of the form Λ =\\{λ 1, a+/- bi, \\ldots, a+/- bi\\} . The constructive nature of our results allows for the computation of a solution matrix. The paper also discusses an application of M-matrices to a capacity problem in wireless communications.

The politics of place: presidential voting patterns and Providers' prescription of emergency contraception.

PubMed

Cleland, Kelly; Wagner, Brandon; Batur, Pelin; McNamara, Megan; Wu, Justine; Rothberg, Michael B

2018-05-17

The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. This study seeks to assess whether political alignment of a provider's county is associated with provider attitudes and behaviors regarding EC. We analyzed survey data collected from 1313 healthcare providers from February 2013 to April 2014 at 14 academic medical centers in the United States. Using logistic regression, we estimated associations between the county political alignment of a provider's practice and his or her EC-related beliefs and practices: 1) if the provider is aware of the most effective EC methods; 2) if knowing that a hypothetical EC method prevented implantation would make a provider less likely to prescribe that method because of personal ethical or religious reasons; and 3) if the provider prescribes any form of EC in his or her practice. In multivariate models, a one percentage-point increase in county Republican vote share was associated with a 2.9% decrease in the odds of a provider prescribing EC, after accounting for provider knowledge and attitudes about EC. EC provides a critical last chance to prevent pregnancy after unprotected sex, yet women living in Republican-leaning counties may face difficulty obtaining EC from healthcare providers. Programs seeking to improve access to EC should focus on areas likely to have fewer providers willing to prescribe EC, which may be those that are more Republican-leaning. The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. Women living in Republican-leaning counties may face difficulty obtaining emergency contraception from healthcare providers. Copyright © 2018. Published by Elsevier Inc.

Suicide by means of opioid overdose in patients with chronic pain.

PubMed

Madadi, Parvaz; Persaud, Nav

2014-11-01

Deaths from prescription opioid use continue to rise in North America. The main focus to date has been developing strategies to prevent nonintentional (accidental) fatalities, which constitute the majority of opioid deaths across all jurisdictions. Often overlooked is the complex group of individuals whose cause of death was suicide by opioid overdose. Although most opioid prescribing tools focus on identifying risk factors for potential abuse, diversion, and propensity for opioid addiction, physicians who consider prescribing opioids should also screen and optimize chronic pain treatment for patients at risk for suicide.

The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

PubMed

Niquille, Anne; Ruggli, Martine; Buchmann, Michel; Jordan, Dominique; Bugnon, Olivier

2010-04-01

Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more comprehensive collaborative programs, such as medication reviews, adherence-enhancing interventions, or disease management approaches.

20 CFR 410.240 - Evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... evidence may be submitted as part of a prescribed application form if the form provides for its inclusion... disability or death due to pneumoconiosis. For evidence requirements to support allegations of total disability or death due to pneumoconiosis; for the effect of the failure or refusal of an individual to...

29 CFR 99.320 - Report submission.

Code of Federal Regulations, 2014 CFR

2014-07-01

... completed and the data collection form and reporting package shall be submitted within the earlier of 30... the data elements prescribed by OMB. (c) Reporting package. The reporting package shall include the... data collection form described in paragraph (b) of this section and one copy of the reporting package...

29 CFR 99.320 - Report submission.

Code of Federal Regulations, 2010 CFR

2010-07-01

... completed and the data collection form and reporting package shall be submitted within the earlier of 30... the data elements prescribed by OMB. (c) Reporting package. The reporting package shall include the... data collection form described in paragraph (b) of this section and one copy of the reporting package...

14 CFR 47.1 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... REGISTRATION General § 47.1 Applicability. This part prescribes the requirements for registering aircraft under... Aircraft Registration, AC Form8050-3. Subpart C applies to each applicant for, and holder of, a Dealer's Aircraft Registration Certificate, AC Form 8050-6. [Amdt. 47-29, 75 FR 41979, July 20, 2010] ...

14 CFR 47.1 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REGISTRATION General § 47.1 Applicability. This part prescribes the requirements for registering aircraft under... Aircraft Registration, AC Form8050-3. Subpart C applies to each applicant for, and holder of, a Dealer's Aircraft Registration Certificate, AC Form 8050-6. [Amdt. 47-29, 75 FR 41979, July 20, 2010] ...

14 CFR 47.1 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-01-01

... REGISTRATION General § 47.1 Applicability. This part prescribes the requirements for registering aircraft under... Aircraft Registration, AC Form8050-3. Subpart C applies to each applicant for, and holder of, a Dealer's Aircraft Registration Certificate, AC Form 8050-6. [Amdt. 47-29, 75 FR 41979, July 20, 2010] ...

14 CFR 47.1 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGISTRATION General § 47.1 Applicability. This part prescribes the requirements for registering aircraft under... Aircraft Registration, AC Form8050-3. Subpart C applies to each applicant for, and holder of, a Dealer's Aircraft Registration Certificate, AC Form 8050-6. [Amdt. 47-29, 75 FR 41979, July 20, 2010] ...

A retrospective cohort study of long-term immediate-release hydrocodone/acetaminophen use and acetaminophen dosing above the Food and Drug Administration recommended maximum daily limit among commercially insured individuals in the United States (2008-2013).

PubMed

DeVeaugh-Geiss, Angela; Kadakia, Aditi; Chilcoat, Howard; Alexander, Louis; Coplan, Paul

2015-06-01

Immediate-release (IR) hydrocodone/acetaminophen is the most prescribed opioid in the United States; however, patterns of use, including long-term treatment and dose, are not well described. Duration of use, including the percentage of patients on long-term treatment (>90 days of continuous use), was assessed for patients newly prescribed IR hydrocodone/acetaminophen compared to other opioid analgesics in a national commercial insurance database (January 2008-September 2013). Though only a small percentage of IR hydrocodone/acetaminophen patients continued treatment long-term (1.7%), the number was large (104,839) and was nearly 5 times the number receiving extended-release (ER) morphine (n = 22,338) and nearly 4 times the number receiving ER oxycodone (n = 26,946) long-term. Using a less conservative allowable gap in treatment increased the number of patients meeting the criteria for long-term use (approximately 160,000 for IR hydrocodone/acetaminophen vs <30,000 for ER morphine and ER oxycodone). Most patients meeting these criteria received IR hydrocodone doses between >20 and ≤60 mg/d (n = 56,220, 53.6%) in month 4; 5.5% (n = 5,743) received doses >60 mg/d. Moreover, approximately 15% of IR hydrocodone/acetaminophen patients (n > 900,000) were prescribed total daily acetaminophen doses exceeding 4 g (the limit recommended by the U.S. Food and Drug Administration) at their initial IR hydrocodone/acetaminophen prescription or any time during therapy. Although most patients were prescribed IR hydrocodone/acetaminophen for acute pain, the number of patients prescribed long-term therapy exceeds the number of patients prescribed ER opioids. It is important to consider the benefits and risks inherent with long-term opioid therapy, whether with IR or ER opioids, to ensure safe use of these products. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Electronically delivered, multicomponent intervention to reduce unnecessary antibiotic prescribing for respiratory infections in primary care: a cluster randomised trial using electronic health records-REDUCE Trial study original protocol.

PubMed

Juszczyk, Dorota; Charlton, Judith; McDermott, Lisa; Soames, Jamie; Sultana, Kirin; Ashworth, Mark; Fox, Robin; Hay, Alastair D; Little, Paul; Moore, Michael V; Yardley, Lucy; Prevost, A Toby; Gulliford, Martin C

2016-08-04

Respiratory tract infections (RTIs) account for about 60% of antibiotics prescribed in primary care. This study aims to test the effectiveness, in a cluster randomised controlled trial, of electronically delivered, multicomponent interventions to reduce unnecessary antibiotic prescribing when patients consult for RTIs in primary care. The research will specifically evaluate the effectiveness of feeding back electronic health records (EHRs) data to general practices. 2-arm cluster randomised trial using the EHRs of the Clinical Practice Research Datalink (CPRD). General practices in England, Scotland, Wales and Northern Ireland are being recruited and the general population of all ages represents the target population. Control trial arm practices will continue with usual care. Practices in the intervention arm will receive complex multicomponent interventions, delivered remotely to information systems, including (1) feedback of each practice's antibiotic prescribing through monthly antibiotic prescribing reports estimated from CPRD data; (2) delivery of educational and decision support tools; (3) a webinar to explain and promote effective usage of the intervention. The intervention will continue for 12 months. Outcomes will be evaluated from CPRD EHRs. The primary outcome will be the number of antibiotic prescriptions for RTIs per 1000 patient years. Secondary outcomes will be: the RTI consultation rate; the proportion of consultations for RTI with an antibiotic prescribed; subgroups of age; different categories of RTI and quartiles of intervention usage. There will be more than 80% power to detect an absolute reduction in antibiotic prescription for RTI of 12 per 1000 registered patient years. Total healthcare usage will be estimated from CPRD data and compared between trial arms. Trial protocol was approved by the National Research Ethics Service Committee (14/LO/1730). The pragmatic design of the trial will enable subsequent translation of effective interventions at scale in order to achieve population impact. ISRCTN95232781; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Persistent use of against-label statin-fibrate combinations from 2003-2009 despite United States Food and Drug Administration dose restrictions.

PubMed

Alford, Julie C; Saseen, Joseph J; Allen, Richard R; Nair, Kavita V

2012-07-01

To describe the prevalence of prescribing against-label statin-fibrate combination therapy. Retrospective cohort study. Medstat MarketScan Commercial Claims and Encounter database. Adults (aged 18-89 yrs) who were prescribed statin-fibrate combination therapy between January 1, 2003, and June 30, 2009, had pharmacy claims demonstrating two or more concurrently filled prescriptions for a statin and a fibrate, and had continuous insurance enrollment for at least 12 months. Claims data were used to identify patients with dyslipidemia based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. National Drug Codes were used to describe concurrent statin-fibrate combination therapy. The primary outcome was recent use of against-label statin-fibrate combination therapy, defined as use during the last 18 months (January 1, 2008-June 30, 2009) of the study period. Patients were stratified according to statin and dosage to identify against-label combination use (e.g., simvastatin > 10 mg/day with gemfibrozil). Within the recent-use period, 131,394 patients were prescribed concurrent statin-fibrate combination therapy; of these patients, 13,420 (10.2%) had against-label therapy. Simvastatin-gemfibrozil accounted for 8978 (66.9%) of all against-label combinations. Of all 9877 simvastatin-gemfibrozil combinations prescribed in the recent-use period (both on-label and against-label use), 8978 (90.9%) were against label. The secondary outcome was prevalence of against-label statin-fibrate combination therapy on an annual basis: 15.5% in 2003, 18.7% in 2004, 9.1% in 2005, 8.3% in 2006, 9.2% in 2007, and 9.8% in 2008. Against-label statin-fibrate combination therapy continues to be prescribed despite established United States Food and Drug Administration (FDA) dose restrictions. Nearly every time the simvastatin-gemfibrozil combination was prescribed, it was against label because simvastatin exceeded the maximum dose restriction. Updated simvastatin labeling in June 2011 includes additional maximum dose restrictions and new contraindications, which include gemfibrozil. Different approaches in clinical practice are needed to ensure adherence with the revised FDA labeling. © 2012 Pharmacotherapy Publications, Inc. All rights reserved.

Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis

PubMed Central

Rice, Nigel; Dixon, Paul; Lloyd, David C E F; Roberts, David

2000-01-01

Objective To develop a weighted capitation formula for setting target allocations for prescribing expenditures for health authorities and primary care groups in England. Design Regression analysis relating prescribing costs to the demographic, morbidity, and mortality composition of practice lists. Setting 8500 general practices in England. Subjects Data from the 1991 census were attributed to practice lists on the basis of the place of residence of the practice population. Main outcome measures Variation in age, sex, and temporary resident originated prescribing units (ASTRO(97)-PUs) adjusted net ingredient cost of general practices in England for 1997-8 modelled for the impact of health and social needs after controlling for differences in supply. Results A needs gradient based on the four variables: permanent sickness, percentage of dependants in no carer households, percentage of students, and percentage of births on practice lists. These, together with supply characteristics, explained 41% of variation in prescribing costs per ASTRO(97)-PU adjusted capita across practices. The latter alone explained about 35% of variation in total costs per head across practices. Conclusions The model has good statistical specification and contains intuitively plausible needs drivers of prescribing expenditure. Together with adjustments made for differences in ASTRO(97)-PUs the model is capable of explaining 62% (35%+0.65% (41%)) of variation in prescribing expenditure at practice level. The results of the study have formed the basis for setting target budgets for 1999-2000 allocations for prescribing expenditure for health authorities and primary care groups. PMID:10650026

Using Big Data to Assess Prescribing Patterns in Greece: The Case of Chronic Obstructive Pulmonary Disease.

PubMed

Souliotis, Kyriakos; Kani, Chara; Papageorgiou, Manto; Lionis, Dimitrios; Gourgoulianis, Konstantinos

2016-01-01

Chronic Obstructive Pulmonary Disease (COPD) is one of the top leading causes of death and disability, and its management is focused on reducing risk factors, relieving symptoms, and preventing exacerbations. The study aim was to describe COPD prescribing patterns in Greece by using existing health administrative data for outpatients. This is a retrospective cross-sectional study based on prescriptions collected by the largest social insurance fund, during the first and last trimester of 2012. Selection criteria were the prescription of specific active substances and a COPD diagnosis. Extracted information included active substance, strength, pharmaceutical form and number of packages prescribed, diagnosis, time of dispensing, as well as insurees' age, gender, percentage of co-payment and social security unique number. Statistical analysis included descriptive statistics and logistic regression. 174,357 patients received medicines for COPD during the study period. Patients were almost equally distributed between male and female, and age above 55 years was strongly correlated with COPD. Most patients received a long-acting beta agonist plus inhaled corticosteroid combination (LABA +ICS), followed by long-acting muscarinic agonist (LAMA). 63% patients belonging in the 35-54 age received LABA+ICS. LAMA was prescribed more frequently among males and was strongly correlated with COPD. The study provides big data analysis of Greek COPD prescribing patterns. It highlights the need for appropriate COPD classification in primary care illustrating the role of electronic prescribing in ensuring appropriate prescribing. Moreover, it indicates possible gender differences in treatment response or disease severity, and the impact of statutory co-payments on prescribing.

A Framework for the Development of Mathematical Thinking with Teacher Trainees: The Case of Continuity of Functions

ERIC Educational Resources Information Center

Brijlall, Deonarain; Maharaj, Aneshkumar

2011-01-01

Continuity of functions appears throughout the grades in South African high school (FET (further education and training)) topics as prescribed by the final draft of the Curriculum and Assessment Policy Statement. This article reports on the use of a combined framework of APOS (action-process-object-schema) and DCT (dual coding theories) to analyze…

Antibiotic Use in Cold and Flu Season and Prescribing Quality: A Retrospective Cohort Study.

PubMed

Alsan, Marcella; Morden, Nancy E; Gottlieb, Joshua D; Zhou, Weiping; Skinner, Jonathan

2015-12-01

Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality. We included Medicare beneficiaries in the 40% random sample denominator file continuously enrolled in fee-for-service benefits for 2010 or 2011 (7,961,201 person-years) and extracted data on prescription fills for oral antibiotics that treat respiratory pathogens. We collapsed the data to the state level so they could be merged with monthly flu activity data from the Centers for Disease Control and Prevention. Linear regression, adjusted for state-specific mean antibiotic use and demographic characteristics, was used to estimate how antibiotic prescribing responded to state-specific flu activity. Flu-activity associated antibiotic use varied substantially across states-lowest in Vermont and Connecticut, highest in Mississippi and Florida. There was a robust positive correlation between flu-activity associated prescribing and use of medications that often cause adverse events in the elderly (0.755; P<0.001), whereas there was a strong negative correlation with beta-blocker use after a myocardial infarction (-0.413; P=0.003). Adjusted flu-activity associated antibiotic use was positively correlated with prescribing high-risk medications to the elderly and negatively correlated with beta-blocker use after myocardial infarction. These findings suggest that excessive antibiotic use reflects low-quality prescribing. They imply that practice and policy solutions should go beyond narrow, antibiotic specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.

17 CFR 274.219 - Form N-17f-1, cover page for each certificate of accounting of securities and similar investments...

Code of Federal Regulations, 2010 CFR

2010-04-01

... each certificate of accounting of securities and similar investments of a management investment company... PRESCRIBED UNDER THE INVESTMENT COMPANY ACT OF 1940 Forms for Other Statements § 274.219 Form N-17f-1, cover page for each certificate of accounting of securities and similar investments of a management...

76 FR 18322 - Federal Acquisition Regulation; Clarification of Standard Form 26-Award/Contract

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

.... This revised form includes changes above blocks 17 and 18 and in block 18 to clarify that block 18... blocks 17 and 18 of the Standard Form (SF) 26, Award/Contract. FAR 53.214(a) prescribes the SF 26 for use... identified instances in which contracting officers mistakenly checked block 18 when awarding negotiated, not...

26 CFR 301.6227(c)-1 - Administrative adjustment request by the tax matters partner on behalf of the partnership.

Code of Federal Regulations, 2010 CFR

2010-04-01

... tax matters partner on behalf of the partnership shall be filed on the form prescribed by the Internal Revenue Service for that purpose in accordance with that form's instructions. Except as otherwise provided in that form's instructions, the request shall be— (1) Filed with the service center where the...

26 CFR 301.6227(c)-1 - Administrative adjustment request by the tax matters partner on behalf of the partnership.

Code of Federal Regulations, 2012 CFR

2012-04-01

... tax matters partner on behalf of the partnership shall be filed on the form prescribed by the Internal Revenue Service for that purpose in accordance with that form's instructions. Except as otherwise provided in that form's instructions, the request shall be— (1) Filed with the service center where the...