Prescription Drugs Ebook

Prescription Freedom: Natural Remedies To Live Drug Free

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Writing prescriptions

Prescriptions for POM-V and POM-VPS products have specific legal requirements. Prescriptions for CDs have additional requirements over and above those for other POMs. In addition, there are some recommendations regarding prescription writing, which it would be good practice to take into account. Table 19.13 demonstrates legal and recommended guidelines for prescription writing. Prescriptions for POM products should not be dispensed any more than 6 months from the date of issue. Prescriptions for CD products should not be dispensed any more than 3 weeks from the date of issue.

Electronic Prescribing and Future Priorities

As mentioned in the introduction, this book is not intended as an exhaustive review of EP research rather, it is designed to help EP implementers and stakeholders to reflect on the various methodological, clinical and professional issues associated with electronic prescribing. The previous chapters have aimed to do this from the standpoint of a number of recognised benefit areas of EP systems. This final chapter is therefore arguably the most speculative chapter, as it aims to consider the future challenges and areas of development in EP implementation.

Opiates Nonmedical Use of Prescription Drugs

Hydrocodone (Vicodin) is the most frequently prescribed opioid in the United States. Oxycodone (Oxycontin) and hydrocodone are prescribed in the treatment of acute and chronic pain. Abusers of hydrocodone and oxycodone experience euphoria, relaxation, and sedation. Long-term use can result in tolerance. Abusers may overdose as they take increasing doses of the medication while pursuing euphoric sensations that they previously experienced. Overdoses may result in severe respiratory depression, hypotension, coma, and death. Recently, methadone, primarily diverted from prescriptions for chronic pain and not metha-done maintenance treatment, has been linked to increased opiate overdoses as well. Its relatively long onset of action and long half-life make methadone-naive individuals more prone to overdose as they seek a stronger high with escalating doses, which accumulate, causing overdose.

Prescription Drugs

Prescription drugs including painkillers, sedatives and tranquilizers, and stimulants have been abused for many years. Drugs such as Valium, Xanax, Vicodin, OxyContin, and methadone show up frequently in ER emergency situations. In a National Survey more than six million Americans over the age of 12 stated they used prescription drugs for nonmedical uses. Prescription drugs have been implicated in the deaths of Marilyn Monroe, Jimi Hendrix, Elvis Presley, Heath Ledger, and Michael Jackson among others. Celebrities may be more at risk for prescription drug overdose because they have easier access from Dr Feelgoods who in some cases are on their payroll. Prescription drugs have not inspired many creative products.

Definitions and Terminology

Since electronic systems for medicine prescribing have been developed independently in different countries, under the auspices of different healthcare systems, it is inevitable that there will be variations in terminology. Furthermore, terms that are not synonymous may be used interchangeably or in an indiscriminate manner. A recent UK definition of electronic prescribing is as follows Connecting for Health Electronic Prescribing Baseline Specification.3 In Europe, the European Committee for Standardisation has defined electronic prescriptions in terms of the exchange of prescription messages between prescribers and dispensers, and between healthcare providers and official authorities as permitted by national regulations.6

EP and the Organisation

The earliest prescribing and medical information systems in the UK were designed for use in general practice and their use in primary care has become widespread, following the introduction of Read codes, which enabled the common classification of medical terms for audit purposes,13 and which in turn facilitated the electronic storage and transmission of patient information, including information about their prescriptions. GP systems have been on the market for over 20 years and have adapted to changes in medical practice in primary care during that time. Furthermore, the databases provided by leading third-party data suppliers were originally designed to meet the needs of primary care computer systems primary care systems suppliers are still the chief consumers of third party drug databases.

Legal Requirements for EP Systems

The prescription, supply and administration of medicines in the UK are primarily regulated by the Medicines Act 1968, and its dependent legislation. The UK law defines prescription only medicines (POMs) as those medicines where a legally valid prescription from a clinician is required before the medicine can be supplied to a patient for self-administration. However, in the UK, any medicine - including over the counter (OTC) medicines, and unlicensed medicines - may be prescribed (subject to any specific local restrictions). Consequently, when configuring drug datasets, implementers should not make the legal category of a medicine alone a condition for prescribability. cine orders for outpatient and discharge supply legally constitute prescriptions, whereas electronic medicine orders for inpatients are orders for administration, which do not, in fact, need to conform fully to prescription regulations. Nevertheless, it has been regarded as good practice for all medicine orders generated...

The Development of Information Technology in Healthcare

Correspondingly, in primary care, GP systems have been in use since the mid-1980s and, in recent years, have become quite elaborate, in terms of the functionality they offer. In addition to the ability to store clinical notes (usually with a problem note hierarchy) and generate prescriptions, these systems are able to provide prescription pricing information, detailed medical information from reference sources such as the British National Formulary (BNF) or the Physicians Desk Reference, pathology order management and items of service billing and claim management. S. Goundrey-Smith, Principles of Electronic Prescribing, 21 In any case, aside from the issues of silo development and intraoperability, there are some areas of secondary care that have not as yet been adequately catered for with IT applications. These are primarily clinical applications, most notably the so-called electronic patient record (EPR) and the broader term electronic health record (EHR). These areas have not been...

Development of EP Systems in the United States

In the late 1990s, US Government Agencies increasingly began to recognise the potential for electronic prescribing systems to reduce clinical risk in busy hospitals. (b) National Council for Prescription Drug Programs (NCPDPs) SCRIPT 5.1 - to deal with the majority of transactions between prescribers and dispensers.

Development of EP Systems in the United Kingdom

The adoption of EP systems in the UK has been equally slow. In early 2007, it was reported that only three hospitals in England (the Wirral Hospitals, Burton on Trent and Winchester) had whole-hospital electronic prescribing systems.16 This is broadly consistent with a survey of 188 hospitals conducted in the UK in 2000,17 indicating that, at the time, 89.4 of hospitals surveyed had no EP system, 11 had an EP system but only 2 of hospitals had full electronic prescribing facilities. This suggests that the uptake of EP systems in UK centres has been minimal since 2000. The likely scenario is that local EP innovation has been slowed down, pending the availability of the full clinical IT solutions from the English Connecting for Health IT programme. In any case, the difficulties associated with EP implementations due to commercial and organisational factors have been commented on in the literature.1819 The Burton on Trent Trust has also been working with electronic medicines management...

Development of EP Systems A European Perspective

A survey of the use of electronic prescriptions in Europe, conducted in 2003,30 indicated that automated solutions for electronic prescribing were not in widespread use in Europe and that the only two countries where electronic prescriptions were issued routinely were Denmark and Sweden. Pilot studies had taken place in the United Kingdom, and Germany had plans to implement electronic prescriptions. This study related primarily to electronic prescriptions in primary care and was concerned with the development of an EU-wide standard for dispensing and reimbursement of prescriptions. However, it is likely then that adoption of EP systems in secondary care in continental Europe has been equally slow.

Integration of EP Systems with Pharmacy Systems

Because of their expertise in software for managing medicines information, the key pharmacy system providers in the UK, JAC Computer Services and Ascribe, have been developing electronic prescribing modules for use in conjunction with their pharmacy systems. The most established example of this is the use of the JAC Computer Services EP module at the Royal Hampshire County Hospital, Winchester, UK. In 2006, the existing HIS prescribing functionality, which had been originally installed in 1989, was replaced by a second-generation EP system from JAC.34 Thus, in the UK, despite the establishment of a national IT programme, some healthcare providers are implementing EP systems as a development of their hospital pharmacy system, rather than as a module of a wider EPR system.

EP Systems and Oncology Systems

The historical development of oncology and haematology prescribing systems represents a special case within the electronic prescribing initiative. Systems for electronic prescribing and dissemination of prescriptions for oncology and hae- A number of systems have been developed to meet oncology clinic management requirements and many of these have electronic prescribing and records management functions for chemotherapy and or radiotherapy prescribing. The Inhealth Systems Torex iSOFT suite of applications for oncology, radiotherapy and palliative care management - OPMAS, RCAS and PCAS respectively - were developed and implemented at various sites in the UK between 1987 and 2004. Newer, comprehensive systems include ChemoCare from Clinisys, and MedOncology from Varian. Another system that has a large share in the US market and may become more popular in the UK is the IMPAQ system. In 2005, the UK government announced its intention to bring forward the electronic prescribing initiative...

Barriers to Implementation of EP Systems

Some of these are human factors - social and psychological factors - and have been discussed in the previous chapter on the philosophical issues surrounding electronic prescribing. However, some of these are regulatory, financial and political factors, and will be considered here. A number of studies have examined the potential barriers to adoption of healthcare IT applications in general38,39 and these factors are equally applicable to EP systems. These factors would include ( e) Failure of software vendors to produce acceptable systems, within agreed timescales. It is widely recognised that not all organisations in the healthcare IT market place are able to provide and install software that is fit for purpose for every application. This is especially the case with electronic prescribing, which is arguably one of the more innovative areas of healthcare IT. There may be a number of reasons for this. First, it is widely understood that the awarding of large contracts to healthcare IT...

Notes and References

Summers V Association of Scottish Chief Pharmacists. Electronic Prescribing - The way forward. Pharm. J. 2000 265 834 18. Goundrey-Smith S.J. Is electronic prescribing a Holy Grail Pharm. J. 2004 272 412. 19. Moule G. Electronic prescribing - Will it ever happen Guild of Healthcare Pharmacists J. 2002 October 20 20. Gross Z. What it means to staff when hospitals are ahead in electronic prescribing. Pharm. J. 2002 268 679 21. Curtis C., Ford N.G. Paperless electronic prescribing in a district general hospital. Pharm. J. 1997 259 734-735 22. Fowlie F., Bennie M. et al. Evaluation of an electronic prescribing and administration system in a British hospital. Pharm. J. 2000 265 (Suppl) R16. 23. Gray S., Smith J. Practice report - Electronic prescribing in Bristol. Healthcare Pharm. 2004 August 20-22 26. Foot R., Taylor L. Electronic prescribing and patient records - Getting the balance right. Pharm. J. 2005 274 210-212. 27. Beard R., Candlish C. Is electronic prescribing the best...

Organisational Benefits of EP

Electronic prescribing systems can offer possible solutions to all of these problems with the current medicine supply process, and therefore, can promote efficiency in the medicine prescribing process and medicines administration process in hospital. As mentioned previously, a review of UK EP implementations has identified a number of key benefits with EP systems.5 They are as follows (a) Availability of a fully electronic prescribing history. (b) Improvement in legibility and completeness of prescriptions. (c) Improvement in hospital business processes due to electronic dissemination of prescriptions. 3. Improvement in hospital business processes due to electronic dissemination of prescriptions

Workflow Management for Clinical users of EP Systems

For many healthcare systems, designed for use in a busy working environment, the design of the user interface is important. For an application such as electronic prescribing, where there is a need to present complex prescribing information in a way that enables appropriate professional decision making, and to input comprehensive medicine order information in a straightforward and timely manner, user interface design is critical.

Medicines Administration Workflow Design

Some systems have been designed to capture the prescribing history electronically but, rather than providing a real-time on-screen medicines administration system, they have instead produced computer-generated charts based on the electronic prescribing record. There is then the facility to reprint, or overprint, these computergenerated charts, following on from changes to the electronic prescribing history. While such a system avoids the complexities of an electronic medicine administration

Facilitation of a Seamless Pharmaceutical Supply Chain

Many of the inefficiencies of existing manual prescribing and medicine supply processes in hospitals surround the way in which prescriptions written on the wards are filled with actual medicines from the hospital pharmacy department. Consequently, a direct link between each ward and the pharmacy department, either as different workstations in a networked EP system, or as an interface between an EP hub and a pharmacy system, represents the means for automating order transfer between wards and the pharmacy, and a valuable tool for reducing inefficiency in the pharmacy requisition process. This is shown in the architecture diagram in Chapter 2 (Fig. 2.2). A conspicuous benefit from a UK perspective is the potential for EP to streamline the discharge process.6 However, while systems offer a seamless transmission from the ward to the pharmacy, or real-time display of prescribing information in the pharmacy, the total business processes of handing pharmacy supply of discharge prescriptions...

Reduced Use of Paper and Consumables

The introduction of electronic prescribing and medicine administration will therefore reduce the amount of consumables used by a health provider - charts, paper, pens etc. Depending on the size of the healthcare provider, the resulting savings may be significant. Nevertheless, while these savings may represent a clear, unambiguous and relatively easily measurable benefit of introducing an EP system, they are insignificant compared to the costs of wasted staff time due to inefficient paper-based systems and processes, and the possible costs of litigation when errors are made, as a result of these inadequate processes. However, unlike savings on paper and consumables, costs for staff time and potential litigation are more difficult to calculate, and it will be tempting for health providers not to attempt to quantify them.

Clinical System Intraoperability

In a number of UK EP implementations, authors have commented on the ability of an EP system to provide a complete and comprehensive prescribing history, which is interfaced with the hospital EPR system.6,9,11 This reduces the number of lost or absent medication records, facilitates remote electronic prescribing and enables the easy production of hard copy discharge prescriptions and other supporting information from different locations. There is therefore the potential for transferability of the prescribing history to and from different systems. For example, this enables electronic prescriptions to be routed to the hospital pharmacy departmental system, to streamline the medicine supply process, as discussed previously. This

EP Systems as a Risk Management Tool

Electronic systems cannot completely eradicate risk in medicine since, by definition, they operate heuristically using defined and discrete datasets and logical algorithms, and their ability to be intuitive is limited. Nor can electronic systems address the human elements of the communication of risk information to, and the assimilation of risk information by, individual patients. Although electronic systems can provide some information support for this, this aspect of risk assessment remains primarily in the domain of the face-to-face consultation between patient and professional, and rightly so. Nevertheless, there is a reasonable body of evidence to suggest that electronic prescribing systems can reduce prescribing risks that are associated with, or may be influenced by, prescribing procedures.

Principles of Risk Management in Therapeutics

Goundrey-Smith, Principles of Electronic Prescribing, 59 Prescribing. The prescription written by the prescriber should clearly state the medicine, the formulation, the dose, the route, the frequency and any other special instructions concerning the use of the medicine. When prescriptions are handwritten on hospital drug charts, it is easy for some aspects of the prescription to be unclear or omitted. What often happens in practice in this situation is that the pharmacist will either contact the prescriber to clarify the exact instructions, or may themselves add the necessary additional instructions, if they are satisfied with the prescriber's intention. However, there are risks associated with both of these practices. Furthermore, there is the risk that items may be erroneously omitted or duplicated when a drug chart is rewritten, which can happen at least once during a patient's hospital stay (more often if they are in an acute medical setting, and taking a large number of...

Reduction in Medication Error Rates With EP Systems Experience From US Implementations

The potential for an electronic prescribing system to reduce medication errors in hospitals is a key benefit of using the system, given the financial cost of medication errors, both in terms of patient morbidity mortality and in terms of costs to the healthcare system. For this reason, considerable research has been conducted into the extent to which EP systems can reduce medication errors. Many of the demonstrated benefits in the area of risk reduction for electronic prescribing systems (CPOE systems) themselves are in the prescribing, dispensing and medicine administration stages of the medicine management cycle. The decision support tools associated with EP systems are likely to have risk management benefits in the diagnosis, assessment, care planning, treatment choice and monitoring stages of the medicine management cycle, and will be discussed in the next section. A particular issue with US data on risk reduction with EP systems is concerning the transcription process. In the US,...

Reduction in Medication Error Rates With EP Systems Experience From UK Implementations

Reductions of errors associated with the prescribing process itself have been noted for some UK EP implementations. Farra has indicated an increase in the number of complete and correct doses on drug charts, following the introduction of EP. In research information available from the Wirral Trust10 2,180 prescriptions for 267 patients were analysed for legibility and completeness, with reference to hospital standards for prescription writing, based on the British National Formulary. One thousand two hundred and seventeen prescriptions generated prior to computerisation and 963 prescriptions generated after computerisation were assessed electronic prescribing significantly improved the legibility and completeness of prescriptions, compared to prescribing by hand (p 0.0001). These improvements in prescription accuracy and legibility and completeness of prescriptions may be attributed to a number of factors the availability of a comprehensive 1. The electronic prescribing system led to a...

Increases in Medication Errors Due To the Introduction of EP Systems

Nebeker et al.7 commented on how a high rate of ADEs could occur even at a hospital where there was a high level of IT usage, to support hospital processes. The study looked at ADEs across the electronic prescribing process, by performing a prospective daily review of the electronic medical record for a random sample of all admissions over a 20-week period at a US hospital. The study showed that, of 937 admissions, there were significant ADEs in 483 admissions. 99 of the ADEs identified resulted in serious harm to the patient and 27 of the ADEs were due to medication. The study observed that ADE rates were still relatively high after CPOE introduction, if decision support systems were not present as an integral part of the system. The role of decision support systems in reducing prescribing risk with electronic systems is discussed in detail in the next section. This phenomenon has also been noted in the UK. As mentioned previously in this chapter, an initial increase in prescribing...

Reduction of Medication Errors Due To the Availability of Electronic Decision Support Tools At the Point of Prescribing

In the study by Nebeker,7 documenting 937 hospital admissions, it was found that 483 admissions had significant ADEs associated with them and that 27 of these were associated with medication. Of the medication-related ADEs, 61 were associated with prescribing errors and 25 with monitoring errors and the authors concluded that EP with decision support (DS) features would have a major impact on these error rates, by reducing inappropriate prescribing at the outset and by providing suitable monitoring tools when certain drugs are prescribed (e.g. digoxin, lithium, theophylline). Indeed, the consensus among electronic prescribing specialists is that decision support tools should be an integral part of EP systems, as they have the potential to add value to the system as a clinical tool. The above data suggest that DS functions are particularly valuable in reducing selection errors and inappro Another question to be addressed in the provision of DS is whether there is any type of...

The Development of Medicines Information Reference Sources

There is therefore a wealth of information available in various electronic formats concerning the pharmacology and clinical use of medicines. For example, compendial information, such as the British National Formulary (BNF) or the Physicians' Desk Reference (PDR), is available in Internet or CD-ROM form, and therefore links could be made to these reference sources (mounted either on a local network or on the Internet) from an EP system. Indeed, many EP systems have implemented controls to link passively to standard electronic medicines reference sources, in order that these reference sources may be used as passive decision support tools, although there may be issues concerning licensing in a multi-user situation, or with performance if the reference source is mounted on a remote server. Links to the BNF and local clinical guidelines in this manner are a requirement of the UK Connecting for Health baseline specification for electronic prescribing.7

Legal Issues with EP Data

It is an important principle in systems analysis that the function of the software and the accuracy and integrity of the data handled by the software cannot be considered in isolation. This is certainly the case with clinical systems, which seek to facilitate the patient care process by automation, because the correct outcome is dependent on both the software and the data, and errors made by the system could cause harm to the patient. With an EP system, it is of no value to have a well-constructed workflow for the prescribing and administration of medicines, if the drug data used to formulate the prescriptions generated are full of errors and inconsistencies.

Modernisation of Healthcare Working Practices

Of the healthcare professionals that are principal stakeholders in the implementation of electronic prescribing, medical and nursing staff have traditionally had the most contact with patients in hospitals. On the contrary, pharmacists have in the past been departmentally-based, at a distance from patients, since historically, their role has revolved around the dispensing and supply of medicines. S. Goundrey-Smith, Principles of Electronic Prescribing, 95

EP Systems Support for Professional Practice

It is clear that, in twenty-first century healthcare systems, health professionals are facing various professional and political challenges, and that professional roles are changing. Nevertheless, healthcare professionals are still committed to providing optimum patient care, according to best standards of practice, and in the light of an adequate evidence base. On this basis, there is a clear potential for electronic prescribing systems to support and enhance clinical practice, both in terms of optimising current practice, and supporting and developing new roles and services. A number of papers have discussed the capacity of EP systems to support and enhance professional practice, within the health professions. American hospital pharmacists have long recognised the potential of electronic prescribing and computerised decision support systems to support clinical practice in pharmacy. In her discussion on the potential for computerised physician order entry (CPOE) to enhance pharmacy...

EP Systems and Patient Centred Medicines Reviews

Advantages of an EP system facilitated medicines review process in hospitals is that it is possible for the review process to be designed and implemented in consultation with, and taking into account the needs of, both prescribers and reviewers. In this way, the process will be acceptable and relevant to all stakeholders, and is more likely to be used effectively. Furthermore, the recommendations of the medicines review are available directly to the prescriber in electronic form, thus reducing the possibility of the review not being available to the prescriber. Future, more sophisticated systems might offer functionality to link medicine review recommendations to prescribing routines. Then, if the prescriber accepts the recommendations of a review, by clicking on the relevant parts of the review form, new or amended prescriptions are automatically generated, which must then be authorised by the prescriber. It is clear that, due to the use of decision support tools at the point of...

EP Systems and Role Based Access RBAC

An electronic prescribing system will usually have a comprehensive function set for managing user permissions and log-ons. This is essential, not only for the security of the system and the data on it (which is sensitive personal information), but also to control access to functionality and to generate an audit trail of user activity, which can be used to create management reports and to track critical incidents.

Records Management and Multiuser Systems

The other issue highlighted was that of access to prescribing records, and input of prescriptions by non-medical prescribers who may be peripatetic healthcare professionals. Electronic systems offer solutions to this problem, and there has been considerable experience of using portable devices for inputting medical information in peripatetic settings. Typically, a system might use a slave application mounted on a portable device, such as a personal digital assistant (PDA) or a palm PC or tablet PC. The slave application would have some, or all, of the functionality of the main system, together with a subset of patient records, depending on the memory capability of the device. The peripatetic health professional would enter the relevant patient information on the device and then, at some future time, the information on the device would be downloaded to the main application, either via a networked connection at the hospital or healthcare provider site, or via a telephone dial-up...

Workflow for Different Prescriber Types

As has already been discussed, one of the benefits of an EP system to prescribers of all professional backgrounds is that it facilitates the generation of clear, complete and accurate prescriptions9,10. This benefit is of value both to experienced prescribers who may be complacent about clarity and completeness of prescriptions, and also to newer prescribers from other healthcare professions, who may be inexperienced in the process of prescription writing. However, in addition to the standard prescribing workflow, consideration should be given to the specific needs and requirements for non-medical prescribers in the design of an EP system's prescribing workflow.

Structured Prescribing and Care Plans

Therefore, on activating the prescribing function, an independent prescriber would have the option of prescribing for the patient directly from the system formulary, or setting up a CMP for the patient to be followed by a dependent prescriber. By contrast, when a dependent prescriber activates the prescribing function, any activated CMPs for the patient are displayed. If there are no valid CMPs setup for the patient, the dependent prescriber cannot proceed with the prescribing process for that patient. Each CMP will contain medicine orders, which can be activated by the dependent prescriber to generate prescriptions. It is likely that each CMP will have logic embedded in it possibly with limits to prescribing, dependent on time, test results or other medicines prescribed. There may be certain situations where the dependent prescriber is forced to refer the CMP back to the independent

The Challenge of Device Integration

Goundrey-Smith, Principles of Electronic Prescribing, 133 However, while the integrations described above can improve the prescribing decision support process, the logical goal of clinical decision support in electronic prescribing is a system that provides decision support intuitively, working with dynamic data from patient monitoring devices, such as blood pressure and blood gas monitoring devices.

Medicines Management in Hospitals Existing Business Processes

Traditionally, in a hospital, medicines for inpatients have been prescribed on a medicine administration chart, commonly referred to as a drug chart, and sometimes called a Kardex. An example of the layout of a drug chart is shown in Fig. 3.2. The drug chart will have sections of the page allocated to prescriptions of REGULAR PRESCRIPTIONS Date i REGULAR PRESCRIPTIONS Date i (a) Because prescriptions are handwritten - often in a hurry by busy clinicians -they may be illegible or incomplete. Alternatively, in patients with large numbers of medicines, there may be inadvertent duplications. (b) Nursing staff may have to query prescriptions before they administer them, leading to inefficiencies in the medicine administration process.

Case Study

The Shrewsbury and Telford NHS Trust is an acute healthcare provider in Shropshire, UK, which has developed eSCRIPT, an electronic system which enables prescriptions transcribed from the wards to be fulfilled in the pharmacy. Because the prescription history is captured electronically, a patient medication record (PMR) and legible discharge documentation can be generated for each patient. The eSCRIPT system was developed in-house at the Trust with a Crystal database platform, a custom-designed user interface and links with the PAS and bed management systems. The rationale for developing the system was to streamline the discharge process, produce legible discharge prescriptions and Future development of the system will involve enhancing the system to become a thoroughgoing electronic prescribing and medicine administration system. The Shrewsbury & Telford NHS Trust will consider this development, if there is no timely production of appropriate software from the Connecting for Health...

Patient Safety

As discussed previously, it is recognised that electronic prescribing and electronic health records reduce medication errors, including prescribing errors6,7. It is envisaged then that this benefit could be realised for all types of prescriber, using an integrated prescribing workstation in an EP system. This would certainly be the case if there were specific tools in the EP system to support and manage workflow for particular types of non-medical prescriber. However, while supportive of non-medical prescribing in general terms, the Committee on Safety of Medicines has expressed some concerns about non-medical prescribing, around the area of records access and management8. The first issue was whether all prescribing professionals would have full access to the patient's records prior to prescribing, something that is a key prerequisite to making a clinically appropriate prescribing decision. The concern was that, while surgery, health centre or hospital-based staff would have access to...

Traditional Chinese Medicine

Pharmaceutical knowledge was recorded with astonishing sophistication in a collection of prescriptions found among the Ma-wang-tui scripts named Wu-shih-erh ping fang (Prescriptions against 52 ailments) by modern researchers. At about the time of the compilation of the Nan-ching (and coinciding with the appearance of the materia medica of Dioscorides in A.D. 65 in the West), Chinese pharmaceutical knowledge found its own literary form when the first Chinese herbal was compiled, which became known by the title Shen-nung pen-ts'ao ching (The divine husbandman's classic on materia medica). Its real author is unknown, and like the other works discussed, this classic was linked to a mythical culture hero, Shen-nung, who is also credited with the development of agriculture and markets as well as with the establishment of drug lore.

Literature and Specialties

Tion works and individual monographs were devoted to such problems as children's diseases, the diseases of women, skin problems, eye complaints, and throat ailments. The following provide a few examples The earliest extant title concerned with the diseases of children is the Lu-hsin ching (Classic of the Fontanel), of unknown authorship and compiled around A.D. 907, which was presumably based on sources of the fourth century or even earlier. The oldest available text today on women's diseases and obstetrics is the Fu-jen liang fang (Good prescriptions for females) of 1237 by Ch'en Tzu-ming. A text, lost now, possibly dating back to T'ang times and indicating the Indian origins of Chinese ophthalmology, is the Lung-shu p'u-sa yen lun (Bodhisattva Nagaijuna's discourse on the eyes), and a first monograph on leprosy was published by Hsiieh Chi in 1529 under the title Li-yang chi-yao (Essentials of the li-lesions). On ailments affecting the throat, the oldest text extant is the Yen-hou...

The Final Centuries of the Imperial

This does not mean, however, that this period lacked brilliance several authors made contributions to their respective fields that were never surpassed. The Pen-ts'ao kang mu (Materia medica arranged according to drug descriptions and technical aspects) of 1596 by Li Shih-chen is a most impressive encyclopedia of pharmaceutics touching on many realms of natural science. It contains more than 1,800 drug monographs and more than 11,000 prescriptions in 52 volumes. In 1601 Yang Chi-chou published his Chen-chiu ta-ch'eng (Complete presentation of needling and cauterization) in 10 volumes, offering a valuable survey of the literature and various schools of acupuncture and moxibustion, which is cauterization by the burning of a tuft of a combustible substance (moxa) on the skin (including a chapter on pediatric massage), of the preceding one and a half millennia.

Brief History of Clinical Trials

I solemnly affirm and believe, if a hundred or a thousand of men of the same age, same temperament and habits, together with the same surroundings, were attacked at the same time by the same disease, that if one followed the prescriptions of the doctors of the variety of those practicing at the present day, and that the other half took no medicine but relied on Nature's instincts, I have no doubt as to which half would escape.

Naturopathic Medicine

Naturopathic medicine is an approach to healing practiced by naturopathic doctors (NDs), who diagnose illness with the same techniques used by conventional physicians. They treat illness with natural methods, however, generally avoiding pharmaceutical drugs and other products of modern medicine. Naturopathy was organized in the late nineteenth century. By the early 1900s, there were more than twenty schools of naturopathic medicine in the United States, and naturopathic conventions in the 1920s often attracted more than 10,000 practitioners.

Carol Jagger And Antony J Arthur

By 2010 in most of the developed countries, the 65+ age group will form over 15 of the total population and over 20 in Japan. In the UK, those aged 65 years and over make up 18 of the population but they receive nearly half of all prescriptions.2 Despite this, few trials, unless specially designed and conducted in this age group, have sufficient numbers of older people, particularly the 'oldest-old', to provide evidence of efficacy, even for treatments of diseases and conditions that are seen predominantly in later life. A recent review of clinical trials in Parkinson's disease, where prevalence increases with age and incidence peaks between 70 and

History of Chiropractic

The chiropractic solution to the problem of the medical trust was simple open competition. The United States was built on rugged individualism. The merit of each practitioner and each healing profession should be established solely by a jury of patients. Individuals should determine whether their health care was adequate government regulation was unnecessary and demeaned the common man by suggesting that he was incapable of assessing the quality of his health care. Physicians had no right to expect governmental protection or to hold themselves up as elite members of the healing profession. Rather, they were a wealthy aristocracy attempting selfishly to protect their interests. AMA efforts at educational and licensing reform were guaranteed to exclude the honest poor from the medical profession. By requiring collegiate training before medical school and the use of Latin prescriptions, the AMA had erected artificial barriers designed to elevate the physician and intimidate the

Organizational Requirements

Prescription drug inserts serve to reinforce and augment the information given by a doctor to the patient.78 Providers, however, are expected to fulfill a separate duty to exercise good judgment particularly when applying new technologies and procedures (Jones v. Karrker).19 In a case in which a woman used Accutane in the first trimester,80 the court ruled that the manufacturer's warnings about the dangers of Accutane therapy were adequate. The company had developed a Pregnancy Prevention Program for physicians to use which included patient information and a consent form that patients signed. The defendants were shown to have complied with the prevention program protocol.

Effectiveness of Counseling

Existing studies on physical activity counseling are inadequate to determine the overall efficacy, effectiveness, and feasibility of counseling in a primary care setting. Combining provider counseling with behavioral interventions such as patient goal setting, written exercise prescriptions, and individually tailored physical activity regimens may be the most effective way to change physical activity levels and warrants more research. Linking patients to community-based physical activity and fitness programs may enhance the effectiveness of primary care clinician counseling (Eden et al., 2002).

Sociologicalcultural perspective

This perspective greatly influences how one grieves or fails to grieve, and encompasses the impact that one's culture has on the bereaved. A culture society establishes norms, many of which are unspoken but exert subtle (or not too subtle) pressures for conformity and prescriptions for belief systems and behaviours. Today we are influenced by past and present cultures, and as we look towards a new century, there is evidence of ideological shifts and some return to former beliefs and behaviours. There is a growing opinion that past emphasis on scientific rationality for answers in this century has created new problems that need new solutions. Within the field of loss and grief work, there is a growing awareness of the need for support systems, renewed emphasis on spirituality (a view especially held from a fundamentalist religious standpoint), and a return to the use of rituals during times of loss and transition. by the counsellor who is not perceptive. Counsellor training, in the...

Epidemiology And Etiology

Asthma is also a significant economic burden in the United States, costing 19.7 billion in 2007. Prescription drugs are the single largest direct medical expenditure and account for 42 of direct medical costs. Costs increase with disease severity, and it has been suggested that less than 20 of asthma patients account for over 80 of direct medical expenditures.4

Pressure Points to Take the Ache

Simone worked as an office manager in a small company. She knew everyone and was on a first name basis with all the customers. She could coordinate the activities of multiple executives because they all knew each other's needs so well. When her chronic headaches kept her out of work, or she had to lie down in a darkened office for several hours, the office was a wreck. She came in with a diagnosis of migraine headaches for which she had taken numerous prescriptions and over-the-counter medications for years without satisfaction. We began a series of acupuncture sessions twice a week for three weeks to see if the results gave us both confidence to continue. By the second week she noticed a significant reduction in both the frequency and intensity of her headaches. Following the third week she had almost a whole week without pain and was learning to do home acupressure. She continues to work at a job where she is wanted and appreciated and has gone on to live a happier, more fulfilled...

Managing Patient Relationships

Secure e-mail can provide easy and efficient access to health care services and information for many patients. A patient portal allows patients to view sections of their EHR, request prescriptions or appointments, and report the results of home monitoring. Patient portals are also used to help direct patients to preferred Internet-based resources for education and support.

PUD Secondary to Helicobacterpylori

A 51-year-old woman presents to the emergency department complaining of abdominal pain for the past 3 days and dark tarry stools over the past 2 days. She states that she has never had these symptoms before and that she has been feeling weak and tired for the past 2 weeks. She denies having bright red blood in her stools or vomiting. She does not take any prescription medications and only takes extra-strength acetaminophen for occasional headaches.

Data from Health Maintenance Organizations

As increasing numbers of people in the United States receive their pharmacy benefits through health maintenance organizations (HMOs), use of HMO databases in psychopharmacoepidemiologic studies has become widespread. Automated databases from Group Health Cooperative of Puget Sound, the Kaiser Permanente Medical Care Program, United Health Care, Fallon Health Plan, and Harvard Pilgram Health Care have all been successfully used in psychopharmacoepidemio-logic studies. As with other administrative data, these sources can be obtained at relatively low cost and reflect prescriptions actually filled by patients. One significant advantage of data from HMOs is that the clinical information collected for billing purposes can be supplemented with more complete or accurate information from review of patients primary medical records. HMO databases provide an ideal means to study psychotropic medication use in the increasingly important setting of primary care however, because HMO membership...

Alternative Regimens Level

The preferred NNRTI continues to be efavirenz, with nevirapine (Viramune) remaining an alternative option. Efavirenz now comes coformulated with two other NRTIs, emtricitabine and tenofovir, in a single pill (Atripla) to be taken once daily as a complete antiretroviral regimen, which has increased prescriptions for Atripla. Atripla is not recommended for pregnant women because of potential CNS malformations Physicians

Modernity Consciousness And Emotion

As part of the retreat of the social, moderns have been less guided by the feeling rules that were readily available in premodern cultural designs. These are the socially sanctioned prescriptions that are made available to people in order to guide the expression of emotion along clearly defined pathways.22 They constitute the emotion work of culture, which reflects the traditionally interactive nature of human emotion, as well as the way in which culture once regulated subjective experience as a means of avoiding dilemmas of emotional expression.

Interventions to Optimize Psychiatric Medication

Psychotropic drug use and costs have included requiring patients to share their psychotropic medication costs through copayments, and limiting the number of prescriptions patients can fill per month. However, evaluations of such policy experiments have been instructive in showing that interventions may not always have their intended effects. Investigators have shown that copayments deter use of needed psychotherapeutic drugs to a greater extent than comparable treatments for other general medical conditions (Reeder and Nelson, 1985). Soumerai and colleagues (1994) have shown that among patients with schizophrenia, prescription caps significantly reduced use of essential psychiatric drugs, increased use of mental health services, especially emergency care, and increased health care costs over drug cost savings by a factor of 17.

Monoamine Releasing Agents

These drugs are also categorized as stimulants and primarily include amphetamine, methylphenidate, and pemoline. They cause the release and weakly block the reuptake of NE, DA, and 5-HT. Amphetamine was available on an over-the-counter basis until the FDA reclassified it as a prescription drug in 1938 and further restricted its availability in 1951 due to widespread misuse and abuse (Grinspoon and Hedbloom, 1975).

Health Promotion Activities and Information for

Preparation for the birthing process is a key theme around which to discuss care issues and choices such as breastfeeding. Structured educational programs to promote breastfeeding have unclear effectiveness. Pregnant women should be counseled about the risks of possible teratogens, including smoking, alcohol, and drug use, including exposure to medications, prescriptions, OTC drugs, and herbal remedies. Good handwashing is always encouraged because this is one of the best ways to avoid community-acquired infectious diseases. Appropriate immunizations such as influenza and novel influenza A (H1N1) virus should be offered. Common exposures such as workplace conditions and use of hot tubs and saunas should be explored. Exercise should also be encouraged if there is no obstetric contraindication (Box 21-4). Intercourse during pregnancy should be actively addressed because some women are reluctant to discuss this topic even with their physician. Sexual activity can generally...

Coordination of IDEA Medicaid and Private Health Insurance

When a child with disabilities has multiple health-related needs, the cost of school nursing services can be extraordinarily high. IDEA monies, however, typically fund only a small portion of the extra expenses involved in educating a child with disabilities. Consequently, since 1990, the U.S. Department of Health and Human Services (HHS) has signaled greater willingness to allow Medicaid coverage for health-related services for children receiving special education (see the 1991 HHS Policy Clarification prepared by HHS in cooperation with OSEP and DOE). In its 1991 policy clarification statement, HHS stated that school districts can bill the Medicaid program for medically necessary health-related services provided at school, home, or in a residential facility if the child is eligible under the state's Medicaid plan. Medicaid now covers a broad range of medical services (e.g., physician's services, prescription drugs, therapeutic interventions such as occupational therapy,...

Mothers Health Babys Risks

Risks for a child can be caused by maternal age (a mother who is older or an adolescent), obesity or malnutrition, high blood pressure, or any number of infectious diseases. Low birth weight, which puts a newborn at a higher risk for complications due to underdeveloped organs and body systems, has been linked to the mother's use of nicotine, alcohol, and both illegal and certain prescription drugs during pregnancy.

Impediments to Access

Lack of access is an important impediment to the use of contraception. With the exception of emergency contraception, all hormonal methods in the United States are available by prescription only. More than 47 million Americans (2010) do not have health insurance and have problems accessing primary care, and even with health insurance, access to contraception may be hampered by lack of coverage. For example, in a Washington state study comparing the 91 top-selling insurance plans, almost half did not cover any contraceptive method 37 of women had no access to sterilization and 53 had no access to pregnancy termination (Kurth et al., 2001). Another important impediment to the use of contraception can be physician difficulty in being reimbursed for contraception services. Therefore, Table 26-1 lists common International Classification of Diseases (ICD-9) codes for contraception counseling, prescriptions, and follow-up.

What Constitutes An Appropriate Evaluation For The Epilepsy Patient With Psychiatric Symptoms

A critical part of the history is a thorough review of past and current substance use, including frequency, amount, effects, and related complications or problems (such as legal or medical complications). Substances to inquire about include tobacco, caffeine, alcohol, marijuana, cocaine, stimulants, depressants, hallucinogens, prescription medications, over-the-counter medications, and intravenous drugs. and prescription drugs, and other substances Psychiatric History Outpatient and inpatient treatments, medication trials, suicidal or homicidal behavior

The elusiveness of null effects of LOP on estimates of automatic retrieval

Observed (as are also observed in intentional inclusion tests), they reflect contamination by voluntary or controlled retrieval of studied items (e.g., Toth & Reingold, 1996 Toth, Reingold, & Jacoby, 1994). Accordingly, it was reported that estimates of automatic retrieval (A) from the process-dissociation procedure in word-stem completion showed no effect of LOP at study only estimates of controlled retrieval (C) were larger for deep than for shallow study processing (Toth et al., 1994, Experiment 1). However, in two large-scale experiments (Richardson-Klavehn, Gardiner, & Ramponi, 2002), which took every possible precaution to ensure that the process-dissociation procedure had been implemented according to the prescriptions of the originators of that procedure (e.g., Jacoby, 1998), and which included a direct replication of the procedures of Toth et al. (1994, Experiment 1), we found that estimates of automatic retrieval (A) were either uninterpret-able, or were systematically lower...

Description Of Social Patterns And Trends

Among the 29 chapters in Recent Social Trends were ''The Population of the Nation'' by Warren S. Thompson and P. K. Whelpton, ''Shifting Occupational Patterns'' by Ralph G. Hurlin and Meredith B. Givens, ''The Rise of Metropolitan Communities'' by R. D. McKenzie, ''The Status of Race and Ethnic Groups'' by T. J. Woofter, and ''The Family and its Functions'' by William F. Ogburn. These reports were aimed to be ''scrupulously empirical and factual'' studies of social trends without policy prescriptions, but the latent intent was surely to provide knowledge on the state of American society to those who did make policy. It was rumored that the page proofs of Recent Social Trends were read by President-Elect Franklin Roosevelt before he took office, and that these studies had an influence on the formulation of New Deal social policy, including the social security program (Worcester 2001 23).

Fernlea ward a comparison

These extracts indicate that at one level certainly, the pressure for senior nurses to 'know the patient(s)' appeared to come from the perception that relatives and doctors expected them to have all the necessary information at hand. In the past, it was the ward sister or charge nurse who was the repository of knowledge on the ward and all nursing decisions were filtered through them and, as Abbott (1988) has suggested, public perceptions of occupational jurisdiction can last for years after change has occurred. These tensions cannot be explained solely in terms of an historical legacy however. Notice also, how the extracts contain references to senior nurses' sense of clinical accountability and their discomfiture when they do not have immediate access to patient information. Arguably, a further factor contributing to these strains are the contradictory prescriptions for practice contained in the discourses of professionalism and managerialism that placed the ward co-ordinators in a...

Antisocial Impulsive And Borderlinenarcissistic Trends

Today both narcissists and normal individuals display a deliberative technique-driven self-structure that demotes the status of sharing relationships. Likewise, both emphasize manipulation and control in order to maximize personal outcomes, simultaneously creating a social veneer designed to mask disinterest. In a paradoxical way, the plague of narcissistic pathology is being cured to some extent by the rapid cultural normalization of narcissism itself. As a product of collective regression, normal narcissism expresses itself in many ways, including enthusiasm for personal achievement, health and fitness, bodily perfection, diet, the ultimate orgasm, spiritual bestowals, and all sorts of self-improvement prescriptions. This is all part of a cultural situation in which radical self-preoccupation is an acceptable, and even admirable, approach to life.

Vitamins and Minerals

While there's nothing wrong with taking a daily multivitamin, megadoses aren't a good idea because their long-term safety remains in question. Over the years, various supplements have been recommended for an assortment of ailments. B-vitamins, for instance, were used to treat diabetic neuropathy, but their beneficial role was never proven and they're not recommended as a therapeutic option. Although chromium piccolinate was reported to have a good effect on blood-sugar control, it was never conclusively demonstrated. One antioxidant, alphalipoic acid, is a prescription drug in Germany that has been used to treat diabetic neuropathy. Although studies are underway in the United States, results will not be available for years.

Analysis of Barbiturates and Benzodiazepines

When a seizure of pharmaceutical drugs is made, it may comprise a single dose unit, or many tens or hundreds of thousands of units. The number to be analysed depends upon the legislative system in which the scientist is working, but the following is recommended by the United Nations Drug Control Programme for commercially produced drugs 1, 2 . If between 1 and 50 units are seized, then 50 , to a maximum of 20, chosen at random, should be analysed. Of samples containing between 51 and 100 units, 20 should be analysed. For samples of between 101 and 1000 units, 30 should be chosen, while for samples greater than

Psychosocial Adjustment

Family dynamics and social support also play a significant role in children's adjustment and adaptation to JRA. For example, results from one study indicated that children from cohesive families adjust better to JRA, whereas children from families high in conflict demonstrate poorer adjustment (Helgeson et al. 2003). Moreover, there is evidence to indicate that greater parental distress is associated with higher levels of depressive symptoms in children with JRA (Wagner et al. 2003). In fact, social support from peers and parents may mitigate the effects of stress in children with rheumatic disease. Von Weiss et al. (2002) investigated the influence of daily hassles (psychosocial stressors that occur on a daily basis, e.g., waiting in line for prescriptions, finding a parking space at the doctor's office) and social support as these predicted adjustment in children with rheumatological diseases. Findings revealed that children who reported greater social support and less daily hassles...

History and Geography

Pliny, a Roman, published his book Natural History in the first century A.D. in it he describes the prevalence of periodontal disease among the Romans as well as various remedies for its prevention and care. The most notable prescriptions were the use of dentifrices, mouthwashes, and toothpicks the first mention of toothbrushing seems to have been made by the Roman poet Ovid in his Art of Love-making, in the first century A.D. The siwak, a fibrous wood product which preceded the toothbrush, was used by the Arabians since the ninth century, and can still be found in use in some areas today. The modern-day toothbrush, however, was invented in China only in 1498.

Homelessness A Modern

In trying to comprehend our lack of collective will on this count, we need to delve into the beliefs and attitudes of modern Western culture. John McMurty lists a number of social commandments that make up the unifying belief system of contemporary global culture.39 As the building blocks of our global market doctrine, they constitute an overall value program that orders normality, determines cultural prescriptions, and dictates social policy. Obedience to these commandments is equated with survival in the market. The specific social commandments are human justice and liberty reside in the freedom of money exchange the money-price system is an ideal system by which to distribute services and goods profit-maximization is the optimal vehicle for social and personal well-being accelerating consumer desire is good the pursuit of maximal income and wealth is natural and good there should be no limits to the conversion of life into salable commodities and those who have only labor and...

Challenge Of Combining Paradigms

Biological psychiatry, abetted by the managed-care industry, has made possible rela-tionshipless psychiatry (Gardner, 2001) in which patients are managed by non-psychiatric (lower-cost) therapists and given prescriptions by psychiatrists who, at times, barely know them. Proponents of traditional psychoanalysis have maintained that mental states have a psychological background that, if analyzed, can lead to symptom remission but have largely failed to embrace the use of standard nosologic diagnosis, or to openly sanction the use of medication in alleviating symptoms. The combining of medication and psychotherapy by practitioners who understand both depth psychology and psychopharmacology represents a significant advance in the evolution of psychiatric practice. Since this approach falls between two very different paradigms, it calls for the willingness to adapt our psychoanalytic traditions and biological knowledge to the real needs of our patients.

Recruitment Of Volunteers

Naturally, it is crucial for participants to be able to perceive the stimuli properly. The experimenter should make sure that they have normal hearing (at 20 dB HL), normal or glasses-corrected vision, normal acuity, and color vision. Again, they should not have suffered from cranial traumas followed by coma, and should not be affected by any psychiatric syndrome (unless the study is aimed directly at individuals suffering from such syndromes, or specified groups of people with psy-chomotor handicaps). The investigator should also make sure that the participants are not taking prescription medications that may affect cognitive processes, and are not under the influence of alcohol or recreational drugs.

Forensic Psychiatry and the Internet

Early twenty-first century, surprisingly little research has been published on the importance of the Internet to the practice of psychiatry. The news media are replete with accounts of crimes in which evidence found on computers or in Internet service provider archives figured heavily into the outcome of a case. The Internet has also led to new problems for society, with such phenomena as cyberbullying and cyberstalking. Patients are researching medical conditions online, doctors are being disciplined for issuing Internet prescriptions to patients they have never seen, and our own lives and those of our patients and evaluees are changing dramatically with the endless stream of new technology that we integrate into our lives. McGrath and Casey (2002) provide an informative discussion of the Internet's relevance to forensic psychiatry, focusing especially on sexual predators and cyberharass-ment. They note unique aspects of the Internet that can be helpful to the psychiatrist, such as...

Coagulation Disorders

An accurate history and physical examination of a patient scheduled to undergo elective operation offer the most valuable source of information regarding the risk of bleeding during surgery. A patient with a history of bleeding, easy bruisability (either spontaneous or traumatic), frequent or unusual mucosal bleeding, exceptionally high menstrual flow in females, prior history of significant or life-threatening hemorrhage associated with invasive procedures, or a family history of such problems may be at risk. A history of repeated severe epistaxis or abnormal laboratory tests may also be significant. The intake of medications should always be elicited. Especially important are drugs such as aspirin and nonsteroidal anti-inflammatory drugs, and because these preparations are widely available over the counter, it is important to inquire specifically about them. Patients may not consider the intake of aspirin or nonsteroidal anti-inflammatory drugs as being important enough to mention...

Psychoanalytic Concepts Illuminating Cultural Forms

How orthodox Jewish mourning prescriptions segment bereavement into periods that correspond to the natural phases of grieving crisis, grief, and coming to terms with loss Guilt over ambivalence toward the deceased is symbolically articulated in prayers and ritual injunctions, such as rending of the garments, or that the mourner should comport himself as if the sword lay between his shoulders ' and then as if it was standing upright in a corner in front of him (p. 18). Mourning prescriptions help the bereaved to deal writh die demands of the work of remembering Freud 1917) and to face more difficult emotional issues that might otherwise lead to pathology. Janice Reid's (1979) article on Yol-ngu mortuary rites in Northern Australia made a similar case and showrcd the extreme distress that beset a Yolngu woman working far from her tribe when she missed the death rites first for her husband and then for her father. Piers Vitebsky's (1993 analysis of Sora dialogues with the dead in India,...

The Internets Impact on Clinical Psychiatry

As Internet technology makes more medical information available to the public, relationships between patients and physicians are changing. Patients often do not tell their physicians about what they learned or did online (Hart et al. 2004). Today, patients go online to research their symptoms and their illnesses, often arriving at the doctor's office with printouts or information they learned online. Pharmaceutical manufacturers have also been using the Internet for direct-to-consumer advertising of prescription medications. When a RealAge quiz became a popular link among users of social networking sites, a journalist found that the quiz was a clearinghouse for several large drug companies allowing them to use almost any combination of answers from the test to find people to market to, including whether someone is taking antidepressants, how sexually active they are and even if their marriage is happy (Clifford 2009). Social networking sites for health, such as PatientsLikeMe (http...

Toward Societal Therapy

Mainstream clinical psychology embraces a status quo that acknowledges individualism and consumption as prescriptions for positive mental health. At the very least, it does not actively challenge the psychological risks inherent in capitalistic constructions that predispose members toward alienation, loss of self, meaninglessness, and general disorientation. Rather than seeking to rekindle communitarian values and to reconnect people to social resources, psychotherapy accepts the validity of the self-serving autonomous human being who thrives on self-fulfillment, personal choice, and individual achievement. Therapy consultation rooms continue to echo with the message that we best treat ourselves by making sure that all our private needs, urges, and wishes are satisfied without compromise or sacrifice. In this way, however, it has the adverse effect of magnifying the underlying interiority that creates social and intrapsychic problems for the person. It also contaminates further the...

Current Trends In The Us

There is very heavy use of analgesics. Forty-five percent of Americans say they take prescription analgesics for some form of pain (CBS News Poll 2003). Amazingly, 877,, of all adults say they take over-the-counter analgesics (Harris Interactive 2003). Fifteen percent take them every day, 14 several times a week, and 27 several times a month. There is particular concern about increasing use of opioids. Hunkele & Vogt (2002) studied analgesic use in a Pittsburgh area Health Maintenance Organization in 2001. Fifty-six percent of 17228 patients with back pain received an average of 4.6 prescriptions for analgesics. A third were for narcotics, 267 for narcotics and non-selective opioids, 97 for narcotics and other analgesics, and 277 for non-steroidal anti-inflammatories alone.

Education of Patients Adherence

Patients need to understand the purpose of each prescription and be advised about off label indications for these medications. When patients pick up their prescriptions at the pharmacy they may be educated by the pharmacist or read the drug information sheets provided, which will indicate the intended use of the prescribed medication. Since headache medications are often used off label in the prevention and acute treatment of headaches, this leads to confusion when the medication is not identified ahead of time as useful for headache treatment. In fact, many prescribing inserts list headaches as a common side effect, leading to poor or no adherence.

Reawakening Social Justice

Whereas social justice was an issue in the early days of psychology, recent years have seen the evolution of a pragmatic psychology that is not strongly motivated to promote positive social change. This orientation is another manifestation of psychology's inclination to maintain the continuity of the existing sociopolitical and economic system. This approach offers little hope that psychology will have much to say about large-scale problems of social injustice or macroscopic prescriptions for needed social restructuring. Also, since this asocial and amoral approach is not working in the West toward the cause of social justice, it is of no value to export this orientation for use in the developing world, which often finds itself in urgent need of social transformation.

Nutrition for the Athlete

When dealing with athletes the first question physicians must ask is, What type of exercise do they participate in For example, a body builder has very different goals and requirements than a marathon runner. Although total calories and protein are key issues to the strength athlete, carbohydrate and hydration aid endurance performance. Basic dietary prescriptions for health and fitness apply to athletes and nonathletes alike. They are given in the following.

The Impact of Technology on Thinking in Medicine

As the basis for many medical decisions, diagnostic reasoning requires collecting, understanding, and using many types of patient information, such as history, laboratory results, symptoms, prescriptions, images, and so on. It is affected by the expertise of the clinicians and the way the information is acquired, stored, processed, and presented. If we consider clinicians as rational decision makers, the format of a display, as long as it contains the same information, should not affect the outcome of the reasoning and decision-making process. But the formats of displays do affect many aspects of clinicians' task performance. Several recent studies examined how different displays of information in EMR affect clinicians' behavior. Three major types of displays have been studied -source-based, time-based, and concept-based. Source-based displays organize medical data by the sources of the data, such as encounter notes, laboratory results and reports, medications, radiology imaging and...

Alcohol Use Disorder in Women

Nonmedical use of prescription drugs in general and opioids in particular has been identified as a significant problem since the late 1990s. Women also have higher associated rates with first use of illicit drugs after age 24, serious mental illness, and cigarette smoking (Tetrault et al., 2008). Comorbid conditions for women include drug addiction, sexual abuse, intimate partner violence, borderline personality disorder, eating disorders, mood disorders and anxiety disorders, and HIV infection. Women who drink alcohol may be more sensitive to the behavioral effects of concomitant cocaine use (Zweben, 2009).

Treatment of Older Adults

Alcohol use disorders and prescription drug abuse are prevalent in older adults (Blow et al., 2002). Specific geriatric alcohol use disorder screening tests can be used by family physicians, including the SMAST-G, MAST-G, AUDIT, and CAGE (see earlier discussion) (Blow et al., 2009). Older adults are often categorized as binge drinkers. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Centers for Substance Abuse Treatment (CSAT) have published alcohol use guidelines for older adults (Blume, 2009). Often, comorbid affective disorders are present in older adults. Premorbid alcohol use disorders predict a more severe course of affective disorders (Cook et al., 1991).

Physician with Alcohol Use Disorders

Male physicians outnumber female physicians in studies of substance use disorders. Risk factors used in other patient groups apply to physicians as well (see online discussion of causative factors). The pattern of physician abuse differs from that in the general population by the increased use of alcohol, benzodiazepines, and prescription opiates (Hughes et al., 1992). Much of the prescription drug use is self-prescribed. Impairment is generally noted first in the alcohol-abusing physician's family and social life. Marital discord, relationship problems, and heavy drinking at social events can progress to work dysfunction and impairment (Talbott et al., 1987). The physician's thinking initially becomes impaired in spatial and constructive skills, along with negative effects on memory. Verbal skills are maintained, although cognition is affected as drinking continues. An alcoholic physician will frequently turn to benzodiazepines for relief of anxiety or stress symptoms. Further...

Patient Education Home Care Instructions Fluoride Application

Oral hygiene procedures including scaling, polishing, sub-gingival root planing and curettage should be performed and home-care instructions and fluoride prescriptions given between the initial screening appointment and commencement of external beam radiation therapy (EBRT).7 In addition, overhanging and faulty

History of Present Illness and Debilitating Symptoms

Cleeland and associates (1997) reported that members of ethnic minority groups are likely to receive inadequate treatment for pain. Their study showed that minority patients were three times more likely to be undertreated for pain. Sixty-five percent of minority patients did not receive guideline-recommended analgesic prescriptions. Latino patients reported less pain relief than did African-American patients. Morrison and colleagues (2000) investigated the availability of commonly prescribed opioid analgesics in pharmacies in New York City. They found that 50 of a random sample of pharmacies surveyed did not stock sufficient medications to treat patients with severe pain adequately. Pharmacies in predominantly nonwhite areas were less likely to stock opioid analgesics than were pharmacies in predominantly white neighborhoods.

Basic Principles of Geriatric Medicine

Americans older than 65 years of age use about 25 of all prescription medications consumed in the United States, and at any one time, the average geriatric patient uses 4.5 prescription medications. The average nursing home resident consumes the most medications, averaging eight medications at any one time. The use of mood-altering drugs is common in the geriatric population. Approximately 7 of nursing home residents are taking three or more psychoactive drugs.

Ephemeral Identity And Selfabsolving Morality

With self-satisfaction as the new basis for moral evaluations, moderns have become removed from traditional goodness opportunities thathistor-ically have served as the basis for self-regard. The case has been made a number of times that being a good cultural member may be a universal human need that fosters security and well-being by informing the person of a legitimate place in the group and its survival practices. The ancient Aristotelian claim that one must be good in order to be happy rests on the related premise that life satisfaction and healthy-mindedness are dependent upon modes of moral action that transcend mere self-interest. When autonomous individuals rely chiefly on self-goodness prescriptions, they can become predisposed to self-concept impairments and existential anxiety, as

Pregnancy and Migraine

The WHO International Survey found that 50 of pregnancies are unplanned, so inadvertent fetal exposure to medications is likely. In one registry, 86 of 14,778 pregnant women took a prescription drug. On average, 2.9 prescription medications were used by women who became pregnant (see Table 18.10).

Acupressure The Match Points

Len came to the office in desperation. He wanted to keep playing in his tennis league and be able to hold the phone or type at work. I immediately suggested he get a headset for his office and asked him to cut back on all unnecessary tennis. You'd have thought it was a death sentence. He reluctantly agreed to the tennis part to avoid further aggravation of his condition. He was taking prescription medication from his physician, but that had not helped. We began treatment consisting of electromagnetic acupuncture, home acupressure and biomagnetic treatments with ice and a topical homeopathic ointment named Rhuta Graveolus. His pain and stiffness began to consistently lessen. He tried to go back to his original schedule too soon and re-injured his elbow. The setback is not uncommon, but added another two weeks of treatment time to correct. He now is able to do what he wants and cuts back a little to do his home treatments when his discomfort increases.

Depression Cultural Catharsis And Modern Rage

The disappearance of cultural prescriptions for emotional catharsis is exacerbated by a higher degree of negative emotion that somehow must be managed. There is a resultant accumulation of impounded emotion that, if acted upon without cultural direction, can culminate in irrational displays of anger and rage. In this regard, the term raging self is sometimes used to describe the conditions of modernity that culminate in infantile psychic tantrums that emerge when the fueling of grandiosity and narcissism is followed by frustration.10 As a result of frustrated desire and thwarted narcissism, an excess of unresolved emotion may increase the risk of depression. Even if some discharge can be accomplished by way of cathartic consumer strategies, these tend not to be effective enough to fend off eventful depression. Although internalized negative emotion may set some of the groundwork for depression, it is important to consider cultural mediation processes that serve to regulate emotion....

Hidden Home Exercises

A Swedish doctor who lived in Enkoping in the early twentieth century gave detailed prescriptions six walks a day around the park, three sit-downs and stand-ups from each of the park benches and so on. In ancient literature, from the Egyptians and Greeks to the Chinese, exercise is named as a basic and essential ingredient of life. If we sit still we die

The Regime Of Medicalization

The Federal Food and Drugs Act of 1906, known as the Pure Food and Drugs Act, was the first of several federal initiatives designed to regulate the content, labeling, sale, and safety (but not yet the effectiveness) of pharmaceutical drugs during the first few decades of the twentieth century.

Alexander Technique and Pilates

Alexander depended on one of the oldest human tools, simple self-observation, to develop his bodywork system. Alexander was an Australian actor, born in 1869. While performing on stage, he periodically suffered episodes of voice loss, and the problem threatened to end his acting career. Visits to physicians resulted in prescriptions for rest and medications, but these did not solve the problem.

Causes And Outcomes Of Sexual Harassment

Self-medicating via the misuse of cigarettes, prescription medications (e.g., sedatives and antidepressants), and alcohol are not uncommon among those who have been sexually harassed.53,54 Clearly, many victims of sexual harassment use such substances to reduce their associated feelings of stress, depression, anxiety, hostility, and a perceived lack of control related to being sexually harassed.53-55 These negative health behaviors used to cope with harassment are detrimental to long-term health.56,57

Diagnostic Tools in Pulmonary Medicine History and Physical Examination

Diagnosis starts with the patient history and physical examination. Pulmonary symptoms may be evaluated by traditional history-of-present-illness questions, such as character and quality of the symptoms, duration, onset, timing, exacerbating and alleviating factors, efforts at self-treatment, and the patient's own understanding of what is causing the symptoms. For example, the symptoms of asthma may be variously described by patients as shortness of breath, wheezing, whistling, wheezling, chest tightness, tight breathing, or poor exercise tolerance. In addition, patients often self-medicate with over-the-counter (OTC) and prescription medications, as well as use herbal and nonmedicinal alternative therapies, which they typically do not report to their personal physician unless specifically asked (Braganza et al., 2003).