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By Z. Nerusul. San Diego State University. 2018.

Study of the accuracy of prescription by using a computerized chemotherapy order system buy aciphex 10 mg amex. Applying social network analysis techniques to measure the efficacy of computerized medication records buy aciphex 10mg online. A prospective case control study of the benefits of electronic discharge summaries aciphex 10 mg discount. An economical application of bar code technology to dispensing and departmental charges cheap 10 mg aciphex. Implementing an electronically based discount aciphex 20mg with mastercard, nurse-driven pneumococcal vaccination protocol for inpatients. Medication cart-filling time, accuracy, and cost with an automated dispensing system. Multidisciplinary communication effectiveness flow sheet from emergency department area to medical/surgical floor. Technology marathon: Lessons learned implementing a pharmacy information system, bar code automation and point of care bed side scanning and electronic medication documentation system within 120 days. The use of a computer-based decision support system facilitates primary care physicians’ management of chronic pain. Standardized documentation of drug recommendations in discharge letters--a contribution to quality management in cooperative care. From individual patient care to population-based error dynamics: New opportunities for hospital pharmacists in the management of automated health care information. Improving nursing home dental pre-op medication administration with a system analysis monitoring project by pharmacy, dental, and nursing. Project management tools for the 21st century: Process in the successful integration of a computer technology program Bar Code Medication Administration. Cost analysis of computerized physician order entry using value stream analysis: A case study. Computer consultant for optimizing geriatric patient medication plan for multiple conditions: A medical expert system East Texas State UniversityEditor. Electronic monitoring in medication adherence measurement implications for dermatology. Advances in Navy pharmacy information technology: accessing Micromedex via the Composite Healthcare Computer System and local area networks. Human Errors in Medical Practice: Systematic Classification and Reduction with Automated Information Systems. Errors in medical practice: identification, classification and steps towards reduction. Identifying and quantifying medication errors: evaluation of rapidly discontinued medication orders submitted to a computerized physician order entry system. Safe chemotherapy administration: using failure mode and effects analysis in computerized prescriber order entry. Process improvement approach to tracking and trending computerized order entry medication variances using a formal error classification system. Process improvement using clinical decision support for high-risk medications based on medication variance reporting. Collaborative pharmacist and nurse before/after study to evaluate patient safety using electronically standardized admission and discharge medication reconciliation in a tertiary care hospital. The treatment of hyperglycaemia in critically ill patients: comparison of standard protocol and computer algorithm. Streamlining the workflow process of a hospital pharmacy department implementation of a computerized physician order entry system. Patient acceptance of educational voice messages: A review of controlled clinical studies. Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study. Adherence to continuous quality improvement principles lead to reduced harmful medication errors. Bedside bar code charting, smart pump dose mode programming and computer assisted physician order entry system utilization monitoring and quality improvement lead to reduced harmful medication errors. Antimicrobial stewardship programs: Role in optimizing infectious disease outcomes. System for exchanging information among pharmacists in different practice environments. Medication errors in inpatient pharmacy operations and technologies for improvement.

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For the purpose of this study order 10 mg aciphex free shipping, racial-related stress was determined by the score on the 22-item Index of Race-Related Stress-Brief Version buy cheap aciphex 10 mg on line. Depression: Depression is an individual‘s depressed mood exhibiting sadness buy aciphex 10mg cheap, hopelessness aciphex 10 mg with mastercard, and discouragement or a loss of interest in previous pleasurable activities characterized by changes in appetite order aciphex 10 mg line, altered sleep pattern, impaired thinking, and decreased physical functioning (Diagnostic and statistical manual, 2000). In this study, depression was defined as a score of greater than 24 or equal to 5 on the nine-item Patient Health Questionnaire-9 indicating mild to severe depressive symptoms (Kroenke, Spitzer, & Williams, 2001). Medication adherence: Medication adherence is the self-report of an individual‘s medication-taking behavior. For this study, adherence was measured by the score on the 14-item Hill-Bone Compliance to High Blood Pressure Therapy Scale (M. Specific Aims and Research Questions The specific aims and associated research questions are: 1. Describe Black women who adhere to antihypertensive medication treatment and those who do not adhere. Explore the relationship between reactant behaviors and antihypertensive medication adherence in Black women. Secondly, with the theory of psychological reactance, individuals want freedom to make their own choices and any interference whether positive or negative, interferes with their freedom to choose. Finally, the last 26 assumption is that answers to questions on instruments, tools, and scales reflect honest and accurate responses from participants and thus, represent reality or truth. Summary The purpose of this study was to describe the characteristics of Black women who are adherent versus nonadherent to antihypertensive medication treatment and examine issues that influence medication adherence. In addition, this study explored the relationship between reactant behaviors and medication adherence. Results of this study will assist researchers to identify issues that influence adherence to antihypertensive medications and determine the impact of reactant behaviors on medication adherence in hypertensive Black women. Frequently used synonymously, compliance, adherence, and concordance are three concepts with different meanings. The historical and current interchange of these concepts in health care creates confusion and ambiguity (Bissonnette, 2008; Lehane & McCarthy, 2009). Ideally, conceptual frameworks or models are used to integrate concepts into a meaningful configuration (Fawcett, 1999). However, no conceptual frameworks or models were found that consistently explain or predict any of the three concepts, thus contributing to a plethora of confusion surrounding these concepts. While scholars and researchers continue to debate and explore these concepts, the lack of adherence to medication regimens has become a major crises in the United States and worldwide ("Enhancing prescription medicine adherence", 2007). Conceptual Views on Adherence Brawley and Culos-Reed (2000) proclaim that no distinct conceptual model exits for adherence and that while several health belief models have attempted to predict compliance/adherence, including the Pender‘s Health Belief Model (Hwang, 2010), results have been inconsistent and do not account for large amounts of variance in health outcomes. According to Gearing and Mian (2005), no single model assimilates all the constructs underpinning adherence nor is applicable to every client and their specific illness and associated contexts. This lack of a model is concerning since adherence is viewed as one of the most serious problems facing health care today (Becker, 1985; Middleton, 2009). Examining three concepts, compliance, adherence, and concordance, assist in determining which concept is most suitable for use in nursing research and clinical practice. The first concept, compliance, is defined as the extent the client‘s behavior matches the health care providers‘ recommendations (Haynes, 1979). Compliance implies passive subordination to an order and suggests blame for failure to comply with treatment (Haynes, 1979). Further delineated, compliance infers that the client is a 29 passive recipient of paternalistic orders from the health care provider in the same manner as when the law commands obedience. According to Evangelista (1999), use of the concept compliance leaves the client little choice or power to make decisions regarding his or her health status and sets the stage for a power relationship between the client and health care provider, whereby all power rests with the health care provider. Because clients should be active participants in his or her health care and more credence should be given to the client‘s perspective of his or her health problem (Evangelista, 1999), focusing on the client‘s perspective of the costs and benefits of the health regimen is essential to implementing a plan the client is willing to follow. Adherence, the second concept, is defined as the extent the client‘s behavior matches agreed recommendations made by the health care provider (Barofsky, 1978). Hearnshaw and Lindenmeyer (2005) conducted a literature review to identify and categorize definitions and measurements of adherence in diabetic populations. The chronicity of many diseases require adherence to the recommended health regimen to ensure a reasonable quality of life with lifestyle changes and medications. Defining adherence is important and would contribute to a consistent measurement of the concept. Based on a review of 26 papers, Hearnshaw and Lindenmeyer (2005) assigned five categories of adherence definitions. Three of the categories addressed aspects of medication-taking behavior such as the agreement of 30 client behavior with health care provider advice, evaluation of outcome and process targets, and taking the medication as prescribed.

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Chapter 9: Considering Medications and Other Physical Treatment Options 161 Viva vitamins! The results of several studies link mood dis- orders to vitamin deficiencies aciphex 20mg for sale, and especially severe deficiencies may make your anxiety worse aciphex 20 mg with mastercard. However generic 10 mg aciphex with mastercard, they may help to keep your body in better shape for handling the stresses that come your way buy aciphex 10 mg fast delivery. Sifting through the slew of supplements If you search the Internet and your local health food stores aciphex 20 mg mastercard, you can probably find over a hundred supplements advertised as antidotes for anxiety. The following have at least garnered a smidge of evidence in support of their value as possible anxiety axes: ✓ Melatonin: Reaching a peak around midnight, this hormone helps to regulate sleep rhythms in the body. In particular, it addresses the prob- lem of falling asleep at the right time (known as sleep onset) as opposed to the problem of awakening in the early morning and being unable to go back to sleep. Synthetic melatonin taken in the early evening, a few hours before bedtime, may alleviate this particular type of insomnia, a common problem among those who have excessive anxiety. Side effects such as dizziness, irritability, fatigue, headache, and low- level depression are all possible, but the long-term side effects aren’t really known at this time. If you have an autoimmune disease or if you’re depressed, you should probably avoid melatonin. Possible side effects such as gastrointestinal upset, nervousness, insom- nia, headache, and agitation may result, but again, little is known about the possible long-term effects. Evidence of their usefulness for anxiety is less robust, but there is sufficient evidence that having enough omega 3 fatty acids in the body improves cardiovascular health. So, consider taking these supplements (make sure that they’re purified to eliminate toxins like mercury). This supplement may have a mild tranquilizing effect, but little data is available to substantiate that claim. Stimulating the Brain People with severe cases of anxiety often try many different treatments. Unfortunately, a few cases neither resolve nor even improve with standard treatments such as psychotherapy or medication. For those people, new advances in science and technology may offer hope for improvement or even a cure to their suffering. However, you should be aware that the effectiveness of these new approaches has not yet been firmly established. Anxiety is usually experienced throughout these systems, with symptoms ranging from stomach upset to rapid breath- ing to feelings of fear to thinking that something bad might happen. Chapter 9: Considering Medications and Other Physical Treatment Options 163 Later, this treatment was found to help those with severe depression. Many of those who experienced relief from either epileptic seizures or depres- sion also noted decreases in anxiety. This treatment was first used to help those with Parkinson’s disease, a progressive neurological disorder that effects movement. This treatment does not require surgical implantation, so side effects are less dangerous than those treatments that involve surgery. However, research on the successful use of this technique for those with anxiety disorders is quite sparse. Because studies have varied in the strength of the magnetic field, the placement of the coil, and the duration of the treatment, it is hard to compare and contrast the results. We show you how connec- tions with other people, relaxation exercises, breathing techniques, good sleep habits, and proper nutrition all help quell anxious feelings. You also discover why taking a mindful approach to anxi- ety is emerging as an exciting, empirically validated way to overcome anxiety. Mindfulness helps you accept the inevitable uncertainty and risk in life with calm detachment. Chapter 10 Looking at Lifest yle In This Chapter ▶ Discovering what’s really important to you ▶ Working out anxiety’s kinks ▶ Sleeping away anxiety ▶ Creating a calming diet o you lead a busy life with too much to do and too little time? Do you Dgrab dinner from the nearest drive-through for you and the kids on the way home from soccer practice?

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A self-described “creature of habit” discount 20 mg aciphex with visa, Bill attributes changes in “pattern” or “routine” of his medication schedule to his past non-adherence and could be seen to imply that an absence of consistent routine could represent a future barrier to adherence for him (“otherwise I might not take it”) generic 10 mg aciphex with visa. In the next extract buy 20 mg aciphex, Margaret could be seen to highlight how changes in consumers’ typical routine purchase aciphex 20 mg on line, such as holidaying buy cheap aciphex 20 mg, can interfere with their adherence: Margaret, 04/02/2009 L: What about in terms of your lifestyle and that sort of thing? M: Uh, it’s a bit of a hassle getting all me medication before like the holidays, making sure I had all my medications to last the two weeks while the doctor is away. Margaret states that she has “always managed to work [medication] in” to her lifestyle, thus minimizing the impact of taking medication on her life. She then acknowledges the “hassle” of having to arrange to have sufficient medication to take away on “holidays” and additionally having to take into consideration her doctor’s schedule (“making sure I had all my medications…while the doctor is away”). Whilst she does not report 146 personal non-adherence as a result of such “practical things”, she constructs them as potential barriers to adherence for other consumers (“I could see how for some people they may not take it because of that”). Various studies have shown that adherence is positively influenced when a patient has a relative, carer or friend prepared to supervise medication, including studies of family-based interventions (Falloon et al. Some studies have also indicated that adherence is negatively influenced by social isolation, living alone, social deprivation and lack of employment (Barnes et al. In the following extracts, interviewees talk about how friends, housemates, partners, family members and case workers have reminded them to take their medication, thus, enabling interviewees to overcome unintentional non- adherence, or have assisted with adherence by motivating them or providing constructive advice. In the following extracts, Anna and Steve talk about how co-residents, who also take medications, help them to overcome difficulties remembering to take their medication: Anna, 18/02/2009 L: What are some of the barriers to adherence? A: Well like I said, I try to take them the same time every day, my medication and well the other person in the house takes medication as well. Friends that live with me, they help me, like they remind me as well, have you taken your tablet? Anna represents “remembering” to take medication as a key influence on adherence, whereas Steve denies difficulties remembering to take his medication. When asked about strategies to overcome difficulties related to remembering to take medication, Anna posits that in addition to taking her medication at “the same time every day”, which could be seen to reflect an attempt to establish a routine of medication taking, “the other person in the house” who also takes medication, has a similar routine (“we virtually have them around the same time”). According to Anna, her co-resident will prompt her to take her medication when she is home (“she’ll be, oh shit, tablets”). Steve also states that his “friends”, with whom he co-resides, “help” and “remind” him to take his medication. Consistent with this, in the next extract, Rachel indicates that her daughter reminds her to take her medication: Rachel, 25/02/2009 R: It’s part of my routine now, you know. Eight thirty, nine o’clock in the morning, 148 eight o’clock in the morning, medication. She says to me every night when she goes to bed, don’t forget to take your tablets, Mummy. Rachel starts off by highlighting how taking medication has become “part of [her] routine” and could be seen to imply that it has become an automatic process for her (“It’s just a done thing”). She then continues to explain how her daughter asks her whether she has taken her medication before school (“Have you taken your medication? According to Rachel, in addition to reminding her to remember to take her medication, her daughter points out the negative consequences associated with non- adherence (“You don’t wanna get sick because then you won’t be able to look after me”). Rachel’s reliance on her daughter to reinforce adherence, who she concedes is “only six” albeit intelligent, could be seen to possibly reflect parentification of her daughter. Nonetheless, during Rachel’s interview it became apparent that being able to care for her daughter motivated her to sustain her adherence. Similarly, in the next extract, Nathan indicates that his girlfriend motivates him to remain adherent: 149 Nathan, 25/02/2009 L: And um, you remember most of the time. When asked directly, Nathan concurs that his girlfriend, whom he lives with, “reminds [him] to take” his medication. He emphasizes the important role that his girlfriend plays in assisting with his adherence, by stating, “If it wasn’t for her, I wouldn’t take it”. Nathan elaborates that in the absence of his girlfriend’s support, he “would probably take [medication] a few times” but would then “just forget” and that he “just couldn’t be bothered”. The latter statement could be seen to imply that, in addition to helping him to overcome unintentional non-adherence as a result of forgetfulness, Nathan’s girlfriend provides him with more motivation and gives him a reason to take his medication. All of these codes relate to consumers’ cognitive processes in some ways, including 150 their attributions of symptom exacerbation and relief, their self-awareness (and in some cases, interpretations of the behaviours and mental health statuses of others), increased knowledge about their illness and medication partly as a result of their experiences, memory deficits and behavioural strategies to overcome deficits. Consistent with previous findings, insight was presented in interviewees’ talk as a multi-faceted construct which operates at various levels.

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Pharmacists are an essential part of the medication use process and better integration of e- Prescribing and pharmacy information systems through cheap aciphex 20 mg online, at a minimum buy aciphex 20 mg with amex, one-way complete electronic data interchange should be a focus of further research discount aciphex 10mg without prescription. Prescribers were also concerned 95 that notification by pharmacies of prescription fill status (filled or not filled) could 839 increase their exposure to malpractice claims aciphex 20mg for sale. Nearly all of the systems evaluated in the United States described the use of prescription writing software limited to generating e-Prescriptions safe aciphex 10mg, but without any other clinical record keeping 736,839 functionality. These systems generated prescriptions and retrieved pharmacy dispensing histories while requiring providers to concurrently maintain paper-based medical records. Evidence from the limited set of one-way e- Prescribing studies was extrapolated to identify possible key facilitators and barriers to completely electronic, two-way e-Prescribing systems. Possible facilitators include monetary or other incentives to providers, a permissive regulatory environment, and the existence of enabling technical standards necessary for e-Prescribing. These studies involved 4,709 providers and approximately 828,441 patients in total (numbers were not specified in all articles). Patients included were primarily adults, with only two studies addressing issues specific to children. All studies assisted with at least the prescribing (71 percent) or monitoring (29 percent) phases of medication management. Notably, none concentrated solely on the order communication, dispensing, or administering phases of medication management. The studies were much more likely to focus on process changes than clinical (patient­ important) outcomes. Furthermore, many studies did not report directly which outcome was their 96 main endpoint—a fundamental flaw. Only five of 34 studies measuring clinical outcomes, whether a main endpoint or not, had a statistically significant impact on a clinical outcome. Where clinical outcomes were thought to be designated main endpoints, 12 of 16 studies showed no differences in clinical outcomes between intervention and control 403,518-520,526,528,624,630,637,697,699,700 groups. Strengths and Limitations As per our inclusion criteria, all trials used randomization for allocation. One of the most important features to avoid bias, allocation concealment was only described to a minimally acceptable degree by 25 studies. Twenty articles scored six or more and none of the studies scored the maximum nine points. Cluster numbers are often small, and therefore, if clusters initially randomized to control group drop out, or participants within the clusters (who are known to be in the intervention or control group) are selected in a biased manner, trial results may not be valid. Only a small minority of these focus on clinical outcomes—those outcomes that are most important to guide decisions of patients’ providers and policymakers about these interventions. General Study Characteristics Of the 77 trials, 46 (60 percent) were rated as impacting primarily the prescribing phase of medication management, 12 (16 percent) aimed primarily at medication monitoring, 15 (19 percent) tried to impact both phases and one addressed administering. Three trials (4 percent) attempted to influence a mix of prescribing, monitoring, order communication, and administering phases of medication management. The setting for the studies was judged to be ambulatory care in 53 (69 percent), or hospital- based in 19 (25 percent), with a small minority based in long term care (two (3 percent)), or other settings (three (4 percent)) such as community or home. Approximately half (36 or 47 percent) of these studies were identified as associated with academic institutions. However, many studies did not address the specific type of provider targeted by the intervention. Three studies identified pharmacists as one of the 97 intervention targets and one study targeted nurses specifically. Patients were named as targets of the intervention in 22 studies, 13 of which exclusively targeted patients. Drug topics were evaluated in 42 studies—19 were vascular medications, 13 antibiotics or vaccines, and five addressed multiple medications. Similarly, we were not able to critique the suitability of control groups in this systematic review, which were typically described as usual care. Outcomes Of the 77 studies, 54 indicated in some way that they had a primary or main outcome and only 16 appeared to have designated a clinical outcome as a main endpoint.

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