Dissertations / Theses: 'Drug problems'

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Mannheimer, Buster. "Drug-related problems with special emphasis on drug-drug interactions." Stockholm : Department of Clinical Science and Education, Karolinska Institutet, 2009. http://diss.kib.ki.se/2009/978-91-7409-602-6/.

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Barry, Peter Walter. "Problems with inhalational drug delivery." Thesis, University of Leicester, 1999. http://hdl.handle.net/2381/29591.

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Inhalational therapy is used to deliver medication to the lung, either to treat diseases or, less commonly, for systemic absorption. A number of devices have been developed to aid or improve inhalational therapy, and this thesis deals with metered dose inhalers, used with spacer devices, and nebulisers. Despite their seemingly simple construction and concept, the correct choice and use of an inhalational drug delivery device can dramatically alter the amount of drug available for inhalation. Studies in this thesis, supported by emerging pharmacokinetic evidence, have highlighted areas where the device can affect the drug delivery. In vitro methods were used to quantify and characterise the different devices, including inertial impaction for aerosol particle sizing, sinus flow pumps for breathing simulation and high speed video recordings to analyse aerosol plume geometry and spacer function. The results these studies reveal a number of factors that may affect drug delivery. Firstly, delay between metered dose inhaler actuation into a spacer and inhalation can reduce the amount of drug available to the patient. Secondly, multiple actuations of the metered dose inhaler into the spacer prior to inhalation also reduce the amount of drug available. The size of the spacer may also affect the amount of drug available for inhalation, and this will vary with the drug prescribed. Different formulations may differ in their aerosol cloud speed and volume, and this may alter the amount of drug delivered from different spacers. Plastic and polycarbonate spacers may be highly charged with static electricity. Such spacers deliver less drug than those where the static charge has been reduced by an anti-static lining, or where the spacer is constructed from static dissipative materials. Washing the spacer also reduces its charge, but the optimum washing regime for spacers is not known. Different nebulisers deliver different amounts of drug, and the assessment of nebulisers varies with the method used. Accurate assessment should include direct measurement of the mass of drug released, and should incorporate simulated patient breathing. Effective nebulisation of drug ends after a few minutes. This time will depend on the nebuliser and drug being used, but for some medications administered for asthma, little drug may be delivered after five minutes, and patients should be advised to stop nebulisation after this time. In conclusion, studies in this thesis support the hypothesis that the method of use or choice of inhalational drug delivery device affects the amount of drug that is available for inhalation by the patient.

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Al-Deagi, Fawzi A. A. "Drug-related problems in elderly patients." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318951.

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Easton-Carter, Kylie 1973. "The consequences of drug related problems in paediatrics." Monash University, Dept. of Pharmacy Practice, 2001. http://arrow.monash.edu.au/hdl/1959.1/8988.

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Ibrahim, N. "Drug-related problems (DRPs) in children with kidney disease." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1448344/.

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Introduction: Medicines are used with the intention of benefitting from their effect. The effects of medicines can also be undesirable and potentially lead to harm. A drug-related problem (DRP) is a term used to describe problem(s) that exist in the use of medicines. There remains a distinct paucity of data on the epidemiology of DRPs in children with kidney disease. Aim: To investigate the epidemiology of DRPs in children with kidney disease in clinical practice at tertiary Paediatric Nephrology units. Methods: Study 1: Prospective observational study on the characteristics of DRPs in hospitalised children with kidney disease. Study 2: Randomised control trial on clinical pharmacist (CP) interventions in resolving DRPs on the renal outpatient clinic. Results: Study 1: A total of 127 patients were recruited and a total of 203 DRPs were identified. The incidence of DRP was 51.2% (95% CI 43.2-60.6%) of patients reviewed by the CPs. The number of medicines prescribed per child was the only significant risk factor for the occurrence of DRPs (OR 1.06, 95% CI 1.02-1.10, p=0.002). The majority of DRPs were minor in clinical significance (68%, n=138/203). The predominant DRPs were sub-optimal drug effect. These DRPs were associated with drug selections and dosage errors. Study 2: A total of 100 patients were recruited (Control n=53, Intervention n=47). The trial showed no effect of intervention in the resolution of active DRPs (p=0.96) between the Control and Intervention arms. Conclusion: DRPs are common in children with kidney disease and necessitate a comprehensive approach to their identification and resolution. Their characteristics in both settings are different even though the majority of them shared a similar level of clinical significance. Further research is required to evaluate the effectiveness of pharmacists’ intervention in resolving DRPs at the outpatient clinics.

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Gordon, Karen Joyale. "Drug related problems in cardiovascular patients in primary care." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269639.

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Morrison, Valerie L. "Illicit drug use : patterns, problems, and predictors of change." Thesis, University of Edinburgh, 1993. http://hdl.handle.net/1842/20033.

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This thesis describes the results of a longitudinal study of regular illicit drug users in Edinburgh, Scotland. Subjects were recruited using the method of 'snowballing'. An initial group of 115 regular users of illicit substances was interviewed using a semi-structured schedule. It was found that multiple substance use was the norm with many individuals reporting adverse consequences resulting from their use of licit and illicit drugs. Concern about HIV infection affected the drug taking behaviour of injectors, but in contrast, had little influence upon the sexual behaviour of both injectors and non-injectors. Sixty-three percent (n = 72) of respondents were reinterviewed approximately 18 months after the initial interview, in order to assess patterns of behaviour change. It was hypothesised that level of involvement in drug-using lifestyles at first interview and repondents' cognitions about their current and future use would be predictive of behaviour change at the time of follow-up. Drug involvement variables, such as length of drug using career, opiate use and having an income from drug dealing, discriminated significantly between users who 'reduced' in terms of the nature and level of their use, and those who 'progressed' or remained 'static'. Cognitions about use, such as perceptions of being addicted and desire to stop, discriminated 'statics' from the 'reducers' and 'progressors'. Results from this study show that drug use behaviour change has multiple predictors at personal, social and environmental levels. These predictors are as varied and complex as those of drug initiation suggested in the retrospective data. Further studies of predictors of change should facilitate the identification of those new users who are 'at risk' of progression, which would have important implications for both primary and secondary prevention.

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Boys, Annabel Frances. "Young substance users : modelling consumption patterns, problems and expectations." Thesis, King's College London (University of London), 2001. https://kclpure.kcl.ac.uk/portal/en/theses/young-substance-users--modelling-consumption-patterns-problems-and-expectations(350a7ff3-f70f-4d4a-9acb-814c5ded88d5).html.

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Campbell, Michael, Mobeen Moslem, Preston Spriggel, and Terri Warholak. "Identifying Drug Therapy Problems Through Patient Consultation at Community Pharmacies." The University of Arizona, 2013. http://hdl.handle.net/10150/614231.

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Class of 2013 Abstract
Specific Aims: The objective of this quality improvement project is to evaluate if drug therapy problems in a community pharmacy setting can be identified via patient counseling at the time of prescription pick up. The central hypothesis of the project is that patient consultation will aid in identifying drug therapy problems and reduce the amount of negative effects posed by these problems. Methods: This project will assess data obtained through a medication therapy intervention report utilized in multiple community pharmacy environments in Arizona. Any consultation provided to a patient by a pharmacist or pharmacy intern regarding a new or transferred prescription will be eligible for data collection. The primary dependent variable is the number of drug therapy problems identified during consultation. Drug therapy problems will be assessed via expert opinion to identify the potential negative impact they may have posed to patients. Data analysis will involve the frequency and type of drug therapy problems identified during data collection. Main Results: A total of 1305 prescriptions were screened during the data collection period. A total of 29 drug therapy problems were identified upon patient consultation. This yielded a 2.2% drug therapy problem occurrence during data collection. The most commonly occurring drug therapy problem involved a patient drug allergy or sensitivity issue. Conclusion: Future research is warranted on the effects that drug therapy problems have on patients and the healthcare system. This project is descriptive in nature and may not be applicable to every community pharmacy in Arizona.

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Akhter, K. P. "Computational problems associated with fitting the Michaelis-Menten models." Thesis, University of Manchester, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.233023.

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Elmarakeby, Haitham Abdulrahman. "Deep Learning for Biological Problems." Diss., Virginia Tech, 2017. http://hdl.handle.net/10919/86264.

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The last decade has witnessed a tremendous increase in the amount of available biological data. Different technologies for measuring the genome, epigenome, transcriptome, proteome, metabolome, and microbiome in different organisms are producing large amounts of high-dimensional data every day. High-dimensional data provides unprecedented challenges and opportunities to gain a better understanding of biological systems. Unlike other data types, biological data imposes more constraints on researchers. Biologists are not only interested in accurate predictive models that capture complex input-output relationships, but they also seek a deep understanding of these models. In the last few years, deep models have achieved better performance in computational prediction tasks compared to other approaches. Deep models have been extensively used in processing natural data, such as images, text, and recently sound. However, application of deep models in biology is limited. Here, I propose to use deep models for output prediction, dimension reduction, and feature selection of biological data to get better interpretation and understanding of biological systems. I demonstrate the applicability of deep models in a domain that has a high and direct impact on health care. In this research, novel deep learning models have been introduced to solve pressing biological problems. The research shows that deep models can be used to automatically extract features from raw inputs without the need to manually craft features. Deep models are used to reduce the dimensionality of the input space, which resulted in faster training. Deep models are shown to have better performance and less variant output when compared to other shallow models even when an ensemble of shallow models is used. Deep models are shown to be able to process non-classical inputs such as sequences. Deep models are shown to be able to naturally process input sequences to automatically extract useful features.
Ph. D.

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Taylor, Molly. "Problem drug use and fatherhood." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3376/.

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In spite of longstanding concern over the impact that parental problem drug-use may have on the lives of children, very little is currently known about the way in which problem drug-using fathers experience and interpret their parenting roles. This study explores the lived experience of fathering among problem drug-using men and considers the impact that drug addiction may have on how these fathers enact their roles as parents and the relationships that they have with their children. Through qualitative interviewing with a sample of fathers with a history of drug addiction, this research highlights the incompatibility between a problem drug-use career and an active and involved fathering role. However, it also reveals how although many of these men may not be fathering in a practical sense, they would appear to nonetheless hold well-developed notions of what qualifies as good parenting and a desire to better fulfill their role as a father. The findings suggest that greater acknowledgement of fathering issues and of men’s parenting status in the provision of services would be beneficial. Furthermore, engaging with these men as fathers and addressing their parenting issues whilst treating their drug addiction problems could potentially facilitate better, more responsible, involved, and perhaps most importantly drug-free fathering.

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Palm, Jessica. "Moral concerns : treatment staff and user perspectives on alcohol and drug problems /." Stockholm : Department of Criminology, Stockholm University, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-1003.

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Chen, Y.-F. "Prescribing problems in primary care : focusing on potentially hazardous/contradicted drug combinations." Thesis, University of Nottingham, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289070.

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Mauldin, Jo A. Seaman John Weldon. "Bayesian approaches to problems in drug safety and adaptive clinical trial designs." Waco, Tex. : Baylor University, 2008. http://hdl.handle.net/2104/5177.

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Abramsson, Linnea. "PREVALENCE OF DRUG RELATED PROBLEMS STOPP/START in elderly people with dementia." Thesis, Umeå universitet, Farmakologi, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-157692.

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Casault, Sebastien. "Exact enumeration approach to solving transient diffusion problems applied to drug delivery." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27817.

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This is a study of drug delivery problems from hydrogels and it is mainly focused on the effects of the hydrogel's geometry on the behaviour of the release profile. Studying drug delivery also offers one the opportunity to delve into the physical mechanisms involved in the release process to better understand its theoretical implications. We can apply the well-developed theory of diffusion in order to understand many aspects of drug delivery. Thus, this thesis starts with a presentation of concepts and theories used in the following two articles (chapters). We go over the basic concept of drug delivery, followed by an introduction on diffusion. We then explain the ideas governing drug release and how we have modeled it. The tools used to generate our drug release platforms are presented followed by a discussion on characterizing the resulting drug release profiles. This thesis is presented as a series of two articles that have been submitted to peer-reviewed scientific journals. The first article presents a novel combinatorial technique used to obtain controlled drug delivery profiles. We use an exact enumeration diffusion model in order to obtain our drug release profiles and test its validity by comparing these results with analytical theory and widely used empirical tools. By using a genetic algorithm, we then show that it is possible to tailor the drug delivery platform in order to get a specific functional form of the release profile. The second article consists in testing two widely used empirical functions that are used in the literature to characterize drug release profiles. Several claims have been made regarding the interpretation of these functions and we have used our exact enumeration data to argue that although the functions fit the data relatively well on certain time scales, they do not necessarily convey reliable information about the mechanism of release. Finally, we conclude with preliminary work that was done on a second optimization technique to be used in controlling drug delivery profiles. The Metropolis simulated annealing was used to further optimize the design of the drug release platform and was shown to be quite effective, albeit being computationally demanding.

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Koubaity, Majda. "Drug-Related Problems in Belgium: From community pharmacies to hospital: State of the situation and Impact." Doctoral thesis, Universite Libre de Bruxelles, 2019. https://dipot.ulb.ac.be/dspace/bitstream/2013/294510/3/TM.doc.

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IntroductionDepuis plusieurs décennies, la pratique et les soins pharmaceutiques sont soumis à plusieurs changements en partie en raison de l’évolution de la société, des progrès de la recherche et de la mise sur le marché de nouveaux médicaments. La pratique du pharmacien a passée d’une délivrance centrée sur le médicament vers la délivrance centrée sur le patient notamment par la détection, l’intervention et la résolution des Problèmes Liés aux Médicaments (PLM).Certains patients atteints d’une condition médicale particulière, tels que les patients cancéreux, peuvent être soumis à des traitements lourds qui leurs sont nécessaires mais qui peuvent les rendre plus vulnérable à l’apparition d’un PLMObjectifsL'objectif de cette thèse était de mettre en évidence la proportion des PLM dans les pharmacies d’officines ainsi qu’à l'hôpital et d’évaluer les potentielles conséquences en milieu hospitalier.La première partie était composée de deux projets ;1) Traduction et adaptation de la classification du PCNE V6.2 à la pratique et au cadre juridique pharmaceutique belge en intégrant la validation du contenu et la fiabilité inter-évaluateur de la classification adaptée. 2) Étude pilote visant à évaluer la proportion de PLM des antidouleurs les plus utilisés en Belgique.La deuxième partie de cette thèse était composée de trois projets. 1) Quantification et classification des réadmissions des PLM des patients cancéreux réadmis dans les 30 jours et mise en évidence des facteurs de risque liés à ces réadmissions ;2) Évaluation des coûts liés aux réadmissions dues aux PLM et les potentielles économies de PLM évitables ;3) Détection des interactions médicamenteuses à partir de différentes sources disponibles au sein de la population cancéreuse réadmise lors du premier projet et évaluation de l’impact de ces interactions sur la survie des patients.MéthodeLa classification du PCNE V6.2 a été adaptée et traduite pour le contexte belge. Afin d’évaluer la validité du contenu, les pharmaciens académiques et d’officines ont évalué six critères, deux qui ciblaient le mode d’emploi (compréhensibilité, utilité) et quatre le formulaire d’encodage (pertinence, logique d’agencement, exhaustivité et redondance). Lors de leur pratique quotidienne, les pharmaciens ont appliqué l'outil adapté du PCNE afin d’évaluer si les instructions avaient été respectées et de quantifier le temps nécessaire pour résoudre un PLM. Par la suite, l’analyse des encodages des pharmaciens a permis d’estimer la fiabilité inter-évaluateurs. Le second projet était une étude pilote qui a permis aux étudiants de Master 2 d’encoder avec l’outil adapté du PCNE V6.2 les PLM détectés en officine par leur maître de stage. Les PLM impliquant les antidouleurs ont été extraits de la base de données initiale et ont été analysés.La deuxième partie s’est basée sur une étude rétrospective observationnelle de six mois dans deux établissements de soins Bruxellois :un hôpital général universitaire et un centre de référence en oncologie. Afin d’évaluer les PLM, une revue de médication de type 2b a été appliquée pour chaque patient réadmis aux urgences ou suite à une consultation médicale. La probabilité d’implication d’un PLM dans la réadmission a été évaluée à l’aide du système du Centre de surveillance de l'organisation mondiale de la santé d'Uppsala (OMS-UMC). La réception de la base de données des différents coûts liés à ces réadmissions a permis une estimation des coûts de réadmission de ces PLM pour chacun des deux établissements impliqués. Le caractère évitable d’un PLM a pu être évalué par l’utilisation du questionnaire de Schumock et al. Le dernier projet à évaluer les potentielles interactions médicamenteuses à l'aide des bases de données en ligne Lexicomp® et Epocrates®. Une analyse de survie de Kaplan-Meier et une analyse de Cox ont été effectuées pour évaluer le lien entre les variables interaction et survenue du décès.RésultatsL'adaptation de l’outil a permis l'ajout de 16 items. Une bonne validation du contenue a été obtenue suite à l’évaluation des pharmaciens académiques et des pharmaciens d’officine. Un total de 109 PLM a été encodé, avec un temps de résolution moyen de 5 min. Concernant la fiabilité inter-évaluateur, 74 items sur un ensemble de 83 ont montré une fiabilité élevée. L’étude pilote a permis de recueillir 15 952 PLM, dont 1 832 pour les antidouleurs, 3 200 interventions ont été produites afin de résoudre les PLM. La majorité des PLM ont été totalement ou partiellement résolus (77,2%).Lors de la seconde partie de la thèse, l’analyse des dossiers de patients cancéreux réadmis dans les 30 jours a révélé que 123 patients avaient été réadmis pour un PLM certain (4,9%), probable (49,6%) ou possible (45,5%). Les facteurs de risque mis en évidence étaient un faible score de Charlson, la polymédication et certaines chimiothérapies (préparations à base de Platine, les anthracyclines ou les vinca-alcaloides). Un montant total de 495 869,10 € a été mis en évidence pour les réadmissions dues aux PLM, avec une durée médiane d’hospitalisation de 7 jours. Les cancers prédominants liés à ces réadmissions étaient le poumon (19,5%) et le sein (17,9%). En se basant sur les diagnostiques des médecins, une part importante (71,5%) des réadmissions du aux PLM était liée aux effets indésirables de la chimiothérapie.Le troisième projet de la seconde partie de ce travail a inclus une population finale de 299 patients réadmis 30 jours après la sortie de l'hôpital en raison d’un PLM. Selon les bases de données en ligne, entre 78,9% et 80,9% des patients étaient réadmis avec au moins une interaction. En moyenne entre 1,6 et 2,3 interactions par patient ont été détectés pour Lexicomp® et Epocrates®. Les opioïdes (29,9%) suivis des anxiolytiques (15,8%) étaient les médicaments les plus souvent impliqués. Les effets indésirables les plus prédominants étaient les dépressions du système nerveux central (SNC) et les dépressions respiratoires. Des analyses de Kaplan-Meier ont montré une différence statistiquement significative sur la survenue du décès, entre les patients avec et sans interactions. Néanmoins, le décès ne semble pas être directement lié à la présence d'une interaction.ConclusionLa première partie a pu montrer que l’adaptation de l’outil au contexte francophone belge était fiable et avait une validité suffisante pour une utilisation quotidienne. La participation de 6 facultés belges a permis une implication nationale permettant d’obtenir une grande proportion de PLM (15 952) ;parmi eux, plus de 10% concernaient les antidouleurs dont la quasi-totalité ont été complètement résolus.Concernant la deuxième partie, environ 10% des réadmissions de patients cancéreux dans les 30 jours suivant leur dernier soin étaient liées à un PLM, parmi ces réadmissions 71,5% étaient liées à un effet indésirable. Le coût médian par réadmission était de 2 406,10 €. Les PLM évitables représentaient 7,3% dont le coût s’élevait à un total 27 938,61 €. L’évaluation des interactions a pu mettre en évidence une forte proportion de potentielles interactions liées aux traitements de patients cancéreux, néanmoins cela ne semble pas être lié à la survenue du décès.Ce travail a pu mettre en évidence la présence importante de PLM en officine et la volonté des pharmaciens d’officines belges à améliorer leur pratique. Néanmoins l’intégration d’un outil plus spécifique à la pratique officinale sur le terrain permettrait une adhésion plus complète et potentiellement une meilleure détection. La deuxième partie de ce travail a montré quelques facteurs de risque intéressants et l’importante présence d'interactions, qui demandent une potentielle vigilance chez les patients cancéreux afin de réduire les risques de réadmission dues aux PLM et les coûts associés. Cependant, une meilleure communication entre les professionnels de santé au sein de l’hôpital mais également avec les prestataires extérieurs tels que les médecins de famille et les pharmaciens d’officine, pourrait permettre un meilleur suivi et une diminution de ces réadmissions avec pour objectif d'améliorer la qualité de vie des patients.
Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie)
info:eu-repo/semantics/nonPublished

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O'Gorman, Aileen. "Drug problems and social exclusion : the development of heroin careers in risk environments." Thesis, Middlesex University, 2005. http://eprints.mdx.ac.uk/6939/.

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The location-specificd rug scenesi dentified in Ireland and the UK in the 1980s indicated that problem drug use had a particular social and spatial focus in urban working-class communities, particularly those affected by unemployment and deprivation. This thesis explores localised drug problems in a number of disadvantaged neighbourhoods of Dublin by locating the perspective and experience of heroin users within the context of the social and economic contexts in which they live and operate. Taking a critical interpretivist methodological approach, the concepts of social exclusion and risk environments are used as heuristic devices for understanding the context in which problematic drug careers develop in marginalised areas. Using a multi-method research design, the study draws on secondary demographic, socioeconomic and policy data to provide a contextual framework of risk environments. The study then explores the development of heroin careers and the lived experience of social exclusion through in-depth qualitative interviews with sixty-one heroin users and an ethnographic study of the five socially excluded Dublin neighbourhoods in which they lived. An inductive analysis of the themes arising from the data describes the interactive dynamics at play in which social and structural processes are seen to both facilitate, and be facilitated by, local drug problems. The multiple and interconnected risks that drug users are seen to encounter at both a micro and macro environmental level contributes to our knowledge of localised drug problems and their relationship with social exclusion, and leads to the development of the concept of a risk environment for drug problems with consequent potential for informing grounded policy interventions.

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McLeese, Michelle Frances. "Increases in Drug and Alcohol Problems: A Combination of Job and Home Stressors?" Thesis, Virginia Tech, 2005. http://hdl.handle.net/10919/30846.

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Using data from the National Comorbidity Survey (NCS) from the Fall of 1990 to the Spring of 1992 among respondents between the ages of 15 and 54 in 48 of the contiguous United States, this paper hypothesized an increase in serious drug problems and serious alcohol problems when a combination approach was used regarding home and work stressors. Results indicate support for the hypotheses that the combination of home and work stressors leads to an increase in both serious drug and alcohol problems (each measured separately). These findings are important especially since they suggest that stressors from home affecting work are significant and positively related to problems with both alcohol and drugs and stressors from work affecting home are not. In addition to demographic controls and stress scales of work and home, the model takes into account other possible explanations. These include past traumatic or recent life events that are considered high in stress, the family background of the parents of the respondents with regard to past psychiatric disorders, and the comorbidity of the respondents themselves. Results imply that stressors from home affecting work are significant and matter more than work stressors affecting home in every model. This research improves upon previous research by both exploring the inter-relationship between home and work stress and controlling for alternative explanations. Although more research needs to be carried out in the area of â home stressors,â these results suggest previous conflicting findings within the work stress literature may be due in part to too narrow of a focus on stressors at the workplace or related to the job environment separate from home stressors.
Master of Science

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Luger, Lisa. "Enhancing cultural competence in staff dealing with people with drug and alcohol problems." Thesis, University of West London, 2009. https://repository.uwl.ac.uk/id/eprint/385/.

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The need for cultural competence in making services more responsive to the diverse needs of patients has been highlighted by many authors (NCCC, 2004b; Geiger,2001; Philleo and Brisbane, 1997; Ehrmin, 2005). Philleo and Brisbane (1997)argued that at a time of increasing globalisation and international communication,cultural competency is as important as computer literacy. This means that to be considered a competent professional, such as a nurse, drug worker, youth worker or social worker, one needs to take into account the wider cultural context of the person who is coming for help. A cultural dialogue, where the healthcare worker is able to communicate with people from a different cultural group, should be part of professional approach. With regard to the treatment of substance use problems,Philleo and Brisbane (1997) pointed out that a competent professional must know more than the harm alcohol and drugs can do to the body. Substance problems call for cultural solutions and a cultural dialogue, otherwise professionals are unlikely to achieve a change in their patients' behaviour. The need for better quality services for people from different cultural backgrounds has been recognised in a number of UK government policies, for example the Race Relations (Amendment) Act 2000 (RR(A)A 2000) (The Home Office (HO), 2000). These policies have pressurised organisations into promoting anti-racism and equal opportunities for both service users and staff, and to provide more accessible and culturally competent services. There has been much debate since the 1980s about how to make services more culturally aware and many training initiatives have been developed. Yet, there has been much confusion abuiot the focus of training such as, what needs to be addressed more: racism, discrimination, equal opportunity or diversity? There has been little discussion on the effectiveness of these training activities. Few have been evaluated to measure their impact, such as change in knowledge, attitude and behaviour of those trained, or their organisation's performance towards clients (Papadopoulos et al., 2004; Bhui et al., 2007). Consequently there is little evidence concerning the success of these educational activities. This PhD wants to make an original contribution to the debate surrounding cultural competence and educational practice by evaluating the effectiveness of an educational module to enhance the cultural competence of staff dealing with people with drug and alcohol problems. This study also includes an evaluation of the teaching and learning strategy used.

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Carruthers, Jayne. "Processes in help seeking among amphetamine users who experience problems with drug taking." Thesis, University of Leicester, 1997. http://hdl.handle.net/2381/31261.

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It has been recognised that amphetamine users who experience problems with drug taking rarely initiate or retain contact with services. Reasons for this have been attributed to a stereotyped view that drug services are orientated towards opiate users and therefore have little to offer other drug using populations who may wish to seek formal help. Amphetamine dependency is a growing problem in the United Kingdom and commentators suggest that services will have to begin to acknowledge the diverse clinical needs of this population. The research undertaken in this study focused on how amphetamine users sought help from a local community drug service. A qualitative research paradigm was used. This facilitated exploration of the process and action involved in help seeking and its associated behaviours. Interviews with amphetamine users were analysed using grounded theory. This was aimed at discovering the principle relationships between help seeking phenomena in the data. In the resulting account, a three-stage process of help seeking illustrated users' constructions of problematic drug use, help seeking needs and the impact of service contact on these. Related themes were identified around the development of problems, experiences of loss and helping encounters. These emphasised the personal and social sequelae of problematic drug taking. Unexpected hypotheses emerged about the role of personal identity and therapeutic relationships. The analysis focused on the conceptual development of help seeking. Theoretical, organisational and clinical implications emerged from the analysis. The need to develop a formal theory of help seeking was recognised. Findings suggested that information needs to be targeted at amphetamine users. Therapeutic context rather than content was highlighted by users. This major finding indicated that person focused approaches informed the general style of preferred engagement for users who sought and retained contact with the service.

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Gustafsson, Maria. "Optimizing drug therapy among people with dementia : the role of clinical pharmacists." Doctoral thesis, Umeå universitet, Geriatrik, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118309.

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Background: Drugs are one of the cornerstones in the management of many diseases. In general, drugs are used for diagnosis, prevention, mitigation of symptoms, and, sometimes, to cure disease. However, drug treatment in elderly people, especially those with dementia and cognitive impairments, may involve significant risk of adverse drug events. The aim of this thesis was to identify the extent of potentially inappropriate drug treatment among people with dementia and cognitive impairment and to assess the occurrence and character of drug-related problems that lead to acute hospital admissions. Another aim was to assess the potential impact of a comprehensive medication review conducted by clinical pharmacists as part of a health care team on quality of patients’ drug therapy and drug-related hospital readmission rates. Method: Long-term use of antipsychotic/psychotropic drugs and associated factors were investigated among 344 and 278 people respectively with dementia living in specialized care units. Trends in the prescribing of potentially inappropriate drugs between 2007 and 2013, comprising 2772 and 1902 people, living in nursing homes in the county of Västerbotten, were assessed using six national quality indicators. Data on drug use, function in the activities of daily living, cognitive function and behavioral and psychological symptoms were collected using the Multi-Dimensional Dementia Assessment Scale. Further, an investigation of a separate corresponding population from 2012 was done, where potentially inappropriate drug use was measured before and after a total of 895 medication reviews. Finally, a randomized, controlled trial was carried out among people 65 years or older with dementia or cognitive impairment in internal medicine and orthopedic wards at two hospitals in northern Sweden. The proportion of hospital admissions that were drug-related were estimated, and also whether comprehensive medication reviews conducted by clinical pharmacists as part of a health care team could affect the risk of drug-related hospital readmissions. Results: Antipsychotic and other psychotropic drugs were frequently prescribed to people with dementia living in specialized care units for prolonged periods. Associations were found between behavioral and psychological symptoms and different psychotropic drugs. The extent of potentially inappropriate drug use declined between 2007 and 2013. In the separate corresponding population from 2012, the frequency of potentially inappropriate drug use was significantly reduced among people who underwent medication reviews. Hospitalizations due to drug-related problems among old people with dementia or cognitive impairment were prevalent. We found that inclusion of a clinical pharmacist in the health care team significantly reduced the risk of drug-related 30-day and 180-day readmissions. However, in a subset of patients with concomitant heart failure no effect was seen. Conclusion: Among patients with dementia or cognitive impairment long-term treatment with antipsychotic and other psychotropic drugs is common. The results indicate that these drugs are prescribed to treat behavioral and psychological symptoms among cognitively impaired individuals, despite limited evidence of their efficacy and the high risk of adverse effects. Drug-related problems, such as adverse drug reactions, constituted a major cause of hospital admissions. By reducing potentially inappropriate drug use and optimizing overall drug therapy, inclusion of clinical pharmacists in a health care team might improve the quality of patient care and reduce the risk of hospital readmissions among people with dementia.

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Petropulos, Anthony J. A. (Anthony John Alexander). "Understanding the dynamics of drug-related problems in public housing and its surrounding neighborhood." Thesis, Massachusetts Institute of Technology, 1996. http://hdl.handle.net/1721.1/69362.

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Forsyth, Alasdair John MacGregor. "A quantitative exploration of dance drug use the new pattern of drug use of the 1990s /." Thesis, Connect to electronic version, 1997. http://hdl.handle.net/1905/184.

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Novotny, Kevin A. "The interaction of financial problems and psychological health in rural communities." Theological Research Exchange Network (TREN) Access this title online, 2004. http://www.tren.com.

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Payne, Linda Gail. "The experience of caring for women with drug or alcohol problems in the general hospital." Thesis, Florida Atlantic University, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10154941.

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The purpose of this study was to describe the lived experience of nurses who care for hospitalized women outside of an addiction treatment setting who have a problem with drugs and / or alcohol. The relational experiences of ten registered nurses who had cared for women with drug and alcohol problems were elicited. Heideggerian hermeneutic phenomenology was the method used to interpret the nurse participants’ meaning of their experience. The theoretical framework that was used to explore the nurses’ experience of caring for women who abuse or are dependent on alcohol was Boykin and Schoenhofer’s Nursing as Caring (1993). The relational themes that emerged were: Caring in the dark; Intentionally knowing the woman with AOD as a unique person; and Experiencing sisterhood.

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Andersson, Henrike. "Therapists' experiences of the therapeutic alliance with clients with drug problems : an interpretative phenomenological analysis." Thesis, University of East London, 2014. http://roar.uel.ac.uk/4024/.

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The therapeutic alliance is fundamental for therapists who work with clients with drug problems. The alliance is central to engaging and retaining clients with drug problems in treatment and in facilitating a positive treatment outcome. Moreover, clients with drug problems may have significant difficulties in relating to others, which manifests itself in the client-therapist relationship. There is a paucity of research investigating therapists’ perceptions of the alliance with clients who use drugs. Consequently, this study aimed to explore how therapists experience and understand the alliance with clients who use drugs. Six therapists were interviewed and their narratives analysed using Interpretative Phenomenological Analysis. The data analysis generated four superordinate themes; Trapped in the system; Struggling to connect; The contradictory therapist and Resources transcending the alliance. The themes illustrate the participants’ experiences of how they have little choice but to work within a treatment system they perceive as impacting upon the alliance. Moreover, most participants experience their clients as unreachable, and the results suggest that therapists may take responsibility for developing and maintaining the alliance to accommodate their clients’ ambivalence. The participants further seem contradictory in their understanding of the alliance, which indicates their struggle to acknowledge the difficulties and differences in forming the alliance with their clients as opposed to with generic clients. The participants describe how clinical supervision, peer support and the use of self enable them to connect with their clients. Finally, the study demonstrates that the participants experience the alliance as heavily intertwined with unconscious processes. The study results suggest that therapists require specific and structured support to acknowledge and manage the challenges inherent in relating to clients with drug problems, focussing particularly upon the use of self and the management of countertransference. Moreover, the study highlights the necessity of acknowledging the therapeutic alliance as inseparable from unconscious processes. Additional recommendations are made in relation to clinical practice, training and research.

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Kim, June-Yung. "VARIATIONS IN THE CO-OCCURRENCE OF MENTAL HEALTH PROBLEMS IN ADOLESCENTS WITH PRENATAL DRUG EXPOSURE." Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1596435824634679.

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Kim, Eunju. "Sequential drug decision problems in long-term medical conditions : a case study of primary hypertension." Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/10004/.

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Background: Sequential drug decision problems (SDDP) occur when assigning drugs sequentially in long-term medical conditions. SDDPs are important for both clinical decision-making and resource allocation. They can be large and complex because of the considerable number of drug sequences and disease pathways and the interdependence between them over time. Where classic mathematical programming has a limited capacity for dealing with the complexities of a sequential decision problem, approximate optimisation methods have been widely used to solve the problem more efficiently using simulation. Objective: This thesis aims to set down the definitions of SDDPs mathematically to understand the nature of SDDPs, to examine the potential methods to identify optimal or near-optimal sequential treatment strategies in a long-term SDDP; and to discuss the performance of the proposed methods using a case study of primary hypertension. Methods: A mathematical description of SDDPs was developed to gain an understanding of the nature of SDDPs. A systematic review was conducted to examine potential optimisation methods for solving large and complex SDDPs. A hypothetical simple SDDP was used to test the feasibility of incorporating the promising methods into an economic evaluation model. A de novo hypertension cost-effectiveness model estimating blood pressure lowering effects of sequential use of antihypertensive drugs was developed. Enumeration, simulated annealing (SA), genetic algorithm (GA) and reinforcement learning (RL) were used to solve the SDDP in primary hypertension. Their performance was tested in terms of computational time and the quality of solution, which is defined by the closeness of the final objective function values and the real global optimum are obtained from enumeration. Results: The computational complexity of SDDPs comes from a range of factors, which are: 1) the number of relevant health states, 2) the number of potential drug treatment options, 3) the number of times that a treatment change may occur, 4) whether the transition probability between health states depends on historic health states and drug uses and 5) relevant clinical-based rules that need to be incorporated. Various trade-offs, such as the trade-off between the computational complexity and model validity, the trade-off between the research effort and time required to develop the optimisation model and the underlying evaluation model, and the trade-off between the amount of search time and the quality of the solution, are fundamental features of SDDP modelling. These trade-offs are all interrelated with each other rather than existing separately. In the case study of primary hypertension, the optimal solution identified by enumeration was to start with an angiotensin converting enzyme inhibitor or an angiotensin II receptor blocker (ACEI/ARB), followed by the combination of thiazide-type diuretic (D) and ACEI/ARB, the combination of D, ACEI/ARB and calcium channel blocker (CCB) and the combination of D, ACEI/ARB and beta-blocker (BB) as second, third and fourth-line treatments. The total expected net benefit for this optimal sequential treatment policy was £330,080 (95% CI £330,013-£330,147). SA and GA found the same (or statistically indifferent) solution(s) identified by enumeration with shorter search time and smaller iteration number. The computational time was 4.1-4.6 hours in SA or GA whereas enumeration took 12.20 hours. The performance depended on some key parameters of the methods: cooling rate and the maximum number of iterations within the same temperature for SA and the number of generation, population size, crossover rate and mutation rate for GA. The performance of RL was relatively less favourable. This may be because of the structure of the hypertension SDDP model, whose total net benefit is mostly affected by the add-on Markov model after the drug switching period than the short-term drug switching model. Conclusion: SA and GA can be used to solve a large and complex SDDP as demonstrated in the primary hypertension case study. They can find the optimal or near optimal solutions efficiently where the key parameters are properly set. The optimal parameter setting is problem specific and requires a tuning procedure considering various scenarios with different sets of parameters. RL needs further investigation to improve the performance possibly by using more complicated RL methods or in a different structure of the underlying evaluation model. This study can be extended to construct the underlying evaluation model using a DES and to technically improve the optimisation methods. Producing the data relevant to SDDPs will also help to make better informed decisions for SDDPs in health technology appraisal.

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Mdege, Noreen D. "Reducing substance misuse and related problems : how can unhealthy alcohol users and problem drug users be effectively intervened with in general hospital settings?" Thesis, University of York, 2015. http://etheses.whiterose.ac.uk/10655/.

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Background: There is a high prevalence of unhealthy alcohol use and problem drug use among patients presenting to general hospital settings. However, many unhealthy alcohol users and problem drug users in these settings are not even aware, or do not acknowledge that they have such problems. Their presentation to hospital for the treatment of other conditions offers an opportunity to engage with them. However, there is uncertainty over how best to identify, assess and intervene with this population. Aim: To investigate how unhealthy alcohol users or problem drug users can be effectively identified, assessed and intervened with when they present to general hospital settings for the treatment of other conditions. Methods: This thesis is based on six published papers that used systematic review, meta-regression and Delphi methods. Main findings: To date, research on interventions for unhealthy alcohol use in general hospital settings has focused on brief interventions (BIs). Multiple session BIs are likely to be beneficial for unhealthy alcohol use in these settings. Where targeted screening and intervention is the strategy of choice, a focus on gastroenterology and emergency medicine is a promising way to target resources for unhealthy alcohol use. There is lack of evidence on how to effectively identify and intervene with problem drug users. The available evidence favours the ASSIST as the problem drug use screening instrument of choice. There is also lack of evidence to inform which comprehensive substance misuse assessment package to use in these settings. Conclusions: There is still need for robustly designed research on how to effectively identify, assess and intervene with unhealthy alcohol users and problem drug users within general hospital settings. It is to be hoped that the body of work presented in this thesis will, effectively, contribute to the development stage for other primary research in the future.

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Wouters, Olivier. "Essays on prices, volumes, and policies in generic drug markets in high- and middle-income countries." Thesis, London School of Economics and Political Science (University of London), 2018. http://etheses.lse.ac.uk/3827/.

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Background and importance: Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. Objective: The aim of this Ph.D. was to explore issues relating to the prices and usage of generic medicines in high- and middle-income countries in five articles. This was done using quantitative and qualitative methods, including price and Herfindahl-Hirschman indexes, difference-in-differences regression analyses, semi-structured stakeholder interviews, and literature reviews. As a Ph.D. "thesis by papers", each of the five articles should be read as a stand-alone piece. However, the thesis presents an overarching narrative, outlined at the end of Chapter 1. Novelty and empirical contribution: My original contributions to knowledge are: (i) updated analyses of generic drug policies, prices, and usage rates in high-income countries, based on a large, representative sample of generic medicines from 2013 (Chapters 2 and 3); (ii) evidence on the impact of a pharmaceutical tendering system on medicines prices, demand, and competition over a 15-year period (Chapter 4); (iii) quantitative data on the impact of therapeutic tendering on drug spending and prices (Chapter 5); and (iv) qualitative data on how a country can move from a fragmented health-care system to a single-payer one, using tendering as the basis for a comprehensive drug-benefit plan (Chapter 6). Key findings: The prices and market shares of generics varied widely across Europe. For example, prices charged by manufacturers in Switzerland were, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. However, the results varied depending on the choice of index, base country, unit of volume, method of currency conversion, and therapeutic category. The results also differed depending on whether one looked at the prices charged by manufacturers or those charged by pharmacists. The proportion of prescriptions filled with generics ranged from 17% in Switzerland to 83% in the United Kingdom. The results of the first two studies indicated that the countries which used tender or tender-like systems to set generic drug prices in retail pharmacies (ie, Denmark, Germany, the Netherlands, and Sweden) had among the lowest prices among the countries included in the studies. Tendering can be an effective policy to procure essential medicines at low prices, based on analysis of data from South Africa and Cyprus. For instance, the average prices of antiretroviral therapies, anti-infective medicines, small-volume parenterals, drops and inhalers, solid-dose medicines, and family-planning agents dropped by roughly 40% or more between 2003 and 2016 in South Africa. Many tender contracts in South Africa remained competitive over time, based on the Herfindahl-Hirschman results, with some notable exceptions. However, the number of different firms winning contracts decreased over time in most tender categories. Also, there were large discrepancies between the drug quantities the health ministry estimated it would need to meet patient demand and the quantities the ministry went on to procure during tender periods. In South Africa, the introduction of therapeutic tendering was associated with an estimated 33% to 44% reduction in the prices of solid-dose drugs in 2014. National governments in countries aiming to introduce national health systems (eg, Cyprus and South Africa) will need to adapt their tendering systems and other pharmaceutical policies during transition periods. Future research directions: More research is needed to better understand the drivers of differences in generic drug prices between countries. It is also important to examine why there are large differences in the prices of drugs in various therapeutic areas, both within and between countries. Also, data from more countries, especially low- and middle-income ones, are needed to determine which features of tendering systems are associated with lower prices. Future studies should re-examine the South African therapeutic tendering system once data from more post-intervention periods are available, possibly using other research designs like interrupted time-series models (ie, segmented regression analysis). Policy implications: Price indexes are useful statistical approaches for comparing drug prices across countries, but policymakers should interpret price indexes with caution given their limitations. This thesis offers useful data for policymakers using, or planning to introduce, tendering systems, especially in countries aiming for universal health coverage, like Cyprus (Chapter 6) and South Africa (Chapters 4 and 5).

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McCully, Jeff. "Scare tactics, ordinary consequences, and parental advice the individualization of social problems in television anti-drug commericals /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2007. http://hdl.handle.net/10355/4918.

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Thesis (M.A.)--University of Missouri-Columbia, 2007.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on April 1, 2008) Includes bibliographical references.

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Morningstar, Bridget A. "Examination of drug-related problems in Nova Scotia seniors with diabetes using the Pharmacare Database, 1993-1995." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0021/MQ49412.pdf.

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Wallace, RIcky Reanell. "The study of the effects of religiosity on adolescent alcohol and drug use and alcohol-related problems." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2007. http://digitalcommons.auctr.edu/dissertations/1164.

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The purpose of this study is to examine the effect of religiosity as a central feature on juvenile delinquents, ages 12-17, who are chronically involved with drugs and alcohol. An estimated 400,000 adolescents sought treatment for substance abuse, which does not include those who failed to come to the attention of parents, school officials, treatment providers, or researchers (Adger, 1991). It is hypothesized that religiosity will have minima] statistical significance in the lives of substance abuse adolescents. Secondly, a positive relationship between several dimensions of parental and family religiosity is also predictive of adolescent substance use. Thirdly, a positive relationship exist between religiosity and violation of social norms and laws. Its findings suggest that despite drug abusing adolescents delusional ways of thinking about the world, they continue to embrace a sense of hope that something other than themselves [God, Allah, Buddha] can help them re-establish an intrinsic sense of equilibrium in their lives. Relationships with religious oriented friends as role models is found to have had a 1 protective impact on juvenile adolescents who are involved with substance use in this study. This study further highlights the need for more empirical-based treatment strategies in working with this target population that incorporates religiosity as a intervention strategy. Key Terms: Religiosity- supernatural power or spirit [God, Buddha, or Allah] who is the center of the universe and controls all natural and living organisms. Spirituality- innate feeling of connectiveness to something greater than oneself that invokes a sense of serenity and peace of mind.

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Cunningham, Gillian. "An assessment of drug related problems in the elderly in the community and methodology for their prevention." Thesis, Robert Gordon University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296171.

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Tamulevich, Jeffrey S. "Perceived differences in self-reported problems with sexual harassment, racial prejudice, and drug misuse amoung USNA varsity athletes." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2005. http://library.nps.navy.mil/uhtbin/hyperion/05Jun%5FTamulevich.pdf.

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Thesis (M.S. in Leadership and Human Resource Development)--Naval Postgraduate School, June 2005.
Thesis Advisor(s): Armando Estrada, Linda Mallory. Includes bibliographical references (p. 91-94). Also available online.

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Tamulevich, Jeffrey S. "Perceived differences in self-reported problems with sexual harassment, racial prejudice, and drug misuse among USNA varsity athletes." access online version, LEAD access online version, DTIC (Note: may not work with Internet Explorer), 2005. http://handle.dtic.mil/100.2/ADA435784.

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Persson, Anders J. "Ethical problems in work and working environment contexts." Licentiate thesis, KTH, Infrastructure, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-1741.

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This thesis identifies and systematizes two categories ofpractical problems that stem from work and working environmentcontexts: workplace privacy and occupational health risks. Thefocus of the discussion is on ethical justification. Do we havereason to accept a certain level of (potential) harm toemployees by virtue of the fact that they are employees, and ifso, under what circumstances? The thesis consists of a briefintroduction and three essays.

InEssayI, it is argued that employees have a prima facieright to privacy, but that this right can be overridden bycompeting moral principles that follow, explicitly orimplicitly, from the contract of employment. Three types ofjustification are specified: those that refer to the employer'sinterests, those that refer to the interests of the employee,and those that refer to the interests of third parties. A setof ethical criteria is developed and used in the subsequentessay to determine the moral status of infringement ofworkplace privacy.

InEssayII, these criteria are applied to three broadcategories of intrusive workplace practices: (1) monitoring andsurveillance, (2) genetic testing, and (3) drug testing.Scenarios are used to show that such practical ethical problemscan be handled systematically using proposed guidelines. It isalso shown that some practices are dubious and at least some ofthem can be replaced by less intrusive means of ensuring thedesired outcome, for instance efficiency or safety in aworkplace.

EssayIII deals with the fact that health and safetystandards for employees are less protective than those thatapply to the public. Emphasis is put on the distinction betweenexposure and risk, and this distinction is claimed to be a keyfactor in the relevance of arguments in favour of such doublestandards. The analysis of 'double standards' for public andoccupational exposure to risk aims to show that a justificationof such standards is closely linked to two separate types ofissues, namely empirical and normative issues. It is claimedthat this kind of differentiation seems to be supported neitherby a reasonable conception of the contract of employment nor byany obvious ethical principle that is applicable to workplacesor work situations in general.

Key words:Contract of employment, double standards,drug testing, ethics, ethical justification, exposure, genetictesting, health and safety standards, privacy, surveillance,risks, work, work environment

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Conway, Jane Frances. "Utopia unrealised: an evaluation of a consultancy to develop a national framework for police education and training to enhance frontline response to illicit drug problems in Australia." University of Southern Queensland, Faculty of Education, 2004. http://eprints.usq.edu.au/archive/00001418/.

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This dissertation presents an evaluation of a funded consultancy that was intended to bring about change in the education and training of police in Australia in response to illicit drugs. Sponsored by what was at the time known as the Commonwealth Department of Health and Aged Care, the ultimate goal of the consultancy was a national framework for police education and training to enhance frontline police response to illicit drug problems. The research used a case study design. Guba and Stufflebeam’s (1970) Context, Input, Process, and Product (CIPP) model was used to organise the presentation of a rich description of the design, development and implementation of the consultancy. Application of this framework enabled illumination of a number of issues related to social policy, change and innovation, and quality improvement processes. The study explores the role of education and training in organisational change and concludes that the potential of external consultancy activity to effect meaningful change in police education, training and practice is limited by a number of factors. Key findings of the study are that while a number of consultancy processes could have been enhanced, the primary determinants of the extent to which a change in police education and training will enhance frontline practice are contextual and conceptual factors. The study reveals that the response of frontline police to illicit drug use is influenced by multivariate factors. The findings of this study suggest that while frontline police are keen to provide solutions to a range of practice issues in response to illicit drug problems, they desire concrete strategies that are well defined and supported by management, consistent with policy and within the law. However, the complexity of police activity in response to illicit drugs; the dissonance between the conceptual frameworks of police and health agencies; and, resistance to what is perceived as externally initiated change in police practice, education and training; were found to be powerful inhibitors of an utopian attempt to enhance frontline police response to illicit drug problems. Using the metaphor of board games, the study concludes that the development of an education and training framework will be of little value in achieving enhanced frontline practice in response to illicit drug problems unless the criteria for enhanced response are made more explicit and seen to be congruent with both the conceptualisation and operationalisation of police roles and functions. Moreover, the study questions the mechanisms through which changes in policy are conceived, implemented and evaluated and highlights a need for greater congruence between evaluation frameworks and the nature of change.

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Harris, A. J. "A study of liquid chromatography-particle beam mass spectrometry and its application to problems in drug metabolism and bioanalysis." Thesis, Swansea University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.637233.

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Liquid chromatography-particle beam mass spectrometry was invented to provide a method for acquisition of library-searchable electron impact and chemical ionisation data for compounds in complex mixtures. My studies explore the potential of using this technique for quantitative and qualitative applications in the areas of drug metabolism and bioanalysis. A systematic evaluation of the key operational variables is conducted, providing a basis for the development of a novel optimisation procedure which takes account of the interactive nature of many of these variables. The origin of carrier effects is discussed. The various hypotheses suggested previously by other workers to account for carrier effect are considered but I conclude that none of these, alone or in combination, can explain all of the accumulated experimental evidence. This infers the involvement of at last one other factor: I believe this to be variability in particle morphology. The evidence to support this proposal is described. The spectral data obtained by particle beam mass spectrometry can be extremely useful for structural studies. Examples are discussed where it proved superior to tandem mass spectrometry but generally, the two approaches are complementary. This is exemplified by a case where both techniques were necessary to elucidate some highly unusual biotransformations of an antiviral compound. For quantitative applications, atmospheric pressure ionisation has made other interfaces largely redundant, but examples are given where the alternative ionisation mechanisms available with particle beam yielded superior results. The complementary nature of these techniques is illustrated by descriptions of analyses by particle beam for a non-polar compound, and an electrospray assay method for a polar compound. The thesis concludes with a brief discussion of the future of particle beam mass spectrometry in the drug metabolism environment, and warns that unless improvements to interfaces are made, there is a danger that what is potentially a very useful technique may disappear.

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Tse, Brittany, Jill Augustine, and Kevin Boesen. "Impact of a Nationwide Medication Therapy Management Program on Drug-Related Problems at the Medication Management Center in 2012." The University of Arizona, 2015. http://hdl.handle.net/10150/614023.

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Class of 2015 Abstract
Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

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Myhrene, Steffenak Anne Kjersti. "Mental Distress and Psychotropic Drug Use among Young People, and Public Health Nurses` Conceptions of Their Roles." Doctoral thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-30600.

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Aim: The overall aim of this thesis was to study mental distress, health and lifestyle habits, social factors and psychotropic drug use by young people, and how PHNs conceive their roles in relation to this. Methods: Quantitative and qualitative methods were used. Study I included data from the Norwegian Youth Health Study (NYHS, 11 620 participants, aged 15-16 years) (2000–2003) linked to the Norwegian Prescription Database (NorPD) (2004–2009). Study II included prescription data on psychotropic drugs among 15-16 year olds from the NorPD (2006–2010). Eight young people were interviewed and qualitative content analysis was used to analyse the data (III). Study IV included interviews with 20 Public Health Nurses (PHN), and was analysed using a phenomenographic approach. Main results: Mental distress was reported among 15.5% of the adolescents non-users of psychotropic drugs, 75% of whom were girls. In both genders reporting mental distress, incident psychotropic use was higher one to nine years, up to 27.7% among girls, as compared with the rest of the participants. In addition, health, lifestyle habits and social factors were associated with incident use (I). Psychotropic drug use increased during 2006–2010, hypnotics and melatonin accounted for most of the increase. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010 (II). Young people experience both beneficial and undesired effects from psychotropic drugs. Access to professional support and follow-up was experienced as insufficient. Life with family, friends, school and work was influenced by psychotropic drug use, and they were afraid of being lonely and stigmatized (III). The PHNs conceived their roles in relation to young people as; the discovering PHNs who became aware of psychotropic drug use in the health dialogues and chose either to act or not to act in relation to this. Those PHNs who took action continued to be the cooperating PHNs who cooperated with the young people, their families, schools, and others. If cooperation was established, the supporting PHNs teach and support the young people in relation to psychotropic drug use (IV). Conclusions: Attention must be paid to poor mental health and increasing psychotropic drug use by young people. Advances in knowledge, treatment and follow-up are needed. The prevalence of mental distress among young people, with differences between the genders, as well as between socioeconomic groups, should have consequences for health promotion strategies. PHNs in Norway, working in health centres and schools, have responsibility and opportunity to identify and follow-up young people with mental health problems.
Baksidestext International studies indicate an increase in mental distress and psychotropic drug use among young people. In this thesis mental distress is reported among 15.5 % of the young people. Of those reporting mental distress 75 % were girls. One quarter of the girls reporting mental distress at 15-16 years of age was incident users of psychotropic drugs one to nine years later. Psychotropic drug use, increase among young people, particularly hypnotic drugs. The young people experience beneficial and undesired effects of the psychotropic drugs. They miss out on professional availability and follow-up, and experience negative reactions related to their psychotropic drug use by their significant others. The public health nurse who discovers psychotropic drug use among young people chooses either to act or not to act in relation to this. Those who choose to act continue to cooperate with the young people and others. An established cooperation was followed by a public health nurse who supports and teaches the young people. The prevalence of mental distress, with a high frequency of initiation of psychotropic drug use among young people should have consequences for health promotion in the school health service. Public health nurses, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the responsibility and opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others.

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Ghaswalla, Parinaz K. "Medication-Related Problems in Older Adults: A Focus on Underuse of Warfarin and Warfarin-Antibiotic Interactions." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2631.

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The work presented in this dissertation focuses on two important medication-related problems in older adults, that is, untreated indication and drug-drug interactions, specifically with respect to a high-risk medication such as warfarin. Warfarin is a challenge to use in clinical practice due to its narrow therapeutic index, variability in dose-response and its interactions with numerous foods and drugs. This dissertation presents the research from two projects. In the first project the prevalence and predictors of warfarin use in nursing home (NH) residents with atrial fibrillation (AF), and use of secondary stroke prevention strategies was determined, in order to understand the patterns of anticoagulant use in frail NH residents and to identify patient characteristics associated with warfarin use. In the second project the effect of oral antibiotics on anticoagulation outcomes, when prescribed concomitantly with warfarin, was determined, in order to provide evidence on the clinical significance of warfarin-antibiotic interactions in older adults. In the first project a cross-sectional analysis of the prescription and resident files from the 2004 National Nursing Home Survey was done to determine the prevalence of AF and rates of use of warfarin and other anti-platelet agents, such as aspirin and clopidogrel. A multiple logistic regression model was used to determine factors associated with warfarin use. In this sample of older NH residents, 13% of residents had a diagnosis of AF, with indications for warfarin use and no contraindications to warfarin. From these patients, 30% received anticoagulant therapy with warfarin and 23% of the remaining patients received either aspirin or clopidogrel, suggesting that more than 50% of residents with AF did not receive any form of anticoagulant therapy. Non-white race, history of bleeding, and use of anti-platelet medications were associated with reduced odds of receiving warfarin. The second project was a retrospective medical record review of older patients from an outpatient anticoagulation clinic at a Veterans Affairs medical center. Results of the repeated measures ANOVA suggested a significant increase in post-antibiotic INR values with fluoroquinolones, azithromycin and amoxicillin. In addition, the percentage of patients with warfarin dose adjustments was significantly greater with fluoroquinolones and azithromycin as compared to cephalexin. No bleeding events were reported for any of these patients. In conclusion, the results of the projects suggest that there is underuse of warfarin in NH settings. Furthermore, antibiotics may be safely prescribed with warfarin in older adults as long as the INR is monitored closely.

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Björkman, Ingeborg. "Towards Improved Medication Use : Increasing Understanding of Professional Efforts." Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7343.

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Professionals and researchers have developed a number of strategies aimed at improving the quality and safety of medication use. However, studies continue to demonstrate persistent problems. For instance, the first paper in this thesis reveals the prevalence of potentially harmful drug combinations among elderly people in Europe. The following four papers focus on two professional groups and how they have approached safety and quality issues related to medication use: 1) the Swedish drug and therapeutics committees (DTCs) and 2) pharmacist involved in pharmaceutical care, an international movement. Qualitative research approaches were applied.

Papers II and III focus on the DTCs: analyses indicate a development of the perception of the DTC role over time. The focus of the activities was broadened – from targeting prescribing physicians to incorporating decision-makers and patients. However, a clear patient-centered perspective was generally lacking. Moreover, the findings indicate a shift in focus from cost aspects of medication use to an increased focus on quality and safety aspects.

In the studies addressing pharmaceutical care (Papers IV and V), the findings propose that different classification systems for drug-related problems had different characteristics which reflected differences in goals in the pharmaceutical care process. It was also found that the concept of pharmaceutical care was understood in different ways and that the perceptions were based on at least two different understandings of health and illness. First, a patient-centered perspective characterized by a holistic understanding of health and illness, and, second, an “EBM perspective” primarily based on a biomedical understanding of health and illness.

This thesis has disclosed new aspects of how two groups of professionals perceive their work towards improved quality and safety of medication use. A patient-centered perspective among healthcare collectives is not obvious; therefore, efforts and comprehensive strategies supporting change are necessary. Strategies should focus on challenging the traditional thought patterns and care approaches among professionals and students.

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Peterson, Cecilia. "Characterization of drugrelated problems and associated factors at a clinical pharmacy-naïve hospital in the northern part of Sweden." Thesis, Umeå universitet, Farmakologi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-131902.

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Radchenko, Tatiana L. 1984. "The Unresolved problems of peptide drug metabolism : Software-aided approach designed to analyze and predict cleavage sites for natural and synthetic peptides." Doctoral thesis, Universitat Pompeu Fabra, 2018. http://hdl.handle.net/10803/665008.

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The work of this thesis aims to develop of a new workflow to predict potential Sites of Cleavage (SoCs) in new candidate peptide drugs. The main goal of this workflow is to understand the protease specificity rules from data coming from different sources and with no limitations on peptides structure. To complete this goal, we implemented a new algorithm to store the information from experimental and external sources in a chemically aware database WebMetabase. This database can be further enriched with new data without limitations. Moreover, we were able to process information about cyclic peptides. Than we developed and applied a frequency analysis to reveal the metabolically labile amide bonds defined by similar properties of residues around the SoC towards the specific proteases. Finally, we built several predictive models using a training dataset, where each SoC was described by its molecular descriptors and frequency. Prediction ability of these models was not limited to only natural amino acids. We demonstrated that models have a comparable predictive performance as other public tools such as PROSPERous.
El objetivo de esta tesis doctoral es el desarrollo de uno nuevo sistema para predecir el sitio de hidrolisis (SoC) para péptidos con actividad terapéutica. El objetivo principal de la metodología es el establecer reglas de especificidad catalíticas paras proteasas sin limitaciones en cuanto a fuente de datos y/o estructura. Con este fin, se implementó un nuevo algoritmo para guardar la información en una base de datos que considera la estructura química, WebMetabase. Esta base de datos puede enriquecerse con nueva información sin límites, pudiendo procesar péptidos cíclicos. Se ha desarrollado un nuevo análisis de frecuencias con el fin de encontrar los enlaces amida metabólicamente lábiles, definidos mediante la similitud de los residuos cercanos al SoC. Se construyeron modelos de predicción donde cada SoC se describe con descriptores moleculares y frecuencia. Estos modelos no se limitan a los aminoácidos naturales y son comparables a los obtenidos con herramientas públicas como PROSPERous.

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Potter, Clare. "Drug assisted sexualised assault in the UK : a feminist, discursive-narrative exploration of the experiences of women and professionals." Thesis, University of Huddersfield, 2009. http://eprints.hud.ac.uk/id/eprint/6977/.

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This research was concerned with drug assisted sexualised assault(hereafter referred to as DASA*)in the UK. Sexual assault has been highlighted by the Home Office as a top priority and a recent consultation document(Home Office, 2000)recognises that different forms of rape have come to the attention of the public over the last ten years, for example, date rape, drug rape and male rape. However studies relating to DASA in the UK are extremely limited and therefore relatively little is known empirically or conceptually about the phenomenon. The research had a number of aims: 1) To explore the discourses within the accounts of professionals when discussing their experiences of providing services to survivors of DASA. 2) To explore how survivors perceive their experiences of being subjected to DASA. 3) To explore how discourses around rape and DASA relate to survivors’ accounts of their experiences after the assault. 4) To contribute towards the development of a conceptual understanding of DASA in terms of experience and ‘recovery’. A total of ten interviews were carried out with individual women about their understandings and experiences of DASA. The sample included survivors, policewomen, counsellors and managers of sexual assault services. A discursive analysis based on a ‘macro approach’ (Foucault, 1972) was carried out on the interviews with professionals. The analysis highlighted the ways in which the ‘tellability’ (Livesey, 2002) of DASA may be undermined by a number of current dominant discourses reflected in the accounts of professionals. Analysis of the interviews with survivors took a narrative approach in that the interviews were analysed for the ways in which women storied themselves within their accounts (Taylor, Gilligan and Sullivan, 1996). There were a number of ways in which the survivors interviewed seemed to be constrained by dominant cultural resources relating to sexualised violence. These survivors were not, however, constituted by these dominant resources but rather sought to resist them in a number of ways. This provides a challenge to discourses around sexualised violence as having a permanently devastating impact on women’s lives, suggesting that women can and do move on to regain control over their lives after having been subjected by men to DASA. * The author was reluctant to abbreviate drug assisted sexualised assault to DASA - to do so may contribute to the ‘hidden’ nature of this form of violence against women. However the decision was made to use the DASA abbreviation in order to improve the readability of the text.

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Sundén, Jens. "Anabola Androgena Steroider : En analys om hur AAS skildras i svensk media." Thesis, University of Kalmar, School of Human Sciences, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hik:diva-2499.

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Title: Anabolic Androgenic Steroids – An analysis of how AAS is portrayed in Swedish media.

Author: Jens Sundén

Tutor: Philip Lalander

Keywords: AAS, Anabolic steroids, social problems, media, drug abuse, gender

The purpose of this study was to investigate how Anabolic Androgenic Steroids (AAS) are portrayed and described in the media, how AAS is constructed as a social problem, and how society in a social context uses knowledge and power for disciplinary and educational means. The study is based on the perception of AAS as a constructed social problem and analyzes the discourses surrounding AAS depicted in three Swedish newspapers. The sample was prepared on the basis that it represents different aspects of daily Swedish press. The method used in the paper is a discourse analysis with social constructivism and gender as theoretical tools used to analyze the sample material. An important conclusion of the analysis is that the use of AAS is a socially constructed problem, which incorporates both a stereotyped, aggressive male individual who desires an ideal body, and the use of AAS defined as an illegitimate abuse by society. Another important aspect of the analysis is how gender roles are highlighted in the sample and how these from a gender perspective are used to perpetuate male superiority and female subordination in society.

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Goodin, William John, and bgoodin@nursing usyd edu au. "AN INVESTIGATION OF FACTORS THAT DETERMINE SELF-REPORTED KNOWLEDGE, ATTITUDES, AND CLINICAL BEHAVIOURS OF PRACTISING REGISTERED NURSES TOWARDS PEOPLE WITH ALCOHOL, TOBACCO, AND OTHER DRUG-RELATED PROBLEMS." Flinders University. Nursing and Midwifery, 2006. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20061110.120239.

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There is an enduring and prevailing disparity between the clinical prevalence of alcohol, tobacco and other drug-related problems and the frequency that nurses recognise and intervene in these common problems. The extant nursing literature has long determined an urgent need for further investigation into why nurses do not respond to patients with ATOD-related problems in the consistent and effective manner that the prevalence of these costly health problems require, or in a manner that reflects the opportunities that nurses have to offer brief and timely intervention. This thesis reports and discusses the investigation of factors that determine identification, assessment and interventions of patients with alcohol, tobacco and other drug-related problems by a randomly selected sample of Registered Nurses [n=1281] in practice in New South Wales, Australia. Of particular interest was the relationship between nurses' ATOD knowledge, therapeutic attitudes and clinical activity. Multiple quantitative and qualitative methods were used, firstly to systematically investigate factors within the nurse and their clinical setting that might predict desired clinical behaviour towards addressing ATOD-related problems, and secondly, to analyse and describe nurses' self-reported perceptions, views and experiences of the issue and what aids or impedes it. The research instrument - a 72 item self-completed questionnaire was developed and refined within a process of three (3) pilot studies and test-retest method. A multiple regression model was developed to establish the predictors of key clinical behaviours. Thematic coding was used to analyse the perceptions of these nurses as to the factors that affect their ability to intervene with patients who have ATODrelated problems. Convergent and divergent concerns between quantitative and qualitative findings became apparent. Thematic analysis of open-ended responses demonstrated that nurses report a complex of factors that affect their ability and capacity to intervene with patients who have ATOD-related problems. Among these are factors located within nurses themselves, within their patient(s), within their workplace, within other health professionals and within the broader social/cultural context. The latter part of the thesis systematically considers the relationships between the quantitative and qualitative findings within this large sample of registered nurses. From this comprehensive level of analysis, workforce implications for ATOD education, training and organisational support for nurses, the most numerous group of health care workers, have been readily identified. The major empirical finding of this investigation is that there is a significant difference between positive attitudinal sets and motivation of practicing registered nurses to perform desired ATOD-related clinical activities, and the lower reported frequency at which this occurs. The qualitative findings are highly convergent with the empirical ones. It is the nurse's self-identified lack of knowledge, skills, experience and confidence that is now reported as having the greatest effect on their ability to assess, identify and offer brief and timely intervention for patients with ATOD-related problems, rather than any prevailing beliefs and attitudes that these patients were not worthy of their care, or outside the legitimate framework of their nursing role.

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Dissertations / Theses on the topic 'Drug problems'

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