Tesis: "Drug utilisation"

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Bardel, Annika. "Women's health and drug utilisation /". Uppsala : Acta Universitatis Upsaliensis, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8225.

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2

Darwish, Dana Abdel Bari. "Cardiovascular drug utilisation in Jordanian hospitals". Thesis, University College London (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440542.

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3

Piovani, Daniele. "Determinants of drug utilisation during childhood". Thesis, Open University, 2018. http://oro.open.ac.uk/55058/.

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Paediatric pharmacology is a neglected area in terms of rational use of drugs. Wide differences have been observed in children’s exposure to drugs between and within countries and regions. The aim of the current thesis is to investigate the determinants of drug prescription in paediatrics. Pharmacoepidemiology and the use of administrative databases can be a useful tool for this scope. Data collected in regional and multiregional administrative prescription databases were analysed. Prevalence data by sex and age were calculated by dividing the number of drug users by the total number of male and female residents in each age group. Univariable and multivariable analyses were performed with the aim to identify the determinants of drug prescriptions. The studies showed quantitative and qualitative differences in drug prescription to children and adolescents among Italian regions and within regions. The prescription of a great number of different, redundant, active substances, even among experienced paediatricians, was found. A North-South trend was found in antiasthmatic and antibiotic prevalence, with an important association with average income at the area level. A confirmation of the high prevalence of these drugs and poor qualitative profile was also found. Large heterogeneity was found in psychotropic drug prevalence among different Italian regions. Psychotropic drugs were scantly prescribed and some of the most used drugs were prescribed off-label. The analyses of the prescription of generic antibiotics showed that generic formulations are scantly prescribed by Italian paediatricians, and the lowest prescription rate of generic drugs was found in paediatricians who prescribe more antibiotics. Some quality indicators for antibiotic prescribing were developed at the paediatrician level. The youngest paediatricians and those who were not exposed to educational interventions showed a significantly worse quality of prescribing. The thesis provide some useful data for policy makers in order to improve the rational drug use in children.

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4

Grundmark, Birgitta. "Prostate Cancer; Metabolic Risk Factors, Drug Utilisation, Adverse Drug Reactions". Doctoral thesis, Uppsala universitet, Institutionen för kirurgiska vetenskaper, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-194297.

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Increased possibilities during the last decades for early detection of prostate cancer have sparked research on preventable or treatable risk factors and on improvements in therapy. Treatments of the disease still entail significant side effects potentially affecting men during the rest of their lives. The studies of the present thesis concern different aspects of prostate cancer from etiological risk factors and factors influencing treatment to an improved methodology for the detection of treatment side effects. Papers I, II, both based in the population based cohort ULSAM (Uppsala Longitudinal Study of Adult Men), investigate possible risk factors of prostate cancer with options for intervention: selenium levels and the metabolic syndrome. The phenomenon of competing risk of death from other causes than prostate cancer and its impact on and importance for choice of statistical methods is also exemplified and discussed for the first time in prostate cancer research. -Smokers with low selenium status have an increased future risk of later development of prostate cancer. Influence of genetic variability appears plausible. -The metabolic syndrome and especially its increased waist circumference component are associated with later development of prostate cancer – taking competing risks of death from other causes into account. Papers III and IV using pharmacoepidemiological methods investigate aspects of drug utilisation in prostate cancer using nationwide and international databases. In Paper III factors influencing anti-androgen use in prostate cancer are investigated, both from a prescriber- and patient perspective. The age and disease risk group of the patient, unsupported scientifically, influence both the prescribers’ choice of dose and the patients’ adherence to treatment. -Adherence, not previously investigated in male cancer patients, was considerably higher than reported for adjuvant breast cancer treatment. Subgroups of men suitable for intervention to increase adherence were identified. Paper IV, investigates the feasibility of improving an established method for screening large adverse drug reactions databases, the proportional reporting ratio (PRR), this by using restricted sub-databases according to treatment area (TA), introducing the concept of PRR-TA. -The PRR-TA method increases the signal-noise relationship of analyses; a finding highly relevant for possibly conserving manual resources in Pharmacovigilance work in a drug-authority setting.

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5

Monaghan, Mark Peter. "The turmoil of evidence : research utilisation in UK drug classification". Thesis, University of Leeds, 2008. http://etheses.whiterose.ac.uk/701/.

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This thesis investigates the thorny relationship between evidence utilisation and policy making in a heavily politicised policy area. Expectations for the conflux of researcha nd policy formulation have been consolidated in the last decade under the banner of 'evidence-based policy'. In recent times, the debateo ver the nature and utility of evidence-based policy has become much more sophisticated. No longer can the connection between evidence utilisation and policy formulation be conceived in terms of evidence shaping policy outcomes or, conversely, policy being evidence free, where evidence has no impact. Such conceptualisations persist, however, in heavily politicised policy areas, where there is intense media scrutiny of decision making, a lack of consensus on its direction, prolonged conflict between competing interest and stakeholder groups and a permeating sense of crisis. These tend to relate to more 'macro' policy areas, not usually the remit of evidence-based policy-making and evaluative research. Using recent and ongoing developments in UK drug classification policy as a case-study, an explanatory framework of the complex role and nature of evidence in heavily politicised policy areas is developed. Central to this, is the use of a methodological approach that can account for the role of conflict in the policy process. A modified version of the Advocacy Coalition Framework is employed to this end. This, in turn, allows for a range of data-collection methods to be used, including observation and documentary analysis of Parliamentary Select Committee hearings alongside qualitative interviews with a wide-range of key policy actors involved in the decision-making process. From this a nuanced account of the evidence and policy relationship in such contexts is ascertained,which departs from the more established models explaining the evidence and policy nexus. Traditionally, such explanations have been conceived as models of research utilisation. In this research it is suggested that these do not translate effectively as models of evidence-based policy-making. This is because they are beset with some, or all, of the following problems: a) they focus more on 'research' rather than the broader concept of 'evidence'; b) they operate with a static view of the policy process where there is a direct connection between research and policy; c) they restrict the role of evidence to one of policy outcomes, rather than viewing the role of evidence in the process of decision-making; d) they assume that research is the defining influence on the decision-making processe; e) they operate at a high level of abstraction, offering little account of how research is selected for use in decision making. Consequently, a newer addition to the literature is developed, which, it is claimed, avoids these shortcomings.

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6

Bardel, Annika. "Women's Health and Drug Utilization". Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8225.

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Objectives. To study medication utilization and adherence to prescribed therapy in a female population in central Sweden. To study usage of hormone replacement therapy (HRT) in this population and to assess how HRT users compare to non-users regarding symptom reporting, general health and other variables. To evaluate symptom prevalence adjusted for potential symptom affecting variables.

Material and methods. A cross-sectional postal questionnaire study was performed in 1995 in seven counties in central Sweden. A questionnaire was sent to a random sample of 4,200 women aged 35-64, of whom 2,991 responded (71.2%). The questionnaire contained questions on psycho-socio-economic background, quality of life, self-reported health, height and weight, climacteric symptom prevalence, and menopausal status and symptoms. It also comprised questions on medication prescribed during the past year.

Results. 40% used prescribed medication and 12% took four drugs or more. Age, educational level, self-rated health, and BMI remained significantly correlated to drug use in multivariate analysis. Adherence ranged from 15%-98% depending on age, a scheduled check-up, perceived importance of medication, concern about medication, taking cardiovascular and respiratory disease drugs. The highest adherence was found for hormonal medication the lowest for musculoskeletal medication.

HRT was used by 15% of the women. 13 % used other symptom relieving therapy. HRT users reported higher score of vasomotor symptoms, except for sweating during the daytime.

Prevalence of general symptoms did not necessarily increase with age. Especially symptoms related to stress-tension-depression decreased with age. Four different symptom prevalence patterns were found.

Conclusions. Age, health status, educational level and body mass index (BMI) appear to affect drug use. Adherence to therapy is highest among elderly women who regard their medication as important and have a scheduled check-up. HRT relieves some vasomotor symptoms but does not affect other symptoms or self-rated health. Prevalence of symptoms related to Stress-tension-depression appears to decrease with age.

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7

Wright, Alison Katrina. "Examining drug utilisation patterns and optimal treatment pathways of antidiabetic medications". Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/examining-drug-utilisation-patterns-and-optimal-treatment-pathways-of-antidiabetic-medications(bfef381c-583d-4747-9b8e-44cb904f48a2).html.

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Background: Type 2 Diabetes is a chronic metabolic condition which occurs as a result of insufficient insulin production and insulin resistance. This results in less glucose uptake by muscle and fat cells, allowing blood glucose levels to rise in the body. Higher blood glucose levels place patients at an increased risk of diabetes-related complications. The treatment is characterised by the initiation, switching and intensification of antidiabetic medications. The goal for patients with diabetes is to maintain glycaemic control, with blood glucose levels (HbA1c) between 6.5-7.0%(48-53mmol/mol). International guidelines recommend prescribing of metformin at initiation but there is no consensus on optimal agents in a combination regimen. The aim of this thesis was to assess the drug utilisation patterns of first-line therapies and the impact of this pathway on second-line regimens. This entailed: (i.) observing the prescribing of the first-line therapy, (ii.) characterising the medication-taking process of the first-line therapy and effectiveness of the regimens, and (iii.) determining the most effective second-line regimen in delaying the onset of microvascular complications. Methods: Patients with type 2 diabetes, prescribed a first-line antidiabetic regimen, were identified from the Clinical Practice Research Datalink (a large UK anonymised primary care database) between 01/01/05 and 31/12/09, were followed-up until 31/12/12. A multinomial logistic regression model was used to assess the relationship between patient characteristics and the choice of first-line agent. Adherence to first-line therapy was estimated using the Medication Possession Ratio calculation, expressing the percentage of days covered by a drug supply. To assess the factors influencing achievement of glycaemic goals from the first-line therapy, a logistic regression analysis was performed. To investigate second-line regimens, a Marginal Structural Cox model was implemented to explore the causal relationships between the time to development of microvascular complications and the second-line regimens. Results: Of the 72,429 individuals diagnosed with type 2 diabetes, 44,838 started therapy with an antidiabetic medication regimen. Metformin and sulphonylureas were the most frequently prescribed agents at initiation (82.9% and 9.8%,respectively). Deviations from metformin were associated with patients presenting with higher HbA1c levels, lower BMI values and had concurrent prescriptions (immunosuppressants and oral corticosteroids). Achieving glycaemic control, to the target of 6.5% (48mmol/mol), was only met in 22.7% of patients. Characteristics of the patient, choice of first-line agent and medical support influenced the effectiveness of the treatments. Patients at the greatest risk of failing to achieve the target glycaemic goal from therapy had HbA1c levels>8.0% (64mmol/mol) and a BMI≥25kg/m2. Adherence was significantly associated with greater lowering of HbA1c levels but these reductions did not guarantee reaching the ideal glycaemic target. Intensification of the monotherapy to a dual therapy regimen was observed in 30.2% of patients in a mean time of 2 years. The most frequently prescribed second-line regimens consisted of metformin/sulphonylurea (SU) (74.5%), metformin/thiazolidinediones(TZD) (11.3%) and metformin/DPP-4 inhibitors (14.2%). Metformin/SU was the most effective dual therapy regimen for delaying the onset of microvascular diagnoses. The rate of development of these events was significantly higher for the DPP-4 combination in comparison to the SU combination with a hazard ratio of 1.85 (95% CI: 1.53,2.24). A TZD combination resulted in a non-significant increase of 19% in the rate of development compared to the SU combination (HR 1.19; 95% CI: 0.98,1.47). Metformin/SU resulted in the greatest lowering in HbA1c levels (-3.3%; 12mmol/mol) in comparison to the DPP-4 and TZD regimens. Conclusions: It is unlikely that patients starting first-line therapy with high HbA1c levels will be able to reduce blood glucose levels sufficiently on a monotherapy regimen. It is important for practitioners to consider a faster uptake of a dual therapy regimen (metformin/SU) to prevent sustained suboptimal glycaemic control and reduce the risk of future complications. Other important considerations in the optimal treatment pathway would be to provide more frequent support from health professionals; this may help to highlight inadequate drug regimens, offer management of risk factors and provide education. These aspects may help patients to achieve better control of their condition, with the aim of reducing the risk of diabetes-related complications; which, severely impact patient quality of life and NHS costs and resources.

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8

Burger, Solé. "A drug utilisation review of Isotretinoin in the management of acne". Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/673.

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Acne is a common, chronic disorder that affects many adolescents. The most effective acne medication is systemic isotretinoin. It provides a permanent cure for many patients, but has various side effects. A South African Acne Treatment Guideline was introduced in 2005. Adherence to this guideline could lead to safer, more effective acne management. The primary aim of this study was to investigate the appropriateness of medications prescribed in the treatment of acne in South Africa, and to evaluate the safety and efficacy of systemic isotretinoin utilised by patients in the Nelson Mandela Metropole (NMM). A drug utilisation study (including 18 803 South African acne patients’ chronic prescription data between 2000 and 2005) and a patient questionnaire survey (including information from 57 patients in the NMM who used systemic isotretinoin) were conducted. Basic descriptive and interferential statistics were calculated. The drug utilisation study revealed that systemic antibiotics were the acne treatment prescribed to most (43.3 percent) patients, followed by 42.1 percent of patients on systemic isotretinoin, 33.2 percent on hormonal therapy and 18.9 percent on topical therapy. Topical retinoids were underused. The questionnaire survey indicated a lack of compliance by prescribers with guideline recommendations regarding the prescription (and accompanying counselling and monitoring) of isotretinoin. Incorrect cumulative doses were frequently prescribed, and a lack of proper implementation of pregnancy prevention measures was evident. The majority of isotretinoin patients reported a high efficacy of isotretinoin in clearing their acne.

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9

Larsson, Mattias. "Antibiotic use and resistance : assessing and improving utilisation and provision of antibiotics and other drugs in Vietnam /". Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-630-8/.

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10

Hedna, Khedidja. "Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects". Doctoral thesis, Linköpings universitet, Avdelningen för läkemedelsforskning, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122266.

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Background: Inappropriate use of medications (IUM), in particular inappropriate prescribing and non-adherence to prescribed medications, are important causes of drug-related morbidities (DRMs). They are increasing problems with the ageing populations and the growing burden of chronic conditions. However, research is needed on the association of IUMs with DRMs in outpatient settings and in the general population. Aim: The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods: A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV). Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period; PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions: A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention. Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs. Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice. In summary, this thesis shows a significant potential for improvements of medication use and outcomes.

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Scholtz, Daniël Jacobus. "Prescribing patterns of antiretroviral drugs in the private health care sector in South Africa : a drug utilisation review / Daniël Jacobus Scholtz". Thesis, North-West University, 2005. http://hdl.handle.net/10394/1723.

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Sripa, Saksit. "Variation in drug utilisation and quality of prescribing across different health insurance schemes in Thailand". Thesis, University of Aberdeen, 2013. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=203535.

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Introduction: In 2001, the Universal Coverage (UC) policy was introduced in Thailand. This policy aimed to provide equal access to health care regardless of socioeconomic status. There are now three different health care schemes serving Thai people including the Civil Servant Medical Benefit Scheme (CSMBS), the Social Security Scheme (SSS), and the UC Scheme. Soon after the introduction of the UC there was evidence of health inequalities among beneficiaries of different schemes. The purpose of this thesis is to explore the utilisation patterns of drugs and quality of prescribing across the different health insurance schemes in order to investigate whether there are any differences or inequalities in access to health care for people covered by the different schemes. Aims: 1. Investigate whether routinely collected data held by Thai hospitals can be used to examine the drug utilisation patterns and quality of prescribing. 2. Investigate the published criteria for assessment of prescribing quality and its applicability to apply to the Thai datasets. 3. Explore the patterns of drug utilisation for patients under the different health insurance schemes. 4. Determine the extent of potentially inappropriate prescribing across the different health insurance schemes. 5. Explore the UC patients' opinions of quality of health care and prescribing. Methods: The programme of work was grouped into two main studies: i) drug utilisation study; and ii) prescribing quality study. There are six sub studies which contribute to address the study aims. A national survey of routinely collected data held in Thai hospitals was conducted to gain information of the types of data collected and types of operating software employed. Also, the survey was used as a way to engage with hospitals to ask if they would be interested in participating in the main drug utilisation study. The drug utilisation study is the main study in this programme of work with aim to illustrate patterns of drug utilisation across the different health insurance schemes and trends of drug use in the years since the introduction of the UC. Drug use in patients with diabetes and hypertension were selected as a sample to show the utilisation of drug across the schemes. A purposive sample of four hospitals was selected with respect to geographical location (north, south, north east, and central) and hospital type (regional and general) and informed by a previous national survey. Separate drug utilisation studies were undertaken at each hospital for the fiscal year 2008 using routinely acquired data. A detailed analysis was undertaken for a subsample of patients with diabetes and hypertension. The Anatomical Therapeutic Chemical classification and the Defined Daily Dose (ATC/DDD) system were used to categorise and to quantify volume of drug prescribed. The findings from the four studies were then meta-analysed to provide additional information to give more insight about the national drug utilisation and comparison across the schemes. The meta-analysis was done for only year 2008 data, seven years after the introduction of the UC. The systematic review was undertaken to provide information of the published criteria for assessing quality of prescribing on theirs development, reliability and validity, applicability, association with health-related outcomes, as well as to identified published criteria to be applied to Thai electronic datasets. The relevant drugs were selected from the drug-to-avoid list from the most widely recognised criteria, to determine the extent of potentially inappropriate drug use in patients with diabetes and hypertension who aged 65 and older. The comparison between the schemes were analysed using the year 2008 data the seventh year after the UC introduction to provide additional information for the drug utilisation study. The qualitative interview study was considered to gain more in-depth understanding about UC patients' views on quality of health care and prescribing. Patients with diabetes or hypertension were included in the interview. The thematic framework approach was applied. This study provides additional information on patients' perspectives and clearer insight on access to health care and equality which is the ultimate goal of this thesis. Results: The findings from the national survey revealed that dispensing data and patient data were routinely collected in electronic format in all hospitals. Dispensing and patient databases could be linked in most hospitals. There were 20 different software used for computerised hospital information systems. Fifty four percent of hospitals indicated their interest in participating in the study of drug utilisation. The results of the drug utilisation study identified that the number of outpatient visits increased during the period, whilst the number of inpatient hospitalisations rose moderately. Female and older people were more likely to make hospital visits than male and younger people. People under the CSMBS were more likely to visit outpatient services at the hospital than those under the UC and SSS, whilst the UC people appear to have higher admission rates than that of the CSMBS. The mean cost of all drugs prescribed per patient per year for the CSMBS was the highest, while the mean drug cost per patient per year for the SSS and the UC was similar. The mean drug costs per patient per year for patients with diabetes and hypertension show similar patterns to general population; with a substantial increase in drug cost for the CSMBS and a slight increase for the SSS and the UC. The mean DDDs of dispensed antidiabetic drug per diabetic patient per year for the different schemes after adjustment were not significantly different throughout the year. Similarly, the DDDs of dispensed cardiovascular drugs for patients with hypertension under the three schemes were not significantly different during the period. The CSMBS patients were more likely to be prescribed the newer and expensive drugs such as glitazones, atorvastatin, and ARB, with very small amounts of those prescribed to patients under the SSS and UC. The SSS and the UC patients were more likely to receive older and cheaper drugs such as glibenclamide and beta blockers. The findings from meta-analysis of summary findings from four hospitals have confirmed the drug utilisation study. These findings suggest that variation in drug utilisation across the three schemes exist. The systematic review identified published criteria for assessing quality of prescribing. The Beers criteria have been proved valid through many consensus studies, and widely adopted in many countries and settings. The criteria also have been applied with electronic data in many studies. The STOPP criteria have been proved reliable and valid. The STOPP criteria also have used up-to-date evidence in the criteria development. The extent of potentially inappropriate drug use in people aged 65 and older identified according the published drug-to-avoid lists from the Beers and the STOPP criteria varied across the hospitals. The main problematic drug prescribed to elderly patients was glibenclamide ranging from 2.1%-6.1% of elderly people. The CSMBS patients were less often prescribed drugs to avoid than UC and SSS patients. Female, older, and patients with more hospital visits were more likely to receive the problematic drugs. Twenty nine patients were interviewed. The majority of participants was female, aged over 60 years old, had elementary school education, and worked in agricultural roles. Most interviewees felt the doctors treated them well, and they had great confidence in their doctors. They felt that the treatment they received was of high quality. They also believed that their prescribed medications were good and would control their diseases. Most participants perceived that the UC had reduced the financial burden of health care for them and led to an increase in accessible health care. They also believed that they received similar treatment and services compared to those who were under the alternative schemes. Only those participants with a higher socioeconomic status were dissatisfied with the service and medications under the UC and believed that it was worse than the services under the other schemes. Conclusion: The thesis has demonstrated the existence of inequalities in drug utilisation and prevalence of inappropriate drug use across health insurance schemes after the introduction of UC. The CSMBS members are the better-off with the highest drug cost and are more likely to receive the high-cost drugs. The drug utilisation and prevalence of potentially inappropriate drug use are similar for the UC and the SSS. A more indepth study to examine clinical outcomes of the differences in drug selection under different schemes should be conducted in the future. On another side, generally, people under the UC expressed their satisfaction with the quality of health care and prescribing. The hospitals and the doctors were reliable, responsive, and trustworthy. Policy or programmes at both hospital and national level in order to address the variation in drug prescribing should be implemented.

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13

Moore, Marna. "Usage analysis of dermatological products according to a medicine claims database / Marna Moore". Thesis, North-West University, 2006. http://hdl.handle.net/10394/1026.

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A large number of people all over the world suffer from skin conditions. Dermatological problems comprise about 10 % of a general practitioner's caseload and probably more for pharmacists. The literature furthermore emphasises that skin diseases are becoming a significant problem in the developing world. There is a need to establish an effective method to achieve good health and quality of life for patients with dermatological problems. The general objective of this study was to investigate the usage patterns and cost of dermatological products in the private health care sector of South Africa by using a medicine claims database. The focus was specifically on dermatological products with a prevalence of more than 10 % in the database. A quantitative retrospective drug utilisation research design was used to evaluate the usage patterns and costs of dermatological products in three four-monthly intervals of 2001 and 2004. Data were analysed by using the Statistical Analysis System, 9.1 (SAS). The dermatological product groups for this study were antibacterial and antifungal drugs, corticosteroids and anti-acne products and were analysed according to the MIMS classification. Of all analysed prescriptions issued only 8.57 % (n = 126 447) during 2001 (N = 1 475 380) and 6.82 % (n = 177 122) during 2004 (N = 2 595 254) consisted of dermatological products. Of the total number of products prescribed, the dermatological products constituted 4.77 %I (n = 140 701) for 2001 (N = 2 95 1 326) and 3.77 % (n = 199 976) for 2004 (N = 5 305 882). The total cost of the dermatological products was 4.98 % (n = R18 913 889.92) of the total cost of all medicine products during 200 1 (N = R379 708 489). During 2004 (N = R66 1 223 146) the total cost of dermatological products was 4.09 % (n = R27 025 540.48) of the total cost of all medicine products in the database. The cost-prevalence index for 2001 and 2004 respectively showed that the dermatological products were relatively expensive with values of 1.03 and 1.09. The antibacterial and antifungal drugs, corticosteroids and anti-acne products represented 91.92 % (n = 129 336) and 87.97 % (n = 175 9 16) of all dermatological products during 2001 (N = 140 701) and 2004 (N = 199 976), respectively. These dermatological groups named above represented 91.57 % (n = R17 319 645.61) and 85.85 '% (n = R23 200 594.71), respectively, of the total cost of dermatological products during 200 1 (N = R18 9 13 889.92) and 2004 (N = R27 025 540.48). It was further found that the majority of dermatological products prescribed during the research periods was innovator products. The prevalence of innovator products for 2001 was 86.17 % (n = 12 1 249) with a total cost representing 94.16 % (n = R17 809 603.12). For 2004 the prevalence was 82.33 % (n = 164 640) with a total cost representing 91 .O1 '% (n = R24 594 923.72) of all the dermatological products prescribed. The number of innovator and generic products claimed during 2001 amounted to 86.17 % (n = 12 1 249) and 13.83 % (n = 19 452) respectively of the total number of products claimed (N = 140 701). During 2004 the number of innovator and generic products represented respectively 82.33 % (n = 164 640) and 17.67 O/o (n = 35 336) of the total number of products claimed (N = 199 976). The prevalence in the use of the dermatological products during 2004 increased with 55.25 % from January to April versus September to December. The cost-prevalence index indicated that the dermatological products were relatively expensive during January to August 2004. During September to December 2004 the cost-prevalence decreased and indicated that dermatological products became inexpensive. The average cost of dermatological products during the 2004 study period showed that the cost decreased. January to April (before implementation of the new single exit price structure) was compared to September to December (after implementation of the new single exit price structure). This comparison indicated that the average cost decreased by 22.88 %. It can be summarised that the average cost in the last study period decreased due to the changed price structure. The innovator products' prevalence was high and therefore more generics are needed in dermatology. If more generics are used the total cost of dermatological products might also decrease. The number of dermatological prescriptions increased towards 2004, but this may be because of more members or more medical aids claiming through this database.
Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2006.

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14

Scheepers, Jenine. "A retrospective analysis of the usage patterns of antiretroviral drugs : a pharmacoeconomic approach / Jenine Scheepers". Thesis, North-West University, 2008. http://hdl.handle.net/10394/2298.

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Harmzen, Magdalena Adriana. "Overview of the prescribing patterns of non-steroidal anti-inflammatory drugs : 2004-2006 / Magdalena Adriana Harmzen". Thesis, North-West University, 2008. http://hdl.handle.net/10394/3719.

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Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for systemic control of acute and chronic pain and inflammation (Lin et ah, 2000:1129), but usage problems and side-effects that occur during the post-marketing phase of these drugs are well documented (Thiefin & Beaugerie, 2005:287). Following the demonstration of the value of anti-inflammatory therapy in diseases like rheumatoid arthritis (Boardman & Dudley Hart, 1967:268), new NSAIDs appeared on the market (Dieppe et al., 2004:867), and the indications steadily broadened from inflammatory diseases to almost any painful condition. Studies have indicated that NSAID-associated serious upper gastro-intestinal (GI) adverse events result in 103 000 hospitalisations (Bombardier, 2002:4) and 165 000 deaths per year in the United States. A study in South Africa in 2002 indicated that NSAID utilisation contributed considerably to the total cost of all medicine items from a medicine claim database in the private health care sector (Joubert, 2002:260). The objective of this study was to determine the prevalence and cost of non-steroid anti-inflammatory drugs in a section of the private health care sector, and specifically to determine the prevalence, usage and cost of Coxib (Specific cyclo-oxygenase-2 inhibitor) medicine items before and after the withdrawal of Vioxx® from the market in September 2004 (Merck, 2004). Data from two medicine claim databases for the years 2004, 2005 and 2006 (medicine claim database I) and the years 2005 and 2006 (medicine claim database M), were analysed by means of a retrospective drug utilisation review (DUR) study. The usage of Coxib medicine items was determined, and compared for the periods before and after the withdrawal of Vioxx® in September 2004. It was found that between 9 and 10.5 per cent of prescriptions dispensed through both medicine claim database I and medicine claim database M during the study period were NSAID prescriptions. NSAID medicine items on medicine claim database I represented between 3.9 % (R25 942 986) and 2.9 % (R8 073 034) of the total cost of all medicine items claimed from 2004 to 2006. NSAIDs represented 3.1 % (R58 290 412) and 2.8 % (R57 752 267) of the cost of all medicine items claimed through medicine claim database M during 2005 and 2006 respectively, indicating similar trends in the two medicine claim databases. The prevalence of Coxibs on medicine claim database I decreased from almost 20 % (47 938) in 2004 to 8.4 % (13 276) in 2005, but showed an increase again to 10.9 % (12 355) in 2006. The prevalence of both cyclo-oxygenase (COX) inhibitors, and Coxibs demonstrated a change during 1 September 2004 to 31 December 2004 when COX-inhibitors showed an increase in use, while Coxibs showed and almost equal but opposite trend with a decrease in use. This could possibly be related to perceptions of providers and public with regard to Coxibs and their related safety after the withdrawal of Vioxx® on 30 September 2004 (Merck, 2004) and other Coxibs such as Bextra® (FDA, 2005) in 2005 in USA. It is concluded that most patients who were using Coxibs before the withdrawal of Vioxx®, substituted Coxibs for COX-inhibitors, that are known for their possible gastro-intestinal side-effects. Recommendations for future research regarding NSAID use were also made, and included an investigation of the usage of Coxibs in different age groups, as well as the combination of NSAIDs with gastro-protective medicines in long-term use.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

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16

Nhokwara, Primrose Tinashe. "Factors that influence the utilisation of ototoxicity monitoring services for patients on treatment for drug-resistant tuberculosis". Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15683.

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Multi-drug resistance is increasingly becoming a challenge to tuberculosis control programmes globally. Treatment of multi-drug resistance tuberculosis (MDR-TB) includes aminoglycoside antibiotics which are known to cause hearing loss. Ototoxicity monitoring services are often provided to patients undergoing treatment for MDR-TB for early detection of ototoxic hearing loss to facilitate alerting the patients and relevant medical staff about the presence and progression of any hearing loss. Previously, models of managing patients with MDR-TB required mandatory hospitalization for at least 6 months. This made it relatively easy to monitor the hearing status of patients during their stay in the hospital. However, with recent introduction of policy guidelines that support management of patients with MDR-TB on an outpatients basis, ototoxicity monitoring for these patients will need to be reorganized to align with the new policy guidelines. The extent of the uptake of these services when patients are accessing them as outpatients is however, unknown. This study therefore aimed to describe the patterns of utilisation and explore the barriers and factors that facilitate the use of ototoxicity monitoring services when provided on an outpatient basis in the Cape Town Metropolitan area, Western Cape, South Africa.

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17

Katende-Kyenda, Norah Lucky. "A retrospective drug utilisation study of antimicrobials in a private primary health care group / Norah Lucky Katende-Kyenda". Thesis, North-West University, 2005. http://hdl.handle.net/10394/720.

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The commonest prescribed group of drugs is antimicrobials. Various studies have shown that they are overused globally. Since Primary health care represents the first tier of the health care system, evaluation of antimicrobial use in primary health w e settings is a necessity to ensure rational and cost-effective use of these agents in the treatment of infectious diseases. It has been reported by Hooton and Levy (2001 : 1088) that 20% to 50% of antimicrobials are inappropriately used in developing countries. According to Rebana et al. (1998: 175) the increasing overuse of antimicrobials has resulted in an enormous escalation in the total costs of drugs contributing to 15% to 30 % of the total health budget. Hooton and Levy (2001: 1087) reported in a study that inappropriate use and overuse of antimicrobials are risk factors for the emergence of antibiotic resistant bacteria. There is a high incidence of infectious diseases in developing countries that are due to the rapid spread of resistant strains through over-crowding, poor sanitation and unsafe sexual practices (Liu et al., 1999: 540). The general objective of the study was the analysis and interpretation of the usage and related costs of antimicrobial prescriptions in a private primary health w e setting in South Africa. The study is a non-experimental, quantitative, retrospective drug utilisation review of antimicrobial usage in a private primary health care setting. Data were obtained from the central database of a private primary health care service provider. Data of nine randomly selected clinics, situated in different geographical areas of South Africa, were extracted for the period 1st January to 31st December 2001. The study population was made of the total patient population of patients using antimicrobials during this one year period. Antimicrobial usage was analysed according to: number of patients, age and gender distribution, diagnosis, pharmacological groups. The total number of patients who visited the nine clinics during the year was 83 655 of which 59.50% were females and 40.22% males. In 0.28% of the cases gender was not indicated. Patients in age groups 6 (20-40 years) and 7 (40-60 years) accounted for the highest number of patients (66.31%, n = 54 964). A total of 515 976 medicine items costing R1 716 318.90 were prescribed, of these, 18.69%, (N=96 423) were antimicrobials costing 60.89%, (R1 045 108.00). Of the total number of patients that visited the nine clinics, 65.34% (N=54 663) were prescribed antimicrobials. The total number of diagnoses (140 723) where antimicrobials were prescribed accounted for 68.52% (N46 42 1). The highest number of antimicrobial prescriptions according to pharmacological and age groups were: penicillins followed by sulphonamides and tetracyclines. The diagnoses with the highest number of antimicrobial prescriptions were the respiratory tract infections (viral influenza, acute bronchitis and upper respiratory tract infection) and pelvic inflammatory disease The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these drugs. Because most of these infections are caused by viruses or other non-bacterial agents, are self limiting. Therefore, the use of antibiotics courses is neither necessary nor appropriate in these conditions. The overuse and inappropriate use of such drugs have an effect on the health of the patients needing cure, and the general budget on health care service. It is recommended that further studies are conducted on antimicrobial prescribing and use.
Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

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18

Ansari, Faranak. "Evaluation and management of hospital antibiotic use". Thesis, University of Dundee, 2010. https://discovery.dundee.ac.uk/en/studentTheses/917390eb-a8ea-477a-8cc8-58b6babac813.

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Antimicrobials are unique drugs in that they target "infectious" or "transferable" diseases. There is considerable evidence linking increasing antimicrobial use withincreasing resistance. Resistant bacteria do not know the boundaries, either between countries or within a society between hospital and primary care. Inappropriate prescribing of antimicrobials in hospitals therefore has consequences for whole communities and problems may spread both nationally and internationally. The gathering of reliable measurements of antibiotic use in hospitals employing standardised methods is essential to building an evidence base and highlighting inconsistencies at national and international levels. In this study, after data processing, validating and record linkage, a method forelectronic conversion of drug supply data to the ATC/DDD classification and forlongitudinal analysis was established for Tayside and then for a set of Europeanhospitals. Time series analysis and interrupted time series analysis were described and used for longitudinal surveillance and interventional study of antimicrobial use. This thesis explores issues concerning the evolution and management of hospital antimicrobial use using a wide range of methods. A series of drug utilisation research studies were implemented as the basis of research methods that, in combination of previously described methods, provided novel studies. No single measure can currently capture all of the aspects of hospital antibiotic use. However, a combination of detailed, point prevalence data from individual patients with longitudinal analysis of total consumption can provide meaningful data for comparison between hospitals and for analysis of the relationship between use and outcome. Additionally, there is a need to apply standard processes and novel methods to produce more meaningful surveillances. Longitudinal and point prevalence surveillances together with an explanation ofvariations in hospital characteristics are used to produce a set of coherent measurements of hospital antimicrobial use. Administrative data for longitudinal surveys requires continuous quality control.Whereas drug utilisation researchers and clinicians should target a set of indicators for interventional studies, large studies at national or international level need central data processing by country to identify targets for evaluation and for interventional studies. Support from experts in other fields is needed to address any shortcomings that may be experienced during continuous antibiotic drug utilisation monitoring at national and international levels.

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Donnelly, Neil James Public Health &amp Community Medicine Faculty of Medicine UNSW. "The use of interrupted time series analysis to evaluate the impact of Pharmaceutical Benefits Scheme policies on drug utilisation in Australia". Awarded by:University of New South Wales. Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/22509.

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PROBLEM INVESTIGATED: Methodological issues and policy implications arising from the application of interrupted time series (ITS) analyses to assess the impact of Pharmaceutical Benefit Scheme (PBS) subsidisation policies on drug utilisation in Australia. PROCEDURES FOLLOWED: A critical review of methodological issues relating to the application and analysis of ITS designs was undertaken. This included an examination of drug utilisation data sources in Australia. The PBS policies examined were: (i) the introduction of copayments in 1990; (ii) the introduction of re-supply limits in 1994 and (iii) the introduction of a form of reference pricing in 1998. Monthly aggregate drug utilisation data was obtained from the Australian Department of Health and Ageing. Segmented regression analyses incorporating autocorrelated errors were implemented and statistical diagnostics applied to ensure correct ITS model specification. Alternative seasonal modelling approaches were compared. RESULTS OBTAINED: The copayment ITS evaluation found that while these copayments produced a reduction in the utilisation of essential and discretionary medications, this effect was stronger for discretionary drugs. An unintended policy effect was a large anticipatory increase in drug utilisation during the month prior to the copayments. Repatriation PBS data was also utilised due to the limited number of pre-intervention data points in the Community series. The re-supply limit ITS evaluation found that the 20-day rule markedly reduced the size of the seasonal increase during the month of December. However, logistic regression analyses showed that the size of this reduction attenuated over time, highlighting the need to consider alternative analysis strategies when applying a ITS approach. The reference pricing ITS evaluation found that this policy had achieved its drug utilisation objectives for H2RAs and ACE Inhibitors. However with regard to CCBs, no increase in the utilisation of benchmark priced drug was apparent, which probably reflected clinical concerns at the time about the safety of these drugs. MAJOR CONCLUSIONS: Well implemented ITS analyses provide a valuable tool for evaluating the impact of PBS subsidisation policy change on drug utilisation in Australia. As with any methodology, however, different design and data integrity issues will affect the quality of information provided.

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20

Burger, Johanita Riétte. "A drug utilisation review of the concept of metabolic syndrome using a South African medicines claims database / Burger JR". Thesis, North-West University, 2012. http://hdl.handle.net/10394/8072.

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The aim of the study was to determine the prevalence, medicine prescribing patterns and direct treatment cost associated with the metabolic syndrome and its components in the private health care sector of South Africa. A two–dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide background to the study by conceptualising the metabolic syndrome and the components forming part thereof. The empirical investigation consisted of a descriptive, quantitative, retrospective drug utilisation review study, utilising medicine claims data sourced from a South African Pharmaceutical Benefit Management (PBM) company for the period January 1, 2005 to December 31, 2008. Data for a total 246 122 patients from 2005, 252 080 from 2006, 208 632 from 2007 and 196 242 from 2008, receiving at least one medicine item from the pharmacological medicine classes of antihypertensives (including diuretics, MIMS® classifications 7.3 and 16.1), hipolipidaemics (MIMS® classification 7.7) and antidiabetics (MIMS® classification 19.1) were analysed. Metabolic syndrome was defined according to the American Heart Association/National Heart, Lung and Blood Institute criteria, as patients with claims for 1 medicine item(s) per year from each of these drug classes. Seventy one per cent (n = 261 036) of patients from 2005 met one risk selection criterion for the metabolic syndrome, compared with 69.9% from 2006 (n = 269 452), 66.6% (n = 226 264) from 2007 and 64.9% (n = 214 109) from 2008 (male:female ratio 1:1.5 for 2005–2008; age peak >45,60 year). A total 60 683 (4.0%, n = 1 509 621) of patients from the 2005 dataset met at least two risk criteria for the metabolic syndrome. This number of patients increased to reach 63 835 (4.1%, n = 1 558 090) in 2006, thereafter decreasing to 57 992 (4.9%, n = 1 178 596) in 2007 and 57 220 (5.9%, n = 974 497) in 2008. A total 5.7% (n = 246 122) of patients in 2005 met inclusion criteria for the metabolic syndrome, increasing to 6.5% (n = 252 080) in 2006, 7.8% (n = 208 632) in 2007 and 8.3% (n = 196 242) in 2008 (male to female ratio for 2005 – 2008:1.2:1). In general, prevalence increased from ~0.1% of patients aged >0,15 years to ~0.3% in those >15,30 years, ~6% in patients >30,45 years, ~40% in patients aged >60,75 years and ~20% in patients >75 years. The average prevalent age appeared earlier in males than in females by 2 years. The average pill burden per prescription for patients from the 2005–metabolic syndrome category was 2.6 ± 1.43, compared with 2.6 ± 1.47 in 2006, 2.7 ± 1.52 in 2007 and 2.7 ± 1.53 in 2008, with a maximum of 16 items claimed per patient in 2005, 14 in 2006 and 2007, respectively and 19 in 2008. Antidiabetics, hipolipidaemics and antihypertensives were claimed in a ratio of 1:1:2 across the 4–year study period. A prescribing index of 20 medicine items (active substances) based on prescribing volume was established for metabolic syndrome patients; the 5 most claimed medicine items on this index was metformin, simvastatin, atorvastatin, insulin and gliclazide. A total of 17 716 different treatment regimens was identified for patients from the 2008–metabolic syndrome category, containing from one to 12 different active substances per regimen. Overall 90.7% (n = 17 716) of treatment regimens contained between 3 and 7 different active substances per prescription; a further 3.3% contained 8 active substances each. The combination of indapamide and perindopril with amlodipine, or simvastatin and/or metformin had the highest prevalence among those regimens containing 3 active substances. The total direct medicine treatment cost from the metabolic syndrome category amounted to R71.7 million in 2005, increasing to R94.7 million in 2008. Medical aid schemes contributed 90.0% (n = R71 724 445.88) towards these costs in 2005, decreasing to 86.0% (n = R94 690 393.54) in 2008. The average scheme contribution was R131.14 ± 135.64 (median R103.12) per medicine item in 2005, compared with R126.63 ± 133.65 (median R101.24) in 2006, R128.39 ± 141.69 (median R101.35) in 2007 and R122.45 ± 143.97 (median R94.27) in 2008. Patients paid the excess 10% (2005) to 14% (2008) of costs out–of–pocket for co–payments on medicine items at an average cost of R14.55 ± 34.26 (median R0.00) per item for 2005, compared with R15.80 ± 38.04 (median R0.00) during 2006, R16.61 ± 38.01 (median R0.00) in 2007 and R19.95 ± 40.06 (median R2.28) in 2008. The average annual direct medicine treatment cost for a patient from the metabolic syndrome category summed to R4 809.20 ± 4 057.46 (median R3 850.67) in 2005, compared with R5 053.34 ± 4 033.85 (median R4 041.16) in 2006, R5 503.88 ± 4 348.67 (median R4 357.79) in 2007 and R5 300.03 ± 4 433.93 (median R4 100.06) in 2008. A total 7 050 patients (39.5%, n = 17 866) or approximately every third patient from the metabolic syndrome category had at least one other Chronic Disease List (CDL) condition during 2008. An average chronic disease count of 1.4 ± 0.63 (median 1) (range: 1–5) per patient was calculated. Diseases that co–occurred most were hypothyroidism (22.7%, n = 7 050), coronary artery disease (13.6%, n = 7 050), cardiac failure (10.7%, n = 7 050), asthma (7.3%, n = 7 050) and glaucoma (4.5%, n = 7 050). In conclusion, this study established base–line estimates on the prevalence, medicine prescribing patterns and associated direct medicine treatment cost of patients with metabolic syndrome and/or those at risk for the development thereof in the private health care sector of South Africa, as defined by surrogate measures of criteria from the American Heart Association and National Blood Institute. Recommendations for future extensions and diversifications to the study were made.
Thesis (PhD (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.

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Costa, Gouveia Joana. "Utilisation de nanoparticules pour le développement de nouvelles thérapies antituberculeuses". Thesis, Lille 2, 2017. http://www.theses.fr/2017LIL2S035/document.

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La tuberculose (TB) est un problème de santé mondiale majeur à l’origine de 10.4 millions de nouveaux cas et 1.8 millions de morts en 2015 selon l’Organisation Mondiale de la Santé (OMS). Cette maladie est causée par la bactérie Mycobacterium tuberculosis (Mtb) qui infecte principalement les poumons et se transmet par l'inhalation d’aérosols contaminés.Le traitement de TB nécessite la prise quotidienne d’antibiotiques pendant 6 mois, dont une mauvaise utilisation peut être à l’origine de l’apparition de souches Mtb multi-résistantes.La nouvelle stratégie de l’OMS, “End TB”, vise à réduire de 90% l’incidence de TB d'ici 2035. Pour y parvenir, il est important de définir de nouvelles approches pour réduire la durée et la toxicité des traitements et améliorer leur efficacité vis-à-vis des bactéries actives et latentes.L’approche abordée lors de ma thèse vise à utiliser des nanoparticules (NP) pour développer de nouvelles thérapies anti-TB. La bibliographie sur le sujet montre que cela pourrait être une stratégie prometteuse. Nous avons par conséquent étudié quatre applications potentielles des NP:1-Vectorisation des médicaments pour les administrer au niveau pulmonaire. L’éthionamide (ETH) est un antibiotique utilisé pour le traitement de TB avec des effets secondaires indésirables. L’ETH est une «pro-drogue» qui nécessite une activation par une monooxygenase bactérienne, dont l’efficacité peut être elle-même augmentée par des molécules chimiques appelées “booster”. Nous avons étudié l’effet de l’ETH et de booster co-encapsulés dans des NP de poly-β-cyclodextrine (pCD) pour le traitement de TB. Nous avons d’abord évalué leur efficacité in vitro sur la croissance extracellulaire et intracellulaire (dans les macrophages) de Mtb grâce à l'utilisation d'un système automatisé de microscopie confocale à haut contenu. Dans les deux essais, nous avons constaté que les médicaments conservaient leur activité après encapsulation et que les NP n'étaient pas cytotoxiques. L’efficacité de ces NP a ensuite été étudiée in vivo chez des souris infectées avec Mtb. La suspension de NP a été délivrée sous forme d’aérosols directement dans les poumons par voie endotrachéale à l’aide d’un Microsprayer Aerosolizer. Une réduction significative de la charge bactérienne dans les poumons de 3 log a été observée après 6 administrations de doses inférieures à celles thérapeutiques.2-Amélioration de la solubilité et biodisponibilité des antibiotiques. La Clofazimine (CLZ) est un antibiotique utilisé dans le traitement de la lèpre et pourrait être, au regard de son efficacité in vitro sur les souches de Mtb multi-résistantes, un candidat potentiel pour celui de TB. La CLZ est extrêmement lipophile, gênant ainsi sa solubilité. Dans notre étude, son encapsulation dans des particules de silice nanoporeuses a stabilisé l'état amorphe de la CLZ et a augmenté radicalement sa solubilité. Après encapsulation ou solubilisation dans le DMSO, la CLZ a d’autre part montré une activité antibactérienne similaire sur Mtb.3-Stabilisation des antibiotiques. La Vancomycine (VAN) est utilisée pour des applications cliniques comme alternative de la pénicilline dans le traitement de Staphylococcus aureus et pourrait être utilisée pour celui de TB. Alors que la VAN présente une faible stabilité dans les milieux biologiques, nous avons montré que l'encapsulation de cet antibiotique à l'intérieur de NP à base de PLGA a amélioré son efficacité tant sur les bactéries Mtb extracellulaires qu’intracellulaires.4-Activité antimycobacterial Intrinsèque de NP. Différentes NP (60 pCD, 1 NanoMOF et 1 NP en argent) ont été évaluées in vitro. Aucune n'a présenté d'activité antituberculeuse intrinsèque prometteuse.En conclusion et au regard des options thérapeutiques limitées pour combattre les souches résistantes et de la rareté de solutions innovantes dans le pipeline de découverte de médicament, ces travaux ont montré que les NP pouvaient constituer une approche anti-TB originale
Tuberculosis (TB) is a major problem of global health, responsible for 10.4 million new cases and 1.8 million deaths in 2015 according to the World Health Organization (WHO). This disease is caused by inhalation of small aerosol droplets containing Mycobacterium tuberculosis (Mtb), and lungs are usually the major site of infection.TB can usually be treated with a daily six months course of standard, or first-line, anti-TB drugs. If first-line drugs are misused, the onset of multidrug-resistant Mtb can occur.The new WHO global public health strategy “End TB” aims at the reduction of TB incidence 90% by 2035. To reach these ambitious targets, new approaches are urgently needed to get a faster, less harmful and more-efficient treatment for active and latent TB.My thesis focused on the use of nanoparticles (NPs) to develop new anti-TB therapies. Our review of the literature showed that it could be a promising approach. Here, we investigated four potential uses of the NPs.1- Nanocarrier for pulmonary delivery of drugs. Ethionamide (ETH) is a second line antibiotic with high toxicity and several adverse side effects. ETH is a prodrug that requires bioactivation by a bacterial monooxygenase, which can be enhanced by chemical molecules named “boosters”. We investigated the simultaneous delivery of ETH and boosters coencapsulated in biodegradable poly-β-cyclodextrin (pCD) based NPs by the pulmonary route for the treatment of TB. First, we evaluated the in vitro efficacy of the designed formulations on Mtb extracellular growth and intracellular growth inside macrophages using an automated confocal high-content microscopy system. And we found for both assays that the drugs maintained their activity after encapsulation and the pCD were not cytotoxic. Given these promising results, their efficacy was then tested in vivo. The NPs suspension, administered directly into mouse lungs by endotracheal way using a Microsprayer® aerosolizer, was proved to be well-tolerated and led to a 3-log decrease of the pulmonary mycobacterial load after 6 administrations and using lower doses than the therapeutic ones.2- Enhancement of the solubility and the bioavailability of antibiotics. Clofazimine (CLZ) is an antibiotic usually used in a combination therapy for the treatment of leprosy and could be a potential candidate for the treatment of TB because of its in vitro efficacy on resistant Mtb strains. CLZ is extremely lipophilic and has important solubility problem. In our study, its encapsulation in nanoporous silica particles stabilized the amorphous state of CLZ and dramatically increased the drug solubility. On the other hand, CLZ encapsulated in nanoporous silica particles or efficiently dissolved in DMSO showed a similar antibacterial activity on Mtb, validating the assessment of solubility of CLZ by encapsulation.3- Improvement of the antibiotic stabilization. Vancomycin (VAN) is used for clinical applications for nearly 50 years as a penicillin alternative to treat penicillinase-producing strains of Staphylococcus aureus. VAN can be used for TB treatment as a repurpose. While VAN presented low stability in biological media at 37°C, we showed that the encapsulation of this antibiotic inside PLGA-based NPs enhanced its efficacy both on extracellular and intracellular bacteria.4- Intrinsic antimycobacterial activity of NPs. Different NPs (60 pCD, 1 NanoMOF, and 1 silver NP) were tested in vitro but none presented promising intrinsic antitubercular activity. However some pCD were slightly active in vitro on extracellular Mtb but cytotoxic.In conclusion, these works demonstrated that nanoparticles can provide a novel anti-TB approach regarding the limited therapeutic options to fight drug-resistant Mtb and the scarcity of novel antituberculosis drugs in the drug discovery pipeline

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22

Dhippayom, Teerapon. "Drug utilisation studies on the impact of the reduction of the prescription charge in Wales and the reclassification of medicines". Thesis, Cardiff University, 2008. http://orca.cf.ac.uk/55716/.

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Since 2000 there have been a number of policy changes in the UK to remove barriers that limit access to medicines. Perhaps the most significant of these have been the phased reduction and abolition of the prescription charge in Wales and the efforts of the UK Government to encourage the reclassification of medicines. This thesis explored aspects of both these changes. The percent change in the number of prescription items dispensed over the two year period before and after the first reduction of the prescription charge in October 2004 was determined. There was an increase in the percent change median interquartile range for non-sedating antihistamines 7.3 5.0 - 10.7 to 13.7 10.9 - 17.1, p=0.001 and laxatives 2.2 0.8 - 3.1 to 3.7 1.4 - 6.4, p=0.04, whilst no change was observed for loperamide -1.2 -3.3 - 3.2 to 2.6 -0.9 - 5.2, p 0.11 and fluconazole -7.4 -14.4 - 2.1 to -3.7 -10.9 - 1.4, p=0.52. Over the counter OTC sales of omeprazole and simvastatin were monitored following reclassification and accounted for less than 1 of the volume of their prescription counterpart. In contrast, sales of OTC hyoscine butylbromide and chloramphenicol eye drops were more than 20 of the number of items dispensed. Twelve months after reclassification there was an increase in the percent change in the number of prescription items dispensed for hyoscine butylbromide in Wales 5.8 0.2 - 12.6 to 20.7 4.4 - 25.6, p=0.007, whilst prescriptions for chloramphenicol eye drops decreased 10.0 6.0 - 13.6 to -8.9 -13.1 - -4.4, p=0.001. More OTC chloramphenicol was sold in less deprived areas r=-0.44, p=0.04. The changes in prescription volume and OTC medicine sales varied from medicine to medicine and require a qualitative evaluation to better understand the reasons behind the differences observed.

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23

Errico, Claudia. "Ultrasound sensitive agents for transcranial functional imaging, super-resolution microscopy and drug delivery". Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCC013.

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Cette thèse porte sur deux branches majeures de l'utilisation d'agents sensibles aux ultrasons: l'échographie ultrarapide du cerveau assistée par microbulles et la délivrance par ultrasons de médicaments pour la thérapie du cancer. Dans la première approche, des microbulles remplies de gaz fluoré ont été utilisés pour observer l'activation du cerveau à travers le crâne des rongeurs. Nous avons été en mesure de reconstituer de manière non invasive le réseau vasculaire du cerveau, puis de récupérer sa réponse hémodynamique avec une résolution spatio-temporelle élevée. La validation de cette approche d'imagerie fonctionnelle par échographie (FUS) a été facilitée par la grande sensibilité de la technique du Doppler ultrarapide ultrasensible. En effet, cette modalité d'imagerie permet de détecter les changements hémodynamiques dus au couplage neurovasculaire avec une grande résolution (1ms, 100pm). Ces résultats suggèrent que la combinaison des agents de contraste et l'imagerie ultrarapide peut aider à compenser entièrement l'atténuation par le crâne, et ce en préservant la résolution et en augmentant la profondeur de pénétration. L'injection d'agents de contraste ultrasonore a également conduit à des résultats remarquables en imagerie ultrasonore ultrarapide. La barrière de la diffraction a été contournée pour aller au-delà de la limite de demi-longueur d'onde de résolution. Nous avons démontré que des microvaisseaux cérébraux de 9pm de diamètre peuvent être distingués par microscopie échographie ultrarapide de localisation (uULM). Des millions de sources «clignotantes» sont localisées dans l'espace et dans le temps, conduisant à des images super-résolues (cartographie de densité de microbulles) de l'ensemble du réseau vasculaire du cerveau du rat avec une résolution spatiale de À / 10. En outre, les trajets des microbulles au cours du temps ont pu être relevés et ainsi permettre d'extraire les vitesses des flux sanguins avec une grande dynamique. Dans la seconde approche, nous avons exploité la manière dont nous pouvons contrôler, spatialement et temporellement, la vaporisation de micro gouttes composites de perfluorocarbone (PFC) lorsque leur activation est déclenchée par de courtes impulsions ultrasonore. Le concept de "chimie in-situ" est introduit dès lors que nous avons été en mesure de contrôler une réaction chimique spontanée in vitro. En outre, dans le cadre des applications in vivo de la chimie in situ, un nouveau dispositif microfluidique en verre a été proposé afin de permettre une production stable et rapide de gouttes monodisperses. Ce nouveau dispositif présente 128 générateurs en parallèles avec deux canaux sous pression. Finalement, de nouvelles séquences d'échographie de contrôle ultra-rapides ont été développées dans le but de contrôler et de surveiller la libération des gouttelettes composites
This thesis focuses on two main branches of the application of ultrasound contrast agents: microbubbles-aided ultrafast ultrasound imaging of the brain and ultrasound-triggered drug delivery for cancer therapy. At first, gas-filled microbubbles have been used to retrieve the brain activation through the skull in large animais. With this approach we have been able to non-invasively reconstruct the cerebral network of the brain, as well as retrieve its hemodynamic response to specific evoked tasks with high spatiotemporal resolution. The validation of this novel functional ultrasound (fUS) imaging approach was facilitated by the high sensitivity of the ultrasensitive Doppler technique able to detect subtle hemodynamic changes due to the neurovascular coupling. These resuits suggested that combining microbubbles injections with ultrafast imaging may help to fully compensate for the attenuation from the skull. Indeed, by combining both, we preserved resolution and increased penetration depth. The injection of ultrasound contrast agents has also lead to outstanding resuits in ultrafast ultrasound imaging by breaking the diffraction barrier and move beyond the half-wavelength limit in resolution. We have demonstrated that cerebral microvessels of 9pm in diameter can me distinguished via ultrafast ultrasound localization microscopy (uULM). Millions of blinking sources were localized in space and in time in few seconds in a higher dimensional space, leading to super-resolved images (microbubble density map) of the whole rat brain with a spatial resolution of À/10. Moreover, a displacement vector allowed microbubbles-tracking within frames yielding to in-plane velocity measurements retrieving a large dynamic of cerebral blood velocities. Next, we have exploited how we can spatiotemporally control the vaporization of composite perfluorocarbon (PFC) microdroplets when their activation is triggered by short ultrasound pulses. The concept 'chemistry in-situ' is introduced as we have been able to control a spontaneous chemical reaction in-vitro. Moreover, a new microfluidic device in glass has been proposed to robustly produce monodisperse droplets for future in-vivo applications of the chemistry in situ. This new device presents 128-parallel generators with two pressurized rivers. Eventually, new ultrafast ultrasound monitoring sequences have been developed in order to control and monitor the release of composite droplets

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24

Mouton, Jeanine. "The treatment of paediatric asthma in the private health care sector of South Africa : a retrospective drug utilisation review / J. Mouton". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4648.

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Asthma is the most common chronic disease among children worldwide. The prescribing patterns of the medication used to treat asthma in South Africa, as well as the prevalence of paediatric asthma are of interest and need to be investigated. A drug utilisation review was performed to determine the prevalence of asthma, and in particular paediatric asthma in a section of the private health care sector of South Africa. The prescribing patterns of asthma medication were investigated according to different demographic factors, such as gender, geographical area and prescriber type. Data from a medical claims database were extracted and processed to reveal the different prescribing patterns from 1 January 2005 to 31 December 2008. Medication from the MIMS® pharmacological groups 10.2 and 10.4 were used as a basis for asthma medication. Patients had to use at least one medicine item from one of these groups to be included in the study. The prevalence of asthma in the general population showed an increase from 2005 to 2008. The prevalence of asthma as a part of the total database according to the number of patients increased from 23.01% in 2005 (n=347342) to 24.72% in 2008 (n=240854), although the number of patients on the total database decreased from 2005 to 2008. When investigating the number of prescriptions that were dispensed during 2008, asthma prescriptions comprised 7.16% (n=484983) of all prescriptions and the number of asthma medicine items that were dispensed made up 3.72% (n=611139) of the total number of medicine items dispensed in 2008. Paediatric asthma was divided into two age groups for the purpose of this study namely, 0 - 4 years of age and older than 4 years, but younger or equal to 11 years of age ( >4 - 11 years), according to a previous study done by the National Heart Lung and Blood Institute (NHLBI). The results from the data confirmed that the prevalence of asthma was higher in the younger age group. The number of patients using asthma medication in the 0 - 4 years age group comprised 44.40% (n=11306) of the total number of patients in this age group on the database in 2008, compared to 32.84% (n=28347) in the >4 - 11 years age group. Asthma was more common among male patients, whether they were included in the paediatric groups or not. The geographical distribution of paediatric asthma seemed to be connected to the provinces without coastlines and different mining facilities. The combination of asthma medication with antibiotics and systemic corticosteroids were investigated and it was concluded that antibiotics that were used for respiratory tract infections were prescribed the most frequently to asthma patients. The refill–adherence rates of patients with asthma were not satisfactory when considering that asthma is a chronic disease. The average adherence rate for all the asthma products that were brought into account when calculating the refill–adherence rate was 60.95%. A rate above 90% indicates optimal patient adherence. In conclusion this study determined that asthma has a significant prevalence among children in South Africa. The prescribing patterns for the different medication used in the treatment of asthma were investigated and recommendations for further research in this field of study were made.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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25

Monge, Aurélien. "Création et utilisation de chimiothèques optimisées pour la recherche in silico de nouveaux composés bioactifs". Phd thesis, Université d'Orléans, 2006. http://tel.archives-ouvertes.fr/tel-00122995.

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Le choix des molécules à tester joue un rôle essentiel dans le succès d'un criblage destiné à identifier de nouveaux composés bioactifs. Les deux étapes importantes dans la préparation des molécules pour le criblage sont le choix de l'espace chimique à considérer et la sélection des molécules pertinentes dans cet espace.
Idéalement la préparation des composés destinés au criblage devrait se faire grâce à un logiciel dédié à cette problématique. Il n'existe cependant aucun logiciel qui soit complètement adapté. Nous avons donc entrepris le développement d'un logiciel de ce type : ScreeningAssistant.
Ce logiciel s'appuie sur un système de gestion de bases de données et permet de créer et de maintenir à jour des chimiothèques de plusieurs millions de molécules uniques provenant de fournisseurs différents. Il permet également de filtrer les structures, en éliminant les molécules potentiellement problématiques ou avec des probabilités d'activités faibles, et de sélectionner un ensemble de composés divers.
Ce logiciel a été utilisé pour l'analyse d'une base de 5 millions de références provenant de 38 fournisseurs de produits chimiques. La proportion de composés uniques, originaux, « drug-like », « lead-like », et divers ont été comparés. La diversité a été étudiée en utilisant des notions différentes, et un score de diversité globale, prenant en compte la diversité suivant les différents critères, a été proposé.
Différentes applications de sélection de composés pour le criblage sont présentées. Ces applications utilisent le programme ScreeningAssistant et d'autres algorithmes développés pour résoudre certains problèmes particuliers.

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26

Ljungberg, Christina. "Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View". Doctoral thesis, Uppsala universitet, Institutionen för farmaci, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-132544.

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The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative. In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern. The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.

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27

Bouillot, Philippe. "Copolymères diblocs amphiphiles monomethoxypolyoxyethylene-acide polylactique : synthèse et utilisation pour la fabrication de microsphères". Vandoeuvre-les-Nancy, INPL, 1997. http://www.theses.fr/1997INPL131N.

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Notre travail a porté sur la synthèse de copolymères diblocs MPOE-PLA et leur utilisation pour la préparation de systèmes de libération contrôlée, microsphères, présentant des propriétés spécifiques en raison de leur structure organisée. Nous voulions réduire l'adsorption de protéines sur la matrice en copolymère et favoriser la dégradation de celle-ci afin d'accélérer la libération du principe actif. Nous avons mis au point la synthèse de copolymères MPOE-PLA par polymérisation du lactide sur l'extrémité hydroxile du MPOE en milieu solvant et en présence d'un catalyseur, l'octoate d'étain. Nous avons utilisé cette méthode pour synthétiser une série de copolymères diblocs MPOE-PLA présentant un segment hydrophobe PLA constant (45 000 g/mole) alors que la partie hydrophile varie de 2 000 à 20 000 g/mole. Ces copolymères ont été utilisés pour préparer des microsphères contenant de la BSA comme protéine modèle par la méthode de la double émulsion. Les propriétés de ces systèmes de libération ont été étudiées et comparées à celles de microsphères en PLA. Nous avons montré que l'utilisation de copolymères diblocs conduisait à la formation d'une structure organisée avec orientation des chaines hydrophiles à la surface des microsphères et au niveau des inclusions. La longueur du segment à une influence sur la taille et la morphologie des microsphères, sur la cinétique de dégradation des microparticules et donc sur les profils de libération de la BSA, et sur le taux de BSA adsorbée à la surface des microsphères. Des copolymères diblocs tensioactifs MPOE-PLA ont également été synthétisés afin de remplacer le PVA, surfactant utilisé pour la préparation de microsphères par la double émulsion. En effet, ces copolymères MPOE-PLA sont biodégradables et bio éliminables ; les risques de toxicité dus à une accumulation dans l'organisme seront alors nuls contrairement au cas du PVA.

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28

Kimber, Joanne Public Health &amp Community Medicine Faculty of Medicine UNSW. "Role of the Sydney Medically Supervised Injecting Centre in reducing injecting drug use-related harm: evaluating accessibility, utilisation, coverage and selected health impacts". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/23038.

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Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related morbidity and mortality, and improve access to drug treatment. This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia???s first DCR, the Sydney Medically Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on injecting practices and injecting related health, and referral to drug treatment were also examined. Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation, and prospective follow-up of MSIC referrals. Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range 59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range 7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of psychiatric treatment and/or self harm. This research was confounded by substantial changes in heroin availability during the study period but provides new evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.

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29

Ledwaba, Lerato Clara. "Aspects of drug usage in a private primary health care setting : a pharmacoeconomic approach / Lerato Clara Dedwaba". Thesis, North-West University, 2004. http://hdl.handle.net/10394/80.

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In South Africa, significant changes in health care have taken place since the first democratic elections in 1994. The change had lead to a position of integrated service delivery with specific reference to primary health care. Increasingly in developing countries, the private sector impacts significantly on the rights to education and the highest attainable standard of health. Inappropriate prescribing e.g. prescribing a drug without an acceptable indication, specifying an incorrect dosage, schedule or duration of treatment, duplicating therapeutic agents and prescribing drugs without adequate regard to potential interactions, can cause adverse outcomes, deplete health care resources, compromise the quality of care and possible increase in health costs. One approach monitoring prescribing practices is drug utilisation review. The general objective of this study was to review and interpret aspects of drug usage patterns in a private primary health care setting, with special reference to the top ten diagnoses made and the top twenty medicine items prescribed as well as the associated costs. A quantitative, retrospective drug utilisation review as well as certain aspects of managed and primary health care, pharmacoeconomics, pharmacoepidemiology, medicine formularies and standard treatment guidelines were reviewed in the literature as a base for the study. The results of the empirical study showed that 83648 patients consulted at the nine medicentres during the study period (1 January to 31 December 2001). A total number of 132591 patient visits (consultations) were made, 140723 medical conditions (diagnoses) performed and 516177 medicine items prescribed during the study period. Analysis of medicine usage patterns and associated costs of the top ten diagnoses made and top twenty medicine items prescribed in the study population, revealed the following: The top ten diagnoses determined accounted for 29.07% of the total number of diagnoses made, . a total medicine treatment cost accounting for 32.11% in the study population, . the top twenty medicine items determined accounted for 56.23% of the total medicine items prescribed and . a total medicine treatment cost accounting for 28.63% in the study population. The highest prevalence of diagnoses made and medicine items prescribed was found in age groups 4 and 5 (Le. patients between the ages of 19 to 40 years) and was also found to be more prevalent in the female than in the male population. In completion of the research, recommendations to review the medicentres medicine treatment protocols and on provision of primary health care education were made. Reference to the investigation of environmental factors is also made.
Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2004.

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30

Dombu, Youta Christophe Lionel. "Utilisation de nanoparticules pour délivrer des protéines dans les épithéliums respiratoires : caractérisation des mécanismes impliqués". Phd thesis, Université du Droit et de la Santé - Lille II, 2012. http://tel.archives-ouvertes.fr/tel-00787621.

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Utilisation de nanoparticules pour délivrer des protéines dans les épithéliums respiratoires. Caractérisation des mécanismes impliquésL'administration de médicaments par les voies respiratoires humaines est un domaine de la recherche en pleine expansion. Un effort croissant est porté sur le développement de systèmes innovants capables d'échapper aux mécanismes de clairance des voies respiratoires, d'améliorer la biodisponibilité des molécules d'intérêt, leur absorption dans la muqueuse et leur efficacité thérapeutique. Dans ce contexte, le but de ce travail était d'évaluer le potentiel de nanoparticules polysaccharidiques cationiques et poreuses (NP+) comme vecteurs de protéines à travers les voies respiratoires humaines. Les NP+ sont utilisées avec succès in vivo, comme vecteurs mucosaux dans de nombreuses applications telles que la vaccination, l'allergie, la thérapie anticancéreuse et la délivrance de molécules thérapeutiques. Cependant, les mécanismes d'interaction de ces nanoparticules avec les cellules épithéliales des voies respiratoires sont peu connus. Nous avons étudié l'endocytose, l'exocytose et la localisation intracellulaire de ces nanoparticules dans des cellules épithéliales bronchiques humaines. Leur toxicité a été évaluée sur ces cellules et plus particulièrement leur cytotoxicité et leur génotoxicité. Enfin, nous avons étudié et caractérisé les mécanismes de délivrance intracellulaire de protéines par ces nanoparticules et l'influence de leur composition interne sur ces mécanismes. Nos travaux montrent une endocytose rapide des NP+ par la voie des clathrines, ainsi qu'une importante exocytose par des mécanismes dépendant du cholestérol. Elles sont localisées dans les vésicules de clathrines, les endosomes précoces et pas dans les endosomes tardifs, ni dans les lysosomes. De manière ces nanoparticules s'associent quantitativement aux protéines et augmentent leur délivrance intracellulaire, tout en les protégeant de l'hydrolyse enzymatique à pH physiologique. De plus, la présence de lipides anioniques dans leur structure interne influence significativement les mécanismes d'interactions avec les cellules et de délivrance intracellulaire de protéines. Enfin, les études de toxicité ne montrent aucune cytotoxicité ni génotoxicité à des concentrations < 326 µg/cm2. Ces concentrations sont toutefois très élevées et difficilement atteignables in vivo. En conclusion, les NP+ ne sont pas toxiques sur les cellules épithéliales des voies respiratoires, elles interagissant fortement avec celles-ci et augmentent significativement la délivrance de protéines. Ce travail souligne l'intérêt de développer ce type de nanoparticules pour la délivrance de molécules d'intérêt pharmaceutique à travers les voies respiratoires humaines.

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31

Lesén, Eva. "Psychotropic drugs among the elderly : Population-based studies on indicators of inappropriate utilisationin relation to socioeconomic determinants and mental disordersEva LesénGothenburg". Doctoral thesis, Nordic School of Public Health NHV, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3721.

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Background: Drug utilisation among the elderly is complex due to multiplemorbidities, extensive drug utilisation and an increased sensitivity to drugs. One of the most common drug groups utilised in this population is psychotropic drugs, which include antipsychotics, anxiolytics, hypnotics, and antidepressants. In appropriat eutilisation of drugs among the elderly is an issue of great public health importance. Aims: The overall aim of this thesis is to assess and analyse potentially in appropriat eutilisation of psychotropic drugs among the elderly in Sweden. The specific aims are to assess to what extent the indicator “concurrent use of three or more psychotropic drugs”captures the utilisation of Potentially Inappropriate Psychotropics (PIP) among theelderly, and to analyse potentially inappropriate utilisation of psychotropic drugs inrelation to time, mental disorders, institutionalisation, and socioeconomic determinants among the elderly in Sweden. Methods: Data from individual-based registers on dispensed drugs and socioeconomic determinants in 2006, the Gothenburg 95+ Study (1996-1998), and aggregated drug sales statistics from 2000-2008 were used. The agreement between the two indicators“concurrent use of three or more psychotropic drugs” and PIP was assessed. Utilisationof psychotropic drugs and PIP was assessed in relation to mental disorders and institutionalisation among the 95-year olds, and in relation to socioeconomic determinants among individuals aged 75 years and older. Further, trends over time inutilisation of PIP and recommended drugs were analysed. Results: During 2006, about half of the elderly aged 75 years and older utilised psychotropic drugs and one fifth of all elderly utilised PIP. One fourth of individualsutilising PIP were captured by the indicator “concurrent use of three or morepsychotropic drugs”. In 1996-1998, less than one tenth of the 95-year olds with depression utilised antidepressants, while hypnotics and anxiolytics were more common. Individuals with low income and the non-married were more likely to utilise PIP compared to those with high income and the married, respectively. During 2000-2008, utilisation of PIP decreased and utilisation of recommended psychotropic drugs increased. Conclusions: There are substantial problems in the utilisation of psychotropic drugsamong the elderly. This thesis found that the agreement between two indicators of inappropriate psychotropic drug utilisation was poor, which emphasises the importance of choosing relevant indicators. The findings also show socioeconomic inequities inpsychotropic drug utilisation among the elderly, a low utilisation of antidepressants among 95-year olds diagnosed with depression, and a trend towards the utilisation of recommended rather than inappropriate psychotropic drugs among the elderly
Bakgrund: Användning av läkemedel bland äldre är komplicerat på grund avmultisjuklighet, användning av flera läkemedel och en ökad känslighet för läkemedel.En av de vanligaste läkemedelsgrupperna hos äldre är psykofarmaka, som inkluderarantipsykotika, ångestdämpande, sömnmedel och antidepressiva läkemedel. Olämpliganvändning av läkemedel bland äldre är ett betydande folkhälsoproblem. Syfte: Det övergripande syftet med avhandlingen är att beskriva och analyserapotentiellt olämplig användning av psykofarmaka bland äldre i Sverige. De specifikasyftena är att undersöka i vilken utsträckning indikatorn ”samtidig användning av treeller fler psykofarmaka” fångar användningen av potentiellt olämpliga psykofarmaka(PIP) bland äldre och att analysera potentiellt olämplig användning av psykofarmaka irelation till förändring över tid, psykiatriska diagnoser, boendeform och socioekonomiska determinanter bland äldre i Sverige. Metod: Avhandlingen baseras på data från individbaserade register över läkemedelsköp och socioekonomiska determinanter under 2006, Göteborg 95+ studien (1996-1998)samt aggregerade data över läkemedelsförsäljning under 2000-2008. Överensstämmelsen mellan de två indikatorerna ”samtidig användning av tre eller flerpsykofarmaka” och PIP undersöktes. Användning av psykofarmaka och PIP studerades i relation till psykiatriska diagnoser och boendeform hos 95-åringar och i relation till socioekonomiska determinanter hos de som var 75 år och äldre. Vidare analyseradesförändring över tid i användning av PIP och rekommenderade psykofarmaka. Resultat: Hälften av alla äldre som var 75 år och äldre använde psykofarmaka under2006 och en femtedel av alla äldre använde PIP. En fjärdedel av individerna somanvände PIP fångades av indikatorn ”samtidig användning av tre eller flerpsykofarmaka”. Bland 95-åringarna med depression år 1996-1998 använde färre än enav tio antidepressiva läkemedel, medan sömnmedel och ångestdämpande läkemedel varvanligare. PIP var vanligare hos de äldre med låg inkomst och bland de som inte vargifta, jämfört med individer med hög inkomst och de gifta. Under 2000-2008 minskade användningen av PIP medan användningen av rekommenderade psykofarmaka ökade. Slutsatser: Det finns fortfarande stora problem i äldres användning av psykofarmaka.Avhandlingen visar en låg överensstämmelse mellan två indikatorer för olämpliganvändning av psykofarmaka, vilket pekar på betydelsen av att välja relevantaindikatorer. Avhandlingen visar också på socioekonomiska ojämlikheter i användningenav psykofarmaka hos äldre, en låg användning av antidepressiva läkemedel bland 95-åringar med depression och en ökning i användningen av rekommenderade istället förolämpliga psykofarmaka bland äldre

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32

Åkerblad, Ann-Charlotte. "Adherence to Antidepressant Medication". Doctoral thesis, Uppsala University, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7769.

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Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients.

A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years.

Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group.

The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen.

The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders.

Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse.

The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.

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33

Van, der Westhuizen Elmarie. "Overview of antidepressant usage and cost 2004 until 2006 / E. van der Westhuizen". Thesis, North-West University, 2007. http://hdl.handle.net/10394/1948.

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Kruger, Hanlie. "A review of the prescribing patterns of combination analgesics in the private health care sector / Hanlie Kruger". Thesis, North-West University, 2007. http://hdl.handle.net/10394/1824.

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South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

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35

Bloem, Johann. "A retrospective analysis of the prescribing patterns of hipolipidaemic drugs : a pharmacoeconomic approach / J. Bloem". Thesis, North-West University, 2009. http://hdl.handle.net/10394/4134.

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Background: More than 5.5 million South Africans aged 30 years and older are at risk of chronic disease by virtue of their triglyceride levels (Maritz, 2006:101). Dyslipidaemia is common in westernized and industrialized communities (Steyn et al., 2000:720), especially so for South Africa, where burden of disease data show dyslipidaemia to be the second most prevalent of all the chronic conditions in the country (Council for Medical Schemes, 2006:48). It is therefore no surprise that at 3.3 per cent hipolipidaemics ranked second highest based on prevalence percentage per therapeutic group in the 2005 Mediscor medicines review on South African medical claims data (Bester et al., 2005:8-11). Hipolipidaemic drugs subsequently also ranked second highest for expenditure per therapeutic group, achieving a total expenditure of 5.8 per cent. Objective: The purpose of this study was to characterise the usage and cost of hipolipidaemic drugs in the private health care environment in South Africa based on various categories, including age, sex, prescriber type and generic indicator. Methods: A quantitative retrospective drug utilisation review was performed using dispensing records from a medicine claims database. Data for a two-year period (1 Jan. 2005 to 31 Dec. 2006) were used. Hipolipidaemic medicine usage was analysed according to five patient age strata: patients younger than 9 years, 10 ≤ 19 years, 20 ≤ 45 years, 46 ≤ 59 years and older than 59 years. Basic descriptive statistics such as frequencies and arithmetic mean (average) were used to characterise the study sample, and were calculated using the Statistical Analysis System (SAS®) for Windows 9.1® program (SAS Institute Inc., 2002-2003). Results: The database consisted of 19 860 593 and 21 473 062 medicine item claims for 2005 and 2006 respectively, at a total cost of R 1 893 376 921.00 (for 2005) and R2 046 944 383.00 (for 2006). Patients receiving hipolipidaemic medicine items represented about 7.2% of the total number of patients on the database in both 2005 and 2006. About 47% of the study population in both 2005 and 2006 was female, compared to 53% males. Hipolipidaemics represented between 3.1% (N = 19 860 593) and 3.3% (N = 21 473 062) of the total number of items claimed during the study period. The total cost of hipolipidaemics accounted for between 5.6% (N = R1 893 376 921.00) and 5.8% (N = R2 046 944 383.00) of the total cost of all medications claimed during the study period. The average cost per item of hipolipidaemics was R170.63 ± 70.19 in 2005 compared to R167.08 ± 71.93) in 2006. HMG-CoA reductase inhibitors formed the leading therapeutic class in hipolipidaemic medicine items in all age groups on the database, except for children aged 0 ≤ 9 years, where the “others” group, in particular cholestyramine (Questran Lite 4 mg) was claimed more frequently. Of the items claimed for both study periods, simvastatin was the most commonly claimed, accounting for 45.35% (n = 284 232) and 46.21% (n = 325 970) respectively of the number of hipolipidaemic items claimed, at a total cost of 30.97% (n = R33 119 294.18) and 31.38% (n = R36 983 938.41) for 2005 and 2006 respectively. Non-substitutable and generic hipolipidaemic medicine items carried the largest percentage of prevalence and cost in both study periods for both sex categories and all age groups. The majority of claims for hipolipidaemic medicine items were prescribed by general medical practitioners, followed by “other prescribers” and then by cardiologists. Only a small number of prescriptions claimed were prescribed by thoracic surgeons and even fewer by pharmacotherapists and pharmacists. Trade name products that were mostly prescribed were Lipitor and Adco-Simvastatin. Of all the hipolipidaemic drugs utilised on the database, only three active ingredients (bezafibrate, simvastatin and pravastatin) had generic equivalents available at the time of the study. With total substitution (100%) of these three drugs with the average price of the available generic hipolipidaemic equivalents on the database, a cost saving of R1 744 462.27 or 1.63% (N = R106 943 348.53) was possible in 2005. In 2006, a total cost saving of R1 526 985.79 or 1.30% (N = R117 862 631.87) was calculated. Conclusion: The study highlighted the most commonly prescribed hipolipidaemics within a sub-population of South African patients. The high average cost per prescription of hipolipidaemic drugs indicates that they are relatively expensive in comparison to other medications. Generic (and therapeutic) substitution should be investigated as potential cost-saving mechanisms in the private health care sector of South Africa.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

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36

Saley, Shenaaz. "The value of the "top twenty" pharmaceutical products as a management instrument in a managed health care organisation / Shenaaz Saley". Thesis, North-West University, 2004. http://hdl.handle.net/10394/428.

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Health is a fundamental human right. Access to health care, which includes providing a population with safe, effective, good quality drugs at the least possible cost, is a prerequisite to realising that right. Drugs or medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. Drugs also constitute a major recurrent expense in both state-run and private sector health care. To ensure that health care workers prescribe the most cost-effective drugs through the essential drugs list, training, as well as evaluation and monitoring systems must be regarded as important elements of containing costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR), evidence-based medicine and disease management have emerged as tools to ensure cost-effective selection and use of drugs, particularly for chronic diseases. These managed care tools are often investigated to determine whether new technologies or interventions are appropriate and have "value". Affordable prices of medicines, on their own, however, do not ensure access to medicines. Also important are reliable procurement, distribution and storage systems, and appropriately trained personnel to manage these components of drug management. Poorly regulated drug supply systems can have serious consequences such as antibiotic resistance, problems with safety or quality and most importantly wastage, as it is believed that a significant proportion of drugs purchased by the state in South Africa find their way into the private sector market through a "grey market". The general objective of this study was to review and analyse the cost and medicine usage of the "top twenty" pharmaceutical products according to the monthly pharmaceutical purchasing reports of the Department of Health in the North West Province. The research can be classified as retrospective and quantitative. The data used for the analysis were obtained over a two-year study period (1 Apr 2000 - 28 Feb 2002) from the private provider operating the medical stores in the North West Province. The results of the empirical investigation, showed the total number of "top twenty" products appearing during the study period amounted to 460 different products having a total purchasing cost of R 66,263,674.51 representing 37.2% (n = R 178,163,061.50) of all pharmaceutical products purchased during the two-year period. Through analysis it was found, when classified according the Anatomical Therapeutic Chemical (ATC) therapeutic main group, antihypertensives had the highest quantity purchased for year one (20.69%; n = 134,515,640) with cough and cold preparations revealing the highest purchasing quantity for year two (40.55%; n = 103,567,031) of all "top twenty" pharmaceuticals during the study period. Antibacterials for systemic use presented with the highest cost percentages for both years, representing 20.68% (n = R35, 568,221.31) and 16.72% (n = R 31,370,435.51) respectively. Hydrochlorothiazide presented with the highest purchasing quantity for both years when classified according to chemical substance with, Methyldopa having the highest purchasing cost for year one followed by vaccine Hib-DTP 10 dose vial (Haemophilus influenzae type B vaccine-diphtheria, pertusis and tetanus vaccine) for year two. Furthermore it was also found that the majority of the "top twenty" products were in the oral dosage form. Finally it was concluded that drugs used in the treatment of hypertension and cardiac failure were the most utilised in comparison to other "top twenty" products during the study period. Possible misappropriation based on the defined daily dose of the "top twenty" products might have occurred. In completion of this study, recommendations for future research were made.
Thesis (M.Pharm.)--North-West University, Potchefstroom Campus, 2004.

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37

Smit, Corlee. "Aspects of drug usage in a section of the private health care sector of South Africa : A managed health care approach / C. Smit". Thesis, North-West University, 2008. http://hdl.handle.net/10394/4175.

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Background: According to the Council of Medical Schemes of South Africa (CMS, 2007:52), nearly seventeen percent of the total benefits paid during 2006 were for medicine. Medicine is thus a cost-driving contributor to total healthcare financing. There are various factors influencing and driving medicine usage and cost patterns, including inter alia provider preference, therapeutic committees, marketing and cost. Objectives: The purpose of this study was to identify the top twenty trade name products according to total cost and prevalence in a section of the private health care sector of South Africa, and to identify cost driving products. Methodology: A quantitative, retrospective drug utilisation review (DUR) study was performed on computerised medication records (medicine claims data) for two consecutive years (i.e. 2005 and 2006) that were obtained from a South African pharmaceutical benefit management company (PBM). The study population consisted of 1 218358 and 1 259 099 patients for 2005 and 2006 respectively. A total of 19 860 679 and 21 473017 medicine items that were claimed during 2005 and 2006 were included in the review. Descriptive statistics were used to describe the data, and were analysed using the Statistical Analysis System® SAS 9.1® programme. The cost prevalence index (CPI), developed by Serfontein (1989:180), was used as an indicator of the relative expensiveness of medicine. Resource- and activity driver products (cost driving products) were identified on the database by calculating the total cost of the product, the CPI of the product as well as the prevalence of the product. Variables for analysis included age, gender, prescriber and provider types. Resurts and discussion: A total number of 8 522 574 and 9 046 138 prescriptions were analysed, with an average of 2.33 ± 1.56 and 2.37 ± 1.58 items per prescription during 2005 and 2006 respectively. The average cost per prescription for the total database was R222.16 ± R463.13 for 2005 and R226.25 ± R557.49 for 2006. Members had to co-pay an average of R26.33 ± R102.70 per prescription in 2005 compared to R29.74 ± R103.96 per prescription in 2006. Children under the age of nine accounted for approximately 13% of the total study population, the adolescent age group < 9 and ≥ 19 years) represented 12%, age group three < 19 and ≥ 45 years) represented 38%, age group four < 45 and ≥ 59 years) represented 21% and the geriatric age group (patients older than 59 years) represented 16% of the total study population on the database. About 44% of the study population were male compared to 56% female patients. The top twenty trade name products ranked according to total cost represented about 13% (N=R1 893376 921.00 and N=R2 046 944382.50 in 2005 and 2006 respectively) of the overall medicine cost. The top five trade name products according to total cost for 2005 in descending order were Upitor 1 Omg and 20mg, Fosamax 70mg, Celebrex 200mg and Prexum 4mg. During 2006 the top five trade name products were similar except for Cipralex 10mg in the place of Celebrex 200mg. The CPls for all these products were above one; these products were also all activity drivers. The top twenty trade name products ranked according to prevalence represented about 11% (N=19 860679 and N=21 473074) of the total medicine prevalence for both study periods. The top five trade name products according to prevalence for both years contained Eltroxin 100mcg, Ecotrin 81 mg, Upitor 10mg and Alcophyllex syrup, with Myprodol capsules in 2005 and Mybulen tablets in 2006. Upitor 1 Omg was the only cost driver product in this list. General medical practitioners prescribed the largest quantity of medicine items and represented about 73% of all the medicine items on the database. The medicine prescribed by general medical prescribers accounted for 65% of the overall medicine expenditure on the database. Pharmacies can be seen as the main providers of medicine items. Pharmacies provided approximately 80% of the medicine items and represented over 91% of the total medicine expenditure. Cardiovascular agents were the main pharmacological group that represented the greatest percentage of the total medicine cost, about 19% in both study years. Cardiovascular agents were also positioned 1st according to prevalence and represented about 14% of the overall medicine prevalence in both the study periods. Conclusions and recommendations: Cost driver products can be seen as the products that drives medicine expenditure in the managed health care environment, thus driving the total cost of medicine treatment in the private health care sector of South Africa. Through the implementation of managed health care information- and management instruments medicine expenditure can be reduced. Recommendations for future research have been made.
Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2009.

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38

Dieudonné-Vatran, Antoine. "Accès à des 3‐aryl‐1(2H)‐isoquinolones via une réaction d’aminocarbonylation/cyclisation pallado catalysée : utilisation dans le développement d’agent antivasculaire inhibiteur de la sérine thréonine phosphatase I". Thesis, Paris 5, 2012. http://www.theses.fr/2012PA05P615.

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Le sujet de cette thèse porte sur la synthèse d'inhibiteurs spécifique de la Sérine-Thréonine phosphatase I (PP1). Un criblage de la chimiothèque de l'institut Curie, réalisé par l'équipe du Dr. Popov a permis d'identifier une 3-aryl-1(2H)isoquinolone, qui perturbe la dynamique des microtubules et qui s’est ensuite avéré être un inhibiteur sélectif de PP1. Dans une première partie, nous avons mis au point une nouvelle méthodologie de synthèse de ces composés hétérocycliques par une réaction tandem d’aminocarbonylation-cyclisation pallado catalysée. L’étude d’une seconde voie de synthèse de ces composés a été étudié par réaction d'arylation direct d'une 1(2H)isoquinolone. Dans le but de trouver d’autres hit, ligand de cette phosphatase, nous avons tenté de développer un test de triple hybride chimique, en collaboration avec la société Hybrigenics. Ce test est basé sur l’interaction de notre inhibiteur hit avec la phosphatase PP1. Pour cela, nous avons synthétisé une sonde à partir de la molécule hit initiale. La deuxième partie a trait à un développement de chimie médicinal pour optimiser le hit initial. Des dérivés de très bonne sélectivité pour l’enzyme cible ont été préparés
This PhD thesis deals with the synthesis of serine threonine phosphatase I (PPI) inhibitors. This project started with the screening of the Institut Curie’s Library carried out by Dr. Popov team. They identified a 3-aryl-1(2H)isoquinolone (hit molecule) which strongly disturbs the microtubules dynamics. In the first part, we designed an original methodology to prepare those heterocycles, though a tandem palladium catalyzed aminocarbonylation/cyclization reaction. Then, we studied the direct arylation reaction to obtain the desired scaffold. In collaboration with Hybrigenics, we synthesize a probe for a triple hybrid system, based on the specific interaction of the hit molecule with its target PPI. Thanks to this system, one could identify new inhibitors of the targeted phosphatase protein. Eventually, a library of isoquinolones derivatives was synthesized. During the invitro tests, some of those molecules proved to be very specific for the serine threonine phosphatase I

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39

Rothmann, Stephan. "Prescribing patterns of methylphenidate and atomoxetine containing products in a section of the private health care sector of South Africa / Stephan Rothmann". Thesis, North-West University, 2009. http://hdl.handle.net/10394/4905.

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The general aim of this study was to investigate the prescribing patterns of products that contain methylphenidate or atomoxetine in a section of the private health care sector of South Africa. A quantitative, retrospective drug uitilisation review was performed according to data obtained from the database of a South African medicine claims pharmacy benefit management company's for three consecutive study years (Le. 2005 to 2007). The results indicated that a total of 7,990 patients had been prescribed products that contained methylphenidate or atomoxetine in 2005. The total for 2006 was 8,575 and it decreased to a total of 7,828 in 2007. Of all the patients who received the mentioned products, the percentage for females increased from 27.75% (N = 7,990) in 2005 to 29.06% (N =7,828) in 2007. With regard to the same products the percentage for males decreased from 72.03% (N = 7,990) in 2005 to 70.89% (N = 7,828) in 2007. The ratio for the gender-related prescribing patterns of medicine items that contained methylphenidate or atomoxetine in this section of the private health care sector of South Africa was ± 2.55:1 for males to females in comparison with the international male:female ratio of 3:1. According to the medicine claims on the database for 2005 the total number of prescriptions that indicated products containing methylphenidate or atomoxetine was calculated as 8,522, 798 (i.e. N = 8, 522,798) or as a percentage of 0.32% prescriptions. The percentage showed an increase to 0.41 % in 2007 (N = 8,015,538). Of all the medicine items containing methylphenidate or atomoxetine those products that contained atomoxetine represented 4.69% and those that contained methylphenidate represented 95.31%. In 2005 the average cost per prescription that indicated items containing methylphenidate or atomoxetine amounted to R318.29 ± R162.09. In 2007 the amount increased to R358.91 ± R208.10. The percentage of children younger than five years of age, and who had been prescribed products containing methylphenidate or atomoxetine, increased from 0.91 % in 2005 (N = 7,990) to 1.11 % in 2007 (N =7,828). The percentage for children aged 5 to 12 years decreased from 53.62% in 2005 to 49.23% in 2007. For adolescents the percentage increased from 26.32% in 2005 to 27.35% in 2007. The same pattern repeated itself in the case of adults (age 18+ years). Among the top trade name products prescribed were Ritalin LA 20mg®, Ritalin 20mg®, Concerta 36mg®, Ritalin LA 30mg® and Concerta 18mg®. Possible drug-drug interactions were found between products containing methylphenidate or atomoxetine and products containing imipramine, amitriptyline and carbamazepine. Findings indicated that the number of products containing methylphenidate or atomoxetine increased from 2005 to 2007, while also revealing that those products containing methylphenidate remained in the majority. The average costs of products containing methylphenidate or atomoxetine increased from 2005 to 2007.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

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40

Laurent, Morgane. "Utilisation d'une décharge à barrière diélectrique pour développer une matrice polymère plasma dégradable pour des applications vasculaires". Thesis, Université Laval, 2017. http://www.theses.fr/2017TOU30189/document.

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Chaque année, environ 1,5 million de patients requièrent un remplacement vasculaire en réponse à une athérosclérose avancée, causant le rétrécissement interne des vaisseaux sanguins. Malheureusement, encore aujourd'hui les matériaux synthétiques utilisés pour remplacer les artères de petits diamètres (inférieurs à 6 mm) restent associés à un haut taux d'échecs, démontrant ainsi un manque de biocompatibilité certain. L'une des principales complications observées est l'hyperplasie néointimale artérielle caractérisée par l'obstruction du vaisseau sanguin due à la prolifération tridimensionnelle de cellules sur la paroi interne de la prothèse. Différentes stratégies visant à limiter cette réaction naturelle sont aujourd'hui envisagées, notamment l'utilisation d'un système à libération contrôlée de médicament intégré localement aux prothèses vasculaires. En parallèle, l'essor des technologies plasma a permis de montrer qu'il était possible de revêtir la surface de matériel biomédical pour améliorer son interaction avec un environnement biologique. La stratégie consiste à utiliser l'énergie et la réactivité d'un plasma pour polymériser un précurseur gazeux. En sélectionnant la structure moléculaire du précurseur et les conditions expérimentales du plasma appropriées, il est possible de déposer un polymère plasma à la surface du matériel sélectionné pour lui conférer des propriétés sur mesure. C'est dans ce contexte que cette thèse a consisté à synthétiser, à l'aide d'un plasma, une matrice polymère plasma biodégradable pour revêtir la paroi interne d'une prothèse vasculaire, dans le but d'y incorporer un médicament choisi de façon à limiter l'hyperplasie néointimale. Ce projet a permis d'une part de réaliser une preuve de concept en déposant un revêtement polymère plasma dégradable par décharge à barrière diélectrique en configuration planaire. En utilisant le lactate d'éthyle en tant que précurseur et après de nombreuses analyses, des conditions de dépôt optimales ont pu être élues pour leur potentiel dans le cadre d'applications vasculaires. D'autre part, grâce à une caractérisation approfondie de la décharge, une corrélation étroite entre la physico-chimie du plasma et les dépôts dégradables obtenus a pu être établie. Afin d'élargir les possibilités de vitesse de dégradation, l'influence d'une alimentation impulsionnelle sur la décharge et sur le dépôt a de plus été étudiée. Si la manière d'apporter l'énergie a eu une forte influence sur la décharge, aucune influence majeure n'a été notée sur la chimie et la morphologie des dépôts faits à partir de lactate d'éthyle. Enfin, la construction d'un réacteur plasma tubulaire permettant de déposer la matrice développée à l'intérieur de prothèses artérielles a permis de s'étendre aux conditions réelles de dépôt. Dans l'ensemble, ce projet de recherche a mis en évidence le potentiel des procédés plasma pour le développement de matrices polymères plasma dégradables, notamment dans le cadre de systèmes à libération contrôlée et locale de médicaments pour des applications en chirurgie vasculaire. D'un point de vue de la physique des plasmas, ce travail a de plus souligné l'importance de l'étude de la décharge dans de véritables conditions de dépôt de couches minces
Every year, about 1.5 million patients need a vascular replacement due to advanced arteriosclerosis, which causes the internal narrowing of blood vessels. Unfortunately, even today the synthetic materials used to replace small diameter arteries (below 6 mm) remain associated with low patency rate, which demonstrates an evident lack of biocompatibility. One of the main observed complications is arterial neointimal hyperplasia, which is characterized by the blood vessel obstruction due to the tridimensional proliferation of cells on the graft internal wall. Different strategies aiming at limiting this body reaction are currently considered, in particular the use of a drug delivery system locally integrated to the vascular grafts. Concurrently, the rise of plasma technologies enabled to demonstrate the possibility to coat the surface of biomedical devices to improve their interaction with a biological environment. The strategy consists in using the plasma energy and reactivity to polymerize a gaseous precursor. By selecting the appropriate precursor molecular structure and plasma experimental conditions, one can build up a plasma polymer with tailored properties. It is in this context that this thesis consisted in synthesizing, using plasma, a biodegradable polymeric plasma polymer matrix to coat the internal wall of a vascular graft, with the goal to incorporate a drug chosen to limit neointimal hyperplasia. On one hand, this project acted as proof of concept by developing a degradable plasma polymer coating using a planar dielectric barrier discharge. After extensive studies using ethyl lactate as precursor, optimal chemical vapor deposition conditions were elected for their potential in terms of vascular applications. On the other hand, thanks to an extended discharge characterization, a strong correlation was established between the plasma physico-chemistry and the properties of the degradable coatings synthesized. In addition, to broaden possibilities in terms of degradation rate, the influence of a squared pulse power supply on the discharge and the coating was studied. If changing the way to bring the energy had a strong influence on the discharge, no major influence was noticed on the ethyl lactate-based coatings' chemistry and morphology. Finally, a tubular plasma reactor was build up to empower the internal wall of vascular prosthesis to be coated, which enabled to extend this project to the deposition conditions of its final application. Overall, this research project highlighted the potential of plasma processes for the development of degradable plasma polymer matrices, particularly for local drug delivery systems for vascular applications. On a physics perspective, this work emphasized the importance of studying the discharge under actual thin layer deposition conditions

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41

Doyen, Camille. "Utilisation de la RMN pour la caractérisation structurale et cinétique d'associations peptide-liposome comme aide à la conception de formulation". Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASS110.

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L’encapsulation de principes actifs (PA) dans des liposomes est utilisée dans de nombreux domaines tels que les industries pharmaceutiques et cosmétiques. Les liposomes sont des systèmes d’administration de médicaments utilisés pour leur relargage contrôlé des PA. Pour augmenter l’efficacité de peptides comme PA, nous cherchons à optimiser des liposomes en jouant à la fois sur leur composition et la structure des peptides. Les paramètres à améliorer sont leurs interactions, l’efficacité d’encapsulation et la cinétique de relargage. Pour atteindre cet objectif, j’ai évalué l’intérêt de la spectroscopie par Résonance Magnétique Nucléaire (RMN) pour caractériser les peptides, les liposomes et leurs comportements pendant le relargage. Les peptides utilisés dans cette étude sont dérivés de l’apeline, qui a un intérêt pour la régulation homéostatique du système cardiovasculaire. Les structures des liposomes et des peptides ainsi que leurs interactions ont été étudiées par RMN ¹H et ³¹P et par cryo-EM. J’ai montré que les méthodes de diffusion par RMN, en s’appuyant sur la taille apparente des molécules, permettent de différencier les compartiments internes et externes des liposomes et de suivre les cinétiques in situ en temps réel de relargage de peptide, sans perturber le processus. Les cinétiques de relargage ont aussi été quantifiées par intégration spectrale de spectres RMN ¹H. J’ai aussi montré que la méthode de préparation des liposomes avait un impact sur leur structure, leur cinétique de relargage et leurs interactions avec des peptides. L’addition d’une chaîne lipidique augmente les interactions avec les liposomes, mais la longueur et le type de chaîne induisent peu de différences. Les outils de RMN mis en place pourront être étendus à d’autres PA et systèmes d’administration pour des applications pharmaceutiques et cosmétiques
The encapsulation of active ingredients (AI) in liposomes is used in several domains such as pharmaceutical and cosmetic industries. Liposomes are drug delivery systems (DDS) used for a controlled release of AIs. To increase the efficiency of peptide drugs, I aim at designing optimized peptide/liposomes formulation by playing both on their composition and peptide structure. Potential parameters to be improved are their interactions, encapsulation efficiency and release kinetics. To reach this goal, I explored the potentiality of Nuclear Magnetic Resonance (NMR) spectroscopy to characterize peptides, liposomes and their behavior during release. The AIs used in this study are apelin-derived peptides that are of interest for homeostasis regulation of the cardiovascular system. Liposome and peptide structures as well as their interactions were characterized by ¹H and ³¹P NMR and cryo-EM. I showed that diffusion NMR methods that report on the apparent size of molecules can discriminate between the inner and the outer space of liposomes and for release quantification in-situ and in real-time without perturbing the process. Moreover, ¹H NMR spectra were used to monitor and quantify peptide release kinetics by spectral integration. I showed that the preparation method of liposomes drastically impacts their structure, release kinetics and interactions with peptides. Addition of a lipid chain increases the interaction with the liposomes, but the type and length of the chain induce only few differences. This approach could certainly be extended to other AIs and DDSs used for pharmaceutical and cosmetic applications

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42

Steyn, Rianda. "The usage of antidiabetic drugs : a managed care approach / Rianda Steyn". Thesis, North-West University, 2005. http://hdl.handle.net/10394/1029.

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"Diabetes mellitus" refers to a spectrum of conditions, which all present with hyperglycaemia as a common medical finding. Diabetes was once thought of as a single disease, but according to Setter et a/. (2000:378), it includes a heterogeneous group of disorders that are secondary to various genetic predispositions and precipitating factors. Type 1 diabetes mellitus (DM) accounts for 10 to 15% of all cases of diabetes mellitus and is clinically characterised by hyperglycaemia and a propensity to diabetic keto-acidosis. Its control requires chronic insulin treatment. Although it may occur at any age, it most commonly develops in childhood or adolescence and is the predominant type of diabetes mellitus diagnosed before age 30 (Beers & Berkow, 2004). Type 2 DM is usually the type diagnosed in patients older than 30 years of age. It is also commonly associated with obesity (Berkow, 1992:1108). The objective of this study was to review the usage and cost of antidiabetic drugs and to determine the influence of the pricing regulations on the cost of these drugs. This research can be classified as retrospective and quantitative. Data were obtained from a prescription claims database, and the study population consisted of all the antidiabetic prescriptions for the year 1 January 2004 to 31 December 2004. The one-year period was divided into three study periods, namely January to April, May to August and September to December. Firstly diabetes mellitus was investigated in order to understand the disease and to determine the prevalence and treatment thereof. It was found that diabetes mellitus is a heterogeneous disorder acquired from both genetic and environmental factors and that education for the general population, and in particular for the patients, is the key to preventing and controlling diabetes and reducing the complications arising from it. Secondly managed health care, pharmaco-economics and a drug utilisation review were investigated in order to understand these concepts. The influence of the South African Government on health care was discussed, including the new pricing regulations of medicine in South Africa. Thirdly, the utilisation patterns of antidiabetic drugs were reviewed, analysed and interpreted. It was determined that the oral antidiabetic agents are relatively less expensive than the insulins and that they are prescribed more frequently, and secondly that the biguanides presented almost half (49.4%, n = 116 138) of all the oral antidiabetic agents. It was also determined that the average cost of the oral antidiabetic drugs was between 21 .O% and 28.0% lower in 2004 than in 1996 - an indication that, despite inflation, the antidiabetic drugs were less expensive in 2004 than eight years ago in 1996. It was also calculated that the total cost savings in antidiabetic medication could have been R1 448 682.26 if the lower price of antidiabetic agents had been implemented during the period January to April. And finally it was also determined that further substantial "cost savings" could have been possible if all the innovator antidiabetic products had been substituted for less expensive generic antidiabetic products. Abstract
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006.

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43

Rothmann, Lourens Johannes. "Prescribing patterns of angiotensin-converting enzyme inhibitors for the period 2001 until 2006 / Lourens Johannes Rothmann". Thesis, North-West University, 2007. http://hdl.handle.net/10394/1946.

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Eksteen, Margaritha Johanna. "Medicine usage patterns in a district hospital : a therapeutic budget model approach / Margaritha Johanna Eksteen. Part 2". Thesis, North-West University, 2008. http://hdl.handle.net/10394/2885.

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De, Franca Carla Ermelinda. "Medicine claims in South Africa : an analysis of the prescription patterns of providers in the private health care sector / Carla Ermelinda de Franca". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4717.

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Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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46

Van, der Merwe Suné. "Prescribing patterns of medicines used in Parkinson's and other related diseases in the private health care sector of South Africa / S. van der Merwe". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4924.

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Parkinson's disease is the most recurrent movement disorder and has a radical effect on the lives of people. This chronic neurological disorder is accompanied by a significant social and financial burden with a negative brunt on sufferers' quality of life. The main cause of Parkinson's disease is still unknown, however, the main goal of existing treatment for Parkinson's disease is to improve the patient's quality of life and ability to go about as normally and easily as possible. The general objective of this study was to investigate the prescribing patterns of medicine items used in Parkinson's disease and other movement disorders associated with Parkinson's disease, as well as the cost associated with the medication in a section of the private health care sector of South Africa. A quantitative, retrospective drug utilisation review (DUR) study was performed according to data obtained from a medicine claims database, of a South African pharmacy benefit management company (PBM) for four consecutive years (i.e. 2005 to 2008). Of all patients on the total database 0.26% (n = 3 993) were Parkinson's disease patients in 2005 (N = 1 509 621), 0.28% (n = 4 423) in 2006 (N = 1 558 090), 0.34% (n = 4 028) in 2007 (N = 1 178 596) and 0.42% (n = 4 072) in 2008 (N = 974 497). Female Parkinson's disease patients were between 56% and 60% of all Parkinson's disease patients from 2005 to 2008. According to age groups, Parkinson's disease patients had the highest representation in age group five (70 80 years) and age group six (> 80 years). In total the number of Parkinson's disease prescriptions claimed through the PMB accounted for 0.3% from 2005 to 2007 and 0.4% in 2008 of all prescriptions claimed on the database. From 2005 (N = R1 819 865 251) to 2008 (N = R1 785 871 013) Parkinson's disease expenditures represented 0.6% (2005, n = R10 459 835; 2006, n = R11 320 616; 2007, n = 11 040 596; 2008, n = 10 697 155) of the total database's prescription expenditure. The female gender and patients of 70 years and older, presented with the highest number of prescriptions claimed and also with the highest costs within the specific age and gender groups. In 2005 the medicine treatment expenditure for a year's Parkinson's disease treatment was approximately R2 619 R4 179, decreasing with 2% to R2 559 R4 237 in 2006, from thereon increasing with 7% to R2 740 R 4 337 in 2007, decreasing again with 4% to R 2 627 R4 424 in 2008. Medicine item analyses indicated that dopaminergic medicine items were the most frequently used antiparkinson medicine items from 2005 to 2008. Carbidopa/levodopa containing medicine items were most frequently claimed throughout the study period. The average cost per tablet increased from 2005 to 2008, with the most expensive tablets during the four–year study period indicated as, Tasmar® 100 mg tab and Permax® 1 mg tab. The PDD of all antiparkinson medicine items appeared intact. There were only two medicine items that indicated a PDD, above the maximum daily dosage, namely Permax® 1 mg tablets and Tasmar® 100 mg tablets. The frequencies of medicine items prescribed in combination decreased rather drastically with an increase of medicine items per prescription throughout the study period. CNS medicine items prescribed together with antiparkinson medicine items per prescription often occurred. The highest frequencies encountered in combination with antiparkinson medicine items were found to include the antidepressants, hypnotics, antipsychotics and anxiolytic medicine items. A majority of antiparkinson medicine items (53.50%, n = 4 691) had low refill–adherence rates below 90% and were therefore unacceptable. These accounted for 41.62% (n = R16 398 512) of the total cost (N = R39 402 898) of all antiparkinson medicine items included in this study. Only 36.78% (n = 3 225) of antiparkinson medicine items had acceptable refill–adherence rates between 90% and 110%. Those with unacceptably high refill–adherence rates accounted for 9.72% (n = 852) of all antiparkinson medicine items and represented 6.5% (n = R2 574 597) of the total cost. Conclusion: It can be concluded that even though antiparkinson medicine items are used by only a small percentage of the total patient population in a section of the private health care sector of South Africa, they are expensive and bear implications for the patient as well as medical schemes. Good prescribing patterns were adhered to, with the exception of the poor refill–adherence of antiparkinsons medication items.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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47

Visser, Christoffel Dawid. "Prescribing patterns of benzodiazepines : a comparative study between two provinces in South Africa / C.D. Visser". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4925.

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Background: In 2007 the population density for the Gauteng Province was 614 persons per km2 and in the Northern Cape Province it was 2.9 persons per km2 . High population density leads to an increase in crime. This was evident in the percentage distribution of total crime reported from 2000 to 2003 of 27.4% in Gauteng Province, while the percentage distribution of total crime reported in the Northern Cape for the same period of time was 2,8%. Stress and insomnia can be caused by crime which is influenced by population density. Crime and high population density, may cause stress and fear, which may lead to insomnia and anxiety, which in turn may lead to an increase in benzodiazepine usage. Objective: The general objective of this study was to investigate the benzodiazepine usage in the private health care sector in South Africa based on age, sex, geographical areas, prescriber type and days between refills. Methods: The data were obtained from a medicine claims database of a pharmacy benefit management company covering the periods from 1 January 2006 to 31 December 2006 and 1 January 2008 to 31 December 2008. The statistical analysis was performed by making use of the Statistical Analysis System®. A drug utilisation review was performed. Results: Patients claiming benzodiazepines represented about 7.25% of all patients in total database in 2006 and 7.97% in 2008. Female patients claimed more benzodiazepines than male patients in both Gauteng (67.24% in 2006 & 67.36% in 2008 respectively) and Northern Cape Province (67.77% in 2006 & 67.70% in 2008 respectively). Patients aged 40 years to 65 years claimed the highest number of benzodiazepine items, while patients younger than 12 years claimed the lowest number of benzodiazepine items. The number of patients that claimed benzodiazepines in the Northern Cape was lower than those in Gauteng. The percentage of patients that claimed benzodiazepines in 2006 was 7.91% in Gauteng versus 8.96% in Northern Cape. In 2008 the percentage of patients that claimed benzodiazepines was 8.47% in Gauteng versus 9.51% in Northern Cape. The percentage of benzodiazepine prescriptions claimed in Gauteng was 4.79% in 2006 and 5.10% in 2008. In the Northern Cape the percentages of benzodiazepine prescriptions claimed in 2006 and 2008 were 4.62% and 4.30% respectively. General medical practitioners prescribed most of the benzodiazepine prescriptions in both Northern Cape and Gauteng Province. Trade name products that were mostly prescribed in the Gauteng was Adco–Alzam® 0.5 mg and in the Northern Cape it was Brazepam® 3 mg for both 2006 and 2008. Conclusion: The difference in the prescribing patterns of benzodiazepines in Gauteng and the Northern Cape was not statistically significant. Recommendations for future research were made.
Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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48

Roux, Ilanca. "Prescribing patterns of biologic immunomodulating medicine in the South African private health care sector / Ilanca Roux". Thesis, North-West University, 2010. http://hdl.handle.net/10394/4936.

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Advances in molecular immunology and rapid technical evolution during the past two decades have led to a new class of medicines called biologics. Recently, a large number of biologics, or biologic immunomodulators, directed towards an array of immune–mediated diseases, have entered the market. This has lead to a dramatic change in the immunotherapy of autoimmune diseases, as biologics present new potential to improve or substitute conventional immunosuppressive therapies. According to literature, biologics are used by only a small number of a health plan’s members, (approximately one per cent), but a single occurrence can be relatively expensive. Furthermore, there is an indication that the frequency of use and cost of biologics are on the rise, and as more biologics enter the market, health plans and employers face the challenge of controlling costs while ensuring that biologics are affordable. The general objective of this study was to determine the prevalence and cost of biologic immunomodulating medicine in the treatment of certain autoimmune diseases during the period 2005 to 2008 in a section of the private health care sector of South Africa, by employing a medicine claims database as a source to obtain necessary information. A quantitative, retrospective drug utilisation review (rDUR) was performed on computerised medication records (medicine claims data) for four consecutive years (i.e. 2005 to 2008) provided by a pharmacy benefit management company (PBM). The study population consisted of all patients on the database who received at least one medicine item with adalimumab, etanercept, infliximab, interferon beta–1a, interferon 1–b or rituximab as active ingredient and who were diagnosed with either rheumatoid arthritis (RA), multiple sclerosis (MS) or Crohn’s disease between 1 January 2005 and 31 December 2008. Between 2005 and 2008, an average of 1,305,201 patients appeared on the total database, and of these 0.055% (n = 713) received biologic immunomodulating medicine. More than two thirds of biological users were female and most patients who received these medicine items were between the ages of 39 and 64 years, followed by those patients aged between 25 and 39 years. Biologic immunomodulating medicine items (n = 11,914) and biologic prescriptions (n = 9,537) represented 0.016% of the total number of medicine items (N = 76,129,173) and 0.030% of the total number of prescriptions (N = 31,985,153). The percentage contribution of biologic immunomodulators to the total number of medicine items and prescriptions on the total database increased each year, and in four years’ time the percentage of all the medicine items on the total database that included biologic immunomodulators had tripled, from 0.009% to 0.023%. The total cost of biologic immunomodulating medicine accounted for 1.278% of the total cost (N = R7, 483,759,176.23) of all medication claimed through the PBM between 2005 and 2008. The percentage contribution of biologic immunomodulators to the total medicine expenditure also increased from one year to another for the four–year study period. The average cost of a biologic immunomodulating medicine item increased with 71.10% from 2005 (R5602.71 ± 2166.61) to (R9586.25 ± 5956.56) in 2008. The CPI for biologic immunomodulators, (CPI = 60.00 for 2005; CPI = 74.62.17 for 2006; CPI = 85.26 for 2007; and CPI = 86.96 for 2008) indicated that biologic immunomodulating medicine items were relatively expensive and the d–value between the average cost per biologic immunomodulator and the average cost per non–biological medicine item (d–value = 2.54 in 2005, d–value = 3.32 in 2006, d–value = 2.23 in 2007 and d–value = 1.59 in 2008) furthermore indicated that the impact of biological therapies was large and practically significant. Rheumatoid arthritis patients represented 19.78% of the total number of patients (n = 713) who claimed the biologic immunomodulators during the four–year period, MS patients (n = 172) represented 24.12% and Crohn’s patients (n = 11) represented 1.5%. Biological drugs prescribed to RA patients represented 0.28% (n = R20, 708,818.82) of the total cost (N = R7, 483,759,176.23) of all medication claimed through the PBM during the four–year period, while those prescribed to MS patients represented 0.41% (R30, 922,520.07) and those prescribed to Crohn’s disease patients represented 0.015% (R1, 108,568.02). Although biologic immunomodulating medicine items used in the treatment of RA, MS and Crohn’s disease are relatively expensive, it seems that the number of other medication prescribed to patients with these diseases decreased after treatment with biologics, which may influence the medicine treatment cost of these patients. It can be concluded that even though biologic immunomodulators are used by only a very small percentage of the total patient population in a section of the private health care sector of South Africa, they are relatively expensive and have a considerable impact not only the medical aid scheme, but also on the patient.
Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

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49

Coetzee, Renier. "An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier Coetzee". Thesis, North-West University, 2004. http://hdl.handle.net/10394/91.

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The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated.
Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

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50

Bretin, Ludovic. "Thérapie photodynamique (PDT) dans un modèle in vitro et in vivo de cancer colorectal : utilisation d'un photosensibilisateur nanovectorisé". Thesis, Limoges, 2019. http://www.theses.fr/2019LIMO0052/document.

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Le cancer colorectal (CCR) est l’un des cancers les plus diagnostiqués dans le monde mais surtout le 2ème cancerle plus mortel. Malgré les progrès de la recherche médicale dans les traitements anticancéreux, de nombreux effetssecondaires subsistent chez les patients ainsi que l’apparition de résistances aux traitements conventionnels. Ledéveloppement de nouvelles stratégies thérapeutiques anticancéreuses est donc nécessaire afin d’améliorer la priseen charge de ces patients. La thérapie photodynamique (PDT) utilisant des photosensibilisateurs (PS) se présentecomme une stratégie thérapeutique innovante limitant fortement ces effets secondaires indésirables. La PDT a étéapprouvée pour le traitement de certains cancers grâce à la génération d’espèces réactives de l’oxygènecytotoxiques uniquement après photoactivation des PS. Cependant, une faible solubilité et un manque de sélectivitédes PS vis à vis des sites tumoraux sont les principales limites en clinique. En effet, l’administration ciblée demédicaments est un point essentiel dans la thérapie anticancéreuse. La nanomédecine par l’utilisation denanoparticules permet d’améliorer le ciblage tumoral car elles sont capables de s’accumuler spontanément dansles tumeurs solides grâce à l’effet de perméabilité et de rétention accrue. L’objectif de cette étude a été dedémontrer l’intérêt de la vectorisation de la 5-(4-hydroxyphényl)-10,15,20-triphénylporphyrine-xylane (TPPOHX)sur des nanoparticules de silice (SNPs) afin d’augmenter l’efficacité anticancéreuse par un meilleur ciblagetumoral du traitement. Il a été démontré une augmentation significative de l’efficacité anticancéreuse des TPPOHXSNPs-PDT grâce à l’amélioration de l’internalisation cellulaire par rapport à la TPPOH libre-PDT sur 3 lignéescellulaires de CCR humain. De plus, il a été caractérisé que la mort cellulaire induite par les TPPOH-X SNPs-PDTest dépendante de la voie apoptotique et que l’autophagie joue un rôle de résistance à la mort cellulaire. Par ailleurs,in vivo et en l’absence de toxicité, les TPPOH-X SNPs-PDT induisent une augmentation de l’efficacitéanticancéreuse grâce à un meilleur ciblage tumoral par rapport à la TPPOH libre-PDT. Cette étude a donc permisde démontrer l’intérêt de la combinaison de la PDT et de la nanomédecine afin d’améliorer les futurs traitementsanticancéreux
Colorectal cancer (CRC) is one of the most common cancer globally but above all the second leading cause ofdeath for oncological reasons. Despite medical research advances in anti-cancer treatments, many side effectspersist in patients as well as development of resistances to conventional treatments. The development of new anticancertherapeutic strategies is necessary in order to improve care of patients. Photodynamic therapy (PDT) usingphotosensitizers (PS) comes as an innovative therapeutic strategy severely restricting these undesirable sideeffects. PDT has been approved for treatment of some cancers due to the generation of cytotoxic reactive oxygenspecies only with photoactivated PS. However, low physiological solubility and lack of selectivity towards tumorsites are the main limitations of their clinical use. Indeed, targeted drug delivery is a crucial point in cancer therapy.Nanomedicine through the use of nanoparticles improves tumor-targeting because they are able to spontaneouslyaccumulate in solid tumors through an enhanced permeability and retention effect. The purpose of this study wasto prove added value of 5-(4-hydroxyphenyl)-10,15,20-triphenylporphyrin-xylan (TPPOH-X) vectorization bysilica nanoparticles (SNPs) in order to enhance anti-cancer efficacy through better tumor-targeting. It has beendemonstrated significant anti-cancer efficacy increase of TPPOH-X SNPs-PDT thanks to cellular uptakeimprovement relative to free TPPOH-PDT in 3 human CRC cell lines. Moreover, it has been characterized thatcell death induced by TPPOH-X SNPs-PDT is conducted via apoptosis and autophagy acts as a resistance pathwayto cell death. Furthermore, in vivo and without toxicity, TPPOH-X SNPs-PDT induce an elevated anti-cancerefficacy through improvement of tumor-targeting compared to free TPPOH-PDT. This study therefore highlightedthe added value of PDT and nanomedicine combination in order to improve future cancer treatments

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