5,848 research outputs found

    Pharmacy Manager System Implementation Strategies to Mitigate the Cost of Prescription Errors

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    AbstractOne of the most frequent medical errors in contemporary medicine is incorrect prescriptions, and the profits from retail pharmacy operations are adversely impacted by the costs associated with prescription errors. Independent pharmacy managers are interested in finding workable strategies to mitigate the cost of prescription errors and increase profit. Using the resource-based theory of competitive advantage (RBTCA), the purpose of this qualitative multiple-case study was to explore strategies some independent pharmacy managers in Texas use to mitigate the cost of pharmacy employee prescription errors and increase profitability. The participants were five independent pharmacy managers who implemented strategies to mitigate the cost of prescription errors. Data were collected using semistructured, face-to-face interviews, a review of company documents, and site observation notes. Through thematic analysis, four themes emerged: (a) cost of prescription quality check and errors reduction strategy, (b) increased profitability strategy through error cost mitigation, (c) positive utilization of organization resources strategy, and (d) technology system implementation strategy to reduce prescription errors. A key recommendation is for independent pharmacy managers to involve pharmacy staff in developing the pharmacy system to promote user acceptance, which will assist in reducing prescription errors and raising profit. The implications for positive social change include the potential to mitigate the cost of prescription errors, prevent hospitalization and fatalities caused by medication errors, enhance patients’ quality of life, and boost the economy and employment opportunities in their communities

    Stress, Anxiety and Depression in Parents of Autistic Children in Saudi Arabia

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    Parents of autistic children commonly report experiencing higher levels of stress, anxiety and depression compared to parents of typically developing children and parents of children with other various developmental conditions. Considering the worldwide increase in the prevalence of autism, understanding the experiences of these parents and how they cope with their child’s condition has become increasingly important. Studies exploring parental experiences caring for their autistic child have yielded inconsistent results in relation to the impact certain factors have on their mental health. Part of this inconsistency might be explained by the tendency of previous studies to measure the effect of a single factor on parental mental health as well as investigating parental stress, anxiety and depression as a single outcome variable which could compromise the potential for research to clearly isolate and understand the specific factors that contribute to each mental health construct independently. Considering that it is more likely that there are multiple contributing factors which affect parental mental health, an analysis of the interplay between key factors linked to parental mental health issues will be better able to effectively assess the experiences of parents caring for an autistic child. Moreover, despite it being well established that caring for an autistic child can have a significant impact on parents despite their cultural background, the intricacy of this impact is not yet well understood across varying cultures since the bulk of research on the mental health of parents of autistic children is typically conducted in Western countries. To date, little research has investigated factors associated with the mental health of parents of autistic children in the Middle East. As such the overarching aim of this thesis was to explore how parental stress, anxiety and depression are impacted by different factors in a participant sample from Saudi Arabia through five quantitative studies. The first aim of this thesis was to explore the factors negatively affecting mental health in parents of autistic children in Saudi Arabia (Chapter 2 and 3). In chapter 2, the impact of child specific factors (i.e., challenging child behavior and autism symptom severity) on parental stress, anxiety and depression were explored. Results indicated that parents who rated their children as presenting with more severe autism symptomology also reported higher levels of stress, anxiety and depression. In order to gain a better understanding of the high levels of reported mental health issues in this group of parents, chapter 3 incorporated the factor of affiliate stigma to the previous factors investigated. Results from chapter 3 indicated that affiliate stigma was the only significant predictor of parental stress, anxiety and depression in this participant sample. Although it is common for parents with autistic children to report experiencing mental health issues, not all parents report such high levels of stress, anxiety and depression. As such, the second aim of this thesis was to explore how parents of autistic children from Saudi Arabia adaptively cope with their child’s condition. In chapter 4, the buffering effect of parent-specific factors (i.e., resilience and religious coping) on parental mental health was explored. Results indicated that resilience was the only significant factor predicting lower levels of stress, anxiety and depression in this participant sample. In chapter 5, the impact of perceived social support on parental mental health was also investigated in order to explore the extent of which it could protect against stress, anxiety and depression. Results indicated that perceived social support had a positive impact on parental mental health, specifically when the source of social support was from a spouse/life partner. In Chapter 6 a more holistic approach was incorporated in order to explore the interplay between the previously investigated factors and their impact on parental mental health. The double ABC-X model was employed in this chapter for this purpose. Results from chapter 6 indicated that affiliate stigma was the only significant predictor of parental stress, anxiety and depression and that resilience and social support mediated the relationship between affiliate stigma and depression. However, only resilience was found to be a significant mediator in the relationship between stigma and anxiety. Although there are various factors associated with the mental health of parents of autistic children in Saudi Arabia, affiliate stigma seems to play a major role. Resilience has been shown to be a key protective factors against mental health issues in this participant sample. The results from this thesis have important implications for clinical practice and future research. It is evident that there is an urgent need for Saudi Arabia to tackle the issue of mental health stigma effectively, and for healthcare and intervention providers to help parents develop their resilience skills and encourage them to seek social support to ensure the overall wellbeing of both parent and child

    Cerebrovascular dysfunction in cerebral small vessel disease

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    INTRODUCTION: Cerebral small vessel disease (SVD) is the cause of a quarter of all ischaemic strokes and is postulated to have a role in up to half of all dementias. SVD pathophysiology remains unclear but cerebrovascular dysfunction may be important. If confirmed many licensed medications have mechanisms of action targeting vascular function, potentially enabling new treatments via drug repurposing. Knowledge is limited however, as most studies assessing cerebrovascular dysfunction are small, single centre, single imaging modality studies due to the complexities in measuring cerebrovascular dysfunctions in humans. This thesis describes the development and application of imaging techniques measuring several cerebrovascular dysfunctions to investigate SVD pathophysiology and trial medications that may improve small blood vessel function in SVD. METHODS: Participants with minor ischaemic strokes were recruited to a series of studies utilising advanced MRI techniques to measure cerebrovascular dysfunction. Specifically MRI scans measured the ability of different tissues in the brain to change blood flow in response to breathing carbon dioxide (cerebrovascular reactivity; CVR) and the flow and pulsatility through the cerebral arteries, venous sinuses and CSF spaces. A single centre observational study optimised and established feasibility of the techniques and tested associations of cerebrovascular dysfunctions with clinical and imaging phenotypes. Then a randomised pilot clinical trial tested two medications’ (cilostazol and isosorbide mononitrate) ability to improve CVR and pulsatility over a period of eight weeks. The techniques were then expanded to include imaging of blood brain barrier permeability and utilised in multi-centre studies investigating cerebrovascular dysfunction in both sporadic and monogenetic SVDs. RESULTS: Imaging protocols were feasible, consistently being completed with usable data in over 85% of participants. After correcting for the effects of age, sex and systolic blood pressure, lower CVR was associated with higher white matter hyperintensity volume, Fazekas score and perivascular space counts. Lower CVR was associated with higher pulsatility of blood flow in the superior sagittal sinus and lower CSF flow stroke volume at the foramen magnum. Cilostazol and isosorbide mononitrate increased CVR in white matter. The CVR, intra-cranial flow and pulsatility techniques, alongside blood brain barrier permeability and microstructural integrity imaging were successfully employed in a multi-centre observational study. A clinical trial assessing the effects of drugs targeting blood pressure variability is nearing completion. DISCUSSION: Cerebrovascular dysfunction in SVD has been confirmed and may play a more direct role in disease pathogenesis than previously established risk factors. Advanced imaging measures assessing cerebrovascular dysfunction are feasible in multi-centre studies and trials. Identifying drugs that improve cerebrovascular dysfunction using these techniques may be useful in selecting candidates for definitive clinical trials which require large sample sizes and long follow up periods to show improvement against outcomes of stroke and dementia incidence and cognitive function

    Impaired risk avoidance in bipolar disorder and substance use disorders

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    Comorbid substance use disorders (SUDs) are highly prevalent in bipolar disorder (BD), with up to 60% of individuals with BD developing an SUD at some point in their lifetime. In addition, research suggests that individuals with this comorbid presentation (BD+SUD) typically have worse outcomes -- including increased mortality, morbidity, and functional impairment -- than individuals with BD alone. Given the increased illness burden associated with BD+SUD, I conducted a systematic review evaluating existing psychosocial treatments for individuals with these comorbidities. Results from this review indicated that no existing psychosocial treatments for these comorbid conditions effectively target both the substance use and mood domain of symptoms. An alternative path to treatment development is to identify mechanisms that underlie BD+SUD that can subsequently be targeted in treatment. Accordingly, I evaluated impairments in risk avoidance (a tendency to engage in a persistent pattern of problematic behaviors despite negative outcomes resulting from such behaviors) as a potential mechanism underlying negative illness outcomes in BD+SUD. Participants with BD (n = 45) or BD+SUD (n = 31) in a relatively euthymic mood state completed clinical risk behavior assessments, laboratory-based risk avoidance assessments, and neurocognitive assessments in a single study session. I hypothesized that the BD+SUD group would exhibit increased clinical risk behaviors, increased impairments on laboratory-based measures of risk avoidance, and increased deficits on neurocognitive assessments relative to the bipolar disorder alone group. Contrary to my hypotheses, results indicated a lack of notable between-group differences in clinical risk behaviors, laboratory-based risk avoidance assessments, and neurocognitive assessments, with the exception of self-reported executive dysfunction which was elevated among individuals with BD+SUD. Collapsing across group, I found that increased discounting of delayed rewards, older age, and an earlier age of (hypo)mania onset predicted increased clinical risk behaviors. These findings underscore the potential importance of delay discounting as a mechanistic target for reducing clinical risk behaviors among individuals with BD both with and without comorbid SUDs. I also discuss the neurocognitive correlates of delay discounting and interventions for addressing delay discounting as potential new directions for treating the disability associated with BD

    Análisis global y local de la predicción mediante Potenciales Relacionados con Eventos. Aplicación al Trastorno del Espectro Autista

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    Bajo la perspectiva teórica de la codificación predictiva, el cerebro humano funciona como una sofisticada máquina que está constantemente evaluando las características de los estímulos percibidos y la relación existente entre ellos, con el objetivo de extraer nuevos patrones de diferentes niveles de abstracción para anticipar el siguiente evento. Esta dinámica automática de generación o modificación de las predicciones con el fin de dirigir la atención y ajustar la respuesta, es considerada uno de los procesos psicofisiológicos más fundamentales que existen, por lo que su alteración está relacionada con diversas patologías. El presente trabajo describe dos estudios desarrollados mediante EEG, en los que fueron analizados (i) la habituación y discriminación auditiva preatencional mostrada por un grupo de niños con TEA en comparación con uno control, y (ii) el establecimiento y actualización de las predicciones desarrolladas por un grupo de adultos sanos en paradigmas de diferente complejidad. Para conseguir estos objetivos, todos los sujetos registrados en ambos estudios recibieron una estimulación auditiva pasiva similar a la del tipo Oddball, aunque las características y la organización de los estímulos fueron diferentes en ambos experimentos. La estimulación auditiva presentada en el estudio de TEA estuvo compuesta por tonos generados electrónicamente o producidos por una cantante profesional, con el objetivo de investigar si la alteración en el desarrollo del lenguaje, típicamente descrita para estos niños, es causada por un déficit selectivo al procesar las características internas de la voz humana. Los componentes analizados para el estudio del TEA fueron el P1 y la MMN. Los niños con TEA presentaron una menor amplitud para los componentes P1 y MMN en comparación con el grupo control, lo cual sugiere una habituación y discriminación auditivas reducidas tanto para el sonido electrónico como el humano. Dado que la MMN también se ha relacionado con la codificación predictiva, los sujetos con TEA tendrían disminuida esta capacidad. El diseño experimental presentado al grupo adulto sano estuvo compuesto por dos paradigmas experimentales diferentes según el nivel de abstracción requerido para extraer un patrón: en un caso, la predicción dependía de las características físicas de los estímulos presentados (las frecuencias de los tonos) mientras que, en el otro caso, dependía de su organización (la dirección ascendente o descendente de las secuencias de tonos). Un componente similar a la MMN (“MMN-like”) y uno lento (posiblemente una Postimperative Negative Variation, PINV) fueron analizados con el objetivo de comprobar la hipótesis de la codificación predictiva. Los resultados obtenidos son detallados en dos artículos. Estos componentes registrados en población adulta fueron, primero, propuestos como una MMN y una Slow Preceding Negativity (SPN) y, posteriormente, reconceptualizados en el segundo artículo como un N1 tardío y una PINV. Ambos componentes se desarrollaban en la latencia de la MMN y el intervalo entre ensayos, respectivamente. Los resultados obtenidos en la investigación realizada en el grupo adulto, mostraron una mayor amplitud ante los ensayos desviantes y el paradigma más complejo, en ambos componentes analizados, lo que sugiere que están involucrados en el establecimiento y actualización de las predicciones basadas no solo en las características físicas de los estímulos, sino también en reglas abstractas. Además, tanto el N1 tardío como la PINV presentaron respuestas de diferente amplitud dependiendo del ensayo previamente presentado, lo que sugeriría una actualización continua de los ensayos, hasta donde sabemos, no descrita para estos componentes en la literatura previa

    Exploring how family carers of a person with dementia manage pre-death grief: A mixed methods study

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    Objectives: Many family carers of a person with dementia experience pre-death grief. We aimed to identify strategies that help carers manage pre-death grief. We hypothesised that emotion and problem focussed styles would be associated with lower, and dysfunctional coping with higher grief intensity. Methods: Mixed methods observational study using structured and semi-structured interviews with 150 family carers of people with dementia living at home or in a care home. Most participants were female (77%), caring for a parent (48%) or partner/spouse (47%) with mild (25%), moderate (43%) or severe (32%) dementia. They completed the Marwit-Meuser Caregiver Grief Inventory Short Form and the Brief Coping Orientation to Problems Experienced (Brief-COPE) questionnaire. We asked carers to identify strategies used for managing grief. We recorded field notes for 150 interviews and audio-recorded additional interviews with a sub-sample of 16 participants. Results: Correlations indicated that emotion-oriented coping was associated with lower grief (R = −0.341), and dysfunctional coping with higher grief (R = 0.435), with a small association with problem-focused strategies (R = −0.109), partly supporting our hypothesis. Our qualitative themes broadly match the three Brief-COPE styles. Unhelpful strategies of denial and avoidance align with dysfunctional coping strategies. Psychological strategies (including acceptance and humour) and seeking support were consistent with emotion-focused strategies, but we did not identify a theme relating to problem-focused strategies. Conclusion: Most carers identified multiple strategies for processing grief. Carers could readily identify supports and services that they found helpful for managing pre-death grief, yet current services appear under-resourced to meet growing demand. (ClinicalTrials.gov ID: NCT03332979)
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