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Intermediate Outcomes Summary of the Findings Articles measuring intermediate outcomes as their main endpoint were selected buy discount dilantin 100 mg online. We focused on the intermediate outcomes of: use; measures which were correlated with use (such as ease of use of the system buy dilantin 100 mg with amex, perceptions of users of the system generic 100 mg dilantin with mastercard, computer experience, etc. Few hypothesis-driven studies with comparison groups assessed such intermediate outcomes as their main measure; 42 studies published in 44 articles were retrieved (Appendix C, Evidence Table 7). The study results tended to show positive levels of satisfaction and use and measured a number of correlates of both to determine driving factors barriers, or both. Studies of complex interventions often covered more than one phase of medication 540,644-647 management. Most of the studies were conducted in hospitals (n = 27) or primary care (n = 17), one in long-term care, and four in pharmacies, and assessed intermediate outcomes for health care staff. Prescribing was the most commonly studied phase of medication management, but each other phase was represented. Most studies did not report on the proprietary nature of their systems, 17 studied commercial systems and seven were home grown. Many studies looked to correlate use of medication management systems with other factors. Only nine studies assessed intermediate outcomes for patients (Table 633,637,639,641,642,648-651 13). Twenty-six studies looked at intermediate outcomes for interventions aimed at the prescribing phase (see Appendix C, Evidence Table 22). One study 653 focused on the use of standards for medical history, formulary, and benefits. Satisfaction and 636,637,644,645,654-659 correlates of satisfaction were measured in ten studies; use and measures 534,643,649,650,653,660-665 666 correlated with use were studied in 11 studies. Glassman and colleagues looked at the impact of drug-drug interaction alerts on physician knowledge over time. Participants were generally health care providers, located in either hospitals (16 540 studies), primary care (ten studies), or both, and one pharmacy. Four studies looked at the order communication phase; three 540,645,668 focussed on e-transfer of prescriptions, and all studied the perceptions of pharmacy staff 645 as well as other stakeholders. Rupp and Warholak administered a survey and followed up with interviews of American chain community pharmacy staff to assess their attitudes towards e- Prescribing and recruited a sample of 1094 pharmacists, technicians, and interns from 276 668 pharmacies. Porteous and colleagues surveyed 494 patients, 145 general practitioners, and 148 pharmacists, and held interviews and focus groups to assess peoples’ views regarding the upcoming implementation of e-Transfer of prescription information in the United Kingdom. On 39 669 the other hand, Kirking and Thomas performed a survey looking at pharmacists’ attitudes towards computer technology used to detect and prevent adverse drug interactions, and correlated their findings with pharmacist computer use. Their sample included 218 pharmacists in Michigan using one of two pharmacy computer systems and a group of nonusers. Johnson and 540 colleagues assessed the perceived usefulness of alerts and override comments appended to e- Prescriptions. Chan assessed factors associated with medication administration records use in nursing homes. Weingart 641 and colleagues measured the use of PatientSite, a patient internet portal, by 416 patients in three primary care practices to facilitate communication between physicians and patients regarding medication adherence and adverse effect rates. One study evaluated patient and physician satisfaction and perceptions of a 651 discharge reconciliation application. The study by Liu and colleagues is the only study focusing on the education aspect of medication management. Knowledge was assessed in pre-post surveys of 154 patients and they reported perceived knowledge gains. From our included studies, use and measures 40 660 that were correlated with use were frequently measured. Access to medication history was more frequently used for patients with low socioeconomic 650 status and a greater number of medications. Wang 653 and colleagues found that a positive performance measure based on ease, efficiency, and care was correlated with nonuse of an e-Prescribing system incorporating standards for medication history, benefits, and formulary. A study assessing the frequency of use of three common pediatric order sets found differential use rates, with asthma order sets used significantly more often than both appendectomy and community-acquired pneumonia order 649 sets. Three studies looked at usability and also included data on comparison 638,647,652 638 groups.

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Taking into account the fact that bioflm structures examined strains and 7 reference strains did not form bioflms are the main factor of virulence involved in infections (Table 1) dilantin 100 mg mastercard. Bacteria growing in a form thepresenceoftheicaA gene did not induce the phenotypical of bioflm are from 100- up to 1000-fold more resistant than presence of bioflm in any of the methods used buy dilantin 100 mg fast delivery. Tese strains were more suscep- tive inhibiting bioflm formation for the examined strains of tible to gentamicin with even higher diferences between the coagulase-negative staphylococci was 86 cheap 100mg dilantin with visa. In the case of 4-fuorophenylamino derivatives the mean Analysis of the susceptibility of eight S. A signifcant variation in bactericidal activity between An analysis of various antibiotic (cefazolin, vancomycin, planktonic and bioflm forms of bacteria was also reported dicloxacillin, tetracycline, and rifampicin) activity mecha- by El-Banna et al. Analyzing eight strains of staphy- nisms towards six strains of coagulase-negative staphylococci lococci (three strains of S. Otto, “Staphylococcus epidermidis infections,” for 4-fuorophenylamino derivative they were approximately Microbes and Infection,vol. Arciola,“Bioflmin of the examined compounds demonstrate high activity implant infections: its production and regulation,” International with respect to strains growing in a bioflm, and a clear Journal of Artifcial Organs,vol. Goldmann, “Coagulase-negative staphy- in this heterocyclic class of quinoline molecules depends on lococci: role as pathogens,” Annual Review of Medicine,vol. Mierzejewski, “Bioflm as were similarly as sensitive as their planktonic counterparts, multicellular organism created by bacteria. Microbiologist and probably due to the dual activity of tested compounds on doctor’s perspective,” Military Pharmacy and Medicine,vol. Costerton,“Antibioticresistanceof documented for the frst time in this study which outlines bacteria in bioflms,” Te Lancet,vol. Greenberg,“Bacterial toelucidatethecomplexmodeofactionofnewlysynthetized bioflms: a common cause of persistent infections,” Science,vol. Ciofu, “Antibiotic resistance of bacterial bioflms,” International Jour- nal of Antimicrobial Agents,vol. Bueno, “Anti-bioflm drug susceptibility testing methods: looking for new strategies against resistance mechanism,” Jour- Te administration of suboptimal chemotherapeutic con- nal of Microbial & Biochemical Technology,vol. Terefore, it seems to be viable and purposeful to bacteria embedded in a bioflm,” Virulence,vol. Michiels,“Roleofpersister eringtheexaminedcompounds,weconcludethatonly4- cells in chronic infections: clinical relevance and perspectives chlorophenylamino derivative demonstrates such abilities. Nakonieczna, and chronic cumulative toxicities due to long-term adminis- “Innovative strategies to overcome bioflm resistance,” BioMed tration is needed prior to clinical application of these drugs. Bou, “Antimicrobial resistance Conflict of Interests and virulence: a successful or deleterious association in the bacterial world? Kouznetsov, “Recent devel- “Characterization of the -Acetylglucosaminyltransferase opments on antimicrobial quinoline chemistry,” in Microbial activity involved in the biosynthesis of the Staphylococcus Pathogens and Strategies for Combating Tem: Science, Technol- epidermidis polysaccharide intercellular adhesin,” Te Journal ogy and Education,A. Jabbouri, “Neither the cultureplates:aquantitativemodelfortheadherenceofstaphy- presence of ica locus, nor in vitro-bioflm formation ability is a lococci to medical devices,” Journal of Clinical Microbiology,vol. Gotz, “Characteriza-¨ [37] Clinical and Laboratory Standards Institute, “Performance tion of the importance of Staphylococcus epidermidis autolysin standards for antimicrobial disk and dilution susceptibility and polysaccharide intercellular adhesin in the pathogenesis of test: M2-A9. Performance standards for antimicrobial sus- intravascular catheter-associated infection in a rat model,” Te ceptibility testing,” Tech. Greenberg, “Te involvement of cell-to-cell Complementary and Alternative Medicine,vol. Gotz,¨ “Activity of gallidermin on Staphylococcus “Resistance of bacterial bioflms to disinfectants: a review,” aureus and Staphylococcus epidermidis bioflms,” Antimicrobial Biofouling,vol. Stewart, “Reduced glucopyranose on bioflm formation by Staphylococcus aureus,” susceptibility of thin Pseudomonas aeruginosa bioflms to Antimicrobial Agents and Chemotherapy,vol. Gilbert, “Changes Shindo, “Antimicrobial susceptibility of Staphylococcus aureus in the biocide susceptibility of Staphylococcus epidermidis and and Staphylococcus epidermidis bioflms isolated from infected Escherichia coli cells associated with rapid attachment to plastic total hip arthroplasty cases,” Journal of Orthopaedic Science,vol. Antimicrobial activity of novel 1-methyl-3- rapid determination of antibiotic susceptibilities of bacterial thio-4-aminoquinolinium salts,” Folia Microbiologica,vol.

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At present generic dilantin 100mg otc, the most that research on opioid addiction and treatment is can be said is that there seems to be a clarifying what works to improve treatment specific neurological basis for the com- outcomes trusted 100 mg dilantin, with an emphasis on accelerating the pulsive use of heroin by addicts and incorporation of evidence-based methods into that methadone taken in optimal doses treatment cheap dilantin 100 mg on-line. They found that genet- of Treatm ent ic, personal-choice, and environmental factors played comparable roles in the etiology and Opioid addiction as a m edical course for these disorders and that rates of relapse and adherence to medication were simi- disorder lar, although substance addiction often was Discussions about whether addiction is a medi- treated as an acute, not chronic, illness. Their cal disorder or a moral problem have a long review of outcome literature showed that, as history. For decades, studies have supported with the other disorders, substance addiction the view that opioid addiction is a medical dis- has no reliable cure but that patients who com- order that can be treated effectively with medi- ply with treatment regimens have more favor- cations administered under conditions consis- able outcomes. Fewer than 30 percent of tent with their pharmacological efficacy, when patients with asthma, hypertension, or diabetes treatment includes comprehensive services, adhered to their medication regimens, pre- such as psychosocial counseling, treatment for scribed diets, or other changes to increase their co-occurring disorders, medical services, voca- functional status and reduce their risk of symp- tional rehabilitation services, and case manage- tom recurrence. For ing neurological and endocrinologic example, patients who were older and processes in patients whose endogenous employed with stable families and marriages ligand-receptor function has been were found to be more likely to comply with deranged by long-term use of powerful treatment and have positive treatment results narcotic drugs. W hy some persons who than were younger, unemployed patients with are exposed to narcotics are more less stable family support. Treatment also was similar to such conditions as diabetes, hyper- associated with a significant reduction, but not tension, and asthma. For example, W oody and necessarily cessation, of drug use for many Cacciola (1994) found that the risk of relapse individuals. Similar findings on the positive for a person who was opioid addicted was high- health outcomes associated with maintenance est during the first 3 to 6 months after cessa- treatment of opioid addiction, regardless of tion of opioid use. This risk declined for the whether abstinence was attained, were seen in first 12 months after cessation and continued to studies finding that methadone maintenance decrease but at a much slower rate. The goal is always reducing or opioid addiction with maintenance medication, eliminating the use of illicit opioids and other along with other treatment services for related illicit drugs and the problematic use of pre- problems that affect patientsí motivation and scription drugs. Conversely, dis- The medical community recognizes that opioid continuation of maintenance medication often addiction is a chronic medical disorder that results in dropout from other services and a can be treated effectively with a combination of return to previous levels of opioid abuse, with medication and psychosocial services. After hearing from experts and C, and tuberculosis (see chapter 10) and to and the public and examining the literature, increase compliance with medical, psychiatric, the panel concluded that ì[opioid addiction] is and prenatal care (Chaulk et al. Recent data on ed with significant benefits for the patient and buprenorphine indicate that treatment with this societyî (National Institutes of Health 1997b, medication, like methadone, has similar positive p. It called for ìa commitment to Viewing opioid addiction as a medical disorder offer effective treatment for [opioid addiction] is consistent with the idea that treatment of to all who need itî (p. For through increased funding, less restrictive 4 Chapter 1 regulation, and efforts to make treatment avail- addiction. For example, many States Buprenorphine is have removed restrictions on the length of time used to treat individu- tion is a chronic that patients may remain in treatment. These medications are (Substance Abuse and Mental Health Services discussed in chapter 3. A designated medication unit tive treatment medications for chronic opioid Introduction 5 (e. Although important strides have been made, much remains to be done to improve and Based on the framework provided by the Drug expand treatment and to address the stigma Addiction Treatment Act of 2000 (21 United that affects patients and programs. From 1995 to 2002, the rate among chronically or occasionally use heroin in the youth ages 12 to 17 increased from 0. For people Abuse and Mental Health Services who abuse opioid medications normally Administration 2003c). Prom oting Evidence-Based Lack of funding for services remains a significant barrier to treatment. The Rikers Island jail facility in New York City has been providing inmates access to methadone treatment since Com bating Stigm a 1987 (National Drug Court Institute 2002). For almost a century, the predominant view of Rhode Island jail facilities offer a 30-day opioid addiction has been that it is a self- dose-tapering program. Use of methadone and other therapeutic medications has been viewed Prom oting Com prehensive traditionally as substitute therapyómerely Treatm ent replacing one addiction with another and the In its 1999 publication, Principles of Drug treatment of choice for those too weak to over- Addiction Treatment: A Research-Based Guide, come temptation. Fortunately, positive changes are munity institutions, affecting the attitudes of occurring in each area. It negative stereotypes discourages them from entering treatment and effective skills for and media stories. It cre- Managers and staff ates a barrier for those trying to access other working with the members should parts of the health care system.

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