An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

Medicines optimisation for young people with juvenile arthritis and other long-term conditions:system-level barriers to engagement

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings:protocol for a systematic review of qualitative studies

Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.

Consistency of the decision-maker in pair-wise comparisons

Most authors assume that the natural behaviour of the decision-maker is being inconsistent. This paper investigates the main sources of inconsistency and analyses methods for reducing or eliminating inconsistency. Decision support systems can contain interactive modules for that purpose. In a system with consistency control, there are three stages. First, consistency should be checked: a consistency measure is needed. Secondly, approval or rejection has to be decided: a threshold value of inconsistency measure is needed. Finally, if inconsistency is ‘high’, corrections have to be made: an inconsistency reducing method is needed. This paper reviews the difficulties in all stages. An entirely different approach is to elaborate a decision support system in order to force the decision-maker to give consistent values in each step of answering pair-wise comparison questions. An interactive questioning procedure resulting in consistent (sub) matrices has been demonstrated.

The 3 per cent Barcelona Target: A Critical Appraisal of the Failure of the Lisbon Strategy’s Knowledgebased Economy and Society Project

Ten years after the unanimous approval of the Lisbon Strategy at a special meeting of the European Council on 23-24 March 2000 in Lisbon, it will be inevitable for the European Council, the European Commission and the majority of the EU member states to face with its fi asco and to account for the reasons of their fundamental policy, governance and economic failures in 2010. The recent turbulence of the global economy offers some excuses for the underperformance of the main objectives of the Lisbon Strategy in the essential social and economic domains, like job creation, economic growth, and environmental sustainability. Negative growth rates, macroeconomic and fi nancial instability, the contraction of the internal and external markets of the European economy, drop in demand for capital investment, goods and services, sinking corporate revenues, depreciation of corporate assets, increasing private and public indebtedness, falling rate of employment, weakening social cohesion, widening social inequality, and so forth not only deprive the majority of the EU member states of fulfi lling the main objectives of the Lisbon Strategy but also drive them into worse social and economic conditions in many policy domains than they were in 2000.

The corruption risks of EU funds in Hungary

In corruption, a group of players gain an economic advantage without providing any socially beneficial services in return, therefore corruption is considered to be a form of rent-seeking. Similar to other forms of rent-seeking, corruption causes losses on a societal level, due to the less efficient allocation of resources, as well as the costs of operation and prosecution. Fighting corruption is important not just because of ethical but also economic considerations. Contributions from the European Union are making possible the use of more funds than ever, and spending the full amount of this money is a priority preference of the government. The abundance of funds and the pressure on absorption increase corruption, by the managers of the funds overplanning the amount of money to be allocated to individual tender invitations, setting generous rules on eligible costs, and specifying low rates of own contribution wherever possible. As a result, the opportunities for rent-seeking are increased, as it is worth it for beneficiaries to carry out the project even after relinquishing part of the funds they have been awarded. Thus, the abundance of funds generates a sphere of corruption in which rent-seekers may appear on various levels of the system, often even without the knowledge or approval of those on higher decisionmaking levels.

Faculty Bylaws

A draft of the College of Medicine's Faculty Bylaws submitted for review and approval by the Florida International University Administration on October 5, 2007.

Essays on the political economy of the Dominican reform process

This dissertation provides an analytical framework to study the political economy of policy reform in the Dominican Republic during the nineties. Based on a country study, I develop two theoretical models that replicate the mechanisms of policy approval in developing countries with weak democracies. The first model considers a pro-reform President who submits a tariff bill to an anti-reform Congress dominated by the opposition party. In between, two opposing lobbies try to get their favored policy approved. Lobbies act as Stackelberg leaders vis a vis a weak President. The behavior of the Congress is determined exogenously while the lobbies act strategically pursuing the approval of the reform bill and indirectly affecting the President's decision. I show that in such a setting external agents like the Press play an important role in the decision-making process of the political actors. ^ The second model presents a similar framework. However, the President, who is a Stackelberg leader, is allowed only two choices, total reform or status-quo. I show how a lobby reacts to an increase in its rival's or its own size. These reactions depend on the President's level of commitment to the reform. Finally, I discuss the effect of variations in the size of the lobbies on the President's choice. The model suitably explains real events that took place in the Dominican Republic in the mid-nineties. ^

Gender across cultures: The immigration experience/Bulgarian immigrants in South Florida

During the last decade, the United States has witnessed a high increase in its immigration flow. Despite recent surge of interest in numerically small ethnic groups, data on Bulgarian immigrants in the United States is almost non-existent. This is the first comprehensive study on the Bulgarian ethnic group in the United States. ^ This study examined the impact of immigration upon the negotiation of cultural prescriptions by Bulgarian immigrants in the United States. Several fundamental Bulgarian prescriptions for daily behavior, such as emphasis on stability rather than mobility, preference for collectivism instead of individualism, and wide use of social critique rather than social approval were tested on U.S. soil. Furthermore, the impact of gender upon cultural appropriation and retention was considered. The study made use of a comprehensive historical analysis of Bulgarian immigration to the United States, statistical descriptions of contemporary Bulgarian immigrants in the United States, and over a three-year long qualitative study of Bulgarian immigrants in South Florida. ^ The results of the study indicated that the transferring of cultural prescriptions due to immigration did not occur unaffected by gender. Bulgarian and U.S. cultural models clashed, intermingled, and resisted each other in various ways depending on the immigrants' gender. At the same time, gender did not solely determine the validity of prescriptions for daily behavior, but it rather acted in concert with other principles of everyday life. In addition, gender impacted significantly the method, type, and structure of the immigration journey. Gender was a very significant variable in the determination of these features of the immigration process, but it did not account independently for historical variations. Other factors, such as larger contexts of reception and rejection also played an important role. ^

Substance use and sexual risk behaviors among adolescent detainees

There is a commonly presumed link among sexual risk behavior, substance use, and other psychosocial factors among adolescents. However, these relationships have been relatively understudied in detained, low-income, minority, substance abusing adolescents. This study addresses this gap in the literature with a secondary data analysis based on a sample of adolescent offenders in two detention and treatment centers in Miami-Dade County. Univariate, bivariate statistical analysis and multivariate logistic regressions were conducted on baseline data from structured interviews with 455 adolescents participating in an NIH funded prevention intervention. Data were analyzed to assess relationships among self-reported substance use, STD history, HIV/AIDS knowledge, condom use, condom use attitudes, and skills, peer and parental approval to use condoms, and race/ethnicity. The adolescent sample was 74.1% male, and 25.9% female and 35.4% African American, 25.1% non-African American Latino, 11.2% White, and 28.4% of other race/ethnicity categories. The mean age was 15.6 years. Results suggested that alcohol use (p < 0.001) and use of marijuana, cocaine and other drugs (p < 0.001) are significant variables when explaining the variability in sexual risk behaviors. Results also suggested that unprotected vaginal, anal, and oral sex increased with higher alcohol and drug use (p < 0.001) and that positive attitudes about personally using condoms (p < 0.001) were also significantly related to condom use. Logistic regressions showed that race/ethnicity was a significant control variable when explaining the variability of condom use. Being White and Latino were significantly associated with less condom use during oral and anal sex when compared to other racial/ethnic groups. These results indicated that risky sexual behavior and HIV infection risk are significantly associated with substance use, particularly alcohol use. Therefore, proper screening and identification of alcohol use, and condom use attitudes could maximize the efficacy of referrals to programs targeting both issues and increase the potential for appropriate primary and secondary prevention and treatment among adolescent detainees.

Domestic Politics in the Dominican Republic after the Earthquake in Haiti

Despite historical tensions between the Dominican Republic and Haiti, Dominicans appear to have put aside their resentment in favor of supporting Haitians after the earthquake that devastated the neighbor nation in January 2010. Over the past several months, there has been unprecedented cooperation between the Dominican Republic and Haiti, with little evidence of a negative impact on domestic politics in the Dominican Republic. In fact, the high ratings of President Leonel Fernández and the results of the May Parliamentary elections may suggest that how the Fernández administration handled the Haitian crisis did not have a negative impact on citizens’ perception. However, the issue of Haitian immigration remains very sensitive in the Dominican Republic, and has the potential to become the major concern on the domestic political front. As of June 2010, the Haitian crisis seemed to have little or no impact on Dominican politics, as the following points indicate: The May 16, 2010 Parliamentary elections increased President Fernández political party to 31 out of 32 Senate seats, and 105 out of 183 Chamber of Deputies seats; this is a total increase of 18 seats from the previous term. Polls indicate that President Fernández has a 54 percent approval rating. Polls also indicate that Haiti is not among the most pressing issues of concern to Dominican citizens. Instead, 65 percent of the population identifies drug trafficking and corruption as the greatest concerns. The immigration debate will remain the major consideration in domestic politics in the Dominican Republic; 62.4 percent of Dominicans polled think that the military should be strengthened along the DR-Haitian border.

Discipline And Due Process In The Workplace

In the article - Discipline and Due Process in the Workplace – by Edwin B. Dean, Assistant Professor, the School of Hospitality Management at Florida International University, Assistant Professor Dean prefaces his article with the statement: “Disciplining employees is often necessary for the maintenance of an effective operation. The author discusses situations which require discipline and methods of handling employees, including the need for rules and due process.” In defining what constitutes appropriate discipline and what doesn’t, Dean says, “Fair play is the keystone to discipline in the workplace. Discrimination, caprice, favoritism, and erratic and inconsistent discipline can be costly and harmful to employee relations, and often are a violation of law.” Violation of law is a key phrase in this statement. The author offers a short primer on tact in regard to disciplining an employee. “Discipline must be tailored to the individual,” Dean offers a pearl of wisdom. “A frown for one can cause a tearful outbreak; another employee may need the proverbial two-by-four in order to get his attention.” This is a perceptive comment, indeed, and one in which most would concede but not all would follow. Dean presents a simple outline for steps in the disciplinary process by submitting this suggestion for your approval: “The steps in the disciplinary process begin perhaps with a friendly warning or word of advice. The key here is friendly,” Dean declares. “It could progress to an oral or written reprimand, followed by a disciplinary layoff, terminating in that equivalent of capital punishment, discharge.” Ouch [!]; in order from lenient to strident. Dean suggests these steps are necessary in order to maintain decorum in the workplace. Assistant Professor Dean references the Weingarter Rule. It is a rule that although significant, most employees, at least non-union employees, don’t know is in their quiver. “If an interview is likely to result in discipline, the employee is entitled to have a representative present, whether a union is involved or not,” the rule states. “The employer is not obligated to inform the employee of the rule, but he is obligated to honor the employee's request, if made,” Dean explains. Dean makes an interesting point by revealing that a termination often reflects as much on the institution as it does the employee suffering the termination. The author goes on to list several infractions that could warrant an employee disciplinary action, with possible approaches toward each. Dean also cautions against capricious disciplinary action; if not handled properly a discipline could and can result in a lawsuit against the institution itself.

Essays on Competition in the Pharmaceutical Industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.

Substance Use and Sexual Risk Behaviors among Adolescent Detainees

During the past two decades there has been much research conducted on the relationship between the risky sexual behavior practices and substance use among U.S. adolescents. This body of research has documented the fact that substance use and not using condoms are the most important indicators associated with the risk of becoming infected with sexually transmitted diseases (STD) both among adolescents and adults (Florida Department of Public Health, 2004; Malow, Devieux, Jennings, & Lucenko, 2001; McCoy & Inciardi, 1995). Data from those reports and studies indicate that adolescents and adults who use a condom regularly and appropriately are 20 times less likely to contract an STD than those who do not (Pinkerton & Abramson, 1997). However, less empirical evidence exists about the factors that influence adolescent use of condoms, particularly among adolescents who are detained due to their criminal lifestyle. Researchers have found both a high prevalence of STD in addition to early onset of sexual activity without protection among some adolescent groups such as the detainees (D'angelo & DiClemente, 1996) and that adolescents tend to underestimate their risks of acquiring the human immunodeficiency virus (HIV) (Magura, Shapiro, & Kang, 1994). Many adolescents will experiment with alcohol and other drugs. This behavior may compromise their judgment and increase their chances of engaging in risky sex (Rotheram-Borus, 2000). Hence the need for research that investigates the influence that substance use, risky sexual attitudes, knowledge about the transmission of HIV, and both peer and parental approval of condom use have on the use of condoms among both female and male adolescent detainees. Lastly, it is important for additional research to be conducted because adolescent detainees have been identified as being at high risk of becoming infected with an STD (Malow, Rosemberg, & Devieux, 2006). The purpose of this study was to examine the relationship among adolescent substance use, gender, sexual risk attitude, attitude about personal use of condoms, knowledge associated with the transmission of HIV, peer and family approval of condom use, history of sexually transmitted diseases (STD) and the level of condom use in a sample of adolescents housed in a correctional institution. Further details of the explanatory variables, the control variables and their expected relationships can be found in the review of the Literature in Chapter 2. Also, more information about the separate analysis of the research questions is detailed in the Methods section in Chapter 3. Based on the literature detailed in Chapter 2 (e.g., Malow et al., 2006), the current study’s researcher anticipated that adolescents’ higher levels of illicit drug use would be related to higher levels of sexual risk behaviors, as measured by lower levels of condom use, than their counterparts who used no drugs. Similarly, it was hypothesized that positive attitudes toward condom use and higher levels of HIV risk knowledge would be associated with a lower level of risky sexual behaviors along with a higher level of condom use skill. It was further hypothesized that the level of approval perceived from parents and peers regarding condom use was going to be related to adolescents’ safe sex behavior (i.e., condom use). Therefore, it was expected that participants’ perception of a high level of approval to use condoms from peers and parents would be a statistically significant variable in helping explain the condom use within this sample of adolescent detainees.

Essays on the political economy of the dominican reform process

This dissertation provides an analytical framework to study the political economy of policy reform in the Dominican Republic during the nineties. Based on a country study, I develop two theoretical models that replicate the mechanisms of policy approval in developing countries with weak democracies. The first model considers a pro-reform President who submits a tariff bill to an anti-reform Congress dominated by the opposition party. In between, two opposing lobbies try to get their favored policy approved. Lobbies act as Stackelberg leaders vis a vis a weak President. The behavior of the Congress is determined exogenously while the lobbies act strategically pursuing the approval of the reform bill and indirectly affecting the President's decision. I show that in such a setting external agents like the Press play an important role in the decision-making process of the political actors. The second model presents a similar framework. However, the President, who is a Stackelberg leader, is allowed only two choices, total reform or status-quo. I show how a lobby reacts to an increase in its rival's or its own size. These reactions depend on the President's level of commitment to the reform. Finally, I discuss the effect of variations in the size of the lobbies on the President's choice. The model suitably explains real events that took place in the Dominican Republic in the mid-nineties.