Development of a quality use of medicines coding system to rate clinical pharmacists' medication review recommendations

Objective: To develop a 'quality use of medicines' coding system for the assessment of pharmacists' medication reviews and to apply it to an appropriate cohort. Method: A 'quality use of medicines' coding system was developed based on findings in the literature. These codes were then applied to 216 (111 intervention, 105 control) veterans' medication profiles by an independent clinical pharmacist who was supported by a clinical pharmacologist with the aim to assess the appropriateness of pharmacy interventions. The profiles were provided for veterans participating in a randomised, controlled trial in private hospitals evaluating the effect of medication review and discharge counselling. The reliability of the coding was tested by two independent clinical pharmacists in a random sample of 23 veterans from the study population. Main outcome measure: Interrater reliability was assessed by applying Cohen's kappa score on aggregated codes. Results: The coding system based on the literature consisted of 19 codes. The results from the three clinical pharmacists suggested that the original coding system had two major problems: (a) a lack of discrimination for certain recommendations e. g. adverse drug reactions, toxicity and mortality may be seen as variations in degree of a single effect and (b) certain codes e. g. essential therapy were in low prevalence. The interrater reliability for an aggregation of all codes into positive, negative and clinically non-significant codes ranged from 0.49-0.58 (good to fair). The interrater reliability increased to 0.72-0.79 (excellent) when all negative codes were excluded. Analysis of the sample of 216 profiles showed that the most prevalent recommendations from the clinical pharmacists were a positive impact in reducing adverse responses (31.9%), an improvement in good clinical pharmacy practice (25.5%) and a positive impact in reducing drug toxicity (11.1%). Most medications were assigned the clinically non-significant code (96.6%). In fact, the interventions led to a statistically significant difference in pharmacist recommendations in the categories; adverse response, toxicity and good clinical pharmacy practice measured by the quality use of medicine coding system. Conclusion: It was possible to use the quality use of medicine coding system to rate the quality and potential health impact of pharmacists' medication reviews, and the system did pick up differences between intervention and control patients. The interrater reliability for the summarised coding system was fair, but a larger sample of medication regimens is needed to assess the non-summarised quality use of medicines coding system.

A comparison of model laws as a starting point for the development of an enforceable international consumer protection regime

This article is concerned primarily with an examination and comparison of select aspects of the model international consumer protection laws proposed by the United Nations (UN), the European Union (EU), and the Organisation for Economic Co-operation and Development (OECD), using the Trade Practices Act 1974 (Australia) as a basis for examination and comparison. As a secondary consideration, it also broadly examines the content of, and differences between, the model laws. The motive for this article is that any future enforceable international consumer protection regime (possibly in the form of an international treaty or convention) would need to take into account the UN, EU and OECD guidelines. A cross-comparison of those model laws, and a comparison of them with the consumer protection provisions of a well established national consumer protection law, should provide a useful starting point for the development of such a regime. The 'select aspects' of the model laws in question are the various provisions of those laws which could relate to situations involving the wrong delivery or non-delivery of goods.

Sport-specific practice and the development of expert decision-making in team ball sports

The role of sport-specific practice in the development of decision-making expertise in the sports of field hockey, netball, and basketball was examined. Fifteen expert decision-makers and 13 experienced non-expert athletes provided detailed information about the quantity and type of sport-specific and other related practice activities they had undertaken throughout their careers. Experts accumulated more hours of sport-specific practice from age 12 years onwards than did non-experts, spending on average some 13 years and 4,000 hours on concentrated sport-specific practice before reaching international standard. A significant negative correlation existed between the number of additional activities undertaken and the hours of sportspecific training required before attaining expertise, suggesting a functional role for activities other than sport-specific training in the development of expert decision-making.

A retrospective analysis of leadership development through sport

The purpose of this study was to examine the development of six leader-athletes. In-depth qualitative interviews were used to explore the various activities that leader athletes engaged in from an early age as well as the roles and influences that peers, coaches, and parents played within these activities. Results indicated that leadership development in sport focused on developing four central components: high skill, strong work ethic, enriched cognitive sport knowledge, and good rapport with people. The types of activities engaged in throughout development as well as receiving feedback, acknowledgement, support, cognitive engagement, mature conversations with adults, and physical encounters with older peers are important social influences that can play an instrumental role in the formation of these four central tenets.

The development of chromatography for the characterization of protein interactions: a personal perspective

This article reviews the progress of a personal endeavour to develop chromatography as a quantitative procedure for the determination of reaction stoichiometries and equilibrium constants governing protein interactions. As well as affording insight into an aspect of chromatography with which many protein chemists are unfamiliar, it shows the way in which minor adaptations of conventional chromatographic practices have rendered the technique one of the most powerful methods available for the characterization of interactions. That pathway towards quantification is followed from the introduction of frontal gel filtration for the study of protein self-association to the characterization of ligand binding by the biosensor variant of quantitative affinity chromatography.

Use of confocal microscopy to follow the development of penetrative hyphae during growth of Rhizopus oligosporus in an artificial solid-state fermentation system

Two methods were compared for determining the concentration of penetrative biomass during growth of Rhizopus oligosporus on an artificial solid substrate consisting of an inert gel and starch as the sole source of carbon and energy. The first method was based on the use of a hand microtome to make sections of approximately 0.2- to 0.4-mm thickness parallel to the substrate surface and the determination of the glucosamine content in each slice. Use of glucosamine measurements to estimate biomass concentrations was shown to be problematic due to the large variations in glucosamine content with mycelial age. The second method was a novel method based on the use of confocal scanning laser microscopy to estimate the fractional volume occupied by the biomass. Although it is not simple to translate fractional volumes into dry weights of hyphae due to the lack of experimentally determined conversion factors, measurement of the fractional volumes in themselves is useful for characterizing fungal penetration into the substrate. Growth of penetrative biomass in the artificial model substrate showed two forms of growth with an indistinct mass in the region close to the substrate surface and a few hyphae penetrating perpendicularly to the surface in regions further away from the substrate surface. The biomass profiles against depth obtained from the confocal microscopy showed two linear regions on log-linear plots, which are possibly related to different oxygen availability at different depths within the substrate. Confocal microscopy has the potential to be a powerful tool in the investigation of fungal growth mechanisms in solid-state fermentation. (C) 2003 Wiley Periodicals, Inc.

The Utility of the Human Security Agenda for Policy-makers

The idea of “human security” is gaining attention among policy-makers and security analysts. Little scholarly attention has been given to the questions of why states accept (or reject) a human security agenda or how such an agenda is incorporated into policy practices. The article suggests that a human security approach is most likely to be applied when both humanitarian and national interests combine. Yet when states or organisations adopt a human security approach, they often misjudge the complex and long-term commitment required of such an approach. There is also the potential for such an agenda to be manipulated to justify questionable courses of action. These issues frame an analysis of six recent case studies.

Seguridade social no Brasil

Este artigo analisa a pol??tica de seguridade social brasileira na perspectiva de sua formula????o legal na Carta Constitucional de 1988, com o objetivo de discutir tr??s enfoques relativos a esta pol??tica: os grupos de interesse implicados no projeto da seguridade social na Assembleia Nacional Constituinte de 1987/88; os princ??pios pol??tico-ideol??gicos que nortearam a defini????o deste modelo protetor; e os obst??culos surgidos na elabora????o e operacionaliza????o desta proposta. Passados nove anos da promulga????o da ???Constitui????o Democr??tica???, os princ??pios norteadores da Seguridade Social ainda n??o foram implementados, e os tr??s setores nela inseridos ??? sa??de, assist??ncia e previd??ncia social ??? deram prosseguimento ?? elabora????o de pol??ticas setorializadas e independentes. Este artigo discute, assim, as perspectivas da pol??tica protetora brasileira, utilizando como refer??ncia o debate hist??rico de formula????o desta pol??tica e apresentando os principais impasses no desenvolvimento da pol??tica protetora.

Ocupa????o no setor p??blico: tend??ncias recentes e quest??es em aberto

Com base neste trabalho, poder-se-ia hoje afirmar com maior seguran??a que: i) o movimento de recomposi????o de pessoal no setor p??blico brasileiro, observado durante toda a primeira d??cada de 2000, mostrou-se apenas suficiente para repor praticamente o mesmo estoque de servidores ativos existentes em meados da d??cada de 1990; ii) tampouco se deduz dos dados analisados que os gastos com pessoal tenham sa??do do controle do governo federal, pois, em termos percentuais, essa rubrica permaneceu praticamente constante ao longo da primeira d??cada de 2000, em um contexto de retomada relativa do crescimento econ??mico e tamb??m da arrecada????o tribut??ria; e iii) do ponto de vista qualitativo, evid??ncias da pesquisa indicam que esse movimento atual deve trazer melhorias gradativas ao desempenho institucional, pois vem sendo promovido a partir de crit??rios meritocr??ticos de sele????o (concursos p??blicos), e diante disso as atividades-fim, que exigem n??vel superior de escolariza????o, s??o mais contempladas do que as atividades-meio, indicando a possibilidade de maiores impactos sobre a produtividade agregada do setor p??blico; e tem assumido a forma de vincula????o estatut??ria, em detrimento do padr??o celetista ou de v??rias formas de contrata????o prec??rias, o que coloca o novo contingente sob direitos e deveres comuns e est??veis, podendo com isso gerar maior coes??o e homogeneidade no interior da categoria como um todo, aspecto considerado essencial para um desempenho satisfat??rio do Estado a longo prazo.

Lead reduces tension development and the myosin ATPase activity of the rat right ventricular myocardium

Lead (Pb2+) poisoning causes hypertension, but little is known regarding its acute effects on cardiac contractility. To evaluate these effects, force was measured in right ventricular strips that were contracting isometrically in 45 male Wistar rats (250-300 g) before and after the addition of increasing concentrations of lead acetate (3, 7, 10, 30, 70, 100, and 300 µM) to the bath. Changes in rate of stimulation (0.1-1.5 Hz), relative potentiation after pauses of 15, 30, and 60 s, effect of Ca2+ concentration (0.62, 1.25, and 2.5 mM), and the effect of isoproterenol (20 ng/mL) were determined before and after the addition of 100 µM Pb2+. Effects on contractile proteins were evaluated after caffeine treatment using tetanic stimulation (10 Hz) and measuring the activity of the myosin ATPase. Pb2+ produced concentration-dependent force reduction, significant at concentrations greater than 30 µM. The force developed in response to increasing rates of stimulation became smaller at 0.5 and 0.8 Hz. Relative potentiation increased after 100 µM Pb2+ treatment. Extracellular Ca2+ increment and isoproterenol administration increased force development but after 100 µM Pb2+ treatment the force was significantly reduced suggesting an effect of the metal on the sarcolemmal Ca2+ influx. Concentration of 100 µM Pb2+ also reduced the peak and plateau force of tetanic contractions and reduced the activity of the myosin ATPase. Results showed that acute Pb2+ administration, although not affecting the sarcoplasmic reticulum activity, produces a concentration-dependent negative inotropic effect and reduces myosin ATPase activity. Results suggest that acute lead administration reduced myocardial contractility by reducing sarcolemmal calcium influx and the myosin ATPase activity. These results also suggest that lead exposure is hazardous and has toxicological consequences affecting cardiac muscle.

Tendências contemporâneas da política de assistência social : uma análise das transformações ocorridas na concepção de assistência social no Brasil

O presente trabalho reúne os elementos que compõem a atual concepção de assistência social no Brasil, a partir da promulgação da constituição de 1988, quando a assistência social foi reconhecida pela primeira vez como direito de cidadania e dever legal do Estado, garantido pela Lei Suprema. Nesta lei, a assistência social pressupunha uma lógica de pleno emprego, destinada, portanto, prioritariamente aos incapazes para o trabalho. No entanto, em um contexto de desemprego estrutural esta passa a ser compreendida em termos de garantias de seguranças, buscando assumir a proteção social daqueles capazes para o trabalho, tendo em vista a deterioração do mercado de trabalho, restrição de oportunidades e de renda e o crescimento progressivo do desemprego e da informalidade. A ideia central é a de que se trata de uma descrição crítica da concepção de assistência social no Brasil, problematizando cada um de seus argumentos mais explícitos com o intuito de revelar uma intencionalidade vinculada à uma perspectiva de Estado. Utilizamos o termo concepção no sentido de conceber, pensar, sentir, entender ou interpretar algo. A assistência social, na atualidade, responde a um único processo que reúne aspectos históricos, econômicos, políticos, sociais e ideológicos e neste sentido, representa uma concepção de mundo e um projeto de sociedade, defendido pela classe dominante, pautado pela exploração do trabalho. A atual concepção de assistência social segue, portanto, uma nova forma de política social a partir da perspectiva de desenvolvimento humano e combate à pobreza em que a grande ênfase tem sido a de retirar as discussões e a intervenção na pobreza do âmbito da questão social, alocando-a nos indivíduos e em suas “incapacidades”. A assistência social ao assumir a responsabilidade ou coresponsabilidade no desenvolvimento de capacidades dos indivíduos sinaliza a tendência de uma nova concepção de bem-estar social.

Há salvação para a África? Thabo Mbeki e seu New Partnership for African development

O NEPAD - New Partnership for African Development - tem seus primórdios em 1996, proposto pelo atual presidente da África do Sul, Thabo Mbeki e outros líderes africanos, para erradicar a marginalização e o subdesenvolvimento africanos e promover o crescimento econômico, através da integração continental. Seus objetivos, inseridos no contexto da globalização e do African Renaissance, incorpora valores da luta antiapartheid sul-africana, restauração da auto-estima e resgate de valores pré-coloniais. O que o difere de outros planos que não deram certo na África é o vínculo inseparável entre democracia, direitos humanos, paz, governabilidade e o desenvolvimento econômico, as responsabilidades assumidas pelos participantes e a propriedade africana do plano.

Security issues during Lula's administration: from the reactive to the assertive approach

Brazil's security agenda during Lula's administration was not homogeneous through the two mandates: the first tenure (2002-2006) revealed a reactive approach towards security topics, while the second one (2006-2010) was more assertive. More specifically, the shift occurred in terms of both its geographical scope - once it incorporated global issues in a more systematic way -, and instruments through which the security agenda was exercised, given the multilateral initiative of Unasur's CDS

Terrorism as war by other means: national security and state support for terrorism

The conventional approach in the discipline of International Relations is to treat terrorist organizations as "non-state" actors of international relations. However, this approach is problematic due to the fact that most terrorist organizations are backed or exploited by some states. In this article, I take issue with the non-stateness of terrorist organizations and seek to answer the question of why so many states, at times, support terrorist organizations. I argue that in the face of rising threats to national security in an age of devastating wars, modern nation states tend to provide support to foreign terrorist organizations that work against their present and imminent enemies. I elaborate on my argument studying three cases of state support for terrorism: Iranian support for Hamas, Syrian support for the PKK, and American support for the MEK. The analyses suggest that, for many states, terror is nothing but war by other means.