subject:(pharmacoepidemiology)

University of Alberta

1. Gamble, John-Michael. The Impact of Restrictive Drug Coverage Policies on Pharmacoepidemiologic Methods and Health Outcomes.

Degree: PhD, School Public Health Sciences, 2012, University of Alberta

URL: https://era.library.ualberta.ca/files/9306t0331

► The unintended consequences of restrictive drug coverage policies on epidemiologic research methods and population health outcomes have been understudied. The primary objective of this program… (more)

▼ The unintended consequences of restrictive drug coverage policies on epidemiologic research methods and population health outcomes have been understudied. The primary objective of this program of research was to study the impact of these policies on the magnitude and direction of potential bias within administrative database studies. This was achieved through three related studies: 1) an observational study that estimated the magnitude of drug exposure misclassification in administrative data across seven therapeutic classes; 2) a simulation cohort study that quantified the potential degree of bias resulting from varying amounts of exposure misclassification to antidiabetic drugs introduced by restrictive drug coverage policies; and 3) a real-world cohort study that measured the effect of exposure misclassification introduced by capturing benefit drug use only on observed associations between exposure and outcome. We demonstrated that incomplete drug exposure information for drugs with a restrictive coverage policy is more common than previously thought. In fact, we found that on average, drugs with a restrictive coverage had a 40% absolute lower capture rate within one of the most widely used and accepted drug administrative databases, compared to drugs without coverage restrictions. Although our simulation study suggested a large degree of bias might be introduced when drug exposure is differentially misclassified according to a drug policy, results from our cohort study with real-world data demonstrated that a clinically important degree of bias was not apparent, at least for our three study drugs. In addition to impacting research methods, restrictive drug coverage policies themselves may have unintended clinical consequences at the population-level. Therefore, a second major initiative of the research program was to examine the population-level impact of removing a specific restrictive coverage policy. The fourth study demonstrated that removal of a prior authorization policy for thiazolidinediones significantly influenced drug utilization but did not adversely impact health outcomes. The results from our program of research highlight the importance of giving serious consideration to the impact of restrictive drug coverage policies when designing, analyzing, and interpreting a pharmacoepidemiologic study. Further, we demonstrate the usefulness of rigorous evaluation for understanding the population-level consequences of the removal of a drug policy.

Subjects/Keywords: Pharmaceutical Policy; Pharmacoepidemiology

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APA (6^th Edition):

Gamble, J. (2012). The Impact of Restrictive Drug Coverage Policies on Pharmacoepidemiologic Methods and Health Outcomes. (Doctoral Dissertation). University of Alberta. Retrieved from https://era.library.ualberta.ca/files/9306t0331

Chicago Manual of Style (16^th Edition):

Gamble, John-Michael. “The Impact of Restrictive Drug Coverage Policies on Pharmacoepidemiologic Methods and Health Outcomes.” 2012. Doctoral Dissertation, University of Alberta. Accessed March 04, 2021. https://era.library.ualberta.ca/files/9306t0331.

MLA Handbook (7^th Edition):

Gamble, John-Michael. “The Impact of Restrictive Drug Coverage Policies on Pharmacoepidemiologic Methods and Health Outcomes.” 2012. Web. 04 Mar 2021.

Vancouver:

Gamble J. The Impact of Restrictive Drug Coverage Policies on Pharmacoepidemiologic Methods and Health Outcomes. [Internet] [Doctoral dissertation]. University of Alberta; 2012. [cited 2021 Mar 04]. Available from: https://era.library.ualberta.ca/files/9306t0331.

Council of Science Editors:

Gamble J. The Impact of Restrictive Drug Coverage Policies on Pharmacoepidemiologic Methods and Health Outcomes. [Doctoral Dissertation]. University of Alberta; 2012. Available from: https://era.library.ualberta.ca/files/9306t0331

Vanderbilt University

2. Wiese, Andrew David. Opioid analgesics and the risk of serious infections.

Degree: PhD, Epidemiology, 2017, Vanderbilt University

URL: http://hdl.handle.net/1803/14511

► Although certain opioid analgesics have shown immunosuppressive properties in animal experiments, the clinical implications of prescription opioid use on the risk of serious infection among… (more)

▼ Although certain opioid analgesics have shown immunosuppressive properties in animal experiments, the clinical implications of prescription opioid use on the risk of serious infection among humans are unknown. We conducted a series of epidemiological studies to test the hypothesis that prescription opioid use is an independent risk factor for serious infections and that the association differs across opioid type and dose. In a nested-case control study conducted among subjects enrolled in Tennessee Medicaid (TennCare), we showed that opioid use was strongly and consistently associated with an increased risk of laboratory-confirmed invasive pneumococcal disease (IPD). The observed association was strongest for long-acting and high potency formulations, and for high dose opioids. As laboratory-confirmed IPDs are relatively rare, a separate study was conducted to assess the performance of coding algorithms for identifying hospitalizations for serious infections from TennCare administrative data. Using medical chart reviews as reference, we demonstrated that coded algorithms had a high positive predictive value for identifying true infections, supporting their use in epidemiological studies. Finally, we assembled a retrospective cohort of adults enrolled in TennCare who initiated use of long-acting opioids to compare the risk of serious infection among subjects initiating opioids with previously reported immunosuppressive properties compared to those initiating opioids without known immunosuppressive properties. Hospitalizations for serious infection were identified using our previously validated coding algorithms. The incidence of serious infections was significantly higher among users of opioids with previously described immunosuppressive properties, compared with users of opioids without immunosuppressive properties. These findings complement previous experimental evidence and support the hypothesis that opioid use is a novel, clinically important risk factor for serious infections. Advisors/Committee Members: Robert Greevy (committee member), Marie Griffin (committee member), William Schaffner (committee member), C. Michael Stein (committee member), Carlos Grijalva (Committee Chair).

Subjects/Keywords: opioids; infection; pharmacoepidemiology

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APA (6^th Edition):

Wiese, A. D. (2017). Opioid analgesics and the risk of serious infections. (Doctoral Dissertation). Vanderbilt University. Retrieved from http://hdl.handle.net/1803/14511

Chicago Manual of Style (16^th Edition):

Wiese, Andrew David. “Opioid analgesics and the risk of serious infections.” 2017. Doctoral Dissertation, Vanderbilt University. Accessed March 04, 2021. http://hdl.handle.net/1803/14511.

MLA Handbook (7^th Edition):

Wiese, Andrew David. “Opioid analgesics and the risk of serious infections.” 2017. Web. 04 Mar 2021.

Vancouver:

Wiese AD. Opioid analgesics and the risk of serious infections. [Internet] [Doctoral dissertation]. Vanderbilt University; 2017. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1803/14511.

Council of Science Editors:

Wiese AD. Opioid analgesics and the risk of serious infections. [Doctoral Dissertation]. Vanderbilt University; 2017. Available from: http://hdl.handle.net/1803/14511

Queens University

3. Boyes, Randall. Patterns of Use and Comparative Safety of New and Old Anticholinergic Medications in Older Adults: a Population-Based Study .

Degree: Community Health and Epidemiology, 2015, Queens University

URL: http://hdl.handle.net/1974/13495

► Overactive bladder (OAB) and urge urinary incontinence (UUI) are conditions that affect 12 – 18% of Canadians and that grow increasingly common with age. Patterns… (more)

▼ Overactive bladder (OAB) and urge urinary incontinence (UUI) are conditions that affect 12 – 18% of Canadians and that grow increasingly common with age. Patterns of use and comparative safety of six anticholinergic medications used to treat OAB and UUI were examined. Two of these medications (oxybutynin, tolterodine) have been included for many years on the provincial drug formulary, while the other four (solifenacin, darifenacin, trospium chloride, fesoterodine) have only recently been listed with conditions as “limited use” (LU) products. Acute urinary retention is a possible adverse outcome associated with these medications and was the outcome selected for the analysis of comparative safety. Participants were patients from Ontario between 66 and 105 years of age who received a new prescription for one of the bladder anticholinergic medications listed on the formulary between December 15, 2011 and December 31, 2013. A retrospective cohort design was used. Patients who were new users of any of the six bladder anticholinergic medications were identified from ODB program data. Descriptive statistics were used to assess physician adherence to the LU criteria. These patients were assigned to groups based on the bladder anticholinergic medication they received and the risk of acute urinary retention in new users of each medication was compared. Cox Proportional Hazards models were used to calculate hazard ratios to compare the risk of acute urinary retention among new users of each of the newer medications as compared to new users of oxybutynin. Analyses were stratified by sex, as men are known to be at greater risk of urinary retention than women. Only 10% of patients met the LU criteria for a prior trial of oxybutynin. Among men (but not women), new use of solifenacin, darifenacin, or tolterodine was associated with a reduced risk of acute urinary retention as compared to oxybutynin. The LU criteria for newer bladder anticholinergic medications do not appear to serve as an effective means of regulating their prescription. Exposure to these medications appears to confer a lower risk of acute urinary retention than oxybutynin in male patients. Further research into other potential adverse effects of these medication is needed.

Subjects/Keywords: Pharmacoepidemiology ; Drug Safety

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Boyes, R. (2015). Patterns of Use and Comparative Safety of New and Old Anticholinergic Medications in Older Adults: a Population-Based Study . (Thesis). Queens University. Retrieved from http://hdl.handle.net/1974/13495

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Boyes, Randall. “Patterns of Use and Comparative Safety of New and Old Anticholinergic Medications in Older Adults: a Population-Based Study .” 2015. Thesis, Queens University. Accessed March 04, 2021. http://hdl.handle.net/1974/13495.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Boyes, Randall. “Patterns of Use and Comparative Safety of New and Old Anticholinergic Medications in Older Adults: a Population-Based Study .” 2015. Web. 04 Mar 2021.

Vancouver:

Boyes R. Patterns of Use and Comparative Safety of New and Old Anticholinergic Medications in Older Adults: a Population-Based Study . [Internet] [Thesis]. Queens University; 2015. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1974/13495.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Boyes R. Patterns of Use and Comparative Safety of New and Old Anticholinergic Medications in Older Adults: a Population-Based Study . [Thesis]. Queens University; 2015. Available from: http://hdl.handle.net/1974/13495

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

University of Toronto

4. Ban, Joann. A Descriptive Analysis of Older Adults Who Initiated Denosumab in Ontario, 2012/02 – 2015/03.

Degree: 2018, University of Toronto

URL: http://hdl.handle.net/1807/97654

►

Denosumab was added to the Ontario Drug Benefit formulary for patients at high risk of osteoporotic fractures in 2012/02. We described patients who initiated denosumab… (more)

Subjects/Keywords: denosumab; osteoporosis; pharmacoepidemiology; rheumatology; 0572

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Ban, J. (2018). A Descriptive Analysis of Older Adults Who Initiated Denosumab in Ontario, 2012/02 – 2015/03. (Masters Thesis). University of Toronto. Retrieved from http://hdl.handle.net/1807/97654

Chicago Manual of Style (16^th Edition):

Ban, Joann. “A Descriptive Analysis of Older Adults Who Initiated Denosumab in Ontario, 2012/02 – 2015/03.” 2018. Masters Thesis, University of Toronto. Accessed March 04, 2021. http://hdl.handle.net/1807/97654.

MLA Handbook (7^th Edition):

Ban, Joann. “A Descriptive Analysis of Older Adults Who Initiated Denosumab in Ontario, 2012/02 – 2015/03.” 2018. Web. 04 Mar 2021.

Vancouver:

Ban J. A Descriptive Analysis of Older Adults Who Initiated Denosumab in Ontario, 2012/02 – 2015/03. [Internet] [Masters thesis]. University of Toronto; 2018. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1807/97654.

Council of Science Editors:

Ban J. A Descriptive Analysis of Older Adults Who Initiated Denosumab in Ontario, 2012/02 – 2015/03. [Masters Thesis]. University of Toronto; 2018. Available from: http://hdl.handle.net/1807/97654

University of Manitoba

5. Dawe, David. The effect of statin use on the incidence of prostate cancer: a population-based nested case-control study.

Degree: Community Health Sciences, 2017, University of Manitoba

URL: http://hdl.handle.net/1993/32380

► Literature review revealed a compelling pre-clinical rationale for statins as chemopreventive agents for prostate cancer (PC). However, epidemiological literature results vary widely. We completed a… (more)

Subjects/Keywords: Pharmacoepidemiology; Chemoprevention; Prostate cancer; Statins

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APA (6^th Edition):

Dawe, D. (2017). The effect of statin use on the incidence of prostate cancer: a population-based nested case-control study. (Masters Thesis). University of Manitoba. Retrieved from http://hdl.handle.net/1993/32380

Chicago Manual of Style (16^th Edition):

Dawe, David. “The effect of statin use on the incidence of prostate cancer: a population-based nested case-control study.” 2017. Masters Thesis, University of Manitoba. Accessed March 04, 2021. http://hdl.handle.net/1993/32380.

MLA Handbook (7^th Edition):

Dawe, David. “The effect of statin use on the incidence of prostate cancer: a population-based nested case-control study.” 2017. Web. 04 Mar 2021.

Vancouver:

Dawe D. The effect of statin use on the incidence of prostate cancer: a population-based nested case-control study. [Internet] [Masters thesis]. University of Manitoba; 2017. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1993/32380.

Council of Science Editors:

Dawe D. The effect of statin use on the incidence of prostate cancer: a population-based nested case-control study. [Masters Thesis]. University of Manitoba; 2017. Available from: http://hdl.handle.net/1993/32380

University of Manitoba

6. Vasilyeva, Irina. Adverse events in the elderly population of Manitoba treated with antipsychotic pharmacotherapy.

Degree: Pharmacy, 2010, University of Manitoba

URL: http://hdl.handle.net/1993/4217

► The safety of antipsychotic use in elderly persons has recently been questioned. The incidence of adverse events (AEs) (extrapyramidal syndromes (EPS), cerebrovascular and cardiac events,… (more)

▼ The safety of antipsychotic use in elderly persons has recently been questioned. The incidence of adverse events (AEs) (extrapyramidal syndromes (EPS), cerebrovascular and cardiac events, and all-cause mortality) in the elderly users of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) was compared. Risks of AEs in antipsychotic-exposed persons and non-exposed individuals were also assessed. A population-based retrospective cohort study was conducted in the elderly Manitoba residents who received their first antipsychotic medication between April 1, 2000 and March 31, 2007. Cox proportional hazards models were built to compare risks of AEs in FGA and SGA users, as well as in non-exposed subjects. SGAs were associated with a lower risk of all-cause mortality (adjusted HR 0.683, 95% CI 0.577–0.809) and a higher risk of myocardial infarction (1.614 [1.024–2.543]) compared to FGAs. No significant differences between FGAs and SGAs were found for cerebrovascular events, cardiac arrhythmia and congestive heart failure (CHF) but a higher incidence of EPS was observed for FGAs compared to risperidone. Both FGA and SGA users were at a higher risk of cerebrovascular events (FGAs 1.415 [1.114–1.797]; SGAs 1.611 [1.388–1.869]) and CHF (FGAs 1.228 [0.893–1.689]; SGAs 1.242 [1.003–1.536]) compared to non-exposed subjects. Only FGA-users were at a higher risk of death compared to non-exposed subjects (FGAs 1.387 [1.065–1.805]; SGAs 0.824 [0.708–0.959]). Both FGA and risperidone use were associated with a higher risk of EPS (FGAs 3.503 [2.271–5.403]; risperidone 1.733 [1.214–2.472]). Both classes of antipsychotics might lead to potentially life-threatening AEs. Neither FGAs nor SGAs seem to have a superior overall safety profile. Antipsychotic pharmacotherapy should be prescribed in elderly persons after careful consideration of all risks and benefits. Advisors/Committee Members: Alessi-Severini, Silvia (Pharmacy) (supervisor), Metge, Colleen (Pharmacy) Biscontri, Robert (Management) Enns, Murray (Medicine) (examiningcommittee).

Subjects/Keywords: antipsychotics; elderly; adverse events; pharmacoepidemiology

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Vasilyeva, I. (2010). Adverse events in the elderly population of Manitoba treated with antipsychotic pharmacotherapy. (Masters Thesis). University of Manitoba. Retrieved from http://hdl.handle.net/1993/4217

Chicago Manual of Style (16^th Edition):

Vasilyeva, Irina. “Adverse events in the elderly population of Manitoba treated with antipsychotic pharmacotherapy.” 2010. Masters Thesis, University of Manitoba. Accessed March 04, 2021. http://hdl.handle.net/1993/4217.

MLA Handbook (7^th Edition):

Vasilyeva, Irina. “Adverse events in the elderly population of Manitoba treated with antipsychotic pharmacotherapy.” 2010. Web. 04 Mar 2021.

Vancouver:

Vasilyeva I. Adverse events in the elderly population of Manitoba treated with antipsychotic pharmacotherapy. [Internet] [Masters thesis]. University of Manitoba; 2010. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1993/4217.

Council of Science Editors:

Vasilyeva I. Adverse events in the elderly population of Manitoba treated with antipsychotic pharmacotherapy. [Masters Thesis]. University of Manitoba; 2010. Available from: http://hdl.handle.net/1993/4217

University of Sydney

7. Karanges, Emily. Antidepressant use in adolescents: pharmacoepidemiological and neurobehavioural perspectives .

Degree: 2014, University of Sydney

URL: http://hdl.handle.net/2123/12816

► Psychotropic medications are widely used for the treatment of mental health problems in children and adolescents, yet there are growing concerns about their risk-benefit profile… (more)

▼ Psychotropic medications are widely used for the treatment of mental health problems in children and adolescents, yet there are growing concerns about their risk-benefit profile in this population. Particularly controversial is the widespread use of antidepressants, which have been associated with an increased risk of self-harm, suicidal ideation and attempts in young people. Children and adolescents also appear less likely to benefit from antidepressant treatment than adults, and may be more susceptible to adverse long-term effects. Despite these concerns, recent studies from around the world suggest that the prescription of antidepressants and other psychotropic medications to children and adolescents is increasing. This thesis investigated these issues using two different approaches: pharmacoepidemiological (Part 1) and neurobehavioural (Part 2). Chapter 1 gives an historical account of international trends in the use of the psychotropics from the 1950s to the present day. Various key events are covered, including the introduction of the modern psychotropics during the 1950s; the rise of sedatives, anxiolytics and hypnotics (1960s and 1970s); increasing use of stimulants in children (1970s); and the emergence and increasing popularity of the second-generation antidepressants and antipsychotics (1990s to present). It also briefly considers the drivers of these trends, with reference to historical and current controversies including changing ideology, diagnostic broadening, pharmaceutical marketing and expanding clinical uses. This chapter concludes with a focus on the particular issues surrounding the use of psychotropics in children and adolescents. Given the scarcity of systematic data on the current use of psychotropic medications in Australia, Part 1 investigated psychotropic dispensing trends using data obtained from the Department of Human Services within the Australian Government. The first study (Chapter 2) examined dispensing to the overall Australian population from the beginning of 2000 to the end of 2011. Results revealed major increases in the use of antidepressants, antipsychotics and ADHD medications, a smaller increase in mood stabilisers, relatively stable use of anxiolytics and a small decline in the use of sedatives. A second study (Chapter 3) extended on these findings, focusing on trends in the use of antidepressants, antipsychotics and ADHD medications among children, adolescents and young adults between the start of 2009 and the end of 2012. Increasing trends were observed for all three classes of drug in all age groups investigated (3-9 years, 10-14 years, 15-19 years, 20-24 years and 25+ years). Notably, more rapid increases in antidepressant and antipsychotic use were observed in those aged under 25 than in those aged over 25, although younger age groups showed much lower overall use of these psychotropics. Use of ADHD medications was highest in younger age groups and increased most rapidly in young adults aged 20-24 years. While prescribing patterns showed general adherence to treatment…

Subjects/Keywords: Antidepressant; Adolescent; Psychotropic; Pharmacoepidemiology; Neuroscience

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APA (6^th Edition):

Karanges, E. (2014). Antidepressant use in adolescents: pharmacoepidemiological and neurobehavioural perspectives . (Thesis). University of Sydney. Retrieved from http://hdl.handle.net/2123/12816

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Karanges, Emily. “Antidepressant use in adolescents: pharmacoepidemiological and neurobehavioural perspectives .” 2014. Thesis, University of Sydney. Accessed March 04, 2021. http://hdl.handle.net/2123/12816.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Karanges, Emily. “Antidepressant use in adolescents: pharmacoepidemiological and neurobehavioural perspectives .” 2014. Web. 04 Mar 2021.

Vancouver:

Karanges E. Antidepressant use in adolescents: pharmacoepidemiological and neurobehavioural perspectives . [Internet] [Thesis]. University of Sydney; 2014. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/2123/12816.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Karanges E. Antidepressant use in adolescents: pharmacoepidemiological and neurobehavioural perspectives . [Thesis]. University of Sydney; 2014. Available from: http://hdl.handle.net/2123/12816

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

8. Pranckevičienė, Gabrielė. Pharmacoepidemiologic assessment of low-molecular-weight heparins utilization in Lithuania and development of pharmacoeconomic model.

Degree: Dissertation, Pharmacy, 2014, Lithuanian Academic Libraries Network (LABT)

URL: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2014~D_20140305_141832-70667 ;

►

In recent years, many countries have struggled with the fact that expenditures on health care are growing much faster than the overall level of wealth.… (more)

▼

In recent years, many countries have struggled with the fact that expenditures on health care are growing much faster than the overall level of wealth. Research objectives: 1) to conduct a meta-analysis of heparins by the means of their efficacy, safety parameters and treatment outcomes; 2) to conduct pharmacoepidemiological assessment of long-term heparins utilization in Lithuania; 3) to develop a pharmacoeconomic cost-minimization model for low-molecular-weight heparins based on reference pricing methodology; 4) to investigate heparins prescribing trends and to evaluate heparins prescription adherence to international clinical guidelines at a secondary level clinical hospital. Meta-analysis results showed that low-molecular-weight heparins could be considered interchangeable due to similar therapeutic profiles in some indications. In Lithuania consumption of heparins and corresponding costs were constantly increasing during the period of investigation; therefore it would be relevant to implement modern pharmacoeconomic methodologies to regulate costs. Cost-minimization model suggested that expenditures on this group of medicines could be decreased by nearly 70 percent. Analysis of pharmacoepidemiological study data confirmed that heparins prescription practices at the clinical hospital were insufficiently regulated. In addition this study conducted at the clinical hospital revealed non-compliance of heparins safety monitoring practices with clinical guidelines.

Pastaraisiais metais daugelyje šalių sveikatos priežiūros išlaidos augo daug greičiau nei bendras gerovės lygis, todėl yra nuolat diskutuojama, kaip šį išlaidų augimą reikėtų kontroliuoti. Darbo uždaviniai: 1) atlikti heparinų preparatų meta-analizę, palyginant jų efektyvumo ir saugumo parametrus bei gydymo baigtis; 2) atlikti heparinų preparatų ilgalaikio suvartojimo Lietuvoje farmakoepidemiologinį tyrimą; 3) suformuluoti farmakoekonominį kaštų mažinimo sprendimų modelį mažos molekulinės masės heparinų preparatų grupei, remiantis referentinės kainos metodika; 4) ištirti heparinų preparatų skyrimo tendencijas antrinio lygio klinikinėje ligoninėje ir palyginti heparinų preparatų skyrimo atitikimą tarptautinėms gairėms. Meta-analizės rezultatai parodė, jog mažos molekulinės masės heparinai gali būti tarpusavyje pa¬keičiami dėl analogiškų terapinių savybių tam tikrose indikacijose. Heparinų preparatų suvartojimas ir atitinkamos išlaidos tiriamuoju laikotarpiu Lietuvoje nuolat didėjo, todėl būtų aktualu taikyti šiuolaikines farmakoekonomines išlaidų reguliavimo metodikas. Pritaikius kaštų mažinimo modelį heparinų preparatų grupei, būtų galima sumažinti išlaidas šios grupės preparatams beveik 70 procentų. Farmakoepidemiologinio tyrimo rezultatai atskleidė, jog heparinų preparatų skyrimo praktika klinikinėje ligoninėje buvo nepakankamai reglamentuota. Taip pat heparinų preparatų saugumo parametrų stebėjimo praktika ligoninėje neatitiko tarptautinių rekomendacijų.

Advisors/Committee Members: Briedis, Vitalis (Doctoral dissertation advisor), Ramanauskienė, Kristina (Doctoral dissertation committee chair), Maciulaitis, Romaldas (Doctoral dissertation committee member), Vanagas, Giedrius (Doctoral dissertation committee member), Muceniene, Ruta (Doctoral dissertation committee member), Vilskersts, Reinis (Doctoral dissertation committee member), Pačiūra, Rimantas (Doctoral dissertation opponent), Vanagas, Giedrius (Doctoral dissertation opponent).

Subjects/Keywords: Pharmacoeconomic; Pharmacoepidemiology; Heparins; Farmakoekonomika; Farmakoepidemiologija; Heparinai

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Pranckevičienė, G. (2014). Pharmacoepidemiologic assessment of low-molecular-weight heparins utilization in Lithuania and development of pharmacoeconomic model. (Doctoral Dissertation). Lithuanian Academic Libraries Network (LABT). Retrieved from http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2014~D_20140305_141832-70667 ;

Chicago Manual of Style (16^th Edition):

Pranckevičienė, Gabrielė. “Pharmacoepidemiologic assessment of low-molecular-weight heparins utilization in Lithuania and development of pharmacoeconomic model.” 2014. Doctoral Dissertation, Lithuanian Academic Libraries Network (LABT). Accessed March 04, 2021. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2014~D_20140305_141832-70667 ;.

MLA Handbook (7^th Edition):

Pranckevičienė, Gabrielė. “Pharmacoepidemiologic assessment of low-molecular-weight heparins utilization in Lithuania and development of pharmacoeconomic model.” 2014. Web. 04 Mar 2021.

Vancouver:

Pranckevičienė G. Pharmacoepidemiologic assessment of low-molecular-weight heparins utilization in Lithuania and development of pharmacoeconomic model. [Internet] [Doctoral dissertation]. Lithuanian Academic Libraries Network (LABT); 2014. [cited 2021 Mar 04]. Available from: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2014~D_20140305_141832-70667 ;.

Council of Science Editors:

Pranckevičienė G. Pharmacoepidemiologic assessment of low-molecular-weight heparins utilization in Lithuania and development of pharmacoeconomic model. [Doctoral Dissertation]. Lithuanian Academic Libraries Network (LABT); 2014. Available from: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2014~D_20140305_141832-70667 ;

Erasmus University Rotterdam

9. O.U. Osokogu (Osemeke). Studying Disease Occurrence and Drug Effects in Children: A global approach.

Degree: 2017, Erasmus University Rotterdam

URL: http://hdl.handle.net/1765/95504

► markdownabstractChildhood diseases result from different causes and exhibit different characteristics. The occurrence of such diseases can be estimated from electronic healthcare records but the characteristics… (more)

▼ markdownabstractChildhood diseases result from different causes and exhibit different characteristics. The occurrence of such diseases can be estimated from electronic healthcare records but the characteristics of both the diseases and the databases should be considered. Licensed drugs have limited or no direct evidence of safety and effectiveness in children, resulting in high levels of unlicensed and off-label drug use. To address this unfairness, evidence on safety and effectiveness should be generated using ‘real-world’ data in children. Methods need to be made ‘child-proof’. In this thesis, we studied and developed methods for assessing the occurrence of disease, and drug safety and effectiveness in children. Based on our findings, we made appropriate recommendations. In the studies that comprise this thesis, we utilized different types/sources of data including the published literature, spontaneous reporting (suspected adverse drug reactions) data and electronic health records (data from general practitioners). We found that disease occurrence can be estimated from electronic health care databases. Also, we demonstrated that both left censoring and the choice of episode duration impact the incidence and prevalence estimates of childhood diseases. For the common and recurrent diseases like acute otitis media (AOM), increasing the assumed length of an episode decreases the incidence but increases the prevalence estimates. For the chronic diseases, increasing the length of the run-in period prior to start of follow-up decreases the incidence rate with negligible effect on the prevalence. Of note, the length of the run-in period impacts both common and rare diseases. In order to test the performance of signal detection algorithms when applied to pediatric data specifically, we created a pediatric-specific reference set comprising 37 known (positive controls - PC) and 90 ‘unknown’ (negative controls - NC) DECs. We found that age-stratified analysis is important when performing pediatric-specific drug safety surveillance. Regarding pediatric pharmacoepidemiological safety studies, we discovered that such studies are few and the studies are almost exclusively conducted in high income countries and receive limited funding from pharmaceutical companies and other private sources. Designs differed a lot between drug and vaccine studies. Focus in these studies was only on a small fraction of registered drugs and mainly intermediate outcomes (signs/symptoms). Regarding the quality of the studies, cohort studies were most likely to be biased because historical time prior to study start was not considered for the identification of prevalent cases of the outcome of interest and because follow-up time after study start was not long enough to observe occurrence of the outcome(s). Case control studies were most likely to be of poor quality because of differences in non-response rate (regarding ascertainment of the exposure) between the cases and controls, and because the authors did not specifically report that the…

Subjects/Keywords: Children; methodology; incidence; prevalence; pharmacovigilance; pharmacoepidemiology

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APA (6^th Edition):

(Osemeke), O. O. (2017). Studying Disease Occurrence and Drug Effects in Children: A global approach. (Thesis). Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/95504

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

(Osemeke), O.U. Osokogu. “Studying Disease Occurrence and Drug Effects in Children: A global approach.” 2017. Thesis, Erasmus University Rotterdam. Accessed March 04, 2021. http://hdl.handle.net/1765/95504.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

(Osemeke), O.U. Osokogu. “Studying Disease Occurrence and Drug Effects in Children: A global approach.” 2017. Web. 04 Mar 2021.

Vancouver:

(Osemeke) OO. Studying Disease Occurrence and Drug Effects in Children: A global approach. [Internet] [Thesis]. Erasmus University Rotterdam; 2017. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1765/95504.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

(Osemeke) OO. Studying Disease Occurrence and Drug Effects in Children: A global approach. [Thesis]. Erasmus University Rotterdam; 2017. Available from: http://hdl.handle.net/1765/95504

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Virginia Commonwealth University

10. Yang, Shibing. Application of Marginal Structural Models in Pharmacoepidemiologic Studies.

Degree: PhD, Epidemiology, 2014, Virginia Commonwealth University

URL: https://doi.org/10.25772/JDC2-Z133 ; https://scholarscompass.vcu.edu/etd/3471

► Background: Inverse-probability-of-treatment-weighted estimation (IPTW) of marginal structural models was proposed to adjust for time-varying confounders that are influenced by prior treatment use. It is… (more)

▼ Background: Inverse-probability-of-treatment-weighted estimation (IPTW) of marginal structural models was proposed to adjust for time-varying confounders that are influenced by prior treatment use. It is unknown whether pharmacoepidemiologic studies that applied IPTW conformed to the recommendations proposed by methodological studies. In addition, no previous study has compared the performance of different analytic strategies adopted in IPTW analyses. Objectives: This project aims 1) to review the reporting practice of pharmacoepidemiologic studies that applied IPTW, 2) to compare the validity and precision of several approaches to constructing weight, 3) to use IPTW to estimate the effectiveness of glucosamine and chondroitin in treating osteoarthritis. Methods: We systematically retrieved pharmacoepidemiologic studies that were published in 2012 and applied IPTW to estimate the effect of a time-varying treatment. Under a variety of simulated scenarios, we assessed the performance of four analytic approaches what were commonly used in studies conducting IPTW analyses. Finally, using data from Osteoarthritis Initiative, we applied IPTW to estimate the long-term effectiveness of glucosamine and chondroitin on treating knee osteoarthritis. Results: The practice of reporting use of IPTW in pharmacoepidemiologic studies was suboptimal. The majority of reviewed studies did not report that the positivity assumption was assessed, and several studies used unstablized weights or did not report that the stabilized weights were used. With data simulation, we found that intention-to-treat analyses underestimated the actual treatment effect when there was non-null treatment effect and treatment non-adherence. This underestimation was linearly correlated with adherence levels. As-treated analyses that took into account the complex mechanism of treatment use generated approximately unbiased estimates without sacrificing the estimate precision when the treatment effect was non-null. Finally, after adjustment for potential confounders with marginal structural models, we found no clinically meaningful benefits of glucosamine/chondroitin in relieving knee pain, stiffness and physical function or slowing joint space narrowing. Conclusions: It may be prudent to develop best practices of reporting the use of IPTW. Studies performing intention-to-treat analyses should report the levels of adherence after treatment initiation, and studies performing as-treated analyses should take into the complex mechanism of treatment use in weight construction. Advisors/Committee Members: Juan Lu.

Subjects/Keywords: Marginal Structural Models; Pharmacoepidemiology; Osteoarthritis; Diseases

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APA (6^th Edition):

Yang, S. (2014). Application of Marginal Structural Models in Pharmacoepidemiologic Studies. (Doctoral Dissertation). Virginia Commonwealth University. Retrieved from https://doi.org/10.25772/JDC2-Z133 ; https://scholarscompass.vcu.edu/etd/3471

Chicago Manual of Style (16^th Edition):

Yang, Shibing. “Application of Marginal Structural Models in Pharmacoepidemiologic Studies.” 2014. Doctoral Dissertation, Virginia Commonwealth University. Accessed March 04, 2021. https://doi.org/10.25772/JDC2-Z133 ; https://scholarscompass.vcu.edu/etd/3471.

MLA Handbook (7^th Edition):

Yang, Shibing. “Application of Marginal Structural Models in Pharmacoepidemiologic Studies.” 2014. Web. 04 Mar 2021.

Vancouver:

Yang S. Application of Marginal Structural Models in Pharmacoepidemiologic Studies. [Internet] [Doctoral dissertation]. Virginia Commonwealth University; 2014. [cited 2021 Mar 04]. Available from: https://doi.org/10.25772/JDC2-Z133 ; https://scholarscompass.vcu.edu/etd/3471.

Council of Science Editors:

Yang S. Application of Marginal Structural Models in Pharmacoepidemiologic Studies. [Doctoral Dissertation]. Virginia Commonwealth University; 2014. Available from: https://doi.org/10.25772/JDC2-Z133 ; https://scholarscompass.vcu.edu/etd/3471

University of Toronto

11. Weisman, Alanna. Associations between Allopurinol and Cardiovascular and Renal Outcomes in Diabetes.

Degree: PhD, 2020, University of Toronto

URL: http://hdl.handle.net/1807/101109

► Diabetes is a leading cause of cardiovascular and kidney disease, and novel therapies to reduce these adverse diabetes outcomes are urgently required. Allopurinol, a uric… (more)

▼ Diabetes is a leading cause of cardiovascular and kidney disease, and novel therapies to reduce these adverse diabetes outcomes are urgently required. Allopurinol, a uric acid-lowering therapy traditionally used for the treatment of gout, may reduce mortality and cardiovascular and kidney disease through reductions in oxidative stress and improved endothelial function, but this has not been well-studied in diabetes. Through three related projects, this thesis examines the associations between allopurinol and all-cause mortality, cardiovascular and renal outcomes in individuals with diabetes using population-based administrative health care data in Ontario, Canada. The first project examined patterns of allopurinol use and their predictors, to inform the design of subsequent studies. In 38,416 individuals with diabetes newly prescribed allopurinol, discontinuation and interruption of allopurinol were common. Female sex and greater severity of gout were associated with worse adherence. The second project evaluated the association between allopurinol-exposed time and all-cause mortality and cardiovascular outcomes in 38,416 new allopurinol users with diabetes. Allopurinol-exposed time was associated with a reduced risk of the primary composite outcome of all-cause mortality, atherothrombotic cardiovascular events (myocardial infarction, revascularization, stroke), or heart failure, which was primarily driven by a reduction in all-cause mortality. However, healthy user bias could not be completely excluded. The third project evaluated the association between allopurinol use and progression of chronic kidney disease (CKD) or development of end-stage renal disease (ESRD). In 5937 individuals with a gout flare and Stages 1 to 3 CKD at baseline (1911 with diabetes), renal outcomes did not differ between allopurinol users and non-users after weighting by the inverse probability of treatment. Based on the thesis results, allopurinol may reduce mortality and atherothrombotic cardiovascular events in individuals with diabetes, but does not appear to reduce heart failure, CKD progression, or development of ESRD. Defining allopurinol exposure in pharmacoepidemiology studies is challenging due to frequent interruptions and discontinuation. Thus, study designs incorporating time-varying exposure and time-varying confounders may be more robust. A clinical trial designed to evaluate the effect of allopurinol on atherothrombotic cardiovascular events in individuals with diabetes and hyperuricemia is strongly justified. Advisors/Committee Members: Hawker, Gillian A, Dalla Lana School of Public Health.

Subjects/Keywords: allopurinol; clinical epidemiology; diabetes; gout; pharmacoepidemiology; 0564

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Weisman, A. (2020). Associations between Allopurinol and Cardiovascular and Renal Outcomes in Diabetes. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/101109

Chicago Manual of Style (16^th Edition):

Weisman, Alanna. “Associations between Allopurinol and Cardiovascular and Renal Outcomes in Diabetes.” 2020. Doctoral Dissertation, University of Toronto. Accessed March 04, 2021. http://hdl.handle.net/1807/101109.

MLA Handbook (7^th Edition):

Weisman, Alanna. “Associations between Allopurinol and Cardiovascular and Renal Outcomes in Diabetes.” 2020. Web. 04 Mar 2021.

Vancouver:

Weisman A. Associations between Allopurinol and Cardiovascular and Renal Outcomes in Diabetes. [Internet] [Doctoral dissertation]. University of Toronto; 2020. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1807/101109.

Council of Science Editors:

Weisman A. Associations between Allopurinol and Cardiovascular and Renal Outcomes in Diabetes. [Doctoral Dissertation]. University of Toronto; 2020. Available from: http://hdl.handle.net/1807/101109

University of Manitoba

12. Alkabbani, Wajd. The utilization of pharmaceutical cannabinoid agents in Manitoba, Canada. A population-based study using administrative health care data.

Degree: Pharmacy, 2019, University of Manitoba

URL: http://hdl.handle.net/1993/33777

► Introduction: Pharmaceutical cannabinoids are third-line therapeutic options for several indications, despite the lack of strong evidence to support their efficacy. The extent and patterns of… (more)

Subjects/Keywords: Drug utilization; Cannabinoids; pharmacoepidemiology; Administrative data

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APA (6^th Edition):

Alkabbani, W. (2019). The utilization of pharmaceutical cannabinoid agents in Manitoba, Canada. A population-based study using administrative health care data. (Masters Thesis). University of Manitoba. Retrieved from http://hdl.handle.net/1993/33777

Chicago Manual of Style (16^th Edition):

Alkabbani, Wajd. “The utilization of pharmaceutical cannabinoid agents in Manitoba, Canada. A population-based study using administrative health care data.” 2019. Masters Thesis, University of Manitoba. Accessed March 04, 2021. http://hdl.handle.net/1993/33777.

MLA Handbook (7^th Edition):

Alkabbani, Wajd. “The utilization of pharmaceutical cannabinoid agents in Manitoba, Canada. A population-based study using administrative health care data.” 2019. Web. 04 Mar 2021.

Vancouver:

Alkabbani W. The utilization of pharmaceutical cannabinoid agents in Manitoba, Canada. A population-based study using administrative health care data. [Internet] [Masters thesis]. University of Manitoba; 2019. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1993/33777.

Council of Science Editors:

Alkabbani W. The utilization of pharmaceutical cannabinoid agents in Manitoba, Canada. A population-based study using administrative health care data. [Masters Thesis]. University of Manitoba; 2019. Available from: http://hdl.handle.net/1993/33777

University of Florida

13. Dave, Chintan V. Health Outcomes Related to Statin Medications.

Degree: PhD, Pharmaceutical Sciences - Pharmaceutical Outcomes and Policy, 2017, University of Florida

URL: https://ufdc.ufl.edu/UFE0051391

Subjects/Keywords: adherence; pharmacoepidemiology; statin

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APA (6^th Edition):

Dave, C. V. (2017). Health Outcomes Related to Statin Medications. (Doctoral Dissertation). University of Florida. Retrieved from https://ufdc.ufl.edu/UFE0051391

Chicago Manual of Style (16^th Edition):

Dave, Chintan V. “Health Outcomes Related to Statin Medications.” 2017. Doctoral Dissertation, University of Florida. Accessed March 04, 2021. https://ufdc.ufl.edu/UFE0051391.

MLA Handbook (7^th Edition):

Dave, Chintan V. “Health Outcomes Related to Statin Medications.” 2017. Web. 04 Mar 2021.

Vancouver:

Dave CV. Health Outcomes Related to Statin Medications. [Internet] [Doctoral dissertation]. University of Florida; 2017. [cited 2021 Mar 04]. Available from: https://ufdc.ufl.edu/UFE0051391.

Council of Science Editors:

Dave CV. Health Outcomes Related to Statin Medications. [Doctoral Dissertation]. University of Florida; 2017. Available from: https://ufdc.ufl.edu/UFE0051391

University of Toronto

14. Leombruno, John Paul. Effects of Infliximab Therapy on Hospitalization, Surgery and Healthcare Consumption in Crohn’s Disease: A Population Based Propensity Score Matched Analysis.

Degree: 2009, University of Toronto

URL: http://hdl.handle.net/1807/24314

►

Background : The majority of patients with Crohn’s Disease (CD) will be hospitalized and receive surgery for their disease. Hospitalizations and surgical procedures account for… (more)

▼

Background : The majority of patients with Crohn’s Disease (CD) will be hospitalized and receive surgery for their disease. Hospitalizations and surgical procedures account for the majority of the direct costs of CD. Purpose : Our objective was to use population-based administrative data from the province of Quebec, Canada, to estimate the effectiveness of infliximab therapy in reducing CD-related surgery, hospitalization and health care resource consumption in subjects with CD. Methods : We obtained patient level prescription data, physician billing claims and hospitalization data from the Régie de l'Assurance Maladie du Québec (RAMQ) a Canadian provincial health care provider. Subjects who were enrolled in the system for a minimum of two years and who received prescription drug benefits for each year they participated in the study were identified as being affected by CD using a validated algorithm. For each subject treated with infliximab, up to two closely matched comparison subjects were selected using propensity score methods. We compared time to first CD-related intra-abdominal surgery and hospitalization as well as total hospitalized days and physician visits between infliximab users and non-users. Results : We were able to match 319 (77%) out of the 414 infliximab users to comparison subjects using propensity score matching; 300 were matched to two infliximab non-users and 19 were matched to one non-user to create 619 matched-pair sets. Subjects who received infliximab therapy had a significantly reduced risk of experiencing a CD-related intra-abdominal surgery (HR=0.674, 95%CI 0.533-0.853, p=0.001), any hospitalization (HR=0.753, 95%CI 0.619-0.917 p=0.005), and CD-related hospitalization (HR=0.726, 95%CI 0.565-0.934 p=0.013). Infliximab users experienced lower rates of hospitalized days (RateR=0.6418, 95%CI 0.4399-0.9362; P=0.021) and gastroenterologist visits (RateR=0.810, 95% CI 0.700-0.937; P=0.005). Infliximab users and non-users had similar rates of non-gastroenterologist physician visits (RateR=0.928, 95% CI 0.851-1.057; P=0.262). Conclusion : Infliximab therapy was associated with significant reductions in CD-related intra-abdominal surgeries, hospitalizations, hospitalized days and gastroenterologist visits. Our results confirm the population-based effectiveness of infliximab beyond the ideal conditions of clinical trials.

PhD

Advisors/Committee Members: Einarson, Thomas Ray, Pharmaceutical Sciences.

Subjects/Keywords: infliximab; pharmacoepidemiology; 0573

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APA (6^th Edition):

Leombruno, J. P. (2009). Effects of Infliximab Therapy on Hospitalization, Surgery and Healthcare Consumption in Crohn’s Disease: A Population Based Propensity Score Matched Analysis. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/24314

Chicago Manual of Style (16^th Edition):

Leombruno, John Paul. “Effects of Infliximab Therapy on Hospitalization, Surgery and Healthcare Consumption in Crohn’s Disease: A Population Based Propensity Score Matched Analysis.” 2009. Doctoral Dissertation, University of Toronto. Accessed March 04, 2021. http://hdl.handle.net/1807/24314.

MLA Handbook (7^th Edition):

Leombruno, John Paul. “Effects of Infliximab Therapy on Hospitalization, Surgery and Healthcare Consumption in Crohn’s Disease: A Population Based Propensity Score Matched Analysis.” 2009. Web. 04 Mar 2021.

Vancouver:

Leombruno JP. Effects of Infliximab Therapy on Hospitalization, Surgery and Healthcare Consumption in Crohn’s Disease: A Population Based Propensity Score Matched Analysis. [Internet] [Doctoral dissertation]. University of Toronto; 2009. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1807/24314.

Council of Science Editors:

Leombruno JP. Effects of Infliximab Therapy on Hospitalization, Surgery and Healthcare Consumption in Crohn’s Disease: A Population Based Propensity Score Matched Analysis. [Doctoral Dissertation]. University of Toronto; 2009. Available from: http://hdl.handle.net/1807/24314

University of Dundee

15. Morales, Daniel. Quantifying the risk of beta-blockers and non-steroidal anti-inflammatory drugs in asthma.

Degree: PhD, 2014, University of Dundee

URL: https://discovery.dundee.ac.uk/en/studentTheses/56ca8828-73f6-47cc-b919-6e3e78e11a7b ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642914

► Beta-blockers and non-steroidal anti-inflammatory drugs (NSAIDs) are often avoided in asthma over risk of bronchospasm which may vary according to drug selectivity and duration of… (more)

▼ Beta-blockers and non-steroidal anti-inflammatory drugs (NSAIDs) are often avoided in asthma over risk of bronchospasm which may vary according to drug selectivity and duration of administration. This thesis attempts to quantify the risk of beta-blocker and NSAID exposure in asthma by synthesising clinical trial evidence and conducting observational studies using linked electronic medical records. As part of this thesis, three systematic reviews of clinical trials were conducted evaluating: the prevalence of aspirin-exacerbated respiratory disease (AERD); risk of selective NSAIDs/COX-2 inhibitors in people with AERD; and risk of acute beta-blocker exposure in people with asthma. Electronic primary care data from the Clinical Practice Research Datalink (CPRD) was used to define a cohort of people with active asthma, measure the prevalence of beta-blocker and NSAID prescribing, and perform a series of nested case control studies evaluating asthma death, asthma hospitalisation and primary care asthma exacerbations (PCAE). A self-controlled case-series was performed for PCAE as well. Based upon work in this thesis, the prevalence of AERD in people with asthma was around 9%. Selective NSAIDs triggered respiratory symptoms in 8% of people with AERD whilst no significant changes in lung function or symptoms occurred with COX-2 inhibitors. Acute non-selective beta-blocker exposure caused a significant mean fall in FEV1 of 10%, a significant increase in respiratory symptoms in around 1 in 13 and a non-significant increase in falls in FEV1 of ≥20% in around 1 in 9. Acute selective beta-blocker exposure caused a significant mean fall in FEV1 of 7%, significant falls in FEV1 of ≥20% in around 1 in 8 and a non-significant increase in respiratory symptoms in around 1 in 33. The prevalence of selective beta-blocker prescribing in asthma rose by around 200% over the 12 year period whilst the prevalence of non-selective beta-blocker prescribing rose by around 90%. Changing trends in NSAID prescribing occurred over the 12 year period with COX-2 inhibitors now rarely prescribed. Using the nested case control design, both incident and high-dose non-selective beta-blocker exposure was associated with significantly increased risk of asthma morbidity (hospitalisation and PCAE). In contrast, no significant increased risk of asthma morbidity occurred with any type of selective beta-blocker exposure. Consistent findings were seen for PCAE using the self-controlled case series. No significantly increased risk was seen with different oral NSAIDs apart from weak evidence of an association between asthma death and non-selective NSAID exposure which is unlikely to be causal. Significant numbers of people with asthma are prescribed beta-blockers and NSAIDs. Evidence from clinical trials and observational studies demonstrate that non-selective beta-blockers significantly increase asthma morbidity with risk appearing to vary according to dose and duration of administration. Although selective beta-blockers have the potential to cause significant…

Subjects/Keywords: 616.2; Asthma; Pharmacoepidemiology; Beta-blocker; NSAID

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APA (6^th Edition):

Morales, D. (2014). Quantifying the risk of beta-blockers and non-steroidal anti-inflammatory drugs in asthma. (Doctoral Dissertation). University of Dundee. Retrieved from https://discovery.dundee.ac.uk/en/studentTheses/56ca8828-73f6-47cc-b919-6e3e78e11a7b ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642914

Chicago Manual of Style (16^th Edition):

Morales, Daniel. “Quantifying the risk of beta-blockers and non-steroidal anti-inflammatory drugs in asthma.” 2014. Doctoral Dissertation, University of Dundee. Accessed March 04, 2021. https://discovery.dundee.ac.uk/en/studentTheses/56ca8828-73f6-47cc-b919-6e3e78e11a7b ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642914.

MLA Handbook (7^th Edition):

Morales, Daniel. “Quantifying the risk of beta-blockers and non-steroidal anti-inflammatory drugs in asthma.” 2014. Web. 04 Mar 2021.

Vancouver:

Morales D. Quantifying the risk of beta-blockers and non-steroidal anti-inflammatory drugs in asthma. [Internet] [Doctoral dissertation]. University of Dundee; 2014. [cited 2021 Mar 04]. Available from: https://discovery.dundee.ac.uk/en/studentTheses/56ca8828-73f6-47cc-b919-6e3e78e11a7b ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642914.

Council of Science Editors:

Morales D. Quantifying the risk of beta-blockers and non-steroidal anti-inflammatory drugs in asthma. [Doctoral Dissertation]. University of Dundee; 2014. Available from: https://discovery.dundee.ac.uk/en/studentTheses/56ca8828-73f6-47cc-b919-6e3e78e11a7b ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.642914

University of New South Wales

16. Schaffer, Andrea. Big Data for pharmacoepidemiology research in Australia: using Pharmaceutical Benefits Scheme claims data to evaluate the effects of large-scale interventions.

Degree: Community Medicine, 2017, University of New South Wales

URL: http://handle.unsw.edu.au/1959.4/58671 ; https://unsworks.unsw.edu.au/fapi/datastream/unsworks:46590/SOURCE02?view=true

► Big Data has been used increasingly in pharmacoepidemiology, the study of medicines in large populations, where the majority of observational research uses population-based health data… (more)

▼ Big Data has been used increasingly in pharmacoepidemiology, the study of medicines in large populations, where the majority of observational research uses population-based health data including pharmaceutical claims. The Pharmaceutical Benefits Scheme (PBS) collects data on all medicines dispensed in Australia. This is an extremely important source of information for how medicines are used in the real-world; however, compared to other countries Australia has lagged behind in making best use of its data holdings for pharmacoepidemiology and pharmaceutical policy research, primarily due to the challenges of linking PBS claims with hospital, emergency department and other data collections. This thesis demonstrates how to make best use of exposure data in the form of dispensing claims in the absence of outcomes data. We used a 10% sample of PBS dispensing data to evaluate four large-scale interventions and their impact on quality use of medicines in Australia, using robust and innovative statistical methods.The four interventions include: (i) media coverage critical of statins; (ii) the re-scheduling of alprazolam to a “Controlled Drug”; (iii) the PBS-listing of cardiovascular fixed-dose combination products; and (iv) the introduction of a tamper-resistant formulation of controlled release (CR) oxycodone. First, we found that the media coverage resulted in a decrease in statin dispensing, and an increase in statin discontinuation, even in people at high risk of cardiovascular events. Second, we found that increasing restrictions on the prescribing and dispensing of alprazolam resulted in decreased prescribing and dispensing of alprazolam, and a decrease in alprazolam poisonings; but an increase in switching to other, less harmful, benzodiazepines. Third, we found that fixed-dose combinations were associated with greater adherence in certain patient subgroups and poorer adherence in others, especially those not following prescribing guidelines, despite industry claims of benefits to all. And last, we found that while the reformulation of oxycodone CR to be tamper-resistant led to a reduction in dispensing of high-strength oxycodone, there was also an increase in switching to other potent opioids in people most at risk of opioid misuse.This thesis describes how standalone PBS data can be used to perform research that is timely, methodologically robust, policy-relevant, and internationally-relevant, even when outcome data are not available. Advisors/Committee Members: Pearson, Sallie-Anne, Public Health & Community Medicine, Faculty of Medicine, UNSW, Buckley, Nicholas, Pharmacology, University of Sydney.

Subjects/Keywords: population health; pharmacoepidemiology; biostatistics; public health

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APA (6^th Edition):

Schaffer, A. (2017). Big Data for pharmacoepidemiology research in Australia: using Pharmaceutical Benefits Scheme claims data to evaluate the effects of large-scale interventions. (Doctoral Dissertation). University of New South Wales. Retrieved from http://handle.unsw.edu.au/1959.4/58671 ; https://unsworks.unsw.edu.au/fapi/datastream/unsworks:46590/SOURCE02?view=true

Chicago Manual of Style (16^th Edition):

Schaffer, Andrea. “Big Data for pharmacoepidemiology research in Australia: using Pharmaceutical Benefits Scheme claims data to evaluate the effects of large-scale interventions.” 2017. Doctoral Dissertation, University of New South Wales. Accessed March 04, 2021. http://handle.unsw.edu.au/1959.4/58671 ; https://unsworks.unsw.edu.au/fapi/datastream/unsworks:46590/SOURCE02?view=true.

MLA Handbook (7^th Edition):

Schaffer, Andrea. “Big Data for pharmacoepidemiology research in Australia: using Pharmaceutical Benefits Scheme claims data to evaluate the effects of large-scale interventions.” 2017. Web. 04 Mar 2021.

Vancouver:

Schaffer A. Big Data for pharmacoepidemiology research in Australia: using Pharmaceutical Benefits Scheme claims data to evaluate the effects of large-scale interventions. [Internet] [Doctoral dissertation]. University of New South Wales; 2017. [cited 2021 Mar 04]. Available from: http://handle.unsw.edu.au/1959.4/58671 ; https://unsworks.unsw.edu.au/fapi/datastream/unsworks:46590/SOURCE02?view=true.

Council of Science Editors:

Schaffer A. Big Data for pharmacoepidemiology research in Australia: using Pharmaceutical Benefits Scheme claims data to evaluate the effects of large-scale interventions. [Doctoral Dissertation]. University of New South Wales; 2017. Available from: http://handle.unsw.edu.au/1959.4/58671 ; https://unsworks.unsw.edu.au/fapi/datastream/unsworks:46590/SOURCE02?view=true

17. DÃbora Bomfim Costa. UtilizaÃÃo de medicamentos por gestantes em atendimento prÃ-natal no municÃpio de Santo AntÃnio de Jesus - BA.

Degree: Master, 2015, Universidade Federal do Ceará

URL: http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15450 ; http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15452 ;

►

A utilizaÃÃo de medicamentos na gestaÃÃo Ã um fenÃmeno que tÃm sido descrito por estudos farmacoepidemiolÃgicos em todo o mundo, isso porque gestantes podem apresentar… (more)

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A utilizaÃÃo de medicamentos na gestaÃÃo Ã um fenÃmeno que tÃm sido descrito por estudos farmacoepidemiolÃgicos em todo o mundo, isso porque gestantes podem apresentar problemas de saÃde que muitas vezes requerem o uso de medicamentos, porÃm existem inÃmeras lacunas sobre as consequÃncias ao feto e Ã gestante. Para orientar o prescritor na escolha terapÃutica mais adequada para uma gestante, a agÃncia norte-americana Food and Drug Administration (FDA) classificou os medicamentos segundo critÃrios de risco, na tentativa de direcionar e tornar mais segura a prescriÃÃo. Este trabalho caracteriza o perfil farmacoepidemiolÃgico, os fatores associados a utilizaÃÃo de medicamentos antes e durante a gestaÃÃo e os fatores associados a utilizaÃÃo de medicamentos considerados seguros ou de risco em uma populaÃÃo de gestantes usuÃrias do Sistema Ãnico de SaÃde que estavam inscritas em atendimento prÃ-natal. Foi realizado um estudo transversal, com 1091 gestantes, os dados foram coletados de junho de 2012 a fevereiro de 2014, atravÃs de um formulÃrio previamente estruturado. Esse formulÃrio continha perguntas sobre condiÃÃes socioeconÃmicas da famÃlia, dados demogrÃficos, histÃria reprodutiva materna, hÃbitos maternos e alimentares, trabalho materno, consumo de medicamentos e assistÃncia prÃ-natal. O perfil encontrado foi de uma mulher com idade mÃdia de 25 anos, negra, ativa, com ensino fundamental completo e que mora com companheiro. Cerca de 83,0% das entrevistadas iniciaram seu prÃ-natal no 1Â trimestre e 37,41% realizaram pelo menos quatro consultas prÃ-natais. A prevalÃncia para consumo de medicamentos antes e durante a gestaÃÃo foi de 52,1% e 84,7% respectivamente. ApÃs anÃlise os seguintes fatores estavam associados a utilizaÃÃo de medicamentos antes da gestaÃÃo: Gestantes com idade ≥ 30 anos de idade, as nÃo negras, as que iniciaram o prÃ-natal depois do 1Â trimestre e as que fazem parte da classe econÃmica C/D/E. HÃ um aumento na prevalÃncia da utilizaÃÃo de medicamentos durante a gestaÃÃo entre as gestantes com escolaridade ≥ 11 anos de estudo, ter feito mais de trÃs consultas prÃ-natais e ter algum problema de saÃde. O uso de medicamentos de risco foi observado em 25,2% das gestantes e os fatores associados a essa utilizaÃÃo foram: idade maior que 24 anos, inÃcio do prÃ-natal durante o primeiro trimestre e ter algum problema de saÃde. Os resultados deste estudo sÃo semelhantes aos descritos na literatura, onde as gestantes sÃo expostas a uma grande variedade de medicamentos, e sugerem uma medicalizaÃÃo da gestaÃÃo e necessidade do desenvolvimento de evidÃncias cientÃficas capazes de promover a melhoria contÃnua da qualidade da assistÃncia materno-infantil, alÃm de investimentos em educaÃÃo profissional continuada que promovam o uso racional de medicamentos no perÃodo prÃ-natal.

The use of medication during pregnancy has been described in pharmacoepidemiological studies. Pregnant women may have health problems that often require the use of drugs, but there are numerous on the consequences to the fetus…

Advisors/Committee Members: Helena LutÃscia Luna Coelho, Luis Carlos Rey, Djanilson Barbosa dos Santos.

Subjects/Keywords: FARMACIA; Uso de Medicamentos; Gravidez; Farmacoepidemiologia; Drug Utilization; Pregnancy; Pharmacoepidemiology

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Costa, D. B. (2015). UtilizaÃÃo de medicamentos por gestantes em atendimento prÃ-natal no municÃpio de Santo AntÃnio de Jesus - BA. (Masters Thesis). Universidade Federal do Ceará. Retrieved from http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15450 ; http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15452 ;

Chicago Manual of Style (16^th Edition):

Costa, DÃbora Bomfim. “UtilizaÃÃo de medicamentos por gestantes em atendimento prÃ-natal no municÃpio de Santo AntÃnio de Jesus - BA.” 2015. Masters Thesis, Universidade Federal do Ceará. Accessed March 04, 2021. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15450 ; http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15452 ;.

MLA Handbook (7^th Edition):

Costa, DÃbora Bomfim. “UtilizaÃÃo de medicamentos por gestantes em atendimento prÃ-natal no municÃpio de Santo AntÃnio de Jesus - BA.” 2015. Web. 04 Mar 2021.

Vancouver:

Costa DB. UtilizaÃÃo de medicamentos por gestantes em atendimento prÃ-natal no municÃpio de Santo AntÃnio de Jesus - BA. [Internet] [Masters thesis]. Universidade Federal do Ceará 2015. [cited 2021 Mar 04]. Available from: http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15450 ; http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15452 ;.

Council of Science Editors:

Costa DB. UtilizaÃÃo de medicamentos por gestantes em atendimento prÃ-natal no municÃpio de Santo AntÃnio de Jesus - BA. [Masters Thesis]. Universidade Federal do Ceará 2015. Available from: http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15450 ; http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=15452 ;

Universiteit Utrecht

18. Scheifes, A. Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation.

Degree: 2015, Universiteit Utrecht

URL: http://dspace.library.uu.nl:8080/handle/1874/320363

► Treatment with psychotropic drugs is highly prevalent in people with intellectual disability, especially in those with behavioural problems. The high rates of psychotropic drug use… (more)

▼ Treatment with psychotropic drugs is highly prevalent in people with intellectual disability, especially in those with behavioural problems. The high rates of psychotropic drug use in this population is contrasted by the limited evidence on their effectiveness and the high risk of adverse events. The overall objective of this thesis was to critically evaluate psychotropic drug use in people with mild to borderline intellectual disability and behavioural problems. This thesis showed that people with intellectual disability are underrepresented in randomised controlled trials (RCTs) of pharmacological treatment of behavioural problems. At the same time psychotropic drugs are used extensively, often for long periods of time and without a clear indication for use. Psychotropic drug use often starts young, with 30% of institutionalised children and adolescents with intellectual disability and behavioural problems being treated with at least one psychotropic drug. Adverse drug events are common in treatment with psychotropic drugs, but are often not diagnosed in people with intellectual disability. Adverse events, such as serious movement disorders are very common, 44% of in-patient adults with mild to borderline intellectual disability and behavioural problems had a movement disorder. To improve the quality of pharmacotherapy a medication review intervention was performed in which the medication used by people with intellectual disability was thoroughly reviewed by a team consisting of the psychiatrist, a pharmacist and a nurse. In over a third of all medications used a drug-related problem was found, that needed intervention. In almost 60% of those cases the recommended actions were also executed. The research in this thesis has increased the knowledge on psychotropic drug use in people with mild to borderline intellectual disability and behavioural problems. The findings from this thesis show that psychotropic drugs play a major role in treatment of people with intellectual disability and behavioural problems, even though the evidence base is weak. People with intellectual disability and behavioural problems are at risk of starting psychotropic drugs at a young age and for unclear indications. The adverse events associated with psychotropic drug use can have a negative impact on the quality of life. To improve care for people with intellectual disability more attention is needed for pharmaceutical care during regular treatment plan evaluations, in combination with periodic structured medication reviews for complicated patients. Prescribing psychotropic drugs in people with intellectual disability and behavioural problems is complicated. The 6-step model of the World Health Organization (WHO) Guide to Good Prescribing can provide tools in the process of prescribing a (psychotropic) drug in people with intellectual disability. We propose the medication review as an additional step (6A) in the 6-step model. In the process of decision-making to start, continue or discontinue (psychotropic) drugs, a multidisciplinary… Advisors/Committee Members: Egberts, Toine, Nijman, H, Heerdink, Rob, Stolker, Jan.

Subjects/Keywords: intellectual disability; psychotropic drugs; pharmacoepidemiology; prevalence; adverse events; medication review

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APA (6^th Edition):

Scheifes, A. (2015). Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/320363

Chicago Manual of Style (16^th Edition):

Scheifes, A. “Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation.” 2015. Doctoral Dissertation, Universiteit Utrecht. Accessed March 04, 2021. http://dspace.library.uu.nl:8080/handle/1874/320363.

MLA Handbook (7^th Edition):

Scheifes, A. “Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation.” 2015. Web. 04 Mar 2021.

Vancouver:

Scheifes A. Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2015. [cited 2021 Mar 04]. Available from: http://dspace.library.uu.nl:8080/handle/1874/320363.

Council of Science Editors:

Scheifes A. Psychotropic drug use in people with intellectual disability: patterns of use and critical evaluation : patterns of use and critical evaluation. [Doctoral Dissertation]. Universiteit Utrecht; 2015. Available from: http://dspace.library.uu.nl:8080/handle/1874/320363

19. Joseph, Rebecca. Maximising the utility of electronic health records: answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility.

Degree: 2018, University of Manchester

URL: http://www.manchester.ac.uk/escholar/uk-ac-man-scw:317330

► Electronic health records (EHR) have become a widely used data source for epidemiological research. Such datasets often contain rich, prospectively-collected health data for a large… (more)

▼ Electronic health records (EHR) have become a widely used data source for epidemiological research. Such datasets often contain rich, prospectively-collected health data for a large number of patients. The data are less susceptible to recall bias than retrospectively-collected data, and using existing data can be cheaper and more efficient than setting up a new prospective cohort study. However, there are recognised challenges to reusing data originally collected for another purpose which could limit the value of research set within EHR. For example, the raw datasets are complex and thus the process of preparing EHR for analysis can be time-consuming and difficult to report transparently. In addition, routinely-collected data, such as EHR, are typically of lower quality than data collected directly for research. This can increase the risk of measurement errors and misclassification bias. This thesis explores the benefits and challenges of using EHR for health research, and presents methodologies developed to address some of the challenges. Eight publications are presented, arranged into three themes. First, examples of health research set within UK primary care EHR and the contribution of these publications to the literature are presented. Second, the challenge of preparing EHR for analysis is explored. An example of developing and sharing a reusable and flexible data preparation algorithm as a means to improve the transparency and efficiency of the process is presented. Third, the challenge of measurement error is explored. A novel study design combining EHR with data collected directly from patients is presented, alongside a validation study using patient-reported drug use information to quantify measurement error in prescription-derived estimates of drug exposure. The work presented in this thesis demonstrates that while studies set within EHR represent a valuable contribution to the literature, there remain a number of challenges to resolve. However, all data sources have limitations and, if appropriately accounted for, these challenges should not preclude the use of EHR for health research. A focus on transparency, validation, and replication of findings could help increase confidence in utilising EHR for research. Advisors/Committee Members: Dixon, William.

Subjects/Keywords: Electronic Health Records; Epidemiology; Pharmacoepidemiology; Transparency; Measurement Error

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APA (6^th Edition):

Joseph, R. (2018). Maximising the utility of electronic health records: answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility. (Doctoral Dissertation). University of Manchester. Retrieved from http://www.manchester.ac.uk/escholar/uk-ac-man-scw:317330

Chicago Manual of Style (16^th Edition):

Joseph, Rebecca. “Maximising the utility of electronic health records: answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility.” 2018. Doctoral Dissertation, University of Manchester. Accessed March 04, 2021. http://www.manchester.ac.uk/escholar/uk-ac-man-scw:317330.

MLA Handbook (7^th Edition):

Joseph, Rebecca. “Maximising the utility of electronic health records: answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility.” 2018. Web. 04 Mar 2021.

Vancouver:

Joseph R. Maximising the utility of electronic health records: answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility. [Internet] [Doctoral dissertation]. University of Manchester; 2018. [cited 2021 Mar 04]. Available from: http://www.manchester.ac.uk/escholar/uk-ac-man-scw:317330.

Council of Science Editors:

Joseph R. Maximising the utility of electronic health records: answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility. [Doctoral Dissertation]. University of Manchester; 2018. Available from: http://www.manchester.ac.uk/escholar/uk-ac-man-scw:317330

Kaunas University of Medicine

20. Paulauskaitė, Inga. Trends in the use of statins in Lithuania on 2005 – 2007 years.

Degree: Master, Pharmacy, 2008, Kaunas University of Medicine

URL: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100427-84402 ;

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Objective: To compare statins according to the pharmacokinetic and pharmacodynamic characteristics within the drug class and to perform the comprehensive analysis of statins consumption in… (more)

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Objective: To compare statins according to the pharmacokinetic and pharmacodynamic characteristics within the drug class and to perform the comprehensive analysis of statins consumption in Lithuania between 2005 and 2007 years. Methods: MEDLINE database was searched to identify and evaluate all literature relating to pharmacokinetic and pharmacodynamic chareacteristics of statins. The statins sales data on units and wholesale prices in all Lithuanian regions over three years (2005 – 2007) were obtained from SoftDent, JSC database. Drugs were classified according to the Anatomic Therapeutic Chemical system and use was quantified in terms of defined daily doses. The consumption of statins was calculated by DDD methodology and expressed as DDD per 1.000 inhabitants per day. Expenditures were calculated using retail drug costs noted in basic price catalogue for reimbursement medicines, for each year separately. Pharmacoeconomic calculations were done according to cost minimization and reference price methodologies. Results: According to meta-analysis, Nice (2006 years) recommendations and clinical trials data statins are therapeutically equivalent medicines. The total consumption of these drugs increased from 3.9 DDD/1000 inhabitants/day in 2005 and reached the value 8.4 DDD/1000 inhabitants/day in 2007 in Lithuania, so the total consumption of statins increased by 53.6% over three years (2005 – 2007) period. Comparing with statins consumption in other countries, this meaning was... [to full text]

Tikslai: Šio darbo tikslas yra palyginti statinus tarpusavyje pagal farmakokinetines ir farmakodinamines savybes bei atlikti statinų suvartojimo Lietuvoje analizę 2005 – 2007 metais. Metodai: Duomenys apie statinų farmakokinetines ir farmakodinamines savybes buvo surinkti iš MEDLINE elektroninių duomenų šaltinių. Duomenys apie statinų pardavimus vienetais ir didmeninėmis kainomis Lietuvoje per 2005 – 2007 metus gauti iš UAB SoftDent duomenų bazės. Vaistai buvo suklasifikuoti pagal anatominę terapinę cheminę (ATC) klasifikaciją. Statinų suvartojimas buvo vertinamas pagal apibrėžtos dienos dozės (DDD – daily defined dose) metodiką, o duomenys įvertinti pagal DDD skaičių, tenkantį 1000 gyventojų per vieną dieną. Išlaidos statinams buvo suskaičiuotos mažmeninėmis kainomis, remiantis kiekvienų metų kompensuojamųjų vaistų bazinių kainų kainynu. Statinų farmakoekonominei analizei atlikti buvo taikytas kainų mažinimo bei referentinės kainos nustatymo principas. Rezultatai: Remiantis metaanalizių, Nice (2006 metų) rekomendacijų ir klinikinių tyrimų duomenimis galima teigti, kad statinai prilygsta vienas kitam klinikiniu poveikiu. Bendras statinų suvartojimas padidėjo nuo 3,9 DDD/tūkstančiui gyventojų/dieną 2005 metais iki 8,4 DDD/tūkstančiui gyventojų/dieną 2007metais, taigi, per trejus metus bendras šių vaistų suvartojimas išaugo 53,6%. Palyginus su kitų šalių duomenimis, statinų suvartojimas 2007 metais Lietuvoje buvo apie 20 kartų mažesnis. Išlaidos statinams per trejus metus ( 200... [toliau žr. visą tekstą]

Advisors/Committee Members: Kaduševičius, Edmundas (Master’s thesis supervisor), Šlapikas, Rimvydas (Master’s thesis reviewer), Barsteigienė, Zita (Master’s degree committee chair), Vainauskas, Paulius (Master’s degree committee member), Savickas, Arūnas (Master’s degree committee member), Janulis, Valdimaras (Master’s degree committee member), Radžiūnas, Raimondas (Master’s degree committee member), Tarasevičius, Eduardas (Master’s degree committee member), Gumbrevičius, Gintautas (Master’s degree committee member).

Subjects/Keywords: Statins; Pharmacoepidemiology; Reference price; Statinai; Farmakoepidemiologija; Referentinė kaina

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APA (6^th Edition):

Paulauskaitė, Inga. (2008). Trends in the use of statins in Lithuania on 2005 – 2007 years. (Masters Thesis). Kaunas University of Medicine. Retrieved from http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100427-84402 ;

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Author name may be incomplete

Chicago Manual of Style (16^th Edition):

Paulauskaitė, Inga. “Trends in the use of statins in Lithuania on 2005 – 2007 years.” 2008. Masters Thesis, Kaunas University of Medicine. Accessed March 04, 2021. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100427-84402 ;.

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

MLA Handbook (7^th Edition):

Paulauskaitė, Inga. “Trends in the use of statins in Lithuania on 2005 – 2007 years.” 2008. Web. 04 Mar 2021.

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

Vancouver:

Paulauskaitė, Inga. Trends in the use of statins in Lithuania on 2005 – 2007 years. [Internet] [Masters thesis]. Kaunas University of Medicine; 2008. [cited 2021 Mar 04]. Available from: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100427-84402 ;.

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

Council of Science Editors:

Paulauskaitė, Inga. Trends in the use of statins in Lithuania on 2005 – 2007 years. [Masters Thesis]. Kaunas University of Medicine; 2008. Available from: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100427-84402 ;

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

Kaunas University of Medicine

21. Lasinskas, Marius. Trends in the consumption of analgesic drugs in Lithuania in 2005 – 2007.

Degree: Master, Pharmacy, 2008, Kaunas University of Medicine

URL: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100523-46119 ;

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Objective: To evaluate the consumption of analgesics in Lithuania in the year 2005 – 2007. Material and methods: The data on sales of analgesics drugs… (more)

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Objective: To evaluate the consumption of analgesics in Lithuania in the year 2005 – 2007. Material and methods: The data on sales of analgesics drugs in Lithuanian over a 3-year period (2005 – 2007) were obtained from Softdent database. Data were calculated by defined daily dose (DDD) methodology and expressed in DDDs per 1000 inhabitants per day. Results: The total analgesic drugs consumption increased by 16.55% in a 3-year period (2005 – 2007): from 58.37 DDDs/1000 inhabitants/day to 68.03 DDDs/1000 inhabitants/day. Diclofenac (ATC M01A) seemed to be the most highly consumed drug in Lithuania in the three-year period. Diclofenac (M01A) price/DDD is only 0.28 Lt. For these reasons diclofenac was more often used than other painkillers. The second most used agent for pain control was glucosamine (6.38 DDDs/1000 inhabitants/day in 2005), which is used for the treatment of osteoarthritis and, along with new products, its popularity increased sharply. Its consumption grew by 29.80% and achieved 8.28 DDDs/1000 inhabitants/day in 2007. Glucosamine value (Price/DDD) is 1.39 Lt, while paracetamol - 0.59 Lt. Glucosamine is OTC drug so people can buy it easily without control. Maybe for this reasons the usage of glucosamine is enough high. Ibuprofen has regained its popularity after the problems with coxibs. In 2005, the consumption of ibuprofen (4.42 DDDs/1000 inhabitants/day) grew rapidly once again, reached 7.26 DDDs/1000 inhabitants/day in 2007 and showed 64.25% increase.... [to full text]

Tikslas. Įvertinti analgetikų vartojimo tendencijas Lietuvoje 2005 – 2007 m. Metodai. Duomenys apie analgetikų pardavimą Lietuvoje 2005 – 2007 metais rinkti iš UAB „Softdent" duomenų bazės. Vaistai buvo klasifikuojami pagal anatominę terapinę cheminę (ATC) klasifikaciją. Vaistų suvartojimas buvo vertinamas pagal apibrėžtos dienos dozės (DDD – angl. defined daily dose) metodiką, o duomenys pateikiami apibrėžta dienos doze tūkstančiui gyventojų. Rezultatai. Lietuvoje per trejus metus (2005 – 2007) analgetikų vartojimas padidėjo 16.55%: nuo 58.37 iki 68.03 DDD/tūkstančiui gyventojų. Daugiausiai buvo suvartojama diklofenako (ATC grupė M01A), tai galėjo būtų dėl tam tikrų priežasčių: diklofenako vieno DDD kaina tik 0.28 lito. Antroje vietoje pagal suvartojimą – gliukozaminas, kuris vartojamas osteoartritui gydyti. Jo suvartojimas išaugo 29.80% ir 2007 m. pasiekė 8.28 DDD/tūkstančiui gyventojų. Gliukozamino vieno DDD vertė 1.39 Lt, kai paracetamolio – 0.59 Lt. Gliukozaminas yra bereceptis vaistas, taigi žmonėms jis legvai prieinamas. Galbūt dėl šių priežasčių gliukozamino suvartojama gana daug. Ibuprofenas susigrąžino savo populiarumą: 2005 metais jo suvartojimas pradėjo vėl sparčiai didėti, 2007 metais pasiekė 7.26 DDD/tūkstančiui gyventojų, ir parodė 64.25% augimą. Nimesulido vartojimas dramatiškai išaugo ir 2007 metais pasiekė 4.91 DDD/tūkstančiui gyventojų. Jo vieno DDD vertė 1.69 Lt, kai paracetamolio ir kitų analgetikų ši vertė nesiekė 1 Lt. Airijoje nimesulidas buvo... [toliau žr. visą tekstą]

Advisors/Committee Members: Kaduševičius, Edmundas (Master’s thesis supervisor), Petrikonis, Kęstutis (Master’s thesis reviewer), Savickas, Arūnas (Master’s degree committee member), Vainauskas, Paulius (Master’s degree committee member), Janulis, Valdimaras (Master’s degree committee member), Radžiūnas, Raimondas (Master’s degree committee member), Tarasevičius, Eduardas (Master’s degree committee member), Gumbrevičius, Gintautas (Master’s degree committee member), Barsteigienė, Zita (Master’s degree committee chair).

Subjects/Keywords: Pharmacoepidemiology; Analgesics; DDD/1000 inhabitants/day; Farmakoepidemiologija; Analgetikai; DDD/tūkstančiui gyventojų

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Lasinskas, Marius. (2008). Trends in the consumption of analgesic drugs in Lithuania in 2005 – 2007. (Masters Thesis). Kaunas University of Medicine. Retrieved from http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100523-46119 ;

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

Chicago Manual of Style (16^th Edition):

Lasinskas, Marius. “Trends in the consumption of analgesic drugs in Lithuania in 2005 – 2007.” 2008. Masters Thesis, Kaunas University of Medicine. Accessed March 04, 2021. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100523-46119 ;.

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

MLA Handbook (7^th Edition):

Lasinskas, Marius. “Trends in the consumption of analgesic drugs in Lithuania in 2005 – 2007.” 2008. Web. 04 Mar 2021.

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

Vancouver:

Lasinskas, Marius. Trends in the consumption of analgesic drugs in Lithuania in 2005 – 2007. [Internet] [Masters thesis]. Kaunas University of Medicine; 2008. [cited 2021 Mar 04]. Available from: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100523-46119 ;.

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

Council of Science Editors:

Lasinskas, Marius. Trends in the consumption of analgesic drugs in Lithuania in 2005 – 2007. [Masters Thesis]. Kaunas University of Medicine; 2008. Available from: http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2008~D_20080616_100523-46119 ;

Note: this citation may be lacking information needed for this citation format:
Author name may be incomplete

University of Illinois – Chicago

22. Adimadhyam, Sruthi. Risk of Arrhythmias Associated with Inhaled Anticholinergics in Young Individuals with Asthma.

Degree: 2012, University of Illinois – Chicago

URL: http://hdl.handle.net/10027/9266

► Context: Asthma is a common chronic condition with significant morbidity. Inhaled anticholinergics (IACs) are being investigated for maintenance therapy in asthma. However, little is known… (more)

▼ Context: Asthma is a common chronic condition with significant morbidity. Inhaled anticholinergics (IACs) are being investigated for maintenance therapy in asthma. However, little is known about the cardiovascular safety of these drugs in asthma. Objective: To evaluate the risk of arrhythmias associated with IAC use in young individuals with asthma. Design, Setting, and Patients: A population-based, nested case-control study of new users of asthma controller medications was conducted. Patients aged 5 to 24 years were identified between July 1997 and April 2010 in the IMS LifeLink™ Health Plan Claims Database for inclusion in the study. Cases were newly diagnosed with arrhythmia and were matched with up to 10 controls based on age, gender, geographic region, and quarter and year of first controller medication dispensing. Active use of anticholinergics was defined as days supply for a prescription extending through the event date. Main Outcome Measure: New arrhythmia diagnoses Results: Among 283,429 individuals with asthma, there were 7,656 cases matched to 76,304 controls. The majority of those included were female (58.8%) and older than 12 years (73.3%). Active exposure of IACs was observed in 0.69% of cases and 0.18% of controls. Active use was associated with a 1.56-fold increase in arrhythmia risk compared with non-active/nonusers (Adjusted Odds Ratio (ORadj), 1.56; 95% CI, [1.08–2.25]). Risk was highest among active users of ipratropium (ORadj, 1.59 [1.08–2.33]) compared with tiotropium (ORadj, 1.20 [0.29–4.89]) and combination ipratropium and short-acting beta-agonists (ORadj, 1.20 [0.74–1.94]). Active high dose users of IACs (>0.114mg ipratropium equivalents) had a 69% increase in risk (ORadj, 1.69 [1.10–2.59]) whereas the added risk for active users on low dose (≤ 0.114mg ipratropium equivalents) (ORadj, 1.22 [0.53–2.65]) was not statistically significant. Conclusion: IAC use was associated with an increased risk of arrhythmias in young individuals with asthma Advisors/Committee Members: Schumock, Glen (advisor).

Subjects/Keywords: Asthma; Arrhythmia; Inhaled anticholinergics; Nested case-control study; Pharmacoepidemiology; Drug safety

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APA (6^th Edition):

Adimadhyam, S. (2012). Risk of Arrhythmias Associated with Inhaled Anticholinergics in Young Individuals with Asthma. (Thesis). University of Illinois – Chicago. Retrieved from http://hdl.handle.net/10027/9266

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Adimadhyam, Sruthi. “Risk of Arrhythmias Associated with Inhaled Anticholinergics in Young Individuals with Asthma.” 2012. Thesis, University of Illinois – Chicago. Accessed March 04, 2021. http://hdl.handle.net/10027/9266.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Adimadhyam, Sruthi. “Risk of Arrhythmias Associated with Inhaled Anticholinergics in Young Individuals with Asthma.” 2012. Web. 04 Mar 2021.

Vancouver:

Adimadhyam S. Risk of Arrhythmias Associated with Inhaled Anticholinergics in Young Individuals with Asthma. [Internet] [Thesis]. University of Illinois – Chicago; 2012. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/10027/9266.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Adimadhyam S. Risk of Arrhythmias Associated with Inhaled Anticholinergics in Young Individuals with Asthma. [Thesis]. University of Illinois – Chicago; 2012. Available from: http://hdl.handle.net/10027/9266

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

University of Illinois – Chicago

23. Xing, Shan. Second Generation Antipsychotics and Diabetes Outcomes in Patients with Depression and Diabetes.

Degree: 2017, University of Illinois – Chicago

URL: http://hdl.handle.net/10027/22207

► This dissertation evaluated the use of and comparative effects of second generation antipsychotics (SGAs) and non-SGA depression pharmacotherapies [bupropion, lithium, mirtazapine, tricyclic antidepressants (TCAs) and… (more)

▼ This dissertation evaluated the use of and comparative effects of second generation antipsychotics (SGAs) and non-SGA depression pharmacotherapies [bupropion, lithium, mirtazapine, tricyclic antidepressants (TCAs) and thyroid hormone] on diabetes outcomes in patients with pre-existing diabetes and depression who previously used a selective serotonin reuptake inhibitor or selective norepinephrine reuptake inhibitor. Three clinical studies compared 1) non-adherence and non-persistence to SGA versus non-SGA depression therapies, 2) non-adherence and non-persistence to oral antidiabetic drugs (OAD) between SGA and non-SGA users, and 3) SGA and non-SGA users on the risk of diabetes-related hospitalization or diabetes drug intensification. Use of SGAs was associated with a 1.8 times higher odds of non-adherence and a 1.4 times higher risk of non-persistence to therapy compared to non-SGA use. Also, SGA users had a 30-40% higher odds of a 10% or greater decline in OAD adherence compared to non-SGA users, while persistence to OAD therapy was similar between groups. Risk of diabetes of diabetes-related hospitalization or diabetes drug intensification was no different comparing SGA versus non-SGA users; however, there were differences when comparing specific treatment subgroups: bupropion was associated with a 15% reduced risk of diabetes-related hospitalization or treatment intensification compared to TCAs, quetiapine was associated with a 18% reduced risk of events compared to mirtazapine, and quetiapine was associated with a 16% reduced risk of events compared to TCAs. Differences for other subgroup comparisons between aripiprazole, quetiapine, bupropion, mirtazapine and TCAs were small and non-significant. Future studies are needed to access the impact of SGA and non-SGA therapies on other diabetes outcomes, including hemoglobin A1c, diabetic complications, and mortality. A fourth methodological study assessed the performance of full-cohort high dimensional propensity score (HDPS) matching approaches versus subgroup-specific HDPS approaches. The full-cohort HDPS matching approaches sometimes resulted in non-overlapping propensity score distributions, more imbalance in potential confounders, and greater than 10% change in effect estimates compared to the subgroup-specific approach. Therefore, examining covariate balance after matching to ensure that patient subgroups are balanced with respect to potential confounders is recommended if one of the full-cohort HDPS approaches are used. Advisors/Committee Members: Lee, Todd A (advisor), Calip, Gregory S (committee member), Leow, Alex D (committee member), Kim, Shiyun (committee member), Schumock, Glen T (committee member), Touchette, Daniel R (committee member), Lee, Todd A (chair).

Subjects/Keywords: Antipsychotic Agents High dimensional propensity score Depression Diabetes Comorbidity Pharmacoepidemiology

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Xing, S. (2017). Second Generation Antipsychotics and Diabetes Outcomes in Patients with Depression and Diabetes. (Thesis). University of Illinois – Chicago. Retrieved from http://hdl.handle.net/10027/22207

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Xing, Shan. “Second Generation Antipsychotics and Diabetes Outcomes in Patients with Depression and Diabetes.” 2017. Thesis, University of Illinois – Chicago. Accessed March 04, 2021. http://hdl.handle.net/10027/22207.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Xing, Shan. “Second Generation Antipsychotics and Diabetes Outcomes in Patients with Depression and Diabetes.” 2017. Web. 04 Mar 2021.

Vancouver:

Xing S. Second Generation Antipsychotics and Diabetes Outcomes in Patients with Depression and Diabetes. [Internet] [Thesis]. University of Illinois – Chicago; 2017. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/10027/22207.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Xing S. Second Generation Antipsychotics and Diabetes Outcomes in Patients with Depression and Diabetes. [Thesis]. University of Illinois – Chicago; 2017. Available from: http://hdl.handle.net/10027/22207

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

24. Newlove-Delgado, Tamsin Victoria. Service use and unmet mental health need in children and young adults : analysis of three years of follow up from the 2004 British Child and Adolescent Mental Health Survey & description of primary care psychotropic prescribing & transition in young adults with Attention Deficit Hyperactivity Disorder.

Degree: PhD, 2016, University of Exeter

URL: http://hdl.handle.net/10871/21211

► This thesis aimed to examine service contact among children and young people with mental health problems, and has three complementary parts. The first is a… (more)

▼ This thesis aimed to examine service contact among children and young people with mental health problems, and has three complementary parts. The first is a secondary analysis of data from the British Child and Adolescent Mental Health Survey (BCAMHS) 2004, which explored mental health related service contact in relation to psychopathology over three years. The second and third parts focussed on young people with ADHD in transition from child services, which is a particularly challenging time. This involved a qualitative interview study of young peoples’ experiences, and an analysis of primary care prescribing of ADHD medication over the transition period using a cohort from the Clinical Practice Research Datalink from 2005-2013. Less than a third of children with a psychiatric disorder in BCAMHS reported contact with child mental health services. Instead, teachers were the most frequently used service, with two-thirds reporting mental health related contact. Interviews with young people with ADHD highlighted themes including concerns around medication management post transition and need for information. The prescribing analysis found that the majority of adolescents on ADHD medication at age 16 stopped during the transition period. This continuing disparity between estimates of symptom persistence and medication persistence suggests that many may be stopping medication from which they could still benefit; as various barriers have been identified to ongoing prescribing. In summary, the findings of these three linked studies suggest common themes in terms of unmet needs and gaps between policy and practice in mental health services for children and young people. One of the chief implications is the need for oversight and policy levers to ensure the implementation of best practice, accompanied by complementary efforts to better understand and overcome other barriers to providing optimal care, including research into knowledge and attitudes of different groups and the provision of targeted training.

Subjects/Keywords: 618.92; ADHD; Pharmacoepidemiology; Child mental health; Child mental health service use

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APA (6^th Edition):

Newlove-Delgado, T. V. (2016). Service use and unmet mental health need in children and young adults : analysis of three years of follow up from the 2004 British Child and Adolescent Mental Health Survey & description of primary care psychotropic prescribing & transition in young adults with Attention Deficit Hyperactivity Disorder. (Doctoral Dissertation). University of Exeter. Retrieved from http://hdl.handle.net/10871/21211

Chicago Manual of Style (16^th Edition):

Newlove-Delgado, Tamsin Victoria. “Service use and unmet mental health need in children and young adults : analysis of three years of follow up from the 2004 British Child and Adolescent Mental Health Survey & description of primary care psychotropic prescribing & transition in young adults with Attention Deficit Hyperactivity Disorder.” 2016. Doctoral Dissertation, University of Exeter. Accessed March 04, 2021. http://hdl.handle.net/10871/21211.

MLA Handbook (7^th Edition):

Newlove-Delgado, Tamsin Victoria. “Service use and unmet mental health need in children and young adults : analysis of three years of follow up from the 2004 British Child and Adolescent Mental Health Survey & description of primary care psychotropic prescribing & transition in young adults with Attention Deficit Hyperactivity Disorder.” 2016. Web. 04 Mar 2021.

Vancouver:

Newlove-Delgado TV. Service use and unmet mental health need in children and young adults : analysis of three years of follow up from the 2004 British Child and Adolescent Mental Health Survey & description of primary care psychotropic prescribing & transition in young adults with Attention Deficit Hyperactivity Disorder. [Internet] [Doctoral dissertation]. University of Exeter; 2016. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/10871/21211.

Council of Science Editors:

Newlove-Delgado TV. Service use and unmet mental health need in children and young adults : analysis of three years of follow up from the 2004 British Child and Adolescent Mental Health Survey & description of primary care psychotropic prescribing & transition in young adults with Attention Deficit Hyperactivity Disorder. [Doctoral Dissertation]. University of Exeter; 2016. Available from: http://hdl.handle.net/10871/21211

25. Joseph, Rebecca. Maximising the utility of electronic health records : answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility.

Degree: PhD, 2018, University of Manchester

URL: https://www.research.manchester.ac.uk/portal/en/theses/maximising-the-utility-of-electronic-health-records-answering-clinically-important-questions-whilst-expanding-methods-for-data-quality-transparency-and-reproducibility(4f7bee30-ccc5-4f51-af66-fe50b5550b4d).html ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.779559

► Electronic health records (EHR) have become a widely used data source for epidemiological research. Such datasets often contain rich, prospectively-collected health data for a large… (more)

▼ Electronic health records (EHR) have become a widely used data source for epidemiological research. Such datasets often contain rich, prospectively-collected health data for a large number of patients. The data are less susceptible to recall bias than retrospectively-collected data, and using existing data can be cheaper and more efficient than setting up a new prospective cohort study. However, there are recognised challenges to reusing data originally collected for another purpose which could limit the value of research set within EHR. For example, the raw datasets are complex and thus the process of preparing EHR for analysis can be time-consuming and difficult to report transparently. In addition, routinely-collected data, such as EHR, are typically of lower quality than data collected directly for research. This can increase the risk of measurement errors and misclassification bias. This thesis explores the benefits and challenges of using EHR for health research, and presents methodologies developed to address some of the challenges. Eight publications are presented, arranged into three themes. First, examples of health research set within UK primary care EHR and the contribution of these publications to the literature are presented. Second, the challenge of preparing EHR for analysis is explored. An example of developing and sharing a reusable and flexible data preparation algorithm as a means to improve the transparency and efficiency of the process is presented. Third, the challenge of measurement error is explored. A novel study design combining EHR with data collected directly from patients is presented, alongside a validation study using patient-reported drug use information to quantify measurement error in prescription-derived estimates of drug exposure. The work presented in this thesis demonstrates that while studies set within EHR represent a valuable contribution to the literature, there remain a number of challenges to resolve. However, all data sources have limitations and, if appropriately accounted for, these challenges should not preclude the use of EHR for health research. A focus on transparency, validation, and replication of findings could help increase confidence in utilising EHR for research.

Subjects/Keywords: Transparency; Pharmacoepidemiology; Measurement Error; Electronic Health Records; Epidemiology

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APA (6^th Edition):

Joseph, R. (2018). Maximising the utility of electronic health records : answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility. (Doctoral Dissertation). University of Manchester. Retrieved from https://www.research.manchester.ac.uk/portal/en/theses/maximising-the-utility-of-electronic-health-records-answering-clinically-important-questions-whilst-expanding-methods-for-data-quality-transparency-and-reproducibility(4f7bee30-ccc5-4f51-af66-fe50b5550b4d).html ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.779559

Chicago Manual of Style (16^th Edition):

Joseph, Rebecca. “Maximising the utility of electronic health records : answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility.” 2018. Doctoral Dissertation, University of Manchester. Accessed March 04, 2021. https://www.research.manchester.ac.uk/portal/en/theses/maximising-the-utility-of-electronic-health-records-answering-clinically-important-questions-whilst-expanding-methods-for-data-quality-transparency-and-reproducibility(4f7bee30-ccc5-4f51-af66-fe50b5550b4d).html ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.779559.

MLA Handbook (7^th Edition):

Joseph, Rebecca. “Maximising the utility of electronic health records : answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility.” 2018. Web. 04 Mar 2021.

Vancouver:

Joseph R. Maximising the utility of electronic health records : answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility. [Internet] [Doctoral dissertation]. University of Manchester; 2018. [cited 2021 Mar 04]. Available from: https://www.research.manchester.ac.uk/portal/en/theses/maximising-the-utility-of-electronic-health-records-answering-clinically-important-questions-whilst-expanding-methods-for-data-quality-transparency-and-reproducibility(4f7bee30-ccc5-4f51-af66-fe50b5550b4d).html ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.779559.

Council of Science Editors:

Joseph R. Maximising the utility of electronic health records : answering clinically important questions whilst expanding methods for data quality, transparency, and reproducibility. [Doctoral Dissertation]. University of Manchester; 2018. Available from: https://www.research.manchester.ac.uk/portal/en/theses/maximising-the-utility-of-electronic-health-records-answering-clinically-important-questions-whilst-expanding-methods-for-data-quality-transparency-and-reproducibility(4f7bee30-ccc5-4f51-af66-fe50b5550b4d).html ; https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.779559

University of Washington

26. Chen, Lu. Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients.

Degree: PhD, 2016, University of Washington

URL: http://hdl.handle.net/1773/36675

► Background: Management of comorbidities is a critical issue among 2.9 million breast cancer survivors in the U.S. Hypertension and diabetes are two common chronic conditions… (more)

▼ Background: Management of comorbidities is a critical issue among 2.9 million breast cancer survivors in the U.S. Hypertension and diabetes are two common chronic conditions affecting this patient population. Despite the generally good safety profile of widely used antihypertensive medications and diabetes treatments, few studies have examined their relationships with adverse breast cancer outcomes. In particular, metformin, a first line diabetes treatment, is hypothesized to lower the risk of incident breast cancer, but it is unclear whether metformin influences breast cancer progression. The purpose of this dissertation was to characterize how commonly prescribed classes of antihypertensive medications and diabetes treatments relate to adverse breast cancer outcomes. Methods: We conducted a retrospective cohort study of women between ages 66 and 80 years newly diagnosed with stage I or II breast cancer during 2007-2011. A total of 14,766 eligible women were identified in the linked Surveillance, Epidemiology and End-Results (SEER)-Medicare database. Medicare Part D Prescription Drug Event data were obtained to characterize women’s use of commonly used antihypertensive medications (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers and diuretics) and diabetes treatments (metformin, sulfonylureas, insulin therapy and other diabetes treatments) after their breast cancer diagnosis. Primary outcomes were any second breast cancer events (SBCEs, recurrence or second primary breast cancer, n=791), recurrence per se (n=627), and breast cancer-specific mortality (n=327). Time varying Cox proportional hazard models, adjusted for demographic characteristics, tumor characteristics, first course treatment and a history of diabetes and hypertension, were used to estimate hazard ratios (HRs) and their associated 95% confidence intervals (CIs). Results: Use of diuretics (n=8,517) after breast cancer diagnosis was associated with 40% (95% CI: 1.20-1.64), 41% (95% CI: 1.18-1.67) and 78% (95% CI: 1.32-2.40) higher risks of a SBCE, recurrence and breast cancer death, respectively, compared to nonusers of diuretics. Use of β-blockers (n=7,145) was associated with a 1.63-fold (95% CI: 1.24-2.13) higher risk of breast cancer death compared to women who did not use this class of drug. Use of angiotensin II receptor blockers was associated with 1.26-fold (95% CI: 1.08-1.48) higher risk of a SBCE. Use of calcium channel blockers and angiotensin-converting enzyme inhibitors were generally not associated with an altered risk of adverse breast cancer outcomes. With respect to diabetes treatments, use of metformin after breast cancer (n=2,558) was associated with a 22% (95% CI: 0.62-0.98), 26% (95% CI: 0.57-0.96), and 40% (95% CI: 0.40-0.90) lower risk of a SBCE, breast cancer recurrence, and breast cancer death, respectively, compared to metformin nonusers. Use of sulfonylureas and insulin were associated with 1.58 (95% CI: 1.08-2.30) and 2.64-fold (95%CI: 1.78-3.92)… Advisors/Committee Members: Li, Christopher I (advisor).

Subjects/Keywords: breast cancer; diabetes; hypertension; pharmacoepidemiology; seer-medicare; Epidemiology; epidemiology

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Chen, L. (2016). Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients. (Doctoral Dissertation). University of Washington. Retrieved from http://hdl.handle.net/1773/36675

Chicago Manual of Style (16^th Edition):

Chen, Lu. “Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients.” 2016. Doctoral Dissertation, University of Washington. Accessed March 04, 2021. http://hdl.handle.net/1773/36675.

MLA Handbook (7^th Edition):

Chen, Lu. “Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients.” 2016. Web. 04 Mar 2021.

Vancouver:

Chen L. Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients. [Internet] [Doctoral dissertation]. University of Washington; 2016. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1773/36675.

Council of Science Editors:

Chen L. Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients. [Doctoral Dissertation]. University of Washington; 2016. Available from: http://hdl.handle.net/1773/36675

University of Iowa

27. Moga, Daniela Claudia. Bladder antimuscarinics use in the veterans affairs community living centers: description of medication use and evaluation of risks and benefits.

Degree: PhD, Epidemiology, 2012, University of Iowa

URL: https://ir.uiowa.edu/etd/2586

► Urinary incontinence, one of the most prevalent conditions in elderly living in nursing homes (NH) was shown to significantly impact patient's quality of life… (more)

▼ Urinary incontinence, one of the most prevalent conditions in elderly living in nursing homes (NH) was shown to significantly impact patient's quality of life (QOL) and health outcomes. Bladder antimuscarinics (BAM), the main drug class to treat urinary incontinence, have limited effects in managing the condition; however, given their anticholinergic properties and the characteristics of those living in NH, BAM could potentially lead to serious health consequences in this population. We conducted a retrospective cohort study with a new-users design by linking existing Veterans Affairs (VA) data (inpatient, outpatient, pharmacy administrative files, and Minimum Data Set- MDS) between fiscal years 2003 and 2009. Potential risks (i.e. fractures and negative impact on cognitive performance) and benefits (i.e. improvement in urinary incontinence, social engagement and overall QOL) associated with initiation of a BAM were assessed in elderly (65+) admitted for long-term care in the VA Community Living Centers. Descriptive statistics were used to compare BAM new-users and non-users at baseline; in addition, logistic regression was used to identify important predictors of BAM initiation. Treatment selection bias was addressed by using the propensity score matching method. After balancing the groups on baseline characteristics, the risk of fractures (hip fracture, any fracture) in relationship with BAM initiation was evaluated using Cox proportional hazard analysis. BAM impact on the cognitive status measured by the MDS-Cognitive Performance Scale (CPS) was evaluated through generalized estimated equations (GEE) method. Similarly, possible benefits measured through MDS were assessed via GEE. The final cohort included 1195 BAM new-users (with the majority being prescribed Oxybutynin immediate-release) and 22,987 non-users. Predictors of BAM initiation included demographic characteristics, bladder and bowel continence status, comorbidities, medication use, cognitive performance and functional status. Our study showed that BAM improved urinary continence (OR=1.27, 95%CI: 1.07-1.50) in those treated; social engagement as measured by MDS-Index of Social Engagement also improved in users, although at a level that is not clinically significant (difference in mean MDS-ISE=0.2074, 95%CI: 0.0550-0.3598). However, BAM initiation increased the risk of fractures (hip: HR=3.69, 95% CI: 1.46 - 9.34, p=0.0059; any fracture: HR=2.64. 95% CI: 1.37 - 5.10, p=0.0039). Our results showed no difference between new-users and non-users with regard to mean CPS and overall QOL. The purpose of the study was to clarify the proper role of medication use… Advisors/Committee Members: Chrischilles, Elizabeth A. (supervisor).

Subjects/Keywords: aging; bladder antimuscarinics; outcomes research; pharmacoepidemiology; Clinical Epidemiology

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APA (6^th Edition):

Moga, D. C. (2012). Bladder antimuscarinics use in the veterans affairs community living centers: description of medication use and evaluation of risks and benefits. (Doctoral Dissertation). University of Iowa. Retrieved from https://ir.uiowa.edu/etd/2586

Chicago Manual of Style (16^th Edition):

Moga, Daniela Claudia. “Bladder antimuscarinics use in the veterans affairs community living centers: description of medication use and evaluation of risks and benefits.” 2012. Doctoral Dissertation, University of Iowa. Accessed March 04, 2021. https://ir.uiowa.edu/etd/2586.

MLA Handbook (7^th Edition):

Moga, Daniela Claudia. “Bladder antimuscarinics use in the veterans affairs community living centers: description of medication use and evaluation of risks and benefits.” 2012. Web. 04 Mar 2021.

Vancouver:

Moga DC. Bladder antimuscarinics use in the veterans affairs community living centers: description of medication use and evaluation of risks and benefits. [Internet] [Doctoral dissertation]. University of Iowa; 2012. [cited 2021 Mar 04]. Available from: https://ir.uiowa.edu/etd/2586.

Council of Science Editors:

Moga DC. Bladder antimuscarinics use in the veterans affairs community living centers: description of medication use and evaluation of risks and benefits. [Doctoral Dissertation]. University of Iowa; 2012. Available from: https://ir.uiowa.edu/etd/2586

University of Washington

28. Spieker, Andrew Justin. Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use.

Degree: PhD, 2016, University of Washington

URL: http://hdl.handle.net/1773/37038

► In the modern era, cardiovascular biomarkers are often measured in the presence of medication use, whereby the observed value is different than the underlying untreated… (more)

▼ In the modern era, cardiovascular biomarkers are often measured in the presence of medication use, whereby the observed value is different than the underlying untreated value for participants on medication. However, for certain problems, the natural history of the biomarker that would have occurred in the absence of medication use is of greater interest than the observed value. In observational data, medication use is nonrandom in that participants on medication tend to have higher underlying biomarker values than participants off medication. That is to say that medication use is endogenous. When faced with endogenous medication use, traditional methods such as adjustment for medication use in linear regression models are inappropriate. The goal of this dissertation is to develop methods to estimate associations between predictors of interest and biomarker outcomes in the presence of endogenous medication use. First, we focus on methods for use in a cross-sectional setting. Heckman's treatment effects model, as suggested by its name, has historically been used to estimate the effect of medication use on a continuous outcome. In this research, we take a definitive departure from the historical use of the model, in that we utilize the Heckman framework in order to estimate associations between exposures and underlying (off-medication) outcomes, regarding the effect of medication on the biomarker as a nuisance rather than a parameter of interest. We show that the treatment effects model is fairly robust to departures from several of its main assumptions. One assumption to which the treatment effects model is particularly sensitive, however, is the assumption of uniform treatment effects. In particular, the expected effect of medication use on the biomarker is presumed to be constant across participants (an assumption that is often thought to be unrealistic in practice). We extend the treatment effects model to allow effect modification, or "subgroup-specific" treatment effects. The second major aim of this dissertation pertains to developing methodology to address endogenous medication use when repeated measures are available on subjects over time. Very little work has been done to address the challenges of endogenous medication use in longitudinal data. For certain types of probit analyses, existing methods invoke standard results on M-estimation theory to construct asymptotically valid estimates of marginal parameters. As cardiovascular biomarkers of interest show strong within-subject correlation over time, there is much efficiency to be gained by modeling that correlation. We seek to understand situations in which accounting for correlation can be advantageous (e.g., in the setting of deterministic covariates), and elucidate efficiency gains with specification of a working covariance. These two objectives primarily target bias reduction for the challenge of addressing endogenous medication use in estimating biomarker associations. Improving estimation of these associations can help us better understand underlying… Advisors/Committee Members: McClelland, Robyn L. (advisor).

Subjects/Keywords: Endogeneity; Natural history; Observational data; Pharmacoepidemiology; Biostatistics; biostatistics

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APA (6^th Edition):

Spieker, A. J. (2016). Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use. (Doctoral Dissertation). University of Washington. Retrieved from http://hdl.handle.net/1773/37038

Chicago Manual of Style (16^th Edition):

Spieker, Andrew Justin. “Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use.” 2016. Doctoral Dissertation, University of Washington. Accessed March 04, 2021. http://hdl.handle.net/1773/37038.

MLA Handbook (7^th Edition):

Spieker, Andrew Justin. “Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use.” 2016. Web. 04 Mar 2021.

Vancouver:

Spieker AJ. Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use. [Internet] [Doctoral dissertation]. University of Washington; 2016. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1773/37038.

Council of Science Editors:

Spieker AJ. Recovering Natural History: Modeling Cardiovascular Biomarkers in the Presence of Endogenous Medication Use. [Doctoral Dissertation]. University of Washington; 2016. Available from: http://hdl.handle.net/1773/37038

University of Toronto

29. Tadrous, Mina. Advancing Comparative Effectiveness Research: Filling in the Gaps for Bisphosphonates.

Degree: PhD, 2015, University of Toronto

URL: http://hdl.handle.net/1807/89017

►

Drug approval regulations for market-entry often only require that medications be proven efficacious compared to placebo. This drug approval policy creates a gap in information… (more)

Subjects/Keywords: Bisphosphonates; Comparative Effectiveness; Health Outcomes; Medications; Pharmacoepidemiology; Pharmacy; 0766

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Tadrous, M. (2015). Advancing Comparative Effectiveness Research: Filling in the Gaps for Bisphosphonates. (Doctoral Dissertation). University of Toronto. Retrieved from http://hdl.handle.net/1807/89017

Chicago Manual of Style (16^th Edition):

Tadrous, Mina. “Advancing Comparative Effectiveness Research: Filling in the Gaps for Bisphosphonates.” 2015. Doctoral Dissertation, University of Toronto. Accessed March 04, 2021. http://hdl.handle.net/1807/89017.

MLA Handbook (7^th Edition):

Tadrous, Mina. “Advancing Comparative Effectiveness Research: Filling in the Gaps for Bisphosphonates.” 2015. Web. 04 Mar 2021.

Vancouver:

Tadrous M. Advancing Comparative Effectiveness Research: Filling in the Gaps for Bisphosphonates. [Internet] [Doctoral dissertation]. University of Toronto; 2015. [cited 2021 Mar 04]. Available from: http://hdl.handle.net/1807/89017.

Council of Science Editors:

Tadrous M. Advancing Comparative Effectiveness Research: Filling in the Gaps for Bisphosphonates. [Doctoral Dissertation]. University of Toronto; 2015. Available from: http://hdl.handle.net/1807/89017

30. Morello, Manuela Roque Siani. Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados.

Degree: Mestrado, Medicamentos e Cosméticos, 2014, University of São Paulo

URL: http://www.teses.usp.br/teses/disponiveis/60/60137/tde-30102014-163819/ ;

► O crescente consumo de medicamentos psicoativos (MPA) pela população brasileira e mundial no século XXI, atrelado ao fato de que algumas dessas substâncias podem gerar… (more)

▼ O crescente consumo de medicamentos psicoativos (MPA) pela população brasileira e mundial no século XXI, atrelado ao fato de que algumas dessas substâncias podem gerar dependência física e/ou psíquica nos sujeitos que os utilizam, apontam para a necessidade de desenvolver estudos epidemiológicos que forneçam subsídios para o planejamento de intervenções em saúde que garantam o uso racional desses medicamentos. Este estudo transversal visa estimar a prevalência e caracterizar o perfil de utilização de MPA entre usuários de medicamentos atendidos por todas as farmácias das unidades de saúde do município de Ribeirão Preto-SP, relacionando esses achados com fatores associados ao consumo dessas substâncias. Uma amostra de 1355 usuários de medicamentos (psicoativos ou não) foi entrevistada nas filas das referidas farmácias de setembro a dezembro de 2012. Os pesquisadores coletaram dados sociodemográficos e relacionados à saúde dos indivíduos, além de registrarem todos os medicamentos contidos nas prescrições. Em seguida, três instrumentos foram aplicados para avaliar as variáveis clínicas (i) conhecimento dos indivíduos sobre a farmacoterapia, (ii) adesão à farmacoterapia e (iii) qualidade de vida relacionada à saúde (QdV). A prevalência de uso de MPA foi 31,0% (n=420), sendo que os mais prescritos foram antidepressivos (53,5%) e benzodiazepínicos (24,6%). A maioria dos usuários de MPA era do gênero feminino (81,9%), vivia com companheiro (52,6%), não trabalhava (70,7%), possuía plano de saúde privado (69,2%) e renda per capita de até um salário mínimo (54,0%), não realizava acompanhamento com psicólogo (93,3%), não praticava atividade física regular (78,3%), consumia café diariamente (81,0%), não consumia álcool (86,7%), não fumava (81,4%) e não encontrava-se em polifarmácia (62,4%). A idade média foi 54,5 (DP 13,9) e a escolaridade média correspondeu ao Ensino Fundamental incompleto. Pouco mais da metade dos usuários de MPA exibiram conhecimento satisfatório sobre a farmacoterapia e foram considerados aderentes (57,8% e 53,0%, respectivamente) e a maioria não apresentou QdV satisfatória (73,1%). Houve diferença estatisticamente significativa (p<0,05) entre usuários de MPA e não usuários para as variáveis gênero, faixa etária, situação conjugal, moradia, situação profissional, cuidador, acompanhamento com psicólogo, atividade física regular, consumo de álcool, tabagismo, polifarmácia, conhecimento médio sobre a farmacoterapia, adesão média à farmacoterapia, QdV satisfatória, índice médio EQ- 5D e QdV autorreferida média. Os valores de odds ratio (OR) ajustados mostraram que os fatores associados positivamente com o uso de MPA foram gênero feminino (OR = 2,02; IC 95% 1,31; 3,11) e maior idade (ORref./idosos = 0,36; IC 95% 0,13; 0,99). Dentre os usuários de benzodiazepínicos, 51,1% relatou estar em uso desses MPA há dois anos ou mais, dos quais 55,1% eram idosos. Aproximadamente um em cada três indivíduos utilizava pelo menos um MPA no período estudado, sendo que idosos e mulheres apresentaram maiores chances de uso. Os MPA… Advisors/Committee Members: Pereira, Leonardo Régis Leira.

Subjects/Keywords: drug utilization studies; estudo de utilização de medicamentos; farmacoepidemiologia; pharmacoepidemiology; psicotrópicos; psychotropic drugs

Record Details Similar Records Cite « Share

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Morello, M. R. S. (2014). Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados. (Masters Thesis). University of São Paulo. Retrieved from http://www.teses.usp.br/teses/disponiveis/60/60137/tde-30102014-163819/ ;

Chicago Manual of Style (16^th Edition):

Morello, Manuela Roque Siani. “Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados.” 2014. Masters Thesis, University of São Paulo. Accessed March 04, 2021. http://www.teses.usp.br/teses/disponiveis/60/60137/tde-30102014-163819/ ;.

MLA Handbook (7^th Edition):

Morello, Manuela Roque Siani. “Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados.” 2014. Web. 04 Mar 2021.

Vancouver:

Morello MRS. Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados. [Internet] [Masters thesis]. University of São Paulo; 2014. [cited 2021 Mar 04]. Available from: http://www.teses.usp.br/teses/disponiveis/60/60137/tde-30102014-163819/ ;.

Council of Science Editors:

Morello MRS. Medicamentos psicoativos na rede pública de saúde de RibeirãoPreto-SP: perfil de utilização e fatores associados. [Masters Thesis]. University of São Paulo; 2014. Available from: http://www.teses.usp.br/teses/disponiveis/60/60137/tde-30102014-163819/ ;

Open Access Theses and Dissertations