Pharmacy and Generic Substitution of Antiepileptic Drugs: Missing in Action?

2007 ◽  
Vol 41 (6) ◽  
pp. 1065-1068 ◽  
Author(s):  
Timothy E Welty
Keyword(s):  
Decision Making ◽  
Antiepileptic Drugs ◽  
Generic Substitution ◽  
Careful Consideration ◽  
Professional Organizations ◽  
Missing In Action

Generic substitution of antiepileptic drugs is an issue that is gathering a lot of attention in the neurology community but is not receiving much attention within pharmacy. Several proposals have been drafted that restrict a pharmacist's decision-making in generic substitution. These proposals highlight concerns about the pharmacy community related to generic substitution. Careful consideration needs to be given to these issues by pharmacists and pharmacy professional organizations. Unless pharmacy as a profession takes strong positions in support of a pharmacist's ability to make decisions about pharmacotherapy and addresses many of the pharmacy-related problems of generic substitution, policies that negatively impact pharmacy will be established.

The Role of Healthcare Professionals in Environmental Health and Fertility Decision-Making

2017 ◽  
Vol 27 (1) ◽  
pp. 28-50 ◽  
Author(s):  
Ellen Sweeney
Keyword(s):  
Decision Making ◽  
Healthcare Professionals ◽  
Endocrine Disrupting Chemicals ◽  
Consumer Products ◽  
Professional Organizations ◽  
Toxic Substances ◽  
Industrial Chemicals ◽  
Fertility Decision ◽  
Guidelines And Recommendations

There is increasing evidence that raises specific concerns about prenatal exposures to toxic substances which makes it necessary to consider everyday exposures to industrial chemicals and toxic substances in consumer products, including endocrine disrupting chemicals. Pregnant women have measurable levels of numerous toxic substances from exposures in their everyday environments, including those which are associated with adverse developmental and reproductive health outcomes. As a result, environmental contexts have begun to influence the decisions women make related to fertility, as well as the formal guidelines and advice provided by healthcare professionals. This article provides an overview of the potential role for obstetricians and gynecologists in educating their patients about the role of toxic substances in fertility decision-making and pregnancy. It explores the emerging guidelines and recommendations from professional organizations and problematizes the limitations of these approaches.

Generic substitution of antiepileptic drugs — A survey of patients' perspectives in Germany and other German-speaking countries

2013 ◽  
Vol 27 (1) ◽  
pp. 135-139 ◽  
Author(s):  
Katrin Hensler ◽  
Carmen Uhlmann ◽  
Thomas Porschen ◽  
Reiner Benecke ◽  
Johannes Rösche
Keyword(s):  
Antiepileptic Drugs ◽  
Generic Substitution ◽  
German Speaking

Principles of Treatment of Disabled Infants

PEDIATRICS ◽  
1984 ◽  
Vol 73 (4) ◽  
pp. 559-560 ◽  
Author(s):  
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Professional Education ◽  
Medical Condition ◽  
Disabled Persons ◽  
Professional Organizations ◽  
Care Givers ◽  
Individual Care ◽  
The Government ◽  
Education And Employment

Discrimination of any type against any individual with a disability/disabilities, regardless of the nature or severity of the disability, is morally and legally indefensible. Throughout their lives, all disabled individuals have the same rights as other citizens, including access to such major societal activities as health care, education, and employment. These rights for all disabled persons must be recognized at birth. NEED FOR INFORMATION There is a need for professional education and dissemination of updated information which will improve decision-making about disabled individuals, especially newborns. To this end, it is imperative to educate all persons involved in the decision-making process. Parents should be given information on available resources to assist in the care of their disabled infant. Society should be informed about the value and worth of disabled persons. Professional organizations, advocacy groups, the government, and individual care givers should educate and inform the general public on the care, need, value, and worth of disabled infants. MEDICAL CARE When medical care is clearly beneficial, it should always be provided. When appropriate medical care is not available, arrangements should be made to transfer the infant to an appropriate medical facility. Consideration such as anticipated or actual limited potential of an individual and present or future lack of available community resources are irrelevant and must not determine the decisions concerning medical care. The individual's medical condition should be the sole focus of the decision. These are very strict standards. It is ethically and legally justified to withhold medical or surgical procedures which are clearly futile and will only prolong the act of dying.

Valences of the Corporate Governance in the Process of Accounting Reporting

2019 ◽  
pp. 145-166 ◽  
Author(s):  
Tatiana Dănescu ◽  
Mihaela Prozan
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Risk Management ◽  
Corporate Governance ◽  
Global Economy ◽  
Accounting Information ◽  
Reliable Information ◽  
Professional Organizations ◽  
Prospective Risk

In the context of the issues that the global economy is facing, one of the main concerns of the regulative authorities, of the professional organizations, and of entities was and still is identifying the risk factors that affect the systems of corporative governance and the systems and processes through which the supply of reliable information in the decision-making process is insured. Another concern is identifying reliable solutions for insuring the implementation of a proactive and prospective risk management that makes a mark on the utility of the information presented and communicated to the targeted users, especially through accounting reporting. Hence, through the necessity of insuring the transparency and the utility of accounting information, in this chapter, the role of corporate governance, in improving the process of accounting reporting and as a consequence of the value of accounting information, will be synthetically presented.

Management of the difficult airway

2016 ◽  
Author(s):  
Mary C. Mushambi ◽  
Rajesh Pandey
Keyword(s):  
Decision Making ◽  
Pregnant Woman ◽  
Difficult Airway ◽  
Cricoid Pressure ◽  
Careful Consideration ◽  
Situational Factors ◽  
Morbidity And Mortality ◽  
General Anaesthetic ◽  
Failed Intubation ◽  
Airway Equipment

Failed or difficult intubation is still a major cause of maternal morbidity and mortality. The management of the airway in the pregnant patient requires careful consideration of anatomical and physiological changes, training issues, and situational factors. Despite significant improvements in monitoring and airway equipment, and a reduction in anaesthetic-related maternal mortality, the incidence of failed intubation in the pregnant woman in many units has remained between 1/250 and 1/300. This may result from many factors such as the reduction of the number of caesarean deliveries performed under general anaesthesia which has resulted in limited opportunities to teach airway skills in obstetrics, the increased incidence of obesity, and the rise in maternal age and associated co-morbidities. Improved training and careful planning and performance of a general anaesthetic (i.e. reducing the risk of aspiration; optimum pre-oxygenation, patient positioning, and application of cricoid pressure; and availability of appropriate airway equipment) have the potential to reduce airway-related morbidity and mortality in the pregnant woman. Simple bedside tests such as Mallampati scoring, thyromental distance, neck movement, and ability to protrude the mandible may help to predict a potential difficult airway, particularly when used in combination. Management of a predicted difficult airway requires early referral to the anaesthetists, formulation of an airway management strategy, and involvement of the multidisciplinary team in decision-making. Fibreoptic equipment and skills should be readily available when required. Management of the unpredicted difficult airway should make maintenance of maternal and fetal oxygenation the primary goal. Decision-making during a failed intubation on whether to proceed or wake the patient should involve the obstetrician and ideally be planned in advance. The periods during extubation and recovery are high risk and require preparation and planning in advance.

The Economic Consequences of Generic Substitution for Antiepileptic Drugs in a Public Payer Setting: The Case of Lamotrigine

2007 ◽  
Vol 10 (4) ◽  
pp. 216-225 ◽  
Author(s):  
Mei Sheng Duh ◽  
Frederick Andermann ◽  
Pierre Emmanuel Paradis ◽  
Jennifer Weiner ◽  
Ranjani Manjunath ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Generic Substitution ◽  
Economic Consequences ◽  
Public Payer

The Controversy over Generic Antiepileptic Drugs

2010 ◽  
Vol 15 (2) ◽  
pp. 81-93 ◽  
Author(s):  
Susan J. Shaw ◽  
Adam L. Hartman
Keyword(s):  
Antiepileptic Drugs ◽  
Generic Substitution ◽  
Patent Protection ◽  
Cost Savings ◽  
Pharmacokinetic Profile ◽  
Test Procedures ◽  
Rigorous Study ◽  
Clinically Significant ◽  
Few Data ◽  
Patients With Epilepsy

ABSTRACT As patent protection ends for the next generation of antiepileptic drugs (AEDs), a complex debate continues over generic substitution of AEDs. On one hand, generic drug formulations provide cost savings for patients and society. On the other hand, patients with epilepsy and physicians are wary about the adequacy and efficacy of the Food and Drug Administration's (FDA) standards for generics. This article reviews current and proposed bioequivalence test procedures, summarizes new generic AED formulations and their costs, and discusses potential pitfalls in the current standards. These shortcomings include certain pharmacokinetic factors and clinical pharmacologic factors that may affect bioequivalence of generic AEDs, and statistical limitations of the standards. While the drug concentration differences between the brand name drug and each generic formulation are unlikely to be substantial, the differences with generic-to-generic switches will be greater and potentially clinically significant. Conversely, owing to their more favorable pharmacokinetic profile, newer AEDs may be less prone to problems with generic substitution than older ones. Unfortunately, very few data are available to guide decisions regarding what is best for an individual patient. Based on new prediction methods, generic substitution should be safe for many patients but identifying them ultimately requires more rigorous study.

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