Administrative difficulties

In developing countries that lack adequate facilities for intensive therapy of poisoned people, antidotes may be more essential in the prevention and treatment of poisoning. But availability of antidotes is different from one country to another. In developing countries, physicians reported difficulties in obtaining even common antidotes. Even in industrialized countries, could be noticed administrative difficulties and the lack of suitable drugs (pharmaceutical formulation, concentration etc.). 

Abstract On average 50% of patients are compliant to long term medication treatment. Non-compliance is a drug-related problem as it may result in negative outcomes for the patient. Non-compliance can be intentional or non-intentional and related to knowledge, attitudes, and also practical problems including memory and administration difficulties. The decision to take a medication or not (compliance) lay in the hand of the patient, but the health care providers can support the patient in this decision with the aim to improve the patients health. Definitions and tools to detect negative patient and health-care behaviour and methods for concordance are presented in this chapter. 

Servers offer networks the capability of centralizing the control of resources and can thus reduce administrative difficulties. They can be used to distribute processes for balancing the load on the computers and can thus increase speed and performance. They can also offer the departmentalizing of files for improved reliability. That way, if one server goes down, then not all of the files are lost. 

Another difficult aspect in the design of open-label studies is how one assesses those patients who withdraw from the study. The reasons for withdrawal can be at least as varied as in double-blind studies (intolerability, administrative difficulties, coincidental emergent disease or concomitant therapies, etc.). However, in addition, in an open-label design, patients may develop an opinion on the superiority of one or other treatment for reasons that may or may not be explicit. If completion of a course of therapy is one end point of the study, then all withdrawals can be accounted treatment failures, and the statistical handling is fairly straightforward. However, if there is another end point, and if withdrawals are imbalanced between the treatment groups and unrelated to product intolerability, then the situation becomes a lot more clouded. Under these latter conditions, the entire trial may have to be abandoned when it becomes apparent that the trial design cannot answer the hypothesis under test one way or the other. 

Due to the administrative difficulties with switching drviers from intrastate to interstate (and back), many companies use the approach once interstate, always interstate. ... 

The transfer of elements of the Chief s office to Edgewood in the fall of 1942 led to some administrative difficulties, particularly in personnel matters. The Technical Division, OC CWS, for example, wanted to control its members located at Edgewood directly through the Washington office. The chief of the Technical Division felt that he could obtain more and better qualified employees in that way. The Chief, CWS, nevertheless, de-... 

In order to insure that the testing at San Jose would not be obstructed by administrative difficulties, the Chief, CWS, activated a San Jose Project Division in his office on 27 September 1944. Under this arrangement the San Jose Project became a branch of the new division. General Bullene was made chief of the San Jose Project Division, at the same time retaining command at the project. 

Since that date we have suffered more than 160 000 gas casualties, the majority from mustard gas and although the percentage of mortality has been very low the almost continuous removal of large numbers of men from the front has involved us in serious tactical and administrative difficulties. ... 

Hours and the arrangements for shift working Administration and technical staff on day shift Difficulty is often experienced when workers are shared between departments. Some information will not be documented but since employees are generally paid for attendance hours these are meticulously recorded. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

Neuromuscular blockade or respiratory paralysis may occur after administration of the aminoglycosides Therefore, it is extremely important that any symptoms of respiratory difficulty be reported immediately. If neuromuscular blockade occurs, it may be reversed by the administration of calcium salts but mechanical ventilation may be required. 

Oral administration requires great care because some patients have difficulty swallowing (because of a dry mouth or other causes). Other patients may refuse to take the drug. If the patient refuses to take the drug, the nurse contacts the primary health care provider regarding this problem because parenteral administration of the drug may be necessary. 

The adverse reactions associated widi metoclopramide are usually mild. Higher doses or prolonged administration may produce central nervous system (CNS) symptoms, such as drowsiness, dizziness, Parkinson-like symptoms (tremor, mask-like facial expression, muscle rigidity), depression, facial grimacing, motor restlessness, and involuntary movements of die eyes, face, or limbs. Dexpandienol administration may cause itching, difficulty breadiing, and urticaria... 

Delivery of peptides and proteins via the gastrointestinal tract has not been successful because of poor penetration through the intestinal epithelium and high levels of proteolytic activity in the gastrointestinal tract. Liposomal encapsulation of proteins and peptides will not improve the efficiency and capacity of this absorption pathway considerably (e.g., Ryman et al., 1982 Machy and Leserman, 1987 Weiner and Chia-Ming Chiang, 1988). These difficulties in delivery via the oral route caused the parenteral route to remain the preferred route for the administration of therapeutic peptides... 

Opioids maybe administered in a variety of routes including oral (tablet and liquid), sublingual, rectal, transdermal, transmucosal, intravenous, subcutaneous, and intraspinal. While the oral and transdermal routes are most common, the method of administration is based on patient needs (severity of pain) and characteristics (swallowing difficulty and preference). Oral opioids have an onset of effect of 45 minutes, so intravenous or subcutaneous administration maybe preferred if more rapid relief is desired. Intramuscular injections are not recommended because of pain at the injection site and wide fluctuations in drug absorption and peak plasma concentrations achieved. More invasive routes of administration such as PCA and intraspinal (epidural and intrathecal) are primarily used postoperatively, but may also be used in refractory chronic pain situations. PCA delivers a self-administered dose via an infusion pump with a preprogrammed dose, minimum dosing interval, and maximum hourly dose. Morphine, fentanyl, and hydromorphone are commonly administered via PCA pumps by the intravenous route, but less frequently by the subcutaneous or epidural route. 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

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