Physicians prescribing practices

In general, no more than one product is necessary per category of enteral feeding formulations and it may be possible to omit certain categories based on the specific population and physician prescribing practices within a given institution. The selection of product should be based on meeting patient nutritional requirements. Additional selection criteria include container size and type, liquid or powder form, shelf life, ease of use, and cost. 

It is not often that researchers find their work leading to such widespread changes of behaviour. Still, the 44 per cent figure reveals a split opinion. Most physicians did not intend to alter their prescribing practices. Our analysis has provoked a vociferous and continuing debate on the effectiveness of antidepressants and the circumstances under which they should be prescribed. In this chapter I consider and respond to the various criticisms that have been levelled at our data-based conclusions about the efficacy of antidepressants. 

Powers, R. L., K. A. Halbritter, J. G. Arbogast, J. L. Neely, and A. J. Williams. 1998. Do Interactions with Pharmaceutical Representatives Influence Antihypertensive Medication Prescribing Practices of Family Medicine and General Internal Medicine Physicians Journal of General Internal Medicine 13, Supplement 13. 

Every indicator available, including scientific abuse liability studies, actual abuse, paucity of scientific studies on possible adverse effects associated with long-term use of stimulants, divergent prescribing practices of U.S. physicians, and lack of concurrent medical treatment and follow-up, urge greater caution and more restrictive use of MPH. 

Standing apart from the academic researchers, the Clinical Initiatives Center sees four discrete activities in the medication use process that need reform—physician prescribing, order processing, drug delivery and reporting and event capture (shown below)—mutually-exclusive intellectual divides each describing a specific problem in need of attention. Our recommended best practices address these problems, their components and their root causes. 

The epoxide metabolite is believed to exhibit activity similar to that of the parent compound and therefore contributes substantially to the overall therapeutic effects of carbamazepine. This feet must be taken into consideration when a patient is taking other medications. For instance, the antibiotic clarithromycin has been found to inhibit the action of the enzyme epoxide hydroxylase. This causes the concentration of the epoxide to be higher than normal, increasing the potency of carbamazepine. Before a physician prescribes carbamazepine for a patient, potential drug interactions must be taken into account This is an example of one important factor that practicing physicians must consider—specifically, the effect that one drug can have on the potency of another drug. 

A final area of research focuses on how the piU. can best be used by women. Physicians used to recommend pid-free hoHdays, but it is now known that there is no vaUd reason for this practice. Similarly, further research indicated that the U.S. EDA s restrictive guidelines for prescribing the piU. to women over the age of 35 are not justified, and those guidelines have been changed. EinaHy it is clear that cigarette smoking increases the risk of cardiovascular side effects, especially in women over 35 who utilize combination oral contraceptives. 

In the mid-nineteenth century, it was the custom for doctors to frequently prescribe morphine (first isolated from opium by Friedrich Serturner in 1806) and other opium preparations. Morphine did not have a major impact on medical practice until the invention of the hypodermic needle in 1840. Soldiers illness was recognized after the Civil War when more than 50,000 veterans became dependent on morphine as a result of treatment for combat injuries (Musto 1987). The public also had ready access to opium and purified drugs in grocery stores and pharmacies. Medicinal mixtures and nostrums, usually unlabelled as to contents, often contained opium or morphine. By the end of the century, many physicians had come to recognize that chronic use of morphine was a disorder (morphinism), although others in society... 

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