A comparison of network sampling designs for a hidden population of drug users: Random walk vs. respondent-driven sampling.

Both random walk and respondent-driven sampling (RDS) exploit social networks and may reduce biases introduced by earlier methods for sampling from hidden populations. Although RDS has become much more widely used by social researchers than random walk (RW), there has been little discussion of the tradeoffs in choosing RDS over RW. This paper compares experiences of implementing RW and RDS to recruit drug users to a network-based study in Houston, Texas. Both recruitment methods were implemented over comparable periods of time, with the same population, by the same research staff. RDS methods recruited more participants with less strain on staff. However, participants recruited through RW were more forthcoming than RDS participants in helping to recruit members of their social networks. Findings indicate that, dependent upon study goals, researchers' choice of design may influence participant recruitment, participant commitment, and impact on staff, factors that may in turn affect overall study success.

Gauging patient safety programs.

In response to evidence that adverse medical events are widespread, patient safety programs have emerged and proliferated worldwide in recent years. Patient safety may be considered a new and distinct healthcare discipline. It emphasizes the reporting, analysis, and prevention of medical errors that can lead to adverse healthcare events. While this is a useful generic definition, it takes on different meanings for each healthcare discipline. When patient safety programs were studied, it was found that many are generic and may be inappropriately focused and researched. In planning a patient safety program, the basis of patient safety programs for all disciplines will have similarities. But each discipline will require nuances specific to the discipline since the goals, objectives, and requirements of each are unique. Furthermore, each discipline will have its own preferred outcomes that may change over time as new data become available and service providers become more knowledgeable of ways to increase the likelihood of desired outcomes.

The pathology of alcohol use and abuse.

Alcohol is the most widely abused substance in the United States and its pathology is responsible for more pathological conditions than all other forms of drug use combined. Alcohol dependence is associated with a number of adverse individual and societal consequences and high rates of morbidity and mortality. Alcohol use and abuse have a significant pathological effect on the brain, fetus, liver, heart, pancreas, and immune system. Cancer risks have also been attributed to alcohol use and abuse. Assessing acute and chronic alcohol consumption is critical to effective treatment but unfortunately currently available clinical laboratory testing procedures lack the ability to inform alcohol treatment providers about use and abuse.

Patient safety and quality improvement: a policy assessment.

BACKGROUND: The regulation implementing the Patient Safety and Quality Improvement Act of 2005 (PSQIA) was published on November 21, 2008, and became effective on January 19, 2009 (42 C.F.R. Part 3). PSQIA establishes a voluntary reporting system to enhance the data available to assess and resolve patient safety and health care quality issues. To encourage the reporting and analysis of medical errors, PSQIA provides federal privilege and confidentiality protections for patient safety information. PURPOSE: Greater reporting and analysis of patient safety events will yield increased data and better understanding of patient safety events. A PSO's workforce must have expertise in analyzing patient safety events, such as the identification, analysis, prevention, and reduction or elimination of the risks and hazards associated with the delivery of patient care. IMPLICATIONS: This new legislation provides a vehicle to better understand at a macro level how the clinical laboratory threatens patient safety and how that threat can be better controlled. What is imperative is that the clinical laboratory staff be involved in collecting and analyzing data. If they are not, the probability is high that data being reported by the laboratory will be misunderstood at the PSO and laboratories may be cited as a threat to patient safety because of a lack of understanding of laboratory operations.

An overview of FDA regulatory requirements for new medical devices.

BACKGROUND: US national healthcare expenditure reached over 2 trillion dollars in 2007. medical device expenditure has remained nearly a constant 6% of the total healthcare expenditure. medical technology may be one of the driving factors increasing healthcare costs. the number of medical device (which includes diagnostic tests) and laboratory equipment manufacturers, and investment in research for medical devices continue to rise. medical device manufacturers can receive a higher than average return on investment if they successfully navigate the food and drug administration (FDA) approval process. OBJECTIVE: this paper focuses on the series of steps a manufacturer can pursue to facilitate the introduction of a new device to the us market. METHOD: a review of the FDA regulations and current literature was conducted. RESULTS/CONCLUSION: exemption from a full review by the FDA owing to substantial equivalence is one of the pathways a manufacturer can pursue for quicker and easier approval of the new device. three classes of devices are reviewed, as are some of the key regulations governing them. the regulations for advertising and promotion are still unclear because of the gray area that exists between the federal trade commission and the FDA. this paper concludes by summarizing the advertising and promotion regulations set forth by the FDA during the post-approval phase.

E-detailing: information technology applied to pharmaceutical detailing.

BACKGROUND: E-detailing can be best described as the use of information technology in the field of pharmaceutical detailing. It is becoming highly popular among pharmaceutical companies because it maximizes the time of the sales force, cuts down the cost of detailing and increases physician prescribing. Thus, the application of information technology is proving to be beneficial to both physicians and pharmaceutical companies. When e-detailing was introduced in 1996, it was limited to the US; however, numerous other countries soon adopted this novel approach to detailing and now it is popular in many developed nations. OBJECTIVE: The objective of this paper is to demonstrate the rapid growth of e-detailing in the field of pharmaceutical marketing. METHODS: A review of e-detailing literature was conducted in addition to personal conversations with physicians. RESULTS/CONCLUSION: E-detailing has the potential to reduce marketing costs, increase accessibility to physicians and offer many of the advantages of face-to-face detailing. E-detailing is gaining acceptance among physicians because they can access the information of a pharmaceutical product at their own time and convenience. However, the drug safety aspect of e-detailing has not been examined and e-detailing remains a supplement to traditional detailing and is not yet a replacement to it.

The root cause of patient safety concerns in an Internet pharmacy.

BACKGROUND: The Internet has become a revolutionary technology that affords worldwide opportunities never seen before. One such opportunity is the purchase of drugs over the Internet and the business of Internet pharmacies which has become prolific. Associated with this proliferation is the concern for patient safety. Numerous studies have shown that drugs purchased over the Internet come from pharmacies in a country other than the one where the patient resides and these pharmacies are not licensed, sometimes provide drugs without a prescription and that are not of the same composition as they should be, and do not provide adequate directions to the patient. In addition, the packaging of the drugs may be compromised resulting in altered medication. OBJECTIVE: This paper examines the root cause of patient safety issues in Internet pharmacies. METHODS: A review of the literature including the marketing literature was conducted. RESULTS/CONCLUSION: Healthcare marketing concepts guide business owners to identify patients' wants and distinguish them from their needs. Marketing principles detail aggressive marketing strategies within an organization's mission and in an ethical manner. Some Internet pharmacies misinterpret proven marketing principles and become overly aggressive in the market place focusing only on sales and profit rather than focusing on patient safety and long-term success of the Internet pharmacy.

Direct-to-consumer advertising: its effects on stakeholders.

The escalating growth in the development of pharmaceutical drugs has caused the pharmaceutical industry to market drugs directly to consumers. Direct-to-consumer (DTC) advertising has increased immensely in the past 15 years and continues to grow each year. The advantages of DTC advertising include an increase in consumer knowledge, patient autonomy, and possibly providing physicians and pharmacists with up-to-date information about the recent trends in the marketplace. However, there is also an equally notable list of disadvantages, which include concerns about the quality of information provided, loss in physician productivity due to time spent convincing patients that what they want is not in their best interest, and increases in the reimbursement expenditure of the insurers. Because of these conflicting outcomes, the issue of DTC advertising has become controversial. This report offers an overview of DTC advertising and focuses on its effects on physicians, pharmacists, consumers, insurers, the government, and pharmaceutical manufacturers.

Propofol-related infusion syndrome in intensive care patients.

The Institute of Medicine has identified adverse drug events as factors that significantly contribute to increased patient morbidity and mortality. As critically ill patients receive numerous drugs to treat a multitude of complicated health problems, they are at high risk for adverse drug events. Sedation is often a key requirement for the optimal management of critical illness, and propofol, a common sedative, has many desirable characteristics that make it the ideal agent in numerous circumstances. However, over the last decade, increasing numbers of reports have described a potentially fatal adverse effect called propofol-related infusion syndrome. Whether this adverse drug event is preventable is unclear, but recommendations have been proposed to minimize the potential for development of this syndrome. Research is under way to collect data on the use of propofol in intensive care units and on its prevalence.

Online pharmacies: safety and regulatory considerations.

Sales of consumer products over the Internet have grown rapidly, including sales of pharmaceutical products. Online pharmacies mimic mail order pharmacies. To operate legally online, pharmacies must be licensed in every state in which sales occur. Although online pharmacies provide benefits to consumers, when compared with traditional pharmacies patients' safety may be compromised. Purchasing prescription drugs online may pose a risk to consumers because they cannot tell whether the site is offering drugs of the same quality offered by a retail pharmacy. There is also a possibility that prescription drugs purchased online may be counterfeit, illegal, or unapproved. A U.S. General Accounting Office study conducted in June 2004 showed that most counterfeit and unapproved drugs sold online are from non-U.S. pharmacies. The Food and Drug Administration and other government agencies have worked to enforce laws on drug sales over the Internet. The biggest challenge in regulating non-U.S. pharmacies is due to their off-shore location. Unfortunately, given the widespread anonymous and ever-changing nature of the Internet, it is very difficult to close down illegal websites.

A marketing clinical doctorate programs.

Over the past decade, clinical doctorate programs in health disciplines have proliferated amid both support and controversy among educators, professional organizations, practitioners, administrators, and third-party payers. Supporters argue that the explosion of new knowledge and increasing sophistication of technology have created a need for advanced practice models to enhance patient care and safety and to reduce costs. Critics argue that necessary technological advances can be incorporated into existing programs and believe that clinical doctorates will increase health care costs, not reduce them. Despite the controversy, many health disciplines have advanced the clinical doctorate (the most recent is the doctor of nursing practice in 2004), with some professions mandating the doctorate as the entry-level degree (i.e., psychology, pharmacy, audiology, and so on). One aspect of the introduction of clinical doctoral degrees has been largely overlooked, and that is the marketing aspect. Because of marketing considerations, some clinical doctorates have been more successfully implemented and accepted than others. Marketing is composed of variables commonly known as "the four P's of marketing": product, price, promotion, and place. This report explores these four P's within the context of clinical doctorates in the health disciplines.

Differences in drug treatment services based on profit status.

The goal of this article is to examine whether profit status affects the provision of seven "core" drug treatment services and nine "auxiliary" treatment services. Data on the type of services provided by 8,606 treatment providers obtained from the National Survey of Substance Abuse Treatment Services (N-SSATS) collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2000 were used for this study. The types of services offered by the providers were modeled to be a function of the drug treatment providers' (DTP) profit status, DTP organizational and financial characteristics, staff's characteristics, clients' characteristics, and regional variables. A total of 16 logistic regressions were estimated. For-profit DTPs were found to be more likely to offer only two core services and were less likely to offer eight auxiliary services. However, after correcting for sample selection bias many differences in the supply of services between for-profit and nonprofit providers disappeared.

Perceiver and relationship effects on perceptions of HIV status: A naturalistic study in a high drug use sample.

This article examines the effect of target, perceiver, and relationship characteristics on the perceiver's assessment that the target may be HIV seropositive (HIV+). A sample of 267 persons was recruited from low income, high drug use neighborhoods. Respondents (perceivers) were asked to name people (targets) with whom they had a social, drug sharing, or sexual relationship. Perceivers described 1,640 such relationships. Perceivers were asked about the targets' age, gender, and race/ethnicity, whether the targets were good-looking, their level of trust with the target, and how long they had known them. Perceivers were then asked to evaluate the chances that the target mentioned was HIV+. Two regression models were estimated on the 1,640 relationships mentioned. Model 1 included variables reflecting only target characteristics as independent variables. Model 2 included variables reflecting target characteristics as well as variables reflecting perceivers and perceiver-target relationship characteristics. The results showed that targets that were female, younger, and good-looking were perceived as being less likely to be HIV+. However, when accounting for perceiver and relationship effects, some of the target characteristic effects disappeared.

HIV/AIDS in the Middle East: a guide to a proactive response.

After 24 years of being declared an epidemic, the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has found its way to the remote parts of the Middle East. There are no fastidious HIV/AIDS epidemiological data available specific for the Middle East and insufficient surveys have been conducted in a larger area including the Middle East and North Africa. Currently the total number of people living with HIV in the Middle East and North Africa is 540,000. About 92,000 individuals were newly infected in 2004 and 28,000 people have died of AIDS during the same time period.2 With increasing spread of sexually transmitted infections (STIs), injection drug users (IDUs), numbers of unemployed youth, a conservative culture and low awareness of HIV the region is especially vulnerable to a large-scale epidemic. In this age of globalization the rapid spread of HIV along with highly virulent and multi-drug-resistant HIV strains that progress rapidly to AIDS, the more difficult and expensive prevention efforts and treatment regimes become. Complicating the issue there are many unresolved socio-economic conflicts in the Middle East. Valid and reliable HIV/AIDS epidemiological data, to facilitate policy formulation and to effect urgent prevention intervention is inadequate. This article identifies numerous gaps and shortfalls in the existing programs, elucidates the reasons behind the lack of information, and provides suggestions for taking actions.

The association between EIC receipt and employment in a sample of drug using and non-drug using TANF recipients.

This article examines the extent to which Temporary Assistance to Needy Families (TANF) recipients file income tax returns and take advantage of the Earned Income Credit (EIC), a program specifically designed to increase the economic self-sufficiency of lower income earners by supplementing earned and other income to make working more profitable. This study consisted primarily of Black and Hispanic women (n = 317), recruited for a longitudinal study designed to examine the effects of welfare reform on drug using and non-drug using welfare recipients. At the 2-year mark, 70% of the sample reported having ever filed an income tax return, of these 76% had received an EIC. Both hours worked and earnings were positively associated with EIC receipt. In this population, EIC appears to be a successful mechanism for improving economic self-sufficiency.

Effect of peers on employment and implications for drug treatment.

We examined the effect peers have on Temporary Assistance to Needy Families (TANF) recipients' employment behavior. Nondrug using and chronic drug using TANF recipients (n=433) participating in a study funded by the National Institute on Drug Abuse were asked how many of the people they regularly spent time with over the past 4 months had jobs and how many of them encouraged the individual to look for work. Results of a path analysis showed that age, education, and chronic drug use were significantly related to the nature of peer relationships. A significant and positive association between the number of peers that worked and the number of hours worked in the following 4 months was observed. Examining the effect of peers on labor force participation by TANF recipients is necessary to assist recipients in securing and maintaining employment.

Personal adjustment and substance abuse problems in a longitudinal study of TANF recipients and the potential need for treatment.

OBJECTIVE: This study assessed the need over time for treatment of personal adjustment and substance abuse problems among chronic drug using and other recipients of Temporary Assistance for Needy Families (TANF). METHODS: Participants were administered the personal adjustment problems and substance abuse problems scales contained in the Multidimensional Addictions and Personality Profile (MAPP) at intake, one-year, and two-year interviews. RESULTS: Most participants who were not chronic users had total scale scores that would indicate no recommended referral or a referral to outpatient treatment. Approximately one-third of chronic users had scores that would indicate referral to inpatient treatment. Many chronic users had comorbid conditions but reported receiving no psychological or substance abuse treatment. CONCLUSIONS: Many TANF recipients may be experiencing coexisting personal and substance abuse related problems that are going untreated.