Occupational Justice: Staff Member's Understanding of the Role of Occupational Therapy within Organizations Serving Persons Experiencing Homelessness.

The purpose of this descriptive study was to explore the understanding of occupational justice and occupational therapy's role among staff members working within organizations serving persons experiencing homelessness. A survey was developed to determine if staff (N = 43) understood what occupational therapists can do to help persons experiencing homelessness. Responses were split almost equally between agree/strongly agree and disagree/strongly disagree. Most or 95% (n = 38) of respondents stated their organization would be interested in increasing programming to support the ideas of occupational justice. This suggests that occupational therapy can fill a need in these organizations to promote occupational justice.

[The information potential of the names of drugs]. / Informacný potenciál názvov lieciv a liekov.

Authors pay their attention to the issue of names of pharmaceuticals and drugs and their relationship to their therapeutic use. They specify way of making names of pharmaceuticals and structure of those names (chemical name, trivial name, generic name, unprotected name--INN, name in dispensatory) and way of making names of drugs (protected titles of original drugs, names of generic drugs). One part of the work comprises a chapter applying to subsidiary pharmaceutical agents and their E-code.

Pharmacoeconomic aspects of patients treated by hemodialysis.

Hemodialysis as a therapeutic procedure in patients being in the end-stage of renal failure has been used since the sixties of the 20th century. Generally speaking, the conservative drug therapy in patients treated by hemodialysis is complex, and economically it consummes as great proportion of financial expenses. The aim of the study was to perform an economic analysis of 101 patients, both sexes (37 females and 64 males, aged from 22 to 81 years) treated by hemodialysis, in respect of drug treatment costs. The total average cost of treatment medication represented 161,589 SKK/patient/year. Eighty one percent of total expenses were linked with the consumption on antianemic drugs (102,298.40 SKK/patient/year). The second most expensive drug group (9% of the total cost) were medications used in coincidence with hemodialysis complications (14,981 SKK/patient/year). Diuretic--furosemid was the most frequently used drug out of the category of antihypertensive medications (68% of patients), followed by beta-blockers (preparation Concor), calcium channel blockers (preparations Norvasc and Plendil) and angiotensin converting enzyme tritace inhibitors (ACEI, preparations Trirace, Enap, Prestarium), respectively. Only 27% of patients were treated by hypolipidemic drugs mostly by the preparations of Gevilon and Innogen. In the majority of patients (93%) preparations for the correction of calcium and phosphorus metabolisms such as Vitacalcin and Rocaltrol were administered, the latter being most expensive. Antianemic drugs have been used in all patients. In this category of preparations, those composing acid folate and erythropoetin were used most frequently. Alkaline supplementation of NaHCO, (bicarbonate) was used in 88% of patients. In order to prevent the development of thrombosis and other vascular complications, the drugs with antiaggregative effects were used (Ibustrin, Curantyl, Anopyrin). To prevent the manifestation of gastrointestinal adverse reactions, the administration of H2-antagonists have been preferred (Famosan, Quamtel). The group of "Other drugs" was represented by vitamins and drugs with anti-uratic effects (ascorbic acid--preparation Celaskon, tocopherol--preparation E-vitamin and Milurit). When summed together, the costs of therapy in patients treated by hemodialysis are three times higher compared with those in the pre-dialysis phase. In addition to the latter hemodialysis is associated with a large number of medical, psychic and social complications. In the presented pilot study the authors analysed the financial expenses coinciding with drug costs (direct loads) which are significant, but represent only a part of the pharmacoeconomic complexity. In the future it is necessary to perform a more complex pharmacoeconomic analysis in order to evaluate also other factors, such as the costs of hospitalization, dialysate solutions, technologys, salaries of the staff, etc. (Tab. 6, Ref. 37.).

[Analysis of the present status of conservative therapy of nephropathies]. / Analýza súcasného stavu konzervatívnej liecby nefropatií.

Treatment by dialyzing represents an important contribution to the therapy of nephropathic patients. On the other hand, besides high financial costs it is not possible to forger significant social and psychic consequences of this therapy. The present paper aimed at a pharmacoeconomic evaluation of the costs of conservative treatment of nephropathic patients. The secondary aim was to compare the costs of conservative treatment in patients with markedly limited renal functions, creatinine clearance (Ccr < 0.4 ml/s), with those in patients with only slightly and medium-reduced renal functions (Ccr 0.4-1 ml/s). Health documentation from three nephrological out-patient surgeries was used to evaluate the results, the criterion for the selection of patients being a nephrological diagnosis with Ccr below 1 ml/s. The group comprised 102 patients aged 21-84 years (average age being 63.99 years), including 56 females (54.9%) and 46 males (45.1%). According to the stage of renal disease, they were divided into two groups. The patients with slightly and medium-reduced renal functions (Ccr 0.4-1.0 ml/s) represented nearly three quarters, whereas the patients with markedly reduced renal functions (Ccr < 0.4 ml/s) only slightly more than one quarter. In the group under study, the pharmacotherapeutic costs represented 2,889,778.0 SK/year (28,331.16 SK/1 patient/1 day), in patients with renal insufficiency the costs being markedly higher (47,427.3 SK/1 patient/1 day in comparison with 21,456.7 SK/1 patient/1 day). Of total pharmacotherapeutic costs, 29.38% was represented by antihypertensive agents, 24.47% by preparations supplementing essential amino acids, 14.83% by hypolipidemic agents, 14.37% by preparations supplementing calcium, 6.19% by antianaemic agents, and 7.76% by other drugs. The results demonstrate that pharmacotherapy of renal diseases is costly but in comparison with elimination methods (dialysis) it is incomparably less expensive. The spectrum of employed agents is in agreement with the present-day trends in conservative treatment which decelerates the progress of nephropathies.

[Drug policy in Slovakia and its reflection in prescriptions. 2. Prescriptions of individually prepared drugs based on the medical specialty]. / Lieková politika na Slovensku a jej odraz v preskripcii. 2. Preskripcia IPL podla odbornosti lekárov.

The paper aims to analyze the frequency of medical prescriptions for the group of extemporaneously prepared drugs in relation to the specialization of physicians. The evaluation is based on the database of prescriptions dispensed by four pharmacies within 14.5 months in the years 1999-2000. The total number of prescriptions was 133,857, out of which 5615 (4.2%) were extemporaneous preparations. The share of specialists in the prescription of extemporaneous drugs was 7%, that of general practitioners, 1.4%. Out of the specialists, the largest share in the prescription of extemporaneously prepared drugs belonged to dermatologists, otorhinolaryngologists, and pediatricians. The economic aspect of prescription of the group of extemporaneous drugs was also evaluated. The average value of a medical prescription for an extemporaneously prepared drug was 68.40 SK, which represents 17.8% of the average value of a medical prescription for a mass-produced drug.

[Treatment of allergic rhinitis in clinical practice and its pharmacoeconomic aspects]. / Stav liecby alergickej rinitídy v terénnej praxi a jej farmakoekonomické aspekty.

The present paper aims to analyze therapeutic trends in allergic rhinitis and their relationships to selected pharmacoeconomic parameters. Health and Disease out-patient records from three out-patient allergologic-immunologic surgeries in the towns of Trencín, Nové Zámky, and Bratislava were surveyed. The analysis is based on the recorded prescription of drugs prescribed to the patients in the period of his or her "most recent season" in the years 1999-2000. Altogether 279 records (164 females, 115 males) were evaluated. The highest percentage of pollinotics was dispensed in Bratislava (73%) followed by Nové Zámky (55%) and Trencín (31%). In all three out-patient surgeries, the dominant therapy was a combination of specific immunotherapy (SIT) and antihistanime treatment (AH, 70-75%). Average costs for one day of treatment of allergic rhinitis in the out-patient surgeries under study did not significantly differ (22.20-24.50 Sk, the average value of the daily defined dose being 23.20 Sk). Due to confused kept records, the economic analysis did not take into account the financial costs connected with SIT. The present analysis shows a positive state in the field of diagnostics, connected with improved identification of the inducing allergen and application of causal therapy based on SIT (72%). Approximately one third of patients (27%) received only solo medicamentous therapy without application of SIT, and the SIT therapy alone was received by less than 2% of patients (1.4%).

Pharmacoeconomic analysis of conservatively treated patients with nephropathies in western Slovakia regions.

UNLABELLED: The prevalence of patients with chronic nephropathies leading to the end stage of renal failure (ESRF) is increased. The conservative therapy of patients in the phase of ESRF as well as the performance of hemodialysis represent an extensive burden on health care budgets. AIM: The aim of the study was to evaluate the financial expenses for medications in group of conservatively treated patients with nephropathies. PATIENTS AND METHOD: One hundred and two patients (56 females, 46 males) aged 21-84 years with nephropathies collected from three out-patient departments of nephrology in the regions of Bratislava and Nitra (Western Slovakia) were enrolled into the study. RESULTS: The total financial expenses represented 2,889,778 Sk The average expense per 1 patient/1 year was 28,331 Sk and that of 1 patient/1 day was 77.6 Sk, respectively. Antihypertensive therapy represented 1st position (29.4%) of the total financial cost followed by keto-analogs (27.5%), hypolipideamics (14.8%), drugs for disorders of calcium metabolism (14.4%) and antianaemics (6.2%), respectively. The group of "other" drugs represented 7.7% of total costs. CONCLUSIONS: Results show that the financial expenses for pharmacotherapy in conservatively treated patients with nephropathies are high, but significantly less expensive in comparison with hemodialysis (700,000-1,000,000 Sk/year/patient). The prevention and the slowing down of the progression of renal disease seem to be crucial in the management of nephropathies. The therapeutic approach in conservatively treated patients with renal diseases was rational and up to date. (Tab. 1 Fig. 5, Ref. 12. )

[Drug policy in Slovakia and its reflection in prescriptions. 1. Prescriptions for mass-produced drugs according to physician specialty]. / Lieková politika na Slovensku a jej odraz v preskripcii. 1. Preskripcia HVL podla odbornosti lekárov.

The present paper aims at pharmacoeconomic analysis of prescriptions of physicians according to their specialization. The database was based on medical prescriptions from four pharmacies. Altogether 133,856 prescriptions were evaluated in two periods (the years 1999 and 2000) with different legislative regulations of the conditions for prescription of drugs from the funds of health insurance (fully covered drugs, drugs with participation of the policy holder, prescription and indication limitation). The results show that 1.45 kinds of drugs and 2.28 packages of mass-produced drugs were prescribed per 1 prescription. The average value of drugs per one prescription was 370.28 Slovak crowns. General practitioners prescribed 50.5% of prescriptions, the value of prescribed drugs being 42.0%. As to specialization, the highest share of prescriptions (36.5%) was written by pediatricians, the highest value of drugs as expressed per 1 prescription was prescribed by diabetologists (1340.20 Slovak crowns). When comparing the indices under study in two periods, in the second one (the year 2000) the financially expressed consumption of drugs continued to show an increasing trend (in the case of the value of 1 prescription by 10.6%).

Optimization and validation of a rapid high-resolution T1-w 3D FLASH water excitation MRI sequence for the quantitative assessment of articular cartilage volume and thickness.

In view of follow up, survey and development of therapeutic strategies for osteoarthritis where cartilage deterioration plays an important role, a non invasive, reliable and quantitative assessment of the articular cartilage is desirable. The currently available high resolution T(1)-weighted (T1-w) 3D FLASH pulse sequences with frequency selective fat suppression are very time consuming. We have 1) optimized a high resolution T1-w 3D FLASH water excitation (WE) sequence for short acquisition time and cartilage visualization, and 2) validated this sequence for cartilage volume and thickness quantification. The spectral fat presaturation was replaced by selective water excitation. The flip angle of the WE sequence was optimized for the contrast to noise (C/N(cart)) ratio of cartilage. Sagittal datasets (voxel size: 0.31 x 0.31 x 2 mm(3)) of the knees of nine healthy volunteers were acquired both, with the 3D FLASH WE (17.2/6.6/30 degrees ) sequence (WE) and a previously validated 3D FLASH fat saturated (42/11/30 degrees ) sequence (FS). For validation of the WE sequence, cartilage volume, mean and maximal cartilage thickness of the two sequences were compared. Reproducibility was assessed by calculating the coefficient of variation (COV %) of 4 consecutive WE data sets in the volunteers. The acquisition time was reduced from 16'30" (FS) down to 7'14" for the WE sequence. Image contrast and visualization of the cartilage was very similar, but delineation of the basal layer of the cartilage was slightly improved with the WE sequence. A flip angle of 30 degrees provided the best C/N(cart) ratios (WE). Reproducibility (COV) was between 1.9 and 5.9%. Cartilage volume and thickness agreed within 4% between FS and WE sequence. The WE sequence allows for rapid, valid and reproducible quantification of articular cartilage volume and thickness, prerequisites for follow-up examinations. The reduced acquisition time (50% of FS) enables routine clinical application and thus may contribute to a broader assessment of osteoarthritis.

Review of the South American-Antarctic triplefin fish genus Helcogrammoides (Perciformes: Tripterygiidae).

The genus Helcogrammoides comprises three species of small, cryptic shorefishes, H. antarcticus, H. chilensis, and H. cunninghami. All three species inhabit shallow water along exposed rocky coasts. Specimens reported herein extend the known distributions of H. chilensis and H. cunninghami to the vicinity of Lima, Peru, approximately 1600 km north of their previously reported northernmost records in Chile. Helcogrammoides chilensis and H. cunninghami occur sympatrically over most of their ranges in Peru and Chile and are frequently taken together in the same field collections. Lectotypes are designated for H. chilensis and H. cunninghami. Diagnoses and an identification key are provided for the species.

Validation of high-resolution water-excitation magnetic resonance imaging for quantitative assessment of thin cartilage layers.

OBJECTIVE: To employ a magnetic resonance (MR) imaging technique for quantitative assessment of thin cartilage layers, and to validate the cartilage volume and thickness measurements. METHODS: We investigated 10 normal elbow joints (age 20 to 69 years) with a 3D gradient echo sequence with selective water excitation (TR 18 ms; TE 9 ms; FA 25 degrees, resolution 1x0.25x0.25 mm2, imaging time 19 min). After interpolating the image data to a 0.125x0.125 mm2 in-plane resolution, the cartilage plates were segmented, reconstructed in 3D, and the cartilage volume and thickness determined with a 3D Euclidean distance transformation algorithm, independent of the original section plane. The cartilage volume and thickness values were compared with CT arthrography and A-mode ultrasound. RESULTS: The mean systematic difference between the elbow cartilage volume obtained from MR imaging and CT arthrography was -0.11% (-6.0 mm3) and the mean random difference 5.7% (314 mm3). Except for the fovea capitis radii, the deviations were not statistically significant (range -7.6 to +11.7%). In the humerus, the mean cartilage thickness (average = 1.35 mm) was overestimated relative to CT arthrography (+20.7%/+0.23 mm), and slightly underestimated relative to A-mode ultrasound (-6.0%/-0.05 mm). With few exceptions, there were no significant differences between MRI, CT arthrography and ultrasound in the other joint surfaces of the elbow (random deviations between 0.08 and 0.39 mm). CONCLUSIONS: The technique presented can be applied for determining the cartilage volume and 3D thickness in joints with thin cartilage layers with a reasonable degree of accuracy.

[Noninvasive analysis of cartilage volume and cartilage thickness in the human elbow joint using MRI]. / Nichtinvasive Analyse des Knorpelvolumens und der Knorpeldicke im menschlichen Ellbogengelenk mittels MRT.

The aim of the study was to non-invasively analyse the cartilage volume and thickness in the human elbow joint with magnetic resonance imaging. 12 fresh frozen specimens (ages 20 to 69 yrs.) were investigated using a 1.5 T magnet, and a water-excitation FLASH-3D sequence at a resolution of 1 x 0.25 x 0.25 mm3. After linear interpolation to 0.125 x 0.125 mm2 in the image plane, the cartilages were segmented interactively with a Snake algorithm. Following three-dimensional reconstruction, the cartilage volumes were determined, and the mean and maximal cartilage thickness computed by Euclidean distance transformation. The total cartilage volume of the human elbow joint amounted to between 3.90 and 7.17 ml (mean 5.5 ml +/- 20%). The humerus occupied 49 to 60%, the radius 15 to 27% and the ulna 20 to 29% of the total volume. The mean cartilage thickness ranged from an average of 0.9 (proximal part of the ulna) to 1.4 mm (capitulum humeri), and the maximal thickness from 2.3 mm (proximal part of the ulna) to 2.9 mm (distal part of the ulna). The ulnar cartilage showed a more inhomogeneous distribution than that of the humerus and radius. The interindividual variability of the cartilage thickness was less than that of the volume. There was no significant relationship of the volume with age (r = 0.11) or body weight (r = 0.51). However, based on the joint size (r = 0.71-medio-lateral extension of the articular surfaces) about 50% of the variability of the total cartilage volume could be predicted. The technique presented is suitable for designing computer models to investigate the load transmission and functional adaptation of diarthrodial joints, and for diagnosing and monitoring joint disease.

[Pharmacies during the transformation of health care. IV. Sociologic study of pharmacy service]. / Lekárne v období transformácie zdravotníctva. IV. Sociologický prieskum poskytovaných lekárenských sluzieb.

In Slovakia, similarly as in the Czech Republic, marked changes in the pharmaceutical services have gradually been taking place since 1990. Principal legal and organizational changes have been connected also with the extent and standard of provided pharmaceutical services. The present paper reports the results of a questionnaire research regarding the evaluation of the standard of pharmaceutical services in the year 1995 where there existed both state-owned and private public pharmacies. The questionnaire research was carried out in 20 pharmacies of the Region of West Slovakia, 407 questionnaires were evaluated. The questionnaires were evaluated from the viewpoint of sociological classification of respondents (economically active persons, old-age pensioners) as well as the sex of pharmacy customers. The results confirmed relatively little significant differences between the satisfaction with pharmaceutical services either according to the sex or the social position of the respondents. A relatively significant proportion of the respondents have expressed critical views about the participation of the patient in covering the costs of drugs and slow execution of order of drugs.

The pharmacoepidemiological phenomenon of age-dependent drug consumption and analysis of its regression models.

A randomized pharmacoepidemiological full-year, 7x realized experiment was carried out with the purpose of analyzing the age dependence of drug volumes consumed by the population, using financial and physical measuring units to express per-capita consumption. The experiment was performed for a complete metropolitan population, representing 0.5 million people. Causal age-based dependence of the drug consumption level was found in an analytical form. Subsequently, the optimum regression model describing this dependence was sought by methods of regression and correlation analysis.

[Analysis of the use of medicinal teas in relation to their effects]. / Analýza spotreby liecivých cajov vo vztahu k úcinku.

The paper analyzes the consumption of mass-produced preparations of teas from the viewpoint of the sort and the group of indication. The packed plant drugs and teas were classified into the groups of indication according to Wichtl's pharmacodynamic system and the consumption was expressed in physical and financial indices. It follows from the results that mass-produced teas represent on average 6.6% of total sales of OTC drugs and supplementary assortment per month. The highest average monthly consumption was achieved by packed plant drugs and teas from group VI, miscellaneous teas for external and internal use, group I, diseases of the stomach and intestines, and group II, diseases of the respiratory tract.

[Theory and practice within the framework of pharmaceutical education]. / Teória a prax v rámci farmaceutického stúdia.

The present paper deals with the problems of the graduate study of pharmacy with regard to the relationship of theoretical and practical teaching. The situation in Slovakia is discussed and compared with the present-day states in some countries of Western Europe.

Pharmaco-epidemiological study of drug consumption in the preproductive age period.

Based on the global hypothesis of drug consumption being a function of human age and growing with its increase, an analysis of that dependence was carried out in the preproductive interval of the human lifetime. The experiment included a total metropolitan population of 450,000, involving all outpatient prescriptions of all physicians in the area. The paper shows results obtained over a period of two years. The methodology, based on the expression of drug consumption in numbers of original package and in terms of financial costs, enabled to formulate the course of this dependence and to define its structure. It was found that preproductive age drug consumption shows a characteristically declining trend, progressively descending from a post-natal maximum to local minimums appearing in the 15-19 year (costs), and 20-24 year (number of packages) age groups, respectively; in addition, it shows sex-specific differences and has the analytical shape of a 2nd degree polynomial. After the local minimums the curve begins to ascend according to the characteristic trend in the productive period of the human lifetime.

[Demographic-statistical analysis of pharmacotherapy with emphasis on the geriatric population]. / Demograficko-statistická analýza farmakoterapie s dôrazom na gerontologickú populáciu.

The present paper is a contribution to the field of population pharmacoepidemiology and presents an analysis of the effect of the determinant of age on the magnitude of requirements for medicines, particularly with regard to gerontological population. The paper reports both demographic and pharmacoepidemiologic analysis of pharmacotherapy and formulates a trend of development in connection with expected demographic ageing of the Slovak population. The results reported in the paper document the demographic-health background of pharmacotherapy and point to some population connections of it.