The Importance of the Physician in the Generic and Trade-name Article

The Importance of the Physician in the Generic and Trade-name Prescription Decision - Article Example The time frame and period analyzed in the whole article ranges between 1984 and 1996. This is evident during the introduction of generics in 1984, when all firms that wanted to market, a post-patent expiration generic had to show the efficacy and safety of the drug through tests to the Food and Drug Administration. In the course of time, the Congress implemented the permissive substitution laws in an effort to encourage the use of generic drugs. In addition, the research shows that in 1996, information from IMS America Inc. showed that managed care payments such as private managed care as HMOS AND Medicaid HMOs amounted for over 505 of dollar revenues for pharmaceutical retail sales (Hellerstein, 109). The data sources used in the analysis involve information from a survey of physicians, their patients, and drugs prescribed. In this case, physicians use patient by patient basis to test whether physicians prescribe generics to patients who are not covered by insurance and the effects of state legislation on generic prescription (Hellerstein, 109). The main findings of the whole research show that physicians are important agents in prescription decisions. Therefore, identifying the sources of heterogeneity in behavior across physicians is an integral factor of understanding how the markets for prescription drugs operate. Individuals learn how physicians behavior whenever they have different information and incentives in the areas of specialization. The new information learned from the article indicates that changes are still occurring among physicians through the continued growth of managed care due to increase in market share of generic drugs. At the same time, there probabilities that emphasis on cost containment in Health Maintenance Organizations may cause price differential between a trade name and generic drugs since there are existing negotiations with manufacturers on price discounts.

Research for nursing practice - Pre operative fasting Literature review

Research for nursing practice - Pre operative fasting - Literature review Example The pathophysiological basis of the aspiration pneumonia was the aspiration of acidic stomach contents into the lungs and the consequent harmful damage to the lung tissues known as chemical pneumonia. As the years went by, the innovative techniques of anaesthesia including the endotracheal intubation led to rethinking on the duration of fasting times. Frequent discussion and research led to the Guidelines from the Royal College of Anaesthetists, the Royal College of Nurses and the Anaesthetists of the US: they stipulated specific periods for fasting for worldwide use (AAGBI, 2001; RCN, 2005; ASA Practice guidelines, 1999). The guidelines sanctioned the shortening of the pre-operative fasting durations but the message was not taken in the right spirit by the nurses and the patients did not enjoy the benefit. The nurses were the ones who instructed the patients about the fasting. Promotion of evidence-based fasting times was to be enforced by them (Crenshaw, 2008). They also had to mon itor the patient’s compliance. The scientific evidence related to the liberalized fasting times were to be initially understood by the nurses themselves before efficacious implementation. Research indicated many fallacies in the system whereby fasting practices were still not conforming to the guidelines. Medication instructions also were not accurately transferred to patients (Crenshaw, 2008). Recent researches were moving away from the strict fasting regimen to a partial fasting method whereby a carbohydrate drink or oral carbohydrate nutrients were administered to improve the outcomes of surgery. The nurses were the ones who actually conveyed the right information about the fasting to the patients. The role of the nurses also involved the promoting of evidenced-based guidelines apart from monitoring the patients to check for compliance and untoward effects (Crenshaw and Winslow, 2006).This paper will be written with the intention of unearthing evidence suitable to provide more alterations in the implementation of pre-operative fasting or partial fasting to conform to the evidence-based guidelines. The aim of this research will be to search for methods that could ensure that the elective surgery patients had the benefit of shorter pre-operative fasting times as per guidelines and the improved outcomes of having the pre-carbohydrate drink and how the nurses were to be encouraged to conscientiously perform their work where the pre-operative fasting was concerned. Review of RCTs Brady et al (2003) studied 22 randomised control trials or quasi RCTs. Healthy patients were included as the controls. Permitted intake of food was a small breakfast in the morning before surgery posted for the afternoon. Liquid intake was limited to not more than 30 ml. to help swallow medicine. Methodological quality was maintained by the randomisation method. â€Å"Allocation concealment, blinding, a prior sample size calculation, and whether analysis was by intention to trea t† were additional methods of maintaining quality (Brady et al, 2003). Regurgitation and aspiration were complications just after the surgery and death was a possibility in many trials. The review of the research articles revealed some limitations. The RCTs were mostly small sampled trials with less than 100 patients. The quality of methodology was inadequate in some trials. The variety in the populations too was minimal and the samples were