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By I. Flint. Bethany Bible College.
Individual hospitals may develop relations with travel agencies or wider brokerage companies (Whittaker slimex 10mg with visa weight loss 30, 2008). Securing accreditation from international programmes may be a part of the development of services. In addition to accreditation, other approaches to raising the profile of countries and their health facilities have been used. For example, partnerships and oversight by overseas hospitals and universities, most often from the American private sector, can fulfil a similar role. Formalised linkages with widely recognised medical providers and educators (like Harvard Medical International, the Mayo Clinic, the Cleveland Clinic, John Hopkins Hospital, are becoming increasingly popular among hospitals catering for medical travellers. Medical tourist facilities will often target particular cultural groups – Bumrungrad for example has a wing for Middle East patients (Cohen, 2009, Reddy and Qadeer, 2010). A range of national government agencies and policy initiatives have sought to stimulate and promote medical tourism in their countries. Many countries see significant economic development potential in the emergent field of medical tourism. The Thai, Indian, Singaporean, Malaysian, Hungarian, Polish and Maltese governments have all sought to promote their comparative advantage as medical tourism destinations at large international trade fairs, via advertising within the overseas press, and official support for activities as part of their economic development and tourism policy (Mudur, 2004, Chee, 2007, Whittaker, 2008, Reisman, 2010). Since 2003, SingaporeMedicine has been a multi-agency government-industry partnership aiming to promote Singapore as a medical hub and a destination for advanced patient care. India has introduced a special visa category – an M visa – to cater for the growing number of medical tourists (Chinai and Goswami, 2007) as well as allowing tax breaks to providers. Sengupta (2008) notes that medical tourism facilities allow increased rate of depreciation on life saving equipments, and also prime land at subsidised rates. In Malaysia, the National Committee for Promotion of Medical and Health Tourism was formed by the Ministry of Health in 1998. It developed a strategic plan and networked both domestically and overseas with relevant interests. Toyota (2011) suggests that the medical tourism markets of both Singapore and Dubai, alongside those of India, Thailand, and Malaysia should be considered as the ‗first wave‘ of Asian medical tourism. She points to the post-2008 expansion of both the Japanese and South Korean medical tourism markets as representing a second wave, one marked by increasing state involvement. In the Japanese case, the low numbers of trained doctors and high cost of treatment has severely constrained the growth of the medical tourism market (Hall, 2009, Toyota, 2011, p. Indeed, as Connell highlights, Japan has until recently been primarily thought of as a source country rather than a destination country in terms of medical tourism, with large numbers of Japanese citizens travelling abroad for healthcare (Connell, 2006, p. The Japanese government has recently outlined plans to reverse the outbound medical tourism trend, rolling out a new organisation with the sole aim of increasing inbound medical tourism. The rationale being that Japan cannot compete with the lower costs offered in such markets and thus should concentrate on the types of procedure where access and quality are the primary motivations for medical tourism rather than simply the cost (Hall, 2009). In contrast to Japan, the Korean government have matched their commitment to the expansion of the inbound medical tourism market with investment in a market to directly compete with other Asian countries. The high quality and low cost of treatment is also being used as part of a targeted campaign to encourage Korean expatriates and members of Korean communities in countries such as the United States and New Zealand (Lee et al. As with Asian countries, State involvement varies from country to country with a mixture of private and public facilities catering for medical tourism. In Poland, a popular destination for dental tourists and cosmetic tourists, medical tourism is facilitated through private companies, many of the clinics used are state-owned, serving Polish citizens alongside medical tourism. This reflects the Polish government‘s desire to capture the potential of medical tourism and marked by the creation of the Polish Medical Tourism Chamber of Commerce (Reisman, 2010, p. While many of the clinics offering treatment to medical tourists are undoubtedly private, the role of the Hungarian government should not be overlooked. Beyond national strategies there a range of ways that national policy can directly foster the domestic medical tourism industry. There are a range of organisational dimensions related to the quality and safety of medical treatment abroad. Many of these are not necessarily unique to medical tourism in that health care is replete with information asymmetries and potential threats to the quality and safety of patient care pathways, but these are intensified given the dimensions of ―distance‖ including legal jurisdiction. Ideally, a common regulatory platform and reporting system would serve as the basis of an assessment of comparative quality of care using a range of performance indicators as facilitated by international accreditation and certification. Presently, there is a lack of comparative quality and safety data, and knowledge of infection rates for overseas institutions and reporting of adverse events is lacking. Importantly, bodies like the World Health Organisation have yet to publish any firm guidance on this and there does not appear to be any immediate intention to do so.
Primaquine is not recommended during pregnancy or in infants < 6 months order slimex 10mg mastercard weight loss pills plexus, as limited data are available on its safety in these groups. A large focus of naturally acquired Plasmodium knowlesi infections in human beings. Two nonrecombining sympatric forms of the human malaria parasite Plasmodium ovale occur globally. Major burden of severe anemia from non-falciparum malaria species in southern Papua: a hospital-based surveillance study. Plasmodium vivax and mixed infections are associated with severe malaria in children: a prospective cohort study from Papua New Guinea. Severe Plasmodium vivax malaria: a report on serial cases from Bikaner in northwestern India. Severe 6 Plasmodium knowlesi malaria in a tertiary care hospital, Sabah, Malaysia. A prospective comparative study of knowlesi, falciparum, and vivax malaria in Sabah, Malaysia: high proportion with severe disease from Plasmodium knowlesi and Plasmodium vivax but no mortality with early referral and artesunate therapy. Combining parasite lactate dehydrogenase-based and histidine-rich protein 2-based rapid tests to improve specifcity for diagnosis of malaria due to Plasmodium knowlesi and other Plasmodium species in Sabah, Malaysia. Safety, effcacy and population pharmacokinetics of fxed-dose combination of artesunate–mefoquine in the treatment of acute uncomplicated Plasmodium falciparum malaria in India. Effcacy and safety of dihydroartemisinin–piperaquine for treatment of Plasmodium vivax malaria in endemic countries: meta-analysis of randomized controlled studies. Effcacy of artemether–lumefantrine as a treatment for uncomplicated Plasmodium vivax malaria in eastern Sudan. A comparison of two short-course primaquine regimens for the treatment and radical cure of Plasmodium vivax malaria in Thailand. Effcacy of three different regimens of primaquine for the prevention of relapses of Plasmodium vivax malaria in the Amazon Basin of Peru. Diagnosis of resistance to chloroquine by Plasmodium vivax: timing of recurrence and whole blood chloroquine levels. Mitigation of the haemolytic effect of primaquine and enhancement of its action against exoerythrocytic forms of the Chesson strain of Plasmodium vivax by intermittent regimens of drug administration: a preliminary report. Russell B, Chalfein F, Prasetyorini B, Kenangalem E, Piera K, Suwanarusk R, et al. Simple in vitro assay for determining the sensitivity of Plasmodium vivax isolates from fresh human blood to antimalarials in areas where P. The greatest problem with antimalarial drug resistance is with Plasmodium falciparum. All geographical areas are affected, with the exception of Central America, and the worst affected is mainland South-East Asia, where parasites with reduced susceptibility to all the available antimalarial medicines are now prevalent. Yet, chloroquine resistance appears to have arisen de novo and then spread on only a few occasions. Against a background of chloroquine resistance, mefoquine resistance arose over a 6-year period on the north-west border of Thailand (2). Currently, there are no “bedside” tests for determining the susceptibility of malaria parasites to antimalarial medicines. Monitoring is therefore needed to determine geographical trends in susceptibility and the emergence and spread of drug resistance to guide treatment choices and planning. Drug resistance to an antimalarial compound refects a right-hand shift in the concentration–effect (dose–response) relation (Fig. It may be a parallel shift (red) from the “normal” profle (green), or, in some circumstances, the slope changes or the maximum achievable effect (Emax) is reduced (blue). The effect measured in vivo is parasite killing (refected by reduction in parasite density), and that in vitro is usually a measure of parasite development, such as schizont maturation or uptake of 3H-hypoxanthine or some other labelled substrate. Clinical characterization of resistance should therefore also include measurement of blood or plasma concentrations to distinguish true resistance from inadequate drug exposure. In the case of a prodrug (a drug that is not active in the ingested form and requires chemical conversion through metabolic processes to become pharmacologically active, such as proguanil), it is also necessary if possible to show adequate conversion to the active metabolite. Total parasites Malaria parasites 1012 Drug levels 1010 Detection limit 108 106 104 102 1 0 1 2 3 4 5 Weeks Shows the range of total numbers of parasites in the body (blue) and antimalarial drug concentrations in blood (red) that typically occur in adult patients after administration of a slowly eliminated antimalarial drug. At low levels of resistance, there are no early treatment failures, but the proportion of patients with late recrudescence increases. As the level of resistance rises, recrudescence occurs earlier and earlier, until, with high-grade resistance, eventually parasitaemia fails to clear or, worse still, continues to increase (7).
Problems with unextractable data and multiple different comparators limited the analyses possible for the review and a number of fndings were contradictory or diffcult to interpret buy slimex 10mg free shipping weight loss pills extreme. In the frst year of follow-ups, the short-term therapies were signifcantly more effective than the long-term therapy; however, these differences were not signifcant after 2 years. After 3 years, long-term psychodynamic psychotherapy was signifcantly more effective than either of the short-term therapies. There is some evidence that guided self- help has a benefcial effect in those with largely subclinical depression. This evidence is derived mainly from studies comparing guided self-help to a waitlist control. It consists of fve interactive modules, available sequentially on a week-by-week basis, with revision in the sixth week. The Sadness program consisted of four components: six online lessons, homework assignments, participation in an online forum, and regular email contact with a clinician. There were no differences between the groups on the measures assessing level of psychosocial disability. An additional weekly telephone contact of up to 30 minutes was included in the intervention. Participants were randomly assigned to either assisted self-help, minimal contact, or to a waitlist control. Those in the assisted self-help group received more intensive assistance in completing the workbook than those in the minimal contact group. The guided self- help group received a maximum of 4 brief (15-30 minute) sessions with a therapist in addition to the purposely written psychoeducation self-help manual. Those in the waitlist control received routine care from primary-care professionals (e. The individualised self-help package was designed to improve treatment adherence, decrease treatment drop-out, and teach simple self-help strategies. Psychoeducation group title of PaPer Patient education and group counselling to improve the treatment of depression in primary care: A randomized control trial authors and journal Hansson, M. The group psychoeducation program, Contactus, comprised 6 weekly lectures on topics such as diagnosing and treating depression and non-pharmacological alternatives to treatment, followed by post-lecture group discussions (8-10 patients per group). The intervention aimed to promote positive thinking, pleasant activities, social skills and social support. Treatment gains were maintained at 12-months, but the difference was no longer signifcant. Psychosocial interventions appear to have the greatest beneft in reducing risk of relapse and improving functioning during the maintenance phase. Psychoeducation group title of PaPer Clinical practice recommendations for bipolar disorder authors and journal Mahli, G. Group participants also had fewer recurrences of any type, spent less time acutely ill, and spent less time in hospital. When standardised recovery criteria to pathological worry were applied, the rate of recovery at posttreatment was very small, although it improved at follow up. Each session followed an agenda and focused on specifc formal and informal mindfulness-based stress reduction techniques (e. Furthermore, those whose baseline symptoms were in the clinical range experienced a reduction in their symptoms comparable to those of a non-clinical population. Psychodynamic PsychotheraPy title of PaPer Short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalised anxiety disorder: A randomised, controlled trial authors and journal Leichsenring, F. Participants in both groups received up to 30 weekly 50-minute sessions carried out according to treatment manuals. The main elements of the brief Adlerian treatment were encouraging relationships, identifying the focus, and determining areas of possible change within the focus therapy. The participants were granted access to the website and instructed to complete each of the 11 modules on a weekly basis. They were also asked to fll out three self-report questionnaires each week to monitor their progress. Each treatment was combined with either imipramine or placebo, resulting in 8 treatment conditions. All treatments were conducted in small groups, that met for 14 three hour sessions over 18 weeks.
Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients generic slimex 10 mg free shipping weight loss 5-htp. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. A prospective, randomized trial comparing neoadjuvant chemotherapy with radiotherapy alone in patients with advanced nasopharyngeal carcinoma. Preliminary report of the Asian-Oceanian Clinical Oncology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasopharyngeal carcinoma. A randomized trial on addition of concurrent- adjuvant chemotherapy and/or accelerated fractionation for locally-advanced nasopharyngeal carcinoma. Local control, survival, and late toxicities of locally advanced nasopharyngeal carcinoma treated by simultaneous modulated accelerated radiotherapy combined with cisplatin concurrent chemotherapy: long-term results of a phase 2 study. Cisplatin and 5-fluorouracil continuous infusion for metastatic nasopharyngeal carcinoma. Surveillance for recurrent head and neck cancer using positron emission tomography. Here are some things they would like you to know: n Tere are treatment choices—be sure to know them all. I chose radiation therapy because we thought it was the best choice for my situation. After talking with several doctors who specialize in prostate cancer, we decided that surgery was the best choice for me. And while it is good to have choices, this fact can make the decision hard to make. Yet, each choice has benefts (how treatment can help) and risks (problems treatment may cause). While you are waiting for treatment, you should meet with different doctors to learn about your treatment choices. Use this booklet to help you talk over treatment choices with your doctor before deciding which is best for you. After all, having prostate cancer and the treatment choice you make affect both of you. Its purpose is to help you learn about early-stage prostate cancer, diferent treatments, and the benefts and risks of each type of treatment. Most men will need more information than this booklet gives them to make a decision about treatment. For a list of groups that provide more information and support, please see the Ways to Learn More section on page 32. Also, see that section if you have prostate cancer that has spread beyond the prostate or that has returned after treatment. Semen is the milky fuid that carries sperm from the testicles through the penis during ejaculation. Te prostate surrounds part of the urethra, the tube that carries urine out of the bladder and through the penis. This means that it can take 10 to 30 years before a prostate tumor gets big enough to cause symptoms or for doctors to fnd it. Most men who have prostate cancer will die of something other than prostate cancer. Each has benefts (how treatments can help) and risks (problems treatment may cause). Te choice of treatment depends on many factors: n Your prostate cancer risk group. Doctors use details about your cancer to place you into a low-, medium-, or high-risk group. Having heart problems, diabetes, or other illnesses may affect your treatment options. The skills and experience of specialists and types of treatment available in your area may vary. You will need to ask tough questions to make sure you receive the best possible care.
Tis is fewer than in either of the previous 2 years but is similar to the numbers detected in 2012 and 2013 discount slimex 10 mg without prescription weight loss pills and breastfeeding. Te causes of this decrease are unclear, but may in part be due to measures taken by national governments in Europe to prohibit new substances, particularly their open sale as ‘legal highs’. In addition, control measures and law enforcement operations in China targeting laboratories producing new substances may be another factor. Together, the synthetic cathinones and synthetic reported for the frst time in 2016. Although currently cannabinoids accounted for over 60 % of all seizures of playing a small role in Europe’s drug market, the new new substances in 2015 (over 47 000). Increases were fentanyls are highly potent substances that pose a serious also observed in the quantities seized in 2015, compared threat to individual and public health. New opioids have been seized in various forms: mainly powders, tablets, capsules, and since 2014, also as liquids. European seizure totals for new substances must be Over 60 % of the 600 seizures of new synthetic opioids understood as minimum values, as data are drawn from reported in 2015 were fentanyls. Reported synthetic opioids was seized in 2015, an increase from the seizures are infuenced by a range of factors such as 240 ml reported the previous year. Fentanyls were found in increasing awareness of new substances, their changing 85 % of the liquids seized. One concern in this respect is legal status, law enforcement capacities and priorities, and the appearance on the market of nasal sprays containing the reporting practices of law enforcement agencies. Refecting their low share of the market as well as their high potency, these opioids account for 0. Tese powders, when exploited this efect by importing bulk powders of the processed into ‘herbal smoking mixtures’, could have been cannabinoids and mixing them with dried plant material in capable of producing many millions of doses. Synthetic cathinones are chemically related to cathinone, which is a naturally occurring stimulant found in the khat In 2015, just over 22 000 seizures of synthetic plant (Catha edulis). During 2015, more than European countries take measures to prevent the supply of 300 000 tablets containing new benzodiazepines such as drugs under three United Nations Conventions, which clonazolam, diclazepam, etizolam and fubromazolam provide a framework for control of production, trade and were seized — almost twice the number reported in 2014. Te Some new benzodiazepines were sold as tablets, capsules rapid emergence of new psychoactive substances and the or powders under their own names. In other cases, diversity of available products has proved challenging for counterfeiters used these substances to produce fake the Conventions and for European policymakers and versions of commonly prescribed anti-anxiety medicines, lawmakers. At national level, various measures have been used to control new substances, and three broad types of legal response can be identifed. Many countries in Europe frst responded by using consumer safety legislation, and subsequently extended or adapted existing drug laws to incorporate new psychoactive substances. Increasingly, countries have designed specifc new legislation to address this phenomenon. Tere is wide variation in the defnitions of the ofences and the penalties — as is the case for drug laws across Europe. Te general trend in national drug control laws, that is to reduce penalties for personal possession, is also evident in recent laws on new drugs. Most of the new laws specifc to new psychoactive substances only penalise illegal supply and have no penalty for personal possession. Where suspension of sentence was considered possible, median sentence is not presented. Tese variations may be a result of national historical and cultural factors infuencing a country’s criminal law systems, as well as diferent national views on the efectiveness of sentencing as a deterrent. Te study also revealed that, although the legislation may contain similar penalties for diferent substances, in most countries the practitioners predicted that penalties would vary by substance. Tis would imply that judges take into account aspects such as perceived harm to society caused by the diferent drugs. Overall, reports of drug supply ofences increased by 18 % since 2006, with an estimate of more than 214 000 cases in 2015. Drug trafcking penalties across the European Union: a survey of expert opinion, Technical reports. New psychoactive substances in Europe: legislation Legal approaches to controlling new psychoactive and prosecution — current challenges and solutions.
Revising the defnition to include improvement in wound healing buy slimex 10 mg amex weight loss pills kenya, long-term pain scores 167,168 cases with radiographic signs alone may overestimate the and quality of life scores. Staging present with non-specifc symptoms or clinical and radio- graphic fndings, such as, Modifcations in the staging system are necessary to ensure that it remains an accurate refection of disease Symptoms presentation and to assist in the appropriate stratifcation • odontalgia not explained by an odontogenic cause of patients. A Stage 0 category was added in 2009 to in- • dull, aching bone pain in the body of the mandible, clude patients with non-specifc symptoms, or clinical and which may radiate to the temporomandibular joint radiographic abnormalities that may be due to exposure to region an antiresorptive agent. At that time the risk of a patient with Stage 0 disease advancing to a higher disease stage • sinus pain, which may be associated with infamma- was unknown. Since then several case studies have report- tion and thickening of the maxillary sinus wall ed that up to 50% of patients with Stage 0 have progressed • altered neurosensory function to Stage 1, 2 or 3. Also, the defni- • loosening of teeth not explained by chronic peri- tion of exposed bone was broadened (see above) to include odontal disease the presence of cutaneous or mucosal fstulae that probe to • periapical/periodontal fstula that is not associated bone for Stage 1, 2 and 3 categories. They do not have exposed bone nor the periodontal ligament space)153 do they require any treatment. Systemic management may Stage 1 include the use of medication for chronic pain and control of infection with antibiotics, when indicated. These Exposed and necrotic bone, or fstulae that probes to bone, patients will require close monitoring given the potential in patients who are asymptomatic and have no evidence of for progression to a higher stage of disease. These patients may also present with radiograph- patients with radiographic signs alone suggesting Stage 0, ic fndings mentioned for Stage 0 which are localized to (see above), the committee recommends close monitoring the alveolar bone region. Other Stage 2 diagnoses, eg fbro-osseous disease, chronic sclerosing osteomyelitis should also be considered. Exposed and necrotic bone, or fstulae that probe to bone, with evidence of infection. These patients are typically Stage 1 – These patients beneft from medical management symptomatic. These patients may also present with radio- including the use of oral antimicrobial rinses, such as graphic fndings mentioned for Stage 0 which are localized chlorhexidine 0. Stage 3 Stage 2 – These patients beneft from the use of oral antimicrobial rinses in combination with antibiotic Exposed and necrotic bone, or fstulae that probe to therapy. Although local bone and soft tissue infection bone, with evidence of infection, and one or more of the is not considered the primary etiology for this process, following: the colonization of the exposed bone is a very common • exposed necrotic bone extending beyond the region occurrence. Most of the isolated microbes have of alveolar bone, ie, inferior border and ramus in been sensitive to the penicillin group of antibiotics. Microbial cultures • pathologic fracture should also be analyzed and the antibiotic regimen • extra-oral fstula should be adjusted accordingly. Bioflm formation on the • oral antral/oral nasal communication surface of the exposed bone has been reported in several reports and may be responsible for the failure of systemic • osteolysis extending to the inferior border of the antibiotic therapies that are described in some refractory mandible or sinus foor 66,70,179 cases. In such cases, operative therapy directed at reducing the volume of colonized, necrotic bone may serve as a benefcial adjunct to antibiotic therapy. Symptomatic patients with stage 3 disease may require resection and immediate reconstruction with a reconstruction plate or an obturator. The potential for failure of the reconstruction plate because of the generalized effects of the bisphosphonate exposure needs to be recognized by the clinician and patient. Case reports with small sample sizes describe successful immediate reconstruction with vascularized bone. The extraction of symptomatic teeth within exposed, necrotic bone should be considered since it is unlikely that the extraction will exacerbate the established necrotic process. A thorough histologic analysis is indicated for all resected bone specimens (especially for patients with a history a malignant disease) since metastatic cancer has been reported in such specimens. Primary Nitrogen Dose Route Indication Containing Alendronate Osteoporosis Yes 10 mg/day Oral ® (Fosamax ) 70 mg/week Risedronate Osteoporosis Yes 5 mg/day Oral ® (Actonel ) 35 mg/week Ibandronate Osteoporosis Yes 2. Therefore further controlled, prospective studies will be required to more fully characterize the risk of jaw necrosis associated with these agents. Am J ical Oncology clinical practice guidelines: the role of bisphospho- Med 95:297, 1993.
Prevalence of celiac dis- ease in at-risk and not-at-risk groups in the United States: a large Sesame Street Complete Vitamins & Minerals multicenter study purchase slimex 10 mg free shipping weight loss pills 5 htp. Obesity-related conditions, which include type 2 diabetes, heart disease, stroke and certain cancer types,1 are the leading cause of death among adults in the United States. The decision by the American Medical Association to recognize obesity as a disease in June 2013 created discussion and dialogue on the importance of managing diabetes and supporting provider reimbursement for oversight. If medications are elected as part of the treatment strategy, which already includes lifestyle changes such as increased physical activity and healthy eating patterns, experts recommend a weight loss of 5-10% is needed within the first six months of maximal medication dose to reduce the complications and health risks associated with obesity. Patients who are not achieving the recommended minimum 5% weight loss after three months or who are experiencing adverse effects should be switched to an alternative medication or evaluated for bariatric surgery. Therefore, it is important for diabetes educators to be familiar with the available weight loss medications along with their mechanism of actions, dosages, adverse effects, contraindications and special considerations. A diabetes educator who is familiar with these medications can be an advocate for the patient and make suggestions for potential weight loss medications to the health care team when appropriate. It is important to note that weight loss medications may be particularly beneficial for weight loss maintenance in those patients who lose weight via intensive lifestyle strategies. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Consensus Statement By The American Association Of Clinical Endocrinologists And American College Of Endocrinology On The Comprehensive Type 2 Diabetes Management Algorithm – 2016 Executive Summary. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. They are written to enable nurses and midwives to reflect on the key points associated with medication management and the related principles, and thus support effective, safe and ethical practice. The professions’ responsibilities, activities and accountability involving medications are intrinsically linked to the individual’s scope of practice. It is, therefore, important to consider the guidelines outlined in this document in association with the Scope of Nursing and Midwifery Practice Framework (An Bord Altranais, 2000), which provides the foundation for this guidance document. The fundamental concepts of accountability, autonomy, competence and delegation that are considered in determining scope of practice also relate to the professions’ role in medication management. Medication management, broadly defined, is the facilitation of safe and effective use of prescription and over-the-counter medicinal products (Bulechek and McCloskey, 1999). The nursing, midwifery, medical and pharmaceutical professions are all participants in medication management and contribute to patient/service-user care. Medication management is a comprehensive intervention which encompasses the knowledge of nurses and midwives (and that of other health care professionals) and the activities that are performed to assist the patient/service-user in achieving the greatest benefit and best outcomes involving medications (Naegle, 1999). The responsibilities of medication management incorporate the assessment, planning, implementation and evaluation of the nursing and midwifery process in collaboration with other health care professionals in providing care. The nurse/midwife should have knowledge of the relevant statutes and legislation regarding the practices of prescribing, dispensing, storing, supplying and administering scheduled medicinal products. There is an obligation to practice according to the legislation governing nursing and midwifery practice, and the current standards and policies of regulatory bodies and health service providers1. Nurses and midwives should be aware of their legal and professional accountability with regard to medication management. It is acknowledged that local need may dictate specific policies and protocols authorising the practices of individuals involved with medicines. The health service provider and health care regulatory and professional organisations have a responsibility to the patient/service-user to assure safe and effective medication management practices. Consultation with the drugs and therapeutics committee (where available), or similar governance structures, and other relevant personnel is advised in determining local policies and protocols involving medicinal products. Medication management practices should be audited on a regular basis to ensure effective and safe patient/service-user care. More recently, the Irish Medicines Board Act (Miscellaneous Provisions) Act, 2006 (No.
