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Gemifloxacin mesylate tablets fluoroquinolones

160; following repeat doses of 100 mg kg gemifloxacin per day, the mice had skin gemifloxacin concentrations of approximately 4 μ g g.
The activity of gemifloxacin was similar to that of trovafloxacin and moxifloxacin, but was more active than nalidixic acid, ciprofloxacin or levofloxacin against the gyr a mutant strains. Consumer information pdr ; more like this - factive ' return false; add to my drug list factive gemifloxacin ji-mi-flox-a-sin ; belongs to the class of medicines known as antibiotics. No. of volunteers with no urinary bactericidal activity total no. tested Gemifloxacin 06 612 1224 Ofloxacin 612 1224.
Factive 5 medication gemifloxacin
K. Metzler et al. International Journal of Antimicrobial Agents 24 2004 ; 161167 [14] Stevens DL, Herr D, Lampiris H, et al. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis 2002; 34: 48190. [15] Johnson AP, Livermore DM, Tillotson GS. Antimicrobial susceptibility of Gram-positive bacteria: what's current, what's anticipated? J Hosp Infect 2001; 49 Suppl A ; : S311. [16] Surveillance NNI. National Nosocomial Infections Surveillance NNIS ; system report, data summary from January 1992June 2001, issued August 2001. J Infect Control 2001; 29: 40421. [17] Archibald L, Phillips L, Monnet D, McGowan JE, Tenover FC, Gaynes R. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Drug Invest 1997; 24: 2115. [18] Conly J. Antimicrobial resistance in Canada. CMAJ 2002; 167: 885 [19] Fluit AC, Jones ME, Schmitz FJ, et al. Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY Antimicrobial Surveillance Program, 1997 and 1998. Clin Infect Dis 2000; 30: 45460. [20] Diekema DJ, Pfaller MA, Schmitz FJ, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe and the Western Pacific region for SENTRY antimicrobial surveillance program, 19971999. Clin Infect Dis 2001; 32 Suppl 2 ; : S11432. [21] Blondeau JM. A review of the comparative in vitro activity of 12 antimicrobial agents with a focus on 4 new "respiratory quinolones". J Antimicrob Chemother 1999; 43 Suppl B ; : 111. [22] Blondeau JM, Hansen G, Borsos S, Irvine L, Blanco L, et al. In vitro susceptibility of 4903 bacterial isolates of gemifloxcin--an advanced fluoroquinolone. Int J Antimicrob Agents 2003; 9: 449. [23] Dong Y, Zhao X, Domagala J, Drlica K. Effect of fluoroquinolone concentration on selection of resistant mutants of Mycobacterium bovis BCG and Staphylococcus aureus. Antimicrob Agents Chemother 1999; 43: 17568. [24] Blondeau JM, Zhao X, Hansen G, Drlica K. Mutant prevention concentration of fluoroquinolones for clinical isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother 2001; 45: 4338. [25] Hansen G, Metzler KL, Drlica K, Blondeau JM. Mutant prevention concentration of gemifloxacin for clinical isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother 2003; 47: 4401. [26] Standards. NCfCL. Methods of dilution antimicrobial susceptibility tests for bacteria that grow aerobically M7-A5 ; . National Committee for Clinical Laboratory Standards., 2000. [27] Drlica K, Schmitz FJ. Therapeutic options in an era of decreasing antimicrobial susceptibility. J Chemother 2002; 14 Suppl 2 ; : 512. [28] Microbiology ASf. In: Isenberg HD, editor. Clinical Microbiology Procedures Handbook. vol. 1: American Society for Microbiology, 1992. [29] Blondeau JM, Hansen G, Metzler KL, Borsos S, Chau J. Optimal killing of Streptococcus pneumoniae by gemifloxacin, levofloxacin and moxifloxacin. Royal Society of Medicine Press 2002: 1526. [30] Blondeau JM, Drlica K, Hansen G, Zhao X. The relationship between the mutant prevention concentration MPC ; of fluoroquinolones FQ ; against Streptococcus pneumoniae SP ; and the 24-hour doseresponse curves., 7th International Symposium of New Quinolones, Edinburgh, Scotland, 2001. Abstract #71.

Gemifloxacin pharmacology

1. Fisher, L. M. & Heaton, V. J. 2003 ; . Dual activity of fluoroquinolones against Streptococcus pneumoniae. Journal of Antimicrobial Chemotherapy 51, 4634. 2. Smith, H. J., Nichol, K. A., Hoban, D. J. & Zhanel, G. G. 2002 ; . Dual activity of fluoroquinolones against Streptococcus pneumoniae: the facts behind the claims. Journal of Antimicrobial Chemotherapy 49, 8935. 3. Bush, K. & Goldschmidt, R. 2000 ; . Effectiveness of fluoroquinolones against Gram-positive bacteria. Current Opinion in Investigational Drugs 1, 2230. 4. Heaton, V. J., Ambler, J. E. & Fisher, L. M. 2000 ; . Potent antipneumococcal activity of gemifloxacin is associated with dual targeting of gyrase and topoisomerase IV, an in vivo target preference for gyrase, and enhanced stabilization of cleavable complexes in vitro. Antimicrobial Agents and Chemotherapy 44, 31127 and gemtuzumab.

Compliance. Feb 10, 2006 G TBT N CAN 149 CANADA Proposed Amendment to the Food and Drug Regulations Project No. 1405 -- Schedule F ; 4 pages, in English and French ; This notification announces the availability of a letter that provides an opportunity to comment on the proposed addition of 7 medicinal ingredients to Part I of Schedule F to the Food and Drug Regulations. Description of the medicinal ingredients: Atazanavir and its salts - is a protease inhibitor indicated for the treatment of human immunodeficiency virus HIV ; , a serious and potentially life-threatening illness. Individualized instructions are necessary in all potential use settings for atazanavir. It is to used only in combination with other Schedule F HIV drugs. Fulvestrant - is an estrogen receptor antagonist. It is used in the hormonal treatment of locally advanced or metastatic breast cancer in postmenopausal women in whom the disease has spread in spite of previous endocrine therapy. Gefitinib - is an enzyme inhibitor that affects the rate at which cells grow divide ; and die. It is used to treat specific types of lung cancer in patients who have not responded to other types of chemotherapy. Gefitinib belongs to a new therapeutic class of drugs called epidermal growth factor receptor tyrosine kinase inhibitors. Gemifloxacin and its salts - is a synthetic broad-spectrum antibacterial agent that belongs to the fluoroquinolone class of antibiotics. Gemifloxacin is used to treat chronic bronchitis when caused by susceptible strains of microorganisms. Hetastarch and its derivatives - is a plasma volume expander administered by intravenous infusion to treat low blood plasma volume. Ibandronic acid and its salts - is a bisphosphonate that acts on bone tissue to reduce bone resorption with no direct effect on bone formation. Ibandronic acid is used to treat and prevent osteoporosis thinning or weakening of the bones ; in postmenopausal women. Ponazuril - is an antiprotozoal treatment for horses. It is used to treat equine protozoal myeloencephalitis EPM ; , a progressive, degenerative disease of the central nervous system of horses caused by the protozoal parasite, Sarcocystis neurona. Schedule F is a list of medicinal ingredients, the sale of which is controlled under sections C.01.041 to C.01.049 of the Food and Drug Regulations. Part I of Schedule F lists ingredients that require a prescription for human use and for veterinary use. Part II of Schedule F lists ingredients that require a prescription for human use, but do not require a prescription for veterinary use if.

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Gemifloxacin cost
Wazni OM, Rossillo A, Marrouche NF, Saad EB, Martin DO, Bhargava M, Bash D, Beheiry S, Wexman M, Potenza D, Pisano E, Fanelli R, Bonso A, Themistoclakis S, Erciyes D, Saliba WI, Schweikert RA, Brachmann J, Raviele A, Natale A. Embolic events and char formation during pulmonary vein isolation in patients with atrial fibrillation: impact of different anticoagulation regimens and importance of intracardiac echo imaging. J Cardiovasc Electrophysiol. 2005 Jun; 16 6 ; : 576-81. Cummings JE, Schweikert R, Saliba W, Hao S, Martin DO, Marrouche NF, Burkhardt JD, Kilicaslan F, Verma A, Beheiry S, Belden W, Natale A. Left atrial flutter following pulmonary vein antrum isolation with radiofrequency energy: linear lesions or repeat isolation. J Cardiovasc Electrophysiol. 2005 Mar; 16 3 ; : 293-7. Kilicaslan F, Verma A, Yamaji H, Marrouche NF, Wazni O, Cummings JE, Hao S, Andrews MW, Beheiry S, AbdulKarim A, Belden WA, Minor S, Burkhardt JD, Saliba W, Schweikert RA, Natale A. The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery. J Coll Cardiol. 2005 Mar 1; 45 5 ; : 690-6. Khaykin Y, Marrouche NF, Martin DO, Saliba W, Schweikert R, Wexman M, Strunk B, Beheiry S, Saad E, Bhargava M, Burkhardt JD, Joseph G, Tchou P, Natale A. Pulmonary vein isolation for atrial fibrillation in patients with symptomatic sinus bradycardia or pauses. J Cardiovasc Electrophysiol. 2004 Jul; 15 7 ; : 784-9. Saad EB, Rossillo A, Saad CP, Martin DO, Bhargava M, Erciyes D, Bash D, Williams-Andrews M, Beheiry S, Marrouche NF, Adams J, Pisano E, Fanelli R, Potenza D, Raviele A, Bonso A, Themistoclakis S, Brachmann J, Saliba WI, Schweikert RA, Natale A. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation. 2003 Dec 23; 108 25 ; : 3102-7 and gemzar.
Antibacterial effect and emergence of resistance to gemifloxacin and levofloxacin were studied in an in vitro pharmacokinetic model of infection. A panel of Streptococcus pneumoniae strains with known mechanisms of resistance were used; two strains had no known resistance mechanism, two had efflux pumps, three had gyrA plus parC mutations, and one had only a parC mutation. Gemifloxacin MICs were in the range of 0.016 to 0.25 mg liter, and levofloxacin MICs ranged from 1 to 16 mg liter. Antimicrobial effect was measured by area under the bacterial-kill curve up to 72 h, and emergence of resistance was determined by population analysis profile before and during drug exposure. The area under the curve AUC ; MIC ratios for gemifloxacin and levofloxacin were 35 to 544 and 3 to 48, respectively. As expected on the basis of these AUC MIC ratio differences, antibacterial effect was much greater for gemifloxacin than levofloxacin. In the gemifloxacin simulations, mechanism of resistance as well as MIC determined the antibacterial effect, as indicated by gemifloxacin's greater effect against efflux strains compared to those with gyrA or parC mutations despite similar MICs. This was not true of levofloxacin. Emergence of resistance was not easily demonstrated with either agent, and mechanism of resistance did not have any impact on it. Fluoroquinolone resistance in Streptococcus pneumoniae is, at present, an uncommon occurrence British Society for Antimicrobial Chemotherapy Working Party, Abstr. 41st Intersci. Conf. Antimicrob. Agents Chemother., 2001 ; . However, it is well described in terms of its genetic basis and phenotypic expression, being related to either mutations in the quinolone resistance-determining regions QRDR ; of the genome or the presence of efflux pumps in the bacterial membrane. Highlevel fluoroquinolone resistance ciprofloxacin MIC of 64 mg liter ; in S. pneumoniae is commonly associated, as determined by DNA sequence analysis, with mutations in parC and gyrA, although changes in parE and gyrB also occur. However, such strains are more susceptible to advanced-generation fluoroquinolones, such as gemifloxacin [V. J. Heaton, C. Goldsmith, J. Ambler, and L. M. Fisher, J. Antimicrob. Chemother. 44 Suppl. A ; : 140, abstr. P452, 1999] ; . Efflux-mediated resistance, detected phenotypically by determination of norfloxacin MICs with or without an efflux inhibitor, was associated with ciprofloxacin MICs of 2 mg liter but with gemifloxacin MICs of 0.06 mg liter [N. Brenwald, M. J. Gill, F. Boswell, and R. Wise, J. Antimicrob. Chemother. 44 Suppl. A ; : 145, abstr. P477, 1999]. The impact of the two types of fluoroquinolone resistance in gram-positive bacteria on the pharmacodynamics of antibacterial effects of and emergence of resistance to fluoroquinolones has not been fully explored. In an in vitro fibrin clot pharmacokinetic model with Staphylococcus aureus, inhibition of the NorA efflux pump by omeprazole increased the antibacterial activity of ciprofloxacin and decreased the emergence of resistance. There was little effect on the antibacterial activity of levofloxacin and none on the emergence of resistance 1 ; . When S. pneumoniae was used in an in vitro model, the presence of efflux pumps reduced the antibacterial effects of levofloxacin, moxifloxacin, and sparfloxacin and promoted the emergence of resistance K. J. Madaras-Kelly, C. Daniels, M. Hegbloom, C. Nielson, and T. Kurtz, Abstr. 40th Intersci. Conf. Antimicrob. Agents Chemother., abstr. 296, 2000 ; . In contrast, in a neutropenic murine thigh infection model with S. pneumoniae resistant to ciprofloxacin as a result of efflux or gyrase parC and parE mutations, the gemifloxacin area-underthe-curve AUC ; MIC ratio needed to produce a net bacteriostatic effect was lower for the efflux pump-containing strains than for the other strains tested D. Andes and W. A. Craig, Abstr. 39th Intersci. Conf. Antimicrob. Agents Chemother., abstr. 2032, 1999 ; . To further define the impact of the mechanism of fluoroquinolone resistance on the pharmacodynamic effects of this drug class on S. pneumoniae, we compared the antibacterial effects of and emergence of resistance to gemifloxacin or levofloxacin for a panel of S. pneumoniae strains with no known mechanism of resistance and with efflux pumps or mutations in the QRDR.

Gemifloxacin brand

Displayed MICs of 0.125, and 0.5 g ml, respectively, against ACH-0216 while the MICs of ciprofloxacin, moxifloxacin and gemifloxacin against this double mutant were and genotropin.
Tion. By contrast, FDG given subcutaneously to healthy.

25. 37 EXT. FIELD NEAR ROAD - DAY An aluminum water tank spews a violent leak. 38 INT. EXT. CAR - DAY BUTCH We got a handful of caps and yer' shootin' water tanks. He's a smart guy, huh, Phillip? Phillip doesn't move or change expression. Jerry smiles, almost to himself, and FIRES TWICE more for the hell of it. The ROOF of the Impala EXPLODES with two holes as the car speeds off down the highway. 39 EXT. PARKING LOT - DAY Red is finishing up with several reporters near the door to the parking lot. Adler jumps in, holds up his hands. ADLER All right, that's it, boys. work to do. Chief's got 39 38 37 and gentamicin.
Buck Cases of. Rotation Tahipes A. of the. Longus time Reduction witim Joint. The. Figure 2. Relationship between cyclooygenase COX ; selectivity and acute myocardial infarction AMI ; . This curve was fit using nonlinear assumptions and displays a cubic spline. The solid line represents the log of the odds ratio OR ; of sustaining an MI based on the log of the COX-1: COX-2 ratio for each nonsteroidal anti-inflammatory drug NSAID ; regimen of cases and controls. The dashed lines represent the 95% confidence interval. Subjects using multiple NSAIDs were excluded from these analyses. Zero on the x-axis represents nonselective NSAIDs, whereas positive values represent NSAIDs with COX-1: COX-2 selectivity greater than 1, and negative numbers are ratios less than 1. On the y-axis, the log of 0.0 signifies an OR of 1.0 for acute MI, and values below this signify ORs less than 1.0 and gentian.
MIC range of 0.5 to 8 g and a MIC90 of 1 g for gemifloxacin and a MIC90 of 0.5 g ml range, 0.25 to 4 g for trovafloxacin. They did not, however, report results for other individual member species of the B. fragilis group. In our study, sitafloxacin was generally four times more active MIC90, 0.25 g ml ; than gemifloxacin, and trovafloxacin MIC range, 0.125 to 4 g ml; MIC90, 0.5 g ml ; was twice as active. For almost all Bacteroides distasonis and Bacteroides ovatus strains, the MIC of gemifloxacin was 2 g ml. For all but one Bacteroides stercoris strain, the MIC of gemifloxacin was 0.5 g ml. B. thetaiotaomicron and Bacteroides caccae strains had a biphasic distribution of susceptibility to gemifloxacin, which had a MIC50 of 1 g but a MIC90 of 16 g ml. Bacteroides uniformis and Bacteroides vulgatus showed marked strain variation in relation to gemifloxacin. All Prevotella intermedia strains and all but one strain of Prevotella melaninogenica were susceptible to 0.5 and 1 g of gemifloxacin ml, respectively. Generally, 2 g ml was required for inhibition of Prevotella buccae and 8 g ml for that of Prevotella bivia. The only species of Porphyromonas that we tested was Porphyromonas asaccharolytica, all strains of which were inhibited by 0.125 g of gemifloxacin ml. Gemifloxacin showed generally good activity against grampositive anaerobic bacteria. The respective MIC90s of gemifloxacin, trovafloxacin, and sitafloxacin against the various clostridia were as follows: for Clostridium clostridioforme, 0.5, 8, and 0.25 g ml; for Clostridium difficile, 16, and 1 g ml; for Clostridium innocuum, 2, 4, and 1 g ml; for Clostridium perfringens, 0.06, 0.25, and 0.06 g ml; and for Clostridium ramosum, 8, and 4 g ml. Marco et al. 4 ; noted that gemifloxacin and trovafloxacin had MIC90s of 1 g against a melange of clostridial species. They also noted that sparfloxa cin was much less active, with a MIC90 of 8 g ml. In our study, gemifloxacin was 1 to 2 dilutions more active than trovafloxacin against fusobacteria and peptostreptococci Peptostreptococcus anaerobius, Peptostreptococcus asaccharolyticus, Peptostreptococcus magnus, Peptostreptococcus micros, and Peptostreptococcus prevotii ; and was equivalent to trovafloxacin in activity against P. asaccharolytica and clostridia. Gemifloxacin was equivalent to sitafloxacin against peptostreptococci, C. perfringens, and C. ramosum and was 2 to 3 dilutions less active against fusobacteria. Sparfloxacin, grepafloxacin, and levofloxacin were generally less active than gemifloxacin against all anaerobes. Marco et al. 4 ; reported that gemifloxacin and trovafloxacin each had a MIC90 of 2 g against a combined.

Gemifloxacin resistance

CME available in print version and on RSNA Link ; Neal C. Dalrymple, MD Brant Casford, MD David P. Raiken, MD Kelcey D. Elsass, MD Rafael A. Pagan, MD Several signs to assist interpretation of unenhanced helical computed tomographic CT ; scans obtained for suspected ureterolithiasis have been described. Because signs such as perinephric stranding are not always readily apparent, a methodical approach to interpretation of CT studies is important in determining the presence or absence of ureterolithiasis. Evaluation of the poles of the kidneys is helpful in detecting subtle stranding of the perinephric fat. Inspection of the intrarenal collecting system within the poles of the kidneys is helpful in identifying subtle collecting system dilatation and can help prevent mistaking an extrarenal pelvis for hydronephrosis. Careful inspection of the ureter throughout its course is the most reliable method of distinguishing between ureteral stones and phleboliths. However, when the ureter cannot be followed antegrade, the pelvic portion can often be identified in a retrograde fashion. When secondary signs of obstruction are present but no stone is present, differential diagnostic considerations include a recently passed stone, pyelonephritis, urinary tract obstruction unrelated to stone disease, and protease inhibitor deposition disease and ginger. Membranes were purified from Caco-2 cells and were subjected to immunoblot analysis. A primary band of 80 kDa was detected using affinity-purified antiPEPT1 antibodies, which disappeared when the antibody was preabsorbed to the synthetic antigen peptide Fig. 6A ; . Densitometric quantification indicated that expression of PEPT1 protein was decreased in cells 0.05 ; . An pretreated with T3 Fig. 6, B and C, P additional band below PEPT1 was also detected. This band may correspond to a degradation product of and gemifloxacin.

Neurologic deficits. Patients should be treated with dexamathasone and then evaluated with magnetic resonance imaging MRI ; or computed tomography myelogram. MRI is currently the most sensitive method for evaluating spinal cord compression. Patients with metastases to the spine with or without spinal cord compression can be treated with external beam radiation, although the optimal dose for treatment has not been defined. Benefit can be demonstrated for patients even if neurologic changes have already occurred. Alternatively, patients with spinal cord compression can be treated with surgery or a combination of surgery radiation. It is unclear whether radiation or surgery is better therapy for spinal cord compression; however, at least one randomized study demonstrated that surgery plus radiation was better than radiation alone in allowing patients to remain ambulatory and continent.62 It is appropriate to consult both the radiation oncologist and neurosurgeon for patients with spinal cord compression to determine the best therapy for a particular patient and ginkgo.

Gemifloxacin synthesis

Manufactured for: oscient pharmaceuticals waltham, ma 02451-1478 usa licensed from lg life sciences, ltd seoul, korea fda rev date: 5 1 2007 brand name: factive generic name: gemifloxacin mesylate next: factive - side effects & drug interactions » « previous: factive - drug description « previous 1 2 3 next » - health questions.

Self-medication. This, turn, is relevant because, while it is conceivable that selfmedication strategies with nonprescription bron chodilators might be safe for the mildest forms of asthma, standard-of-care for moderate and severe asthma includes the use of anti-inflammatory regi mens available only by prescription. In summary, while acknowledging that there are inherent difficul ties in characterizing asthma severity, our findings suggest that asthma OTC medication use is not restricted to persons with only the mildest forms of asthma. Particularly among those who tend to mix prescription and OTC pharmaceuticals, asthma se and ginseng. Fluoroquinolones When fluoroquinolones such as ciprofloxacin were first introduced into clinical practice staphylococci were uniformly susceptible to this class of drugs. There was optimism about the role fluoroquinolones might play in the treatment of MRSA infections and the eradication of MRSA colonization 52 ; . However, rapid emergence of ciprofloxacin resistance in staphylococci, especially in MRSA, occurred 53, 54 ; . Currently, the vast majority of MRSA isolates in Canada are resistant to ciprofloxacin 6 ; . More recently, newer fluoroquinolones with enhanced activity in vitro against gram-positive organisms have become available. Although drugs such as moxifloxacin, gatifloxacin, and gemifloxacin have enhanced activity against staphylococci and MRSA MIC 90, 0.5-8.0 Fg ml ; 55-58 ; , there have been no published reports describing the use of these agents for the treatment of MRSA infections. Currently available fluoroquinolones are not recommended for the treatment of MRSA infections and gemtuzumab. Strongly isotropic, their properties, particularly drainage, are very different in horizontal and vertical direction. Drainage starts as soon as the load is applied. A uniform pore pressure may not be developing throughout a sample, and the initial undrained compression cannot be measured directly. Besides the natural condition of the sample, sampling disturbance will have a more pronounced effect on the results of the test done on small samples. Furthermore, the boundary effect from the ring enhances the friction of the sample. Friction reduces the compression during loading and reduces swelling during unloading and gleevec.

Schemes such as `Investors in People' and the Chartermark ; are used [9]; health services accreditation schemes have proliferated over the last 15 years and now exist for many types of health care organization [10]; the NHS Litigation Authority inspects NHS trust arrangements for managing clinical negligence [11]; and there are many formal statutory authorities with the remit to review health care organizations such as the Audit Commission, the National Audit Office, and the Health and Safety Executive. With such a miscellany of external review activities in the NHS, it is not surprising that there is considerable overlap, duplication of effort and some conflict over the respective roles and responsibilities of agencies involved in external review. From the point of view of the organizations being reviewed, this can be confusing and overwhelming. Since the market-oriented NHS reforms of the late 1980s loosened traditional bureaucratic controls over public sector health care provider organizations and increased local managerial autonomy [12], the use of external review has been increased to compensate for the loss of direct managerial oversight [13], and this has further contributed to a sense of `inspectorial overload' [14]. Despite the widespread use of external review in the NHS in England, it has not been widely evaluated or researched, and its impact on the organizations that are reviewed is not well understood [15]. For example, we know little about the beneficial or adverse impacts that external review actually has on the performance of reviewed organizations, how much external reviews cost both for the review agency and the reviewed organizations ; , and which review methods, approaches or measurement techniques are most valid, reliable and effective in particular contexts. However, there is a large and growing literature on the use of external review and regulation in settings outside health care [1618]. External reviews of clinical governance in the NHS In 1997, the current UK government introduced a range of reforms intended to improve the quality of health care in the NHS [19]. At the centre of these new policies was a requirement for health care provider organizations to have.

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