Search results for: Prescription

Authors: Ilma Robo, Saimir Heta, Gerhard Nokaj

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Introduction: The method of treatment and the treatment protocols of apical periodontitis are now known, but the ongoing debate remains on whether or not prescription antibiotics should be given to patients suffering from this type of pathology. In fact, as an indication for prescribing antibiotics, this type of pathology remains between clinical indication and contraindication. Material and Methods: This article is of the short-communication type and has the sole purpose of analyzing the clinical picture of apical periodontitis and the fact that the appearance and extent of this pathology in the periapex area passes the stage when the host or the immune cells of the organism of the affected individual, react against bacterial factors. Results: Determining whether or not to prescribe systemic antibiotics according to literature sources can be avoided. In some cases, research in this field about this pathology even indicates endodontic rinsers or irrigants, such as chlorhexidine, in typical cases, mainly in persistent apical periodontitis. Conclusions: In times when bacterial resistance is a hot topic in some fields of scientific research, it is important to divide dental pathologies of bacterial origin into those when systemic antibiotic prescriptions must be given and those when every clinical issue is resolved only with endodontic root canal treatment. Even certain sources of published literature show the specifics of the most effective antibiotics against the bacterial flora causing the pathology of apical periodontitis.

Keywords: endodontic treatment, apical periodontitis, antibiotics, chlorhexidine

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Authors: Salma Ainine, Colin Ritchie, Tracey McFee

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Background: The societal impact of antibiotic resistance is a major public health concern. The increase in the incidence of resistant bacteria can ultimately be fatal. Objective: To analyse the appropriateness of antibiotic prescribing in Dundee Dental Hospital, ultimately improving the safety and quality of patient care. Methods: Two examiners independently cross-checked approximately fifty consecutive prescriptions, and corresponding patient case notes, for three data collection cycles between August 2014–September 2015. The Scottish Dental Clinical Effectiveness Program (SDCEP) Drug Prescribing for Dentistry guidelines was the standard utilised. The criteria: clinical justification, regime justification, and review arrangements was measured, and compared to the standard. Results: Cycle one revealed 42% of antibiotic prescriptions were appropriate. Interventions included: multiple staff meetings, an introduction of a checklist attached to the prescription pack, and production of patient leaflets explaining indications for antibiotics. Cycle two and three revealed 44%, and 30% compliance, respectively. Conclusion: The results of the audit have yet to meet target standards set out in prescribing guidelines. However, steps are being taken and change has occurred on a cultural level.

Keywords: antibiotic resistance, antibiotic stewardship, dental infection, hygiene standards

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Authors: Ajit Kumar Sah, Rajesh Kumar Jha, Phoolgen Sah, Dev Kumar Shah

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Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The purpose of this study was to determine the prevalence of potentially inappropriate medicine (PIM) prescribing in older Nepalese patients in a medicine outpatient department. Beers’ criteria are the most widely used tools to assess PIM to elderly patients. Prospective observational analysis of drugs prescribed in medicine out-patient department (OPD) of a hospital of Bharatpur, Chitwan, Nepal during November 2011 to October 2012 to 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM) in elderly patients was analyzed using Beers Criteria updated to 2013. In the 869 patients included the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%), amlodipine (23.16%), paracetamol (17.6%), salbutamol (15.72%) and vitamin B complex (13.26%). The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with a number of medications prescribed. Further research is warranted to study the impact of PIMs towards health-related outcomes in these elderly.

Keywords: Beers criteria, elderly, polypharmacy, potentially inappropriate medicines

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Authors: Donna L. Roberts

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Heroin has appeared on the drug scene before. Yet the current opioid crisis differs in significant ways. In order to address the grave challenges, this epidemic poses, the unique precipitating and sustaining conditions must be thoroughly examined. This research explored the various aspects of the political, economic, and social conditions that created a 'perfect storm' for the evolution and maintenance of the current opioid crisis. Specifically, the epidemiology, demographics, and progression of addiction inherent in the current crisis were compared to the patterns of past opioid use. Additionally, the role of pharmaceutical companies and prescribing physicians, the nature and pharmaceutical properties of the available substances and the changing socioeconomic climate were considered. Results indicated that the current crisis differs significantly with respect to its evolution, magnitude, prevalence, and widespread societal effects. Precipitated by a proliferation of prescription medication and sustained by the availability of cheaper, more potent street drugs, including new versions of synthetic opioids, the current crisis presents unprecedented challenges affecting a wider and more diverse segment of society. The unique aspects of this epidemic demand unique approaches to addressing the problem. Understanding these differences is a key step in working toward a practical and enduring solution.

Keywords: addiction, drug abuse, opioids, opioid crisis

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Authors: Zhan Dong, Qiu Jianrong, Li Qinghui, Zhang Lei

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The quantity and quality of the papers published on sport science from 2001 to 2013 had been counted and analysed and compared with the papers published on the journal from 1990 to 2000. The result showed that: 1. In the sports medicine field, the proportion of basic/application was abnormal. Basic research was far more than the application research. The papers on researching of imitating altitude training was the main part. Gene research made great progress.The research on sport injury and medical supervision were lower and lower. Research on sports prescription had made much progress, especially in the patients of heart infarction. 2. In building up people’s health field, the research on the old people had been more and more compared with the 10 years before, but it was not enough. 3. In the field of sports psychology, the research on disable people had been more compared with the 10 years before. Solved the problem of the sportmen before the game. 4. In the field of sports biomechanics, it showed that methods had made great progress compared with the 10 years before. Sport biomechanics combined with sports medicine, helped the sportsmen in good condition in the game. 5. In the exercise training field, the experts pay more attention to the outstanding sportsmen, and the researches emphasized that biology knowledge is the main basic for them to the research.

Keywords: sport medicine, sport injury, medical supervision

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Authors: M. Umar Hafeez, Furqan Khursheed Hashmi, Nadeem Irfan Bukhari, Shahzad Ali, Muzammil Ali

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The trend of self-medication is increasing due to various factors and is associated with a large number of complications. A cross-sectional study was aimed to investigate self-medication trend in an urban community and its correlates such as level of education, gender and behavior of using psychoactive medicines. A validated questionnaire was used to collect the data from different locations of Lahore, provincial capital of Punjab, Pakistan. The trend of self-medication was noted in reference to difference in educational level and in gender. This study showed that total 110 respondents, all literate,were found to be self-medicating, and their educational status was as 73.13% primary, 63.15% secondary, 61.12% higher secondary and 62.15% university going. In this sample 74.99% were males and 48.00%were females. Twenty nine (26.36%) of the total sample were found to be using psychoactive agents without consulting the physician. The trend of self-medication was 10% higher in individuals having primary level education, whereas there was not much difference of self-medication trend in other levels of education. The main reasons involved in self-medication trend were socio-economic status, medicine accessibility, religious and cultural beliefs, lack of awareness about risks associated with medicine, non-prescription sale of medicines and previous medication experience. The trend of self-medication of psychotropic agents is quite significant.

Keywords: self-medication, educated community, psychotropic drugs, education levels

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Authors: E. K. Linsenmayer

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Traditional international relations theorists define state security, the principal national interest, as a state’s military force. However, many political theorists argue the current definition of security is not comprehensive and therefore, problematic. This paper argues that women’s physical security is not only linked but also necessary to achieve state security. In today’s unipolar political international system, the United States continues to accredit national security to its military. However, in one of the most militarized countries, women remain insecure. Through a case study method of the United States, this paper illuminates a necessary political prescription: the empowerment of women through an inside-out, feminist theoretical approach that makes state security attainable. The research through empirical testing, drawing from several databases, shows the positive effects of women’s physical security on state security. Women’s physical security is defined in terms of equal legal practices, health, education, and female representation in the government. State security is measured by the relative peace of a state, its involvement in conflict and a state’s relations with neighboring states. This paper shows that empowering women, 50% of the world’s population, is necessary for ending the current vicious circle of militarization, war, and insecurity. Without undoing gender power dynamics at the individual and societal level, security at all levels remains unattainable.

Keywords: gender inequality, politics, state security, women's security

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Authors: Argaw Amare, Abbuna Fuffa, Stringer Andy

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Improving public knowledge and changing their attitudes towards antibiotic use will be a crucial early strategy to contain Antibiotic resistance. The current study was undertaken from November 2015 to June 2016. A cross-sectional survey using a pretested questionnaire was conducted on 392 residents (330 male and 62 female) aged 18 and above. Participants were selected randomly. Data was analyzed using simple descriptive statistics; the Chi-square test was used to determine any significant difference. The majority of participants (81%) were farmers in their occupation. Most of the respondents (76%) were not able to define the difference between antimicrobials and antibiotics. Furthermore, (61%) of participants were not able to define what antibiotics and for what purpose they are used. Thirty-four percent of participants do not know the names of antibiotics they have used for their animals and for themselves. Nearly 68% have no knowledge about the disease they have been treated for. The majority of participants (73.5%) agree to complete their course of treatment even if they feel better. About 72.5% of participants disagree that antibiotics are safe and can be used to treat different diseases, without prescription. Most of the participants (95%) treat their animals after diagnosis; more than 80% of them agree to not purchase veterinary drugs from local traders. This study showed that the participants have poor knowledge and good attitude, with an average score of 41.3±16.1% and 79.6±16, respectively. Knowledge and attitude are significantly correlated (p<0.01). The participants in this study had a good attitude toward the rational use of antibiotics. Whereas they lack knowledge with regard to the kinds of antibiotics and the diseases they are prescribed for. Therefore, further educational interventions are necessary to improve their understanding of the antibiotics currently available and the major bacterial diseases they are prescribed.

Keywords: AMR, knoweledge, attitude, perception

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Authors: Muhammad Faizan Butt, Maria Ambreen Tahir, Joshua James Pilkington, A. A. Warsi

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Background: Total parenteral nutrition (TPN) use within the NHS is crucial in the prevention of malnourishment. TPN prescriptions are tailored to an individual patient’s needs. TPN bags come in fixed sizes, and minimizing wastage has financial and sustainability implications for the health service. The aim of the study is to assess current prescribing practices, look at the volume of TPN wastage and identify reasons for it. Methodology: A retrospective cohort study on TPN prescriptions over a period of 1 year (Jan-Dec 2022) was performed. All patients prescribed TPN that had been admitted under a general surgery consultant in a small district hospital were included. Data were extracted from hospital electronic records and dietician charts. Data were described, and reasons for TPN wastage were explored. Results: 49 patients were identified. The average length of TPN prescription was 8 days (median). This totaled 608 prescriptions. Of the bags prescribed, 258, 169, and 181 were 10g (2500ml), 14g (2000ml), and 18g (2000ml), respectively. The mean volume wasted from each type of bag was 634ml, 634ml, and 648ml, respectively. Reasons for TPN wastage identified were: no loss (25%), smaller bags not available (53.6%), step-down regime (8.1%), and other (12.2%). Conclusion: This study has identified that the current stocking and prescribing of TPN within a district general hospital leads to a significant wastage of 638.2ml (average). The commonest reason for wastage is the non-availability of a more appropriate sized bag.

Keywords: general surgery, TPN, sustainability, wastage

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Authors: Rui Sousa, Aurora Futuro, António Fiúza

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The exploitation of gold ore deposits is highly dependent on efficient mineral processing methods, although actual perspectives based on life-cycle assessment introduce difficulties that were unforeseen in a very recent past. Cyanidation is the most applied gold processing method, but the potential environmental problems derived from the usage of cyanide as leaching reagent led to a demand for alternative methods. Ammoniacal thiosulfate leaching is one of the most important alternatives to cyanidation. In this article, some experimental studies carried out in order to assess the feasibility of thiosulfate as a leaching agent for the ore from the unexploited Portuguese gold mine of Castromil. It became clear that the process depends on the concentrations of ammonia, thiosulfate and copper. Based on this fact, a few leaching tests were performed in order to assess the best reagent prescription, and also the effects of different combination of these concentrations. Higher thiosulfate concentrations cause the decrease of gold dissolution. Lower concentrations of ammonia require higher thiosulfate concentrations, and higher ammonia concentrations require lower thiosulfate concentrations. The addition of copper increases the gold dissolution ratio. Subsequently, some alternative operatory conditions were tested such as variations in temperature and in the solid/liquid ratio as well as the application of a pre-treatment before the leaching stage. Finally, thiosulfate leaching was compared to cyanidation. Thiosulfate leaching showed to be an important alternative, although a pre-treatment is required to increase the yield of the gold dissolution.

Keywords: gold, leaching, pre-treatment, thiosulfate

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Authors: Tsung-yin Lin, Yi-yu Lee, Ching-hua Hung

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Snoring, the lay term for obstructive breathing during sleep, is one of the most prevalent of obnoxious human habits. Loud snoring usually makes others feel noisy and uncomfortable. Snoring also influences the sleep quality of snorers’ bed partners, because of the noise they do not get to sleep easily. Snoring causes the reduce of sleep quality leading to several medical problems, such as excessive daytime sleepiness, high blood pressure, increased risk for cardiovascular disease and cerebral vascular accident, and etc. There are many non-prescription devices offered for sale on the market, but very limited data are available to support a beneficial effect of these devices on snoring and use in treating obstructive sleep apnea (OSA). Mandibular advancement devices (MADs), also termed as the Mandibular reposition devices (MRDs) are removable devices which are worn at night during sleep. Most devices require dental impression, bite registration, and fabrication by a dental laboratory. Those devices are fixed to upper and lower teeth and are adjusted to advance the mandible. The amount of protrusion is adjusted to meet the therapeutic requirements, comfort, and tolerance. Many devices have a fixed degree of advancement. Some are adjustable in a limited degree. This study focuses on the stress analysis of Mandibular Advancement Devices (MADs), which are considered as a standard treatment of snoring that promoted by American Academy of Sleep Medicine (AASM). This paper proposes a new MAD design, and the finite element analysis (FEA) is introduced to precede the stress simulation for this MAD.

Keywords: finite element analysis, mandibular advancement devices, mechanical stress, snoring

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Authors: Nashalla Gwyn Nyinda

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The ancient system of Tibetan Medicine, known as Sowa Rigpa across the Himalayan regions, is a systematic system of healing encouraging balance primarily through diet and behavior modifications. With the rise of the popularity of Tibetan Medicine, compliance is critical to successful treatment outcomes. As patients learn more about who they are as individuals and how their elemental balances or imbalances affect disorders and mental-emotional balance, they develop faith and dedication to their healing process. Specifically, regarding diet and behavior and the basic principles of the medical system, patient compliance increases dramatically in all treatment areas when they understand why a treatment or dietary prescription guidance is effective. Successful responses to Tibetan treatment rely on a buy-in from the patient. Trust between the slower process of Traditional medicine treatments, the Tibetan physician and the patient is a cornerstone of treatment. The resulting decrease in the use of allopathic medicine and better health outcomes for acute and chronic disorders are well documented. This paper addresses essential points of the Tibetan Medicine system, dialogue between doctor and patient focused on appropriate and seasonal changing dietetics. Such fluctuating treatment approaches, based on external elemental factors, dramatically increase treatment outcomes. Specifically, this work addresses why allopathic medicine models may need more trust development between practitioner and patient.

Keywords: compliancy in treatment, diet and lifestyle medicine, nature and elements as medicine, seasonal diets, Sowa Rigpa, traditional Tibetan medicine, treatment outcomes

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Authors: Han Guan Chew, Keith Yong Ngee Ng, Shan-Wei Fan

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In Singapore, talent retention is one of the most persistent and real issue companies have to grapple with due to the tight labour market. Being resource-scarce, Singapore depends solely on its talented pool of high quality human resource to sustain its competitive advantage in the global economy. But the complex and multifaceted nature of turnover phenomenon makes the prescription of effective talent retention strategies in such a competitive labour market very challenging, especially when it comes to monetary incentives, companies struggle to answer the question of “How much is enough?” By examining the interactive effects of perceived alternative employment opportunities, annual salary and satisfaction with compensation on the turnover intention of 102 Singapore Professionals, Managers, Executives and Technicians (PMET) through correlation analyses and multiple regressions, important insights into the psyche of the Singapore talent pool can be drawn. It is found that annual salary influence turnover intention indirectly through mediation and moderation effects on PMET’s satisfaction on compensation. PMET are also found to be heavily swayed by better external opportunities. This implies that talent retention strategies should not adopt a purely monetary based blanket approach but rather a comprehensive and holistic one that considers the dynamics of prevailing market conditions.

Keywords: employee turnover, high performers, knowledge workers, perceived alternative employment opportunities salary, satisfaction on compensation, Singapore PMET, talent retention

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Authors: Kouorsh Zarea, Fatemeh Hassani, Samira Beiranvand, Akram Mohamadi

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Background and Objectives: Medication error in hospitals is a major cause of the errors which disrupt the health care system. The aim of this study was to assess the nurses’ medication errors and related factors. Material and methods: This was a descriptive study on 225 nurses in various hospitals, selected through multistage random sampling. Data was collected by three researcher made tools; demographic, medication error and related factors questionnaires. Data was analyzed by descriptive statistics, Chi-square, Kruskal-Wallis, One-way analysis of variance. Results: Based on the results obtained, the type of medication errors giving drugs to patients later or earlier (55.6%), multiple oral medication together regardless of their interactions (36%) and the postoperative analgesic without a prescription (34.2%), respectively. In addition, factors such as the shortage of nurses to patients’ ratio (57.3%), high load functions (51.1%) and fatigue caused by the extra work (40.4%), were the most important factors affecting the incidence of medication errors. The fear of legal issues (40%) are the most important factor is the lack of reported medication errors. Conclusions: Based on the results, effective management and promotion motivate nurses. Therefore, increasing scientific and clinical expertise in the field of nursing medication orders is recommended to prevent medication errors in various states of nursing intervention. Employing experienced staff in areas with high risk of medication errors and also supervising less-experienced staff through competent personnel are also suggested.

Keywords: medication error, nurse, clinical care, drug errors

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Authors: Abu Zafor Sadek

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Pharmaceuticals were one of the least impacted business sectors during the corona pandemic as they are the center point of Covid-19 fight. Emergency use authorization, unproven indication of some commonly used drugs, self-medication, research and production capacity of an individual country, capacity of producing vaccine by many countries, Active Pharmaceutical Ingredients (APIs) related uncertainty, information gap among manufacturer, practitioners and user, export restriction, duration of lock-down, lack of harmony in transportation, disruption in the regulatory approval process, sudden increased demand of hospital items and protective equipment, panic buying, difficulties in in-person product promotion, e-prescription, geo-politics and associated issues added a new dimension to this industry. Although the industry maintains a reasonable growth throughout Covid-19 days; however, it has been characterized by both long- and short-term effects. Short-term effects have already been visible to so many countries, especially those who are import-dependent and have limited research capacity. On the other hand, it will take a few more time to see the long-term effects. Nevertheless, supply chain disruption, changes in strategic planning, new communication model, squeezing of job opportunity, rapid digitalization are the major short-term effects, whereas long-term effects include a shift towards self-sufficiency, growth pattern changes of certain products, special attention towards clinical studies, automation in operations, the increased arena of ethical issues etc. Therefore, this qualitative and exploratory study identifies the post-covid-19 landscape of the global pharmaceutical industry.

Keywords: covid-19, pharmaceutical, businees, landscape

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Authors: Samson F. Agberotimi, Rachel B. Asagba, Choja Oduaran

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Disturbing rate of use of different substances such as cannabis, alcohol, as well as pharmaceutical drugs among Nigerian youth in recent times has been affirmed in the literature. There is, however, a paucity of literature addressing the pattern of usage of such drugs, especially for clinical relevance and intervention planning. The present study investigated the prevalence and pattern of drug usage among youth in Ogbomoso, Nigeria. A cross-sectional survey involving 92 purposively selected participants comprising of 82 males and 10 females aged between 15 and 24 years was conducted. A measure of drug involvement and demographic characteristics was administered to the participants. Descriptive analysis was done using the SPSS v.21. Cannabis (79.4%), alcohol (77.2%), codeine (70.7%), tobacco (65.2%) and tramadol (47.8%) are the five most frequently used substances. However, the majority of the users of tobacco (68.3%) and alcohol (62.0%) are casual users indicating a mild level of use of the substances among the participants. On the other hand, 49.2% of the codeine users, 27.3% of the tramadol users, and 21.9% of the cannabis users reported harmful/intensive levels of use. Furthermore, the results revealed individuals at the pathological level of use as 28.8% for cannabis, 25.0% for tramadol, and 21.6% for codeine, and thus require clinical/therapeutic intervention. In conclusion, cannabis remains the most frequently used substance among youths. However, there appears to be a shift from the use of conventional psychoactive substances to pharmaceutical/prescription drugs such as codeine and tramadol. The findings of this study raised the need for both preventive and therapeutic interventions addressing the problem of substance use disorder among youth in contemporary society.

Keywords: Ogbomoso, pattern of drug use, prevalence of drug use, youth

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Authors: Asima Ranjan Parhi

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English language teaching-learning in higher education departments in Indian and Asian contexts needs to be one of innovation and experimentation rather than rigid prescription. The communicative language teaching has been proposing the context to be of primary importance in this process. Today, English print and electronic media have flooded the market with plenty of material suitable to the classroom context. The entries are poetic, catchy and contain a deliberate method in them which could be utilized to teach not only English language but literature, literary terms and the theory of literature. The Bollywood movies, especially through their songs have been propagating a package which may be useful to teach language and even theory in the sub-continent. While investigating, one may be fascinated to see how such material in the body of media (print and electronic), movies and popular songs generate a data for our classroom in our context, thereby developing a mass language with huge pedagogical implications. Harping on the four skills of teaching and learning of a language in general and English language in particular appears stale and mechanical in a decontextualised, matter of fact classroom. So this discussion visualizes a model beyond these skills as well as the conventional theory, literature, language classroom practices in order to build up a systematic pattern stressing the factors responsible in the particular context, that of specific language, society and culture in tune with language-literature teaching. This study intends to examine certain catchy use of the language entries in mass media which could be in the direction of inviting more such investigations in the Asian context in order to develop a common platform of decolonized pedagogy.

Keywords: pedagogy, electronic media, Bollywood, decolonized, mass media

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Authors: Palanisamy Sivanandy, Tan Tyng Wei, Tan Wee Loon, Lim Chong Yee

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Background: Patient safety has become a major concern over recent years with elevated medication errors; particularly prescribing and dispensing errors. Meticulous prescription screening and diligent drug dispensing is therefore important to prevent drug-related adverse events from inflicting harm to patients. Hence, pharmacists play a significant role in this scenario. The evaluation of patient safety in a pharmacy setup is crucial to contemplate current practices, attitude and perception of pharmacists towards patient safety. Method: The questionnaire for Pharmacy Survey on Patient Safety Culture developed by the Agency for Healthcare and Research Quality (AHRQ) was used to assess patient safety. Main objectives of the study was to evaluate the attitude and perception of pharmacists towards patient safety in retail pharmacies setup in Malaysia. Results: 417 questionnaire were distributed via convenience sampling in three different states of Malaysia, where 390 participants were responded and the response rate was 93.52%. The overall positive response rate (PRR) was ranged from 31.20% to 87.43% and the average PRR was found to be 67%. The overall patient safety grade for our pharmacies was appreciable and it ranges from good to very good. The study found a significant difference in the perception of senior and junior pharmacists towards patient safety. The internal consistency of the questionnaire contents /dimensions was satisfactory (Cronbach’s alpha - 0.92). Conclusion: Our results reflect that there was positive attitude and perception of retail pharmacists towards patient safety. Despite this, various efforts can be implemented in the future to amplify patient safety in retail pharmacies setup.

Keywords: patient safety, attitude, perception, positive response rate, medication errors

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Authors: In Hee Shim, Dong Sik Bae

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Introduction: Obesity and unfavorable lipid profile may be linked to depressive disorders. This study compared the levels of obesity, lipid profiles and depression severity of patients with depressive disorders. Methods: This study included 156 patients diagnosed with a depressive disorder who were hospitalized between March 2012 and February 2016. The patients were categorized into mild to moderate and severe depressive groups, based on Hamilton Depression Rating Scale scores (Mild to moderate depression 8-23 vs. severe depression ≥ 24). The charts of the patients were reviewed to evaluate body mass index and lipid profiles, including total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TG), confounding factors, such as other general medical disorders (hypertension, diabetes mellitus, and dyslipidemia), except smoking status (insufficient data). Demographic and clinical characteristics, such as age, sex, comorbidities, family history of mood disorders, psychotic features, and prescription patterns were also assessed. Results: Compared to the mild to the moderate depressive group, patients with severe depression had significantly lower rate of male and comorbidity. The patients with severe depression had a significantly lower TG than patients in the mild to moderate depressive group. After adjustment for the sex and comorbidity, there were no significant differences between the two groups in terms of the obesity and lipid profiles, including TG. Conclusion: These results did not show a significant difference in the association between obesity, lipid profiles and the depression severity. The role of obesity and lipid profiles in the pathophysiology of depression remains to be clarified.

Keywords: depression, HAM-D, lipid profiles, obesity

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Authors: Yasin I. Tayem, Jamil Ahmed, Mahmood Bahzad, Abdullah Alnama, Fahad Al Asfoor, Mahmood A. Jalil, Mohammed Radhi, Ahmed Alenezi, Khalid A. J. Al-Khaja

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Drug-drug interactions (DDIs) represent a significant cause of patient’s morbidity and mortality. The rate of DDIs is rapidly increasing worldwide with the increasing proportion of ageing population and frequent requirement of polypharmacy-prescription of multiple drugs to treat comorbidities. Prescribing physicians are responsible for checking their prescriptions for the presence and severity of DDIs. However, since a large number of new drugs are approved and marketed every year, new interactions between medications are increasingly reported. Consequently, it is no longer practical for physicians to rely only upon their previous knowledge of medicine to avoid potential DDIs. The aim of this study was to explore the perceptions of physicians working at primary healthcare centers in Bahrain towards DDIs and how they manage them during their practice. Methodology: In this cross-sectional study, physicians working at all governmental primary healthcare centers in Bahrain were invited to voluntarily, privately and anonymously respond to a self-administered questionnaire. The questionnaire aims to assess their self-reported knowledge of DDIs and how they check for them in their practice. The participants were requested to provide socio demographic data and information related to their attitudes towards DDIs including strategies they employ for detecting and managing them, and their awareness of drugs which commonly cause DDIs. At the end of the questionnaire, an open-ended item was added to allow participants to further add any comment. Findings and Conclusions: The study is going on currently, and the results and conclusions will be presented at the conference.

Keywords: awareness, drug interactions, health centres, physicians

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Authors: Ranitha Guna Selvi D, Ramakrishnan R, Mohideen Abdul Kader

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Purpose: To study the role of Vision centers in managing preventable blindness through refractive error correction in Rural South India. Methods: A retrospective analysis of patients attending 15 Vision centers in Rural South India from a period of January 2021 to December 2021 was done. Medical records of 10,85,81 patients both new and reviewed, 79,562 newly registered patients and 29,019 review patient’s from15 Vision centers were included for data analysis. All the patients registered at the vision center underwent basic eye examination, including visual acuity, IOP measurement, Slit-lamp examination, retinoscopy, Fundus examination etc. Results: A total of 1,08,581 patients were included in the study. Of the total 1,08,581 patients, 79,562 were newly registered patients at Vision center and 29,019 were review patients. Males were 52,201(48.1%) and Females were 56,308(51.9) among them. The mean age of all examined patients was 41.03 ± 20.9 years (Standard deviation) and ranged from 01 – 113 years. Presenting mean visual acuity was 0.31 ± 0.5 in the right eye and 0.31 ± 0.4 in the left eye. Of the 1,08,581 patients 22,770 patients had refractive error in right eye and 22,721 patients had uncorrected refractive error in left eye. Glass prescription was given to 17,178 (15.8%) patients. 8,109 (7.5%) patients were referred to the base hospital for specialty clinic expert opinion or for cataract surgery. Conclusion: Vision center utilizing teleconsultation for comprehensive eye screening unit is a very effective tool in reducing the avoidable visual impairment caused due to uncorrected refractive error. Vision Centre model is believed to be efficient as it facilitates early detection and management of uncorrected refractive errors.

Keywords: refractive error, uncorrected refractive error, vision center, vision technician, teleconsultation

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Authors: Jennifer Holbein, Maritza Wiedel

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Background: Aging is associated with an increased risk of falls in older adults, and as a result, falls have become public health crises. However, the incidence of falls can be reduced through healthy aging and the implementation of a regular exercise and strengthening program. Public health and healthcare professionals authorize the use of evidence‐based, exercise‐focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practices. The purpose of this study was to assess the feasibility of an intervention, A Matter of Balance, in terms of demand, acceptability, and implementation into current exercise programs. Subjects: Seventy-five participants from rural communities, above the age of sixty, were randomized to an intervention or attention-control of the standardized senior fitness test. Methods: Subject completes the intervention, which combines two components: (1) motivation and (2) fall-reducing physical activities with protocols derived from baseline strength and balanced assessments. Participants (n=75) took part in the program after completing baseline functional assessments as well as evaluations of their personal knowledge, health outcomes, demand, and implementation interventions. After 8-weeks of the program, participants were invited to complete follow-up assessments with results that were compared to their baseline functional analyses. Out of all the participants in the study who complete the initial assessment, approximately 80% are expected to maintain enrollment in the implemented prescription. Furthermore, those who commit to the program should show mitigation of fall risk upon completion of their final assessment.

Keywords: aging population, exercise, falls, functional assessment, healthy aging

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Authors: Ajay Kumar Yadav, Masum Paudel, Ritesh Chaudhary

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Background: Understanding the diagnosis and the treatment plan is very important for the patient which reflects the effectiveness of the patient care as well as counseling. Large groups of patients do not understand their emergency care plan or their discharge instructions. With only a little more than 2/3ʳᵈ of the adult population is literate and poorly distributed health service institutions in Nepal, exploring the current status of patient understanding of their diagnosis and treatment would help identify interventions to improve patient compliance with the provided care and the treatment outcomes. Objectives: This study was conducted to identify and describe the areas of patients’ understanding and confusion regarding emergency care and discharge instructions at the Emergency ward of B. P. Koirala Institute of Health Sciences teaching hospital, Dharan, Nepal. Methods: A cross-sectional study was conducted among 426 patients discharged from the emergency unit of BPKIHS. Cases who are leaving against medical advice absconded cases and those patients who came just for vaccination are excluded from the study. Patients’ understanding of the treatment plan and diagnosis was measured. Results: There were 60% men in this study. More than half of the participants reported not being able to read English. More than 90% of the respondents reported they could not read their prescription at all. While patient could point out their understanding of their diagnosis at discharge, most of them could not tell the names and the dosage of all the drugs prescribed to them at discharge. More than 95% of the patients could not tell the most common side effects of the drugs that they are prescribed. Conclusions: There is a need to further explore the factors influencing the understanding of the patients regarding their treatment plan. Interventions to understand the health literacy needs and ways to improve the health literacy of the patients are needed.

Keywords: discharge instruction, emergency ward, health literacy, treatment plan

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Authors: Angelis P. Barlampas

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PURPOSE: Presentation of an interesting finding in an asymptomatic patient. MATERIAL: A patient came at hospital because of dysuric complaints and after a urologist’s prescription of a US exam of the urogenital system. The simple ultrasound examination of the lower abdomen revealed a moderate hypertrophy of the prostate and a solitary large bladder stone. The kidneys were normal. Then, the patient underwent a CT scan, which depicted the bladder stone and, as an incidental finding, a cystic lesion in contact with the upper anterior right surface of the bladder, with mural calcifications. METHOD: Abdominal ultrasound and abdominal computed tomography before and after intravenous contrast administration. RESULTS: The repeated US exam showed a cylindrical cystic lesion with a double wall and two mural hyperechoic foci, with partial posterior shadowing. Blood flow was not recognized on color doppler. The CT exam confirmed the cystic-like anechoic lesion, in the right iliac fossa, with the presence of two foci of mural calcifications. The differential diagnosis includes cases of enteric cyst, intestinal duplication cyst, chronic abscess, urachal cyst, Meckel's diverticulum, bladder diverticulum, old hematoma, thrombosed vascular aneurysm, diverticular abscess, etc. The patient refused surgical removal and is being monitored by ultrasound. CONCLUSIONS: The careful examination of the wider peri-abdominal area, especially during the routine ultrasound examination, can contribute to the identification of important asymptomatic findings. The radiologist must not be solely focused in a certain area of examination, even if the clinical doctor asks so, but should give attention to the neighboring areas, too.

Keywords: enteric cyst, US, CT, urogenital tract, miscellaneous findings

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Authors: Nasir Ullah

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Marketing strategies are important factors in the success of a company. Local pharmaceutical companies in Pakistan face several issues, such as low-level budgets, lack of skilled human resources, and challenges to competing with multinational competitors that have negative impacts on their success. However, still there exist local companies with great levels of success in the pharmaceutical sector. This study aims to evaluate the marketing strategies of successful local companies in the pharmaceutical sector of Khyber Pakhtunkhwa, Pakistan. The study employed a constructivist approach to know about successful strategies of the marketing managers that worked well. For this purpose, in-depth interviews were conducted with marketing managers of four pharmaceutical companies which were deemed as successful on the basis of their annual target achievements. Thematic analysis was conducted using Nvivo to devise major themes from the collected data. Four major themes or successful strategies were identified. These are i) share in the profit to marketing and sales staff, ii) invitation to the doctors for participation in free medical camps and health awareness seminars, iv) incentives for the Doctors and retailers, v) utilization of traditional capital (local social relationships) by the marketing officers. The study concludes that profit share to the employees, valuing doctors through their involvement and utilization of traditional capital are the successful marketing strategies of the successful pharmaceutical companies in the Pakhtun society of Pakistan. The study suggests hiring local staff that can utilize their traditional capital to influence doctors' decisions regarding the prescription of their medicine to the patients. The study also suggests profit share or increased bonuses to the marketing and sales staff as a measure of success.

Keywords: successful marketing strategies, pharmaceutical industry, traditional social capital, local companies

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Authors: Jing Niu, Jun X. Wang

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Arterial stiffness predicts mortality and morbidity, independently of other cardiovascular risk factors. And it is a major risk factor for age-related morbidity and mortality. The non-invasive industry gold standard measurement system of arterial stiffness utilizes pulse wave velocity method. However, the desktop device is expensive and requires trained professional to operate. The main objective of this research is the proof of concept of the proposed non-invasive method which uses measurement of magnetic flux disturbance and electrocardiogram (ECG) signal for measuring arterial stiffness. The method could enable accurate and easy self-assessment of arterial stiffness at home, and to help doctors in research, diagnostic and prescription in hospitals and clinics. A platform for assessing arterial stiffness through acquisition and analysis of radial artery pulse waveform and ECG signal has been developed based on the proposed method. Radial artery pulse waveform is acquired using the magnetic based sensing technology, while ECG signal is acquired using two dry contact single arm ECG electrodes. The measurement only requires the participant to wear a wrist strap and an arm band. Participants were recruited for data collection using both the developed platform and the industry gold standard system. The results from both systems underwent correlation assessment analysis. A strong positive correlation between the results of the two systems is observed. This study presents the possibility of developing an accurate, easy to use and affordable measurement device for arterial stiffness assessment.

Keywords: arterial stiffness, electrocardiogram, pulse wave velocity, Magnetic Flux Disturbance

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Authors: Syed Qasim Gilani, Muhammad Umair, Muhammad Noman, Syed Bilawal Shah, Aqib Abbasi, Muhammad Waheed

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Cardiovascular Diseases(CVD's) are the major cause of death in the world. The main reason for these deaths is the unavailability of first aid for heart failure. In many cases, patients die before reaching the hospital. We in this paper are presenting innovative online health service for Cardiac Patients. The proposed online health system has two ends. Users through device developed by us can communicate with their doctor through a mobile application. This interface provides them with first aid.Also by using this service, they have an easy interface with their doctors for attaining medical advice. According to the proposed system, we developed a device called Cardiac Care. Cardiac Care is a portable device which a patient can use at their home for monitoring heart condition. When a patient checks his/her heart condition, Electrocardiogram (ECG), Blood Pressure(BP), Temperature are sent to the central database. The severity of patients condition is checked using Artificial Intelligence Algorithm at the database. If the patient is suffering from the minor problem, our algorithm will suggest a prescription for patients. But if patient's condition is severe, patients record is sent to doctor through the mobile Android application. Doctor after reviewing patients condition suggests next step. If a doctor identifies the patient condition as critical, then the message is sent to the central database for sending an ambulance for the patient. Ambulance starts moving towards patient for bringing him/her to hospital. We have implemented this model at prototype level. This model will be life-saving for millions of people around the globe. According to this proposed model patients will be in contact with their doctors all the time.

Keywords: cardiovascular disease, classification, electrocardiogram, blood pressure

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Authors: Saeed Abbasi, Davood Farsi, Soudabeh Shafiee Ardestani, Neda Valizadeh

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Objectives: Peripheral vertigo is a common complaint of patients who are visited in emergency departments. In our study, we wanted to evaluate the effect of betahistine as an oral drug vs. intravenous diazepam for the treatment of acute peripheral vertigo. We also wanted to see the possibility of substitution of parenteral drug with an oral one with fewer side effects. Materials and Methods: In this randomized, double-blind study, 101 patients were enrolled in the study. The patients were divided in two groups in a double-blind randomized manner. Group A took oral placebo and 10 mg of intravenous diazepam. Group B received 8mg of oral betahistine and intravenous placebo. Patients’ symptoms and signs (Vertigo severity, Nausea, Vomiting, Nistagmus and Gate) were evaluated after 0, 2, 4, 6 hours by emergency physicians and data were collected by a questionnaire. Results: In both groups, there was significant improvement in vertigo (betahistine group P=0.02 and Diazepam group P=0.03). Analysis showed more improvement in vertigo severity after 4 hours of treatment in betahistine group comparing to diazepam group (P=0.02). Nausea and vomiting were significantly lower in patients receiving diazepam after 2 and 6 hours (P=0.02 & P=0.03).No statistically significant differences were found between the groups in nistagmus, equilibrium & vertigo duration. Conclusion: The results of this randomized trial showed that both drugs had acceptable therapeutic effects in peripheral vertigo, although betahistine was significantly more efficacious after 4 hours of drug intake. As for higher nausea and vomiting in betahistine group, physician should consider these side effects before drug prescription.

Keywords: acute peripheral vertigo, betahistine, diazepam, emergency department

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Authors: Amin Padash, Gholam Reza Nabi Bid Hendi, Hassan Hoveidi

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Purpose: The aim of this research is developing a model for green management based on Health, Safety and Environmental Management System. An HSE-MS can be a powerful tool for organizations to both improve their environmental, health and safety performance, and enhance their business efficiency to green management. Model: The model is developed in this study can be used for industries as guidelines for implementing green management issue by considering Health, Safety and Environmental Management System. Case Study: The Pars Special Economic / Energy Zone Organization on behalf of Iran’s Petroleum Ministry and National Iranian Oil Company (NIOC) manages and develops the South and North oil and gas fields in the region. Methodology: This research according to objective is applied and based on implementing is descriptive and also prescription. We used technique MCDM (Multiple Criteria Decision-Making) for determining the priorities of the factors. Based on process approach the model consists of the following steps and components: first factors involved in green issues are determined. Based on them a framework is considered. Then with using MCDM (Multiple Criteria Decision-Making) algorithms (TOPSIS) the priority of basic variables are determined. The authors believe that the proposed model and results of this research can aid industries managers to implement green subjects according to Health, Safety and Environmental Management System in a more efficient and effective manner. Finding and conclusion: Basic factors involved in green issues and their weights can be the main finding. Model and relation between factors are the other finding of this research. The case is considered Petrochemical Company for promoting the system of ecological industry thinking.

Keywords: Fuzzy-AHP method , green management, health, safety and environmental management system, MCDM technique, TOPSIS

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Authors: Nathan Reeves

Abstract:

Aim: The aim of this study was to evaluate if there was an impact on student learning when peer role play was substituted for a professional actor in the role of simulated patient in a simulation-based scenario. Method: Third-year exercise science students enrolled in a field project course in 2015 (n=24), and 2016 (n=20) participated in a simulation-based case scenario designed to develop their client-centred exercise prescription skills. During the simulation, students were provided with feedback from the simulated patients. In 2015, three professional actors played the part of the simulated patient, and in 2016 one of the simulated patients was a student from another exercise science cohort (peer role play). The student learning experience, consistency in case fidelity and feedback provided by the simulated patients was evaluated using a 5-point Likert scale survey and collecting phenomenological data. Results: Improvements to student pre and post confidence remained constant between the 2015 and 2016 cohorts (1.04 and 0.85). The perceived usefulness and enjoyability also remained high across the two cohorts (4.96 and 4.71). The feedback provided by all three simulated patients in 2016 was seen to strongly support student learning experience (4.82), and was of a consistent level (4.47). Significance of the findings to allied health: Simulation-based education is rapidly expanding in the curricula across the allied health professions. The simulated patient methodology continues to receive support as a pedagogy to develop a range of clinical skills including communication, engagement and client-centeredness. Upskilling students to peer role play can be a reasonable alternative to engaging paid actors.

Keywords: exercise science, simulation-based learning, simulated patient, peer role play

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