Search results for: ADHD medication

Authors: P. H. Tee, S. M. Zamri, K. M. Kasim, S. K. Tiew

Abstract:

This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.

Keywords: Awareness, knowledge, osteoporosis, practices.

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Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

Abstract:

Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialized software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarize and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, re-evaluate their perceptions about hospitalization, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalized peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective-taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimize escapism and feelings of exclusion and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: Hospitalized children, interactive games, long-term illness, cognitive enhancement, socioemotional development.

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Authors: P. Murphy, D. Vasic, A. W. Gunaratne, T. Tugonon, M. Ison, C. Pagonis, E. T. Sitchon, A. Le Busque, T. J. Borody

Abstract:

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by an alteration in bowel movements. There are three different types of IBS: diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C) and IBS with mixed bowel habit (IBS-M). Antimicrobials are increasingly being used as treatment for all types of IBS. Due to this increased use and subsequent success, the gut microbiome as a factor in the etiology of IBS is becoming more apparent. Accepted standard treatment has focused on IBS-C and involves either vancomycin or rifaximin. Here, we report on a cohort of 18 patients treated with both vancomycin and rifaximin for IBS-D. These patients’ records were reviewed retrospectively. In this cohort, patients were aged between 24-74 years (mean 44 years) and nine were female. At baseline all patients had diarrhea, four with mucus and one with blood. Other reported symptoms include abdominal pain (n = 11) bloating (n = 9), flatulence (n = 7), fatigue (n = 4) and nausea (n = 3). Patient’s treatments were personalized according to their symptom severity and tolerability and were treated with a combination of rifaximin (500-3000 mg/d) and vancomycin (500 mg-1500 mg/d) for an ongoing period. Follow-ups were conducted between 2-32 weeks. Of all patients, 89% reported improvement of at least 1 symptom, one reported no change and one patient’s symptoms got worse. The success of this combination treatment could be due to the different mechanisms of action undertaken by each medication. Vancomycin works by inhibiting the cell wall of the bacteria and rifaximin by inhibiting protein synthesis. This success in treatment validates the idea that IBS-D may be driven by a bacterial infection of the gastrointestinal microbiome. As IBS-D presents similarly to Clostridium difficile and symptom improvement can occur with the same treatment as Clostridium difficile of rifaximin and vancomycin, there is reason to suggest that the infectious agent could be an unidentified strain of Clostridium. Although these results offer some validity to the theory, more research is required.

Keywords: Clostridium difficile infection, diarrhea predominant irritable bowel syndrome, microbiome, vancomycin/rifaximin combination.

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Authors: V. Holeva, V. Aliki Nikopoulou, P. Kechayas, M. Dialechti Kerasidou, M. Papadopoulou, G. A. Papakostas, V. G. Kaburlasos, A. Evangeliou

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Cognitive Behavioral Therapy (CBT) has been proven an effective tool to address anger and anxiety issues in children and adolescents with Autism Spectrum Disorders (ASD). Robot-enhanced therapy has been used in psychosocial and educational interventions for children with ASD with promising results. Whenever CBT-based techniques were incorporated in robot-based interventions, they were mainly performed in group sessions. Objectives: The study’s main objective was the implementation and evaluation of the effectiveness of a relaxation training intervention for children with ASD, delivered by the social robot NAO. Methods: 20 children (aged 7–12 years) were randomly assigned to 16 sessions of relaxation training implemented twice a week. Two groups were formed: the NAO group (children participated in individual sessions with the support of NAO) and the control group (children participated in individual sessions with the support of the therapist only). Participants received three different relaxation scenarios of increasing difficulty (a breathing scenario, a progressive muscle relaxation scenario and a body scan medication scenario), as well as related homework sheets for practicing. Pre- and post-intervention assessments were conducted using the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire for parents (SDQ-P). Participants were also asked to complete an open-ended questionnaire to evaluate the effectiveness of the training. Parents’ satisfaction was evaluated via a questionnaire and children satisfaction was assessed by a thermometer scale. Results: The study supports the use of relaxation training with the NAO robot as instructor for children with ASD. Parents of enrolled children reported high levels of satisfaction and provided positive ratings of the training acceptability. Children in the NAO group presented greater motivation to complete homework and adopt the learned techniques at home. Conclusions: Relaxation training could be effectively integrated in robot-assisted protocols to help children with ASD regulate emotions and develop self-control.

Keywords: Autism spectrum disorders, CBT, children relaxation training, robot-assisted therapy.

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Authors: Hind Bouami, Patrick Millot

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Medication dispensing system is a life-critical system whose failure may result in preventable adverse events leading to longer patient stays in hospitals or patient death. Automation has led to great improvements in life-critical systems as it increased safety, efficiency, and comfort. However, critical risks related to medical organization complexity and automated solutions integration can threaten drug dispensing security and performance. Knowledge about the system’s complexity aspects and human machine parameters to control for automated equipment’s security and performance will help operators to secure their automation process and to optimize their system’s reliability. In this context, this study aims to document the operator’s situation awareness about automation risks and parameters involved in automation security and performance. Our risk management approach has been deployed in the North Luxembourg hospital center’s pharmacy, which is equipped with automated drug dispensing systems since 2009. With more than 4 million euros of gains generated, North Luxembourg hospital center’s success story was enabled by the management commitment, pharmacy’s involvement in the implementation and improvement of the automation project, and the close collaboration between the pharmacy and Sinteco’s firm to implement the necessary innovation and organizational actions for automated solutions integration security and performance. An analysis of the actions implemented by the hospital and the parameters involved in automated equipment’s integration security and performance has been made. The parameters to control for automated equipment’s integration security and performance are human aspects (6.25%), technical aspects (50%), and human-machine interaction (43.75%). The implementation of an anthropocentric analysis system before automation would have prevented and optimized the control of risks related to automation.

Keywords: Automated drug delivery systems, hospitals, human-centered automated system, risk management.

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Authors: S. Vijayakumar, M. Sasikala, T. S. Mohammed Saleem, Gurusharan, K. Gauthaman

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The main objective of our study is to collect data about the profile of the asthmatic patients in Assam and thereby have a comprehensive knowledge of the factors influencing the asthmatic patients of the state and their medication pattern. We developed a search strategy to find any publication about the community based survey asthma related and used. These to search the MEDLINE (1996 to current literature) CINAHL DOAJ pubmed databases using the key phrases, Asthma, Respiratory disorders, Drug therapy of Asthma, database decision support system and asthma. The appropriate literature was printed out from the online source and library (Journal) source. The study was conducted through a set of structured and non-structured questionnaires targeted on the asthmatic patients belonging to the rural and urban areas of Assam, during the month of Dec 2006 to July 2007, 138 cases were studied in Gauwathi Medical College & Hospital located in Bhangagarh, Assam in India. The demographic characteristics a factor in 138 patients with asthma with allergic rhinitis (cases) gives the detail profile of asthmatic patient-s distribution of Assam as classified on the basis of age and sex. It is evident from the study that male populations (66%) are more prone to asthma as compared to the females (34%).Another striking features that emerged from this survey is the maximum prevalence of asthma in the age group of 20- 30 years followed by infants belonging to the age group of 7 (0.05%) 0-10years among both male and female populations of Assam. The high incidence of asthma in the age group of 20-30 years may probably be due to the allergy arising out of sudden exposure to dust and pollen which the children face while playing and going to the school. The rural females in the age group of 30-40 years are more prone to asthma than urban females in the same age group may be due to sex differentiation among the tribal population of the state. Pharmacists should educate the asthmatics how to use inhalers considering growing menace of asthma in the state. Safer drugs should be produced in the form of aerosol so that easy administration by the asthmatic patients and physicians of the state is possible for curing asthma. The health centers should be more equipped with the medicines to cure asthma in the state like Assam.

Keywords: Asthma, Respiratory disease, Smoker.

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Authors: Lorho Mary Maheo, Arundhati Maibam Devi

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Background: Maternal and child health (MCH) cares are the health services provided to mothers and children. It includes the health promotion, preventive, curative and rehabilitation health care for mothers and children. Materials and method: The present study sample comprises of 208 women within the age range 15-69 years from two remote villages of Tamenglong District in Manipur. They were randomly chosen for assessing their health as well as the child’s health adopting an interview schedule method. Results: The findings of the study revealed that majority (80%) of the women have their first conception in their first year of married life. A decadal change has been observed with regard to the last pregnancy i.e., antenatal check-up, place of delivery as well as the service provider. However, irrespective of age of the women, home delivery is still preferred though very few are locally trained. Pre- and post-delivery resting period vary depending on the busy schedule of the agricultural works as the population under study is basically agriculturist. Postnatal care remains to be traditional as they are strongly associated with cultural beliefs and practices that continue to prevail in the studied community. Breast feeding practices such as colostrums given, initiation of breastfeeding, weaning was all taken into account.  Immunization of children has not reached the expected target owing to a variety of reasons. Maternal health care also includes use of birth control measures. The health status of women would invariably improve if family planning is meaningfully adopted. Only 10.1% of the women adopted the modern birth control implying its deep-rooted value attached to the children. Based on the self-assessment report on their health treatment a good number of the respondents resorted to self-medication even to the extent of buying allopathic medicine without a doctor’s prescription. One important finding from the study is the importance attributed to the traditional health care system which is easily affordable and accessible to the villagers. Conclusion: The overall condition of maternal and child care is way behind till now as no adequate/proper health services are available.

Keywords: Antenatal, breastfeeding, child health, maternal, Tamenglong District.

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Authors: Andrea Zielke-Nadkarni

Abstract:

Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: Pain management, migrants, sociocultural context, palliative care.

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Authors: Yu-Yu Wang, Shih-Hua Hsieh, Ru-Shian Hsieh

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Wishes and choices being respected, and the right to be supported rather than coerced, have been internationally recognized as the human rights of persons with mental illness. In Taiwan, ‘coerced hospitalization’ has become difficult since the revision of the mental health legislation in 2007. Despite trend towards human rights, the real problem families face when their family members are in mental health crisis is the lack of alternative services. This study aims to explore: 1) When is hospitalization seen as the only solution by family members? 2) What are the barriers for arranging hospitalization, and how are they managed? 3) What have family carers learned, in their experiences of caring for their family members with mental illness? To answer these questions, qualitative approach was adopted, and focus group interviews were taken to collect data. This study includes 24 family carers. The main findings of this research include: First, hospital is the last resort for carers in helplessness. Family carers tend to do everything they could to provide care at home for their family members with mental illness. Carers seek hospitalization only when a patient’s behavior is too violent, weird, and/or abnormal, and beyond their ability to manage. Hospitalization, nevertheless, is never an easy choice. Obstacles emanate from the attitudes of the medical doctors, the restricted areas of ambulance service, and insufficient information from the carers’ part. On the other hand, with some professionals’ proactive assistance, access to medical care while in crisis becomes possible. Some family carers obtained help from the medical doctor, nurse, therapist and social workers. Some experienced good help from policemen, taxi drivers, and security guards at the hospital. The difficulty in accessing medical care prompts carers to work harder on assisting their family members with mental illness to stay in stable states. Carers found different ways of helping the ‘person’ to get along with the ‘illness’ and have better quality of life. Taking back ‘the right to control’ in utilizing medication, from passiveness to negotiating with medical doctors and seeking alternative therapies, are seen in many carers’ efforts. Besides, trying to maintain regular activities in daily life and play normal family roles are also experienced as important. Furthermore, talking with the patient as a person is also important. The authors conclude that in order to protect the human rights of persons with mental illness, it is crucial to make the medical care system more flexible and to make the services more humane: sufficient information should be provided and communicated, and efforts should be made to maintain the person’s social roles and to support the family.

Keywords: Family carers, coercive treatment, independent living, mental health crisis, persons with mental illness.

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