what is patient counselling, objective of patient counselling, steps in patient counselling, patient counselling contents, process, conclusion, communicative skill for effective counselling, verbal communication, non verbal communications
Pharmacy and Therapeutic Committee (PTC) & Hospital Formulary
The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs.
What is a pharmacy and therapeutics committee?
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.
what is patient counselling, objective of patient counselling, steps in patient counselling, patient counselling contents, process, conclusion, communicative skill for effective counselling, verbal communication, non verbal communications
Pharmacy and Therapeutic Committee (PTC) & Hospital Formulary
The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs.
What is a pharmacy and therapeutics committee?
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.
Basic introduction to patient counselling for the clinical pharmacy services. Educating the patient on their disease, medication and lifestyle for better patient care and quicker recovery.
Monitoring Plan and Basic Monitoring Visits: Everything that a CRA Needs to KnowTrialJoin
A monitor in a clinical trial is also called a CRA - clinical research associate. This person is a professional who’s responsible for monitoring the clinical trial and making sure that everything is according to rules, regulations, and good clinical practice.
Whether you already are a CRA or you’re trying to become one, the most important thing you should be aware of is the monitoring plan. You, as a CRA or a future CRA, should know what a monitoring plan is, what it serves for, and what it consists of. The second most important information for you are the monitoring visits. Below, we’ll explain all the components of a monitoring plan, as well as which are the most basic and important monitoring visits.
INSTITUTIONAL REVIEW BOARD (IRB/IEC).pptxRAHUL PAL
The International Council on Harmonisation (ICH) defines an institutional review board (IRB) as a group formally designated to protect the rights, safety and well-being of humans involved in a clinical trial by reviewing all aspects of the trial and approving its startup. IRBs can also be called independent ethics committees (IECs).
An IRB/IEC reviews the appropriateness of the clinical trial protocol as well as the risks and benefits to study participants. It ensures that clinical trial participants are exposed to minimal risk in relation to any benefits that might result from the research.
IRB/IEC members should be collectively qualified to review the scientific, medical and ethical aspects of the trial.
Per the FDA, an IRB/IEC should have:
At least five members.
Members with varying backgrounds.
At least one member who represents a non-scientific area (a lay member).
At least one member who is not affiliated with the institution or the trial site (an independent member).
Competent members who are able to review and evaluate the science, medical aspects and ethics of the proposed trial.
It is a very important topic in healthcare. Pharmacists must be aware of few important counselling points for every medicine. Community Pharmacist must be aware of counselling.
Basic introduction to patient counselling for the clinical pharmacy services. Educating the patient on their disease, medication and lifestyle for better patient care and quicker recovery.
Monitoring Plan and Basic Monitoring Visits: Everything that a CRA Needs to KnowTrialJoin
A monitor in a clinical trial is also called a CRA - clinical research associate. This person is a professional who’s responsible for monitoring the clinical trial and making sure that everything is according to rules, regulations, and good clinical practice.
Whether you already are a CRA or you’re trying to become one, the most important thing you should be aware of is the monitoring plan. You, as a CRA or a future CRA, should know what a monitoring plan is, what it serves for, and what it consists of. The second most important information for you are the monitoring visits. Below, we’ll explain all the components of a monitoring plan, as well as which are the most basic and important monitoring visits.
INSTITUTIONAL REVIEW BOARD (IRB/IEC).pptxRAHUL PAL
The International Council on Harmonisation (ICH) defines an institutional review board (IRB) as a group formally designated to protect the rights, safety and well-being of humans involved in a clinical trial by reviewing all aspects of the trial and approving its startup. IRBs can also be called independent ethics committees (IECs).
An IRB/IEC reviews the appropriateness of the clinical trial protocol as well as the risks and benefits to study participants. It ensures that clinical trial participants are exposed to minimal risk in relation to any benefits that might result from the research.
IRB/IEC members should be collectively qualified to review the scientific, medical and ethical aspects of the trial.
Per the FDA, an IRB/IEC should have:
At least five members.
Members with varying backgrounds.
At least one member who represents a non-scientific area (a lay member).
At least one member who is not affiliated with the institution or the trial site (an independent member).
Competent members who are able to review and evaluate the science, medical aspects and ethics of the proposed trial.
It is a very important topic in healthcare. Pharmacists must be aware of few important counselling points for every medicine. Community Pharmacist must be aware of counselling.
Patient compliance: Challenges in management of cardiac diseases in Kuala Lum...pharmaindexing
Background
The objective of this study was to investigate the degree of compliance among cardiac patients who attend the health facilities in Kuala Lumpur and Perak, Malaysia. The reasons for non-compliance and recommendations from healthcare professionals were also evaluated.
Method
A cross-sectional study of 400 patients and 100 healthcare professionals was carried out. This study utilizes variables on external factors and internal factors as the measurement tools. The questionnaire which consists of Morisky self-reported medication adherence questions was administered to patients and causes for non-compliance sought. Questionnaire for healthcare professionals was used to determine strategies that can improve compliance rate.
Results
The study revealed a 15.8% of high adherence rate, 54.3% of moderate adherence rate and 30% of poor adherence to cardiovascular disease medications. The chi-square tests showed the strong association between dependent and independent variables. The model chosen for testing the patient compliance through external and internal factors gives an R2 value of 85.0% with an adjusted R2 of 84.7%. The F value (317.187) was also significant (p=0.000) which means that the variables have better fit in the multivariate model. The major reasons determined for non-adherence were attitudes and beliefs, lifestyle, side effects and cost of medications. The study recommends that pharmacists and dispensing technicians should be adequately qualified to provide proper counselling to cardiac patients on their medicines and disease conditions.
Conclusion
The result of this study is of value to health care providers. Compliance to cardiovascular medications will avoid treatment failures encountered in therapy.
Knowledge, Attitude and Practice of Self-Medication among Medical Studentsiosrjce
Self-medication is a common practice worldwide and the irrational use of the drugs is a major
cause of concern. Self-medication is an issue with serious global implication. The current study aimed to
determine the Knowledge, Attitude and Behavior of self-medication by medical students. A descriptive crosssectional
study was conducted among medical students currently studying first year to assess knowledge,
attitude and practice regarding self-medication in Chitwan Medical College, Bharatpur, Nepal. Seventy five
students studying in first year were selected for the study using stratified random sampling technique and data
was collected using a semi-structured self-administered questionnaire. The study finding revealed, the mean age
of 75 enrolled students was 20 years, 65.3% were in the age group of 17-20 years. Most of them were female
(72%). Seventy three point three percent belong to urban area. Prevalence rate of self-medication of one year
period seems high i.e. 84% and 68.25% in were females. The most common sources of information used by the
respondent were pharmacist (60.31%) and text book (46.03%). More than half of the respondent found to have
a good knowledge about self-medication regarding definition, adverse effect and different types of drug. The
attitude was positive towards self-medication and favored self-medication saying that it was acceptable. The
principal morbidities for seeking self-medication include cold and cough as reported by 85.7% followed by pain
76.2%, fever 73%, diarrhea 47.6% and dysmenorrheal 46%. Drugs / drugs group commonly used for selfmedication
included analgesics 75.8%, and anta-acids 53.2% and antipyretic 46.3%. Among reasons for
seeking self-medication, 79.2% felt that their illness was minor while 61.9% preferred as it is due to previous
experience. This study shows that self-medication is widely practiced among first year students of this medical
institution. There is dire need to make them aware about the pros and cons of self-medication in order to ensure
safe usage of drugs.
Factors Affecting Non-Compliance among Psychiatric Patients in the Regional I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
An Internet questionnaire to identify Drug seeking behavior in a patient in t...Nelson Hendler
Drug seeking behavior in patients with little or no real pain, has led to the opioid crisis. Until now, there was no reliable method for detecting drug seeking behavior. The Pain Validity Test from www.MarylandClinicalDiagnostics.com can predict with 95% accuracy who will have medical test abnormalities, i.e. who has a valid complaint of pain, and predicts with 85%-100% accuracy who will not have any medical test abnormalities, i.e. who is faking and drug seeking. The Pain Validity Test has been admitted as evidence in over 30 legal cases in 8 states.
Pain Validity Test to detect drug seeking behaviorNelson Hendler
The Pain Validity Test predicts which patient will have medical test abnormalities with 95% accuracy, thereby validating their complaint of pain. The Pain Validity Test also predicts with 85%-100% accuracy who will not have medical test abnormalities, thereby detecting drug seeking behavior, faking and malingering.
Pain Validity Test identifies drug seeking behavior. Stop opioid abuse. Prote...Nelson Hendler
Physician prescribing practices are under constant scrutiny. An Internet questionnaire will predict if a patient will have a medical test abnormality with 95% accuracy, and 100% if the patient will not. This Pain Validity Test can be used to detect drug seeking behavior in patients, at a far high level of accuracy than tests currently in use (34.4%-48.2% accuracy).. The Pain Validity test has been admitted as evidence in 30 cases in 9 states.
ASSESSMENT OF SELF MEDICATION AMONG RURAL VILLAGE POPULATION IN A HEALTH SCRE...Gangula Amareswara Reddy
THE STUDY AIMS AT IDENTIFYING SELF MEDICATION PATTERN AMONG RURAL POPULATION AND VARIOUS FACTORS INFLUENCING IT LIKE OCCUPATION, HABITS, LITERACY RATE, EXTENT OF AWARENESS, SOURCE FOR DRUG INFORMATION ETC.......
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Article 1527760801
1. Prudhvi et al. World Journal of Pharmaceutical and Medical Research
www.wjpmr.com 211
STUDY ON IMPACT OF CLINICAL PHARMACIST INTERVENTION ON
MEDICATION ADHERENCE IN STROKE PATIENTS IN TERTIARY CARE HOSPITAL
V. Prudhvi*, T. Sravani, U. Mounika, M. L. Prathyusha, N. Soujanya, A. M. S Sudhakar Babu
Department of Pharmacy Practice, AM Reddy Memorial College of Pharmacy, Petlurivaripalem, Narasaraopet, Guntur-
522 601, Andhra Pradesh, India.
Article Received on 05/04/2018 Article Revised on 26/04/2018 Article Accepted on 16/05/2018
INTRODUCTION
Stroke is a medical condition in which poor blood
flow to the brain results in cell death. Stroke is one of the
most common neurological disorders in clinical
practice.[1]
According to WHO, it is the second
commonest cause of death worldwide. It is forecasted
that the deaths because the of stroke will rise to 6.5
million by 2015 and by 2020, stroke and coronary artery
disease are expected to be the leading causes of losing
life. Earlier Surveys on stroke in different parts of India
shown that the prevalence of stroke varies in different
regions of India and ranges from 40 to 270 per 1, 00,000
populations. Stroke is responsible for around 11% of all
deaths worldwide.[2]
The causes of stroke are diverse
hypertension are the most common.[3]
Adherence can be summarized as “The extent to which a
person‟s behaviour taking medication, following a diet,
and/or executing lifestyle changes-corresponds with
agreed recommendations from a healthcare provider”[4]
Adherence to prescribed medication predicts outcome. In
a population-based sample of 1, 00,000 patients under
the age 65 with Diabetes, Hypertension,
Hypercholesterolemia, and Hospitalization rates as well
as healthcare costs were significantly lower for patients
with high medication adherence. [5]Stroke events were
almost twice as high in non-adherent study participants
and remained independently predictive of adverse events
after adjusting for baseline disease severity and known
risk factors.[6-12]
OBJECTIVE
General objective
To Assess the Risk factors, Medication adherence, cost
burden associated with stroke disease in a tertiary care
hospital.
Specific objectives
To evaluate the impact of Pharmacist counseling on
medication adherence for patients with Stroke disease.
wjpmr, 2018,4(6), 211-219 SJIF Impact Factor: 4.639
Research Article
ISSN 2455-3301
WJPMR
WORLD JOURNAL OF PHARMACEUTICAL
AND MEDICAL RESEARCH
www.wjpmr.com
*Corresponding Author: V. Prudhvi
Department of Pharmacy Practice, AM Reddy Memorial College of Pharmacy, Petlurivaripalem, Narasaraopet, Guntur- 522 601, Andhra
Pradesh, India.
ABSTRACT
Objective: The objective of this study was to evaluate the impact of pharmacist intervention on Risk factors and
Medication adherence for patients with stroke. Methodology: This Study was conducted in the Neurology
department of Lalitha Super Specialty Hospital, Guntur, and Andhra Pradesh. The procedure of the study was a
prospective randomized interventional comparative design was conducted in the hospitalized patients. A Self-
administered questionnaire was prepared using information and thorough review from the literature survey and
factors used in previous studies. Questionnaire statistically it was validated by using Cronbach‟s α value which
reported a good measure of. 0.79 Results & discussions: A sample of 120 patients were enrolled into the study. 76
(63%) patients are male and 44 (37%) patients were female respectively. In this study unintentional reasons for
non-adherence have been reported more frequently than intentional reasons before counselling causes of
noncompliance. The most prevalent causes of non-compliance were forgetfulness (48.11%), too expensive
(47%),confusion (42.45%), side effects (38.67%),Trouble reading pills (34.9%), Alter dosing schedule for
convenience (31.13%), Don‟t care to take medication (30.18%),Trouble swallowing pills (30.18%),Stop to see it
still need (20.75%), Think medication not effective (18.86%).The commonest reported reason for un intentional
non adherence was forgetfulness. This test performed by using chi square (χ2
test) test statistics. Chi square statistic
value is 53.6251 this result is significant at p < .05 whose p value is <0.00001. Conclusion: The current study
identified unintentional reasons for non-adherence to be more common than intentional non-adherence.
KEYWORDS: Stroke, Medication adherence, Cronbach alpha, Chi square test, Compliance, Noncompliance.
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To collect the demographic data of selected patients of
Stroke affected in South region.
To improves health and effectiveness of medication
therapy by patient education.
To educate and promote awareness of the importance of
adherence to stroke medication and outcomes to avoid
non adherence.
METHODOLOGY
Study design
This was a prospective randomized interventional
comparative study in which information was obtained on
the risk factors, mediational adherence associated with
stroke diseases by the administration of a structured
interviewer-administered questionnaire. The study was
carried out October-2017 to march- 2018.
Study site
The study was carried out in tertiary care hospital of
Guntur district.
Study Period
06 Months.
Study Population & Sampling
A sample of 120 subjects was drawn in order to yield 5
% accuracy at the 90% confidence level. Initially a total
of 150 sample size was collected and estimated to be the
sample size and due to non-response factor and
communication errors it was settled down to 120. The
estimated prevalence rate was derived from the study.
Since, knowledge of the cause of a disease is one of the
most important factors in the control of the disease, the
knowledge that „Stroke was caused by risk factors
smoking, alcohol, hypertension, diabetes mellitus was
taken as the prevalence rate for the purpose of
calculating the sample size.
Study Criteria
Inclusion criteria
1. Population who were 18 years or older of rural areas
who are interested to participate.
2. Stroke patients undergoing treatment in selected
neurology care center of Guntur district.
Exclusion criteria
1. The patients below 18yrs old.
2. The patients who were non respondent to the study.
3. The pregnant patients.
Study Tools
A Self-administered questionnaire was prepared using
information and thorough review from the literature
survey and factors used in previous studies and it was
validated by faculties in department of pharmacy practice
and who expertise as a physician in Neurology care
center. It consists of 11 questions.
1. Do you forget to take your medications regularly?
The intention of this question is to enquire whether the
patient is taking medications regularly and to evaluate
the patient behavior towards the medication.
2. Do you miss any of your prescribed doses in the past 2
weeks?
The intention of this question is to enquire whether the
patient has missed any of their prescribed doses in the
medication during the past two weeks.
3. Do you stop taking your medication, if you feel better
or if your symptoms are under control?
The intention of this question is to enquire whether the
patient stop medication when the patient feels or
believed by themselves that they are relieved
symptomatically or whether the patient stop medication
when their symptoms are in control.
4. Do you feel worse while you are on your medication
do you stop taking them?
The intention of this question is to enquire whether the
patient stop medications when they feel worse while
taking medication due to the occurrence of side effects
like headache, vertigo etc.
5. Do you take your medication at the prescribed time?
The intention of this question is to enquire whether the
patients administering medication at the right time.
6. Do you often feel difficult in remembering your
medication?
The intention of this question is to enquire whether the
patients is able to remember their medication daily or
how often they feel difficulty in remembering
medication.
7. Do you carry your medications with you regularly?
The intention of this question is to enquire whether the
patient is able to carry their medications with them
regularly where ever they go Example: office, tours.
8. Do you take your medication only if you are sick?
The intention of this question is to enquire whether the
patient administer medication only if when they feel sick
or with signs and symptoms.
9. Do you feel at times being careless to take your
medications?
The intention of this question is to enquire whether the
patient is active at the time when the medication is to be
taken.
10. Do you believe that taking medication regularly can
control your disease?
The intention of this question is to enquire whether the
patient believe that taking medication regularly can
control their disease this helps in evaluating the patient
attitude towards medication can be known.
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11. Are you afraid of being addicted to your medication
by taking it regularly?
The intention of this question is to enquire whether the
patient is afraid of being taking their medication
regularly at proper time.
Score ranges 0-1, where affirmative answers get no score
with a higher score representing a high level of
adherence. (The adherence score was given accordingly
< 3 -poor, 4-7: Medium, 8-11 are considered as high
level of adherence).
Questionnaire Validation
Two physicians with experience in Neurology
Department were asked to evaluate the clarity, relevance
and conciseness of items included in the questionnaire
(limitations on questionnaire was a feedback which was
rectified by eliminating). Statistically it was validated by
using Cronbach‟s α value which reported a good measure
of. 0.79
Interviewers
The interviews were carried out by the students of the
project members by telephone communication and
through direct interview. The interviewers were
familiarized with the questionnaire and trained in the
proper manner of questioning as well as being
familiarized with the operational definitions in order to
maintain the uniformity of interpretation and explanation
for the benefit of the illiterate and non-English speaking
respondents. It was stressed that the interviewers write
the responses as stated by the respondents and not their
own interpretation of what was stated. The interviewers
were also trained not to show bias or emotion during the
interview. Non-respondents were not replaced for the
purpose of the survey. A brief introduction about the
purpose and nature of the study and assurance about
confidentiality were explained to the respondents prior to
the interview. The interview for each respondent lasted
10 to 15 minutes on average.
Data analysis
The responses in the recording form were manually
checked for errors and omission. Standardized codes
were used to simplify the coding process and analysis.
Data were analyzed using Statistical Package for Social
Sciences (SPSS) software Version 11.0. Data analysis
was done based on the objectives of the study. Data
screening was done to determine associations or
correlations between variables. Chi square test was used
to compare differences in proportions for categorical
variables and Chi square test & Student paired t test for
trend was used to compare trends for selected ordinal
independent variables. A p value less than 0.05 was
considered to be statistically significant.
Study variables
Outcome variable
The main outcome variable in this study was attitudes of
the respondents towards those affected by stroke. The
responses to hypothetical statements on attitudes were
framed on own in taking follow up with questionnaires
based on +1,-1 values.
Independent variables
Two groups of independent variables were measured in
relation to the attitudes towards stroke medication
adherence.
(i) Socio-demographic characteristic of the
respondents: The age, gender, habits like smoking,
alcohol, family history were considered and risk factors
were evaluated.
(ii) Mediating Variables: General medications of
stroke, comorbid diseases along with questionnaires for
analyzing medication adherence were included and score
was given. The responses to questions under the
knowledge and attitudes sections were analyzed
individually and as aggregated scores.
Minimizing errors
The steps taken to minimize errors in data collection and
data entry were as follows:
1. The interviewers were familiarized with the
questionnaire and adequately trained to complete the
required responses to minimize interviewer bias.
2. A weekly assessment of completed questionnaires
was carried out by a single coordinator and feedback
provided to the interviewers.
3. Regular supervision of interviewers was carried out
during the course of data collection.
4. Random checks on the accuracy of the responses
were carried out by the coordinator by re-visiting the
housing units of the respondents and reviewing the
questionnaire with them.
5. Accuracy of data entry was assessed by a 10 %
reassessment of data entry and cross checks with the
hard copy of the data.
Ethical issues
The following ethical issues were considered in the
design of the study:
1. The participants were briefed regarding the nature,
objectives and method of study and their voluntary
participation acquired.
2. Participants were reserved the right to withdraw
from the study at any point of time.
3. Total confidentiality with regard to the identification
of the participants and information volunteered was
assured at all times during and after survey.
RESULTS AND DISCUSSION
To the best of our knowledge, this is our first study in
south India that evaluates risk factors, medication
adherence associated with stroke disease in a tertiary
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care hospital of Guntur district, Andhra Pradesh. The
results were obtained after 6 months duration study in the
neurology department of tertiary care hospital. A total of
120 patients enrolled into the study & the data was
analyzed using Microsoft excel 2010.
Gender distribution of the Participants
Out of 120 patients, males are more prone to the disease
than females with the data representing in the figure: 1.
76 (63%) patients are male and 44 (37%) patients were
female respectively.
Fig 1: Gender Distribution of the Participants.
Age based demographic details of the stroke patients
21 to 90Y Age groups were considered under the study.
From the collected data, more no. of patients lie in the
age range of 61-70Y were observed. The following data
denoting the no. of patients belonging to their respective
age groups in the table 01and Fig: 2
Table 1: Age based demographic details of the stroke patients.
Age Range(Y) 21-30 31-40 41-50 51-60 61-70 71-80 81-90 Total
No. of Patients 4 9 18 30 39 13 7 120
Fig 2: Age wise Range distribution of Participants.
Out of 120 patient‟s data, based on the range of age, the
number of patients are 4, 9, 18, 30, 39, 13, and 7.
respectively with the age range of 21-30,31-40,41-50,51-
60,61-70,71-80,81-90.
Distribution of frequency of patients in Types of
stroke
The data was also used to analyze the types of stroke
which were observed during this study with following
distribution of frequency in the table 02 and Fig: 3.
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Table 2: Distribution of frequency of patients in Types of stroke.
Types of Stroke Ischemic Stroke Transient Ischemic Stroke Hemorrhagic stroke
No. of Patients 45 41 21
Percentage of Patients 37.5% 34.16% 17.5%
Fig 3: Distribution of frequency of patients in Types of stroke.
Out of 120 patients received data, 34.16% patients
having transient ischemic attack and 37.5% patients
having Ischemic Stroke and 17.5% patients having
Hemorrhagic stroke are reported.
Frequency of Risk factors distribution of stroke
patients
Frequency of risk factors distribution of stroke patients
has been studied considering factors like Age,
Hypertension, Diabetes mellitus, Smoking and Alcohol
consumption in the respective area of South India. The
results were attained in the table 03 as follows and
representing in the Fig: 4.
Table 3: Frequency of Risk factors distribution of stroke patients.
Risk factors Age, HTN, DM Age, HTN Age, DM Smoking Alcohol Abuse
No. of Patients 15 26 4 37 38
Percentage (%) 12.5 21.67 3.33 30.83 31.6
Fig 4: Frequency of Risk factors distribution of stroke patients.
There are various risk factors for provoking stroke which
include: Age, HTN, DM, Smoking, Alcohol
consumption. According to the data obtained, out of 120
subjects Age, HTN along with DM may be the reason for
the stroke in 15 patients; Age, HTN may be the reason in
26 patients; Age, DM may be the reason in 4 patients;
Smoking may be the reason for stroke in 32, Alcohol
consumption may be the reason for stroke in 39 patients.
Reasons for Non-Adherence
The most prevalent causes of non-compliance were
expensive medications(49.05%), forgetfulness(48.11%),
confusion(42.45%), side effects(38.67%), trouble
reading pills(34.9%), altering dosing schedule for
convenience(31.13%), don‟t care to take
medication(30.18%), trouble swallowing pills(30.18%),
stop to see if still needed(20.75%), fasting(19.81%),
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think medication not effective(18.86%). The most
common reason for intentional non-adherence was side
effects(38.67%) and the most common reason for
unintentional non-adherence was expensive medication.
Unintentional reasons for non-adherence were found to
be more common than intentional non-adherence. The
majority(n=77) of the subjects (49.3%) reported two
reasons, 36.3% reported three reasons, 11.6% reported
four reasons and 2.59% five reasons for non-adherence.
Intentional Non-Adherence
Table 4: Reasons for intentional Non-Adherence.
Reasons
Side
effects
Think medication
not effective
Don’t care to
take medication
Stop to see if
still needed
Alter dosing schedule
for convenience
Fasting
No. of Patients 41 20 32 22 33 21
Percentage (%) 38.67 18.86 30.18 20.75 31.13 19.81
Fig 5: Reasons for intentional Non-Adherence.
Out of 106 patients, reasons for intentional non-
adherence were side effects, Think medications not
effective, Don‟t care to take medications, stop to see if
still needed, Alter dosing schedule for convenience,
fasting the results were reported as 38.67%(41),
18.86%(20), 30.18%(32), 20.75%(22), 31.13%(33),
19.81%(21) respectively.
Non-Intentional Non-Adherence
Table 5: Reasons for Non-Intentional Non-Adherence.
Reasons Forgetfulness Confusion Expensive
Trouble
swallowing pills
Trouble
reading pills
No. of Patients 51 45 52 32 37
Percentage (%) 48.11 42.45 49.05 30.18 34.9
Fig 6: Reasons for Non-Intentional Non-Adherence.
In 106 patients, reasons for non-intentional adherence
were forgetfulness, confusion, expensive, trouble
swallowing pills, trouble reading pills the reasons were
reported are 48.11%,42.45%,49.05%,30.18%,34.9%.
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Frequency of Drug therapy design in stroke patients
Most of the patients were prescribed with Triple regimen
therapy (41.66%) followed by Double regimen therapy
(35%), Single regimen therapy (14.16%) and quadruple
regimen therapy (9.16%) tabulated in table 06
representing in Fig: 7.
Table 6: Frequency of Drug therapy design in stroke patients.
Drug Therapy Design Quadruple Triple Double Single
No. of Patients 11 50 42 17
Percentage (%) 9.16 41.6 35 14.16
Fig 7: Frequency of Drug therapy design in stroke patients.
In a total data, based on the drug therapy design, 9.16%
patients receiving quadruple regimen, 41.6% patients
receiving triple regimen, 35% patients receiving double
regimen, 14.16% patients receiving single regimen.
NOTE: Through this study, Aspirin (70%) was reported
to be most preferable drug for treating the stroke disease.
This was followed by piracetam (67.5%), Statins
(46.3%), Clopidogrel (5.3%), Heparin (8.33%), Tirofiban
(11.6%).
The study finally focusses on assessing the risk factors,
medication adherence, associated with stroke disease
patients which was attained to an optimum best with
88.33% overall patients are non-compliance to
medication before counselling and 61.66% patients were
compliance after counselling. The scale used to measure
the non-compliance has been found to have an internal
consistency with Cronbach‟s alpha value of 0.7906.
Table 7: Data distribution of Adherence in stroke patients before & after counseling.
Intervention Before Counselling After Counselling
Level of Adherence POOR MEDIUM HIGH POOR MEDIUM HIGH
No. of Patients 62 44 14 18 58 44
Percentage (%) 51.66 36.66 11.66 15 48.3 36.6
Fig 8: Data distribution of Adherence in stroke patients before and after counseling.
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Improvement in Medication Adherence
Fig 9: Diagrammatic representation of Level of Adherence showing improvement.
Before Counselling, 88.33% of patients were non-adhere
to medications while 11.67% of patients were adhere to
medications by SDPQ. After Counselling, the final result
stating that 38.34% patients belonging to non-adhere
medications and 61.66% patients adhere to medications
by our counselling and follow-up.
This test performed by using chi square (χ2
test) test
statistics. Chi square statistic value is 53.6251 this result
is significant at p < .05 whose p value is <0.00001. & by
using student paired t-test considering the P-value 0.68
with 95% confidence interval. By conducting pharmacist
patient counselling on medication adherence for patients
with stroke which gives 95% confidence interval value
of P=0.68 which gives more confidence to conclude that
pharmacist interventions improves medication adherence
in stroke patients.
SUMMARY
1. The main aim of this study is to evaluate risk
factors, medication adherence associated with stroke
disease in a tertiary care hospital.
2. The general objective of the study is to assess the
risk factors, medication adherence associated with
stroke disease.
3. A self- designed questionnaire was prepared and a
prospective randomized interventional comparative
study was conducted on a sample of 120 patients
with stroke disease.
4. The questionnaire was validated by using
Cronbach‟s alpha and the value was found to be
0.07906.
5. The patients of 18yrs or older of rural areas and
patients undergoing treatment in selected neurology
care center were included in the study.
6. The patient demographic data was collected and
were questioned regarding the medication adherence
and the individual patient score was given.
7. From the data collected before counselling the
patients who were non adherent to the medication
was found to be 83.33and the patients who were
adherent were found to be 11.67.
8. The patient was counselled regarding the importance
of medication adherence and educated to overcome
the barriers of non -adherence to achieve desired
therapeutic outcome.
9. The patients were communicated through telephone
and a direct follow up of six months was done.
10. The patient who received continuous follow up are
questioned again to assess the medication adherence
before and after counselling.
11. From the data collected after the counselling the
patients who were non adherent was found to be
38.34 and the patients who were adherent was found
to be 61.66.
12. From the above study out of 120 patients the
provoking risk factors for stroke observed are age,
hypertension, diabetes mellitus, smoking and
alcohol.
13. By using chi square (χ2
test) test statistics. Chi
square statistic value is 53.6251 this result is
significant at p < .05 whose p value is <0.00001.
14. By using student paired T-test the P value was found
to be 0.68.Based on this value the study concluding
the main role of pharmacist intervention in
improving the patient medication adherence.
CONCLUSION
The main aim of this study is to evaluate risk factors,
medication adherence associated with stroke disease was
achieved successfully. This study concludes the
importance of the pharmacist intervention in overcoming
barriers contributing to the medication non-adherence
and improving the individual patient medication
adherence for achieving the desired therapeutic outcome
and also assessing the risk factors to decrease the risk
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ratio of stroke occurrence and helps in the secondary
prevention of the disease.
The present study shows that participants (patients) who
attended the interactive educational intervention session
on evaluation of risk factors, medication adherence
associated with stroke disease was much satisfied, and
considered more effective and valuable.
ACKNOWLEDGEMENTS
The authors are thankful to A.M. Reddy Memorial
College of Pharmacy for providing facilities for bringing
out this work.
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