BackgroundPatients’ knowledge about their prescribed medicines is one of the most important antecedents of successful therapy. Poor knowledge about medicines can lead to serious consequences such as non-adherence and misunderstanding of the significance of adverse events. The objective of this study is to understand the factors that are responsible for a patients’ lack of knowledge regarding their medicines, by taking the perspective of the patient as well as that of healthcare professionals. Much of the work in this area has been undertaken in the setting of developed or semi-developed countries, and there is a scarcity of information from developing nations such as Pakistan.MethodsThis was a large qualitative study set in the hospital outpatient environment in a teaching hospital in the Punjab province of Pakistan. Data were collected from dialogue with patients (n = 19) and healthcare providers (n = 16) i.e., doctors and dispensers (where a dispenser is a person who merely dispenses medicines; i.e. is not a pharmacist) through in-depth semi-structured interviews. Patients having limited knowledge about their dispensed medicines were assessed using a checklist. The healthcare providers were recruited through a convenience sampling strategy, based on their availability and willingness to participate in the study. Based on the objectives of the study, a pilot tested interview protocol was developed, and used to conduct the interviews. The sample size was controlled by using saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis.ResultsThe analysis of data yielded 31 categories (patients = 19, healthcare professionals = 12), 10 subthemes and three themes. The major themes were healthcare professional-related factors, patient-related factors and system-related factors. The health professional related subthemes included: behaviour and attitude and professional liabilities and liaison. The patient related subthemes included: eagerness of the patients and lack of understanding and misconception. The system-related factors included: patients with special needs, perceived role of the pharmacist, prescription and medicines, and staff workload.ConclusionHealthcare professional related, patient related and system related factors have a significant influence on patients’ knowledge about dispensed medicines. The non-professional behaviour of doctors, increased staff workload, inadequate time and attention provided by healthcare professionals to patients, illiteracy of patients, lack of specialized labelling on medicines for illiterate patients and absence of pharmacists at the hospital, were the major concerns identified in this study. The study points to a need for appropriate patient education and counselling with regards medicines, improved coordination between hospital staff, and provision of some basic system-related facilities which are pivotal for enhancing patients’ knowledge and adherence to their tr...
Background
Community acquired pneumonia is a commonly presenting respiratory tract infection around the world. Its treatment is problematic at times because of diversity of infecting organisms and change in susceptibility pattern to commonly prescribed antimicrobials.
Methods
This was a single centred prospective cross sectional study. About 165 patients diagnosed with community acquired pneumonia were included and blood samples, sputum samples were taken for culture sensitivity and antimicrobial susceptibility.
Results
Of the 165 patients (43% males and 57% females), 77 (46.6%) patients tested positive for bacterial pathogens out of a total of 165. The most common pathogen was Streptococcus pneumonia (34%) followed on by Hemophilus influenza (16%), Staphylococcus aureus (13%) Klebsiella (12%), Pseudomonas aeruginosa (10%), Legionella (6%), Eschericha coli (5%) and Proteus mirabilis (2%). The sensitivity pattern of all 77 bacterial isolates was high for cephalosporins (ceftriaxone, 81%; ceftazidime, 80%), penicillins (amoxicillin/sulbactam, 70%), quinolones (levofloxacin, 74%) and aminoglycosides (amikacin, 80.5%). The sensitivity to macrolides (azithromycin, 59.7%; clarithromycin, 53.2%) and tetracycline's (55.8%) is somewhat intermediate and low for ampicillin (42.8%) and cotrimoxazole (51.9%).
Conclusion
The decreased susceptibility to macrolides and tetracyclines is a matter of concern and judicious use of antimicrobials should be done to prevent further rates of resistance.
A conservative system always admits Hamiltonian invariant, which is kept unchanged during oscillation. This property is used to obtain the approximate frequency-amplitude relationship of the governing equation with sinusoidal nonlinearity. Here, we applied Hamiltonian approach to obtain natural frequency of the nonlinear rotating pendulum. The problem has been solved without series approximation and other restrictive assumptions. Numerical simulations are then conducted to prove the efficiency of the suggested technique.
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