Background: Non-adherence to medication increases patient’s risk of morbidity, mortality and economic wastage of scare medical resources. This study was conducted to assess the role of doctor-patient communication and duration of consultation, as tools to improve adherence to hypertension treatment. Methods: Data of this cross-sectional study were collected by face to face interview and document review at Combined Military Hospital (CMH), Dhaka among 253 conveniently recruited hypertensive patients attending outpatient department during July 2016 to June 2017. Mean-age of the respondents was 49.2 (±10.4) years, mostly married male (54.9% male, 95.3% married). Mean consultation duration experienced by the respondents was 5.3 (± 1.3) minutes. Among the participants, 63.64% experienced effective communication, 66% were adherent and 34% were non-adherent to medication. Among the respondents with effective communication, 92.5% were adherent to medication. On the contrary, among the respondents with ineffective communication, 80.4% were non-adherent. Results: Duration of consultation had significant association with adherence to hypertension treatment (p<0.001). Association between communication and adherence to medication was highly significant (p<0.001). Binary logistic regression revealed that respondents were 3.23 times more adherent to medication with favorable response to the item- ‘Doctor gave me as much information as I wanted’ (p = 0.041); and 10.24 times with favorable response to the item- ‘Doctor checked to be sure that I understood everything’(p=0.006). Patients’ faithfulness in carrying out prescription and proscriptions correctly, depends on the adequacy and accuracy of patient’s knowledge of what they were supposed to do and on their motivation. Conclusion: Thus, it is necessary to formulate interventions to scale up communication skill of the physicians, and devise effective ways to educate patients on medication of chronic diseases. Further studies on characteristics of consultation to make it motivating and more effective may be conducted. Bangladesh Med Res Counc Bull 2018; 44: 145-151
Introduction: EA is characterized by agitation, inconsolable sobbing, disorientation, delusions, and hallucinations, decreased cognition and memory. Sevoflurane is widely used as an anesthetic agent for children because of its less pungent nature, lower solubility but it has a greater incidence of EA in preschool aged children. Propofol is a hypnotic amnestic agent with a short duration of action, commonly used for sedation, induction, and maintaining anesthesia and it has been used to prevent Emergence agitation. Aim of the Study: The aim of this study was to determine the efficacy of low dose propofol in reducing the incidence of EA at the end of face-mask sedation with sevoflurane. Methods: This was a prospective observational study and was conducted in the Department of Pediatric Anesthesia of Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during the period from July, 2021 to December, 2021.In our study we took 220 children operated for hernia were randomized into two groups – Group A (Control group, n=110) and Group B (Propofol group, n= 110). Result: In total 220 patients from both the groups completed the study. In our study we found the mean age in group A & B was 6.3 ± 1.6 & 6.1 ± 1.9 years respectively. The mean PAED score was 14.41 ± 2.59 & 9.83 ± 3.51, the mean emergence time was 7.1 ± 2.0 & 13.4 ± 2.5, time in PACU was 44.5 ± 5.9 & 46.6 ± 7.6 mins in control & propofol group respectively. In contrast to the control group, no patient in the propofol group experienced EA beyond 15 or 20 minutes of emergence. Conclusion: In our study, we found that 0.5mg,/kg propofol was effective in preventing Emergence Agitation in children underwent herniotomy with caudal block and who’s sedation were maintained with sevoflurane.
Introduction: Emergence agitation is a common postoperative phenomenon in pediatric patients that can lead to adverse outcomes. Propofol and fentanyl have been used for its management, but their comparative efficacy remains unclear. This study aimed to compare the efficacy of propofol and fentanyl in reducing emergence agitation in pediatric patients after Sevoflurane anesthesia. Methods: This prospective observational study was conducted at the Pediatric Anesthesia Department of Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh over a 6-month period. 160 pediatric patients between the ages of 2-8 who underwent elective surgery and experienced emergence agitation under Sevoflurane anesthesia were selected. Patients with certain medical conditions or allergies were excluded. The participants were randomly divided into two groups: one receiving propofol and one receiving fentanyl. Anesthesia was induced with 8% sevoflurane, and data was collected and analyzed to compare the efficacy of propofol and fentanyl in reducing emergence agitation in pediatric patients. Ethical approval and informed consent were obtained. Result: Both groups had similar mean age and weight, with the propofol group having a mean age of 3.6 (SD 2.8) years and a mean weight of 15.7 (SD 3.3) kg, while the fentanyl group had a mean age of 3.7 (SD 2.5) years and a mean weight of 15.9 (SD 3.6) kg. Most subjects were male, with 75% in the propofol group and 57.5% in the fentanyl group. The mean duration of anesthesia was similar, with the propofol group at 63.5 (SD 14.8) minutes and the fentanyl group at 61.6 (SD 11.9) minutes. The mean PAED score was lower in the propofol group (4.3, SD 3.2) compared to the fentanyl group (4.9, SD 3.5). Airway obstruction and laryngospasm were less frequent in the propofol group (2.5% and 1.25%, respectively) compared to the fentanyl group (6.25% each), and nausea/vomiting was lower in the propofol group (6.25%) compared to the fentanyl group (26.25%). ....
Introduction: Patients need intravenous fluids during Surgery to maintain adequate intravascular volume, cardiac output, and ultimately tissue Oxygen delivery. Aim of the study: Aim of the study was to evaluate serum sodium after infusion of isotonic fluid containing 131 mEq/L sodium with no glucose versus that after infusion of hypotonic fluids containing 75 mEq/L sodium with 5% dextrose. Methods: This study was conducted on pediatric patients of Bangladesh Shishu Hospital and Institute who underwent hernia operations between January 2021 and September 2021. Data are given as mean+standard deviation. P-value <0.05 was considered to be significant. continuous demographic variables were compared using the unpaired t-test, and the chi-square test was used for categorical variables. Result: There were no adverse events and all 40 patients enrolled in this study completed the procedures. The pre-anesthesia and post-anesthesia induction blood sodium concentration. Pre-anesthesia sodium (mEq/L), Isotonic was 138.7 + 1.4 and Hypotonic was 138.9 + 1.5, the charges from pre-anesthesia to postanesthesia induction was - 0.20 + 1.6. Post-anesthesia sodium (mEq/L), Isotonic was 138.5 + 1.5 and Hypotonic was 137.3 + 1.2, the charges from pre-anesthesia to postanesthesia induction was - 1.60 + 1.8. Conclusion: The administration of hypotonic fluids tends to reduce serum sodium absorption in pediatric cases, indeed when administered for a short period. But the use of isotonic fluids helps to avoid a reduction in serum sodium in pediatric and so may enhance patient safety.
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