98 research outputs found
Role of Community Pharmacists in Optimizing Opioid Therapy for Chronic Non-malignant Pain Patients in Pakistan
Background
Chronic Non-Malignant Pain (CNMP) is one of the most common conditions in both high-income countries (HICs) and low middle-income countries (LMICs). CNMP can have a substantial impact on people, communities and puts an economic burden on the society. Opioids are commonly used worldwide for CNMP management. However, their use might have contributed to opioid use-related harm and increased mortality. There have been substantial reports of opioid diversion and misuse in Pakistan. Community pharmacists (CPs) might be able to help optimise the use of opioids in CNMP management but there is no regularised CP-based patient-centred services in Pakistan.
Aim and objectives
The aim of the study was to explore the potential role of CPs in opioid optimisation in people with CNMP in Pakistan. Objectives of this study included systematically exploring the role of CPs in opioid optimisation in CNMP management, exploring the current use of opioids in Pakistan and identify the role CPs can play to optimise the use of opioids in people with CNMP and explore factors that might influence the development and delivery of role of CPs in an opioid optimisation service.
Methodology
Conceptual guiding framework
The UK Medical Research Council (MRC) guidelines for complex interventions was used as conceptual guiding framework for exploring the aim of this study.
The data was collected in two phases:
Phase 1: Systematic review
The systematic review followed the 27-item PRISMA guidelines and studies between January 1990-June 2020 were included. All studies where pharmacists in ambulatory care settings helped in optimisation of opioids in the treatment of CNMP, as individuals or as part of a team were included and were descriptively synthesized.
Phase 2: In-depth qualitative methods (Interviews, focus groups and case studies)
Two studies were conducted to collect the data. The first study constituted of semi-structured interviews and focus groups from four stakeholder groups: pharmacy policy makers, people with CNMP, doctors and CPs. The second study included non-participant multiple case study observations in six community pharmacies. The data in phase two was collected from November 2019âDecember 2020.
Data analysis
Interviews and focus groups with all stakeholders in phase two were inductively analysed using reflexive thematic analysis using N-Vivo 12. For case studies, reflexive thematic analysis as well a cross case synthesis method using explanation building technique was used to analyse the data across six cases.
Data triangulation
Findings from both studies in phase two were triangulated using two steps; comparing, and categorising. Any code or subtheme about a particular phenomenon or a theme across both studies were brought together using one sheet one paper data visualisation technique.
Diagrammatic model development
Schematic diagrammatic models were developed in this thesis usual process mapping data visualisation technique. This was done selecting and representing events and situating data in time/process meaningfully.
Results
In this study 98 stakeholders participated (38 females). A total of 240 hours (40 hours/case) were observed during a six-week period of non-participant observational case studies in six community pharmacies.
Phase 1: Systematic review
In the systematic review 14 studies were included in the final data synthesis (total number of participants n=1175). Interventions by pharmacists decreased opioid dose in four studies and improved patient opioid safety in five studies. Qualitative studies showed positive perception of stakeholders for the development of CP role in optimisation of opioid therapy for people with CNMP. No actual interventions involving CPs or studies form LMICs were identified.
Phase 2: Focus groups, interviews and case studies
These studies were able to identify reasons contributing towards the non-availability of opioids, factors contributing towards the unsafe use of opioids and certain actions that can be taken by CPs to overcome existing barriers contributing to the unsafe use of opioids and help optimise their use. These studies also highlight advantages and benefits of developing the role of CPs in optimising opioid use in people with CNMP.
In addition, these studies identified multiple level barriers and facilitators for the development and delivery of CP opioid service. They also helped identify strategies to overcome the perceived barriers and to leverage the facilitators in order to develop and deliver an opioid service.
Data visualisation helped develop diagrammatic models after triangulation. Firstly, a logic model was developed that identifies the possible actions that can be undertaken by CPs to help overcome the barriers causing/contributing towards unsafe use of opioids. Secondly a CP proposed opioid service model was developed, tailored to the health system of Pakistan, that is anticipated to help optimise the use of opioids in people with CNMP. Finally, a CP opioid service logic model was developed that shows strategies perceived to develop and improve the capability of CPs to deliver the opioid service and help optimise the use of opioids.
Conclusion
This thesis explored the process, the need and service delivery of CP role in opioid optimisation. This thesis identified factors contributing towards unsafe use of opioids (logic model), what can be done by CPs to help people use opioids in an optimised manner (CP proposed service model), what challenges might CPs face while delivering the service and what can be done to improve the development and delivery of a CP opioid service for people with CNMP using opioids (CP service logic model). The findings provide policy makers with possible steps and actions that may be followed to facilitate the development and delivery of a CP service for opioid optimisation in Pakistan
Are antimicrobial stewardship and sepsis awareness competing goals?
Antimicrobial resistance (AMR) has emerged as one of the most significant threats to population health of recent times. It is estimated that its associated mortality could reach 10 million by 2050. Availability of effective antimicrobial prophylaxis is essential to allow many routine surgical and obstetric procedures to be performed safely. Reducing unnecessary antimicrobial use is integral to controlling the spread of AMR. As awareness of the need for judicious antimicrobial prescribing has grown, so has recognition of the importance of early diagnosis and management of sepsis, with high profile media reporting of selected cases, often involving children. Early administration of antibiotics to improve outcomes from sepsis conflicts, in part, with a drive to reduce antimicrobial prescribing. Previous research has suggested that AMR is often perceived as a distant and theoretical threat that has little personal impact, which may in part be related to how it is framed in news media. There is no evidence about how reporting of sepsis in children impacts on public understandings about antibiotic use. This PhD aims to better understand how the risks of antimicrobial resistance and sepsis are constructed in the popular news and how these impact on the attitudes and behaviour of the public, as parents and carers.
Content analysis of 616 articles from 6 national newspapers published between 1988 and 2018 demonstrated key differences in the way AMR and sepsis are framed. AMR is framed predominantly according to its potential impact on future global health. Its causes and solutions are presented as complex and dependent on co-ordinated actions between policymakers and the healthcare, farming and pharmaceutical industries. In contrast, sepsis is framed as an issue whose drivers lie predominantly within the healthcare sector and whose main solution is better awareness. The use of personalised narratives about individuals affected by sepsis increases its relevance and accessibility for the public. Thematic analysis of a subset of articles demonstrated that failings in the health service were portrayed as the cause of avoidable deaths in children, often through failure to prescribe timely antibiotics, with parents positioned as advocates for their children.
Exploration of these themes in 20 focus groups with 84 parents, carers and individuals with lived experience of sepsis demonstrated that decisions about when to seek health advice had to be balanced against a perceived moral duty to avoid placing excessive demands on healthcare resources. Health professionals were frequently perceived to be ambivalent about the need for antibiotics, with parent preference often influencing decisions. Few participants had direct experience of AMR, which was widely perceived to be a risk confined to individuals who use antibiotics inappropriately. There is a need to align messages about the complex interplay between AMR, sepsis and antimicrobial use. Personal narratives about individuals affected by AMR, similar to those used in sepsis awareness campaigns, may increase accessibility of public health messaging about preserving the efficacy of antibiotics
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Adolescents, sexting and consent; a discursive approach
Sexting is the interpersonal exchange of sexually suggestive, self-produced pictures/videos/texts. The present thesis employs a critical discursive psychology approach to explore the discursive constructions of the key stakeholders associated with adolescent sexting; adolescents, parents/carers and teachers.
The first study explores how adolescents construct sexting in relation to relationships, gender and consent/coercion. The study employs focus groups of 18 adolescents, aged 16-18. The findings indicate that sexting is constructed as a contested category. I initially introduce the interpretative repertoire (IR) of sexting as normal. However, adolescents also construct sexting as an ideological dilemma concerning power and popularity and open different positions regarding gender and sexuality. This study introduces the constructions regarding sexting consent/coercion, and the emerging ideological dilemmas in relation to justification of coercion.
The second study explores parental constructions of sexting regarding gender and consent, as well as parental monitoring. It employs 15 dyadic interviews with parents/carers of adolescents. I introduce the IR of adolescents as immature which entails constructions of sexuality and agency. This study showcases the antithetical positions that open in relation to gender. Moreover, it introduces the repertoire of sexting as victimisation and the dilemmic positions adolescents are interpellated to occupy regarding victimhood and gender. The discursive constructions of sexting consent constitute an ideological dilemma. Monitoring produces conflicting repertoires, such as liberal and strict parenting. Finally, parents/carers constructed adolescentsâ engagement with sexting as an indicator of good/bad parenting.
The third study explores teachersâ constructions of sexting and consent in relation to gender, and how teachers frame sexting education and monitoring practices. For this study, I conducted 30 individual interviews with educators of adolescents. Sexting is constructed both as a threat and an ideological dilemma. Varying positions opened regarding gender. Teachers framed adolescents as naĂŻve and parents and schools as co-responsible for adolescent sexting. Here, I present the conflicting repertoires that emerged regarding consent, and the repertoire of sexting as a sign of times. Finally, I discuss the construction of sexting education as insufficient.
The present thesis contributes to knowledge by offering critical insight on the differences in the discursive constructions among the three key stakeholder groups. It offers a holistic understanding of sexting by situating it in a socio-political and historical context. The thesis discusses potential theoretical and practical implications of the findings
Personalized Care and Treatment Compliance in Chronic Conditions
People who have chronic diseases spend a significant amount of time in self-management in out-of-hospital environments, in their homes and in their community settings. These patients have different disease statuses and management requirements, so providing personalized care is key.Personalized care is a collaborative process that should be used in chronic condition management in which patients, caregivers, and healthcare providers identify and discuss problems caused by or related to the patient's condition and then develop plans and goals to empower patients.Personalized care can improve aspects of physical health, mental health, and the ability to self-manage conditions. Thus, a personalized care approach could greatly benefit patients with chronic conditions.In this book, we have included 20 articles that expand the current knowledge on the personalized care approach to diagnosing and treating chronically ill patients
An ethnographic study of Knowledge, Attitudes and Health Seeking Behaviours of Patients, Healthcare Worker (HCWs) and Community Members towards Pulmonary Tuberculosis in Akure, Ondo State, Nigeria
This ethnographic study is an exploration of a research study conducted on Pulmonary Tuberculosis (PTB) infection that has claimed many lives. The incidence of TB in Nigeria in 2016 was estimated to be 219 cases per 100,000 population, which accounts for about 4% of the TB incidence globally. Nigeria holds the highest TB burden in West Africa with Nigeria among the 30 countries with the highest burden for pulmonary TB (PTB) and TB/HIV Multiple drug resistant-tuberculosis (MDR-TB) is prevalent in Africa. The management of PTB in Nigeria has been affected by the lack of funding, poor human resources, and weak health systems that are unable to support an efficient scale-up of TB services. Despite a high prevalence of MDR-TB in Nigeria, to date, there have been few or no qualitative studies which have sought to explore the knowledge, attitudes, and health-seeking behaviours that could influence the high prevalence of the disease. Aim: The aim of this study is to investigates the knowledge, attitudes, and health-seeking behaviours of patients, HCWs, and community members that comprises (Palace chiefs, religious leaders, traditional healers), in regard to PTB in Akure South, Ondo State, Nigeria. Methods: This ethnographic study adapted the health belief model and social ecological model as a theoretical framework. This ethnographic study used multiple methods of data collection methods, namely, semi structured interviews, focus groups, and participant observation in a PTB clinic and community DOTS site clinic. The purposive samples comprised of 2 community nominated leaders, 2 palace chiefs, 2 traditional healers, 2 religiousâ leaders, 5 patients, 5 carers/relatives, and 12 healthcare workers. The focus groups who participated in the study comprised seven Muslim men, seven Muslim women, seven church groups and seven university students. The total sample size was 58 participants, and analysis of the data was performed using the NVivo programme. Findings: The study identified four themes:âąBarriers to accessing healthcare servicesâąKnowledge and perceptions of PTBâąThe socio-cultural context of PTBâąHealth promotion and preventionThe fear of PTB by society led to imposition of a socialâphysical distance of the community from PTB sufferers. Within the HCWs system, the fear of PTB affected the attitudes and behaviour of the HCWs towards the patients and the work with PTB. The doctors indicated that TB clinics were not adequately equipped to enable the provision of quality services. For accessing services, the fear of stigmatisation, traditional beliefs, and the implications of poverty resulted in people reporting to the hospital only after a prolonged period of self-medication. Many participants highlighted that religious and traditional beliefs resulted in a reluctance or refusal to accept PTB test results. The prevention and management of PTB in Nigeria is inadequate due to a lack of funding and human resources. Implications: The findings provide a baseline for the government to set up health promotion and disease prevention programmes in partnership with the community and non-governmental organisations (NGOs). Healthcare workers and NGOs can participate in promoting health education and prevention messages through mass media to the community to aid understanding of the disease. PTB services should be integrated into the curriculum to all schools, colleges, and universities, as well as religious programmes. The national tuberculosis and leprosy control programme (NTBLCP) is well placed to provide a monitoring and evaluation of progress
Collected Papers (on Neutrosophic Theory and Applications), Volume VII
This seventh volume of Collected Papers includes 70 papers comprising 974 pages on (theoretic and applied) neutrosophics, written between 2013-2021 by the author alone or in collaboration with the following 122 co-authors from 22 countries: Mohamed Abdel-Basset, Abdel-Nasser Hussian, C. Alexander, Mumtaz Ali, Yaman Akbulut, Amir Abdullah, Amira S. Ashour, Assia Bakali, Kousik Bhattacharya, Kainat Bibi, R. N. Boyd, Ămit Budak, Lulu Cai, Cenap Ăzel, Chang Su Kim, Victor Christianto, Chunlai Du, Chunxin Bo, Rituparna Chutia, Cu Nguyen Giap, Dao The Son, Vinayak Devvrat, Arindam Dey, Partha Pratim Dey, Fahad Alsharari, Feng Yongfei, S. Ganesan, Shivam Ghildiyal, Bibhas C. Giri, Masooma Raza Hashmi, Ahmed Refaat Hawas, Hoang Viet Long, Le Hoang Son, Hongbo Wang, Hongnian Yu, Mihaiela Iliescu, Saeid Jafari, Temitope Gbolahan Jaiyeola, Naeem Jan, R. Jeevitha, Jun Ye, Anup Khan, Madad Khan, Salma Khan, Ilanthenral Kandasamy, W.B. Vasantha Kandasamy, Darjan KarabaĆĄeviÄ, Kifayat Ullah, Kishore Kumar P.K., Sujit Kumar De, Prasun Kumar Nayak, Malayalan Lathamaheswari, Luong Thi Hong Lan, Anam Luqman, Luu Quoc Dat, Tahir Mahmood, Hafsa M. Malik, Nivetha Martin, Mai Mohamed, Parimala Mani, Mingcong Deng, Mohammed A. Al Shumrani, Mohammad Hamidi, Mohamed Talea, Kalyan Mondal, Muhammad Akram, Muhammad Gulistan, Farshid Mofidnakhaei, Muhammad Shoaib, Muhammad Riaz, Karthika Muthusamy, Nabeela Ishfaq, Deivanayagampillai Nagarajan, Sumera Naz, Nguyen Dinh Hoa, Nguyen Tho Thong, Nguyen Xuan Thao, Noor ul Amin, Dragan PamuÄar, Gabrijela PopoviÄ, S. Krishna Prabha, Surapati Pramanik, Priya R, Qiaoyan Li, Yaser Saber, Said Broumi, Saima Anis, Saleem Abdullah, Ganeshsree Selvachandran, Abdulkadir SengĂŒr, Seyed Ahmad Edalatpanah, Shahbaz Ali, Shahzaib Ashraf, Shouzhen Zeng, Shio Gai Quek, Shuangwu Zhu, Shumaiza, Sidra Sayed, Sohail Iqbal, Songtao Shao, Sundas Shahzadi, DragiĆĄa StanujkiÄ, Ćœeljko SteviÄ, Udhayakumar Ramalingam, Zunaira Rashid, Hossein Rashmanlou, Rajkumar Verma, Luige VlÄdÄreanu, Victor VlÄdÄreanu, Desmond Jun Yi Tey, Selçuk Topal, Naveed Yaqoob, Yanhui Guo, Yee Fei Gan, Yingcang Ma, Young Bae Jun, Yuping Lai, Hafiz Abdul Wahab, Wei Yang, Xiaohong Zhang, Edmundas Kazimieras Zavadskas, Lemnaouar Zedam
Proceedings of the 19th Sound and Music Computing Conference
Proceedings of the 19th Sound and Music Computing Conference - June 5-12, 2022 - Saint-Ătienne (France).
https://smc22.grame.f
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