ROLE OF COMMUNITY PHARMACIST AND NUTRITIONISTS IN OBESITY MANAGEMENT: A LITERATURE REVIEW

The idea of engaging community pharmacists and nutritionists in weight management services has been well accepted by the community, as both can help to improve behavior and knowledge regarding obesity among obese patients. The aim of this study is to summarize research findings from developed and developing countries as well as from Pakistan regarding role of community pharmacists and nutritionists in obesity management. A total of 38 studies were reviewed regarding trends in obesity management. The review concluded that the role of community pharmacists and nutritionists in obesity management is not well acknowledged in most of the developing countries including Pakistan. Limited data are available on a number of nutritionists and type of services provided by them for weight management in these countries. There is urgent need to identify the barriers and gaps to further enhance the effectiveness of obesity management. Beside this intervention studies involving multi-disciplinary health- care professionals must be designed to control current obesity crisis worldwide.Keywords: Community pharmacists, Counseling, Nutritionists, Obesity, Weight management program

Effects of product composition and price level on bundling

Denne bacheloroppgaven tar for seg hvordan sammensetning av produkter og prisnivå påvirker kjøpsintensjonen for pakkeløsninger. Pakkesammensetninger (bundling) er en prisstrategi som kan bidra til at bedrifter skaper større fortjeneste og redusere kostnader. Denne oppgaven tar sikte på å undersøke viktigheten av hvordan bedrifter utvikler pakkeløsninger og hvordan dette kan bidra til å øke forbrukernes kjøpsintensjon og fortjeneste for bedrifter. I oppgaven har vi en forklarende problemstilling med formål om å avdekke faktorer som påvirker kjøpsintensjonen av bundler. Oppgavens problemstilling er som følgende: “Hvilke faktorer påvirker kjøpsintensjonen av pakkeløsninger?” For å kunne svare på problemstillingen benyttet vi oss av eksperimentell design ettersom det er ansett som en god metode for å finne ut hvordan uavhengige variabler påvirker de avhengige. Vi benyttet et 2x2 eksperiment med to ulike stimuli produktsammensetning og prisnivå. Formålet med studien er å teste hvordan komplementær versus ikke-komplementær produktsammensetning og lav versus høy pris påvirker kjøpsintensjonen av pakkeløsninger. I tillegg benyttet vi risiko som moderator for å undersøke hvordan dette modererte effekten av pris og produktsammensetning på kjøpsintensjon. Vi utformet fire ulike stimuli med hensikt av å avdekke kjøpsintensjon og utvalget vårt bestod av studenter på høyskolen Kristiania hvor undersøkelser ble sendt ut på e-post. For å kunne svare på problemstillingen utformet vi fem hypoteser. Hypotese en, to og tre ble analysert ved hjelp av “General Linear Model” som vi benyttet for å avdekke effekten av komplementaritet og prisnivå på kjøpsintensjon. Deretter testet vi hypotese fire og fem ved hjelp av “process” for å avdekke hvordan risiko som moderator påvirket kjøpsintensjonen. Vår studie fikk støtte for to av våre fem hypoteser og våre funn indikerer at produktsammensetning har en positiv effekt og dette innebærer at komplementære produkter kan bidra til å øke kjøpsintensjonen hos forbrukerne. Vi fant også ut at økonomisk risiko hadde en signifikant negativ interaksjonseffekt på produktsammensetningen noe som tyder på at økonomisk risiko negativt modererer effekten av kjøpsintensjon

Hospital-Based Cancer Registry

Background :. To  determine the frequency of different types of malignancies in different gender and age groups, presenting at a surgical unit. Methods:  In this observational study  cancer patients of both genders were included to determine frequencies of different malignancies that presented to a surgical unit.  All the patients with age greater than 12 years and being admitted in surgical unit 1 with the diagnosis of malignancy, were included. The variables recorded included age, sex, address, diagnosis, biopsy, date of biopsy, treatment timeline, stage at presentation, final outcome and referral to other care units. Data was entered and analyzed using the statistical package for social sciences (SPSS) software, version 22. Results: A total of 150 malignant tumours were analyzed. There were 50 (33.3%) male patients and 100 (66.7%) females. Malignant tumours of breast 67 (44.7%) and esophagus 16 (10.7%), were found to be the most common whereas malignant melanoma  (0.7%), submandibular tumours (0.7%), and parotid tumours (0.7%), were least common. The most common malignancy in males were of stomach (16.0%) and rectum (16.0%), whereas in females it was the breast malignancies (67.0%). Dividing the age distribution of the patients into 15-year bands, the peak age-category was 41-60 years (46.0%), while only 3 (2.0%) patients were above 80 years.  Conclusion: Cancer trends were found to be similar as that of other studies in Pakistan with a few differences. Data management is sub optimal. There is a dire need of integrated system of Cancer Registry

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Are community pharmacists and nutritionists capable for obesity management in Pakistan? A cross-sectional study

The main objective of the study was to evaluate knowledge and perceptions among community pharmacists and nutritionists/ dietitians regarding obesity management in Pakistan. A semi-structured questionnaire was distributed to a random sample of sample of 277 community pharmacists and 146 nutritionists. The data were collected, computed and analyzed using SPSS. Kruskal–Wallis and Mann–Whitney tests (P ≤ 0.05) were used to compare the knowledge scores of community pharmacists and nutritionists regarding obesity management by profession, length of experience, type of health-care facility, gender, age and city. Out of 423 respondents, 66.5 % agreed on the availability of guidelines. Most of them considered obesity management guidelines (75.5 %), computer programs/internet (66.6 %) and patient experience (68.7 %) as the most frequently used sources for information regarding obesity management. Orlistat (55.1 %) and metformin (55.7 %) were considered the most effective antiobesity drugs by most of the respondents. The median score for overall knowledge of community pharmacists and nutritionists regarding standard obesity management guidelines was 33 (range 24-48) and 34 (range 24-48), respectively. No significant differences (P < 0.05) were found among the knowledge scores of community pharmacists and nutritionists. The results of the present study showed adequate knowledge and positive perceptions among community pharmacists and nutritionists regarding management of obesity in Pakistan. The results of the study are quite encouraging and indicate that opportunities exist for involving community pharmacist in weight-management services with other healthcare professional