Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care.

The aim of this Cochrane review was to find out if prescribing by health professionals other than doctors delivers comparable outcomes to prescribing by doctors. Cochrane researchers collected and analysed all relevant studies to answer this question and found 46 studies. Key messages With appropriate training and support, nurses and pharmacists are able to prescribe medicines as part of managing a range of conditions to achieve comparable health management outcomes to doctors. The majority of studies focus on chronic disease management in higher-income counties where there is generally a moderate-certainty of evidence supporting similar outcomes for the markers of disease in high blood pressure, diabetes, and high cholesterol. Further high-quality studies are needed in poorer countries and to better quantify differences in prescribing outcomes for adverse events, and to determine health economic outcomes. Further studies could also focus more specifically on the prescribing component of care. What was studied in the review? A number of countries allow health professionals other than doctors to prescribe medicines. This shift in roles is thought to provide improved and timely access to medicines for consumers where there are shortages of doctors or the health system is facing pressures in coping with the burden of disease. In addition, this task shift has been supported by a number of governments as a way to more appropriately use the skills of health professionals, such as nurses and pharmacists, in the care of patients. We compared the outcomes of any healthcare workers who were prescribing with a high degree of autonomy with medical prescribers in the hospital or community setting in low-, middle- and high-income countries. What are the main results of the review? This review found 45 studies where nurses and pharmacists with high levels of prescribing autonomy were compared with usual care medical prescribers. A further study compared nurse prescribing with guideline support with usual nurse prescribing care. No studies were found with other health professionals or lay prescribers. Four nurse prescribing studies were undertaken in the low- and middle-income settings of Colombia, South Africa, Uganda, and Thailand. The remainder of studies were undertaken in high-income Western countries. Forty-two studies were based in a community setting, two studies were located in hospitals, one study in the workplace, and one study in an aged care facility. Prescribing was but one part of many health-related interventions, particularly in the management of chronic disease. The review found that the outcomes for non-medical prescribers were comparable to medical prescribers for: high blood pressure (moderate-certainty of evidence); diabetes control (high-certainty of evidence); high cholesterol (moderate-certainty of evidence); adverse events (low-certainty of evidence); patients adhering to their medication regimeans (moderate-certainty of evidence); patient satisfaction with care (moderate-certainty of evidence); and health-related quality of life (moderate-certainty of evidence). Pharmacists and nurses with varying levels of undergraduate, postgraduate, and specific on-the-job training related to the disease or condition were able to deliver comparable prescribing outcomes to doctors. Non-medical prescribers frequently had medical support available to facilitate a collaborative practice model

اختر رضا سلیمی کے ناولوں کا نوآبادیاتی تناظر

Frantz Fanon and Edward Said are the founders of Postcolonialism. In urdu literary world, it is a new style of criticism which has been introduced in the early years of 21st century. Postcolonialism analyzes, explains and responds to the cultural legacy of colonialism. Postcolonialism helps to discuss the struggle of characters for their specific cultural identities in the wake of colonization. Novel is such a unique multidimensional genre of literature that covers all aspects of life. Culture is an integral part of life. That's why culture is also an integral part of novel too. Akhtar Raza Saleemi is a prominent urdu novelist of 21st century. He is the first urdu novelist who introduced Hazarvi life and rituals in urdu novel. His both novels Jaage hain Khawab mein and Jander speciallynbsp; focus the cultural activities of Hazara region in the post colonial context. Therefore,this research paper interprets the cultural aspects of novels of Akhter Raza Saleemi in the lens of postcolonial criticism.</p

A Multifactorial Intervention to Enhance Adherence to Medications and Disease-Related Knowledge in Type 2 Diabetic Patients in Southern Punjab, Pakistan

Purpose: To assess the impact of pharmacist-led multifactorial interventions on health parameters, medication adherence, and disease-related knowledge among type 2 diabetic patients in southern Punjab, Pakistan. Methods: The effect of intervention was evaluated by randomly assigning patients into control group (n = 170), receiving conventional medical care, and intervention group (n = 178), receiving predefined specialized care. The primary outcome of this intervention study was improvement in glycemic control which was assessed by measuring fasting blood glucose and glycosylated haemoglobin (HbA1c) values. Results: The outcomes obtained clearly show the role of pharmacist counseling in the control of type 2 diabetes while improving fasting blood glucose (FBG) and HbA1c levels, reduction in Body Mass Index (BMI), improvement in disease knowledge as well as reduction in smoking. The intervention significantly reduced BMI and waist circumference by a difference of 1.87 (p = 0.014) and 1.27 (p = 0.002) between control and intervention groups. Glycemic control was significant within the intervention group, as evident by a reduction in fasting blood glucose level {-19.26 mg/dL (p = 0.003)} and HbA1c level {-1.01 % (p < 0.001)} compared to control group. The mean difference in glycemic control between both groups was insignificant but mild reductions were seen in fasting blood glucose (-11.95 mg/dL, p = 0.11) and HbA1c (-0.43 %, p = 0.12). A significant increase in disease-related knowledge was seen in the intervention group, compared to the control group which was evident by mean differences in compliance (p = 0.003), foot-care (p < 0.001) and self-monitoring of blood glucose (p = 0.001). Conclusion: The purpose of study was achieved in that it demonstrates that pharmacists can play a pivotal role in improving glycemic control in diabetic patients and that involvement of pharmacists in diabetic clinics is beneficial to the patients in terms of medication adherence and promotion of healthy lifestyle