The use of a MED calendar to increase medication compliance

This study describes the successful design and implementation of a medications calendar to increase medication compliance among Navajo patients who have difficulty complying with prescription instructions. This paper is presented as an example of a successful method for trying to ensure that medications are taken according to instructions. The MED calendar is designed to help non-English speaking and elderly patients in particular.Initially the calendars were hand made by the drivers from the Public Health Nursing Department. Their primary duty was to serve as interpreters for the Public Health Nurse. Poster board (20 x26 ) was used to simulate a monthly calendar. The days of the week were marked on each grid on each board. The boards were then laminated and the laminated surface was used to mark the name and days of the month for which the calendar was being used. The patients medications were then placed in single unit dose packages. The dose packages were then taped to the calendar according to the prescribed schedule. The patient then received a detailed verbal explanation on when and how to take his or her medicine. The calendar was attached to the wall of the patient\\u27s residence with stick pins and medications were placed for 2-4 weeks at a time. The material cost of the original calendars was $1.75 without labor. Now a professional printer produces them at a total cost of$3.00 per unit. There were two primary safety considerations explored with the implementation of the MED calendars. The first was concern for the stability of the medication in a clear package as opposed to opaque bottle. The Chief of Pharmacy indicated that medicine can be kept in unit dose packages up to six months. The benefits of patient compliance were much greater than any small risk of medication instability. The second concern was safety around small children. In most cases the calendar can be placed high enough on the wall to be out of reach of the children. If this is not possible then the use of the MED calendar is not considered.MED calendars were well accepted by the patients. Navajo patients relate well to ordinary monthly calendars, and this does not require knowledge of the English language. Also, the calendars are highly visible making them difficult to ignore. Medication doses are more easily understood with a pictorial association. The calendars are durable and last at least two or three years. From 1985 to 1987, the MED calendars were used with non-compliant patients. Seventy-three percent of the patients showed some improvement. Improvement was measured by 1) improvement in clinical symptoms including decreased hospitalization, 2) accurate or improved pill count, and 3) patient\\u27s and/or doctor\\u27s affirmation of compliance. There are several difficulties noted in the use of the MED calendar. Safety in the presence of small children is a major concern. Some patients become very dependent on the MED calendar, and this becomes time consuming for the Public Health Nurse who must visit every 2-4 weeks to refill the unit dose packages. Sometimes the unit dose packages do not remain secured to the calendar. Finally, the large size of the calendar can create difficulties in transporting them and are therefore objectionable to some of the patients.The study concludes that the benefits of the MED calendar far outweigh the difficulties encountered in using this system of promoting and facilitating patient compliance

Regional differences in Indian health - 1997

This study (1) determined the present health status of the urban Indian population in the State of Arizona, and determined the extent of use and availability of all health resources for that population, (2) identified the health needs of the population and the barrier\\u27s that exist in addressing those needs, and (3) provided accurate and timely information that will serve as an objective base for decision making in addressing the identified needs and problems.A needs assessment approach was used with an overall framework represented by the model: Health Status (minus-) Health Resources Used (plus+) Barriers/Health Resources Not Used (equals=) Health Needs. The study also incorporated the PRECEDE model developed by Lawrence Green of the University of Texas and the Needs Assessment for Prevention Planning developed by the Alcohol, Drug Abuse and Mental Health Administration of the PHS. The study used data compiled on the Phoenix Service Unit for Phoenix and the Pima County urban census tract mortality data for Tucson. Interview data and other sources were also used.The health status of urban Indians in Arizona is poor, and three of the six major causes of death - accidents, alcoholism, homicide - are complex problems with which medical technology has had little success. Heart disease, cancer and diabetes, the other leading causes of death are chronic conditions requiring long-term health monitoring. Urban Indian reported high prevalence of vision problems (40.5%), overweight (37.3%), dental (30.7%), and back problems (21.7%). Mental health problems affected many in the Indian community - 14.5% reported anxiety and depression and 13.5% reported fatigue and exhaustion. Infant mortality rates for urban Indians are well above the rate of the Arizona general population and the overall Arizona Indian population. The urban Indian infant mortality rate exceeds the 1990 U.S. Surgeon General\\u27s Objective for the nation by 60%. Health risk factor levels are high among the Arizona urban Indian community. High blood pressure readings in the Indian males combined with the low numbers taking blood pressure medication point to the importance of screening and follow-up for heart health risks. Levels of obesity, binge drinking and diabetes are also elevated within the urban Indian community in Arizona. Other health risks of urban Indians include high driving speeds, driving while intoxicated, and sedentary life-styles. The major source of health care for urban Indians is the IHS. Other sources such as county medical facilities, community health centers, and private providers are rarely used. Over 40% of the urban Indian community went to the emergency room for health care during 1988. However, many of these visits represent inappropriate use of the emergency facilities. Social services in the metropolitan areas are under-utilized by the Indian community. Indian-specific programs with the exception of alcohol-related services and Women, Infants, and Children (WIC) nutrition services are not available. Both WIC and the alcohol-related programs are among the few used by the Indian community, indicating that services geared toward Indian people will have greater utilization than those not culturally specific. American Indians living in urban areas with limited access to phones and transportation are best reached by the word-of-mouth about services. American Indian staff in urban health programs, particularly the Community Health Representatives, provide an important link to the urban Indian community. They are able to outreach through their work in both homes and community health. They can follow the movement of clients through their family and friends within the community. Most of the urban health programs provide transportation services that enable urban Indians to access services they would otherwise forego. Barriers to care were identified in the categories of socioeconomic factors, lack of health insurance, complexity of Medicaid program requirements, limited availability of services for low-income Indians in urban areas, and limited accessibility and acceptability of services for urban Indians. The combination of poor health status, underutilization of services, and numerous barriers to services leave the urban Indian community with service requirements for medical items, prescriptions, emergency care, pediatric care, and overnight hospital stays. In addition, culturally sensitive mental health programs are needed based on the high prevalence of anxiety, depression, and exhaustion within the community. There is a critical need for basic preventive, family-centered medical services, and for comprehensive perinatal care. Because of the high number of young children, there is a great need for well-child clinics focusing on preventive medicine. Clinics providing culturally-specific services need to be incorporated into the health plan for the urban Indian community. Low-cost ambulatory clinic facilities with eye and dental care are needed. Prevention programs targeting diabetes, alcohol and drug abuse, sexually transmitted diseases, violence, and accidental injuries should be established to assuage the high costs of such conditions among urban Indian communities in Arizona. Transition programs for new residents in each urban area would help bring Indians into the service stream and avoid the downward spiral into despairing poverty. Indian-specific mental health services are needed to deal with the high rate of homicide and suicide among Indian youth, the high rates of alcohol and substance abuse, and reported mental health problems. In policy terms, there is a need for a Medicaid education program and a coalition of efforts among the tribes, IHS, state, and private agencies. Arizona should be addressed as a contract care state since legislation has been already passed; but no funding has been allocated to carry out the legislation. The role of the Phoenix Indian Medical Center needs to the clarified to establish whether it functions as a referral hospital (as originally intended) or as an outpatient clinic (as it is currently utilized but without adequate resources). The IHS needs to explore the feasibility of shared service in Arizona between urban Indian health care delivery programs and local service units. Full-time urban Indian positions at the state and federal levels need to be established

Rasam Indian Restaurant: Early Bird Menu

Rasam Indian Restaurant is located in the Glasthule, a suburb of Dublin and opened in 2003. The objective is to serve high quality, authentic Indian cuisine. We blend, roast and grind our own spices daily to provide a flavour that is unique to Rasam. Cooking Indian food is founded upon long held family traditions. The secret is in the varying elements of heat and spices, the tandoor clay oven is a hugely important fixture in our kitchen. Marinated meats are lowered into the oven on long metal skewers and cooked in this smoky and extremely hot environment. Making Naan bread in a tandoor is a skill that not only requires a deft hand but also some tolerance to high temperatures, though the resulting bread – a little crisp on the outside but soft in the centre – is well worth the effort. The secret of the tandoor is that heat can only escape through the top; the direct heat of the fire is reflected by the thick ceramic sides creating a cooking environment that reaches 480°C (900°F). The combination of direct heat from smouldering embers at the bottom and ambient heat radiated by the clay walls ensures meat cooks quickly and retains its natural moisture inside, producing the distinctive and succulent results which characterize Indian tandoori food. Taken from the restaurant\u27s website September, 2013 The Early Bird Menu is available for €19.95 per personhttps://arrow.tudublin.ie/menus21c/1060/thumbnail.jp

Rasam Indian Restaurant Menu 2017

A little bit about us, we opened our doors for business in November 2003 with the solid ambition to serve high quality authentic Indian cuisine in Dublin. Indian food over time has escaped the European misunderstanding or notion of ‘one sauce fits all’ and has been recognised for the rich dining experience with all the wonderful potent flavours of India Rasam wanted to contribute to the Indian food awakening and so when a suitable premise came available in Glasthule at the heart of a busy Dublin suburb, Rasam Restaurant as it is today was born. The Rasam team will happily espouse the many virtues of their style of cooking, dedicated to balance and care of the body. Our staff hail from many regions of India, each person holding an academic catering qualification and/or experience in a 5* hospitality setting in India. Each guest of Rasam Restaurant is welcomed individually and with great enthusiasm. We will always take great care that a novice Indian diner, a seasoned foodie and of course our precious regulars experience true Indian hospitality. Our promise is that every guest on every occasion at Rasam will enjoy the choice of dishes, the appropriate wines, the history of our regions and the overall restaurant experience. We take immense pride in our spices created daily to accentuate our range of dishes. We mix, roast and grind spices & herbs daily to create the diverse flavours that our patrons love to enjoy. We are committed to the use of the freshest ingredients down to our lemons that are freshly squeezed daily for maximum flavour.https://arrow.tudublin.ie/menus21c/1282/thumbnail.jp

American Indian Plank for Republican and Democrat National Conventions, Undated

This undated document is a American Indian plank for an unspecified political party to be presented at the Republican and Democratic national conventions. The plank supports a Claims Commission comprising three president-appointed members, at least one of whom must have at least 50% Indian blood. This proposed Commission would hear all claims of any tribe or band, and its findings be conclusive. See also: Statement by Representative Burdick on Indian Claims, Undatedhttps://commons.und.edu/burdick-papers/1115/thumbnail.jp