Patients’ satisfaction on nursing care.

This study was conducted to determine the satisfaction of patients on nursing care provided at medical ward, West Yangon General Hospital with the objectives: to assess the patients' satisfaction on nursing care provided from the point of physical, psychological, and interpersonal aspects. Non-experimental descriptive design was used. Fifty patients were selected by using convenient sampling method. Structured interviewing questionnaires consisted of 37 items (13 items for physical, 13 items for psychosocial aspects, and 11 items for interpersonal aspects) was used as the research instrument. Data were analyzed in terms of gender, age, education, frequency and duration of hospitalization. The results shown that male had more satisfaction than female, most patients over 60 years of age had goad satisfaction, those who attained primary level of education had more satisfaction on physical and interpersonal aspects while the patients with middle school had more satisfaction on psychosocial aspects. Mostly, patients with first time admission had good satisfaction especially those having 3-day hospitalization. Recommendation was made that necessary information should be given as much as possible on admission. Nurses should spend more time with patients during the initial phase of establishing trusting relationship to ensure that their feelings on their health problems expressed. Good communication skills and quality of nursing care play a role in order to obtain patients satisfaction.

Cobra bite in Sanpya Hospital, Thingangyun

Cobra bite is the second commonest poisonous snake bite in Myanmar. This descriptive study includes definite cobra bite patients (n=10) admitted to Thingangyun Sanpya Hospital from May 1999 to January 2000. their ages ranged from 5 years to 38 years; 70 per cent were bitten in South Dagon. 40 per cent had severe local reactions requiring wound debridement and skin grafting; 10 per cent had digital amputation. All patients received antivenom and 80 per cent received prostigmine and atropine; 9 patients survived; 30 per cent required assisted ventilation. One patient, who received antisnake venom 100ml within 20 minutes, died after 30 hours on respirator. although antisnake venom and respirator are useful in the management of cobra bite, survival rate is not 100 per cent. as 40 per cent of bites occurred while sleeping, particular attention should be given to tucking and sleeping in the middle of big mosquito net. As cobra bite also occurred in suburbs of Yangon, alnd survival despite therapy is not 100 per cent, everysone should exercise snake bite preventive measures.

Clinical pharmacology in general practice: Bioavailability and therapeutic outcome

When physicians administer drugs to their patients.They do so in the expectation that the anticipated therapeutic effect will result.They are dismayed, therefore, when the patient either derives inadequate or no therapeutic benefit from the medication or worse still develops toxicity.Pharmacological principles state that effective drug therapy requires, not only that the appropriate drugs be given in adequate doses for adequate periods, but also that adequate concentraction of the drug must reach the site of action (blood) to be able to produce a reaponse.Bioavailability is the fraction of the admistered does which reaches the systemic circulation to be available to the receptors to produce a response and this is now reconized as one of the most important factors which determine the therapeutic outcome of many drugs.From the research done, the paper described two different done, the paper described two different aspects of bioavaility, which have to be taken into consideration.The first, fractional bioavailability, is due to the difference in the formulation of the same drug like Lariam and Mephaquin, as with mefloquine.The second phrmacokinetic availability, is due to difference in pharmacokinetics between sex, ethnic groups or diseases states like diarrhea and malaria. In addition, blood levels of different drugs like dapsone, chloroquine and propranolol can still differ (increased, descreases or delayed), .even in the same disease condition making off-hand prediction of response differcult.The use of clinical pharmacology to overcome this difficulty is discussed.

Role of guardians in adolescents'reproductive health behaviors in rural area

A cross-sectional community-based study was undertaken in Taikkyi Township during July 1997, to explore the guardians' attitudes and practices relating to adolescents' reproductive health behavior. Altogether 102 guardians who have adolescents between 10 to 19 years of age involved in the study. Majority of the guardians did not favor their adolescents on choosing their fiancees by themselves and having more than one fiancee. While 52 per cent thought adolescents should know about contraceptives before their marriage, 38.2 per cent thought they should not. Most of the guardians approved that dissemination of messages about sex education for the adolescents through mass media was an appropriate way. It was found that most did not allow their teens to discuss such things either in front of them or with others. But some of them (36.3 per cent) said they would respond about those things willingly if or when they were asked. By knowing sex education and reproductive health, about 48 per cent (46.2 per cent of the mothers and 53.6 per cent of the fathers) said adolescents will gain benefits. Regarding information on Reproductive Health, this study highlights the needs for proper education and counselling for guardians, especially on adolescents.

Comparison of the effect of combinations of parentral artemisinin derivatives (I/M artemether, I/V artesunate) plus oral mefloquine with intravenous quinine plus oral tetracycline on patients with cerebral malaria: A multicentre trial (Preliminary Report)

In order to find out the best drug combination for treatment of cerebral malaria at less equipped hospitals, 105 cases of cerebral malaria belonging to Mawlamyine, Pyin Oo Lwin and North Okkalapa hospitals were studied in a controlled trial of three regimens. (1) Intramuscular artemether total dose 480 mg plus mefloquine 750 mg in a single dose given through nasogastric tube at day 0. (2) Intravenous artesunate total dose 240 mg plus mefloquine 750 mg as in regimen 1. (3) Intravenous quinine dighdrochloride 600 mg in 180 ml infusion of dextrose saline given over 4 hours. The dose is repeated every 8 hours until the patient can swallow the tablets. Then oral quinine sulphate tablets were given 600 mg 8 hourly. Total period of quinine therapy is 7 days. Tetracycline 250 mg capsules were given 6 hourly for 7 days (started via nasogastric tube while the patient is unconscious). There was no significant difference in overall mortality rate, mean parasite clearance time, mean fever clearance time and mean time to regain consiousness between the three groups. Thus quinine-tetracycline (if necessary to supplement with artemether-mefloquine at 48 hours if the patient failed to respond to initial treatment) is suggested, as the drug of first choice for the management of cerebral malaria in Myanmar.

Carcinoma Vulva (Five Years Analysis)

A 5 years study (1989-1993) of cases of Carcinoma vulva admitted to Central Women's Hospital was carried out to find (a) the clinico-epidemiologic features and (b) the association between clinical staging (FIGO) with the histological evidence of lymph node involvement. Objective (a) was achieved with preformed questionnaire and Objective (b) from clinical and pathological assessments. Out of 32 cases of Ca vulva, the modal age group on the study was 50 to 59 years and modal parity 7. Seven cases had medical disease and one had prior history of carcinoma cervix. The presenting features were growth or ulcer, pruritis vulva, leukoplakia, white discharge. Two cases were recurrent growths. According to FIGO staging, 3 belonged to stage (2), 21 to stage (3) and 8 to stage (4). There were no nodal desease in stage (2) cases. Stage (3) cases had 4.76 percent superficial nodal disease and no deep nodal disease. Stage (4) had 75 percent superficial and 25 percent deep nodal disease in 100 percent cases. Regarding histological spread in cases with palpable nodes, the positive predictive values were 25.9 percent with superficial inguinal enlargement, 40 percent with gland of Cloquet enlargement and O with external iliac node enlargement.

Comparing the efficacy of mefloquine-artesunate combination with that of mefloquine and artesunate as single agents in uncomplicated falciparum malaria

To find out whether the combination regimen of mefloquine and artesunate tablets improves the cure rate in uncomplicated falciparum malaria compared to the use of mefloquine and artesunate as single agents, a prospective, randomised, uniblind controlled study was done between May and November 1991, on one hundred and eighty cases of acute uncomplicated falciparum malaria. The patients were randomised to the following three frug regimens: - (1) Mefloquine - 1000 mg stat, (2) Tab Artesunate 600 mg over 48 hours, (3) Mefloquine 1000 mg plus tab Artesunate 600 mg over 48 hours. The regimen of mefloquine as a single agent gave a cure rate of 83.3 percent (with R1 = 15 percent and R2 = 1.7 percent), PCT = 52.15 + 55.2 hours and FCT = 23.98 + 59.87 hours. Tab artesunate gave a cure rate of 75 percent (with R1 = 25 percent), PCT = 33.16 + 5.15 and FCT = 23.4 + 22.7 hours. The combination regimen gave a cure rate of 98.27 percent with only one patient recrudescing at R1 level, PCT = 35.11 + 29.16 and FCT = 8.15 + 10.34 hours. The side effects were not much increased by using the combination. No cardiovascular effects were noted. The combination is superior to that of the single agents.