Why people avoid prescribed medical treatment in India?

Avoidance in seeking prescribed medical treatment can result in adverse consequences. The study was conducted to find out the reasons to avoid prescribed medical treatment and associations with various socioeconomic variables in India. Data from the National Sample Survey Organisation 71st Round on “Key Indicators of Social Consumption: Health” (January and June 2014) have been used. Variables such as place of residence, social categories, religion, and socioeconomic status have been used to study the associations with the various reasons to avoid prescribed medical treatment. Nonseriousness about the ailment was found to be the primary reason for not seeking prescribed medical treatment. Lack of availability of medical facility, long-waiting time, and financial constraints were other important reasons. Understanding the socioeconomic differentials among the reasons why people avoid prescribed medical treatment is critical in improving the effectiveness of health-care facilities in India.

Evidence-based review of methods used to reduce pain after excisional hemorrhoidectomy / Revisão baseada em evidências de métodos utilizados para reduzir a dor após hemorrroidectomia excisional

ABSTRACT Background: Excisional hemorrhoidectomy is one of the most commonly performed anorectal procedures. Despite the satisfactory outcomes of excisional hemorrhoidectomy, the pain perceived by the patients following the procedure can be a distressing sequel. This review aimed to search the current literature for the existing evidence on how to avoid or minimize the severity of post-hemorrhoidectomy pain. Methods: An organized literature search was performed using electronic databases including PubMed/Medline and Google Scholar service for the articles that evaluated different methods for pain relief after excisional hemorrhoidectomy. Then, the studies were summarized in a narrative way illustrating the hypothesis and the outcomes of each study. The methods devised to reduce pain after excisional hemorrhoidectomy were classified into three main categories: technical tips; systemic and topical agents; and surgical methods. The efficacy of each method was highlighted along the level of evidence supporting it. Results: Stronger evidence (level Ia) supported LigaSure hemorrhoidectomy and the use of glyceryl trinitrate ointment to be associated with significant pain relief after excisional hemorrhoidectomy whereas the remaining methods were supported by lower level of evidence (level Ib). Conclusion: The use of LigaSure in performing excisional hemorrhoidectomy and the application of topical glyceryl trinitrate ointment contributed to remarkable relief of postoperative pain after excisional hemorrhoidectomy according to the highest level of evidence. Perhaps a multimodality strategy that combines systemic and topical agents can be the optimal method for control of pain after excisional hemorrhoidectomy, yet further prospective trials are required to draw such conclusion.

RESUMO Introdução: A hemorroidectomia excisional (HE) é um dos procedimentos anorretais mais comumente realizados. Apesar dos resultados satisfatórios da hemorroidectomia excisional, a dor percebida pelos pacientes após o procedimento pode ser uma sequela angustiante. Esta revisão teve como objetivo buscar na literatura atual as evidências existentes sobre como evitar ou minimizar a gravidade da dor pós-hemorroidectomia. Métodos: Uma busca organizada da literatura foi realizada usando bancos de dados eletrônicos, incluindo PubMed/Medline e Google Scholar, para os artigos que avaliaram diferentes métodos para o alívio da dor após hemorroidectomia excisional. Em seguida, os estudos foram resumidos de forma narrativa, ilustrando a hipótese e os resultados de cada estudo. Os métodos desenvolvidos para reduzir a dor após a hemorroidectomia excisional foram classificados em três categorias principais: dicas técnicas; agentes sísticos e ticos; e métodos cirúrgicos. A eficácia de cada método foi destacada ao longo do nível de evidência que a suporta. Resultados: Evidências mais fortes (nível Ia) apoiaram a hemorroidectomia de LigaSure e o uso de pomada de trinitrato de glicerila para ser associado com alívio significativo da dor após hemorroidectomia excisional, enquanto os métodos restantes foram apoiados por menor nível de evidência (nível Ib). Conclusão: O uso de LigaSure na realização de hemorroidectomia excisional e a aplicação de pomada tópica de gliceril trinitrato contribuíram para o notável alívio da dor pós-operatória após hemorroidectomia excisional, de acordo com o maior nível de evidência. Talvez uma estratégia multimodal que combine agentes sistêmicos e tópicos possa ser o método ideal para o controle da dor após hemorroidectomia excisional, mas ainda são necessários mais estudos prospectivos para chegar a essa conclusão.

The End of Catheter Dislodgement? Three Facile Steps to Secure a Tunneled Central Venous Catheter

Central Venous Line (CVL) catheter can easily dislodge. An improvised technique in three easily reproducible steps is described in detail. The placement of the cuff approximately 1cm from the exit wound with the placement of additional sutures at the neck area helps prevent its displacement.

Evaluation and Change of Pre-avoid Report Format to Reflect Pharmacists’ Ability / 医薬品情報学

<b>Objective: </b>Pharmacist interventions are effective for appropriate medical management.  The Japanese Society of Hospital Pharmacists has recommended the “pre-avoid report” to foster appropriate pharmacotherapy since 1999.  The “pre-avoid report” format consists of two forms : “serious report” and “preventive report.”  The number of “preventive reports” has comprised about 90% of “pre-avoid reports.”  However, this format of the “preventive report” since 1999 has shown inadequacy due to changes in pharmacists’ ability.  In the present study, we conducted a re-modification of the “preventive report” format using an assay to create the present “preventive report” format.<br><b>Methods: </b>We retrospectively reviewed the pharmacists’ “preventive report” of the “pre-avoid report” from January 2014 to December 2014 in the Department of Pharmacy, Okayama University Hospital.<br><b>Results: </b>The present format included 101 cases of “others” in the “preventive report” format.  This “others” section consisted of “non-intervention of pharmacotherapy” (51%), “forget to stop pre-operation drugs” (14.7%), and “inadequate treatment (wrong administration day, unnecessary treatment).  These factors were not identified with the present format of the “preventive report.”<br><b>Conclusion: </b>In the present study, we suggested that it is necessary to revise the format of the “preventive report” to reflect.

Investigation of potential toxic factors for fleece-flower root： from perspective of processing methods evolution / 中国中药杂志

In recent years, the rapid growth of reports on fleece-flower root-caused liver damages has drawn wide attention of both at home and abroad, however, there were rare literature on toxicology of fleece-flower root in ancient Chinese medicine. But why there are so many reports on toxicology of fleece-flower root now compared with the ancient literature? As a typical tonic medicine, the clinical utility of fleece-flower root was largely limited by its standardization and reliability of processing methods in ancient Chinese medicine. The ancient processing methods of fleece-flower root emphasized nine times of steaming and nine times of drying, while the modern processes have been simplified into one time of steaming. Whether the differences between ancient and modern processing methods are the potential cause of the increased events of fleece-flower root-caused liver damages. We will make deep analysis and provide new clues and perspectives for the research on its toxicity. This article, therefore, would discuss the affecting factors and key problems in toxicity attenuation of fleece-flower root on the basis of sorting out the processing methods of fleece-flower root in ancient medical books and modern standards, in order to provide the reference for establishing specification for toxicity attenuation of fleece-flower root.

Comparison of 23 G and 20 G vitreous cut system in silicone oil extracting operation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the safety and effectiveness of 23G and 20G vitreous cutting system in silicone oil extracting operation. ●METHODS:A total of 98 cases (98 eyes) patients, after 3- 6mo silicone oil filling with retinal attachment and suitable for retrieving silicone oil. Patients were randomly divided into two groups. 20G vitreous cutting system group including 48 cases ( 48 eyes ) and 23G vitreous cutting system group including 50 cases ( 50 eyes ) . A series of comparative analyses were conducted on the times for set up and closing the passage and the time for taking the oil time on the two groups:intraocular pressure of preoperative and of postoperative for 1, 3d, 1wk, 3 and 6mo. The comparisons were also made between the best corrected visual acuity of preoperative and postoperative. The section inflammation of postoperative 1, 3d, 1mo were compared. Complications were compared between intraoperative and postoperative. ●RESULTS:Establishing surgery channel for 20G and 23G group were ( 243. 54 ± 51. 17 ) s and ( 91. 16 ± 21. 37 ) s respectively;closing wound time were (235. 04 ± 42. 89) s and (86. 04±21. 76)s. Extracting oil time were (6. 7±1. 65) min and ( 7. 35 ± 2. 02 ) min. There was a significant difference ( P0. 05). The first day was statistically different ( P0. 05). The best corrected visual acuity for 20G and 23G group preoperative and postoperative after 6mo were:4. 21 ± 0. 61, 3. 91 ± 0. 64; 4. 03 ± 0. 46 and 4. 22 ± 0. 39 respectively. There was no significant difference between the two groups (P>0. 05). There was significant difference ( P0. 05). The findings also reported that 20G and 23G group had no intraoperative complications and postoperative. For 23G group, 5 cases of temporarily had lower intraocular pressure, 1 case was retinal again, 1 case was choroid detachment. For 20G group, 1 case of temporarily had lower intraocular pressure, 3 cases were retinal detachment and 2 cases were choroid detachment. ●CONCLUSION:23G vitreous cutting system has the advantages of low operation steps, intraoperative injury. The postoperative complications of low probability, used in silicone oil is safe and effective.

Pharmacodynamic Drug-Drug Interactions Considered to be Added in the List of Contraindications with Pharmacological Classification in Korea

OBJECTIVES: Drug utilization review program in Korea has provided 'drug combinations to avoid DCA)' alerts to physicians and pharmacists to prevent potential adverse drug events or inappropriate drug use. Seven hundred and six DCA pairs have been announced officially by the Ministry of Food and Drug Safety (MFDS) by March, 2015. Some DCA pairs could be grouped based on the drug interaction mechanism and its consequences. This study aimed to investigate the drug-drug interaction (DDI) pairs, which may be potential DCAs, generated by the drug class-drug class interaction method METHODS: Eleven additive/synergistic and one antagonistic drug class-drug class interaction groups were identified. By combining drugs of two interacting drug class groups, numerous DDI pairs were made. The status and severity of DDI pairs were examined using Lexicomp and Micromedex. Also, the DCA listing rate was calculated. RESULTS: Among 258 DDI pairs generated by the drug class-drug class interaction method, only 142 pairs were identified as official DCA pairs by the MFDS. One hundred and four pairs were identified as potential DCA pairs to be listed. QT prolonging agents-QT prolonging agents, triptans-ergot alkaloids, tricyclic antidepressants-monoamine oxidase inhibitors, and dopamine agonists-dopamine antagonists were identified as drug class-drug class interaction groups which have less than 50 % DCA listing rate. CONCLUSION: To improve the clinicians' adaptability to DCA alerts, the list of DCA pairs needs to be continuously updated.

Progress on functions of lateral habenula and related mechanisms / 中国药理学通报

Lateral habenula ( LHb ) , which is situated in the dorsal diencephalon of all vertebrates, is an important component of the habenular complex. The neural network outlined in previ-ous studies indicates that LHb acts not only as an important relay station to link the forebrain with the midbrain regions that in-volved in regulating behavioral responses to reward and mediating the transmassion of negative feedback information, but also is closely connected with 5-HT system. Indeed, recently studies demonstrate that experimental manipulations of LHb are followed by behavioural alterations in relation to drug addiction, reward-a-version responses, pain, sleep, depression and so on. This arti-cle mainly reviews the mechanisms of LHb involved in all kinds of physiological activities.

CT tube purchasing patternexplore / 中国医学装备

Objective:To reduce the purchase cost as far as possible, avoid the risk, ensure the continuity of hospital’s work and minimize economic losses in the legal premise. Methods:Take Philips heat capacity 8M MRC tube for example, According to the reasonable and objective actual exposure seconds every month, hospital assumes no responsibility for the ending of life cycle in the process of tube use at any time , and the supplier must offer new tube unconditionally within 3 days. Results:Explore a new mode to use the second exposure time paid for the first time to purchase the ball tube, to achieve the collaboration, and mutual, benefit both sides for the supplier and the demander. Conclusions:Pay rate according to the reasonable and objective actual exposure seconds every month, Can avoid risk and pressure for demander, Meanwhile adjust the price dynamically in due time, is beneficial to both sides long-term good faith friendly cooperation, mutual benefit and win-win.

Mortalidad materna: análisis de las tres demoras / Maternal mortality: analysis of the three delays

Analizar las características de la mortalidad materna ocurrida en el Distrito Capital durante los años 2008-2009, aplicando el modelo de las tres demoras. Estudio descriptivo, retrospectivo y transversal de las muertes maternas ocurridas durante el período enero 2008 - diciembre 2009. Se registraron 78 muertes maternas. La razón de mortalidad materna fue de 98,97 por cada 100 000 nacidos vivos para 2008 y 103,9 por cada 100 000 nacidos vivos para 2009. Predominaron las muertes de causa obstétrica directa (57,7 por ciento) representada por los trastornos hipertensivos del embarazo (40 por ciento), hemorragias (31,1 por ciento) y sepsis (26,7 por ciento). La principal causa indirecta fue la sepsis (62,2 por ciento). La demora 3 fue identificada mayormente en las historias clínicas registradas (69,2 por ciento) seguida de la demora 1 (38,5 por ciento). Treinta pacientes ameritaron referencia a otros centros para la atención médica definitiva, la mayoría (80 por ciento) requirió una referencia y demoraron menos de seis horas en llegar al centro donde ocurrió la defunción (36,7 por ciento). Los principales motivos de referencia fueron no contar con atención obstétrica (33,3 por ciento) y no contar con terapia intensiva de adultos (26,6 por ciento). Un gran número de muertes fue catalogado como evitable (59 por ciento). La tasa de mortalidad materna es elevada, y resulta más alta que las cifras presentadas en Venezuela para el año 2007 (56,6 por ciento). Predomina la demora tres, por falta de personal médico especializado y necesidad de referencia a otro centro y en segundo lugar la demora 1 por identificación tardía de los síntomas

Analyze the characteristics of maternal mortality occurred in the Capital District for the 2008- 2009 years, applying the three delays model. Descriptive, retrospective cross-sectional study of maternal deaths during the period January 2008 - December 2009. 78 maternal deaths were recorded. The maternal mortality ratio was 98.97 for every 100 000 live births for 2008 and 103.9 per 100 000 live births for 2009. Predominated the deaths of direct obstetrical cause (57.7 percent) represented by the hypertensive disorders of pregnancy (40 percent), hemorrhage (31.1 percent) and sepsis (26.7 percent). The main indirect cause was sepsis (62.2 percent). 3 Delay was identified mostly in the recorded histories (69.2 percent) followed by delay 1 (38.5 percent). Thirty patients deserved reference to other definitive medical care centers, the majority (80 percent) required a reference and took less than six hours to get to the Center where the death occurred (36.7 percent). The main reasons of reference were not having obstetric care (33.3 percent) and not count on intensive care for adults (26.6 percent). A large number of deaths were listed as avoidable (59 percent). The rate and maternal mortality is high, and is higher than the figures reported for the year 2007 (56.6 percent) in Venezuela. Predominant delay three, due to lack of specialized medical staff and need to refer to another center and secondly delay 1 by late identification of the symptoms

On the inevitability and controllability of medical negligence / 中华医学教育探索杂志

This thesis analyzed the inevitability of medical negligence according to the nature of medical behavior,particularity of medical profession and psychological factors of medical staff.How to control the occurrence of medical errors is an important social problem which is the whole community has been looking forward to solve.This thesis proposed methods to reduce medical negligence from the aspects of service concept,medical education and healthy psychology.

Approaches and Methods for Medical Staff to Avoid Professional Risks in Clinical Practice / 中国医学伦理学

Empirical research showed that when medical disputes arise,the emergence of that damage must be due to the fault of either party,while everyone ignored the unforeseen,difficult-to-prevent and ubiquitous occurrence of medical professional risk,and the fact that the professional risk can also occur when no party makes mistake in medical events.It is of particular importance to explore ways to avoid medical professional risks,to allow medical staff in a safer,less risk condition,and meanwhile throw themselves wholeheartedly into the cause of life-saving career.