Patients with osteoporosis have an increased risk of sustaining fractures because of the low bone mineral density (BMD) and altered bone micro-architecture which are characteristic features of the disease. Although a good correlation exists between BMD and fracture risks, many other factors influence this relationship. While there is consensus that patients with osteoporosis should be investigated and treated, the issue is much less clear for patients with osteopenia. Because osteopenia is so prevalent, it would be unrealistic to treat all patients with this condition. Therefore, there is a need to identify those patients who are at risk of sustaining a fracture and would benefit most from the available therapy. Providing treatment to the appropriate risk group would not only reduce the number of fractures, but could also reduce the adverse effects associated with treatment, as treating patients earlier could shorten the treatment time. The availability of tools to select patients at risk of fracture should change the impact of the disease.

Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB treatment guidelines. The overarching question asked the study participants centered on eliciting their perceptions towards the guidelines. Guided by the theory of planned behavior, this qualitative narrative study explored the perceptions of private medical practitioners in Anambra State, Nigeria towards the Nigerian National TB Treatment Guidelines. To elicit these perceptions, in-depth interviews were conducted on 11 purposefully selected practitioners. Data analysis comprised coding of data obtained and extracting themes from them. The QSR Nvivo 11 helped to manage data. The main finding of the study was that the practitioners perceived the treatment guidelines to be adequate to meet most of their needs in the diagnosis and treatment of TB patients. Other key findings were that provision of financial incentives and regular training will motivate collaboration with the TB program and adherence to the guidelines. Positive social change may occur by insight being gained into how private medical practitioners view the treatment guidelines and how this knowledge will lead to improved management of TB patients. This may in turn result in the reduction in the morbidity and mortality associated with TB in Nigeria.

SAMMANFATTNING Patienter som drabbas av höftfrakturer är en vårdkrävande och utsatt patientgrupp inom sjukvården. Riktlinjer för handläggning av misstänkta höftfrakturer har utformats för ett snabbare omhändertagande, så kallat snabbspår. Dessa används för att optimera och förkorta handläggningstiden, förbättra behandlingen samt minska risken för komplikationer. I Västernorrlands län tillämpas detta snabbspår, vilket medför att delar av den behandling som tidigare utfördes på akutmottagningen, nu utförs av ambulanssjuksköterskor redan i den prehospitala vården. Dessa medicinska och omvårdnadsmässiga åtgärder utförs i varierande och ibland svåra vårdmiljöer. Därför finns ett behov av att studera ambulanssjuksköterskornas upplevelser och erfarenheter av att vårda patienter med misstänkt höftfraktur. Syftet med studien var att beskriva ambulanssjuksköterskors upplevelser och erfarenheter vid omhändertagande av patienter med misstänkt höftfraktur. Kvalitativ ansats användes och designen var semistrukturerade intervjuer som analyserades med kvalitativ manifest innehållsanalys. Studiepopulationen bestod av åtta ambulanssjuksköterskor stationerade i Ångermanland. I resultatet framkom att ambulanssjuksköterskorna innehar både positiva och negativa erfarenheter av att arbeta med misstänkta höftfrakturer. Äldre människor utgjorde den största patientgruppen och dessa patienter led ofta av demenssjukdomar samt andra sjukdomar och tillstånd som försvårade kommunikation och interaktion, vilket skapade svårigheter i handläggningen av dessa patienter. Vårdmiljön försvårade arbetet ytterligare för ambulanssjuksköterskorna och innebar ofta svåra förflyttningar och lyft. Positivt för både patienten och ambulanssjuksköterskorna var att det strukturerade omhändertagandet gav en snabbare vårdkedja och likvärdig vård för patienterna samt mer tid för omvårdnad. Andra aspekter som framkom var att ambulanssjuksköterskorna hade en del förutfattade meningar gällande patientgruppen och svårigheter att få patienten tillräckligt smärtlindrad. Själva omhändertagandet uppgavs vara alltför strukturerad, handläggningen tog lång tid och att det var svårt att få patienten tillräckligt smärtlindrad utan biverkningar. Slutsatsen var att ambulanssjuksköterskorna hade både positiva och negativa erfarenheter kring det strukturerade omhändertagandet, samt en del förutfattade meningar. Samtliga informanter ansåg att de hade mer tid för omvårdnaden och att de på så vis fick lära känna patienten bättre, därför kunde de enklare utvärdera behandlingsresultatet. De positiva erfarenheterna var att omhändertagandet gav en snabbare handläggning med bättre struktur och därigenom en likvärdig vård i hela länet gällande denna patientgrupp. Det accepterades att uppdragen tog längre tid och därför fick personalen även mer tid tillsammans med patienterna. Ambulanssjuksköterskorna kunde se ett konkret resultat av omhändertagandet. De negativa erfarenheterna innefattade att patientgruppen var svårbedömd på grund av eventuella tidigare sjukdomar och läkemedelsbehandlingar. Att anhöriga och vårdpersonal ibland trängde sig in i vårdrummet, med syfte att vara behjälplig, men flyttade istället fokus från patienten. / ABSTRACT Patients with hip fractures are a care-intensive and vulnerable patient population in health care. Guidelines for dealing with suspected hip fractures have been designed for a faster disposal, so-called fast track. These are used to optimize and shorten the processing time, improve treatment and reduce the risk of complications. Västernorrland county has applied a fast track, which means that parts of the processing previously performed in the emergency department, now is performed by ambulance nurses already in the prehospital care. These medical and nursing activities performed in varying and sometimes difficult healthcare environments. Therefore there was a need to study the ambulance nurses' experiences of caring for patients with suspected hip fracture. AIM: The aim of the study was to describe Ambulance nurses experiences of treatment of patients with suspected hip fracture. Qualitative approach was used and the design was semi-structured interviews were analyzed using qualitative manifest content analysis. The study population consisted of eight ambulance nurses stationed in Ångermanland, Sweden. The result showed that ambulance nurses possess both positive and negative experiences of working with suspected hip fracture. Older people represented the largest group of patients and these patients often suffered from dementia and other diseases and conditions that impeded communication and interaction, which created difficulties in dealing with these patients. The healthcare environment complicated the work further for the ambulance nurses and often includes difficult movements and lifting. Positive for both the patient and ambulance nurses was that it structured the care provided faster care chain and equivalent care for patients as well as more time for care. Other aspects that emerged were that the ambulance nurses have some preconceptions regarding the patient group and the difficulties in getting the patient adequate pain relief. The fast track was described to be too structured, the processing takes a long time and that it was difficult to get the patient enough pain relief without side effects. The conclusion was that it emerged that the ambulance nurses had both positive and negative experiences of the structured care, and had some preconceptions. All the respondents felt that they had more time for care, and that they got to know the patient better, because they could more easily evaluate the treatment outcome. The positive experience was that the fast track provided faster processing with better structure and thereby an equal treatment throughout the county regarding this population. It was accepted that missions took longer therefore the staff spent more time with the patients. The ambulance nurses could see concrete result of the fast track. The negative experiences included that the patient group was difficult to assess because of past illnesses and drug treatments. Relatives and caregivers are sometimes forced into the nursing room, with the aim to be helpful, but instead moved focus from the patient.

No description available.

No description available.

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

The commonest prescribed group of drugs is antimicrobials. Various studies have shown that they are overused globally. Since Primary health care represents the first tier of the health care system, evaluation of antimicrobial use in primary health w e settings is a necessity to ensure rational and cost-effective use of these agents in the treatment of infectious diseases. It has been reported by Hooton and Levy (2001 : 1088) that 20% to 50% of antimicrobials are inappropriately used in developing countries. According to Rebana et al. (1998: 175) the increasing overuse of antimicrobials has resulted in an enormous escalation in the total costs of drugs contributing to 15% to 30 % of the total health budget. Hooton and Levy (2001: 1087) reported in a study that inappropriate use and overuse of antimicrobials are risk factors for the emergence of antibiotic resistant bacteria. There is a high incidence of infectious diseases in developing countries that are due to the rapid spread of resistant strains through over-crowding, poor sanitation and unsafe sexual practices (Liu et al., 1999: 540). The general objective of the study was the analysis and interpretation of the usage and related costs of antimicrobial prescriptions in a private primary health w e setting in South Africa. The study is a non-experimental, quantitative, retrospective drug utilisation review of antimicrobial usage in a private primary health care setting. Data were obtained from the central database of a private primary health care service provider. Data of nine randomly selected clinics, situated in different geographical areas of South Africa, were extracted for the period 1st January to 31st December 2001. The study population was made of the total patient population of patients using antimicrobials during this one year period. Antimicrobial usage was analysed according to: number of patients, age and gender distribution, diagnosis, pharmacological groups. The total number of patients who visited the nine clinics during the year was 83 655 of which 59.50% were females and 40.22% males. In 0.28% of the cases gender was not indicated. Patients in age groups 6 (20-40 years) and 7 (40-60 years) accounted for the highest number of patients (66.31%, n = 54 964). A total of 515 976 medicine items costing R1 716 318.90 were prescribed, of these, 18.69%, (N=96 423) were antimicrobials costing 60.89%, (R1 045 108.00). Of the total number of patients that visited the nine clinics, 65.34% (N=54 663) were prescribed antimicrobials. The total number of diagnoses (140 723) where antimicrobials were prescribed accounted for 68.52% (N46 42 1). The highest number of antimicrobial prescriptions according to pharmacological and age groups were: penicillins followed by sulphonamides and tetracyclines. The diagnoses with the highest number of antimicrobial prescriptions were the respiratory tract infections (viral influenza, acute bronchitis and upper respiratory tract infection) and pelvic inflammatory disease The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these drugs. Because most of these infections are caused by viruses or other non-bacterial agents, are self limiting. Therefore, the use of antibiotics courses is neither necessary nor appropriate in these conditions. The overuse and inappropriate use of such drugs have an effect on the health of the patients needing cure, and the general budget on health care service. It is recommended that further studies are conducted on antimicrobial prescribing and use. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

The commonest prescribed group of drugs is antimicrobials. Various studies have shown that they are overused globally. Since Primary health care represents the first tier of the health care system, evaluation of antimicrobial use in primary health w e settings is a necessity to ensure rational and cost-effective use of these agents in the treatment of infectious diseases. It has been reported by Hooton and Levy (2001 : 1088) that 20% to 50% of antimicrobials are inappropriately used in developing countries. According to Rebana et al. (1998: 175) the increasing overuse of antimicrobials has resulted in an enormous escalation in the total costs of drugs contributing to 15% to 30 % of the total health budget. Hooton and Levy (2001: 1087) reported in a study that inappropriate use and overuse of antimicrobials are risk factors for the emergence of antibiotic resistant bacteria. There is a high incidence of infectious diseases in developing countries that are due to the rapid spread of resistant strains through over-crowding, poor sanitation and unsafe sexual practices (Liu et al., 1999: 540). The general objective of the study was the analysis and interpretation of the usage and related costs of antimicrobial prescriptions in a private primary health w e setting in South Africa. The study is a non-experimental, quantitative, retrospective drug utilisation review of antimicrobial usage in a private primary health care setting. Data were obtained from the central database of a private primary health care service provider. Data of nine randomly selected clinics, situated in different geographical areas of South Africa, were extracted for the period 1st January to 31st December 2001. The study population was made of the total patient population of patients using antimicrobials during this one year period. Antimicrobial usage was analysed according to: number of patients, age and gender distribution, diagnosis, pharmacological groups. The total number of patients who visited the nine clinics during the year was 83 655 of which 59.50% were females and 40.22% males. In 0.28% of the cases gender was not indicated. Patients in age groups 6 (20-40 years) and 7 (40-60 years) accounted for the highest number of patients (66.31%, n = 54 964). A total of 515 976 medicine items costing R1 716 318.90 were prescribed, of these, 18.69%, (N=96 423) were antimicrobials costing 60.89%, (R1 045 108.00). Of the total number of patients that visited the nine clinics, 65.34% (N=54 663) were prescribed antimicrobials. The total number of diagnoses (140 723) where antimicrobials were prescribed accounted for 68.52% (N46 42 1). The highest number of antimicrobial prescriptions according to pharmacological and age groups were: penicillins followed by sulphonamides and tetracyclines. The diagnoses with the highest number of antimicrobial prescriptions were the respiratory tract infections (viral influenza, acute bronchitis and upper respiratory tract infection) and pelvic inflammatory disease The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these drugs. Because most of these infections are caused by viruses or other non-bacterial agents, are self limiting. Therefore, the use of antibiotics courses is neither necessary nor appropriate in these conditions. The overuse and inappropriate use of such drugs have an effect on the health of the patients needing cure, and the general budget on health care service. It is recommended that further studies are conducted on antimicrobial prescribing and use. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.