Introduction: Medication errors are more common in patients suffering from chronic diseases. In under-developed countries like Pakistan overburden healthcare system, lack of disease-surveillance system, and shortage of healthcare staff are potential risk factors for medication errors. Objective: to assess the prevalence and risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of south Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for occurrence of medication errors was associated with age ≥ 60 years (OR = 1.9; 95 % CI=1.3–3.1; p=0.001), Overburden (OR = 2.2; 95% CI=1.64-3.56; P<0.000), No. of prescribed drugs ≥ 5 (OR =1.74; 95% CI=1.02-2.64; p<0.000), comorbidities ≥ 3 (OR=2.6; 95% CI=1.72-3.6; p=0.003 ), CCI ≥ 1 (OR=1.31; 95% CI=0.49-1.84; p=0.004), and multiple prescribers to one patient (OR=1.12; 95% CI=0.64-1.76; p=0.001). Conclusion: Reduction of complexity in the act of prescribing by the introduction of automation, improved prescriber’s knowledge by education, use of on-line aid, and feedback control systems can help in the reduction of medication errors.

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Risk Factors Associated With Medication Errors Among Patients Suffering From Chronic Disorders.

This article aimed to summarize the pharmacological and non-pharmacological management of COPD and limitations and prospects of the currently available pharmacological therapies in the management of COPD. COPD is a complex comorbid disease that irreversibly affects the pulmonary system and is considered the fifth leading cause of death worldwide. Currently, the diagnosis, assessment and management of COPD are difficult because of its complex syndrome involving numerous pulmonary and extra-pulmonary components. It is diagnosed based on the subjective and objective findings of a chronic cough, sputum production, dyspnoea, exercise intolerance and spirometry values. The GOLD report recommends bronchodilators as the first-line treatment agents in all stages of COPD severity, commonly combined with inhaled corticosteroids (ICS), methylxanthines and antibiotics, depending upon the condition and symptoms of patients. Non-pharmacological treatments of COPD include smoking cessation, influenza and pneumococcal vaccination, pulmonary rehabilitation, LTOT and surgical lung volume reduction. The efficacy of the therapy is directly related to the patients’ inhaler use training and education. A new future in COPD medication is essential to ensure the optimal management of COPD. New alternative sources should be considered in the treatment of COPD. New approaches such as e-technology can play an essential role in improving compliance and adherence to therapy. New therapies with better and long-lasting effects and minimized side effects need to be discovered to improve the pharmacological management of COPD.

Pharmacological and non-pharmacological management of COPD; limitations and future prospects: a review of current literature

Chronic obstructive pulmonary disease (COPD) requires long-term pharmacological and non-pharmacological management that encompasses continuous economic burden on patients and society, and also results in productivity losses due to compromised quality of life. Among working-age patients, COPD is the 11th leading cause of work productivity loss. The aim of this study was to assess the economic burden of COPD in Malaysia, including direct costs for the management of COPD and indirect costs due to productivity losses for COPD patients. Overall, 150 patients with an established diagnosis of COPD were followed-up for a period of 1 year from August 2018 to August 2019. An activity-based costing, ‘bottom-up’ approach was used to calculate direct costs, while indirect costs of patients were assessed using the Work Productivity and Activity Impairment Questionnaire. The mean annual per-patient direct cost for the management of COPD was calculated as US$506.92. The mean annual costs per patient in the management phase, emergency department visits, and hospital admissions were reported as US$395.65, US$86.4, and US$297.79, respectively; 31.66% of COPD patients visited the emergency department and 42.47% of COPD patients were admitted to the hospital due to exacerbation. The annual mean indirect cost per patient was calculated as US$1699.76. Productivity losses at the workplace were reported as 31.87% and activity limitations were reported as 17.42%. Drugs and consumables costs were the main cost-driving factors in the management of COPD. The higher ratio of indirect cost to direct medical costs shows that therapeutic interventions aimed to prevent work productivity losses may reduce the economic burden of COPD.

/pdf/economic-burden-of-chronic-obstructive-pulmonary-disease-3bosupvila.pdf

Economic Burden of Chronic Obstructive Pulmonary Disease Patients in Malaysia: A Longitudinal Study.

Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials.

Cultural differences affect the administration and results of health status questionnaires. “Cross cultural adaptation” ensures retention of psychometric properties such as validity and reliability at an item and/or scale level. To develop a Malaysian version of St George’s respiratory COPD specific questionnaire (SGRQ-CM), to evaluate the full spectrum of psychometric properties (reliability, validity and responsiveness), to test the factor structure and to assess minimum clinically important difference for the SGRQ-CM, to be used in population of Malaysia. SGRQ-C was translated to Bahasa Malaysia using a standard protocol. 240 COPD patients were included in the study. All patients were followed-up for six months. Construct validity, internal consistency, item convergent validity, test-retest ability, responsiveness, factor analysis and MCID of the Malaysian version of SGRQ-C to be used in population of Malaysia were evaluated. The Cronbach alpha coefficient and intraclass correlation coefficients (ICC) for SGRQ-CM were reported as 0.87, and 0.88 respectively. Correlation of SGRQ-CM with CAT, EQ-5D-5 L, mMRC dyspnea scales and FEV1%predicted were reported as 0.86, − 0.82, 0.72 and − 0.42 respectively. Correlation coefficient between the subscales and other clinical and health status measures ranged from r = − 0.35 to r = − 0.87. The MCID was reported as 5.07 (− 2.54–12.67). The Malaysian version of SGRQ-C has a good psychometric property comparable to those of the original version and has a strong evidence of validity, reliability and responsiveness towards disease severity in Malaysian COPD patients. It can be recommended as a reliable quality of life measure for future research.

/pdf/validation-and-clinical-interpretation-of-the-st-george-s-29rz5wt0gu.pdf

Validation and clinical interpretation of the St George's respiratory questionnaire for COPD (SGRQ-C) after adaptation to Malaysian language and culture, in patients with COPD.

To investigate the effectiveness of short message service (SMS) in promotion of non-pharmacological treatment approach in hypertension patients. A prospective, randomized control study to measure the effect of short message service in improving self-management of hypertension by educating patients. One hundred and twenty hypertensive patients who had manual sphygmomanometers were selected, and were divided into two groups, i.e., an intervention group and a control group. But only the intervention group had mobile numbers of related health care professionals for SMS assistance. All of them were briefed on how they can improve HTN control by achieving a healthy life style, proper diet, and exercise (non-pharmacological approach in addition to pharmacological therapy). Patients were educated about the non-pharmacological approach for managing hypertension at each clinic visit, and were sent regular text messages about healthy diet, exercise, and adherence. Apart from educational text messages, reminder SMSs were also sent to them twice daily to remind them about taking their medicines. Patients’ feedback was collected to assess improvement in adherence and reduction in blood pressure. At the end of the study, the intervention group showed better hypertension control, with systolic blood pressure (SBP) declining by 8 mmHg to 141.15 ± 5.73 mmHg, and diastolic blood pressure (DBP) declining by 6 mmHg to 88 ± 3.97 mmHg. The control group showed a 2 mmHg and 3 mmHg decline in SBP and DBP respectively. SMS proved to be very useful to enhance adherence to non-pharmacological treatment of HTN (hypertension). It also improved patient compliance.

Utilization of short message service (SMS) in non-pharmacological management of hypertension. A pilot study in an URBAN public hospital of Multan, Pakistan

Many organizations process and store classified data within their computer networks. Owing to the value of data that they hold; such organizations are more vulnerable to targets from adversaries. Accordingly, the sensitive organizations resort to an ‘air-gap’ approach on their networks, to ensure better protection. However, despite the physical and logical isolation, the attackers have successfully manifested their capabilities by compromising such networks; examples of Stuxnet and Agent.btz in view. Such attacks were possible due to the successful manipulation of human beings. It has been observed that to build up such attacks, persistent reconnaissance of the employees, and their data collection often forms the first step. With the rapid integration of social media into our daily lives, the prospects for data-seekers through that platform are higher. The inherent risks and vulnerabilities of social networking sites/apps have cultivated a rich environment for foreign adversaries to cherry-pick personal information and carry out successful profiling of employees assigned with sensitive appointments. With further targeted social engineering techniques against the identified employees and their families, attackers extract more and more relevant data to make an intelligent picture. Finally, all the information is fused to design their further sophisticated attacks against the air-gapped facility for data pilferage. In this regard, the success of the adversaries in harvesting the personal information of the victims largely depends upon the common errors committed by legitimate users while on duty, in transit, and after their retreat. Such errors would keep on repeating unless these are aligned with their underlying human behaviors and weaknesses, and the requisite mitigation framework is worked out.

A Framework for Human Error, Weaknesses, Threats & Mitigation Measures in an Airgapped Network

The current research was conducted at Vermi-tech Unit, Muzaffarabad in 2018 to evaluate the efficacy of cow dung and vermicompost on seed sprouting, seedlings, and vegetative developmental parameters of Viola x wittrokiana (pansy). In the current study, vermicompost was produced using Eisenia fetida. Physicochemical parameters of vermicompost and organic manure were recorded before each experimentation. The potting experiment was designed and comprised of eight germination mediums containing different combinations of soil, sand, cow dung, and various concentrations of vermicompost such as 10% VC, 15% VC, 20% VC, 25% VC, 30% VC, and 35% VC. Seed sprouting and seedling developmental parameters were observed for 28 days while vegetative plant growth parameters were recorded after 10 weeks of transplantation in various vermicompost amended germination media. Pre and post-physicochemical analysis of germination media were also recorded to check their quality and permanency. The current findings showed that 30% VC germination media was an effective dose for early seed germination initiation and all seed germination parameters. However, the significant vegetative plant growth and flowering parameters of pansy occurred at 35% VC. Findings revealed that vermicompost not only enhanced the seed germination and growth of pansy but also improved soil health. These results indicate that vermicompost can be exploited as a potent bio-fertilizer for ornamental plant production.

/pdf/cow-dung-putrefaction-via-vermicomposting-using-eisenia-3hwaopfs.pdf

Cow dung putrefaction via vermicomposting using Eisenia fetida and its influence on seed sprouting and vegetative growth of Viola wittrockiana (pansy)

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Utilization of short message service (SMS) in non-pharmacological management of hypertension. A pilot study in an URBAN public hospital of Multan, Pakistan

A Framework for Human Error, Weaknesses, Threats & Mitigation Measures in an Airgapped Network

Cow dung putrefaction via vermicomposting using Eisenia fetida and its influence on seed sprouting and vegetative growth of Viola wittrockiana (pansy)