Modern Clinical Medicine Research

16

Authors: Daniel Sop, Wally Smith, Abdulkhaliq Alsalman, Jennifer Li Wong, Ding-Yu Fei, Donna McClish, Azhar Rafiq, Patrick Coyne, Shirley Johnson, Thokozeni Lipato

Sickle cell disease (SCD) pain is often acute-on-chronic, likening it to other chronic acuteon-chronic pain conditions. Pain treatment of SCD was already reported as inadequate prior to the current opioid epidemic, but attitudes underlying treatment were understudied. Understanding these attitudes prior to the current epidemic would be revealing. Therefore in 1997, before the current opioid epidemic, we surveyed physicians’ attitudes toward pain management and treatment preferences for acute pain exacerbations in the Emergency Department in SCD versus those of chronic pancreatitis and chronic low back pain, two other acute-on-chronic pain diseases. Thirty-nine residency trainees were surveyed in a level one triage hospital. Resident estimates of the rate of opioid addiction in SCD were higher than estimates in both chronic pancreatitis and chronic low back pain. Most residents relied on their personal clinical experience rather than external sources of data or knowledge as the most important driver when they managed chronic pain. This survey research shows that, predating the current opioid epidemic, there was both a backdrop of opioidphobia and a bias against treating SCD pain compared to other chronic pain conditions among our sample. Repeating this survey research among current training physicians, along with surveys of other attitudes, would provide useful comparisons.

7

Authors: Jack Leiss

In order to determine the association between safety climate and blood exposure in a population of home care/hospice nurses, a mail survey was conducted in 2006 in North Carolina, USA. Safety climate, defined as employees’ shared perceptions regarding safety within their work organization, was examined according to level of use of safety-engineered medical devices and personal protective equipment (PPE), work experience, type of employment, and characteristics of the work environment. The adjusted response rate was 69%. The overall exposure rate was 27.4 per 100,000 home visits. Nurses who had a weak safety climate had nearly 2½ times the risk of total blood exposure and twice the risk of needlestick as nurses who had a strong safety climate. Similar relationships were found for safety climate by use of safety devices and PPE, work experience, type of employment, and characteristics of the work environment. The author concluded that safety climate appears to be associated with reduced blood exposure among home care and hospice nurses. Safety climate may be among the factors that management can strengthen in order to reduce home care/hospice nurses’ risk of blood exposure.

6

Authors: Omaima N. Najib, Rana Hassan, Bassam Alwadi, Nasir M. Idkaidek, Naji M. Najib

A randomized, two-way, crossover study was conducted in 34 fasting, healthy, male volunteers to compare the bioavailability of two brands of etoricoxib 120mg tablets; Etoricoxib-SAJA (Saudi Arabian Japanese Pharmaceutical Company, Saudi Arabia) as test and ARCOXIA® (Merck Sharp & Dohme Ltd, UK) as reference product. The study was performed at the International Pharmaceutical Research Centre (IPRC), Amman, Jordan. The drug was administered with 240 ml of water after a 10-h overnight fasting on two treatment days separated by 2-weeks washout period. After oral dosing, serial blood samples were collected for a period of 72 h. Plasma harvested from blood was analyzed for etoricoxib by validated HPLC method with UV-visible detector capable to detect etoricoxib in the range of 30-3000 ng/ml with limit of quantitation of 30.0 ng/ml. The pharmacokinetic parameters including truncated AUC0→72, Cmax and Tmax were determined from plasma concentrations of both formulations and found to be in good agreement with reported values. Truncated AUC0→72 and Cmax were tested for bioequivalence after log-transformation of data. No significant difference was found based on ANOVA; 90% confidence interval 95.72 -102.48 % for AUC0→72, 89.76-106.81 % for Cmax of test/reference ratio for these parameters were found within bioequivalence acceptance range of 80–125%. Based on these statistical inferences, it was concluded that Etoricoxib-SAJA is bioequivalent to ARCOXIA®.

8

Authors: Meerambika Mahapatro, Shalini Kelkar

Antenatal care (ANC) is very important intervention needed for management of normal cases of pregnancy as well as for screening and detection of complications at an earlier stage so as to manage them effectively in time. This article has tried to highlight the factors that are proved to be the driving and restraining forces in accessing antenatal care services in India and how it influences the women to take decision for the place of delivery (home or institutional). A mixed method approach was applied to 320 women from 16 villages of Ganjam and Gajapati districts of Odisha. Indepth interviews were carried out till data saturation was observed at 10 with women having child of less than one year. 10 Focus Group Discussion were conducted with an average of 8 women in each group having a child of less than 5 years of age, and with the community. In-depth interview of women regarding their antenatal checkups revealed that 55.63% had visited the ANC clinics 3 or more times, 42% were primi and 58% were multipara. A large mass of population still had not taken full antenatal checkup in-spite of all the available health facilities at their door step. The infrastructure of the government health facilities needs improvement. Access to health services has to be guaranteed to all people irrespective of rural or urban divide. Where patriarchal traditional values still prevail, it is often difficult for women, to use health services unless the provided services are culturally acceptable in practice. The most important and challenging need of the hour is 'women empowerment' in the society to access their rights.