The identification of drug related problems (DRPs) using profilaxis antibiotics in orthopedic surgical patients at a Government Hospital in Yogyakarta

Background: Antibiotic prophylaxis in orthopedic surgery cases aims to prevent surgery site infections (SSI). For antibiotic prophylaxis, it is recommended to use the first generation of cephalosporin, namely cefazolin which can kill the bacteria commonly found in orthopedic surgery infection. The prophylactic administration of cefotaxime is not the first line but is definitive for surgical prophylaxis. Objective: The aim of this study was to determine the rationale for the use of antibiotic prophylaxis for orthopedic surgery, the drug problems (DRPs) that occurred and their potential interactions. Method: This study was conducted using a cross sectional design with a total sampling technique of medical record samples from January to February 2019 at the Government Hospital in Yogyakarta. Observational analytical descriptive data processing by ensuring the appropriate of indications, route of administration, timing of administration and an appropriate of prophylactic doses as well as how to compare DPRs to the literature and analysis of potential co drug interaction with Drug Information Handbook (DIH), AHFS Clinical Drug Information, Drug Interaction Facts, and Interactions Stockley’s Drug Interaction. Results: All patients received appropriate therapy for indication, type of drug, routes of administration for pre and postoperative. All patients received an under dose of ranitidine and 1 patient (1,69%) received an over dose of piracetam. Potential interactions that occur include ketorolac-ranitidine, NSAIDs with other NSAIDs, NSAIDs-ranitidine, NSAIDs-ACEi, NSAIDs-bisoprolol, bisoprolol-calcium, calcium-vitamin C, and paracetamol-ranitidine. Conclusion: Pre and postoperative prophylactic antibiotics are rational. The accompanying drug, ranitidine and piracetam were not properly doses. Drug interactions in this study are potential. Keywords: prophylaxis antibiotic, orthopedic surgery, cefotaxim, DRPs

Early Adversity and Later Health: The Pathway of Social Relationships in Adulthood in HRS and ELSA

Early adversity is associated with compromised health and well-being in later life, but whether social functioning mediate the association is unclear. We examined 2 longitudinal samples of older adults (>= 50 years) whose baseline surveys were between 2006 and 2008 with follow-up until 2016 in the Health and Retirement Study (HRS, n = 15,946) and its sister study in England (ELSA, n = 9,692). Health outcomes included depressive symptoms, chronic health conditions, and subjective memory complaints. Social relationships were measured by contacts, relationship strains, and feelings of loneliness. Early adversity was measured by parental physical abuse and alcohol and drug problems in the family before the age of 16. Patterns of association were similar in these 2 samples, where social contacts decreased over time, while relationship strains and loneliness increased especially for older adults with early trauma, which in turn mediated the associations between early adversity and poorer later health.

Early Trauma and Later Health: Examining the Mediation of Social Relationships in Adulthood in HRS

Early trauma is associated with compromised health and well-being in later life, but whether social functioning mediates the association is unclear. Participants in the Health and Retirement Study (n = 15,946) had baseline surveys in years 2006 and 2008 (T1), and were followed up twice (T2-3) every 4 years. Health outcomes included depressive symptoms, chronic health conditions, and subjective memory complaints. Social relationships were measured by contacts, relationship strains, and feelings of loneliness. Early trauma was measured by parental physical abuse and alcohol and drug problems in the family before the age of 16. Social contacts decreased over time, while relationship strains and loneliness increased especially for older adults with early trauma, which in turn mediated the associations between early trauma and poorer health in later life. The findings suggested that maintaining positive social relationships are beneficial for better health in late life, especially for individuals with early trauma exposures.

Warriors against the ‘War on Drugs’: Lay experts in Norwegian drug policy

International drug policy is undergoing change, and certain types of lay experts, those who have experienced problems with drug use, are getting a more important role. By drawing on 30 in-depth interviews with representatives from drug users’ organizations, bureaucrats and researchers, we explore the rise of lay experts in Norwegian drug policy. We show how these lay experts’ personal credibility is based on a history of serious drug problems, in particular injecting amphetamine or heroin, as well as the ensuing stigma. On an organizational level, lay experts’ roles as service users or patients generate credibility, even if the background is often the users’ experiences of pain and stigma. We document how lay experts have been included and have influenced the Norwegian drug policy process. However, a problem with representativeness remains, as some groups of drug users, for example, young persons, those who mainly use cannabis or benzodiazepines, those involved in crime and those who belong to ethnic minorities, have not been included to the same extent. Thus, the increasing role of lay experts in the Norwegian drug policy process poses some unexpected challenges in terms of the democratization of expertise. This lack of representativeness may be part of the reason why the initially successful reform movement now seems to face a setback.

His Brain Has Just Gone Haywire: the Development of Children and Young People's Concepts of Mental Illness

<p>This thesis examines children and young people's ideas about mental illness. Frequently, previous research in this area has suffered from methodological flaws or a limited theoretical framework. Qualitative methodology was utilised in this thesis in order to both gather the range of ideas that children have about mental illness, and to propose a theoretical model to explain the development of these ideas. In the first study, 63 children (comprising 4 age groups: 6 - 7, 9 - 10, 12 - 13, and 16 - 18 years old) participated in focus group discussions. Groups were presented with 3 illustrated vignettes, each depicting a story about an adult with a mental health problem (schizophrenia, agoraphobia, or depression). A thematic analysis was used to examine the ideas that children expressed in these discussions. Analysis found that children have a wide range of ways of explaining the characters' behaviours. Children and young people's ideas were grouped into 5 main categories: 'medical explanationsà ¢ , 'psychiatric explanations', 'abnormal behaviour explanations', 'psychological explanations', and 'event explanations'. Following this, a second study was conducted to focus on children's ideas about causes and treatments for mental illness. 36 children (ages 9 - 10, 12 - 13, and 16 - 18) were interviewed individually. Participants were presented the same 3 vignettes and asked to create a story that explains why each character has their problem and how their problem is resolved. Grounded theory methods were used to analyse the stories, with 6 primary categories and 1 secondary category (' psychological explanations') emerging. All stories included a cause from one of the 6 primary categories, and sometimes that primary category also led to a thinking problem (from the secondary category). Resolutions to the stories either came from the same primary category as the suggested cause, or alternatively, treatment came from one of the treatments included in the secondary category ('think or act differently', 'counselling', or 'support from others'). The primary categories were 'event' (problem was due to an external event happening, and resolution comes from an external event occurring); 'physiological' (the problem is seen as a medical problem, and treatment came from doctors); 'neurological / psychiatric' (characters have problems with their brains or a diagnostic label, resolutions include psychiatric medication, hospitalisation, and negative outcomes); 'drug' problems; 'spiritual' (discussion related to ghosts or religion); and 'responsibility' (the character had done something wrong, and must fix it to resolve their problem). Further analysis then compared the data from both studies with previous theoretical literature. It is argued that as children grow older they develop a concept of mental illness, which they can then use when discussing vignettes or understanding abnormal behaviour. This domain-specific development occurs throughout late childhood and adolescence as children incorporate information they have learned from families, schools, and media, and build on pre-existing domains (in particular, naive psychology and naive biology). Evidence from the current study is used to support this proposed model, and implications for future research, school curriculum, and helping children with mentally ill relatives are discussed.</p>

His Brain Has Just Gone Haywire: the Development of Children and Young People's Concepts of Mental Illness

<p>This thesis examines children and young people's ideas about mental illness. Frequently, previous research in this area has suffered from methodological flaws or a limited theoretical framework. Qualitative methodology was utilised in this thesis in order to both gather the range of ideas that children have about mental illness, and to propose a theoretical model to explain the development of these ideas. In the first study, 63 children (comprising 4 age groups: 6 - 7, 9 - 10, 12 - 13, and 16 - 18 years old) participated in focus group discussions. Groups were presented with 3 illustrated vignettes, each depicting a story about an adult with a mental health problem (schizophrenia, agoraphobia, or depression). A thematic analysis was used to examine the ideas that children expressed in these discussions. Analysis found that children have a wide range of ways of explaining the characters' behaviours. Children and young people's ideas were grouped into 5 main categories: 'medical explanationsà ¢ , 'psychiatric explanations', 'abnormal behaviour explanations', 'psychological explanations', and 'event explanations'. Following this, a second study was conducted to focus on children's ideas about causes and treatments for mental illness. 36 children (ages 9 - 10, 12 - 13, and 16 - 18) were interviewed individually. Participants were presented the same 3 vignettes and asked to create a story that explains why each character has their problem and how their problem is resolved. Grounded theory methods were used to analyse the stories, with 6 primary categories and 1 secondary category (' psychological explanations') emerging. All stories included a cause from one of the 6 primary categories, and sometimes that primary category also led to a thinking problem (from the secondary category). Resolutions to the stories either came from the same primary category as the suggested cause, or alternatively, treatment came from one of the treatments included in the secondary category ('think or act differently', 'counselling', or 'support from others'). The primary categories were 'event' (problem was due to an external event happening, and resolution comes from an external event occurring); 'physiological' (the problem is seen as a medical problem, and treatment came from doctors); 'neurological / psychiatric' (characters have problems with their brains or a diagnostic label, resolutions include psychiatric medication, hospitalisation, and negative outcomes); 'drug' problems; 'spiritual' (discussion related to ghosts or religion); and 'responsibility' (the character had done something wrong, and must fix it to resolve their problem). Further analysis then compared the data from both studies with previous theoretical literature. It is argued that as children grow older they develop a concept of mental illness, which they can then use when discussing vignettes or understanding abnormal behaviour. This domain-specific development occurs throughout late childhood and adolescence as children incorporate information they have learned from families, schools, and media, and build on pre-existing domains (in particular, naive psychology and naive biology). Evidence from the current study is used to support this proposed model, and implications for future research, school curriculum, and helping children with mentally ill relatives are discussed.</p>

Advice to policy-makers for improving services to the drug-death bereaved

Aims: The objective of this study is to contribute to an improvement of bereavement services and experiences for the bereaved after drug-related deaths (DRDs) by investigating their expressed opinions on what would constitute improvements. Methods: As part of a larger survey questionnaire, we asked people bereaved by DRDs what advice they would give to politicians to improve bereavement services. Out of 255 respondents, we received 196 written statements of advice, 83 focusing on the time after death. Two-thirds of these respondents were either parents or siblings, the other third were other family members or close friends. A thematic analysis was conducted to examine the written statements. Results: We found four central themes: broad-spectrum help, routinised help, respectful help and competent help. The advice represents a long list of psychosocial support to ideally be offered on a regular and long-term basis. Furthermore, the bereaved also discussed the cognitive and normative side of the services by including considerations about stigma and respect, and the need for more research- and experience-based knowledge about their experiences both before and after DRDs. Conclusions: Many of the services sought by the bereaved are already in place and described in national guidelines for follow-up strategies after sudden unexpected deaths. DRDs, however, has not been included as a task for the services and are not explicitly mentioned in these guidelines. The scope of research and policymaking on drug problems and DRDs should be broadened to include families and social networks in order to make the group more visible and strengthen their influence on policy.

A Small Area Estimation Method for Investigating the Relationship between Public Perception of Drug Problems with Neighborhood Prognostics: Trends in London between 2012 and 2019

The correlation of the public’s perception of drug problems with neighborhood characteristics has rarely been studied. The aim of this study was to investigate factors that correlate with public perceptions in London boroughs using the Mayor’s Office for Policing and Crime (MOPAC) Public Attitude Survey between 2012 and 2019. A subject-specific random effect deploying a Generalized Linear Mixed Model (GLMM) using an Adaptive Gaussian Quadrature method with 10 integration points was applied. To obtain time trends across inner and outer London areas, the GLMM was fitted using a Restricted Marginal Pseudo Likelihood method. The perception of drug problems increased with statistical significance in 17 out of 32 London boroughs between 2012 and 2019. These boroughs were geographically clustered across the north of London. Levels of deprivation, as measured by the English Index of Multiple Deprivation, as well as the percentage of local population who were non-UK-born and recorded vehicle crime rates were shown to be positively associated with the public’s perception of drug problems. Conversely, recorded burglary rate was negatively associated with the public’s perception of drug problems in their area. The public are influenced in their perception of drug problems by neighborhood factors including deprivation and visible manifestations of antisocial behavior.