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Biomedical subjects

P K Goel

Publications and source records attributed to P K Goel.

At least 37 records · Page 2Linked to original sources
PubMed1996

The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies.

Private pharmacies are an important source of health care in developing countries. A number of studies have documented deficiencies in treatment, but little has been done to improve practices. We conducted two controlled trials to determine the efficacy of face-to-face educational outreach in improving communication and product sales for cases of diarrhoea in children in 194 private pharmacies in two developing countries. A training guide was developed to enable a national diarrhoea control programme to identify problems and their causes in pharmacies, using quantitative and qualitative research methods. The guide also facilitates the design, implementation, and evaluation of an educational intervention, which includes brief one-on-one meetings between diarrhoea programme educators and pharmacists/owners, followed by one small group training session with all counter attendants working in the pharmacies. We evaluated the short-term impact of this intervention using a before-and-after comparison group design in Kenya, and a randomized controlled design in Indonesia, with the pharmacy as unit of analysis in both countries (n = 107 pharmacies in Kenya; n = 87 in Indonesia). Using trained surrogate patients posing as mothers of a child under five with diarrhoea, we measured sales of oral rehydration salts (ORS); sales of antidiarrhoeal agents; and history-taking and advice to continue fluids and food. We also measured knowledge about dehydration and drugs to treat diarrhoea among Kenyan pharmacy employees after training. Major discrepancies were found at baseline between reported and observed behaviour. For example, 66% of pharmacy attendants in Kenya, and 53% in Indonesia, reported selling ORS for the previous case of child diarrhoea, but in only 33% and 5% of surrogate patient visits was ORS actually sold for such cases. After training, there was a significant increase in knowledge about diarrhoea and its treatment among counter attendants in Kenya, where these changes were measured. Sales of ORS in intervention pharmacies increased by an average of 30% in Kenya (almost a two-fold increase) and 21% in Indonesia compared to controls (p < 0.05); antidiarrhoeal sales declined by an average of 15% in Kenya and 20% in Indonesia compared to controls (p < 0.05). There was a trend toward increased communication in both countries, and in Kenya we observed significant increases in discussion of dehydration during pharmacy visits (p < 0.05). We conclude that face-to-face training of pharmacy attendants which targets deficits in knowledge and specific problem behaviours can result in significant short-term improvements in product sales and communication with customers. The positive effects and cost-effectiveness of such programmes need to be tested over a longer period for other health problems and in other countries.

Adult↗
PubMed1996

Influence of location and staff knowledge on quality of retail pharmacy prescribing for childhood diarrhea in Kenya.

BACKGROUND: Retail pharmacies are important sources of advice on pharmaceuticals in developing countries, where many purchasing decisions are unmediated by medical professionals. For childhood diarrhea, choice of drug sales in pharmacies has been found to be consistently poor, whether with or without prescription, as evidenced by a low use of effective oral rehydration salts (ORS) and high use of marginally effective or ineffective products such as antimotility agents, adsorbents, and antimicrobials. Little information is available about factors influencing prescribing by pharmacy personnel in these settings. This paper reports results of an analysis which examined the influence of rural versus urban location, neighborhood socio-economic status (SES), and clinical knowledge of pharmacy assistants on quality of prescribing in retail pharmacies in Kenya. METHODS: Using WHO treatment guidelines, we measured quality of prescribing in childhood diarrhea as: (1) the proportion of client encounters in which ORS is prescribed (indicating higher quality practice); and (2) the proportion of visits in which an antidiarrheal product is prescribed (lower quality practice). We obtained data on prescribing in a simple case of childhood diarrhea using surrogate patient visits to 91 pharmacies located in the major urban area of Kenya (Nairobi) and four rural towns. Multivariate logistic regression was used to examine the association between pharmacy predictor variables and the quality of prescribing. RESULTS: No consistent relationship was found between the clinical knowledge of pharmacy assistants and quality of prescribing. Controlling for number of products prescribed, gender of the assessor, and level of knowledge, multivariate analyses indicated that in comparison to rural pharmacies, the odds of prescribing ORS were significantly higher in pharmacies located in high SES (OR = 4.7; 95% CI = 1.4,16.1) or middle SES (OR = 4.5; CI = 1.9,10.6) urban neighborhoods; the odds in low SES urban pharmacies were similar to those in rural areas (OR = 2.0; CI = 0.6,6.2). The odds of prescribing antidiarrheal products did not differ significantly in any geographic area. CONCLUSIONS: Location of a retail pharmacy in a rural area or in a low-income urban neighborhood was associated with suboptimal quality of prescribing as evidenced by lower use of ORS. No relationship between clinical knowledge and quality of practice was detected. Future research is needed to examine such factors as the influence of intra-pharmacy authority structure, perceived efficacy of pharmaceuticals, local patterns of physician practice, and economic incentives on the quality of prescribing.

Adult↗
PubMed1995

Urinary calcium, sodium, and bone mass of young females.

Calcium is an important determinant of peak bone mass in young adults because of its influence on skeletal development during growth. Attainment of maximum peak bone mass requires optimal positive balance between calcium intake and obligatory losses of calcium, primarily in urine and feces. Urinary excretion is an important determinant of calcium retention in the body. Accordingly, the purpose of this study was to evaluate the influence of various nutrients on urinary calcium excretion, and to assess their impact on bone mass of young females, aged 8-13 y, during early puberty. The study was conducted in 381 healthy white females in pubertal stage 2. From each participant we collected basic anthropometric measurements, a 3-d food record, blood, a 24-h urine sample, and bone mass measurements of the total body and forearm by dual X-ray absorptiometry. Urinary sodium was found to be one of the most important determinants of urinary calcium excretion: [urinary calcium (mmol/d) = 0.01154 x urinary sodium (mmol/d) + 0.823], whereas calcium intake had relatively little impact: [urinary calcium (mmol/d) = 0.02252 x calcium intake (mmol/d) + 1.5261]. Urinary calcium was much higher at a calcium intake of approximately 37.5 mmol/d (1500 mg/d), supporting the notion that calcium is a threshold nutrient. Calcium intake had a significant positive influence on the bone mineral content and density of the whole body and radius shaft whereas urinary calcium had a negative influence, presumably by reducing calcium accretion into the skeleton.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1994

Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model.

To determine the timing of peak bone mass and density, we conducted a cross-sectional study of bone mass measurements in 265 premenopausal Caucasian females, aged 8-50 yr. Bone mass and bone mineral density were measured using dual X-ray absorptiometry and single-photon absorptiometry at the spine (anteroposterior, lateral), proximal femur, radius shaft, distal forearm, and the whole body. Bone mass parameters were analyzed using a quadratic regression model and segmented regression models with quadratic-quadratic or quadratic-linear form. The results show that most of the bone mass at multiple skeletal locations will be accumulated by late adolescence. This is particularly notable for bone mineral density of the proximal femur and the vertebral body. Bone mass of the other regions of interest is either no different in women between the age of 18 yr and the menopause or it is maximal in 50-yr-old women, indicating slow but permanent bone accumulation continuing at some sites up to the time of menopause. This gain in bone mass in premenopausal adult women is probably the result of continuous periosteal expansion with age. Since rapid skeletal mineral acquisition at all sites occurs relatively early in life, the exogenous factors which might optimize peak bone mass need to be more precisely identified and characterized.

Adolescent↗
PubMed1993

Atrio-ventricular regurgitations in constrictive pericarditis: incidence and post-operative outcome.

We studied 33 surgically proven cases of constrictive pericarditis during the period 1989-1991 by color Doppler echocardiography and angiography to look for incidence and postoperative outcome of atrioventricular regurgitation. The mean age was 27.2 + 16.5 years (21 males, 12 females). There was a very high incidence of mitral (79%, trivial in 13, mild in 11 and moderate in 2) and tricuspid (73%, trivial in 7, mild and moderate in 6 each and severe in 5) regurgitation. There was good correlation between 'color Doppler' and angiography for detection and quantification of these regurgitations (r = 0.89 for mitral and 0.76 for tricuspid regurgitation, respectively). There were no preoperative clinical or hemodynamic predictors for the incidence or severity of these regurgitations. Immediate postoperative (7-10 days) evaluation by color Doppler did not show any change in these regurgitations. A follow-up study (by color Doppler and angiography) in 18 patients at a mean period of 229 + 105 days revealed regression of these regurgitations by at least 1 grade in 50% of patients. Patients with persisting regurgitations had persisting hemodynamic abnormality and relatively longer duration of symptoms. The presence of atrio-ventricular regurgitations should not be taken as evidence favoring diagnosis of restrictive cardiomyopathy and against that of constrictive pericarditis. The mechanism of these regurgitations is not clear to us.

Adult↗
PubMed1991

Aneurysm of the left sinus of Valsalva causing severe mitral regurgitation.

A 24-year-old male presented with exertional dyspnoea of one year's duration. Echocardiography revealed an unruptured aneurysm of the left sinus of Valsalva distorting the mitral valvar apparatus and producing severe regurgitation in the absence of myocardial ischemia or infarction. We propose an alternate mechanism for the mitral regurgitation.

Adult↗
PubMed1989

Ciprofloxacin versus amoxycillin/clavulanic acid in the treatment of urinary tract infections in general practice.

An open, randomized general practice study was performed to assess the comparative efficacy and tolerability of ciprofloxacin and amoxycillin/clavulanic acid in the treatment of uncomplicated urinary tract infection. One hundred and eighty nine patients were recruited into the study. In comparison of pre- and post-treatment urine cultures and symptomatology, ciprofloxacin was significantly more effective (P less than 0.01) than amoxycillin/clavulanic acid. Both drugs were well tolerated with minimal adverse side effects. Ciprofloxacin is an effective and safe treatment for uncomplicated urinary tract infection in general practice.

Acute Disease↗
PubMed1983

A comparative trial of amoxycillin 3g bd and conventional amoxycillin therapy in the treatment of urinary tract infection in a general practice population.

An open, randomised, General Practice study was carried out to determine the comparative efficacy and tolerability of two doses of amoxycillin 3 g and amoxycillin 250 mg tds for five days in the treatment of uncomplicated urinary tract infection. Two hundred and seven patients entered the study, of these 98 were shown to have negative bacteriology. Using pre- and post-treatment MSU culture and symptomatology as measures of efficacy it was found that the two treatment groups were not significantly different on both measures. Both treatments were well tolerated with only a low level of gastrointestinal side effects reported.

Amoxicillin↗