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J.S.S COLLEGE OF NURSING
1ST MAIN SARASWATHIPURAM, MYSORE
SYNOPSIS SUBMISSION
BY,
MS. NEETHU MANUAL
1ST YEAR M.Sc. NURSING
J.S.S COLLEGE OF NURSING
1ST MAIN, SARASWATHIPURAM
MYSORE- 570009
GUIDE:
Mrs. ANITHA VICTORIA NORONHA
ASSISTANT PROFESSOR
JSS COLLEGE OF NURSING
1ST MAIN, SARASWATHIPURAM
MYSORE – 570009
BATCH: 2010-2012
PROFORMA FOR REGISTRATION OF
SUBJECTS FOR DISSERTATION
|1. |NAME OF THE CANDIDATE AND ADDRESS |Ms. NEETHU MANUAL |
| |(IN BLOCK LETTERS) |1ST YEAR M.Sc. NURSING |
| | |JSS COLLEGE OF NURSING |
| | |1ST MAIN, SARASWATHIPURAM |
| | |MYSORE-570009. |
|2. |NAME OF THE INSTITUTION |JSS COLLEGE OF NURSING |
| | |MYSORE |
|3. |COURSE OF STUDY AND SUBJECT |M.Sc. NURSING, |
| | |MEDICAL SURGICAL NURSING |
|4. |DATE OF ADMISSION OF THE COURSE |08-07 -2010 |
|5. |TITLE OF THE TOPIC |USE OF NSAIDs AS OVER THE COUNTER DRUGS [OTCDs]: A COMPARISON OF THE |
| | |EFFECT OF STRUCTURED TEACHING PROGRAMME ON THE KNOWLEDGE, ATTITUDE |
| | |AND PRACTICES OF RURAL AND URBAN ADULTS FROM SELECTED DISTRICTS OF |
| | |MYSORE. |
6. BRIEF RESUME OF THE INTENDED WORK
6.0 INTRODUCTION
The word ‘health’ is derived from the old English word ‘hale’ meaning wholeness, a being whole, sound or well. In Medilexicons medical dictionary the meaning of health is the state of the organism when it functions optimally without evidence of disease or abnormality.1
Health promotion is the art and science of helping people to discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them in changing their lifestyle to move towards a state of optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual and intellectual health. Lifestyle change can be facilitated through a combination of learning experiences that enhances awareness, increase motivation, and build skills and most important, through the creation of opportunities that open access to environments that make positive health practices the easiest choice.2
Drugs play an important role in restoring the health of public. A drug is a chemical substance used as the treatment, prevention or diagnosis of disease or otherwise to enhance physical or mental well-being. A medication or medicine is a drug taken to cure or ameliorate any symptoms of an illness or medical condition.3
Self medication can be defined as obtaining and consuming drugs without the advice of a physician. Mostly the easily available Over The Counter Drugs [OTCDs] are self medicated by some older adults. Even in developed countries like USA, every year thousands of unnecessary hospitalisations occur due to misuse of non-prescription drugs .In a drug utilization study in USA, it was found that even medications that are contraindicated in pregnancy were misused at a high rate.4
In developing countries like India, availability of a wide range of drugs coupled with inadequate health services, result in increased self medication by the people. Although OTCDs are meant for self medication, their improper use leads to serious side effects. Symptomatic treatment by OTCDs may relieve the discomfort but may result in increased complications and hospitalisations. It is seen that people use OTCDs improperly due to lack of knowledge of their side effects and their interaction with other drugs. The adverse effects caused by OTCDs are found to be more in extreme ages, children, geriatric people, and in pregnant and lactating mothers and some of the effects can be deleterious causing even death.4
According to a survey conducted to detect the use of analgesics reported that various analgesics were frequently used by 78% of the surveyed population. As many as 17% to 23% of the surveyed population used OTCDs each week for the management of headaches, fever, toothache and muscle cramps. The widely used OTCDs included acetaminophen and NSAIDs. More over 43% of the surveyed population did not know about the side effects and their interaction with other drugs.5
6.1 NEED FOR THE STUDY
Dispensing of drug is often regulated by government into three categories-Over The Counter Drugs [OTCDs], behind the counter drugs [BTCDs] which are dispensed by a pharmacist without needing a doctor’s prescription and prescription only medication [POM] which must be prescribed by a licensed medical professional. Over the counter drugs are medications which can be purchased at any local pharmacy without the doctor’s prescription.6
NSAIDs are medications with analgesic, antipyretic and anti inflammatory effects. It is reported that some patients are at risk of developing side effects after taking NSAIDs. In fact there are possible side effects to anybody who takes these drugs. These include gastrointestinal side effects, cardiovascular effects, renal and hepatic effects.7
According to an estimation, the most commonly used medications in the world are NSAIDs with as many as 30 million people taking a NSAID each day as OTCDs and in prescription forms. It has been reported that long term use of NSAIDs has been associated with gastrointestinal and renal complications. NSAID gastropathy is the most significant side effect caused by this drug. NSAID related gastrointestinal side effects such as peptic ulcer and gastrointestinal bleeding are the cause of 200,000 to 400,000 hospitalisations and 16500 deaths annually. 8
According to a survey conducted to assess the awareness and use of OTC pain medications among patients in emergency departments, a significant use of OTC pain medication among patient population was revealed. The result revealed the fact that 67% of the subjects used NSAIDs, 40% of the surveyed population did not know about the toxic interactions caused by these drugs and 60% did not know about the relationship between these drugs and hepatic and renal diseases. As many as 50% of them had disclosed the fact of taking NSAIDs as OTCDs to their physician.9
According to a survey of 807 adult house holds in United States regarding the perceptions of NSAID users on the effectiveness of the drugs and their safety and the knowledge regarding the side effects and medical complications associated with OTDCs and prescription pain killers, it was found that 54% were not aware of side effects, and as many as18% had already experienced side effects .The commonly reported side effects were stomach pain, internal bleeding and ulcers. Similarly, the users of prescription pain killers too were unaware of their risk for complications. It was reported that every day more than 36 million people take NSAIDs as OTDCs for pain relief, head ache, arthritis, with nearly 25% exceeding the recommended doses.10
Even though NSAIDs are considered as an important weapon in relieving the pain and inflammation, the ill effects caused by these cannot be neglected. It has become clear that most of the people taking NSAIDs as OTCDs are not aware of their side effects and interaction with other drugs. In order to protect the public from the ill effects caused by NSAIDs awareness should be created in the minds of the people.
An interventional study to evaluate the knowledge and attitude of general population regarding the use of NSAIDs revealed that, out of 348 adults, 30% could not spontaneously remember any NSAID and 90% of them did not remember any medical reaction. Self medication was as common and usual as medical prescription. It was concluded that, passive distribution of pamphlets or informative material was useless and an active sensitizing intervention is necessary to enhance knowledge and promote positive attitude and practices among public.11
The review of literature and the clinical experience of the researcher revealed that the use of OTCDs is increasing among people. Most of the times the drugs, usually NSAIDs were purchased and used without even being aware of their effects and side effects. There are very few published studies available regarding the self medication pattern among Indian population. Researcher has observed that there is a lack of research studies regarding the effectiveness of STP on the knowledge, attitude and practice of adults regarding the use of NSAIDs. Hence, the present study is aimed comparing the effect of Structured Teaching Programme on the knowledge, attitude and practice of rural and urban adults regarding the use of NSAIDs as OTCDs.
6.2 REVIEW OF LITERATURE
Incidence of the frequency of use of over the counter drugs in India and Abroad
A published report on the adverse effects of the use of NSAIDs says that NSAIDs are the most commonly used and abused drugs in the world today. Annually about 20,000 tonnes of aspirin is consumed in US alone. Moreover, the unwanted effects of aspirin the earliest known NSAID are also reported which includes erosion of the upper Gastrointestinal tract, bronchospasm, nasal allergies, inhibition of cartilage repair etc. Besides prolonging bleeding and causing gastric ulcers, Aspirin and other NSAIDs can trigger asthmatic attacks.12
The survey conducted among 4799 American adults to assess the frequency and indication of the use of NSAIDs as OTCDs and to what extent the public is aware of the side effects revealed that NSAID were used by 17% of the surveyed population. Of these 30% used only prescription, 32% used only OTCDs and 38% used both prescription and OTCDs. Among 38% dual users, 30% used more prescription, 35% more OTCDs and 35% used prescription and OTCDs in the same amount .It was concluded that , NSAIDs as OTCDs were widely used without being aware of the side effects. It was also recommended that, an educational intervention is necessary for both patients and physicians.13
A cross sectional study was conducted to determine the Self –medication pattern among urban population in Jammu city. In this study 600 nuclear families were selected randomly by stratified sampling; Jammu city was arbitrarily divided in 10 sections and 60 families were randomly selected from each section. The families under study were further classified into two classes: class-A with head of the family having qualification more than 12th standard and class-B with qualification less than 12th standard. Majority [380] of the families were included in class-A and 220 families in class-B. A simple questionnaire was prepared and each family was interviewed. In class- A, the use of NSAIDs was 86% and in class- B the use was 57%. Among class-A, NSAIDs were widely administered as self medication .It was concluded that educated adults have more affinity towards self medication than the less educated adults. According to their literature review, it was stated that previous studies have shown the prevalence of self-medication as 37% in urban population and 17% in rural population in India, where as 12.7% to 95% in other developing countries. More over the self medication practice was seen more commonly in urban population than the rural population.4
KNOWLEDGE ATTITUDE AND PRACTICE OF PEOPLE REGARDING THE USE OF OVER THE COUNTER NSAIDS
An explorative survey to explore patient experiences of purchasing OTCDs in Flemish community pharmacies was conducted using anonymous postal Questionnaire. The response rate was 46% .The results revealed that 61% of patients contacted pharmacists for OTCDs and only 29% contacted physician. As many as 75% of the patients felt that pharmacist provided sufficient information about OTC medicine use. Patients tended to purchase OTCDs for acute treatment of pain, gastrointestinal conditions, common cold cough or musculo-skeletal pain. It was concluded that there should be coordinated communication between pharmacists and physicians; and maintenance of record of use of OTCDs with pharmacists.14
An empirical study was conducted to evaluate the factors contributing to the purchase of OTCDs in Bangladesh. In this study, 280 samples were selected randomly and a structured questionnaire with 5-point scale were mailed to them. It was revealed that 30%-40% of them especially women, elderly, poor and the ultra poor have under taken self medication for managing illness. As many as 56.2% of the sample believed that the medicine of any kind should be bought with an authorised prescription. Contrarily, the evidence showed that, majority [83.4%] of them have bought medicines without prescription and only 54.8% had had knowledge about the term OTCDs. Some of the factors contributed for the use of OTCDs included past experience with the drugs, the belief that OTCDs are safe to use, promotional activity by the Drug Company and distrust over the physicians. However, many people with low educational background were not even aware that OTCDs can cause life threatening side effects as they believed that every medicine is for cure. 15
A cross sectional study was conducted to assess the self medication pattern of older clients with high blood pressure attending blood pressure clinics. In this study the personal interview survey of 667 people revealed that 65% of the sample used a combination of treatment-OTCDs or drug –alcohol combination with possible adverse reactions. In the survey, 99 of the subjects disclosed that they took some pain medication over the month preceding the survey; 49 reported taking an OTC NSAID. Among the NSAID users, 46.9% reported taking NSAID for pain for three or more days at a time and 36.7% were taking NSAIDs daily. The study also revealed that chronic NSAID use increased blood pressure in both normotensive and untreated hypertensive patients. Additionally, NSAID use had been found to counter act the antihypertensive effect of Thiazide diuretics. Though, the results were not very clear and generalisable, it was recommended that future research is necessary to understand the pattern and factors of use of OTCDs among adult population.16
In a survey to assess the frequency and the use of NSAIDs as OTCDs, among the 4263 interviewees, 83% reported OTC analgesic use in the past year; 15% of them used daily, 29% used several times a week. Women used more OTC pain medications than men. Majority [42%] of people used OTCDs for arthritic joint pain and 41% for back pain and 40% for muscle cramps. Majority [61%] of the people reported that they used OTCDs because it was easy to purchase and they also believed that OTCDs were as effective as prescription drugs. Among them, 30% felt that there were no potential side effects associated with these drugs.12
A survey to investigate the general public’s opinion on perception of OTCDs including the misuse of such preparations was conducted using a structure interview technique. The structured interview schedule consisted of four sections namely attitude towards community pharmacy, attitude towards use of OTCDs, views on OTCDs and knowledge and opinion of misuse of OTCDs, a 1000 members were interviewed. The results revealed that, 74.6% of them visited a community pharmacy at least once a month and 86.4% of them always followed the directions of the product. The survey revealed that the general public had a high level of awareness of the abuse potential of OTCDs.17
A retrospective study analysed the records of 106 patients who underwent endoscopy for upper GI bleeding and revealed that 28 [26.4%] patients used NSAIDs. Among 25 patients with erosive mucosal disease, 19 [76%] had a history of NSAID ingestion prior to the onset of symptoms of bleeding.18
A study to find out the adverse effects of the use NSAIDs revealed that NSAID use had been linked to intestinal damage. In this study among a group of arthritis patients with a history of NSAID use, 70% of the sample population were found to have intestinal erosion; and25% had severe large lesions in the gut.19
A literature review based on a research study stated, that NSAIDs are the major contributors to heart problems. It was found out that NSAIDs decrease the ability of the body to excrete excess salt and water, resulting in fluid retention and further leading to congestive heart failure. There was evidence that NSAIDs are a major factor for 20% of hospital admissions for congestive heart failure.20
According to a research study to find the effect of NSAIDs on pregnancy revealed thatNSAIDs taken by pregnant women dramatically increased the risk of miscarriages. In this study those who took NSAIDs during pregnancy had an 80% increase in miscarriages. It was scientifically established that NSAIDs interfere with the implantation of a fertilized egg in the uterus.21
A study to find out the adverse effects of NSAIDs revealed that NSAID use has been associated with hypersensitive reactions including asthma, respiratory problems and urinary problems. It was proved that 8-20% of adult asthmatics experience bronchospasm following ingestion of aspirin and other NSAIDs.22
A study conducted on the adverse effects of the use of NSAIDs revealed that prolonged use of NSAIDs may lead to occult gastrointestinal bleeding with anaemia, gastritis, epigastric pain, dyspepsia, duodenal ulcer with perforation and haemorrhage and ulcerative oesophagitis. NSAIDs may cause water retention in most reported cases and had been the cause of cerebral oedema with effect on central nervous system and increased the risk of cardiovascular disorders. Besides the gastrointestinal adverse effects of NSAIDs, the other adverse effects are observed in the renal system as well. Some of the severe renal toxic effects are like renal arteriolar constriction, renal tubular necrosis, renovascular disease, renal failure hyperkalaemia and renal papillary necrosis.12
6.3 STATEMENT OF THE PROBLEM
Use of NSAIDs as Over The Counter drugs [OTCDs]: A comparison of the effect of Structured Teaching Programme on the knowledge, attitude and practices of rural and urban adults from selected districts of Mysore.
6.4. OBJECTIVES
The objectives of the study are:
1. To assess and compare the knowledge regarding the use of NSAIDs as OTCDs among rural and urban adults.
2. To assess and compare the attitude regarding the use of NSAIDs as OTCDs among rural and urban adults.
3. To assess and compare the practices regarding the use of NSAIDs as OTCDs among rural and urban adults.
4. To determine the effectiveness of structured teaching programme regarding the use of NSAIDs as OTCDs in terms of gain in knowledge, attitude and practice scores of rural and urban adults.
5. To compare the effectiveness of Structured teaching programme regarding the use of NSAIDs as OTCDs among rural and urban adults.
6. To determine the relationship between rural and urban adult’s :
▪ Knowledge and attitude
▪ Knowledge and practice
▪ Attitude and practice regarding the use of NSAIDs and OTCDs
7. To find the association of levels of knowledge, attitude and practice of rural and urban adults regarding the use of NSAIDs as OTCDs with their selected personal variables viz. age, gender, education, religion, income, previous exposure to any educational programme regarding the use of NSAIDs as OTCDs and any past complications suffered due to use of NSAIDs.
6.4.1 CONCEPTUAL FRAMEWORK
Conceptual framework is based on Pender’s health promotion model.
6.4.2 OPERATIONAL DEFINITIONS
1. Structured Teaching Programme: Refers to systematic teaching strategy aimed to provide information enhancing the knowledge of rural and urban adults regarding the use of NSAIDs as OTCDs (common drugs, effects, adverse effects and complications) which there by improves their attitude and practice.
2. Effect: In this study effect refers to positive change which is exhibited through significant gain in post test knowledge, attitude and practice scores of rural and urban adults regarding the use of NSAIDs as OTCDs.
3. a) NSAIDs: NSAIDs are any class of drugs, including aspirin, ibuprofen used for reducing inflammation and pain in rheumatic diseases. In this study NSAIDs refers to the drugs viz. aspirin, naproxen sodium, ibuprofen, celecoxib, ketoprofen and piroxicam which are frequently used by adults for various aches and pains, general discomfort and febrile illnesses etc.
b) NSAIDs as Over The Counter drugs: OTCDs are the drugs available without a prescription. In this study OTCDs refers to NSAIDs which are purchased and used by adults from many pharmacy without any valid prescription or supervision from authorized health care professionals.
4. Knowledge: Knowledge refers to the information and understanding you have in your mind. In this study it refers to the correct response of the rural and urban adults to the questions included in the structured knowledge questionnaire regarding the use of NSAIDs as OTCDs, and are expressed in terms of knowledge scores.
5. Attitude: Attitude refers to the general feelings or frame of reference about a concept or topic in the study. It refers to the general feeling or a frame of reference around which rural and urban adults organize their knowledge towards the use of NSAIDs as OTCDs, which is measured as expressed responses of rural and urban adults to attitude scale and expressed in terms of attitude scores.
6. Practice: Practice refers to habitual or customary performance of procedures. In the study it refers to the frequency of the use of NSAIDs as OTCDs by rural and urban adults during the past three months at the time of data collection and during the three weeks after administration of STP.
7. Urban adults: inhabitants of the urban area. In this study it refers to adults aged between 18 - 60 years residing in urban areas.
8. Rural adults: inhabitants of the rural area. In this study it refers to adults aged between 18 - 60 years residing in rural areas.
6.5 HYPOTHESES
The following hypotheses are formulated and will be tested at 0.05 level of significance.
H1: The mean post test knowledge, attitude and practice scores of both rural and urban adults regarding the use of NSAIDs as OTCDs will be higher than their mean pre test scores.
H2: The mean post test knowledge, attitude and practice scores regarding the use of NSAIDs will be significantly different among rural and urban adults
H3: There will be significant relationship the rural and urban adults
1. Knowledge and attitude.
2. Knowledge and practice.
3. Attitude and practice regarding the use of NSAIDs as OTCDs.
H4: The levels of knowledge , attitude and practice of rural and urban adults regarding the use of NSAIDs as OTCDs will have significant association with their selected personal variables viz. education, income, religion, gender and previous exposure to any educational programme regarding the use of NSAIDs as OTCDs.
6.6 ASSUMPTIONS
1. NSAIDs are commonly used as OTCDs by adults.
2. Adults from rural and urban setting will have some awareness about effects and side effects of NSAIDs
3. Many complications of NSAIDs taken as OTCDs can be prevented through proper education of consumers.
4. Educational programme can bring about desired cognitive and affective change in adults.
6.7 DELIMITATIONS
1. The study is delimited to use of NSAIDs as OTCDs only.
2. In this study practices regarding the use of NSAIDs as OTCDs is elicited through self reported practice questionnaires only.
3. In this study practice regarding use of OTCDs will be explored only for past three months and three weeks post administration of STP.
7.0 MATERIAL AND METHODS:
Research approach/design:
Research approach: Exploratory, comparative and evaluative approach.
Research design: One group pre test-post test pre experimental design.
VARIABLES OF THE STUDY:
Research variables:
Independent variables: Structured teaching programme regarding the use of NSAIDs
Dependent variables: Knowledge, attitude and practices of rural and urban adults regarding the use of NSAIDs as OTCDs
Extraneous variables: Age, gender, religion, education, income, previous exposure to any educational programmes regarding the use of NSAIDs as OTCDs and any past complications suffered due to use of NSAIDs.
7.1 SOURCE OF DATA
Setting: Selected rural and urban areas of Mysore district.
Population: Rural and urban adults aged between 18-60 years.
7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PRODEDURE, IF ANY):
SAMPLE AND SAMPLING CRITERIA
• Inclusion Criteria
Rural and urban adults who are:
o Aged between 18-60 years
o Available during the period of data collection
o Willing to participate in the study
o Able to comprehend and communicate English or Kannada.
• Exclusion Criteria
o Rural and urban adults who are not willing to participate in the study.
SAMPLE TECHNIQUE:
Convenient sampling
SAMPLE SIZE:
30 samples from rural adults and 30 samples from urban adults.
DATA COLLECTION TECHNIQUE:
➢ Structured knowledge questionnaire: To assess knowledge of rural and urban adults regarding the use of NSAIDs as OTCDs
➢ Structured attitude scale: To assess attitude of rural and urban adults regarding the use of NSAIDs as OTCDs
➢ Structured practice questionnaire: To assess practice of rural and urban adults regarding the use of NSAIDs as OTCDs
METHOD OF DATA COLLECTION:
1. Approval from the authorities.
2. Select samples as per the criterion and obtain informed consent.
3. Collect data as per design.
PLAN OF DATA COLLECTION
| |PRE TEST |INTERVENTION |POST TEST |
|GROUPS |DAY I |DAY 2 |DAY 9 |DAY 22 |
| | | | | |
| | | | | |
| |Assessing the | | | |
|Experimental 1 |Knowledge, | |Assessing the |Assessing the |
| |attitude and | |Knowledge, |Knowledge, |
|Rural adults |practice |STP on the use of |attitude and |attitude and |
| |regarding the |NSAIDs as |practice |practice |
|Experimental 2 |use of NSAIDs as |OTCDs. |regarding the |regarding the |
|Urban adults |OTCDs. | |use of NSAIDs as |use of NSAIDs as |
| | | |OTCDs. |OTCDs. |
PLAN OF DATA ANALYSIS:
❖ Descriptive and inferential statistical analysis.
Descriptive statistics:
o Frequency and percentage to analyze selected personnel variables
o Frequency, percentage, mean, range and standard deviation to analyze knowledge attitude and practice scores of rural and urban adults regarding use of NSAIDs as OTCDs
Inferential Statistics:
o Paired t test to compare the pre test knowledge attitude and practice scores with that of post test scores within the group.
o Independent ‘t’ test to compare the knowledge, attitude and practice scores between the groups.
o Coefficient of correlation to analyze the relationship between rural and urban adults applying
a. knowledge and attitude
b. knowledge and practice
c. Attitude and practice
o Chi square will be used to determine the significant association of level of knowledge, attitude and practice with selected personal variables of rural and urban adults.
3. Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly?
Yes, an educational programme will be administered to rural and urban adult’s regarding the use of NSAIDs as OTDCs.
4. Has ethical clearance been obtained from your institution in case of 7.3
Yes
8.0 BIBLIOGRAPHY
1. Christian Nordquist. What is health? What does good health mean? Medical News Today 2009; 21 : May1.
2. O. Donnell MP. Science and art of health promotion. American Journal of Health Promotion. 2009 May.
3. Dictionary Com. Unabridged. Wikepedia. 2007 September.
4. Sharma.R Verma. Self medication among urban adults. j. pharmacol 2000; 37: 40-43.
5. Yvette C .Torre. Proper use of OTC analgesics. Pharmacy times 2010; March 18
6. Mhra. Drugs. pharmaceutical 2008.
7. Christian Nordquist. What are NSAIDS ? What are NSAIDS used for. Medical News Today 2010; 15; February
8. Capriotti Teri. The New NSAIDS COX-2 Inhibitors. Medical Surgical Nursing 2000; December 1.
9. Weiss. Steven J. Awareness and use of Over the Counter Pain Medication a Survey of Emergency department patients. Southern Medical Journal 2002; May
10. American Gastroenterological Association. People Not Aware of The Harmful Effects OF Drugs. Medical News Today 2005; November.
11. Montano Alonso A. Torello Isertic .Knowledge and attitude of Consumers in relation to the Use of NSAIDS .Pub med February 15 2010.
12. Gujar. K.N. Sagar B. Derle DV. Adverse effects associated with the use of NSAIDS. Journal of Rheumatology 2005; 32: 2218-24.
13. Wilmox. CM.et. al. Patterns of use and public perception of over the counter pain relievers focus on NSAIDS 2005; 32: 2218-24.
14. S Simon. Patient Experience of over the counter medicine Purchase in Flemish community pharmacy 2009;31: 450-7.
15. Mujahid Mohiuddin Babu. Factors contributing to the purchase of OTCDs in Bangladesh. The internet Journal of third world medicine 2008; 18(3)
16. Patrica J Neafsey .Juliette Shellman .The internet journal of Mental Health 2001; 1
17. Mayyada Wazaifa.Eileen Shieldsb. Societal perceptive on Over the counter medicines 2004; 22: 170-6.
18. SK Musthapa. NSAIDS are found to cause adverse Gastro intestinal effects. Internet Journal of Third world Medicine 2009; 8.
19. Dr David Graham. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther 1977; 11:283-91.
20. D Henry. Consumption of NSAIDs and the development of congestive heart failure in elderly patients: An unrecognised public health problem. Archives of Internal Medicines 2000; 160: 777-84.
21. Nielsen GL, Sorensen HT, Larsen H. Risk of adverse birth outcome and miscarriage in pregnant users of NSAIDs : population based observational study and case control study. British Medical Journal 2001; 322: 266-70.
22. Lazarous J Pomeraz, BH. Incidence of adverse drug reactions in hospitalized patients. Journal of the American Medical Association 2000.284 :483-85.
9.0 SIGNATURE OF THE CANDIDATE:
10.0 REMARKS OF THE GUIDE:
RECOMMENDED AND FORWARDED
11.0 NAME AND DESIGNATION OF GUIDE (in block letters)
Mrs. ANITHA VICTORIA NORONHA
ASST. PROFESSOR
J.S.S COLLEGE OF NURSING, I MAIN, SARASWATHIPURAM,
MYSORE.
11.2 SIGNATURE:
11.3 CO-GUIDE IF, ANY:
11.4 SIGNATURE:
11.5 HEAD OF THE MEDICAL SURGICAL NURSING DEPARTMENT
PROF. SHEELA WILLIAMS
PRINCIPAL
J.S.S COLLEGE OF NURSING, I MAIN, SARASWATHIPURAM,
MYSORE.
11.6 SIGNATURE
12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL:
RECOMMENDED AND FORWARDED
PROF. SHEELA WILLIAMS
PRINCIPAL
J.S.S COLLEGE OF NURSING, I MAIN, SARASWATHIPURAM,
MYSORE.
12.2 SIGNATURE
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