Background: One way to target polypharmacy and inappropriate medication in hemodialysis (HD) patients is with medication deprescribing. Objective: To assess the impact of implementing a pharmacist-led deprescribing program on medication adherence among HD patients. Method: A prospective interventional, one-group pretest-posttest-only design study was conducted at a hemodialysis center in Wasit Governorate, Iraq. Medication reconciliation followed by medication review based on the deprescribing program was done for all eligible patients, and the patients were monitored for three months for any possible complications. Results: Two hundred and seventy patients were screened for eligibility. Only one hundred and eighteen were enrolled in the deprescribing program. The median age was 51.5 years, 56.8% were males, and hypertension was the most common etiology for their chronic kidney disease (CKD); 78% had comorbidities. After deprescription, there was a significant reduction in the number of medications from 6.0 to 4.0 and a reduction in the number of pills from 7.0 to 5.0. Medication adherence accessed using the Arabic version of Morisky, Green, and Levine’s (MGL) adherence scale also had a significant reduction from 2.0 to 1.0. Conclusion: A pharmacist-led deprescribing program is a successful strategy for decreasing the number of medications and daily pills prescribed while simultaneously improving hemodialysis patients' adherence to their regimens without compromising the patient’s safety.
A three-stage learning algorithm for deep multilayer perceptron (DMLP) with effective weight initialisation based on sparse auto-encoder is proposed in this paper, which aims to overcome difficulties in training deep neural networks with limited training data in high-dimensional feature space. At the first stage, unsupervised learning is adopted using sparse auto-encoder to obtain the initial weights of the feature extraction layers of the DMLP. At the second stage, error back-propagation is used to train the DMLP by fixing the weights obtained at the first stage for its feature extraction layers. At the third stage, all the weights of the DMLP obtained at the second stage are refined by error back-propagation. Network structures an
... Show MoreThis paper presents a new design of a nonlinear multi-input multi-output PID neural controller of the active brake steering force and the active front steering angle for a 2-DOF vehicle model based on modified Elman recurrent neural. The goal of this work is to achieve the stability and to improve the vehicle dynamic’s performance through achieving the desired yaw rate and reducing the lateral velocity of the vehicle in a minimum time period for preventing the vehicle from slipping out the road curvature by using two active control actions: the front steering angle and the brake steering force. Bacterial forging optimization algorithm is used to adjust the parameters weights of the proposed controller. Simulation resul
... Show MoreIs to obtain competitive advantage legitimate objective pursued by all organizations to achieve, because they live today in environments of rapid change and dynamic in order to meet the demands of the customer changing as well as intense competition between the organizations, which requires them to get the location of competitive markets in order to do this will remain to do the building and strengthening competitive advantage to be able to achieve, but that this feature is not easy and is not only through the identification and use of a successful strategy for a competitive standard and then manage it successfully. Hence the research problem of determining the sources of differentiation strategy and its impact on the dimensions of compe
... Show MoreIn vitro tests have been carried out to find out the efficacy of watery extracts of garlic Allium sativum and hot pepper Capsicum spp. against the trophozoites of Entamoeba histolytica cultivated in liver infusion agar media at 37 c . The doses of ( 0.01, 0.05 ,0.1, 0.5, 1 ml )of garlic and hot pepper watery extracts were added to certain number of E. histolotica trophozoits for exposure time of 24 hrs., the mortality percentage of trophozoites treated with garlic extract were ( 14.82 %, 31.05% ,46.16% , 64.29% , 92.7%) respectively , these percentages were very close to that obtained from the treatment with the hot peper extract which were (17.86%, 32% , 44% ,66.67% ,100%) respectively . Generally these results showed that the ga
... Show MoreGiardia lamblia parasite was isolated from the diarrhea samples of patients with Giardiasis dysentery and was developed in HSP media, four mice groups have been used to find in vivo efficacy of two concentrations (128,256) mg/ml of chlorophorm extracts from Cladophora glomerata algae against Giardia lamblia parasite as compared with (Flagyl) by measuring several biochemical markers as ( GPT and GOT) enzymes ,sodium ,potassium and iron concentration as well as counting the number of parasitic cysts in each mice groups. The results demonstrate that levels of GPTA GOT enzymes have been decreased in mice treated with algal extract. As for the concentration of the Sodium, Potassium and Iron increased in mice treat
... Show MoreMarketing information system (KMIS) is an essential factor of developing business’ performance and getting sustainable success. The main goal of the research is to measure effect of MIS on customer orientation and product innovation. Also, another goal is to analyze the mediation role of product innovation in relationship MIS and customer orientation. This study sought to analyze the marketing information system and measure its effect on the customer orientation and product innovation. The data of the study were collected using questionnaire. The data were analyzed using statistical tools and SPSS programming. The results of the study showed that the KMIS can positively and significantly effect product innovation. Also, t
... Show MoreIn this paper, the researcher suggested using the Genetic algorithm method to estimate the parameters of the Wiener degradation process, where it is based on the Wiener process in order to estimate the reliability of high-efficiency products, due to the difficulty of estimating the reliability of them using traditional techniques that depend only on the failure times of products. Monte Carlo simulation has been applied for the purpose of proving the efficiency of the proposed method in estimating parameters; it was compared with the method of the maximum likelihood estimation. The results were that the Genetic algorithm method is the best based on the AMSE comparison criterion, then the reliab
... Show MoreThe dividends is one of difficult and important decisions taken by the administration in the economic units, because this decision has a direct impact on the investor and economic unit, so the main objective of any investor is achieve earnings, as well as information borne by dividends about the earnings quality of the economic unit and the level and efficiency of management to achieving earnings.
The research aims at explaining the effect of the dividends policy on the earnings quality in the companies listed in the Iraq Stock Exchange. The Miller model was used to measu
... Show MoreMagnetic Abrasive Finishing (MAF) is an advanced finishing method, which improves the quality of surfaces and performance of the products. The finishing technology for flat surfaces by MAF method is very economical in manufacturing fields an electromagnetic inductor was designed and manufactured for flat surface finishing formed in vertical milling machine. Magnetic abrasive powder was also produced under controlled condition. There are various parameters, such as the coil current, working gap, the volume of powder portion and feed rate, that are known to have a large impact on surface quality. This paper describes how Taguchi design of experiments is applied to find out important parameters influencing the surface quality generated during
... Show MoreFrom a large number of bacterial samples collected from different hospital in Iraq in central health laboratory ,only ten isolates were identified primary as Vibrio. A number of morphology and biochemical test were carried out to complete this identification that showed all bacterial isolates were related to Vibrio cholerae .In this study all Vibrio isolates were investigated for Bio typing and the result showed that all (10) isolate were related to (Eltor biotypes) .Also, the susceptibility test towards eight antibiotics were carried out .
Results shows that ciprofloxacin , Norfloxacin, Erythromycin, Ampicillin, ceftriaxone and Amikacin were the most effective
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