JPMA. The Journal of the Pakistan Medical Association
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Reliance on revenue generated from tobacco is one of the fundamental barriers to effective tobacco control in Pakistan. The tobacco control component of the National Action Plan for Non-Communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) deems it critical to address this issue. A range of policy and environmental strategies are part of this comprehensive effort; these involve regulating access and limiting demand through restrictions on advertising, marketing, promotion and through price and taxation. ⋯ Other priority areas include the gradual phasing out of all types of advertising and eventually a complete ban on advertising; allocation of resources for policy and operational research around tobacco and building capacity in the health system in support of tobacco control. NAP-NCD also stresses on the need to develop and enforce legislation on smuggling contrabands and counterfeiting and legislation to subject tobacco to stringent regulations governing pharmaceutical products. The adoption of measures to discourage tobacco cultivation and assist with crop diversification; integration of guidance on tobacco use cessation into health services and insuring the availability and access to nicotine replacement therapy are also part of NAP-NCD.
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In Pakistan a public-private partnership--led by the NGO Heartfile and constituted additionally by the Ministry of Health, Government of Pakistan and the WHO Pakistan office--was launched in April 2003. Mandated with the task of developing and implementing a national strategy for achieving national goals for the prevention and control of non-communicable diseases (NCDs). This was the first opportunity to mount a truly 'National Plan of Action' in Pakistan enlisting a broader range of inputs and with the Governments commitment to NCD as a priority. ⋯ The partnership has brought value to all the three partners. The government has harnessed the technical strength of a private sector partner, which in turn is contributing to the country's National Plan within the framework of priorities set by broad-based national consensus; WHO, on the other hand, is gaining experience in working in a country model in which the private sector can be supported through WHO country resources, which are typically earmarked for public sector initiatives. Work is currently underway to implement the first phase of NAP-NCD.
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Trauma fluid resuscitation continues to be a hotly debated issue. There is overwhelming experimental evidence to suggest that administration of resuscitation fluids is not entirely innocuous. Aggressive intravenous crystalloid administration in the presence of uncontrolled hemorrhage promotes continued bleeding and increases mortality. ⋯ However most prudent trauma surgeons propose, that a policy of judicious fluid administration to maintain the MAP in the 60-80 mmHg range is advisable and appropriate. Fluid resuscitation in trauma should be considered a double edged sword (too much too early or too little too late!). It should not be considered definitive therapy; as in a number of trauma patients it is only a temporizing measure, until surgical control of bleeding can be achieved.
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Biography Historical Article
In memory of Dr. Sarwar Jahan Zuberi editor of Pakistan Medical Association (Centre) 1974 - 2004.
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Clinical Trial
Patient controlled intravenous analgesia (PCIA) in postoperative surgical patients: an audit.
We conducted an audit for the evaluation of the effectiveness, adverse effects and degree of patient satisfaction with Patient Controlled Intravenous Analgesia (PCIA) for postoperative pain control in surgical patients. ⋯ Patient controlled intravenous analgesia is an excellent method of postoperative pain relief, which provides a high degree of satisfaction to the patients.