Journal articles on the topic 'Oral medication Problems, exercises, etc'

This review presents the problems that arise when learning Tamil and the solutions for it, which is our mother tongue, and which has been a virgin language for a long time. Solutions to problems in learning can be found through oral training and error free writing training. Oral training should be given through different and flexible exercises. The speech of the linguist should be an example to eliminate the shortcomings of unedited speech. The difference in the duration of the writing of the characters and the place of birth of a word should be clearly stated through individual training and group training. Writing training plays an important role in providing error & free writing training. Being able to write without error is made possible by clear pronunciation, oral reading, relaxed writing, checking what is written, knowing the rules of grammar etc.

4608 Background: Oral therapies (angiogenesis inhibitors and mammalian target of rapamycin (mTOR) inhibitors) for renal cell carcinoma (RCC) have demonstrated significant improvements in progression-free survival but also possess toxicities. The objective of this study was to evaluate whether different toxicities of oral RCC therapies had equal importance to patients. Methods: US adults from the Kidney Cancer Association with a self-reported diagnosis of RCC completed a web-enabled survey. Respondents were asked to select the 3 most and 3 least troublesome toxicities from a list of 20 common RCC therapy toxicities. For each respondent, a value of 1 was assigned to each of the 3 most troublesome toxicities, a value of -1 was assigned to each of the 3 least troublesome toxicities, and a value of 0 was assigned to the remaining toxicities. A straight count method was applied to estimate the mean relative importance of each toxicity. Respondents also answered 10 treatment-choice questions, each of which included a pair of hypothetical RCC medication profiles described by survival, toxicities, and serious adverse events. Four toxicities including fatigue, mouth sores, hand-foot syndrome, and stomach problems were included in both exercises. Results: 264 of the 272 respondents completed the entire ranking exercise. Among the 20 toxicities, stomach problems was the most troublesome and was assigned an importance of 10. Changes in hair color was the least troublesome and was assigned an importance of 0. Patients ranked fatigue (8.2), mouth sores (7.7), hand-foot syndrome (6.6) by order of importance. When given choices among eliminating severe toxicities, fatigue was as important as stomach problems, both fatigue and stomach problems were more import than mouth sores, and mouth sores was more important than hand-foot syndrome; although not statistically significant. Conclusions: This statistical approach offers insight into those toxicities important to patients on chronic RCC therapies.

Relevance. The article presents an analysis of the key dental problems during the pandemic of the novel coronavirus infection (COVID-19), discussed on the platform of the interdisciplinary all-Russian online conference „Prevention of cross-infection at dental appointments in the context of the COVID-19 pandemic”. The high professional interest of dentists in the problems of high risk of transmission of infection at a dental appointment, the role of dental manifestations in the general symptom complex of COVID-19, the possibilities of testing saliva for SARS-CoV-2, the peculiarities of providing specific types of dental care in different periods of a pandemic, dental (hygienic) accompanying patients in outpatient and inpatient treatment, including in intensive care units. Based on the analysis of existing data on the immunopathogenesis of the disease, the main risk factors and routes of infection, the principles of systematization of COVID-associated diseases (conditions) of the oral cavity, the proposed approaches to their correction and treatment were discussed. Based on the results of our own observations and analysis of foreign publications, clinical variants of the manifestation of the disease (or its medication support) in the oral cavity have been analyzed. The important role of interdisciplinary approaches (dentists, healthcare organizers, epidemiologists, microbiologists, immunologists, etc.) to solving dental problems during a pandemic is emphasized. The role of modern IT-technologies, telemedicine and teledentistry in the implementation of educational and scientific-practical activities for the medical and dental community during a pandemic is highlighted.

Clinical reasoning is the specific cognitive process used by health care practitioners to formulate accurate diagnoses for complex patient problems and to set up and carry out effective care. Athletic training students and practitioners need to develop and display effective clinical reasoning skills in the assessment of injury and illness as a first step towards evidence-based functional outcomes. In addition to the proper storage of and access to appropriate biomedical knowledge, an equally important component of effective clinical reasoning is the ability to select and interpret various conclusions from the mounting quantity of evidence-based medicine (EBM) sources. In assessing injury and illness, this competency is particularly reliant upon experience, skill execution, and available evidence pertaining to the diagnostic accuracy and utility of various special tests and physical examination procedures. In order to both develop and assess the ability of our students to integrate EBM into their clinical reasoning processes, we have designed exercises and evaluations that pertain to evidence-based clinical decision making during oral practical examinations in our assessment of athletic injury labs. These integrated oral practical examinations are designed to challenge our students' thinking and clinical performance by providing select key features of orthopaedic case pattern presentations and asking students to pick the most fitting diagnostic tests to fit that particular case. Students must not only match the appropriate special/functional tests, etc, to the case's key features, but also choose and explain how useful the chosen tests are for the differential diagnosis process, relative to the best diagnostic evidence. This manuscript will present a brief theoretical framework for our model and will discuss the process we use to evaluate our students' ability to properly select, perform, and explain various orthopaedic examination skills and the relevant evidence available. Specific examples of oral practical exam modules are also provided for elucidation.

This article proposes the results of performed work, which aims are to prepare junior schoolchildren with severe speech disorders to solve arithmetic problems in speech therapy classes. Our previous research has found that children with severe speech disorders had difficulty solving arithmetic problems. In the process of preparing junior schoolchildren with severe speech disorders to solve arithmetic problems in speech therapy classes, we observed specific errors at the level of: pronunciation of sounds, words; sentence construction; text translation. To overcome them, we used correction tasks. They were offered to children to perform only when they saw in them a mistake of a certain type, and therefore did not include these tasks in the text of the lesson, and offered them as tips in the working mode. The duration of these correction tasks is 1-2 minutes. The purpose of their use is the awareness of children with severe speech disorders of mistakes and formation of their skills of independent control over their own speech. In order to overcome errors, we offered different tasks based on analytical systems: visual, auditory, tactile-kinesthetic, changing them each time. The final analysis of the features of speech therapy classes has shown that in order to overcome specific errors in oral and written speech among pupils with severe speech disorders during speech therapy classes was effective to use not only tasks for speech development, but also corrective exercises that were involved in different situations depending on the manifestation. In particular, to correct the phonetic side of speech, pupils with severe speech disorders were taught to focus on analytical systems: auditory – associating speech sounds with different sounds of the environment; tactile-kinesthetic – feeling vibration; visual – imagining the articulatory image and associating the sound of speech with visual support. In the future, based on the concise tips of a speech therapist (figurative, gestural, facial expressions, etc.) children were offered to correct mistakes. And when the tips were taken away, they were applied only when needed to individual pupils with severe speech disorders.

Background. The main problems of the postoperative period include organ dysfunction (“surgical stress”), morbidity due to hypothermia, pain, hyper- or hypovolemia, cognitive dysfunction, sleep disturbances, immobilization, semi-starvation, constipation, thromboembolism, anemia, postoperative delirium and more. A multimodal approach to optimizing enhanced recovery after surgery (ERAS) includes improving the preoperative period, reducing stress and pain, exercise, and switching to oral nutrition. These measures accelerate recovery and reduce morbidity. Objective. To describe the measures required for ERAS. Materials and methods. Analysis of literature sources on this issue. Results and discussion. The majority of postoperative complications are associated with the so-called surgical stress involving the release of stress hormones and the start of inflammatory cascades. The stress response is triggered not only directly as a result of surgery, but also as a result of the use of regional anesthesia and other medications. Mandatory prerequisites for ERAS include procedure-specific dynamic balanced analgesia, as well as patient blood management (PBM). The latter consists of hematopoiesis optimization, minimization of bleeding and blood loss, improvement of anemia tolerability. The presence of preoperative anemia before joint replacement significantly increases the number of complications in the 30-day period (Gu A. et al., 2020). Preoperative anemia also leads to the unfavorable consequences of other interventions, which underlines the need to detect and treat it early. An optimal infusion therapy with a positive water balance (1-1.5 L) is an integral component required for ERAS. Balanced solutions should be used; opinions on the use of colloids are contradictory. Venous thrombosis remains a significant problem, as immobilization is an important pathogenetic mechanism. The question of optimal prevention of this condition has not been clarified yet. In 40-50 % of cases after major surgery and in <5 % of cases after minor interventions, the patient develops postoperative orthostatic intolerance. The mechanisms of the latter are a decrease in sympathetic stimulation against the background of increased parasympathetic stimulation; the effects of opioids and inflammation are likely to play an additional role. Preventive methods have not been definitively established, α1-agonists (midodrine) and steroid hormones are likely to be effective. Unfortunately, for most of these problems, there is a gap between the available scientific evidence and the actual implementation of the recommended procedures. The ERAS Society has created recommendations for the management of patients, undergoing a number of surgical interventions (gastrectomy, esophagectomy, cesarean section, oncogynecological surgeries, etc.). For example, recommendations for colon interventions include no premedication and bowel preparation for surgery, use of middle thoracic anesthesia/analgesia, administration of short-acting anesthetics, avoidance of sodium and fluid overload, use of short incisions, absence of drainages, use of non-opioid oral analgesics and non-steroid anti-inflammatory drugs, stimulation of intestinal motility, early removal of catheters, oral nutrition in the perioperative period, control of surgery results and adherence to treatment. Knowledge of procedure-specific literature data and recommendations, multidisciplinary cooperation, monitoring, identification and sharing of methods that have economic advantages are necessary for the ERAS improvement. Outpatient surgery and one-day surgery are becoming more and more common. In a study by N.H. Azawi et al. (2016) 92 % of patients after laparoscopic nephrectomy were discharged home within <6 hours after surgery. Repeated hospitalizations of these patients were not recorded. In a study by G. Ploussard et al. (2020) 96 % of patients after robotic radical prostatectomy were discharged home on the day of surgery; 17 % required re-hospitalization. Early physical activity is an important component of rapid recovery after surgery. There is an inverse relationship between the number of steps per day and the severity of pain after a cesarean section. Despite a large body of literature on the subject, large-scale randomized trials and definitive procedure-specific recommendations are still lacking. This justifies the need for thorough pathophysiological studies and, once completed, randomized controlled or cohort studies. The objectives of these studies should include clear clarification of the pathophysiology of postoperative organ dysfunction, the introduction of a procedure-specific and evidence-based set of perioperative measures, monitoring of purely surgical and general medical consequences of surgeries, identifying areas for improvement and finding new treatment and prevention strategies. Conclusions. 1. Multimodal approach to ERAS optimization includes improvement of the preoperative period, reduction of stress and pain, physical activity, transition to oral nutrition, etc. 2. Procedure-specific dynamic balanced analgesia, PBM, optimal infusion therapy with a positive water balance are the mandatory prerequisites for ERAS. 3. For the majority of problems of the perioperative period, there is a gap between the available scientific evidence and the actual implementation of the recommended procedures. 4. New preclinical and clinical studies are needed to form definitive guidelines for the management of patients in the perioperative period.

Diabetic patients generally require life-long treatment and continuous follow up. In spite of their benefit of achieving glycemic control, there are many safety concerns with antidiabetic drugs such as gastrointestinal side effects, metabolic complications, central nervous system (CNS) symptoms, musculo-skeletal problems, genito-urinary disorders like UTI, development of peripheral oedema, weight gain etc. To highlight pattern of Adverse Drug Reactions with use of oral anti-diabetic drugs.All suspected Adverse Drug Reaction Reporting Form having any anti-diabetic drug as suspected cause of ADR were collected. The reported ADRs on the notification forms, after being confirmed by the physician-in-charge, were assessed for causality using WHO-UMC Causality Categories14, preventability using Modified-Schumock and Thornton scale15 and severity using Modified Hartwig and Siegel scale.: The data from the forms was presented in tabular form and data will be interpreted by using Microsoft Excel 365 software. Adverse drug reaction related to gastrointestinal system were most reported ADRs (41.31%). Among GI adverse events, nausea was mostly reported ADR and it was mostly associated with DPP-4 inhibitors. Hypoglycemia was most frequently observed in patients taking sulfonylureas. Causality assessment according to WHO-UMC criteria showed 61.68% ADRs had probable causality while 37.43% had possible causality and only 0.90% had certain causality. Most of the ADRs in our study were non-preventable (57.78%) & were of mild to moderate grade. Hypoglycemia continues to be major concern in patients taking anti-diabetic medications and sulfonylureas were commonest drugs responsible for it. As anti-diabetic medication is generally taken for lifetime, the risk of development of adverse effects related to concurrent related co-morbidities of patients shouldn’t be ignored while prescribing. The physician should report these adverse effects to ADR monitoring centre, so that proper signal could be generated for the welfare of the society.

Background and Aims: Asthma is a chronic disease that reduced quality of life. People with asthma are less active than their peers, leads the patient to become more and more sedentary. Asthma can cause postural changes in the spine, shoulder girdle, which is a good option to prevent and correct these changes. The use of complementary therapies along with medication for people with chronic asthma can help improve posture and rehabilitation of the respiratory system, so the use of hyperkyphosis curvature correction exercises strengthens the extensor muscles of the trunk, serratus, rhomboid, and middle trapezius. On the other hand, stretching exercises have increased the flexibility of the pectoralis muscles, which has corrected the deformity of the shoulder girdle and spine, which can reduce the angle of kyphosis and round shoulder [10,11]. The use of breathing exercises in addition to improving the quality of life can reduce pulmonary function and physiological effects on the airways to reduce irritability and inflammation to the extent that it reduces the use of bronchodilators [12]. Therefore, it seems that by using the right combination of corrective and breathing exercises, on the one hand, it is possible to overcome the long-term effects of asthma, which is muscular imbalance in the shoulder girdle and cervical and thoracic spine [13], and on the other hand, with correction. Posture can reduce these complications and improve lung function by modifying the chest posture. In addition to strengthening the main and auxiliary respiratory muscles, breathing exercises also help to expand the chest [14,15]. Therefore, the aim of this study was to investigate the effect of combined corrective and respiratory exercises at home on kyphosis angle and respiratory capacity in children with asthma. Materials and Methods: The present study was a Clinical trial study with a pretest-posttest design. For this purpose, 30 children with mild asthma living in Rasht, with the approval of a pediatric pulmonologist, were included in the study purposefully and voluntarily. Subjects were randomly divided into two experimental (15 people with mean age: 10.53 ± 2.09 years) and control groups (15 people with mean age: 11.40 ± 2.13 years). Inclusion criteria included age between 8 and 14 years, mild asthma and the desire of the subject and parents to participate in the study and exclusion criteria include: older and lower ages, severe or moderate asthma, severe asthma attacks and having Scoliosis and orthopedic problems, the unwillingness of the child or parents to participate in research, musculoskeletal disorders, the child with heart disease or any disease that is prohibited by the doctor from activity and exercise, as well as the exacerbation of asthma attacks following exercise It was a training program. To start and conduct this research process, the code of ethics (IR.GUMS.REC.1398.537) and the code of IRCT20160815029373N6 from Iran Clinical Trial Registration Center were received from the ethics committee of Guilan University of Medical Sciences. Also, in all stages of the research, the Helsinki Code of Ethics was followed. Measurement of dependent variables in both pre- and post-test stages including assessment of dorsal spinal curvature (kyphosis) using a flexible ruler, respiratory capacity using spirometry, anthropometric indices (width, depth and chest circumference using a bin the experimental group performed combined corrective and respiratory exercises for eight weeks. To analyze the results of this study, dependent-t test and covariance analysis were used at significance level of p<0.05. Results: The results of analysis of covariance showed that after controlling the effect of pre-test (covariate), there is a significant difference in the results of dorsal spine curvature and respiratory capacity (FEV1 and FVC / FEV1) in the post-test between the control and experimental groups. The difference results are as follows difference between the Thoracic spine curvature (P = 0.004), FEV1 (P=0/001) ، FEV1/FVC (P=0/02) and Anthropometric indices of the chest (P = 0.001). The results of correlated t-test show that combined corrective and respiratory exercises had a significant effect on the variables of dorsal spine curvature, respiratory capacity, width, depth and chest circumference of the subjects in the training group (p <0.05). In the control group, no significant difference was observed between pre-test and post-test scores of variable width, depth and chest circumference. Conclusion: The results of this study showed that the combination of corrective and respiratory exercises in addition to reducing the curvature of chest kyphosis can have a significant effect on improving respiratory capacity and increasing chest dilatation in children with chronic asthma. However, the posture of people with chronic asthma due to respiratory struggles and overuse of the main and secondary respiratory muscles and the pattern of oral respiration changes and increases the prevalence of hyperkyphosis [6]. According to the results, it seems, combined corrective and respiratory exercises can be a positive influence on the extensor muscles of the chest improves lung function and postural correction in children with asthma. Therefore, it is recommended to therapists, coaches and exercise teachers to use combined corrective and respiratory exercises to improve the physical, postural and respiratory factors of children with asthma. Keywords

The article examines the problems and methods of teaching russian spoken speech at a chinese university, taking into account the ethnocultural characteristics of the chinese audience and the specifics of the chinese student education system. A system of methods and approaches is justified, which contributes to the effective mastery of russian spoken speech. The article describes the features of the chinese audience, complicating the mastery of russian spoken speech in the RCT lesson. The principles and exercises proposed in the article contribute to the organization of such an educational process that will ensure the achievement of a high level of communicative competence of chinese students, the author considers certain didactic techniques that allow achieving a high level of formation of foreign-language communicative competence, neutralization of passion and psychological barrier («psychological counseling», debates, «brainstorming», «fun pictures», comic dialogues, thematic autostoritelling, «black box», «director himself», roleplaying games, «lexical physical education», etc.). The article notes that the main way to overcome this is to use means, methods and techniques in the process of training based on the pedagogical impact of humor, the use of which should become an integral component of the process of teaching chinese students of oral speech and be consistently implemented in all aspects of this process: in the speech behavior of the teacher, in the selection of didactic material, in the typology of the proposed tasks. The author justifies the concept of lessons in colloquial speech as an «encyclopedia of life» and the need to expand the outlook of students by providing them with new information from the field of «background knowledge», not only aimed at expanding the lexical base, but also containing interesting information about psychological and cultural phenomena.

Abstract Background: Prophylactic treatment allows patients with haemophilia (PWH) to live an approximately normal life. The majority of German PWH receive prophylaxis. The need of frequent weekly injections may impact negatively treatment adherence. This is the expected reason which might result in increased annual bleeding rate. Therefore there is a need for half-life extended products which will be launched end of this year in Germany. However, little is known about patients' perspectives on the use of new products with extended half-life and their willingness to switch to these products. Aim: The German patient organisation DHG is interested to better understand PWH's expectations and concerns towards these new products in order to adapt their support for the haemophilia community. Methods: The study consisted of two phases: 1) conduct of separate focus groups with adult haemophilia patients and parents of haemophilic children with respect to the new long-lasting products across Germany; 2) based on the focus group results construction of a questionnaire for a systematic postal survey among DHG members with haemophilia A or B (n=1,499). Results: The postal survey included questions concerning haemophilia, knowledge about half-life of actual factor concentrates (FC) and attitudes towards actual FC and open ended questions concerning the expectations towards new products and how therapy could be facilitated. The open ended questions should give the participants the chance to write down other aspects, problems, laments and other wishes. Several aspects could be mentioned by the same subject. Out of the sent 1,499 questionnaires 697 questionnaires were sent back; mainly from adult patients (n=518), 177 from parents of haemophilic children. Patients had haemophilia A (83.7%), in a severe form (77.8%), were on prophylaxis (61.4%), mostly three times a week (47.8%) and used recombinant products (57.8%). 14.1% have had an inhibitor. Open questions were answered by 462 respondents, at least 1 to maximum 5 aspects were mentioned. Open questions on the current situation ["facilitation of therapy"] (n=302): less packaging waste (n=129), no cooling required (n=61), sc injections/oral medication/nasal medication (n=54), better supplies like perfect injection needle etc. (n=27), prefilled syringe (n=25), diversity of package size (125 iU to 4000 iU) (n=24), support in home care therapy (n=17), simpler treatment documentation (n=9), improved logistic/delivery for home treatment (n=8). Open questions for future situation (n=160) ["expectations towards new long-lasting products"]: less injections (n=492), same safety/efficacy/compatibility (n=44), better quality of life (n=22), no fridge (n=16), treatment costs/reduction-no increase (n=15), higher trough level (n=9), smaller packaging (n=8), easier handling (n=8), and many more mentioned 1- 3 times. Conclusions: The answers to the open questions in this representative survey among German haemophilia patients and parents of children with haemophilia provide important additional information and insights in the unmet needs of haemophilia patients, which will help the German patient association and pharmaceutical companies to better inform patients about the new up-coming products taking patients needs into consideration. Disclosures Kalnins: SOBI: Consultancy. Miesbach:SOBI: Consultancy. von Mackensen:SOBI: Consultancy.

PCOS, a hormone imbalance that causes infertility, obesity etc. Polycystic ovarian syndrome (PCOS) is the most frequent endocrinopathy among women of reproductive age. It is the most common female endocrine disorder with prevalence rates ranging from 4% to 18%. There are many associated condition with PCOS like obesity, many types of cancer, infertility, cardiac diseases etc. It is confirm that women who have this syndrome are at risk more than other women. The treatment of PCOS is determined by whether a woman wishes to become pregnant or not. If pregnancy is not a goal, then weight loss, oral contraceptives, and the diabetes medication. It should also include all metabolic effects and potential problems. More study and knowledge of the biology of PCOS will lead to better treatment outcomes and patient management.

Abstract Background Self-care and professional care of implants may prove difficult for elderly people who require nursing care. However, the actual state of care and problems remains unknown. In this study, we investigated the actual state of implant problems in elderly people living in their own home or in a nursing home who received visiting dental treatment. Methods We mailed questionnaire survey forms to 2339 representatives or specialists who were members of the Japanese Society of Oral Implantology, the Japanese Society of Gerodontology or the Japan Prosthodontic Society. We narrowed down the respondents to those who provided visiting dental treatment, and analyzed the actual state of implants observed during visiting dental treatment (type, care, problems, countermeasures, etc.). Results Of the 924 dentists who responded to the questionnaire survey, 291 (22%) provided visiting dental treatment. While the majority of implant types encountered in the previous 12 months were root-form implants, there were still a certain number of blade and subperiosteal implants. Daily implant care involved mostly cleaning with a toothbrush + auxiliary tools. The most frequent implant problems encountered in the past were difficulty in cleaning and peri-implantitis. Medication and antiphlogistic treatment were most frequently adopted as countermeasures to implant problems, followed by observation. When we classified the results into those for the dentists who provided implant treatment and those for the dentists who did not, we found that many of the dentists who did not provide implant treatment opted for observation or medication, while those who provided implant treatment also implemented removal of superstructure, retightening of screws, repair and so forth. Conclusions We found that many of the implant troubles encountered by dentists who provided visiting dental care were difficulty in cleaning or peri-implantitis, and that the actions taken against these troubles varied depending on the experience of the dentist performing the implant treatment. Our study also revealed that dentists who provide visiting dental care need to acquire knowledge and skills of implant treatment, to have actions prepared in case they encounter such cases, or to closely coordinate with dentists who specialize in implants.

The article deals with the problems of teaching Ukrainian collocations to those foreign students who speak Russian as a first foreign language. Acquisition of skills needed to be able to combine the proper words entails great difficulties at all stages of teaching Ukrainian as a foreign language. One of the conditions for overcoming these difficulties is the development of a system of work, which would allow foreign students to master the combinatory power of Ukrainian words as a component of the formation of mechanisms for designing sentences and coherent statements. The author presents methodical recommendations on teaching specifics of combining words in the Ukrainian language to foreigners. The article contains a description of typical errors in word combinations, which occur in the oral speech of foreign students. Hence, there is a need to identify ways to prevent and overcome manifestations of lexical interference: development of a complex of educational and training exercises; organization of an effective system for monitoring acquisition of training material. Accounting for lexical interference when studying Ukrainian as a foreign language allows foreseeing possible errors in the oral speech of Russian-speaking foreign students and reducing the number of such errors, that could facilitate the learning process and, therefore intensify it. The author recommends practicing skills of translating collocations from Russian into Ukrainian in the form of individual tasks. Developing phrase constructing skills in students, one should move from the function to form, from the value to the means of its expression, based on such universal concepts of logic and semantics, as an action, attitude, subject, object, addressee, tool, etc. In the process of mastering Ukrainian, the study of the laws governing the combinatory power of words in the context, understanding the features of a word functioning and its interaction with other words in the language system play an important role. The absence of such knowledge and language intuition causes numerous speech errors, which significantly reduce the level and quality of communicative-speech skills.

ABSTRAK Drug Related Problems (DRPs) merupakan suatu kejadian yang tidak diinginkan atau yang timbul dari suatu terapi pengobatan terhadap pasien. DRPs dapat berupa, ketidaktepatan dosis (lebih tinggi atau lebih rendah dari yang dibutuhkan), interaksi obat DM dengan obat lain, pemilihan jenis obat DM yang kurang tepat, adanya indikasi DM namun tidak mendapatkan terapi obat DM, efek samping obat yang timbul, gagal dalam menerima terapi obat (kepatuhan pasien dll). Berdasarkan hal tersebut, penulis merasa tertarik untuk mengambil judul “Analisa Drug Related Problems (DRPs) Pasien Gagal Ginjal dengan Komplikasi Diabetes Mellitus di RSUD X ”. Jenis penelitian yang digunakan dalam penelitian ini adalah metode analisis deskritif yaitu metode penelitian yang bertujuan mengetahui gambaran Drug Related Problems (DRPs) dari pengobatan injeksi insulin dan Obat Anti Diabetik Oral (OADO) terhadap penurunan fungsi ginjal. Berdasarkan penelitian yang telah dilakukan pada pasien Nefropati Diabetik yang sedang menjalani terapi hemodialisa di RSUD X pada periode bulan januari 2017 sampai dengan bulan mei 2017 diperoleh kesimpulan sebagai berikut :Terdapat 2 (94 %) pasien yang tidak memperoleh obat gagal ginjal dan 3 (81 %) pasien tidak mendapatkan obat DM dari total peresepan yang diterima, hal ini bisa disebabkan tidak terkontrolnya data pasien sebelumnya sehingga terputus pada saat pemeriksaan selanjutnya, dari 16 sampel pasien yang diteliti terjadi 9 pasien mengalami ketidaktepatan pengobatan dengan prosentase 56 %. Ketidaktepatan ini berupa pemberian dosis yang sama pada pasien yang sudah ada perbaikan kadar gula darah, hal ini dapat menimbulkan resiko hipoglikemia pada pasien tersebut., hampir seluruh sampel pasien nefropati diabetik mendapatkan dosis berlebih (100%), hasil pengamatan efek samping obat pada pasien nefropati diabetik pasien mengalami keluhan mual (31 %), pusing (25%), lemas (94 %), nyeri badan(31 %) , gatal atau alergi (12.5 %), hasil pengamatan ketidaktepatan pemilihan jenis obat, terdapat 6 sampel pasien yang mengalami ketidaktepatan pemilihan jenis obat dengan prosentase 43,75 %. Ketidaktepatan pemilihan jenis obat ini dapat berpengaruh terhadap penurunan fungsi ginjal atau memperberat fungsi ginjal penderita nefropati diabetic, hasil pengamatan interaksi obat diperoleh data interaksi antagonis terjadi 95 % sedangkan untuk interaksi sinergis terjadi 81 %, hasil pengamatan pasien tidak menerima obat, diperoleh data bahwa semua pasien memperoleh obat sesuai dengan resep ( 100 %). Kata kunci: Drug Related Problems (DRPs), penderita nefropati diabetic, rumah sakit X ABSTRACT Drug Related Problems (DRPs) is an undesirable event or arising from a therapeutic treatment of a patient. DRPs may be, inaccurate doses (higher or lower than required), DM drug interactions with other drugs, inappropriate selection of DM drugs, presence of DM indications but not DM drug therapy, adverse drug side effects, failure in receiving drug therapy (patient compliance etc). Based on this, the authors feel interested to take the title "Analysis Drug Related Problems (DRPs) Patients Kidney Failure with Complications of Diabetes Mellitus in RSUD X". Type of research used in this research is descriptive analysis method that is research method which aim to know Drug Related Problems (DRPs) from insulin injection treatment and Oral Anti Diabetic Drug (OADO) to decrease kidney function. Based on the research that has been done on Diabetic Nephropathy patients who are undergoing hemodialysis therapy in RSUD X in the period of January 2017 up to May7 2017 obtained the following conclusion: There are 2 (94%) patients who do not get kidney failure drug and 3 (81% ) patients did not receive DM medication from total prescribed acceptance, this could be due to uncontrolled patient's previous data so disconnected during subsequent examination, from 16 samples of patients studied occurred 9 patients experiencing treatment inaccuracy with percentage of 56%. This inaccuracy in the form of giving the same dosage to an existing patient improves blood sugar levels, this can lead to the risk of hypoglycemia in these patients., Almost all diabetic nephropathy patients sample get overdose (100%), observed drug side effects in patients with nephropathy diabetic patients (31%), dizziness (25%), weakness (94%), body aches (31%), itching or allergies (12.5%), observation of inaccurate selection of drugs, 6 patients the inaccuracy of the selection of drugs with the percentage of 43.75%. Inaccurate selection of this type of drug may affect the decline in renal function or aggravate the function of kidney patients diabetic nephropathy, the observation of drug interactions obtained by antagonistic interaction data occurred 95% while for the synergistic interaction occurred 81%, the observation of patients did not receive the drug, obtained data that all patients get the medicine according to the prescription (100%). Keywords: Drug Related Problems (DRPs), diabetic nephropathy patients, hospital X

Management of illness through medication is entering a new era in which growing number of novel drug delivery systems are being employed and are available for therapeutic use. Pharmaceutical research and development is currently focused on the development of drug delivery systems to target a drug to the desired organ or site with the aim of minimizing its overall distribution in the body. The oral mucosa has many properties which make it an attractive site for drug delivery but simultaneously provide several problems for researchers for effective and efficient delivery of therapeutic active agents. However, with the development of novel delivery techniques overcome several challenges. Oral mucosa delivery has many advantageslike high blood flow, rapid recovery, prevention of hepatic first-pass effect and pre-systemic elimation in gastrointestinal tract. On the other hand relatively small surface area and significant loss of drug due to swallowing and salivary flow are main limitations of buccal delivery. Different formulations including sprays, tablets, mouthwashes, gels, pastes and patches are presently used for delivery into and/or across the oral mucosa. Over the last 20 years, a wide range of formulations has been developed for buccal drug delivery systems but unfortunately few have been accomplished to be a medicine. One of the main reasons of this unsuccessful result could be the lack of the standardized methods which evaluate in vitro performance of buccal dosage forms. Thus aim of this review, to discuss the potential of buccal drug delivery and buccal dosage forms and also explore recent studies and in vitro analysesmethodology of buccal dosage forms. Peer Review History: UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file Average Peer review marks at initial stage: 4.5/10 Average Peer review marks at publication stage: 7.0/10 Name: Robert Tungadi Affiliation: State University of Gorontalo, Indonesia E-mail: rtungadi@yahoo.com Name: Dr. Sally A. El-Zahaby Affiliation: Pharos University in Alexandria, Egypt E-mail: sally.elzahaby@yahoo.com Comments of reviewer(s): Similar Articles: BUCCAL DRUG DELIVERY SYSTEM: A TOOL FOR THE EFFECTIVE DELIVERY OF PHARMACEUTICALS

IntroductionThis article addresses the experience of designing and conducting life-writing workshops for a group of clients with severe mental illness; the aim of this pilot study was to begin to determine whether such writing about the self can aid in individual ‘recovery’, as that term is understood by contemporary health professionals. A considerable amount has been written about the potential of creative writing in mental health therapy; the authors of this article provide a brief summary of that literature, then of the concept of ‘recovery’ in a psychology and arts therapy context. There follows a first-hand account by one of the authors of being an arts therapy workshop facilitator in the role of a creative practitioner. This occurred in consultation with, and monitored by, experienced mental health professionals. Life-Writing as ‘Therapeutic’ Life-story or life-writing can be understood in this context as involving more than disclosure or oral expression of a subject’s ‘story’ as in psycho-therapy – life-story is understood as a written, structured narrative. In 2001, Wright and Chung published a review of the literature in which they claimed that writing therapy had been “restimulated by the development of narrative approaches” (278). Pennebaker argues that “catharsis or the venting of emotions” without “cognitive processing” has little therapeutic value and people need to “build a coherent narrative that explains some past experience” in order to benefit from writing” (Pennebaker, Telling Stories 10–11). It is claimed in the Clinical Psychology Review that life-writing has the therapeutic benefits of, for example, “striking physical health and behaviour change” (Esterling et al. 84). The reasons are still unclear, but it is possible that the cognitive and linguistic processing of problematic life-events through narrative writing may help the subject assimilate such problems (Alschuler 113–17). As Pennebaker and Seagal argue in the Journal of Clinical Psychology, the life-writing processallows one to organise and remember events in a coherent fashion while integrating thoughts and feelings ... This gives individuals a sense of predictability and control over their lives. Once an experience has structure and meaning, it would follow that the emotional effects of that experience are more manageable. (1243)It would seem reasonable to suggest that life-writing which constructs a positive recovery narrative can have a positive therapeutic effect, providing a sense of agency, connectedness and creativity, in a similar, integrating manner. Humans typically see their lives as stories. Paul Eakin stresses the link between narrative and identity in both this internal life-story and in outwardly constructed autobiography:narrative is not merely a literary form but a mode of phenomenological and cognitive self-experience, while self – the self of autobiographical discourse - does not necessarily precede its constitution in narrative. (Making Selves 100)So both a self-in-time and a socially viable identity may depend on such narrative. The term ‘dysnarrativia’ has been coined to describe the documented inability to construct self-narrative by those suffering amnesia, autism, severe child abuse or brain damage. The lack of ability to achieve narrative construction seems to be correlated with identity disorders (Eakin, Fictions in Autobiography 124). (For an overview of the current literature on creative and life-writing as therapy see Murphy & Neilsen). What is of particular relevance to university creative writing practitioners/teachers is that there is evidence, for example from Harvard psychiatrist Judith Herman and creative writing academic Vicki Linder, that life-narratives are more therapeutically effective if guided to be written according to fundamental ‘effective writing’ aesthetic conventions – such as having a regard to coherent structure in the narrative, the avoidance of cliché, practising the ‘demonstrate don’t state’ dictum, and writing in one’s own voice, for example. Defining ‘Recovery’There remains debate as to the meaning of recovery in the context of mental health service delivery, but there is agreement that recovery entails significantly more than symptom remission or functional improvement (Liberman & Kopelowicz). In a National Consensus Statement, the Substance Abuse and Mental Health Services Administration (SAMHSA) unit of the US Department of Health and Human Services in 2005 described recovery (in general terms) as being achieved by the enabling of a person with a mental illness to live meaningfully in a chosen community, while also attempting to realize individual potential. ‘Recovery’ as a central concept behind rehabilitation can be understood both as objective recovery – that is, in terms of noting a reduction in objective indicators of illness and disability (such as rates of hospital usage or unemployment) and a greater degree of social functioning – and also as subjective recovery. Subjective recovery can be ascertained by listening closely to what clients themselves have said about their own experiences. It has been pointed out (King, Lloyd & Meehan 2) that there is not always a correspondence between objective indicators of recovery and the subjective, lived experience of recovery. The experience of mental illness is not just one of symptoms and disability but equally importantly one of major challenge to sense of self. Equally, recovery from mental illness is experienced not just in terms of symptoms and disability but also as a recovery of sense of self … Recovery of sense of self and recovery with respect to symptoms and disability may not correspond. (King, Lloyd & Meehan; see also Davidson & Strauss)Symptoms of disability can persist, but a person can have a much stronger sense of self or empowerment – that is still recovery. Illness dislocates the sense of self as part of a community and of a self with skills and abilities. Restoring this sense of empowerment is an aim of arts therapy. To put it another way, recovery is a complex process by which a client with a mental illness develops a sense of identity and agency as a citizen, as distinct from identification with illness and disability and passivity as a ‘patient’. The creative arts have gone well beyond being seen as a diversion for the mentally ill. In a comprehensive UK study of creative arts projects for clients with mental illness, Helen Spandler et al. discovered strong evidence that participation in creative activity promoted a sense of purpose and meaning, and assisted in “rediscovering or rebuilding an identity within and beyond that of someone with mental health difficulties” (795). Recovery is aided by people being motivated to achieve self-confidence through mastery and competence; by learning and achieving goals. Clearly this is where arts therapy could be expected or hoped to be effective. The aim of the pilot study was not to measure ‘creativity’, but whether involvement in what is commonly understood as a creative process (life-writing) can have flow-on benefits in terms of the illness of the workshop participant. The psychologists involved, though more familiar with visual arts therapy (reasonably well-established in Australia – in 2006, the ANZAT began publishing the Australian and New Zealand Journal of Art Therapy), thought creative writing could also be valuable. Preparation for and Delivery of the Workshops I was acutely aware that I had no formal training in delivering a program to clients with mental health illness. I was counselled during several meetings with experienced psychologists and a social worker that the participants in the three workshops over two weeks would largely be people who had degrees of difficulty in living independently, and could well have perceptual problems, could misjudge signals from outside and inside the group, and be on medication that could affect their degree of engagement. Some clients could have impaired concentration and cognition, and a deficit in volition. Participants needed to be free to leave and rejoin the workshops during the afternoon sessions. Attendance might well fall as the workshops progressed. Full ethical clearance was attained though the University of Queensland medical faculty (after detailed description of the content and conduct of the proposed workshops) and consent forms prepared for participants. My original workshop ‘kit’ to be distributed to participants underwent some significant changes as I was counselled and prepared for the workshops. The major adjustment to my usual choice of material and approach was made in view of the advice that recounting traumatic events can have a negative effect on some patients – at least in the short term. For the sake of both the individuals and the group as a whole this was to be avoided. I changed my initial emphasis on encouraging participants to recount their traumatic experiences in a cathartic way (as suggested by the narrative psychology literature), to encouraging them to recount positive narratives from their lives – narratives of ‘recovery’ – as I explain in more detail below. I was also counselled that clients with mental health problems might dwell on retelling their story – their case history – rather than reflecting upon it or using their creative and imaginative ability to shape a life-story that was not a catalogue of their medical history. Some participants did demonstrate a desire to retell their medical history or narrative – including a recurring theme of the difficulty in gaining continuity with one trusted medical professional. I gently guided these participants back to fashioning a different and more creative narrative, with elements of scene creation, description and so on, by my first listening intently to and acknowledging their medical narrative for a few minutes and then suggesting we try to move beyond that. This simple strategy was largely successful; several participants commented explicitly that they were tired of having to retell their medical history to each new health professional they encountered in the hospital system, for example. My principal uncertainty was whether I should conduct the workshops at the same level of complexity that I had in the past with groups of university students or community groups. While in both of those cohorts there will often be some participants with mental health issues, for the most part this possibility does not affect the level or kind of content of material discussed in workshops. However, within this pilot group all had been diagnosed with moderate to severe mental illness, mostly schizophrenia, but also bipolar disorder and acute depression and anxiety disorders. The fact that my credentials were only as a published writer and teacher of creative writing, not as a health professional, was also a strong concern to me. But the clients readily accepted me as someone who knew the difficulty of writing well and getting published. I stressed to them that my primary aim was to teach effective creative writing as an end in itself. That it might be beneficial in health terms was secondary. It was a health professional who introduced me and briefly outlined the research aims of the workshop – including some attempt to measure qualitatively any possible benefits. It was my impression that the participants did not have a diminished sense of my usefulness because I was not a health professional. Their focus was on having the opportunity to practice creative writing and/or participate in a creative group activity. As mentioned above, I had prepared a workshop ‘kit’ for the participants of 15 pages. It contained the usual guidelines for effective writing – extracts from professional writers’ published work (including an extract from my own published work – a matter of equity, since they were allowing me to read their work), and a number of writing exercises (using description, concrete and abstract words, narrative point of view, writing in scenes, show don’t tell). The kit contained extracts from memoirs by Hugh Lunn and Bill Bryson, as well as a descriptive passage from Charles Dickens. An extract from Inga Clendinnen’s 2006 account in Agamemnon’s Kiss: selected essays of her positive interaction with fellow cancer patients (a narrative with the underlying theme of recovery) was also valuable for the participants. I stressed to the group that this material was very similar to that used with beginning writers among university students. I described the importance of life-writing as follows: Life-writing is simply telling a story from your life and perhaps musing or commenting on it at the same time. When you write a short account of something chosen from your life, you are making a pattern, using your memory, using your powers of description – you are being creative. You are being a story-teller. And story-telling is one very important thing that makes us humans different from all other animals – and it is a way in which we find a lot of meaning in our lives.My central advice in the kit was: “Just try to be as honest as you can – and to remember as well as you can … being honest and direct is both the best and the easiest way to write memoir”. The only major difference between my approach with these clients and that with a university class was in the selection of possible topics offered. In keeping with the advice of the psychologists who were experts in the theory of ‘recovery’, the topics were predominantly positive, though one or two topics gave the opportunity to recount and/or explore a negative experience if the participant wanted to do so: A time when I was able to help another personA time when I realised what really mattered in lifeA time when I overcame a major difficultyA time when I felt part of a group or teamA time when I knew what I wanted to do with my lifeA time when someone recognised a talent or quality of mineA time I did something that I was proud of A time when I learned something important to meA memorable time when I lived in a certain house or suburbA story that begins: “Looking back, I now understand that …”The group expressed satisfaction with these topics, though they had the usual writing students’ difficulty in choosing the one that best suited them. In the first two workshops we worked our way through the kit; in the third workshop, two weeks later, each participant read their own work to the group and received feedback from their peers and me. The feedback was encouraged to be positive and constructive, and the group spontaneously adopted a positive reinforcement approach, applauding each piece of writing. Workshop DynamicsThe venue for the workshops was a suburban house in the Logan area of Brisbane used as a drop-in centre for those with mental illness, and the majority of the participants would be familiar with it. It had a large, breezy deck on which a round-table configuration of seating was arranged. This veranda-type setting was sheltered enough to enable all to be heard easily and formal enough to emphasise a learning event was taking place; but it was also open enough to encourage a relaxed atmosphere. The week before the first workshop I visited the house to have lunch with a number of the participants. This gave me a sense of some of the participants’ personalities and degree of engagement, the way they related to each other, and in turn enabled them to begin to have some familiarity with me and ask questions. As a novice at working with this kind of client, I found this experience extremely valuable, especially as it suggested that a relatively high degree of communication and cognition would be possible, and it reduced the anxiety I had about pitching the workshops at an appropriate level. In the course of the first workshop, the most initially sceptical workshop participant ended up being the most engaged contributor. A highly intelligent woman, she felt it would be too upsetting to write about negative events, but ultimately wrote a very effective piece about the empowerment she gained from caring for a stray cat and locating the owner. Her narrative also expressed her realisation that the pet was partly a replacement for spending time with her son, who lived interstate. Another strong participant previously had written a book-length narrative of her years of misdiagnoses and trauma in the hospital system before coming under the care of her present health professionals. The participant who had the least literacy skills was accepted by the group as an equal and after a while contributed enthusiastically. Though he refused to sign the consent form at the outset, he asked to do so at the close of the first afternoon. The workshop was comprised of clients from two health provider organisations; at first the two groups tended to speak with those they already knew (as in any such situation in the broader community), but by the third workshop a sense of larger group identity was being manifested in their comments, as they spoke of what ‘the group’ would like in the future – such as their work being published in some form. It was clear that, as in a university setting, part of the beneficial effect of the workshops came from group and face to face interaction. It would be more difficult to have this dimension of benefit achieved via a web-based version of the workshops, though a chat room scenario would presumably go some way towards establishing a group feeling. Web-based delivery would certainly suit participants who lacked mobility or who lived in the regions. Clearly the Internet is a vital social networking tool, and an Internet-based version of the workshops could well be attempted in the future. My own previous experience of community digital storytelling workshops (Neilsen, Digital Storytelling as Life-writing) suggests that a high degree of technical proficiency can not be expected across such a cohort; but with adequate technical support, a program (the usual short, self-written script, recorded voice-over and still images scanned from the participants’ photo albums, etc) could make digital storytelling a further dimension of therapeutic life-writing for clients with mental illness. One of the most useful teaching techniques in a class room setting is the judicious use of humour – to create a sense of sharing a perspective, and simply to make material more entertaining. I tested the waters at the outset by referring to the mental health worker sitting in the background, and declaring (with some comic exaggeration) my concern that if I didn’t run the workshop well he would report adversely on me. There was general laughter and this expression of my vulnerability seemed to defuse anxiety on the part of some participants. As the workshop progressed I found I could use both humorous extracts of life-writing and ad hoc comic comments (never at the expense of a participant) as freely as in a university class. Participants made some droll comments in the overall context of encouraging one another in their contributions, both oral and written. Only one participant exhibited some temporary distress during one of the workshops. I was allowing another participant the freedom to digress from the main topic and the participant beside me displayed agitation and sharply demanded we get back to the point. I apologised and acknowledged I had not stayed as focused as I should and returned to the topic. I suspect I had a fortunate first experience of such arts therapy workshops – and that this was largely due to the voluntary nature of the study and that most of the participants brought a prior positive experience of the workshop scenario, and prior interest in creative writing, to the workshops. Outcomes A significantly positive outcome was that only one of the nine participants missed a session (through ill-health) and none left during workshops. The workshops tended to proceed longer than the three hours allotted on each occasion. Post-workshop interviews were conducted by a psychologist with the participants. Detailed data is not available yet – but there was a clear indication by almost all participants that they felt the workshops were beneficial and that they would like to participate in further workshops. All but one agreed to have their life-writing included in a newsletter produced by one of the sponsors of the workshops. The positive reception of the workshops by the participants has encouraged planning to be undertaken for a wide-ranging longitudinal study by means of a significant number of workshops in both life-writing and visual arts in more than one city, conducted by a team of health professionals and creative practitioners – this time with sophisticated measurement instruments to gauge the effectiveness of art therapy in aiding ‘recovery’. Small as the workshop group was, the pilot study seems to validate previous research in the UK and US as we have summarised above. The indications are that significant elements of recovery (in particular, feelings of enhanced agency and creativity), can be achieved by life-writing workshops that are guided by creative practitioners; and that it is the process of narrative construction within life-writing that engages with or enhances a sense of self and identity. NoteWe are indebted, in making the summary of the concept of ‘recovery’ in health science terms, to work in progress by the following research team: Robert King, Tom O'Brien and Claire Edwards (School of Medicine, University of Queensland), Margot Schofield and Patricia Fenner (School of Public Health, Latrobe University). We are also grateful for the generous assistance of both this group and Seiji Humphries from the Richmond Queensland Fellowship, in providing preparation for the workshops. ReferencesAlschuler, Mari. “Lifestories – Biography and Autobiography as Healing Tools for Adults with Mental Illness.” Journal of Poetry Therapy 11.2 (1997): 113–17.Davidson, Larry and John Strauss. “Sense of Self in Recovery from Severe Mental Illness.” British Journal of Medical Psychology 65 (1992): 31–45.Eakin, Paul. Fictions in Autobiography: Studies of the Art of Self-Invention. Princeton: Princeton UP, 1985.———. How Our Lives Become Stories: Making Selves. Ithaca: Cornell UP, 1999.Esterling, B.A., L. L’Abate., E.J. Murray, and J.W. Pennebaker. “Empirical Foundations for Writing in Prevention and Psychotherapy: Mental and Physical Health Outcomes.” Clinical Psychology Review 19.1 (1999): 79–96.Herman, Judith. Trauma and Recovery: The Aftermath of Violence - from Domestic Abuse to Political Terror. New York: Basic Books, 1992.King, Robert, Chris Lloyd, and Tom Meehan. Handbook of Psychosocial Rehabilitation. Oxford: Blackwell Publishing, 2007.Liberman, Robert, and Alex Kopelowicz. “Recovery from Schizophrenia: A Criterion-Based Definition.” In Ralph, R., and P. Corrigan (eds). Recovery in Mental Illness: Broadening Our Understanding of Wellness. Washington, DC: APA, 2005.Linder, Vicki. “The Tale of two Bethanies: Trauma in the Creative Writing Classroom.” New Writing: The International Journal for the Practice and Theory of Creative Writing 1.1 (2004): 6–14Murphy, Ffion, and Philip Neilsen. “Recuperating Writers – and Writing: The Potential of Writing Therapy.” TEXT 12.1 (Apr. 2008). ‹http://www.textjournal.com.au/april08/murphy_neilsen.htm›.Neilsen, Philip. “Digital Storytelling as Life-Writing: Self-Construction, Therapeutic Effect, Textual Analysis Leading to an Enabling ‘Aesthetic’ for the Community Voice.” ‹http://www.speculation2005.qut.edu.au/papers/Neilsen.pdf›.Pennebaker, James W., and Janel D. Seagal. “Forming a Story: The Health Benefits of Narrative.” Journal of Clinical Psychology, 55.10 (1999): 1243–54.Pennebaker, James W. “Telling Stories: The Health Benefits of Narrative.” Literature and Medicine 19.1 (2000): 3–18.Spandler, H., J. Secker, L. Kent, S. Hacking, and J. Shenton. “Catching Life: The Contribution of Arts Initiatives to ‘Recovery’ Approaches in Mental Health.” Journal of Psychiatric and Mental Health Nursing 14.8 (2007): 791–799.Wright, Jeannie, and Man Cheung Chung. “Mastery or Mystery? Therapeutic Writing: A Review of the Literature.” British Journal of Guidance and Counselling, 29.3 (2001): 277–91.