usman munir | University of the Punjab, Lahore, Pakistan (original) (raw)
Papers by usman munir
Indian Journal of Forensic Medicine & Toxicology, 2019
The Province of West Nusa Tenggara is known as one of the Indonesian provinces which has become a... more The Province of West Nusa Tenggara is known as one of the Indonesian provinces which has become a tourism destination apart from Bali. This province has two main islands, which are Lombok Island and Sumbawa Island. They have a richness in the variation of nature and culture, so that they have a high potential for the development of tourism. The problem which must be taken into consideration in creating a better tourism destination is giving healthcare services which are agreed upon through the local government's policies. The scope of tourism health is very broad, as it includes the health of the tourists, the health of the society as the hosts, the health of the workers in the tourism industry, the health of the environment in the tourism area, the safety of food in the tourism area, including the different policies regarding health and tourism. Apart from that, the effort of chemoprophylaxis may be informed to the tourists who have the risk to be contracted of an illness, but may be avoided through the use of some medications. For example, the tourists who visit West Nusa Tenggara, or the other eastern parts of Indonesia, may be advised to consult to health workers to receive preventative medicine. Tourism consultants and tourism guides may also have the role to give suggestions regarding the general health situations which are present in the area on several occasions.
YUSTISIA MERDEKA : Jurnal Ilmiah Hukum, 2019
Lombok is one of the islands of West Nusa Tenggara province with enormous tourism potential, from... more Lombok is one of the islands of West Nusa Tenggara province with enormous tourism potential, from nature, beaches and culture. So that if this is developed properly it will bring prosperity to the Lombok people in particular and NTB in general. Tourism development policies have not been widely felt to bring effects to welfare to the community. The purpose of this study is to provide an overview of policies and implementation of tourism development policies on tourism on the island of Lombok. Data was collected by observation and interviews. From these data, then analyzed descriptively qualitatively, the data formed becomes a description that describes a situation or event described. Based on the results of the analysis of tourism development policies in Lombok island, it is inseparable from the four tourism pillars contained in regional regulations, namely tourism, marketing, industry and institutional development. The implementation of the policy has not maximally affected the welf...
The American Journal of Geriatric Psychiatry, 2019
Introduction: Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of aging, ... more Introduction: Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of aging, affecting approximately 5.4 million individuals in the US, and predicted to increase to 13.8 million by 2050. Occurring in over 90% of AD patients, neuropsychiatric symptoms such as agitation, depression and apathy, contribute to caregiver burden and increase patient morbidity and mortality. With no FDA-approved options available, treatments for severe agitation in people with advanced dementia are limited, with modest evidence for efficacy and substantial safety concerns. Behavioral therapies are recommended as first-line treatments for agitation in AD; however, they require substantial time to take effect and may be less efficacious for the most severely agitated patients. Psychotropic medications, especially antipsychotics, are widely used off-label to treat agitation in AD even with documented limitations in efficacy and safety concerns. Therefore, new treatments for severe agitation in AD refractory to standard interventions are timely and warranted. Randomized controlled trials have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for the treatment of severe psychiatric disorders of late life, including depression, mania and psychosis. Recently, small open label studies suggest efficacy and safety of ECT for agitation in individuals with AD who are refractory to standard therapies. The present randomized controlled trial builds upon prior work and aims to determine the efficacy and safety of ECT for severe agitation in moderate to severe stage AD, while also examining the durability of the acute treatment effect in an exploratory maintenance naturalistic design. Methods: We describe an NIA-funded multi-site, single blind, randomized trial of ECT plus usual care (UC) versus Simulated-ECT (S-ECT) plus UC. We will enroll 200 inpatients with severe agitation and moderate to severe dementia, who have not responded well to prior trials of psychotropic medications. Our primary efficacy outcome measure is the Cohen Mansfield Agitation Inventory (CMAI), and the Neuropsychiatric Inventory − Clinician Version (NPI-C), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale (ADCS-CGIC), and Pittsburgh Agitation Scale (PAS) will be secondary measures. Safety and tolerability will be assessed with the Severe Impairment Battery − 8 item (SIB-8), the Confusion Assessment Method (CAM), and adverse event monitoring. Results: Preliminary open-label data from our team suggests acute ECT treatment is safe and effective in reducing agitation in this population as measured by the CMAI, PAS, CGI, and adverse event monitoring. A multi-site, prospective case series investigated ECT treatment in 23 consecutive inpatients with dementia and severe agitation who did not benefit from standard behavioral interventions and pharmacotherapy. Eighteen of the 23 subjects experienced a significant reduction in agitation from baseline to discharge on the CMAI. In a retrospective chart review study of 16 patients undergoing ECT for agitation related to AD, only two experienced more than transient confusion post-ECT that required treatment, and no other clinically significant adverse events were noted in this group. We hypothesize ECT+UC will be more efficacious in reducing severe agitation in AD subjects than S-ECT+UC, as measured by our primary and secondary efficacy measures, and that there will be no difference in tolerability/safety outcomes for ECT+UC and S-ECT+UC as measured by cognitive decline (SIB-8), development of delirium (CAM), and serious adverse event monitoring. Conclusions: This innovative study will fill a gap in the current clinical practice of treating severe agitation in AD using a rigorous methodological approach thus providing evidence for a new therapeutic application (severe agitation in AD) of a wellstudied, established, and safe treatment (ECT). Study findings may demonstrate support for a new therapeutic use of ECT for severe agitation in AD. Successful management of neuropsychiatric symptoms reduces long-term care placement, decreases the risk of mortality, and enhances patient and caregiver quality-of-life. Such an approach has the potential to offer enormous relief to the substantial socioeconomic burden of AD-related behavioral disturbances.
Indian Journal of Forensic Medicine & Toxicology, 2019
The Province of West Nusa Tenggara is known as one of the Indonesian provinces which has become a... more The Province of West Nusa Tenggara is known as one of the Indonesian provinces which has become a tourism destination apart from Bali. This province has two main islands, which are Lombok Island and Sumbawa Island. They have a richness in the variation of nature and culture, so that they have a high potential for the development of tourism. The problem which must be taken into consideration in creating a better tourism destination is giving healthcare services which are agreed upon through the local government's policies. The scope of tourism health is very broad, as it includes the health of the tourists, the health of the society as the hosts, the health of the workers in the tourism industry, the health of the environment in the tourism area, the safety of food in the tourism area, including the different policies regarding health and tourism. Apart from that, the effort of chemoprophylaxis may be informed to the tourists who have the risk to be contracted of an illness, but may be avoided through the use of some medications. For example, the tourists who visit West Nusa Tenggara, or the other eastern parts of Indonesia, may be advised to consult to health workers to receive preventative medicine. Tourism consultants and tourism guides may also have the role to give suggestions regarding the general health situations which are present in the area on several occasions.
YUSTISIA MERDEKA : Jurnal Ilmiah Hukum, 2019
Lombok is one of the islands of West Nusa Tenggara province with enormous tourism potential, from... more Lombok is one of the islands of West Nusa Tenggara province with enormous tourism potential, from nature, beaches and culture. So that if this is developed properly it will bring prosperity to the Lombok people in particular and NTB in general. Tourism development policies have not been widely felt to bring effects to welfare to the community. The purpose of this study is to provide an overview of policies and implementation of tourism development policies on tourism on the island of Lombok. Data was collected by observation and interviews. From these data, then analyzed descriptively qualitatively, the data formed becomes a description that describes a situation or event described. Based on the results of the analysis of tourism development policies in Lombok island, it is inseparable from the four tourism pillars contained in regional regulations, namely tourism, marketing, industry and institutional development. The implementation of the policy has not maximally affected the welf...
The American Journal of Geriatric Psychiatry, 2019
Introduction: Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of aging, ... more Introduction: Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of aging, affecting approximately 5.4 million individuals in the US, and predicted to increase to 13.8 million by 2050. Occurring in over 90% of AD patients, neuropsychiatric symptoms such as agitation, depression and apathy, contribute to caregiver burden and increase patient morbidity and mortality. With no FDA-approved options available, treatments for severe agitation in people with advanced dementia are limited, with modest evidence for efficacy and substantial safety concerns. Behavioral therapies are recommended as first-line treatments for agitation in AD; however, they require substantial time to take effect and may be less efficacious for the most severely agitated patients. Psychotropic medications, especially antipsychotics, are widely used off-label to treat agitation in AD even with documented limitations in efficacy and safety concerns. Therefore, new treatments for severe agitation in AD refractory to standard interventions are timely and warranted. Randomized controlled trials have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for the treatment of severe psychiatric disorders of late life, including depression, mania and psychosis. Recently, small open label studies suggest efficacy and safety of ECT for agitation in individuals with AD who are refractory to standard therapies. The present randomized controlled trial builds upon prior work and aims to determine the efficacy and safety of ECT for severe agitation in moderate to severe stage AD, while also examining the durability of the acute treatment effect in an exploratory maintenance naturalistic design. Methods: We describe an NIA-funded multi-site, single blind, randomized trial of ECT plus usual care (UC) versus Simulated-ECT (S-ECT) plus UC. We will enroll 200 inpatients with severe agitation and moderate to severe dementia, who have not responded well to prior trials of psychotropic medications. Our primary efficacy outcome measure is the Cohen Mansfield Agitation Inventory (CMAI), and the Neuropsychiatric Inventory − Clinician Version (NPI-C), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale (ADCS-CGIC), and Pittsburgh Agitation Scale (PAS) will be secondary measures. Safety and tolerability will be assessed with the Severe Impairment Battery − 8 item (SIB-8), the Confusion Assessment Method (CAM), and adverse event monitoring. Results: Preliminary open-label data from our team suggests acute ECT treatment is safe and effective in reducing agitation in this population as measured by the CMAI, PAS, CGI, and adverse event monitoring. A multi-site, prospective case series investigated ECT treatment in 23 consecutive inpatients with dementia and severe agitation who did not benefit from standard behavioral interventions and pharmacotherapy. Eighteen of the 23 subjects experienced a significant reduction in agitation from baseline to discharge on the CMAI. In a retrospective chart review study of 16 patients undergoing ECT for agitation related to AD, only two experienced more than transient confusion post-ECT that required treatment, and no other clinically significant adverse events were noted in this group. We hypothesize ECT+UC will be more efficacious in reducing severe agitation in AD subjects than S-ECT+UC, as measured by our primary and secondary efficacy measures, and that there will be no difference in tolerability/safety outcomes for ECT+UC and S-ECT+UC as measured by cognitive decline (SIB-8), development of delirium (CAM), and serious adverse event monitoring. Conclusions: This innovative study will fill a gap in the current clinical practice of treating severe agitation in AD using a rigorous methodological approach thus providing evidence for a new therapeutic application (severe agitation in AD) of a wellstudied, established, and safe treatment (ECT). Study findings may demonstrate support for a new therapeutic use of ECT for severe agitation in AD. Successful management of neuropsychiatric symptoms reduces long-term care placement, decreases the risk of mortality, and enhances patient and caregiver quality-of-life. Such an approach has the potential to offer enormous relief to the substantial socioeconomic burden of AD-related behavioral disturbances.