This article defines principles of pragmatism and text. It endeavors to elements of interpretation of text as well as relation which plays its vital role for connecting both; text and pragmatism with each other. It goes on to describe a mechanism of reading and understanding of text along with elaboration of its interaction with text. It is so because Arabic based structure and text is having multi-coloured aspects and meanings. It has several ups and downs like surface and depth, metaphor, imagery and allegory in addition to exploitation and adaption. Interpretation of text is the grass-roots of productive cognition. Because the ambiguity in word, sentence even in structure weather it is shorten or long is interpreted in addition to the interpretation of meanings of structures which are ordinarily defined and recognized through involving context and situation of context, bearing in view the original meaning; lexical meaning alongside interpretation with its significant principles and elements. However, all the description said before locates frequently infinity of text meanings.
In specific clinical circumstances, pharmacy or medical practitioners may need to take decisions about patient, based upon systematically developed clinical practice guidelines. Guidelines for clinical practice are statements that are systematically developed for healthcare providers to help make a decisions about patient in specialized or specific clinical situation. It must not be ignored that benefit of these guidelines are entirely dependent upon quality of guidelines applied. During the course of this cross sectional, qualitative and quantitative research main objective is to assess the extent of applicability of IOF (International Osteoporosis Foundation) Guidelines for management, finding, prevention and treatment of Osteoporosis in Asia particularly in Pakistani population, because International Osteoporosis Foundation (IOF) guideline for diagnosis, prevention and treatment of osteoporosis in Asia is made with epidemiological data of Hong Kong and China. Population of Pakistan is growing rapidly and thus elderly population is increasing day by day. Therefore, among medical community, osteoporosis is a big threat. According to one estimate based upon ultrasound 9.91 million people (women=7.19 million, men=2.71 million) are sufferer of osteoporosis in Pakistan. Extrapolation of current data reveals 11.3 million in 2020 and 12.91 million in 2050. It is therefore necessary to evaluate the application of above mentioned guidelines by using AGREE-II instrument in Pakistani population. In order to determine the applicability and variability in quality of IOF guideline for Asia, Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument – II was employed. AGREE – II instrument evaluates the methodologies and transparencies for development of guidelines by six domains scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, editorial independence and overall quality of IOF guide for Asia. The research carried out in duration from December 2014 to January 2017. Sample size of 250 practitioners was determined by precision analysis technique. The basic data gathered from pharmacy and medical practitioners who work in clinical setting either government or private. The data analyzed by SPSS software and validated and reliable mathematical formula. During current study number of healthcare providers (N=250) from hospital are 67% (N=168), clinic 31% (N=77) and primary care centers 2% (N=5), from setup of private sector 78% (N=195) and government 22% (N=55). Demographics of specialties are pharmacists (N=50) from hospital are 80% (N=40), primary care center 10% (N=5), community setup 10% (N=5), government sector 70% (N=35), private sector 30% (N=15), family physicians (N=50) from hospital are 20% (N=10), clinics 80% (N=40), and all belongs to private sector, orthopedicians (N=90) from hospital are 97% (N=87), clinic 3% (N=3), government sector 73% (N=66), private sector 27% (N=24), internists and rheumatologists (N=30) from hospital are 57% (N=17), clinic 43% (N=13), government sector 27% (N=8), private sector 73% (N=22), gynecologists (N=30) from hospital are 47% (N=14), clinic 53% (N=16), government sector 27% (N=8), private sector 73% (N=22). Magnitudes of scope and purpose of guideline for all healthcare providers (69%), pharmacists (66%), family physicians (66%), orthopedicians (72%), internists (71%), and gynecologists (65%). Magnitudes of stakeholder involvement for all health care providers (64%), pharmacists (68%), family physicians (65%), orthopedicians (70%), internists (62%), and gynecologists (36%). Magnitude of rigour of development for all healthcare providers (82%), pharmacists (89%), family physicians (84%), orthopedicians (78%), internists (86%), and gynecologists (75%). Magnitudes of clarity of presentation for all healthcare provider (88%), pharmacists (91%), family physicians (86%), orthopedicians (91%), internists (88%), and gynecologists (76%). Magnitudes of applicability for all healthcare provider (84%), pharmacists (87%), family physicians (84%), orthopedicians (87%), internists (85%), and gynecologists (73%). Magnitude of editorial independence for all healthcare providers (71%), pharmacists (81%), family physicians (61%), orthopedicians (74%), internists (74%), and gynecologists (61%). ANOVA reveals significant differences (p<0.0000) among mean domain scores of each specialties. Independent sample t-test identified that domain scores are significantly lower compares to ideal score, all specialties combined (p<0.002, 95%CI), pharmacists (p<0.007, 95%CI), family physicians (p<0.003, 95%CI), orthopedicians (p<0.002, 95%CI), internists (p<0.003, 95%CI), gynecologists (p<0.002, 95%CI). Magnitude of overall quality of IOF guidelines rated by all healthcare providers (83%), pharmacists (91%), family physicians (82%), orthopedicians (83%), internists (84%), and gynecologists (71%). Weightage of pharmacists (19%), family physicians (19%), orthopedicians (38%), internists (12%) and gynecologists (11%) in total domain score of scope and purpose (69%). Weightage of pharmacists (21%), family physicians (20%), orthopedicians (39%), internists (12%) and gynecologists (7%) in total domain score of stakeholder involvement (64%). Weightage of pharmacists (22%), family physicians (20%), orthopedicians (34%), internists (13%) and gynecologists (11%) in total domain score of rigour of development (82%). Weightage of pharmacists (21%), family physicians (19%), orthopedicians (37%), internists (12%) and gynecologists (10%) in total domain score of clarity of presentation (88%). Weightage of pharmacists (21%), family physicians (20%), orthopedicians (37%), internists (12%) and gynecologists (10%) in total domain score of applicability (84%). Weightage of pharmacists (23%), family physicians (17%), orthopedicians (37%), internists (12%) and gynecologists (10%) in total domain score of editorial independence (71%). Weightage of pharmacists (22%), family physicians (20%), orthopedicians (36%), internists (12%) and gynecologists (10%) in rating overall quality of IOF guideline (83%). Total score of each domain is not dependent upon weightage of each individual specialty (χ2=2.311, p>0.05). Comparison of proportions of overall quality of guideline among specialties are pharmacists and family physicians (z=0.1181, p>0.05, at 95%CI), pharmacists and orthopedicians (z= - 0.707 , p>0.05, at 95%CI), internists and gynecologists (z=0.206, P>0.05, at 95%CI), orthopedicians and family physicians (z=0.868, p>0.05, at 95%CI). Quality rating and all six domains are compared for differences among five major specialties by KRUSKAL-WALLIS test reveals overall quality rating score among specialties (p=0.945), scope and purpose (p=0.152), stakeholder involvement (p=0.098), rigour of development (p=0.0001), clarity of presentation (p=0.009), applicability (p=0.002), and editorial independence (p=0.068). Specialties are independent of items of domain scores (Items of domain 1 χ2=11.035, p>0.05, Items of domain 2 χ2=11.061, p>0.05, Items of domain 3 χ2=21.614, p>0.05, Items of domain 4 χ2=1.024, p>0.05, Items of domain 5 χ2=2.096, p>0.05, Items of domain 6 χ2=0.21, p>0.05). Research findings showed that clinical practice guideline was not unrestricted by most of healthcare providers. Majority (51.60%) of practitioners demanded guidelines to be modified as per Pakistani requirements, 42% rate the use of guideline without any modifications while 6.40% professionals are not in favor of use of these guidelines during clinical practice. Specialty wise evaluation of discloses that 72% pharmacists are ready to practice guidelines without any modifications, while 28% need some amendments before implementing in to clinical practice, 30% family physicians are ready to practice guidelines without any modifications, while 60% need some amendments before implementing in to clinical practice and 10% rejected the guideline, 42.22% orthopedicians are ready to practice guidelines without any modifications, while 55.56% need some amendments before implementing in to clinical practice and 2.22% rejected the guideline, 43.33% internists are ready to practice guidelines without any modifications, while 53.33% need some amendments before implementing in to clinical practice and 3.33% rejected the guideline, and 10% gynecologists are ready to practice guidelines without any modifications, while 63.33% need some amendments before implementing in to clinical practice and 26.67% rejected the guideline. Healthcare providers in Pakistan believe that two third of guidelines is meeting the overall aim, specific health questions pertaining to Pakistani population suffering from osteoporosis. Healthcare providers of Pakistan believe that views of target patients and population of Pakistan have not been sought which are also important stakeholders. Healthcare providers in Pakistan are in more agreement but not full, that during synthesis of evidence, comprehensive search strategy was applied up to maximum extent to avoid the possibility of biases and explanation is clearly mentioned. For this domain highest magnitude was reported by pharmacists, it is because of Pharmacist’s unique background and training, they are skilled at evidence based practices to improve the quality of pharmaceutical care. Healthcare providers in Pakistan are convinced that recommendations of IOF for Asia provides concrete and precise description of different options in particular situations of patients. Regarding applicability domain healthcare providers are not in full agreement that criteria for audit and monitoring of guideline clearly presented. Similarly for editorial independence healthcare providers in Pakistan are in almost complete but not full agreement that development and recommendation of guideline is not influenced by competing interests. Demography of study reveals that most of the healthcare providers are from the specialty of orthopedics, it is imperative to know that like most of the countries, bone disease and fractures are mainly deals in orthopedic clinics in Pakistan. Main contributing risk factors of osteoporosis in Pakistan are weight loss, personal and family history of osteoporotic fracture, smoking, lack of exercise, lack of fruit and vegetable consumption, vitamin D deficiency, corticosteroid use, rheumatoid arthritis and frequent falls. Age, family history, corticosteroid use and eating disorder are significant factors for osteoporotic fracture." xml:lang="en_US