Quest for good quality medicines in hospitals: a structured approach

Patients use medicines to gain speedy recovery from illness or to maintain wellbeing under the care of their physicians. For chronic illnesses, the pharmacotherapy may continue for the entire lifetime. Significant expenditure is incurred in sustaining this pharmacotherapy. Quite expectedly, the patients are concerned about the quality of medicines that they receive and consume. In recent times, the quality concerns have increased phenomenally due to media hype and overexposure all around. Ensuring quality of medicines in developing countries is not easy. Multi-pronged approaches are needed to ensure procurement of good quality medicines by institutional buyers. However, ensuring the procurement of good quality medicines is not enough. The quality of medicines has to be maintained till their consumption by patients and a rational, scientific method has to be adopted to ensure this goal. A structured approach in ensuring good quality medicines for optimum pharmacotherapy is being presented in this review

How uniform is donor history questionnaire for screening potential blood donors: a critical analysis

Background: Transfusion of whole blood or blood products are a clinical necessity in numerous clinical conditions. Blood donated from healthy human volunteers is the only method currently available to acquire blood transfusion and production of blood products. Donor history questionnaire (DHQ) contributes immensely to ensure safe blood donation. The aim was to compare the donor history questionnaire for blood donation deferral of various regions and organizations with that of World Health Organization (WHO).Methods: An extensive internet search for donor history questionnaires (DHQ) for blood donation deferral of different regions, countries and organization was conducted. Seven such forms were found which could be downloaded. A critical analysis of these forms was conducted based on history pertaining to use of medicines, disease history or procedure undergone recently. A comparative analysis was conducted finally with the World Health Organization (WHO) recommendations on the issue of donor screening and deferral. Descriptive analysis was done for comparison of donor history questionnaires in regards to drugs taken, disease history and invasive procedures performed.Results: After the analysis of the DHQs, we found that despite many similarities, there were significant differences in the questionnaires. The differences were more with respect to questions asked about the medicines, both traditional as well as modern.Conclusions: DHQs analysed by us revealed wide variations in their enquiry from potential donors about exposure to prescription medicines as well as the disease history. A suggestion is that more questions related to alternative medicines, nutraceuticals and other similar xenobiotic should be included

An outpatient department based observational study to review the pattern of utilization of proton pump inhibitors for their co-relation with the indications in a tertiary care centre

Background: Proton pump inhibitors (PPIs) are one of the commonest drugs prescribed for a variety of indications. They are considered remarkably safe and prescribed liberally. However, on long term administration, they can cause a number of adverse effects. In a tertiary care hospital, where the patient numbers are large and many attending super speciality centre, a number of patients were observed to receive PPIs for approved and unapproved indications. It was therefore considered prudent to study the prescribed PPIs for a co-relation with their indications or otherwise so as to formulate corrective interventions.Methods: The observational study was conducted in the dispensary of a tertiary care centre. The prescriptions of the patients were the study material. Prescriptions for a full week were taken in for consideration. A total of 4142 prescriptions were studied. All aspects related to PPIs were noted and analysed. Additionally, a note on prescribed calcium supplements, vitamins and antioxidants was made.Results: Of all the prescriptions studied by us, 33% had PPIs in them. Omeprazole was the commonest PPI followed by pantoprazole. Almost half the patients prescribed PPIs, the duration of administration was over 30 days. 78% patients prescribed PPIs also had some or the other non-steroidal anti-inflammatory drug (NSAID) in their prescription. Over one fourth of the total patients also received calcium supplements, vitamins or anti-oxidants.Conclusions: Proton pump inhibitors are very popular drugs and are being prescribed for approved and unapproved indications in the hope of providing relief to the patients. They are being advised quite liberally and more so if any NSAID has been co-prescribed. Even for prescriptions lasting for less than 5 days, PPIs have been included in the presumption to prevent gastritis due to NSAIDs. This practice is contrary to guidelines and also exposes the patients to avoidable adverse drug reactions

Design and Implementation of Computeraided Learning Module in Pharmacology for Vasoactive Drugs: An Experience from a State Medical College in Haryana, India

Introduction: In the Competency-based Medical Education (CBME) curriculum, one of the core competencies involves demonstrating the effects of autonomic drugs. It is a skill competency, and students have to learn to demonstrate the acquisition of this competency in a skill lab. Computer-aided demonstrations can enhance the teaching-learning experience and fulfill the learning objectives related to the effects of vasoactive drugs. Aim: To design and evaluate a Computer-aided Learning (CAL) module to teach the effects of vasoactive drugs. Materials and Methods: The study, being a curriculum implementation project, was conducted using a mixed methods study design at Kalpana Chawla Govt. Medical College, Karnal, Haryana, India over a period of one year from October 2020 to October 2021. Here, the impact of the intervention was measured through a multiple-choice quiz on the topics learned through CAL. The study population included all students undergoing the Phase-2 stage of the MBBS course at our institute. For skill acquisition in the cognitive domain, a video bank in the computer lab was made available to 120 undergraduate medical students. During practical training, in small groups, the training videos and animations were played, showing the effects of selected common vasopressors, vasodepressors, and their antagonists to the students. Simulated experiments on vasoactive drugs were shown to the students using ExPharm software (Free version). The achievement of learning objectives was assessed through a quiz. The perception of the students toward the new method was assessed through a questionnaire, and that of the faculty was evaluated with a Focused Group Discussion (FGD). Simple descriptive statistics, specifically the mean and standard deviation, were used to generate results. Results: All the students who participated in providing feedback on the module 113 (100%) had used CAL-based learning to acquire the skills. 60.7% of students (n=68) used both the animation and simulation components of the CAL to achieve proficiency in learning about vasoactive drugs. All teachers (n=5, 100%) during the FGD expressed satisfaction with the development and outcomes of the learning module, while highlighting the need for better CAL devices and methods. Conclusion: The CAL module developed for teaching and learning the effects of vasoactive drugs in experimental pharmacology was considered to be just about satisfactory

Greater concern about hypoglycemia in Type 2 diabetics is the need of the hour—findings from a prospective, single-center, observational study

Context: Hypoglycemia is a well-recognized adverse effect in the treatment of type 1 diabetes mellitus. For patients of type 2 diabetes mellitus (T2DM) on stabilized treatment with the current oral antidiabetic drugs, occurrence of hypoglycemia is considerably less well studied. The current study was undertaken to understand the extent of this problem in elderly Indian patients. Objectives: Primary Objective: Assessment of incidence of hypoglycemia in patients of T2DM on stable treatment. Secondary Objectives: 1. Estimation of incidence of episodes of severe hypoglycemia in patients. 2. Correlation of presence of hypoglycemia with treatment modality. Settings and Design: This study was conducted as an open label, single-center observational study at a multispecialty tertiary care hospital. Materials and Methods: The study participants consisted of 50 elderly confirmed patients of either gender suffering from T2DM undergoing treatment and follow-up in the hospital for at least 12 weeks. After a brief training session and enrolment, the patients were asked to report to study site every month for next 2 months. Parameters recorded were plasma glucose levels, HbA1c levels, treatment regimen, body mass index, possible hypoglycemic episode based on symptoms and self-monitoring of blood glucose, and quality of life based on questionnaire score. Statistical Analysis: Descriptive and other statistics were used to analyze the hypoglycemic episodes experienced by the patients for correlation with medicines and the effect of hypoglycemia on their quality of life. Results: Total of nine hypoglycemic episodes were recorded. Severe hypoglycemia did not occur in any patient. Patient on insulin reported significantly more hypoglycemia. Quality of life is not much different in patients using insulin in T2DM

Safety monitoring of precautionary third dose of COVID-19 vaccines in a district in Northern India

Background: The World Health Organization (WHO) declared Coronavirus disease-19 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) a pandemic on March 11, 2020. On 16th January 2021, India began its vaccination programme using two COVID-19 vaccines (Covishield and Covaxin). Precautionary dose (booster shots) was administered to health and front-line workers in the beginning and then to all eligible populations. Material and Methods: This was a descriptive observational study conducted in the COVID-19 vaccination centres of Karnal district and the ADR monitoring centre, KCGMC, Karnal. During the visits to vaccination centres, all beneficiaries of the precautionary third dose of COVID-19 vaccines as well as healthcare workers were sensitized to report in case of any adverse event following vaccination as part of the policy of the vaccination programme run by the government and Pharmacovigilance Programme of India. The data were collected in suspected adverse drug reaction (ADR) reporting form version 1.4, and causality assessment was done as per the WHO–UMC scale. The data were analysed as simple proportions and percentages. Results: The booster dose was administered to 72,853 individuals, while the 1st dose and 2nd dose were given to 13,30,042 and 10,73,050, respectively. Only three ADRs were reported with the booster dose in 34 vaccination centres in the Karnal district. These three ADRs were classified as unlikely on causality assessment and hence not included in the analysis. Conclusion: The booster dose administered for the prevention of COVID-19 has been found to be reasonably safe. The population who received COVID-19 booster doses was significantly less than the populations who received the first and second doses, which suggests a low acceptance rate