Telenursing - A Potential Resource in the eHealth Agenda of India

In spite of wide-ranging successes that have improved population health, the call of ‘health for all’ across the globe remains significant. In India, making provision for basic healthcare to all people is a difficult task because of its large and diverse geographical terrain, and huge ethnically and culturally diverse population. Telenursing could provide better access to healthcare in communities and ensure a more effective, comprehensive and acceptable relationship of trust within communities. The focus of this paper is on availability and utilization of healthcare service types and health human resources, and factors influencing healthcare seeking behaviour in marginalized communities, and to use these findings to discuss the potential of integrating telenursing into  planning as a stimulus for inter-professional and system-wide change. Methods: The availability and utilization of healthcare services through available health systems were explored in urban, rural, slum, and rehabilitated communities through a cross-sectional survey in the Union Territory of Chandigarh, India. Primary data were collected through structured interviews, observation, checklists, and periodic visits, including reasons for preference of a particular care system by consumers and factors affecting their health seeking behaviour. Results and Conclusions: All health systems studied had a limited scope of services. This lack of a suitable range of health services led consumers to seek traditional (unscientific) care for meeting their health needs. Telenursing could stem this trend by improving clinical outcomes for chronic diseases, and thereby safeguard the interests of consumers, reduce costs associated with long-term care or delayed institutionalization, and help prevent the global threat of non-treatable hospital acquired infections

Effectiveness of a module to promote competency in adverse drug reaction reporting in undergraduate medical students

Background: Adverse drug reaction (ADR) under-reporting is a hindrance to the implementation of Pharmacovigilance Program of India. This is essentially due to lack of ADR reporting culture among healthcare professionals. Thus, study was conducted to assess and enhance awareness about ADRs and strengthen reporting among medical undergraduates.Methods: This is an interventional crossover study. A total of 140 students of 2nd professional, MBBS were included and divided into two groups of 70 each. In phase 1, group A was given a didactic lecture (DL) on ADR and pharmacovigilance. Group B was also given DL with an addition of a case narrative exercise and they were asked to fill an ADR form. Both groups were assessed based on an MCQ questionnaire for knowledge and skill. After 15 days of washout period, groups were crossed and reassessed. Feedback from students was taken on a 5 point Likert’s scale.Results: The mean scores of batch A without case was 17.5±3 out of a total score of 25 marks, which showed improvement with case narrative and mean increased to 19.6± 2.4 (p 0.05). Similarly, Batch B showed improvement as well and the mean 17.7±3.1 score without case narrative increased to 19.2±2.7 (p <0.05). Student’s perception of the effectiveness of module-based teaching was positive.Conclusions: Case narrative in addition to didactic lecture enhanced awareness and may strengthen ADR reporting culture among the medical students

Knowledge attitude and practice of pharmacovigilance among nursing professionals in a tertiary care teaching hospital in Dehradun, Uttarakhand

Background: Pharmacovigilance deals with identification, assessment and prevention and reporting of adverse drug reaction (ADR), play a pivotal role in ensuring safe use of drugs. However, in spite of having well established ADR reporting system in India and worldwide, the ADR underreporting is a big challenge till date. It is therefore very important to assess the level of awareness of Pharmacovigilance among healthcare professionals to identify the factors affecting ADRs reporting. The objective of the study was to evaluate knowledge, attitude and practice of pharmacovigilance among nursing professionals in a tertiary care teaching hospital in Dehradun, India.Methods: It was a cross sectional observational study conducted at HIMS over a period of 1 year. Nursing professionals who work in internal medicine, Surgery, PAC and intensive care unit (ICU) were included in this study. A self-administered questionnaire comprising of 15 items related to ADRs and Pharmacovigilance programme of India (PvPI) activity was provided to them and sufficient time to fill the questionnaire was given. The completely filled questionnaire was collected and data was analyzed using SPSS ver.20.0.Results: A total of 415 participants were included in the study. The mean age of the participant was 28.52 years. The number of female was more than male participants. Majority of participant (56%) couldn’t answer the meaning of pharmacovigilance. Only 25% participants were aware about ADR reporting process to ADR monitoring centre (AMC). Although majority of the participants understand the necessity of ADR reporting and aware about AMC centre and PvPI, but most of them showed unfamiliarity about ADR reporting form and previous experience of any kind of ADR. The most common reason for not reporting the ADR was difficulty in deciding the nature of adverse effects (AE) (44%) followed by lack of time (30%). Majority of participant (67%) denied any previous pharmacovigilance training and almost all (98%) have shown their interest in PvPI training.Conclusions: Nursing professionals in our hospital may lack adequate knowledge about ADR reporting and may need more education and training on the National Pharmacovigilance System and ADR reporting process

The study of awareness and adherence in patients receiving anti-hypertensive drugs: a hospital based study

Background: Hypertension is an important worldwide public health challenge. It has changed from a trivial cause of death and disability to one of the global burden diseases. The biggest obstacle for inadequate therapeutic control of blood pressure is meagre knowledge, poor attitude, inadequate treatment practices and lack of adherence towards antihypertensive treatment. The present study was planned to assess the awareness of hypertension on various aspects and to evaluate treatment adherence in hypertensive patients.Methods: This cross-sectional study was conducted on 100 hypertensive patients of both genders visiting medicine OPD at HIMS, Dehradun over a period of six months. A structured and validated questionnaire was used to assess the knowledge, attitude and practice (KAP) among patients. Morisky 8-Item Medication Adherence Questionnaire was used to assess the adherence towards antihypertensive medications. For statistical analysis Chi square test was used.Results: Out of the 100 patients the median KAP scores were 6(5),5(1) and 10(4) respectively. Most of the subjects had high median scores on attitude but majority of the subjects had low knowledge and self-care practice scores. Further Analysis of data revealed that a poor score in self-care practice was significantly associated to the gender(p<0.004) as well as to the level of education(p<0.006).Only 40% patients were adherent to their medication, this result was statistically associated with the level of education (p<0.00001).Conclusions: Hypertensive patients in our community have good attitude but poor knowledge and self-care practices towards management of hypertension. Patients were also found to be non-adherent to their antihypertensive medications

Effect of a novel succinamic acid derivative as potential anti-diabetic agent in experimental diabetic rats

4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid which is a succinamic acid derivative has been synthesized in 3 step reaction with malic acid. Its structure confirmation was done by various techniques like 1H NMR, 13C NMR, &amp; HRMS and is recently proposed as an insulinotropic agent for the treatment of non-insulin dependent diabetes mellitus. In the present study, the effect of 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid on plasma glucose, serum insulin, serum lipid profile and lipid peroxidation in streptozotocin–nicotinamide induced type 2 diabetic model was investigated.&nbsp; 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid was administered orally (20 mg/kg b.w.) to streptozotocin + nicotinamide (STZ + NAD) induced diabetic rats for 28 days. A significant increase in fasting blood glucose levels, HbA1c levels, Serum lipid profile (TG &amp; TC) and in&nbsp; the levels of Malonaldialdehyde (MDA, end product of lipid peroxidation) was observed in STZ +NAD diabetic rats whereas the levels of high density lipoprotein-cholesterol (HDL-C) and serum insulin levels were significantly decreased&nbsp; in STZ + NAD induced diabetic rats The effect of 4-((benzyloxy)amino)-2-hydroxy-4-oxobutanoic acid was compared with glibenclamide, a reference drug. Treatment with 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid and glibenclamide resulted in a significant reduction of fasting blood glucose levels with increase in plasma insulin levels in diabetic treated rats. 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid also resulted in a significant improvement in serum lipids and lipid peroxidation products. Our results suggest the potential role of 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid in the management of type-2 diabetes mellitus experimental rats. Keywords: 4-((benzyloxy) amino)-2-hydroxy-4-oxobutanoic acid, dyslipidemia, streptozotocin induced diabetes, lipid peroxidatio

Prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus patients in a tertiary care hospital

Background: Prescription pattern studies are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of assessing prescribing pattern is to facilitate rational use of medicines. So the main aim of the study was to assess the prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus, to assess the rationality of the prescribed drugs and also to assess the pattern of co-morbid conditions associated with type 2 diabetes mellitus in a tertiary care hospital.Methods: This cross sectional study was conducted in the Department of Pharmacology in collaboration with Department of General Medicine. Study was conducted from 1st June 2016 to 31st Aug 2016 (3 months). A total of 100 patients were enrolled after taking written informed consent. A structured case recording form was used to record demographic details and prescription details. The rationality of prescriptions was assessed using American Diabetes Association guidelines 2015.Results: Majority of the patients were prescribed combination therapy (54%) followed by monotherapy (46%). Oral anti-diabetic agents used as monotherapy other than metformin were inappropriate. Among the patients receiving combination therapy majority were receiving a fixed dose combination which were inappropriate.Conclusions: Majority of the patients were receiving fixed dose combinations without justifiable pharmacokinetic/pharmacodynamic benefits. Such kinds of studies are required to improve rationality of prescription of drugs, decreasing morbidity and mortality of patients and decreasing the cost of treatment

Antiatherosclerotic Potential of Active Principle Isolated from Eugenia jambolana in Streptozotocin-Induced Diabetic Rats

The aim of the present study was to investigate the antiatherosclerotic effect of active principle (FIIc) isolated from aqueous fruit pulp extract of Eugenia jambolana. Crude aqueous extract of E. jambolana was subjected to purification using chromatographic techniques which yielded purified active compound (FIIc). Purity of FIIc was tested by HPLC. Phytochemical investigation of FIIc by NMR, IR, and UV spectra showed that the purified compound is α-hydroxy succinamic acid. The streptozotocin- (STZ-) induced diabetic rats were fed atherosclerotic (Ath) diet containing 1.5 mL olive oil containing 8 mg (3, 20,000 IU) vitamin D2 and 40 mg cholesterol for 5 consecutive days. The STZ-induced diabetic rats receiving Ath diet were orally administered FIIc at doses of 10, 15, and 20 mg/kg, and results were compared with reference drug, that is, glibenclamide (600 μg/mg) and healthy control. 30-day treatment with FIIc resulted in significant (P < .001) improvement in blood glucose, serum lipid profile, apolipoproteins (Apo A1 and apoB100), and endothelial dysfunction parameters. Histomorphological studies also confirmed biochemical findings. Our results showed that FIIc has protective effect on hyperglycemia-induced atherosclerosis

Design, Synthesis, Characterization, and Computational Studies on Benzamide Substituted Mannich Bases as Novel, Potential Antibacterial Agents

A series of benzamide substituted Mannich bases (1–7) were synthesized. The synthesized derivatives were authenticated by TLC, UV-Visible, FTIR, NMR, and mass spectroscopic techniques and further screened for in vitro antibacterial activity by test tube dilution method using amoxicillin and cefixime as standard drugs. The compounds 5, 6, and 7 were found to be the most active antibacterial agents among all the synthesized compounds. The physicochemical similarity of the compounds with standard drugs was assessed by calculating various physicochemical properties using software programs. The percent similarity of synthesized compounds was found to be good and compound 1 was found to have higher percentage of similarity. The compounds were subjected to QSAR by multilinear regression using Analyze it version 3.0 software, and four statistically sound models were developed with R2 (0.963–0.997), Radj2 (0.529–0.982), and Q2 (0.998–0.999) with good F (2.35–65.56) values

Ameliorative Effect of Active Principle Isolated from Seeds of Eugenia jambolana on Carbohydrate Metabolism in Experimental Diabetes

The aim of this study was to evaluate the antidiabetic activity of LH II purified from ethanolic seed extract of Eugenia jambolana in alloxan-induced mild diabetic (MD) and severely diabetic (SD) rabbits. Ethanolic extract upon chromatographic purification yielded partially purified hypoglycemic principle (SIII) which on further purification by sephadex LH 20 yielded pharmacological active compound LH II. Homogeneity of LH II was tested by HPLC. Phytochemical investigation of LH II by various structural spectra showed the presence of saturated fatty acid, Δ5 lipid and presence of sterol. LH II was administered orally at a dose of 10 mg kg−1 body weight to MD and SD. LH II resulted, significant fall in FBG at 90 min (21.2% MD: 28.6% SD), 7th day (35.6% MD) and 15th day (59.6% SD). Glycosylated hemoglobin was significantly decreased (50.5%) in SD after 15 days treatment (Tt). Plasma insulin levels were significantly increased (P <  .001). In vitro studies with pancreatic islets showed 3-fold increase in insulin levels as compared to untreated animals. LH II also showed extrapancreatic effect by significantly increasing (P <  .001) the activity of key enzymes of glycolysis and significantly decreasing (P <  .001) the activity of key enzymes of gluconeogenesis. Liver and muscle glycogen content were increased by 36.6 and 30% for MD, and 52 and 47% for SD, respectively. Thus, the present study demonstrates that LH II possesses potent antidiabetic activity and it is effective in both MD and SD rabbits

Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13±1.1 years and 2.08±1.1 years and mean age of the patients was 14.67±1.9 years in group A and 16.20±1.6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30±1.1 (p value <0.05) and change group B was -0.20±1.4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17±1.1 and -0.70±1.1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores