Influence of interventions on prescription writing practices in a tertiary care teaching hospital

Background: Prescription practices should be good so that they are correctly interpreted and medications are used or administered accordingly. Studies are found usually focusing on WHO prescribing indicators in various healthcare set-ups. This prescription audit study was conducted to analyse the prescription practices in a tertiary care hospital and see the influence of various interventions on these practices.Methods: It was a quality initiative undertaken to retrospectively assess and evaluate the change in the prescription writing practices in the in-patient department of a tertiary care teaching hospital from March 2017 to April 2018. Number of interventions were conducted to meet the compliance of prescription parameters during the study period and prescription parameters was analysed again thereafter for one-year to see the change.Results: An overall increase in compliance of prescription parameters was found from 67.3% in March 2017 to 94.8% in June 2017. Thereafter this was consistently maintained upto 91% during the study period. Most of the prescription parameters were seen to be improved like allergy history taking from 52.2-95.6%; mention of prescriber’s name, sign, registration number from 53.5-86%; consideration to food-drug interaction from 28.7-99.5%.Conclusions: Prescription writing practices were quite poor initially which improved after various interventions were carried out in the study area

Role of piracetam on cognitive function in epilepsy and with antiepileptics in rats

Background: To study extent of cognitive impairment by epilepsy & antiepileptic treatment and evaluate the role of piracetam on it.Methods: 48 animals were divided into 6 groups: I-Control, II- Topiramate, III-Topiramate+Piracetam, IV-Valproate, V-Valproate+Piracetam, VI-Piracetam. Baseline cognitive functions were measured using Cook’s pole climbing apparatus (CPCA) and Elevated plus maze (EPM). In CPCA, on completion of training, number of avoidances (NOA) out of 10 trials were noted while in EPM, transfer latency (TL) was measured. Kindling was induced by 30mg/kg Pentylenetetrazol (PTZ), i.p. to all groups (except Group I) on alternate days till seizures developed. Groups were treated with respective drugs orally for 21 days and cognitive functions measured again.Results: Significant decrease in NOA & increase in TL was observed after PTZ kindling. Topiramate further significantly impaired NOA and TL whereas Valproate significantly reduced NOA in CPCA but increase in TL was not significant. Treatment with Piracetam significantly increased Topiramate, Valproate and PTZ kindling induced decrease in NOA as also significantly reduced Topiramate and PTZ kindling induced increase in TL.Conclusion: Seizures are associated with cognitive impairment. Cognitive impairment caused by Sodium valproate differs from Topiramate. Piracetam, a known nootropic can be used in alleviating cognitive impairment associated with epilepsy & chronic antiepileptic therapy

Knowledge, attitude and practices of general practitioners about use of antiviral drugs in viral infections other than HIV

Background: Antiviral drugs for viral infections other than HIV are effective only for hepatitis, herpes and influenza. It has been observed that general practitioners (GPs) treat viral infections with antibiotics. The use of antibiotics in viral infections is not rational. Hence, authors conducted this study to assess the Knowledge, Attitude and Practices of General Practitioners (GPs) about treatment of viral infections other than HIV.Methods: It was a descriptive, observational, cross- sectional study among 100 GPs in Southern Pune. A pretested questionnaire was used to assess their knowledge, attitude and practices about treatment of viral infections other than HIV. Prior informed written consent was taken from the GPs who were grouped under MBBS, BHMS and BAMS categories according to their qualifications. Correct answers among these groups were analysed using chi-square test, Spearman’s coefficient test and ANOVA.Results: The percentages of correct answers in the groups were comparable.56% GPs have poor knowledge of Influenza treatment.30-36% do not treat Herpes genitalis and zoster with antiviral drugs. Authors found that 44%, 30% and 28% of total GPs don’t have proper knowledge, attitude and practice respectively about common viral infections other than HIV and antiviral drugs.Conclusions: GPs are significantly unaware about rational use of antiviral drugs. They have poor knowledge about management of influenza

Role of trimetazidine in carbon tetrachloride induced liver damage in rats

Background: Hepatotoxicity by chemicals and drugs is a common clinical problem. Presently very few drugs are showing effectiveness in prevention and treatment of hepatic damage. So in this study, we evaluated the role of trimetazidine in carbon tetrachloride (CCl4) induced liver damage in rats. Objective of current study is to evaluate effects of prophylactic trimetazidine against carbon tetrachloride induced liver damage in rats.Methods: Liver damage was induced in 30 albino rats by CCl4 (0.5 ml/kg, i.p.) once daily for 7 days. Extent of damage was studied by assessing biochemical parameters (SGOT, SGPT, ALP, proteins and bilirubin). These biochemical observations were supplemented by pentobarbitone Sleeping Time and Histological Examination of liver. The effect of co-administration of trimetazidine (doses 5 and 10 mg/kg p. o.) on the above parameters was investigated. Liv.52® was used as Positive Control. Data was analyzed by one way ANOVA, followed by Dunnett's test.Results: Trimetazidine significantly prevented CCl4 induced elevation of serum SGOT, SGPT, ALP and bilirubin (total and direct), and reduction in protein level. Pentobarbitone sleeping time and histological examination of the liver showed consistent results. The results were comparable to that of Liv.52®.Conclusions: Trimetazidine, when administered prophylactically, shows hepatoprotective effect against CCl4 induced liver damage

Antimicrobial prescribing pattern in a tertiary care teaching hospital: a pilot study

Background: The emergence of antimicrobial resistance is a worldwide challenge threatening to negate the gains made by discovery of antimicrobial agents (AMAs).  Antimicrobial Stewardship Program (ASP) is an important strategy for ensuring appropriate use of AMAs and controlling emergence of antibiotic resistance. Implementation of ASP must start with assessment of the current state of antimicrobial use. This study was therefore conducted to assess the prevalent prescribing patterns in a tertiary care hospital and identify gaps which warrant corrective intervention.Methods: This prospective pilot study presents analysis of the first 30 Patients from the medicine ward prescribed at least one antimicrobial agent during the two months of study period. Relevant data was collected in AMA record form. Appropriateness of AMAs was analyzed regarding selection as well as administration protocol as per the hospital antibiotic policy.Results: Out of the 60 AMAs prescribed to these patients, most commonly prescribed were cephalosporins (63.3%), anti-amoebics (26.6%) and macrolides (23.3%). Common diseases involved were urinary tract infection, acute gastroenteritis, sepsis and lower respiratory tract infections.  Use of AMAs was found to be appropriate for the indication in 42 %, dose in 97%, duration 60 %, route 93% and frequency 90 %.Conclusions: This gap between the appropriate and the actual practice use of AMAs indicates an urgent need of rigorous implementation of ASP in order to avoid emergence of resistance and to conserve the sensitivity to the available AMAs

Tetanus immunization: perception of residents in a tertiary care teaching hospital in Western India

Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to assess the knowledge & recommendations about tetanus immunization among randomly selected 157 residents. Results: 73.25% residents were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years. Around 50% residents were not aware of the recommended number of doses of tetanus vaccine for adults over the age of 16 years and during pregnancy. Nearly 60% of the residents considered the wound after every injury to be tetanus prone. 75.8% of residents thought burn injuries to be prone to the development of tetanus while 13.4% and 36.9% of the residents did not consider animal bite and human bite to be tetanus prone respectively. 99.4% residents considered tetanus toxoid administration in wound with rusted iron. The knowledge regarding tetanus immunization in relation to the wound categories depending on the immunization status of the patients was very poor amongst the residents. Conclusion: Better awareness and adherence of tetanus prophylaxis recommendations is needed in residents who are the first tier of health care providers in teaching hospitals

Wound healing in diabetic rats: Comparative efficacy of topical Insulin, Jatyadi formulations and Silver sulphadiazine”

To compare the effect of topical insulin, silver sulfadiazine and two ayurvedic formulations (jatyadi-ghrita and jatyadi-tail) on excision wound in experimentally induced diabetic rats. Diabetes Mellitus was induced by single intraperitoneal (i.p.) injection of 150mg/kg alloxan in wistar rats weighing 150-200gm.Study animals were divided into 6 groups of six rats each.Group I- Non Diabetic Control (no treatment), Group II - Diabetic Control (no treatment), Group III – Topical Insulin, Group IV – Silver Sulpfadaizine, Group - V Jatyadi-tail and Group VI- Jatyadi-Ghrita.An excision wound was inflicted in all rats by cutting full thickness of a pre-determined area (1 X 1 cm) on the depilated back of the rat under ether anesthesia. Drug treatment was given topically once daily. The healing was assessed by parameters like epithelialization period and wound contraction. The results were analyzed using One-way ANOVA followed by Tukey’s test by SPSS Software Version 20. Epithelization was delayed in diabetic control animals(18 days) in comparison to non diabetic control animals(12 days) and was hastened in all drug treated groups (insulin-8 days; silver sulfadiazine-10 days; jatyadi tail-11days and jatyadi ghrita-15 days) in comparison to diabetic control animals. There was significant improvement in wound contraction in Groups III-V (p<0.05from day 8 onwards) as compared to diabetic control group. Topical insulin has comparable wound healing efficacy to silver sulfadiazine in alloxan induced diabetic rats.Jatyadi tail also has shown very promising results in this model

IMPACT OF SERIES OF INTERVENTIONS ON CLINICIANS' AWARENESS ABOUT PHARMACOVIGILANCE SYSTEM IN WESTERN INDIA

Objective: In order to improve the participation of health professionals in spontaneous reporting, it is necessary to design strategies that modify their knowledge, attitude and practices (KAP) about pharmacovigilance.Methods: Initially KAP about pharmacovigilance among consultants and residents was assessed using a pre-tested questionnaire and interventions carried out according to the need. Starting with an informative lecture with voluntary participation, we extended it to various interventions like targeting specific groups of participants, displaying   posters, distributing brochures, one to group communication , sending reminders as emails and  also educating patients by putting up charts. Post intervention KAP was measured by re-circulating the questionnaire. Influence of interventions on KAP of pharmacovigilance was analyzed using chi-square test.Results: Pre-Intervention knowledge regarding pharmacovigilance was very low; particularly in residents than consultants (p<0.001).Though majority (98%) of the participants knew they could report ADRs, none of them had ever reported because of unawareness of reporting system. 96.4% participants wished to be trained for ADR reporting. Interventions significantly improved knowledge about ADR reporting system among them (p<0.0001). 34% Participants reported ADRs to the cell after getting sensitized by interventions (p<0.0001).Conclusion: Overall effect of all the interventions was positive and successful in building up an ADR reporting system at the study site. Constant reminders to the doctors are needed for pharmacovigilance culture to persist and flourish in clinical settings.  Key Words : Pharmacovigilance, Clinicians , Awareness , Interventions , Influenc