Analysis of inappropriate medication use and drug interaction in older people visiting tertiary care center of eastern Nepal

Background: Medication use in older people has been increasing as the incidence of chronic diseases increases worldwide. Use of more medicines may increase the chance of prescribing potentially inappropriate medications (PIMs) and may increases the risk of potential drug-drug interactions (pDDIs). The objective of this study was to assess PIMs and pDDIs to improve the rational use of medicationsMethods: In this study data from the older people were obtained from patient visiting medicine, OPD, BPKIHS, Dharan. Demographic and medications information were collected. PIM and pDDIs were evaluated from medication data using the Beer’s criteria for potentially inappropriate medication use in older adults, 2015 and lexicomp application respectively.Results: Among 550 patients 50.9% patients were male. Common diagnosis was systemic hypertension 335 (64.5%) followed by type 2 diabetes mellitus 276 (50.18%). The most commonly prescribed drug was metformin (215) followed by amlodipine (205), atorvastatin (176), losartan (158), glimepiride (113) and aspirin (100). One or more fixed drug combination was present in 295 prescriptions. One or more PIM were present in 29 (5.3%) prescriptions. Commonly prescribed PIM was prazosin (11) followed by nitrofurantoin (5). There were total of 753 cases of pDDIs, with 116 (15.40%) cases of risk categories X and D.Conclusions: Our findings demonstrated PIM use were relatively less. However, pDDIs were common in older people suggesting that optimal medication use and further similar studies in larger scale are necessary in this population

Measuring What Works: An Impact Evaluation of Women's Groups on Maternal Health Uptake in Rural Nepal.

BACKGROUND: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal. METHODS AND RESULTS: This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child ≤ two years ago, were interviewed. Difference-in-Difference estimation assessed the effects of the intervention on selected outcome variables while controlling for a constructed wealth index and women's characteristics. In the first three years (from 2007 to the 2010), the intervention increased women's likelihood of attending for antenatal care at least once during pregnancy by seven times [OR = 7.0, 95%CI (2.3; 21.4)], of taking iron and folic acid by three times [OR = 3.0, 95%CI (1.2; 7.8)], and of seeking four or more antenatal care visits of two times, although not significantly [OR = 2.2, 95%CI (1.0; 4.7)]. Over five years, women were more likely to seek antenatal care at least once [OR = 3.0, 95%CI (1.5; 5.2)], to take iron/folic acid [OR = 1.9, [95% CI (1.1; 3.2)], and to attend postnatal care [OR = 1.5, [95% CI (1.1; 2.2)]. No improvement was found on attending antenatal care in the first trimester, birthing at an institution or with a skilled birth attendant. CONCLUSION: Community-based health promotion has a much stronger effect on the uptake of antenatal care and less on delivery care. Other factors not easily resolved through health promotion interventions may influence these outcomes, such as costs or geographical constraints. The evaluation has implications for policy and practice in public health, especially maternal health promotion

meDical errors cHallengesFor tHeHealtH ProFessionals: neeD oF PHarmacovigilance toPrevent

The incidence of different aspects of iatrogenic problems due to drugs is Adverse Events (AEs) 3.7%, Adverse Drugs Events (ADEs) 2.4-6.5%, Adverse Drugs Reactions (ADRs) is 6.7%. Negligence in serious ADEs and death is 34% and 51% respectively, preventable ADEs is 28-50%. Medication Errors (MEs) occur most often in prescribing (29-56%). The most common cause of MEs is lack of knowledge about the drug (29%) and the patient about 18%. MEs result malpractice claims in 13-25% of cases which occur due to mistakes and slips of action & lapses of memory. The MEs can be prevented by establishing effective Pharmacovigilance control center, which frequently gives proper guidance to the prescribers. Use of computerized decision for prescription writing, effective communication with patient, families, pharmacists and nurses and continuing medical education on information of new drugs and new information on current drugs can be effective tolls to prevent the errors. Key Words: Medical errors, Pharmacovigilance, Malpractice, Adverse effects

Additional file 1: Table-S1. of Effect of root-extracts of Ficus benghalensis (Banyan) in memory, anxiety, muscle co-ordination and seizure in animal models

Step down latency (s). Table S2. Mean Step-down latency (s). Table S3. One-Way ANOVA Test- mean Step-down latency (s). Table S4. Tukey HSD post hoc tests-comparing mean Step-down latency (s). Table S5. Step down error. Table S6. Comparison of mean Step-down error. Table S7. One-Way ANOVA Test- mean Step down error. Table S8. Tukey HSD post hoc test comparing mean Step down error. Table S9. Time spent in shock zone in s. Table S10. Comparison of mean Time spent in shock-zone. Table S11. Mann–Whitney U test comparing mean time spent in shock-zone (s). Table S12. No. of squares crossed. Table S13. Comparison of mean Number of squares crossed. Table S14. One-Way ANOVA Test- Number of squares crossed. Table S15. Tukey HSD post hoc tests-comparing mean Number of squares. Table S16. Time spent in Central Square(s). Table S17. Comparison of mean Time spent in central-square(s). Table S18. Mann–Whitney U test comparing mean Time (s) spent in Central Square. Table S19. Number of rearing. Table S20. Comparison of mean Number of Rearing. Table S21. Mann-Whitney U test comparing mean number of rearing. Table S22. Total sleep time (s). Table S24. One-Way ANOVA Test- mean total sleep time in Pentobarbital-induced sleep potentiation test. Table S25. Tukey HSD post hoc tests-comparing mean total sleep time. Table S26. Fall-off time (s). Table S27. Comparison of mean Fall-off time. Table S28. Mann–Whitney U test comparing mean fall-off time. Table 29. Animals not showing seizure. Table S30. Latency of seizure onset (s). Table S31. Comparison of mean Latency of seizure-onset (s). Table S32. Mann–Whitney U test comparing mean latency (s) in PTZ-seizure model. Table S33. Animals not showing seizure. Table S34. Duration of tonic hind limb extension (s). Table S35. Comparison of mean duration of tonic hind-limb extension. Table S36. Mann–Whitney U test comparing mean duration of tonic hind limb extension. (XLSX 11 kb

Knowledge integration in IPPD project: role of shared project mission, mutual trust, and mutual influence

Project integration is an important management issue related to product development performance outcomes. Design, development, production, and commercialization of new products and services require a project team's ability to acquire and integrate different knowledge bases of internal capabilities, customers, and suppliers. A literature gap exists regarding critical drivers of knowledge integration and shared knowledge in product development projects that needs to be identified and scientifically validated. Based on goal setting, social exchange, and information processing theories, the current study identifies antecedents of knowledge integration in terms of a shared project mission, mutual trust, and mutual influence, and investigates key relationships among these antecedents to determine the effect of knowledge integration on integrated product and process development (IPPD) project outcomes. Proposed hypothetical relationships among these constructs were tested on primary data collected from 191 respondents (OEM project managers and team members, suppliers, and customers) from IPPD projects from the U.S. automotive industry. With regards to the antecedents of knowledge integration in IPPD projects, our results indicate a statistically significant positive association between shared project mission, mutual trust, mutual influence and knowledge integration. Further, our results indicate a positive relationship between knowledge integration and performance outcomes measured in terms of IPPD project success and IPPD product success. Our results also indicate a partial mediating effect of mutual trust and mutual influence between the relationships of shared project mission and knowledge integration. Discussion of our empirical results, limitations, and recommendation for future studies in the area of knowledge integration in the area of IPPD projects are also provided. © 2019 Elsevier Ltd and Association for Project Management and the International Project Management Associatio

HOW COST EFFECTIVE IS THE TREATMENT? ARE PRESCRIBERS CONCERNED ?

ABSTRACT Cost-effective treatment should be of primary concern to prescribers in poor countries like Nepal. Thepresent study was carried out at a tertiary care hospital in Nepal to find out the perception of prices ofcommonly prescribed drugs among prescribers. The participants selected randomly were directed to writein 10 minutes on a proforma, the generic name(s) and price of the brand preparation of 18 most commonlyused drugs listed under their brand name. The price of the drug was considered correct if the price mentioned was within a range of 20% above or below the brand price. Results indicated that the participants were aware of the composition of majority (80%) of the drugs, but were not aware of the prices of 81.80% of the drugs. No single participant mentioned the correct prices of all the drugs. Among the drug groups studied, the most accurate data was provided about composition (90.43%) and price (24.47%) of non steroidal anti-inflammatory drugs (NSAIDs). Only in 9.22% of brand preparations of antimicrobial agents (AMA), the prices were mentioned correctly. Hence, sensitisation of physicians about cost-effective treatment is of immense importance and to facilitate this, hospital authorities could provide prescribers with regularly updated price lists of commonly prescribed drugs and competitive prices of various brand preparations. Pharmacoeconomics may be introduced in the undergraduate curriculum which can be reinforced by continuing medical education. Key Words: Cost-effective, Pharmacoeconomics

Utilization Pattern Of Nonsteroidal Anti-Inflammatory Drugs(NSAIDS) in Orthopedic Practise at a tertuary Care Hospital In Eastern Nepal

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Antinociceptive effect of amitriptyline in mice of acute pain models

529-531Tricyclic antidepressant drugs induce antinociceptive effect and suggest that their analgesic action could be related to the monoaminergic activity of the drugs. The analgesic activity of amitriptyline was observed in mouse models of acute pain. Mice were divided into different groups and were given amitriptyline in different doses alone and in combination with morphine. Reaction time in Hot-Plate and Tail-Flick tests was observed. Results showed that amitriptyline had antinociceptive effect in acute pain state in experimental models. Amitriptyline in combination with morphine had better analgesic effect than the morphine alone in Hot-Plate test