Drug utilization study in postoperative patients in obstetrics and gynaecology ward of tertiary care hospital

Background: A growing number of pharmaceutical products are available in the world market and there has been an increase both in the consumption of the drugs and in expenditure on them. The aim of the study was to analyse drug usage in post-operative patients in obstetrics and gynaecological ward and to assess the prescribing indicators (WHO: Core Drug Use Indicators).Methods: A prospective observational study was conducted over a period of six months, after getting approval from Institutional Ethics committee. A specially designed proforma was used to collect the data of post-operative patients in Obstetrics and Gynaecological ward of a tertiary care hospital. The data was analysed using descriptive analysis with the help of SPSS software.Results: A total of 582 cases were analysed during the study. Out of 582 patients, 559 (96%) were prescribed with parenteral cefotaxime and metronidazole. Post-operative pain was managed with tramadol (96%). All patients were prescribed with an antibacterial agent and analgesic (100%). The percentage of encounters with an injection prescribed was 100% in our study. Out of 19 different drugs prescribed, 16 (84.21%) were from the Essential Medicines WHO Model List (2015) and 10 (52.63%) were prescribed by their generic name.Conclusions: The present study provides valuable insight about the overall pattern of drug used in postoperative patients. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society

PATTERN OF PSYCHOTROPIC PRESCRIPTION IN A TERTIARY CARE TEACHING HOSPITAL: A CRITICAL ANALYSIS

objectives: (1) To study the prescription pattern of psychotropic drugs amongst patients attending the psychiatry outpatient department (OPD) in atertiary care hospital, Mandya, (2) to evaluate patterns and recent trends in psychotropic polypharmacy.Methods: This was a prospective, cross-sectional and observational study, done over 8 weeks, among patients attending psychiatry OPD. The most recentprescribed psychopharmacological medication of the patients were collected in a standard proforma and analyzed according to World Health Organization(WHO) prescription indicators. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used wherever appropriate.Results: A total of 405 prescriptions were evaluated. Anti-epileptics (22.9%), antidepressants (19.7%) and antipsychotics (11.0%) were the commonlyadvocated drug groups in more than half of prescriptions. Phenobarbitone (30.2%), escitalopram (27.9%), and risperidone (48.9%) were commonly useddrugs among anti-epileptics, antidepressants, and antipsychotics, respectively. Nutraceuticals constituted 8.7% of total drugs. Percentage of drugs prescribedby generic name was 54.9%. Polypharmacy was prevalent in 2.7% of prescriptions. Percentage of drugs prescribed as fixed-dose combination was 21%.Conclusion: The WHO guidelines regarding prescription of drugs were followed consistently. The issue of prescribing by brand names need to beaddressed. Polypharmacy was advocated for negligible number of subjects and the reasons were justifiable.Keywords: Prescription audit, Polypharmacy, Psychopharmacological agent

Assessment of knowledge, attitude and practice of interns towards antibiotic resistance and its prescription in a teaching hospital: a cross sectional study

Background: Aim of the present study is to assess the knowledge, attitude and practices adopted by interns towards the antibacterial resistance and prescription.Methods: This is a cross sectional questionnaire based study conducted among the interns working in a teaching hospital. After obtaining the consent, the interns were asked to answer the preformed structured questionnaire to evaluate their knowledge, attitude and practice towards antibiotic resistance and prescription. Completed questionnaire were collected, compiled and data was analysed using descriptive statistics. Chi-square test was also used at appropriate places to determine the statistical significance.Results: A total of 80 participants completed the questionnaire. The response rate was 100%. Most of the interns had good knowledge of antibiotic resistance. 95% of the interns felt that the antibiotic resistance is an important and serious global health issue. Only 21.2% felt the need of antibiotic to treat common cold symptoms. Majority of the respondents agreed with the need of an antibiotic policy in the hospital to achieve rational antibiotic usage. With regard to having a course on rational use of antibiotics in the curriculum, 63.7% agreed and 31.2% strongly agreed.Conclusions: Our study has generated information about the knowledge, attitude and practice of interns towards antibiotic resistance and prescription which can help planning for an effective curriculum regarding antibiotic resistance and prescription

Effect of educational intervention on knowledge, attitude and practice of hepatitis B vaccine among medical students

Background: Aim of the study were to assess the impact of education on knowledge, attitude and practice of Hepatitis B vaccine among medical students and to educate the students regarding Hepatitis B vaccination.Methods: Non-randomized before and after comparison study was conducted to evaluate changes in knowledge, attitude and practice of Hepatitis B vaccination (HBV), assigning structured questionnaire of 26 different statements concerning knowledge, attitude and practice by pre and post educational intervention on Hepatitis B and its vaccination.Results: The study was conducted among 100 second year medical students. The response rate was 100%. There was statistically significant improvement in knowledge from pre-test mean scores for modes of transmission (87.4+4.70 vs 95.8+1.61; p=0.0001), preventive measures (92+0.47 vs 98+0.94; p=0.001) and Hepatitis B vaccine (71+4.72 to 84.7+6.65; p=0.0001) to post-test. While the increase in mean scores from pre-test for attitude (68.6+9.21 vs 77.43+11.1) and practice (55+25.41 vs 65.6+32.6) were statistically significant in post-test (p=0.0001; p=0.001 respectively).Conclusions: Structured educational intervention among medical students about Hepatitis B vaccination showed improved knowledge and behaviour and also increased the percentage of students willing to get screened and their participation in health education programmes related to Hepatitis B. However, there is slight lack of knowledge regarding the transmission of Hepatitis B and its vaccination schedule. In this regard, implementation and evaluation of educational intervention is needed as a preventative measure

Drug utilization study in otorhinolaryngology outpatient department in a tertiary care teaching hospital

Background: Drug utilization research is defined by the World Health Organization (WHO) as marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences. Drug utilization study identifies the problems that arise from prescription and highlights the current approaches to the rational use of drugs. The main aim of the study is to assess the pattern of drug usage and the rationality of drug use in Otorhinolaryngology out-patient department (OPD).Methods: A prospective observational study was conducted in the OPD of Otorhinolaryngology at tertiary care hospital, Mandya, Karnataka, over a period of one year. Prescriptions of all OPD patients were collected, relevant information entered in a specially designed proforma and analysed using descriptive statistics.Results: A total of 21058 drugs were prescribed out of 8028 prescriptions. Majority of the patients were male (51%). Antimicrobials were the most commonly prescribed drugs (28%), followed by antihistamines (25%), antipyretics (20.5%).Most of the drugs 18576 (88.2%) were prescribed by oral route, followed by topical route. Majority of the drugs were prescribed by the generic names (86.5%). Most common type of infection was ear infection (3176), followed by throat infection (2848) and nose infection (2004).Conclusions: The present study showed that among antimicrobial agents, β lactams were commonly prescribed drugs in the department of Otorhinolaryngology. The maximum number of cases was diagnosed with ear infections and majority of the drugs were prescribed orally

A prospective observational study of drug usage in the management of snake bite patients and their outcome in a tertiary care teaching hospital

Background: The objectives of the study were to assess the pattern of management of snakebite especially with respect to use of anti- snake venom and other supportive treatment given and to assess the effect of anti-snake venom on different types of snakebite and to assess their outcome.Methods: A prospective observational study was conducted over a period of 6 months, after getting approval from Institutional Ethics committee. Total of 144 snake bite patients were analysed for six months duration for use of anti-snake venom and other supportive treatment in their management and were assessed for their outcome like recovery, morbidity and mortality.Results: Out of 144 snake bite patients analysed, 71.5% had poisonous type and 28.4% had non- poisonous type of snake bite. Among the total number of snakebites, 47.2% were unknown type and among the known type 25% were viper, 13.2% cobra, 7.6% krait, 6.3% sea snake and 0.7% green snake. Anti-snake venom (ASV) was given to 62 patients depending on severity, of which, 22 patients developed reaction to ASV. Patient with reaction to ASV were treated with corticosteroid and antihistamine injection. Morbidity was seen in 29.1% of patients who developed either cellulitis or gangrene of bitten area, which was more commonly seen among viper bite patients (54.7%).Conclusions: Snakebite is one of the commonest tropical diseases leading to envenomation and poisoning especially in rural areas of tropical countries which has to be treated as early as possible to prevent complications. Majority of the cases in our study were of viper bite and most of them have recovered after treatment

Pharmaceutical drug promotion: perception and attitude of medical interns towards drug company interactions in a tertiary care teaching hospital

Background: Interactions of pharmaceutical industry with the physicians which are usually mediated through pharmaceutical representatives have a significant impact on physician decision-making. This interaction can start as early as medical school during their training and this is said to influence their prescribing behavior when they become physicians. Aims and objectives of the study was to evaluate the attitude of interns towards pharmaceutical companies interactions including accepting gifts, ethical issues and influence on clinical decisions and also to study perception of medical interns towards the accuracy of information provided by the medical representatives.Methods: This was a cross sectional questionnaire based study that was conducted among the medical interns of the teaching hospital attached to Mandya Institute of Medical Sciences, Mandya. The study was carried out between July and August 2016. A preformed structured questionnaire was distributed to the interns consenting to participate in the study. Completed questionnaires were collected, compiled and data was analyzed.Results: A total of 93 questionnaires were distributed and 90 interns responded (response rate 96.7%). About 44.4% respondents felt that accepting gifts from Drug Company would influence their own decision making. Only 26.6% of them were of the opinion that it is ethical to accept pharmaceutical company gifts. Majority of them felt that Medical Representatives exaggerate the benefits of medicines and downplay the risks and contraindications of medicine. About 32.2% of them were of the opinion that they would prefer to prescribe the drug from the companies offering them with gifts over those without. Majority of the respondents felt that the doctors should be offered with gifts by drug companies whenever their drugs are prescribed.Conclusions: Attitude of Medical Interns towards Drug Company interactions as observed suggests for training the budding doctors on appropriate drug company interactions to prevent the risks associated with promotional efforts of pharmaceutical companies.

Study of drug utilization pattern in the department of radiotherapy in a tertiary care teaching hospital

Background: Drug utilization studies are an important tool in evaluating the rationality of therapeutic practice and also it is said to improvise the therapeutic use of drugs. The present study will be undertaken to evaluate the drug utilization pattern in the department of Radiotherapy.Methods: This was a prospective, observational study that was undertaken in the department of Radiotherapy in a tertiary care teaching hospital. The study was conducted for a period of 6 months after obtaining permission from Institutional Ethical Committee. The study was conducted among cancer patients undergoing radiotherapy. The data was collected from the patient case records and was analyzed as per the WHO prescribing indicators.Results: In the present study it was observed that the average number of drugs prescribed per encounter was 7.7. The drugs prescribed by generic name were 41.4%. Percentage of encounters with an antibiotic prescribed was 100. Percentage of encounters with an injection prescribed was 20.5%. Percentage of drugs prescribed from essential drugs list was 35.8%.Conclusions: Drug utilization studies helps in modifying the prescription pattern and helps in making the drug usage more rational

A randomized open label comparative study to determine the various side effects and patient satisfaction of low dose continuous versus low dose intermittent oral isotretinoin therapy in moderate to severe acne vulgaris

Background: Acne Vulgaris is chronic inflammatory disease of pilosebaceous units. Oral isotretinoin is recommended for moderate to severe acne vulgaris who are not responding satisfactorily to conventional therapies. Recent reports indicate that acne patients have been benefiting from the low dose treatment protocols. However, long term daily use of this drug results in frequent side effects such mucocutaneous and systemic side effects. Our aim was to assess and compare the various side effects and patient satisfaction of oral isotretinoin in low dose continuous and intermittent treatment of moderate to severe acne vulgaris.Methods: This was a prospective randomized open labeled comparative study carried out at outpatient department in the Department of Dermatology in Mandya Institute of Medical sciences, Mandya. Patients with moderate to severe acne were assigned equally (50 subjects each) to one of the two treatment regimens by using block randomization technique, Group A was given low dose continuous regimen-20 mg oral isotretinoin once daily for 4 months and Group B was given low dose intermittent regimen-20 mg oral isotretinoin once daily for 1 week out of every 4 weeks. The patients were followed up every 4th week during the treatment period. The patients were examined and side effects were noted in each visit. A six month follow-up evaluation was done to analyze patient satisfaction.Results: Muco-cutaneous dryness was most common adverse effect noted in both the groups A and B. Itching (42%), Alopecia (44%), Myalgia (36%) were seen most commonly in group A and Acne flaring (47%) was most common with group B. With regard to patient satisfaction, in group A 42% were satisfied and 20% were very satisfied, in group B 36% were satisfied and 14% were very satisfied.Conclusions: Study suggests that, Muco-cutaneous dryness was most common side effect in both treatment regimens. Side effects were more frequent with low dose continuous than low dose intermittent isotretinoin regimen. Patient satisfaction was better in continuous regimen

A prospective study of drug utilization pattern in cardiac intensive care unit at a tertiary care teaching hospital

Background: Cardiovascular diseases remain the most common cause of sudden death. Appropriate drug therapy in cardiac intensive care unit (CICU) is crucial in managing cardiovascular emergencies and to decrease morbidity and mortality. The present study was conducted to observe the emergency cardiac diseases which are most frequently being treated and to study the prescribing prevalence among inpatients in CICU.Methods: A prospective, observational study was carried out among 102 patients admitted in CICU at a tertiary care teaching hospital, Karnataka, for a period of 3 months. Demographic data, clinical history, and complete drug therapy received during their stay in CICU was noted.Results: In our study, males (64.7%) had a higher incidence of cardiovascular emergencies than females (35.3%). Hypertension (32.4%) and Type 2 diabetes mellitus (28.4%) were the frequently associated co-morbid conditions. Antiplatelet drugs 80 (78.4%) was most commonly prescribed, followed by hypolipidemic drugs 75 (73.5%) and anticoagulants 65 (63.7%). The mean duration of stay in the hospital was 4.79±1.9 days. The average number of drugs per prescription was 7.8±2.2. Percentage of drugs prescribed by generic names was 52.9%. The percentage of drugs prescribed from essential drug list was 75.1%.Conclusions: Antiplatelet drugs were the most frequently prescribed drug group. Mean number of drugs per prescription were high. The prescribing pattern could be improved by reducing the number of drugs per prescription and by prescribing generic drugs to reduce the economic burden of the patients