Pattern of adverse drug reaction in geriatric inpatients of medicine in a tertiary care center: a prospective observational study

Background: Adverse drug reactions (ADRs) represent a major public health problem in older age. In order to better evaluate this problem, this study was designed to assess the prevalence and spectrum of ADRs in terms of frequency, type, severity and preventability in geriatric patients in medicine ward of Guru-Gobind Sing hospital, Jamnagar during 12 months study period.Methods: All ADR related patient’s necessary data was obtained and recorded on a pre- designed case record form (CRF). The data record includes general details e.g., name, age, sex, past and present history, general and systemic examination, laboratory investigation, diagnosis and treatment. Details regarding suspected medications, treatment given, and the outcome were documented with prior permission of institutional ethics committee.Results: Demographic analysis of prospective study revealed that out of 84 patients, 45 male and 39 were female. The patients had developed ADR within the age ranges of 31 (65-69) followed by 23 (75-79). The majority of ADR was vomiting and diarrhea 15 followed by chills 08 and cough 04. It is evident that antimicrobials 31 agents were mainly suspected followed by NSAIDs 18. According to WHO-UMC scale, the possible cases had a higher incidence 63, followed by probable 19 and certain 2. After estimating the severity by Hartwigs scale 79.8% were mild to moderate while 20.23% were severe in nature.Conclusions: Age is not an independent risk factor of ADRs and suitable monitoring and regular medication review can reduce the incidence of ADRs in geriatric people

Comparative study of patient-based versus case-based teaching in prescription writing skills of second year MBBS students

Background: Prescription writing errors can lead to deficiencies in healthcare. Although prescription writing is a part of the medical students' curriculum with traditional methods, their prescribing skills are still poor due to inadequate training. To fulfil the need for new educational interventions this study aims to compare patient-based teaching with case-based teaching in improving prescription writing skills of second year MBBS students.Methods: This prospective comparative study was carried out after orientation of participants to prescription writing as per WHO prescribing guidelines (n=71). Group A (n=37) and group B (n=34) were given patient-based teaching and case-based teaching respectively of prescription writing for the same five common clinical conditions. The prescription writing skill was assessed by evaluating the prescriptions written by both the groups and scored by 19-point scoring system. Feedback from the group A students was also taken.Results: Statistical analysis of mean scores of group A (15.90) and group B (13.14) was done by Mann-Whitney U test (p<0.001). Comparison of both the groups for the individual parameters was done by Chi-square test which found significant difference in writing some important parameters like doctor’s registration no., contacts of prescriber, name of the medicine, strength of drug, dosage form, dosing instructions, total quantity of medicine and duration of medication etc. Group A students’ feedback brought out the fact that patient-based teaching is a good tool for teaching and learning.Conclusions: Patient-based teaching for prescription writing improves students’ prescription writing skills in an effective way in comparison with traditional case-based teaching

Adverse drug reactions: a retrospective review of hospitalized psychiatric patients at tertiary care hospital

Background: Hospital data based monitoring of ADRs can shed light on their extensiveness and pattern of occurrence. Study is expected to enable us in obtaining information on the incidence and pattern of ADRs in the local population. The objective of this study was to do surveillance, detect incidence of ADR and to analyse the ADRs according to their demographic distribution, reporting, presentations and causality assessment scale.Methods: A retrospective study conducted from January 2011 to December 2014 and psychiatric hospitalized patients were analysed and ADR reports were assessed for probability, severity, psychotropic drugs involved, and preventability.Results: A total number of 101 ADRs were reported in 72 patients. Most common ADR were mainly tremor 14 (13.86%), salivation 11 (10.89%) followed by muscle rigidity 6 (5.94%) and slurring of speech 6 (5.94%). In majority of the instances, it was antipsychotic agents 41 (56.94%) followed by antidepressants 11(15.27%) and mood stabilizers 11 (15.27%). As per causality assessment, 95 (94.05%) cases were ‘possible’ in WHO-UMC criteria and 72 71.28%) cases were ‘possible’ in Naranjo scale respectively. As per Schumock and Thornton preventability assessment, 91(90.09%) of total ADRs were in the not-preventable category. As per Hartwig and seigle’s severity assessment, majority of ADRs 74 (73.26%) were mild in severity.Conclusions: ADRs were most commonly associated with antipsychotic drugs. Developing an on-going ADR reporting system with continuous motivation and creating awareness among the healthcare professionals for reporting suspecting ADR will help to continue reporting and improving the patient’s safety

Drug prescribing pattern in surgical wards of a tertiary care hospital in Western part of India

Background: In surgical wards, drugs are required to manage pain, nausea, vomiting, infections, etc. A growing number of pharmaceutical products are available in present era. Irrational prescribing of drugs is prevalent worldwide. Drug utilization study can be used to assess prescribing patterns. Authors undertook this study to determine current practice of prescribing in surgical wards of the hospital.Methods: Authors conducted observational, noninterventional, descriptive study among patients admitted in surgical wards for one year. Authors have analysed collected data of 604 patients using descriptive statistics to determine utilization pattern of drugs and drug use indicators.Results: Appendicitis (14.9%) followed by hernia (10.6%) were leading diseases for admission. Mean duration of stay was 7.44. Average number of drugs in a prescription was 8.94. Antibiotics (32.07 %), analgesics (17.11 %) and antacids (16.09 %) were leading drug groups prescribed. Amikacin (5.81 %) followed by metronidazole (5.30 %) and ciprofloxacin (5.19 %) were commonly prescribed antimicrobial drugs. Tramadol (5.31 %) and pantoprazole (7.17 %) were leading drugs prescribed from analgesics and antacids respectively. All prescriptions had at least one injectable drug. At least one antibiotic was present in 92.05 % prescriptions. Majority of drugs (87.27 %) were prescribed by generic names. Proportion of drugs prescribed from essential medicine list was 84.22 %.Conclusions: Polypharmacy and injectable drug prescribing were common in practice. There is a scope for improving such prescribing practices among practitioners. Use of multiple antibiotics should be avoided whenever possible and usage should be evidence based