The impact of information and communication technologies (ICTs) on academic performance of medical students: an exploratory study

Background: Information and Communication Technology (ICT) has a potential to improve teaching and learning process. There are conflicting reports on the effect of ICT on student`s outcome. Though there is an early indication of positive impact, but the technology has a potential to have a detrimental effect. The present study was taken up to explore the effects of ICT on medical student’s academic performance.Methods: All the second professional students were given the questionnaire. Only 75 students had filled up the questionnaires completely.Results: The study population consisted of 48.00% males and 52.00% females. 97.33% students had smart phones, 44.00% had a laptop too. 10.66% students got less than 50% marks in the second professional examination, 14.66% got 50-59% marks, 62.66% got 60-69% marks and 12.00% got 70% or more marks. A low negative correlation was found between academic performance and possession of a smart phone (r= -0.062), and between academic performance and possession of a laptop (r= -0.029). A moderate negative correlation was found between academic performance and the time spent on a smart phone or laptop (r = -0.309). The correlations between academic performance and gender, and academic performance and the time spent on mobile phones or laptops were found statistically significant (p=0.000 and 0.007 respectively).Conclusions: Though ICT has capabilities of improving student`s academic performance, but it has a potential to have a negative effect if not used rationally. There is a vital need to sensitize the students about the potential academic risks associated with improper use of ICT. Students should be assisted and guided on how to use it judiciously

Personalized drug concentration predictions with machine learning: an exploratory study

Background: The dose individualization by therapeutic drug monitoring (TDM) can be improved if population-based reference ranges are available, as there is large inter- and intrapatient variability. If these ranges are not available, dose individualization may not be optimal. Machine learning can help achieve accurate drug dose settings and predict the resultant levels.Methods: Two random forest models, a multi-class classifier to predict dose and a regression model to predict blood drug level were trained on 320 patients’ data, consisting of their age, sex, dose and blood drug level. The classifier consisted of 1000 estimators (decision trees) and the regression model consisted of 1300 estimators. The model was evaluated on randomly split test set having 10% of the total dataset size. The regression model was compared against k-Nearest neighbor and linear regression models. The classifier was evaluated using accuracy, precision, and F1 Score; the regression model was evaluated using R2, Root mean squared error, and mean absolute error.Results: The classifier had an out-of-sample accuracy of 68.75%, average precision of 0.7567, and an average F1 score of 0.6907. The regression model had an out-of-sample R2 value of 0.2183, root mean squared value of 3.7359, and a mean absolute error of 2.5156. These values signify an average classification performance, and a below-average regression performance due to small dataset.Conclusions: It is possible for machine learning algorithms to be used in therapeutic drug monitoring. With a well-structured, rich, and large dataset, a very accurate model can be built

A cross-sectional study on knowledge, attitude, and behavior related to antibiotic use among undergraduate medical students in a tertiary care medical college, Kashmir

Background: Antibiotics represent one of the most prescribed drugs worldwide. The overuse and misuse of antibiotics are key factors contributing to antibiotic resistance. It is estimated that more than 50% of antibiotics are purchased without a proper prescription. Self-medication with antibiotics has been identified as one form of irrational use contributing to increased morbidity and mortality. Antibiotic self-medication assumes a special significance among medical students as they are the future medical practitioners. The objective of this study was to assess the frequency of antibiotic self-medication among medical students and their knowledge and perception about antibiotic use and its dangers.Methods: Pre-validated questionnaires were distributed among 300 medical students by simple randomization out of which 246 were returned completely filled. The analysis was done by manual calculators, VassarStats, and SPSS. Results are expressed in frequencies and percentages.Results: The prevalence of antibiotic self-medication among medical students was found as high as 80.89%. It was also observed that the gender of the respondents did not influence significantly the practice of antibiotic self-medication. The majority (52.26%) of the respondents used penicillins, mostly for upper respiratory tract infections (88.94%). The major source of antibiotics was medical stores (87.93%). Most of the respondents (57.58%) stopped the antibiotics after symptoms disappeared. It was found that the student’s knowledge improved as they progressed in their study. However, the senior students scored poorly on the behavior/practice toward the use of antibiotics.Conclusions: There is an urgent need to improve education on antibiotic use in medical curricula. Furthermore, strict policies must be enforced to regulate dispensing of antibiotics

ASSOCIATIONS BETWEEN THERAPEUTIC REGIMEN-RELATED FACTORS AND MEDICATION ADHERENCE IN PATIENTS ON ORAL ANTICANCER THERAPY

Objective: Good adherence is critical for successful cancer treatment. Complex medication regimens have been found among the various therapy-related factors causing non-adherence. Methods: In a cross-sectional questionnaire-based study of outpatients, we assessed 75 patients suffering from cancer. The objective of this study is to find associations between therapeutic regimen-related factors and medication adherence in patients on oral anticancer therapy. Results: There was an increase in medication adherence as the length of therapy increased. About 10.76% of the patients with treatment duration <4 years showed low adherence. Low adherence was not observed with treatment duration of more than 4 years. About 6.55% of those taking up to four drugs had low adherence as compared to 14.28% taking more than 4 drugs. About 8.69% of patients taking drugs up to thrice a day showed low adherence as compared to 16.66% taking more than thrice a day. The negative associations between medication regimen complexity and adherence observed in this study were in the predicted direction but did not achieve statistical significance (p>0.05). The effect size was small (d=0.28) Conclusion: Complex prescription regimens reduce adherence to oral anticancer treatments, however, there are several other factors to consider than regimen simplification to increase adherence

Effect of age and sex on serum phenytoin concentration in epileptic patients: experience from therapeutic drug monitoring

Background: Phenytoin is a widely prescribed anticonvulsant drug. There is a wide interpatient as well as intrapatient variability in serum phenytoin levels despite standard doses. Phenytoin dosing is challenging because the drug exhibits nonlinear kinetics and interacts with a number of drugs. Children metabolize the drug faster as compared to adults. Ageing is also associated with progressive decline in phenytoin clearance. Many CYP450 enzymes show a sex-dependent difference in activity. The objective for this study was to find the effects of sex and ageing on serum phenytoin levels.Methods: The influence of sex and ageing on the serum phenytoin levels was evaluated retrospectively in 96 anonymized epileptic patients who had received phenytoin alone for more than four weeks. These patients were divided into three age groups, up to 18 years (children), 19-60 years (adults) and more than 60 years (elderly).Results: There were 6.25% children, 84.37% adults and 9.37% elderly. The majority (71.87%) of patients were males. Children achieved a mean phenytoin level of 15.71±4.85 µg/ml after a daily dose of 225.00±75.82 mg. Adults attained a mean serum phenytoin level of 16.12±3.90 µg/ml with a mean daily dose of 282.72±69.44 mg. The elderly achieved a mean serum phenytoin level of 15.85±2.19µg/ml after a mean daily dose of 266.67±70.71 mg. As compared to 77.77% females, 84.05% males had phenytoin levels in therapeutic range. 50.00% children, 82.71% adults, and 100.00% elderly had phenytoin levels in therapeutic range. There was a correlation between sex, age and serum phenytoin levels (r = 0.003 to 0.762).Conclusions: There was a correlation between sex, age and serum phenytoin levels in this study. A better understanding of the effects of sex and age on the clinical pharmacology of phenytoin would enhance the quality of prescribing

A survey to assess awareness about fixed dose combinations (FDCs) among pharmacists in two Central Kashmir Districts, Srinagar and Budgam, Kashmir, India

Background: FDCs are highly popular in Indian pharmaceutical market. The FDCs have both advantages as well as disadvantages. To be advantageous WHO guidelines for the manufacture and use of FDCs must be strictly followed. Irrational use of FDCs is a major public health problem and leads to increased risk of adverse drug events, higher treatment costs and antimicrobial resistance. FDCs as well as other single component drugs cannot be used rationally unless everyone involved directly or indirectly in the health care profession is involved. Pharmacist is a coordinator between different members of healthcare team and the patients. Hence, his role in safe use of medicines is important. The present study was undertaken to assess the knowledge of pharmacists about FDCs.Methods: A descriptive questionnaire survey was conducted in various government and private pharmacies of two Central Kashmir Districts, Srinagar and Budgam, aiming to assess the knowledge of pharmacists about FDCs. The questionnaires were distributed randomly among 79 pharmacists, out of which 60 returned the completed questionnaire.Results: 55.00% of the respondents knew the basic facts about FDCs. 96.66% knew that FDCs reduced the cost of therapy and 93.33% were aware that FDCs improve patient compliance. 60% answered incorrectly when asked about effect of FDCs on cumulative toxicity. Almost equal percentage (63.33%) answered incorrectly when asked about rationality and ADR profile of FDCs. 83.33% knew that it is difficult to know the offending agent in case ADRs occur after FDC use.78.33% respondents thought that all FDCs are approved by drug regulatory authorities.Conclusions: The study showed that pharmacists had not the enough knowledge about FDCs. Pharmacy students in their formative years of learning should be taught to promote rational use of FDCs as they are the future custodians of technical information on the products available on their domestic market

Cost variation analysis of different brands of commonly prescribed antihypertensive drugs, available in Indian market: a pharmacoeconomic study

Background: Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. Globally, the overall prevalence of hypertension in adults aged 25 and over was around 40% in 2008.Despite its benefits, treatment of hypertension is costly. Direct medical spending to treat hypertension totalled $42.9 billion in 2010, with almost half ($20.4 billion) in the form of prescription medications. Being, a silent disease, adherence to antihypertensive drugs is poor. One of the important factors of poor adherence to antihypertensives is the cost of the drugs. There is wide cost variation among different brands of the same antihypertensive drug. Clinician’s awareness of cost of therapeutics is poor. The costly brand of same generic drug is proved to be in no way superior to its economically cheaper counterpart.Methods: The minimum and the maximum cost in Rupees (INR) of a particular antihypertensive agent manufactured by various pharmaceutical companies in the same strength were noted. The cost of 10 tablets/capsules was calculated. The cost ratio and percent cost variation were calculated for each brand.Results: The cost variation observed in the present study was as high as 2337.50 % for Hydralazine. Other significantly high cost variations found in the present study were: 1315.25% (Telmisartan+Hydrochlorthiazide), 870.58% (Amlopdipine), 558.34% (Amlodipine+Atenolol), 537.68% (Valsartan), 394.44% (Metoprolol), 344.44% (Enalapril), 316.22% (Propranolol), 300% (Lisinopril), 290.90% (Carvedilol), 289% (Cilnidipine), 271.99% ( Labetolol), 268.04% (Indapamide), 256.31% (Losartan), 255.19% (Irbesartan), 226% (Methyldopa), 223.04% (Frusemide), 209.78% (Nitrendepine), 192.08% (Terazosin), 189.25% (Atenolol), 142.42% (Bisoprolol) and 120.51% (Felodipine).Conclusions: Financial constraints are a reality in almost all aspects of medicine. Doctors must consider drug costs to their patients. Increasing pharmaceutical costs negatively impacts patients. Given the increasing healthcare costs, there is growing interest in rational prescribing, which takes costs of medication into account

Cost analysis of different brands of antimicrobial agents available in India

Background: A major reason why patients go-off regimen is the cost of drugs. In the global market, the cost of drugs is highly variable. In India, there are more than five hundred pharmaceutical manufacturers and most of the drugs are available in brands. Infectious and parasitic diseases are among the major causes of death worldwide. The greatest burden of infectious disease is found in developing countries. Many of these people could be cured if they receive appropriate treatment such as antimicrobials. People usually purchase the amount of drug they can afford and not what they need for total cure. If a clinician prescribes a cheaper effective brand, it could result in reduction of drug cost as well as total health-care costs. Clinicians cannot be expected to know the exact cost of each drug available in the market, but it would be helpful if they had some impression of the cost variation between different effective brands of the same generic drug. The objective of this study was to analyse the cost (acquisition cost) variation in different brands of commonly used antimicrobials in India.Methods: The minimum and the maximum cost in Rupees (INR) of a particular antimicrobial agent manufactured by various pharmaceutical companies in the same strength were noted. The cost of 10 tablets, 10 capsules or 1 injection was calculated. The cost ratio and Percentage cost variation were calculated for each brand.Results: A great variation was found in the cost of different brands of same antibiotic. Percent cost variation of (2000) was found for Ciprofloxacin 500 mg tablet, followed by (1830) for Imipenem one Gram vial. The lowest percent cost variations found were: Tigecycline 50 mg vial (9), Teicoplanin 400 mg vial (25), Acyclovir 800 mg tab (32), Vancomycin 1 G vial (40), and Lomefloxacin 400 mg tablet (72).Conclusions: Since there is a significant cost variation in different brands of same generic antimicrobial agent, clinicians need to consider drug cost while prescribing. If the clinician prescribes the cheapest of the effective brands available, it will help keep costs down and improve patient compliance

A calm look at the cost of various brands of antiasthmatic drugs available in India

Background: Asthma is an inflammatory disorder of lungs that affects people of all ages and is a significant source of morbidity and mortality worldwide. Approximately 300 million people in the world currently have asthma and there has been a concerning increases in the prevalence of this condition in recent decades. The asthma epidemic experienced by high-income countries over the past 30 years is now an increasing problem in low- and middle-income countries. Because asthma is a chronic condition, it requires continuous medical care. Failure to use appropriate drugs and comply with treatment can lead to unnecessary deaths. Higher and unaffordable drug prices are among the major reasons for non-compliance and resultant treatment failure. In the global market, the cost of drugs is highly variable. The cost of drugs plays a crucial role in patient’s care especially in developing countries. It has been observed that there is a gross variation in the cost of different brands of same generic drug. If doctors are not aware that large differences can exist in the price of medications used for the same indication, they may prescribe costly brands, which ultimately lead to non-adherence. The present study was planned to get some idea about cost differences in various brands of antiasthmatic drugs.Methods: The minimum and the maximum cost in Rupees (INR) of a particular antiasthmatic agent manufactured by various pharmaceutical companies in the same strength were noted. The cost ratio and percentage cost variation were noted for each brand.Results: This study shows that there is a noticeable variation in the prices of different brands of same antiasthmatic drug in Indian market. The highest percent cost variation (663) was found for Deflazacort 6mg tablet, followed (404) for Doxophylline 400 mg tab. Other significant percent cost variations were for: Theophylline 600 mg tab (353), Combination of Formoterol and Budesonide (122), Budesonide (103), Monteleukast 10 mg tab (93) and Deflazacort 1mg (88).The lowest percent cost variations found were for: Monteleukast 4mg tab (10), Ipratropium bromide (14) and Monteleukast 5mg tab (20).Conclusions: Since there is a significant cost variation in different brands of the same generic antiasthmatic drug, a conscientious doctor should always choose cheapest effective brand while prescribing. Asthma being a chronic illness requiring prolonged treatment, even a small cost variation can have significant economical implications

Undergraduate medical student’s perceptions and experiences of m-learning in pharmacology

Background: The current generation of medical students has grown up surrounded by information and communication technology (ICT). The ICT has been a critical component of teaching and learning in  higher education over the last few decades. Mobile devices, such as smart phones, can have a significant contribution to  modern medical education. Mobile learning or m‑learning is a new concept in learning process. M‑learning is supported by a variety of devices including smartphones. These devices integrate a series of features used in various learning environments. Pharmacology is a crucial subject for medical students who are going to be future medical practitioners. The aim of this study was to know how pharmacology students perceive mobile phones as an educational tool?Methods: Prevalidated Questionnaires were distributed among 145 pharmacology students by simple randomization out of which 105 were returned completely filled. Analysis was done by manual calculators, Vassar Stats, and SPSS. Results are expressed in frequencies and percentages.Results: Among the respondents 56.2% were males and 43.8% were females. All the respondents owned a mobile phone. 77.1% revealed that they mainly use mobile phones for internet purposes. 26.7% revealed that they use it solely for social networking, 9.5% for educational purposes and 63.8% used it for both social networking as well as educational purposes. Educational activities smartphones were used for included: reading lecture notes (24.8%), downloading lecture related videos (38.1%), downloading medical e‑books (29.5%), medical dictionaries (27.6%), opening doc and pdf files (35.2%), lab references (10.5%), medical calculators (6.7%). 78.1% had the opinion that m‑learning has a positive impact on learning and 68.6% indicated that mobile phone has improved their learning. Small screen size of phone (13.3%), costly bundled data (49.5%), limited phone storage (25.7%), low battery backup (28.6%), slow internet (48.6%), theft risk (3.8%), and parental prohibition to mobile phone use (12.4%) were the various barriers to m‑learning, indicated by the respondents.Conclusions: The results of this study indicate that medical students have a positive attitude toward m‑learning. M‑learning will facilitate the learning process without being tied to a physical location