Prescription audit of outpatients in tertiary care government hospital

Background: Prescription audit is a tool as well as a technique by its application,all professionals will improve the quality of prescribing drugs. Standards of medical treatment can be assessed by prescription audit. It is based on documented evidences to support diagnosis, treatment and justified utilization of hospital facilities. Prescription audit is a quality improvement process that seeks to improve patient care. In this background the present study was conducted. The objectives of the study were to know the frequently prescribed drugs in OPD, number of the drugs used per prescription and to find out the rationality.Methods: Study was conducted at Sri Chamarajendra Hospital, HIMS, Hassan in OPD of General Medicine.1000 prescriptions were collected and noted down the frequently used medication, number of drugs prescribed and their type of formulations for the particular diagnosis.Results: From the study it is noted that 1910 drugs out of 1000 prescriptions were prescribed which is approximately 1.91 drugs per prescription about 55% of the prescriptions contained single drug. Very few received 4-5 drugs (7%). Almost all the drugs in prescriptions were in Generic names. Around 95% of prescriptions doses were mentioned in mg, ml etc. The most commonly prescribed drugs in order are Antibiotics, antidiabetics antihypertensives, bronchodilators, steroids antiemetics and ORS were prescribed.Conclusions: Polypharmacy was not found in our prescriptions which indicates our prescriptions improved the patient conditions. This type of study will ensure to know the ‘P’ drug development and select the essential medicine list for various levels of health care

Factors associated with polypharmacy in geriatrics

Background: In population with advancing age, the prevalence of medical co-morbid conditions is high and they are prone for complications. Hence the apprehension of using multiple drugs is more. Using more than 5 drugs per day is referred to as Polyphrmacy. Sometimes treatment causes more harm than the disease proper. So, optimizing drug therapy in these aging population is a challenging task for physician. Polypharmacy can also lead to increase in drug interactions, adverse drug reactions and medication errors. Hence the present study was taken up to study drug utilization pattern and factors leading to polypharmacy in geriatrics. The objectives of the study were to study the number and type of drug use and to know the different factors leading to polypharmacy.Methods: Cross sectional study was carried out among 60 geriatric persons ≥60 years of age present in old age home in Hassan. The study was done after taking the consent. All the prescriptions and medications being used along with history were collected and documented. The total number of drugs being used and names of all drugs were noted down and analysed. Results were analysed using descriptive statistics.Results: Among 60 geriatrics 38% males and 62% females age ranges from 60- 87 years. Average number of drugs used per day per person is 5.03 (Males 6.2 and Females 3.8) in 58.03% of individuals. Most common group of drug used is Gastro intestinal system (78.3%) and most common drug being used is Tab. Ranitidine 140mg (50%). Next group is NSAIDs (68.33%) and most common drug being used is Tab. Diclofenac (46.7%). Antihypertensive drugs were prescribed in 53.3% of geriatrics, most commonly prescribed drug is Tab. Amlodipine (5mg). Self medication was found in 100%. Most common group of drugs used as self medication are GIT drugs, supplements and NSAIDs. In supplements (used in 63.3%), Cap. B Complex is widely used (50%).Conclusions: Polypharmacy was found in 58.3% of individuals and highest in age group between 71-75 years and self medication was found to be the most important factor leading to polypharmacy. To counteract the problems associated with Polypharmacy, interventional studies are needed to improve the quality of life of geriatrics patients

A questionnaire based study on the knowledge, attitude, practice of staff nurses about pharmacovigilance in a tertiary care hospital

Background: Adverse drug reactions (ADR) - one of the global problems of major concern leading to morbidity and mortality. Spontaneous reporting of ADR is the cornerstone of Pharmacovigilance (PV) programme and it is important to reduce the risk of drug related harm to the patient. The active participation of healthcare professionals (Doctors, Nurses, Pharmacist) play a major role in the success of Pharmacovigilance. The objective of the study was to assess the knowledge, attitude, practice of Staff Nurses about Pharmacovigilance in a tertiary care hospital.Methods: A Cross sectional, Observational questionnaire based study was carried out using a pre designed KAP questionnaire. Study included 100 staff nurses who were working in Hassan institute of medical sciences (HIMS). The results were analyzed using descriptive statisticsResults: In our study 65% participants knows the correct definition and 48.8% knows the important purpose of Pharmacovigilance and 77.5% aware of existence of ADR reporting system in India. There was huge gap between ADR experienced (53.8%) and ADR reported (21.3%). The determinants of under reporting from our study include Lack of time / overburdened (33.7%) and lack of knowledge about ADR (31.25%).Conclusions: This study showed that majority of participants understand the need for reporting of ADR. In spite of that the reporting rate of ADRs by them is very low. Hence, there is a need to create awareness about the importance of reporting ADR by conducting many Pharmacovigilance programme

Effect of tabebuia heterophylla plant leaves extract on corrosion protection of low carbon steel in 1M HCl medium: Electrochemical, quantum chemical and surface characterization studies.

In the current study the chemical constituents of Tabebuia heterophylla plant leaves extract (THLE) evaluated as corrosion inhibitor for low carbon steel (LCS) in 1 M HCl. The major component present in plant extract was Hexadecanoic acid 2-hydroxy-1-(hydroxymethyl) ethyl ester confirmed by Gas Chromatography with Mass spectroscopic (GC-MS) analysis. Electrochemical impedance spectroscopy (EIS), potentiodynamic polarisation (PDP) and weight loss measurements were used to evaluate the THLE ability to protect low-carbon steel surface against corrosion in 1M HCl medium. The maximum inhibition efficiency reported as 95.45%, 93.99% and 94.79% by weight loss measurements, EIS and PDP methods respectively. In the prolongation of the work, the entropy of adsorption (Δ Sa*), enthalpy of adsorption (Δ Ha*), Gibbs free energy of adsorption (Δ Ga*), and activation energy (Ea) of the reaction were calculated. In absence of inhibitor, the Ea value was found to be minimum 49.38 kJ/mol whereas for optimum concentration of THLE it was found to be 77.2 kJ/mol implies more energy is required to undergo corrosion. The surface morphological observation from Scanning Electron Microscope (SEM), Atomic Force Microscopic (AFM) and Contact angle explored the effective adsorption of THLE. AFM values revealed that average surface roughness (Ra) value of LCS is high (188.08), where as in the presence of THLE, Ra values significantly reduced to minimum value of 37.226. Further chemical interactions between THLE and the low-carbon steel surface as well as inhibitory mechanism were further elucidated by theoretical simulations such as Density Functional Theory (DFT) calculations and Molecular dynamics (MD) simulations

Crupa: Collusion Resistant User Revocable Public Auditing of Shared Data in Cloud

Cloud repository is one of the most important services afforded by Cloud Computing where information is preserved, maintained, archived in distant servers and made available to the users over the Internet. Provided with the cloud repository facilities, customers can organize themselves as a cluster and distribute information with one another. In order to allow public integrity auditing on the information stored in semi-trusted cloud server, customers compute the signatures for every chunk of the shared information. When a malicious client is repudiated from the group, the chunks that were outsourced to the cloud server by this renounced customer need to be verified and re-signed by the customer present in the cluster (i.e., the straightforward approach) which results in huge transmission and reckoning cost for the customer. In order to minimize the burden of customers present in the cluster, in the existing scheme Panda, the semi-trusted Cloud Service Provider (CSP) is allowed to compute the Re-sign key. Further, the CSP audits and re-signs the revoked customer chunks by utilizing the Re-sign key. So, it is easy for the CSP by colluding with the revoked customer to find the secret keys of the existing customer. We introduce a novel Collusion Resistant User Revocable Public Auditing of Shared Data in Cloud (CRUPA) by making use of the concept of regression technique. In order to secure the secret keys of the existing customers from the CSP, we have allowed the information proprietor to compute the Re-sign key using the regression technique. Whenever the information proprietor revokes the customer from the cluster, the information proprietor computes the Re-sign key using the regression technique and sends to the CSP. Further, the CSP audits and re-signs the revoked customer chunks using the Re-sign key. The Re-sign key computed by the information proprietor using regression method is highly secure and the malicious CSP cannot find the private information of the customers in the cluster. Besides, our mechanism achieves significant improvement in the computation cost of the Re-sign key by information proprietor. Further, the proposed scheme is collusion resistant, supports effective and secure customer repudiation, multi-information proprietor batch auditing and is scalable

Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials

Background: Faricimab is a bispecific antibody that acts through dual inhibition of both angiopoietin-2 and vascular endothelial growth factor A. We report primary results of two phase 3 trials evaluating intravitreal faricimab with extension up to every 16 weeks for neovascular age-related macular degeneration (nAMD). Methods: TENAYA and LUCERNE were randomised, double-masked, non-inferiority trials across 271 sites worldwide. Treatment-naive patients with nAMD aged 50 years or older were randomly assigned (1:1) to intravitreal faricimab 6·0 mg up to every 16 weeks, based on protocol-defined disease activity assessments at weeks 20 and 24, or aflibercept 2·0 mg every 8 weeks. Randomisation was performed through an interactive voice or web-based response system using a stratified permuted block randomisation method. Patients, investigators, those assessing outcomes, and the funder were masked to group assignments. The primary endpoint was mean change in best-corrected visual acuity (BCVA) from baseline averaged over weeks 40, 44, and 48 (prespecified non-inferiority margin of four letters), in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (TENAYA NCT03823287 and LUCERNE NCT03823300). Findings: Across the two trials, 1329 patients were randomly assigned between Feb 19 and Nov 19, 2019 (TENAYA n=334 faricimab and n=337 aflibercept), and between March 11 and Nov 1, 2019 (LUCERNE n=331 faricimab and n=327 aflibercept). BCVA change from baseline with faricimab was non-inferior to aflibercept in both TENAYA (adjusted mean change 5·8 letters [95% CI 4·6 to 7·1] and 5·1 letters [3·9 to 6·4]; treatment difference 0·7 letters [-1·1 to 2·5]) and LUCERNE (6·6 letters [5·3 to 7·8] and 6·6 letters [5·3 to 7·8]; treatment difference 0·0 letters [-1·7 to 1·8]). Rates of ocular adverse events were comparable between faricimab and aflibercept (TENAYA n=121 [36·3%] vs n=128 [38·1%], and LUCERNE n=133 [40·2%] vs n=118 [36·2%]). Interpretation: Visual benefits with faricimab given at up to 16-week intervals demonstrates its potential to meaningfully extend the time between treatments with sustained efficacy, thereby reducing treatment burden in patients with nAMD