Assessment of prescription writing skills among undergraduate medical students

Background: The existing medical undergraduate curriculum includes training in prescription writing in second phase under pharmacology and Therapeutics. This study evaluates the prescription writing skills of undergraduate medical students and interns and need for emphasis on prescription writing during various phases of learning process in medical undergraduates.Methods: After obtaining institutional ethics committee approval, we recruited 4th to 8th semester medical undergraduate students and interns into the study, who gave written informed consent. They were given a pilot-tested, pre-evaluated questionnaire addressing the issues of prescription writing. They were asked to prescribe for a common clinical scenario. Their prescriptions were analysed for various parameters as indicated in WHO guidelines.Results: Of the 350 medical undergraduate students and interns invited, 281 of them participated in the study. 169 participants (60.1%) agree that they have not written a formal prescription to any patient when the questionnaire was administered. 134 participants (47.6 %) feel that undergraduate training has not prepared them for prescribing properly. 90% of participants said reinforcing classes during 3rd, 4th year and during Compulsory Routine Rotatory Internship will be beneficial. Though 220 participants have opined that generic name should be used while prescribing, only 124 have actually used generic names in their prescriptions. Fifteen participants have failed to write the symbol while prescribing. All 121 interns in the study have used brand names while prescribing.Conclusions: There are widespread lacunae in prescription writing by medical undergraduates. There is perceived need for reinforcement sessions at third and final phase of undergraduate education to address this gap. Most participants opine that clinicians do not discuss this issue during case discussion. There is knowledge and practice gap in using generic names while prescribing

Knowledge and practices regarding pharmacoeconomics among resident doctors in a tertiary care teaching hospital

Background: With skyrocketing health care costs, even the essential care provided by the health care service providers need to be evaluated under the lens. The development of nationwide awareness of cost-benefit, cost-utility and cost-effectiveness of services is the need of the hour. The objectives of the present study were to assess the knowledge about pharmacoeconomics among resident doctors and to assess the clinical application of pharmacoeconomics among them.Methods: A cross sectional questionnaire-based survey was conducted among resident doctors involving both interns and post-graduates of a teaching medical college. There were 20 questions; initial ten were for knowledge assessment and next ten questions assessed practical applications. Questions assessed the knowledge regarding components of pharmacoeconomics, direct and indirect medical costs, and application of pharmacoeconomics, local cost-effectiveness decisions and advantages of pharmacoeconomics.Results: Of the 118 participants who took part in the study, 42 were clinicians working in medical college hospital, 12 were clinicians working in dental college hospital, 24 medial postgraduates, 30 dental postgraduates and 10 interns. Nearly 90% of the respondents opine that concepts of pharmacoeconomics are not followed in every teaching hospital in India. Many participants (90%) opined that health economics and pharmacoeconomic are different. Nearly 94% of participants have not under gone any training regarding pharmacoeconomics. More than 95% respondents have opined that principles of pharmacoeconomics has to be introduced into current medial undergraduate curriculum.Conclusions: This study shows light on the knowledge and practices of resident doctors regarding principles of pharmacoeconomics. This study has revealed the level of awareness of younger generation regarding pharmacoeconomics

Perturbation Theory for Spin Ladders Using Angular-Momentum Coupled Bases

We compute bulk properties of Heisenberg spin-1/2 ladders using Rayleigh-Schr\"odinger perturbation theory in the rung and plaquette bases. We formulate a method to extract high-order perturbative coefficients in the bulk limit from solutions for relatively small finite clusters. For example, a perturbative calculation for an isotropic $2\times 12$ ladder yields an eleventh-order estimate of the ground-state energy per site that is within 0.02% of the density-matrix-renormalization-group (DMRG) value. Moreover, the method also enables a reliable estimate of the radius of convergence of the perturbative expansion. We find that for the rung basis the radius of convergence is $\lambda_c\simeq 0.8$, with $\lambda$ defining the ratio between the coupling along the chain relative to the coupling across the chain. In contrast, for the plaquette basis we estimate a radius of convergence of $\lambda_c\simeq 1.25$. Thus, we conclude that the plaquette basis offers the only currently available perturbative approach which can provide a reliable treatment of the physically interesting case of isotropic $(\lambda=1)$ spin ladders. We illustrate our methods by computing perturbative coefficients for the ground-state energy per site, the gap, and the one-magnon dispersion relation.Comment: 22 pages. 9 figure

Drug package inserts: how accessible is the information?

Background: Information given in drug package inserts is often not easily accessible by patients and practitioners. Presentation of important information in an easily accessible manner fulfills the very purpose of inserts. In the present study, accessibility of important information in drug package inserts is evaluated.Methods: We evaluated 110 package inserts. Accessibility to important information was noted under following headings: use of box, use of special/bigger font or color, use of table of contents and information in front sheet. Each of these parameters was given a point. Cumulative accessibility score of more than three considered as accessible. Provision of toll free numbers and internet addresses of the companies noted.Results: Information in inserts regarding posology, method of administration, precautions under special conditions, contraindications, pharmacokinetics, interactions, pregnancy and lactation, driving, and machine use precautions were adequate and orderly in most. Only seven drug inserts mentioned important information with special font/different color. 18 drug inserts had used boxes. About 13 inserts used bigger font size for revealing important information. We observed a mean accessible score was 0.37 a insert. Only two inserts carried toll free numbers.Conclusion: Important information in drug package inserts is not easily accessible. Display of toll free numbers and internet addresses for queries and reporting adverse drug reactions is highly recommended

A study on the prescription pattern of antifungal drugs in the Dermatology Department of a tertiary care teaching hospital in Southern Kerala

Background: Skin disorders form 2% of total Out Patient Department consultations worldwide. But no such data is available from India. Studying prescription pattern is a component of medical audit that help prescribers to provide rational and cost-effective medical care. This study is about the prescription pattern of antifungals in this institution and will help in developing local policies for appropriate use of antifungal drugs. The objective was to study the prescription pattern of antifungals in dermatological diseases.Methods: This is a retrospective study conducted from 1st June 2017 to 30th November 2017 in Dermatology Department. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sex who attended Dermatology OPD. Factors considered were sociodemographic parameters, number of patients with combination and monotherapy, number of single topical agents and Fixed Dose Combination (FDC) details of prescribing indicators.Results: 1500 prescriptions were analysed; 500 prescriptions were of fungal infection. 40.2% of the patients were in 18-35 years age group. There were a greater number of males (59.6%) than females (40.4%).Conclusions: The most common oral antifungal used was fluconazole. Terbinafine and clotrimazole were the most commonly used topical agents

A prospective comparative study of efficacy of lenalidomide plus dexamethasone combination therapy versus VAD (vincristine, doxorubicin and dexamethasone) regimen in the treatment of multiple myeloma

Background: Lenalidomide plus Dexamethasone (Len-Dex) and VAD (Vincristine, Doxorubicin and Dexamethasone) regimen are the two common drug therapies employed in the treatment of Multiple myeloma.Objectives: To compare the efficacy of Len-Dex versus VAD regimen based on complete remission achieved with treatment in newly diagnosed cases of multiple myeloma in a tertiary care hospital in Kerala.Methods: Eighty patients (forty in each group) of newly diagnosed cases of multiple myeloma, who were willing to give the informed consent, were included in the study. Patients were allocated by the treating physician to two groups; one group was given Len-Dex (lenalidomide + dexamethasone) regimen and the other VAD (Vincristine, Adriamycin, Dexamethasone) regimen. A total of six cycles were given for both groups. Their baseline investigations and follow up investigations were collected at regular intervals, based on these values, the outcome was classified as partial remission and complete remission and the results were compared and analyzed.Results: Among the forty patients in each group, 17 (38%) on VAD regimen and 28 (62%) on Len-Dex regimen achieved complete remission. The statistical analysis was done using chi square test (χ2= 6.13, df= 1, p= 0.01) which showed statistically significant difference.Conclusions: The study showed that the efficacy of Lenalidomide-Dexamethasone (Len-Dex) combination therapy is clearly higher than that of VAD regimen among the study population. The overall efficacy of Len-Dex combination is 70% and that of VAD regimen is only 42.5%

Macrorealism from entropic Leggett-Garg inequalities

We formulate entropic Leggett-Garg inequalities, which place constraints on the statistical outcomes of temporal correlations of observables. The information theoretic inequalities are satisfied if macrorealism holds. We show that the quantum statistics underlying correlations between time-separated spin component of a quantum rotor mimics that of spin correlations in two spatially separated spin-$s$ particles sharing a state of zero total spin. This brings forth the violation of the entropic Leggett-Garg inequality by a rotating quantum spin-$s$ system in similar manner as does the entropic Bell inequality (Phys. Rev. Lett. 61, 662 (1988)) by a pair of spin-$s$ particles forming a composite spin singlet state.Comment: 5 pages, RevTeX, 2 eps figures, Accepted for publication in Phys. Rev.

Genetic correlates of longevity and selected age-related phenotypes: a genome-wide association study in the Framingham Study

BACKGROUND: Family studies and heritability estimates provide evidence for a genetic contribution to variation in the human life span. METHODS:We conducted a genome wide association study (Affymetrix 100K SNP GeneChip) for longevity-related traits in a community-based sample. We report on 5 longevity and aging traits in up to 1345 Framingham Study participants from 330 families. Multivariable-adjusted residuals were computed using appropriate models (Cox proportional hazards, logistic, or linear regression) and the residuals from these models were used to test for association with qualifying SNPs (70, 987 autosomal SNPs with genotypic call rate [greater than or equal to]80%, minor allele frequency [greater than or equal to]10%, Hardy-Weinberg test p [greater than or equal to] 0.001).RESULTS:In family-based association test (FBAT) models, 8 SNPs in two regions approximately 500 kb apart on chromosome 1 (physical positions 73,091,610 and 73, 527,652) were associated with age at death (p-value < 10-5). The two sets of SNPs were in high linkage disequilibrium (minimum r2 = 0.58). The top 30 SNPs for generalized estimating equation (GEE) tests of association with age at death included rs10507486 (p = 0.0001) and rs4943794 (p = 0.0002), SNPs intronic to FOXO1A, a gene implicated in lifespan extension in animal models. FBAT models identified 7 SNPs and GEE models identified 9 SNPs associated with both age at death and morbidity-free survival at age 65 including rs2374983 near PON1. In the analysis of selected candidate genes, SNP associations (FBAT or GEE p-value < 0.01) were identified for age at death in or near the following genes: FOXO1A, GAPDH, KL, LEPR, PON1, PSEN1, SOD2, and WRN. Top ranked SNP associations in the GEE model for age at natural menopause included rs6910534 (p = 0.00003) near FOXO3a and rs3751591 (p = 0.00006) in CYP19A1. Results of all longevity phenotype-genotype associations for all autosomal SNPs are web posted at http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?id=phs000007. CONCLUSION: Longevity and aging traits are associated with SNPs on the Affymetrix 100K GeneChip. None of the associations achieved genome-wide significance. These data generate hypotheses and serve as a resource for replication as more genes and biologic pathways are proposed as contributing to longevity and healthy aging

Antenatal Care Satisfaction in a Developing Country: A Cross-Sectional Study From Nigeria

Background Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization. Methods Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider’s interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied. Results Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, unrushed service, convenient clinic hours and privacy during consultation, AOR 2.42, 95% CI 2.05–2.87), treatment-facilitation (medical care-related provider communication and ease of receiving medicines, AOR 2.03, 95% CI 1.46–2.80), equipment availability (AOR 1.10, 95% CI 1.01–1.21), staff empathy (AOR 1.82, 95% CI 1.03–3.23), non-discriminatory treatment regardless of patient’s socioeconomic status (AOR: 1.87, 95% CI 1.09–3.22), provider assurance (courtesy and patient’s confidence in provider’s competence, AOR 1.48, 95% CI 1.26–1.75), and number of clinical examinations received (AOR 1.28, 95% CI 1.10–1.50). ANC satisfaction was negatively impacted by out-of-pocket payment for care (vs. free care, AOR 0.44, 95% CI 0.23–0.82). Conclusions ANC satisfaction in Nigeria may be enhanced by improving responsiveness to clients, clinical care quality, ensuring equipment availability, optimizing easy access to medicines, and expanding free ANC services

Mean-Field Theory for Spin Ladders Using Angular-Momentum Coupled Bases

We study properties of two-leg Heisenberg spin ladders in a mean-field approximation using a variety of angular-momentum coupled bases. The mean-field theory proposed by Gopalan, Rice, and Sigrist, which uses a rung basis, assumes that the mean-field ground state consists of a condensate of spin-singlets along the rungs of the ladder. We generalize this approach to larger angular-momentum coupled bases which incorporate---by their mere definition---a substantial fraction of the important short-range structure of these materials. In these bases the mean-field ground-state remains a condensate of spin singlet---but now with each involving a larger fraction of the spins in the ladder. As expected, the ``purity'' of the ground-state, as judged by the condensate fraction, increases with the size of the elementary block defining the basis. Moreover, the coupling to quasiparticle excitations becomes weaker as the size of the elementary block increases. Thus, the weak-coupling limit of the theory becomes an accurate representation of the underlying mean-field dynamics. We illustrate the method by computing static and dynamic properties of two-leg ladders in the various angular-momentum coupled bases.Comment: 28 pages with 8 figure