Objective assessment of handwriting in outpatient prescriptions of a tertiary care hospital

Background: Poor physician handwriting may lead to wrong comprehension and dispensing errors. This study was planned to objectively assess the quality of handwriting of doctors and their readability by physician, pharmacist and patient and to explore the impact of experience and familiarity of pharmacist on prescription readability.Methods: A 100 prescriptions were selected and were given to a pharmacist, a doctor and an educated lay person. They rated the readability of prescriptions on a scale of 1-10 and an average readability score was calculated. Prescriptions with average score 4 or less were subjected to analysis by a pharmacist working at the hospital dispensary (P1) and another pharmacist not working at hospital pharmacy (P2).Results: Average score of pharmacist, physician and lay person was 6.14, 5.2 and 3.14 respectively.  A total of 28 prescriptions, containing 93 medicines, had an average readability score of 4 or less. P1 was not able to comprehend one medicine while P2 could not comprehend 19 medicines out of these 93. The performance of both pharmacists was compared by diagnostic tests (EPI 6.04D). The sensitivity of P2 was 80% (95% CI 70.6-87.7), specificity and positive predictive value were 100, and negative predictive value was 5.3 (0.3-28.1).Conclusions: Familiarity of the pharmacist with the prescribing physicians’ handwriting is an important factor in comprehension of poorly legible prescriptions. This could limit the patients to pharmacists around the prescribers. Implementation of appropriate steps need to be assured to minimize the prescription errors

NUMBER NEEDED TO TREAT AS A TOOL FOR COST EFFECTIVENESS ANALYSIS: A CASE STUDY IN RENAL TRANSPLANTATION

Objective: To assess the utility of number needed to treat (NNT) as a tool for cost effectiveness analysis. Methods: Two monoclonal antibodies (MAbs), used for induction therapy viz basiliximab and daclizumab in renal transplantation, were identified. Pivotal placebo controlled clinical trials, mentioned in the innovator package inserts, were compared and analyzed for acute graft rejection and graft survival at 12 mo. NNT viz-a-vis cost was calculated and compared. Results: Daclizumab was comparable to basiliximab for acute graft rejection (NNT 10 vs. 9) but better for graft survival (20 vs. 25) at 12 mo, when used along with triple drug regimen (cyclosporine, azathioprine and corticosteroid). However, considering the cost of regimen for these drugs, in terms of NNT, basiliximab was more cost effective (INR 12,52,044 vs. 28,70,400 for acute rejection and INR 34,77,900 vs. 57,40,800 for graft survival). On the other hand, when these MAbs were used along with dual drug regimen (cyclosporine and corticosteroid), daclizumab was more cost effective for graft survival at 12 mo. The higher cost of daclizumab regimen (INR 2,87,040 vs. 1,39,116 for basiliximab) was offset by its substantially lower NNT (20 vs. 58-75 for one extra graft survival at 12 mo). Conclusion: This study demonstrates the utility of NNT in ascertaining relative effectiveness of treatment modalities that would help to formulate appropriate healthcare policies

Are acute infusion reactions after rituximab underreported?

Background: Rigorous premarketing trials may fail to capture safety issues associated with new drugs. This is more likely to happen in case of biopharmaceuticals. We take the case of rituximab, and anti CD20 monoclonal antibody, which was the first monoclonal antibody to get approval. This open label observational study was done with the objective of estimating the incidence of acute infusion reaction associated with rituximab infusion.Methods: The study population consisted of patients hospitalized for receiving rituximab, in day care centre(s) of a tertiary care hospital. Number and type of acute infusion reactions (AIR) were recorded on a case record form along with patient characteristics and medical history.Results: A total of 50 infusions were observed and all infusions were followed by at least one AIR. Total 71 AIRs were recorded among these 50 infusions (1.4 AIR per infusion). Non-Hodgkin’s lymphoma was the commonest indication for which patients were receiving rituximab. In a subset analysis, incidence of AIR was statistically lower in patients having received corticosteroids as premedication. However, brand of rituximab, gender of the patient and first or second cycle had no bearing on incidence of AIRs.Conclusions: AIRs are more common in real time clinical settings than what is reported. There is a need to formulate appropriate risk management plan depending on post marketing clinical data. Use of corticosteroids as premedication may be one such strategy. New drugs, esp biopharmaceuticals, may have unidentified/under reported safety issues and there is a need to undertake focussed pharmacovigilance endeavours to unravel them

Evaluation of mass bathing effects on water quality status of eight prominent ponds of Haryana (India): A multi-location study

Amongst the various anthropogenic activities, mass bathing and other religious rituals also affect the water quality of aquatic ecosystem. The present research has been conducted to evaluate the impact of mass bathing and other religious activities on the eight famous religious water bodies of Haryana (Kapalmochan tirth, Kulotarn tirth, Ban-Ganga tirth, Brahmsarovar, Jyotisar, Saraswati tirth, Phalgu tirth and Pandu-Pindara tirth). The water samples were collected from three sampling stations (A, B and C) at each of the eight selected sites (S1 to S8) before and after the religious rituals and also seasonally. The samples were analyzed for Dissolved oxygen (DO), Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD) ammonia and heavy metals . The study highlighted the seasonal variations of physicochemical characteristics and also the effects of mass bathing and religious activities on water quality of the religious sites. Although the water was reported as safe in terms of DO content, total ammonia, BOD and the values of COD before the religious rituals but the values exceeded the maximum permissible limit {DO (0.8±0.1, 0.76±0.11), BOD (25.07±0.13, 18.13±0.13),COD (131.9±2.08), Ammonia (2.31±.23, 6.57±0.02) Iron (5890 µg L-1) and Zinc (200 µg L-1)} after mass bathing and religious rituals indicating that the water was not suitable for drinking as well as bathing purposes after the rituals/mass bathing. So, bathing during/after such rituals may become a health hazards to the bathers or users of the water and also may affect the aquatic biota, further depleting it. There is thus a need of regular monitoring and regular application of suitable remedial measures to prevent the depletion of the quality of lentic waters

Effectiveness of Mixed Cereals Porridge on Malnutrition among Under Five Children in Selected Villages, Salem

A study was done to evaluate the Effectiveness of Mixed Cereals Porridge on Malnutrition among under five Children in Selected Villages, Salem. A Quasi experimental pre test post test with control group design was adopted. Data collection was done over a period of 4 weeks from 11.07.2011 to 07.08.2011.The investigator had selected the 30 samples each for experimental group and control group from Poolavari and Neikkarapatti Villages respectively through convenient sampling technique. Then the subjects from the experimental group were provided mixed cereals porridge for 27 days. Post test was conducted on every 5th day for both experimental and control group and the weight of the children were measured and analysed by Observational Proforma. Findings of the study reveal that the mean pre-test and post-test weight of experimental group was 11.93 and 12.12. Whereas in control group the mean pre test and post test weight was11.80 and 11.79. There was significant difference found in the Post test mean weight of under five children in experimental group and control group (‘t’ value was 2.41 at p < 0.001 level). There was no significant association between the post test weight of under five children with their selected demographic variables in experimental and control group p>0.05 except age where significant association was found (p < 0.05) the Hypothesis H2 was retained. The findings of the study showed that mixed cereals porridge produced a significant increase in body weight of malnourished under five children. This study would help the Child health nurse to motivate the under five children to consume mixed cereals porridge to maintain their good nutritional status

Office hysteroscopy prior to ART cycle-analysis and outcome at a private IVF clinic setup in Surat, Gujarat, India

Background: Hysteroscopy is a gold standard test for assessing the uterine cavity. The presence of uterine pathology may negatively affect the chance of implantation .This study investigated the use of routine office hysteroscopy and correction of any intrauterine pathologies prior to starting IVF cycle on treatment outcome in women seeking IVF treatment for primary infertility and recurrent implantation failure.Methods: This was a retrospective study of 100 women who attended our infertility clinic from July 2016 to December 2016 and who were willing for office hysteroscopy. The main outcomes measured were clinical pregnancy rates achieved in the index IVF cycle, multiple pregnancy rate, ectopic pregnancy rate, miscarriage rate and failure rate.Results: Of the 100 patients who participated in the study, 75 patients conceived, 25 patients failed to conceive. 80.64% patients with normal findings on diagnostic hysteroscopy conceived after the procedure, 58.33% patients conceived after polypectomy, 68.42% conceived after septal resection, 71.42% conceived after adhesiolysis, 50% conceived after lateral metroplasty and 73.07% of recurrent implantation failure conceived after local endometrial injury was done on hysteroscopy.Conclusions: Hysteroscopy in infertile women prior to their IVF cycle when performed atleast 3 months in advance could improve treatment outcome

Reply to Roy and Pucadyil: A gain of function by a GTPase-impaired Drp1

A.V.S. was supported by Spain Ministry of Science and Innovation/National Research Agency/European Regional Development Fund grant PGC2018-099971-B-I00. I.P.J. acknowledges a predoctoral fellowship from the University of the Basque Country. P.M.M. and R.R. were supported by NIH R01 grant GM121583

Reliability Analysis of Instrumentation and Control System: A Case Study of Nuclear Power Plant

Instrumentation and control system (I&Cs) plays a key role in nuclear power plants (NPP) whose failure may cause the major issue in a form of accidents, hazardous radiations, and environmental loss. That is why importantly ensure the reliability of such system in NPP. In this proposed method, we effectively analyze the reliability of the instrumentation and control system. An isolation condenser system of nuclear power plant is taken as a case study to show the analysis. The methodology includes the dynamic behavior of the system using Petri net. The proposed method is validated on operation data of NPP