An initiative to reduce medication errors in neonatal care unit of a tertiary care hospital, Kolkata, West Bengal: a quality improvement report.

BACKGROUND: Medication errors are an emerging problem in various hospital settings, especially in neonates. A study conducted in the neonatal care unit of a tertiary institute in Kolkata as baseline over 3 months, revealed total error to be around 71.1/100 prescriptions (median medication error percentage: 63%). PURPOSE: To assess the occurrences of medication errors and determine efficacy of Point-of-Care Quality improvement (POCQI) model in reducing the same from baseline 63% to less than 10%, in the above setting within next 9 months. MATERIALS AND METHODS: This quality improvement initiative of quasi-experimental design comprised randomly selected prescriptions and monitoring sheets of neonates admitted in the neonatal care unit, obeying inclusion and exclusion criteria. Medication errors were assessed and categorised using a predesigned and pretested checklist. Interventions were planned after forming a quality improvement team in four plan-do-study-act (PDSA) cycles spanning over 6 weeks each (including training of doctors and nurses, signature and countersignatures of respective healthcare personnel, computer-generated prescriptions and newly designed software-generated prescriptions) as per POCQI model of the WHO and results in post-intervention phase (3 months) were compared. RESULTS: A total of 552 prescriptions and monitoring sheets of 124 neonates were studied. Median medication error percentages in first, second, third and fourth PDSA cycle were, respectively, 48%, 42%, 30% and 14%. Total error reduced to 10.4/100 prescriptions (p<0.005), with significant reduction in erred dosage, timing, interval, preparation and rate of infusion of drugs in prescriptions of the post-intervention phase. CONCLUSION: Implementation of change ideas via PDSA cycles, as per the POCQI model with technological aid, significantly decreased the percentage of medication errors in neonates, which was also sustained in the post-intervention phase and facilitated error-free prescriptions.

A study on the anxiety level and stress during Covid19 lockdown among the general population of West Bengal, India- A must know for primary care physicians.

BACKGROUND: Covid19 pandemic has resulted in drastic changes in human lives across the globe in the form of lockdown and an uncertain future. Information regarding the COVID-19-related anxiety and well-being among the public in India is very limited, especially from the state of West Bengal. We conducted this e-survey among the general population of West Bengal to assess the anxiety levels and the well-being status during lockdown. This information would be helpful to guide family physicians to screen patients for anxiety from the primary care level. AIMS: The main aim of this questionnaire based study was to assess the levels of anxiety and well-being status among the public including the frontline workers in West Bengal, India. MATERIALS AND METHODS: A prospective study was conducted with a validated e-questionnaire after Institutional Ethics committee approval, from 18th April, 2020 to 3rd May, 2020. The questionnaire had 12 questions which included the Generalized Anxiety disorder (GAD)-7 scale and the WHO-5 scale (5 question-items) to assess the well-being of the participants. The survey link was distributed through the social networking sites of WhatsApp, LinkedIn, Facebook and Twitter and e-mails within West Bengal. Microsoft Excel (version 2016) was used to analyse the data. RESULTS: A total of 355 responses were received 15.49% responders were observed to have anxiety and 37.74% participants had low well-being scores. Majority of healthcare workers (89.47%) were seen to have anxiety and a significant (52.03%) had a low well-being status. CONCLUSIONS: We report the presence of anxiety and low well-being among the general population of West Bengal. It is important to understand the current psychological status of the public for the family physicians as many would visit them with vague symptoms. There is a dire need to screen all patients including front line workers visiting primary care physicians for mental health to ensure better clinical outcome.

Is There Any Benefit of Integrating Computer-assisted Learning with Conventional Teaching Format in Pharmacology to Demonstrate the Effects of Different Drugs on Mean Arterial Blood Pressure in an Anesthetized Dog?: A Comparative Study.

PURPOSE: Computer-assisted learning (CAL) tools are often used in medical education as it can complement conventional teaching formats and as an alternative to animal experiments in undergraduate medical students. To identify if there is any benefit of integrating CAL tools with conventional teaching format in pharmacology for a specific topic. MATERIALS AND METHODS: Two groups of fourth semester students, Group I (n = 55) and Group II (n = 60), were taught a specific topic in pharmacology using only conventional teaching format (Group I), and both conventional teaching format as well as CAL format (EP Dog version 1.1.0) (Group II). The students were assessed with two different sets of multiple-choice questions, relevant to the topic taught, immediately at the end of the teaching sessions and after 30 days. Acceptability of the two teaching sessions by the students was also assessed using Likert scale. RESULTS: There was no significant difference in the scores of the students of the two groups immediately after teaching (P = 0.1260), there is definitely better residual knowledge reflected by the significantly (P = 0.001) better test scores of the Group II students after 30 days in comparison to Group I students. However, there was no significant difference with regard to the acceptability of the CAL teaching format alone and along with the conventional teaching format between the two groups (P = 0.6033). CONCLUSION: Integrating CAL with conventional teaching format improves students' understanding and performance for a specific topic.

Perception of Learning Environment among Undergraduate Medical Students in Two Different Medical Schools through DREEM and JHLES Questionnaire.

INTRODUCTION: Assessment of learning environment is essential to assess the acceptability of the curriculum among students. Several tools are available to assess undergraduate medical students' perception of learning environment. Dundee Ready Education Environment Measure (DREEM) questionnaire is the most commonly used tool. Here, we have used both the widely used DREEM questionnaire and a relatively new questionnaire Johns Hopkins Learning Environment Scale (JHLES). AIM: Assessment of students' perception of learning environment of two eastern Indian medical schools using DREEM and JHLES questionnaire. MATERIALS AND METHODS: In this cross-sectional questionnaire based study, 200 students from Nil Ratan Sircar Medical College (NRSMC) and 78 students from College of Medicine and Sagore Dutta Hospital (CMSDH) of 5th semester batch duly completed the two questionnaires, DREEM scale and JHLES tool. The DREEM questionnaire has 50 questions arranged in five domains. The JHLES questionnaire has 28 questions arranged in seven domains. Comparison of scores between the two colleges was done by unpaired t-test. RESULTS: There were altogether 100 female and 178 male participants with mean age of 20.46±0.67. There were no significant difference between the overall DREEM score (p=0.81) and the JHLES scores (p=0.10) obtained from NRSMC and that obtained from CMSDH. Analysis of individual domain scores on DREEM scale revealed that there were no significant differences in domain scores for the two medical schools except for Students' Perception of Atmosphere (SPA) score (p=0.0086). JHLES revealed significant differences in terms of engagement, inclusion and safety, and physical space (p<0.001). The DREEM and JHLES results revealed positive correlation (r=0.59). CONCLUSION: Both DREEM and JHLES scores revealed comparable results from two schools with positive correlation between DREEM and JHLES tools, however some areas with low scores require modification especially the domain assessing Students' Academic Self-Perception (SASP) and Students' Social Self Perceptions (SSSP).

Impact of regulatory spin of pioglitazone on prescription of antidiabetic drugs among physicians in India: A multicentre questionnaire-based observational study.

Background & objectives: Pioglitazone was suspended for manufacture and sale by the Indian drug regulator in June 2013 due to its association with urinary bladder carcinoma, which was revoked within a short period (July 2013). The present questionnaire-based nationwide study was conducted to assess its impact on prescribing behaviour of physicians in India. Methods: Between December 2013 and March 2014, a validated questionnaire was administered to physicians practicing diabetes across 25 centres in India. Seven hundred and forty questionnaires fulfilling the minimum quality criteria were included in the final analysis. Results: Four hundred and sixteen (56.2%) physicians prescribed pioglitazone. Of these, 281 used it in less than the recommended dose of 15 mg/day. Most physicians (94.3%) were aware of recent regulatory events. However, only 333 (44.8%) changed their prescribing pattern. Seventeen of the 416 (4.1%) physicians who prescribed pioglitazone admitted having come across at least one type 2 diabetes mellitus patient (T2DM) who had urinary bladder carcinoma, and of these 13 said that it was in patients who took pioglitazone for a duration of more than two years. Only 7.8 per cent of physicians (n=58) categorically advocated banning pioglitazone, and the rest opined for its continuation or generating more evidence before decision could be taken regarding its use in T2DM. Interpretation & conclusions: Majority of the physicians though were aware of the regulatory changes with regard to pioglitazone, but their prescribing patterns were not changed for this drug. However, it was being used at lower than the recommended dose. There is a need for generating more evidence through improved pharmacovigilance activities and large-scale population-based prospective studies regarding the safety issues of pioglitazone, so as to make effectual risk-benefit analysis for its continual use in T2DM.

Is This a Drug?" Answers From Medical Students in a Tertiary Care Teaching Hospital in Eastern India.

INTRODUCTION: World Health Organization (WHO) defines what is drug and what is not. Second year MBBS students learn the principles of Pharmacology that they use in their later clinical practice life. The aim of the survey was to determine how medical students classify a range of preparations they might encounter in their professional lives and whether a brand name or a commercial preparation of a drug would influence their decision in the categorization of the preparation as a 'drug' or 'not a drug'. AIM: To assess the knowledge of medical students, if a substance or product is a drug. MATERIALS AND METHODS: We surveyed 2 concurrent years of medical students to classify 60 candidate medicinal preparations into "drug" and "not-drug" from a validated questionnaire. The candidate preparations were named either in generic or in their commercially available forms and they were all essential drugs as per WHO definition. RESULTS: The two groups of students, A and B, included 192 and 215 students respectively. Demographically there was little difference in the two groups. Agents like Aspirin, Paracetamol, Amphetamine, Salbutamol, Atropine, Dextromethorphan, Codeine, Diazepam, Ciprofloxacin ear drops, Levonorgestrol, Neosporin eye ointment, Furosemide, Metronidazole, Penicillin, Sorbitrate, Lignocaine, Methotrexate, Penicillin, Zolpidem and Thalidomide received almost unanimous votes as drugs. Arsenic trioxide, Fentanyl and petroleum jelly were considered to be "non-drugs" by most participants. The two groups did not differ significantly in their responses. CONCLUSION: Some major lacunae were noted in the knowledge of the participating students despite book teaching on the definition of a drug. Drugs used for prophylaxis and those used in physiological conditions or topically, were often missed. These gaps need to be filled by more emphasis on definition of a drug and its clinical applicability based on example and case based studies.

Efficacy and safety of add on therapy of bromocriptine with metformin in Indian patients with type 2 diabetes mellitus: a randomized open labeled phase IV clinical trial.

OBJECTIVE: To compare the effectiveness and safety of add on therapy of bromocriptine with metformin in type 2 diabetes mellitus (DM) patients. MATERIAL AND METHODS: Adult type 2 DM patients fulfilling the inclusion criteria were randomized in three groups. Group A received metformin (1000 mg/ day), while group B patients were treated with metformin (1000 mg/day) plus bromocriptine (0.8 mg/day) and group C received metformin (1000 mg/day) plus bromocriptine (1.6 mg/day) for 12 weeks. Fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), and body weight were measured at week 4, 8, and 12 visits and glycosylated hemoglobin (HbA(1C)) at week 12 visit. RESULTS: Metformin alone and in combination with bromocriptine in escalating dose (0.8 mg/day and 1.6 mg/day) significantly (P < 0.05) decreased FPG and PPPG levels at weeks 4, 8, and 12 compared with pretreatment values. HbA(1C) level in all three treatment groups significantly (P < 0.05) decreased at week 12 as compared with pretreatment baseline value. HbA1C level in groups B and C significantly (P < 0.05) decreased as compared with group A at week 12. Addition of bromocriptine to metformin also significantly (P < 0.05) decreased FPG and PPPG levels in a dose-dependent manner as compared with metformin alone. Intergroup analysis did not show any statistically significant change in weight of study subjects at different intervals. CONCLUSION: The combination of bromocriptine with metformin significantly decreased FPG, PPPG, and HbA1C compared with metformin alone in type 2 DM patients in a dose-dependent manner.

A Study on the Performance of Medical Students in Internal Assessment and its Correlates to Final Examinations of 2(nd) MBBS Pharmacology Curriculum in a Medical College of Eastern India.

OBJECTIVES: The present study was undertaken to assess whether performance in the continuous assessment method as determined by internal assessment, correlates to the final summative evaluation in 2(nd) professional MBBS students in Pharmacology for the last four years (2009-2012). MATERIALS AND METHODS: This study was conducted over a period of three months at Nilratan Sircar Medical College and Hospital, Kolkata (West Bengal, India). It was a retrospective non-interventional record-based study based on the students' score sheets of 2(nd) MBBS Pharmacology examinations. RESULTS: The strength of correlation between internal assessment marks and total summative examination was fond to be highly significant at p < 0.0001, thereby implying that continuous assessment plays a vital role in influencing the overall performance of the undergraduate medical students. CONCLUSION: This study revealed that performance in the internal assessment and final examination have a direct correlation although not completely linear, thereby indicating that other possible variables would have influenced the final result of the 2(nd) MBBS Pharmacology curriculum.

The possible role of fluoxetine in adenomyosis: an animal experiment with clinical correlations.

INTRODUCTION: Fluoxetine is a commonly prescribed drug which is used in the psychiatric practice and adenomyosis is a common medical problem in women of the reproductive age group. OBJECTIVE: To explore the role of fluoxetine in the causation of adenomyosis. METHODS: Female Wistar rats (n=18) were divided into three groups (group I (the control), group II and group III) and they were treated with normal saline and oral fluoxetine (4mg/kg and 8 mg/kg) respectively for 100 days. Periodic serum prolactin measurements and histopathological examinations of the uterine horns of all the rats were done at the end. Comparison of the mean serum prolactin levels between the patients (n=15) who were diagnosed with adenomyosis, the healthy age sex matched controls and the female patients (n=20) who received fluoxetine for more than 3 months, before and after the fluoxetine administration, was done separately. Appropriate (paired or unpaired) t tests were used for the data analysis. RESULTS: Out of the 12 test group rats, 10 rats showed the features of adenomyosis histopathologically, along with significantly (p < 0.05) raised serum prolactin levels. The mean serum prolactin levels of the patients of adenomyosis in comparison to those of the controls and of the patients who were treated with fluoxetine (before and after the fluoxetine administration), were significantly high (p=0.001 in both the cases). CONCLUSION: Fluoxetine may have some role in the causation of adenomyosis; although for a stronger evidence, the follow-up of the patients who are treated with fluoxetine on a long term basis should be ideal.

Factors affecting the performance of undergraduate medical students: a perspective.

CONTEXT: Performance of medical students in developing nations like India is perceived to have largely declined. AIMS: We attempted to assess the reasons behind such trends. SETTINGS AND DESIGN: Students in their third year of medical study were given a predesigned, pretested structured and validated questionnaire that they filled in anonymously. The key areas assessed were concentration, interest and understanding of the subject and other perceived causes of poor performance. Tests for descriptive statistics were applied for evaluation. RESULTS AND CONCLUSIONS: One hundred and fifty students participated in the study. Fifty-five (36.66%) students performed poorly. Male gender, inability to clear the previous professional examination at the first attempt, difficulty in understanding medium of instruction, self-assessed depression, sleep disorders and perceived parental and peer pressure and dissatisfaction with career choice were significantly linked with poor performance (P<0.05 for each factor). Socioeconomic status and regularity in class were not linked to academic performance.

Comparison of the effectiveness and safety of cefpodoxime and ciprofloxacin in acute exacerbation of chronic suppurative otitis media: A randomized, open-labeled, phase IV clinical trial.

OBJECTIVE: To compare the effectiveness and safety of cefpodoxime and ciprofloxacin for the treatment of mild to moderate cases of acute exacerbation of chronic suppurative otitis media (AECSOM). MATERIALS AND METHODS: Adult patients diagnosed with AECSOM were screened and patients fulfilling the inclusion criteria were randomized to receive either cefpodoxime 200 mg twice daily or ciprofloxacin 500 mg twice daily orally for 7 days. The primary outcome of this randomized, open-labeled, phase IV clinical trial (Registration Number - CTRI/2011/10/002079) was clinical success rate at day 14 visit and the secondary outcome was incidence of adverse events (AEs). Forty-six patients were enrolled: 23 in the cefpodoxime group and 23 in the ciprofloxacin group. RESULTS: The clinical success rates were 95.6% in the cefpodoxime group versus 90.9% in the ciprofloxacin group. These rates are comparable, but no statistically significant difference was observed between the groups. Few mild and self-limiting AEs were observed and the tolerability of both the drugs was also good. CONCLUSION: The results of this randomized, open-labeled phase IV clinical trial showed that a 7-day course of cefpodoxime is therapeutically comparable to ciprofloxacin in terms of both clinical effectiveness and safety for the treatment of patients with AECSOM.

Evaluation of nootropic and neuroprotective effects of low dose aspirin in rats.

OBJECTIVE: To evaluate the nootropic and neuroprotective effects of aspirin in Sprague Dawley rats. MATERIALS AND METHODS: Retention of conditioned avoidance response (CAR) and central 5-HT-mediated behavior (lithium-induced head twitches) were assessed using repeated electroconvulsive shock (ECS) in rats. Rats were divided into eight groups: control (pretreated with distilled water), scopolamine (0.5 mg/kg i.p.), ECS (150 V, 50 Hz sinusoidal with intensity of 210 mA for 0.5 s) pretreated, aspirin (6.75 mg/kg orally) pretreated, combined scopolamine and aspirin pretreated, ondansetron (0.36 mg/kg orally) pretreated, combined ECS and ondansetron pretreated and combined ECS and aspirin pretreated groups. Data was analyzed by the chi-square test and ANOVA. RESULTS: Findings show that administration of single ECS daily for consecutive 8 days results in enhancement of 5-HT-mediated behavior (lithium-induced head twitches) and in disruption of the retention of CAR. Aspirin and ondansetron administration significantly increased the retention of conditioned avoidance response compared to control. Ondansetron and aspirin significantly prevented ECS-induced attenuation of the retention of conditioned avoidance response also. On the other hand, ondansetron and aspirin significantly retarded the ECS-induced enhancement of 5-HT-mediated behavior. CONCLUSION: Inhibition of the serotonergic transmission by aspirin is responsible for its nootropic and neuroprotective actions.

Impacts of quicklime (CaO) on the toxicity of copper (CuSO4, 5H2O) to fish and fish food organisms.

Static bioassays of 96 h duration were conducted in the laboratory using fry of common carp (Cyprinus carpio), adult tubificid worm (Branchiura sowerbyi) and adult copepod plankton (Cyclops viridis) to determine LC50 values of Cu and CaO to these organisms and effects of interaction between Cu and CaO. Ninety-six hour LC(50) values of Cu to fry of common carp, worm and copepod were found to be 1.40 mgl(-1), 0.08 mgl(-1) and 0.03 mgl(-1) respectively. CaO up to 500 mgl(-1) did not produce any mortality of the fry of common carp up to 96 h. But 96 h LC50 values of CaO to worm and copepod were 83.00 mgl(-1) and 27.80 mgl(-1) respectively. When common carp fry, worm and the copepod were exposed to respective LC50 dose of Cu in presence of varying concentration of CaO, mortality of the organisms significantly reduced and was found inversely correlated with the doses of CaO [y = 48.36-0.807x, r = -0.99 (n = 7) for fish; y = 44.46-0.146x, r = -0.97 (n = 7) for worm; y = 49.46-0.66x, r = -0.99 (n = 7) for the copepod]. The present results indicate that CaO is non-toxic to fish and is capable of reducing the toxicity of Cu to fish while CaO and Cu are antagonistic to each other for the worm and the copepod. Potential of using CaO as antitoxic agent for Cu in water is discussed.