Let's 'play' with molecular pharmacology.

BACKGROUND: Understanding concepts of molecular mechanisms of drug action involves sequential visualization of physiological processes and drug effects, a task that can be difficult at an undergraduate level. Role-play is a teaching-learning methodology whereby active participation of students as well as clear visualization of the phenomenon is used to convey complex physiological concepts. However, its use in teaching drug action, a process that demands understanding of a second level of complexity over the physiological process, has not been investigated. We hypothesized that role-play can be an effective and well accepted method for teaching molecular pharmacology. METHODS: In an observational study, students were guided to perform a role-play on a selected topic involving drug activity. Students' gain in knowledge was assessed comparing validated pre- and post-test questionnaires as well as class average normalized gain. The acceptance of role-play among undergraduate medical students was evaluated by Likert scale analysis and thematic analysis of their open-ended written responses. RESULTS: Significant improvement in knowledge (P < 0.001) was noted in the pre- to post-test knowledge scores, while a high gain in class average normalized score was evident. In Likert scale analysis, most students (93%) expressed that role-play was an acceptable way of teaching. In a thematic analysis, themes of both strengths and weaknesses of the session emerged. DISCUSSION: Role-play can be effectively utilized while teaching selected topics of molecular pharmacology in undergraduate medical curricula.

Drug utilization pattern and effectiveness analysis in diabetes mellitus at a tertiary care centre in eastern Nepal.

An observational follow up study conducted for one year at a tertiary care centre in 154 newly diagnosed diabetes mellitus patients is presented. The aims of the study were to determine the demographics, prescribing patterns, drug cost and analyze effectiveness of different therapies. Effectiveness of therapies were analyzed in patients achieving glycemic control by Wilcoxon signed- rank test. Majority of patients (n = 114) fell into the middle age strata of 35-64 years and 97% were type 2 diabetics. A total of 282 prescriptions were screened that included antidiabetics and other drug categories. Mean number of drugs per prescription sheet was 1.83 +/- 1.31. Oral hypoglycemic agents were advised to 64% of the patients. The prescribing frequency of biguanides (24.5%) was more than sulphonylureas (19.9%). Only 67 patients followed up for 3 months +/- 15 days, of which 46 achieved glycemic control. The biguanides only group (p = 0.002) and combination therapy of biguanides and sulphonylureas group (p = 0.005) were the highly effective therapies, as their p values of fasting blood glucose levels on follow up were the lowest. Nearly 90% of patients on combination therapy achieved glycemic control. In conclusion, this study reflects the therapeutic approach followed in diabetes mellitus as optimal. Future research on a larger patient population is warranted to evaluate existing patterns of therapy for sound practice and quality of care.

Generic versus branded medicines: An observational study among patients with chronic diseases attending a public hospital outpatient department.

BACKGROUND: The concept of generic prescription is widely accepted in various parts of the world. Nevertheless, it has failed to gain popularity in India due to factors such as nonavailability and distrust on the product quality. However, since 2012, the Government of West Bengal, India, has initiated exclusive generic drug outlets called "fair price medicine shop" (FPMS) inside the government hospital premises in a "public-private-partnership" model. This study was undertaken to evaluate the experience and attitude of patients who were consuming generic drugs purchased from these FPMS. MATERIALS AND METHODS: It was a questionnaire-based cross-sectional study where we have interviewed 100 patients each consuming generic and branded drugs, respectively. The perceived effectiveness, reported safety, medication adherence, cost of therapy, and availability of drugs was compared between two mentioned groups. Medication adherence was estimated through Drug Attitude Inventory-10. RESULTS: 93% of generic and 87% branded drug users believed that their drugs were effective (P = 0.238) in controlling their ailments. No significant difference (9% generic, 10% branded drug users, P = 1.000) was observed in reported adverse effects between generic and branded drug users. 82% and 77% of patients were adherent generic and branded drugs, respectively (P = 0.289). As expected, a significantly lower cost of generic drugs was observed compared to its branded counterpart. CONCLUSION: The policy of FPMS implemented by the Government of West Bengal, India appeared to be promising in terms of perceived effectiveness, safety, and adherence of generic drugs from FPMS compared to drugs purchased from open market retailers. Therefore, this study might act as an impetus for the policy-makers to initiate similar models across the country.