Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences.

BACKGROUND OBJECTIVES: Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians. METHODS: It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an 'unacceptable deviation'. RESULTS: Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108). INTERPRETATION CONCLUSIONS: The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.

Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity.

OBJECTIVE: The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS: Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS: Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION: Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Highly effective and stable MWCNT/WO3 nanocatalyst for ammonia gas sensing, photodegradation of ciprofloxacin and peroxidase mimic activity.

The present study discusses the ammonia (NH3) sensing characteristics, photocatalytic degradation of emerging pollutants, and peroxidase mimic activity of multifunctional multi-walled carbon nanotube-tungsten oxide nanocomposite (MWCNT/WO3) prepared by conventional solvothermal method. The prepared MWCNT/WO3 nanocomposites were characterized by various analytical techniques like XRD, Raman, XPS, N2 adsorption, FESEM with elemental analysis and diffuse reflection spectroscopy. The prepared 1% MWCNT/WO3 nanocomposite showed better gas sensing performance for the NH3 vapors at 10-100 ppm than the pristine WO3 and the response and recover time of about 13 and 15s towards 20 ppm of ammonia (NH3) was achieved. The photocatalytic activity of MWCNT/WO3 towards organic dyes such as Rhodamine-B (Rh.B) methylene blue (MB) and pharmaceutical compound ciprofloxacin (CIP) were studied and achieved above 90% degradation at 160 min for CIP and 60 min for MB and Rho-B respectively. The radicle scavenging activity for MWCNT/WO3 nanocomposite showed the predominant formation of hydroxyl (OH•) and superoxide radicle (•O2-). Further, the MWCNT/WO3 nanocomposite showed peroxidase mimic activity and exhibit the limit of detection (LOD) of about 321 nM. From the overall analysis, MWCNT/WO3 hybrid seems to have potential characteristics that can be explored for multiple functional applications.

Use of drugs not listed in the National List of Essential Medicines: Findings from a prescription analysis by the Indian Council of Medical Research-Rational Use of Medicines Centres Network in tertiary care hospitals across India.

BACKGROUND: The concept of listing essential medicines can lead to improved supply and access, more rational prescribing, and lower costs of drugs. However, these benefits hinge on the prescription of drugs from an Essential Medicines List (EML). Several studies have highlighted the problem of underutilization of EMLs by prescribers. Therefore, as part of prescription research by the Indian Council of Medical Research-Rational Use of Medicines Centres Network, we evaluated the extent of prescription of drugs not listed in the National List of Essential Medicines (NLEM). MATERIALS AND METHODS: Prescriptions of outpatients from participating centers were included after obtaining verbal/written informed consent as approved by the Ethics Committee, and evaluated for prescription of drugs from the NLEM 2015. RESULTS: Analysis of 4838 prescriptions from 13 tertiary health-care institutes revealed that 2677 (55.33%) prescriptions had at least one non-NLEM drug prescribed. In all, 5215 (31.12%) of the total 16,758 drugs prescribed were not in NLEM. Of these, 2722 (16.24%) were single drugs and 2493 (14.88%) were fixed-dose combinations (FDCs). These comprised 700 different drug products - 346 single drugs and 354 FDCs. The average number of non-NLEM drugs prescribed per prescription was 1.08, while the average number of all drugs prescribed was 3.35 per prescription. It was also found that some of the non-NLEM drugs prescribed had the potential to result in increased cost (for example, levocetirizine), increased adverse effects (dextromethorphan), and less effectiveness (losartan) when compared to their NLEM counterparts. Nonavailability of an essential drug (oral hydroxocobalamin) was another important finding of our study. CONCLUSION: This study highlights the extent and pattern of drugs prescribed from outside the NLEM at the tertiary health-care level and the need for training and enhanced awareness among prescribers for greater utilization of the NLEM.

Porous reduced graphene oxide (rGO)/WO3 nanocomposites for the enhanced detection of NH3 at room temperature.

Incorporation of reduced graphene oxide (rGO) modifies the properties of semiconducting metal oxide nanoparticles and makes it possible to tune the surface area and pore size to optimum values, which in turn improves their gas sensing properties. In this work, to improve the ammonia (NH3) gas sensing characteristics, reduced graphene oxide (rGO) was incorporated into tungsten oxide (WO3) nanospheres using a simple ultrasonication method. The rGO-WO3 nanocomposites exhibited porous nanosheets with nanospherical WO3 as observed with field-emission scanning electron microscopy (FE-SEM). The oxidation state of the rGO-WO3 nanocomposite was determined using X-ray photoelectron spectroscopy (XPS). Three ratios of (1, 5 and 10% rGO/WO3) nanocomposites and pure WO3 showed good selectivity towards NH3 at 10-100 ppm, and more remarkably at room temperature in the range of about 32-35 °C and at a relative humidity (RH) of 55%. The limit of detection (LOD) of the synthesized rGO-WO3 nanocomposites was 1.14 ppm, which will highly favour low detection ranges of NH3. The sensor response was 1.5 times higher than that of the bare WO3 nanospheres. The sensors showed excellent selectivity, ultrafast response/recovery times (18/24 s), reproducibility and stability even after one month of their preparation. We believe that metal oxides using the rGO modifier can improve the sensitivity and reduce the LOD towards NH3 and can be used effectively in real-time environmental monitoring.

Cytotoxic consequences of Halloysite nanotube/iron oxide nanocomposite and iron oxide nanoparticles upon interaction with bacterial, non-cancerous and cancerous cells.

Cytotoxic effects of iron oxide (Fe3O4) nanoparticles and Halloysite nanotube/iron oxide (HNT/Fe3O4) nanocomposite are compared based on their interaction with Gram-negative bacteria Escherichia coli and Gram-positive bacteria Bacillus subtilis. Similarly, the action of these two nanomaterials on non-cancerous Vero cell lines and human lung cancerous (A-549) cell lines are compared. The cytotoxicity studies on Fe3O4 nanoparticles and HNT/Fe3O4 nanocomposite showed difference in the rate of killing of bacterial cells. This is reflected in differential cell growth, cell membrane integrity loss, lactate dehydrogenase (LDH) release and reactive oxygen species (ROS) production. These factors are measured over a range of concentrations of Fe3O4 nanoparticles and HNT/Fe3O4 nanocomposite and at specified time intervals, to test if there is any statistically significant difference between the toxicity of the two nanomaterials. Between the two nanomaterials, HNT/Fe3O4 nanocomposite is found to be less toxic to bacterial cells than Fe3O4 nanoparticles. HNT, when attached to the Fe3O4 nanoparticles, changes their surface characteristics and suppresses their inherent toxicity on bacteria. In the study on the effect on cell lines, Fe3O4 nanoparticles and HNT/Fe3O4 nanocomposite are both seen to be biocompatible with Vero cell lines. However, HNT/Fe3O4 nanocomposite showed more cytotoxicity than Fe3O4 nanoparticles on A-549 cell lines.

Application of microwaves for microbial load reduction in black pepper (Piper nigrum L.).

BACKGROUND: Black pepper (Piper nigrum L.) is exposed to microbial contamination which could potentially create public health risk and also rejection of consignments in the export market due to non-adherance to microbial safety standards. The present study investigates the use of microwave (MW) radiation for microbial load reduction in black pepper and analyses the effect on quality. RESULTS: Black pepper was exposed to MWs at two different power levels (663 and 800 W) at an intensity of 40 W g(-1) for different time intervals (1-15 min) and moisture content (110 and 260 g kg(-1) on a wet basis). The exposure of black pepper to MWs at 663 W for 12.5 min was found to be sufficient to reduce the microbial load to the permissible level suggested by the International Commission on Microbiological Specifications for Foods and the European Spice Association. The retention of volatile oil, piperine and resin was 91.3 ± 0.03, 87.6 ± 0.02 and 90.7 ± 0.05%, respectively, in MW-treated black pepper. The final moisture content after MW treatment was found to be 100 ± 1 g kg(-1) for black pepper containing initial moisture of 260 ± 3 g kg(-1) . CONCLUSION: These results suggest that MW heating can be effectively used for microbial load reduction of black pepper without a significant loss in product quality. © 2016 Society of Chemical Industry.

Recent Developments in Superheated Steam Processing of Foods-A Review.

Although the use of superheated steam has been known for quite a long time, only in the recent past has it emerged as a viable technology for food processing. Superheated steam, having higher enthalpy, can quickly transfer heat to the material being processed, resulting in its rapid heating. The major advantages of using superheated steam for food processing are better product quality (color, shrinkage, and rehydration characteristics), reduced oxidation losses, and higher energy efficiency. This review provides a comprehensive overview of recent studies on the application of superheated steam for food-processing operations such as drying, decontamination and microbial load reduction, parboiling, and enzyme inactivation. The review encompasses aspects such as the effect of superheated steam processing on product quality, mathematical models reported for superheated steam drying, and the future scope of application in food processing. Recent studies on process improvisation, wherein superheated steam is used at low pressure, in fluidized bed mode, sequential processing with hot air/infrared, and in combination with micro droplets of water have also been discussed.