A cross-sectional study of surveillance of adverse drug reactions in inpatient departments of a tertiary care hospital.

BACKGROUND: Pharmacovigilance plays an imperative role in providing information about adverse drug reactions (ADRs) and drug safety in a hospital. Hence, it was considered worthwhile to study the surveillance of ADRs in inpatient departments (IPD). Our study aims to evaluate the frequency, type, characteristics, causality, and severity and avoidability of ADRs in the IPDs. METHODS: This prospective observational study was done in the IPDs of a 550-bed tertiary care hospital in South India during the period April to September 2012. All the patients had experienced at least one suspected ADR after hospitalization and drug treatment; patients who are hospitalized due to suspected ADR(s) in the last 6 months were assessed after obtaining permission from the Institutional Research and Ethics Committee. All the ADRs were recorded on the appropriate, prescribed form for reporting ADRs designed by the Central Drugs Standard Control Organization. RESULTS: A total of 147 ADRs were reported with the use of 96 drugs used by 91 IPD patients. The maximum number of ADRs reported in our study was with antipsychotic drugs and the maximum number of patients reported rashes (n=30) followed by extrapyramidal symptoms (n=17). Causality assessment by the WHO scale and Naranjo's algorithm showed 48 and 59 ADRs possibly related to drugs, respectively. Of this, 45 patients with ADR had moderate severity and 41 patients with ADRs were not preventable. CONCLUSIONS: The maximum number of ADRs reported in our study was with antipsychotic drugs and the most common ADR reported was rashes. Most of the ADRs reported had a possible causality, were moderate in severity, and were not preventable. The majority of patients had recovered from the ADRs.

Tackling the problems of tumour chemotherapy by optimal drug scheduling.

INTRODUCTION: There are various strategies for overcoming the major pitfalls of cancer chemotherapy, such as toxicity and drug resistance. The scientific computing of drug scheduling by optimisation before drug administration is one among them. In a majority of these strategies, the pharmacodynamic variations are given more importance than the pharmacokinetic variations. This study was meant to analyse the importance of the pharmacokinetic parameters (φ) of the individual patients in cancer chemotherapy scheduling, along with the pharmacodynamic factors. METHODS: A mathematical model is developed and it is implemented in the open source OCTAVE GNU LINUX. Optimisation is done by using an optimization tool in OCTAVE. The present study was aimed at evaluating the daily drug dosaging and cyclic chemotherapy which are commonly practised in the chemotherapy scheduling. Four cases were analyzed with and without considering the pharmacokinetic parameters. The optimal therapy was meant to reduce the number of cancer cells to a minimum at the end of the therapy and to minimise the emergence of resistant cancer cells. Since the dose was within tolerable limits, the toxic effects could also be minimised. RESULTS: Even with the consideration of a 1 per cent effect (φ), the maximum possible dose and the performance index were increased in the daily scheduling. But in the cyclic therapy, even though the maximum tolerated dose or the performance index was not altered, the cumulative toxicity was greatly reduced. CONCLUSION: Daily scheduling and cyclic chemotherapy can be applied alternatively more effectively, by considering the interindividual variations in the pharmacokinetic effect (φ).

Microteaching, an efficient technique for learning effective teaching.

Microteaching, a teacher training technique currently practiced worldwide, provides teachers an opportunity to perk up their teaching skills by improving the various simple tasks called teaching skills. With the proven success among the novice and seniors, microteaching helps to promote real-time teaching experiences. The core skills of microteaching such as presentation and reinforcement skills help the novice teachers to learn the art of teaching at ease and to the maximum extent. The impact of this technique has been widely seen in various forms of education such as health sciences, life sciences, and other areas. The emerging changes in medical curricula by the Medical Council of India and the role of medical teachers envisage the need of this special training of teachers and monitoring of their skills for their continued efficient performance at any age. The alleged limitations of microteaching can be minimized by implementing this at the departmental level in several sequences. The author made literature search of research and review articles in various educational databases, journals, and books. From the reference list of published articles, books were also reviewed. This paper presents an outline of the various phases of microteaching, core teaching skills, implementation aspects, and the impact of microteaching on medical education.

The knowledge, attitude and the perception of prescribers on the rational use of antibiotics and the need for an antibiotic policy-a cross sectional survey in a tertiary care hospital.

BACKGROUND: Antibiotics are prescribed frequently and there is always an overuse with a risk of resistance and increasing costs. Rational drug prescribing is essential for minimizing the health care costs and for reducing the resistance. The implementation of a strict antibiotic policy by all the health care institutes is being made mandatory nowadays. An improving awareness among the prescribers which can be created through educational interventions, can promote the rational use of antibiotics. Hence, we considered it worthwhile to study the knowledge, attitude and the perception of the practitioners towards a rational antibiotic use. MATERIALS AND METHODS: All the registered practitioners who were working in the hospital setting and were willing to give written informed consents, were enrolled in the study. All the participants who were enrolled in the study during a one month period, had to fill up a predesigned, structured and validated questionnaire which was used to assess the knowledge, attitude and the perception among physicians towards the rational use of antibiotics. RESULTS: About 65% of the participants who provided complete information in the questionnaire, were included in analysis. Among them, more than 50 % agreed on the existence of an essential drug list, on the knowledge about new antibiotics and on prescribing antibiotics rationally and on the interpretation of the culture and the sensitivity results. A majority strongly agreed that they ensured that their patients completed the course, that they provided counselling and that they took special interest in the proper use of antibiotics. There was a consensus on the overuse, issues of resistance, and on the input from fellow colleagues. CONCLUSION: The participants in our study had knowledge about the rational use of antibiotics, an attitude to prescribe drugs as per the essential drug list and a perception that antibiotics were being overused and that rational drug prescribing had an important role in the antibiotic resistance.