Identification and quantification of prescription errors.

BACKGROUND: Prescription errors are commonly encountered in health care settings. They can lead to inefficient delivery of health care thus jeopardizing patient care. Knowing the quantum and the possible causes of such errors is the first step in trying to prevent them. We conducted a random audit of prescriptions received in service dispensary of a tertiary care hospital and analyzed them for prescription errors. METHODS: A total of 1000 prescriptions were randomly selected. These prescriptions were analyzed with the help of three qualified pharmacists and were stratified as per the errors encountered. RESULTS: Out of the total of 1000 prescriptions, 650 prescriptions (65%) were found to have a total of 1012 errors. Type B errors were found in 22.4% prescriptions, type C errors in 9.7% prescriptions and type D in 69.1% prescriptions. CONCLUSION: Prescription errors require proactive, continuous and meticulous monitoring so as to minimize them. It requires identification of preventable causes, increasing awareness and sensitizing the prescriber towards this important aspect of health care delivery.

Impact of Nasal Symptoms on the Quality of Life of Fresh Inductees in High Altitude.

BACKGROUND: Troops deployed in high altitude areas of Ladakh face nasal problems in the form of obstructive nasal symptoms and recurrent epistaxis. This study analyses the changes in the nasal mucociliary transit times (NMTT) and deterioration in quality of life of troops on first high altitude induction. METHODS: A prospective study on 100 healthy volunteers was done. Mucociliary transit time was measured and a standardized quality of life questionnaire (RQLQ) administered at onset and after a period of three months in high altitude. Thereafter the subjects were divided into two groups and the study group was administered normal saline nasal drops. The observations were taken and results were statistically analysed after a period of three months. RESULT: The mucociliary transit time was prolonged after a three month stay in high altitude (p< 0.005). Normal saline nasal drops were successful in improving the nasal mucociliary transit times (p < 0.05). There was a statistically significant derangement in the quality of life which was improved by administering normal saline nasal drops (p<0.05). CONCLUSION: An increased muco-cilliary transport time after exposure to high altitude denotes a deranged physiology of the nasal mucosa. This leads to a statistically significant adverse impact on the quality of life of the troops deployed. The use of normal saline nasal drops is a simple and effective method of reversing some of these changes.

Comparative Analysis of Laser Assisted Endoscopie and Conventional Endoscopie Dacryocystorhinostomy.

BACKGROUND: Dacryocystorhinostomy (DCR) is the standard surgical treatment for epiphora caused by obstructions distal to the common canaliculus. Endoscopic DCR (EDCR) and laser assisted DCR (LAEDCR) are becoming increasingly popular alternatives. METHOD: 69 cases of EDCR were compared with 18 cases of LAEDCR. The success rates were noted at 01 week, 01, 03 and 06 months. The operating time required, incidence of adjuvant procedures, complications and post operative morbidity were recorded. RESULTS: At the end of 06 months, 100% and 95% success was achieved with LAEDCR and EDCR respectively. Operating time, complication rates and the incidence of adjuvant procedures required were lesser in the LAEDCR group. CONCLUSION: In our study both the procedures have comparable success rates, though LAEDCR has an edge over EDCR in terms of decreased duration of surgery, decreased post operative morbidity and lesser complications.

Trans-nasal endoscopic holmium: YAG laser correction of choanal atresia.

Five patients with choanal atresia were treated, using a trans-nasal endoscopic Holmium:YAG laser. The age of patients ranged from 15 months to 53 years. The nasal endoscope provides excellent visualization. The advantage of the Holmium:YAG laser is its fibre-optic delivery, allowing the laser to be hand-held, giving greater precision. Good nasal airways were achieved in four out of five cases with a single treatment. The procedure was found to be safe, quick, with minimal morbidity and a shorter in-patient stay.

Auditory neuropathy spectrum disorder: its prevalence and audiological characteristics in an Indian tertiary care hospital.

OBJECTIVE: Auditory neuropathy spectrum disorder (ANSD) has become a well accepted clinical entity. ANSD has now become easy to recognize with advent of test battery approach for hearing loss evaluation. However, little is known about its epidemiology and aetiology, especially its prevalence and incidence in India. This study was conducted to determine the prevalence and audiological characteristics of ANSD in our tertiary care hospital at New Delhi, India. METHODS: We prospectively enrolled all the paediatric cases i.e. less than 12years of age referred to our outpatient department for hearing evaluation. All the cases were evaluated using complete audiological test battery consisting of pure tone audiometry (PTA), impedance audiometry, acoustic reflexes, otoacoustic emissions (OAE), and brain stem evoked response audiometry (BERA). The instrument used was GSI Audera. BERA with both condensation and rarefaction polarity was performed in cases with absent wave V even at highest intensity levels. The criteria used for diagnosis of ANSD was normal or near normal cochlear hair cells (sensory) function (preservation of otoacoustic emissions and/or cochlear microphonics) and absent or abnormal auditory nerve function (absent or severely abnormal auditory brainstem potentials). A repeat test battery was performed after 3months on the diagnosed cases of auditory neuropathy. Based on their behavioural findings the appropriate management programme was formulated. RESULTS: A total of 487 paediatric cases were referred for hearing evaluation. 183 (37.6%) cases showed absent BERA and 26(5.3%) cases fulfilled the diagnostic criteria for ANSD. Repeat examination after 3months revealed presence of OAE's in 57.6% (15/26) cases while cochlear microphonics were present in all the 26 cases. CONCLUSION: The prevalence of ANSD in our study is 5.3% and in children diagnosed with severe to profound hearing loss is 14%. Presence of cochlear microphonics with absent BERA seems to be reliable criteria for diagnosing ANSD.

Correlation between intra-operative high rate neural response telemetry measurements and behaviourally obtained threshold and comfort levels in patients using Nucleus 24 cochlear implants.

The correlation between high rate 250 Hz intra-operative threshold neural response telemetry (t-NRT) with behaviourally obtained psychophysical threshold (T) and comfort (C) levels of the most recent and stable maps of 90 consecutive cochlear implantees using Cochlear Implant 24 Mini (CI 24 M) (M: F - 26:19), aged between two and 60 years with a mean age of 9.61 +/-12.07, was studied. The intra-operative t-NRT levels were seen to fall between the T and C levels and a good correlation was found between t-NRT and T and C levels (r = 0.327 at p < 0.005 for the T level and r = 0.648 at p < 0.001 for C level vs intra-operative t-NRT). The present study supports the view that 250 Hz NRT is not only a valuable clinical tool in evaluating the integrity of the implant and status of peripheral auditory nerves but can be used in programming the speech processor for young and difficult recipients, as has been previously shown using low rate NRT.