Prescription audit of patients attendees in public health facilities in Maharashtra, India with special reference to rational use of antibiotics

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Uddhao Gawande, Sona Deshmukh, Suhas Kadam, Gurudatt Potdar, Hrushikesh Salvitthal.
Background: As soon as a doctor examines the patient, he/she writes the treatment for the illness on a piece of paper and that is called as Prescription. Prescription is a document through which doctor, patient and pharmacist are communicated to each other but many a times if these documents are not properly written or misinterpreted it can affect management of patients. World Health Organization (WHO) has established prescribing indicators to analyze the prescription and promoted rational use of drugs and better management of patients. Prescription audit captures the current practices and identifies opportunities for improvement in patient care and along with the mechanisms for realizing them. The main objective is to analyze the prescription of drugs given to the patients in OPD and IPD of the primary and secondary level public health facilities in Maharashtra. Methods: The study was a cross-sectional and observational based on both qualitative and quantitative data. It comprises of secondary data obtained from copies of prescription collected from selected Rural Hospitals (RHs)/Sub-district Hospitals (SDHs) and District Hospitals (DHs)/ Women Hospitals (WHs) of Maharashtra comprising on prescribing practice, rational use of drugs and antibiotics, patient care and facility specific indicators. The Prescribing patterns were analyzed using WHO guidelines with regard to prescribing, patient care and health facility indicators. Qualitative) data collected on perceptions of the patients attending OPD as regard of doctor's consultation and dispensing of medicine; as well as perceptions of pharmacists regarding working environment that measures the ability to prescribe drugs rationally. The copies of the prescriptions from the patients attending OPD / IPD at the above mentioned public health institutions (PHCs, RHs, SDHs and DHs/ DWHs) were obtained. Statistical analysis of study was analyzed using the frequencies and cross tabs by using MS-Office Excel and SPSS Version 20. Results: This exercise showed that there is a scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions. Conclusions: The present study clearly indicates that there is a great need of interventions like distribution of antibiotic guidelines and running workshops and seminars on rational drug use to prescribers to improve the prescribing behaviour in the state of Maharashtra. This can be enforced through introducing such concepts and those of rational prescribing in curriculum of medical schools. E-prescriptions can be started in E-Aushadhi software with periodic clinical meetings to learn from the evidence.


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A study of the correlation between ventilator associated pneumonia and mortality rate of traumatic in patients in intensive care units

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Farshid Rahimi Bashar, Nahid Manuchehrian, Mohammad Hossein Jarahzadeh.
Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among the traumatic in-patients in Intensive Care Units (ICUs). Trauma is a risk factor for the incidence of VAP, yet, the association between VAP and outcome is not clear in traumatic in-patients in ICUs. This study investigated the correlation between ventilator-associated pneumonia and mortality rate of traumatic in-patients in ICUs in Be'that Hospital in Hamedan, western Iran. Methods: This observational prospective study was conducted in the ICU of Be'that Hospital, Hamedan, Iran, during 1 year (March 2013 until February 2014). The population under study included traumatic in-patients aged less than 18 year who were in need of invasive mechanical ventilation for more than 48 h with APACHE SCORE II of less than 25. They were studied for the incidence or lack of incidence of VAP. Results: Of 154 patients under study, 114 cases (74%) suffered from multiple traumata, 32 cases (20.8%) were affected with head trauma, 5 cases (3.2%) sustained spinal cord injury, and 3 cases (1.9%) suffered from thoracic trauma. Also, 47 cases (30.5%) were affected with VAP. Compared to the non-VAP group, the patients in VAP group had longer ICU stay (18.5±6.21 days vs. 9.21±2.91 days, P


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Comparison of interlaminar epidural steroid versus caudal steroid injection for low back pain with radiculopathy due to disc prolapse

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Sunil Nikose, Gurminder Singh, Pradeep K Singh, Sohael Khan, Devashree Nikose, Mahendra Gudhe.
Background: Low back pain is a common entity with a lifetime prevalence of 65 to 80 percent in general population, and usually disrupts work, social activity and activity of daily living. The purpose of our study was to evaluate the results of interlaminar epidural steroid injection versus caudal steroid injection for patients of lower back pain with radiculopathy, due to disc prolapse or disc degeneration in terms of pain relief and complications. Methods: A total of 272 subjects having low back pain with radicular leg pain and MRI evidence of single or double level disc prolapse were chosen. Out of 272, patients were randomly assigned to two group; the first group having 131 patients and second group having 141 patients. The first group received caudal steroid injection, and second group received interlaminar epidural steroid under fluoroscopy control. Follow up for both groups was at 1 week, 6 weeks, and 12 weeks. Results: The change in pain scores were rated as mild, moderate and excellent. The interlaminar epidural steroid injection fared excellent in earlier follow up, getting to moderate at 12 weeks time. The caudal steroid injection produced moderate relief in early phase at 12 weeks time. Conclusions: The caudal steroid injection is cost effective, easy to administer and is having much less complications as compared to interlaminar steroid injection. Both these procedures are safe, well tolerated procedures, and can be performed as outpatient procedures.


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Audit of prescription notes from a tertiary health centre, AIMS, BG Nagar, India: a cross-sectional study

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Shwetha Shivamurthy, Ghorpade Voomojirao Anand Prakash, Vinay Hosagavi Ramalingaiah.
Background: Prescription is a written order from physician to pharmacist which contains name of the drug, its dose and its method of dispensing and advice over consuming it. The frequencies of drug prescription errors are high. Prescription error contributes significantly towards adverse drug events. The present study was undertaken to understand the current prescription writing practices and to detect the common errors in them at a tertiary health care centre situated in BG Nagar, Mandya, Karnataka, India. Methods: A cross sectional study was conducted in Adichunchanagiri Institute of medical Sciences, BG nagar, Mandya, India during April- May 2015. 187 prescriptions were analyzed. Important information regarding the patient, doctor, drug and the general description of the prescription were obtained. Results: All the prescriptions were on the hospital pad. A significant number of the prescriptions were written in illegible (11%) or barely legible (20%) handwriting. The name, age and sex of the patient were not mentioned in majority of the prescriptions. All the prescriptions (100%) failed to demonstrate the presence of address, height and weight of the patient. Brand name of the drugs was mentioned in all the prescriptions with only 8% of them having the generic name. The quantity, dose and medicinal form were found missing in 1.7%, 29.5%, and 2.2% of the prescriptions. Conclusions: The findings of our study show that there is a need for improvement in the quality of prescriptions written by the doctors. The adoption of a computer aided prescribing system would go a long way in achieving this objective.


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Knowledge, attitude and practice of basic life support among junior doctors and students in a tertiary care medical institute

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Md. Yunus, Animesh Mishra, Habib M. R. Karim, Vandana Raphael, Ghazal Ahmed, Catherine E. Myrthong.
Background: Basic life support (BLS) is an integral part of health care. However, teaching of BLS is not yet a part of protocolized curriculum and uniform throughout. The present study is designed to assess the knowledge, attitude and practice of BLS and compare it among trained and untrained medical students and junior doctors in a medical institute. Methods: After approval from Institute Ethical Committee and informed consent from the participant, the present study was conducted among the undergraduate-level medical and nursing students and junior doctors. A questionnaire consisting of 30 questions based on knowledge, attitude and practice of BLS was used to collect data which is evaluated as per scale defined for this study. Statistical significance was assessed using INSTAT software (GraphPad Software, Inc., La Zolla, USA). Results: Only 16.41% of all participants and 52% of doctors have received class and/or hands on training. The untrained participants have scored poorly as compared to trained participants in theoretical knowledge and practice of BLS (24.36 % and 53.45% versus 9.25 % and 24.07%) respectively. The mean score for both theoretical knowledge and practice of BLS for trained students was higher than that of the untrained participants and the statistical difference was highly significant - p


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Palliation of advanced/metastatic carcinoma esophagus with radiotherapy

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
R. K. Spartacus, Rajan Paliwal, Pradeep Gaur.
Background: Esophageal carcinoma carries an overall poor prognosis. Most patients present with lo¬cally advanced, unresectable or metastatic disease. The main objective in advanced disease is the palliation of dysphagia. Treatment options include surgery (bypass, resection), laser, stent placement, external beam radiotherapy (EBRT), brachytherapy and systemic chemotherapy. We have focused on our experience with EBRT followed by brachytherapy. Methods: From January 2013 to December 2014, 29 patients of advanced/metastatic esophageal cancer were treated by HDR Brachytherapy following EBRT. All patients received 2# of 5Gy HDR brachytherapy. EBRT was 40Gy/20# (18 patients) and 36Gy/12# (11 patients). Disease remission and relief of dysphagia along with toxicity assessment were carried out at 1, 3 and 6 months after completion of treatment. Results: Evaluation at 1 month after brachytherapy showed complete remission (CR) of the disease in 6 patients, partial remission (PR) in 17 patients and no remission (NR) in 6. Overall improvement in swallowing status was seen in 22(75.86%) patients. 7 patients showed no improvement and 1 reported worsening of dysphagia score at 1 month after ILRT. The improvement in swallowing was maintained by 55.17% of patients at 6 months. Strictures had developed in 5 patients, ulceration in 3 patients and fistula in 1. Conclusions: A combination of EBRT and HDR brachytherapy affords effective palliation in advanced esophageal cancer with acceptable toxicity.


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Prevalence of thyroid dysfunction in patients with diabetes mellitus

2015-12-09T00-52-20Z
Source: International Journal of Research in Medical Sciences
Sriram Shanmugam, Suresh Damodharan, Jipin Thomas Jacob.
Background: Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. Various studies have found that diabetes and thyroid disorders mutually influence each other and both disorders tend to coexist. The objective of this study was to investigate the prevalence of thyroid dysfunction in patients with type 1 and type 2 diabetes mellitus. Methods: This is a prospective descriptive study which was conducted on 186 patients of diabetes mellitus who attended the outpatient diabetic clinic of Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu from January 2015 to June 2015. All patients underwent a clinical and laboratory evaluation. The correlation of prevalence of thyroid disorder with gender distribution, age distribution, HbA1C, duration of diabetes, hypertension, family history of thyroid disorder, and dyslipidemia was then done. The observations and interpretations were recorded and results obtained were statistically analyzed. Results: The prevalence of thyroid dysfunction in diabetic patients was found to be 21.5%, in which the most common thyroid disorder being the subclinical hypothyroidism(12.4%) followed by subclinical hyperthyroidism (6.5%) which was followed by primary hyperthyroidism (2.7%) and primary hypothyroidism (0%).Prevalence of thyroid disorders was found to be more in males(n=95) than in females(n=91), highest in the age group of


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