Pramil Tiwari - Academia.edu (original) (raw)

Papers by Pramil Tiwari

Value in Health, 2016

statistics, and quality of studies by using Newcastle-Ottawa scale. Random effect model was used ... more statistics, and quality of studies by using Newcastle-Ottawa scale. Random effect model was used for pooling the results. Heterogeneity potential sources were analyzed using meta-regression and subgroup analysis. This meta-analysis was performed by using comprehensive meta-analysis V2 exe. Results: This systematic review included nine clinical studies (n= 172 patients) as per inclusion criteria. The mean age was found to be 59.4±3.68 years and 71% males were involved. 56% patients were with hemodialysis and 45% with cirrhosis. Treatment naïve patients were 56%. Pooled estimate of efficacy in terms of SVR12 and dropout rate for therapy of sofosbuvir+simeprevir±ribavirin, was found to be 0.879; p< 0.001 and 0.054; p= 0.001, respectively; for sofosbuvir+ribavirin was 0.597; p= 0.445 and 0.136; p= 0.008, respectively; sofosbuvir+ribavirin+interferon with 0.883; p= 0.621 and 0.167; p= 0.299, respectively; simeprevir+daclatasvir with 0.850; p< 0.001 and 0.060; p< 0.001, respectively and sofosbuvir+ledipasvir had 0.900; p= 0.140 and 0.100; p= 0.140, respectively, and for sofosbuvir+daclatasvir was 0.984; p= 0.004 and 0.016; p= 0.004, respectively. Headache, myalgia, nausea/vomiting, anemia, insomnia, diarrhea, and rashes/irritability/pruritus were commonly occurred mild adverse events. ConClusions: Regime containing Sofosbuvir+Daclatasvir was found to be most effective followed by Sofosbuvir+ledipasvir and the most tolerable regimen was Sofosbuvir+Daclatasvir followed by Simeprevir+Daclatasvir in HCV patients with stage 4-5 chronic kidney disease.

Journal of Pharmaceutical Care & Health Systems, 2017

Vitamin D, a fat-soluble vitamin, concentrations need to be maintained for functioning of the met... more Vitamin D, a fat-soluble vitamin, concentrations need to be maintained for functioning of the metabolic, immune, reproductive, muscular, skeletal, respiratory and cutaneous systems of men and women of all ages. A rough estimate indicates that about 1 billion people globally are vitamin D deficient. The physiological functions of active vitamin D (calcitriol) are related to calcium homeostasis and osteoporosis, with possible roles in diabetes, cancer, ischemic heart disease, and autoimmune and infectious diseases. Vitamin D deficit increases the risk of malignancies, particularly of colon, breast and prostate gland, of chronic inflammatory and autoimmune diseases (e.g. insulin-dependent diabetes mellitus, inflammatory bowel disease, multiple sclerosis), as well as of metabolic disorders (metabolic syndrome, hypertension). The eight disorders discussed in this review are heart disease, bone disorder, colorectal cancer and other malignancies, infectious, inflammatory and autoimmune diseases, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis and type-I diabetes mellitus. There is a strong evidence for association between heart diseases, bone disorders, colorectal cancers, infectious, inflammatory and autoimmune diseases, inflammatory bowel diseases, multiple sclerosis, diabetes mellitus type-I and vitamin D. the extent of vitamin D deficiency’s contribution in the development of osteoporosis, breast cancer, rheumatoid arthritis is unclear.

Value in Health, 2014

Objectives: Studies have shown that the use of psychotropic medications such as sedative hypnotic... more Objectives: Studies have shown that the use of psychotropic medications such as sedative hypnotics have a significant association with risk of falls in older adults. However, very few studies have assessed the association with poor sleep, medications used to improve sleep, and the combined effect of these variables on the risk of falls. The objectives were: 1) to determine the prevalence of sleep problems, use of sleep medications and falls and 2) to evaluate the association between sleep problems, sleep medications, and falls in adults aged 65 or older. MethOds: The study population comprised a nationally representative sample of non-institutionalized adults aged 65 years or older participating in the 2010 Health and Retirement Study. Prevalence of sleep problems, sleep medication use and falls was calculated. Logistic regression modeling was used to examine the effect of sleep problems, sleep medications, and both on the risk of falls after controlling for covariates. Statistical analysis was performed using SAS 9.4 statistical software. Results: In 9,937 community-dwelling older adults, 36% had fallen in the past two years. 71% reported sleep problems and 21% reported taking medications or other treatments to help sleep. Older adults who do not have sleep problems and take sleep medications (OR= 1.50, 95%CI= 1.10-2.03) and those who do have sleep problems and take sleep medications (OR= 1.28, 95%CI= 1.07-1.54) have a significant risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. cOnclusiOns: Sleep problems, use of sleep medications, and occurrence of falls are common among older adults. Consistent with previous literature, sleep medication use predicted falls. However, those with sleep problems not taking sleep medication did not have significant risk of falls as has been previously reported. Health care professionals should consider medication-associated risk when treating sleep problems in older adults.

Value in Health, 2014

The probabilistic sensitivity analysis presented Glycopirronium as a dominant alternative compare... more The probabilistic sensitivity analysis presented Glycopirronium as a dominant alternative compared to tiotroprium and formoterol/ budesonide in more than 90% of the cases and against salmeterol/fluticasone the results were inconclusive. ConClusions: Glycopirronium is cost-effective when compared to other long-acting bronchodilators in the Colombian Health Care System.

Biology, Engineering, Medicine and Science Reports, 2016

Background & Aims: Conventional treatment (interferon or ribavirin) for Hepatitis C viral (HCV) i... more Background & Aims: Conventional treatment (interferon or ribavirin) for Hepatitis C viral (HCV) infection in patients with severe chronic kidney disease (CKD) has limitations of high dropout and less response rate. Directly acting antivirals raise hopes for HCV treatment in these patients. This meta-analysis was performed to evaluate the evidence for efficacy and safety of sofosbuvir and simeprevir, with or without ribavirin, in HCV-infected patients with severe CKD. Methods: Data was collected from Medline database, clinical-trial registry sites, and conference proceedings. This meta-analysis screened 78 studies. Quality of studies was assessed by New-Castle Ottawa scale. Heterogeneity and publication bias was checked by chi-square Q test and Eggers' test, respectively. Summary estimate of SVR12 and dropout rate was calculated at 95% confidence interval (CI). Results: Seven relevant clinical studies were identified. Two case-series and one case-report were excluded; only four studies were eligible for analysis. Three studies were cohort and one was retrospective-cohort in nature. Data was analyzed for 56 subjects. 33/56 subjects had cirrhosis. 39/56 subjects were on hemodialysis. 37/56 subjects were male. 30/56 subjects were treatment-naive. Pooled estimate of SVR12 was found 0.897 (CI 95%=0.957-0.772; p<0.01) and dropout estimate was 0.040 (CI 95%=0.011-0.137; p<0.01). Only one subject discontinued the treatment due to worsening Renal function regardless of ribavirin. Conclusion: This study concluded that combination of sofosbuvir and simeprevir, with or without ribavirin, was significantly effective and safe in HCV patients with severe CKD. For conclusive results, more data is required as this study involved only limited number of subjects.

Indian Journal of Pharmacy Practice, 2016

Introduction: Pharmacy practice profession had evolved in India over a period of time, but still ... more Introduction: Pharmacy practice profession had evolved in India over a period of time, but still a lot of work needs to be done. Indian journal of pharmacy practice was started in 2008 to meet the demand of a required forum for the professionals working in the area of pharmacy practice. Objective: To map the publications of Indian Journal of Pharmacy Practice (IJOPP) for a period of Oct 2008 to Jun 2015. Method: This study was carried out for a period of four months from Sept 2015 to Dec 2015. The papers published in IJOPP, both hard and electronic versions from Oct 2008 to Jun 2015 were screened. Publications were classified with respect to publication year, nature of the publication, therapeutic area, area of research, study design, data source, study duration, authors' details, geographical region where the study was conducted, affiliated college and hospitals, nature of healthcare setting, and set of subjects/patients in the study. All the results were represented as percentage(s) and number(s). Results: A total of 321 publications have been published till date.The number of research articles were 203 in number followed by review, case report, short communication and letter to editor (68, 34, 15 and 1, respectively). Infectious diseases were found to be the most common therapeutic area in research and review categories (8 and 43, respectively). Maximum numbers of publications were in pharmacovigilance (57). 93 (of 169) publications explicitly reported the study design and 28 were cross-sectional (28/38 publications did not report study design). Outpatients data were used in 57 publications (out of 193, publications reported data collection source). Study duration was 6 months in 90 (out of total 164, publications). Four authors were involved in 83 publications (out of total 321). Corresponding authors in 278 (278/313) publications were from pharmacy background. 161(161/276) publications belonged to pharmacy practice department. Maximum number of publications were from Karnataka (90/321). Study sites were hospitals in 171 publications. 146 studies were carried out in tertiary care hospital. Out of total, 72 publications included the adults and geriatrics as study population. Conclusion: Infectious diseases and pharmacovigilance were found to be most studied area. Study designs were not reported in 38 publications. Most of the studies were carried out for less than or equal to 6 months. Adults and geriatric "patients/subjects" groups were found to be most commonly studied.

Resistant pathogens pose an enormous challenge to clinicians, infection-control personnel, and ho... more Resistant pathogens pose an enormous challenge to clinicians, infection-control personnel, and hospital administrators worldwide. The NDM-1 issue, in August 2011, has brought out this topic to the forefront. 1,2,3,4 The resistant pathogens have become a common cause of hospital-acquired infections, particularly in ICUs. It is, therefore, imperative to study the pathogens and the nature of the resistance. This surveillance is fundamental to local, national and international efforts to combat AMR. The aim of the study was to evaluate the antimicrobial utilization pattern using RPM plus indicators and to determine the appropriateness of parenteral antimicrobial drugs (AMDs) using Glasgow Antimicrobial Audit Tool (GAAT). A total of 702 patients’ data was collected from two ICUs of a private tertiary care hospital. The information regarding patients’ demography, diagnosis, laboratory parameters, antimicrobials susceptibility test (ASTs) and prescribed AMDs was collected. Cephalosporins w...

Introduction: Available literature has ade- quate evidence to show inappropriate prescribing (IP)... more Introduction: Available literature has ade- quate evidence to show inappropriate prescribing (IP) in the Indian elderly inpatients (Mandavi et al., 2007) and out-patients (Mandavi et al., 2010). This study is in continuity with the latter to determine the prevalence of IP in elderly inpatients. Methods: A prospective observational study was conducted at a public hospital with elderly inpatients’ data (age ≥60 years). The methodology adopted by Mandavi et al., 2007 was used. Results: are presented as percentages and all averages are supported by SD. Results: The results: are based on data of 100 patients; 56% of whom were in 60-69 years bracket with average age of 68.4±7.7 years. The average number of diagnoses and medications was 3.2 and over 9, respectively. 19% patients had at least 1 or more instance of IP. 16/100 patients were prescr- ibed “high severity” medications according to Modi- fied Updated Beers Criteria 2003. The rank order of most common inappropriate medications was ...

Journal of Pharmaceutical Care & Health Systems, 2015

The Indian journal of medical research, 2012

Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group ... more Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group from outpatient setting. However, adverse drug reactions (ADRs) particularly among a large sample of ambulatory elderly patients in India has not been reported. This study has attempted to identify ADRs and assessed their causality, preventability and severity, and also their risk factors in Indian ambulatory elderly patients. A 2 year long term prospective study included 4005 ambulatory elderly patients (60 yr or above; either sex) at a public teaching hospital. Suspected ADRs were assessed for causality, preventability and severity using Naranjo's probability scale, modified Schumock and Thornton's criteria, and modified Hartwig's criteria, respectively. Of the total 4005 prescriptions, 406 were identified with ADRs, giving the occurrence of 10 per cent ADRs in elderly. The total number of ADRs was 422 in 406 prescriptions. Type A ADRs accounted for 46 per cent of the total...

Self-medication is an economical choice of treatment for common self-limiting illnesses. Major pr... more Self-medication is an economical choice of treatment for common self-limiting illnesses. Major problems related to this are wastage of resources, increased resistance of pathogens, and health hazards like adverse reaction. Elderly patients are more likely to self medicate themselves in view of the multiplicity of disorder they may have. The aim of the study was to access the self-medication pattern among elderly inpatients in the medicine wards of the public hospital, Chandigarh. Prospective questionnaire-based interview covered 515 elderly patients. Any medication(s) taken without a prescription, prior (average of two and half months) to hospitalization were considered selfmedication. Approximately 63% patients reported use of the non-prescription drugs/complementary medicine. Out of these 323 patients, 45.8% of the patients had used allopathic medications for treatment of their ailments without prescription or any medical advice. 18% of patients followed homeopathic and 30.3% patients were using ayurvedic medicines as self-medication. 6% patients used household remedies for self treatment. The number of patients who reported gastrointestinal disorders like gastric pain, acidity, diarrhea, and constipation as the most frequently selftreated symptom was 226. The other major reported illnesses include, fever in 110 and cough & cold in 95 patients. Analgesics/antipyretics like diclofenac, paracetamol and aspirin were the frequently used drugs. The drug for the treatment of acidity, flatulence and dyspepsia ranked second was antacids. On the basis of the feedback from 227 patients, the most probable reason for practicing self-medication was financial limitation. The prevalence of selfmedication is quite high. In addition to allopathic drugs, a medicine from other systems of medicine was also commonly used for self-medication. Strict legislation regarding the accessibility of these drugs and education of the community on self-medication is essential for effective use of medicines is required.

Value in Health, 2014

The objective of this study was to compare the promotional strategies of life style drugs (LSD) w... more The objective of this study was to compare the promotional strategies of life style drugs (LSD) with non-lifestyle drugs (NLSD) by content analyzing print advertisements. MethOds: 142 print advertisements were analyzed to see how LSD and NLSD ad messages differed with respect to rational appeals, emotional appeals and readability. Mann-Whitney U test was performed to compare the two groups of drug advertisements with respect to the type of promotional claims. Descriptive statistics were computed to summarize data pertaining to different ad features. The dataset was composed of 64 LSD advertisements and 78 NLSD advertisements. Inter-rater reliability was measured by Cohen's Kappa for two raters and was found to be adequate for all the variables used in the instrument. Results: Significant differences were observed between LSD and NLSD ads with respect to both emotional appeals (p= 0.000) and rational appeals (p= 0.000) based on Mann-Whitney U test. LSD ads focused more on emotional appeals while NLSD ads were heavy on rational content. A logistic regression analysis revealed likelihood estimates for ad claims appearing in the two groups. Readability calculated by Gunning-Fog Index for LSD's was 8.84 and for NLSD's was 11.56. Flesch-Kincaid grade level for LSD and NLSD was found to be 7.65 and 10.73, respectively, indicating increased complexity of language in NLSD ads, which was mostly reflecting of the greater use of technical scientific language. cOnclusiOns: The two groups of ads clearly differed with respect to type of content, presentation, structure and complexity as well as promotional strategies adopted. Rational appeals were more predictive of NLSD ad type while emotional appeals were predominant in LSD ads. PHP115 OPPOrtunities FOr tHe Future OF united states Medical device surveillance: an analysis OF tHe JOint rePlaceMent registry (Jrr) landscaPe in tHe united states

Int J Diabetes Dev Ctries, 2013

Indian Journal of Pharmacy Practice, 2014

Journal of Pharmaceutical Health Services Research, 2010

Value in Health, 2016

statistics, and quality of studies by using Newcastle-Ottawa scale. Random effect model was used ... more statistics, and quality of studies by using Newcastle-Ottawa scale. Random effect model was used for pooling the results. Heterogeneity potential sources were analyzed using meta-regression and subgroup analysis. This meta-analysis was performed by using comprehensive meta-analysis V2 exe. Results: This systematic review included nine clinical studies (n= 172 patients) as per inclusion criteria. The mean age was found to be 59.4±3.68 years and 71% males were involved. 56% patients were with hemodialysis and 45% with cirrhosis. Treatment naïve patients were 56%. Pooled estimate of efficacy in terms of SVR12 and dropout rate for therapy of sofosbuvir+simeprevir±ribavirin, was found to be 0.879; p< 0.001 and 0.054; p= 0.001, respectively; for sofosbuvir+ribavirin was 0.597; p= 0.445 and 0.136; p= 0.008, respectively; sofosbuvir+ribavirin+interferon with 0.883; p= 0.621 and 0.167; p= 0.299, respectively; simeprevir+daclatasvir with 0.850; p< 0.001 and 0.060; p< 0.001, respectively and sofosbuvir+ledipasvir had 0.900; p= 0.140 and 0.100; p= 0.140, respectively, and for sofosbuvir+daclatasvir was 0.984; p= 0.004 and 0.016; p= 0.004, respectively. Headache, myalgia, nausea/vomiting, anemia, insomnia, diarrhea, and rashes/irritability/pruritus were commonly occurred mild adverse events. ConClusions: Regime containing Sofosbuvir+Daclatasvir was found to be most effective followed by Sofosbuvir+ledipasvir and the most tolerable regimen was Sofosbuvir+Daclatasvir followed by Simeprevir+Daclatasvir in HCV patients with stage 4-5 chronic kidney disease.

Journal of Pharmaceutical Care & Health Systems, 2017

Vitamin D, a fat-soluble vitamin, concentrations need to be maintained for functioning of the met... more Vitamin D, a fat-soluble vitamin, concentrations need to be maintained for functioning of the metabolic, immune, reproductive, muscular, skeletal, respiratory and cutaneous systems of men and women of all ages. A rough estimate indicates that about 1 billion people globally are vitamin D deficient. The physiological functions of active vitamin D (calcitriol) are related to calcium homeostasis and osteoporosis, with possible roles in diabetes, cancer, ischemic heart disease, and autoimmune and infectious diseases. Vitamin D deficit increases the risk of malignancies, particularly of colon, breast and prostate gland, of chronic inflammatory and autoimmune diseases (e.g. insulin-dependent diabetes mellitus, inflammatory bowel disease, multiple sclerosis), as well as of metabolic disorders (metabolic syndrome, hypertension). The eight disorders discussed in this review are heart disease, bone disorder, colorectal cancer and other malignancies, infectious, inflammatory and autoimmune diseases, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis and type-I diabetes mellitus. There is a strong evidence for association between heart diseases, bone disorders, colorectal cancers, infectious, inflammatory and autoimmune diseases, inflammatory bowel diseases, multiple sclerosis, diabetes mellitus type-I and vitamin D. the extent of vitamin D deficiency’s contribution in the development of osteoporosis, breast cancer, rheumatoid arthritis is unclear.

Value in Health, 2014

Objectives: Studies have shown that the use of psychotropic medications such as sedative hypnotic... more Objectives: Studies have shown that the use of psychotropic medications such as sedative hypnotics have a significant association with risk of falls in older adults. However, very few studies have assessed the association with poor sleep, medications used to improve sleep, and the combined effect of these variables on the risk of falls. The objectives were: 1) to determine the prevalence of sleep problems, use of sleep medications and falls and 2) to evaluate the association between sleep problems, sleep medications, and falls in adults aged 65 or older. MethOds: The study population comprised a nationally representative sample of non-institutionalized adults aged 65 years or older participating in the 2010 Health and Retirement Study. Prevalence of sleep problems, sleep medication use and falls was calculated. Logistic regression modeling was used to examine the effect of sleep problems, sleep medications, and both on the risk of falls after controlling for covariates. Statistical analysis was performed using SAS 9.4 statistical software. Results: In 9,937 community-dwelling older adults, 36% had fallen in the past two years. 71% reported sleep problems and 21% reported taking medications or other treatments to help sleep. Older adults who do not have sleep problems and take sleep medications (OR= 1.50, 95%CI= 1.10-2.03) and those who do have sleep problems and take sleep medications (OR= 1.28, 95%CI= 1.07-1.54) have a significant risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. cOnclusiOns: Sleep problems, use of sleep medications, and occurrence of falls are common among older adults. Consistent with previous literature, sleep medication use predicted falls. However, those with sleep problems not taking sleep medication did not have significant risk of falls as has been previously reported. Health care professionals should consider medication-associated risk when treating sleep problems in older adults.

Value in Health, 2014

The probabilistic sensitivity analysis presented Glycopirronium as a dominant alternative compare... more The probabilistic sensitivity analysis presented Glycopirronium as a dominant alternative compared to tiotroprium and formoterol/ budesonide in more than 90% of the cases and against salmeterol/fluticasone the results were inconclusive. ConClusions: Glycopirronium is cost-effective when compared to other long-acting bronchodilators in the Colombian Health Care System.

Biology, Engineering, Medicine and Science Reports, 2016

Background & Aims: Conventional treatment (interferon or ribavirin) for Hepatitis C viral (HCV) i... more Background & Aims: Conventional treatment (interferon or ribavirin) for Hepatitis C viral (HCV) infection in patients with severe chronic kidney disease (CKD) has limitations of high dropout and less response rate. Directly acting antivirals raise hopes for HCV treatment in these patients. This meta-analysis was performed to evaluate the evidence for efficacy and safety of sofosbuvir and simeprevir, with or without ribavirin, in HCV-infected patients with severe CKD. Methods: Data was collected from Medline database, clinical-trial registry sites, and conference proceedings. This meta-analysis screened 78 studies. Quality of studies was assessed by New-Castle Ottawa scale. Heterogeneity and publication bias was checked by chi-square Q test and Eggers' test, respectively. Summary estimate of SVR12 and dropout rate was calculated at 95% confidence interval (CI). Results: Seven relevant clinical studies were identified. Two case-series and one case-report were excluded; only four studies were eligible for analysis. Three studies were cohort and one was retrospective-cohort in nature. Data was analyzed for 56 subjects. 33/56 subjects had cirrhosis. 39/56 subjects were on hemodialysis. 37/56 subjects were male. 30/56 subjects were treatment-naive. Pooled estimate of SVR12 was found 0.897 (CI 95%=0.957-0.772; p<0.01) and dropout estimate was 0.040 (CI 95%=0.011-0.137; p<0.01). Only one subject discontinued the treatment due to worsening Renal function regardless of ribavirin. Conclusion: This study concluded that combination of sofosbuvir and simeprevir, with or without ribavirin, was significantly effective and safe in HCV patients with severe CKD. For conclusive results, more data is required as this study involved only limited number of subjects.

Indian Journal of Pharmacy Practice, 2016

Introduction: Pharmacy practice profession had evolved in India over a period of time, but still ... more Introduction: Pharmacy practice profession had evolved in India over a period of time, but still a lot of work needs to be done. Indian journal of pharmacy practice was started in 2008 to meet the demand of a required forum for the professionals working in the area of pharmacy practice. Objective: To map the publications of Indian Journal of Pharmacy Practice (IJOPP) for a period of Oct 2008 to Jun 2015. Method: This study was carried out for a period of four months from Sept 2015 to Dec 2015. The papers published in IJOPP, both hard and electronic versions from Oct 2008 to Jun 2015 were screened. Publications were classified with respect to publication year, nature of the publication, therapeutic area, area of research, study design, data source, study duration, authors' details, geographical region where the study was conducted, affiliated college and hospitals, nature of healthcare setting, and set of subjects/patients in the study. All the results were represented as percentage(s) and number(s). Results: A total of 321 publications have been published till date.The number of research articles were 203 in number followed by review, case report, short communication and letter to editor (68, 34, 15 and 1, respectively). Infectious diseases were found to be the most common therapeutic area in research and review categories (8 and 43, respectively). Maximum numbers of publications were in pharmacovigilance (57). 93 (of 169) publications explicitly reported the study design and 28 were cross-sectional (28/38 publications did not report study design). Outpatients data were used in 57 publications (out of 193, publications reported data collection source). Study duration was 6 months in 90 (out of total 164, publications). Four authors were involved in 83 publications (out of total 321). Corresponding authors in 278 (278/313) publications were from pharmacy background. 161(161/276) publications belonged to pharmacy practice department. Maximum number of publications were from Karnataka (90/321). Study sites were hospitals in 171 publications. 146 studies were carried out in tertiary care hospital. Out of total, 72 publications included the adults and geriatrics as study population. Conclusion: Infectious diseases and pharmacovigilance were found to be most studied area. Study designs were not reported in 38 publications. Most of the studies were carried out for less than or equal to 6 months. Adults and geriatric "patients/subjects" groups were found to be most commonly studied.

Resistant pathogens pose an enormous challenge to clinicians, infection-control personnel, and ho... more Resistant pathogens pose an enormous challenge to clinicians, infection-control personnel, and hospital administrators worldwide. The NDM-1 issue, in August 2011, has brought out this topic to the forefront. 1,2,3,4 The resistant pathogens have become a common cause of hospital-acquired infections, particularly in ICUs. It is, therefore, imperative to study the pathogens and the nature of the resistance. This surveillance is fundamental to local, national and international efforts to combat AMR. The aim of the study was to evaluate the antimicrobial utilization pattern using RPM plus indicators and to determine the appropriateness of parenteral antimicrobial drugs (AMDs) using Glasgow Antimicrobial Audit Tool (GAAT). A total of 702 patients’ data was collected from two ICUs of a private tertiary care hospital. The information regarding patients’ demography, diagnosis, laboratory parameters, antimicrobials susceptibility test (ASTs) and prescribed AMDs was collected. Cephalosporins w...

Introduction: Available literature has ade- quate evidence to show inappropriate prescribing (IP)... more Introduction: Available literature has ade- quate evidence to show inappropriate prescribing (IP) in the Indian elderly inpatients (Mandavi et al., 2007) and out-patients (Mandavi et al., 2010). This study is in continuity with the latter to determine the prevalence of IP in elderly inpatients. Methods: A prospective observational study was conducted at a public hospital with elderly inpatients’ data (age ≥60 years). The methodology adopted by Mandavi et al., 2007 was used. Results: are presented as percentages and all averages are supported by SD. Results: The results: are based on data of 100 patients; 56% of whom were in 60-69 years bracket with average age of 68.4±7.7 years. The average number of diagnoses and medications was 3.2 and over 9, respectively. 19% patients had at least 1 or more instance of IP. 16/100 patients were prescr- ibed “high severity” medications according to Modi- fied Updated Beers Criteria 2003. The rank order of most common inappropriate medications was ...

Journal of Pharmaceutical Care & Health Systems, 2015

The Indian journal of medical research, 2012

Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group ... more Several studies have reported adverse drug events ranging from 5 to 35 per cent in all age group from outpatient setting. However, adverse drug reactions (ADRs) particularly among a large sample of ambulatory elderly patients in India has not been reported. This study has attempted to identify ADRs and assessed their causality, preventability and severity, and also their risk factors in Indian ambulatory elderly patients. A 2 year long term prospective study included 4005 ambulatory elderly patients (60 yr or above; either sex) at a public teaching hospital. Suspected ADRs were assessed for causality, preventability and severity using Naranjo's probability scale, modified Schumock and Thornton's criteria, and modified Hartwig's criteria, respectively. Of the total 4005 prescriptions, 406 were identified with ADRs, giving the occurrence of 10 per cent ADRs in elderly. The total number of ADRs was 422 in 406 prescriptions. Type A ADRs accounted for 46 per cent of the total...

Self-medication is an economical choice of treatment for common self-limiting illnesses. Major pr... more Self-medication is an economical choice of treatment for common self-limiting illnesses. Major problems related to this are wastage of resources, increased resistance of pathogens, and health hazards like adverse reaction. Elderly patients are more likely to self medicate themselves in view of the multiplicity of disorder they may have. The aim of the study was to access the self-medication pattern among elderly inpatients in the medicine wards of the public hospital, Chandigarh. Prospective questionnaire-based interview covered 515 elderly patients. Any medication(s) taken without a prescription, prior (average of two and half months) to hospitalization were considered selfmedication. Approximately 63% patients reported use of the non-prescription drugs/complementary medicine. Out of these 323 patients, 45.8% of the patients had used allopathic medications for treatment of their ailments without prescription or any medical advice. 18% of patients followed homeopathic and 30.3% patients were using ayurvedic medicines as self-medication. 6% patients used household remedies for self treatment. The number of patients who reported gastrointestinal disorders like gastric pain, acidity, diarrhea, and constipation as the most frequently selftreated symptom was 226. The other major reported illnesses include, fever in 110 and cough & cold in 95 patients. Analgesics/antipyretics like diclofenac, paracetamol and aspirin were the frequently used drugs. The drug for the treatment of acidity, flatulence and dyspepsia ranked second was antacids. On the basis of the feedback from 227 patients, the most probable reason for practicing self-medication was financial limitation. The prevalence of selfmedication is quite high. In addition to allopathic drugs, a medicine from other systems of medicine was also commonly used for self-medication. Strict legislation regarding the accessibility of these drugs and education of the community on self-medication is essential for effective use of medicines is required.

Value in Health, 2014

The objective of this study was to compare the promotional strategies of life style drugs (LSD) w... more The objective of this study was to compare the promotional strategies of life style drugs (LSD) with non-lifestyle drugs (NLSD) by content analyzing print advertisements. MethOds: 142 print advertisements were analyzed to see how LSD and NLSD ad messages differed with respect to rational appeals, emotional appeals and readability. Mann-Whitney U test was performed to compare the two groups of drug advertisements with respect to the type of promotional claims. Descriptive statistics were computed to summarize data pertaining to different ad features. The dataset was composed of 64 LSD advertisements and 78 NLSD advertisements. Inter-rater reliability was measured by Cohen's Kappa for two raters and was found to be adequate for all the variables used in the instrument. Results: Significant differences were observed between LSD and NLSD ads with respect to both emotional appeals (p= 0.000) and rational appeals (p= 0.000) based on Mann-Whitney U test. LSD ads focused more on emotional appeals while NLSD ads were heavy on rational content. A logistic regression analysis revealed likelihood estimates for ad claims appearing in the two groups. Readability calculated by Gunning-Fog Index for LSD's was 8.84 and for NLSD's was 11.56. Flesch-Kincaid grade level for LSD and NLSD was found to be 7.65 and 10.73, respectively, indicating increased complexity of language in NLSD ads, which was mostly reflecting of the greater use of technical scientific language. cOnclusiOns: The two groups of ads clearly differed with respect to type of content, presentation, structure and complexity as well as promotional strategies adopted. Rational appeals were more predictive of NLSD ad type while emotional appeals were predominant in LSD ads. PHP115 OPPOrtunities FOr tHe Future OF united states Medical device surveillance: an analysis OF tHe JOint rePlaceMent registry (Jrr) landscaPe in tHe united states

Int J Diabetes Dev Ctries, 2013

Indian Journal of Pharmacy Practice, 2014

Journal of Pharmaceutical Health Services Research, 2010