Knowledge, attitude and practice among consumers about adverse drug reaction reporting

Background: Background: Adverse Drug Reaction (ADR) reporting by consumers is quite low in India. Assessing knowledge and attitude of consumers regarding ADR reporting and observing practice of ADR reporting among them can help explore probable causes for underreporting of ADRs by consumers.Methods: This was a cross-sectional study conducted in a tertiary care teaching hospital using investigator-administered questionnaire and interviewing indoor patients of Surgery, Medicine, Obstetrics & Gynaecology and Dermatology departments. The questionnaire was prepared to assess knowledge, attitude and practice of consumers about ADR reporting. Data was analysed using mean, standard deviation and percentages.Result: A total of 820 consumers of medicines were included. It was found that 32.2% consumers were not aware that a drug can produce adverse effects. After being explained about adverse drug reactions, 94.6% consumers felt that adverse drug reactions should be reported. However, 98.8% consumers were not aware of Pharmacovigilance Programme of India. After consulting about consumer reporting programme, majority of respondents (96.1%) felt that the direct consumer reporting programme helps reporting of ADRs. Moreover, 93.7% of consumers were willing to use it to report ADRs in future. Consumers preferred the Telephonic method with a Toll free number for ADR reporting followed by informing a health care professional.Conclusion: Poor knowledge and awareness about ADR reporting is the major factor for low to nearly absent ADR reporting by consumers in India.

Evaluation of trigger tool method for adverse drug reaction reporting by nursing staff at a tertiary care teaching hospital

Background: To sensitize nurses about Trigger Tool Method (TTM) and to evaluate the impact of TTM on adverse drug event (ADE) reporting by nurses at a tertiary care teaching hospital in India.Methods: This was prospective, interventional, single center study conducted among nursing health professionals of Civil Hospital Ahmedabad (CHA) posted in Medicine Department. They were sensitized about ADE reporting, pharmacovigilance, methods of ADRs reporting and details about TTM. Also, a list of 17 triggers was prepared by the investigator and given to nurses. They were educated to report ADEs using TTM. At the initiation and end of study, questionnaires were given to evaluate knowledge, attitude and practice of ADR reporting among participant nurses. All triggers and ADEs reported were analyzed in terms of association between them, effectiveness of trigger in detecting an ADR and in terms of Positive Predictive Value (PPV). Reported ADRs were also assessed for causality, severity and preventability.Results: A total 758 patients were admitted during the study period in the respective medicine department. List of 17 triggers consists of 9 drug triggers (DT), 1 laboratory trigger (LT) and 7 patient triggers (PT). Of these 17 triggers, 14 triggers were identified by nurses. These 14 triggers were noticed 130 times. These included DT (100 times), LT (0 times) and PT (30 times). Of the various triggers observed, 7 DT and 4 PT were related to ADRs. Hence, 11 triggers (64.70%) were positive (related to ADRs), out of 17 total triggers under evaluation. 21 ADRs were observed using TTM by nurses.Conclusions: The TTM helps to detect and report ADRs by nurses. Educational interventions about TTM help in better detection and reporting of ADRs.

Awareness About The Concept Of Green Corridor Among Medical Student And Doctors In A Rural Medical College Of Maharashtra, India

Background: India’s traffic problem over the years has been the root cause of many deaths. During an medical emer-gency like organ transplantation over long distances, the unsuitability of roads and highways hamper in the worst way possible. In a developing unplanned country like India, where lane discipline is an alien concept, emergency lanes won’t sustain as of now. Thus, for provision of better health services, a temporary emergency lane has been implemented in organ transplantation cases known as a ‘Green Corridor’. It is a special route with manual operation of street signals and traffic to avoid any hindrances that could come in the way of an ambulance. Aims and Objec-tives:To learn about the awareness, strategies and possibilities of Green Corridor in India. Material and Method:This was an interventional study by the undergraduate students of Rural Medical College, Pravara Institute of Medi-cal Sciences, Loni, Maharashtra. The study also included 350 Students and 150 Faculty members of Pravara Institute of Medical Sciences (Deemed University) and Practicing Doctors of Central Maharashtra were included in the survey. The survey conducted was in a pre and post-test format. Results:The study involved 500 participants out of which 135 were medical faculty and practicing doctor and 350 were students of Rural Medical College. The awareness among medical students about green corridor increased from 14% to 61%, while it went up to 71% from 26% in med-icalfacultyafterintervention.Willingnesstodonateorgansincreasedfrom57%to66%and78%to85%amongmed-icalstudentsandmedicalfaculty,respectively.Theparticipantsgavesuggestionstomakeavailableairambulance&emergency roads and increase awareness regarding green corridor. Conclusion: From the survey conducted, it can be perceived that there is a massive lack of awareness about Green Corridor as well as reluctance for organ dona-tion. Therefore, awareness should be created on a large scale so that no person is left oblivious. Even on a smaller scale, an implementation of the suggested strategies could make a massive difference in the present scenario regard-ing medical emergencies.

Frequency Of Alloantibody In Multiple-Transfused Thalassemia Major Patients And Factors Influencing On Alloimmunization.

Background & Objective: The recommended treatment for beta thalassemia major involves regular blood transfusions, whichstimulate the patient’s immune system and results in the formation of antierytrocyte antibodies usually IgG class. They can result in clinical hemolysis and complication of blood cross matching. The purpose of this study was to determine the frequency of RBC alloantibodies, the type of these antibodies, factors influencing on alloimmunization among multiple- transfused thalassemia major patients. Methodology: ABO blood grouping,Rh (D) typesand Phenotyping done by the electromagnetic technology using Qwalys 3 Diagast. Antibody screening was done by using 3-cell panel followed by11- cell panel of Biorad Corporation. Results: 10 patients developed alloantibodies against RBC Antigen. Among total alloimmunizedpatients, 7.35%were female and 4.27% were male. Majority of alloantibodies were directed against antigen in the Rh and Kell system. i. e. Anti c, Anti E and Anti K. Frequency of Alloantibody positivism is maximum in AB positive patients. From extended Antigen typing of voluntary donors, we can see the frequency of D, C and e Antigens are more than frequency of c, E and K Antigens. Conclusion: Frequency of red cell alloimmunizationwas 5.40% in this study. Alloantibodies found were mainly against Rh blood group systemand Kell system. Red cell alloantibody formation was not influenced by age at first transfusion, number of blood transfusion, splenectomy and leuckodepleted blood transfusion. In our study alloimmunized patients did not revealed any evidence of haemolytic transfusion reaction. The frequency of Antibody positivity depends on immunogenicity of Antigen. Females and group AB patients are showing more frequency of alloimmunization. Routine pretransfusion matching of blood, other than ABO and RhD antigen is not recommended because of low rate of red cell alloimmunization and high cost associated with such testing.

The external quality assessment scheme in coagulation: five years’ experience as a participating laboratory.

Background: The attainment of quality services in a laboratory requires a comprehensive quality assurance programme which includes both internal and external quality control. External Quality Assessment Scheme (EQAS) programmes are accepted around the world as invaluable tools by laboratories to assess the performance of their testing systems. Results are objectively compared to other laboratories, using the same methodologies for every parameter. The goal of this study was to review EQAS results from time to time in an effort to improve the performance of the laboratory. Methods: Observational study done at Pramukhswami medical college, Shree Krishna hospital, Karamsad from January 2009 to December 2013. In the present study we have evaluated our EQAS test result of the past five years, from 2009 to 2013. We receive two samples in duplicate in lyophilised form, which are stored at 2-8°C in the refrigerator. The samples are reconstituted with 1 ml of distilled water at the time of procedure. The samples are received quarterly in a year. The test results of all the samples are analysed and documented. Results: Satisfactory results were obtained in all the cycles except four times. Discrepancy was observed in Prothrombin time INR (International Standardized Ratio). Root cause analysis was performed and necessary action taken. Conclusion: This participation in EQAS over the last five years has helped us significantly to improve our laboratory services in terms of performance evaluation, patient care and overall quality of laboratory practices.

Comparison of two doses of oral clonidine as a premedicant for attenuation of pressor response to laryngoscopy.

Background: The present study compared oral clonidine 0.3mg with 0.2 mg to attenuate hemodynamic response to laryngoscopy and intubation and also to evaluate the optimal dose of oral clonidine as premedication. Methods: A prospective, randomized, double blind trial performed on 40 patients of ASA Grade I & II, scheduled for planned ENT surgeries under general anaesthesia. Patients were divided into 2 groups depending on oral clonidine dose given 90 mins prior to induction. Group A received 0.3 mg while group B received 0.2 mg clonidine. Heart rate, SBP, DBP, MAP were monitored at various time intervals e.g. before premedication, before induction, at laryngoscopy, intubation, immediately after intubation and post intubation for 30 minutes. Patients were anesthetized with sodium thiopentone (2.5%) 5-7 mg/kg followed by suxamethonium 2 mg/kg i.v. Results: We observed a significant decrease in mean HR,SBP,DBP,MAP in both the groups (clonidine 0.2 and 0.3mg ) as compared to baseline and preinduction level. Tablet Clonidine 0.3 mg proved to be significantly effective in checking the rise in SBP. A highly significant (p < 0.01) fall in DBP was observed in Group A at 1, 3, 15, 30 mins post intubation as compared to Group B. At 3 min, 15 min and 30 min interval, highly significant (p <0.01) decrease in MAP observed with clonidine 0.3mg as compared to 0.2mg. In this study, no patient encounter complications like bradycardia, hypotension. Conclusions: Oral clonidine 0.3 mg premedication in adult patients 90 mins prior to induction is safe, convenient and more effective in suppressing the hemodynamic response to laryngoscopy & intubation as compared to clonidine 0.2 mg.