Development and pilot testing of a prescription quality index for Ayurveda

Background: Prescription quality can be a direct predictor of the net outcome of a health care deliveryeffort. Quality of prescription may be considered as a cumulative matrix of multiple components of aprescription on the basis of their relative importance. Prescription quality index is a recognized tool inclinical medicine for multiple purposes including the prediction of health care intervention outcome.Objectives: Considering the importance of prescription quality among every system of medicine, anattempt was made to design a prescription quality index for Ayurveda.Materials and methods: The Prescription Quality Index for Ayurveda was designed through item selectionfollowing a thorough literature search and was validated through multiple peer group discussions. Finaldraft of index containing 38 individual items carrying different scores as per their importance in theprescription was subjected to a pilot test upon 1576 indoor prescriptions generated in 2015 at StateAyurvedic College Hospital, Lucknow.Results: The study revealed large information gaps in the components of the prescription where it wassupposed to be noted by the prescribers. These gaps in the Ayurvedic prescriptions were most significantin the areas pertaining to Ayurvedic fundamentals of clinical examination, disease diagnosis and Ayurvedic drug intake methods.Conclusion: Prescription Quality Index for Ayurveda was found useful in underlining the gaps betweenthe ideal and generated prescriptions. This can be utilized as a useful tool to evaluate the quality ofAyurvedic prescriptions by seeing their adherence to the standard prescription template.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Assessing the Ayurvedic prescribing trends on the basis of WHO drug use indicators

Background: Ayurvedic prescriptions are often challenged for their rationality. Excessive use of proprietary medicines, rasa preparations, and samshodhana without any justification and deliverable benefits outweighing the other forms of safer, cheaper and less time consuming therapies is putting theAyurvedic prescribing trends into question. In Ayurvedic practice, prescriptions are often individualizedwith substantial variability between the choices of drugs. Although being welcomed as an advancedapproach of prescription writing by making it tailor made, this method also allows for lapses to creep inthus making it necessary to check common trends of prescribing in Ayurveda and to see whether it raisesany caution.Objectives: The objective of this study was to create a check for common trends of prescribing in Ayurveda and to see if such checks raise any caution.Materials and methods: Present study utilizes the WHO drug use indicators as a preliminary tool foranalyzing Ayurvedic prescriptions.Results: It was found that with a small modification, this tool can help immensely in screening of Ayurvedic prescriptions.Conclusion: Based on the results obtained through this study, it can be concluded that the WHO drug useindicators, with a small modification, can help in identifying the prescribing trends in Ayurveda and canalso help in suggesting remedial measures in case certain anomalies are found.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Ayurvedic management of achalasia.

Achalasia is an esophageal motor disorder characterized by sustained lower esophageal sphincter contraction and reduced esophageal peristalsis. This pathology eventually results in symptoms like dysphagia, regurgitation and occasional chest pain related to food intake. This is an uncommon disorder of unexplained etiology; however viral, autoimmune and neurodegenerative causes are often afflicted to its manifestation. As per the current state of knowledge, achalasia is considered to be a chronic incurable condition. The treatment options offered here primarily aim at reducing the tone of lower esophageal sphincter by pharmacologic, endoscopic or surgical means. We are presenting here a case of achalasia with two years of symptomatic history of food regurgitation, dysphagia and heart burn without any noticeable response from allopathic medicines. The patient was subsequently kept under ayurvedic therapy considering the symptoms caused by vata impairment and hence requiring vatanulomana and reduction in esophageal muscle tone as the primary management. The patient was kept under suggested Ayurvedic therapy and followed‑up for 3 months. A symptom‑free follow‑up in this case was noticed after completion of 1 month of Ayurvedic therapy.

Pigment reduction in nevus of Ota following leech therapy.

Nevus of Ota is a congenital blue-gray color nevus affl icting unilaterally, the area near the eyes. It poses a huge cosmetic concern besides being a potential threat for developing melanoma sometime in the course of the disease. The treatment options are neither many nor promising besides they are too expensive. We have treated a case of nevus of Ota with leech therapy where leech was applied upon the lesion for fi ve times spanned in a period of 2 months. The results in terms of change in the color of lesion were evaluated with the help of serial photographs following every treatment session to mark the level of color changes in the lesion. A substantial reduction in color of the nevus was reported following the completion of the therapy. The results were demonstrated with the photographs. Although, recommended as the classical Ayurvedic management for skin diseases, leech therapy is not reported earlier in such conditions. It proposes a novel approach to deal with such congenital pigment lesions where other options are not promising.

Rehabilitative potential of Ayurveda for neurological defi cits caused by traumatic spinal cord injury.

Spinal cord injury (SCI) is associated with worst outcomes and requires a prolonged rehabilitation. Ayurvedic indigenous methods of rehabilitation are often utilized to treat such conditions. A case of SCI was followed up for 3 months upon an Ayurvedic composite intervention and subsequently reported. The composite treatment plan involved Ayurvedic oral medications as well as a few selected external and internal pancha karma procedures. A substantial clinical and patient centered outcome improvement in existing neurological defi cits and quality of life was observed after 3 months of the Ayurvedic treatment given to this case.

Effectiveness, safety, and standard of service delivery: A patient-based survey at a pancha karma therapy unit in a secondary care Ayurvedic hospital.

Pancha karma is a modality of treatments commonly used in Ayurvedic hospitals. It has elaborate textual reference of its usage in various clinical conditions forming the basis of its extensive use in Ayurvedic clinical practice. Unfortunately, despite its unquestionable popularity and usage among Ayurvedic physicians and patients, it has not been evaluated rigorously on scientific parameters to identify its effectiveness, safety, and procedural standards. Considering the patient’s opinion as an important determinant in this perspective, this study aims at identifying the patient’s (actual recipients of pancha karma therapy) perception toward the effectiveness, safety, and standard of service delivery concerning pancha karma through a structured survey at a pre-identified pancha karma therapy unit in a secondary care Ayurvedic hospital. Majority of the survey respondents considered these therapies as safe and effective (88%). Ninety-four percent respondents have expressed their satisfaction to the standard of services provided to them at the pancha karma unit of the hospital concerned.