Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra.

OBJECTIVE: The main objective of the prescription audit of the secondary level government hospitals under the Maharashtra Health Systems Development Project (MHSDP) was to develop a list of essential drugs. Other objectives were to articulate measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO). MATERIALS AND METHODS: The study was conducted among a representative sample of 31 secondary level hospitals under MHSDP. A copy of the prescription was obtained with the help of a pre-inserted carbon, in a special format. Data for only 'first encounter prescriptions' was collected for all patients attending the Outpatient Department (OPD). RESULTS: About 77 percent of the prescriptions contained only one diagnosis. The average number of drugs per prescription was 3.1. About 60 percent of the drugs were prescribed by generic names and about 23 percent of the prescribed drugs were in combination. About 25 percent of the prescriptions contained at least one injection, while 35 percent contained at least one antibiotic. In 16 percent of the prescriptions a vitamin or tonic was prescribed. About 46 percent of the single ingredient formulations were as per the WHO 2003, Essential Medicines List (EML). Based on the findings of the Prescription Audit an EML was prepared for each category of the secondary level hospitals, for use in the OPD. CONCLUSIONS: Prescription audits are useful in generating data on morbidity, which forms the basis for preparing the list of essential medicines. Mechanisms necessary for improving prescription practices are suggested.

Use of drugs and cost of treatment of diarrhea in secondary level government hospitals in maharashtra.

A prescription audit was carried out among the outpatient attendees of 31 secondary level hospitals under Maharashtra Health Systems Development Project. Use of drugs and cost of treatment of diarrhoea were studied using the prescriptions for diarrhoea collected for the prescription audit. Average number of drugs prescribed per prescription for treatment of diarrhoea was 3.7. It was higher than average number of drugs per prescription in the Maharashtra Health Systems Development Project hospitals in general. About three fourths of the prescriptions contained oral rehydration salts. Furazolidone and metronidazole were prescribed in about half of the prescriptions. Cotrimoxazole was prescribed in about one fourth of prescriptions. About 60% of the prescriptions contained other drugs. The average cost of prescription for diarrhoea was Rs. 14 and increased with the number of drugs prescribed. Average cost of prescription was the highest for those written by general practitioners. Pathological tests were indicated only in case of 11%.

Violence against the silent most.

PIP: Children never receive their due share of attention and care. Their legitimate rights as humans have been grossly ignored and violated. However, like older people, children have the right to safe, preventive, promotive, and curative health care services. Individuals, society, and the state are responsible for a large number of unethical and inhumane practices in medical care upon both fetuses and children. Some of these practices are discussed. A woman's right to abortion under the Medical Termination of Pregnancy Act has greatly curtailed the right of unborn children to live. The act and unsafe abortion are discussed. Violence against children by radiation, drugs, environmental poisons, nutritional deficiency, and female infanticide are then reviewed, followed by consideration of children's rights to safe birth, post-birth safety, and a safe childhood.^ieng

The myth of brain tonics.

PIP: In India, vitamin tonics are promoted and sold as a means to improve the intelligence of children. 3 research studies in the UK have attempted to evaluate the influence of vitamin intake on nonverbal and verbal intelligence. The University of Dundee study by Dr. D. Benton and Dr. G. Roberts in 1988 followed 12-13 year old children who received vitamin supplementation for 8 months and compared the group with a matched group of 30 children who received placebos and a 3rd group who received nothing. The results of pretest and posttest scores showed improvement in nonverbal intelligence (solving problems not requiring vocabulary or information) among the group receiving vitamin and mineral supplementation. Another group of researchers from King College, London, evaluated intelligence scores of 11-12 year old children receiving vitamin and mineral supplementation and found no improvement in scores. This study did not exactly replicate the Benton study. A 3rd group of researchers from the University of Dundee did replicate the Benton and Roberts' study and found supplementation did not improve either verbal or nonverbal scores. Children are used in these research projects because nonverbal intelligence reaches its peak maximum by 18-21 years of age. Verbal intelligence continues to grow throughout life. In India, there is an emphasis in schools on development of verbal intelligence. Manufacturers of "brain tonics" claim that tonics improve children's performance in examinations. Not only are the research findings debatable, but there are other considerations that do not support use of supplementation to increase reasoning performance. The tonics, which contain an excess of vitamins in the daily requirement, are excreted in the urine rather than being stored in the body. Vitamins are also costly and are available to only 30% of the India's population. Production of vitamins such as B-12, B-1, or B-2 are in excess of the amount required if there were vitamin deficiencies. The assured benefit of consuming extra vitamins and minerals is in lining the economic pockets of tonic manufacturers and traders with money.^ieng

Equipment and methods for laboratory testing of ankle-foot prostheses as exemplified by the Jaipur foot.

A load deflection and a cyclic loading apparatus capable of measuring dorsiflexion/plantarflexion, pronation/supination, internal/external rotation, and cyclic dorsiflexion (60 cycles per minute) of ankle-foot prostheses are described. A test protocol was developed to assess the functional parameters of the Jaipur ankle-foot prosthesis before and after prolonged cyclic loading, with the simultaneous aim of evaluating these machines. The results on 26 Jaipur ankle-foot prostheses revealed that: 1) the prosthesis enjoys considerable mobility in three planes, confirming its known versatility; 2) the prosthesis is robust; and, 3) the testing machines deliver reproducible results and are suitable for in-house testing of ankle-foot prostheses.

Ankle-foot prosthesis with articulated human bone endoskeleton: force-deflection and fatigue study.

The durability and function of three ankle-foot prostheses fabricated using a naturally articulated, fresh cadaveric human bone endoskeleton set in a fiber reinforced rubber shell were studied. Radiographic and force-deflection analyses before and after cyclic dorsiflexion for 5,000, 100,000, and 3 million cycles revealed no structural or functional changes. The endoskeleton foot compared favorably with the Jaipur ankle-foot prosthesis. It is concluded that formalin-fixed fresh foot bones with intact articulations obtained from cadaveric or surgically amputated limbs are suitable for use in ankle-foot prostheses because they withstand prolonged use without functional or structural deterioration.

Articulated cadaveric bones as a structural endoskeleton in an ankle-foot prosthesis: a preliminary report.

This report describes the construction and evaluation of an ankle-foot prosthesis using human cadaveric bones as the endoskeleton inside a fiber-reinforced vulcanized rubber shell. Cadaveric bones and exhumed skeletal bones were used. Three designs were fabricated, subjected to radiographic evaluation, and underwent 4-week field trials of normal daily use by a unilateral below-knee amputee. The rubber shell retained the position of the bones, permitted movements at the joints in various stages of the stance phase, and restored the bones to their neutral position when the foot was unloaded. The cadaveric prosthesis provided for plantar flexion of the foot when the heel was loaded and for locking of the joints to restrain excessive movement when the foot came to rest. While fresh cadaveric bones withstood all the stresses of active walking, exhumed macerated bones fractured and fragmented with use.

Idiopathic sclerosing encapsulating peritonitis.

Sclerosing encapsulating peritonitis (SEP) was diagnosed in two men, one middle-aged woman, and a prepubertal girl, none of whom had been treated with beta-blockers, peritoneal dialysis, or peritoneal shunting. Idiopathic SEP has hitherto been reported mainly in adolescent females. It is hypothesised that in these patients, who were from two adjacent districts of Rajasthan, an aetiological factor was consumption of cereals infected with fungus that contained biologically active amines.

Glucose oxidase as an adjunct to penicillin on penicillin resistant staphylococcal isolates.

The study was carried out to find out the efficacy of glucose oxidase as an adjunct to penicillin and its comparison with cloxacillin on fifty penicillin resistant staphylococcal isolates. There is an unequivocal evidence that the combined use of glucose oxidase and penicillin is superior in controlling penicillin resistant coagulase positive staphylococcal infections in comparison to cloxacillin.

The trabecular pattern of the calcaneum as an index of osteoporosis.

Radiographs of the foot and hip in 61 patients with fractures of the upper end of femur have been studied, noting the progressive loss of bone trabeculae with age. The trabecular pattern in the calcaneum (expressed as the calcaneal index) closely parallels that in the upper end of the femur (Singh's index) and is easier to assess. Both indices have a significant correlation with age.