Shankar Pr

Impact of educational intervention on the pattern and incidence of potential drug-drug interactions in Nepal

Objective: To study the impact of educational intervention on the pattern and incidence of potential drug-drug interactions (DDIs). Method: All patients admitted to Internal Medicine wards of Manipal Teaching Hospital during the study period were included. Patient details were collected using a patient profile form and the datum from the filled forms was analyzed using Micromedex electronic database. An intervention was carried out through a presentation during clinical meeting and personal discussion. The target groups for the intervention included doctors and the nurses. Results: Altogether 435 patients during preintervention and 445 during postintervention were studied. The incidence of potential DDIs was 53% (preintervention) and 41% (postintervention) [chi-square =11.27, p=0.001]. The average number of drugs per patient was 8.53 (pre-intervention) and 7.32 (post-intervention) [t=3.493, p=0.001]. Sixty-four percent of the potential DDIs were of ‘Moderate’ type and 58% had a ‘Delayed’ onset in both the phases. Seventy percent of the potential DDIs during the pre-intervention phase and 61% during post-intervention phase had a ‘Good’ documentation status. Pharmacokinetic mechanism accounted for 45% of the potential DDIs during preintervention and 36% in the post-intervention phase. Cardiovascular drugs accounted for 36% of the potential DDIs during pre-intervention and 33.2% during post-intervention phase. Furosemide was the high risk drug responsible for DDIs in both phases. The most common potential DDIs observed were between amlodipine and atenolol (4.82%) (preintervention) and frusemide and aspirin (5.20%) (postintervention). Conclusion: There was an association between potential DDIs and age, sex, and polypharmacy.

Postgraduate students as simulated patients in communication skills learning and assessment

At the Manipal College of Medical Sciences communication skills learning and assessment has been carried out for over 7 years. Postgraduate MSc students in Pharmacology were recently used as simulated patients during learning and assessment of communication skills. The purpose was to train postgraduates to plan, initiate and conduct sessions and to help them in their future role as medical teachers. Common problems and illnesses in Nepal and South Asia were covered and the communication of drug and non-drug information to the patient was emphasised. The postgraduates enjoyed the sessions and found them interesting and useful. Feedback from 116 students was obtained using a modified Likert-type scale. The students were in favour of postgraduate students as simulated patients. Continuation and improvement of the sessions is planned for the future.

Role of Zinc in childhood diarrhea management: a case of Nepal

Diarrhea is one of the leading causes of death among children less than five years of age around the world accounting for about two million child deaths annually. One of the recent strategies made to minimize the diarrhea associated mortality in children involves the use of oral zinc in diarrhea management. The inadequacy of dietary zinc uptake is exacerbated by the net loss of zinc during diarrhea. Zinc is enlisted in WHO essential drug list under medicine for diarrhea where it is indicated in acute diarrhea as an adjunct to oral rehydration salts. Zinc is usually well tolerated. It is necessary to explore public health applications, using zinc either as a preventive measure in children or therapeutically for diarrhea. Key words: Diarrhea, Dehydration, Mortality, Nepal, Zinc.

Relevance of pharmacoepidemiology to Nepal

Drug-related problems such as overuse of injectable drug products and antimicrobials, increased cost of drug therapy, polypharmacy, and adverse drug reactions (ADRs) are prevalent in the healthcare settings of Nepal. To date, no new drug development processes or clinical trials have been conducted in Nepal, despite the fact that studies of real life situations are an essential tool for monitoring medicine use. Pharmacoepidemiology (PE) is an important area that evaluates the effects of drug use in large populations. Data obtained from pharmacoepidemiological studies may highlight ways to reduce certain drug-related problems and provide reliable information on the safety profile of a drug. Moreover, clinicians and regulatory authorities may also use the data to make drug therapy decisions, drug regulation and policy development. Therefore, there is a great need to conduct appropriate pharmacoepidemiological studies that involve multiple regions and in various groups of the population of Nepal, to collect unbiased and reliable information on drug use.