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In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study is to identify drug-related problems (DRPs) for elderly cancer patients receiving chemotherapy by implementing pharmaceutical care services. Methods: In this interventional study, patients were followed after each cycle till 12 weeks. The MOATT-MASCC teaching tool was used to educate patients about their therapy. The outcome measures included the occurrences of any DRPs such as inappropriate medication dose, dosage form, route of administration, therapeutic duplication, failure of the patient to adhere to the medication regimen, adverse drug reactions (ADRs), and drug–drug interactions (DDIs) and to resolve it. Results: On 186 patients, there were 38% ADRs, 16% DDIs, 6% non-adherence to therapy, 4% medical conditions for which no medication was prescribed, and 1% therapeutic duplication and transcribing error was identified. A total of 226 ADRs were documented. Nausea and vomiting were the most frequently occurring ADRs (24%) and platinum compounds caused the highest number of ADRs. Assessments of causality showed that the majority of cases are 'probable' (50%). In evaluating the severity of ADRs, 53% of ADRs were 'moderate' and 51% of ADRs were 'probably' preventable. Upon assessing the DDIs, 35% of the prescriptions had 'monitor therapy'. All of the DRPs, that were identified were notified to the treating oncologists and resolved without any disagreement. Conclusions: Pharmaceutical care is essential for elderly cancer patients. Oncologists and pharmacists should work together to identify and manage DRPs as well as educate patients about their disease. This will help in improved patient care and a better therapeutic outcome. [ABSTRACT FROM AUTHOR]

Objective: This research paper aims to evaluate the relative efficacy of pharmacognosy research on the top 40 tertiary hospitals and its pharmacy in India according to Newsweek's 2021 ranking. Purpose: India's pharmaceutical market is now estimated to be worth $50 billion. India is a significant pharmaceutical exporter, reaching more than 200 nations with its exports. This study will help to identify whether the pharma industry is working efficiently in selected Indian hospitals or not. Thus, to create a bench marking for the hospital pharmacies in India. Design/methodology/approach: Data for the study came from public and private hospitals' official websites, financial records, and government notifications. Crosssectional data analyses were done using a Slack-Based model and data envelopment analysis (DEA). STATA was the software used to scrutinize the results effectively. Results: Thirteen hospital pharmacies out of a total of 40 are judged to be relatively technically efficient overall, according to the research. The findings of the slack analysis demonstrate that government hospitals and pharmacies are better able to handle slack and effectively manage input and output. Conclusion: The researchers also set upped a benchmarking hospital both for private and government healthcare settings for pharmacognosy research. Thus, it can be utilized for the betterment of the pharmacies. [ABSTRACT FROM AUTHOR]

Hospital pharmacies are experiencing significant rise in demand for medicines for treatment and care of patients admitted to hospitals. Nevertheless, inefficient processes continue to be a problem in hospital pharmacy management, resulting in mismatch between demand and supply, time-consuming manual tasks, out-of-stock situations, medicine expiration, and excessive operating costs. Prior research has addressed various aspects of hospital pharmacy management, but limited studies have focused on discovering hidden patterns and knowledge from large volume of data stored in hospital information systems, which can help improve pharmacy operations. Primary goal of this research is to extract meaningful knowledge from hospital databases to improve pharmacy operations. Hospital pharmacy database from multispecialty hospital in India is used to examine associations among medicines prescribed to hospitalized patients using Apriori approach, which is one of the algorithms of Association Rule Mining. Data comprising 745,176 pharmaceutical item order records were gathered, processed and analyzed. Around sixty-three association rules were discovered. Different measures like support, confidence, and lift are used to evaluate the rules. Rule comprising medicines Atracurium, Febuxostat, and Multivitamins achieved the highest confidence of 87.35%. Discovered rules can help pharmacists to anticipate demand, develop better inventory system, improve operational efficiency and lead to effective healthcare system. [ABSTRACT FROM AUTHOR]

While employing a phenomenological perspective, the present study aimed to explore the varied experiences of transgender individuals in Kashmir, concerning their health-seeking behavior, and the constraints they face while accessing healthcare resources on a day-to-day basis in their life world. Participants were recruited through the purposive and snowball sampling strategies and the sufficiency of sample size was determined by data saturation. Data were collected using face-to-face in-depth interviews and analyzed through Colaizzi's procedure of extracting recurrent themes and their interwoven relationships in qualitative research. Three main themes of awareness and the preferences for healthcare, gender identity and persistent stigmatization in care settings, and intra-community support and the resultant caregiving were prominent. Results of the study revealed that the transgender individuals in Kashmir experience inappropriate health-seeking behaviour primarily due to their unawareness regarding health, diseases and public healthcare programs/schemes, financial constraints, social exclusion, improper support and social stigma. They often prefer treating their health issues, mostly through local pharmacies or patent medicine vendors (PMVs), instead of visiting the medical professionals in the organized sector. Moreover, in many instances, they were also found to delay their decisions to seek care or simply decided to remain far from any medical intervention. As a result, the transgender individuals in Kashmir usually experience underutilization of formal healthcare services, which undermines their right to proper health and well-being. [ABSTRACT FROM AUTHOR]

Introduction: Clinical pharmacist can enthusiastically involve in oncology department through utilizing the skills and knowledge to support wide variety of functions in patient care. The impact of pharmaceutical care services in oncology department were analysed through various approaches including the analysis of knowledge level of patients towards the disease and its management through patient counselling, monitoring of performance status, observing of ADR and drug safety. Incidence of cancer was scrutinized during the study. Methodology: A Prospective interventional study was conducted from November 2019 to March 2020 with the support of institutional ethical approval at oncology department of Lourdes hospital, Ernakulam. 133 patients were included with all type of cancer. Data collected through Performa with KAP questionnaire and direct interview was conducted. Statistical significance was evaluated through p value of <0.001 Result: 123 patients were completed both questionnaire. Among this 69.91% were females and most of the patients belonged to 50 – 65yeras age group and carcinoma was frequently reported type. End of the study showed significant change in the knowledge level of patients after interaction with the clinical pharmacist. 26 ADRs were reported including solitary and multiple ADRs. Recommendations associated with drug reconstitution, administration were frequently given to the nurses. Most of the interventions to improve therapeutic outcome of the patients were accepted by the oncologist. Conclusion: Clinical pharmacist can actively participate in all aspects of the oncology department in association with physician and other health care providers to improve the therapeutic outcome and quality of life of patients. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the change in quality adjusted life-years (QALYs) after providing oncology pharmacist services to assess its impact on humanistic outcome. Methods: It was a prospective, single-centered study conducted for a period of two years at Bharat cancer Hospital and Nirali memorial radiation center, Surat. Patients were recruited into the control group (CG) and the intervention group (IG). The oncology pharmacist services (OPS) were provided only to the IG. The humanistic outcome was measured by incorporating the EQ-5D-5L instrument to calculate quality-adjusted life-years (QALYs) in both the groups. Patients have been provided with the EQ-5D-5L questionnaire at the pre-determined intervals i.e. before the commencement of chemotherapy and then after every chemotherapy cycle till the completion of treatment. The analysis was carried out using descriptive analysis (frequency distribution for categorical variables and measures of central tendency (median and average) and dispersion (std. deviation) for quantitative variables). Results: A total of 230 patients were screened and from them 105 patients were recruited, out of which 54 patients were in CG and 51 patients in IG. AC regimen followed by weekly paclitaxel was prescribed in majority of the patients (CG: 59.3%; IG: 60.8%) followed by AC-TRA and AC regimen alone. The majority of patients in the CG were facing improper administration of pre-medication (83.3%), lack of knowledge regarding chemo-mixing, counselling in nursing staff (66.7%) and a sub-therapeutic dose of anti-emetics (37%). The baseline QALY at the inception of chemotherapy was 0.040 and 0.014 in CG and IG, respectively. After the completion of the 6 chemotherapy cycle, the QALY was found to be 0.042 and 0.043 in CG and IG, respectively. Conclusion: The study has demonstrated that the improvisation in QALY after provision of oncology pharmacist services reflect the positive impact of oncology pharmacist on humanistic outcomes. The study also provided the opportunity to identify the thrust area where more clinical pharmacy exposure is needed in order to improve patient care. [ABSTRACT FROM AUTHOR]

Introduction: To increase access to care for the urban American Indian population, a collaboration was developed between an Urban Indian Health Clinic (UIHC) and Federally Qualified Healthcare Center (FQHC) to reduce financial barriers, increase patient access to affordable medications, and augment the integrated model of care. Objective: To describe the design and implementation of an innovative pharmacy model through a partnership between an UIHC and a FQHC. Methods: A collaborative partnership between an UIHC and a FQHC was developed to spread scarce 340B federal resources as a method to enhance patient care. The innovative practice model included the development of processes to (1) increase medication access to all patients by providing access to affordable medications at clinic and the provision of mail order services, (2) minimize program expenses through cost-sharing of a pharmacist salary, (3) expand clinical pharmacy programs (collaborative drug therapy management) to augment integrated patient care, and (4) optimize 340B cost savings for the clinic by establishing contracts and implementing adjudication software to obtain medication reimbursement from Medicaid and other third party insurances. Results: Through the cost-sharing of a pharmacist salary and use of remote verification, the majority of prescription medications were available to patients at the UIHC through implementation and expansion of an other outlet. Collaborative drug therapy management (CDTM) protocols were successfully implemented which allowed clinical pharmacy services to collaboratively manage chronic conditions. All adult primary care providers adopted the integrated patient care model. Third-party pharmacy insurance contracts were obtained and computer software was installed to allow for the adjudication of pharmacy claims, resulting in cost savings from medication reimbursement. Conclusion: The innovative collaborative partnership between an UIHC and an FQHC demonstrated how scarce federal resources can be leveraged using the 340B program to increase patient access to affordable medications. This innovative model reduced financial barriers to the clinic, and allowed for expansion of pharmacist led CDTM programs and augmentation of integrated clinical services. The cost savings observed from this novel program additionally fueled programmatic sustainability through reinvestment into the pharmacy program and is expected to continue to fund the program in the future. [ABSTRACT FROM AUTHOR]

Background: Drug Information Center (DIC) with on-call evidence-based medicine service can revolutionize health-care practice and also can play a major role in health-care delivery in both developed and developing countries. Objective: To assess the feedback received from hospital clinicians for the newly initiated DIC services in a tertiary care hospital of North India. Methods: This is a retrospective cohort study conducted between January 1, 2016, to December 31, 2018. The clinicians approached DIC for specific pharmacotherapeutic questions for managing an index patient. After providing consultation, DIC followed up with them for the action taken and feedback on the consultation. The results of the data analyzed using Fisher Exact test and descriptive statistics. Results: Of 264 encounters, more than 98% of clinicians found the service satisfactory. There was a statistically significant association between the timely answer provided to treating physicians and their level of satisfaction with the service (P <.05). There was no significant association between academic experiences and the satisfaction or dissatisfaction among the clinical fraternity colleagues. The interpretation ability of on-call pharmacology postgraduate students was a significantly associated factor with clinician's satisfaction level (P <.05). More than 96% of clinicians followed the pharmacotherapy advice recommended by DIC in their patient management. Conclusion: Thorough evaluation of published research needs to be taught to budding pharmacologists, pharmacists in their curriculum for an effective DIC service. DIC service has the potential to minimize the barrier of evidence-based medicine practice in developing as well as developed countries. [ABSTRACT FROM AUTHOR]

Background: Fixed-dose combinations (FDCs) are being widely prescribed for the treatment of various disorders in India. However, not all FDCs are rational. To know the awareness of physicians in prescribing rational FDCs was the need of the hour in order to assess the prescribing trends and rationality of FDCs. Eventually, this will help to formulate the guideline for rational use of FDCs. Methods: This was a prospective observational study conducted in All India Institute of Medical Sciences Bhopal, MP, India. Prescriptions were collected over a period of 2 months by the convenience sampling method from hospital pharmacy. The data were subjected to descriptive analysis using Microsoft Excel and Graph Pad Prism. Results were expressed in mean ± standard deviation (SD), percentages and 95% confidence interval. Results: A total of 2496 drugs were prescribed in 1008 prescriptions, of which 945 (37.82%) were FDCs with an average of 0.93 ± 0.94 (mean ± SD) per prescription. Of 945, 67 (7.09%) were included in National List of Essential Medicine 2015 considered as rational. The number of prescriptions containing one or more FDCs was 629 (62.40%). FDCs were more frequently prescribed to male patients (54.92%) and in the age group of 18–30 years (33.44%). FDCs containing a proton pump inhibitor were prescribed most frequently (16.29%) followed by nonsteroidal anti-inflammatory drugs (13.96%) and multivitamins (7.83%). Conclusions: Prescribing irrational FDCs was very common, and hence there is an obvious need to update our prescribers about the irrationality of FDC and motivate them to develop a habit of rational prescribing. [ABSTRACT FROM AUTHOR]

BACKGROUND: Medication errors may account up to one-third of all medical errors in hospitals, thereby leading to adverse outcomes such as higher mortality rate and longer hospital stay. OBJECTIVES: The primary objective of the study was to determine whether patient safety can be improved by clinical pharmacy services. The study also aimed to reveal whether medication errors can be prevented by any means. METHODS: A prospective, observational study was conducted in a multispecialty hospital in India. Prescription audit was performed for patients followed by necessary intervention by the concerned physician. Chi-squared test, paired t-test and ANOVA were performed to test statistical significance. RESULTS: A total of 699 errors were encountered by 501 of 1149 patients enrolled. Prescription errors accounted for the majority (87.1%) of errors followed by administration (7.4%), transcription (4.3%) and dispensing (1.2%) errors. Average error per patient showed a significant gradual decline from baseline (2.08) to the final follow-up (1.06). ICU patients encountered a higher rate (52.8%) of errors than general ward group (42.8%), while geriatric population witnessed a low error rate (18.8%) compared to adults (72%). CONCLUSIONS: The study was not only successful in highlighting the impact of medication error assessment on patient safety, but it also demonstrated that medication errors can be lowered with the help of clinical pharmacy services. Findings from the study conclude that medication errors can be prevented if healthcare professionals are educated appropriately to avoid recurrence of past mistakes. [ABSTRACT FROM AUTHOR]

Background Adverse drug reactions (ADRs) monitoring in cancer patients is important to ensure early detection, effective management and possible prevention subsequently. Objectives This study was conducted to detect and monitor ADRs to anti-cancer agents, and to assess impact of clinical pharmacists (CPs)' interventions in minimizing ADRs to anti-cancer agents. Setting Private, specialty oncology care hospital in South India. Methods CPs prospectively followed cancer patients admitted to inpatient wards and treated at ambulatory care in order to identify ADRs, for a period of 3 years. Identified/reported ADRs were discussed with concerned oncologists and/or nurses, documented electronically and assessed further for their causality, severity, preventability and grading. Based on study findings during year 1, interventions (educational, therapeutic and system based) were developed by CPs and implemented in order to minimize preventable ADRs. Impact of CPs' interventions was studied during year 2 and year 3. Main outcome measure(s) Preventable factors contributing to ADRs and percentage of preventable ADRs before and after CPs' interventions. Results A total of 1279 ADRs were reported in 1133 patients from a cohort of 1328 patients. Vomiting (23.22%), alopecia (9.53%), diarrhoea (8.67%) and myelosuppression (7.42%) were the common ADRs reported. Inappropriate administration frequency and regimen of anti-emetics (22%), lack of/suboptimal supportive care (18%) and administration errors (16%) were identified as common contributing (preventable) factors for ADRs in year 1. Percentage of preventable ADRs was 81% during year 1 (pre-intervention), and 45% and 34% in year 2 and year 3 respectively (post-interventions). Conclusion Interventions by CPs helped to minimize preventable ADRs to anti-cancer agents. [ABSTRACT FROM AUTHOR]

In India, manufacturing, storing, transportation, distribution, and dispensing of drugs are licensed and regulated under the drugs and cosmetic act, 1940; Indian Medical Council Act, 1956; the Pharmacy Act, 1948; and the Narcotic Drugs and Psychotropic Substances Act, 1985. Prescribing and dispensing medicines at the same time to their patients by registered medical practitioners (RMPs) is a well-known practice in all systems of medicine across the country. Further, the kind of branded medicines a patient gets from the clinics will come wrapped in a huge profit margin for RMPs, and this has been an alternative source of income to them. Dispensing and selling of medicines by RMPs at their clinics to their patients may represent a significant potential conflict of interest with the medical ethical principles, namely autonomy, beneficence, and non-maleficence and it raises various ethical and legal challenges. This article focuses on the ethical and legal issues of this practice and emphasizes the need for a proactive and dynamic approach to meet the rising demand for quality healthcare in India. [ABSTRACT FROM AUTHOR]

Objective This study was conducted to investigate medication-related problems after implementation of clinical pharmacy services at a speciality oncology care setting. Methods It was a prospective interventional study conducted for a period of three years at a private academic oncology care setting. Paper-based medical records and medication orders were reviewed and patients and care givers were interviewed to understand the treatment plan. All the medication-related problems were identified by clinical pharmacists by performing drug therapy review. Patients were also followed up at ambulatory care and in-patient units to ensure appropriate administration of anti-cancer drugs by nurses. All the medication-related problems were discussed with the concerned clinicians and then were resolved with the interventions of clinical pharmacists. Clinical significance of these interventions were assessed and classified as "Major", "Moderate "and "Minor". Educational, clinical and system-based interventions were developed and implemented to minimize medication-related problems at the study site. Results A total of 1359 medication-related problems were identified from 2120 medication orders reviewed of 1362 patients followed during the study period. The most common medication-related problems were lack of suboptimal supportive care (17.95%), inappropriate administration of medications (14.56%), untreated indication (14.20%), wrong dosing calculations (12.21%), drug–drug interactions (11.62%) and sub-therapeutic dose (11.11%). Clinical pharmacy interventions were made to resolve all the medication-related problems. Clinical significance of majority (n = 504, 37.08%) of medication-related problems was "Moderate" followed by "Major" (n = 434, 31.93%) and "Minor" (n = 421, 30.97%). Conclusion The study has demonstrated the importance of clinical pharmacy services in improving quality and safe use of medicines in oncology practice. Positive feedback of clinicians on clinical pharmacy services was a reflection of acceptance of clinical pharmacy interventions by clinicians. [ABSTRACT FROM AUTHOR]

Pain is one of most common adverse stimuli experienced by children, occurring as a result of injury, illness and necessary medical procedure. So assessment of pain in children is very important. The objectives of the study were to assess the knowledge and attitude of staff nurses regarding children's pain management and the perceived barriers to optimal pain management in children. Also to find out the association of knowledge and attitude with the selected demographic variables. This observational analytical survey study was conducted among 120 staff nurses working in pediatric care units. Subjects were selected by using convenience sampling. Knowledge and attitude was assessed by using a semi structured questionnaire and the perceived barriers were identified by using a structured checklist. Research showed that among 120 study participants more than half of subjects had average knowledge (58.3%) and (41.7%) had poor knowledge whereas majority of the subjects had a neutral attitude (95.8%) and only (4.2%) had negative attitude regarding children's pain management. Among 21 barriers, most frequently reported 5 barriers were identified. Majority of the study participants reported delay in orders being processed by the pharmacy as barrier (89.2%). Rest of the barriers reported were my concern about children becoming tolerant to analgesics (76.7%), delay in orders being processed by the pharmacy (62.5%), my concern about side effects of medications (53.3%) and patient's reluctance to report or rate pain (48.3%).There was no significant association between the knowledge knowledge scores and attitude scores with socio personal and professional variables. A nurse's knowledge and attitude can affect his or her ability to adequately provide pediatric pain management. Hence there is an exigent need for assessing the knowledge and attitude towards children's pain management. [ABSTRACT FROM AUTHOR]

Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions. Practical implications FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type. Originality/value The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement. [ABSTRACT FROM AUTHOR]

Medicines are major elements of modern healthcare systems and have helped significantly to reduce the burden of deaths and diseases all over the globe. Access to these essential medicines is a major need in order to achieve ‘Good Health to All’. Traditionally, India has been a rural, agrarian economy where the majority of the population still live in villages. The main factors which affect the provision of good healthcare among the rural population are affordability, unavailability and average quality of drugs and other medical supplies. The availability and quality of medicines are substandard when compared to the urban population standards.To promote proper utilization of medicines, there is a need for availability and affordability of quality medicines in the presence of ‘rational drug usage’ ideology among the medical professionals and health workers. They play a vital role in imparting the knowledge of drug information to the patient community which in the long run can help in achieving the goal of health to all. This paper showcases the need and emergence of a pharmaceutical supply chain mechanism in the healthcare industry and how it can prove to be the backbone of the present public healthcare system by enhancing it with information communication technology (ICT) implementation. This paper also discusses the problems and resentment faced with the initial introduction of modernized technology into the current healthcare system. [ABSTRACT FROM AUTHOR]

Background: Permanently recalled drugs are a public health concern if they remain accessible in violation of applicable regulation. Illicit online pharmacies act as an alternative form of access and have been associated with the sale to patients of counterfeit/falsified/fraudulent/substandard drugs. We wished to determine if permanently recalled and significantly restricted drugs were illegally marketed for sale online.Objective: The study was conducted in two phases with two objectives. The first phase attempted to identify drugs subject to permanent recall in certain major pharmaceutical markets as well as those listed as recalled or significantly restricted by the United Nations. We also examined the market authorization status of identified drugs in China and India. The second phase used structured searches on the Internet to determine if identified drugs were marketed for sale online.Setting: The World Wide Web.Method: After identification of permanently recalled and restricted drugs we conducted Internet searches for illegal "no prescription" marketing events. We assessed the form of marketing, whether a site offered direct-to-patient sale, use of social media marketing, and the site's compliance status with external monitoring bodies.Main Outcome: Number of recalled drugs marketed as available for purchase on the Internet.Results: We identified 16 class I equivalent permanently recalled or restricted drugs, 56.3 % (n = 9) of which maintained market authorization in either China or India. Half (n = 8) were marketed for sale online without a prescription direct-to-patient. Use of social media marketing was mixed, with only 18.8 % (n = 3) of recalled drugs having a presence on Facebook, though 50.0 % (n = 8) had content on Twitter. We also found the majority (68.8 %, n = 11) were available and marketed for sale by vendors on the wholesale/business-to-business website alibaba.com primarily as active pharmaceutical ingredient.Conclusion: Despite efforts in several countries to restrict access to these drugs or permanently remove them from the market, our study indicates that various sources actively market recalled drugs for sale online. Drug regulators, public health agencies, and law enforcement officials should act with urgency to appropriately restrict and regulate these sales to protect global patients and consumers. [ABSTRACT FROM AUTHOR]

Introduction: Health care services cover a wide spectrum of community services for the treatment of disease, prevention of illness and promotion of health.[1] Aim and Objective: This study was aimed at assessing the gap in availability and utilization of health services in a resettlement Colony of Chandigarh. Material and methods: Dadu Majra was purposely selected to assess the gap in availability and utilization of health care services and expectations of people from public health sector. Using semi structured interview schedule, interviews were carried with all health care providers. Six focused group discussions and interviews were held 114 sampled service users. Results: Most of the users were utilizing services from private medical clinics (96.5%) for the treatment of acute illnesses. For antenatal checkup/delivery (95.6%), chronic diseases (99.1%), and emergency services (95.6%) Government Multi-Speciality Hospital, Chandigarh was being utilized. Utilization of services provided at civil dispensary of study area was low. The expectations of users were availability of at least one doctor and availability of free medicine & laboratory facilities. Conclusions: Public health services were preferred over by the private and therefore need to be strengthened. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

Background: Geriatrics is an emerging clinical specialty in India. Although studies on medication use in the elderly have been conducted in India, data on medication-related problems (MRP) in the hospitalised elderly population are limited. Aim: To determine the prevalence, nature and predictors of MRP, and the significance of pharmacists' interventions following identification of MRP in elderly inpatients. Method: A prospective active surveillance study conducted over 9 months (July 2008 to March 2009) on the medical wards of JSS Hospital, Mysore, India. Patients 60 years and over that were admitted to the medical wards were evaluated. Pharmacists' interventions following identification of MRP were recorded and their potential clinical significance assessed. The organ systems affected and the management of MRP were investigated. Predictors of MRP were identified using bivariate analysis and subsequent multivariate logistic regression. Results: 411 patients were evaluated and 352 MRP were identified in 230 (56%) patients. Adverse drug reactions were the major (53%) MRP. Cardiovascular drugs accounted for 37% of MRP. Insulin (9.4%) was the most frequently implicated drug. MRP commonly involved the nervous system (19%). In 47% of cases, the drug was discontinued as a management strategy. The majority of pharmacists' interventions (314; 90%) were moderate or major in their level of clinical significance. Age was an influential predictor of MRP (OR 2.1; 95%CI 1.1-4.2; p = 0.03). Conclusion: Around half of the hospitalised elderly experienced an MRP. Pharmacists can contribute to geriatric inpatient care by reducing adverse consequences of MRP through early detection and providing advice in managing MRP. [ABSTRACT FROM AUTHOR]

The ABC and VED (vital, essential, desirable) analysis of the pharmacy store of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, was conducted to identify the categories of items needing stringent management control. The annual consumption and expenditure incurred on each item of pharmacy for the year 2007–08 was analyzed and inventory control techniques, i.e. ABC, VED and ABC–VED matrix analysis, were applied. The drug formulary of the pharmacy consisted of 421 items. The total annual drug expenditure (ADE) on items issued in 2007–08 was Rs. 40,012,612. ABC analysis revealed 13.78%, 21.85 % and 64.37% items as A, B and C category items, respectively, accounting for 69.97%, 19.95% and 10.08% of ADE of the pharmacy. VED analysis showed 12.11%, 59.38% and 28.51% items as V, E, and D category items, respectively, accounting for 17.14%, 72.38% and 10.48% of ADE of the pharmacy. On ABC–VED matrix analysis, 22.09%, 54.63% and 23.28% items were found to be category I, II and III items, respectively, accounting for 74.21%, 22.23% and 3.56% of ADE of the pharmacy. The ABC and VED techniques need to be adopted as a routine practice for optimal use of resources and elimination of out–of–stock situations in the hospital pharmacy. [ABSTRACT FROM AUTHOR]

Excerpts from the articles "New measures to inform Canadians of the risks of prescription opioids out for consultation" and "Draft guidance on provision of data on antimicrobial use by animal species from national data collection systems" are presented which focus on regulatory rules.

Introduction: Considering limited global access to affordable insulin, we evaluated insulin access in public and private health sectors in Bengaluru, India. Methods: Employing modified WHO/HAI methodology, we used mixed-methods analysis to study insulin access and factors influencing insulin supply and demand in Bengaluru in December 2017. We assessed insulin availability, price and affordability in a representative sample of 5 public-sector hospitals, 5 private-sector hospitals and 30 retail pharmacies. We obtained insulin price data from websites of government Jan Aushadhi scheme (JAS) and four online private-sector retail pharmacies. We interviewed wholesalers in April 2018 to understand insulin market dynamics. Results: Mean availability of insulins on India's 2015 Essential Medicine List was 66.7% in the public sector, lower than private-sector retail (76.1%) and hospital pharmacies (93.3%). Among private retailers, mean availability was higher among chain (96.7%) than independent pharmacies (68.3%). Non-Indian companies supplied 67.3% products in both sectors. 79.1% products were manufactured in India, of which 60% were marketed by non-Indian companies. In private retail pharmacies, median consumer prices of human insulin cartridges and pens were 2.5 and 3.6 times, respectively, that of human insulin vials. Analogues depending on delivery device were twice as expensive as human insulin. Human insulin vials were 18.3% less expensive in JAS pharmacies than private retail pharmacies. The lowest paid unskilled worker would pay 1.4 to 9.3 days' wages for a month's supply, depending on insulin type and health sector. Wholesaler interviews suggest that challenges constraining patient insulin access include limited market competition, physicians' preference for non-Indian insulins, and the ongoing transition from human to analogue insulin. Rising popularity of online and chain pharmacies may influence insulin access. Conclusion: Insulin availability in Bengaluru's public sector falls short of WHO's 80% target. Insulin remains unaffordable in both private and public sectors. To improve insulin availability and affordability, government should streamline insulin procurement and supply chains at different levels, mandate biosimilar prescribing, educate physicians to pursue evidence-based prescribing, and empower pharmacists with brand substitution. Patients must be encouraged to shop around for lower prices from subsidized schemes like JAS. While non-Indian companies dominate Bengaluru's insulin market, rising market competition from Indian companies may improve access. [ABSTRACT FROM AUTHOR]

Pharmacovigilance is the pharmacological science relating to the detection, assessment, understanding and prevention of adverse effects, particularly long term and short term side effects of medicines. By giving importance for patient safety, India setup a surveillance system "Pharmacovigilance Programme of India" (PvPI). This work was done mainly to highlight the role of pharmacist in detecting, assessing and documenting adverse drug reactions and also to assess the knowledge, attitude and practice of working pharmacist towards pharmacovigilance programme. A survey was done among 20 working pharmacists and found that 90% of pharmacists were aware of pharmacovigilance and 55% had knowledge about the procedures for reporting ADR. Moreover 95% of them felt that ADR reporting is the responsibility of pharmacist. There are many discouraging factor for ADR reporting, the major barrier was lack of time (40%) and the lack of knowledge about the procedure for reporting (20%). So it is the high time to provide sufficient training and conduct workshop on pharmacovigilance for those working in community or hospital pharmacy in order to uplift the profession of pharmacy into great heights. [ABSTRACT FROM AUTHOR]

This article explores the adherence and reasons for non-adherence to antiretroviral therapy among adult patients who receive free treatment at the Lok Nayak Hospital in New Delhi, India. About 90% of the 200 surveyed patients reported adherence in the four-day period while 30% of them admitted they have missed a dose. The most common reasons are the distance of the hospital from homes and forgetfulness. Nearly 6.5% of them said they missed a dose when they felt sick.