This study aimed to determine the prevalence of inappropriate drug use in hospitalized elderly patients at a tertiary care hospital in Northeast India using the 2006 HEDIS criteria. The study reviewed prescriptions from 502 elderly patients admitted to the medicine and cardiology departments. It found that 12 patients (2.39%) received at least one inappropriate drug, with the most common being short-acting nifedipine. Increased number of concurrent medications (>11) and prolonged hospital stay (>5 days) were identified as predictors of inappropriate medication use. The study concluded that multiple medications and long hospital stays were risk factors for inappropriate drug prescribing in elderly patients based on the 2006 HEDIS criteria.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
A study on drug utilization evaluation of anticoagulant therapy INA tertiary ...SriramNagarajan16
Objectives
Evaluation of a prospective observational study of the Anticoagulants used in tertiary care hospital, to provide
information and correct rationale pertaining to Anticoagulants which also describes various distribution wise of
Anticoagulants by age groups, genders, pattern of prescription, drug wise, dose, route, class and department to assess
the statistical incidence regarding usage and its right provision.
Methodology
Study site was at SUNSHINE HOSPITALS, conducted for a period of 6 months. Both male and female individuals of
age group 16-75years were included.
Results
Study included assessment of utilization of Anticoagulants with total of 200 prescriptions; of which males (54.5%),
females (44.67%), age groups of 60-69 (34%) followed by age groups 70-80(27.5%), parenteral SC route (59%) and
followed by intravenous route. (38%) and oral route was rare (3%), orthopaedics (64, 32%), followed by cardiology
(43, 21.5%), neurology (29, 14.5%), pulmonology (22, 11%).
Conclusion
To conclude with, Anticoagulants are effective drugs in an array of treatment of diseases involving careful
consideration of factors such as potency, formulation, responsiveness and cost. Anticoagulanting agents were mostly
given in cases of post or pre operative care followed by prophylaxis for thrombosis for better patient outcome.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
A study on drug utilization evaluation of anticoagulant therapy INA tertiary ...SriramNagarajan16
Objectives
Evaluation of a prospective observational study of the Anticoagulants used in tertiary care hospital, to provide
information and correct rationale pertaining to Anticoagulants which also describes various distribution wise of
Anticoagulants by age groups, genders, pattern of prescription, drug wise, dose, route, class and department to assess
the statistical incidence regarding usage and its right provision.
Methodology
Study site was at SUNSHINE HOSPITALS, conducted for a period of 6 months. Both male and female individuals of
age group 16-75years were included.
Results
Study included assessment of utilization of Anticoagulants with total of 200 prescriptions; of which males (54.5%),
females (44.67%), age groups of 60-69 (34%) followed by age groups 70-80(27.5%), parenteral SC route (59%) and
followed by intravenous route. (38%) and oral route was rare (3%), orthopaedics (64, 32%), followed by cardiology
(43, 21.5%), neurology (29, 14.5%), pulmonology (22, 11%).
Conclusion
To conclude with, Anticoagulants are effective drugs in an array of treatment of diseases involving careful
consideration of factors such as potency, formulation, responsiveness and cost. Anticoagulanting agents were mostly
given in cases of post or pre operative care followed by prophylaxis for thrombosis for better patient outcome.
Similar to Inappropriate drug use in hospitalized elderly patients of medicine and cardiology departments at a tertiary care hospital of Northeast India
FACTORS ASSOCIATED WITH UNNECESSARY DRUG THERAPY AND INAPPROPRIATE DOSAGE IN ...Jing Zang
To assess factors associated with unnecessary drug therapy and inappropriate dosage in hospitalized patients. A hospital based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, which is 345 Km from South west of Addis Ababa. All patients who were admitted to medical ward from February 5 – March 21, 2011 were included in the study. Data on socio-demographic variables, past medical history, past medication history, current diagnosis, current medications, vital signs and relevant laboratory data were collected by using bed side patient interview guided semi-structured questionnaire and data abstraction formats for card review. The data were analysed by using SPSS version 16 for windows. Descriptive statistics, cross-tabs, chi-square and logistic regression were done. Out of 257 study participants 140(54.5%) had unnecessary drug therapy or inappropriate dosage. The only independent factors which predicted the unnecessary drug therapy in study population was polypharmacy while not considering organ function test, polypharmacy and clinically significant potential drug-drug interaction were independent factors associated with inappropriate dosage . The prevalence of unnecessary drug therapy or inappropriate dosage is significantly high.
According to WHO, Drug utilization research is defined as ‘the marketing, distribution, recommendation and utilize of drugs in a society, with particular focus on the resulting medical, social and economic results. In many developed countries, a number of studies about utilization of drug have been conducted, which indicates a wide proof of irrational drug use. The drug use indicators are considered as objective measures that can be extended to identify practices of medicines utilization in any health facility, country or an entire region. To check the drug utilize pattern in Primary Health Care (PHC) facilities of Bhakkar district Punjab Pakistan. Using WHO core drug use indicators, a prospective cross-sectional descriptive study was carried out in health facilities of Bhakkar district. A total of 40 prescriptions were analyzed. The average age of patients visiting HC centers was 33.11 years (female 35.79; male 30.40). 3.65 was the average number of prescribed drugs. 27% was the percentage of encounters with at least one prescribed antibiotic whereas 35% was the percentage of encounters with at least one prescribed injection prescribed, which was low. 25% is the total percentage of drugs given using generic names was noticed. The average consultation and dispensing time of 40 prescriptions was 2.02 minutes and 42.52 seconds. The study demonstrates that trend toward irrational practice mainly on use of antibiotics and non-generic prescribing in most of health facilities studied. Patient care given by health facilities studied was inadequate and thus for encouragement of rational drug use practice, an effective intervention program is recommended.
POINTS TO BE INCLUDED
Definition, scope,
Technical definitions, common terminologies used in clinical
settings
Daily activities of clinical pharmacists
Ward round participation
Treatment Chart Review
Adverse drug reaction monitoring
Interprofessional collaboration
BRP Pharmaceuticals is a leader in physician dispensing services that provides instant medication to patients located in Burbank, CA. Visit: http://www.brppharma.com/
Study of medication appropriateness during hospital stay and revisits in medi...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Proton pump inhibitor drug assesment pptPavithraG56
drug utillization assesment of proton pump inhibitor in secondary healthcare hospital, review of ppi drug
Similar to Inappropriate drug use in hospitalized elderly patients of medicine and cardiology departments at a tertiary care hospital of Northeast India (20)
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Inappropriate drug use in hospitalized elderly patients of medicine and cardiology departments at a tertiary care hospital of Northeast India
1. Inappropriate drug use in hospitalized elderly
patients of medicine and cardiology departments at
a tertiary care hospital of Northeast India
2. Research Article
Inappropriate drug use in hospitalized elderly
patients of medicine and cardiology departments at
a tertiary care hospital of Northeast India
Ratan J. Lihite a,b,
*, Mangala Lahkar b
a
Department of Pharmacy Practice, National Institute of Pharmaceutical Education & Research (NIPER),
Guwahati, India
b
ADR Monitoring Centre (Pharmacovigilance Program of India) and Department of Pharmacology,
Gauhati Medical College, Guwahati, India
a r t i c l e i n f o
Article history:
Received 17 April 2013
Accepted 22 June 2013
Available online 10 July 2013
Keywords:
HEDIS
Inappropriate
Drug
Hospitalized
Elderly
a b s t r a c t
Background: National committee on quality assurance, USA convened an expert consensus
panel and identified the list of drugs which should be avoided in the elderly people. This
resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer
Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
Methods: The objective of this study was to determine the prevalence of inappropriate drug
use and assess their predictors in the hospitalized elderly patients of tertiary care hospital by
using HEDIS 2006 criteria. A 6-month prospective study was conducted in medicine & cardi-
ology inpatient department of tertiary care hospital by reviewing prescriptions of 502 elderly
patients. The patients of either sex having age more than 60 year were included in this study.
Results: It is found that (2.39%) 12 patients received at least 1 inappropriate drug by 2006
HEDIS measure. Out of 12 inappropriate drugs, short acting nifedipine was prescribed to 4
elderly patients followed by dicyclomine to 2 patients and ketorolac to 2 patients each.
Increased number (!11) of concurrent medications use during hospital stay (OR: 0.015, CI:
0.001e0.199, P ¼ 0.001) and prolonged (!5 days) length of stay (OR: 0.039, CI: 0.005e0.291,
P ¼ 0.002) were found as a predictors of inappropriate medication use.
Conclusion: In this study, low prevalence (2.39%) of inappropriate drug prescribing was
found. Multiple medications and long duration of hospital stay were the risk factors for
inappropriate medication use.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Inappropriate multiple medications use is a major patient
safety concern, as this irrational symptomatic prescribing
practice not only add to the cost and complexity of therapeutic
regimens, but also place patients especially vulnerable geri-
atric patient population at greater risk for adverse drug re-
actions and drugedrug interactions and jeopardize positive
* Corresponding author. Tel.: þ91 9706143510.
E-mail address: r.lihite@yahoo.com (R.J. Lihite).
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 8 e3 2 3
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.06.002
3. therapeutic outcome e including patient experience, health
outcomes, overall performance, and with estimates of the
financial consequences of the healthcare services.1
Although, Beers criteria is the foundation of 2006 HEDIS
quality measures, clinicians contend that Beers criteria is too
broad and sometimes drugs may be appropriate for specific
patients in certain circumstances. The Beers criteria were
derived from expert consensus, some experts and clinicians
argue that they are not strictly evidence based.2
In some cases;
patients may be in the process of being treated successfully
with a potentially inappropriate drug. Thus, Beers criteria
have been controversial since their original publication in
1991.3
Despite controversy about which explicit criteria
should be used, there is a strong body of evidence showing
that suboptimal prescribing is disturbingly common in elderly
patients.4
Based on Beers criteria, National Committee on
Quality Assurance, USA have developed a 2006 Healthcare
Effectiveness Data and Information Set (HEDIS) criteria by
using modified Delphi process to identify rates of inappro-
priate prescribing in the elderly.5
To assess the healthcare
quality for elderly people, this measures included the drugs
that should usually avoided in the elderly.6
HEDIS is the most
widely reported set of performance measures in the industry,
used by health plans, medical groups, federal and state gov-
ernments.7
Thus, we have used 2006 HEDIS measures to
determine the prevalence of inappropriate drugs and assessed
the predictors in hospitalized elderly patient of medicine and
cardiology department of the tertiary care hospital in North-
east region of India.
2. Patients and methods
2.1. Study design and setting
The Institutional Ethic Committee approval was taken prior
the initiation of study. The prospective study was carried out
in an inpatient setting of medicine and cardiology department
of the Gauhati Medical College and Hospital (GMCH), Guwa-
hati, Assam. GMCH is the largest and major tertiary care
government hospital of the entire northeast region of India,
catering to millions of people in this region. This hospital has
geriatric clinical setting in medicine department and more-
over; elderly patients are more prevalent to cardiovascular
diseases; therefore to comprise maximum number of elderly
hospitalized patients in this study we have conducted our
study in medicine and cardiology departments.
The study data was collected for the period of 6 months
from July to December 2010. The elderly patients of either sex
were included in the study and written informed consent was
taken at the time of enrollment. Each prescription was
checked individually from the wards of medicine and cardi-
ology department of hospital for inappropriate drug by 2006
HEDIS Criteria. The inappropriate drugs were collected from
the prescriptions of elderly patients and it includes all the
medications prescribed, right from admission to discharge of
the patient. At the time of data collection the study form was
completed with regards to patient’s age, diagnosis, all the
drugs prescribed during hospital stay, length of hospitaliza-
tion and study form was updated daily until the patient was
discharged. Patients were also interviewed to get the infor-
mation regarding any self medication and past history of
illness. A prescription was said to be inappropriate if it con-
tained one or more drugs included in 2006 HEDIS drug list of
inappropriateness. The patients having incomplete informa-
tion were excluded from the study. The results were repre-
sented as average Æ standard deviation (SD) and percentages
as applicable; age, sex, diagnosis, number of medications and
duration of treatments were the variables for determination of
predictors. Odds ratio was calculated to assess the most
common predictors for inappropriate drug prescribing. Sta-
tistical significance (P < 0.05) was determined at 95% level of
confidence. The data were analyzed using Statistical Package
for Social Science (SPSS) Ver. 16.0.
2.2. Modifications
The criteria used in this study required certain modifications
which were necessary in the Indian setting. The life expec-
tancy at birth for Indian males and females corresponding to
the mid year 2003 was 62.3 and 63.9 years respectively, giving
an overall life expectancy as 63.2 years.8
Thus the modifications were:
1) The cut off age considered in this study was 60 years or
more instead of age 65 years or more and 2) the following
drugs were not considered in this study as they were excluded
from the drug list of 2006 HEDIS criteria (Table 3). These drugs
were Amitriptyline, Doxepin, Indomethacin, Ticlopidine,
Methyldopa, Reserpine, Disopyramide, Oxybutynin, Nap-
roxen, Oxaprozin, Piroxicam, Fluoxetine, Amiodarone, Dox-
azosin, Clonidine, Mineral Oil, Cimetidine, Ethacrynic acid and
long term use of stimulant laxatives except with opiate use.
3. Results
3.1. Population characteristics
Out of the 502 patients, 308 (61.35%) were males and 194
(38.64%) were females. The average age of the patients was
66.87 Æ 4.71 years, the overall age range being 60e84 years.
More than half of the 386 (76.89%) patients belonged to the age
group 60e69 years while 105 (20.91%) of the patients belonged
to the age group 70e79 years and the remaining 11 (2.19%)
patients were more than 80 years of age.
Table 1 e Inappropriate drug use identified by 2006
HEDIS.
Sr. no. Name of drugs Severity No. of patients
(n ¼ 12)
1 Short acting
nifedipine
High 4
2 Dicyclomine High 2
3 Ketorolac High 2
4 Nitrofurantoin High 2
5 Promethazine High 1
6 Chlorpheniramine High 1
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 8 e3 2 3 319
4. 3.2. General distribution of disease
The average disease per patient was found to be 3.20 Æ 1.26.
The total number of diagnosis was 1604 in 502 prescriptions.
Out of 502 prescriptions, 74 (14.74%) patient were diagnosed to
have 1 disease followed by 153 (30.47%) patients were having 2
diseases and 275 (54.78%) patients were found to have more
than 3 diseases. On the system wise analysis of 1604 disorders,
it was found that circulatory system disorders (26.43%) were in
the first rank followed by the endocrine system disorders
(17.14%), Infection & parasitic disorder (16.70%) and digestive
system disorders (9.28%). This finding can be attributed to the
fact that cardiovascular diseases are most prevalent among
the elderly patients.
3.3. General prescription pattern
The average number of medicine per prescription was
9.29 Æ 3.29 and the average duration of prescribed medication
in hospitalized elderly patient was 6.97 Æ 3.65 days. The total
numbers of prescribed drugs were 4664 in 502 prescriptions.
On the category-wise distribution of prescribed drugs, it was
found that antimicrobials drugs (18.84%) were most
frequently prescribed drugs, followed by drugs acting on car-
diovascular system (15.45%), endocrine system (9.60%),
gastrointestinal system (9.47%), analgesic & anti-
inflammatory drugs (9.06%) and vitamin, minerals & dietary
supplements (7.69%). Among the different drug classes, anti-
biotics were the most widely prescribed class of drugs;
approximately 2 antibiotics were prescribed to each patient.
Among the cephalosporin, ceftriaxone was the most widely
prescribed antibiotic followed by quinolones like ciprofloxacin
and ofloxacin. Among drugs acting on central nervous system
(5.93%), benzodiazepines, comprising of alprazolam and lor-
azepam were commonly prescribed anti-anxiety and seda-
tives in recommended daily dose.
3.4. Analysis of inappropriate drug use by 2006 HEDIS
measures
The overall 502 elderly patients aged over 60 year were
admitted during the study period in the medicine and
cardiology department of tertiary care hospital. Of the 502
elderly patients, 288 (57.37%) were from medicine department
and 214 (42.62%) were from cardiology department. In medi-
cine department 8 elderly patients had inappropriate pre-
scription while in cardiology department 4 elderly patients
having inappropriate prescription.
In our study, 12 (2.39%) each patient had received only 1
inappropriate drug identified by 2006 HEDIS measure and
severity of an adverse outcome due to exposure of this
medication (high vs. low) were ranked and shown in Table 1.
Of the 12 inappropriate drugs, short acting nifedipine having
high severity was prescribed to 4 elderly patients each.
3.5. Predictors of inappropriate drug use
In this study, elderly patients’ age of range 60e69 received
maximum number of inappropriate drugs. It is also
observed that patient with !11 number of medication and
stay !11 number of days along with !3 number of diagnosis
were received high number of inappropriate drugs (Table 2).
Using logistic regression analysis, identified that increased
number (!11) of concurrent medications use during hospital
stay (OR: 0.015, CI: 0.001e0.199, P ¼ 0.001) and prolonged (!5
days) length of stay (OR: 0.039, CI: 0.005e0.291, P ¼ 0.002)
were the predictors of inappropriate medication use. There
wasn’t any statistical significance in inappropriate drug
prescribing to male and female patients (OR ¼ 4.538;
CI ¼ 0.940e21.918, P ¼ 0.060). Different age groups and
number of diseases does not predict any inappropriate drug
use (Table 2).
4. Discussion
In this study antimicrobial drugs and drug acting on cardio-
vascular system were highly prescribed to the elderly patients.
Overall2 antibiotics per patientwereprescribed to hospitalized
elderly patients. Among the different classes of antibiotic; 3rd
generation cephalosporin i.e., ceftriaxone was most widely
prescribed drug to the elderly hospitalized patients and have
long half life as compared to other parenteral cephalosporin,
which permit once-daily dosing. Whereas, quinolones
Table 2 e Analysis of predictors associated with inappropriate drug use.
Predictors Total
(n ¼ 502)
Patients with inappropriate
drug use (n ¼ 12)
Significance
(P < 0.05)
Odd ratio 95% confidence
interval
1 Age 60e69 386 9 0.032 1 e
70e79 105 2 0.009 0.014 0.001e0.339
!80 11 1 0.021 0.019 0.001e0.546
2 Sex Female 194 6 1 e
Male 308 6 0.060 4.538 0.940e21.918
3 No. of medication 5 137 0 0.006 1 e
5e10 192 1 0.997 <0.001 0.000e>0.001
!11 173 11 0.001 0.015 0.001e0.199
4 Length of stay 5 209 2 0.002 1 e
5e10 219 4 0.002 0.039 0.005e0.291
!11 74 6 0.002 0.067 0.012e0.372
5 No. of diagnosis 1 74 1 0.706 1 e
2 153 1 0.701 1.564 0.159e15.344
!3 275 10 0.486 0.442 0.044e4.409
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 8 e3 2 3320
5. comprised of ciprofloxacinandofloxacin were2ndmostwidely
prescribed antibiotic in this study. Moreover, this quinolones
are well absorbed and had a considerable spectrum of anti-
bacterial activity. The excessive use of antibiotics has led to the
emergence of bacterial resistance. The inappropriate and ir-
rational use of antibiotic in the clinical medicine is widespread,
sometime at inadequate dosages and often, for non-bacterial
diseases.9
Thus, the antimicrobials drug must be consider
while preparing such quality tools in elderly patient to avoid
the drug resistance and inappropriate prescribing.
In our study, alprazolam and lorazepam were prescribed in
recommended daily dose i.e., 1e2 mg/day and 1e3 mg/day
respectively. Benzodiazepines should be prescribed to the
elderly, only with caution and for a short period at recom-
mended doses.10
While prescribing benzodiazepines, daily
doses should not exceed 2 mg for alprazolam, 3 mg for lor-
azepam, 60 mg oxazepam and 15 mg for temazepam.
4.1. Inappropriate medication use
The prevalence of potentially inappropriate drug in our study
was low (2.39%) by 2006 HEDIS criteria as compared to Pugh
et al study as they have reported prevalence of about 19.6% of
potentially inappropriate drugs by HEDIS 2006 drug list.11
Several commonly used drugs from the 1997 Beers criteria
were not included in 2006 HEDIS measure. The low prevalence
of inappropriate drug use in our study may be due to less
number of drugs being enlisted in HEDIS criteria and our study
was limited to inpatient setting of medicine and cardiology
department which may exclude inappropriate drugs pre-
scribed to elderly patients attending in outpatient setting and
other departments of hospital. Moreover, geographical varia-
tion among physicians in the awareness of the existence of
list of inappropriate drugs might also account for low preva-
lence in this study. Therefore, our prevalence rate may un-
derestimate the true level of potential inappropriate drug use.
Prescriptions of drugs that are considered to be inappro-
priate are deemed to be an important cause of adverse drug
reactions in the elderly population.12
In this study, we haven’t
considered the inappropriate drug induced adverse events
therefore our finding lack the reporting of adverse drug
reactions.
In our study, short acting nifedipine was prescribed to 4
elderly patients likewise of the 114 inappropriate drugs; the 4
drugs were nifedipine detected in Portuguese elderly
outpatient.13
In 11 European countries the study was con-
ducted and it is found that 0.7% (19 patients) of patients had
received nifedipine14
whereas, 2% of patients were received
nifedifine in the study conducted in 17 long term care facil-
ities of Japan.15
Similarly, The French consensus panel ex-
perts also, considered nitrofurantoin, short acting nifedipine
and stimulant laxatives as inappropriate in the elderly pa-
tients.16
Thus, short acting nifedipine is frequently pre-
scribed in elderly hypertensive patients, despite warnings of
possible harmful cardiovascular effects. It is also reported
that short acting nifedipine increased the risk of stroke
within 7 days in the newly diagnosed elderly hypertensive
patient.17
Because of the potential to cause hypotension and
constipation, short acting nifedipine was considered as a
potentially inappropriate drug in the beers and HEDIS
criteria. Cardiovascular system disorder like hypertension
and angina was more prevalent in our study thus short
acting nifedipine was prescribed in the elderly hospitalized
patients.
In our study, 2 elderly patients had received dicyclomine as
an inappropriate drug. In United States, the study was con-
ducted in outpatient prescription claims database and it was
found that 4.2% of the beneficiaries and 4% claims patients
had received dicyclomine.18
Similarly, study conducted in U.S.
health maintenance organization; reported that at least 1% of
elderly members received belladonna alkaloids (2.3%), dicy-
clomine (1.1%), and hyoscyamine (1.2%).19
Gastrointestinal
antispasmodic drugs are highly anticholinergic and have un-
certain effectiveness. The elderly appear to be more prone to
the anticholinergic effects of dicyclomine on the central
Table 3 e 2006 HEDIS drug list.
Sl. no. Drugs list Severity of adverse
effects
1 Barbiturates High
2 Flurazepam High
3 Meprobamate High
4 Chlorpropamide High
5 Meperidine High
6 Pentazocine High
7 Trimethobenzamide High
8 Belladonna alkaloids High
9 Dicyclomine High
10 Hyoscyamine High
11 Propantheline High
12 Chlordiazepoxide High
13 Diazepam High
14 Quazepam, halazepam,
chlorazepate
High
15 Propoxyphene Low
16 Carisoprodol High
17 Chlorzoxazone High
18 Cyclobenzaprine High
19 Metaxalone High
20 Methocarbamol High
21 Dipyridamole Low
22 Chlorpheniramine High
23 Cyproheptadine High
24 Diphenhydramine High
25 Hydroxyzine High
26 Promethazine High
27 Tripelennamine High
28 Dexchlorpheniramine High
29 Ketorolac High
30 Orphenadrine High
31 Guanethidine High
32 Guanadrel High
33 Cyclandelate Low
34 Isoxsuprine Low
35 Nitrofurantoin High
36 Methyltestosterone High
37 Thioridazine High
38 Mesoridazine High
39 Short acting nifedipine High
40 Desiccated thyroid High
41 Amphetamines High
42 Estrogens Low
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 8 e3 2 3 321
6. nervous system. In the study Page JG et al has reported ma-
jority of adverse effects which were related to the anticho-
linergic activity of the dicyclomine.20
Thus, the dicycloamine
prescribing should be avoided especially in elderly patients to
prevent anticholinergic effects.
In our study, nitrofurantoin was prescribed to 2 elderly
hospitalized patients. Nitrofurantoins are potential for renal
and hepatic impairment. Forty-four cases of nitrofurantoin
associated hepatic injury were reported to the Danish Center
for Monitoring of Adverse Drug reactions from 1968 to 1998.
Forty-one were women with a median age of 69 years.21
In our study, ketorolac was prescribed to 2 elderly hospi-
talized patients. Ketorolac on immediate and long term use
should be avoided in older persons, since a significant
number have asymptomatic gastrointestinal pathologic
conditions.
4.2. Predictors of inappropriate medication use
In our study, elderly women and men were not having any
significant difference to receive inappropriate medication and
different age groups of elderly patients don’t predict any
inappropriate drug prescribing. Polypharmacy is the common
and is significantly associated with inappropriate prescrib-
ing.22
The clinical relevance of polypharmacy is always
questionable. This is especially pertinent in the case of elderly
patients, who are particularly vulnerable to adverse drug
events due to their compromised physiological function. In
this study, patients prescribed with !11 medications were
having more prevalence of inappropriate drug use and high-
level of polypharmacy was observed with 52.78% of patients
receiving ! 6 medications. Similarly, in Singapore nursing
homes study significantly higher (70.04%) inappropriate drug
use along with the high (58.59%) prevalence of polypharmacy
was observed.23
In our study, it was also observed that if the patients
hospitalized for !11 days then they are more likely to
receive inappropriate drugs. It is also shown by Mandavi
et al in Indian elderly hospitalized patient that age over 70
years, number of medications prescribed more than 5 and
longer length of stay in the hospital are the three important
predictors for inappropriate prescribing in elderly
patients.24
Number of diagnoses also has significant impact on the
inappropriate prescribing. It was observed that as the num-
ber of diagnosis increases, number of medications to treat
each particular disease condition also increases which may
leads to polypharmacy and more likely to receive inappro-
priate medication.25
In our study, 54.78% of the patients
suffered from !3 diseases. The majority of the diagnoses in
our study pertained to cardiovascular system (26.43%) which
denoted the higher occurrence of cardiovascular diseases
world-wide.
In conclusion, elderly hospitalized patients those having
multiple medications and long duration of hospital stay were
more likely to receive inappropriate drugs. The finding of this
study also suggests that antimicrobial agents should be
included in drug list of such quality measures to avoid irra-
tional and inappropriate use of antibiotic in elderly patients.
Moreover, the drug list included in such criteria should be
updated periodically and implemented in clinical practice to
avoid inappropriate drug use.
Conflicts of interest
All authors have none to declare.
Acknowledgments
Authors would like to acknowledge the Principal and HODs of
Medicine & Cardiology Department of GMCH, Guwahati for
providing permission to collect the data from elderly patients
in the wards.
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