Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Reviews
Year : 2009 | Month : April | Volume : 3 | Issue : 2 | Page : 1455 - 1459

Framing Objective Criteria For Selection Of Medicines In A Nepalese Teaching Hospital: Initial Experiences

JHA N*, SHANKAR PR**, BAJRACHARYA O***, PIRYANI RM****

*M. Pharm, Assistant Professor,** MD ,Associate Professor,***M. Pharm, Lecturer, Dept of Clinical Pharmacology & Thrapeutics, **** MD, Asso. Prof., Dept. of Medicine, KIST Medical College, Imadol, Nepal

Correspondence Address :
Mrs. Nisha Jha, Asst. Prof.,
Dept. of Clinical Pharmacology & Therapeutics,
KIST Medical College, Imadol, Lalitpur, Nepal
Phone: 00977-01-5201680, 00977-01-4472028 (Res.)
Fax: 00977-01-5201496, E-mail: nishavenus@gmail.com

Abstract

Inefficient and irrational use of medicines is a widespread problem at all levels of health care. (1) Per capita wastage from inefficiencies and irrational use tends to be greatest in hospitals. This is particularly worrisome, since resources are scarce and prescribers in the communities often copy hospital prescribers. Many of these sources of wastage could be reduced if some simple principles of drug management and use are followed. However, it is difficult to implement these principles because staff from many different disciplines is involved in different aspects of drug management and use. Often, there is no forum for these different disciplines to work together in developing and implementing appropriate drug policies.

Irrational Use of Medicines and Its Impact
Medically inappropriate, ineffective and economically inefficient use of pharmaceuticals is commonly observed in the health care system throughout the world, especially in developing countries like Nepal. However, various forms of irrational prescribing often remain unnoticed by those who are involved in the health sector decision making or in the delivery of health services. The need for promoting the rational use of drugs in the health care system is not only because of the financial reasons with which policy makers and managers are usually most concerned, but also because the appropriate use of medicines is necessary for achieving a high quality of health and medical care for patients and the community (2). The impact of irrational use of medicines may be seen in various forms, like in the reduction in the quality of drug therapy, leading to increased morbidity and mortality. Waste of resources leading to the reduced availability of other vital drugs and increased costs, increased risk of unwanted effects such as drug reactions and the emergence of drug resistance, is noted. Patients may come to believe that there is “a pill for every ill”. This may lead to an apparent increased demand for drugs (3).

The Medicine and Therapeutics Committee
In hospital settings, a Medicine and Therapeutics committee (MTC) provides a forum to bring together all the relevant people to work jointly to improve health care delivery. A MTC may be regarded as a tool for promoting more efficient and rational use of medicines. In many developed countries, a well-functioning MTC has been shown to be one of the most effective committees in hospitals, which is able to address drug use problems (1). The purpose of the Committee is to take a number of initiatives for the safe, effective and economical use of drugs in the hospital (4), (5).

A MTC can significantly improve drug use and reduce costs in hospitals and other health care facilities by providing advice on all aspects of drug management and by developing drug policies. It also helps by evaluating and selecting drugs for the hospital formulary and develops and implements standard treatment guidelines. Assessing drug use to identify problems and conducting interventions to improve drug use is another strategy of the MTC. It also helps to manage adverse drug reactions and possible medication errors (5).

Medicine Use Problems in Nepal
The major medicine use problems in Nepal are polypharmacy and misuse of antibiotics. Self-medication is a common practice in Nepal (6). Use of vitamins and tonics, irrational fixed dose combinations and unethical and aggressive drug promotion are other common practices (3). These problems may pose a significant clinical risk and have a great economic impact. In a hospital or a regional setting, a MTC can solve different drug use problems by establishing procedures for developing, implementing and updating a formulary list and by using only registered drugs. This is being done in one of the Nepalese hospitals i.e., Patan hospital. A structured drug order form has been successfully used in Patan hospital to manage drug use, especially antibiotics. Such a form has specific medicines printed together with the specific indications for which they may be used and the doses and the dosing intervals. Prescribers must select one of the choices offered on the structured order form for their patient, considering various patient and medicine characteristics and thus may be guided to prescribe in the most cost-effective way (1). Another method for solution of drug use problems can be, establishing procedures for developing and revising the hospital formulary based on the treatments of choice and this is being done at our hospital (7).

MTC at KIST Medical College
KIST Medical College is a tertiary care hospital and a new medical school in Lalitpur, Kathmandu, Nepal. It plans to admit medical, dental, nursing, and pharmacy students. The hospital started functioning in January 2008 and the initial steps towards formation of the Medicine and Therapeutics Committee (MTC) were taken. In the first week of February 2008, the hospital Medicine and Therapeutics Committee (MTC) started functioning. The MTC has members from all the clinical departments. The Chairman is the clinical coordinator from the department of Medicine. The member secretary is the Pharmacy program coordinator and the overall in charge of the pharmacy. Members from various areas, like microbiologist, dental coordinator, hospital director and matron were also selected. Besides these, the in charges of the medication counseling center, drug information services and the pharmacovigilance officer are also members. At present, the MTC operates via four different sub-committees which are assigned with a particular type of work, like drug utilization, formulary, pharmacovigilance and antimicrobial subcommittees. All the members meet frequently to improve the services. The MTC has finalized a medicine list for the hospital and a procedure for selecting medicines on the basis of efficacy, safety, cost and convenience. MTCs are a key recommendation for promoting the more rational use of medicines (7). The MTC has gone in for both educational and managerial interventions to improve medicine use. The hospital pharmacy is run under the guidance and support of the MTC (8).

The Nepalese Pharmaceutical Situation
In Nepal, there are 40 pharmaceutical companies producing medicines, meeting 40% of the total country’s demand and the remaining 60% of the medicines are being supplied by multinational companies (9). Among the Nepalese companies, only 10 are Good Manufacturing Practice (GMP) certified. There are many advantages in using medicines produced by Nepalese companies. There will be less chance of circulation of fake medicines from outside suppliers for international brands. Nepalese companies can be encouraged to add production capacity to meet the demand of the country, which in turn may help the growth and development of the industry and the country’s economy.

GMP implies that the manufacturing company uses proper manufacturing techniques to produce the drug and the drug will satisfy a minimum standard of quality. GMP covers all aspects of the manufacturing process: defined manufacturing process; validated critical manufacturing steps; suitable premises, storage, transport; qualified and trained production and quality control personnel; adequate laboratory facilities; approved written procedures and instructions; records to show that all steps of the defined procedures have been undertaken; full traceability of a product through batch records and distribution records; and systems for recall and investigation of complaints (10).

Selecting Medicines for the Hospital Medicines List
The MTC of KIST Medical College has recommended that for a particular generic, three brands from among the national pharmaceutical companies and three brands from among the multinational pharmaceutical companies will be considered. Common dosage forms and strengths available in the market were selected. Other dosage forms were selected based on the recommendations of the user departments.

Initially, the clinical departments were asked by the pharmacy to provide the name of the drug to be used in the department (using generic names). From this list of six, a maximum of four brands (two Nepalese and two international) were finally selected. A list of medicines where bioavailability would be affected by the formulation has been finalized and the MTC has decided to go in for reputed brands for these medicines. The criteria for selection are registration of the brand with the national drug regulatory authority (Department of Drug Administration (DDA)), possession of Good Manufacturing Practice (GMP) certification by the company and cost. For efficacy, we went by available descriptions in the literature. A limitation was that we did not have the means to directly compare the efficacy of various brands. The DDA while registering a brand considers pharmacokinetics, pharmacodynamics and stability data. The list was then again circulated among all the departments of KIST Medical College for the final selection of four brands. Further additions and deletions are done in MTC meetings using objective criteria. The list was then submitted to the Pharmacy Procurement Committee for procurement. (Table/Fig 1) schematically depicts the process of selecting medicines for the hospital medicines list. We are hoping that our pharmacovigilance program will help us to obtain data on the safety of medicines in our patients.

Brand Selection, an Example
We are illustrating the process of selecting generic names and brands for the hospital medicine list using the example of ciprofloxacin. Ciprofloxacin has been mentioned in the Nepal Essential Medicines list and the Nepalese National Formulary. Also, a number of clinical departments had recommended this generic for inclusion in the hospital medicine list. This medicine was also mentioned in the national drug regulatory authority’s list. Then, we checked for the various brands of ciprofloxacin registered with the DDA and compared the prices of all the available registered brands. Finally, we chose two Nepalese brands and two international brands of ciprofloxacin having the least cost but of good quality. We only chose brands from companies having GMP certification.

After selecting the brands, equal amounts of the selected brands are procured. It is recommended that clinicians prescribe by generic names and if clinicians prescribe brands which are not stocked in the hospital pharmacy, they would be automatically substituted by a stocked brand. To ensure the supply of good quality medicines, they are procured only from authorized distributors who are prequalified, using defined criteria.

Advantages of Limiting Brands
The advantages of limiting the number of brands in the hospital pharmacy are, lesser probability of medication errors and less space required to store the drugs which can aid in the procurement of other needed medicines. The most important one is, buying bulk quantities of a limited number of brands, which will be cheaper for the hospital management and the patient. KIST Medical College had decided to use objective criteria for selecting medicines for the hospital medicine list right from the very beginning. So, it was not possible for us to do a before and after comparison of the impact of this particular procedure.

The Hospital Medicine List
The development and updating of the medicine list is necessary to promote the safe, effective and economic use of medicines in the hospital. The list can also promote drug safety and reduce the risk of medication errors (6). The medicine list consists of 329 generics with 1316 brands. The pharmacy procures approximately equal quantities of the selected brands. Besides these selected medicines, some more medicines were added on the request of the prescribers, which were not listed in the National Drug Regulatory Authority (Department of Drug Administration (DDA) list for their convenience. These brands which were not being registered with the DDA were termed as non-formulary drugs and about 69 generics were added as a separate list of non-formulary medicines while making the hospital medicine list. The brands for these non-formulary generics were chosen by the prescribers from different clinical departments. Some of the non-formulary medicines are ayurvedic preparations and all the 69 generics are available in the market.

Adding or deleting medicines to the list
Medicines are added or deleted after thorough discussion in the MTC meeting, based on recommendations from user departments. The MTC has developed a form for recommending medicines for inclusion, based on the methods described in the Practical Guide to Drug and Therapeutics Committees (1). The advantages of the proposed medicine over medicines from the same class which are already present in the hospital medicine list and the cost of the medicines are among the different information sought. The MTC also plays an active role in controlling irrational combinations and has banned the use of the fixed dose combination of ampicillin and cloxacillin. As Ampicillin and cloxacillin are two antibiotics acting through the same mechanism, they cannot be combined in order to avoid unnecessary drug use.


Advantages of the Hospital Medicine List
The list aims to promote the rational use of medicines and ensure the availability of good quality medicines and economic brands. This will result in better economic outcomes and patient’s health. The list will facilitate the identification of priorities for medicine supply and minimize the number of products. This selection will promote the rational use of medicines with consensus on the treatment of first choice. Prescribers will become more familiar with limited treatments and they will acquire more knowledge in principles of good prescribing. Resources can be spent more effectively. The list will also help in the preparation of the hospital formulary and in developing standard treatment guidelines for common disease conditions.

Limitations
The limitations are the selection of limited brands and the exclusion of the costlier but ‘renowned’ brands, which might sometimes interfere with the laity and the physician’s strong belief towards the particular brand. In this list, we have not discussed the procurement of drugs which are not available in Nepal. Non-availability of the most recent and updated list from the DDA was a problem.

Lesson for Other Hospitals
This process of selecting medicines for the hospital medicines list will be of interest to other hospitals. The importance of selection criteria for different medicines, including medicines with a narrow therapeutic index, the process of finalizing the selected medicines and the issue of procurement for the hospital pharmacy, are important issues. There are only a few hospitals in Nepal who have developed their own medicine list and hospital formulary. Besides this, the non-formulary medicine list and its selection and procurement would be also of interest for other hospitals.

References

1.
. Holloway K, Green T. Drug and therapeutics committees. A practical guide World Health Organization, Geneva: 2003. WHO/EDM/PAR/2004.
2.
. Fresle DA, Wolfheim C. Public education in rational drug use: a global survey. World Health Organization, Geneva: 1997. WHO/DAP/97.5
3.
. INRUD, Nepal, 2003 .Manual of 16th National training course on rational use of drugs. International network for rational use of drugs, 13-18 October, 2003 Nepal.
4.
. Mishra P, Alurkar VM, Subish P. Functions of a drug and therapeutics committee in Nepal. Journal of Pharmacy Practice and Research 2006; 36:81.
5.
. Palaian S, Mishra P. Role of drug and therapeutics committee towards drug safety--experiences from western Nepal. Kathmandu Univ Med J 2005; 3:79-80.
6.
. Kafle KK, Gartoulla RP. Self-medication and its impact on essential drugs schemes in Nepal: a socio-cultural research project. DAP Research Series No.10, Geneva, Action Programme on Essential Drugs, World Health Organization, WHO/DAP/93.4. 1993
7.
. Laing R, Hogerzeil HV, Ross-Degnan D. Ten recommendations to improve the use of medicines in developing countries. Health Policy Plan. 2001; 16:13–20. doi:10.1093/heapol/16.1.13.
8.
. Shankar PR, Humagain B, Piryani RM, Jha N, Osti B. Establishing and strengthening a medicine and therapeutics committee in a medical college in Nepal: initial experiences. Pharm World Sci Published online: 05 December 2008. DOI 10.1007/s11096-08-9263-y.
9.
. Nepal Drug Review (NDR). First Edition. Makalu books & Stationers, Kathmandu: 2005.
10.
. Chaloner-Larsson G, GCL Bioconsult, Anderson R, Egan A. WHO guide to good manufacturing practice (GMP) requirements. Part 2: Validation. World Health Organization, Geneva: 1997.

Tables and Figures
[Table / Fig - 1]
JCDR is now Monthly and more widely Indexed .
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