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Pandit S, Soni D, Krishnamurthy B, Belhekar MN. Comparison of WHO-UMC and Naranjo Scales for Causality Assessment of Reported Adverse Drug Reactions. J Patient Saf 2024; 20:236-239. [PMID: 38345209 DOI: 10.1097/pts.0000000000001213] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES The 2 most commonly used scales worldwide are the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) and the Naranjo scales. The present study was planned to assess the degree of agreement between the 2 scales when the same adverse drug reactions (ADR) were assessed by 5 raters independently. METHODS One hundred individual case safety reports were selected randomly from the ADR database of our institute and the details were emailed to 5 different experts (raters), who were DM Clinical Pharmacology residents from different institutes in India. An independent causality assessment of these ADRs was performed independently by these raters using both the WHO-UMC and Naranjo causality assessment scales. The agreement between the 2 scales was assessed for each rater using Cohen κ, and the overall interrater agreement was assessed using Fleiss κ. RESULTS The Cohen κ level of agreement between the 2 scales for the 5 raters were substantial, fair, substantial, moderate, and substantial, respectively. The most common causality assessment category as per WHO-UMC scale was "possible" but varied among the raters on the Naranjo scale. No ADR was categorized as "certain" by any rater on the Naranjo scale. The Fleiss κ value for agreement among the 5 raters was found to be 0.2 (slight) for the WHO-UMC scale and 0.297 (fair) for the Naranjo scale. CONCLUSIONS A moderate level of agreement was observed in this study between the WHO-UMC and Naranjo scales. The level of agreement among these 5 raters was found to be similar for the WHO-UMC and the Naranjo scales, indicating a similar degree of subjectivity for the 2 scales. Hence, more robust and less subjective scales are required for causality assessment.
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Affiliation(s)
- Sukant Pandit
- From the Department of Clinical Pharmacology, Seth Gordhandas Sunderdas Medical College (GSMC) and King Edward-VII Memorial Hospital (KEMH), Mumbai, India
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More SA, Atal S, Mishra PS. Inter-rater agreement between WHO- Uppsala Monitoring Centre system and Naranjo algorithm for causality assessment of adverse drug reactions. J Pharmacol Toxicol Methods 2024; 127:107514. [PMID: 38768933 DOI: 10.1016/j.vascn.2024.107514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
Determining the causality of Adverse Drug Reactions (ADRs) is essential for management and prevention of future occurrences. The WHO-Uppsala Monitoring Centre (UMC) system is recommended under the Pharmacovigilance Program of India whereas Naranjo's algorithm is commonly utilized by clinicians, but their agreement remains a subject of investigation. This study aims to compare the inter-rater agreement between these two scales for causality assessment of ADRs. In this cross-sectional study, two groups of pharmacovigilance experts were given a set of total 399 anonymized individual case safety reports, collected over six months. The raters were blinded to each other's assessments and applied the WHO-UMC system and Naranjo algorithm to each case independently. Inter-rater agreement was then evaluated utilizing Cohen's kappa. The suspected ADRs were also comprehensively analysed on parameters like age, sex, route of administration, speciality, organ system affected, most common drug categories and individual drugs, outcome of ADRs. Analysis of 399 suspected ADRs revealed that mean age of patients was 36.8 ± 18.0 years, females were more frequently affected, highest proportion of reports were from psychiatry inpatients, seen with antipsychotic drugs, involved the central nervous system, with oral administration, and 91% resolved. On causality assessment by the WHO-UMC system, 53.3% were "Certain" whereas Naranjo's algorithm categorized 96.74% of ADRs as "Probable". Cohen's kappa showed a "Minimal" agreement (0.22) between WHO-UMC and Naranjo system of causality assessment. The considerable lack of agreement between the two commonly employed systems of causality assessment of ADRs warrants further investigation into specific factors influencing the disagreement to improve the accuracy of causality assessments.
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Affiliation(s)
- Sapna A More
- Department of Pharmacology, Mahatma Gandhi Memorial Medical College, Indore, M.P 452001, India.
| | - Shubham Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, M.P 462026, India
| | - Pooja S Mishra
- Department of Pharmacology, Mahatma Gandhi Memorial Medical College, Indore, M.P 452001, India
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Hazra S, Singh PA. Safety Aspects of Herb Interactions: Current Understanding and Future Prospects. Curr Drug Metab 2024; 25:28-53. [PMID: 38482621 DOI: 10.2174/0113892002289753240305062601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The use of herbal medicines is on the rise throughout the world due to their perceived safety profile. However, incidences of herb-drug, herb-herb and herb-food interactions considering safety aspects have opened new arenas for discussion. OBJECTIVE The current study aims to provide comprehensive insights into the various types of herb interactions, the mechanisms involved, their assessment, and historical developments, keeping herbal safety at the central point of discussion. METHODS The authors undertook a focused/targeted literature review and collected data from various databases, including Science Direct, Wiley Online Library, Springer, PubMed, and Google Scholar. Conventional literature on herbal remedies, such as those by the WHO and other international or national organizations. RESULTS The article considered reviewing the regulations, interaction mechanisms, and detection of herb-herb, herb-drug and herb-food interactions in commonly used yet vital plants, including Glycyrrhiza glabra, Mentha piperita, Aloe barbadensis, Zingiber officinale, Gingko biloba, Withania somnifera, etc. The study found that healthcare professionals worry about patients not informing them about their herbal prescriptions (primarily used with conventional treatment), which can cause herb-drug/herb-food/herb-herb interactions. These interactions were caused by altered pharmacodynamic and pharmacokinetic processes, which might be explained using in-vivo, in-vitro, in-silico, pharmacogenomics, and pharmacogenetics. Nutrivigilance may be the greatest method to monitor herb-food interactions, but its adoption is limited worldwide. CONCLUSION This article can serve as a lead for clinicians, guiding them regarding herb-drug, herb-food, and herb-herb interactions induced by commonly consumed plant species. Patients may also be counseled to avoid conventional drugs, botanicals, and foods with a restricted therapeutic window.
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Affiliation(s)
- Subhajit Hazra
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
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Shukla S, Sharma P, Gupta P, Pandey S, Agrawal R, Rathour D, Kumar Kewat D, Singh R, Kumar Thakur S, Paliwal R, Sulakhiya K. Current Scenario and Future Prospects of Adverse Drug Reactions (ADRs) Monitoring and Reporting Mechanisms in the Rural Areas of India. Curr Drug Saf 2024; 19:172-190. [PMID: 37132145 DOI: 10.2174/1574886318666230428144120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Pharmacovigilance (PV) deals with the detection, collection, assessment, understanding, and prevention of adverse effects associated with drugs. The objective of PV is to ensure the safety of the medicines and patients by monitoring and reporting all adverse drug reactions (ADRs) associated with prescribed medicine usage. Findings have indicated that about 0.2- 24% of hospitalization cases are due to ADRs, of which 3.7% of patients have lethal ADRs. The reasons include the number of prescribed drugs, an increased number of new medicines in the market, an inadequate PV system for ADR monitoring, and a need for more awareness and knowledge about ADR reporting. Severe ADRs lead to enhanced hospital stays, increased treatment costs, risk of death, and many medical and economic consequences. Therefore, ADR reporting at its first instance is essential to avoid further harmful effects of the prescribed drugs. In India, the rate of ADR reporting is less than 1%, whereas worldwide, it is 5% due to a need for more awareness about PV and ADR monitoring among healthcare providers and patients. The main objective of this review is to highlight the current scenario and possible futuristic ways of ADR reporting methods in rural areas of India. We have searched the literature using PubMed, Google scholar, Indian citation index to retrieve the resources related to ADR monitoring and reporting in India's urban and rural areas. Spontaneous reporting is the most commonly used PV method to report ADRs in India's urban and rural areas. Evidence revealed that no effective ADR reporting mechanisms developed in rural areas causing underreporting of ADR, thus increasing the threat to the rural population. Hence, PV and ADR reporting awareness among healthcare professionals and patients, telecommunication, telemedicine, use of social media and electronic medical records, and artificial intelligence are the potential approaches for prevention, monitoring, and reporting of ADRs in rural areas.
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Affiliation(s)
- Shalini Shukla
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Priyanka Sharma
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Priya Gupta
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Shikha Pandey
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Reshu Agrawal
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Deepak Rathour
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Dharmendra Kumar Kewat
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | - Ramu Singh
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
| | | | - Rishi Paliwal
- Department of Pharmacy, Nanomedicine and Bioengineering Research Laboratory (NBRL), Indira Gandhi National Tribal University, Amarkantak, India
| | - Kunjbihari Sulakhiya
- Department of Pharmacy, Neuropharmacology Research Laboratory, Indira Gandhi National Tribal University (IGNTU), Amarkantak, Madhya Pradesh, India
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Shaikh S, Raut A, Jambhale P, Iyer S, Shah J. Incidence and Severity of Adverse Drug Reactions in Medical Intensive Care Unit. Curr Drug Saf 2024; 19:332-341. [PMID: 37587829 DOI: 10.2174/1574886318666230816090606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) curtail patients' quality of life by virtue of increasing therapeutic complexity and rising multimorbidity. In India, the frequency of ADRs for individual drugs and their economic burdens are rarely evaluated. This study aimed at identifying the incidence and severity of ADRs leading to hospitalization (ADRA) and occurring during a hospital stay (ADRH). OBJECTIVE The objective of this study is to evaluate the incidence the incidence and severity of ADRs in the ICU and their impact on the duration of hospitalization, along with the cost incurred to treat ADRs in the ICU. METHODS Demographic, clinical, and pharmacological data on patients admitted to the ICU were collected, analyzed and evaluated for ADRs. According to the setting analyzed, a descriptive analysis of the reactions, suspected medicines, and associated factors was undertaken. RESULTS A total of 208 patients were admitted to the ICU during the study period, of which ADRA contributed 9.1% of the incidence rate and 8.1% of ADRH in 36 patients. Males had a higher incidence of ADRs than females. Patients who had ADRs had a substantially longer length of stay than those who did not. Electrolyte disturbance was the most commonly found ADR. According to the Hartwig scale and WHO-causality scale, 88.9% were moderate, and 97.2% were possible ADRs, respectively. CONCLUSION In this study, a similar incidence rate of ADRA and ADRH was observed. The average cost for treating ADRA was higher than that for treating ADRH. As a result, identifying and preventing these reactions is critical, as they cause the patient greater suffering.
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Affiliation(s)
- Sana Shaikh
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Asawari Raut
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Prajkta Jambhale
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shivkumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
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Hegde M, Raj S, Tikadar D, Nyamagoud SB. Unveiling vaccine safety: a narrative review of pharmacovigilance in India's COVID-19 vaccination. Monaldi Arch Chest Dis 2023. [PMID: 38037892 DOI: 10.4081/monaldi.2023.2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023] Open
Abstract
In India, a robust vaccine pharmacovigilance system is essential to the effective implementation of COVID-19 immunization programs, ensuring the safety and efficacy of the administered vaccines. The National Expert Group on Vaccine Administration for COVID-19 and the Pharmacovigilance Programme of India have played vital roles in monitoring and analyzing adverse events following immunization (AEFI). These tools have made it easier to gather, assess, and report information about different adverse drug reactions connected to COVID-19 vaccines. However, there are several issues with India's vaccination pharmacovigilance, including underreporting and sluggish data gathering. To improve the efficiency of the pharmacovigilance system, it is crucial to address these issues and encourage active reporting by healthcare professionals and the general public. This insightful review article serves as a critical resource for shedding light on India's vaccine pharmacovigilance efforts throughout the COVID-19 vaccination drive. It also elucidates how these efforts are pivotal in bolstering public confidence in vaccines. The comprehensive coverage of reported AEFI not only showcases the commitment to vaccine safety but also helps healthcare professionals and policymakers make informed decisions to enhance the overall vaccination program.
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Affiliation(s)
- Megha Hegde
- Department of Pharmacy Practice, KLE College of Pharmacy, Hubli, Karnataka.
| | - Saurav Raj
- Department of Pharmacy Practice, KLE College of Pharmacy, Hubli, Karnataka.
| | - Dhananjay Tikadar
- Department of Pharmacy Practice, KLE College of Pharmacy, Hubli, Karnataka.
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Menang O, Kuemmerle A, Maigetter K, Burri C. Strategies and interventions to strengthen pharmacovigilance systems in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e071079. [PMID: 37709326 PMCID: PMC10503375 DOI: 10.1136/bmjopen-2022-071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES The slow progress of pharmacovigilance (PV) in low-income and middle-income countries (LMIC) raises questions about core challenges on the growth of PV, and the appropriateness of strategies used so far to develop PV. Therefore, this scoping review aims to describe strategies and interventions to strengthen PV in LMIC and to propose recommendations for future investments in PV capacity building. INCLUSION CRITERIA Publications included were primary studies, articles, policy and guideline papers, describing interventions to strengthen PV in LMIC. METHODS The review was conducted following the Joanna Briggs Institute (JBI) guidelines on conducting scoping reviews. Literature searches were performed in MEDLINE, EMBASE, Web of Science, PDQ-evidence, CINAHL and other relevant websites from January 1990 to January 2021. Two reviewers independently screened titles, abstracts and full texts. One reviewer performed data extraction and descriptive analysis, which were reviewed by two other reviewers. RESULTS 10 922 unique titles were screened and 152 were eligible for full text review. Of these, 57 and an additional 13 reports from grey literature fulfilled eligibility criteria for inclusion in the review. These were grouped into two categories: (1) Interventions aimed at increasing PV knowledge and adverse drug reactions (ADR) reporting (45 papers), primarily education of healthcare professionals (HCP), alone or in combination with other interventions such as mobile and electronic reporting and (2) Interventions aimed at strengthening various components of the national PV system (25 papers), describing strategies or mixed interventions implemented at the national level, targeting different components of the national PV system. CONCLUSIONS Results of this review suggest that educating HCP on ADR reporting is the most common approach to build PV capacity in LMIC. Though important, education alone is insufficient and should ideally be organised within the holistic framework of strengthening national PV systems, with a focus on also building capacity for advanced activities such as signal detection.
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Affiliation(s)
- Olga Menang
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Kuemmerle
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Karen Maigetter
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Choudhury A, Singh PA, Bajwa N, Dash S, Bisht P. Pharmacovigilance of herbal medicines: Concerns and future prospects. JOURNAL OF ETHNOPHARMACOLOGY 2023; 309:116383. [PMID: 36918049 DOI: 10.1016/j.jep.2023.116383] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The use of herbal medicines for prophylaxis, prevention, and treatment of various ailments is rising throughout the world because they are thought to be safer than allopathic treatments, which they are. However, several investigations have documented the toxicity and adverse drug reactions (ADR) of certain formulations and botanicals if not consumed wisely. AIM OF THE STUDY The goal of the current study is to address herbal medication pharmacovigilance (PV) modeling and related considerations for improved patient safety. Also, focus is laid on the comprehensive and critical analysis of the current state of PV for herbal medications at the national and international levels. MATERIALS AND METHODS Targeted review also known as focused literature review methodology was utilized for exploring the data from various scientific platforms such as Science Direct, Wiley Online Library, Springer, PubMed, Google Scholar using "pharmacovigilance, herbal medicine, traditional medicine, ADR, under reporting, herb toxicity, herb interactions" as keywords along with standard literature pertaining to herbal medicines that is published by the WHO and other international and national organizations etc. The botanical names mentioned in the present article were authenticated using World Flora Online database. RESULTS The historical developments paving the way for PV in regulatory setup were also discussed, along with various criteria's for monitoring herbal medicine, ADR of herbs, phytoconstituents, and traditional medicines, herb-drug interactions, modes of reporting ADR, databases for reporting ADR's, provisions of PV in regulatory framework of different nations, challenges and way forward in PV are discussed in detail advocating a robust drug safety ecosystem for herbal medicines. CONCLUSION Despite recent efforts to encourage the reporting of suspected ADRs linked to herbal medicines, such as expanding the programme and adding community pharmacists and other healthcare professionals as recognized reporters, the number of herbal ADR reports received by the regulatory bodies remains comparatively low. Since users often do not seek professional advice or report if they have side effects, under-reporting, is anticipated to be significant for herbal medications. There are inadequate quality control methods, poor regulatory oversight considering herbs used in food and botanicals, and unregulated distribution channels. In addition, botanical identity, traceability of herbs, ecological concerns, over-the-counter (OTC) herbal medicines, patient-physicians barriers requires special focus by the regulatory bodies for improved global safety of herbal medicines.
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Affiliation(s)
- Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India.
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
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Khan MAA, Hamid S, Babar ZUD. Pharmacovigilance practices in South Asian Association for Regional Cooperation countries: the need for collaboration. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Objectives
One-fifth of the world’s population lives in eight countries that constitute the South Asian Association for Regional Cooperation (SAARC). There is very little coordination among SAARC countries regarding the harmonization of pharmaceutical regulations and medicines safety. Pakistan, India and Bangladesh have experienced medicine-related tragedies where many patients have died. This study aims to examine current pharmacovigilance activity in the SAARC region to improve pharmacovigilance practices and to make recommendations for building a platform for collaboration to improve the safety monitoring of medicines in the region.
The current review utilized secondary data. We reviewed the official websites of all SAARC countries’ national regulatory authorities for pharmacovigilance-related information. A data set with eleven pharmacovigilance indicators were gathered and synthesized.
Key findings
All eight SAARC member countries have pharmacovigilance systems with full membership in the WHO Program for International Drug Monitoring. Out of eleven pharmacovigilance indicators, India met ten; Pakistan, Bangladesh and Bhutan nine; Maldives and Afghanistan seven; Nepal and Sri Lanka five. The SAARC countries do not have a harmonized pharmacovigilance system or centralized database. Due to positioning in different WHO regions, it is proposed to create a consortium on medicine safety among SAARC countries like other regional organizations of the world to strengthen the pharmacovigilance systems and harmonize the pharmacovigilance practices among member countries.
Summary
To improve the quality of medicines and to strengthen regional medicine safety, the SAARC secretariat should consider forming a technical group of all member countries’ regulatory authorities.
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Affiliation(s)
| | - Saima Hamid
- Health Services Academy Islamabad , Islamabad , Pakistan
- Fatima Jinnah Women University , Rawalpindi , Pakistan
| | - Zaheer-Ud-Din Babar
- Center for Pharmaceutical Policy and Practice Research, Department of Pharmacy, School of Applied Sciences, University of Huddersfield , Huddersfield , UK
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Dave N, Yaddanapudi S, Jacob R, Varghese E. Quality improvement and patient safety in India-Present and future. Paediatr Anaesth 2022; 32:1185-1190. [PMID: 35257432 DOI: 10.1111/pan.14431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
India is a vast, populous and diverse country, and this reflects in the state of health care as well. The spectrum of healthcare services ranges from world class at one end, to a dearth of resources at the other. In the rural areas especially, there is a shortage of trained medical personnel, equipment, and medications needed to carry out safe surgery. Several initiatives have and are being made by the government, medical societies, hospitals, and nongovernment organizations to bridge this gap and ensure equitable, safe, and timely access to health for all. Training medical personnel and healthcare workers, accreditation of healthcare facilities, guidelines, and checklists, along with documentation and audit of practices will all help in improving services. This narrative review discusses the measures that have been taken, systems that have been established and the challenges involved in ensuring quality and patient safety in India.
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Affiliation(s)
- Nandini Dave
- Department of Anaesthesia, NH SRCC Children's Hospital, Mumbai, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Elsa Varghese
- President, Indian Association of Paediatric Anaesthesiologists (IAPA)
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Meher B, Mohanty R. Identifying barriers to report adverse drug reactions using the Delphi method: Experience from an institute of national importance of India. Perspect Clin Res 2022; 13:58-59. [PMID: 35198431 PMCID: PMC8815663 DOI: 10.4103/picr.picr_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 05/05/2021] [Indexed: 11/04/2022] Open
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Chindhalore C, Dakhale G, Gupta A. Does educational intervention change knowledge, attitude, and practice regarding pharmacovigilance among nursing officers in Central India? An interventional study. JOURNAL OF INTEGRATIVE NURSING 2022. [DOI: 10.4103/jin.jin_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Agrawal M, Singh P, Joshi U. Antimicrobials associated adverse drug reaction profiling: a four years retrospective study (Pharmacovigilance study). ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1938425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Manju Agrawal
- Department of Pharmacology, Pt. JNM Medical College, Raipur, Chhattisgarh, India
| | - Preeti Singh
- ADR Monitoring Centre-Pharmacovigilance Programme of India (Amc-pvpi), Department of Pharmacology, Pt. JNM Medical College, Raipur, Chhattisgarh, India
| | - Usha Joshi
- Department of Pharmacology, Pt. JNM Medical College, Raipur, Chhattisgarh, India
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Suvvari T, Bendi S, Kutikuppala LS. Cross-sectional study regarding pattern of adverse drug reactions in a tertiary care hospital, Kakinada, India. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_85_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Arshad V, Samad Z, Das J, Almas A, Rashid N, Virani SS, Bloomfield GS, Jafar TH, Ahmed B. Prescribing Patterns of Antihypertensive Medications in Low- and Middle-Income Countries: A Systematic Review. Asia Pac J Public Health 2020; 33:14-22. [PMID: 33084371 DOI: 10.1177/1010539520965280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension is highly prevalent, but its pharmacological management has not been well evaluated in low- and middle-income countries (LMICs). This review examined the prescribing patterns of antihypertensives in LMICs. Data were extracted from a total of 26 studies spanning the time period 2000 to 2018. In 10 studies, calcium channel blockers (CCBs) were the most frequently prescribed medication for managing hypertension (range = 33% to 72%); in six studies, renin angiotensin system (RAS) blockers (range = 25% to 83%); in five studies, diuretics (range = 39% to 99%); and in five studies, β-blockers (BBs; range = 26% to 49%) were the most commonly prescribed antihypertensive medications. Prescribing sedatives and sublingual administration of captopril for controlling hypertension was also reported in 3 studies. Only 10 studies presented their findings in light of national or international guidelines. This review calls for further antihypertensive utilization and dispensation studies and a better understanding of clinician's perception and practice of hypertension management guidelines in LMICs.
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Affiliation(s)
| | | | - Jai Das
- The Aga Khan University, Karachi, Pakistan
| | | | | | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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An observational study to assess the possibility of patient participation in implementing pharmacovigilance in a busy tertiary care hospital. Med J Armed Forces India 2020; 76:425-429. [DOI: 10.1016/j.mjafi.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/25/2019] [Indexed: 11/20/2022] Open
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17
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Rukmangathen R, Brahmanapalli VD, Thammisetty DP, Pemmasani D, Gali SD, Atmakuru RB. Study of adverse drug reactions to antiretroviral therapy in a tertiary care hospital, Tirupati. Perspect Clin Res 2020; 11:158-163. [PMID: 33489833 PMCID: PMC7819369 DOI: 10.4103/picr.picr_133_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/25/2018] [Accepted: 03/12/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: Human immunodeficiency virus-infected patients do not adhere to their antiretroviral therapy (ART) due to adverse effects of drugs. The continuous monitoring of adverse drug reactions (ADRs) may ensure the safe use of drugs in patients. Hence, a retrospective analysis was carried out to assess the ADRs pattern, causality, and severity associated with various antiretroviral drug regimens in patients receiving ART. Materials and Methods: A retrospective, analytical study was carried out at ART nodal center in Sri Venkateswara Ramnarain Ruia Government General Hospital, Tirupati. Data were collected by spontaneous reporting of health-care professionals from ART centers using Suspected ADR Reporting Forms of Indian Pharmacopoeia Commission to record the ADRs occurred in the patients who underwent treatment from December 2015 to November 2016. A total of 299 ADR reports were collected during the study period. The causality and severity of the reported ADRs were assessed using suitable scales. Results: From a total of 299 ADR reports, females (63.81%) experienced higher ADRs than males (36.12%). The highest number of ADRs was reported to zidovudine/lamivudine/nevirapine (ZLN) regimen (76.92%) than tenofovir/lamivudine/efavirenz (TLE) regimen (23.07%). Cutaneous reactions were higher (34.34%) among patients receiving ZLN therapy, and drowsiness (53.62%) was the most common ADR in patients receiving TLE regimen. According to the World Health Organization causality assessment scale, most of the ADRs were possible (75.92%). On the assessment of Modified Hartwig and Siegel Severity Scale, 55.09% of ADRs were moderate. Conclusion: The study showed an increased incidence of ADRs to ART which calls for efficient pharmacovigilance systems to improve patient care and drug safety.
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Affiliation(s)
| | | | - Durga Prasad Thammisetty
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Andhra Pradesh, India
| | - Deepishka Pemmasani
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Andhra Pradesh, India
| | - Sai Deepak Gali
- Department of Pharmacy Practice, Sri Padmavathi School of Pharmacy, Tiruchanoor, Andhra Pradesh, India
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Kaur K, Kanwal P, Goyal P, Singh P, Yakhmi S, Jain S, Kaushal S. Spontaneous Adverse Drug Reaction Monitoring in a Tertiary Care Centre. Curr Drug Saf 2020; 15:215-221. [PMID: 32735525 DOI: 10.2174/1574886315666200731172405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Adverse drug reactions (ADRs) are associated with increased economic burden on the society. Monitoring of ADRs can help in decreasing the incidence of preventable adverse reactions. METHODS Under Pharmacovigilance Program of India, collection and reporting of ADRs has been going on at Dayanand Medical College and Hospital since January 2011. Here, we have analyzed the individual case safety reports (ICSRs) reported and uploaded between January 2017 and June 2019 from our centre. The ADR form provided by PvPI was used for collecting information, and the causality assessment was done according to the WHO-UMC scale. RESULTS A total of 498 ICSRs were uploaded through Vigiflow software during this period. Highest number of ADRs were recorded in the age group of 31-45 years (29.01%) and the least number of ADRs were recorded in the children less than 15 years of age (6.76%). General Medicine ward reported the highest number of ADRs and the antibiotics were most commonly associated with ADRs (26.21%), followed by antipsychotics (13.83%) and NSAIDs (12.14%). More than 90% of ADRs were non-serious (93.17%) and most of the ADRs were skin and soft tissue related (49.20%). CONCLUSION Spontaneous reporting among indoor patients shows highest number of ADRs with use of antibiotics and almost all of the ADRs were non-serious in nature. Almost half of the total ADRs were skin and subcutaneous tissue related. Continuous efforts are required for further strengthening of the pharmacovigilance program of India.
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Affiliation(s)
- Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Preet Kanwal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Pardeep Goyal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Paramjit Singh
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Sahil Yakhmi
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Samriti Jain
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Sandeep Kaushal
- Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, India
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Abstract
Pharmacovigilance of vaccines is of paramount importance to promote the safe use of vaccines among their recipients. India launched the Adverse Events Following Immunization (AEFI) surveillance program in 1986 for monitoring suspected adverse events following immunization and since then, the AEFI surveillance guideline has been updated periodically, with the latest being in 2015. The successful AEFI surveillance program in India required the concerted effort of all stakeholders such as National AEFI Secretariat, National Technical Collaborating Centre, Central Drug Standard Control Organization, marketing authorization holder, and health-care professionals.
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Affiliation(s)
- Bikash Ranjan Meher
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Krishnappa L, Gadicherla S, Chidambaram P, Anuradha HV, Somanna SN, Naik PR, Das A, Narasimhaiah S, Nagaraja SB. 'Have we missed reporting adverse drug reactions under Revised National TB Control Programme?' - A mixed method study in Bengaluru, India. Indian J Tuberc 2020; 67:20-28. [PMID: 32192612 DOI: 10.1016/j.ijtb.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/27/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Prompt identification, reporting and management of ADRs during anti tuberculosis treatment can ensure better compliance and treatment outcomes. The study was conducted to identify the gaps and associated factors in reporting of ADRs under RNTCP; assess knowledge, attitude and practice of RNTCP staff regarding pharmacovigilance programme and explore the barriers in reporting of ADRs from provider's perspective. METHODS Mixed method research with sequential explanatory design was carried out in Tuberculosis Units of RNTCP administrative district of Bangalore city during July to December 2017. Quantitative study was carried out among 222 patients on intensive phase of Category I and Category II DOTS to study the incidence, severity and causality of ADRs; and records of these patients were analysed for gaps in reporting. Knowledge, attitude and practice (KAP) regarding recording and reporting aspect of pharmacovigilance programme was assessed among RNTCP staff. As part of the qualitative study, focus group discussion was carried out among RNTCP staff to study barriers for reporting ADRs from the provider's perspective. RESULTS Record analysis at the time of recruitment showed documentation of ADRs in only five patients. Subsequent analysis of patient records during the middle and end of the intensive phase (IP) did not show documentation of any ADRs. Simultaneously interviews with patients revealed 116 (52.2%), 72 (32.4%) and 53 (23.8%) patients reported one or more symptoms of ADRs. The commonest ADR symptom reported were fatigability and gastrointestinal symptoms followed by musculoskeletal symptoms. KAP among 25 RNTCP staff showed that 96% of them felt reporting of ADRs was necessary and 92% reported the ADRs to their seniors, however 12% were scared to report. The main reason expressed for non-reporting was 'managing ADRs is more important than reporting' (52%). Also, 32% felt the need for retraining of staff on reporting and documentation. Barriers to reporting of ADRs were both health-system related like insufficient training and inadequate guidelines provided to RNTCP staff and patient-related factors like lack of awareness and reluctance to report ADRs. CONCLUSION Successful implementation of RNTCP and achievement of TB elimination requires provision of adequate information regarding ADRs to patients and intense follow-up and probing at each contact by programme staff to effectively manage ADRs.
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Affiliation(s)
- Lalitha Krishnappa
- Department of Community Medicine, M. S. Ramaiah Medical College, Bengaluru, India
| | - Suman Gadicherla
- Department of Community Medicine, M. S. Ramaiah Medical College, Bengaluru, India.
| | | | - H V Anuradha
- Department of Pharmacology, M. S. Ramaiah Medical College, Bengaluru, India
| | | | - Poonam Ramesh Naik
- Department of Community Medicine, Yenepoya Medical College, Mangaluru, India
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Gupta R, Labh R, Gupta S. Advances in pharmacovigilance in India: Role of mobile application. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhushan S, Ray RS, Prakash J, Singh GN. Global Versus Indian Perspective of Pioglitazone-induced Adverse Drug Reactions Including Bladder Cancer: A Comparative Retrospective Pharmacovigilance Analysis. Clin Ther 2019; 41:2252-2262. [PMID: 31543285 DOI: 10.1016/j.clinthera.2019.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE In 2011, France and Germany banned pioglitazone due to a concomitant risk for bladder cancer. There has been continued debate about this topic. Therefore, we present a detailed analysis of data from individual case safety reports of pioglitazone use (PG-ICSRs) associated with bladder cancer reported worldwide and in India. METHODS Data from PG-ICSRs reported by the National Coordination Centre's Pharmacovigilance Programme of India, as well as over 131 World Health Organization member countries in the Uppsala Monitoring Centre's VigiLyze pharmacovigilance database system, from January 1, 1967, to March 4, 2018, were collected. Comparisons between data from global and Indian PG-ICSRs were made by applying filters such as country, bladder cancer, age group, gender, time period, information component, and data mining. FINDINGS Among the adverse drug reactions (ADRs) reported with pioglitazone use worldwide, bladder cancer and related terms were the most highly reported (43%). The most frequently co-reported concurrently used drug was metformin, which was included in 25% and 40% of overall and bladder cancer-specific PG-ICSRs, respectively. Suspected bladder cancer-specific pioglitazone-related reactions were reported in 27 countries, with 8548 serious and 1858 fatal cases and an information components value of 9.15. The Americas had the highest relative percentage of suspected bladder cancer in PG-ICSRs (53%), while the prevalence was much lower in India (2%). In both cohorts, men over the age of 45 years constituted the most highly reported population. IMPLICATIONS India has a very low prevalence of reported overall and bladder cancer-specific pioglitazone-related ADRs compared to Europe and the Americas. Possible explanations for the difference in reporting rates include variance in genetic makeup, low BC risk factor, pioglitazone prescription at a lower therapeutic dose, greater use of chemopreventive spices in the diet, higher frequency of metformin as a concurrent drug, and under-reporting of ADRs.
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Affiliation(s)
- Shashi Bhushan
- National Coordination Centre-Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Ghaziabad, India.
| | - R S Ray
- National Coordination Centre-Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Ghaziabad, India.
| | - Jai Prakash
- National Coordination Centre-Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Ghaziabad, India.
| | - G N Singh
- National Coordination Centre-Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India, Ghaziabad, India.
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Goyal PK, Semwal A, Prakash A, Medhi B. Emerging antimicrobial resistance and newer tools to address the resistance. Indian J Pharmacol 2019; 51:291-295. [PMID: 31831917 PMCID: PMC6892007 DOI: 10.4103/ijp.ijp_607_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/21/2019] [Accepted: 11/07/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Ankita Semwal
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Ajay Prakash
- Department of Pharmacology, PGIMER, Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India
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Agrawal V, Shrivastava TP, Adusumilli PK, Vivekanandan K, Thota P, Bhushan S. Pivotal role of Pharmacovigilance Programme of India in containment of antimicrobial resistance in India. Perspect Clin Res 2019; 10:140-144. [PMID: 31404182 PMCID: PMC6647896 DOI: 10.4103/picr.picr_29_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Misuse of antimicrobials has become one of the grave concerns of public health. In last two decades, this has been largely contributing in the emergence of antimicrobial resistance (AMR) among all the pathogens. A 2013 report of Centres for Disease Control and Prevention, USA figured that at least 2 million people get an antibiotic-resistant infection every year and as many as 23,000 people lost their life. A multi-country survey in Southeast Asia region conducted by World Health Organization (WHO) in 2015, identified several gaps in knowledge and awareness about the optimal use of antimicrobials and AMR. Following this, the Ministry of Health and Family Welfare (MoHFW), Government of India, developed National Action Plan in the year 2017 to combat AMR. Pharmacovigilance Programme of India (PvPI) being a flagship programme of MoHFW holds the responsibility of ensuring safety of medicines used by India population and has recently identified AMR as one of the strategic priorities. This article intends to provide insights of the recent attempts and deliberate efforts made by PvPI in the containment of AMR in India and it also intends to sensitize healthcare fraternity on restricting AMR in public interest.
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Affiliation(s)
- Vijit Agrawal
- National Coordination Centre, Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, MoHFW, GoI, Ghaziabad, Uttar Pradesh, India.,Research Scholar, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, Government of NCT, New Delhi, India
| | - Tarani Prakash Shrivastava
- National Coordination Centre, Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, MoHFW, GoI, Ghaziabad, Uttar Pradesh, India.,Research Scholar, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University, Government of NCT, New Delhi, India
| | - Pramod Kumar Adusumilli
- National Coordination Centre, Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, MoHFW, GoI, Ghaziabad, Uttar Pradesh, India
| | - Kalaiselvan Vivekanandan
- National Coordination Centre, Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, MoHFW, GoI, Ghaziabad, Uttar Pradesh, India
| | - Prasad Thota
- National Coordination Centre, Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, MoHFW, GoI, Ghaziabad, Uttar Pradesh, India
| | - Shashi Bhushan
- National Coordination Centre, Pharmacovigilance Programme of India, Indian Pharmacopoeia Commission, MoHFW, GoI, Ghaziabad, Uttar Pradesh, India
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Singh Rehan H, Hotha P. Antimicrobial Agents-induced Hypokalemia: A Possible Causality Association. Indian J Crit Care Med 2019; 23:175-177. [PMID: 31130788 PMCID: PMC6521821 DOI: 10.5005/jp-journals-10071-23148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Drugs including some of the antimicrobial agents (AMAs) can cause mild to severe intensity of hypokalemia, which leads to cardiac, muscular, renal, gastrointestinal, and metabolic manifestations. Objective To explore the possible association of AMAs use and the development of hypokalemia as an adverse drug reaction (ADR). Methodology Retrospective analysis of spontaneously individual case safety reports (ICSRs) received during January 2015 to September 2017 for any reduction in serum potassium levels following the use of AMAs. Such ICSRs were further analyzed for age, gender, seriousness and severity of hypokalemia, outcome, concomitant drugs, management of hypokalemia, and causality assessment using WHO-UMC causality assessment scale. Result Out of total 2,880 spontaneous ICSR, 53 had report title of hypokalemia. In almost half of these (27) ICSRs, AMAs were suspected to induced hypokalemia. Ceftriaxone (24.5%) and azithromycin (10.5%) were most suspected AMAs. Females (74.19%) aged between 21 years and 40 years experienced more AMA induced hypokalemia. The mild, moderate, and severe hypokalemia was present in 53.8%, 40.7%, and 7.4% of ICSRs, respectively. Drug-drug interaction of AMA with either furosemide, hydrocortisone and/or deriphyllin was present in six ICSRs. Causal association of all the ICSRs with AMA induced hypokalemia was possible. Conclusion Antimicrobial agents (especially ceftriaxone and azithromycin)-induced hypokalemia alert needs to be investigated. Further, healthcare professionals are advocated to take caution by monitoring serum potassium levels routinely for such patients. How to cite this article Rehan HS, Hotha P, Antimicrobial Agentsinduced Hypokalemia: A Possible Causality Association. Indian J Crit Care Med 2019;23(4):175-177.
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Affiliation(s)
| | - Priyanka Hotha
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
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26
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Analysis and reporting of adverse drug reactions at a tertiary care teaching hospital. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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M PK, Patil A, Kakkar AK, Singh H. Decoding the Roadmap for Capacity Building of Pharmacology Academicians in Catering to Drug Information Center Services in a Developing Country. J Pharm Technol 2019; 35:146-154. [DOI: 10.1177/8755122519841364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Very few medical institutions are currently providing drug information center (DIC) services in low-resource countries. Objective: To assess whether academician pharmacologists of India are prepared to deliver countrywide services with regard to DICs. Methods: A cross-sectional knowledge attitude and practice study was planned in the form of an online survey. A hyperlink to the questionnaire was sent to academician pharmacologists via email, Facebook, and WhatsApp. Determinants associated with pharmacologists’ capacity and willingness in uplifting the DIC services were determined using logistic regression. Results: One hundred and thirteen academician pharmacologists responded. Participants who were working in limited functional DIC had 0.30 (95% confidence interval [CI] = 0.09-0.98) times association with answering that referring to promotional drug literature is an inappropriate practice for DIC services to that of nonfunctional DIC participants. However, the same had 5.28 (95% CI = 1.74-16.00) times association with referring to literature for establishing and running the services more as compared with participants with nonfunctional DIC. Participants from fully functional DICs in their departments had 6.31 (95% CI = 1.92-20.70) times association with identifying that adverse event reporting is not the function of DIC as compared with participants from a non-functional DIC. Participants with more academic experience had 6.7 (95% CI = 1.36 to 32.93) times association with an identification of challenges as compared with that of less experience participants. Conclusion: Academician pharmacologists need to be trained in critical appraisal of published literature and guided on how to establish and maintain the services for hospital clinicians. Senior pharmacology academicians’ advice will be crucial in strengthening the roadmap for capacity building.
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Affiliation(s)
- Praveen Kumar M
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amol Patil
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Kumar Kakkar
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Mulchandani R, Kakkar AK. Reporting of adverse drug reactions in India: A review of the current scenario, obstacles and possible solutions. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2019; 30:33-44. [PMID: 30175985 DOI: 10.3233/jrs-180025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pharmacovigilance is a practice aimed to monitor drug safety in real life conditions and capture adverse drug events during the post marketing phase of drug's life cycle. But under reporting of adverse reactions is a major cause of concern and a threat to the pharmacovigilance systems. The present article looks into the major obstacles affecting the spontaneous reporting of adverse drug reactions (ADRs) in India and the possible solutions. As per available scientific literature, the major impediments to ADR reporting are inadequate knowledge and awareness among health professionals, clinicians' perceptions towards reporting, problems with establishing reporting systems in hospitals and insufficient training to recognize ADRs. Measures to improve the situation include greater involvement of nurses, pharmacists as well as consumers in the reporting of ADRs, making the process simpler and faster through electronic means, introducing educational interventions and training programs for health care providers and spreading awareness about the reporting system amongst caregivers and receivers alike. Providing a momentum to the pharmacovigilance system and ensuring a robust reporting process is a challenge but proper planning, feasible solutions and focussed efforts can help bring about the change ensuring patient safety - the ultimate goal of pharmacovigilance.
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Affiliation(s)
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Opadeyi AO, Fourrier-Réglat A, Isah AO. Educational intervention to improve the knowledge, attitude and practice of healthcare professionals regarding pharmacovigilance in South-South Nigeria. Ther Adv Drug Saf 2019; 10:2042098618816279. [PMID: 30719280 PMCID: PMC6348575 DOI: 10.1177/2042098618816279] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/08/2018] [Indexed: 12/17/2022] Open
Abstract
Background Our aim in this study was to evaluate the effect of a combined educational intervention and year-long monthly text message reinforcements via the Short Messaging System (SMS) on the knowledge, attitude and practice (KAP) of healthcare professionals (HCPs) towards pharmacovigilance. Methods Six randomly selected teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and control groups. The educational intervention consisted of delivering a seminar followed by sending monthly texts message reinforcements via SMS over 12 months. Then a semi-structured questionnaire regarding the KAP of pharmacovigilance was completed by HCPs working in the hospitals after the intervention. Data was analysed descriptively and inferentially. Results A total of 931 HCPs participated in the post intervention study (596 in the intervention and 335 in the control). The M:F ratio was 1:1.5. According to the KAP questionnaire, a significant difference was observed between the intervention and control groups, regarding knowledge of the types of adverse drug reactions (ADRs). ADR resulting from pharmacological action of the drug (85.6% versus 77%, p = 0.001), the fact that ADRs can persist for a long time; (60.1% versus 53.4%, p = 0.024) and a higher awareness of the ADR reporting form (48.7% versus 18.8%, p < 0.001). Most respondents in the intervention group (68.5% versus 60.6%, p = 0.001) believed they should report ADRs even if they were unsure an ADR has occurred, a greater proportion of HCPs from the intervention group had significantly observed an ADR (82% versus 73.4%, p = 0.001). Furthermore, of the 188 who had ever reported an ADR, 41% from the intervention group used the national ADR reporting form compared with 19.8% from the controls (p < 0.001). Conclusion This educational intervention and the use of SMS as a reinforcement tool appeared to have positively impacted on the knowledge and practice of pharmacovigilance in South-South Nigeria with a less-than-impressive change in attitude. Continuous medical education may be required to effect long-lasting changes.
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Affiliation(s)
- Abimbola O Opadeyi
- Department of Medicine, University of Benin Teaching Hospital, Benin-City, Nigeria
| | - Annie Fourrier-Réglat
- Pharmacoepidemiology, Université de Bordeaux, Bordeaux, France Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
| | - Ambrose O Isah
- Department of Clinical Pharmacology and Therapeutics, University of Benin, Benin-City, Nigeria Department of Medicine, University of Benin Teaching Hospital, Benin-City, Nigeria
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Jose J, Rafeek NR. Pharmacovigilance in India in Comparison With the USA and European Union: Challenges and Perspectives. Ther Innov Regul Sci 2018; 53:781-786. [PMID: 30554527 DOI: 10.1177/2168479018812775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pharmacovigilance (PV) is an integral part of the drug regulation system. PV plays an indispensable role in the identification, assessment, and publicizing of adverse drug reactions (ADRs) through various methods. ADRs account for serious harm to the patients and even lead to morbidity and mortality. The PV databases help in the promotion of safe drug use and protection of public health safety. This article compares the PV system in the USA, Europe, and India, highlighting the challenges and future perspectives to be adapted to widen the horizon of the existing PV structure in India. In India, PV programs are still at the dawning stage when paralleled to the other countries. The National Pharmacovigilance Program and the Pharmacovigilance Program of India are the most recent advancements in this field in the country. The USA and Europe have well-established PV systems in place thanks to technological progress and other resources. India is the largest producer of pharmaceuticals in the world and a major clinical research hub; hence, it requires a more stringent PV setup. With the increase in population and novel drugs in the market each day, there is a need for an effective PV system in India.
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Affiliation(s)
- Jobin Jose
- Department of Pharmaceutical Regulatory Affairs, NGSM Institute of Pharmaceutical Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
| | - Naziya Refi Rafeek
- Department of Pharmaceutical Regulatory Affairs, NGSM Institute of Pharmaceutical Sciences, NITTE Deemed to be University, Mangalore, Karnataka, India
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Kalaiselvan V, Srivastava S, Singh A, Gupta SK. Pharmacovigilance in India: Present Scenario and Future Challenges. Drug Saf 2018; 42:339-346. [DOI: 10.1007/s40264-018-0730-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Badyal DK. Evolution of pharmacology education in India: Past and future. Indian J Pharmacol 2018; 50:159-168. [PMID: 30505051 PMCID: PMC6234714 DOI: 10.4103/ijp.ijp_239_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/08/2018] [Indexed: 12/02/2022] Open
Abstract
Pharmacology education has passed through various stages in the evolution sequence due to ever-changing type and repository of drugs as well as technological advancements in the educational processes. This article reviews the journey of evolution of pharmacology education. Pharmacology is relevant component of various curricula in medical, dental, and paramedical courses. A huge number of students learn pharmacology as a subject. Important milestones in evolutionary sequence included revisions and updates in learning objectives, teaching-learning material/methods and assessment in undergraduate (UG) and postgraduate (PG) levels. During this period, a number of pharmacology organizations and associations were formed for the progress of the subject. The inception of Indian Pharmacological Society and International Union of Pharmacology is worth mentioning. There are standardization and unification efforts being done in pharmacology education at national and international levels. The era of animal experimentation is struggling to survive in the new era of animations and simulations. There is increasingly more emphasis on the relevant clinical pharmacy and clinical pharmacology components in the education. The past evolutionary sequences provide leads for future evolutions. New courses and innovations are being designed and implemented to make pharmacology education more meaningful and useful to the new technology-savvy students. A number of innovations in the form of case-based learning, objective-structured practical examination, small group learning, interactive, and integrated methods are being implemented. There is a lot of work being done to introduce a competency-based intergraded curriculum in medical UG and PG courses. All these evolutionary sequences require changing and evolving role of teachers as facilitators.
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Affiliation(s)
- Dinesh K. Badyal
- Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Opadeyi AO, Fourrier-Réglat A, Isah AO. Assessment of the state of pharmacovigilance in the South-South zone of Nigeria using WHO pharmacovigilance indicators. BMC Pharmacol Toxicol 2018; 19:27. [PMID: 29855348 PMCID: PMC5984375 DOI: 10.1186/s40360-018-0217-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/22/2018] [Indexed: 01/21/2023] Open
Abstract
Background WHO pharmacovigilance indicators have been recommended as a useful tool towards improving pharmacovigilance activities. Nigeria with a myriad of medicines related issues is encouraging the growth of pharmacovigilance at peripheral centres. This study evaluated the status of pharmacovigilance in tertiary hospitals in the South-South zone of Nigeria with a view towards improving the pharmacovigilance system in the zone. Methods A cross-sectional descriptive survey was conducted in six randomly selected tertiary hospitals in the South-South zone of the country. The data was collected using the WHO core pharmacovigilance indicators. The language of assessment was phrased and adapted in this study for use in a tertiary hospital setting. Data is presented quantitatively and qualitatively. Results A total of six hospitals were visited and all institutions had a pharmacovigilance centre, only three could however be described as functional or partially functional. Only one centre had a financial provision for pharmacovigilance activities. Of note was the absence of the national adverse drug reaction reporting form in one of the hospitals. The number of adverse drug reaction reports found in the databases of the centres ranged from none to 26 for the previous year and only one centre had fully committed their reports to the National Pharmacovigilance Centre. There were few documented medicines related admissions ranging from 0.0985/1000 to 1.67/1000 and poor documentation of pharmacovigilance activities characterised all centres. Conclusion This study has shown an urgent need to strengthen the pharmacovigilance systems in the South-South zone of Nigeria. Improvement in medical record documentation as well as increased institutionalization of pharmacovigilance may be the first steps to improve pharmacovigilance activities in the tertiary hospitals. Electronic supplementary material The online version of this article (10.1186/s40360-018-0217-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abimbola O Opadeyi
- Department of Clinical Pharmacology and Therapeutics, University of Benin, Benin-City, Edo State, Nigeria. .,Department of Medicine, University of Benin Teaching Hospital, Benin-City, Nigeria.
| | - Annie Fourrier-Réglat
- Inserm, Bordeaux Population Health Research Center, team, Pharmacoepidemiology, University Bordeaux, UMR 1219, F-33000, Bordeaux, France.,Bordeaux PharmacoEpi, INSERM CIC1401, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service de Pharmacologie médicale, F-33000, Bordeaux, France
| | - Ambrose O Isah
- Department of Clinical Pharmacology and Therapeutics, University of Benin, Benin-City, Edo State, Nigeria.,Department of Medicine, University of Benin Teaching Hospital, Benin-City, Nigeria.,National Drug Safety Advisory Committee, National Agency for Food and Drug Administration and Control, Federal Ministry of Health, Abuja, Nigeria
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A national approach to pharmacovigilance: The case of India as a growing hub of global clinical trials. Res Social Adm Pharm 2018; 15:109-113. [PMID: 29602659 DOI: 10.1016/j.sapharm.2018.03.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/17/2018] [Indexed: 11/22/2022]
Abstract
Pharmacovigilance is the pharmacological science associated with the detection, understanding and prevention of adverse effects, especially long-term and short-term adverse effects of medicines. In the present day pharmaceutical scenario, where the development and marketing of an ever-growing array of medicines has rendered their safety and therapeutic efficacy key to determining the success of a drug, pharmacovigilance has come about to play a critical and significant part. While pharmacovigilance, as a system, has witnessed considerable progress and evolution in the West, not as much has been accomplished in India. With India now being recognised as a hub of global clinical trials and with an increasing number of clinical trials and clinical research studies being conducted actively, the need for a dynamic pharmacovigilance network with an efficient and prudent operation methodology is felt, now more than ever. This article observes the evolution of the pharmacovigilance system in India, with a fundamental overview of the present system in place and also various schemes and proposals to establish and sustain the same. It also examines the challenges faced in the execution of an effective pharmacovigilance network as well as the future prospects with regards to the Indian market.
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S. S, K. B, P. K. Audit to evaluate the completeness of adverse drug reporting in an ADR monitoring centre in Tamilnadu. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu T, Gao CC, Lin JS, Zha JL. Active Monitoring of Adverse Drug Reactions with Neural Network Technology. Chin Med J (Engl) 2017; 130:1498-1501. [PMID: 28584215 PMCID: PMC5463482 DOI: 10.4103/0366-6999.207468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tao Wu
- The Glorious Sun School of Business and Management, Donghua University, Shanghai 200051, China
| | - Chang-Chun Gao
- The Glorious Sun School of Business and Management, Donghua University, Shanghai 200051, China
| | - Jing-Sheng Lin
- Department of Information Technology, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jia-Ling Zha
- Department of Information Technology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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