Context: Prescribing is a challenging task requiring knowledge of essential medicine (EM), rational use of medicines (RUM) and personal drugs (P-drug). Though the majority of clinicians recognize the importance of RUM, most of them have not been able to apply this knowledge in their medical practice. Aims: The aim of the following study is to assess knowledge, attitude and practice of clinicians about RUM, EM, P-drugs, and sources of drug information. Settings and Design: A cross-sectional, questionnaire based study. Subjects and Methods: Study was carried out in 100 respondents including faculty members and junior residents (JRs) in a tertiary-care teaching hospital. Statistical Analysis: Univariate analysis was carried out using fisher's exact test. Results: Nearly 93% respondents were aware about EM, but only 79% prescribe them. Percentage is significantly higher in respondents of age more than 30, having clinical experience <5 years and in faculty members as compared to residents. Nearly 87% respondents were aware about RUM, but only 83% practice it. Though 30% respondents practiced P-drug concept only 1% were aware about STEP criteria. Practicing P-drug concept was significantly more in JRs compared to faculty members (P < 0.0001). None of the respondents were aware about the number of drugs in National List of EMs of India. Conclusions: It is an encouraging finding that higher percentages of clinicians were aware about EM and also prescribed it. However, level of understanding related to P-drug concept and existence of essential medicines list are much below par. Also prescribing by trade name and heavy dependency on medical representatives for drug information is the matter of concern.

Objective:To compare the efficacy of agomelatine with escitalopram in the treatment of major depressive disorder (MDD), improve sleep in MDD patients and study the adverse effects of agomelatine.Materials and Methods:Randomized, parallel-group, open-label study. The primary efficacy outcome was change from baseline to last post-baseline value in Hamilton depression rating scale and Leeds sleep evaluation questionnaire scale. Both parametric and nonparametric tests were applied for analysis.Results:Within-group and between-groups comparison of the mean HAMD17 scores showed statistically significant changes (P < 0.0001). Escitalopram showed early onset of response and remission compared to agomelatine at 10th week (P < 0.0001) and 14th week (P < 0.0001), respectively. In agomelatine, within-group and between-groups change of the mean LSEQ score was statistically significant at subsequent follow-up visits (P < 0.0001).Conclusion:Escitalopram is superior to agomelatine in efficacy, considering the early response, early remission, and better relief from symptoms of MDD in adults. Agomelatine may be preferred in MDD patients having insomnia as a predominant symptom. Liver function monitoring should be done in patients on long-term agomelatine therapy.

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: To provide a structured tool to assess rationality based on the 10 domains of Rationality score; To find out the impact of the structured tool for judging the rationality score of Pharmacotherapy in various clinical situations e.g. High, Moderate and Low rationality score. A rationality scale was developed to check the coefficient of variation in each parameter of rationality, on a scale of 1 to 10, acronymed as R.A.T.I.O.N.A.L.I.T.Y.Various clinical cases were discussed and treatment was criticised if any. These cases were then rated according to the rationality scale. High Rationality - Score ≥ 6, Average Rationality – Score &#62; 4 and &#60; 6 & Low Rationality - score ≤ 4.For high rationality score, the top 5 parameter are availability of drugs, lab monitoring, rational combination, Protocol/Regime and if objectives of treatment fulfilled.For average rationality scores, the top 5 parameters are Objective of treatment, Availability of drugs, Treatment correctness, lab monitoring and Protocol/Regime followed.For low rationality, the lowermost 5 parameters were cost of therapy, irrational combination, lab monitoring, use of trade names instead of generic names and availability issues starting from the lowest. Parameters like availability of the drugs, lab monitoring, presence or absence of irrational combinations are critical and common judgement parameters while judging if the therapy is rational or not.

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