Background: Elderly people have multiple co morbidities and are often prescribed potentially inappropriate medications (PIMs). As there is paucity of information about the prescribing practices in elderly this study was undertaken to assess drug utilization patterns in elderly patients.Methods: A prospective observational study was conducted in a tertiary care hospital. A total of 576 prescriptions of elderly patients were included in the study. Prescribing patterns among elderly patients attending OPD and admitted to wards of departments of Medicine, Psychiatry, Dermatology, Pulmonary Medicine, General Surgery, E.N.T., Ophthalmology, Orthopaedics, Obstetrics and Gynaecology were analysed using the prescribing indicators (WHO criteria). The PIMs were identified as per the Beers 2012 criteria.Results: The average number of drugs per patient was 3.91±1.93 for O.P.D and 7.37 ±2.22 for I.P.D. patients. 37.76% patients in I.P.D. and 26.87% patients in O.P.D. received a medication which was potentially inappropriate as per Beers 2012 criteria. 7.58% (234/3088) of total medications prescribed to patients in the study were potentially inappropriate. There was a significant increase in the number of PIMs (p value ˂0.05) as the total number of drugs prescribed increased.Conclusions: Educational programmes are needed to reinforce rational prescribing by physicians and precautions should be taken while prescribing potentially inappropriate drugs to elderly patients.

In the U.S., there is no requirement for research sponsors to compensate human research subjects who experience injuries as a result of their participation. In this article, we review the moral justifications that compel the establishment of a better research-related injury compensation system. We explore how other countries and certain institutions within the U.S. have adopted various systems of compensation. The existence of these systems demonstrates both that the U.S. lags behind other nations in its protection of human research subjects and that the establishment of a compensation system is both practical and feasible. We then examine factors which have prevented the U.S. from establishing its own compensation system. We consider possible alternatives for the U.S. by examining the advantages and disadvantages of both established and proposed systems. We offer a new proposal that addresses the justice concerns which compel the establishment of a national compensation system, distributes the burdens of such a system on multiple stakeholders that benefit from research, and has the additional advantage of minimizing the administrative and logistical challenges associated with initiating such a system.

INTRODUCTIONVitamin D deficiency, as reflected by circulating 25-hydroxyvitamin D (25[OH]D) levels <20 ng/ml, is prevalent in as many as one-half of middle-aged to elderly adults in developed countries.1,2 The ubiquitous distribution of Vitamin D receptors in the body, controlled by nearly 3000 genes, 3,4 suggest that a deficiency could have widespread health consequences. Thus, understanding the characteristics that promote Vitamin D deficiency in the general population has important clinical implications. Vitamin D deficiency is estimated to affect over 1 billion people worldwide, 1 and its prevalence is increasing in conjunction with Type 2 diabetes (T2D), obesity, and derangements in metabolic traits. Recent studies have examined the physiological functions of Vitamin D beyond its well-established role in musculoskeletal health.5 In addition to findings of oncologic 4 and immunologic 5 associations, Vitamin D deficiency is associated with metabolic derangements and T2D. [6][7][8] Although 1, 25(OH)D is the active form of Vitamin D, it is not suitable for measuring Vitamin D serum level. 25(OH)D has a longer half-life and it can more precisely show the food intake and skin production of Vitamin D. A serum level of <20 ng/ml (50 nmol/L) 25(OH)D is considered as Vitamin D deficiency, between 20 and 30 ng/ml as its insufficient level and higher than 30 ng/ml as its desirable or sufficient level. 9-11ABSTRACT Background: In India, 30-50% of children and 50-80% of adults are Vitamin D deficient. Limited data exists to assess the association of Vitamin D status, Type 2 diabetes (T2D), and metabolic traits in Indians. This study was conducted to assess the correlation of Vitamin D deficiency with T2D and metabolic risk factors in the Indian population. Methods: Patients of either gender visiting medicine outpatient department over a period of 1-year and with Vitamin D deficiency (levels <20 ng/ml), not taking Vitamin D supplements and having T2D were selected for the study. Participants were tested for serum Vitamin D, fasting blood sugar, and lipid profile parameters. Correlation between Vitamin D deficiency and blood sugar and Vitamin D deficiency and lipid profile was assessed using Pearson's correlation test. Results: Out of 144 subjects, number of diabetic patients were 74 (51.38%) and non-diabetic patients were 70 (48.61%). Among diabetic patients, 10/74 (13.51%) were Vitamin D deficient and among non-diabetic patients, 20/70 (28.57%) were Vitamin D deficient. There was an inverse correlation between Vitamin D and total cholesterol (p=0.01) and Vitamin D and low-density lipoprotein (p=0.01), and it was statistically significant (p<0.05). Conclusion: Assessment of Vitamin D levels can be useful in diabetic patients as its deficiency is associated with T2D.

Background: Diarrheal diseases cause significant morbidity in developing countries and are the leading cause of death in children. The study was undertaken to assess drug utilization patterns in patients with gastroenteritis in a private setting.Methods: The in-patient data records of 208 patients (96 males, 112 females) admitted with acute gastroenteritis in a private hospital in Mumbai over 2 years were analysed. WHO core drug prescribing indicators - average number of drugs per prescription, percentage of drugs prescribed by generic name, percentage of encounters resulting in prescription of an antibiotic, percentage of encounters resulting in prescription of an injection were assessed. Patient demographics and trends in use of antibiotics, antiemetics and antidiarrheals were assessed.Results: The average total number of drugs prescribed per patient was 6.33 and average number of antibiotics was 1.61. 99% of drugs were prescribed using brand names. Percentage of encounters resulting in prescription of injection was 97.11%. Cephalosporins were the most commonly used group of antimicrobials (62.5%) followed by fluroquinolones (49.03%) and antiamoebic drugs (35.58%). Diphenoxylate was the most commonly prescribed antidiarrheal drug and ondansetron was the most commonly prescribed antiemetic agent. Cephalosporins were the most commonly used antimicrobials in patients diagnosed with enteric fever.Conclusions: Emperical irrational use of antibiotics was observed. There was paucity of stool culture for identification of causative agents. Review of antibiotic susceptibility patterns needs to be done on a regular basis. Educational programmes to reinforce the need for ORS and zinc supplementation are necessary.

Background: Medical error is a mistake committed by health professionals which results in harm to the patient. Medical errors can occur due to wrong diagnosis, error in administration of drugs, error in performance of surgical procedures, error in the use of equipment or misinterpretation of laboratory findings. When medical errors occur, the most common dilemma faced by doctors is whether to disclose the error to the patient. Physicians often conceal the error due to fear of negative consequences. If medical error disclosures are handled well-patient trust in physician could increase, can be used to improve processes (enhance patient safety) and prevent lawsuit on the hospital. Methodology: Undergarduate medical students were taught a step-wise communication process to handle disclosure of medical errors after watching role play videos depicting disclosure conversations. The role play videos depicted the wrong way and the right way of disclosure conversation. A survey was taken to assess the attitude and perception of the students after teaching about communication process. Students answered questions related to three case scenarios. For each question, three response scripts represented increasing amounts of information (no disclosure, partial disclosure, full disclosure) was taken. Principles of bioethics that are violated due to non-disclosure of medical errors were discussed. Results: About 98% of students disclosed medical errors to the patients (partial or full disclosure).It was challenging to make a disclosure conversation after an error occurred. Students voiced the need for teaching communication skills for disclosure of medical errors in the medical curriculum. Conclusions: While disclosure of medical error was felt important, in view of the principles of beneficence, non-maleficence and patient's autonomy, it was difficult to do so. Complete medical error disclosure should be managed as a group (health care team) process.