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Byline: Ratinder. Jhaj, Aditya. Banerjee, Nilima. Kshirsagar, Balakrishnan. Sadasivam, Sujith. Chandy, Heber. Bright, Preetha. Chugh, C. Tripathi, Dinesh. Badyal, Madhulika. Samuel, Bikash. Medhi, Ajay. Prakash, Rupa. Joshi, Sandhya. Kamat, Raakhi. [...]

Background: e-Pharmacy can potentially solve problems related to the quality of services and products, cost, and access to medicines in low- and middle-income countries. This review aims to understand the facilitators and barriers to the implementation of e-pharmacy in India., Objective: This scoping review aimed (1) to understand the facilitators and barriers to the use of e-pharmacy in India and (2) to estimate the potential for e-pharmacy in India for improving access to medication, improving the quality of services and medicines, and decreasing costs of medications., Methods: All published and gray literature from July 1, 2011, to June 30, 2021, relating to e-pharmacy, was searched from MEDLINE, Scopus, ProQuest, and Google using a systematic search strategy., Results: In total, 1464 titles and abstracts were screened, of which 47 full-texts were included in the review. e-Pharmacy can potentially improve access to medications for remote areas, and old and debilitated individuals. e-Pharmacies can enable lean supply chain management, lower cost, and allow easy tracking of dispensed medicines. There is potential for integration of e-pharmacy services into the national program of Bhartiya Jan Aushadhi Pariyojana. However, the country is not adequately regulated to prevent the growth of illicit e-pharmacies. Lack of global accreditation and internet coverage, digital literacy, and transnational access are other challenges., Conclusions: E-pharmacy has the potential to improve universal health coverage in India by improving access to medicines and lowering the overall cost of health care. However, future growth will need specific regulations and accreditation mechanisms., Trial Registration: Open Science Forum; https://doi.org/10.17605/OSF.IO/6R9YQ., (©Aditi Apte, Heber Rew Bright, Sandeep Kadam, Thambu David Sundarsanam, Sujith J Chandy. Originally published in the Online Journal of Public Health Informatics (https://ojphi.jmir.org/), 09.10.2024.)

Purpose: We examined the efficacy of topical capsaicin in reducing delayed chemotherapy-induced nausea and vomiting (CINV)., Methods: Adults on highly emetogenic chemotherapy regimens applied 2 g of capsaicin ointment (0.075%) or matching placebo four times a day to the abdomen for 5 days in addition to standard antiemetic regimen in this blinded randomized controlled trial. Patients were monitored for nausea and vomiting in the immediate (day 1), delayed (days 2-5), and extended phases (days 2-15). Self-reported incidence and daily episodes of CINV were compared between the groups. Onset, severity, need for rescue antiemetics, cumulative vomiting episodes, and safety were also compared., Results: In total, 160 patients were enrolled. The final modified intention-to-treat population included 75 patients each in the capsaicin and placebo groups. Fewer patients experienced nausea (36.0% [n = 27] v 53.3% [n = 40]; P = .033) and vomiting (28.0% [n = 21] v 42.7% [n = 32]; P = .060) in the capsaicin arm during the delayed phase. During the extended phase, there was a significantly lower incidence of nausea (44% v 64.0%; P = .014) in the capsaicin arm. No difference in nausea (26.7% v 25.3%) or vomiting (22.7% v 18.7%) was evident in the immediate phase. The average daily episodes of nausea and vomiting were significantly fewer in the capsaicin arm during the delayed and extended phases. With capsaicin, no grade 3 nausea (9.3% v 0.0%; P = .007) was observed, and the time to first nausea and vomiting was significantly prolonged. There were no differences between the groups with respect to rescue antiemetics, unscheduled hospital visits, and adverse events., Conclusion: Topical capsaicin reduced the incidence of nausea and the average number of vomiting episodes during delayed and extended phases without increasing adverse effects.

Background Objectives: Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians., Methods: It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an 'unacceptable deviation'., Results: Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108)., Interpretation Conclusions: The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions., (Copyright © 2024 Copyright: © 2024 Indian Journal of Medical Research.)

Background: Persons with anxiety regarding health may have an increased tendency to seek online health information especially during a pandemic. The primary objective of this study was to determine COVID-19 induced health anxiety among the general population in India using Google Trends data., Methods: Online health information seeking behaviour with respect to high-risk comorbid conditions for severe COVID-19 disease during the pandemic period was compared to that of the previous year. Correlation between the COVID-19 incidence and online health information seeking behaviour was also computed to explore if the observed health anxiety was due to the pandemic., Results: Overall, the online health information seeking behaviour was highest for diabetes both during (81.46±8.84) and before the pandemic (64.47±9.48). A significant increase (p<0.001) in the information seeking behaviour during the pandemic was observed with all the four high-risk comorbid conditions including diabetes (+16.99), hypertension (+22.57), lung disease (+21.79), and cardiovascular disease (+14.08). The behaviour with respect to diabetes (r=0.39), hypertension (r=0.48) and lung disease (r=0.69) showed significant positive correlation with the COVID-19 incidence. The observed health anxiety was regardless of prevalence, urbanization and literacy rates of individual states., Conclusions: The general population in India has increased its online health information seeking behaviour during the pandemic and this may be due to an underlying health anxiety due to COVID-19., (© Journal of the Association of Physicians of India 2011.)