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Microfluidic devices can sort immunomagnetically labeled cells with sensitivity and specificity much greater than that of conventional methods, primarily because the size of microfluidic channels and micro-scale magnets can be matched to that of individual cells. However, these small feature sizes come at the expense of limited throughput (ϕ < 5 mL h−1) and susceptibility to clogging, which have hindered current microfluidic technology from processing relevant volumes of clinical samples, e.g. V > 10 mL whole blood. Here, we report a new approach to micromagnetic sorting that can achieve highly specific cell separation in unprocessed complex samples at a throughput (ϕ > 100 mL h−1) 100× greater than that of conventional microfluidics. To achieve this goal, we have devised a new approach to micromagnetic sorting, the magnetic nickel iron electroformed trap (MagNET), which enables high flow rates by having millions of micromagnetic traps operate in parallel. Our design rotates the conventional microfluidic approach by 90° to form magnetic traps at the edges of pores instead of in channels, enabling millions of the magnetic traps to be incorporated into a centimeter sized device. Unlike previous work, where magnetic structures were defined using conventional microfabrication, we take inspiration from soft lithography and create a master from which many replica electroformed magnetic micropore devices can be economically manufactured. These free-standing 12 µm thick permalloy (Ni80Fe20) films contain micropores of arbitrary shape and position, allowing the device to be tailored for maximal capture efficiency and throughput. We demonstrate MagNET's capabilities by fabricating devices with both circular and rectangular pores and use these devices to rapidly (ϕ = 180 mL h−1) and specifically sort rare tumor cells from white blood cells.

Introduction: Rising concerns about antimicrobial resistance and inadequate development of effective new anti-infective drugs have stimulated universal efforts to strengthen infectioncontrol interventions. Antimicrobial stewardship is a rational, systematic approach to promote the optimal selection, dosing, and duration of therapy for antimicrobial agents throughout the course of their use in order to improve the outcomes. Aim: Since in Shree Krishna Hospital (SKH), Antibiotic Stewardship Program (ASP) was first implemented in 2013, this study was planned to assess any change in antimicrobial use before and after implementation of ASP and to study the rate and pattern of antimicrobial use in medical ICU. Materials and Methods: A cross-sectional study was conducted in 12 bedded medical intensive care unit, over a period of two years from October 2014 to October 2016 at SKH. Permission was taken from Institutional Human Research Ethics Committee. Total 150 case files i.e., 75 from year 2012 and 75 from year 2015 were retrieved from medical record section of the hospital. Appropriateness of prescriptions was decided on the basis of appropriateness of choice, dose, frequency and duration of antimicrobial agents. Data were analysed by using descriptive statistics. Results: There were 68.67% males and the mean (±SD) age was 57.11 (±16.83) years. Majority of the patients were suffering from respiratory conditions. The most common group of drugs prescribed in MICU was β-lactam antibiotics + β-lactamase inhibitors during 2012 as well as 2015. Total 139 patients i.e., 69 (92%) patients in 2012 and 70 (93.33%) patients in 2015 were given antimicrobial for therapeutic purpose. During the year 2015, 67 (89.33%) antimicrobial prescriptions were adhering to antibiotic policy of SKH. Appropriateness of prescriptions had significantly improved in 2015 in MICU (p-value=0.031). Conclusion: In-depth analysis of the study revealed a positive impact of ASP and antibiotic policy. Implementation of ASP in year 2013, brought an effective increase in the appropriate use of antimicrobials.

Introduction: Pharmacovigilance is the branch of science that deals with the detection, assessment, understanding and prevention of adverse reactions to medicines (i.e., adverse drug reactions or ADRs). The purpose of pharmacovigilance is to implement the safe and rational use of medicines, which ultimately helps in improving patient care. Aim: To investigate the Knowledge, Attitude And Practice (KAP) of clinicians, residents and nursing staff towards pharmacovigilance and Adverse Drug Events (ADE) reporting and to identify possible reasons for underreporting and to receive suggestions to improve the ADE reporting. Materials and Methods: This was a qualitative study, conducted at Shree Krishna Hospital, attached to Pramukhswami Medical Collage, Karamsad, Gujarat, India. ‘Focused Group Discussions’ were organized which consisted of 5-10 clinicians and residents of the same departments and 10-15 nursing staff members. Their KAP regarding ADE reporting were assessed by using a structured open ended questionnaire. Data were analysed with qualitative methods. Results: Total six sessions of Focused group discussion were conducted consisting of 42 clinicians and residents (16 were faculty members and 26 were residents) and seven sessions of Focused group discussion were conducted, consisting of 89 nursing staff members. Most of the participants knew the meaning of ADR and importance of ADR reporting. They all agreed that it’s their responsibility also to report ADE. Some of the participants admitted, forgetfulness and workload as major constraints. There was a suggestion of display phone number of department of Pharmacology for coordination and maintaining a separate register for ADEs in each ward. Conclusion: In spite of awareness and willingness for reporting of ADEs amongst the clinicians and residents, the practice is lacking because they do not consider this work as their priority.

Introduction Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. Aim To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. Materials and methods A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Statistical analysis Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Results Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient's age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. Conclusion As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

Background: The concepts of essential medicines and rational drug therapy are necessary to be understood undergraduate students. Aims and Objectives: (i) To make the second MBBS students aware regarding essential medicine lists (EMLs) through “student assignment.” (ii) To find out differences between 18th and 19th World Health Organization EMLs. Materials and Methods: The assignment-based activity was conducted in pharmacology theory lectures of the fifth semester MBBS batch at Pramukhswami Medical College, Gujarat. A total of 98 undergraduate and four postgraduate students participated in the activity. Students were divided into 19 groups and assigned different categories of EMLs. All the groups were asked to study the assigned categories and prepare the information regarding the 18th and 19th EMLs for presentation in the next session. Descriptive statistics were used to analyze the data. Results: Of 19 groups, four groups submitted the answers through WhatsApp on the same day of assignment. However, only one among the four groups submitted complete and correct answers. Among all groups, presentation of five groups was either incomplete or incorrect. There are total 30 categories in both 18th and 19th EMLs. There are total 409 drugs including 27 fixed-dose combinations (FDCs) in the 19th EML as compared to 377 drugs including 24 FDCs in the 18th EML. However, three new subcategories were added in the 19th EML. Conclusion: This EML-based activity needs to be implemented and repeatedly practiced for the undergraduate MBBS students to make them understand P-drug concept, rational use of medicines now during the student life and also in future during their professional life.

Background: Adverse drug reactions (ADRs) constitute important cause of morbidity and mortality affecting all age groups. Most of the studies in past have explored and reported knowledge and perception toward ADRs among health-care professionals, pharmacists, and medical students. But studies on awareness among patients are limited. To improve understanding of ADR and its reporting, it is important to find out the same among patients. Objective: To assess knowledge and perception toward ADR among patients visiting tertiary-care rural hospital, and to sensitize patients on ADR reporting system. Materials and Methods: This observational study was conducted at tertiary-care teaching hospital and 150 patients were selected randomly. Demographic details of respondents were noted and questionnaire regarding knowledge and perceptions was given to fill up. Data were analyzed by using descriptive statistics. Result: Demographic analysis showed that 59% patients were men, 56% were from rural areas, and 45% were graduates. Regarding knowledge about ADR, 78.6% patients were aware that medicines can cause ADRs and 33% had experienced side effects in past. None of the respondents were aware of ADR reporting center. Regarding perceptions toward ADR, 86.7% agreed to report ADR in future and 56% respondents believed ADR reporting may strengthen the patient safety. According to 70% patients, awareness campaign is the best way to educate them regarding ADR. Conclusion: Educational interventions are needed to improve awareness among patients regarding importance of ADR reporting.