Dr. Deepak Kumar Bandari, PharmD : Short Profile

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Dr Deepak Kumar Bandari, PharmD, (PhD) (Europe)

Current Position: National

1) Project Technical Support - III (Field Investigator) - Indian Council of Medical Research (ICMR) - National Institute of Nutrition (NIN), Hyderabad, India. 

Project: Strengthening the Monitoring of Tuberculosis Elimination in India - District Level Sentenial Survey (DLSS), India.

2) Board of Studies Member - Master’s in Clinical Research and Experimental Medicine, School of Allied and Health Sciences, Malla Reddy University, Hyderabad.

3) Book reviewer - BSP Publications, Pharma Med Press and Kakatiya Publications.

Current Position: International
PhD Researcher and Early Stage Researcher participant
Project: FIP 7 programme of EuroAgeism H2020 project, involving 13 European and Non-European countries.

Early-Stage Researcher (ESR) Participant, Euro Ageism H2020, Faculty of Pharmacy in Hradec Králové, Charles University, Europe.

Thesis: Polypharmacy and comparison of differences in potentially inappropriate prescribing in India, Ethiopia, and European countries.
Projects and Grants handled: 

• Project: FIP 7 programme of EuroAgeism H2020 project, involving 13 European and Non-European countries.

Grant: European Commission, FIP7 program Euro Ageism H2020-764632-MSCA-ITN supported by the scientific group “Ageing and Changes in the Therapeutic Values of Drugs in the Aged”, Charles University, Progress Programme Q42, SVV program 260 417.
Total Finance - 232 422,48 EU (Detailed budget - not disclosed)
EU Consortium: Israel, Czech Republic (CZ), UK, Poland, Netherlands, Sweden, Finland, Belgium.
Participating countries: Czech Republic, Serbia, Croatia, Bulgaria, Estonia, Turkey, Spain, Ireland, Belgium, India, Ethiopia.
Collaborating Institutions: Alliance Health and Social Care Alliance Scotland (AL), EMDA – The Alzheimer’s Association Israel (AAI), European Centre for Social Welfare Policy and Research (Euro Centre), National University of Ireland Galway (NUIG), United Nations Economic Commission for Europe (UNECE) and World Health Organization (WHO).

• Project No. START/MED/093

Thesis: Rational geriatric pharmacotherapy, medication errors and clinical pharmacy services in long-term care.
Total Finance - 2,299,968 CZK (Personal cost-1,353,600; Mentor remuneration-40,000; Travel costs-361,000; Training costs- 120,000; Costs of non-investment equipment, materials etc. - 80,000; Overhead costs - 345,368)
Grant: Charles University, Research Unit “Ageing, Polypharmacy and Changes in the Therapeutic Value of Drugs in the AgeD”, United Nations Economic Commission for Europe and World Health Organization, University of Zagreb, Croatia, University of Belgrade.

Previous Positions: National

1) Associate Consultant (Epidemiology and Outcomes Research) - Bridge Medical Consulting Pvt. Ltd, New Delhi. 

2) Team Leader - Indian Council of Medical Research (ICMR) – National Institute of Nutrition (NIN), Hyderabad, India.

Project: National Sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in India.

3) Investigator (Field) - Indian Council of Medical Research (ICMR) – National Institute for Research in Tuberculosis (NIRT), Chennai, India.

Project: National survey for the state-wise prevalence of microbiologically confirmed pulmonary tuberculosis in India.

4) Assistant Professor and Clinical Preceptor: Vaagdevi Institute of Pharmaceutical Sciences, Warangal, India. 

No. of Research Publications: 18
Cumulative Impact Factor: 153
Number of Citations: 3000+

h-index: 14; i-10 index: 15 

Awarded grants: Total 7 (International: 6, National: 1)
Achievements: Total 9 (International: 5, National: 4)
My Interviews in Magazines and Newsletters: 3 (International: 2, National: 1)

Scientific presentations: (International: 11, National: 8)
Book reviews: 9 (International: 2, National: 7)
Guest Lectures: Total 3 (International: 1, National: 2)
Editorial member and reviewer: 8
Certification courses: Total 10 (2 - Stanford University, 8 - National and International Organizations)
Countries affiliated: USA, Italy, Poland, Slovak Republic, The Czech Republic, Germany, Hong Kong and 10 other European countries.

International collaborative research: Early Stage Researcher participant in the FIP 7 programme of EuroAgeism H2020 project under Marie-Curie Innovative Network and EU COST Action IS1402 network aimed at describing main prescribing problems in rational geriatric pharmacotherapy in 13 European and Non- European countries (including India and Ethiopia). 

Collaborating Institutions: Alliance: Health and Social Care Alliance Scotland (AL), EMDA – The Alzheimer’s Association Israel (AAI), European Centre for Social Welfare Policy and Research (EuroCentre), National University of Ireland Galway (NUIG), United Nations Economic Commission for Europe (UNECE) and World Health Organization (WHO).

Remarkable Achievements:

1. Award and Position: Early Stage Researcher (ESR) participant in the network of FIP7 EuroAgeism H2020 – ITN project, European Commission.
2. Reviewer: Acknowledged in Davidson’s Principles and Practice of Medicine textbook, 23rd Edition, 2018; Elsevier publishers ISBN: 9780702070280.
3. Personal interview: “I expect the 8-star Pharmacist Concept of World Health Organization will come true in India in the Future” published in an International Magazine “Lekarnicke Listy”, March 2018, Bratislava, Slovak Republic.
4. Best reviewer award: Textbook of Hutchison’s Clinical Methods 23rd International Edition by Michael Glynn &William Drake. Saunders Publishers, UK ISBN: 978-0-7020-4091
5. ERASMUS+ Student Mobility: Internship in various European countries.

A few other Achievements:

1. Award and Interview: Winner of “Ideathon” First Nobel Prize Series in India, Department of Biotechnology, India. Interview entitled “Pharmacist Nobel Prize Series: Science Impacts Lives – The Pride of India”, Indian Pharmaceutical Association – Community Pharmacy Division (IPA - CPD) e-Times 6 (2), March – April 2017.

2. Story of Success (2017): Published by Elsevier, as a part of the budding Medicos National contest.

3. Elsevier Student Ambassador (ESA) and Mentor’ for South Asia from July 2014 to June 2016.

4. Felicitation and award: Special Faculty Achievement Award at Viswambhara Educational Society Silver Jubilee Celebrations, March 2018, Warangal, India.

5. Award: Pharmacy Practice contribution award on World Pharmacist’s Day, 25th September 2017 for the successful delivery of an invited lecture on the Prescriptive role of Clinical Pharmacist in Ambulatory Care at Deccan School of Pharmacy, Hyderabad, India.

Acknowledgement: 

• I thank Prof. Daniela Fialova, PharmD, PhD, BCCP; Chair of the Horizon 2020 EuroAgeism FIP7 program; Head of the University Centre of Clinical Pharmacy, Faculty of Pharmacy, Charles University; Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Department of Geriatrics and Gerontology,1st Faculty of Medicine, Charles University, Czech Republic.
• Dr Akshaya Srikanth Bhagavathula, PharmD, PhD; Associate Professor of Epidemiology, Department of Public Health, North Dakota State University, United States of America. 
• Prof. Yamsani Madhusudan Rao, M.Pharm, PhD; Director, Vaagdevi group of Pharmacy Colleges, Warangal, India for their valuable guidance and support throughout my career.

 

Drugs acting on Cardiovascular System : Classification at tips

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Deepak Kumar Bandari,

Pharm.D Intern,

Vaagdevi College of Pharmacy - India

Elsevier Student Ambassador - South Asia

Oral Contraceptive failure due to Antibiotics : A Bogus Interaction

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Over past 3 decades, published literature described hundreds of women on oral contraceptives have become pregnant after a course of oral antibiotic therapy. Accordingly, many pharmacists warned their patients who were on oral contraceptives to take additional precautions to avoid pregnancy when using antibiotics concomitantly. Yet, there exists many misconceptions about this purported interaction. First of which is that adequate data are available to prove or disprove the existence of the interaction.

A Bogus Interaction? 
This interaction has not been disproved, despite frequent proclamations that it is a “myth.” Some people have erroneously concluded that—because there are substantial flaws in the data supporting the existence of the interaction—the interaction has been shown not to exist. In making this claim, however, they have failed to understand the saying

“Absence of proof is not Proof of absence.”

Inadequacies in the Positive Studies and Reports:

The reports of oral contraceptive failure during antibiotic therapy are numerous, but they are with amusing results. Specific details of the cases are rarely reported, and it is not possible to determine whether the unintended pregnancy resulted from the antibiotic or simply represents the “background” failure rate normally seen with oral contraceptives. Although some of the pregnancies occurred in women who had been taking oral contraceptives correctly and successfully for years, there is still no certainty that the antibiotic caused the contraceptive failure in any given case.

Inadequacies in the Negative Studies and Reports:

There are also serious flaws in the studies that failed to find an increase in oral contraceptive failure rate with concurrent antibiotics. All of the studies had 1 or more of the following flaws: retrospective design, dependence on patients’ memory of events, long-term antibiotic use, or combining data for antibiotics that might reduce estrogen levels (amoxicillin) with those for antibiotics that may increase estrogen levels (erythromycin, clarithromycin). 

Some of the antibiotics (clarithromycin, ciprofloxacin, metronidazole) would not be expected to reduce estrogen levels. Moreover, if only a small fraction of women (< 5%) develop this interaction, a statistically significant change in estrogen pharmacokinetics would not be expected. Women taking an antibiotic for an acute infection might be less likely to have sexual intercourse because they are not feeling well, either due to the infection or because of side effects of the antibiotic (nausea, vomiting, diarrhea). This could result in an underestimation of the ability of antibiotics to reduce the efficacy of oral contraceptives. Another flaw in most negative studies is the failure to consider how many of the patients received information on how to avoid the interaction.

Proposed Mechanism of the Interaction:

The mechanism, if any, is not clear. Theoretically, antibiotics such as penicillin and tetracycline can reduce bacteria in the intestine that are involved in the enterohepatic circulation of estrogens, leading to a reduction in estrogen serum concentrations. Other mechanisms include enzyme induction following rifampin, griseofulvin, nafcillin, and dicloxicillin, or malabsorption of contraceptive hormones due to antibiotic-induced diarrhea and vomiting.

Pharmacists’ Role:

Women on oral contraceptives still should be warned about the possibility of contraceptive failure if they receive a prescription for an oral antibiotic. To comply with oral contraceptive product information, the patient should be advised to add alternative non-hormonal contraception during the time and for 7 days after the antibiotic is taken. No one knows, however, whether 7 days is enough. The pharmacist should recommend backup contraception for 2 weeks after discontinuation of the antibiotic or through the end of the current cycle—whichever is longer. Advising the patient to report any menstrual irregularities may be efficient, but there is no evidence that their absence ensures adequate contraception.

Conclusion:

In any given patient, antibiotics are unlikely to impair the efficacy of oral contraceptives. The data emphatically, however, do not establish that any antibiotic can be used in any woman on any oral contraceptive without increasing the risk of unintended pregnancy. Thus, only 2 possibilities are left:

1. Antibiotics cause contraceptive failure in a very small percentage of patients.
2. Antibiotics have no effect on oral contraceptive efficacy.

With the available data, it is simply not possible to choose which of these 2 possibilities is correct, so pharmacists must continue to warn patients accordingly.

References: 

1. Drug Interactions by Hasten and Horn : Current topics in Drug Interactions.
2. Lexicomp - clinical information solutions and drug interaction checker.

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Regards,

Deepak Kumar Bandari,

Pharm.D Intern,

Vaagdevi College of Pharmacy - India

Elsevier Student Ambassador - South Asia

8 Star Pharmacist : A WHO integrated model

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The World Health Organization has proposed an 8 - star Pharmacist model to describe various roles of Pharmacist in providing better pharmaceutical care and decision making. Taking this into account, if practiced under a well trained pharmacy professional, there is a possibility of achieving a better impact in the healthcare system.

Concept from World Health Organization

Caregiver: Pharmacists provide caring services. They must view their practice as integrated and continuous with those of the health care professionals with highest quality.

Decision-maker: The appropriate, efficacious, safe and cost-effective use of resources should be the foundation of the pharmacist’s work. At the local and national levels, pharmacists play a role in setting medicines policy. Achieving this goal requires the ability to evaluate, synthesize data and information and decide upon the most appropriate course of action.

Communicator: The pharmacist is in an ideal position to provide a link between prescriber and patient, and to communicate information on health and medicines to the public. He or she must be knowledgeable and confident while interacting with other health professionals and the public. 

Manager: Pharmacists must be able to manage resources and information effectively; they must also be comfortable being managed by others, whether by an employer or the manager/leader of a health care team. 

Life-long-learner: It is impossible to acquire in pharmacy school all the knowledge and experience needed to pursue a life-long career as a pharmacist. The concepts, principles and commitment to lifelong learning must begin while attending pharmacy school and must be supported throughout the pharmacist’s career. Pharmacists should learn how to keep their knowledge and skills up to date.

Teacher: The pharmacist has a responsibility to assist with the education and training of future generations of pharmacists and the public. Participating as a teacher not only imparts knowledge to others, it offers an opportunity for the practitioner to gain new knowledge and to fine-tune existing skills.

Leader: In multidisciplinary caring situations or in areas where other health care providers are in short supply pharmacist should assume a leadership position in the overall welfare of the patient and the community. Leadership involves compassion and empathy as well as vision and the ability to make decisions, communicate, and manage effectively. A pharmacist whose leadership role is to be recognized must have vision and the ability to lead.

And the added function of:

Researcher: The pharmacist must be able to use the evidences effectively in order to advise on the rational use of medicines in the healthcare team. By sharing and documenting experiences, the pharmacist can also contribute to the evidence base with the goal of optimizing patient care and outcomes. As a researcher, the pharmacist is able to increase the accessibility of unbiased health and medicines-related information to the public and other healthcare professionals.

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Regards,

Deepak Kumar Bandari,

Pharm.D Intern,

Vaagdevi College of Pharmacy - India

Elsevier Student Ambassador - South Asia

Clerkship Versus Internship : Role of Pharm.D

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Main theme of this post: Today, I would like to discuss the main objectives of Clinical Clerkship and Internship; the duties and responsibilities of Doctor of Pharmacy (Pharm.D) students in ward round participation, the steps to deliver a better patient care and the expected outcomes of the clinical pharmacy services.

Pharmaceutical care:

Pharmacists are the important health care providers - drug experts; whose primary job is to interact with the health care team, interview and assess patients, make specific therapeutic recommendations, monitor patient response to drug therapy and provide an evidence based drug information for better pharmaceutical care. "Pharmaceutical care" is a broad-based, patient focused responsible provision of drug therapy to achieve definite and patient specific outcomes that improves the quality of life. The outcomes include:

• Cure of the disease
• Elimination or reduction of symptoms
• Slowing the disease process 
• Prevention of disease 

In order to achieve these patient specific outcomes a pharmacist needs an expert knowledge of therapeutics, strong communication skills, understanding abilities of the diseases, therapeutic planning skills, expertise in drug monitoring and basic knowledge in physical assessment. 

What is Clerkship??

"Clerkship is an organized, directed, post graduate training program in a defined area of pharmacy practice", which is to be carried out under the supervision of a well trained preceptors who have expertise knowledge in drug therapy and clinical skills for better patient care (Unfortunately, this is lacking in India). Clerkship aims to provide students with a practical and stimulating learning experience where they are given an opportunity to participate in ward rounds along with the health care team and provide a wide variety of clinical services.

Responsibilities of a clerkship student:

1. Ward round participation: 

The images below will give an outline on the duties of pharmacist in Ward round participation.

2. Optimization of drug therapy:

The optimization of drug therapy is achieved through proper Medication therapy management which improves the quality care of the patient through education and communication. This mainly focus on the medication related problems and their mismanagement; identification, assessment, monitoring and documentation of adverse events and to address the patient safety through proper analysis. Well established evidence based medicine and standard care guidelines helps in addressing these problems through therapeutic interventions. In case of patients suffering with chronic diseases like HIV, TB, hypertension, diabetes etc.; proper patient counseling through a well approached manner helps in improving their quality of life, which eventually requires medication adjustments, drug monitoring and proper follow-up.

3. Providing drug information :

This is a challenging task and requires proper knowledge on primary, secondary and tertiary resources that include standard drug references, textbooks, practice guidelines and scientific databases. A proper approach to the query, identification of the information lacking and fulfilling the gap with a proper evidence based guidelines is mandatory. The document and follow up of this service is to be carried out for providing better therapeutic care. The pharmacists need to provide information to all the health care professionals and sometimes even to the patient. This requires a better communication with the entire healthcare team. The follow up is carried out to access the satisfaction of the information seeker which is to be graded and documented.

4. Other activities:

The clerkship helps in developing and strengthening students’ pharmaceutical care skills through pharmacotherapy, hospital pharmacy and clinical pharmacy rotations which are to be assessed by the preceptors through assignments, case presentations, journal club presentations, group discussions through a proper grading approach. All the documentations are to be produced by the students during assessment where the preceptor will be evaluating each intervention through the evidence and correlating with the present diseased condition of the patient. This helps in establishing systematic evaluation procedures and standard documentation.

What is Internship??

Internship is a temporary period of supervised training that provides real world experience to gain the relevant knowledge and skills required to enter a particular career field. This period of internship will be usually funded by the respective education councils, where the pharmacists are expected to provide clinical services. The internship includes pre-ward rounds with nurses to gain proper knowledge on the disease state and history of the patient, followed by ward rounds with the physicians and health care team to discuss the present situation and recommend a standard therapeutic approach, followed by post ward rounds to monitor the patient and rule out medication errors. 

Internship can be performed in any of the clinical settings like ambulatory care, critical care, emergency medicine, interventional medicine, pharmacy management etc.; depending on the skills the pharmacist is expertized. An intern can also focus on the research activities provided on the feasibility and access with the health care team, this helps in updating the knowledge on the therapeutic guidelines for getting proper conclusions. Every clinical services provided and therapeutic intervention made through the internship is to be documented well in a standard format which helps in easy access to the data and for further evaluation.

Interventions made and documentations done in the absence of a well trained preceptor are invalid.

Message

This is the procedure I follow in my daily practice, any further suggestions are highly appreciated. I wish good luck to all my juniors and hope a change begins...

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Regards,

Deepak Kumar Bandari,

Pharm.D Intern,

Vaagdevi College of Pharmacy - India

Elsevier Student Ambassador - South Asia

Ebola Virus Disease - Story and Information Leaflet

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Know the story of Ebola- Its origin, spread and prevention 

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