Averting Antibiotic Apocalypse in J&K State

Antimicrobial resistance is rising to dangerously high levels at state as well as national level. Among the key factors responsible for antimicrobial resistance in India are the widespread use and availability of practically all the antimicrobials across the counter, increasing and wanton use of antibiotics in livestock production, inappropriate doses, and irrational use of antibiotics in hospitals. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. A growing list of infections such as pneumonia, tuberculosis, blood poisoning and gonorrhoea are becoming harder, and sometimes impossible, to treat as antimicrobials become less effective. Emergence and growth of superbugs is endangering human lives by making existing antibiotics worthless. In the year 2008 a bacterial strain “New Delhi Metallo-beta-lactamase” (NDM1), named after an enzyme that renders bacteria resistant to a broad spectrum of antibiotics, crossed the shores and spread resistance in the U.K. as well. It was in 2011 that the Union government came up with a National Policy for Containment of Antimicrobial Resistance in India, seeking to reverse what seemed to be a spiralling healthcare concern. However no such policy has been framed or implemented in the state of Jammu and Kashmir as on date.

In almost every nook and corner of our state antimicrobials can be bought for human or animal use without a prescription in spite of the fact that a new schedule H1 under Drugs and Cosmetics Rules of 1945 has been created to restrict the OTC sale of antimicrobials vide gazette notification of the Government of India that came into force from Mar 1, 2014. This makes the emergence and spread of resistance only worse. Similarly, in absence of standard treatment guidelines, antimicrobials are often over-prescribed by health workers and veterinarians as well as over-used by the patients. Self-medication of antibiotics by patients is also highly prevalent in our state where patients resort to antibiotic use either on the basis of earlier use by self or by others. This needs to be reduced through proper education and awareness campaigns.

In times of sickness, people in our part of the world prefer to consult an unqualified pharmacist, a compounder or a Medical Assistant rather than a qualified physician and in turn get dispensed with heavy doses of antibiotics, sans any prescriptions, most often consisting of irrational combinations of newest generation antimicrobials. This only adds to the catastrophe of antimicrobial resistance. Even most of the qualified physicians of the state, in a bid to bring instant symptomatic relief to their patients, rampantly prescribe antimicrobials not only to adults but to paediatric patients too without conducting any culture sensitivity tests. Very few culture sensitivity tests are conducted upon hospitalized patients at primary, secondary as well as tertiary care hospitals before prescribing antibiotics. Situation in private sector is as bad or may be even worse than the government sector. Rational antimicrobial prescribing in accordance with established norms and international guidelines is not precisely followed in either sector.

Current scenario of antimicrobial prescribing and use is likely to bring us sooner than any other part of the world at the doorstep of antibiotic apocalypse unless we take adequate measures to avert the impending crisis. Without urgent action, we are heading towards a post-antibiotic era, in which common infections and minor injuries will be sufficient enough to kill. Therefore there is need to frame “Hospital Antibiotic Policy” for each and every tertiary care hospital of our state; to prepare standard treatment guidelines, SOPs and algorithms for treating various microbial infections and to constitute infection control committees in all hospitals who would function in accordance with discrete infection control procedures that include both prevention and control measures.

Even if new medicines are developed in near future, without behavioural changes, antimicrobial resistance will continue to remain a major threat. Therefore behavioural changes must include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene. Antimicrobial resistance is accelerated by the misuse and overuse of antimicrobials, as well as poor infection prevention and control. Therefore steps need to be taken at all levels of society to reduce the impact and limit the spread of resistance.

People in Kashmir seem to be conventionally inclined towards usage of high cost antibiotics belonging to latest generation due to the perception that they treat infections faster and better. In order to prevent and control the spread of antibiotic resistance, individual patients need to use antibiotics only when prescribed by a certified health professional; never demand antibiotics if health worker doesn’t feel the need to prescribe them; always follow health worker’s advice when using antibiotics, never share or use leftover antibiotics; prevent infections by regularly washing hands; preparing food hygienically; avoiding close contact with sick people; practising safer sex and keeping vaccinations up to date. Stronger hygiene and infection prevention measures, including vaccination, can limit the spread of resistant microorganisms and reduce antimicrobial misuse and overuse.

Policy makers need to frame a robust action plan to tackle antibiotic resistance; improve surveillance of antibiotic-resistant infections; strengthen policies, programmes, and implementation of infection prevention and control measures; regulate and promote the appropriate use and disposal of quality medicines and make necessary information available on the impact of antibiotic resistance. Regulators need to ensure sale of antimicrobials strictly in accordance with prescriptions. Sale and purchase records need to be checked on regular basis by them to ensure that they are not sold over-the-counter without prescriptions.

Antibiotics are frequently used to stimulate growth or prevent infections in poultry farms, cowsheds and slaughterhouses. Sustainable animal husbandry practices can reduce the risk of resistant bacteria spreading through the food chain to humans. In addition to better prescribing practices, the concerned authorities must restrict patients’ and the agricultural industry’s inappropriate and unregulated use of antimicrobial agents. The use of sub-therapeutic doses of antibiotics in animal feed and/or water to promote growth and improve feed efficiency particularly in poultry farms has not perhaps been officially banned as yet in J&K which is leading to the continuation of this malpractice and eventually these drugged chicken are promoting antimicrobial resistance.

Health professionals like qualified pharmacists and nurses can help a great deal to prevent and control the spread of antibiotic resistance by ensuring that their hands, instruments, and environments are clean; by prescribing and dispensing antibiotics only when they are needed, that too in accordance with current guidelines; by reporting antibiotic-resistant infections to surveillance teams; by counselling their patients about how to take antibiotics correctly, and about antibiotic resistance and the dangers of misuse; by educating their patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).

Infection prevention measures such as sanitation, hand washing, food and water safety, and vaccination can decrease the spread of microorganisms resistant to antimicrobial medicines. By preventing infectious diseases whose treatment would require antimicrobial medicines and viral infections which are frequently mistreated with antimicrobial medicines, we can better steward these essential medicines. Raising awareness of antimicrobial resistance and promoting behavioural change through public communication programmes that target different audiences in human health, animal health and agricultural practice as well as consumers is critical to tackling this issue. Including the use of antimicrobial agents and resistance in school curricula will also promote a better understanding and awareness from an early age.

Making antimicrobial resistance a core component of professional education, training, certification, continuing education and development in the health and veterinary sectors and agricultural practice will help to ensure proper understanding and awareness among professionals. With J&K already being labelled as one of the highest consumers of medicines countrywide, irrational prescribing, illegal dispensing and unscientific use of antimicrobials is destined to make us notorious world leaders in antimicrobial resistance too just the way we are leading in corruption on the Transparency International’s Corruption Perception Index. Therefore adequate measures need to be taken well in time by the government through its health ministry, the prescribers, the pharmacists, the drug regulators, hospital administrators, civil society members as well as by individuals to avert this apocalypse, for it is better to be late than never.

What is a Teachers' Association meant for?

What is a Teachers’ Association meant for? Is it a platform to confront the administration? Is it a forum to display one’s might? Is it a ladder to fulfill one’s ambitions and make advancements in one’s career? Is it a weapon to bully your opponents? Is it a means to become popular? After giving a serious thought to it I arrived at the conclusion that actually it is meant for none of them. Essentially it is a dignified and democratic space to voice genuine concerns of teachers. However another question that merits consideration is what qualifies as “the genuine concerns of teachers”?

Following appointment in the University what are the chief concerns, grievances and aspirations of a teacher? Most of his desires revolve around a congenial working atmosphere, good service conditions, timely promotions and equal merit-based placement opportunities, decent in-campus residential accommodation, intermittent deputation to conferences and seminars to strengthen his insight and knowledge base, timely remuneration and allowances commensurate to UGC Regulations, appreciation and incentivization of his good work and prompt disposal of files at various sections of the administrative block be it recruitment, research or accounts sections sans any red-tapeism and spine breaking hassles. But do these concerns really qualify as grievances of teachers whereas they actually are legitimate rights of a teacher that a University education system should automatically ensure in due course of time without a teacher exerting himself and struggling for the same.

Unfortunately in our scheme of things teachers have to pass through an ordeal and present these genuine aspirations and legitimate rights in the form of a charter of demands which otherwise should have been an inherent part of the institutional policy framework and should have been taken care of suo moto by the administration of our higher educational institutions since they are vital to the overall institutional development and no institution can thrive or progress without addressing these basic service issues of the most significant stakeholder of higher education i.e., a teacher. Sadly our systems haven’t evolved to that level as yet where these concerns could be automatically addressed without a teacher having to personally follow the same.

The very fact that there is no single yardstick in our institutions of higher learning for addressing these issues and there is no uniform treatment accorded to all teachers while dealing with such matters on case to case basis sometimes paves way for cheap and dirty politics that otherwise should have no space in a teachers’ association or in the administration. Both teachers and administration sometimes fall prey and draw mileage from such politicking and this is what results into personal agendas both of positive and negative nature propping up every now and then. People develop vested interests, grudges, personal ambitions, proximities as well as bitterness and animosities as a result of such discrimination and unequal treatment. In the long run such practices lead to institutional decay and degradation of both the associations as well the educational institutions. This lack of uniform policy and practice and non-adherence to the principles of equity and justice ultimately leads to mistrust, loss of credibility and sanctity of our associations as well as to the erosion of our institutional integrity and work culture.

Apart from redressing genuine grievances of teachers, teacher associations are also duty bound to extend full support to the administration for contributing substantially, positively and significantly in all their progressive and constructive measures that are aimed at bringing about progress and development of the institution as a seat of higher learning and raising its standards at par with institutions of national and international repute. They also owes something to the prime stakeholders of our educational set up i.e., the students and to the society as well. Administration too needs to view teachers’ association as an ally and a votary rather than an opponent or adversary. All positive measures taken by the administration for the welfare of the teaching community should be remembered for all times to come as a great contribution and legacy. Teachers must consider their institution as their pride, its growth as their growth and its degradation as their degradation. Administration’s objectives of institutional growth cannot be at loggerheads or at conflict with the objectives of teachers’ association. Both are complementary and supplementary to each other and that should be a strong reason for both of them to work together to achieve their respective as well as collective aim and objectives, both of which are essentially noble, reformative and well-meaning in character.

Main aim and objectives of a Teachers’ Association are not only to promote welfare of the teachers, to safeguard their legitimate academic and professional interests and to strive for improving their service and work conditions but also to explore opportunities for meetings and discussions related to the welfare of the society, in general, and of the teachers, in particular; to work for the maintenance, promotion and up-gradation of academic standards of our educational institutions; to co-ordinate with other organizations and associations having similar aims and objectives, both within and outside the state; to promote healthy professional relationships between teachers and students, teachers and administration, teachers and ministerial staff and to work in collaboration with other like-minded organizations and associations for addressing various societal issues and concerns. While teachers associations strive hard to secure genuine rights of teachers, they need to accord equal importance to the duties of teachers too. While they struggle to address genuine grievances of teachers they also need to work towards upliftment of the academic standards of their institution. Right and duties must go hand in hand for a sustainable growth and development of the institution. There is nothing wrong for teachers associations in working shoulder to shoulder with the administration as long as they are not working surreptitiously or clandestinely to achieve any of their own selfish motives or vested interests. They should not resort to opposition of administration for the heck of it. 

Teachers, students and the educational institutions are the three cornerstones of our higher education system and their welfare means the welfare of the higher education system on the whole. All government plans and policies aimed at improving the higher education system must be primarily focused upon these three sections that act as pillars of the higher education system. No progress is possible without taking all three of them on board in all measures of reform.

Upsurge of renewed interest in the use of HRT among post-menopausal women in the light of revised global consensus statement

Menopause is that time in the reproductive phase of a woman where by the levels of circulating estrogen diminishes to such low levels as to cause physical, psychological and sexual disturbances. At or around menopause (between 48 to 52 years) there is a decline in the ovarian functions and in the amounts of hormones produced by hypothalamus-FSH and LH which results in decrease in the ovarian hormones. While cessation of periods can be welcome to many a women, the wide ranging effects of lack of estrogen can be discomforting to an equal many. One alternative to overcome the hazards of menopausal syndrome is the use of Hormone Replacement Therapy (HRT).

Many trials on the use of hormone replacement therapy during the past two decades have provided contradictory results on its risks and benefits in post-menopausal women that has consequently put the medical community in quandary in decision making about use of HRT. The use of HRT declined globally following publication of the first data from the Women’s Health Initiative (WHI) trial in 2002, with the revelation that there was an increased risk of breast cancer and coronary heart disease (CHD) in postmenopausal women taking HRT. Following this, Heart and Estrogen/Progestin Replacement Study & its follow-up (HERS I & II), WHI Memory Study (WHIMS), Women’s international study of long duration oestrogen after menopause (WISDOM) and the Million Women Study (MWS) published results that were consistent with the findings of the WHI study. This reduced enthusiasm for HRT use, and many health professionals and patients considered the use of such hormones as ‘unsafe’, leading to reduction in HRT prescribing¹.

However, recent publications from the International Menopause Society^13,14 indicate that HRT is the first-line and most effective treatment for menopausal symptoms.  Moreover when the full results of the WHI trial were subsequently published it appeared that HRT may confer benefit for CHD prevention below age 60. The 2013 British Menopause Society & Women’s Health Concern recommendations² on hormone replacement therapy and European guidance³ for the diagnosis and management of osteoporosis in postmenopausal women published in 2013 also supported this opinion. These revelations renew interest in realms of HRT use among post-menopausal women.

The differences in age at initiation and the duration of HRT are key points. The intention dose and regimen of HRT need to be individualized based on the principle of choosing the lowest appropriate dose in relation to the severity of the symptoms and the time and age. HRT appears to decrease coronary artery disease in younger women, near menopause yet, in older women, HRT increases risks of coronary event. New findings also showed that the additional benefits of HRT use for those initiating HRT in the 50-59 age group, or for those less than 10 years past the menopause – trends to a lower risk from heart disease; a lower risk of death from any cause; no clear increased risk from stroke. They also showed a general increased risk for those starting HRT after the age of 60⁴. This article reviews the current body of evidence on HRT use among post-menopausal women in light of the consensus statement published by International Menopause Society in 2013 and revised recently in 2016.

In 1975, estrogen only was found to be associated with an increased risk of endometrial cancer. In November 2015, NICE guidelines on hormone therapy were published that did not take this risk into account. A systematic literature review of 28 published studies assessing the safety of estrogen plus progestin therapy according to the risk of endometrial cancer, while considering both regimen and type of progestin concluded that use of unopposed estrogen, tibolone and sequential combined therapy increases the risk of endometrial cancer. Continuous combined therapy might provide a lower risk than never use, even when treatment lasts less than 5 years, and therapy for more than 10 years does not increase risk; micronized progesterone increases the risk of endometrial cancer, regardless of regimen⁵.

Global consensus statement on menopausal hormone therapy

The past one and a half decade has witnessed much confusion regarding the use of menopausal hormone therapy (MHT). New evidence challenged previously accepted clinical guidelines, especially on aspects of safety and disease prevention. This led to many women unnecessarily being denied the use of MHT. Detailed revised guidelines were published and regularly updated by the major regional menopause societies. The confusion was initially escalated by significant differences amongst published guidelines. In recent revisions, the differences have become much less. In view of this, The International Menopause Society (IMS) took the initiative to arrange a round-table discussion, in November 2012, between representatives of the major regional menopause societies to reach consensus on core recommendations regarding MHT. The aim was to produce a short document, only containing the points of consensus. It is acknowledged that, in view of the global variance of disease and regulatory restrictions, these core recommendations do not replace the more detailed and fully referenced recommendations prepared by individual national and regional societies^6,7,8,9,12. IMS document serves to emphasize international consensus regarding MHT and is aimed at empowering women and health-care practitioners in the appropriate use of MHT. The publication of the Global Consensus on Menopausal Hormone Therapy in 2013^10,11 by leading global menopause societies succeeded in presenting guidelines in a troubled therapeutic area that are helpful to both health-care providers and potential users of menopausal hormone therapy.

In June, 2016, a Revised Global Consensus Statement on menopausal hormone therapy^13,14 has been endorsed by The International Menopause Society, The North American Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The Asia Pacific Menopause Federation, The International Osteoporosis Foundation and The Federation of Latin American Menopause Societies. This statement has been simultaneously published in the journals Climacteric and Maturitas, on behalf of the International Menopause Society and The European Menopause and Andropause Society, respectively. Statement reads as under:

The revised statement aims at updating and expanding the areas of consensus. The revised statement contains only areas of consensus and does not replace the more detailed and fully referenced recommendations of the individual societies. This statement is expected to enable health-care providers to offer those women in midlife, who may benefit from MHT, the opportunity to make an informed decision.

Benefit/risk profile of MHT^13,14

MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause.

If MHT is contraindicated or not desired for treatment of VMS, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors such as paroxetine, escitalopram, venlafaxine and desvenlafaxine, which have been shown to be effective in randomized controlled trials (RCTs), may be considered. Gabapentin may also be considered.

Quality of life, sexual function and other menopause-related complaints, such as joint and muscle pains, mood changes and sleep disturbances, may improve during MHT.

MHT, including tibolone and CE/BZA, is effective in the prevention of bone loss in postmenopausal women.

MHT has been shown to significantly lower the risk of hip, vertebral and other osteoporosis-related fractures in postmenopausal women.

MHT is the only therapy available with RCT-proven efficacy of fracture reduction in a group of postmenopausal women not selected for being at risk of fracture and with mean T-scores in the normal to osteopenic range.

MHT, including tibolone, can be initiated in postmenopausal women at risk of fracture or osteoporosis before the age of 60 years or within 10 years after menopause.

Initiation of MHT after the age of 60 years for the indication of fracture prevention is considered second-line therapy and requires individually calculated benefit/risk, compared to other approved drugs. If MHT is elected, the lowest effective dose should be used.

MHT, including tibolone, is effective in the treatment of vulvovaginal atrophy (VVA), now also considered as a component of the genitourinary syndrome of menopause (GSM). Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections. Ospemifene, an oral selective estrogen receptor modulator, is also licensed in some countries for the treatment of dyspareunia attributed to VVA.

RCTs and observational data as well as meta-analyses provide evidence that standard-dose estrogen-alone MHT may decrease the risk of myocardial infarction and all-cause mortality when initiated in women younger than 60 years of age and/or within 10 years of menopause.

Data on estrogen plus progestogen MHT initiated in women younger than age 60 years or within 10 years of menopause show a less compelling trend for mortality benefit, and evidence on cardioprotection is less robust with inconsistent results compared to the estrogen-alone group.

The risk of venous thromboembolism (VTE) and ischemic stroke increases with oral MHT, although the absolute risk of stroke with initiation of MHT before age 60 years is rare. Observational studies and a meta-analysis point to a probable lower risk of VTE and possibly stroke with transdermal therapy (0.05 mg twice weekly or lower) compared to oral therapy.

The risk of breast cancer in women over 50 years of age associated with MHT is a complex issue with decreased risk reported from RCTs for estrogen alone (CE in the Women's Health Initiative (WHI)) in women with hysterectomy and a possible increased risk when combined with a progestin (medroxyprogesterone acetate in the WHI) in women without hysterectomy. The increased risk of breast cancer thus seems to be primarily, but not exclusively, associated with the use of a progestin with estrogen therapy in women without hysterectomy and may be related to the duration of use.

The risk of breast cancer attributable to MHT is rare. It equates to an incidence of women experiencing a spontaneous or iatrogenic menopause before the age of 45 years and particularly before 40 years are at a higher risk for cardiovascular disease and osteoporosis and may be at increased risk of affective disorders and dementia. In such women, MHT reduces symptoms and preserves bone density. Observational studies that suggest MHT is associated with reduced risk of heart disease, longer lifespan, and reduced risk of dementia require confirmation in RCTs. MHT is advised at least until the average age of menopause.

MHT initiated in early menopause has no substantial effect on cognition, but, based on observational studies, it may prevent Alzheimer’s disease in later life. In RCTs, oral MHT initiated in women aged 65 or older also has no substantial effect on cognition and increases the risk of dementia.

MHT may be beneficial in improving mood in early postmenopausal women with depressive and/or anxiety symptoms. MHT may also be beneficial for perimenopausal women with major depression but antidepressant therapy remains first-line treatment in this setting.

General principles governing the use of MHT^13,14

The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use.

Consideration of MHT for symptom relief or osteoporosis prevention should be a part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking cessation and safe levels of alcohol consumption for maintaining the health and quality of life of peri- and postmenopausal women.

MHT includes a wide range of hormonal products and routes of administration, including tibolone (where available) or CE/BZA, with potentially different risks and benefits. However, evidence regarding differences in risks and benefits between different products is limited.

The type and route of administration of MHT should be consistent with treatment goals, patient preference and safety issues and should be individualized. The dosage should be titrated to the lowest appropriate and most effective dose.

Duration of treatment should be consistent with the treatment goals of the individual, and the benefit/risk profile needs to be individually reassessed annually. This is important in view of new data indicating longer duration of VMS in some women.

Estrogen as a single systemic agent is appropriate in women after hysterectomy but concomitant progestogen is required in the presence of a uterus for endometrial protection with the exception that CE can be combined with BZA for uterine protection.

The use of continuous testosterone therapy, either alone or with MHT, is supported in carefully selected postmenopausal women with sexual interest/arousal disorder (in countries with regulatory approval).

The use of custom-compounded hormone therapy is not recommended because of lack of regulation, rigorous safety and efficacy testing, batch standardization, and purity measures.

Current safety data do not support the use of systemic MHT in breast cancer survivors, although discussions, in selected women and in conjunction with each woman’s oncologist, may occur for compelling reasons after non-hormonal or complementary options have been unsuccessful.

On continuing use of systemic hormone therapy after age 65, The North American Menopause Society Statement has provided that if a woman has been advised of the increase in risks associated with continuing HT beyond age 60 and has clinical supervision, extending HT use with the lowest effective dose is acceptable under some circumstances, such as for the woman who has persistent bothersome menopausal symptoms and for whom her clinician has determined that the benefits of menopause symptom relief outweigh the risks. Use of HT should be individualized and not discontinued solely based on a woman’s age. The decision to continue or discontinue HT should be made jointly by the woman and her healthcare provider¹⁵.

Conclusion

Body of evidence on HRT use suggests that all interventions to relieve menopausal symptoms should be individually tailored to the specific needs and concerns of each woman to provide an optimal quality of life. Menopause – the natural event in every woman’s life should be treated keeping in view the symptoms experienced by many women in milder or severe form. For relief of hot flushes and vaginal dryness HRT remains the most effective pharmacologic intervention. The benefits of HRT include protection from osteoporotic fracture and colon cancer but evidences show that the risk of CHD is reduced in younger women (less than 60 years) and women beginning  HRT near menopause (within 10 years). HRT for the treatment of menopausal symptoms and prevention of osteoporosis is suggestive because studies support that estrogens and estrogen plus progestins increase bone density and reduce risk of fractures by preventing bone loss in both young and older postmenopausal women. The decision to use HRT should be a joint one between a woman and her doctor with consideration to her need for treatment, her age, history, risk factors and personal preferences. For all women the lowest effective dose should be used for the shortest time. The need to continue the HRT should be reviewed every 6 to 12 months taking into consideration the change risk-benefit balance. Recent literature review suggests that the use of HRT in management of menopause in specific age groups, regimens, dosage forms is safe as the benefits in such patterns outweigh the risks associated with the HRT usage.

References:

1. Geer MI, Hussain PT, Mir JI. Risk-benefit analysis of combination versus unopposed HRT in post-menopausal women. International Journal of User-Driven Healthcare 2011;1(4):61-76.
2. Panay N, Hamoda H, Arya R. The 2013 British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy. Menopause International: The Integrated Journal of Postreproductive Health 2013; 0(0):1–10.
3. Kanis JA, McCloskey EV, Johansson H. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013;24:23–57.
4. Palacios S. Advances in hormone replacement therapy: making the menopause manageable. BMC Women’s Health 2008;8:22.
5. Sjogren LL, Morch LS, Lokkegaard E. Hormone replacement therapy and the risk of endometrial cancer: A systematic review. Maturitas 2016;91:25-35.
6. Baber RJ, Panay N, Fenton A, and the IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2015;19:109–50.
7. Shifren JL, Gass ML; NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause 2014;21:1038–6.
8. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2015;100:3975–4011.
9. Neves-e-Castro M, Birkhäuser M, Samsioe G, et al. EMAS position statement: The ten point guide to the integral management of menopausal health. Maturitas 2015;81:88–92.
10. de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric 2013;16:203–4.
11. de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Maturitas 2013;74:391–92.
12. Wierman M, Arlt W, Basson R, et al. Androgen therapy (testosterone and DHEA) in women: a reappraisal: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2014;99:3489–510.
13. de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised global consensus statement on menopausal hormone therapy. Climacteric 2016;19(4):313-5.
14. de Villiers TJ, Hall JE, Pinkerton JV, et al. Revised global consensus statement on menopausal hormone therapy. Maturitas 2016;91;153-55.
15. NAMS: The North American Menopause Society Statement on continuing use of systemic hormone therapy after age 65. Menopause 2015; 22(7):1.

Pharmaceutical Care – Emerging New Role of a Clinical Pharmacist

Over the past few decades there has been a trend for pharmacy profession to move away from its original focus on medicine supply towards a more inclusive focus on patient care. The role of the pharmacist has evolved from that of a compounder and supplier of pharmaceutical products towards that of a provider of services and information and ultimately that of a provider of patient care. Number of medication options have also multiplied manifold thus raising the complexity of therapies. Pharmacists have a unique role to play in evaluating these options and utilize their knowledge and skills to prevent, detect, monitor and resolve any medicine related problems. The concept of the seven-star pharmacist, introduced by WHO and taken up by the International Pharmaceutical Federation (FIP) in 2000 in its policy statement on Good Pharmacy Practice, sees the pharmacist as a caregiver, communicator, decision-maker, teacher, life-long learner, leader and manager.

However the involvement of qualified pharmacists in J&K state in this regard has remained abysmally low, contrary to trends in other Indian states and developed countries. While seeking medical help, people think of a doctor or a nurse or a medical assistant, but seldom does a pharmacist come to mind probably because even a matriculate is eligible to be registered as a pharmacist in this state and anybody can get a license to sell medicines irrespective of his educational and technical background. Amidst all the mess prevailing in our state, people holding degrees in Pharmaceutical Sciences are jobless and have been left to lurch to fend for themselves. All this needs correction by introducing professional services of Clinical Pharmacy alongwith a novel concept of “Pharmaceutical Care”.

Pharmaceutical Care is a patient-centered, outcome-oriented pharmacy practice that requires the qualified pharmacist to work in concert with the patient and the patient's other healthcare providers to promote health, to prevent disease and to make sure that drug therapy regimens are safe and effective. Professional Clinical Pharmacy services offered by trained personnel holding graduate and post-graduate degrees in Pharmaceutical Sciences can help a great deal in identifying potential and actual drug-related problems; addressing needs and resolving actual drug related problems; preventing potential drug-related problems and optimizing patient therapy outcomes.  It is a practice in which the pharmacy practitioner assures that all of a patient's drug therapy is used appropriately for each medical condition; the most effective drug therapy available is used; the safest drug therapy possible is used, and the patient is able and willing to take the medication as intended. Patients in our part of the globe have not been able to avail such professional pharmaceutical care services so far as a result of which there is large scale dissatisfaction and disillusionment among them since they largely remain uninformed about various lab investigations conducted upon them and about the necessity for various drug therapies prescribed to them.

Clinical Pharmacy on the whole is in its infancy in the state of Jammu and Kashmir and the concept of Pharmaceutical Care is completely new to most of the physicians, nurses and even pharmacists presently working at the government health facilities. As a result of the patient overload of physicians and some other reasons, they are not in a position to offer detailed counseling, patient education and pharmaceutical care services on individual basis to all their patients. Therefore it is for the trained pharmacy practitioners to step in and fill the void by offering such services with a view to achieve definite therapeutic outcomes that improve a patient’s quality of life. Overall goal of professional Clinical Pharmacy services is to optimize the therapeutic outcome management and decrease the burden of five D’s viz, death, disease, disability, discomfort and dissatisfaction among patients. Clinical, economic and humanistic outcomes will also shift towards the positive side as a result of these integrated and seamless healthcare services rendered by a trained pharmacy practitioner. With these aims and objectives, University of Kashmir started a post-graduate programme in Pharmacy Practice seven years back at its Department of Pharmaceutical Sciences. The course includes a mandatory practical internship training for six months in a hospital besides a year-long research work in hospital, clinical or community pharmacy that culminates with compilation and submission of a dissertation.

Overall scenario in relation to professional pharmacy services in the entire state of J&K is very dismal where we have mostly unqualified people working as pharmacists in retail pharmacies and dispensing medicines to patients without any technical know-how about the same and without providing any basic information to the patients about the use and possible side-effects of medicines. In government sector too, pharmacies within hospitals, primary health centres and sub-centres are manned by Medical Assistants who have not undergone any formal training as required under norms, specifically in pharmacy. We don’t have any positions available for pharmacy graduates and post-graduates at any level in our government sector. In fact their applications are not accepted for Junior Pharmacist posts on the pretext of being ‘over-qualified’ for the job. Consequently the services of qualified pharmacists remain completely unutilized in the state, depriving patients of precious information about the use of drugs.

Need of the hour is that our state government recognizes the role of pharmacy graduates well in time and creates adequate number of vacancies for them in all primary, secondary and tertiary care hospitals of the state. As of now our pharmacy graduates are not even able to apply against any position of a pharmacist advertised by the govt. because essential qualification for the same is Medical Assistant diploma and the applications of our graduates are not even accepted by govt. officials on the pretext that they are over-qualified for the post. This is a paradox that needs to be addressed. If we are not able to give suitable opportunities to our pharmacy graduates to utilize their expertise and offer their services to the patients and if we are not able to chalk out their clear cut role in patient care, then we and our government shall be failing in our respective duties and responsibilities towards our society. Every major hospital in our state needs to have a full-fledged Department of Pharmacy Practice with adequate infrastructure, manpower, equipments and funding but unfortunately none of our major hospitals has taken a leap towards establishing Clinical pharmacy practice departments in spite of being a compulsory MCI norm. Since this requirement is already well stipulated in the approved drug policy of our state, government needs to start working in that direction in its right earnest.

Need of the hour is to design, implement and monitor policies aimed at providing professional Clinical Pharmacy services to the patients at primary, secondary and tertiary care level so that the services of pharmacy graduates and post-graduates can be availed at every level of our healthcare system for the greater benefit of the patients at large. Such services will also pave way for the engagement of trained and qualified pharmacists in providing patient education and counseling services, monitoring drug therapy and suggesting interventions wherever required, reporting any adverse drug reactions and drug interactions, supplying drug information to physicians and nurses, conducting drug-utilization evaluation studies, assist in framing policies, preparing monographs and hospital formularies and in providing poison control services. Trained and qualified pharmacy practitioners should be a part and parcel of the medical team during ward rounds and their assistance must be sought in prescribing best possible drug therapy to the patients. It is time to keep pace with fast changing times and trends and establish clinical pharmacy as a full-fledged profession in the state, ultimate aim of which is to optimize the clinical outcomes of drug therapy and thereby improve patient’s health-related quality of life.

(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and can be reached at ishaqgeer@gmail.com)

JKMSCL and the quality of drugs supplied to govt. hospitals

Dr Geer Mohammad Ishaq in his article published by Daily Greater Kashmir for publication dwells upon the measures needed to be taken by JKMSCL in order to ensure quality and streamline supply of medicines in the state

J&K Medical Supplies Corporation Limited has once again been in news albeit for wrong reasons. Several cases of substandard drugs being supplied by JKMSCL to government hospitals have surfaced in recent past that includes a spine-chilling case of steroids and antibiotics being supplied together in the same boxes in large quantities for use by children at a pediatric hospital. Boxes of antibiotic Vancomycin injection were found to contain vials of Prednisolone injection, a steroid and both the injections had same size, labeling and packaging design and even the same batch number, making it difficult to differentiate between the two without going through the labeling information. As many as 7000 vials were confiscated by the drug control officials from the hospital apart from seizing additional 12000 vials from the drug warehouse at Government Medical College, Srinagar. Any use of steroid in place of an antibiotic would have wreaked disaster among pediatric patients making them vulnerable to potentially serious health hazards. Recently it also came to the fore that five out of the six substandard drugs supplied by the JKMSCL to the state hospitals during past few months had come from a single Himachal Pradesh based company against which reportedly no immediate action was taken due to some “procedural formalities”. 

The minister for Health and Medical Education of the state is on record to have admitted on the floor of the House that 85 drugs were found to be sub-standard including drugs like Amoxicillin capsules and Ceftriaxone injections supplied by Jammu and Kashmir Medical Supplies Corporation Limited. Earlier a CAG report tabled in the state legislative assembly had also brought to light some serious lapses in the procurement processes for equipments and supplies in J&K Health Department, and had also depicted gross negligence and apathy on part of the officials in ensuring supply of quality and safe medicines to patients that can be gauged from the fact that as per this report, 50.95 lakh sub-standard tablets, capsules and injections had been issued to patients in various govt. hospitals. CAG report has also revealed acute deficiency of drugs and disposables for testing in healthcare institutes. All this has led to soaring mass resentment and anxiety and has further diminished already plummeted faith and trust of common people upon medicines being issued at public health facilities.

Local print media particularly GK has been doing a commendable job in highlighting these crucial issues of high importance having serious implications on overall public health. However, while rightly blaming the faulty drug procurement and flawed quality testing procedures being adopted by JKMSCL at present, for the dismal scenario, some sections of the pharmaceutical traders as well as medical fraternity have also been suggesting winding up of the whole JKMSCL and reverting back to previous mode of decentralized procurement by different institutions and departments in a fragmented manner. Question is whether dissolution and dismantling of JKMSCL is the right answer to the miseries of common masses vis-à-vis quality and availability of medicines at govt. health centres. Answer inevitably is a clear ‘No’ since JKMSCL is a step in the right direction taken on the basis of premier drug policy of the J&K state that was formulated and adopted by the state govt. in the year 2012.

Main purpose behind establishing JKMSCL was to centralize procurement and decentralize distribution of standard quality medicines on the lines of Tamil Nadu and Rajasthan Medical Services Corporations which have been successful, WHO-endorsed models in this field and have led to conservation of 38 to 45% of financial resources meant for drug procurement that in turn has directly benefited patients of these states for whom availability and affordability of standard quality generic medicines has drastically improved. Since getting good health care is not a privilege but a fundamental right of every human being, a just and humane society must be able to provide reasonable, universal access to safe, effective and standard quality medicines to all its citizens irrespective of their caste, creed, religion or their paying capacity. Universal access to health care is well recognized as a basic right of the people under the right to protection of life and personal liberty as enshrined under Article 21 of the Constitution of India as well as under Section 24 of the Constitution of Jammu & Kashmir state. Therefore main idea behind JKMSCL was to pool all the previously fragmented and dispersed financial resources meant for procurement of quality medicines and to utilize them to the best possible benefits of patients. Hence those who talk of its dismantling or dissolution cannot be considered as the well-wishers of patients. Then the next obvious question would be as to where does the actual fault lie and what needs to be done to rectify the same.

Roots of the problem lie in the fact that JKMSCL is functioning in the state in absence of proper drug procurement policy framework, there is lack of adequate, scientific warehousing and inventory management system that includes state-of-the-art drug storage facilities fully equipped with Management Information System (MIS) for real-time monitoring of stocks in all districts and divisions of the state, lack of sufficient, dedicated transportation vehicles laced with cold-chain facilities, non-availability of qualified and adequate manpower trained specifically in supply chain management, paucity of funds for procurement as well as non-procurement purposes, lack of adequate, sophisticated drug testing facilities and deficiency of frequent, random drug sampling procedures, non-compliance with stringent pre- and post-qualification criteria to promote competition and enforce quality, dearth of scientific demand estimation and forecasting system to accurately quantify procurement, well defined, precise and localized Essential Drugs List, protocols for regular inspection of supplier premises and mandatory multiple external quality testing. A lot can be written about each of these supply chain management activities, however due to constraints of space only a couple of important issues shall be briefly discussed in the remaining part of this write-up.

While the spirit with which JKMSCL was established is admirable, the way it is functioning is unscientific and needs some serious thinking. No such corporation can be a success unless it is fully autonomous, completely transparent and accountable and functions on well established scientific principles of pharmaceutical supply chain management. There is need to streamline the entire system on modern, scientific and professional lines and organize all its activities in a systematic manner in tune with international standards and norms. A foolproof quality assurance system needs to be adopted leaving no room at all for any compromises on the quality of medicines being supplied to patients. Government needs to engage suitably qualified and adequately trained personnel for the purpose of drug procurement, demand estimation, quantification, pre-qualification and post-qualification procedures. At present no such executive or administrative staff is available in sufficient numbers exclusively for medicine management activities at any of the government health departments of J&K state like Departments of Health, Family Welfare, Medical Education, Provincial Medical Stores or Govt. Medical College, Srinagar that are adequately trained to serve the purpose. Furthermore JKMSCL needs to fulfill all necessary pre-requisites like state-of-art warehouses, dedicated transportation, qualified manpower, adequate funds, sophisticated quality testing facilities, regular inspections of retail outlets and frequent drug sampling in order to bring it back on track and fulfill its objectives. In absence of such a robust mechanism JKMSCL will continue to fail in its objectives of making standard quality medicines available throughout the year without any stock-outs in all healthcare facilities of the state.

Establishment of a comprehensive Quality Assurance system involving both surveillance and testing of drug quality, involving both technical and managerial activities, helps in ensuring quality of the medicines. Various national standards suggest that drug quality should be assessed as compliance with pharmacopoeial specifications concerning a drug’s identity, purity, potency and other characteristics like uniformity of the dosage form, bioavailability, bioequivalence and stability. Basic quality assurance procedures like visual inspection of labelling carried out by a qualified pharmacist can easily be adopted at facility level. Random sampling of drug consignments for the purpose of testing soon after its procurement as well as from district and block level health facilities after distribution is an important step in ensuring quality of medicines. However JKMSC must not rely completely upon the insufficient govt. drug testing facilities available in the state. It must empanel accredited private drug testing laboratories on the lines of Tamil Nadu Medical Services Corporation and send coded samples to them for testing after carrying out due process of their validation. Meanwhile govt. needs to accord top priority to augmenting drug testing facilities in the state on modern lines by installing state-of-the-art sophisticated equipments and mobile testing vans laced with all the modern gadgetry required to test drugs on the spot in far flung areas. Gujarat FDA has taken lead in this respect by procuring around 30 mobile testing vans that are able to reach any nook and corner of the state and conduct on-the-spot testing of drugs without even opening the containers at the first instance. Our state too needs to follow the suit.

Inappropriate and inefficient medicine procurement system leads to sub-optimal use of resources with poor value for money. Government needs to promulgate a robust drug procurement policy and implement the drug policy in letter and spirit that has already been approved by the state assembly five years back. It is highly deplorable on part of the government that even after the lapse of five years drug policy is still awaiting implementation because of which poor patients are suffering for want of good quality medicines at government health facilities of the state. In this direction free drug policy need not be confused with drug policy per se since they are not one and the same thing. Some time back news reports appeared in the local press revealing that first ever state level Essential Drugs List (EDL) has been customized and the same consists of a total of 1200 medicines. Such a huge list kills the basic aim and objective of formulating an Essential Drugs Lists since a concise list would have allowed concentration of all efforts vis-à-vis medicines management activities as well as limited resources on a small number of drugs leading to better results in terms of conservation of resources, large volume of purchases and consequently greater availability of essential medicines. Having 1200 drugs in EDL literally means including almost all drugs available in the market which would hardly translate into any tangible benefits for the patients. If the essential list finalized by JKMSC consists of 1200 drugs, it need correction as the essence of EDL lies in limiting the number of essential drugs based on individual facility/societal needs.

In conclusion appropriate measures need to be taken in the form of decisions, actions particularly for proper selection, quantification, forecasting, procurement, distribution and use of medicines to make the supply chain more efficient. Moreover disbursement of funds should also be sufficient and timely to cater to the needs of individual hospitals across all levels of care. Scattered and sparse budgetary allocations for medicines available with individual hospitals need to be pooled at the central level for optimal utilization of available resources resulting into more efficient procurement since centralized procurement and decentralized distribution has been found to improve access to medicines in all settings. All the activities related to medicines management and supply chain need to be carried out in accordance with standard guidelines and good practices involving only qualified and professional manpower. Evaluation of supply chain should be carried out regularly to monitor the performance. Facility specific policies and procedures with SOPs should be developed and adhered to for better compliance with existing standards. It is high time that the Govt. of J&K state starts implementing its premier drug policy that has been gathering dust over the past five years in the corridors of power, in letter and spirit. That shall go a long way in alleviating the sufferings and addressing the concerns of common masses regarding quality of medicines.

(Author teaches at the Dept. of Pharmaceutical Sciences, University of Kashmir and can be reached at ishaqgeer@gmail.com)

Refresher Course in Behavioural Sciences held at UGC-HRDC, UoK

A total of 32 faculty members from various colleges and universities of the Jammu and Kashmir state assembled in the apparently secluded and visibly deserted fag end of the Naseembagh campus over the past three weeks of ongoing frigid, snowy winter when every inch of the surface was covered by a thick blanket of snow and it was intermittently down pouring from above. However they were here with a specific purpose and the purpose was to convert this part of celestial Naseembagh into an epicentre of intense academic brainstorming and intellectual discourse on various issues concerning human behavior. The purpose of staying together for twenty one days was to invigorate themselves and update their knowledge, skills and competencies vis-à-vis influence of various aspects of human behavior on the teaching-learning process, higher education system, research output, educational pedagogy, higher education administration and management besides other socio-economic and political concerns.

This very goal was achieved by inviting eminent resource persons in the field of education, psychology, commerce and management, science and technology, political and social sciences, medicine, law, literature, media and religious studies to interact with the participants on various relevant issues. Invited resource persons were experienced academicians of repute whose illustrious careers spanned over several decades. They deliberated upon several topics of interest like personality development and organizational citizenship behavior, law and human behavior, importance of mental health, psychiatric and personality disorders, role of teachers in containing substance abuse among young adults, health issues of the elderly, natural environment, climate change and human behavior, use of media for mind control and behavioural psychology, transactional analysis, teaching-learning process and student behavior, research methodology issues in behavioural sciences, youth in Kashmir and South Asia through the behavioural prism, creativity as a tool of behavior management, problems of adolescents and role of teachers in restricting misbehavior, total quality management and human resource development in higher education, stress management, applications of spiritual psychology, psycho-spiritual dimensions of jihad, spiritual counseling, contribution of Mir Sayyid Ali Hamadani towards Taswuf, basic question of human existence, spiritual evolution of man from finite to infinite, language and behaviourism, behaviouralism through sociological imagination, cell sensing and communication and an introduction to data mining.

Resource Persons who deliberated on these topics included Prof. Akbar Hussain, Dept. of Psychology, Aligarh Muslim University, Prof. Mushtaq Marghoob, Dr Arshad Hussain, Dept. of Psychiatry, Govt. Medical College, Srinagar, Prof. Hamidullah Marazi, Dean, Social Sciences, Central University of Kashmir, Prof. Khurshid Ali, Former-Dean Academic Affairs, University of Kashmir, Prof. Shafi Shouq, Former Dean, Faculty of Arts, University of Kashmir, Prof. Mahmood Ahmad Khan, Dean, Faculty of Education and Behavioural Sciences, University of Kashmir, Prof. Mohammad Hussain, Dean, Faculty of Law, University of Kashmir, Prof. Gull Mohammad Wani, Dept. of Political Sciences, University of Kashmir, Prof. Abdul Gani, School of Business Studies, University of Kashmir, Prof. S. Mufeed Ahmad, Director, Business School, University of Kashmir, Prof. Zafar Ahmad Reshi, Dept. of Botany, Dr. Sheikh Showkat Hussain, Head, School of Law, Central University of Kashmir, Dr. Showkat Ahmad Shah, Head, Dept. of Psychology, University of Kashmir, Mr. Faruq Masoodi, Head, MERC, University of Kashmir, Prof. Raies Ahmad Qadri, Head, Dept. of Biotechnology, UOK, Prof. Manzoor Ahmad Bhat, Islamic Studies, UOK, Dr Mohammad Muzaffar Khan, Director, Drug De-addiction Centre, J&K Police, Prof. Pirzada Mohammad Amin, Dept. of Sociology, Dr. Khursheed Ahmad Qureshi, Dr. Sanaullah Kuchay, GMC, Srinagar, Dr. Farooq Ahmad Shah, School of Business Studies, Central University of Kashmir, University of Kashmir, Dr Mushtaq Ahmad Darzi, Business School, University of Kashmir, Prof. Manzoor Ahmad Bhat, Islamic Studies, Dr Syeda Afshana, MERC, Dr. Majid Zaman Baba, IT&SS, Dr Mohammad Ishaq Geer, Dept. of Pharm. Sciences and  Dr Mufti Mudasir, Dept. of English, University of Kashmir.

Dr. Showkat Ahmad Shah, Head, Dept. of Psychology served as Coordinator of the Refresher Course whereas Prof. Mohiuddin Sangmi, Director, HRDC offered him full support, cooperation and guidance in successful conduct of the course. Feedback about each resource person as well as about the whole course was obtained from all the participants which revealed that the participants were fully satisfied with the design, organization, conduct and content of the course. They were of the firm opinion that the course will positively impact upon their outlook as well as behavior towards their students, colleagues, administrators and will help them better manage their day-to-day chores in pursuit of their duties and goals. Kudos to Course Coordinator and Director, HRDC for their efforts in making this programme a success. Few suggestions for improvement were also received from the participants which shall be duly considered in the design and conduct of future courses. We wish all the participants best of luck in all their future endeavours.

Dr. Geer Mohammad Ishaq

C O O R D I N A T O R

General Orientation Programme for newly appointed teachers of higher education sector

Our educational system needs to provide adequate opportunities for the professional, personality and career development of teachers since they are central to the whole education system. We need to develop inbuilt mechanisms for their continuing education in order to provide adequate opportunities for teachers within the framework of knowledge society. Generally college or university teachers learn their art of teaching by emulating outstanding models such as their own teachers or senior colleagues. However, today, it is no longer possible to expect newly appointed teachers to acquire the art of teaching by emulating their peers. Furthermore, there has been a knowledge explosion in every discipline. College and university teachers have to continuously update their knowledge in their own areas of expertise, or simply run the risk of becoming totally redundant in a very short span of time. While the really motivated and industrious teachers use their own resources to keep themselves abreast of new knowledge and to train themselves in the latest processes, methodologies and techniques of teaching, it is necessary to provide systematic and organized orientation programmes for the large number of teachers at the college and university level. This assumes greater importance in light of the fact that unlike doctors, IAS and IPS officers no internship or probationary training is imparted to teachers before sending them into the actual profession of teaching. While most of them know their own subject very well, some of them find themselves at loggerheads when it comes to teaching in a classroom.

In light of these aims and objectives, 66 Human Resource Development Centres, formerly known as Academic Staff Colleges have been established in 26 states across India by the University Grants Commission with a view to organize specially designed orientation programmes and refresher courses in pedagogy, educational psychology and philosophy, information technology and socio-economic and political concerns for all new entrants at the level of lecturers, covering every teacher at least once in three to five years and to encourage teachers to participate in seminars, symposia, workshops, etc.

Aim of the UGC-Human Resource Development Centre, University of Kashmir is to design, organize, conduct, monitor and evaluate General Orientation and Refresher Courses for college and university teachers, interaction programmes for doctoral and post-doctoral scholars, short-term courses for senior administrators, heads of departments, principals, deans and functionaries, teaching programmes for non-teaching staff besides seminars, symposia, workshops for all these categories in accordance with UGC guidelines. It was in fulfillment of this function that the UGC-HRDC, UOK organized 73^rd General Orientation Course for newly appointed college and university teachers from December 6^th, 2016 to January 4^th, 2017, which was attended by a total of 29 faculty members from different colleges and universities of J&K in the serene Naseembagh campus of the University of Kashmir where the tranquil winter ambience and soothing shade of blazing chinars provided a perfect atmosphere for brainstorming, intellectual discourse and exchange of ideas.

This course was like a bouquet of flowers that had flowers of different hues, colours and fragrances. Under the dynamic leadership of Director, HRDC, Prof. Mohi-ud-din Sangmi a host of Resource Persons from diverse streams of Education, Economics, Computer Sciences, Information Technology, History, Central Asian Studies, Psychology, Earth Sciences, Home Science, Women’s Studies, Physics, Media Education, Law, English Literature, Electronics and Communication Technology, Commerce, Business and Management Studies, Islamic Studies and Environmental Studies were invited to interact with the participants of the course. As per the feedback received from participants of this course most of the invited resource persons were highly resourceful, eloquent and articulate in putting across their viewpoints even though it needs to be mentioned that a few Resource Persons did not receive a very encouraging feedback from the participants. However presentations and deliberations made by most of the invited resource persons were rich in content wherein they not only shared their knowledge but also their wisdom, and their lifetime experiences giving real life examples of the efforts they had put in their own areas of expertise and the bottlenecks they had faced. This gave the participants an insight on how to overcome such difficulties while in pursuit of their goals and missions and that is surely going to stand them in a good stead in the times to come.

Some of the eminent resource persons who interacted with the participants of the 73^rd General Orientation Course include Dean Academic Affairs, Prof. Mohammad Ashraf Wani, Dean Research, Prof. Sheikh Javed Ahmad, Registrar, Prof. Musadiq Amin Sahaf, Ex-Registrar, Prof. Zafar Ahmad Reshi, Dean College Development Council, Prof. Nilofar Khan, Controller of Examination, Prof. Abdul Salam Bhat, Dean, Applied Sciences and Technology, Prof. Ghulam Mohiuddin Bhat, Director, North Campus, Dr Irshad Ahmad Wani, Dean and Director, Research and Development, Central University of Kashmir, Prof. Mohammad Aslam, Dean, Social Sciences, CUK, Prof. Hamidullah Marazi, Dean, Faculty of Law, Prof. Mohammad Hussain, Dean, Faculty of Education, Prof. Mahmood Ahmad Khan, Chief Coordinator, DIQA, Dr Manzoor Ah Shah, Retired Justice Bashir Ahmad Kirmani, Veteran Educationist, Prof. A.G. Madhosh, Veteran Economist, Prof. Nisar Ali, Principal, S. P. College, Srinagar, Prof. Yaseen Ahmad Shah, Head, Business School, Prof. Mufeed Ahmad, Head, Dept. of Earth Sciences, Prof. Shakil Ah. Romshoo, Head Dept. of Food Sciences, Prof. Farooq Masoodi, Head, Dept. of Physics, Prof. Manzoor Ahmad Malik, Head Dept. of Psychology, Dr. Showkat Hussain, Ex-Joint Director Finance, Mohammad Ashraf Malik, Director I.T & S.S Er Maroof Qadri, Ajaz ul Haque, EMMRC, Dr Sayeda Afshana, MERC, Dr Mufti Mudasir, Dept. of English, Er. Majid Zaman, IT&SS, Dr Muheet Ahmad, Institute of Computer Sciences, Dr. Bashir Ah. Joo, Prof. Mustaq Ahmad Darzi and Dr. Tariq Ah. Lone, Business School, Dr Bashir Ahmad, Mr. Fazl Illahi and Mr. M. S. Allaye from IASE, Dr Manzoor Ah. Bhat, Islamic Studies, Dr. Arshad Hussain, GMC, Dr. Shariq Masoodi, SKIMS, Dr. M. Ayub Dar, Dept. of Law, Mr. Shahnaz Bashir, CUK, Dr. Tabasum Firdous, CCAS, Dr Maroof Shah and Dr. M. I. Geer, Dept. of Pharm. Sciences. Most of these lectures were perceived as very insightful and enlightening by the participants.

Major thrust during the General Orientation Course was laid upon basic modalities of teaching and learning process besides imparting induction type training so that the participants are familiarized with basic functioning of Examining Wing, IT&SS dept, DIQA etc. In pursuit of these very goals, apart from regular teaching sessions a day-long workshop on choice-based credit system was conducted by Dr. S. M. Shafi of the Dept. of Commerce wherein participants were made to design new curricula in accordance with CBCS and another day-long workshop on e-content development was conducted at EMMRC, University of Kashmir wherein participants were given hands-on training on e-content development. Two full days were devoted to sessions on higher education, teaching skills, microteaching, effectiveness and philosophy of education and two full days were devoted to information technology, e-governance, e-learning and e-resources. All these workshops were a unique learning experience that infused new skills among the participants and apprised them about the application and use of such modalities in higher education system. Participants also had a few sessions on service rules, income tax and leave rules governing teaching faculty in higher education. They also wrote book reviews, gave presentations of their own works and areas of expertise, appeared in a written test at the end of the course and conducted day to day sessions in an amiable manner. Feedback about each and every resource person, feedback about the whole course as well as reports of day-to-day proceedings were obtained from the participants of both the courses on daily basis. Most of the course material pertaining to the course has been made available on HRDC website for the benefit of the participants.

Valedictory function of the course was held on January 4^th, 2017 that was presided over by the Hon’ble Vice-Chancellor, University of Kashmir, Prof. Khurshid Iqbal Andrabi who in his presidential address emphasized upon the need to change and transform teachers as well as teaching pedagogies in accordance with changing paradigms of higher education so that they can keep pace with fast changing times and trends. He urged upon teachers to be proud of being a teacher and carry forward the legacy of being a teacher. He also called for a few sessions on teaching and educational ethics in every such course.

(Author is Coordinator at the UGC-HRDC, University of Kashmir)