Use of student feedback in teacher evaluation: need for revalidation

While there is need to ensure academic accountability of teachers working in higher educational institutions and welcome any initiatives and reforms aimed at streamlining teacher performance through student feedback or any other mechanism, it becomes imperative to validate and standardize any such system before invoking it owing to the fact that any biased or prejudiced feedback will seriously dent the career and reputation of teachers involved. Therefore there is need to doubly ensure that there is no element of bias or prejudice in the student feedback mechanism suggested by the institutions of higher learning. The existing student feedback system used by higher educational institutions across India is statistically as well as scientifically inaccurate and needs to be made fool-proof and efficient before utilizing it for the desired purpose. Standard practice proposed by UGC in this regard needs to be converted into best practice first. As per National Assessment and Accreditation Council (NAAC), “a standard practice qualifies to a best practice status if it results in high-value impact on any aspect of educational activity in an institution. Best practice is nothing but value-added standard practice. Continual review and improvement of a current practice becomes necessary to elevate it to the status of a best practice, more so in the present day scenario of fast-paced educational innovations”.

NAAC guidelines also stipulate that “students are supposed to be the most important stakeholders of higher education system. The interest and participation of students at all levels in both internal quality assurance and external quality assurance have to play a central role. Higher education is first and foremost about the enhancement and empowerment of students as participants in a process of learning for transformation. Any higher education institution therefore needs to ensure that students have a voice at various decision-making processes, formulating learning and teaching practices and the views of students are to be considered as the primary evidence on which the quality of teaching and learning is evaluated.”

Having said this, fact of the matter is that the present system of student feedback has a potential to generate many false positive and false negative results that needs attention. Existing system allows students to score teachers on sympathetic, personal, vindictive as well as other stray considerations and not purely on their teaching qualities. For instance in departments where total number of students in a class is less (say 10-20), few bad scores on personal and non-scholastic considerations are sufficient to bring the mean score of the teacher drastically down no matter if all others have rated him/her highly on all parameters. This statistical error needs to be rectified. Furthermore there should be some grading of top ranking and bottom ranking students’ feedback because top ranking students are studious, sincere, serious and forthright in their feedback whereas same cannot be said about the bottom ranking students who mostly remain absent, keep failing in internals and externals, do not complete their assignments in time and lack discipline. Every student cannot be placed at the same pedestal while according weightage or value to his/her score. Few bad scores of few bad students should not be allowed to ruin the hardwork, career and reputation of a sincere and committed teacher.

While students need to be empowered they cannot be allowed to overpower teachers or vice versa. It will never be in the interest of academics. If that happens, instead of bringing some semblance of order and discipline back in our higher education system which the student feedback is understandably aimed it, it will only wreak havoc in the same. A teacher will literally become subservient to students’ sweet will and dictates. Teacher supremacy must sustain in a student-teacher relationship and decision making though there is no denial of the fact that in the changing global scenario it should be more of a mentorship rather than dictatorship. A teacher has to act like a friend, philosopher, counselor and guide of his students rather than a whip flouting master.

Student feedback should be anonymous, external and tamper-proof for if there is any scope of tampering and manipulation of the same, it will only become a tool of vendetta in the hands of those who want to settle personal scores and grudges. All outgoing students of the final semester should be called to an external venue by an external agency for collecting their anonymous feedback or the same can also be collected online by a third party using a fully secure and confidential software system. Those who have failed or have had shortages in their attendance or bad track record should be debarred from this exercise. More weightage should be given to the feedback of top ranking students. Parameters of evaluation should be exhaustive rather than selective in order to remove any scope of ambiguity, lack of clarity and confusion. Five-point feedback criteria being used at present somewhere lacks in reliability, selectivity, specificity and predictive value of teacher quality. A ten-point explicit scale having greater accuracy and precision that takes into account all important attributes of a good teacher needs to be devised for this purpose. Before approving and utilizing the same, its pre-testing/validation must be done by seeking feedback from experts in the field on its clarity, comprehensibility, lucidity and un-ambiguity.

                       

It is very important that teachers who receive poor student feedback must be immediately informed about the same for taking corrective measures and intensive in-house training sessions should be conducted to orient such teachers for improving their performance. Anonymous students’ feedback should also be given due weightage in the promotion of teachers so that those receiving poor feedback will get automatically penalized leaving little scope for any additional penalties. However teachers who fail to improve their score beyond a certain threshold level for three consecutive years must be penalized, for instance by withholding their annual increments, for upholding academic accountability. Entire feedback system needs to be made fully transparent while at the same time maintaining confidentiality of students.

Furthermore it is high time when the new Vice-Chancellors of our universities should stop ruling from the ivory towers, deviate from conventional bureaucratic ways and means and connect with their staff and students directly. They should act like field commanders by sparing one hour daily or alternately for making surprise visits to the departments and centres to physically check teaching and research activities, talk to students, staff, HODs and teachers regarding their issues and concerns, themselves sit in the classrooms randomly to witness teaching quality and suggest improvements instantly, counsel the staff and students persistently and even take action wherever needed. This will act as a big deterrent and automatically improve the system. They should prefer a conciliatory and restorative approach over an aggressive or punitive one.

Apart from seeking feedback from students about teachers and their teaching quality, written or online feedback should also be sought on regular basis from them in tune with NAAC recommendations about their courses, departments, HODs, university and its administration on the whole. That will make the feedback all-inclusive and help in overall improvement of the system. A Students Council should be constituted in every university that has a President and a Vice-President from final or pre-final semesters and a Secretary and Joint Secretary from 2^nd or 3^rd semesters duly elected by the General Council of class representatives who in turn are elected through secret ballot by the students in their respective classes under the supervision of a teacher who acts as student coordinator. President of the Students Council must have a say in all student related matters at every forum and decision-making body of the university and the student grievance cell must also be constituted and made fully functional in every university.

Dean Students Welfare of every university apart from organizing student welfare activities must maintain a close rapport with Students Council and Students’ Grievance Cell for an overall supervision of the related activities. This will ensure student participation in quality assurance in a democratic manner and pave way for their active role in decision making and grievance redressal system of the university. It will also foster and promote cordial relationships between students and teachers and among students themselves. Furthermore each and every department must convene regular open-house meetings of all students of a class with all teachers of that department to facilitate open discussions between students and teachers regarding all matters which are important for both the parties.

Teachers on their part also need to connect with the society directly by establishing a community centre where common people can throng once in a week with their problems, issues and needs so that we can address the same through our teaching, innovation and research.  A state-of-art innovation incubation centre can also be established in the University for this purpose. There is a huge gap between us and our society that has resulted into some trust deficit and alienation.  People don't seem to be thinking too high about the quality of our teaching and research. While all that a few people say about us might not be true, somewhere we are failing in living up to the expectations of our society.  We need to bridge the gap and connect with them like agricultural scientists do and probably that is the reason why nobody takes potshots on them on the social media. Worldwide universities are establishing innovation rooms, social shops and community centres to connect with their society and address their needs.

Dr Geer M Ishaq

No college versus university teachers issue at all

This bears reference to a couple of articles published in GK in response to the joint press statement issued by KUTA and JUTA against the order issued by Principal Secretary, Higher Education, Govt. of J&K authorizing all college teachers to act as guides and co-guides for supervising M.Phil. and Ph.D. scholars. Pointed references have been made to the joint statement of KUTA and JUTA in these articles vehemently criticizing the same and taking jibes at their stand on the issue. While constructive criticism is the life and soul of any democracy, undue criticism not based on reason and facts is not only unwarranted and distasteful but divisive too. While putting across their point authors have used some choicest invectives to describe KUTA, University Teachers in general and University Research which is highly unbecoming owing to the fact that use of such language does not help in any manner to promote collaborations and foster inter-institutional relationship rather it only dents any such advancements.

While initially KUTA didn’t deem it necessary to respond to these articles since our initial press statement was self-explanatory wherein we had made our stand amply clear. Furthermore the arguments made in these articles were based on faulty premise and ill conceived conclusions. However since a wrong impression and incorrect message was being passed on to the readers it was deemed needful to clear the haze and set the record straight. It is quite surprising that while authors seem to be reasonably well-read, articulate as well as eloquent in putting forth their point, they seem to have willfully chosen to ignore the assertion made in our joint statement that reads, “It needs to be clarified that KUTA and JUTA are not against authorizing college teachers to act as research guides but against the way it is sought to be done. KUTA never had any problems with that as long as it is done within the purview of statutes and regulations in vogue at present. But if attempts are made to circumvent and override the existing norms and guidelines, overstepping one’s authority, undermining the statutory bodies and usurping the autonomy of the institutions of higher learning, KUTA will oppose any such move,”. There was hardly any need to say anything more after having said that in so clear and unambiguous terms. Nowhere in this statement has JUTA and/or KUTA opposed the recognition of college teachers as research guides/co-guides following codal procedure and statutes in vogue. Even the subsequent clarification issued by the Kashmir University authorities emphasized upon the fact that UGC regulations and statutes in vogue at present shall be followed while recognizing college teachers as guides and co-guides for supervising M.Phil. and Ph.D. scholars. It is beyond one’s comprehension as to what makes the authors doubt the intentions of KUTA and JUTA and not believe their assertion. It is not clear as to what makes them believe that the University teachers somehow feel threatened or insecure by this govt. order and that they vie to have a monopoly on research. These apprehensions are totally ill-founded and baseless. University teachers have never at any point of time stated or done anything that remotely points towards these conclusions.

It is really astonishing how unsolicited motives are being attributed to KUTA and how sweeping judgments are being passed on the quality of research being done at KU as well as on the competence of university teachers while it has never been a case of university versus college teachers even though the authors in question have tried their level best to make it appear like one. At least KUTA never intended it to be that way. There is absolutely no point in pitching college teachers against university teachers for we consider both as the pivots of higher education sector in the state. Both have to work shoulder to shoulder for taking the higher education system of the state to all new heights. No sane and seasoned individual, group or association can ever seek or claim a monopoly or fiefdom on research. Research is a collective means of creating knowledge and evolving solutions to the most intriguing problems faced by the society. All stakeholders have to work in tandem to achieve these goals.

University teachers will be among the happiest lot if government allocates sufficient funds from its kitty for the upliftment of facilities and development of world-class infrastructure in colleges that is necessary to make them capable of conducting high quality research. College teachers should actually press for that rather than going gungho about an order issued from an office of the secretariat that has little significance owing to the fact that college teachers have to anyhow fulfill criteria laid out in the existing statutes and regulations and follow the proper procedure laid out in rule books before getting recognized as guides and co-guides. Kashmir University has been recognizing college teachers as co-guides since its inception several decades back and there is nothing new about it. This government order can only serve as opium for those who want to thrive upon its euphoria and enter into a mud-slinging match against university teachers. Even the Chancellor of Kashmir University, Governor of J&K state in a recent meeting held with Vice-Chancellors of Jammu and Kashmir University on March 6^th, 2018 has made it clear in presence of Education Minister and Principal Secretary Education at Jammu that, “The decisions relating to academic matters such as introduction of new courses, framing rules and regulations for running courses, authorising Professors, Associate Professors and Assistant Professors of the colleges to act as guides, co-guides for MPhil and PhD scholars should be taken strictly in terms of Jammu and Kashmir University statutes”.

Cluster Universities of Jammu and Srinagar have been established under the provisions of Srinagar and Jammu Cluster University Act 2016 as an initiative of the Centrally Sponsored Scheme, RUSA (Rashtriya Uchchatar Shiksha Abhiyan) with an aim to create new universities through upgradation of existing colleges and conversion of these colleges into a cluster. Five prominent and leading colleges of Jammu and Srinagar each have been clustered into these two universities that offer undergraduate, postgraduate, integrated masters and research degrees in humanities, social sciences, natural sciences, applied sciences, management and commerce besides some professional courses. That means they have to anyhow recognize the senior faculty working in their cluster of colleges as research supervisors and co-supervisors in order to enable them to guide M.Phil. and Ph.D. scholars registered with these universities. So when nobody has opposed establishment of these two cluster universities why would anybody oppose the research degrees that they intend to offer and the associated recognition of guides and co-guides from colleges. Only matter of concern could be the availability of adequate facilities, infrastructure, staff and funds to go ahead with research at these colleges. Furthermore as per news reports more cluster universities are in the pipeline (GK dated March 6^th, 2018: J&K seeks 6 more cluster universities: Altaf Bukhari) implying that more colleges of J&K state will be clustered together to become part of these upcoming universities paving way for more college teachers to be recognized as guides and co-guides and more infrastructure getting created at these colleges to establish research laboratories. These are all positive developments that are always welcome. This will only pave way for radical developments in the higher education sector of the state provided sufficient funds, manpower and necessary infrastructure is made available to these college and they do not meet the same fate as newly established colleges many of whom were being run in cow-sheds as per news reports. It should not be reduced to just paperwork with no substantial progress on ground and that is what college teachers and their associations should actually push for rather than prowling upon an authoritative order flown like a paper plane from some office and feeling overwhelmed about it. I am sure university teachers and their association will lend all possible support in this endeavour at every stage.

While the college teachers strive to achieve these goals they need to simultaneously protect and preserve the dignity and stature of the office of Vice-Chancellor. It is quite shocking that one of the prime constituent colleges of Cluster University Srinagar is going to organize a conference in the fourth week of March, information brochure of the conference as well as its website shows Principal Secretary higher education as Chief Patron, Principal of the college as Patron and some faculty of the college as members of organizing committee of the conference. Astonishingly name of the Vice-Chancellor of Cluster University Srinagar does not figure anywhere either in the brochure or on the website. He is nobody in the conference. This shows the level of sycophancy that some of the college teachers and principals are resorting to throwing all conventions and norms to the wind. This type of approach will not lead us anywhere. Supremacy of academics in all academic institutions has to be maintained at all costs and that is the prime issue KUTA or JUTA had with the order issued by the Principal Secretary who had marked a copy of his order to all vice-chancellors of the state with directions of immediate compliance thus attempting to reduce the vice-chancellor’s office merely to a post-office that could not have been allowed to go unopposed since no respect had been shown to the office of the vice-chancellor in this very order. Unfortunately authors in question have given the joint statement a totally new and unwanted diversion that was never intended to be the case. Perhaps they found a vent for their victimhood syndrome under the garb of our joint statement and started firing their salvos against us. We are being made a butt of the ridicule for no fault of ours.

Due to constraints of space I am not going into some other debatable issues raised in the articles like quality of teaching and research done in the university, quality and quantum of teaching in our colleges, basic mandate of colleges and universities as per statutes and regulations, contribution of college and university teachers towards the progress and development of higher education sector in the state and promotion of science, technology, social sciences and humanities. Those issues will be discussed in another piece but one thing needs to be emphasized that one-upmanship and self-righteousness will lead us nowhere. Mud-slinging and passing the buck will only push us further into an abyss. Negative campaigns do not serve any purpose other than creating animosities and bad blood among two communities of the same system. Rather we need to join hands and work together to improve our lot and uplift the standards of our education and research that will entail this state on a path of sustainable progress and development and enable us the meet the challenges of globalization of education in twenty first century. Drawing sadistic pleasure out of unduly criticizing an entire community of teachers while blissfully ignoring one’s own shortcomings and lacunae will not serve any ends other than bringing some solace to the hurt egos and complexes. Magnanimity demands working above all levels and sects for the benefit of our student community.

(Author is General Secretary of Kashmir University Teachers Association and can be reached at ishaqgeer@gmail.com)

Ills plaguing pharmaceutical procurement and quality assurance system of medicines in the state

Major ills that have been plaguing the pharmaceutical procurement and quality assurance system in the state are lack of foolproof quality assurance system and inappropriate procurement mechanism that has led to frequent complaints of non-availability of medicines and that of substandard quality of medicines being supplied by the Corporation. Areas that need immediate attention include drug selection, forecasting and demand estimation, supplier selection, fixing and adherence to pre- and post-qualification criteria and robust quality control mechanism. Roots of the problem lie in the fact that J&K Medical Supplies Corporation (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.

Establishment of a comprehensive Quality Assurance system involving both surveillance and testing of drug quality, involving both technical and managerial activities, is needed 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. 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. Drugs Controller General of India had promised a couple of such vans in 2015 but the promise remains unfulfilled till date.

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. It is high time when the J&K State Essential Drugs List needs to be updated and modified in tune with changes in new drug development and new morbidity patterns surfacing from different parts of the state.

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)