Friday, 29 March 2013

National free access to The Cochrane Library in India: Freedom may end at midnight…

Dr. Prathap Tharyan, Director, South Asian Cochrane Network & Centre, blogs about why it is imperative that the Indian Council of Medical Research renews its national subscription to The Cochrane Library, due to expire on midnight of March 31, 2013.


National free access to The Cochrane Library in India: Freedom may end at midnight…

 The Indian Council of Medical Research (ICMR) created history in February 2007 when India became the first and only low-income country in the world with a national subscription to The Cochrane Library.  This initiative of the ICMR to purchase a national license was widely hailed as an exemplar of responsible leadership in health-research governance, as it gave all people in India with an internet connection free access to the online collection of reliable evidence-based resources to aid health decisions. Easy access to trust-worthy summaries that synthesize all relevant evidence, and that is not influenced by the marketing manipulations of drug companies, is the key step in evidence-informed health care; as it facilitates the working together of public and private health providers and their patients to better understand treatment options.

The increased use of the resources in The Cochrane Library over the three years of the national provision led to the ICMR renewing the subscription for India-wide free access for a further three years to January 2013. This renewal created history again, since India became the first middle-income country in the world with a national provision; having moved in the interim from being a low-to a middle-income country. The current national provision expired on 31 January 2013, and is up for renewal.

Unless the national license is renewed, before the two-month extension granted by the publishers also expires, people in India will have free access to The Cochrane Library only till midnight on March 31, 2013.

Read more at:

Cross posted from Evidence Informed Musings.  

Friday, 15 March 2013

National Snakebite Survey: Day 2 of Protocol Development Workshop

By Soumyadeep Bhaumik
Bhaumik is a medical doctor, independent researcher and freelance writer from Kolkatta.

With a fabulous mix of experts from various arenas outlining a host of problems  that might hamper the national snakebite survey on Day 1, I did actually lose sleep worrying whether this so important national survey  would actually take off. However, Day 2 was indeed remarkable. March 12, 2013 is indeed a day that will be looked down the line as a day which changed the course of snake bite management in India.

The venom detection group gave a few presentations .They also outlined what kind of data and help they would require from the clinicians as well as the herpetologists and the study trial co-ordinators. The venom detection group met separately to get their act together and to ensure parity in protocols, laboratory and storage methods etc .They also had a teleconference with Prof. David Lalloo, Liverpool School of Tropical Medicine, UK to finalise the plan on the venom detection group.  

Venom Detection Group

In the mean time the clinical group actually discussed the nitty-gritty of the study – smoothening out whatever problems that has been foreseen the day before. The protocol as well as the patient proforma was finalised. The basic details of the operating manuals which all the centres will adhere to was also discussed. Even ethical and patient privacy concerns were addressed. The amazing amount of integration which followed in this couple of hours is indeed something that I have not seen for a really long time.  With the clinicians almost final on the study protocols the venom detection group joined them and together they synthesized whatever little things that were left. Preliminary discussion on data entry, communication, statistic
al tools and mobile based technologies were also undertaken. 
               Jeevan Kuruvilla from Jharkhand

Just when I thought nothing more could be achieved and the session was about to end, the workshop threw in another surprise when Jeevan Kuruvilla of Navjivan Hospital, Jharkhand, proposed that his centre was ready to act as a nodal centre and pool data from various other hospitals around his. Even others in the group gave similar proposals.

This proposal, if accepted and then later acted upon, will definitely increase the  sample size massively thereby enhancing the practicality and reliability of the data obtained massively.

While I fly back from Vellore, I go with the hopes of having witnessed a move that will in the future save at least 40,000 lives per year.  A move that is not hyped by media attention but a will to change the nation.

Read  my feature titled 'Snakebite: a forgotten problem' at the British Medical Journal

Monday, 11 March 2013

National Survey of Snake bites in India - Protocol Development Workshop

By Sowmyadeep Bhaumik. 
Bhaumik is a medical doctor, an independent researcher and free-lance writer from Kolkatta, West Bengal.

March 11 - 12, 2013.  

National survey of Snake bites in India (venomous and non-venomous): syndrome-snake species correlations, outcomes and ASV dose requirements for the Indian Sub-continent

Day 1
April of last year saw a two-day workshop titled "Formulating a research agenda for treatment: A workshop on pesticide and plant poisonings and snake envenomations" being organised at the South Asian Cochrane Network & Centre (SASIANCC) in Vellore , The workshop then brought together scientists , activists , clinicians. health advocates, industry as well as various other stakeholders from across South Asia and they had identified potential research gaps in the snakebite research arena as well as identified it as a major public health issue in the Indian sub-continent affecting thousands. It has also been found out then that there is an immense need about the syndrome-species correlation to be done. The need to conduct a anti-snake venom dose finding study was also considered.

From there the SASIANCC has taken a remarkable leap in the way of holding the protocol development workshop for a national survey which I would like to call SSSSSSNAKES-India - Survey of Snake Species, Syndromes, Snake-bite outcomes, and anti-Snake venom requirements in Indian Sub-Continent.
The study is expected to be done simultaneously in more than 15 centres across the nation and is being jointly organised by the Toxicology Special Interest group and the South Asian Cochrane Network & Centre. This multi-centric study, aims to evaluate the profile of snakebites in centers located across the country that deal with snake envenomation and to assess whether the clinical syndromes correlate with the identified snake species. This study also aims to demonstrate the outcomes including morbidity and mortality due to snake envenomation in the different centres and the anti-snake venom dose.

Day 1 of the workshop saw the presentation regarding the study protocol-by the Christian Medical College Toxicology Group which were then deliberated upon in some details followed by presentations about the snakebite treatment data and information about the protocols being used by all the individual hospitals which are supposed to be centres for this study. What was evident from these presentations is that the there is an entire gamut signs of symptoms of snakebite being available across the nation and also about varying dosage patterns of anti-snake venoms being used in India (from 2 vials to 20 vials and rare 50 vials too). The rate of bites as well as envenomations was also surprisingly very varied and so also was the adverse effect profile (from 2% to 80%).Even prophylactic medications for this purpose is also quite varied with some areas having reported even no use of them and achieving no anaphylaxis whereas some centres reported higher anaphylaxis rates and yet having used no prophylactic medicines. 
Prof. Oommen, Chairman, State Biodiversity Board, Kerala
The day also saw a presentation by Professor Oommen , Chairman of the Kerala Biodiversity Board where he talked about his new inventions which biosensors and mobile applications in identifying the snake in a very accurate fashion. 

Rom Whitaker, internationally acclaimed herpetologist 
Post –lunch, a session on the training in snake storage ,specimen collection and species identification was held by Mr Gerry Martin and Mr Romulus Whitaker who extensively identified gaps in the knowledge about ecology of snakes as well as the problems which the study group might face in collection and transportation of snake victims on account of them being protected by various wildlife laws . 
The practical problems of identifying snakes by photographs was also discussed and so also the idea of identification vide DNA analysis was discussed upon.

The day ended with the a presentation by Dr Khadilkar, Technical Director from Premium Pharmaceuticals who talked about the various problems in the anti-venom manufacturing business which affect the cost and quality of ASV. 

Dr. Khadilkar of Premium Pharmaceuticals

With almost all problems that might be faced in the national survey being discussed the day winded up with dinner at Hillside Resort, Bagayam where the enthusiasm among participants  was palpable where people were more interested about discussing on the study than actually concentrating on the very delicious meal. The issue of variability in clinical response from various manufactures and even batch-to batch variations were discussed. 

(Read my feature titled 'Snakebite: a forgotten problem' at the British Medical Journal
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