Drug-related problems are a common problem among stroke patients due to comorbidities resulting from the complex management of stroke treatment leading to polypharmacy management. Studies show that 90% of stroke patients have drug-related problems (DRPs). However, there is limited information on the impact of comorbidities as risk factors for DRP prevalence and unfavorable prognosis in patients with ischemic stroke. This study aimed to determine the risk factors for DRP and clinical outcomes as modifiable comorbidities in ischemic stroke patients admitted to a tertiary hospital between January 2020 and October 2021 were indeed significant influences. The study was conducted retrospectively using a cross-sectional analysis of patient’s medical records. The study found no significant association between the presence of comorbidities and polypharmacy in patients with the incidence of DRP, although we found that the DRPs occurrence was found more in a patient with comorbidities and polypharmacy. Diabetes mellitus was found to have a significant association with no improvement in NIHSS scores in ischemic stroke patients. We found that diabetes mellitus patient had an increased risk of non-improvement NIHSS score 2,987 times compared to patients without diabetes mellitus. The second increased risk was the presence of comorbid hypertension (OR 1.352), the third was the occurrence of polypharmacy (OR 1,175), and the fourth was dyslipidemia (OR 1.138).

Hypertension is one of the world’s most hazardous diseases since it harms the heart, brain, kidneys, and other organs. Patients’ understanding of hypertension can be the key to successful treatment. Nonadherence with antihypertensive medication is a primary cause of therapeutic failure and is considered a serious issue. The purpose of this study is to examine the association between antihypertensive knowledge and adherence at public healthcare facilities. This study employed a quantitative approach using a cross- sectional design. The purposive sampling technique determined the sample, resulting in 100 hypertensive respondents from Public Healthcare. Knowledge is the independent variable in data collection; adherence to antihypertensive medications is the dependent variable; and demographic variables are the confounding variable. We employed the HFQ (Hypertension Fact Questionnaire) and MMAS-8 (Modified Morisky Adherence Scale-8) questionnaires as data-gathering instruments. We conducted univariate, bivariate, and multivariate analyses on the data using SPSS. Based on the study’s findings, it is possible to conclude that there is a significant association between knowledge level and adherence with antihypertensive medicine use in public healthcare, with a p-value of 0.003. Comorbidities are a risk factor for hypertension that affects adherence, with a p-value of 0.007 and an OR of 0.801, indicating that patients are 0.801 times more likely to take their medicine

Head lice (Pediculus humanus capitis), a parasite causing hair problem,  often occurs in society.The study aimed to evaluate in vitroeffectiveness of shampoo formulation containing neem oil as an anti head lice. An experimental method was used to examine the formulation of shampoo, irritation test, testing the effectiveness of shampoo against head lice (Pediculicidal activity), and testing the effectiveness of shampoo against nits (Ovicidal activity). The effectiveness test employed an in vitromethod where neem oil shampoo were tested directly towards head lices and nits isolated from humans, then the mortality was observed. To recognize the safety of the shampoo, skin and eye irritation tests were carried out by applying 0.5 ml on the skin and dripping 0.1 ml shampoo into New Zealand white rabbit’s eyes.Data were analyzed using Kruskal Wallis and Mann Whitney. The study results showed that the primary irritation index for 5%, 10%, 15%, and 20% neem oil shampoo were 0; 0111; 0.222; and 0.222, respectively. All of the shampoos were very mild irritation response category. Eye irritation tests showed that only the 20% neem oil shampoo gave a mild irritation response with degree of corneal opacity ≥ 1 and recovered after 7 days of observation. The 5%, 10%, 15%, and 20% neem oil shampoo were effective as an anti head lice. The 15% and 20% neem oil shampoo had anti head lice effectiveness activity as same as 1% permethrin lotion. In conclusion, the 15% neem oil shampoo was chosen as the best shampoo, its high anti head lice effect and light irritation response. Keywords: Head lice, neem oil (Azadirachta indica A. Juss), shampoo

The resin compound is obtained from Jernang (Daemonorops draco blume), a plant that grows in the tropical rainforests of Indonesia. This study was undertaken to determine the antibacterial ability of ethanol extract of Jernang resin against both Salmonella typhi and Streptococcus mutans. The crude extract was prepared by soxhlet extraction in ethanol, is then fractionated vacuum liquid chromatography (VLC) with increasing solvent polarity starting from n-hexane (100%); n-hexane: ethyl acetate (80:20); ethyl acetate: methanol (40:60) up to methanol (100%) by. The antibacterial activity were evaluated using the disc diffusion method, these were compared with that of standards chloramphenicol as positive control and DMSO as a negative control. Determination of the antibacterial activity, we verified the diameter of inhibition of growth zone against Salmonella typhi at the variation of the extract concentration were 0.00mm/10ppm, 9.03mm/50ppm, 8.4mm/100ppm, 11.73mm/500ppm. These were compared with that of standards chloramphenicol (21.03mm/300ppm) and DMSO (0.00mm/300ppm). On the other hands, the diameter of inhibition of growth zone against Streptococcus mutans at the variation of the extract concentration were 9.33mm/50ppm, 9.83mm/75ppm, 10.67mm/100ppm, 11.5mm/125ppm, and 13.33mm/150ppm. These were compared with that of standards chloramphenicol (25.7mm/300ppm) and DMSO (0.00mm/300ppm). The ethanol extract of Jernang Resin exhibited antibacterial effects on Salmonella typhi and Streptococcus mutans, but these effects were less than chloramphenicol. The antibacterial effect increased with an increase in the concentration of the extract.

Analgesic drugs like morphine and other opioids exhibit several harmful effects. Thus, the exploration of a new and safer analgesic drug is necessary. Utilizing Indonesia's biodiversity richness, medicinal plants can serve as an alternative source of novel analgesic drugs. Here, we show the analgesic activity of Kratom (Mitragyna speciosa) leaf ethanol extract (KE) in formaldehyde-induced rat (Rattus norvegicus) models. The effect of KE was examined by observing the duration of spontaneous nociceptive behavior such as paw licking or limp leg. The result showed that rats treated with 70 mg/kg KE demonstrated significantly (p<0.01) decreased nociceptive behavior compared to those receiving vehicles. However, a higher KE dose (210 mg/kg) failed to increase the analgesic effect and showed a slight reduction (not significant) compared to the control group. These findings proved that kratom leaf ethanol extract has the potential to alleviate painful conditions.

Hospital-acquired infection has become serious issue during previous decades. In Indonesia, the prevalence of nosocomial infection reached almost 10% of total patients encounter. The objective of this study was to investigate the sterility status of 160 sets of re-used instruments in three intermediate care rooms, including High Care Cardiac Unit (HCCU), Neosurgical Critical Care Unit (NCCU) and Burn Care Unit (BCU) of Dr. Hasan Sadikin General Hospital and analyzed whether there was association between time and storage condition towards sterility status. All tested instruments were sterilized in Central Sterile Supply Department (CSSD) of the hospital and distributed to those intermediate care rooms. Observations and microbiology assays were carried out for four weeks. We found that the worst contamination was found in BCU room with 2.50% bacterial infection in week I, II and III, and 4.375% of fungal infection in week I, II and IV. The best sterility status of reusable instruments was found in CSSD, followed by NCCU, and HCCU. Time and storage condition influenced fungal contamination, while these factors did not associated with the bacterial contamination. In conclusion, sterility status of reusable medical instruments was relatively satisfactory, but there was still room for improvement, particularly at burn care facilities.Keywords: hospital-acquired infections, hospital, nosocomial, sterility

Routine immunization is a program that must ensure adequate coverage as one preventive measure against the transmission of vaccine-preventable disease (VPD). Vaccines are the most cost-effective healthcare investment as it has been shown to prevent and reduce the incidence of disease, disability, and death from VPD, which is estimated to kill 2 – 3 million people each year. As of July 11, 2020, the COVID-19 pandemic has been deemed the worst public health emergency in the world, with over 12 million positive cases and 556,342 fatalities documented in 213 nations. The impact of the pandemic on routine immunization has resulted in higher morbidity and mortality from this VPD in countries with low coverage. This review article comprehensively describes routine immunization services and case reports of immunization performance during the COVID-19 pandemic.

Treatment for pneumonia has always been a challenge due to the difficulties in diagnosis and the growing incidence of antibiotic resistance. Beta-lactam antibiotics are the first line treatment for pneumonia. The combination of beta-lactam with other antibiotics are preferred than single antibiotic therapy. However, there was limited information regarding the effectiveness of combination between beta-lactam with either macrolides or fluoroquinolone for the treatment of pneumonia.The purpose of this study was to determine the most effective combination of antibiotics for hospitalized adults pneumonia patients. This was a cross-sectional study with prospective data collection. The data source was the medical record of the subjects. We included adult pneumonia patients hospitalized at Dr. Hasan Sadikin General Hospital during June-August 2015. We found that mean reduction of body temperature in group who received combination of a beta-lactam antibiotic and azithromycin was 1.53 0C, while in levofloxacin group, the reduction was 1.22 0C (p=0.210). Reduction in leukocytes and respiratory rate were 7800 and 2.29 times/minute, respectively, in the former group, while in the latter group the reduction of leukocytes and respiratory rate were 2600 and 5 times/minute. The differences were not statistically significant in both parameters (p=0.036 and 0.149, respectively). In conclusion, better clinical outcomes were observed in patients treated with combination of beta-lactam and azithromycin compared to combination of beta-lactam and levofloxacin, although the difference was not statistically significant.Keywords: pneumonia, pneumonia therapy, combination therapy for pneumonia

Schizophrenia is a chronic severe psychiatric disorder. Antipsychotic medications are a highly efficacious modality of treating patients with schizophrenia. Non-adherence to antipsychotic medication is a critical problem leading to increased relapse rate, hospitalization rate, and health care costs. Non-adherence is caused by multi-factors and might be varied within the globe. Assessing non-adherence and influencing factors would help in framing preventive strategies. This cross-sectional study involved 100 patients with schizophrenia fulfilling inclusion criteria. Patients’ demographics, clinical parameters, and prescribed drugs were collected. Medication adherence was assessed using the MARS scale (medication adherence rating scale) and symptom severity by PANSS (positive and negative symptom scale). Statistical analysis was done to identify the potential predictors of non-adherence to antipsychotic medication. The correlation of medication adherence with severity of illness was tested. Males were significantly associated with decreased likelihood of being non-adherent with odds ratio of 0.095 (0.014, 0.667) p value of 0.018. An increase in positive and cognitive scores was significantly associated with higher odds of being non-adherent with OR of 1.188 (1.044, 1.325) p-value 0.009 and OR 1.258 (1.073, 1.475) p value 0.005. From this study, non-adherence to medication was noted in 45% of the study population. Thus, strategies need to be framed for regular monitoring and follow-up of female patients on antipsychotics and patients with high PANSS. These steps could reduce the frequency of non-adherence among patients with schizophrenia.

Acute respiratory infections (ARIs) are infectious diseases of the upper or lower respiratory tract that cause a spectrum of illnesses from mild to severe infections. ARI is one of the leading causes of death in children in developing countries. The high incidence of ARI in children results in the use of off-label drugs. Off-label medicine is the use of drugs outside the provisions of the license relating to dose, age, route of administration, contraindications. This study aims to determine the use of off-label drugs in children with a diagnosis of ARI at Pandega Pangandaran Hospital, Pangandaran District, West Java - Indonesia. This study was an observational study with a cross sectional design and data collection was done retrospectively using Chi-square data analysis with a significance level of 0.05. Of the 84 patients who fit the inclusion criteria, there was an off-label drug use of 16.01% with the categories of off-label age (11.16%), off-label dose (4.37%), and off-label indication (0.48%) while in the category of route of administration and contraindications no off-label drug use was found. The most common type of off-label drug used was cetirizine antihistamine.  Based on the results, pharmacist’s supervision related to the risk of drug use is strongly recommended.

Cyclooxygenase (COX) or prostaglandin H2 synthase (PGHS) catalyzes the conversion of arachidonic acid into prostaglandins. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by inhibiting both COX-1 and COX-2 isoforms, thus disturbing this reaction. In Indonesia, Andrographis paniculata (local name: sambiloto), is empirically used to reduce inflammation by consuming the herb tea of this plant. This work studied the inhibitory activity of andrographolide and andrograpanin, diterpenoids of the plant, on the rate of prostaglandin formation. Previous works have proven that andrographolide inhibited PGE2 production in LPS-induced human fibroblast cells. This study was performed by measuring the absorbance of TMPD (tetramethyl-p-phenyldiamine) oxidized by andrographolide and andrograpanin. Acetosal was used as a control drug. The rate of PGH2 formations on either COX-1 or COX- 2 was affected by andrographolide and andrograpanin. Andrographolide and andrograpanin interact longer with COX-1 than COX-2. Andrographolide shows weak inhibition on the rate of PGH2 formation, whilst andrograpanin might be further developed for potential antiinflammatory drugs.Keywords: Andrographis paniculata, anti-inflammatory, COX, cyclooxygenase, prostaglandin

Schizophrenia is a psychiatric disorder impacting behavior, emotions, and communication. Atypical antipsychotics are increasingly prescribed due to their significant reduction of both positive and negative symptoms and low risk of extrapyramidal side effects (EPS) in schizophrenia patients. However, long-term effects of atypicals may include weight gain, insulin resistance, and hyperglycemia. This study was conducted in Palu, Madani General Hospital, and Anutapura General Hospital. It used a prospective cross-sectional design with a sample of 40 outpatient participants who received monotherapy or combination therapy with clozapine, olanzapine, and risperidone for more than three months. Blood samples were collected to determine the presence of metabolic syndrome, defined as meeting at least three of the following five criteria: BMI > 30 kg/m², blood pressure ≥ 130/85 mmHg, triglycerides ≥ 150 mg/dL, HDL ≤ 40 mg/dL, and fasting blood glucose ≥ 110 mg/dL. The prevalence of metabolic syndrome was (25%), pre-metabolic syndrome (37,5%), and non-metabolic syndrome (37,5%) with a significance value of 0,5 > 0,05. The percentage of schizophrenia patients by gender was dominated by males (58%). Age-wise, adults dominated the sample (77.5%). Risperidone was the most frequently used atypical antipsychotic (56%). The most common concomitant medications were antimuscarinics (29.6%). The use of atypical antipsychotics did not significantly impact the side effects associated with metabolic syndrome with a p-value 0,5 > 0,05. However, there was an increase in the values for one or two of the five criteria for metabolic syndrome in schizophrenia patients. Future research should consider using only olanzapine or clozapine monotherapy for medication criteria.

In 2017, a patient case in Sangau, West Kalimantan, involving a women with syringomyelia has drawn public attention. The case ended with the arrest of her husband who cultivated Cannabis to treat her disease. Currently, Indonesian regulation classifies Cannabis as the first group of narcotics which are prohibited to be used as medicine. This research aimed to ellaborate whether Cannabis as medicine should be specifically regulated. Data source was national and international regulation on narcotics and scientific evidence regarding medical benefit of Cannabis The data was obtained from literature search with following keywords; regulation of Cannabis, medical use of Cannabis, Cannabis medicine. Analysis was conducted using qualitative approach. The results of this study showed that Indonesian regulation regarding Cannabis is associated with International Convention on narcotics. Evidence-based data on Cannabis application in medical treatment have been extensively studied. Given beneficial effect of Cannabis to treat many diseases, several countries have already regulated the use of Cannabis for medical purpose. In conclusion, it is worth to consider a specific regulation for medical Cannabis in Indonesia, given its beneficial utilization to treat certain diseases.Key words: Regulation, Cannabis, medical Cannabis, syringomelia

Mangrove plants are one of the most extensive biodiversity in Jambi. Besides functioning as a coastal ecosystem protector, it also has any potential of its chemical content. The study of mangrove’s bioactive compound is important to generate a new therapeutic agent. This study aims to obtain chemical compounds that have cytotoxic activity, reveal the chemical formula and molecular structure of that active compound, and determine the cytotoxic activity level of active compound from perepat (Sonneratia alba) root extract. The extract was isolated and purified using Liquid Vacuum Chromatography, Graphitation Column Chromatography, and Thin Layer Chromatography. The isolate was characterized using FT-IR spectrophotometry. Our result found that it corresponds to the β-sitosterol compound group with a high similarly chromophore. Furthermore, both of the extract and isolate was tested for toxicity activity using the Brine Shrimp Lethality Test (BSLT) method using Artemia salina shrimp larvae. Herein, we reported that acetone isolated extract possesses lower cell death average 100% (start 200 μg/ml) than isolate extract 80% (50μg/ml). Furthermore the toxicity of total extract has LC50 23,98 (μg/ml), while Isolate 10,04 (μg/ml). From the LC50 value, it can be concluded that the toxicity of the extract lower than the isolate, and both were classified as very toxic compounds, and very potential to be developed into anti-cancer drug compounds.

Ischemic Heart disease (IHD) occurs due to an imbalance between myocardial oxygen supply and demand. In stable IHD, second-line anti-anginal drugs like Ranolazine and Nicorandil are used as add-on therapy with first-line agents like Nitrates and beta-blockers. Our study compared the efficacy of Ranolazine versus Nicorandil utilizing the patient’s responses to the Short Seattle Angina Questionnaire (SAQ7) score. A prospective observational study on stable IHD patients attending the cardiology Outpatient Department (OPD) of IPGME&R and SSKM Hospital, Kolkata, with either Ranolazine or Nicorandil as add-on therapy (50 patients in each group). SAQ7 score was recorded at baseline and three follow-up visits (1.5, 3, and 6 months). Adverse effects and the changes in HbA1C levels in diabetic patients among these patients were also compared. There was a significant increase in SAQ7 score in Ranolazine [median (IQR) - 26.50 (25.00 - 29.25) to 32.00 (30.75 - 34.00), p < 0.0001] and also in Nicorandil [median (IQR) - 27.00 (24.00 - 30.00) to 32.50 (31.00 - 34.00), p < 0.0001] group in third follow up visits from baseline. The comparison between the groups didn’t show any significant changes. There were no significant changes in HbA1C levels between the pre and post-treatment period. Adverse effects were more in the Nicorandil group. Both drugs significantly improved IHD patients’ symptom control and were well tolerated. There were no significant differences in the change of HbA1C level in Diabetic patients. However, a larger study is required to decide whether these drugs can be used as a single agent alone.

The risk of paracetamol induced hepatotoxicity could increase with alcohol consumption.Paracetamol was usually given to tropical malaria patients to treat fever. The aim of this studywas to determine the hepatotoxicity effect of alcohol consumption in malaria tropica patientsreceiving paracetamol. This study was a cross-sectional study which was conducted duringApril-June 2015 at a hospital in Jayapura, Indonesia. The data were obtained from questionnairesand medical records. Alcohol status was determined by Short Michigan Alcoholics ScreeningTest (SMAST) questionnaire. Level of ALT, AST and bilirubin were observed before and afterreceiving paracetamol therapy for 5 days. Based on the results, the ALT and bilirubin levels ofalcoholic group were higher than in non-alcoholic. However, chi-square test showed that alcoholstatus did not have a significant influence in ALT, AST, and bilirubin levels. Otherwise,logistic regression analysis showed that age gave a significant effect on AST level (P=0.067).Keywords: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alcohol,malaria

Background: Pharmacist-led interventions, encompassing patient education, adherence monitoring, and personalized care, have emerged as a critical strategy to optimize treatment outcomes in Hepatitis C (HCV) management, particularly in improving Sustained Virologic Response (SVR) and mitigating drug-related challenges.Objective: This review assesses the impact of pharmacist-led interventions on key HCV patient outcomes, including SVR rates, medication adherence, and the management of Adverse Drug Reactions (ADRs) and Drug-Drug Interactions (DDIs).Methods: A systematic search was conducted on PubMed database for studies published between January 2000 and December 2024, following PRISMA guidelines. The search included Randomized Controlled Trials (RCTs), cohort, and retrospective studies. An initial search identified 192 records, from which 12 studies were included in the review. Result: In hepatitis C management, pharmacists intervened in many ways including direct close monitoring, patient education, and individualized care which led to enhanced clinical outcomes and improved patient engagement. Most included studies, both RCTs and Observational studies showcased high SVR rates. Some studies that demonstrated lower SVR rates or did not differ significantly from the control group were due to more complex patient demographics.  Recorded improvements also included medication adherence, patient engagement, and effective management of ADRs and DDIs. Conclusion: The findings indicate that pharmacist-led interventions demonstrated predominantly positive impacts on clinical outcomes. However, the evidence is limited by variations in study design and shortage of RCTs. Further research with standardized protocols is recommended to better define the role of pharmacists in HCV care.

Phyllanthus emblica is empirically used to treat various diseases. Chemical compounds in this plant includes benzene derivatives, diterpen and monoterpen, furanolacton, flavonoids and sterols. The purpose of this research is to investigate anti-hyperglycemic activity of P. emblica. The diabetic animal model was obtained by administration of alloxan 120 mg/kg BW intraperitonial. The rats were divided into 9 groups, i.e., normal group, negative control (1% CMC), positive control (glibenclamide 0.5 mg/kg BW) and P. emblica leaves and bark ethanol extract at the dose of 500, 750, and 1000 mg/kg BW. Determination of flavonoid content was performed through colorimetric method using UV-Vis spectrophotometer at 425 nm. After 7 days of induction, the entire group was treated for 21 days, fasting blood glucose was performed on days 0, 1, 8, 15 and 22. Then the data of fasting blood glucose level in mice was treated with one way ANOVA analysis and advanced test with post hoc Least Significant Differences (LSD) method. The percentage of the blood glucose decrease from the animal treated with leaves extract at doses of 500, 750 and 1000 mg/kg BW, respectively, were 22.47%; 21.03%; and 24.52%, while those of bark extract were 32.19%; 31.61%; and 37.24%, respectively. Determination of total flavonoid level showed that the highest amount of flavonoids was observed in leaves (35.838 mg/g Quercetin). In conclusion, P. emblica bark and leaves showed anti-hyperglycemic activity.  Keywords: anti-hyperglycemic,  alloxan, Phyllanthus emblica, Wistar

Psoriasis is a chronic, inflammatory, hyperproliferative, immune-mediated skin disorder, having a prevalence of 0.44-2.8% in India. Methotrexate is a widely used systemic regimen for moderate to severe psoriasis. Supplementation of omega-3 fatty acids has decreased the severity of the disease in some studies. This study aimed to assess the efficacy and safety of omega-3 fatty acids as an add-on to methotrexate versus methotrexate monotherapy in patients with moderate to severe plaque psoriasis. A total of 40 patients with moderate to severe plaque psoriasis were recruited in the study and randomized into two groups of 20 patients each. Group O received omega-3 fatty acids as add-on to methotrexate and Group M received methotrexate monotherapy. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Physician’s Global Assessment (PGA) were assessed at baseline, 4 weeks, 8 weeks and 12 weeks of treatment. The adverse events were assessed throughout the study period. There was a significant decrease in PASI and DLQI scores from baseline to end of 12 weeks in both groups (p<0.001) but the difference between the two groups was not significant (p>0.05). A higher number of patients had a PGA score of 0 or 1 at the end of 12 weeks in Group O (60%) as compared to Group M (40%) but the difference between the groups was not significant (p=0.34). The treatment was well tolerated in both the groups, with most common adverse events being nausea, diarrhea and epigastric pain. This study showed that the treatment in both the groups was equally effective in decreasing the severity of psoriasis and was well tolerated.

Rational use of medicine is an integral part of the health care system, which has become the weakest part due to various contributors like prescribers, producers, controllers, and consumers that have led to irrationality and increased the patient’s socio-economic burden. This study aimed to assess junior residents’ knowledge, attitude, and practice of rational medicine of medicine in a tertiary care teaching hospital. This cross-sectional observational study was conducted in the Department of Pharmacology at the tertiary care teaching hospital in Rajasthan, India, for a period of six months, from February 2021 to June 2021. All first- and second-year hospital residents, except those unwilling to participate, were included in the study. The first part of the questionnaire was about knowledge, and the second part was about the attitude and practice of junior residents regarding the rational use of medicines. The data was presented in the form of figures and percentages. Most residents (98%) were aware of the term rationality and rational use of medicines. Maximum numbers of residents (97%) were aware of the term essential medicines. The residents who were aware of drugs included in the National Essential of Medicine and term P-drug were 55% and 69%, respectively. Nearly 21% of residents prescribe drugs by generic names, while the majority (65%) prescribe both generic and brand names. Almost all (98%) of residents agreed that regular training is needed about the rational use of medicines to improve rational prescribing and 89% of residents think regular prescription auditing should be done. This study concludes that most residents were aware of the rational use of medicines, essential medicines, and the P drug concept. But they should receive regular training on the rational use of medications. This will prevent serious problems related to the inappropriate prescribing of medicines during their medical practice.