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BOOK REVIEWS
the alternative approaches to evaluate veterinary drugs
when it is not possible to set an ADI. The role and
relationship of risk management and risk assessment in
the evaluation process are also elucidated. The
Committee recommended that JECFA should develop a
set of guidelines to carry out risk assessment and provide
intervention to codex risk mangers whenever a request
is made.
Under Section 2.4 new procedure for estimating
chronic dietary intakes of veterinary drug residues has
also been discussed. It uses the same formula as used
previously for the calculation of “Theoretical maximum
daily intake” (TMDI) including factors such as the ratio
of marker to total residue concentrations, with one
exception of using median concentration instead of MRL
as the point estimate of the residue concentration in the
formula. In section 2.5 use of spreadsheet based
procedure for statistical evaluation of residue depletion
data has been highlighted. It is a new approach and is
based on linear regression analysis and statistical
estimation of one-sided upper tolerance limits for the
marker residue depletion in the individual target tissues.
Iterative method is used to calculate different time points
on the depletion curve, the intake of residues of a
particular drug in food basket. This calculated intake
can be compared with the ADI and time point of
depletion below ADI can be selected to determine
MRLs.
Section 2.6 describes the importance of following
a revised approach to derive microbiological ADI. This
will be useful in studies to evaluate the safety of residues
of veterinary drugs in human food, particularly their
effects on human intestinal microflora.
Under section 2.7 another important issue on non-
human antimicrobial usage and antimicrobial resistance
has been discussed. There is caution on emergence of
drug resistance due to non-human antimicrobial usage
and need to develop newer methods to carry out risk
assessment.
In chapter 3 data on biochemical, toxicological and
microbiological evaluation of three antimicrobials
(colistin, erythromycin, flumequine) two production aids
(melengestrol acetate, ractopamine hydrochloride), an
insecticide (trichlorfon) and an antihelminthic
(triclabendazole) have been nicely elucidated.
Using the decision tree approach potential effect of
any veterinary drug can be evaluated. Taking the
example of colistin and erythromycin application of this
167
approach has been demonstrated in a step-by-step
manner. Calculation of microbiological ADI has also
been described in a lucid manner. This chapter concludes
with discussion on tylosin as an example to investigate
if evaluations are possible based on published data in
the absence of data from sponsors. However, it was not
possible to perform toxicological evaluation of tylosin
based on published scientific literature.
Chapters 4 and 5 pertain to suggestions for taking
up future work and recommendations respectively.
There are two annexures. Annexure 1 cites an
impressive list of 183 important references right from
the first report of JECFA, 1957 to WHO Food
Additives Series, No.57, 2006. This is a very useful
compendium and very important for those involved in
this area of work. Annexure 2 provides summary of the
Committee’s recommendations on these drugs. The ADI
and proposed maximum residue limits are also given.
The report provides valuable information to all those
involved in food safety, be it regulator, policy maker,
industry personnel, researcher or consumer. It also
illustrates the method and discusses very important
issues related to toxicity of these drugs, fixation of ADI
and MRLs.
Kalpgam Polasa
Food and Drug Toxicology Research Centre
National Institute of Nutrition
Hyderabad 500007, India
e-mail: fdtrc_kp@yahoo.com
Modern trends in planning and designing of
hospitals: Principles and practice, S.K. Gupta, S.
Kant, R. Chandrashekhar & S. Satpathy (Jaypee
Brothers Medical Publishers, New Delhi) 2007.
238-pages. Price: Rs.1995/-
ISBN 81-8061-912-5
Modern healthcare delivery has undergone a
tremendous and rapid changes recently. The rule,
function, perceptions and expectation of various stake
holders have undergone radical transformation from
earlier emphasis on cure to present day emphasis on
wellness. Hospitals are the part of this paradigm shift.
However, to achieve success in this paradigm it is
essential that newer hospital when planned and designed
must meet the criteria of efficiency and effectiveness in
their operations so as to meet the ever increasing
demands of the consumers by designing better hospital
facilities.
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168 INDIAN J MED RES, AUGUST 2007
This publication has filled up this void to a major
extent. It provides a comprehensive and holistic views
in planning and designing of hospitals. It has provided
in depth coverage of issues in the planning and designing
of clinical, administrative and supportive services and
facilities. The chapters on Facilities for the Aged and
the Disabled, Ready Reckoner, Pictorial Sample Project
Report have made the book explicit and easy to
understand.
The book carries compendium of some of the
regulatory requirements in the planning and designing
of hospitals and its services which can be referred to
while developing the new hospitals and/or the existing
services. The quality and appropriate layout plans,
architectural drawings, engineering drawings and
photographs associated with each chapter are brilliantly
incorporated.
The book is recommended as a useful guide in the
planning and designing of modern hospitals and their
services. It would be of immense value to those involved
in remodeling, renovating and retrofitting of existing
hospitals. The policy makers, academicians, architects,
administrators, clinicians, engineers and students
associated with planning and designing of patient care
will find it a useful resource guide.
It may be an excellent reference book for developing
newer services and/or improving the existing services
of 100 bedded hospital to a large tertiary care teaching
hospital. Salient features in this book wherever
implemented while developing and/or renovating the
existing services will certainly improve efficiency in
those services. It is recommended that hospitals from
100 beds upwards must have this book as a resource
guide.
A.K. Gupta
Department of Hospital Administration
& Superintendent
Postgraduate Institute of Medical
Education & Research
Chandigarh 160012, India