广西贵港地区乡镇卫生院医生、药师三阶梯止痛治疗认知度调查

目的：了解广西贵港地区乡镇卫生院医生、药师对三阶梯止痛治疗的认知度。方法：采用自行设计的“镇痛药物三阶梯止痛治疗认知调查表”,对331名乡镇卫生院的医生、药师进行调查分析。结果：82.5%的医生、药师未参加过癌症疼痛治疗的培训,对三阶梯止痛治疗的基本知识认知度不高。医生、药师对麻醉镇痛药的品种选择、首选给药方式、最佳给药时机和理想的镇痛效果等知识的认识存在明显误区,回答正确率分别只有67.4%,56.8%,36.3%和44.4%,此外还普遍表现出对药物依赖的担忧和恐惧。医生与药师相比较,总体上差异无统计学意义（P〉0.05）。结论：贵港地区乡镇卫生院的医生、药师对三阶梯止痛治疗的认识尚有不足,需要加强培训和继续教育,提高疼痛治疗的专业能力。     

Do physicians with diabetes have differences in dialysis use and survival than other patients with diabetes

Aims

To assess whether the increased knowledge and resources available to physicians led to differences in dialysis and survival rates between physicians and non-physician patients with diabetes.

Methods

All newly diagnosed (1997–2009) type 2 diabetes patients aged ≥35 years from the National Health Insurance Program of Taiwan database were included. After propensity score matching (1:10), we estimated the relative risk of dialysis and death using Cox proportional hazards model adjusted for demographic characteristics and comorbidities.

Results

Physicians with diabetes were more likely to start dialysis than general patients, with a 48% increased hazard risk (HR) (P = 0.006). Physicians with diabetes had significantly lower risk of death (HR: 0.88; P = 0.025). However, those requiring dialysis had a non-significant increased risk of death (HR: 1.19). There was an increased HR for death in older physicians (HR: 1.81; P < 0.001) and those with cancer or catastrophic illness. The HR of dialysis (7.89; P < 0.0001) increased dramatically with increasing Charlson Comorbidity Index scores.

Conclusions

Physicians with DM survived longer than other patients with diabetes, likely benefiting from their professional resources in disease control and prevention. Nonetheless, they displayed no advantage from their medical backgrounds compared with the general patients if they developed end stage renal disease.     

Physician attitudes toward the use of fecal microbiota transplantation for the treatment of recurrent Clostridium difficile infection

BACKGROUND:

Fecal microbiota transplantation (FMT) is a safe and effective, yet infrequently used therapy for recurrent Clostridium difficile infection (CDI).

OBJECTIVE:

To characterize barriers to FMT adoption by surveying physicians about their experiences and attitudes toward the use of FMT.

METHODS:

An electronic survey was distributed to physicians to assess their experience with CDI and attitudes toward FMT.

RESULTS:

A total of 139 surveys were sent and 135 were completed, yielding a response rate of 97%. Twenty-five (20%) physicians had treated a patient with FMT, 10 (8%) offered to treat with FMT, nine (7%) referred a patient to receive FMT, and 83 (65%) had neither offered nor referred a patient for FMT. Physicians who had experience with FMT (performed, offered or referred) were more likely to be male, an infectious diseases specialist, >40 years of age, fellowship trained and practicing in an urban setting. The most common reasons for not offering or referring a patient for FMT were: not having ‘the right clinical situation’ (33%); the belief that patients would find it too unappealing (24%); and institutional or logistical barriers (23%). Only 8% of physicians predicted that the majority of patients would opt for FMT if given the option. Physicians predicted that patients would find all aspects of the FMT process more unappealing than they would as providers.

CONCLUSIONS:

Physicians have limited experience with FMT despite having treated patients with multiple recurrent CDIs. There is a clear discordance between physician beliefs about FMT and patient willingness to accept FMT as a treatment for recurrent CDI.     

Perspectives of physicians practicing in low and middle income countries towards generic medicines: A narrative review

Objectives

This review was conducted to document published literature related to physicians’ knowledge, attitudes, and perceptions of generic medicines in low- and middle-income countries (LMICs) and to compare the findings with high-income countries.

Methods

A systematic search of articles published in peer-reviewed journals from January 2001 to February 2013 was performed. The search comprised nine electronic databases. The search strategy involved using Boolean operators for combinations of the following terms: generic medicines, generic medications, generic drugs, generic, generic substitution, generic prescribing, international non-proprietary, prescribers, doctors, general practitioners, physicians, and specialists.

Results

Sixteen articles were included in this review. The majority (n = 11) were from high income countries and five from LMICs. The main difference between high income countries and LMICs is that physicians from high income countries generally have positive views whereas those from LMICs tend to have mixed views regarding generic medicines. Few similarities were identified among different country income groups namely low level of physicians’ knowledge of the basis of bioequivalence testing, cost of generic medicines as an encouraging factor for generic medicine prescribing, physicians’ concerns towards safety and quality of generic medicines and effect of pharmaceutical sales representative on generic medicine prescribing.

Conclusion

The present literature review revealed that physicians from LMICs tend to have mixed views regarding generic medicines. This may be due to differences in the health care system and pharmaceutical funding system, medicine policies, the level of educational interventions, and drug information sources in countries of different income levels.     

A personal philosophy of a radiation oncologist

All humans are of one species and are near identical genetically, viz. >99.5%. Also note, the Chimp is >96% genetically identical to humans. There has been extremely rapid increase in information and knowledge and this is accelerating. Several points: time is absolutely equalitarian. There is and has not been an unnatural event in this universe. Luck is the dominant factor in an individual’s success in life. At birth, the infant has zero choice of genes, parents, siblings, relatives, era and site of birth. In addition, the young child has essentially no choice in school [if any], health, etc. The key to advancing knowledge is asking decisive questions, proceeding to investigate and generate answers to the question posed and publishing the investigation, data and interpretation. The number 1 interest and concern of the physician is the care of the individual patient. The potential of “humanized experimental animals” for selected Phase III clinical trial within 2-3 decades is judged feasible. Physicians should view our current best treatment as obsolete and use this as a provocation for active effort to develop superior management strategies.     

临床药师在现代药学服务中的作用调研

目的:了解福建省医院临床药学工作的现状。方法:对10家综合性医院随机发放的575份问卷调查表中药师对临床药学发展状况及医师和护士(师)在医院临床药学服务中的行为进行调研评估。结果:调查中的大部分医院对临床药学工作都比较重视,但医师和护士(师)对临床药学服务都不够了解,对药师的能力都有所怀疑。结论:福建省临床药学工作的现状并不乐观,培养高素质临床药师队伍是提高临床药学水平的关键。     

基于医师处方行为的制药企业销售策略分析

目的:为我国制药企业基于医师处方行为制定药品销售策略提供参考。方法:采取文献查询、专家访谈的形式进行调查、分析。结果:医师处方行为受诸多因素影响,多数制药企业在销售策略的制定中存有惯性思维,使其策略多局限于提高医师获取信息的数量,忽略了信息的质量,导致销售业绩不佳。结论:制药企业可透过医师处方行为的分析,纠正惯性思维,通过采取针对性的策略提升销售业绩。