Teaching medical students about the appropriateness of social and sexual contact between doctors and their patients: evaluation of a programme

The purpose of this study was to assess the impact of an educational intervention on medical students' attitudes toward social and sexual contact with patients by doctors from three medical specialties (general practice, obstetrics/gynaecology and psychiatry). Medical students from two consecutive fifth year classes at one medical school participated in one 3 hour session that included instruction on the standards of the profession that prohibit doctor–patient sexual contact. Students were assigned to either intervention groups or control groups and responded to an anonymous questionnaire (overall response rate 66·8% ; n=141). As many as 14·5% of control group students thought it was (sometimes or usually) appropriate for general practitioners to date their own patients and at least 3% thought it appropriate for members of any of these three medical specialties to engage in sexual contact with their own patients. However, there were no significant differences in attitudes toward hugging, dating or sexual contact with current patients between those who had attended the seminar and the control groups. The session significantly influenced attitudes regarding obstetrician/gynaecologists and psychiatrists hugging and having sexual contact with former patients. These findings are discussed in relation to a need for expansion of such instruction.     

Toxicity of the blue-green alga (cyanobacterium) Microcystis aeruginosa in drinking water to growing pigs,as an animal model for human injury and risk assessment

Hepatotoxins from blue-green algae are increasingly recognized as a potential hazard in drinking water supplies. The clinical consequences of ingestion include acute or chronic liver injury, with the possibility of enhanced susceptibility to, and growth of, liver tumors. To establish guidelines for water safety requires the demonstration of dose-dependent effects of toxicity and experimental determination of maximum “no-adverse-effect levels.” This paper describes the use of growing pigs as a model for human injury resulting from Microcystis toxins in drinking water. Risk assessment calculations using a series of safety factors are carried out, resulting in a guideline level after incorporating an additional safety factor for tumor promotion of approximately 1.0 μg toxins/L. With the Microcystis used for this trial, that concentration corresponds to 5000 cells/mL. © 1994 by John Wiley & Sons, Inc..     

105Changes in Nitric Oxide Levels After Deep Dermal injury in the Female,Red Duroc Pig (FRDP)

Introduction : Hypertrophic scar is a devastating sequel to burns and other tangential skin injuries. It follows deep dermal injuries and does not occur after superficial injuries. Nitric oxide (NO) plays many important roles in wound healing from inflammation to scar remodeling. Studies have shown that expression of nitric oxide synthase and nitric oxide production are decreased in human hypertrophic scar. However little is known about NO involvement in the early stages of hypertrophic scarring, because of the lack of an animal model. It was recently reported that the female red Duroc pig (FRDP) makes thick scar, which is similar to human hypertrophic scar. We hypothesized that NO production in wounds on the female, red Duroc pig is similar to that of human hypertrophic scar and that NO involvement in deep wounds is different from that in superficial wounds. Methods : Superficial (0.015” to 0.030”) and deep (0.045” to 0.060”) wounds were created on the backs of four FRDPs. Biopsies were collected at weeks 1.5, 4, 8 and 21 post wounding including samples of uninjured skin. Nitric oxide levels were measured with the Griess reaction assay and normalized with tissue protein level. Results : Superficial wounds healed with an invisible scar whereas the deep wounds healed with scar resembling mild hypertrophic scar. The thickness of the scars from the deep wounds was significantly greater than uninjured skin and healed superficial wounds (p < 0.01). NO levels were increased at 1.5 weeks in deep wounds compared to superficial wounds and uninjured skin (p < 0.05). At 8 weeks, NO levels in deep wounds had returned to the level of uninjured tissue and superficial wounds. By 21 weeks, NO levels had decreased significantly when compared to superficial wounds (p < 0.01). There were no differences in NO levels between uninjured skin and superficial wounds at any time point (p > 0.05). Conclusions : NO production is similar in late, deep wounds on the female, red Duroc pig to that reported in the literature for human hypertrophic scar further validating this animal model. NO production is quite different after deep wounds as compared to superficial wounds in the FRDP. Early elevation in nitric oxide production might account for excessive inflammation in deep wounds that become thick scars in the FRDP. Nitric oxide regulators and effects at early stages of scar formation should be elucidated further and the FRDP appears to be a useful model.     

Social and sexual contact between general practitioners and patients in New Zealand: attitudes and prevalence.

BACKGROUND. Doctor-patient social and sexual contact is increasingly acknowledged as an issue of importance for the medical profession. However, there is little research concerning general practitioners on this topic. AIM. A study was undertaken to obtain data on social and sexual contact between general practitioners and their patients. METHOD. An anonymous questionnaire was mailed to a nationwide randomized sample of 217 general practitioners in New Zealand. RESULTS. A response rate of 86% was obtained. Dating and sexual contact with patients was considered to be sometimes or usually acceptable to 35% and 10% of general practitioners, respectively. Of respondents, 6% reported having dated a patient, 4% reported having had sexual contact with a patient at some point during their career and 2% reported having engaged in sexual contact with a former patient. General practitioners who had personally known of a colleague who had engaged in sexual contact with a patient were more likely to believe this behaviour had negative consequences than general practitioners who themselves reported having engaged in sexual contact with a patient. CONCLUSION. The study results have implications for developing behavioural guidelines and educational interventions for general practitioners.     

Cardiac allograft vasculopathy: the green lane hospital experience 1987-1998

AIMS: To determine the prevalence of cardiac allograft vasculopathy in heart transplant recipients at Green Lane Hospital and to examine potential risk factors for vasculopathy. METHODS: We retrospectively reviewed the coronary angiograms of all cardiac transplant recipients. Angiography was usually performed one, two and five years after operation. The diagnosis of allograft vasculopathy was made if there was any evidence of coronary artery disease. Patients' medical records were reviewed for potential risk factors. RESULTS: Ninety-one patients underwent cardiac transplantation between December 1987 and March 1998. One year survival was 87%. Angiographic evidence of coronary disease was present in 30 patients and in three patients coronary lesions were first identified at post mortem. Vasculopathy was present in 25%, 35% and 61% of patients at one two and five years following transplant. Donor-acquired lesions could not be excluded as few patients had immediate postoperative angiograms for comparison. Five late deaths have been due to vasculopathy. Recipient age, race, donor age and ischaemic time were similar for those with and without vasculopathy. Frequency or severity of acute rejection episodes, cytomegalovirus infection, lipid profiles, diabetes and hypertension were not significantly different in patients with vasculopathy. CONCLUSION: Cardiac allograft vasculopathy is a common finding after heart transplantation. No definite risk factors were identified in this patient group.     

TREATMENT OF PALMOPLANTER HYPERHIDROSIS BY IONTOPHORESIS

Twenty-seven patients with idiopathic palmoplanter hyperhidrosis were treated with Iontotherapy over a one year period. In twenty-four cases there was a good response but maintenance therapy was required every 3-4 weeks.KEY WORDS: Iontophoresis, Palmoplanter hyperhidrosis