Survey of antidoping knowledge,attitudes and practices amongst elite Indian sportsmen and the way forward

BackgroundIndian sportspersons have reported several antidoping rule violations with several cases suggesting inadvertent use of prohibited substances. This study was designed to evaluate the anti-doping knowledge, attitudes and practices amongst elite Indian sportsmen to suggest future interventions.MethodsThis study conducted at a Sports institute used an anonymized questionnaire to survey 181 male (18–35 years old) elite young athletes' attitudes toward performance-enhancing substances and anti-doping rules.ResultsAthlete awareness regarding antidoping agencies and antidoping rule violations was poor. 40% or less reported receiving antidoping updates. All reported improvement in antidoping knowledge and attitude changes after attending updates. Health is more important than sporting performance for 80% or more. Very low percentage reported consumption of banned substances amongst themselves and team mates. One-third of these athletes reported not having being tested for banned substances. Athletes who have attended antidoping sessions exhibit significantly higher knowledge levels and a significantly higher 80% reported consulting their Team doctor before any therapeutic drug use as compared with non-attendees.ConclusionIndian elite athletes report low awareness about anti-doping rules and prohibited substances with low proportion of athletes reporting doping and being tested for doping. Grass root level education, supplement regulation, trained athlete support personnel and accessible reference material seems to be the way forward.     

Prescribing patterns in agoraphobia with panic attacks

Although medication is used commonly in the treatment of agoraphobia with panic attacks, the actual drug-prescribing patterns of the medical profession have not been well studied in this condition. The present study compares the prescribing patterns of general practitioners and psychiatrists in their treatment of agoraphobia with panic attacks. The medical records of 111 agoraphobic patients with panic attacks were analysed and divided into those who were referred by general practitioners and those who were referred by psychiatrists. Over all, in the treatment of agoraphobia with panic attacks, general practitioners prescribed drugs less often than did psychiatrists. They used fewer combinations of drugs and tended to prescribe tricyclic antidepressant agents in doses which generally are considered to be below the therapeutic range. This finding would suggest that general practitioners are less effective than are psychiatrists in prescribing for this condition as judged by current practice, although they are less likely to prescribe combinations of drugs--a practice which might well be to their credit.     

我国惩罚性赔偿制度的立法现状及完善

惩罚性赔偿制度是一种带有私法外壳的公法责任制度.目前,我国已经开始逐步建立该项制度.要进一步完善该制度,就其适用范围方面,应该在侵权行为法中确立并扩展其适用,同时在合同法领域适当限制其适用;就赔偿数额的确定方面应设立一些参考因素,具体的数额赋予法官一定的自由裁量权;同时,为防止当事人滥用权利,法律应明文规定其适用范围,要求受害人主动提出加重赔偿的请求及规定较高的证明标准来限制该权利的使用.     

Unacceptable face of private practice: prescription of controlled drugs to addicts

Self administered questionnaires completed by 69 out of 100 consecutive drug addicts attending two drug dependence clinics suggested that some private general practitioners were easily persuaded to prescribe controlled drugs. These drugs were usually methadone, dipipanone-cyclizine (Diconal), and methylphenidate (Ritalin). Numbers of new narcotic addicts notified to the Home Office confirmed the practice, which may lead to a severe spread of addiction, as occurred in the 1960s with heroin and cocaine. If the General Medical Council or a tribunal set up in accordance with the Misuse of Drugs Act 1971 cannot stop the practice, then the present licensing system should be extended to include all controlled drugs.     

Unauthorized practice: teaching pelvic examination on women under anesthesia

Medical ethics evolved over the past half-century. This brought close reexamination and scrutiny of medical education and the "hands-on training" of future medical practitioners. Likewise societal opinions have intensified regarding the rights of patients, especially those deemed less likely to express their humiliation if they should discover themselves in compromising positions during treatment. Informed consent is modern medico-legal terminology; if the public felt that all patients were treated with the self-determination and dignity required by current HIPAA regulations, then there would be no reason to legislate such requirements. Law professor Robin Fretwell Wilson, Esq., and obstetrics and gynecology professor Nancy G. Chescheir, MD, present evidence and opinions from the legal and medical perspectives regarding conducting pelvic exams on anesthetized women without or with vague consent.     

Web 2.0 technologies for undergraduate and postgraduate medical education: an online survey

Objectives

To identify the current familiarity and use of Web 2.0 technologies by medical students and qualified medical practitioners, and to identify the barriers to its use for medical education.

Methods

A semi‐structured online questionnaire survey of 3000 medical students and 3000 qualified medical practitioners (consultants, general practitioners and doctors in training) on the British Medical Association''s membership database.

Results

All groups had high familiarity, but low use, of podcasts. Ownership of digital media players was higher among medical students. There was high familiarity, but low use, of other Web 2.0 technologies except for high use of instant messaging and social networking by medical students. All groups stated that they were interested in using Web 2.0 technologies for education but there was lack of knowledge and skills in how to use these new technologies.

Conclusions

There is an overall high awareness of a range of new Web 2.0 technologies by both medical students and qualified medical practitioners and high interest in its use for medical education. However, the potential of Web 2.0 technologies for undergraduate and postgraduate medical education will only be achieved if there is increased training in how to use this new approach.     

生产者破产后产品责任的解决路径

生产者破产后产品责任的解决是消费者面临的新难题。我国产品责任既有的生产者与销售者不真正连带责任的制度设计，旨在让销售者承担生产者破产后的产品责任，使销售者承担了与其对产品的控制力和收益不相称的风险。我国生产者产品责任保险的局限性使生产者破产后产品责任问题的解决雪上加霜。我国《破产法》应首先认可人身伤害债权的优先性，并将产品致害预期债权人代表制度作为一项特殊制度加以规定，通过设立赔偿基金、预期产品责任转让等方式，有效解决生产者破产后产品责任问题，全面保护生产者破产后其仍在市场流通的产品相关消费者的权益。     

Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike

The current practice of non-consensual medical treatment of hunger-striking asylum seekers in detention needs closer inquiry. An Australian Government regulation empowers the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) to authorise non-consensual medical treatment for a person in immigration detention if they are at risk of physical harm, but there are doubts about whether the regulation would withstand legal challenge. Authorisation by DIMIA does not compel medical practitioners to enforce treatment if such action is contrary to their "ethical, moral or religious convictions". The World Medical Association has established guidelines for doctors involved in managing people on hunger strikes. The Declaration of Tokyo (1975) and the Declaration of Malta (1991) both prohibit the use of non-consensual force-feeding of hunger strikers who are mentally competent. If called upon to treat hunger strikers, medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.     

Reducing 'information overload' in the teaching of pharmacology: the '200 Drug List'

The author in this report describes the development and use of a restricted list of drugs in the medical pharmacology course at the Medical College of Georgia (MCG) School of Medicine. The "200 Drug List" was developed by the author by analyzing recent examinations given to students at the MCG and other places. The list contained 60 percent fewer drugs than had been taught in the course in prior years. Only those drugs on the list appeared on subsequent pharmacology examinations, regardless of the scope of the teaching program. Despite the limited number of drugs that the students were required to learn to satisfy the requirements of the teaching program, the average score for the class on the pharmacology subtest of the National Board of Medical Examiners Part I examination improved each year since the new approach was adopted. The 200 Drug List concept is viewed as an effective way to reduce the "information overload" for students without sacrificing the quality of an introductory course in pharmacology.     

Shuttle case records: link between general practice and the specialist unit

General practitioners have participated in the long term follow up of 367 patients who have undergone treatment with potent antirheumatic drugs at this hospital. Over the past two and a half years we have used the "shuttle case record" system, whereby patients' records are mailed back and forth between our department and general practitioners. This seems to work well. It is safe for the patients, and they save time and money in travel. The general practitioners like it, it improves communication between them and the specialist unit, and it enables the specialist unit to use its resources and manpower more effectively. The system may also be used to monitor patients with other chronic disorders, and it may be a valuable tool for doing research in general practice.     

Use of thrombolysis for acute myocardial infarction by general practitioners.

The early administration of thrombolytic agents significantly reduces mortality following a myocardial infarct and ideally they could be given by general practitioners when the patient is first seen. However, the diagnosis of myocardial infarction in the early stages can be very difficult especially if an electrocardiogram is not available. This may limit the use of thrombolytic drugs by general practitioners. We assessed the accuracy of diagnosis in general practice by asking general practitioners referring patients with chest pain, the likelihood that the event was due to a myocardial infarction and if they would use thrombolysis if it were available. Diagnostic accuracy and appropriate use of thrombolysis was analysed retrospectively, comparing the general practitioner with the admitting hospital doctor. One hundred consecutive patients were studied. The general practitioners accurately diagnosed myocardial infarctions in approximately 45% of cases and would have given thrombolysis inappropriately on 67% of occasions mainly because the final diagnosis in most of these patients was unstable angina rather than infarction. The hospital doctors administered streptokinase inappropriately to 33% of the patients and four had complications during treatment. Of those patients receiving thrombolysis, the average time delay from the general practitioner referring the patient to hospital to the patient being treated was 107 minutes. This study confirms that the diagnosis of myocardial infarction in the early stages is difficult and that thrombolytic therapy may be given inappropriately (mainly to patients with unstable angina). We conclude that until the accuracy of diagnosis of myocardial infarction can be improved in general practice it would seem inappropriate for thrombolysis to be given in the community at the moment.     

When to intervene for male and female patients' alcohol consumption: what general practitioners say

Results of a telephone survey of 103 Sydney general medical practitioners are reported. General practitioners were asked to indicate how much alcohol male and female patients would need to be consuming to warrant their intervention. The mean levels at which general practitioners stated they would intervene were 5.1 drinks per day for male patients and 3.8 drinks per day for female patients. These mean scores fall within the consumption ranges identified by the National Health and Medical Research Council (NHMRC) as being hazardous and are below the levels specified as harmful. While the results of the present study indicate some consistency between general practitioners' views and NHMRC recommended levels for low-risk alcohol consumption, there were important discrepancies. For instance, using NHMRC categories of risk, general practitioners would intervene for female patients at significantly higher levels (P less than 0.05) of associated risk than they would for male patients. In addition, many general practitioners did not differentiate between the quantities of alcohol consumed for which they would intervene for male and female patients; this is an area needing attention. While the results indicate that some general practitioners have the basic knowledge required for involvement in detection and early intervention activities for alcohol-related problems, future training programmes should address the fact that two-thirds of general practitioners either overestimate or underestimate the level of patient alcohol consumption at which it is appropriate to intervene.     

患者对拔牙术后抗生素使用的认知调查分析

目的 通过探讨患者对拔牙术后抗生素使用的认知情况,促进抗生素的合理使用.方法 选取2015年1~4月期间到四川医科大学附属口腔医院口腔颌面外科门诊就诊的健康成年拔牙患者,完成问卷调查.采用χ2检验,分别分析问题答案是否与年龄,性别和教育程度有关.结果 收回完整问卷调查共978份,有842例患者(86.1%)希望拔牙术后医生开具抗生素,674例患者(69.9%)会在医生未开具抗菌素的时候要求医生开,因为他们认为使用抗生素可以预防术后感染.901例患者(92.1%)因为牙龈肿胀就诊的时候,会要求医生使用抗生素,62.0%的患者(606/978)在牙痛就诊的时候会要求医生开具抗生素,64.0%的患者(626/978)曾经在感冒时要求医生开具抗生素.年龄、性别和受教育程度对这些问题答案的影响差异无统计学意义(P>0.05).结论 大部分患者对于常规拔牙术后抗生素使用的认知不足,需要加强抗生素知识的宣教和普及.     

Patient-flow and waiting times in general medical and dental clinics in Jamaica's primary health care services

Jamaica has implemented primary health care services closely in accordance with the philosophy of the Declaration of Alma Ata. However, resources are scarce and need to be well managed. Ideal patient-flow in health centres (HCs) would achieve both high efficiency in use of staff time and minimum waiting times for patients. This study of 465 patients in 44 general medical clinics served by 34 doctors and 25 nurse practitioners, and 167 patients served by dentists in each of 15 clinics, showed that mean contact time of patients with doctors was 7 minutes, with nurse practitioners 11 minutes, and dentists 4 minutes. Medical patients waited an average of 3 hours 53 minutes, whilst dental patients waited an average of 2 hours 23 minutes. Doctors', nurse practitioners' and dentists' median times for starting to see patients were 10.00 a.m., 9.35 a.m. and 9.48 a.m. respectively. They were able to work without experiencing any delays in patient-flow since many patients were waiting at the HC by 8 a.m., and preliminary processing was short. It is suggested that if they started seeing patients earlier, patients' waiting times would be shorter. The shortage of pharmacists to dispense drugs after medical consultations added to patients' waiting time. The results were a natural outcome of the low supply of personnel and high demand for services situation being experienced in the medical and dental services.     

基于种子类中药逢子必炒探讨中药炮制共性机理及特征性质量标准

种子类中药逢子必炒的炮制理论具有丰富的科学内涵,但在种子类中药炒制机理研究中,其炒制过程的内在变化过程和变化规律尚不清楚,药效物质不明确,且缺少特征性质量标志物,难以有效控制质量。揭示种子类中药逢子必炒共性规律,对于建立中药饮片特征性质量标准具有指导意义。基于逢子必炒炮制理论的研究,提出采用谱效相关分析的研究方法,研究炒制过程化学成分及药效作用变化,阐明其药效物质基础,揭示炒制过程共性变化规律;同时,结合体内过程研究,阐明炒制过程对药效物质的影响,进而明确中药的体内药效物质基础;在此基础上,采用一测多评技术和液质联用技术等方法,研究建立中药饮片特征性质量标准,指导中药饮片规范化炮制和临床合理使用。      

Hormone replacement therapy: a survey of Ontario physicians'' prescribing practices

BACKGROUND: Although much has been written about hormone replacement therapy (HRT), there are few clearcut recommendations on its use. The purpose of this study was to determine Ontario physicians' patterns of and reasons for prescribing HRT, their use of pretreatment investigations and their surveillance of HRT users, and to determine whether physicians' reported practice is consistent with existing recommendations. METHODS: A self-administered questionnaire was mailed to a nonproportional stratified sample of 327 Ontario physicians (23.9% gynecologists, 76.1% general practitioners/family physicians [GP/FPs]). Outcome measures were ranking of reasons for prescribing HRT, nature of preliminary testing, regimens prescribed, duration of HRT and frequency of follow-up. RESULTS: The response rate was 60.9% overall (70.9% of the gynecologists, 58.3% of the GP/FPs). Prevention of osteoporosis was reported by 97.4% as an important or very important reason for prescribing HRT; prevention of coronary artery disease was important or very important for 89.3%. When considering whether or not to prescribe HRT, 97.3% stated that breast cancer was an important or very important factor. When presented with hypothetical cases, 97.0% stated that they would prescribe combined estrogen-progestin for a symptomatic woman with an intact uterus; 13.6% stated that they would do so for a woman with no uterus. Most reported that they would prescribe HRT for 12 or more years (73.3%) and would follow up patients every 1 to 2 years (70.6%). INTERPRETATION: Despite controversy about HRT in the published literature, the Ontario physicians surveyed reported similar reasons and patterns of prescribing, pretreatment investigations, and surveillance of postmenopausal women using HRT. These results suggest that Ontario physicians' knowledge about HRT is consistent with recommendations in the published literature.     

Herbal medicine takes root in Germany

The sale of Herbal Medicine is a growth industry in Germany, where physicians routinely prescribe these products and annual sales have surpassed $ 2 billion. Pam Harrison says the rising popularity has been driven by German patients, who began demanding herbal alternatives to synthetic drugs. Medical schools responded by reintroducing lessons on a topic that had been phased out of the medical curriculum.