Selling organs for transplantation

The need for transplant organs has far outstripped the supply of available cadaveric organs. Hundreds of people on waiting lists, who could be saved by transplantation, die each year. This severe shortage has justified the extension of transplantation to the use of living donors, but there are still not enough organs to meet the need. This paper discusses the justification for changing policies in order to encourage organ donation. It presents reasons for allowing payments to be made to families that donate cadaveric organs. It also presents reasons for allowing payments to be made to living donors, and guidelines for how an ideal policy could be structured.     

A comparative study of knowledge about and attitudes toward the combined oral contraceptives among Korean and Japanese university students

PURPOSE: To compare university students' knowledge about and attitudes toward the combined oral contraceptives (COC) in two countries with different pharmaceutical systems (Japan and Korea), and to explore the reasons limiting the use of the COC in these populations. METHODS: University students in Korea and Japan completed a questionnaire containing a total of 55 questions about the students' demographics (8 questions), knowledge about the COC (15 questions), attitudes toward the COC (24 questions) and the reasons for limited use of the COC among the population (8 questions). RESULTS: Male students' attitudes toward the COC were significantly more positive than those of female students in Korea, but not in Japan. Knowledge about and attitudes toward the COC did not differ significantly between the two countries. The age at which students desired to use the COC was significantly correlated with age in both countries. There were significant correlations between knowledge about and attitude towards the COC in both countries and between age and attitude towards the COC in Japan. In both countries, the most commonly cited reasons for limited use of the COC were concern about adverse side effects. CONCLUSIONS: These results confirm the need to develop appropriate sex education programs in Korea and Japan. Cultural differences and differences in the pharmaceutical and medical systems between the two countries should be considered when designing sex education programs for young people in Korea and Japan.     

Construction and evaluation of a cancer chemotherapy regimen database using an electronic medical chart network

PURPOSE: There are many regimens for cancer chemotherapy, and thus information management is complicated. It is thought that the safe and appropriate use of cancer chemotherapy can be achieved by developing a system that involves information-sharing among medical staff. A system facilitating the choice of regimen was developed in our institution using an electronic medical chart network. In addition, a questionnaire was distributed to evaluate the usefulness of the cancer chemotherapy regimen database (DB). METHODS: Microsoft Access 2000 was used for the DB. Microsoft Internet Information Services Ver. 6.0 included in the Windows 2003 Server was used as the management software of the Web-version DB. RESULTS: With the Web-version DB, it was possible to offer chemotherapy regimen information to all departments in the hospital. The DB received an excellent evaluation based on the questionnaire results. The reasons for this were the exceptional ability to share information among medical staff and the appeal of a checking system. CONCLUSION: Obtaining information regarding cancer chemotherapy regimens became easier with the Web-version DB, which received an excellent evaluation by all medical staff. Proactive use of the Web-version DB can contribute to proper cancer chemotherapy choice and strengthening of hospital risk management.     

Attitudes towards substance use and substance use disorders among medical students in Israel

Background: Negative attitudes towards substance use and Substance Use Disorders (SUDs) are among the commonly cited barriers to screening and treating these disorders by physicians. These negative attitudes have also been reported in medical students. The aim of this study was to examine attitudes of medical students in Israel towards nicotine, alcohol and drug use and SUDs based on their stage of training and personal experience. Methods: A sample of 329 medical students responded to the Attitudes Towards Substance Use questionnaire, which includes 50 questions regarding substance use and SUDs, as well as specific questions focusing on nicotine, alcohol, cannabis and heroin use. Results: Students at the clinical phase of their training had higher rates of moralism and lower rates of self-reported competency in treating SUDs compared to those in the pre-clinical phase of training. Personal experience with nicotine or alcohol use, as well as having a friend who suffers from addiction, were associated with lower rates of moralism. Across substances, the lowest ratings of treatment efficacy and of self-reported competence, were directed towards alcohol dependence. Conclusions: Medical education programs should include training in addiction medicine throughout all phases of medical school. This may have a significant role in future physicians’ attitudes towards individuals with substance use and SUDs, and eventually in the treatment these patients receive.     

Development and validation of a scale for assessing reasons for substance use in schizophrenia: The ReSUS scale

This paper reports on the development of a questionnaire to assess self reported reasons for substance use in schizophrenia: the ‘reasons for substance use in schizophrenia’ (ReSUS) scale and explores the relationship between reasons for use, psychiatric symptoms and substance use in a sample of 230 people with psychosis. Principal components analysis revealed three subscales: “coping with distressing emotions and symptoms', “social enhancement and intoxication” and “individual enhancement”. Predicted associations were partially supported. ‘Coping’ reasons for use were related to positive symptoms, general symptoms, global functioning, depression and suicide behaviour as well as substance use (quantity of use and problems related to use). ‘Individual enhancement’ reasons were related to positive symptoms, to global functioning and to negative consequences of substance use. ‘Social enhancement and intoxication’ reasons were related to negative consequences of use but not to psychopathology. The findings suggest that the ReSUS is a reliable and valid instrument which can be used to explore self reported reasons for substance use and their relationship to psychotic symptoms in people with schizophrenia and other psychotic disorders.     

Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs

Abstract

Anabolic Androgenic Steroids (AAS) are used by the general population (particularly male gym users) for their anabolic effects (increased muscle mass). Few studies have sought AAS users’ views on what information and support they need. This study focuses on ideal support wanted by people who use AAS. Interviews were conducted with 23 self-declared adult AAS users. Using thematic analysis, six themes were identified aligned to support and information wanted by AAS users: (1) specific types of information wanted: managing risks, (2) mechanisms for communication of advice, (3) specific types of support wanted: medical and emotional, (4) stigmatisation of people who use AAS, (5) paying for support services, (6) legality of AAS use.

Integral to the support was that it should be considered within the context of use and identity. Support needs to be specific, targeted towards AAS users ensuring that balanced and evidenced-based advice is given. Sensitivity to AAS users’ perceptions of their drug-use and the stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement. Furthermore, there is a need to consider the emotional issues surrounding AAS use and how to meet these needs.     

吸毒人群对自身和同伴染患HIV/AIDS的态度调查

目的·· :了解吸毒人群对自身和同伴染患HIV/AIDS后的态度。方法·· :随机抽取正在接受脱毒治疗的500名海洛因依赖者 ,匿名填写问卷进行调查。结果·· :91.6 %的吸毒者担心过去的行为会感染HIV;89 %的人希望接受HIV检测,11 %拒绝检查,其原因依次为:恐惧 (70.9 % )、没必要 (20.0 % )、担心被人知道 (9.1 % ) ;对自身感染HIV后的态度:寻求治疗者66.0% ,报复社会者12.6 % ,有轻生倾向者11.2 % ,希望得到别人的理解和帮助者94.6% ;对同伴感染HIV后的态度 :69.2 %的人采取远离和回避,愿意提供帮助者仅为8.8 %。结论·· :吸毒人群对自身和同伴染患HIV/AIDS存在矛盾的心理 ,HIV感染造成的精神压力和逆反心理 ,有使其产生轻生或违法行为的倾向 ;提供相应的医疗、管理与咨询服务,进行必要的预防教育、行为干预和集中治疗 ,对预防和减少吸毒者感染HIV后对正常人群的威胁具有积极和重要的意义     

U.S. system for organ procurement and transplantation.

The establishment and responsibilities of the organ procurement and transplantation network in the United States are discussed, and the process of receiving an organ transplant through the system is described. The National Organ Transplant Act of 1984 provided for a federally funded network for organ procurement and transplantation, which would function as a private, non-profit organization. This organization is the United Network for Organ Sharing (UNOS). UNOS monitors the activities of and provides service to transplant centers and organ procurement organizations (OPOs). The names of all candidates awaiting cadaveric organ transplants are placed on a central waiting list maintained by UNOS; UNOS also is responsible for maintaining a scientific registry to collect relevant data from transplant centers on the recipients of organ transplants. Although there is a national list of more than 25,000 persons waiting at any given time for a cadaveric organ, there are far fewer actual organ donors (less than 5000 in 1991). The hospital's best resource with respect to the donation process is the local OPO, which provides services related to organ donor referral, evaluation, and surgical recovery. The organ donation process consists of eight components: donor identification, referral, evaluation, consent, management, recovery of organs, allocation, and follow-up. An organ recovery coordinator from the local OPO helps the hospital staff in determining donation potential, seeking consent from the next of kin, and managing the donor after consent has been obtained. The OPO--never the donor's family or their insurer--is billed for charges relating to the donation. The OPO then bills the costs associated with the donation to the transplant centers receiving each organ for implantation.(ABSTRACT TRUNCATED AT 250 WORDS)     

The medical complications of alcohol use: understanding mechanisms to improve management

The use of alcohol in a dependent or even a regular heavy pattern predisposes the drinker to a range of adverse consequences. These include a risk of direct harm from alcohol, including organ damage, mental health disorders and a range of social and legal problems associated with behaviours due to alcohol's effects. The range of organ damage associated with regular heavy alcohol consumption is well described. Much new information on the mechanisms by which damage occurs is available and is reviewed in this paper. New knowledge can assist in the development of more appropriate management strategies for those affected by the medical complications of alcohol use. Genetic susceptibility to tissue injury is explored and the reasons why many heavy drinkers do not appear to experience organ damage are considered. Approaches to the management of certain alcohol-related disorders are outlined.     

Non-medical drug use in students.

A questionnaire was used with tertiary education students. This obtained information regarding the use of, and attitudes towards, various illicit drugs, tobacco and alcohol. The results demonstrate the almost universal acceptance among the samples of regular alcohol use. Tobacco and cannabis are the next most popular social drugs, used by about one-third of those surveyed. Respondents' reasons for regular use suggest wide acceptance of these drugs to alleviate psychological discomfort. Use of other illicit drugs remains minimal.     

Innovations in organ donation

The growing disparity between organ availability for transplantation and the number of patients in need has challenged the donation and transplantation community of practice to develop innovative processes, ideas, and techniques to bridge the gaps. Advances in the sharing of best practices in the donation community have contributed greatly over the last 8 years. Broader sharing of updated guidelines for declaration of brain death in conjunction with improvements in deceased donor management have increased opportunities for organ donation. New techniques for organ preservation and organ resuscitation have allowed for better utilization of the potential donor pool. This review will highlight processes, ideas, and techniques in organ donation.     

Diagnostic microspheres: an overview

Diagnostic methods have become increasingly complex and frequently involve the use of agents that must meet the same approval criteria as drugs. The search for diagnostic contrast agents has spread from X-ray to other imaging modalities, especially to magnetic resonance imaging (MRI) and ultrasound. A wide variety of methods have been used to develop microencapsulated agents, from liposomal entrapment to use of biodegradable polymers. Various scientific and technological advancements have been made in the research and development of diagnostic microspheres. Diagnostic microspheres can be used to understand the human body functions in both healthy and sick people. For example, they allow the detection of malignancies vs. benign tissue changes. Diagnostic microspheres give useful clinical information for various diseases, are very stable, and have proven efficacy in the quantitative measurement of blood flow to an organ. This review discusses various aspects of diagnostic microspheres, such as the choice of contrast agents and radioactive molecules, and their applications in blood flow measurements and organ imaging.     

Willingness to communicate about organ donation among migrant workers in mainland China:a cross-sectional questionnaire survey

Objective Voluntary organ donation is the sole legitimate source of deceased transplantable organs in China.Migrant workers have been major donors.The aim of this study was to examine willingness to communicate about organ donation and identify its predictors among Chinese migrant workers.Methods A total of 660 Chinese migrant workers were recruited into the study.Data were collected by the Chinese version of Organ Donation Attitude Scale,Death Attitude Profile-Revised (DAP-R),Self-Report Altruism Scale (SRA),Willingness to Communicate Sale (WTCS),and a socio-demographic data sheet.Results A total of 688 eligible migrant workers was approached and 660 workers completed the study with the response rate of 95.9％.Migrant workers reported moderate level of willingness to communicate about organ donation.The best-fit regression analysis revealed five variables that explained 32.6％ of the variance in willingness to communicate about organ donation.They were approval of organ donation,obstacle of organ donation,approach acceptance and death avoidance.Conclusion Migrant workers who had a stronger feeling about organ donation or death,and stronger altruism tendencies had a higher willingness to communicate about organ donation.Accordingly,the campaign strategy to promote family communication should enhance positive attitudes about donation,alleviate the fear of death and focus on the altruism element of donation behavior.     

A survey of undergraduate and continuing medical education about antimicrobial chemotherapy in the United Kingdom. British Society of Antimicrobial Chemotherapy Working Party on Antimicrobial Use

1 A questionnaire about undergraduate teaching on antimicrobial chemotherapy was sent to academic Departments of Clinical Pharmacology, Pharmacology and Medical Microbiology throughout the UK. 2 Questionnaires about postgraduate lectures and information circulated to doctors about antimicrobial chemotherapy were sent to Drug Information Centres and Postgraduate Tutors throughout the UK. Review articles and editorials in general medical journals were assessed. 3 The median amount of core undergraduate teaching on antimicrobial chemotherapy was 13.5 h but the range was from 9.0 h to 102.0 h. Content was predominantly oriented towards drugs rather than diseases and towards prescribing in hospital rather than in the community. Most teaching was by formal lecture as part of a core programme. On a scale from 0 to 5 the median emphasis given to individual topics ranged from 2.50 to 3.75 but the range of emphasis given by individual medical schools was wide, for example from 1.00 to 4.50 for teaching on pharmacokinetics. 4 Postgraduate tutors identified advice from local specialists and requests from local practitioners as the most important determinants of content of continuing medical education. Material from drug information centres was predominantly oriented towards discussion of individual drugs rather than management of specific diseases and even this limited survey found evidence of duplication. The UK general medical literature contained a total of 112 reviews or editorials on antimicrobial chemotherapy covering a wide range of topics but these were not, and should not be assumed to be comprehensive. 5 Almost all doctors regularly prescribe antimicrobials and require education about the subject. Wide variations in current medical practice should be addressed explicitly through more extensive use of problem solving. The literature suggests that knowledge is most effectively disseminated through local networks of practitioners. There should be more national co-ordination of the content of information to be disseminated through the existing drug information networks.     

Living donor liver transplantation: ethical considerations

Most solid-organ transplants performed in the Western world are from deceased donors. In the last decade, deceased donation rates have reached a plateau as the number of patients with end-stage organ disease has steadily increased, resulting in a large discrepancy between organ supply and demand. Living donor transplantation is one way to decrease this discrepancy. However, living donation is not universally accepted. For instance, living donation rates vary geographically (eg, living donation is more accepted in Asia than in the Western world) and depend on the organ donated (eg, kidney versus liver donation). In this article we will review the ethical principles guiding living donor liver transplantation, with emphasis on justification and safeguards that support the practice of adult-to-adult living donor liver transplantation, the most clinically and ethically challenging type of living organ donation. Our ethical justification will include a presentation of triangular or tripartite equipoise, a framework that aims to balance donor safety, expected recipient outcomes, and need.     

<Emphasis Type="Italic">Caveat patiens</Emphasis> — ethical dilemmas in decision -making

More than 99,358 men, women and children are on organ transplant lists in the United States. Pressure on family members to donate organs can therefore be intense. The medical excuse was created to address this potential coercion. It is a fabricated anatomical or physiological reason given to a donor (with or without the donor’s request) that provides an immediate shield against coercive pressure by family and friends on the potential donor. While the long-term risks and benefits of the medical excuse have not been studied, they could arguably include: 1) Reinforced perception that donation is expected; hence, declining donation is aberrant, and requires legitimization by external authority; 2) Eroded family trust of transplant physicians; 3) Eroded family trust in the individual reporting a “true” medical excuse; 4) Falsification of potential donor’s medical record; 5) Development of “toxic secrets” in the family unit; 6) Paternalism; and 7) General erosion of trust in both health care providers and the healthcare system. This author proposes a system of transparent and balanced communication where both the potential donor and the transplant team are clearly cognizant of the voluntary nature of the purported donation and where provisions for “opting-out” occur at any point along the pre-transplantation continuum.     

Pilot study of the practical use of Internet in medical services: the questionnaire for pharmacists in Japan

We performed a questionnaire survey to 260 pharmacists as a pilot study, in order to know the actual application of IN to medical services in Japan. The response rate of our questionnaire was 40% (105 persons), and 91% of the answers were from pharmacists who works in hospitals, community pharmacies, or clinics. According to the results, 90 of the 105 pharmacists had had some experience of using IN, and 68% of whom (58% of respondents) use IN daily as a means of problem solution on their works. IN was probably used as a relatively reliable information source something like text-books in such cases as acquiring the medical information for patients or other medical staffs. In addition, IN may have been esteemed its facilities and the informational usefulness and reliability. However, since this survey is just a pilot trial, the result dose not necessarily reflect a general situation around IT use. Consequently, this study result could be need by still further research.     

Internet use amongst New Zealand general practitioners

AIMS: To assess how extensively New Zealand doctors are using medical information on the Internet, and to examine how the new technology is affecting their practice of medicine. METHODS: All general practitioners (GPs) known to be working in Otago and Southland were asked to complete a postal questionnaire regarding their use of the Internet and their impressions of patient use of online medical resources. RESULTS: Of 259 questionnaires mailed out, 168 (65%) were returned by GPs currently in practice. Of those, 114 (68%) said they used the Internet at least monthly. A total of 71% of GPs had patients who indicated they had sought medical information from the Internet. Nearly half of respondents expressed concerns that the Internet could have unwelcome effects on the doctor-patient relationship. CONCLUSIONS: Internet use among New Zealand doctors and patients is widespread, and is likely to have significant impact on medical practice now and in the future. While the potential benefits of the new technology are numerous, the Internet may become a source of conflict between doctors and patients.     

医务人员对细胞毒药物溢出及防护的认知和行为现状调查

目的:了解医务人员对细胞毒药物溢出及防护知识的认知和行为现状,分析存在的问题,为进一步研究防范对策提供依据。方法:设计问卷,对首都医科大学附属北京妇产医院西院区医生、药师、护士共105人进行细胞毒药物溢出及防护的认知和行为情况问卷调查。结果:调查问卷的回收率为100%,其中医生30名、药师18名、护士57名。86名(81.90%)表示知晓细胞毒药物溢出的概念。33名(31.43%)发生过细胞毒药物的破碎或溅洒,20名(19.05%)发生过细胞毒药物溅洒至人的身上。57名护士全部知晓细胞毒药物溢出防护制度,药师和医生的知晓率分别为83.33%和66.67%。在细胞毒药物溢出的防护处理方面,71名(67.62%)知晓如何防护处理,护士的知晓率较高为89.47%,医生和药师对如何防护处理的知晓率仅分别为36.67%和50.00%。在细胞毒药物溢出防护包的配置情况方面76名(72.38%)表示知晓。结论:医务人员对细胞毒药物溢出及防护的认知有待通过培训等手段进一步提高。应加强标准化操作规程的制定、培训和管理,从而保证医务人员和患者的健康。