Doctor's Consent Research Articles

Ramadan fasting without the doctor's consent: which patient, and what impact? Results of a prospective study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Brief Consent Methods Enable Rapid Enrollment in Acute Stroke Trial: Results From the TICH-2 Randomized Controlled Trial.

Seeking consent rapidly in acute stroke trials is crucial as interventions are time sensitive. We explored the association between consent pathways and time to enrollment in the TICH-2 (Tranexamic Acid in Intracerebral Haemorrhage-2) randomized controlled trial. Consent was provided by patients or by a relative or an independent doctor in incapacitated patients, using a 1-stage (full written consent) or 2-stage (initial brief consent followed by full written consent post-randomization) approach. The computed tomography-to-randomization time according to consent pathways was compared using the Kruskal-Wallis test. Multivariable logistic regression was performed to identify variables associated with onset-to-randomization time of ≤3 hours. Of 2325 patients, 817 (35%) gave self-consent using 1-stage (557; 68%) or 2-stage consent (260; 32%). For 1507 (65%), consent was provided by a relative (1 stage, 996 [66%]; 2 stage, 323 [21%]) or a doctor (all 2-stage, 188 [12%]). One patient did not record prerandomization consent, with written consent obtained subsequently. The median (interquartile range) computed tomography-to-randomization time was 55 (38-93) minutes for doctor consent, 55 (37-95) minutes for 2-stage patient, 69 (43-110) minutes for 2-stage relative, 75 (48-124) minutes for 1-stage patient, and 90 (56-155) minutes for 1-stage relative consents (P<0.001). Two-stage consent was associated with onset-to-randomization time of ≤3 hours compared with 1-stage consent (adjusted odds ratio, 1.9 [95% CI, 1.5-2.4]). Doctor consent increased the odds (adjusted odds ratio, 2.3 [1.5-3.5]) while relative consent reduced the odds of randomization ≤3 hours (adjusted odds ratio, 0.10 [0.03-0.34]) compared with patient consent. Only 2 of 771 patients (0.3%) in the 2-stage pathways withdrew consent when full consent was sought later. Two-stage consent process did not result in higher withdrawal rates or loss to follow-up. The use of initial brief consent was associated with shorter times to enrollment, while maintaining good participant retention. Seeking written consent from relatives was associated with significant delays. URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.

PrEazy : A Road Map from Traditional Prescription System To Digital Prescription System

Fake Prescriptions have emerged lately becoming hazardous for people’s lives; bringing their lives at stake. Drugs like Schedule-H cannot be bought without a doctor's consent and thus cases of such drugs being bought with the help of fake prescriptions have become very common today. Sometimes pharmacists find it hard to identify the medicine names from handwritten descriptions and it may eventually lead to misinterpretation of the prescribed medicine name. We provide a solution to this problem. PrEazy is an android application that provides secured and digital prescriptions such that it reduces the use of fake prescriptions. Also, it is a Paperless Technology making it Environment-Friendly. This application is digital prescription software which transmits communication between doctor, patient and pharmacist.

Non-medical use of prescription drugs and HIV risk behaviour in transgender women in the Mid-Atlantic region of the United States.

Male-to-female transgender women (TGW) experience high rates of substance use and HIV. A recent substance use trend is the use of prescription medication without a doctor's consent. No research to date has examined the associations between this non-medical use of prescription drugs and HIV risk behaviour in TGW. In the present study, TGW recruited from community venues (N = 104) in the Mid-Atlantic region of the United States completed surveys assessing demographic information, non-medical use of prescription drugs, other substance use, injection practices and sexual risk behaviour. Twenty-four per cent of the sample reported lifetime non-medical use of prescription drugs across the following categories: analgesics (21.2%), anxiolytics (14.4%), stimulants (12.5%) and sedatives (8.7%). Participants reporting non-medical use of prescription drugs were more likely to report other substance use, needle use to inject drugs, injecting silicone and sharing needles. In multivariable analyses, non-medical use of prescription drugs was associated with unprotected sex, sex after engaging in substance use, and commercial sex work, after controlling for demographic factors. Self-esteem and social support from family served as protective factors for non-medical use of prescription drugs. HIV-prevention programmes focused on TGW in the United States may wish to expand their assessment of substance use to include the use of prescription medications without a physician's consent.

Adolescent Indoor Tanning Use and Unhealthy Weight Control Behaviors

Youth indoor tanning rates remain high despite the potential for increased melanoma risk. No previous study has assessed the prevalence of unhealthy weight control behaviors in both male and female adolescent indoor tanning users using a nationally representative survey. Pooled data on high school students from the 2009 and 2011 Youth Risk Behavior Survey were used (n = 26,951). Multivariate logistic regression was used to assess associations between the recent indoor tanning use and recently doing the following to lose weight: fasting for more than 24 hours; taking a pill, powder, or liquid without a doctor's consent; and vomiting or taking a laxative. Pooled data showed 23.3% of females reported indoor tanning within the past year; 6.5% of males did so as well. Adjusted multivariate results show that females who indoor tan were, on average, more likely to have fasted (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.5), taken a pill, powder, or liquid (OR, 2.4; 95% CI, 1.9-3.0), and vomited or taken a laxative to lose weight (OR, 1.4; 95% CI, 1.1-1.7) within the past 30 days than those who did not. Males who indoor tanned within the past year were, on average, more likely to have fasted (OR, 2.3; 95% CI, 1.7-3.1), taken a pill, powder, or liquid (OR, 4.4; 95% CI, 3.3-6.0), and vomited or taken a laxative to lose weight (OR, 7.1; 95% CI, 4.4-11.4) within the past 30 days. Significant associations between indoor tanning use and unhealthy weight control behaviors exist for both male and female adolescents, with a stronger association observed among males.

Analiza struktury i częstości przyjęć pacjentów w stanie zatrucia alkoholem na przykładzie dwóch lubelskich szpitali

IntroductionOn June 30th 2002 the sobering station in Lublin was closed as part of public spending cuts. Currently, the city lacks an appropriate facility to provide care for intoxicated individuals. The aim of the work was to investigate the proportion of alcohol intoxicated patients admitted to the Admission Room/Hospital Emergency Department (AR/HED) before the sobering station in Lublin was closed in 2002, and a decade later in 2011. MethodThe research method comprised an analysis of medical records from the emergency department and admission room of two hospitals in Lublin. In each hospital the records from 4 selected months (January, April, July, and October) were examined. Of the 8625 patient admission cards from AR and HED, 772 records in a state of alcohol intoxication were selected (215 records from 2001 and 2002, and 557 records from 2011), and were analysed in the second stage of the research.The target group of patients was identified with the use of medical diagnostic codes ICD-10: F10.0 (acute intoxication due to use of alcohol) and T51 (the toxic effect of alcohol) to define the principal diagnosis or comorbidity, or according to a doctor's explicit annotation in medical records stating that the patient was intoxicated. The obtained research results were statistically analysed. The database and statistical analysis was carried out by means of the STATISTICA 10.0 software (StatSoft, Poland). Results and conclusionsStatistical analysis showed that after June 30th 2002 and in 2011, the frequency of the admissions of patients with alcohol intoxication was significantly higher than in 2001 and 2002, i.e. before the sobering station was closed. The research indicated that not all individuals in a state of insobriety required advanced medical intervention in a hospital emergency department, 72 patients were kept in for observation only, and the majority (232 patients) were only administered an intravenous saline solution. A large group of patients admitted in a state of alcohol intoxication left the hospital unauthorised (41.97%) without doctor's consent. The reopening of the sobering station in Lublin could relieve patient traffic in hospital emergency departments and admission rooms.

The Preference Survey for Long-Acting Injectable Antipsychotics of Community-Dwelling Patients with Schizophrenia and their Caregivers

Objective : The prescription rates of long-acting injectable (LAI) antipsychotics are very low around 1% in Korea. This study was aimed to explore the preference of LAIs in patients with schizophrenia, who are currently living in community, and their caregivers. Methods : The patients, diagnosed with schizophrenia by DSM-IV TR and were registered in the 31 mental health centers of Gyeonggi province and their caregivers were inquired the knowledge of the LAIs. The questionnaires contained information such as demographic characteristics, history of psychiatric treatment, and so on. Results : About 5,318 were registered in 31 community mental health centers of Gyeonggi province in February 2012. The ques- tionnaires of 614 patients and 365 caregivers were gathered from 20 community mental health centers. The mean ages (±SD) of patients and caregivers were 41.9 (±10.2) and 62.2 (±13.4) years old, respectively. 272 patients (44.6%) had experienced the discontinuation of medications without doctor's consent. 217 patients (35.9%) and 97 caregivers (27.1%) knew about the LAIs. The preference rates for LAIs were 35.2% and 46.8% for the patients and caregivers, respectively. Conclusion : There is still huge discrepancy between the preference and the real prescriptions of LAIs in community-dwelling patients and their caregivers, much higher than in those of hospital settings. This study suggests that both patients and caregivers registered in the community mental health centers have a strong commitment to live in the community. The obstacles against the benefits of LAIs need to be resolved. (Korean J Schizophr Res 2013;16:14-24)

OC-003 Nurse vs doctor consent within endoscopy: are they equal?

IntroductionThis study compared the effectiveness of nurse led consent vs doctor led consent for patients undergoing day case diagnostic endoscopy. There have been no previous studies that have directly compared...

Gynecomastia caused by ethionamide

A 43 year old male patient, known case of multidrug resistant tuberculosis, was prescribed antitubercular drugs: kanamycin, levofloxacin, ethionamide, terizidone, Para-Aminosalicylate Sodium (PAS), pyrazinamide and pyridoxine. After 4 months of treatment, the patient developed a lump in the right breast which was approximately around 3 × 3 cm in size, tender on palpation, and not fixed to the underlying tissues. Ultrasonography (USG) revealed a hypoechoic mass of size 2.5 × 0.92 × 2.6 cm in the right breast region behind the nipple without any infiltration to the deeper structures. Gynecomastia due to ethionamide was suspected and the patient was advised anti-inflammatory drugs for 5 days without any change in drug therapy. The pain subsided; however, the nodule remained. Treatment was continued without any change till the patient stopped using the drugs on his own and without doctor's consent. Within a week of stopping of treatment the nodule also disappeared.

The Western Australian Melanoma Health Study: Study design and participant characteristics

Background: Cutaneous malignant melanoma is a major public health issue in Australia and other nations. A greater understanding of the genetic determinants and their interactions with environmental factors may lead to better interventions and control of the disease. The Western Australian Melanoma Health Study (WAMHS) is a population-based case-collection and biospecimen resource established to investigate the genetic epidemiology of melanoma. This manuscript discusses the design of the WAMHS and the characteristics of the participants. Methods: Participants were recruited through the Western Australian Cancer Registry, which is notified of all incident cancers in the state of Western Australia by law. Once the diagnosing doctor's consent was obtained, all eligible, resident Western Australian, adult cases of melanoma diagnosed between January 2006 and September 2009, were contacted by mail and invited to participate. Clinical, questionnaire-based phenotypic and blood samples for extraction of DNA, RNA and serum were collected from consenting cases. Clinical data consisted of all pathological data recorded by the cancer registry and the questionnaire, administered by telephone interview, covered major risk factors for melanoma, such as sun exposure history and skin type. Results: The final sample consisted of 1643 consenting cases out of 3420 cancer notifications (48.04%), of which 1455 cases completed one or more components of the study and 1157 completed all components. The WAMHS sample differed to all melanoma notifications only in age, with a bias towards older individuals (P<0.0001). No significant differences were observed in sex, melanoma site, Breslow thickness or Clark's level. Conclusions: The WAMHS study is novel in its non-family based approach and focus on common (low penetrance) genetic determinants. This comprehensive resource will enable further steps to be taken towards understanding the complex pathways involved in melanoma.

Nonmedical Use of Prescription Drugs and HIV Risk Behavior in Gay and Bisexual Men

Previous research has demonstrated associations between substance use and sexual risk behavior in men who have sex with men (MSM). Recent trends in substance use show increasing use of prescription medications (e.g., Vicodin) without a physician's prescription, yet associations between the nonmedical use of prescription drugs (NMUPD) and HIV risk behavior have not been well examined in MSM. MSM attending a gay pride festival completed a self-report measure assessing NMUPD, motivations for use, use of traditional recreational drugs, and HIV risk behavior. More than one-third of the sample (38%) reported lifetime NMUPD and 17% reported NMUPD in the previous 3 months. The most common class of medications used was prescription analgesics. Men reporting NMUPD also reported higher rates of the use of marijuana, poppers, ecstasy, cocaine, methamphetamine, GHB, ketamine, heroin, and rohypnol, and had significantly higher rates of HIV risk behaviors, including more sexual partners and more unprotected sex. A significant minority of MSM are using prescription medications without a doctor's consent. Men who do so are risking negative consequences of such use, including the potential for addiction, potentially dangerous interactions between prescription and recreational drugs, and greater risk for contracting HIV.

Non-medical use of prescription drugs and sexual risk behavior in young adults

In recent years, the non-medical use of prescription drugs (without a doctor's prescription) has increased dramatically, particularly in young adults. Previous work has noted associations between the non-medical use of prescription drugs and the use of illicit drugs, and associations between the use of illicit drugs and sexual risk behavior. Investigations examining associations between the non-medical use of prescription drugs (NMUPD) and sexual risk behavior are sparse. In the present study, undergraduate students ( n = 435) ages 18–25 completed an instrument assessing these behaviors. Overall, 35.6% of participants reported NMUPD. Individuals who reported NMUPD were more likely to also report the use of alcohol, marijuana, ecstasy, cocaine, methamphetamine, and poppers. Participants who indicated they had used prescription medications without a doctor's consent had significantly higher rates of sexual risk behavior, including more sexual partners and more instances of unprotected sex in the previous 3 months. Results suggest that a significant minority of young adults are using prescription medication recreationally and are risking negative consequences, including the potential for addiction, dangerous interactions between prescription and recreational drugs, and greater risk for contracting sexually transmitted infections.

Long-term Follow up of Congenital Adrenal Hyperplasia Patients with Hyponatremia

Congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency is an autosomal recessive disease, which leads to cortisol and aldosterone deficiency and hyperandrogenism. Typical medical treatment includes oral glucocorticoid and mineralocorticoid administration to suppress adrenal androgens and to compensate for adrenal steroid deficiencies. However, some patients stopped taking medicine without the doctor's consent. Among these patients, four cases of CAH patients showing the presence of hyponatremia as an initial electrolyte disorder were found with adrenal adenoma. Hypersecretion of adrenocorticotrophic hormone and chronic poor compliance to therapy appears to be associated with the development of the adrenal tumor. Two cases were managed with adrenalectomy because of increasing adrenal tumor size and virilization. Whereas the other two cases did not increase in size and were observed without adrenalectomy. Therefore, it is important that patients with CAH maintain steroid medication to avoid the appearance of adrenal tumor.

The Queensland Familial Melanoma Project: study design and characteristics of participants.

Family history of melanoma is associated with an increased risk for the disease. Neither the relative contributions of genetic and shared environmental factors to familial risk nor how genetic susceptibility is mediated are known. The Queensland Familial Melanoma Project was undertaken to investigate (a) the role of genetic susceptibility as indicated by skin type, pigmentation and the prevalence of naevi and (b) exposure to solar ultraviolet radiation, and their interaction in the aetiology of familial melanoma. After obtaining doctor's consent, a brief family history questionnaire was mailed to all Queensland residents with a first primary cutaneous melanoma diagnosed between 1982 and 1990. Detailed information on melanoma history and standard melanoma risk factors was sought from all responding twins and familial cases, from a sample of non-familial cases and from cases' relatives. Medical confirmation was sought for all relatives reported to have had melanoma. The final sample comprises 15,907 persons in the 1,912 families of 2,118 melanoma cases, including 509 families in which there are two or more individuals with confirmed melanoma. Melanoma history and risk factors were obtained for 9,746 relatives, including 94 twins of cases. This is the largest family and twin study of cutaneous melanoma yet conducted in an unselected, geographically-defined population. We describe the design of the study and the characteristics of the total study population.

Louis Pasteur Film

THE Louis Pasteur film, of which a gala first night exhibition took place at the New Gallery Kinema, Regent Street, London, on Monday, June 22, in aid of St. Peter's Hospital, Covent Garden, was in more than one sense a remarkable event. The title role was taken by Mr. Paul Muni, who had obviously made a careful study of the great French savant in all his strength and weakness. Not only were his passionate ardour in research, dauntless courage in facing opposition and sympathy for human suffering admirably portrayed, but also his abruptness, outbursts of temper, and fits of despondency. It is, therefore, all the more regrettable that the film should contain many historical errors. We are shown, for example, Napoleon III, who in actual fact always took a warm interest in Pasteur's investigations, forbidding him to continue his researches on anthrax and to recant what he had already written on the subject, whereas his work on anthrax was not commenced until after the Emperor's death. Lister is represented as making a special journey to France to witness the results of Pasteur's inoculation of sheep against anthrax in 1881, whereas these two great men did not meet until 1892, when Lister represented the Royal Society at the ceremony held at the Sorbonne in honour of Pasteur's seventieth birthday. Another objectionable feature is that we are shown Pasteur hurrying from one doctor's house to another on a rainy night to find an accoucheur for his daughter, the wife of one of his former opponents, and after a prolonged and fruitless search at last persuading the president of the Academie de Medecine, his chief antagonist, to carry out the confinement under antiseptic precautions. The doctor's consent, however, was only obtained on the condition that Pasteur signed a document to be published in the medical press that his researches in rabies had been a failure.