Majority Of Doctors Research Articles

The data of national medical interview on hyperprolactinemia treatment in real clinical practice

Hyperprolactinemia is one of the most common endocrine pathology, which doctors of different specialties face in real clinical practice.Aim of the study was to determine the features of management and treatment of patients with hyperprolactinemia in different regions of Russian Federation.Material and methods. The national medical interview on hyperprolactinemia treatment was conducted in 2014-2015 among 74 endocrinologists from 30 regions of Russia.Results. Endocrinologists in regions of Russian Federation have satisfactory access to various methods of diagnostics of the disease and its complications, knowledge of different dopamine agonists for treatment, and have practice in management of patients with drug-induced hyperprolactinemia.Conclusion. According the data of the interview majority of doctors have insufficient level of knowledge in management and treatment of patients with hyperprolactinemia that is why additional lectures and seminars should be conducted by specialists of that problem.

A study on the interactions of doctors with medical representatives of pharmaceutical companies in a Tertiary Care Teaching Hospital of South India.

Background:The promotional activities by medical representatives (MRs) of the pharmaceutical companies can impact the prescribing pattern of doctors. Hence, the interaction between doctors and the pharmaceutical industry is coming under increasing scrutiny.Objective:The primary objective was to assess the attitude of the doctors toward the interaction with the MRs of the pharmaceutical company. The secondary objective was to assess the awareness of the doctors about regulations governing their interaction with the pharmaceutical company.Materials and Methods:This was a cross-sectional study. This study was carried out using a pretested questionnaire containing 10 questions between June and September 2014. The doctors working in the Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur (Tamil Nadu) during the study period was included.Results:A total of 100 pretested questionnaires were distributed, and 81 doctors responded (response rate 81%). 37% doctors responded that they interacted with MR once a week whereas 25.9% told that they interact with MRs twice a month. About 69.1% doctors think that MR exaggerate the benefits of medicines and downplays the risks and contraindications of medicine(P = 0.000). 61.7% doctors think that MR has an impact on their prescribing (P = 0.000). 63% doctors stated that they had received promotional tools such as stationery items, drug sample, textbooks or journal reprints from MR in last 12 months (P = 0.0012). Unfortunately, 70.4% doctors have not read the guidelines about interacting with the pharmaceutical industry or its representative (P = 0.000).Conclusion:Rather than forbidding any connection between doctors and industry, it is better to establish ethical guidelines. The Medical Council of India code is a step in the right direction, but the majority of doctors in this study have not read the guidelines about interacting with the pharmaceutical industry or its representative.

A questionnaire based survey to evaluate the usage pattern of carbapenems for sepsis management in intensive care unit

Background: Sepsis remains one of the most common critical illnesses for patients to be admitted to an intensive care unit (ICU) and has very high associated morbidity and mortality ranging from 18 to 50%. It is a well-known fact that early goal directed therapy with broad spectrum antibiotics, IV fluids and other supportive therapies improve outcome. The current study was done to know the importance of carbapenems in the management of sepsis focusing on perceived use and the clinical outcome in real time setting in tertiary care hospitals. Methods: A structured questionnaire designed to collect information on the perceived use of carbapenems, the clinical outcome, response period for clinical cure and combination antibiotic therapy preferred with carbapenem was circulated among 50 clinicians in tertiary care hospitals and nursing homes in and around Mangalore between January 2015 to March 2015. Results: Majority of doctors (>80%) felt that carbapenems a broad spectrum antibiotic administration provided good clinical improvement in hospital infections along with improvement in blood cell count and bacteriological cure. Conclusions: Our study provides an important insight regarding the knowledge, practice pattern and clinical outcome through the use of carbapenem in Sepsis management in ICU’s around Mangalore. The experience of practice patterns and clinical outcomes with carbapenem shared by doctors through this survey is similar to that in other studies.

Assessment of perception about medication reconciliation among healthcare professionals at Saint-Justine hospital

Our main objective is to assess nurses and doctors perception about medication reconciliation. This is a descriptive and cross-sectional study. We have created three surveys, one for each health worker (nurses, doctors, resident, pharmacists). Each survey consists of single or multi-choice closed questions. A four-point Likert scale was used to collect the perception. Descriptive statistics have been calculated. A total of 114nurses, 98doctors and residents and 26pharmacists from all care services, replied to the survey. The majority of doctors (58%), pharmacists (60%) and nurses (52%) recognized the relevance and utility of medication reconciliation in healthcare safety. However, few healthcare professionals (6% of doctors, 13% of nurses et 46% of pharmacists) know that medication reconciliation is a required organizational practice. Only 25% of doctors always consult the best possible medication history after a patient admission while the majority do not use it because of unreliability issues. So, there have been some major changes to optimize medication reconciliation process in our hospital. This study shows a increasing interest to medication reconciliation by healthcare professionals. However, the use of medication reconciliation remains marginal.

Awareness, knowledge and views of off-label prescribing in children: a systematic review.

The aim of this review was to provide an updated overview of awareness, knowledge and views of off-label prescribing in children. A literature search using electronic databases including PubMed, Medline, Scopus, Science Direct, Springer Link, Proquest, Ebsco Host and Google Scholar was conducted. Additional articles were identified by reviewing the bibliography of retrieved articles. The articles were searched with any of the following medical subject headings (MeSH) terms in the title: attitude, awareness, knowledge, experience, view, off-label, pediatric, paediatric and children. The inclusion criteria were full text articles published in English between January 2004 and February 2015 and reported outcome related to awareness, knowledge and views regarding off-label prescribing in children. Editorials, reviews, notes, conference proceedings, letters and studies reporting prevalence of off-label prescribing were excluded. The articles were scrutinized using thematic analysis. Eleven studies conducted among doctors, community pharmacists, paediatric nurses, parents and children met the inclusion criteria. Nine themes were developed through document analysis which included main domains such as knowledge, awareness and views on off-label drug use in children, choice of information sources, reasons and suggestions to reduce off-label prescribing, concern regarding obtaining consent and participation in clinical trials. The studies reviewed reported that the majority of doctors and community pharmacists were familiar with the term off-label prescribing but knowledge among parents was low. Awareness on off-label prescribing in children remains low among all study participants. There is a mismatch between views on off-label prescribing in children of study participants and the finding of previous studies.

How does evidence affect clinical decision-making?

In 1998, the ‘Evidence Cart’ was introduced to provide decision support tools at the point of care. A recent study showed that a majority of doctors who previously stated that...

THE METHODS OF CHOLEDOCHOLITHIASIS TREATMENT

The methods of choledocholithiasis treatment, which are currently used in clinics of the Russian Federa-tion, has been presented. The problems of diagnosis and treatment of gallstones (GSD) in individuals of different age groups are spotlighted. In the study of treatment of cholelithiasis and choledocholithiasis, including arising complications, it can be concluded that so far the ideal method of treatment of this pa-thology has not been found. Up to now, the majority of doctor’s main treatment is surgical removal of gall stones by some method or other. This article also considers a conservative approach (drug: antispasmodics (selective and nonselective), and non-pharmacological: treatment, diet), describes the criteria and assessment of the effectiveness of therapeutic interventions that help in the question of further treatment: the continuation of drug therapy or assignment of surgical treatment. Invasive techniques that are covered in the article, namely, a tech-nique of remote and endoscopic lithotripsy, are high-tech and in demand at the moment, which, along with high efficiency removal of a stone, reduced the number and severity of postoperative complications. Additionally, in the analysis of the features of a particular method of treatment, advantages and disadvantages of different treatment methods are described, indications and contraindications (absolute and relative) together with complications, possible outcomes, and further prognosis are high-lighted.

Challenges to malaria surveillance following elimination of indigenous transmission: findings from a hospital-based study in rural Sri Lanka.

Sri Lanka has eliminated local transmission of malaria. Assessing physician preparedness for early case detection is important, in order to prevent re-establishment of local transmission. Adherence to malaria screening practices in patients admitted with fever to 12 hospitals in a previously malaria endemic district was evaluated using a cross sectional survey. In addition, knowledge and attitudes among doctors on current malaria surveillance practices and treatment recommendations was assessed. Of 403 fever patients, 150 warranted screening for malaria under the criteria defined by the Anti Malaria Campaign (AMC), with 93 of them having fever for over 7 days. Of these eligible patients, 12.6% (19/150) were investigated by doctors (including 3 persons with fever over 7 days), 14.6% (22/150) by laboratory staff and 72.6% (109/150) by the research team. The majority of doctors were not familiar with the treatment guidelines for malaria (76.5%, 75/98). Mandatory continuous medical education programmes need to continue to ensure that malaria remains on the differential diagnosis of a fever patient, especially in patients with fever over 7 days. It is essential to publicize the availability of free-of-charge malaria diagnostic facilities, and to ensure that proper notification procedures are followed when a malaria patient is diagnosed.

Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

BackgroundDoctors are taught to auscultate with the stethoscope applied to the skin, but in practice may be seen applying the stethoscope to the gown.ObjectivesTo determine how often doctors auscultate heart...

Doctors' views on the quality of claims provided by pharmaceutical representatives: A comparative study in Malaysia and Australia

Abstract Objectives Doctors perceive the interactions with pharmaceutical representatives as professionally appropriate. However, studies have shown that the interaction is associated with less rational prescribing of medications. No previous study has assessed doctors' opinions of the presentation of pharmaceutical representatives and the quality of claims provided to the doctors in Australia and Malaysia. The aim of this study was to compare the opinions of Australian and Malaysian doctors of sales explanations and quality of claims provided by the pharmaceutical representatives. Methods We recruited samples of primary care doctors in Australia and Malaysia to evaluate pharmaceutical sales visits. After a visit, doctors were asked to fill out a questionnaire on the main product and claims discussed during the visit. Descriptive statistics were employed, and Chi-square analysis and clustered linear regression were used to assess differences between doctors from both countries. Results The majority of doctors reported that the presentations were convincing as well as likely to change their prescribing habits and improved their knowledge. The majority of marketing claims recorded by doctors in Australia and Malaysia were classified as vague claims. Approximately one-third of the claims were unambiguous (Australia 31% and Malaysia 33%). In a majority of the presentations (Australia, 65%, Malaysia, 84%), doctors indicated that the primary claims by the pharmaceutical representatives were entirely or nearly accurate. Conclusions Doctors in Australia and Malaysia held generally positive views of the presentations of pharmaceutical representatives, although the information being presented varied.

A qualitative study of GPs' views towards obesity: are they fighting or giving up?

ObjectivesSeveral studies indicate that general practitioners (GPs) are not taking the issue of obesity as seriously as they should. Therefore, the aim of this study was to understand GPs' views about obesity and obese people and how these professionals perceive their role in the treatment of this disease. Study designQualitative study using semi-structured interviews. MethodsSixteen semi-structured interviews were conducted with Portuguese GPs. Data were analyzed according to thematic analysis procedures. ResultsGPs are negative about their own role in obesity treatment. Although they believe it is part of their job to advise obese patients on the health risks of obesity, the majority of doctors think they are not making any difference in getting their patients to make long term lifestyle changes. GPs hold negative attitudes towards these patients blaming them for being unmotivated and non-compliant and are also pessimistic about their ability to lose weight. Doctors are facing a dilemma in their practices: they want to play an active role but, due to a set of negative beliefs and perceived barriers, they are playing a relatively passive role, feeling defeated and unmotivated, which is reflected in a decrease of efforts and a willing to give up on most of the cases. ConclusionsThis issue should be taken in to account during physicians' education since doctors should be aware of how their own beliefs and attitudes influence their behaviour and practices, compromising, therefore, the adherence to and the success in obesity treatment. They seem to need more precise guidelines and better tools for screening and management of obesity, more referral options, and improved coordination with other specialities.

English

BACKGROUND: Disruptive behavior in a medical setting is defined as objectionable or offensive interpersonal behavior that leads to disruption of professional activities in the workplace. 1 It has been observed that majority of doctors do not show disruptive behavior in their day today conduct and only few doctors are identified for their disruptive behavior. Special committee on professional conduct and ethics defines disruptive behavior in physicians as a berrant behavior manifested through personal interaction with physicians, hospital personnel, health care professionals, patients, family members or others which interferes with patient care or could reasonably be expected to interfere with the process of delivering quality care. 2 Common forms of disruptive behaviors generally seen amongst young doctors are use of abusive language, yelling or shouting at patients, colleagues and subordinate staff, showing in disciplined behavior and at times indulging in physical abuse.3-4STUDY DESIGN: Study was conducted at a tertiary care hospital where 614 health care professionals participated which included 108 doctors 432 nursing staff and 74 paramedical staff METHOD: Data collection was done by semi structured pretested questionnaire and was entered in Microsoft Excel and analyzed for frequency and percentages. RESULTS: 64 % doctor, 66% nursing staff and 50% of the paramedicals answered that they have seen doctors showing disruptive behavior at one time or the other. Not all the doctors show disruptive behavior but this type of aberrant behavior is seen mainly in2-3 percent of doctors only. While answering to the question as to the type of disruptive behavior, 57% health care professionals reported that commonest form of disruptive behavior noticed by them amongst doctors was yelling or shouting on junior staff, patients and colleagues. 47% answered that doctors with disruptive behavior do not follow laid down orders or protocols, 1%respondents reported that they have seen doctors showing cast discrimination amongst staff. Sexual remarks or physical abuse was reported by negligible number of respondents. CONCLUSION: Majority of health care professionals reported that problem of intimidating or disruptive behavior does exist in small minority of doctors and while working with such doctors it causes mental stress, frustration, inability to concentrate on work, fear to communicate, reduction in teamwork and relation with such doctors remain tense.

A questionaire study evaluating the knowledge and approach by physicians about arterial blood gas.

Arterial blood pressure analysis is a frequently applied method in the diagnosis and follow-up of respiratory insufficiency and in the treatment of patients under risk. It is very important to take and analyze the blood gas sample properly. Therefore, a questionary study was performed which evaluated the knowledge and the approach of doctors working in various specialties. A questionary form consisting of 27 questions were filled by 100 specialist physicians who participated in the study. It was observed that doctors participating in our study had partly sufficient knowledge regarding administration and evaluation of arterial blood gas. It was considered that in intensive care unit experience of participant doctors during their intern periods was a very important factor. But it was observed that most of the participant specialist physicians performed Allen test before radial artery puncture, and they frequently preferred femoral artery for their first puncture option, and they did not pay attention in the proper transportation of the samples and in sending cultures from arterial cannula against risk of infection. The majority of doctors who participated in our study stated that they would like to receive training in arterial blood gas administration and evaluation. In conclusion, to take samples from arterial blood gas is an invasive operation and if not performed correctly it can cause complications to develop. Transportation and evaluation is as much important as sampling. It is very important to provide sufficient education to candidates of specialist physicians and to organize training courses aimed to increase their knowledge and experience during the period of their speciality without taking their speciality into account.

Attitudes and knowledge of medical practitioners to hereditary cancer clinics and cancer genetic testing

Genetic testing for susceptibility for common cancers is widely available. Thus, doctors have a role in identifying and referring patients who would benefit from a consultation with a specialist in genetics. This study aims to assess doctors' referral rates, knowledge and attitudes towards cancer genetic testing, broken down by specialty (gastrointestinal, breast/ovarian, other specialties and General Practitioners-GPs). A 4-page questionnaire was mailed out to the GPs of all patients seen in 2012 in the Hereditary Cancer Clinic of St. Vincent's Hospital Sydney (n = 128) and all the specialists in St. Vincent's Hospital Sydney that might refer to the HCC (n = 33). 50 questionnaires were returned (31 %). Most doctors had referred a patient for cancer genetic testing (90 %). The average proportion of patients referred was 1 in 68.5 patients with breast/ovarian specialists referring the most, followed by gastrointestinal specialists and GPs. There was suboptimal knowledge of cancer genetic testing amongst doctors. Breast/ovarian specialists were most knowledgeable, followed by gastrointestinal specialists, other specialists and GPs. There were indications of inappropriate referral amongst doctors. Most (77.6 %) doctors were willing to receive further information on cancer genetics. Nearly all (94 %) doctors believe that it is their duty to inform an individual at high risk for hereditary cancer that cancer genetic counselling and testing is available. The majority of doctors have positive attitudes towards cancer genetic testing. Defective knowledge scores, however, indicate that doctors need further training or tools to enable them to refer patients appropriately for cancer genetic testing.

Breaking bad news—How to improve communication?

subject of enforcing do not attempt resuscitation in situation of circulatory and respiratory arrest. Methods: The researchwas conducted bymeans of the diagnostic survey method applying a self-constructed questionnaire. The study was carried out among 111 (100%) doctors and nurses, from January to May 2013. Obtained information were analyzed statistically, Chi-square of independence with assumed p≤0.05. level of significance was used for statistical analysis. Results: The study of the respondents’ opinion shows that 72.07% healthcare employees think that DNAR declaration should be obligatory in Poland. Contrary opinion has 8.11% of respondents. In their opinion the decision to refrain from resuscitating should be made by attending physician – 48.65% andmedical board – 32.43%. Information enclosed within DNAR declaration, in most of respondents’ opinion – 70.27%, should be only passed on in written form. Conclusions:Majority of doctors and nurses agree that patients have a right to refrain fromcardiopulmonary resuscitation as a selfdetermination act. Respondents concur the introduction of DNAR declaration in Polish Healthcare system. In respondents’ opinion that decision should be required in written form and an attending physician should decide about its implementation, what violates the existing rule. The executionof livingwill declaration raises ethical issues. Additionally, it also appears aspublic/social problem. The last stage of incurable disease is given as justifiable circumstances of DNAR.

Abdominal Crises 1

Despite the mechanical contrivances which clutter our modern world solutions to the crises which constantly beset us in every sphere still depend upon the wisdom of individuals. This is nowhere more true than in the management of abdominal crises which at some stage falls to the lot of every medical man. If disaster is to be averted, a correct diagnosis has to be made and a correct line of action determined within a space of time so short that the opportunity to call upon other opinions or to invoke the corroborative aid of laboratory tests may be severely curtailed. For the vast majority of doctors who are not practising surgeons the overriding responsibility is to decide whether an abdominal crisis is such that operative treatment may be needed. If the medical student, nurtured in the hospital environment gains the impression that this decision is one of no great difficulty he is forgetting that the wheat has already been separated from the chaff before the patient ever reaches hospital. It is a tribute to the general practitioners that so few patients are needlessly referred to hospital and that even fewer are referred with serious complications already established.

Medical education: A new pedagogy of the oppressed?

Medical education has undergone rapid change in the last few decades. Not long ago, males made up the vast majority of doctors and medical students but this has changed: today the majority of stude...

Fin de vie et soins palliatifs en médecine d’urgence : à propos d’une enquête nationale de pratique

IntroductionThere are very few recommendations specific to emergency medicine regarding the subject of end of life and palliative care.PurposeThe aim of this study is to analyse the level of understanding, treatment and care carried out by emergency care specialists for patients in urgent palliative care situations.Material and methodA telephone survey of opinions and practices, carried out between November 2010 and March 2011, of 100 French emergency care specialists.ResultsA total of 87 doctors responded. Of these, 76% were unaware of the official definition of palliative care, 71% did not follow official recommendations and 93% did not have any training in this area. However, 74% considered that this type of care was part of their job and 91% of hospitals had a palliative care structure in place. The reasons for being seen were as much social as they were medical. Care given was mainly providing comfort and rarely involved social or psycho-spiritual aspects. Admission to hospital into a specialised facility was proposed in 64% of cases.DiscussionThis study highlights the lack of training for emergency care specialists in the field of palliative care, despite this being part of their everyday job. If the majority of doctors have access to a palliative care structure for referrals, the policy is left to their discretion. Primarily patients were seen for medico-social reasons, ranging from receiving care, which on the whole was to make them more comfortable, and issues in social, psychological and spiritual areas. The management of these patients by emergency care specialists should be improved, from initial theoretical training for doctors, to ethical questions that they may face.

So you want to be a nurse?

T he UK Government’s initial response to the Francis Report, given in the House of Commons on 26 March by Mr Jeremy Hunt, Member of Parliament for South West Surrey and Secretary of State for Health in England, was brief. He did, I am very pleased to say, acknowledge that what went wrong at the Mid Staffs Trust was ‘Not typical and that the vast majority of doctors and nurses give excellent care day-in day-out’. Mr Hunt also noted that more time was needed to consider the report in full but that some response was required as a matter of urgency. A number of key areas for urgent action were identified and of course nursing loomed large among them. It is hard to disagree with much of the initial response, which focused on the need for compassionate care, zero harm, training for healthcare support workers, reducing frontline bureaucracy and a review of the complaints process. At last the Nursing and Midwifery Council (NMC) (and other professional regulators) were asked by Government to ‘tighten’ their procedures for dealing with cases of failure to adhere to professional standards. Some of you might share my view that ‘tightening’ does not come close to what needs to happen at the NMC and radical change to protect nurses as well as the public is long overdue. Sir Robert Francis said that the responsibility for what went wrong at Mid Staffs lies with the trust board. In response Mr Hunt says the Government will look at new legal sanctions at a corporate level for organisations that deliberately withhold information they are required to provide. It would have been helpful if he had assured us that board members would be required to have an understanding of the NHS before their appointment and some insight into what delivering safe compassionate care to millions of patients every day across primary community and secondary care actually means. It would also have been helpful to restate the need, as Sir Robert does (Recommendation 204) to have a nurse on the board of every healthcare organisation. Recommendation 187 from the Francis Report seems to have struck a particular chord with the Secretary of State and it appears already to be policy in the making. Recommendation 187 states:

Pay more attention to the role of surgery on the treatment of ulcerative colitis in China

Ulcerative colitis (UC) is a relapsing and remitting disease characterized by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of the inflammation. But for a long time, the majority of doctors and patients in China show an excessive dependence on medication and ignore the importance of surgical treatment. This has seriously affected the overall level of UC treatment in China and resulted in a poor prognosis of some patients. Abandoning obsolete concept, grasping the operation timing, selecting the proper operation mode, enhancing surgical technique and founding a multi-disciplinary team, are the key to successfully curing UC.