Relevant Professional Societies Research Articles

Improving the availability and accessibility of opioids for the treatment of pain: The International Pain Policy Fellowship

Opioid analgesics are simultaneously indispensable medicines for the treatment of moderate to severe pain and are harmful when abused. The challenge for governments is to balance the obligation to prevent diversion, trafficking, and abuse of opioids with the equally important obligation to ensure their availability and accessibility for the relief of pain and suffering. Over the last 30years, significant progress has been made toward improving access to opioids as measured by increasing global medical opioid consumption. However, this progress is marked by ongoing large disparities among countries, with most increases in medical opioid consumption attributed to high-income countries, not low- and middle-income countries (LMICs). The International Pain Policy Fellowship (IPPF) was developed by the Pain & Policy Studies Group, with the central goal of developing national leaders from LMICs and empowering them to improve availability and accessibility of opioids for the treatment of pain. To date, two classes of fellows have been selected, representing 17 fellows from 15 countries. Progress achieved by the leadership of three fellows from Sierra Leone, Colombia, and Serbia is highlighted in this paper. The fellows from each country were successful at initiating collaboration with relevant governmental bodies, national authorities, and professional societies, which resulted in a new supply of oral opioids in Sierra Leone and Serbia, and improvements in the distribution of already available opioids in Colombia. All fellows were instrumental in facilitating evaluation of national policy. The IPPF program empowers fellows with the necessary knowledge, skills, and guidance to improve the availability and accessibility of opioids for the treatment of pain.

Egg freezing, procreative liberty, and ICSI: the double standards confronting elective self-donation of oocytes

The consensus view among relevant professional societies opposing the offering of elective oocyte cryopreservation for potential future self-donation withstands neither clinical nor ethical scrutiny. The favorable risk-benefit ratio of this technology mandates both the prioritization of patient autonomy for informed women seeking to maximize-not guarantee-their chances of having genetically related children, and a justification for viewing egg freezing differently from intracytoplasmic sperm injection.

Antibiotic prophylaxis for leptospirosis

Leptospira infection is a global zoonosis with significant health impact for agricultural workers and those persons whose work or recreation takes them into endemic areas. This systematic review assessed the current literature for evidence for or against use of antibiotic prophylaxis against Leptospira infection (leptospirosis). The authors searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and SCI-Expanded as well as relevant professional society meeting abstracts until January 2009. Prospective, randomised clinical trials studying antibiotic prophylaxis against leptospirosis were selected. Data collection abstracted participant demographics and outcomes as well as features of trial design and quality. Trial results were analysed to independently determine outcomes, while multiple trial data was pooled when relevant. Three trials were included, all of which evaluated doxycyline use. Trial quality suffered from a lack of intention-to-treat analysis and variability across trials in methodology and targeted outcomes. One trial assessed post-exposure prophylaxis in an indigenous population after a flood without apparent efficacy in reduction of clinical or laboratory identified Leptospira infection. Two trials assessed pre-exposure prophylaxis, one among deployed soldiers and another in an indigenous population. Despite an odds ratio of 0.05 (95% CI 0.01 to 0.36) for laboratory-identified infection among deployed soldiers on doxycyline in one of these two trials, pooled data showed no statistically significant reduction in Leptospira infection among participants (Odds ratio 0.28 (95% CI 0.01 to 7.48). Minor adverse events (predominantly nausea and vomiting) were more common among those on doxycycline with an odds ratio of 11 (95% CI 2.1 to 60). Regular use of weekly oral doxycycline 200 mg increases the odds for nausea and vomiting with unclear benefit in reducing Leptospira seroconversion or clinical consequences of infection.

Writing a British Association of Dermatologists clinical guideline: an update on the process and guidance for authors

Writing a British Association of Dermatologists clinical guideline: an update on the process and guidance for authors

International bowel function extended spinal cord injury data set

International expert working group. To develop an International Bowel Function Extended Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of an extended amount of information on bowel function. Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets and later by the ISCoS Scientific Committee and the ASIA Board. Relevant and interested scientific and professional organizations and societies (around 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, ISCoS Council and ASIA Board received the data set for final review and approval. The International Bowel Function Basic SCI Data Set includes 26 items providing a thorough description of bowel-related symptoms as well as clinical assessment of anal sphincter function and description of total gastrointestinal or segmental colorectal transit times. An International Bowel Function Extended SCI Data Set has been developed. This Data Set is mainly for research purposes and it should be used in combination with the information obtained from the International SCI Core Data Set and the International Bowel Function Basic SCI Data Set.

International bowel function basic spinal cord injury data set

International expert working group. To develop an International Bowel Function Basic Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on bowel function in daily practice or in research. Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCoS Scientific Committee and the ASIA Board. Relevant and interested scientific and professional (international) organizations and societies (approximately 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, Council and ASIA Board received the data set for final review and approval. The International Bowel Function Basic SCI Data Set includes the following 12 items: date of data collection, gastrointestinal or anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, awareness of the need to defecate, defecation method and bowel care procedures, average time required for defecation, frequency of defecation, frequency of fecal incontinence, need to wear pad or plug, medication affecting bowel function/constipating agents, oral laxatives and perianal problems. An International Bowel Function Basic SCI Data Set has been developed.

President's page

President's page

Taming the Expert: Standards and Implications of Radiologist Expert Witness Testimony

In light of the proliferation and pitfalls of expert witness testimony provided by radiologists, this article offers an overview of the standards for such testimony, as enforced by the courts, the relevant professional societies, and peer-review processes. The article also offers practical suggestions that encourage radiologist expert witnesses to be both ethical and effective in spite of the often inconsistent ambitions, expectations, and obligations of the expert's role.

External glucose meter quality assurance in the UK: are we doing enough?

In 1987, as a consequence of a patient’s death, the Scottish Health Service issued a safety hazard relating to the use of glucose meters. Following this, comprehensive guidelines were published by the relevant professional bodies and specialist societies in the Joint Working Group on Quality Assurance guidelines on `near patient testing’. In response to these issues, many laboratories have implemented quality assessment (QA) schemes to help ensure the validity of hospital-based glucose meter results. These devices are also used in general practitioners’ (GP) surgeries, nursing homes, hospices and in the community. Quality issues are as relevant in these areas as they are in hospitals but there are very few published data or reports on the extension of QA schemes to GPs and the community. As a consequence, we undertook a national survey to ascertain the scope of extra-laboratory glucose meter QA schemes across the UK.

Quality Control in Diagnostic Radiology in the Netherlands

Application of the general principles of radiation protection to medical diagnostic radiology implies that each procedure using X rays or radionuclides is to be justified and optimised. Optimisation in diagnostic radiology implies that the radiation burden to the patient should be as low as possible, but compatible wih the image quality necessary to obtain an adequate diagnosis or to guide treatment. Quality control of equipment is a prerequisite for achieving optimisation in diagnostic radiology. This was especially recognised for mammography as employed for breast cancer screening. Existing legislation in the Netherlands includes only a few criteria for equipment used in diagnostic radiology. In addition, the criteria are not all operational and measurement methods are lacking. Therefore, upon the initiative of the Dutch Ministry of Health, Welfare and Sports, the relevant professional societies, in collaboration with the former TNO Centre for Radiological Protection and Dosimetry, formulated eleven guidelines for quality control of equipment used in diagnostic radiology, including test procedures, test frequencies and limiting values. The implementation of quality control of equipment was included in the 1984 European Directive (84/466/Euratom) laying down basic measures for the radiation protection of persons undergoing medical examination or treatment. In the most recent European Directive on medical exposure (97/43/Euratom) the importance of quality control is stressed. In addition, the latter EC directive proposes the use of diagnostic reference levels for limiting the risks for patients undergoing diagnostic radiology. In the Netherlands preliminary reference levels for various procedures employed in diagnostic radiology are suggested. Finally, methods applied in the Netherlands for assessment of image quality are discussed.

Geburtsleitung bei Zustand nach Sectio caesarea

Caesarean section rates are rising continually during the last years (Bavarian Perinatal Inquiry/BPI 1994: 17.7%). Consequently, the number of women who become pregnant after previous Caesarean section is increasing (BPI 1994: 8%). Trial of labour is fearible in almost all women with nonrecurrent indication for the preceding Caesarean section. Despite this fact, elective repeat Caesarean section is performed in many cases. The aim of the study presented here is to clarify according to which criteria obstetric management is effected in women after previous Caesarean section. 329 German hospitals were addressed, 53.5% answered the questionnaire. The evaluation of the inquiry shows considerable discrepancies concerning obstetric management of women after previous Caesarean section: Trial of labour after one preceding Caesarean section was allowed in 79% (min: 26.5%; max: 100%) and completed successfully in 71.2% (min: 47%; max: 92%). Obviously there is a need for an official state-ment by the relevant professional associations or societies in respect of this problem.