Wherefore art thou, chaperone?

Respect for the dignity of a patient and their privacy are fundamental concerns for all doctors. When an intimate examination is to be undertaken, that respect needs to be especially maintained. The offer of an appropriate chaperone during that examination can help to demonstrate that respect and can safeguard interests of the patient and the doctor.

Ethics, a critical friend of research

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The vegetarian who could not sleep: a case report

Sleep disorders are not unusual presentations to family medicine clinicians. Similarly, patients may have diets that can render them susceptible to vitamin deficiencies. Although not a commonly considered risk factor for sleep disorders, vitamin B12 is involved in the production of melatonin, a hormone regulating the sleep-wake cycle, and supplementation of vitamin B12 has been used to treat sleep disorders. This case study described a patient who presented with a sleep disorder and who was a vegetarian. Although he lacked obvious manifestations of vitamin B12 deficiency, his serum level was almost half the lower limit of normal, and with vitamin B12 supplementation, his sleep improved

Tailoring a cognitive behavioural model for unexplained physical symptoms to patient's perspective: a bottem-up approach.

The prevalence of unexplained physical symptoms (UPS) in primary care is at least 33%. Cognitive behavioural therapy has shown to be effective. Within cognitive behavioural therapy, three models can be distinguished: reattribution model, coping model and consequences model. The consequences model, labelling psychosocial stress in terms of consequences rather than as causes of UPS, has high acceptance among patients and is effective in academic medical care. This acceptance is lost when applied in primary care. To increase acceptance of the consequences model among patients in primary care, we tailor this model to patient's perspective by approaching the model from bottom-up instead of top-down. Subsequently, we use this tailored model in an easily accessible group training. We illu

Seasonal influenza vaccination: from hesitancy to social norm

Seasonal influenza is of the most globally burdening vaccine-preventable diseases, infecting 3-5 billion people annually and according to the World Health Organisation (WHO) resulting in 250,000 to 500,000 deaths worldwide. Vaccination against influenza and all respiratory infections carries greater emphasis in the light of the COVID-19 pandemic. With added pressure on healthcare systems due to the coronavirus, Qatar is one country that is keen to emphasise the importance of influenza vaccination to prevent potential co-infection causing severe disease especially in high-risk groups. Currently seasonal influenza vaccines protect against 3 or 4 strains with revised data from the WHO twice yearly due to the changing natures of strains helping to maximise efficacy of the vaccines. It is recommended for specific high-risk groups to be prioritised for vaccination, including pregnant women, the elderly, children above 6 months of age, patients with chronic conditions as well as front line healthcare workers with risk of exposure. However, uptake of the vaccine remains low and contributes significantly to the burden of the disease. Barriers to vaccine uptake can be physical, such as unhealthy lifestyles, psychological, such as perception of disease as low-risk, contextual, such as lack of access to vaccinations, or sociodemographic, such as living alone. Vaccine coverage can be increased by knowledge of these barriers and how to address them. The physical barriers highlight the need to support behavioural change in lifestyle in order to increase vaccine uptake. Psychological barriers, usually due to misconceptions, can be addressed with education through public health campaigns and interactions between health professionals and patients. This education is not just a need for patients but also healthcare workers. It is up to healthcare providers and contractors to find ways of addressing contextual and sociodemographic barriers by increasing access to vaccination whether through transport, or home–care etc. A key barrier of those mentioned to vaccination is a lack of knowledge which needs to be addressed though positive discussions about the health benefits of immunisation as well as the traditional idea of disease-risk prevention. Addressing the above barriers will help to increase vaccine uptake, and produce health-conscientious societies where vaccination becomes a social norm

Informed consent in Sri Lanka: A survey among ethics committee members

<p>Abstract</p> <p>Background</p> <p>Approval of the research proposal by an ethical review committee from both sponsoring and host countries is a generally agreed requirement in externally sponsored research.</p> <p>However, capacity for ethics review is not universal. Aim of this study was to identify opinions and views of the members serving in ethical review and ethics committees in Sri Lanka on informed consent, essential components in the information leaflet and the consent form.</p> <p>Methods</p> <p>We obtained ethical approval from UK and Sri Lanka. A series of consensus generation meetings on the protocol were conducted. A task oriented interview guide was developed. The interview was based on open-ended questionnaire. Then the participants were given a WHO checklist on informed consent and requested to rate the items on a three point scale ranging from extremely important to not important.</p> <p>Results</p> <p>Twenty-nine members from ethics committees participated. Majority of participants (23), believed a copy of the information leaflet and consent form, should accompany research proposal. Opinions about the items that should be included in the information leaflets varied. Participants identified 18 criteria as requirements in the information leaflet and 19 for the consent form.</p> <p>The majority, 20 (69%), believed that all research need ethical approval but identified limited human resource, time and inadequate capacity as constraints. Fifteen (52%) believed that written consent is not required for all research. Verbal consent emerged as an alternative to written consent. The majority of participants rated all components of the WHO checklist as important.</p> <p>Conclusion</p> <p>The number of themes generated for the consent form (N = 18) is as many as for the information leaflet (N = 19) and had several overlaps. This suggests that the consent form should be itemized to reflect the contents covered in the information leaflet. The participants' opinion on components of the information leaflets and consent forms proved to be similar with WHO checklist on informed consent.</p

A global mental health fund for serious mental illness in low-income and middle-income countries.

Serious Mental Illnesses (SMI) are psychiatric disorders (excluding developmental and substance use disorders) that result in considerable functional impairment. These conditions receive little or no funding in most Low and Middle Income (LAMI) countries. The huge gap in resources for SMI can only be met by a global fund to provide the treatment of SMI in LAMI countries. The Global Fund to fight AIDS established more than two decades ago, not only provided enormous funding but most importantly, generated the hope that the condition could be treated. We argue that SMI stand today where HIV-AIDS was a couple of decades ago. The cost effective interventions for these disorders are available. For example, it is estimated that that an extra 11 Naira or I$ 0.27 per capita would need to be invested each year to increase the present treatment coverage for schizophrenia of 20% to a level of 70% in Nigeria. The treatment package should include free access to essential medicines to treat psychotic disorders and a component of appropriate evidence based psychosocial intervention, which have been evaluated in number of studies in these countries. It is ethical and public health imperative that a Global Fund to provide the basic treatment for those suffering from SMI is established and the seed money for the proposed fund should be provided by rapidly developing LAMI countries such as India and South Africa

Expression, Purification and Characterization of Peptidoglycan Recognition Protein 1 From Manduca sexta (L.)

Insects have an effective defense system against invading microbes. Peptidoglycan recognition proteins (PGRPs) in hemolymph detect peptidoglycans (a structural component of bacterial cell walls) and trigger a serine proteinase network that mediates and coordinates various host immune responses. To elucidate its biochemical functions, we have expressed Manduca sexta PGRP-1 in the baculovirus expression system and purified the protein from the conditioned culture medium. Purified PGRP-1 has a molecular mass of 19 kDa. The recombinant PGRP-1 specifically binds to Lys- and DAP-type peptidoglycans from Gram-positive and Gram-negative bacteria, respectively and leads to the proteolytic activation of prophenoloxidase. The binding affinity is high for all polymeric peptidoglycans tested, except for the one from Staphylococcus aureus. M. sexta PGRP-1 is produced at a low, constitutive level by hemocytes and fat body, and its transcripts become highly abundant in both tissues after larvae are challenged by bacterial injection.Department of Entomology and Plant Patholog