Annals of the Royal College of Physicians and Surgeons of Canada 

About: Annals of the Royal College of Physicians and Surgeons of Canada is an academic journal. The journal publishes majorly in the area(s): Health care & MEDLINE. It has an ISSN identifier of 0035-8800. Over the lifetime, 82 publications have been published receiving 580 citations.

Pancreatic enzyme secretion and gastrointestinal hormone release in response to parenteral amino acids and lipid in dogs

Abstract: Parenteral nutrition has been advocated for and used in clinical situations in which provision of calories without stimulation of pancreatic secretion is desired. A recent report, however, provided evidence for substantial stimulation of pancreatic secretion after parenteral administration of amino acids and fat. We have studied the effect of intravenous administration of crystalline amino acids and lipid on pancreatic protein secretion and release of gastrointestinal hormones in five dogs with chronic pancreatic fistulas. The amino acids were given as a 4.25% solution in 5% glucose at 2 gm/hr. Parenteral fat was administered as Intralipid 10% at 3.5 ml/kg/hr. Plasma concentrations of cholecystokinin (CCK) and pancreatic polypeptide (PP) and serum concentrations of gastrin, measured by radioimmunoassay, were determined before, and at intervals during, infusion of amino acids and fat. Pancreatic juice was collected simultaneously with blood sampling, and volume and protein output were measured. Basal concentrations of CCK, PP, and gastrin were not affected by intravenous infusion of amino acids. Pancreatic protein secretion and volume were also unaffected by parenteral amino acids. Parenteral infusion of fat resulted in a significant inhibition of integrated gastrin release but had no effect on plasma concentrations or integrated release of CCK or PP. Neither the volume nor protein output of pancreatic secretion was affected by intravenous fat administration. In summary, no stimulation of pancreatic secretion or release of CCK, PP, or gastrin occurred as a result of parenteral amino acid or fat administration. There is, therefore, no contraindication to the use of parenteral nutrition in situations in which it is desirable to keep the pancreas at rest.

National survey on the attitudes of Canadian physicians towards drug-detailing by pharmaceutical representatives.

Abstract: OBJECTIVE Our objective was to study the attitudes of Canadian physicians toward product presentations by pharmaceutical representatives (PRs), the use of inducements by the pharmaceutical industry, and methods to improve the quality of prescribing information provided to physicians. DESIGN We used a mailed survey. PARTICIPANTS A random sample of 550 Canadian physicians in all settings was chosen. OUTCOME MEASURES The main outcome measure was the proportion of respondents agreeing with a series of statements. RESULTS The response rate was 262 of 525 deliverable surveys (50 per cent). Respondents had a mean of 4.2 interactions per week with PRs. Of the 262 respondents (5.8 per cent of data were incomplete), 193 (80 per cent) believed that PRs overemphasize their products' effectiveness, 108 (45 per cent) thought PRs do not present fairly the drugs' negative aspects, and 223 (92 per cent) felt that PRs have production promotion as a goal. Most, 175 (70 per cent), believe that drug-detailing affects physicians' prescribing behavior. Most, 210 (86 per cent), considered drug samples acceptable, but fewer agreed that other inducements were acceptable. Of the respondents, 183 (74 per cent) agreed that PRs should be required to use guidelines for standardized, comprehensive drug-detailing, and 165 (65 per cent) agreed that face-to-face drug-detailing by PRs using standardized guidelines would be an effective way to receive information. CONCLUSIONS There is dissatisfaction among Canadian physicians about the quality of information provided by the pharmaceutical industry. Standardized, comprehensive guidelines would be accepted by physicians as one improvement.

Pediatricians' knowledge, perceptions, and attitudes towards providing health care for lesbian, gay, and bisexual adolescents.

Abstract: BACKGROUND Pediatricians are often the first health-care contacts for gay, lesbian, and bisexual adolescents who are developing their sexual orientation. OBJECTIVE This study investigated pediatricians' attitudes and practices towards gay, lesbian, and bisexual adolescents. METHOD We sent anonymous self-administered questionnaires to 112 pediatricians in the Ottawa area. RESULTS Of those who responded, 36 per cent reported having treated lesbian, gay, or bisexual patients, and 70 per cent reported not addressing the issue of sexual orientation. Reservations in discussing sexual orientation were due to fears of offending patients, and a lack of knowledge regarding their needs. Furthermore, 59 per cent of these pediatricians were unfamiliar with community resources for homosexual youths, and 78 per cent reported wanting more information with regards to the care of this population. CONCLUSION Many pediatricians experience difficulties in discussing issues of sexual orientation, and generally feel inadequately prepared to address issues pertaining to the health-care needs of these adolescents. While certain issues remain controversial, the overall attitude of pediatricians towards homosexually oriented patients is positive in that they are interested in becoming more aware of issues of homosexual orientation, to better serve this population.