The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (+/- SE) number of drugs per prescription was 4.1 +/- 0.06 for private and 2.7 +/- 0.04 for public providers (p < 0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (p < 0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (p < 0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (p < 0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (p < 0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (p < 0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (p < 0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (p < 0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use.

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BackgroundThe idea for this survey emanated from desk research and two meetings for researchers that discussed medical tourism and out-of-country health care, which were convened by some of the authors of this article (VR, CP and RL).MethodsA Cross Border Health Care Survey was drafted by a number of the authors and administered to Canadian physicians via the Canadian Medical Association’s e-panel. The purpose of the survey was to gain an understanding of physicians’ experiences with and views of their patients acquiring health care out of country, either as medical tourists (paying out-of-pocket for their care) or out-of-country care patients funded by provincial/territorial public health insurance plans. Quantitative and qualitative results of the survey were analyzed.Results631 physicians responded to the survey. Diagnostic procedures were the top-ranked procedure for patients either as out-of-country care recipients or medical tourists. Respondents reported that the main reason why patients sought care abroad was because waiting times in Canada were too long. Some respondents were frustrated with a lack of information about out-of-country procedures upon their patients’ return to Canada. The majority of physician respondents agreed that it was their responsibility to provide follow-up care to medical travellers on return to Canada, although a substantial minority disagreed that they had such a responsibility.ConclusionsCross-border health care, whether government-sanctioned (out-of-country-care) or patient-initiated (medical tourism), is increasing in Canada. Such flows are thought likely to increase with aging populations. Government-sanctioned outbound flows are less problematic than patient-initiated flows but are constrained by low approval rates, which may increase patient initiation. Lack of information and post-return complications pose the greatest concern to Canadian physicians. Further research on both types of flows (government-sanctioned and patient-initiated), and how they affect the Canadian health system, can contribute to a more informed debate about the role of cross-border health care in the future, and how it might be organized and regulated.

Background Postoperative length of stay (LOS) carries a high burden of healthcare costs. In resource‐intense specialties such as neurosurgery, it is imperative to identify factors that influence LOS to improve care. The current study investigates the potential for variables that affect clinical presentation, tumor characteristics, treatment modalities, and postoperative complications to impact overall LOS in pediatric brain tumor patients. Methods A retrospective cohort study design was used with patients enrolled in the McMaster Pediatric Brain Tumor Study Group database. All patients up to 18 years of age, presenting with a newly diagnosed brain tumor admitted to and discharged from neurosurgery, were included. Patients were sorted into three cohorts: short LOS (≤3 days), extended LOS (≥20 days), and control LOS (4‐19 days). Results Of the 124 patients included, 20 (65% male; median age: 9.1 years; range, 0.8‐17.4 years) were considered short LOS, 28 (61% male; median age: 4.7 years; range, 0.4‐14.7 years) were considered extended LOS, and 76 (57% male; median age: 8.5 years; range, 0.3–17.9 years) were considered control LOS. Variables that prolonged LOS were emesis at presentation (P < 0.001), developmental delay (P = 0.02), multiple surgeries (P = 0.004), tumor location (P < 0.05), subtotal resection (P = 0.02), feeding tube (P < 0.001), adjuvant chemoradiotherapy (P < 0.001), and posterior fossa syndrome (P = 0.004). Conclusions This study identifies variables related to clinical presentation, tumor characteristics, treatment modalities, and postoperative complications associated with extended LOS. These findings uncover novel predictors of LOS that can be used to guide future research and improve health resource management.

Breast cancer is a leading cause of cancer deaths in women within the United States. However, current treatment methods for the disease present deleterious side effects themselves. Therefore, there is a move towards finding natural cures in order to mitigate negative side effects while still providing effective treatment for the cancer. Blackseed (Nigella sativa) oil is one particular natural remedy, alongside its active ingredient thymoquinone (TQ), which has been successfully tested for suppressing certain types of breast cancer cell proliferation. TQ itself has been seen to be capable of preventing proliferation of both non-aggressive MCF-7 and highly aggressive MDA-MB-231 cancer cells. However, studies which looked at the effects of TQ on MCF-7 cells alone were limiting in their use of high concentrations of the chemical without emphasis on finding a minimum effective dosage. Additionally, a second study which tested the effects of TQ on both MCF-7 and MDA-MB-231 cell lines conducted the experiments in the presence of a lipid-carrier molecule. This, in turn, may have served as a confounding variable in the results. Therefore, it was hypothesized that a minimal effective dosage for both blackseed oil and TQ could be determined, where a significantly greater suppression of MDA-MB-231, in comparison to MCF-7, cell proliferation would be observed. Cell proliferation, cell adhesion, and soft agar assays were used to test the hypothesis of this study. The minimum effective dosage for each substance, characterized by proliferation of the non-aggressive MCF-7 cells to some extent and suppression of the aggressive MDA-MB-231 cells, were determined to be 0.5 µL for blackseed oil and 1.0 µM for TQ. Additionally, TQ’s effectiveness was noted to be more time-dependent than blackseed oil. This study supports the use of minimal effective doses for blackseed oil or TQ to naturally treat breast cancer while preventing damage to non-aggressive cells. KEYWORDS: Breast cancer; Blackseed oil; Nigella sativa; Thymoquinone; Effective dose; Natural remedies