Background The principle of double effect is often invoked to interpret clinical intentions in palliative sedation (PS), considering that intended effect may differ from foreseen effect. Despite clarifications, intentions concerning patient consciousness remain ambiguous. Moreover, little is known about how non-palliative care specialists understand and apply these intentions. Methods This study aims to explore physicians' intentions regarding PS, with a particular focus on the relationship between their intentions and patients' consciousness. This qualitative study is based on twelve semi-structured interviews with physicians from a university hospital in France. The methodology combined hierarchical evocation, clinical vignettes, and semi-structured interviews. Results The study reveals considerable heterogeneity in physicians' intentions regarding patient unconsciousness. The distinction between intended and foreseen effects was often poorly understood. References to the doctrine of double effect were rare, whereas the principle of proportionality was more frequently acknowledged. Conclusion This study reveals important discrepancies between specialized frameworks and the conceptual models of clinical reasoning. We particularly highlighted the inadequacy of the principle of double effect to enable an explicit evaluation of the ethical significance of induced unconsciousness and proposed a more integrated approach to palliative sedation, grounded in contemporary evidence, and proportionality.

Caffeine appears in breastmilk rapidly after maternal ingestion. Insufficient high-quality data are available to make good evidence-based recommendations on safe maternal caffeine consumption.[1] Fussiness, jitteriness and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes equivalent to about 10 or more cups of coffee daily. Studies in mothers taking 5 cups of coffee daily found no stimulation in breastfed infants 3 weeks of age and older. A maternal intake limit of 300 to 500 mg daily might be a safe level of intake for most mothers, although European authorities set a likely safe level at 200 mg.[2-4] Maternal doses of caffeine greater than 130 mg daily may decrease weight gain in their exclusively breastfed infants, but this needs further confirmation.[5] However, preterm and younger newborn infants metabolize caffeine very slowly and may have serum levels of caffeine and other active caffeine metabolites similar to their mothers' levels, so a lower intake level preferable in the mothers of these infants.[2,6,7] Coffee is thought to decrease milk supply in some cultures, but there is no scientific information on coffee and milk supply.[8] Other sources of caffeine, such as cola and energy drinks, yerba mate or guarana, will have similar dose-related effects on the breastfed infant. Coffee intake of more than 450 mL daily may decrease breastmilk iron concentrations and result in mild iron deficiency anemia in some breastfed infants.[9]

Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.

No information is available on the clinical use of pamabrom during breastfeeding. If the mother requires pamabrom, it is not a reason to discontinue breastfeeding. Monitor the infant for excessive urination, adequate weight gain and skin rash.

Small, occasional doses of pyrilamine are probably acceptable during breast feeding. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly, in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.

Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or antiinflammatory agent in nursing mothers.

The purpose of this research was to develop a fiber optic (FO) dissolution method for quantification of multiple actives in combination pharmaceutical tablets. FO dissolution allows direct API quantification in the vessel, obviating the need for error-prone facets of traditional dissolution methods. However, FO dissolution is potentially challenged by overlapping UV spectra, matrix effects, UV-active excipients, API interactions with excipients and media, and undissolved components attenuating the UV signal. These obstacles might render FO dissolution method development more complex than LC-end dissolution. The case study in this manuscript has the added complexity of a triple combination product (Midol), where acetaminophen, caffeine, and pyrilamine maleate exhibit similar release kinetics, share largely overlapping UV spectra and span an order of magnitude difference in concentration. Single-wavelength quantification required unique features for the actives of interest, which were not available for the formulation of interest without preprocessing. The methods employed for the quantification of actives were a partial least squares multivariate calibration and a peak area calibration, both using prepared mixtures as reference data. The selected combination tablet demonstrated collinear API release; therefore, individual quantification required a design of experiments for mixture design. The advantages of FO dissolution will be discussed in the context of the formulation under investigation. Additionally, some general guidelines will be suggested for the development of other FO methods.

Opuntia ficus indica (OFI) has many physiological effects, but a relationship between OFI and heart-rate variability (HRV) has never been established. The aim of this study was to describe the effects of a diet supplement of OFI on HRV in athletes. The first day, heart rate (HR) was measured at rest in supine (SU) and standing (ST) positions to analyze HRV in 10 athletes, followed by a randomized assignment to an OFI (5) or placebo (5) group. The next day, the athletes repeated the HRV test. One month later the crossover protocol was applied. In OFI, the high-frequency-activity HF(SU) (1,773 +/- 2,927 vs. 5,856 +/- 8,326 ms(2), p < .05), HF(ST) (295 +/- 313 vs. 560 +/- 515 ms(2), p < .05), and low-frequency LF(SU) (1,621 +/- 1,795 vs. 6,029 +/- 9,007 ms(2), p < .01) increased. HR(SU) (66 +/- 13 vs. 57 +/- 11 beats/min, p < .01) and HR(ST) (87 +/- 11 vs. 76 +/- 9 beats/min, p < .01) decreased. A diet supplement of OFI increases HF and LF activities and decreases HR.

Pamabron is a common over-the-counter diuretic used for relief of menstrual-associated symptoms. An urticarial eruption, with systemic complaints consistent with a serum sickness-like reaction, attributed to Pamabron is described. A review of the literature concerning Pamabron and dermatology is discussed.

Primary dysmenorrhoea is the most frequent gynaecological condition, with a prevalence of 40 - 90% in women within the reproductive age. It is characterised by cyclic pelvic pain related to menstrual period, vomiting and headache. As prostaglandins and leukotrienes appear to be a major causative factor in this condition, NSAIDs are the first choice for treatment. Acetaminophen is an over-the-counter analgesic/antipyretic agent widely used in primary dysmenorrhoea as monotherapy or in combination. It has a weak inhibitory action on peripheral prostaglandin synthesis. Acetaminophen displays good gastrointestinal tolerance without any effect on haemostasis. Its combination with pamabrom, a mild diuretic agent, (Women s Tylenol Menstrual Relief Caplets, Midol Teen) was approved by the FDA for use in this indication. Nevertheless, the available information concerning the efficacy of acetaminophen in primary dysmenorrhoea is limited and not conclusive with respect to other NSAIDs or even placebo. The clinical evidence regarding the association with pamabrom is even more scarce. Well-designed, randomised, controlled trials are required to demonstrate the efficacy of the combination of acetaminophen plus pamabrom in the treatment of primary dysmenorrhoea.

The implementation of the Bamako initiative is a central pillar of the health policy of Burkina Faso. The NGO, ASI, working with the health authorities, has set up a program involving the creation of eight health districts in the province of Gnagna. The program covers a population of 115,000 inhabitants in 134 villages and was progressively established between 1994 and 1997. The health districts were set up in phases (2 in the first year and 3 in each of the following two years). The method used to select the members of the village management committees is one of the key aspects of the program. It required a large amount of effort to increase the awareness of villages, and much activity because each committee is elected by the various villages of the district. The training of the managers of these committees and of the managers of the pharmaceutical warehouses in each district is also a key element. In our initial assessment, we noted balance in the accounting of the pharmaceutical warehouses of each district, adhesion of the population to the program, dynamics in the management committees and, above all, the autonomy of the committees. The first results in terms of health are very fragmentary and difficult to interpret because the program has been running for such a short time. We considered the long-term elements of the program, the necessity to set up a system for monitoring activities and the quality of care. An initial assessment showed a clear improvement in the availability of drugs in the 8 districts. Health promotion activities have not yet been developed in these districts. This type of program requires the follow up and support of the management committees, and will be the object of the second phase, begun in 1998.

Three cases of psychological dependence upon the over-the-counter preparation of cinnamedryl, caffeine and aspirin (Midol) are reviewed. The relationship between cinnamedryl, amphetamine and other sympathomimetics is discussed. Similarities are noted in symptomatic response and chemical structure.