Background Heart failure is common and highly morbid in older adults. Performance measurement systems for this condition may work best when they account for the reasons why physicians do not provide guideline-recommended interventions. Objective To develop a conceptual framework for understanding the proximate, patient-centered reasons why physicians do not prescribe ACE inhibitors and beta blockers to patients with heart failure. Design Focus group study using a two-stage design. First, we asked participants to describe reasons for not prescribing ACE inhibitors and beta blockers to patients with heart failure and impaired ejection fraction. Second, we asked groups to develop concept maps that organized these reasons into categories and described the relationships between these categories. Participants Seven focus groups comprising 31 academically-affiliated clinicians of different specialties and levels of training. Participants were recruited via invitations sent to clinicians within each target group. Approach We synthesized each group’s concept maps to develop a consensus scheme for categorizing reasons for non-prescribing. Results We identified two broad themes. First, clinicians hinted at their own attitudinal barriers to prescribing. However, they framed their comments largely around patient-centered reasons for non-prescribing that arose in individual patient encounters. Second, decision-making about heart failure drug therapy often involved a complex and overlapping series of considerations. Five categories of reasons for not prescribing ACE inhibitors and beta blockers emerged: 1) adverse effects of drug therapy, 2) non-adherence to therapeutic and monitoring plan, 3) patient preferences and beliefs, 4) co-management and transitions of care, and 5) prioritization and patient benefit. Conclusions Physician reasons for not prescribing guideline-recommended drugs for heart failure are complex but can be organized into a useful taxonomy. This taxonomy may be helpful for performance measurement and quality improvement programs that seek to understand and account for reasons for physician non-adherence to guidelines.

Background: Internet has become an integral part of our life and internet addiction is a growing problem affecting many spheres of our lives. Considering the potential negative effects of internet addiction on health this study aims to study the prevalence and pattern of Internet addiction among medical students by using Internet Addiction Test in Nagpur.Methods: The cross‑sectional study was conducted in 488 medical students in year 2016. Data was collected by using semi structured proforma including socio-demographic variables and Young’s 20-item Internet Addiction Test (IAT) questionnaire. Statistical analysis done by Epi info 7.1 and SPSS (20).Results: Prevalence of internet addiction by using Young’s original criteria was 3.68%. Internet addiction was significantly more common in males than females (p<0.05). This study reveals that according to IAT score, (61.47%) were average users, (34.83%) were possible addicts and (3.68%) were addicts. Chi square test is applied between average users and addicts, was found to be statistically significant (p<0.01). There was no statistically significant difference in the mean of total IAT scores between male and female students (p=0.27) and F statistics is applied between mean value of three groups (i.e. Average users, Possible addict and addict) was found to be statistically significant (<0.0001).Conclusions: Prevalence of internet addiction was 3.68% with male predominance indicate that internet addiction is growing problem. Prevalence of possible addict was also alarming which was 34.83%. Early recognition of internet addiction and appropriate preventive measures should be taken.

Background: Social determinants of the health are the conditions in which individuals are born, grow, live and age. Increasingly, these are being recognized for their relationship to the soaring incidence of diabetes mellitus. So, we conducted a study to find the social factors of diabetes mellitus.Methods: A cross sectional study was conducted in adults having type 2 diabetes in outpatient department of tertiary care institute in Nagpur from July to September 2015. Socio demographic factors, health care access factors, stress related factors and self-care behavior of these patients were studied. Data was analyzed using Epi Info 7.1 software.Results: Out of 140 diabetic patients studied females were predominant (55.71%). Most of them were married (92.85%), were Muslim by religion (47.14%), were from nuclear families, (53.57%) and lower middle class (40%). 50% said that they have health care facilities nearby their house and 50.71% do not get drugs regularly in that health care facility. and only (27.14%) were insured. 64.28% of study subjects said that they were accompanied by relatives to hospital. The financial stress (73.57%) and family stress (72.85%) was more in the patients than work stress (49.28 %). 75.72% and 71.42 % checked their blood sugar levels every 6 monthly and blood pressure every monthly and very less patients kept follow up for complications.Conclusions: Our study showed that in spite of having health care facility nearby, the irregularity of drugs was a major concern. Very less study subjects were insured for their health, this implicates higher stress related factors. They had less compliance towards follow-up of complications of diabetes mellitus.