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Objectives: In developing countries out-of-pocket payments (OOP) are as high as 80% of healthcare spending. Generic medicines can be instrumental in reducing this expenditure. The current study is aimed to explore the knowledge, perception, and attitude of general practitioners towards generic medicines in Karachi, Pakistan. Methods: This exploratory, descriptive study was conducted on a sample of 289 randomly selected general practitioners who were dispensing at their private clinics in Karachi, Pakistan. The questionnaires were distributed and collected by hand. Data was entered to SPSS version 17. Fischer's exact test was applied to see the association between variables. Results: A total of 206 questionnaires were included in the study. A response rate of 71.3% was achieved. Out of 206 respondents, 139 (67.5%) were male while 67 (32.5%) respondents were female. Close to three quaters of the respondents (n= 148; 71.8%) showed correct knowledge about generic medicines being a 'copy of the brand name medicines' and 'interchangeable with brand name medicines' (n= 148; 71.8%). In terms of safety, the majority of respondents (n=85; 41.26%) incorrectly understood that the generic medicines are less safe than brand name medicines. The total percentage of correct responses was seen in 53% of the respondents. More than half of the respondents agreed that locally manufactured medicines are of the same effectiveness as brand name medicines (n=114; 55.4%). Male practitioners with practice experience of 11-15 years showed positive perception towards the quality of multinational products. The Majority of respondents believed that their prescribing decision is influenced by medical representatives (n=117; 56.8%). More than three-quarters of the respondents expressed their wish to prescribe low cost medicines in their practice (n=157; 76.2%). More than one third of the respondents expressed their uneasiness to prescribe products from all local manufacturers (n=72; 35%). Conclusion: There were gaps identified in the knowledge of respondents. Although good perception and attitude were noted among the respondents, dissemination of information regarding generic medicines may perhaps strengthen generic prescribing. There is a need to introduce 'Quality by Design' concept in local manufacturing units. This, in turn, can inculcate confidence in prescribers towards locally manufactured generic medicines. Scopus

Introduction: The incidence of Clostridium (C.) difficile infection (CDI) was on the rise from 2001 to 2006 in Singapore. Recent unpublished data suggests that its incidence had remained stable or decreased in most local public hospitals between 2006 and 2010. It is, however, not known if the polymerase chain reaction(PCR) ribotype 027 strains have been circulating, although reports suggest that this strain is emerging in Asia, with the first cases reported from Japan in 2007, as well as in Hong Kong and Australia in 2009. We initiated a culture-based surveillance to detect this epidemic strain in Singapore. Methods: From September 2008 to December 2009, all non-duplicate toxin-positive stool samples from the three largest public hospitals in Singapore were collected for culture and further analysis. Results: Out of the 366 samples collected, 272 viable isolates were cultured. Of these, 240 tested toxin-positive and ten tested positive for the binary toxin gene; 35 different PCR ribotypes were found. Three isolates that tested positive for binary toxin contained the same PCR ribotyping pattern as the C. difficile 027 control strain. All three had the 18-bp deletion and single nucleotide tcdC deletion at position 117. Susceptibility testing was performed, demonstrating susceptibility to erythromycin and moxifloxacin. Conclusion: We report the first three isolates of C. difficile 027 from Singapore. However, their susceptibility patterns are more consistent with the historical 027 strains. Rising CDI incidence may not be associated with the emergence of the epidemic 027 strain at this time.

This paper examines the concept of network position in industrial network using a metaphorical mode of analysis. There are three sections in this paper, with section one dealing briefly with the network approach to industrial marketing. Section two looks at network position using four perspectives. They include network position as relationships; structure; strategy; and power. These perspectives are not meant to be exhaustive with considerable overlap between them. The paper concludes by highlighting the challenges faced by network researcher in conceptualisation network position but also suggesting that its contribution to network research is underestimated. Whenever we propose a solution to a problem we ought to try as hard as we can to overthrow our solution rather than defend it. Few of us unfortunately, practise this precept; but other people, fortunately, will supply the criticism for us if we fail to supply it ourselves.

This paper is about managing business relationships and positions in industrial networks. Entrenched business relationships between industrial buyers and sellers are epitomised by the positions occupied by these firms in the network. As structural metaphors, network positions described how firms relate to the other firms in the network. These positions capture the connections, complexity and dynamicity of these relationships. They are the achievement of an on-going historical process and are effective only if there are paired reciprocal relationships between the network partners, resulting in favourable access to the network resources and activities. Managing these positions means managing business relationships with a host of partners, developing strong relationships with some and not with others. All this requires a choice of partners and the development of appropriate resources and activities' ties, particularly in networks that are evolving, with considerable overlap.

Although the interaction approach to industrial marketing, with a preoccupation on building long-term relationship, holds a lot of promise for theoreticians and practitioners alike, we need to confront the inevitability of misjudged partners, particularly those with hidden agenda, and ill conceived business relationships. Business goals and objectives change over time, and accordingly, the transaction cost equation. This state of affairs may or may not be anticipated, and further compounded by a subsequent relationship atmosphere void of any communication and commitment between the parties. What is certain, however, is with the prospect of costly litigation, corporate reluctance to see the demise of the relationship, together with the economic and social cost associated with a failed relationship, parties must be wary at the outset of committing considerable resources to building a relationship. The idealistic, Utopian view of building a long-term relationship must be tempered with the harsh reality that one should under certain circumstances, actively and consciously play the market, seek out opportunities, and develop an opportunistic mentality. Deciding when to get out of an existing relationship and into a new one would minimise the substantial economic, political and emotional cost associated with building a relationship that was never destined to last Under such circumstances, failure or success in industrial market planning are more assured by appreciation and understanding of the circumstances that favour short-term opportunistic relationship as opposed to long-term relationship. This include developing a planning framework, and indeed, a business mentality which encourages the parties to consciously seek out new opportunities with potential new partners when one is already entered into.