A review of enhanced recovery for thoracic anaesthesia andsurgeryN. L. Jones,1 L. Edmonds,2 S. Ghosh1 and A. A. Klein11 Consultant, Anaesthesia and Intensive Care, 2 Library and Knowledge Services Manager, Papworth Hospital,Cambridge, UKSummaryDuring the past decade, there has been a dramatic increase in the number of thoracic surgical procedures carried outin the UK. The current ﬁnancial cli
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Microsoft word - 086_en.docTO UEFA MEMBER ASSOCIATIONS TO CLUBS PARTICIPATING IN UEFA COMPETITIONS For the attention of the President and the General Secretary 2011 List of Prohibited Substances
In accordance with paragraph 4.01 of the 2010 UEFA Anti-Doping Regulations, the 2011
WADA Prohibited List applies to all UEFA competitions, with effect from 1 January 2011.
For this purpose, we enclose the new list of prohibited substances, a WADA summary of the
changes compared with the 2010 list, and some questions and answers on the 2011 list. This
information is also available on the WADA website (www.wada-ama.org).
Summary of amendments to 2011 Prohibited List (see also enclosures)
Substances and methods prohibited at all times (in- and out-of-competition) A new category of substances that are not covered by the other sections of the Prohibited List has been added. It refers to drugs with no official approval, either because they are in an experimental phase of development or because they are not, or no longer permitted for human use. • S2. Peptide hormones, growth factors and related substances More examples have been added to this section in order to reflect the growing number of substances developed to stimulate erythropoeisis, such as hypoxia-inducible factor (HIF) stabilizers and the non-proprietary name of Hematide, peginesatide. Platelet-derived preparations administrated by intra-muscular routes have been removed from the Prohibited List and will therefore no longer require a TUE. Current studies on platelet-derived preparations (PRP) do not demonstrate any potential for performance enhancement beyond a potential therapeutic effect. However, individual growth factors are still prohibited when given separately as purified substances as described in S2.5. Salbutamol (maximum 1600 micrograms over 24 hours) and salmeterol remain
authorised when taken by inhalation but will no longer be subject to a declaration of
use as this requirement has been removed from the 2011 Prohibited List and the
January 2011 version of the International Standard for TUEs.
It is important to note that the presence of salbutamol in urine in excess of
1000ng/mL is presumed not to be an intended therapeutic use of the substance and
will be considered as an adverse analytical finding unless the player proves, through
a controlled pharmacokinetic study, that this is the consequence of the use of a
therapeutic dose (maximum 1600mcg/24hrs) of inhaled salbutamol.
Comment: In order to avoid exceeding the urinary limit for salbutamol and
salmeterol, it is of utmost importance that physicians carefully instruct all
players taking these substances on how to use them correctly. Players should
be reminded to follow the prescription exactly for the administration route,
dosage and frequency of use, and should be explicitly warned of the possibility
of an adverse analytical finding.
All other beta-2 agonists (including formoterol and terbutaline) are prohibited
and therefore require a TUE.
• S5. Diuretics and other masking agents Glycerol, which was added to the Prohibited List as an example last year, can be
found in different foodstuffs and toiletries. However, WADA confirms that such use
will not cause a player to test positive for this substance.
Desmopressin has been added as an example of a masking agent.
The last paragraph of section S5 has been reworded for clarification purposes.
Should an exogenous threshold substance (e.g. salbutamol, morphine, cathine,
ephedrine, methylephedrine or pseudoephedrine) be detected at a sub-threshold
concentration in conjunction with a diuretic or other masking agent, both substances
will be reported as an adverse analytical finding by the laboratory. In such a case, the
player will be required to have a TUE for both the threshold substance and the
diuretic or masking agent to avoid a positive result.
Comment: A player who requires the administration of a diuretic or masking
agent for therapeutic purposes must submit a TUE application. If this player is
also using an exogenous threshold substance, it is highly recommended that
the player also submit a TUE application for such use.
• M2. Chemical and physical manipulation A new paragraph M2.3 has been added to prohibit the “sequential withdrawal, manipulation, and reinfusion of whole blood”. This is not intended to prevent plasmapheresis, a specialised form of blood donation, and other similar processes that do not involve the re-administration of whole blood. This new paragraph has been added to reflect the process by which a player’s blood is removed, treated or manipulated, and then re-injected. Players undergoing haemodialysis as part of the treatment of chronic kidney disease will require a TUE for such procedures and, if applicable, for the other prohibited substances used for the treatment of such a disorder. Significant changes have been made to the wording for clarification purposes. Substances and methods prohibited in-competition Methylhexaneamine has been moved from the non-specified stimulants to the specified stimulants category. In recent months there have been a number of high-profile doping cases in different sports involving methylhexaneamine, which is increasingly being found in nutritional supplements, typically those that are designed to increase energy or aid weight loss. There is a risk that supplements could contain it even if the ingredients listed on the label do not appear on the WADA Prohibited List. This is because methylhexaneamine is known by many names, including: 1,3-dimethylamylamine, dimethylamylamine, dimethylpentylamine, DMAA, forthan, forthane, floradrene, geranamine and geranium oil. It is highly recommended not to use any products which contain any of these ingredients. The definition has been reworded to make it clear that all cannabimimetics are included in this section. Only the prohibited routes of administration (oral, intravenous, intramuscular or rectal) are now listed in this section and are the same as in the previous Prohibited List. All other routes are authorised and no longer subject to a declaration of use. As previously mentioned in the S3 (Beta-2 agonists) section, the declaration of use has been removed from the 2011 Prohibited List and the January 2011 version of the International Standard for TUEs. Therapeutic Use Exemptions Changes to the 2011 Prohibited List do not affect the rules and procedure governing therapeutic use exemptions (TUEs), which are harmonised with those of FIFA. The following requirements remain: • All prohibited substances and methods require a TUE. • Players wishing to use beta-2 agonists – other than inhaled salbutamol (maximum 1600 micrograms over 24 hours) or inhaled salmeterol – must submit a TUE application with a complete medical file meeting the requirements set out in the enclosed document “Asthma – Minimum Requirements”. Declaration of use (DoU)
This has been removed from the 2011 Prohibited List and the January 2011 version of the
International Standard for TUEs. All substances or methods not mentioned on the Prohibited
List will no longer be subject to a declaration of use. This concerns, in particular, non-
systemic use of glucocorticosteroids, inhaled salbutamol (maximum 1600mcg in 24 hours)
and salmeterol, and platelet-derived preparations administered by routes other than intra-
Players participating in UEFA competitions who have to use prohibited substances for
therapeutic purposes must request authorisation from UEFA by means of a UEFA TUE form
(enclosed). Forms must be sent to UEFA only and not to the national anti-doping
organisations (NADO). TUE forms must be completed by the player and their doctor and sent
to the UEFA Anti-Doping Unit (confidential fax +41 22 990 31 31). A TUE must be granted
before the start of treatment.
Should a player already have a TUE granted by FIFA, it will automatically be recognised by
UEFA, therefore no further action is required. However, should a player already have a
TUE from their NADO, they must submit it to UEFA for recognition before the start of
the competition (if possible 21 days before). The initial TUE request must be attached
to the TUE granted by the NADO.
In accordance with paragraph 2.01 of the 2010 UEFA Anti-Doping Regulations, and given
the disciplinary consequences that a player may face in the event of an anti-doping rule
violation, we ask that all players be fully informed of the risks involved in taking any form of
medication or food supplement. In particular, as mentioned above, players should be made
aware of supplements containing methylhexaneamine. If the player is in any doubt, they
should contact their doctor or national anti-doping organisation for clarification.
Players should also be aware that doping controls can be carried out at all times, both in-
Anti-doping leaflet for players We refer to our circular (No. 23) of 12 May 2010, with which leaflets were enclosed. Should you require more leaflets or leaflets in different languages (seven languages available), please send an email request to email@example.com. Please forward this circular and the 2011 Prohibited List to your team doctors, who
must in turn inform the players. This list, the current TUE process and forms, as well
as the 2010 UEFA Anti-Doping Regulations, are also available on the dedicated anti-
doping section of the UEFA website at www.uefa.com or directly at
If you have questions or require further information, please feel free to contact Caroline
Thom (Caroline.Thom@uefa.ch) or Richard Grisdale (Richard.Grisdale@uefa.ch) in UEFA’s
- 2011 WADA Prohibited List
- WADA summary of modifications made to 2011 Prohibited List
cc (with enclosures) - UEFA Executive Committee - UEFA - UEFA Anti-Doping Panel - Clubs participating in UEFA competitions - European members of the FIFA Executive Committee - FIFA,
EFFECT OF DEWORMING WITH IVOMEC POUR-ON PERFORMANCE OF GRAZING STOCKER CATTLE Story in Brief One hundred twelve healthy stocker steers averaging 533 lb and grazingsummer forages were used to evaluate the effect of ivermectin on weight gain. Treatment groups consisted of one or two treatments with ivermectin and acontrol group receiving none. Cattle receiving treatment with ivermectin