Osteopathic Medicine and Primary Care, which enters its third year of operation in 2009 under the umbrella of BioMed Central, continues to promote and advance open access publishing through universal online access without charge, indexing in PubMed and archiving in PubMed Central, retention of authors' copyright, and expeditious peer review. Notable accomplishments during 2008 included a median lag time of four months from initial manuscript submission to publication, designation of eight articles as "highly accessed," and achievement of a balanced proportion of publications in our core topic areas of osteopathic medicine and primary care. In October 2008, Springer Science+Business Media, a major publisher of journals in science, technology, and medicine, acquired the BioMed Central Group. Our 2009 Editorial Board is presented herein, as well as a new mechanism for posting book reviews on the Osteopathic Medicine and Primary Care website. We continue to encourage manuscript submissions and reader comments on our articles. Waivers or discounts of article processing charges are available via several mechanisms for eligible authors who submit qualified manuscripts.
The two decades since the introduction of MEDLARS and the passage of the Medical Library Assistance Act have been especially eventful in the history of the National Library of Medicine. The library's collections and services have grown to keep pace with the expanding health sciences literature and the needs of health professionals. Networking has emerged as an invaluable method for disseminating biomedical information. NLM has assumed new responsibilities for information services in toxicology, pharmacology, and environmental health, and for research and development in biomedical communications. Research now being carried out by NLM has the potential for enhancing the library's archival programs and for improving information dissemination in support of health sciences research, education, and practice.
To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward in many regards, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine and surgery. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients and be valid.
Where are we now?
Today, orthopaedic surgery is in the post-Flexner era of passive didactic learning combined with the practical experience of surgery as taught by supervising experts. The medical student and house officer fill their memory with mountains of facts and classic references ‘just in case’ that information is needed. With libraries and now internet repositories of orthopaedic information, all orthopaedic knowledge can be readily accessed without having to store much in one’s memory. Evidence is often trumped by the opinion of a teacher or expert in the field.
Where do we need to go?
To improve the quality of orthopaedic surgery there should be application of the best evidence, changing practice where needed when evidence is available. To apply evidence, the evidence has to find a way into practice without the long pipeline of change that now exists. Evidence should trump opinion and unfounded practices.
How do we get there?
To create a curriculum and learning space for information management requires effort on the part of medical schools, residency programs and health systems. Internet sources need to be created that have the readily available evidence-based answers to patient issues so surgeons do not need to spend all the time necessary to research the questions on their own. Information management is built on a platform created by EBM but saves the surgeon time and improves accuracy by having experts validate the evidence and make it easily available.
Healing with medicinal plants is as old as mankind itself. The connection between man and his search for drugs in nature dates from the far past, of which there is ample evidence from various sources: written documents, preserved monuments, and even original plant medicines. Awareness of medicinal plants usage is a result of the many years of struggles against illnesses due to which man learned to pursue drugs in barks, seeds, fruit bodies, and other parts of the plants. Contemporary science has acknowledged their active action, and it has included in modern pharmacotherapy a range of drugs of plant origin, known by ancient civilizations and used throughout the millennia. The knowledge of the development of ideas related to the usage of medicinal plants as well as the evolution of awareness has increased the ability of pharmacists and physicians to respond to the challenges that have emerged with the spreading of professional services in facilitation of man's life.
History; medicinal plants; plant drugs; usage
A shortfall exists of female doctors in senior academic posts in the United Kingdom. Career progression depends on measures of esteem, including publication in prestigious journals. This study investigates gender differences in first and senior authorship in six peer-reviewed British journals and factors that are associated with publication rates.
Design and main outcome measures
Data was collected on United Kingdom first and senior authors who had published in the British Medical Journal, Lancet, British Journal of Surgery, Gut, British Journal of Obstetrics and Gynaecology and the Archives of Diseases in Childhood. Authorship and gender were quantified for 1970, 1980, 1990, 2000 and 2004 (n=6457). In addition, selected questions from the Athena Survey of Science Engineering and Technology (ASSET2006), web-based doctor's self-report of publications were also analysed (n=1162).
Female first authors increased from 10.5% in 1970 to 36.5% in 2004 (p<0.001) while female senior authors only increased from 12.3% to 16.5% (p=0.046). Within individual journals, the largest rise was in British Journal of Obstetric and Gynaecology with 4.5- and 3-fold increases for first and senior authors, respectively. In contrast, female senior authors marginally declined in Gut and Lancet by 2.8% and 2.2%, respectively. ASSET2006 identified that female respondents who were parents were less likely to have publications as sole (p=0.02) and joint authors (p<0.001) compared to male respondents. Female respondents with care responsibilities for parents/partner also had less publications as lead authors compared to those without carer responsibilities (p<0.001).
The increase in UK female first authors is encouraging. In contrast, there is considerable lag and in some specialties a decline in female senior authors. Factors that could narrow the gender gap in authorship should be sought and addressed.
The Journal of Biomedical Discovery and Collaboration was created to provide, for the first time, a unified forum to consider all factors that affect scientific practice and scientific discovery – with an emphasis on the changing face of contemporary biomedical science. In this endeavor we are bringing together three different groups of scholars: a) laboratory investigators, who make the discoveries that are the currency of the scientific enterprise; b) computer science and informatics investigators, who devise tools for data analysis, mining, visualization and integration; and c) social scientists, including sociologists, historians, and philosophers, who study scientific practice, collaboration, and information needs. We will publish original research articles, case studies, focus pieces, reviews, and software articles. All articles in the Journal of Biomedical Discovery and Collaboration will be peer reviewed, published immediately upon acceptance, freely available online via open access, and archived in PubMed Central and other international full-text repositories.
This paper presents what we have learned from the Ashtavaidya Ayurveda physicians of Kerala regarding the status of their unique medical tradition of Ayurveda in the contemporary context. We extensively interviewed several practicing Ashtavaidyas for the “Living History of Indian Scientific Traditions” archive, a new initiative at the NCBS, Bangalore to study the history of Indian sciences. As heirs of a tradition that has adapted and evolved over centuries without compromising its fundamental principles, their views on Ayurveda presented here represent an important contribution to the current debate on the role of traditional medicine in the Indian public health system.
Ashtavaidya; Gurukulam learning; Indian sciences; Kerala Ayurveda; Traditional medicine
General and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease.
An exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review.
Those least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual’s marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks.
Routine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.
Health checks; Screening; Public health; Inequalities; Primary care
The proliferation of integrated radiology information system/picture archiving and communication system (RIS/PACS) and teleradiology has been slow because of two concerns: usability and economic return. A major dissatisfaction on the usability issue is that contemporary systems are not intelligent enough to support the logical workflow of radiologists. We propose to better understand the algorithms underlying the radiologists′ reading process, and then embed this intelligence into the software program so that radiologists can interact with the system with less conscious effort. Regarding economic return issues, people are looking for insurance against obsolescence in order to protect their investments. We propose to future-proof a system by sticking to the following principles: compliance to industry standards, commercial off-the-shelf (COTS) components, and modularity. An integrated RIS/PACS and teleradiology system designed to be workflow-driven and future-proof is being developed at Texas Tech University Health Sciences Center
The authors investigated clinician transactions against the Digital Imaging and Communications in Medicine (DICOM) archive within a clinical image management system (CIMS) in support of patient care. A Neurosurgical Oncology practice was audited for image utilization. There were 400 requests for 233 image studies during 297 sessions. Fifty percent were for current studies, and 50% were for historical studies. Current studies alone were requested in 37% of the sessions, current plus historical in 31%, and hisorical alone in 32% of the sessions. Seventy percent of studies were within 8 weeks old and were rapidly available from the CIMS disk cache without an archive image transaction. Conversely, 30% were older than 8 weeks, requiring a clinician transaction against the archive for image retrieval. Approximately 25% of studies were older than 3 months and 10% older than 6 months. Clinician image needs are complex and any CIMS solution must include a DICOM archive that can support clinician-based transactions.
Canadian Aboriginals, like others globally, suffer from disproportionately high rates of diabetes. A comprehensive evidence-based approach was therefore developed to study potential antidiabetic medicinal plants stemming from Canadian Aboriginal Traditional Medicine to provide culturally adapted complementary and alternative treatment options. Key elements of pathophysiology of diabetes and of related contemporary drug therapy are presented to highlight relevant cellular and molecular targets for medicinal plants. Potential antidiabetic plants were identified using a novel ethnobotanical method based on a set of diabetes symptoms. The most promising species were screened for primary (glucose-lowering) and secondary (toxicity, drug interactions, complications) antidiabetic activity by using a comprehensive platform of in vitro cell-based and cell-free bioassays. The most active species were studied further for their mechanism of action and their active principles identified though bioassay-guided fractionation. Biological activity of key species was confirmed in animal models of diabetes. These in vitro and in vivo findings are the basis for evidence-based prioritization of antidiabetic plants. In parallel, plants were also prioritized by Cree Elders and healers according to their Traditional Medicine paradigm. This case study highlights the convergence of modern science and Traditional Medicine while providing a model that can be adapted to other Aboriginal realities worldwide.
Translational science consists of research and development that integrates multiple resources to expedite the successful treatment of disease. The International Park of Translational BioMedicine (IPTBM) is currently being developed within the interface between Zhejiang Province and Shanghai Municipality. IPTBM has been designed to pioneer comprehensive biomedical research that spans the continuum from the education of young scientists to providing the infrastructure necessary for clinical testing and direct observation to better understand human biology while promoting viable commercial results within a vibrant biotechnology community. IPTBM’s goal is to attract global partners organized around five fundamental pillars: 1) Institutional Development, 2) Project Implementation, 3) Development and Production, 4) Investment and 5) Regulatory Clusters to address the needs of an international platform of scientists, institutes, universities, commercial enterprises, investors, politicians, and other stakeholders. The IPTBM differs from existing models including CTSA’s (US, NIH) technology because of its comprehensive approach to merge education, research, innovation, and development to translate clinical and public health needs into target-oriented and cost-efficient projects.
Translational medicine; International; Projects; Development; Management; Strategy
The field of sleep medicine is in a welcome stage of rapid advance, but at a pace that leads to a sometimes overwhelming overload of knowledge for both clinicians and researchers. The nine papers in this issue are designed to give the reader an organized overview of current thinking and background in Basic Science, Clinical Science and Therapeutic Measures, the major divisions of this special issue.
An important trend is the increasing development of basic science knowledge relevant to understanding and treating the clinical features of sleep disorders.
The therapeutic advances section covers both the treatment of narcolepsy and the role of non‐invasive ventilation. The recent neurobiologic knowledge that narcolepsy‐cataplexy results from a deficiency of the hypothalamic neuropeptide hypocretin (orexin) has opened has opened the exciting possibility of using novel therapies. Despite this new knowledge, traditional stimulants and anticataplectic agents including modafinil, a novel wake‐promoting agent and selective serotonergic, adrenergic and dopaminergic reuptake inhibitors and recently introduced sodium oxybate remain the mainstay of treatment for this condition.
To whet the reader’s appetite and to offer a road map for possible reading, we briefly summarize the content of the papers.
Debate over the status of medicine as an Art or Science continues. The aim of this paper is to discuss the meaning of Art and Science in terms of medicine, and to find out to what extent they have their roots in the field of medical practice. What is analysed is whether medicine is an “art based on science”; or, the “art of medicine” has lost its sheen (what with the rapid advancements of science in course of time, which has made present day medicine more sophisticated). What is also analysed is whether the “science of medicine” is a pure one, or merely applied science; or the element of science in it is full of uncertainty, simply because what is accepted as “scientific” today is discarded by medical practitioners tomorrow in the light of newer evidence. The paper also briefly touches upon how, in the field of present medical education, the introduction of medical humanities or humanistic education has the potential to swing the pendulum of medicine more towards the lost “art of medicine”.
The paper concludes by saying that the art and science of medicine are complementary. For successful practice, a doctor has to be an artist armed with basic scientific knowledge in medicine.
Art of Medicine; Science; Evidence-based Medicine; Human Faculty; Humanistic Education
This paper contains excerpts and colloquies selected from interviews which will appear in a proposed book-length oral history of the Yale University School of Medicine. The book, which considers all the constituent members of the Yale academic medical community, is a statement about contemporary issues in medicine. Owing to space constraints, only excerpts from students appear in this paper. It is believed that these selections may be used as case studies to explore in depth issues of contemporary medical interest. The excerpts have been categorized into eight thematic clusters considering different aspects of premedical and medical school life.
Clarification of the aetiology of chronic human diseases such as atherosclerosis or cancer is one of the dominant topics in contemporary medical research. It is believed that identification of the causal factors will enable more efficient prevention and diagnosis of these diseases and, in some instances, also permit more effective therapy. The task is difficult because of the multistep and multifactorial origin of these diseases. A special case in contemporary aetiological studies is definition of the role of viruses in the pathogenesis of human cancer. Virus-associated cancer develops only in a small minority of infected subjects, which implies that, if the virus does play a role in the pathogenesis of the malignancy, other factors must also be involved. In this paper the author attempts to review the present methodological approaches to aetiological studies of chronic diseases, discusses the role of criteria for identifying causal relationships and proposes guidelines that might help to determine the role of viruses in human cancer.
This article illustrates in which sense genetic determinism is still part of the contemporary interactionist consensus in medicine. Three dimensions of this consensus are discussed: kinds of causes, a continuum of traits ranging from monogenetic diseases to car accidents, and different kinds of determination due to different norms of reaction. On this basis, this article explicates in which sense the interactionist consensus presupposes the innate–acquired distinction. After a descriptive Part 1, Part 2 reviews why the innate–acquired distinction is under attack in contemporary philosophy of biology. Three arguments are then presented to provide a limited and pragmatic defense of the distinction: an epistemic, a conceptual, and a historical argument. If interpreted in a certain manner, and if the pragmatic goals of prevention and treatment (ideally specifying what medicine and health care is all about) are taken into account, then the innate–acquired distinction can be a useful epistemic tool. It can help, first, to understand that genetic determination does not mean fatalism, and, second, to maintain a system of checks and balances in the continuing nature–nurture debates.
Genetic determinism; Innate–acquired distinction; Geneticization; Genetic disease; Medicine; Norm of reaction; Parity thesis; Fatalism
It has only recently been recognised that for more than a century before the opening of Great Ormond Street Hospital for Children (1852) children were treated and even admitted in English Voluntary Hospitals. Among the earliest English 18th century records, that contain the patient‘s age, are those found at the Northampton General Hospital within an archive dating from its foundation as the Northampton Infirmary in 1744. They afford a fascinating glimpse into both inpatient and outpatient child health. Although there are no medical notes as such, the hospital archive has recently rediscovered 1743 statutes, contemporary patient literature entitled Some Friendly Advice to a Patient (written by the Northampton Infirmary‘s founding physician Dr (later Sir) James Stonhouse), minute books, contemporary engravings of the outside and inside of the hospital and inpatient menus. Thus we can speculate with a high degree of certainty as to what would be the then current infirmary environment and treatments for illustrative examples of the children seen in the period 1744–45 (two inpatients and two outpatients). Interestingly one of the inpatient cases, Elizabeth Ager, a child with fever, was admitted against the infirmary regulations, suggesting already a stretching of boundaries in favour of paediatric admissions.
This paper gives a flavour of 18th century hospital child healthcare in an era before the formal recognition of paediatrics as a medical specialty and preceding by more than a century the construction of specialist provision through the foundation of the first children‘s hospitals.
Large-scale picture archiving and communication systems (PACS) have not been widely implemented in this or other countries. In almost all radiology departments film remains the medium for diagnostic interpretation and image archive. Chest imaging is the dominant screening examination performed within most imaging departments and as such, is an extremely high-volume, low-margin examination. Digital technologies are being applied to chest imaging to overcome limitations of screen-film receptors (limited latitude) and current film management systems (singleimage copy). Efficient management of images and information is essential to the success of a chest imaging program. In this article we report on a digital imaging and communications in medicine (DICOM)-based centralized printing network for chest imaging. The system components and their operational characteristics are described. Our experience integrating DICOM-compliant equipment supplied by several vendors is described. We conclude that the print model supported by DICOM is adequate for cross-sectional (eg, computed tomography and magnetic resonance) imaging but is too simplistic to be generally applied to projection radiography.
mini-PACS; digital imaging and communication (DICOM); laser cameras; print spooler
A course has been created to examine the ways in which China and the West have approached human health and medicine. Though fundamentally different, these two systems are complementary in a number of ways. This course is a model for a global science course in an educational initiative that incorporates Asian themes into science and engineering courses. The course is designed around an active-learning platform that has as major components: team research projects, oral presentations, role play, and peer-review. The students investigate concepts of scientific proof, clinical efficacy, and the functional structure of two very different systems of health and medical care.
Traditional, complementary and alternative medical (TCAM) systems contribute to the foundation of person-centred medicine (PCM), an epistemological orientation for medical science which places the person as a physical, psychological and spiritual entity at the centre of health care and of the therapeutic process. PCM wishes to broaden the bio-molecular reductionistic approach of medical science towards an integration that allows people, doctors, nurses, health-care professionals and patients to become the real protagonists of the health-care scene. The doctor or caregiver needs to act out of empathy to meet the unique value of each human being, which unfolds over the course of a lifetime from conception to natural death. Knowledge of the human being should not be instrumental to economic or political interests, ideology, theories or religious dogma. Research needs to be broadened with methodological tools to investigate person-centred medical interventions. Salutogenesis is a fundamental principle of PCM, promoting health and preventing illness by strengthening the individual's self-healing abilities. TCAM systems also give tools to predict the insurgence of illness and treat it before the appearance of overt organic disease. A task of PCM is to educate people to take better care of their physical, psychological and spiritual health. Health-care education needs to be broadened to give doctors and health-care workers of the future the tools to act in innovative and highly differentiated ways, always guided by deep respect for individual autonomy, personal culture, religion and beliefs.
Traditional, Complementary and alternative medicine; Biomedicine; Person-centred medicine; Personalised medicine; Prediction; Prevention; Salutogenesis; Health-care reform; Health-care education; Therapeutic relationship
Recent advances in Web and information technologies with the increasing decentralization of organizational structures have resulted in massive amounts of information resources and domain-specific services in Traditional Chinese Medicine. The massive volume and diversity of information and services available have made it difficult to achieve seamless and interoperable e-Science for knowledge-intensive disciplines like TCM. Therefore, information integration and service coordination are two major challenges in e-Science for TCM. We still lack sophisticated approaches to integrate scientific data and services for TCM e-Science.
We present a comprehensive approach to build dynamic and extendable e-Science applications for knowledge-intensive disciplines like TCM based on semantic and knowledge-based techniques. The semantic e-Science infrastructure for TCM supports large-scale database integration and service coordination in a virtual organization. We use domain ontologies to integrate TCM database resources and services in a semantic cyberspace and deliver a semantically superior experience including browsing, searching, querying and knowledge discovering to users. We have developed a collection of semantic-based toolkits to facilitate TCM scientists and researchers in information sharing and collaborative research.
Semantic and knowledge-based techniques are suitable to knowledge-intensive disciplines like TCM. It's possible to build on-demand e-Science system for TCM based on existing semantic and knowledge-based techniques. The presented approach in the paper integrates heterogeneous distributed TCM databases and services, and provides scientists with semantically superior experience to support collaborative research in TCM discipline.
There is considerable evidence that the translation rate of major basic science promises to clinical applications has been inefficient and disappointing. The deficiencies of translational science have often been proposed as an explanation for this failure. An alternative explanation is that until recently basic science advances have made oversimplified assumptions that have not matched the true etiological complexity of most common diseases; while clinical science has suffered from poor research practices, overt biases and conflicts of interest. The advent of molecular medicine and the recasting of clinical science along the principles of evidence-based medicine provide a better environment where translational research may now materialize its goals. At the same time, priority issues need to be addressed in order to exploit the new opportunities. Translational research should focus on diseases with global impact, if true progress is to be made against human suffering. The health outcomes of interest for translational efforts need to be carefully defined and a balance must be struck between the subjective needs of healthcare consumers and objective health outcomes. Development of more simple, practical and safer interventions may be as important a target for translational research as the development of cures for diseases where no effective interventions are available at all. Moreover, while the role of the industry is catalytic in translating research advances to licensed interventions, academic independence needs to be sustained and strengthened at a global level. Conflicts of interest may stifle translational research efforts internationally. The profit motive is unlikely to be sufficient alone to advance biomedical research towards genuine progress.
Interest in ethnomedicine has grown in the last decades, with much research focusing on how local medicinal knowledge can contribute to Western medicine. Researchers have emphasized the divide between practices used by local medical practitioners and Western doctors. However, researchers have also suggested that merging concepts and practices from local medicinal knowledge and Western science have the potential to improve public health and support medical independence of local people. In this article we study the relations between local and Western medicinal knowledge within a native Amazonian population, the Tsimane'.
We used the following methods: 1) participant observation and semi-structured interviews to gather background information, 2) free-listing and pile-sorting to assess whether Tsimane' integrate local medicinal knowledge and Western medicine at the conceptual level, 3) surveys to assess to what extent Tsimane' combine local medicinal knowledge with Western medicine in actual treatments, and 4) a participatory workshop to assess the willingness of Tsimane' and Western medical specialists to cooperate with each other.
We found that when asked about medical treatments, Tsimane' do not include Western treatments in their lists, however on their daily practices, Tsimane' do use Western treatments in combination with ethnomedical treatments. We also found that Tsimane' healers and Western doctors express willingness to cooperate with each other and to promote synergy between local and Western medical systems.
Our findings contrast with previous research emphasizing the divide between local medical practitioners and Western doctors and suggests that cooperation between both health systems might be possible.
This study was completed as part of a project for the Quality Assurance Agency on the enhancement theme of 'Research teaching linkages: enhancing graduate attributes' in the disciplines of Medicine, Dentistry and Veterinary Medicine. The aims of this investigation were to elucidate a list of desirable research related graduate attributes for the disciplines of Medicine, Dentistry and Veterinary Medicine and provide evidence as to how they could be covered within such curricula.
Semi structured interviews, symposium breakout sessions and conference workshops were used to define and rank attributes suggested by curricula design experts from the three disciplines. Students graduating from a BSc Medical Science degree program were surveyed to determine how well they felt the curriculum and associated final year project equipped them with the identified attributes.
A list of seven high level attributes which were desirable in graduates wishing to pursue either a professional or research career were identified. 105 students reported that a final year project was particularly effective at developing an understanding of the need to have an inquiring mind and critical appraisal skills whilst other components of their degree course covered team working skills, core knowledge and an understanding of ethics and governance.
This study identified desirable attributes from graduates from medical, dental and veterinary degree programs and provides evidence to support the case for student projects helping to achieve both clinical and research related graduate attributes in medical undergraduates. The project also provides a focus for debate amongst those involved in curriculum design as to whether the attributes identified are those desirable in their graduates and to examine their current curriculum to determine coverage.