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1.  Challenges and Opportunities in Academic Hospital Medicine: Report from the Academic Hospital Medicine Summit 
ABSTRACT
BACKGROUND
The field of hospital medicine is growing rapidly in academic medical centers. However, few organizations have explicitly considered the opportunities and barriers posed to hospital medicine’s development as an academic field in internal medicine.
OBJECTIVE
To develop consensus around key areas limiting or facilitating hospital medicine’s development as an academic discipline.
DESIGN
Consensus format conference of key stakeholders in academic hospital medicine.
RESULTS
The Consensus Group identified several issues impeding the development of academic hospital medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderate non-teaching roles, and demands to perform non-clinical duties (such as quality improvement) not generally viewed as academic pursuits. The Consensus Group developed recommendations for addressing these concerns, specifically 1) characterizing the ‘optimal’ job description for an academic hospitalist, 2) developing better local and at-a-distance opportunities for training academic hospitalists in key aspects of early career success, 3) advocacy for development of fellows and junior faculty researchers in hospital medicine.
SUMMARY
Fostering academic hospital medicine will help address these issues more effectively and will help the field while also attracting the next generation of generalists needed to care for an increasingly complex inpatient population.
doi:10.1007/s11606-009-0944-6
PMCID: PMC2669869  PMID: 19259748
internal medicine; Consensus Group; opportunities; academic hospital; hospital medicine; hospitalists
2.  Rural family medicine training in Canada. 
Canadian Family Physician  1995;41:993-1000.
OBJECTIVE: To examine the status of postgraduate family medicine training that occurs in rural family practice settings in Canada and to identify problems and how they are addressed. DESIGN: A retrospective questionnaire sent to all 18 Canadian family medicine training programs followed by a focus group discussion of results. SETTING: Canadian university family medicine training programs. PARTICIPANTS: Chairs or program directors of all 18 Canadian family medicine training programs and people attending a workshop at the Section of Teachers of Family Medicine annual meeting. MAIN OUTCOME MEASURES: Extent of training offered, educational models used, common problems for residents and teachers. RESULTS: Nine of 18 programs offer some family medicine training in a rural practice setting to some or all of their first-year family medicine residents, and 99 of 684 first-year family medicine residents did some training in a rural practice. All programs offer some training in a rural practice to some or all of the second-year residents, and 567 of 702 second-year residents did some training in a rural setting. In 12 of 18 programs, a rural family medicine block is compulsory. Education models for training for rural family practice vary widely. Isolation, accommodation, and supervision are common problems for rural family medicine residents. Isolation and faculty development are common problems for rural physician-teachers. Programs use various approaches to address these problems. CONCLUSIONS: The variety of postgraduate training models for rural family practice used in the 18 training programs reflects different regional health care needs and resources. There is no common rural family medicine curriculum. Networking through a rural physician-teachers group or a faculty of rural medicine could further the development of education for rural family practice.
PMCID: PMC2146570  PMID: 7780331
3.  International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine 
There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership.
doi:10.1007/s12245-009-0142-7
PMCID: PMC2850981  PMID: 20414375
Curriculum; International emergency medicine; Medical education; Medical students
4.  Is email a reliable means of contacting authors of previously published papers? A study of the Emergency Medicine Journal for 2001 
Emergency Medicine Journal : EMJ  2003;20(4):352-353.
Methods: A cross sectional study of the Emergency Medicine Journal for 2001.
Results: 118 articles were included in the study. The response rate from those with valid email addresses was 73%. There was no statistical difference between the type of email address used and the address being invalid (p=0.392) or between the type of article and the likelihood of a reply (p=0.197). More responses were obtained from work addresses when compared with Hotmail addresses (86% v 57%, p=0.02).
Conclusions: Email is a valid means of contacting authors of previously published articles, particularly within the emergency medicine specialty. A work based email address may be a more valid means of contact than a Hotmail address.
doi:10.1136/emj.20.4.352
PMCID: PMC1726140  PMID: 12835347
5.  Environmental medicine in Germany--a review. 
Environmental Health Perspectives  2002;110(Suppl 1):113-118.
In this review I describe the development of environmental medicine as a specialized field of clinical medicine in Germany. New scientific societies were founded, based on traditions of public hygiene and occupational medicine, as a reaction to environmental issues concerning human health. Environmental medicine issues were also addressed by independent "critical" physicians. The first institutions to accept patients were centers for environmental medicine affiliated with research institutions and/or with the public health service. Medical professional organizations, particularly the German General Medical Council, described the need for and formulated conditions for additional qualification for doctors in environmental medicine, including a 200-hr course. This course and a qualifying exam were passed by about 3,000 doctors, mainly from the public health service and from occupational medicine. Unfortunately, few general physicians in primary outpatient care were similarly trained. To date, no representative study has been conducted on environmental patients, but I include in this review a typical list of patients' complaints. I also summarize research activities typical for environmental medicine in Germany. Present problems concern accounting systems and, for example, diagnosis and treatment of patients with multiple chemical sensitivities (MCS). A coordinated research program on MCS has been started.
PMCID: PMC1241153  PMID: 11834469
6.  Integrative endeavor for renaissance in Ayurveda 
Currently western medicine has assumed the central position in mainstream global healthcare. Openness to learn from contemporary disciplines of basic sciences, application of modern technology and further adoption of the evidence-based approach has helped western medicine gain its currently acknowledged position as mainstream modern medicine. Modern medicine has further developed forms of integrative medicine by developing interfaces with other systems of medicine, including traditional, complementary and alternative medicine. However, these developments do not seem to address all the problems facing global health care caused by overemphasis on pharmaco-therapeutic drug developments. On the other hand, Ayurveda which is founded on genuine fundamentals, has the longest uninterrupted tradition of healthcare practice, and its holistic approach to healthcare management emphasizes disease prevention and health promotion; if it opens up to incorporate emerging new knowledge into mainstream Ayurveda, and maintains fidelity to Ayurveda fundamentals, it will certainly provide a broad-based opportunity to address the majority of the problems that have emerged from global healthcare requirements. To bring these solutions to bear, however, it will be necessary to progress from the present “utilitarian ethos” to a “unifying ethos” for realization of medical integration.
doi:10.4103/0975-9476.78179
PMCID: PMC3121253  PMID: 21731380
Ayurveda; global healthcare; integrative Ayurveda; integrative medicine
7.  Heart Palpitation From Traditional and Modern Medicine Perspectives 
Background:
Palpitation is a sign of a disease and is very common in general population. For this purpose we decided to explain it in this study.
Objectives:
The purpose of this study was to describe the palpitation in both modern and traditional medicine aspect. It may help us to diagnose and cure better because the traditional medicine view is holistic and different from modern medicine.
Materials and Methods:
We addressed some descriptions to the articles of traditional medicine subjects which have published recently. Palpitation in modern medicine was extracted from medical books such as Braunwald, Harrison and Guyton physiology and some related articles obtained from authentic journals in PubMed and Ovid and Google scholar between1990 to 2013.
Results:
According to modern medicine, there are many causes for palpitation and in some cases it is cured symptomatically. In traditional medicine view, palpitation has been explained completely and many causes have been described. Its aspect is holistic and it cures causatively. The traditional medicine scientists evaluated the body based on Humors and temperament. Temperament can be changed to dis-temperament in diseases. Humors are divided in 4 items: sanguine, humid or phlegm, melancholy and bile. Palpitation is a disease, it is heart vibration and is caused by an abnormal substance in the heart itself or its membrane or other adjacent organs that would result in the heart suffering.
Conclusions:
Our data of this article suggests that causes of palpitation in the aspect of traditional medicine are completely different from modern medicine. It can help us to approach and treat this symptom better and with lower side effects than chemical drugs. According to this article we are able to detect a new approach in palpitation.
doi:10.5812/ircmj.14301
PMCID: PMC3965874  PMID: 24719741
Palpitation, Medicine, Traditional; Iran; Temperament
8.  Aspects of Sino-Japan Complementary and Alternative Medicine and Development on the Traditional Uighur Medicine 
Two consecutive conferences on ‘Sino-Japan Complementary and Alternative Medicine and Development on the Traditional Uighur Medicine’ were held in Xinjiang Medical University on July 3 and Kanazawa Medical University on October 6, 2007. The Vice president Halmurat Upur presided over the meeting and gave congratulatory address on holding of the conference. In order to understand mutually and discuss the possibility of the Uighur Medicine as CAM and the situation of medicine in the global sense, specialist scholars of Traditional Uighur Medicine and postgraduates attended this conference. In the meeting of the CAM, the achievements on the research of Traditional Uighur Medicine were exchanged and warmly discussed. Presentations were made in the consecutive conference.
doi:10.1093/ecam/nen012
PMCID: PMC2686632  PMID: 19470524
CAM; silk root; Traditional Medicine; Uighur Medicine; Urmuqi
9.  Cultivating interest in family medicine 
Canadian Family Physician  2007;53(4):661-665.
PROBLEM ADDRESSED
Fewer medical students are choosing careers in family medicine across Canada. One way to cultivate student interest is through creation of family medicine interest groups. Students, residents, community-based family physicians, and academic faculty can all contribute to the success of such groups.
OBJECTIVE OF PROGRAM
A family medicine interest group provides information about the challenging and rewarding career of family medicine through medical students’ exposure to family physicians and residents.
PROGRAM DESCRIPTION
A group of faculty and undergraduate students combined forces to form the Family Medicine Club. Development of this group and results of evaluation of its effectiveness to date are discussed.
CONCLUSION
One mechanism to increase interest in primary care as a career is to initiate and foster a family medicine interest group that links students with family physicians.
PMCID: PMC1952595  PMID: 17872716
10.  Quality of generic medicines in South Africa: Perceptions versus Reality – A qualitative study 
Background
Generic Medicines are an important policy option allowing for access to affordable, essential medicines. Quality of generic medicines must be guaranteed through the activities of national medicines regulatory authorities. Existing negative perceptions surrounding the quality of generic medicines must be addressed to ensure that people use them with confidence. Campaigns to increase the uptake of generic medicines by consumers and providers of healthcare need to be informed by local norms and practices. This study sought to compare South African consumers’ and healthcare providers’ perceptions of quality of generics to the actual quality of selected products.
Methods
The study was conducted at the local level in three cities of South Africa: Johannesburg, Durban and Cape Town. Purposive sampling was used to recruit consumer participants (n = 73) and random sampling used to recruit healthcare providers from public and private sectors (n = 15). Data were obtained through twelve focus group discussions with consumers and semi-structured interviews (n = 15) with healthcare providers in order to gain familiarity with perceptions of quality. One hundred and thirty five products comprising paracetamol tablets (n = 47), amoxicillin capsules (n = 45) and hydrochlorothiazide tablets (n = 43) were sourced from public and private sector healthcare providers. These products were subjected to in vitro dissolution, uniformity of weight and identity (Fourier Transformed Infrared Spectroscopy) tests using prescribed methods from the British (2005) and United States Pharmacopeias (2006).
Results
Respondents described drug quality in relation to the effect on symptoms. Procurement and use behavior of healthcare providers was influenced by prior experience, manufacturers’ names and consumers’ ability to pay. All formulations passed the in vitro tests for quality.
Conclusions
This study showed clear differences between perceptions of quality and actual quality of medicines suggesting deficiencies in public engagement by government regarding the implementation of generic medicines policy. Implementation of generic medicines policy requires the involvement of consumers and healthcare providers to specifically address their information gaps and needs.
doi:10.1186/1472-6963-12-297
PMCID: PMC3479066  PMID: 22943592
11.  Presidential addresses of the Royal Society of Tropical Medicine and Hygiene: 1907–2013 
Presidents have been required to give an inaugural address on commencing office at the Royal Society of Tropical Medicine and Hygiene (RSTMH) since its foundation in 1907. All presidential addresses were identified, sourced and assembled into an annotated bibliography. The majority of presidential addresses have been published in Transactions of the Royal Society of Tropical Medicine and Hygiene. Unpublished and in some cases ‘lost’ contributions have now been sourced where possible and archived at the RSTMH. This unique, rich and rewarding archive provides a vista into the development of the RSTMH and the discipline of tropical medicine. The archive is freely available to all.
doi:10.1093/trstmh/trt066
PMCID: PMC3892027  PMID: 24026462
Inaugural address; Tropical medicine; RSTMH; STMH
12.  Evidence in the learning organization 
Background
Organizational leaders in business and medicine have been experiencing a similar dilemma: how to ensure that their organizational members are adopting work innovations in a timely fashion. Organizational leaders in healthcare have attempted to resolve this dilemma by offering specific solutions, such as evidence-based medicine (EBM), but organizations are still not systematically adopting evidence-based practice innovations as rapidly as expected by policy-makers (the knowing-doing gap problem). Some business leaders have adopted a systems-based perspective, called the learning organization (LO), to address a similar dilemma. Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate the EBM and LO concepts into one model to address the knowing-doing gap problem.
Methods
During the model development process, the authors searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. To identify the key LO frameworks and consolidate them into one model, the authors used consensus-based decision-making and a narrative thematic synthesis guided by several qualitative criteria. The authors subjected the model to external, independent review and improved upon its design with this feedback.
Results
The authors found seven LO frameworks particularly relevant to evidence-based practice innovations in organizations. The authors describe their interpretations of these frameworks for healthcare organizations, the process they used to integrate the LO frameworks with EBM principles, and the resulting Evidence in the Learning Organization (ELO) model. They also provide a health organization scenario to illustrate ELO concepts in application.
Conclusion
The authors intend, by sharing the LO frameworks and the ELO model, to help organizations identify their capacities to learn and share knowledge about evidence-based practice innovations. The ELO model will need further validation and improvement through its use in organizational settings and applied health services research.
doi:10.1186/1478-4505-7-4
PMCID: PMC2667412  PMID: 19323819
13.  Obesity and hypertension among African Americans: do African-American primary care providers address these conditions when secondary to primary illness? 
This study examined the extent that black family medicine residents manage African-American patients with hypertension and obesity secondary to the primary health problem. A retrospective chart survey of 1806 outpatients was used to select a sample of 362 patients being treated by 12 African-American family medicine residents. Of the 362 patient charts, 31.2% of the patients had hypertension (ie, blood pressure > or = 140/90 mm Hg). A plan for managing hypertension was found in the charts for 77% of these patients. Obesity was present among 37% of the patients, and yet there was documentation of a treatment plan for managing this condition for only 38% of these patients. Black family medicine residents appear to be sensitized about addressing the problem of hypertension among African-American patients being treated for other illnesses. However, there is a vital need to teach family medicine physicians how to address and aggressively manage the problem of obesity among African-American patients, particularly those patients for whom obesity was not the primary reason for seeking medical care.
PMCID: PMC2608042  PMID: 8648658
14.  What is medicine? 
Canadian Family Physician  2006;52(3):329-334.
PROBLEM ADDRESSED
Family medicine is a vital part of health care in Canada. The decline in numbers of new family physicians being trained bodes ill for a sustainable and efficacious health care system. We need to recruit young people more effectively into careers in primary care. Early outreach to high-school students is one approach that holds promise.
OBJECTIVE OF PROGRAM
To provide high-school students with exposure to and appreciation for careers in medicine, particularly family medicine.
PROGRAM DESCRIPTION
Family medicine residents in the University of Alberta’s Rural Alberta North Program initiated an outreach project that was implemented in rural and regional high schools in northern Alberta. The program consisted of visits to high schools by residents who gave interactive presentations introducing medicine as a career. The regional hospital subsequently hosted a career day involving medical and paramedical professionals, such as physicians, pharmacists, nurses, and physical and occupational therapists.
CONCLUSION
Physicians’ visits to high-school students could be an effective way to increase interest in careers in rural family medicine.
PMCID: PMC1479711  PMID: 16572578
15.  New "horizontal" curriculum in family medicine residency. 
Canadian Family Physician  1998;44:1669-1675.
PROBLEM ADDRESSED: Opportunities for residents in a family medicine program to experience continuity of care with a group of patients and to be immersed in the role of a family physician were thought by faculty to be insufficient. OBJECTIVES OF THE PROGRAM: To enhance residents' experience of continuity of care with a group of patients; to create a model for training that better simulates clinical practice; and to position core family medicine experiences as the central and continuing focus of the residency program. MAIN COMPONENTS OF THE PROGRAM: The new curriculum replaces block rotations in family medicine with "horizontal" experiences comprising 3 half-days of patient care and 1 half-day seminar each week for all residents through both years of the program. The remaining time in first year is spent on the major disciplines--medicine, pediatrics, emergency, and obstetrics--for which a horizontal family medicine-centred experience has also been introduced. The second-year curriculum is flexible and largely self-directed. Initial evaluations indicate improved continuity of care of family practice patients and broadened clinical exposure for residents. The program has been fully accredited by the College. CONCLUSIONS: A horizontal curriculum in family medicine, designed to address perceived deficiencies in the traditional block rotational model of training, can be developed and implemented in an urban teaching hospital.
PMCID: PMC2277755  PMID: 9721423
16.  Postgraduate training for rural family practice. Goals and opportunities. 
Canadian Family Physician  1996;42:1133-1138.
PROBLEM BEING ADDRESSED: The continuing shortage of rural family physicians in Canada. PURPOSE OF PROGRAM: To further develop training for rural family practice so that adequate numbers of rural family physicians will be appropriately prepared. MAIN COMPONENTS OF PROGRAM: All family medicine residents should have the opportunity to experience the joys and challenges of rural family practice. Rural family medicine training streams provide the best education for family medicine residents who are planning a career in rural family medicine. Integrated training for rural family practice should be high-quality, academically sound, needs-driven, evidence-based, learner-centered, and outcome-measured. This involves comprehensive development of curricula that provide specific skills and appropriate core subjects in rural practice as well as a solid family medicine foundation. contextual and experiential learning in areas similar to or in actual areas where there is a need for rural physicians, and appropriate hospital rotations to learn skills for the hospital role of many rural family doctors, are important components of rural family medicine training. CONCLUSIONS: Postgraduate rural family medicine training programs can be further focused and developed to train more physicians with the knowledge, skills, and attitudes required for rural practice.
PMCID: PMC2146487  PMID: 8704489
17.  Spirituality and Medicine 
INTRODUCTION
Governing bodies for medical education recommend that spirituality and medicine be incorporated into training.
AIM
To pilot a workshop on spirituality and medicine on a convenience sample of preclinical medical students and internal medicine residents and determine whether content was relevant to learners at different levels, whether preliminary evaluation was promising, and to generate hypotheses for future research.
SETTING
Private medical school and university primary care internal medicine residency program, both in the Northeast.
CURRICULUM DESCRIPTION
The authors designed and implemented a required 2-hour workshop for all second-year medical students and a separate required 1.5-hour workshop for all primary care internal medicine house staff. The workshops used multiple educational strategies including lecture, discussion, and role-play to address educational objectives.
PROGRAM EVALUATION
Learners completed optional, anonymous pre and postworkshop surveys with six 5-point Likert-rated statements and space to cite the most useful part of the curriculum and their remaining questions. One hundred and thirty-seven learners participated and 100 completed both surveys. Medical students and residents had increased (all P≤.002): agreement regarding the appropriateness of inquiring about spiritual and religious beliefs in the medical encounter, their perceived competence in taking a spiritual history, and their perceived knowledge of available pastoral care resources. Medical students, but not residents, had an increase in their perceived comfort in working with hospital chaplains.
DISCUSSION
A brief pilot workshop on spirituality and medicine had a modest effect in improving attitudes and perceived competence of both medical students and residents.
doi:10.1111/j.1525-1497.2006.00431.x
PMCID: PMC1484787  PMID: 16704392
spirituality; curriculum; medical education
18.  Paving the Way to Personalized Genomic Medicine: Steps to Successful Implementation 
Over the last decade there has been vast interest in and focus on the implementation of personalized genomic medicine. Although there is general agreement that personalized genomic medicine involves utilizing genome technology to assess individual risk and ensure the delivery of the “right treatment, for the right patient, at the right time,” different categories of stakeholders focus on different aspects of personalized genomic medicine and operationalize it in diverse ways. In order to move toward a clearer, more holistic understanding of the concept, this article begins by identifying and defining three major elements of personalized genomic medicine commonly discussed by stakeholders: molecular medicine, pharmacogenomics, and health information technology. The integration of these three elements has the potential to improve health and reduce health care costs, but it also raises many challenges. This article endeavors to address these challenges by identifying five strategic areas that will require significant investment for the successful integration of personalized genomics into clinical care: (1) health technology assessment; (2) health outcomes research; (3) education (of both health professionals and the public); (4) communication among stakeholders; and (5) the development of best practices and guidelines. While different countries and global regions display marked heterogeneity in funding of health care in the form of public, private, or blended payor systems, previous analyses of personalized genomic medicine and attendant technological innovations have been performed without due attention to this complexity. Hence, this article focuses on personalized genomic medicine in the United States as a model case study wherein a significant portion of health care payors represent private, nongovernment resources. Lessons learned from the present analysis of personalized genomic medicine could usefully inform health care systems in other global regions where payment for personalized genomic medicine will be enabled through private or hybrid public-private funding systems.
doi:10.2174/187569209788653998
PMCID: PMC2809376  PMID: 20098629
Personalized Genomic Medicine; Personalized Medicine; Ethics; Genomics; Policy
19.  Progress in Complementary and Alternative Medicine Research 
Integrative Medicine at Yale and the Yale Center for Continuing Medical Education (CME) sponsored the Yale Research Symposium on Complementary and Integrative Medicine in March 2010 at the university’s School of Medicine. Delivering the keynote address, Dr. Josephine P. Briggs, Director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), highlighted recent progress made in the field of complementary and alternative medicine (CAM).
PMCID: PMC2946125  PMID: 20885899
20.  Training family medicine residents to care for children 
Canadian Family Physician  2011;57(2):e46-e50.
Abstract
Problem addressed
There is a lack of consensus around the optimal way to train family medicine residents to care for children.
Objective of program
Evaluation of an ambulatory versus an inpatient pediatrics rotation for family medicine residents.
Program description
A 4-week pediatrics rotation for second-year family medicine residents was introduced involving half-day ambulatory pediatric clinics. A nonequivalent control group evaluation study design was followed. Patient logbook entries, as well as residents’ satisfaction, knowledge, and self-reported confidence outcomes were compared between family medicine residents completing the new ambulatory rotation and those completing a traditional inpatient-ambulatory pediatrics rotation.
Conclusion
An ambulatory rotation in pediatrics is a feasible option for facilitating family medicine resident learning in child health care. Residents report exposure to more patient cases that reflect a family practice office setting and the same level of knowledge and confidence as residents completing an inpatient-ambulatory rotation. Intraprofessional collaboration, flexibility in scheduling, and the support of pediatric preceptors are key factors in the organization and implementation of an ambulatory rotation.
PMCID: PMC3038832  PMID: 21321160
21.  Recruitment and Retention of Patients into Emergency Medicine Clinical Trials 
The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in emergency medicine clinical trials.
doi:10.1111/j.1553-2712.2010.00866.x
PMCID: PMC3058592  PMID: 21040112
22.  Medicine in the 21st Century: Recommended Essential Geriatrics Competencies for Internal Medicine and Family Medicine Residents 
Background
Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation.
Methods
Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project.
Results
The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies.
Conclusions
Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory Commission report to Congress. Work is underway through stakeholder organizations to disseminate and assess the competencies among internal medicine and family medicine residency programs.
doi:10.4300/JGME-D-10-00065.1
PMCID: PMC2951777  PMID: 21976086
23.  Importance of novel drug delivery systems in herbal medicines 
Pharmacognosy Reviews  2010;4(7):27-31.
Novel drug delivery system is a novel approach to drug delivery that addresses the limitations of the traditional drug delivery systems. Our country has a vast knowledge base of Ayurveda whose potential is only being realized in the recent years. However, the drug delivery system used for administering the herbal medicine to the patient is traditional and out-of-date, resulting in reduced efficacy of the drug. If the novel drug delivery technology is applied in herbal medicine, it may help in increasing the efficacy and reducing the side effects of various herbal compounds and herbs. This is the basic idea behind incorporating novel method of drug delivery in herbal medicines. Thus it is important to integrate novel drug delivery system and Indian Ayurvedic medicines to combat more serious diseases. For a long time herbal medicines were not considered for development as novel formulations owing to lack of scientific justification and processing difficulties, such as standardization, extraction and identification of individual drug components in complex polyherbal systems. However, modern phytopharmaceutical research can solve the scientific needs (such as determination of pharmacokinetics, mechanism of action, site of action, accurate dose required etc.) of herbal medicines to be incorporated in novel drug delivery system, such as nanoparticles, microemulsions, matrix systems, solid dispersions, liposomes, solid lipid nanoparticles and so on. This article summarizes various drug delivery technologies, which can be used for herbal actives together with some examples.
doi:10.4103/0973-7847.65322
PMCID: PMC3249899  PMID: 22228938
Herbal medicines; herbs; novel drug delivery system; phytopharmaceuticals
24.  The great opportunity: Evolutionary applications to medicine and public health 
Evolutionary Applications  2008;1(1):28-48.
Abstract
Evolutionary biology is an essential basic science for medicine, but few doctors and medical researchers are familiar with its most relevant principles. Most medical schools have geneticists who understand evolution, but few have even one evolutionary biologist to suggest other possible applications. The canyon between evolutionary biology and medicine is wide. The question is whether they offer each other enough to make bridge building worthwhile. What benefits could be expected if evolution were brought fully to bear on the problems of medicine? How would studying medical problems advance evolutionary research? Do doctors need to learn evolution, or is it valuable mainly for researchers? What practical steps will promote the application of evolutionary biology in the areas of medicine where it offers the most? To address these questions, we review current and potential applications of evolutionary biology to medicine and public health. Some evolutionary technologies, such as population genetics, serial transfer production of live vaccines, and phylogenetic analysis, have been widely applied. Other areas, such as infectious disease and aging research, illustrate the dramatic recent progress made possible by evolutionary insights. In still other areas, such as epidemiology, psychiatry, and understanding the regulation of bodily defenses, applying evolutionary principles remains an open opportunity. In addition to the utility of specific applications, an evolutionary perspective fundamentally challenges the prevalent but fundamentally incorrect metaphor of the body as a machine designed by an engineer. Bodies are vulnerable to disease – and remarkably resilient – precisely because they are not machines built from a plan. They are, instead, bundles of compromises shaped by natural selection in small increments to maximize reproduction, not health. Understanding the body as a product of natural selection, not design, offers new research questions and a framework for making medical education more coherent. We conclude with recommendations for actions that would better connect evolutionary biology and medicine in ways that will benefit public health. It is our hope that faculty and students will send this article to their undergraduate and medical school Deans, and that this will initiate discussions about the gap, the great opportunity, and action plans to bring the full power of evolutionary biology to bear on human health problems.
doi:10.1111/j.1752-4571.2007.00006.x
PMCID: PMC3352398
Darwinian; disease; evolution; medicine; public health
25.  Maimonides’ Appreciation for Medicine 
Moses Maimonides, the illustrious medieval rabbi and philosopher, dedicated the last decade of his life primarily to medicine. His strong interest in medicine was an integral component of his religious-philosophical teachings and world view. In this paper various sources from his rabbinic writings are presented that explain Maimonides’ motivation regarding and deep appreciation for medicine: (A) The physician fulfills the basic biblical obligation to return lost objects to their owner, for with his knowledge and experience the physician can restore good health to his sick fellow human being; (B) medicine provides a unique opportunity to practice imitatio dei, as it reflects the religious duty to maintain a healthy life-style; (C) as an important natural science, medicine offers tools to recognize, love, and fear God. These three aspects address man’s relationship and obligation towards his fellow-man, himself and God. Biographical insights supported by additional sources from Maimonides’ writings are discussed.
doi:10.5041/RMMJ.10018
PMCID: PMC3678790  PMID: 23908790
Maimonides; motivation for medicine; Jewish medical ethics

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