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As previous research has observed, medical students and physicians alike confront vast amounts of knowledge in their education and practice, such that no one clinician can know everything there is to know about biomedicine. Even before clerkships, medical students learn to cope with this impossibility by prioritizing certain information based on its perceived utility for exams and clinical practice. Many factors can shape this process, including teamwork, wherein individual medical students rely on one another to address gaps in knowledge at the level of the group. This paper will draw on qualitative data from two allopathic medical schools in the American Midwest to demonstrate that peer-to-peer learning, a widely utilized pedagogical modality in North American medical schools, is amongst the earliest places where future physicians learn how to rely on their peers in the profession as they make choices about what to know and what not to know about biomedicine: cultivating a culture of "intraprofessionalism" between students with different knowledges and values, as they prepare to enter the same profession. The paper will also consider how differences in the student populations at two field sites impact intraprofessional development. Drawing on scholarship of peer-based learning strategies and the sociology and anthropology of medical education, the authors argue that peer-to-peer learning is a key site in the professional socialization of medical students toward the effective management of medical knowledge. [ABSTRACT FROM AUTHOR]

Abstract Artificial intelligence (AI) is rapidly moving from an experimental phase to an implementation phase in many fields, including medicine. The combination of improved availability of large datasets, increasing computing power, and advances in learning algorithms has created major performance breakthroughs in the development of AI applications. In the last 5 years, AI techniques known as deep learning have delivered rapidly improving performance in image recognition, caption generation, and speech recognition. Radiology, in particular, is a prime candidate for early adoption of these techniques. It is anticipated that the implementation of AI in radiology over the next decade will significantly improve the quality, value, and depth of radiology's contribution to patient care and population health, and will revolutionize radiologists' workflows. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI working group with the mandate to discuss and deliberate on practice, policy, and patient care issues related to the introduction and implementation of AI in imaging. This white paper provides recommendations for the CAR derived from deliberations between members of the AI working group. This white paper on AI in radiology will inform CAR members and policymakers on key terminology, educational needs of members, research and development, partnerships, potential clinical applications, implementation, structure and governance, role of radiologists, and potential impact of AI on radiology in Canada. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We, therefore, aim to conduct a systematic review to assess the academic potential of ChatGPT-3.5, along with its strengths and limitations when giving medical exams. METHOD: Following PRISMA guidelines, a systemic search of the literature was performed using electronic databases PUBMED/MEDLINE, Google Scholar, and Cochrane. Articles from their inception till April 4, 2023, were queried. A formal narrative analysis was conducted by systematically arranging similarities and differences between individual findings together. RESULTS: After rigorous screening, 12 articles underwent this review. All the selected papers assessed the academic performance of ChatGPT-3.5. One study compared the performance of ChatGPT-3.5 with the performance of ChatGPT-4 when giving a medical exam. Overall, ChatGPT performed well in 4 tests, averaged in 4 tests, and performed badly in 4 tests. ChatGPT's performance was directly proportional to the level of the questions' difficulty but was unremarkable on whether the questions were binary, descriptive, or MCQ-based. ChatGPT's explanation, reasoning, memory, and accuracy were remarkably good, whereas it failed to understand image-based questions, and lacked insight and critical thinking. CONCLUSION: ChatGPT-3.5 performed satisfactorily in the exams it took as an examinee. However, there is a need for future related studies to fully explore the potential of ChatGPT in medical education. [ABSTRACT FROM AUTHOR]

This paper has been substantially revised by the Canadian Psychiatric Association's Research Committee and approved for republication by the CPA's Board of Directors on May 3, 2017. The original policy paper1 was developed by the Scientific and Research Affairs Standing Committee and approved by the Board of Directors on November 10, 2008. [ABSTRACT FROM AUTHOR]

Surface properties have been found to be one of the key parameters which cause degradation and of thrombogenicity in all polymers used in biomedical devices, thus signifying the importance and the necessity for quantitative and accurate characterization of the polymer surface itself as used in the construction of the device. The characterization techniques employed generally involve thermal and spectroscopic measurements, in which class the electrochemical investigations and scanning probe microscopies can also be included. Current hypotheses on the correlations that exist between surface parameters and hemocompatibility and degradation of polymers are examined herein, but concentrating on the field of clinically utilized polymeric materials as used within medical devices themselves. Furthermore, this review provides a brief but complete synopsis of these techniques and other emerging ones, which have proven useful in the analysis of the surface properties of polymeric materials as used in the construction of cardiovascular devices. Statements and examples are given as to how specific information can be acquired from these differing methodologies and how it aids in the design and development of new polymers for usage in biomedical device construction. [ABSTRACT FROM AUTHOR]

Abstracts of papers presented at the 73rd National Scientific Congress of the Australian Society of Anaesthetists in October 2014, including Protective Lung Strategy During Bronchoscopic Laser Resection of Tracheo-bronchial Tumours: A Case Series" and "The Impact of Indigenous Status on Perioperative Complications and Length of Hospital Stay After Cholecystectomy."

The article presents abstracts on medical topics including blood pressure measurements taken in anaesthetic pre-admission clinic with ambulatory measurements, research on problems with transitioning from regional to systemic analgesia, and transthoracic echocardiography in preadmission clinic.

Several studies have summarized the biomedical publications in Arab countries. However, the quantity of health-related article publications from universities in recent years in Saudi Arabia is unknown. Therefore, this study aimed to perform a bibliometric analysis that showcases the quantitative health-related article publications output from universities in Saudi Arabia between 2008 and 2017. An extensive literature search was conducted using the PubMed database. The search was limited to original research articles, systematic reviews, and meta-analyses published in the English language reporting on humans from medicine and health sciences colleges by researchers affiliated with any university in Saudi Arabia between January 2008 and December 2017. A total of 3172 articles were found published between January 2008 and December 2017. The number of publication output increased significantly (p = 0.0027) from 73 (2.3%) in 2008 to 721 (22.7%) in 2017. The highest quantity of publications came from the Riyadh region (n = 2257), specifically King Saud University (n = 1538). Of specific journals, the BioMed Central journals published the most articles by Saudi Arabian researchers (n = 112). The total number of publications increased from 2% to 24.8% by region. However, approximately 80% of the papers were published in journals with an impact factor (IF) <3. Around 3.8% of the papers were published in journals that had an IF ≥6 and has increased significantly (p = 0.030) from 0% to 1.2% in the past decade. The journal with the highest IF that published a high quantity of articles was the American Journal of Human Genetics. This study has identified a continuous significant increase in the publication of health-related articles from universities in Saudi Arabia. This study extended our knowledge of the quantity of scientific productivity in the field of medicine and health sciences over a recent decade. [ABSTRACT FROM AUTHOR]

This paper historicises the criticisms and backlash from within medicine against new computer technologies in the clinic. Physicians' reactions to proposals for the implementation of algorithmic technologies in the clinic ranged from enthusiastic to cautionary to critical from as early as the 1960s. Clinicians were suspicious of these technologies as they threatened their professional expertise. I argue that these discontent reactions from doctors demonstrate an implicit struggle for authority over clinical spaces and with regards to medicine's place within society more generally. Drawing on Foucault's concept of discursive rules and their function within a closed community, I recover the forgotten debate to include or reject AI and its predecessor technologies of expert systems and neural networks. This paper explains how and why justifications for and against the applicability of AI to the clinic are underpinned by questions of medical authority. I conclude with an inquiry into the transformative possibilities of partisanship. [ABSTRACT FROM AUTHOR]

This cross-sectional study evaluates the knowledge, attitudes, experiences, and behavior of final year medical students, PhD students, and supervisors at the School of Medicine of the University of Zagreb in relation to research misconduct, questionable research practices, and the research environment. The overall response rate was 36.4% (68%–100% for the paper survey and 8%–15% for the online surveys). The analysis reveals statistically significant differences in attitude scores between PhD students and supervisors, the latter having attitudes more in concordance with accepted norms. The results overall show a nonnegligible incidence of self-reported misconduct and questionable research practices, as well as some problematic attitudes towards misconduct and questionable research practices. The incidence of problematic authorship practices was particularly high. The research environment was evaluated as being mostly supportive of research integrity. [ABSTRACT FROM AUTHOR]

The lack of radio navigational aids in early Royal Flying Doctor Service aircraft in Australia occasionally resulted in aircraft being stranded at a remote site with a critically injured patient due to weather and other conditions. For a brief period in the 1950s, at least one Royal Flying Doctor Service pilot was trained to administer anaesthesia to critically ill patients who could not be immediately evacuated. The aim of this paper is to describe the circumstances in which this arose and how it worked in practice. This is based largely on the recollections of pilot anaesthetist Captain Keith Galloway, who shared his recollections during interviews with the authors. [ABSTRACT FROM AUTHOR]

Based on ethnographic research within refugee-serving institutions in Philadelphia, Pennsylvania (USA), this paper examines the relationship between physicians and the knowledge they produce and consume about caring for refugees from around the world. I explore the "seething presence" of race in refugee medicine, a domain of medical practice whose entanglement with racial ideology and practice has been underexamined. I consider how knowledge about refugees from different groups—whether racially laden designations like "Asian" or "African" or national markers like Congolese or Burmese—circulates in clinical spaces as health-care teams diagnose and treat refugees using standards of "evidence-based" medicine. Assessing the primary literatures that refugee health-care providers use to justify varying care plans, I argue that race, while often unmentioned, structures the practice of refugee medicine. Additionally, the implicit use of race as an analytic, not racism or economic injustice, often disguises the impact of structural racism and inequality in refugee health disparities. I end with some reflections on how we might conduct a more just practice of refugee health care—and by extension, health care more generally—by shifting our gaze from the particularities of seemingly obvious cultural difference to social structure. [ABSTRACT FROM AUTHOR]

Epigenetic processes, and the investigative practices that take these as their focus, are of increasing interest to a range of professionals beyond biomedicine. This has been piqued by, especially, the belief that bioscientific research is demonstrating new molecular mechanisms through which the social and physical environment impact upon the bodies of humans and other animals. Beyond the laboratory, epigenetic notions are entangled with wider ideas about the malleability of the soma (e.g., relating to neuroscience). In many contexts (including, to an extent, education), this intertwinement has contributed to producing and valourising a conception of a particularly plastic body. In this paper, I draw on a range of biomedical and education-related texts in order to outline and reflect upon the notions of 'education' and 'epigenetics' that are supported through and propelled by an array of writings that, to greater or lesser extents, bring these spheres of praxis into conversation. Discussions of epigenetics and stress, for instance, are framing certain kinds of educational work (e.g., with new parents) as a means of intervening in soma and society. In so doing, they implicitly extend ideas about what education is and what it can do. On the other hand, writings from educational researchers, for example, are enrolling epigenetic findings and ideas to support various positions or approaches. Many education researchers will be sceptical of some of the more hyperbolic assertations made about the significance of epigenetics. However, the fact that a nascent discourse connecting education and epigenetics is emerging is suggestive of a need for reciprocal, thoughtful, and critical exchange with bioscientists who seek to address educational issues, or whose work is being enrolled by others to do so. [ABSTRACT FROM AUTHOR]

Traditional medical practice among the Igbo is not limited to therapeutic or curative role of healing the sick. It extends to exploration and manipulation of powers inherent in nature and material entities to achieve some ends. This is popularly known as ime ọgwụ (igwọ ọgwọ) in Igbo parlance. One of such manipulative function is the phenomenon of postponement or transfer of death from a patient to another individual without any direct or physical contact. The process raises serious philosophical concerns about causation as well as the ethical justification of the act. Employing simultaneously the empirical method, the philosophical methods of phenomenological analysis and hermeneutics, the present paper sets out to investigate the possibility of relating the cause with the effect in the phenomenon of postponement and porting of death from an individual to another. The paper explores the Igbo-African ontological understanding of realities as forces and mutual interaction of forces. [ABSTRACT FROM AUTHOR]

Every Christmas season children's hospitals in the United States are flooded with gift donations. Businesses, service organizations, and the public deliver carloads of new toys, puzzles, games, books, electronics, sports equipment, art supplies, cosmetics, blankets, and clothing for sick children. The practice is so common and widespread that donors rarely ask whether they may donate, what types of donations are welcome, and when and where they should deliver their donations. Based on ethnographic observations of holiday gifting at University Children's Hospital, a nationally ranked pediatric hospital on the West Coast, the purpose of this paper is to investigate the implicit cultural beliefs that guide holiday gifting practices. Eschewing the popular rhetoric of American hyper-consumption and hedonism, I use a Durkheimian framework to argue that holiday gifting in children's hospital is a sacred ritual. The data presented describe the wide-ranging variety of donors—from Boy Scouts to nightclub strippers—who journey to the hospital bearing gifts. Drawing on sacred conceptualizations of childhood and gifting in American culture, I argue that children's hospitals are more than medico-scientific institutions. They represent sacred unifying spaces and the heart of their local communities where individuals and organizations come to privately and publicly reaffirm their moral commitments to society through holiday gifting. [ABSTRACT FROM AUTHOR]

This paper analyses the historical and epistemological work of the French psychiatrist Georges Lantéri-Laura (1930–2004) within the context of the French ‘tradition’ of history and philosophy of sciences, with special reference to Georges Canguilhem and Michel Foucault. After an introduction devoted to a critical survey of the most recent works on the history and historiography of psychiatry in French, the paper outlines Lantéri-Laura’s approach by focusing especially on the role played by the methodological concept of ‘semiology’ as regards the relation between medicine and psychiatry. The last part of the paper draws attention to the relation between the history and philosophy of psychiatry in light of Lantéri-Laura’s ‘critical epistemology’. [ABSTRACT FROM AUTHOR]

Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors. [ABSTRACT FROM AUTHOR]

The history of Chinese medicine is still widely imagined in terms dictated by the discourse of modernity, that is as 'traditional' and 'Chinese.' And yet, so as to be intelligible to us moderns, it must simultaneously be framed through categories that make it comparable somehow to the 'West' and the 'modern' from which it is said to be essentially different. This is accomplished, for instance, by viewing Chinese medicine as fundamentally shaped by cosmological thinking, as focusing on process rather than matter, and as forever hampered by attachments to the past even when it tries to innovate. At the same time, it is described as pursuing its objectives in ways that make sense in 'our' terms, too, such as the goal of creating physiological homeostasis through methods of supplementation and drainage. In this paper, I seek to move beyond this kind of analysis through a twopronged approach. First, by focusing on the concept of tong 通 - a character that calls forth images of free flow, connectivity, relatedness and understanding - I foreground an important aspect of Chinese medical thinking and practice that has virtually been ignored by Western historians of medicine and science. Second, by exploring how the influential physician Ye Tianshi 葉天士 (1664-1746) employed tong to advance medical thinking and practice at a crucial moment of change in the history of Chinese medicine, I demonstrate that physicians in early modern China moved towards new understandings of the body readily intelligible by modern biomedical anatomy. I argue that this mode of analysis allows us to transcend the limitations inherent in the current historiography of Chinese medicine: because it allows for comparison to emerge from our subject matter rather than imposing our imaginaries onto it in advance. [ABSTRACT FROM AUTHOR]

This paper combines insights from political philosophy, bioethics, and political geography to examine the practice of medicine by the Khmer Rouge during the Cambodian genocide. Through a discussion of both destructive and constructive health-related policies and practices enacted by the Khmer Rouge between 1975 and 1979, this paper documents how the practice of medicine provides a broader understanding of state sovereignty and the right to live or to let die. In so doing this paper contributes to our understanding in two areas: first, to the specific geographies of the Cambodian genocide and, second, the politics surrounding the calculated management of life and death. [ABSTRACT FROM AUTHOR]

Despite a shared interest in engaging critically with biomedicine, there has been little crossover between ‘geographies of bioscience’ and ‘geographies of health’. This paper aims to bridge that gap, using the concept of ontological politics to provide a framework for making connections between geographies of bioscience and geographies of health. Ontological politics can be defined as the conviction that the material or ‘real’ world does not precede our interactions with it and is therefore open to political negotiation. Within social studies of health and bioscience there is a growing body of work that uses ontological politics to gain insight into relations between biomedicine and society and how these are materialized at different sites and scales, ranging from public health interventions to everyday experiences of patient care. This paper takes three of these sites — spaces of biological citizenship, spaces of care, and spaces of cross-species companionship — and explores how they might form shared areas of interest for current research in geographies of health and the biosciences. The paper concludes that ontological politics offers a useful starting point from which to develop research agendas which cross the divide between geographies of health and geographies of bioscience. [ABSTRACT FROM AUTHOR]

Various studies conducted over the past three decades have highlighted the social, political, and economic impact that women homesteaders had on the western prairie region. Their involvement on the family homestead, whether taking part in subsistence and domestic chores or as workers in the fields, was a necessary aspect of the development and success of family farming and an agriculture-based economy in Western Canada. This paper reveals details of another aspect of family labor that often fell on the shoulders of women, that is, the provision of medical care needed to ensure the health of themselves, their spouses, and their children. Given the labor-intensive nature of the frontier lifestyle, the associated physical hazards, the number of disease-susceptible children in the region, and the scarcity of medical institutions and personnel, women were often called upon by their families and neighbors to deal with outbreaks of disease, injuries, and health crises. Using survey data collected by the Saskatchewan Archives Board in 1955 to illustrate the nature of the work performed, this paper argues that women's health care labor efforts were vital to the preservation of homesteading families in the prairie region. [ABSTRACT FROM AUTHOR]

A literature review was conducted to identify the 'trigger factors' associated with a need for increased levels of care and support for elderly people. An expert panel then prioritized the trigger factors into one of five bands of importance. The literature review produced 2037 hits. Of these, 1768 were excluded after reading the abstract and 111 after reading the full paper, leaving 158 papers for inclusion in the review. From these papers, 102 unique factors that triggered a need for greater care and support among elderly people were identified. The expert panel ranked 36 of the trigger factors into the top three bands of importance. Subsequent analysis suggested that telecare could be used to assist, prevent or minimise the impact of some 66% of these 36 trigger factors and 75% of the top 12 factors. This suggests that telecare has a significant role to play in the support of elderly people and should be a major consideration when re-designing services. [ABSTRACT FROM AUTHOR]

We carried out a systematic review of recent telemedicine assessments to identify scientifically credible studies that included comparison with a non-telemedicine alternative and that reported administrative changes, patient outcomes or the results of an economic assessment. From 605 publications identified in the literature search, 44 papers met the selection criteria and were included in the review. Four other publications were identified through references cited in one of the retrieved papers and from a separate project to give a total of 48 papers for consideration, which referred to 42 telemedicine programmes and 46 studies. Some kind of economic analysis was included in 25 (52%) of the papers. In considering the studies, we used a quality appraisal approach that took account of both study design and study performance. For those studies that included an economic analysis, a further quality-scoring approach was applied to indicate how well the economic aspects had been addressed. Twenty-four of the studies were judged to be of high or good quality and 11 of fair to good quality but with some limitations. Seven studies were regarded as having limited validity and a further four as being unacceptable for decision makers. New evidence on the efficacy and effectiveness of telemedicine was given by studies on geriatric care, intensive care and some of those on home care. For a number of other applications, reports of clinical or economic benefits essentially confirmed previous findings. Although further useful clinical and economic outcomes data have been obtained for some telemedicine applications, good-quality studies are still scarce. [ABSTRACT FROM AUTHOR]

The article reports on the number of papers submitted for publication during 2004 for the periodical "Journal of Telemedicine and Telecare." The rapid growth of publications in telemedicine observed in the 1990s seems to have slowed or stopped. 34 weeks was the median time from submission of papers to their publication.

The increasing popularity of complementary and alternative medicine (CAM) in the West raises profound questions for social scientists, not least because it is as much about consumerism as it is about health care. Although the sociology of CAM is well developed, its geography remains almost wholly unexplored. In this paper we argue that one of the main reasons for this neglect is the fact that (post)medical geography has found it extremely difficult to come to terms with the disconcerting fusion of health care and consumer culture, and its dispersion across a vast array of materials and practices that are often far removed from the established concerns of the subdiscipline. Accordingly, in this paper we approach the dispersed geography of CAM through two key sources of consumer information: a range of 'popular' health-related magazines produced for the UK market, contextualized in relation to a sample of twenty-four British-based patient support groups. Specifically, we consider three critical issues that are shaping the mass mediation of CAM: the displacement of efficacy; the abrogation of authority; and the cultivation of anxiety. The paper concludes with a brief consideration of a profoundly geographical problem: the difficulty of constructing effective pathways through a profusion of disparate materials and practices in a context that is literally beyond belief. [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyse the relationship between reference prices (RPs), generic medicines and generic substitution at pharmacy level. In particular, the focus is on generic reference pricing. RPs in general aim to control reimbursement prices to reduce public pharmaceutical expenditure. In addition, generic reference pricing also aims to increase the use of generic medicines. The link between generic reference pricing and generic medicines is that the RP is usually set as a function of generic prices. Generic RPs are also linked with generic substitution because, without the possibility of substitution at pharmacy level, the potential cost savings from reference pricing will be reduced. RPs in general have been relatively successful in reducing prices, but less successful at controlling pharmaceutical expenditure. Moreover, generic reference pricing has not necessarily led to significant increases in generic drug use in those countries where such a system has been implemented. This paper analyses the reasons for these results, and discusses further issues that need to be considered when considering an RP system, concentrating in particular on generic reference pricing. [ABSTRACT FROM AUTHOR]

Abstract From medicine and military warfare to the practices of modern management, we have come to pursue the ideal of precision in order to generate the knowledge necessary to organise our social, cultural and economic lives. Underpinning this valorisation of the ideal of precision is a repulsion for its opposite –vagueness – which is habitually treated as a synonym for chaos, uncertainty and uselessness. Yet vagueness, understood here as a condition of radical uncertainty or open possibility, is inescapably imbricated in the triumphs of precision. This paper challenges this neglect by arguing that, once stripped of its pejorative connotations, vagueness can be understood as the silent but often salient partner in a marriage of opposites. Tracing the conceptual pairing of these contrasting terms, the paper goes on to suggest that instead of prising them apart we need to recognise their mutual reciprocity. By holding vagueness and precision in dynamic tension, it is suggested, we can develop a critical exploration of contemporary thinking in public policy formulation with its predilection for ‘joined-up thinking’ and a general ‘blurring of boundaries’. [ABSTRACT FROM AUTHOR]

Committee 3 of the International Commission on Radiological Protection (ICRP) develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure when ionising radiation is used for medical diagnosis, therapy, or biomedical research. This paper presents a summary of the work that Committee 3 has accomplished over the past few years, and also describes its current work. The most recent reports published by the Commission that relate to radiological protection in medicine are 'Radiological protection in cone beam computed tomography' (Publication 129), 'Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances' (Publication 128, in cooperation with Committee 2), 'Radiological protection in ion beam radiotherapy' (Publication 127), 'Radiological protection in paediatric diagnostic and interventional radiology' (Publication 121), 'Radiological protection in cardiology' (Publication 120), and 'Radiological protection in fluoroscopically guided procedures outside the imaging department' (Publication 117). A new report on diagnostic reference levels in medical imaging will provide specific advice for interventional radiology, digital imaging, computed tomography, nuclear medicine, paediatrics, and hybrid (multi-modality) imaging procedures, and is expected to be published in 2016. Committee 3 is also working on guidance for occupational radiological protection in brachytherapy, and on guidance on occupational protection issues in interventional procedures, paying particular attention to the 2011 Commission's recommendations on the occupational dose limit for the lens of the eye (Publication 118). Other reports in preparation deal with justification, radiological protection in therapy with radiopharmaceuticals, radiological protection in medicine as related to individual radiosusceptibility, appropriate use of effective dose (in cooperation with other Committees), and guidance for healthcare practitioners on radiological and patient protection. Committee 3 has also suggested specific priorities for research on radiological protection in medicine to the Commission. [ABSTRACT FROM AUTHOR]

This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

This paper examines the logic of evaluation of health care services, calling into question the possibility of assessing the extent to which medicine and health care systems are 'rational' or 'irrational'. The paper analyses and rejects claims to rationality made in discourses on evaluation and in particular economic evaluation, by recourse to Weber's distinction between formal and substantive rationalities. The rationality claimed by evaluation is a value-laden and therefore substantive rationality. Similarly, the claims of the rational actor model are seen to over-simplify the ways actors interact in the market. [ABSTRACT FROM AUTHOR]

The use of guidelines represents a new culture in medicine—a shift of emphasis away from reliance on individual discretion towards greater professionalism and accountability. Although they are important vehicles for those who wish to evaluate and monitor healthcare practice against recognized standards, this paper explores the legal problems surrounding the implementation of guidelines in the National Health Service in the UK. The topic is considered from the clinician's perspective, but there are also lessons to be learned by managers. There is discussion of the difficulty in defining and prioritizing the numerous guidelines, and advice is given as to which guidance is the most authoritative. The legal consequences of ignoring guidelines are explored, and the paper concludes with the view that the time is ripe for clinicians to take the initiative in preparing, drafting, and disseminating guidelines before they are pre-empted by managers and employers and the future of clinical freedom is called into question. [ABSTRACT FROM AUTHOR]

This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships. [ABSTRACT FROM AUTHOR]

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries. [ABSTRACT FROM AUTHOR]

In this paper, we present a new approach for mining weighted networks to identify densely connected modules such as quasi-cliques. Quasi-cliques are densely connected subnetworks in a network. Detecting quasi-cliques is an important topic in data mining, with applications such as social network study and biomedicine. Our approach has two major improvements upon previous work. The first is the use of local maximum edges to initialize the search in order to avoid excessive overlaps among the modules, thereby greatly reducing the computing time. The second is the inclusion of a weight normalization procedure to enable discovery of "subtle" modules with more balanced sizes. We carried out careful tests on multiple parameters and settings using two large cancer datasets. This approach allowed us to identify a large number of gene modules enriched in both biological functions and chromosomal bands in cancer data, suggesting potential roles of copy number variations (CNVs) involved in the cancer development. We then tested the genes in selected modules with enriched chromosomal bands using The Cancer Genome Atlas data, and the results strongly support our hypothesis that the coexpression in these modules are associated with CNVs. While gene coexpression network analyses have been widely adopted in disease studies, most of them focus on the functional relationships of coexpressed genes. The relationship between coexpression gene modules and CNVs are much less investigated despite the potential advantage that we can infer from such relationship without genotyping data. Our new approach thus provides a means to carry out deep mining of the gene coexpression network to obtain both functional and genetic information from the expression data. [ABSTRACT FROM AUTHOR]

This paper discusses the so-called non-interference assumption (NIA) grounding causal inference in trials in both medicine and the social sciences. It states that for each participant in the experiment, the value of the potential outcome depends only upon whether she or he gets the treatment. Drawing on methodological discussion in clinical trials and laboratory experiments in economics, I defend the necessity of partial forms of blinding as a warrant of the NIA, to control the participants’ expectations and their strategic interactions with the experimenter. [ABSTRACT FROM AUTHOR]

Papers presented at the three Successes and Failures in Telehealth conferences have made a helpful contribution to what is known about the practicalities of implementing and using telehealth. Ten of the 89 papers covered general concepts, 40 described primary studies and 26 discussed telehealth programmes or networks. Common themes that emerged on determinants of success and failure included the reliability of equipment, the reliability of vendors, political and budgetary issues, the perceived need for telehealth, the involvement of stakeholders, health professionals' opinions, the stability of management structures, the turnover of personnel and cooperation between organizations. Limitations in some papers included an absence of data, weak study designs, short-term perspectives and lack of information on health outcomes. Despite these limitations, the papers have made a valuable contribution to our knowledge of what has worked and what has failed in the field of telehealth. [ABSTRACT FROM AUTHOR]

Portal biliary ductopathy (PBD) is a condition in which biliary and pancreatic ducts are extrinsically compressed by collateral branches of the portal venous system, which in turn have become dilated and varicosed due to portal hypertension. While the majority of patients with PBD are asymptomatic, a minority can present with symptoms of biliary obstruction and cholangitis with the potential of developing secondary chronic liver disease. This paper reports the case of a 29 year old male presenting with acute cholangitis, in whom PBD was diagnosed radiologically. A brief review of current literature regarding the diagnosis and management of this condition will also be presented. [ABSTRACT FROM AUTHOR]

We have developed a telemedicine elective for fourth-year medical students to learn about the delivery of primary care telemedicine. The goals were to expose medical students to telemedicine as a method for delivery of primary care and to reinforce the importance of doctor-patient communication during the health-care encounter. The elective lasted four weeks. It had three components: two online introductory courses to telemedicine; site visits to near and distant telemedicine sites; and a reflective writing paper. In the first year, seven medical students out of a class of 230 chose the telemedicine elective from a list of 188 alternatives. Evaluation ratings and the students' written comments, along with end-of-course discussions, indicated that the telemedicine elective was a valuable experience. An elective in the medical school curriculum may be a useful way of providing future physicians with an understanding of telemedicine. [ABSTRACT FROM AUTHOR]

Objective: This paper describes my experience as a psychiatric registrar working with indigenous communities in a remote setting in Far North Queensland. Conclusions: Working in a remote environment provided an insight into how to engage culturally diverse Indigenous communities and an invaluable training experience. [ABSTRACT FROM AUTHOR]

The General Medical Council's call to modernize medical education prompted the University of Liverpool Medical School to develop a new undergraduate programme, integrating palliative medicine as 'core' curricula. Following successful piloting, the palliative medicine training programme was further developed and expanded. This paper examines whether the additional investment produces improved outcomes. In 1999, fourth year undergraduate medical students (Cohort 1, n=217) undertook a 2-week pilot education programme in palliative medicine. Subsequently, the training programme was refined and extended, incorporating advanced communication skills training, an ethics project and individual case presentations (Cohort 2, n=443). Congruent with the study's theoretical driver of self-efficacy, both cohorts were surveyed pre- and post-programme with validated measures of: (i) self-efficacy in palliative care scale; (ii) thanatophobia scale. No significant differences between cohorts' pre-programme scores were identified. Within each cohort, statistically and educationally significant post-education improvements were recorded in both scales. Further post-education analysis indicated that the extended programme produces significantly greater improvements in all domains of the self-efficacy in palliative care scale (communication, t=-7.28, patient management, t=-5.96, multidisciplinary team-working t=-3.77 at p<0.000), but not thanatophobia. Although improvements were recorded in both cohorts, participation in the extended education programme resulted in further statistically significant gains. Interpreted through the theoretical model employed, improved self-efficacy and outcome expectancies will result in behavioural change that leads to improved practice and better patient care. [ABSTRACT FROM AUTHOR]

Objectives: Syphilis has changed the course of history, shaped the path of medicine and had more influence on psychiatry than any other illness. This paper, part two of a two-part series, investigates the historical, social and cultural aspects of the interaction of syphilis and psychiatry. Conclusion: By the end of the 19th century, social changes such as population growth, mass migration from Eastern Europe and technological developments led to a great rise in syphilis. By 1900, it was estimated that 5–20% of the population of Europe and the USA had, or would have, syphilis. By 1914, there were over 100 000 new cases and 3 million cases of syphilis in Great Britain. There was a constant interaction between syphilis, prostitution and sexual crime; it was the likely motivation for the Jack the Ripper murders, if not many in the next century. The idea of hereditary syphilis fitted perfectly into the theory of degeneration and coursed through psychiatry and caught the attention of Adolf Hitler, facilitating his antisemitic paranoia. Psychiatric progress passed to the German school, led by Kraepelin who did his first research into the symptoms and course of neurosyphilis. In 1906, Wasserman's serological test for syphilis showed that latent lesions could be present. Any doubt about the cause of syphilis was finally eliminated when Noguchi and Moore demonstrated the presence of treponema pallidum in paretic brains in 1913.1 German academic psychiatry defined psychiatric practice for the next century but malariotherapy, the first physical treatment in psychiatry, was announced by Julius Wagner-Juarreg in Vienna in 1917, bringing hope to the incurable and destroying the climate of therapeutic nihilism that haunted psychiatry. The first trial of malariotherapy in Australia was done by Reginald Ellery at Mont Park Hospital In 1927 in Melbourne. The discovery of penicillin was a caesura, ending malariotherapy and leading many to regard syphilis as a nigh-extinct illness, but this turned out to be an illusion. Syphilis is returning in new forms in tandem with the AIDS epidemic. Written-off endlessly by its obituarists, syphilis abides. [ABSTRACT FROM AUTHOR]

Homoeopathy is one of the most widespread forms of complementary and alternative medicine (CAM) currently used in the UK. As an overtly holistic discipline, the homoeopathic consultation process is often regarded as being intrinsically patient-centred. This paper will argue that although an underlying mutualistic or collegial approach is often evident in homoeopathy, there are certain points in a consultation where these types of behaviour are more overt. It is suggested that these points are likely to be located where there is a predictable possibility of misalignment between letting the patient set the agenda, and the practical needs of the consultation process – ie the performance of certain essential consultation ‘tasks’. In order to illustrate this, one particular aspect of the homoeopathic consultation will be examined – the ‘treatment-giving’ phase. Four broad transitional formats will be proposed: categorical; open; deferred; and reversed. The relatively dynamic sequential positioning that the treatment phase occupies in the homoeopathic context will be highlighted, as will the implications that this may have in terms of encouraging patient / practitioner negotiation over treatment decisions. [ABSTRACT FROM AUTHOR]

Objective: Relationships between the pharmaceutical industry and the medical profession enhance the potential for physicians to become involved in conflicts of interest. Whether or not these rise to a level that violates standards of medical ethics depends on the degree to which they detract from the quality of health care and its cost, the objectivity of research, and the profession's integrity. This paper explores those issues from two perspectives - the micro-level of the medical profession and the macro-level of society. Conclusions: Practices and policies that affect varied aspects of the interaction between the pharmaceutical industry and the medical profession - such as education, research and marketing - are discussed. The reader is asked to reflect on the ethics of issues raised; the author offers suggestions for mitigating conflicts of interest and, in turn, the potential for unethical medical care. [ABSTRACT FROM AUTHOR]

Information of papers discussed at the World Stroke Day, which was held during the Pan American Congress of Neurology in Santo Domingo, Dominican Republic in October 2007, is presented. The event brought more than 200 people representing countries from Latin and North America and Spain, many of them representing different fields of neurology, like epilepsy and Parkinson's disease. Topics include; stroke risk factor in Latin America and high blood pressure.

The aims of this paper are to analyze the role of medical and health professions in creating and establishing the disability category. We also explore how the diagnosis, measurement, and treatment of disability have contributed to stigmatization and promoted social, political and economic inequality. Theories from a variety of disciplines are used to examine the ways that medicine and the health-related professions have contributed to the oppression of people with disabilities, including the maintenance of a 'medical/knowledge power differential,' reinforcement of the 'sick role,' and objectification of people with disabilities. We also explore opportunities for empowerment versus 'sick role' status. The medical and health professions are uniquely positioned to promote the empowerment of people with disabilities as active partners in their own health care. Replacing the biomedical model of disability with a socio-political model that prioritizes disease/health care management, wellness and prevention of further disability as opposed to treatments aimed at curing disability could facilitate the empowerment process. [ABSTRACT FROM AUTHOR]

Over the past several years, there has been a perception in the generic industry that brand companies have been using the Citizen Petition process with the US Food and Drug Administration in order to extend the lifecycles of their brand products and prevent or delay approvals of generic applications. While these filings lend credence to this perception, it nonetheless leaves open questions regarding purpose and effect. This paper examines Petition filings since 2004 and explores their purported purpose, their likely purpose, and impact on generic market dynamics.Journal of Generic Medicines (2007) 4, 87–97. doi:10.1057/palgrave.jgm.4950060; published online 19 December 2006 [ABSTRACT FROM AUTHOR]

The genetic revolution is transforming agriculture and medicine, creating markets for genetic materials of both human and non-human origin that might form the basis of new proprietary products. In this paper I outline how these biological materials are combined with specialised scientific knowledge to create engineered artefacts – cell lines, tissue samples, sequenced DNA – that are now commodified and traded internationally as part of the new global resource economy in 'bioinformation'. In so doing I place particular emphasis on the role that spatial relations have played in shaping the organisation and operation of this new scientific and industrial enterprise. [ABSTRACT FROM AUTHOR]

This paper identifies deficiencies in some current practices of causation and risk evaluation by toxicologists and formulates an evidence-based solution. The practice of toxicology focuses on adverse health events caused by physical or chemical agents. Some relations between agents and events are identified risks, meaning unwanted events known to occur at some frequency. However, other relations that are only possibilities – not known to occur (and may never be realized) – also are sometimes called risks and are even expressed quantitatively. The seemingly slight differences in connotation among various uses of the word 'risk' conceal deeply philosophic differences in the epistemology of harm. We label as 'nomological possibilities' (not as risks) all predictions of harm that are known not to be physically or logically impossible. Some of these nomological possibilities are known to be causal. We term them 'epistemic'. Epistemic possibilities are risks. The remaining nomological possibilities are called 'uncertainties'. Distinguishing risks (epistemic relationships) from among all nomological possibilities requires knowledge of causation. Causality becomes knowable when scientific experiments demonstrate, in a strong, consistent (repeatable), specific, dose-dependent, coherent, temporal and predictive manner that a change in a stimulus determines an asymmetric, directional change in the effect. Many believe that a similar set of characteristics, popularly called the 'Hill Criteria', make it possible, if knowledge is robust, to infer causation from only observational (nonexperimental) studies, where allocation of test subjects or items is not under the control of the investigator. Until the 1980s, medical decisions about diagnosis, prevention, treatment or harm were often made authoritatively. Rather than employing a rigorous evaluation of causal relationships and applying these criteria to the published knowledge, the field of medicine was dominated by authority-based opinions, expressed by experts (or consensus groups of experts) relying on their education, training, experience, wisdom, prestige, intuition, skill and improvisation. In response, evidence-based medicine (EBM) was developed, to make a conscientious, explicit and judicious use of current best evidence in deciding about the care of individual patients. Now globally embraced, EBM employs a structured, 'transparent' protocol for carrying out a deliberate, objective, unbiased and systematic review of the evidence about a formally framed question. Not only in medicine, but now in dentistry, engineering and other fields that have adapted the methods of EBM, it is the quality of the evidence and the rigor of the analysis through evidence-based logic (EBL), rather than the professional standing of the reviewer, that leads to evidence-based conclusions about what is known. Recent studies have disclosed that toxicologists (individually or in expert groups), not unlike their medical counterparts prior to EBM, show distressing variations in their biases with regard to data selection, data interpretation and data evaluation when performing reviews for causation analyses. Moreover, toxicologists often fail to acknowledge explicitly (particularly in regulatory and policymaking arenas) when shortcomings in the evidence necessitate reliance upon authority-based opinions, rather than evidence-based conclusions (Guzelian PS, Guzelian CP. Authority-based explanation. Science 2004; 303: 1468–69). Accordingly, for answering questions about general and specific causation, we have constructed a framework for evidence-based toxicology (EBT), derived from the accepted principles of EBM and expressed succinctly as three stages, comprising 12 total steps. These are: 1) collecting and evaluating the relevant data (Source, Exposure, Dose, Diagnosis); 2) collecting and evaluating the relevant knowledge (Frame the question, Assemble the relevant (delimited) literature, Assess and critique the literature); and 3) Joining data with knowledge to arrive at a conclusion (General causation – answer to the framed question, Dose-response, Timing, Alternative cause, Coherence). The second of these stages (which amounts to an analysis of general causation), is addressed by an EBM-styled approach (adapted for the infrequent availability of human experimental studies in environmental toxicology). This involves assembling literature (through documented algorithms for database queries), excluding irrelevancies by use of delimiters as filters, and ranking and rating the remaining articles for strength of study design and for quality of execution gauged by application of either a ready-made quality assessment instrument or a custom designed checklist or scale. The results of this systematic review (including a structured review of relevant animal and in vitro studies) are then themselves systematically used to determine which causation criteria are fulfilled. Toxicology is maturing from a derivative science largely devoted to routinized performance and interpretation of safety tests, to a discipline deeply enmeshed in the remarkable advances in biochemistry and molecular biology to better understanding the nature and mechanism of adverse effects caused by chemicals. It is time for toxicologists, like scientists in other fields, to formalize a method for differentiating settled toxicological knowledge of risk from mere nomological possibility, and for communicating their conclusions to other scientists and the public. It is time for EBT. [ABSTRACT FROM AUTHOR]

We searched the MEDLINE database for publications about telemedicine from 1966 to 2003. Only publications with a first institutional address in Spain and from journals listed in the JCR Science Edition 2002 were included in the study. A total of 118 publications were found. The first publication appeared in 1988 and publication output showed a sudden increase starting in 1995, reaching a maximum in 2002 with 21 publications. The number of authors per publication in non-multicentre studies ranged from 1 to 14 (median 6.5). Most authors (79%) contributed to only a single publication; 10% of authors participated in three or more publications. Most publications were full papers (88%). The most active Autonomous Community in the number of publications relative to inhabitants was Galicia (0.91 publications per 100,000 inhabitants). The Community that produced the highest absolute number of publications was Madrid (29% of the total). The mean impact factor of the journals in which the publications appeared was 0.961. Production of telemedicine publications in Spain has followed the same temporal course as has been observed worldwide. There is an unequal geographical and institutional distribution of publications. The highest production is concentrated in a few institutions and only a small number of authors show steady research activity. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between academic psychiatry and the pharmaceutical industry, focusing on a partnership between academics in Melbourne and Eli Lilly and Company (Lilly Melbourne Academic Psychiatry).Conclusions: Relationships between the pharmaceutical industry and the medical profession (including psychiatry) are under scrutiny as never before. Despite the complex nature of the relationship, the present paper argues that partnerships with external corporations such as pharmaceutical companies are of increasing importance for academic departments of psychiatry and research institutes, in environments in which core funding for tertiary institutes is being reduced. The partnership between Melbourne psychiatric academics and Eli Lilly and Company shows that benefits accrue to both parties, and suggests that there is a worthwhile place for other industry- academic collaborations of a similar nature in Australia. [ABSTRACT FROM AUTHOR]