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Considers the essential questions that a physician should consider before a physician changes a medical practice in the light of a published research paper. Practical question to ask about a new piece of research; Fundamental questions about the design of the study; Avoidance of systematic bias; Important numbers found in the methods section of a paper.

Reports the effectiveness of the statistical assessment scheme for papers submitted to the 'British Medical Journal,'. Statistical criticism of the content; Comparison of reports on published and unpublished papers; Acceptability of assessed papers.

Presents tips of writing a medical paper in Great Britain. Identification of writing the concluding part as a helpful step for an easy paper formulation; Disadvantages of concentrating on the introductory part of the paper; Significance of formulating an interesting title.

The article presents abstracts on medical topics which include the management of inflammatory bowel disease, role of microRNA in the deregulation of Interleukin-13 pathway in ulcerative colitis.

The article presents abstracts on medical topics which include management of gastrointestinal hemorrhage, hemospray, and artificial neural network.

The article presents abstracts on medical topics which include metachronous colorectal liver metastases, oncolytic virus as a vaccine against colorectal liver metastasis, and development of a tertiary pancreatic cancer unit.

The article presents abstracts on medical topics which include esophageal adenocarcinoma, recovery after upper gastrointestinal surgery, and association of obesity with oesophageal adenocarcinoma.

The article presents abstracts on medical topics which include endoscopic resection of large benign rectal lesions, Bowel Cancer Screening Programme, and Bowel Screening program in Wales.

The article presents abstracts on medical topics which includes lymphocytic duodenosis, tumour regression grading, and histopathology of stomach cancer.

The article presents abstracts on medical topics which include the assessment of candidate genes to assist prognosis in gastric cancer, Helicobacter pylori infections, and autoimmune chronic atrophic gastritis.

The article presents abstracts on medical topics which includes clonal progression of Barrett's oesophagus to oesophageal adenocarcinoma, tumor marker celebration with and without oesophageal neoplasia, and oesophageal cancer surgery.

The article presents abstracts on medical topics which include severity of hepatic ischemia-reperfusion injury, hepatic fibrosis in type 2 diabetes mellitus patients, and liver fibrosis.

The article presents abstracts on medical topics which include the gastroscopy rate in general practitioner practice populations in Great Britain, randomised prospective trial of transnasal and standard upper diagnostic endoscopy under local anesthetic, and guidelines on the endoscopic assessment of gastric polyps.

The article presents abstracts on medical topics which include computed tomography in colitis, magnetic resonance cholangio-pancreatography, and endoscopic submucosal dissection.

The article presents abstracts on medical topics which include complications of pancreaticoduodenectomy, utility of quantitative endoscopic ultrasound elastography (qeuse) for the diagnosis of pancreatic malignancy, and cell characterstics in chronic pancreatitis.

The article presents abstracts on medical topics which include hiatus hernia, irritable bowel syndrome exacerbation, and effect of ondansetron on diarrhoea patients.

The article presents abstracts on medical topics which include symptoms of coeliac disease, the gene expression of the enteric hormone fibroblast growth factor (FGF15), FGF19 levels associated with symptoms of diarrhoea in crohn's disease.

The article presents abstracts on medical topics which include the impact of geographical diversity on delivery of end of life care for patients with upper gastrointestinal cancer, sustainable endoscopy training in Malawi, and, dyspepsia management.

Reports developments on medicine in Europe as of January 1988. Negotiation between the General Medical Services Committee and the Department of Health on primary health care; Access of the district health authorities to family practitioner committees; Derivation of circular of community nursing services and community health care teams.

Focuses on the use of computer system for the publication of the journal 'British Medical Journal' in Great Britain. Scheme on the use of computer system in the editorial office; Problems relating to computer systems; Advantage on the use of computer systems.

Reports developments related to medicine in Great Britain. Delay of the publication of the green paper report on general practice; Recommendation of the Social Services Select Committee for extra funding; Criticisms of the pharmaceutical price regulation scheme in the country.

Reports developments related to medicine in Great Britain. Uses of a plastic drip set; Usefulness of waste papers; Preference to live in Africa.

The authors comment on how patients with functional diagnoses have no psychiatric diagnosis or discernible psychosocial difficulties. Physicians often have a prejudice that prevents them from making this diagnosis in someone who is 'normal', resulting in over-investigation but under-diagnosis thorough but unsatisfactory care. Some of the things that can be done include allowing the patient to speak uninterrupted at the beginning of the consultation and noting down all of the patients' symptoms.

The article presents abstracts on medical topics which include content analysis of illness blogs and telemedicine systems in inflammatory bowel disease management.

In medicine, racial differences are frequently presented as part of the best explanation of differences in the risk of diseases. The problem of using racial classification in biomedical research has become important because of its ethical consequences in society. However, the biological relevance of the concept of race cannot be established by any ethical argument and the epistemological role of racial categorisation requires clarification. In this paper, different issues related to the concept of race are considered. This paper analyses the semantic problem concerning the definition of race, considers the ontological problem of race, drawing attention to the biological evidence for genetic differences among human groups, and presents a promising epistemological approach to the problem of race. The purpose of the paper is to examine whether, or when, racial categories belong in biological explanations. It shows that the concept of race cannot be justified in biology because it does not lead to successful predictions, and that genetic discontinuities are sufficient to explain differences in diseases but not needed in the explanation. The biomedical field should search for genetic patterns related to diseases, and should not assume racial discontinuities among human groups and use racial clusters as proxies for undetected genetic patterns. [ABSTRACT FROM AUTHOR]

This article systematically reviews the available literature to improve our understanding of the physiological basis for orthoses under the kinematic, shock attenuation and neuromotor control paradigms. The propositions made under these three paradigms have not been systematically reviewed collectively, and as such, there is no single-point synthesis of this clinically relevant body of evidence and somewhat disparate findings. Our comprehensive search strategy yielded 22 papers. Under each paradigm, the role of orthoses with different design features including combinations of posting, moulding and density was analysed. Where possible, data have been pooled to provide an increased level of confidence in findings. The main findings in the kinematic paradigm were that posted non-moulded orthoses systematically reduced peak rearfoot eversion (2.12° (95% CI 0.72 to 3.53)) and tibial internal rotation (1.33° (0.12 to 2.53)) in non-injured cohorts. In the shock attenuation paradigm, it was found that non-posted moulded and posted moulded orthoses produced large reductions in loading rate and vertical impact force when compared with a control and to a posted non-moulded orthosis. The neuromotor control paradigm seems to be the least conclusive in its outcome. Based on our review, this paper concludes with rudimentary guidelines for the prescription of orthosis, that sports medicine practitioners may use in their clinical decision-making process. The need for further research focusing on the role of injury, particularly in neuromotor control modification and long-term adaptation to orthoses, was highlighted. [ABSTRACT FROM AUTHOR]

Two interpretations of the precautionary principle are considered. According to the normative (action-guiding) interpretation, the precautionary principle should be characterised in terms of what it urges doctors and other decision makers to do. According to the epistemic (belief-guiding) interpretation, the precautionary principle should be characterised in terms of what it urges us to believe. This paper recommends against the use of the precautionary principle as a decision rule in medical decision making, based on an impossibility theorem presented in Peterson (2005). However, the main point of the paper is an argument to the effect that decision theoretical problems associated with the precautionary principle can be overcome by paying greater attention to its epistemic dimension. Three epistemic principles inherent in a precautionary approach to medical risk analysis are characterised and defended. [ABSTRACT FROM AUTHOR]

Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury. Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population. Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH. Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11 .2), headache 1 .02 (95% CI 0.62 to 1 .69), vomiting 0.88 (95% CI 0.67 to 1 .15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0). Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups. [ABSTRACT FROM AUTHOR]

This paper briefly outlines health advisor L.W. Harrison's contribution to venereology or genitourinary (GU) medicine, and shows how his principles of good practice fulfil many of the principles of clinical governance. The paper then outlines some general principles of clinical governance and indicate how they relate to GU medicine. Harrison set up the specialty on a firm foundation of clinical excellence that fulfils many of the latest requirements. He would have been thrilled to see how the specialty has broadened and would have applauded the drive for excellence. However, he might have been concerned over the literature on clinical governance, reminding that the pursuit is excellence of clinical care for the patient, and that clinical governance must not become an end in itself.

Lists several books related to medicine. 'Medical Job Interview: Secrets for Success,' by C. Mumford; 'How to Read a Paper,' by T. Greenhalgh; 'ABC of Mental Health,' by T. Davies and T. K. J. Craig; 'The 10-Minute Diagnosis Manual,' edited by R. B. Taylor; Others.

Presents the medical studies featured in the 'British Medical Journal' in Great Britain. Focus of the majority of the papers on epidemiology; Number of citations received by the studies included in the list; Citation of pharmacologically oriented papers with the highest ratings. INSETS: 1940s;Concourse No 2;The BMJ's top 50.

The charter of medical professionalism in the new millennium (Charter) has been endorsed worldwide, including by the Chinese Medical Doctor Association from 2005. Six years later, the association drafted a Chinese version of medical professionalism based on the Charter, the Chinese Medical Doctor Declaration (Declaration). This Declaration encompasses six tenets, which have large areas of overlap with the Charter. Meanwhile, certain differences also exist between the universal professionalism that the Charter aims to disseminate and the ideal Chinese professionalism that the Declaration endeavours to bolster. In this paper, we explore the unique aspects of the Declaration in contrast with the Charter to gain a deeper understanding of professionalism in the particular context of China. The Declaration may omit some valuable commitments found in the Charter, but it includes longstanding Confucian and cultural traditions of China, as well as consideration of current social circumstances. The Declaration thus re-establishes the ideal of universal professionalism in light of the Chinese context. [ABSTRACT FROM AUTHOR]

Two principles form the basis for much priority setting in health. According to the greater benefit principle, resources should be directed toward the intervention with the greater health benefit. According to the worse off principle, resources should be directed toward the intervention benefiting those initially worse off. Jointly, these principles accord with so-called prioritarianism. Crucial for its operationalisation is the specification of the worse off. In this paper, we examine how the worse off can be defined as those with the fewer lifetime Quality-Adjusted Life Years (QALYs). We contrast this proposal with several alternative specifications. [ABSTRACT FROM AUTHOR]

Face transplantation—or, more properly, facial allograft transplantation (FAT)—generates much public interest and academic debate. In this paper, we suggest that it is up to opponents of FAT to make the case for its impermissibility. We allow that there is a number of apparently strong arguments that might be deployed against FAT. However, all but one of these turn out not to be compelling after examination. The remaining argument is not so easily dismissed—but its central point is fairly workaday and certainly does not tell us anything about FAT in particular. Therefore, qua argument about facial transplant surgery, it fails to hit its target. Overall, we conclude that a compelling case against FAT remains to be made. [ABSTRACT FROM AUTHOR]

Historical skills—especially the methodologies involved in interpreting a wide range of sources—can provide a useful analysis of the structure and function of health services, and be used as a means of improving public understanding of the expectations and experiences of health and health care. This paper discusses some key examples of different strategies used by historians to show how they can collaborate effectively with health professionals. [ABSTRACT FROM AUTHOR]

The ethics review system of research is now well-established, at least in the developed world, although there are many differences in how countries view it and go about managing it. The UK specifically is now seeking to revise its system by speeding up the process of ethics approval but only for some studies. It is proposed that only those studies which pose "no material ethical issues" should be "fast-tracked". However, it is unclear what this means, who should decide and what should be included in this category. In this paper, we go some way towards answering these questions. While we are certain that the debate is only just beginning, we are equally certain that it will continue to run long after the system has been reformed. To stimulate this conversation and to inform a pilot project of the new system directly, we review two candidates to help give some substance to the notion of "material" ethical issues. Firstly, material could mean a certain type or degree of risk. Second, material could mean how physically invasive the research is. We conclude that there is still much work to be done on making the system of governing health and social care consistent and practicable. [ABSTRACT FROM AUTHOR]

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the "Rule of Rescue"). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. [ABSTRACT FROM AUTHOR]

The introduction of conscience clauses after the 1973 US Supreme Court decision in Roe v. Wade allowed physicians and nurses to opt out of medical procedures, particularly abortions, to which they were morally opposed. In recent years pharmacists have requested the same consideration with regard to dispensing some medicines. This paper examines the pharmacists' role and their professional and moral obligations to patients in the light of recent refusals by pharmacists to dispense oral contraceptives. A review of John Rawls's concepts of the "original position" and the "veil of ignorance", along with consideration of the concept of compartmentalisation, are used to assess pharmacists' requests and the moral and legal rights of patients to have their prescriptive needs met. [ABSTRACT FROM AUTHOR]

This paper discusses the notion of using international shipping legislation to provide healthcare technologies to inhabitants of a country on a ship in international waters based just outside the country's border. This allows technologies that would otherwise be unavailable, regulated or banned to the citizens of a particular nation to be available, just offshore. This is because in international waters ships are governed by the laws of their home nation not those they are nearby. We focus on the example suggested recently in the UK of "sperm ships", flying Danish flags to circumvent IVF regulation in the UK. While we acknowledge that this general strategy could be used to do good by providing healthcare where it would not be otherwise available, it also provides a significant challenge to the effective sovereignty of the state and its ability to regulate healthcare technologies for the benefit of its citizens. We discuss this challenge to the regulation of healthcare and suggest a few tentative solutions. [ABSTRACT FROM AUTHOR]

The author discusses the importance of impact factors to editors of medical journals. George Lundberg, former editor of the "Journal of the American Medical Association," who raised that journal's impact factor, is reported to consider that this now central importance of ranking is distorting the basic character of many journals. Medical journals may try to publish only those papers most likely to be cited instead of less citeable, but important work and in so doing, may do science and their readers a disservice. The "Journal Citation Reports" produced by the Institute for Scientific Information is mentioned.

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy-one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline. [ABSTRACT FROM AUTHOR]

Shortly after bacteriologist Paul de Kruif had been dismissed from a research position at the Rockefeller Institute for Medical Research, he started contributing to a novel in collaboration with the future Nobel laureate Sinclair Lewis. The novel, Arrowsmith, would become one of the most famous satires on medicine and science. Using de Kruif's correspondence with his idol Jacques Loeb, this paper describes the many ways in which medical science is depicted in Arrowsmith. This article compares the novel with de Kruif's and Loeb's biographies, and (1) focuses on the struggles of the main character, Martin Arrowsmith, as an allegory of the institutionalisation of medical research in the US, (2) shows that (influenced by de Kruif) Sinclair's purpose is to caricaturise scientific work in modern medical research institutions anywhere and (3) shows that the novel depicts a reductionist philosophy of research that seems to contradict the "messiness" of medical practice. [ABSTRACT FROM AUTHOR]

Objective and method: To outline the direct and indirect approaches in the fight against blood doping in sports, the different strategies that have been used and are currently being used to fight efficiently against blood doping are presented and discussed. Results and conclusions: The paper outlines the different approaches and diagnostic tools that some federations have to identify and target sportspeople demonstrating abnormal blood profiles. Originally blood tests were introduced for medical reasons and for limiting misuse of recombinant human erythropoietin (rHuEPO). In this way it became possible to prevent athletes with haematocrit levels well above normal, and potentially dangerous for their health, competing in sport. Today, with nearly a decade of blood testing experience, sports authorities should be familiar with some of the limitations and specially the ability of blood tests performed prior to competitions to fight efficiently against the misuse of rHuEPO, blood transfusion, and artificial haemoglobin. [ABSTRACT FROM AUTHOR]

Study objective: The aim of this paper is to synthesise empirical findings on the salutogenic concept sense of coherence (SOC) and examine its capacity to explain health and its dimensions. Design: The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992-2003. The review includes 458 scientific publications and 13 doctoral theses. Setting: Worldwide, based on postgraduate scientific publications in eight authorised databases, doctoral theses, and available books. Main results: Soc is strongly related to perceived health, especially mental health. The stronger the soc the better the perceived health in general, at least for those with an initial high SOC. This relation is manifested in study populations regardless of age, sex, ethnicity, nationality, and study design. SOC seems to have a main, moderating or mediating role in the explanation of health. Furthermore, the soc seems to be able to predict health. SOC is an important contributor for the development and maintenance of people's health but does not alone explain the overall health. Conclusion: SOC seems to be a health promoting resource, which strengthens resilience and develops a positive subjective state of health. Salutogenesis is a valuable approach for health promotion and would be worth to implement in practice much more than to date. [ABSTRACT FROM AUTHOR]

A company called Biojewelry has proposed to take a sample of bone tissue from a couple and to grow this sample into wedding rings. One of the ethical problems that such a proposal faces is that it implies surgery without medical need. To this end, only couples with a prior need for surgery are being considered. This paper examines the question of whether such a stipulation is necessary. It is suggested that, though medical need and the provision of health and wellbeing is overwhelmingly the warrant for surgical intervention, there is no reason in principle why other, non-medical, projects such as jewelry creation might not also warrant surgical intervention. Implicitly, this line of thought forces us to consider the proper place of surgical intervention--that is, to ask what surgeons are for. [ABSTRACT FROM AUTHOR]

Although guidance exists for the use of many laboratory tests in a wide range of clinical situations, this guidance is spread among a range of literature sources, and is often directed at laboratory specialists rather than test users. Individual general practices display large variations in standardised test requesting, yet much of their testing activity involves a relatively small range of tests. This paper describes a methodological approach to review the available evidence and guidance and to extract relevant primary research work to examine a range of testing scenarios in general practice, with the aim of formulating guidance based on the best available evidence or consensus opinions. [ABSTRACT FROM AUTHOR]

Some patients have no chance of surviving if not treated, but very little chance if treated. A number of medical ethicists and physicians have argued that treatment in such cases is medically futile and a matter of physician discretion. This paper critically examines that position. According to Howard Brody and others, a judgment of medical futility is a purely technical matter, which physicians are uniquely qualified to make. Although Brody later retracted these claims, he held to the view that physicians need not consult the patient or his family to determine their values before deciding not to treat. This is because professional integrity dictates that treatment should not be undertaken. The argument for this claim is that medicine is a profession and a social practice, and thus capable of breaches of professional integrity. Underlying professional integrity are two moral principles, one concerning harm, the other fraud. According to Brody both point to the fact that when the odds of survival are very low treatment is a violation of professional integrity. The details of this skeletal argument are exposed and explained, and the full argument is criticised. On a number of counts, it is found wanting. If anything, professional integrity points to the opposite conclusion. [ABSTRACT FROM AUTHOR]

Evidence based medicine has been a topic of considerable controversy in medical and health care circles over its short lifetime, because of the claims made by its exponents about the criteria used to assess the evidence for or against the effectiveness of medical interventions. The central epistemological debates underpinning the debates about evidence based medicine are reviewed by this paper, and some areas are suggested where further work remains to be done. In particular, further work is needed on the theory of evidence and inference; causation and correlation; clinical judgment and collective knowledge; the structure of medical theory; and the nature of clinical effectiveness. [ABSTRACT FROM AUTHOR]

There is a long history of medical research that involves intentionally infecting healthy people in order to study diseases and their treatments. Such research--what might be called "human challenge studies"--are an important strand of much current research--for example, in the development of vaccinations. The many international and national guidelines about the proper conduct of medical research do not specifically address human challenge studies. In this paper we review the guidelines on the risk of harm that healthy volunteers may be exposed to in the course of medical research. We examine the ethical arguments that are implicit or explicit in these guidelines. We then ask whether there is reason for limiting such studies on grounds independent of risk of harm. We conclude that the major ethical concern with challenge studies is that of risk of harm and that the fact that a study is a challenge study is not a wrong in itself. [ABSTRACT FROM AUTHOR]

The origins of Japan's medical ideas, which are deeply rooted in its religion, culture and history, are not widely underswod in medical societies of other countries. We have taken up the task of summarising this tradition here so that some insight can be gained into the unique issues that characterise the practice of medicine in Japan. We borrow from the sayings of Tohkaku Wada, a medical philosopher of late eighteenth-century Japan, for a look at Japanese medical tradition. Wada's medical thought was very much reflective of the Buddhism, Zen, and swordsmanship that informed eighteenth-century philosophy in Japan. His central concepts were "chu" and "sei", that is, complete and selfless dedication to the patient and the practice of medicine. This paper explores Wada's thought, explaining it mainly from the standpoint of Japanese traditional culture. [ABSTRACT FROM AUTHOR]