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Introduction: The emergence of artificial intelligence (AI) chat programs has opened two distinct paths, one enhancing interaction and another potentially replacing personal understanding. Ethical and legal concerns arise due to the rapid development of these programs. This paper investigates academic discussions on AI in medicine, analyzing the context, frequency, and reasons behind these conversations. Methods: The study collected data from the Web of Science database on articles containing the keyword "ChatGPT" published from January to September 2023, resulting in 786 medically related journal articles. The inclusion criteria were peer-reviewed articles in English related to medicine. Results: The United States led in publications (38.1%), followed by India (15.5%) and China (7.0%). Keywords such as "patient" (16.7%), "research" (12%), and "performance" (10.6%) were prevalent. The Cureus Journal of Medical Science (11.8%) had the most publications, followed by the Annals of Biomedical Engineering (8.3%). August 2023 had the highest number of publications (29.3%), with significant growth between February to March and April to May. Medical General Internal (21.0%) was the most common category, followed by Surgery (15.4%) and Radiology (7.9%). Discussion: The prominence of India in ChatGPT research, despite lower research funding, indicates the platform's popularity and highlights the importance of monitoring its use for potential medical misinformation. China's interest in ChatGPT research suggests a focus on Natural Language Processing (NLP) AI applications, despite public bans on the platform. Cureus' success in publishing ChatGPT articles can be attributed to its open-access, rapid publication model. The study identifies research trends in plastic surgery, radiology, and obstetric gynecology, emphasizing the need for ethical considerations and reliability assessments in the application of ChatGPT in medical practice. Conclusion: ChatGPT's presence in medical literature is growing rapidly across various specialties, but concerns related to safety, privacy, and accuracy persist. More research is needed to assess its suitability for patient care and implications for non-medical use. Skepticism and thorough review of research are essential, as current studies may face retraction as more information emerges. [ABSTRACT FROM AUTHOR]

The growing adoption of evidence-based medicine in the United States is acting to cause fundamental changes in the delivery of healthcare management services. With the increasing incorporation of electronic patient records (EPRs) into the day-to-day practice of medicine, it necessitates greater dependence on adequate functioning of such resources, as they become more frequently used as a clinical complement in the practice of medicine. Assessing the patterns of adoption of EPRs is likewise of increasing importance, with the recent imposition of uniform government data collection and management requirements. The medium of data storage and maintenance within many organizations is a critical factor in the ultimate delivery of service, with a like need for an integrated, designated medium for the management of data becoming paramount. This study examines, on a nationwide basis, variation in reported adoption of EPRs within U.S. healthcare organizations, and the related maintenance of dual electronic/paper record systems. [ABSTRACT FROM AUTHOR]

In 1978, the nature of the hypnozoite was discussed in an article that appeared in a relatively obscure journal, which is also where the term was adopted for Plasmodium (a little-known fact). As a result, that commentary on the use of the word 'hypnozoite' has been almost completely overlooked. Although the publication is now more than three decades old, the analysis remains valid today. It is explained in the present paper that like 'merozoite' and 'sporozoite', the name 'hypnozoite' is applicable not only to a latent stage in the life cycle of Plasmodium but to some apparently dormant forms of other kinds of apicomplexan parasites as well. Merozoites of different genera of parasitic protozoa are not necessarily the same biologically and/or otherwise. Similarly, although the hypnozoite concept relates primarily to pre-merozoite stages, some atypical post-divisional apicomplexan forms might also be hypnozoites. Examples are likewise given of latent organisms that, in contrast, are clearly not hypnozoites, such as dormant merozoites in malaria infections. Lastly, the plasmodial hypnozoite is placed in context in relation to the relatively unfamiliar (nomenclaturally) malarial bradysporozoite, chronozoite, dormozoite, merophore, merosome and x body. This paper is based on a presentation by the author, as a Life Member of the American Society of Tropical Medicine and Hygiene, to its 59th Annual Meeting in Atlanta, Georgia, USA, 3-7 November 2010. [ABSTRACT FROM AUTHOR]

Over the past 4 decades Chinese medicine (CM) has come increasingly into the spotlight in the United States as the clinical effectiveness of CM has been not only empirically well-tested over a long period of time but also proven by recent scientific research. It has proven cost effectiveness, safety, and is authorized for natural and holistic approaches. In consideration, CM is one of the underutilized health care professions in the United States with a promising future. However, CM faces many challenges in its education and system, its niche in the health care system as an independent profession, legal and ethical issues. This paper discusses the confronting issues in the United States: present education, standards of CM education with shifting first professional degree level, new delivery systems of CM education. Development of new research models, training of evidence-based practice, and implementation of integrative medicine into CM education also are the key issues in the current CM profession. This paper also discusses opportunities for the CM profession going beyond the current status, especially with a focus on fusion medicine. [ABSTRACT FROM AUTHOR]

Many medical toxicologists are interested in participating in a practice-based, multicenter research and toxicosurveillance network. In 2009, the American College of Medical Toxicology established the Toxicology Investigators Consortium (ToxIC). One facet of ToxIC is a registry that can be used for surveillance of new or old agents, assessment of treatment decisions, and the creation of new research questions. This paper describes the development of and the initial experiences with this registry of toxicology patients. In November 2009, ACMT invited members to participate in a new registry of cases evaluated and cared for by practicing medical toxicologists who provide direct hands-on clinical care. A password-protected, encrypted, online registry data site was created to upload a newly developed electronic case report form (CRF) on registry patients. The CRF includes demographics; encounter circumstances; agent; syndrome, symptoms, and signs; and treatment. A test version at four sites began in January 2010, seven additional sites were added in March 2010 for the beta phase, and the registry was opened to all interested US medical toxicology practices in April 2010. The CRF underwent continuous modifications based upon frequent feedback from and discussion among the participants. Thirty-three toxicology practice sites, encompassing 56 hospitals and clinics, have entered data into the ToxIC Registry. During the first 14 months of data collection, 5,412 patients were entered. The experience thus far demonstrates that the creation of this registry is feasible and constitutes a potentially powerful toxicosurveillance and robust research tool. [ABSTRACT FROM AUTHOR]

A major challenge of medical anthropology is to assess how biomedicine, as a vaguely-defined set of diverse texts, technologies, and practitioners, shapes the experience of self and body. Through narrative analyses of in-depth, semi-structured interviews with 158 pregnant women in southern California, this paper explores how the culture of biomedicine, encountered formally at prenatal care check-ups and informally through diverse media, influences pregnant women's perceptions of appropriate prenatal behavior. In the spirit of recent social scientific work that draws on and challenges Foucauldian insights to explore social relations in medicine, we posit a spectrum of compliance and resistance to biomedical norms upon which individual prenatal practices are assessed. We suggest that pregnancy is, above all, characterized by a split subjectivity in which women straddle the authoritative and the subjugated, the objective and the subjective, and the haptic as well as the optic, in telling and often strategic ways. In so doing, we identify the intersection between the disciplinary practices of biomedicine and the practices of pregnant women as a means of furnishing more fruitful insights into the oft-used term "power" and its roles in constituting social relations in medicine. [ABSTRACT FROM AUTHOR]

In this paper, we report on the development and dissemination of a preventive intervention, Families OverComing Under Stress (FOCUS), an eight-session family-centered intervention for families facing the impact of wartime deployments. Specific attention is given to the challenges of rapidly deploying a prevention program across diverse sites, as well as to key elements of implementation success. FOCUS, developed by a UCLA-Harvard team, was disseminated through a large-scale demonstration project funded by the United States Bureau of Navy Medicine and Surgery (BUMED) beginning in 2008 at 7 installations and expanding to 14 installations by 2010. Data are presented to describe the range of services offered, as well as initial intervention outcomes. It proved possible to develop the intervention rapidly and to deploy it consistently and effectively. [ABSTRACT FROM AUTHOR]

Whilst there are not yet laws specifically relating to nanotechnology and its products in any country, the technology and its products are not unregulated. Regulatory frameworks created for conventional technologies and products will be expected to apply to nanotechnology and its products. For example, new medicines are regulated in Australia by the Therapeutic Goods Administration. If a new medicine incorporates nanotechnology, then it should still be regulated as a medicine. However, whether the expectation that pre-existing regulatory frameworks will apply is correct and, if so, whether the application of such frameworks is adequate are important issues to be answered. This paper considers these questions, drawing on lessons learnt from significant regulatory reviews undertaken in the United Kingdom, United States and Australia. [ABSTRACT FROM AUTHOR]

The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them. [ABSTRACT FROM AUTHOR]

The federal government has played a significant role in the financing the education of healthcare professionals since the introduction of Medicare in 1965. However, professional psychology's limited ability to argue the critical nature of its services to the welfare of the nation, and its lack of national workforce information and policy, has hindered its inclusion in Medicare's Graduate Medical Education (GME) program. This paper discusses the evolution and current status of healthcare workforce policy in the United States, and the implications for psychology and the training of future professionals. Also described are recent efforts by the American Psychological Association (APA) and a few psychologists to include professional psychology in the GME program. The importance of organized psychology's sustained involvement in national health policy is emphasized. [ABSTRACT FROM AUTHOR]

This paper describes the growth of psychology in medical schools and the distribution of psychologists across medical school departments. The Association of American Medical Colleges (AAMC) and American Psychological Association (APA) use different data collection approaches that reflect their different missions. AAMC focuses solely on medical school faculty, whereas APA tries to reach all psychologists working in academic health centers (AHCs). The number of psychologists in medical school settings has increased, largely due to their research expertise; but psychologists also contribute through teaching and clinical service. Psychologists hold appointments in wide variety of medical school departments, which has been a key factor in their success. Through partnership and interdisciplinary collaboration with a wide range of academic physicians, psychologists have gained increased support, become valued members of the AHC and medical school communities, and can rise to leadership positions in medical schools. [ABSTRACT FROM AUTHOR]

Presents an index of authors who contributed research articles to the "Pediatric Cardiology" journal in 2003. Research credits; Titles of the research papers; Pages where their research papers were published.

It is estimated that 70 million Americans have used the Internet to acquire health-related information. Multiple factors provide the driving force behind this demand for online health information. Information technology is beginning to change the exclusive focus of medicine from curing disease to prevention of disease and enhancing health status. A critical feature of this change is the development of information and services that assist consumers to assume more responsibility for their own health and to actively participate in health care decisions. At the same time, physicians remain skeptical about the advantages of using the Internet for patient education. Some of the issues that this paper addresses include the following: What are the major factors that are leading to the increased use of the Internet by consumers to obtain health-related information? How do physicians view the use of the Internet by patients to obtain health-related information and services? How is the use of the Internet by consumers affecting physician–patient communications? What are the implications of the Internet for the future of physician–patient relationships? [ABSTRACT FROM AUTHOR]

Traditionally in medicine, nearly all prescribing decisions were made by the treating physician. The patient had relatively little input and hardly any access to alternative sources of information bearing on that decision; the cost of the prescription was covered by the patient or by an insurer, and neither was likely to provide any feedback to the physician to shape his or her decision. Now, all that has changed. Beginning with the consumerist movement of recent decades and culminating in the explosion of health-related information on the Internet, patients are increasingly vocal participants in the prescribing decision, on both clinical and economic grounds. Payers have become participants as well, and increasingly seek to influence prescribing decisions in the light of their own economic imperatives. Added to all these cross-currents is an additional wild card: the proliferation of ‘alternative medicines,’ ‘nutraceuticals’ and other nostrums that society has placed beyond the reach of the evidence-based discourse and regulations that govern conventional drug therapy. In a country where patients struggle to cover the cost of prescription therapies proven both safe and effective in rigorous clinical trials, billions of dollars per year are spent on alternative treatments in the US, unencumbered by concerns about whether they actually work or that they might be toxic. While these patterns of communication, education, disinformation and economic influence are much more chaotic than those that prevailed in the ‘good old days,’ this very ferment may also present opportunities for improvement of rational pharmacotherapy and public health. This paper briefly outlines the above changes in patterns of communication and influence as they relate to medication use in today's industrialised world (particularly the US), and suggests both hopeful and terrifying scenarios describing where these trends might lead in the coming decade. [ABSTRACT FROM AUTHOR]

Minnesota has the largest Somali diaspora in the world. Uniquely, the Minnesotan Somali diaspora utilizes traditional healing practices along with Western medicine. Therefore, medical providers who regularly interact with Somali patients must be aware of traditional healing practices. A scoping review inclusive of three databases (Embase Classic + Embase, Ovid MEDLINE, PsychINFO) was conducted. Fifty-eight studies met established criteria. Traditional medicine is performed with conventional medicine. Illnesses are acknowledged to be caused by a malfunctioning body, evil eye, and/or zar (possession). Examples of the utilization of dawo dhaqmeed (traditional practices) included ilko dacowo (dental enucleation), khat (catha edulis), guboow (use of a fire-heated object), cupping, xoq (scraping), xidhayn (female genital mutilation), duugto (massage), baan (nutrition), herbs, caano geel (camel milk), Qur'anic healing, prayer, zam zam (holy water), tahliil liquid (blessed water), and amulets. Practices ranged from benign to harmful. Identifying Somali traditional healing practices is the first step in understanding the health of the Somali community in Minnesota. [ABSTRACT FROM AUTHOR]

This paper explores ways in which Chinese healing practices have undergone acculturation in the United States since the early 1970s. Reacting to what is perceived as biomedicine's focus on the physiological, those who describe themselves as favoring a holistic orientation often use the language of "energy blockage" to explain illness, whether thought of as "physical," "emotional," or "spiritual." Acupuncture in particular has been appropriated as one modality with which to "unblock" such conditions, leading to its being used by some practitioners in conjunction with more psychotherapeutic approaches which include valuing the verbalizing of feelings. Some non-Chinese practitioners in the United States, returning to older Chinese texts to develop "an American acupuncture," are reinserting diagnoses eliminated from Traditional Chinese Medicine (TCM) by the People's Republic of China as "superstition." The assumption has been that many such diagnostic categories refer to psychological or spiritual conditions, and therefore may be useful in those American contexts which favor this orientation. Among these categories are those drawn from traditions of demonology in Chinese medicine. What was once a religious category in China turns psychological in the American setting. At the same time, many who use these terms have, since the late 1960s, increasingly conflated the psychological and the religious, the latter being reframed as "spiritual." Thus, this indigenization of Chinese practices is a complex synthesis which can be described as simultaneously medical, psychotherapeutic, and religious. [ABSTRACT FROM AUTHOR]

The article presents several news briefs related to medicine. The first of four pivotal trials of AstraZeneca/ Targacept's TC-5214 for major depressive disorder has failed. Pfizer Inc.'s atorvastatin (Lipitor) which grossed over US 130 billion dollars in sales since its approval in 1996 came off patent on November 30, 2011. The U.S. National Institutes of Health (NIH) has released a white paper on the value of "Quantitative and Systems Pharmacology."

The article focuses on the DNA sequence variants that influence gene expression and disease risk in the U.S. It is pointed out that the effects of variations in DNA sequence are often subtle, such as altered levels of gene expression. Moreover, it is said that identifying those DNA sequences that determine levels of expression across individuals could have great medical potential. It also discusses one paper that illustrates the identification of DNA sequences which looks at the two major contractile proteins of the human heart.

The article presents the author's views on the Sexual Medicine Society of North America 2002 meeting, which was actually held in Florida in January 2003. The reason that this meeting was an invited speaker symposium and was held in the early Winter of 2003 as opposed to 2002 was out of respect to the International Society of Sexual and Impotence Research whose biennial meeting was held in Montreal, Quebec in the Fall of 2002. So as not to interfere with this important international meeting in which abstracts were presented, the North American Society decided to provide for their members what should become a traditional symposia-type meeting in even years.

Presents several research articles on pediatric cardiology sourced from other periodicals and published in the "Pediatric Cardiology" journal in the U.S. in 2003. Range of issues and subject matter covered by the research papers; Author credits; Implications on pediatric cardiology.

Evidence-based medicine (EBM) has emerged has a critical clinical competency in the 21st century. Medical schools usually introduce students to critical appraisal in the preclinical years, but there have been few evaluated interventions in teaching EBM in the clinical years. We describe a strategy to encourage students to practice EBM during a required ambulatory medicine clerkship. During this clerkship, our students are required to submit an EBM report, which is prompted by an individual case, and structured with a 5-step approach. One small-group session is devoted to modeling this approach with a case of chest pain. Using a checklist to grade 216 consecutive EBM reports, we found that students were quite successful with the exercise, achieving on average 89.6% of possible checklist points. Students who followed the structure of the exercise closely were more likely to extend their discussions beyond that required and to suggest potential further areas of investigation or design. [ABSTRACT FROM AUTHOR]

Surgery in the first half of the nineteenth century was primarily dominated by pain and fear of lethal infections. Therefore, the absolute majority of fractures and dislocations were treated non-operatively. Development of operative treatment of fractures was influenced by three major inventions: anaesthesia (1846), antisepsis (1865) and X-rays (1895). The first to use external fixation is traditionally considered to be Malgaigne (1843). However, his devices cannot be really considered as external fixation. The external fixation device invented by Lambotte in 1902 is generally thought to be the first "real fixator". In America it was Clayton Parkhill, in 1897, with his "bone clamp" who started the process. Both Parkhill and Lambotte observed that metal pins inserted into bone were tolerated extremely well by the body. Mainly on the basis of their research findings, many external fixation devices have been and are being developed. [ABSTRACT FROM AUTHOR]

Background: Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care.Objective: To describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status.Design: Retrospective cross-sectional study.Patients: A 20 % random sample of Medicare fee-for-service beneficiaries in 2012.Main Measures: Regions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses.Key Results: The proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties: Q1, 93.3 % [92.6-93.7 %]; Q4, 93.1 % [92.9-93.2 %]) and self-reported health status (Q1, 37.1 % [36.9-37.7 %]; Q4, 38.2 % [37.2-38.4 %]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7 % [89.2-91.1 %]; Q4, 94.5 % [94.4-94.8 %]).Conclusions: Substantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care. [ABSTRACT FROM AUTHOR]

The article discusses the role of the American College of Gastroenterology (ACG) in American Board of Internal Medicine (ABIM) recertification in gastroenterology. An ACG representative sits on the Liaison Committee for Recertification at the ABIM to advocate for the group's specialty needs in the recertification process. The representation has allowed ACG to stay abreast of ABIM initiatives, prepare the approved self-assessment module, obtain credit, and develop the online and Web-based module

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation's examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine-Anne Fadiman's The Spirit Catches You And You Fall Down. [ABSTRACT FROM AUTHOR]

The article presents several papers and people who gave headlines in the Biomedicine sector in the U.S. Science journalist Simon Singh was sued by the British Chiropractic Association who wrote for the "Guardian" that questioned practices endorsed by the organization. 20,000 applications were received by the National Health Institute for Challenge Grants. British-born Simone Davis refused to be immunized with Gardasil from Merck & Co. Inc., and threatened with deportation.

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The incorporation of 'culture' into U.S. biomedicine has been increasing at a rapid pace over the last several decades. Advocates for 'cultural competence' point to changing patient demographics and growing health disparities as they call for improved educational efforts that train health providers to care for patients from a variety of backgrounds. Medical anthropologists have long been critical of the approach to 'culture' that emerges in cultural competence efforts, identifying an essentialized, static notion of culture that is conflated with racial and ethnic categories and seen to exist primarily among exotic 'Others.' With this approach, culture can become a 'list of traits' associated with various racial and ethnic groups that must be mastered by health providers and applied to patients as necessary. This article uses an ethnographic examination of cultural competence training to highlight recent efforts to develop more nuanced approaches to teaching culture. I argue that much of contemporary cultural competence education has rejected the 'list of traits' approach and instead aims to produce a new kind of health provider who is 'open-minded,' willing to learn about difference, and treats each patient as an individual. This shift, however, can ultimately reinforce behavioral understandings of culture and draw attention away from the social conditions and power differentials that underlie health inequalities. [ABSTRACT FROM AUTHOR]

Background: A shortage of primary care physicians is expected, due in part to decreasing numbers of physicians entering general internal medicine (GIM). Practicing general internists may contribute to the shortage by leaving internal medicine (IM) for other careers in and out of medicine.Objective: To better understand mid-career attrition in IM.Design and Participants: Mail survey to a national sample of internists originally certified by the American Board of Internal Medicine in GIM or an IM subspecialty during the years 1990 to 1995.Main Measures: Self-reported current status as working in IM, working in another medical or non-medical field, not currently working but plan to return, or retired; and career satisfaction.Key Results: Nine percent of all internists in the 1990-1995 certification cohorts and a significantly larger proportion of general internists (17%) than IM subspecialists [(4%) P < 0.001] had left IM at mid career. A significantly lower proportion of general internists (70%) than IM subspecialists [(77%) (P < 0.008)] were satisfied with their career. The proportion of general internists who had left IM in 2006 (19%) was not significantly different from the 21% who left in 2004 (P = 0.45). The proportion of general internists who left IM was not significantly different in earlier (1990-92; 19%) versus later (1993-95; 15%) certification cohorts (P = 0.15).Conclusions: About one in six general internists leave IM by mid-career compared to one in 25 IM subspecialists. Although research finds that doctors leave medicine because of dissatisfaction, this study was inconclusive about whether general internists left IM in greater proportion than IM subspecialists for this reason. A more likely explanation is that GIM serves as a stepping stone to careers outside of IM. [ABSTRACT FROM AUTHOR]

Background: As with new laparoscopic techniques, the ability to convince surgeons and gastroenterologists to embrace endolumenal techniques and the additional training required to perform the new procedures will correlate with how rapidly endolumenal therapies are adopted. The authors measured their ability to change attitudes among surgeons, who may or may not perform endoscopy as a part of their practice, toward endolumenal therapies.Methods: As part of the endoluminal therapy postgraduate course presented at the annual Society of American Gastrointestinal Endoscopic Surgeons (SAGES) meeting in Ft. Lauderdale, Florida 2005, experts presented current literature and data on new endolumenal techniques. The participants, primarily of surgeons, were polled electronically about a number of case scenarios before and after their presentation. Each scenario was relevant to the topic presented and chosen to reflect potentially controversial disease processes with traditional or endolumenal treatment options. The responses were collected in real time and displayed to course participants.Results: A panel of 10 experts presented data on a range of endolumenal therapies including endolumenal treatment for gastroesophageal reflux disease (GERD), endoscopic stenting, endoscopic treatments in bariatric surgery, intraoperative endoscopy, endoscopic mucosal resection (EMR), transanal endoscopic microsurgery (TEM), mucosal ablation for Barrett's esophagus, intralumenal resection, translumenal endoscopic surgery, and how to educate surgeons in new endolumenal techniques. Demographic data showed that 83.6% of the participants performed endoscopy as part of their practice. A comparison with traditional surgical options showed a statistically significant positive attitude change (p < 0.05) toward adoption of most endolumenal techniques after expert presentation. Only EMR and TEM did not show a statistically significant change in the participants' willingness to adopt these techniques. There was no significant change in the attitudes of how best to train surgeons. After presentation of the training options, 76% of the respondents believed that these techniques should be taught in residency.Conclusions: The education of surgeons in new endolumenal therapeutic techniques can have a significant impact in terms of changing practice attitudes and may accelerate adoption of new endoscopic techniques. [ABSTRACT FROM AUTHOR]

BACKGROUND: International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase. OBJECTIVE: To describe the historical trends and compare the characteristics of IMGs to United States medical graduates (USMGs) in the United States. DESIGN: Longitudinal analysis of the American Medical Association Physicians' Professional Data (AMA-PPD) database using the 1978-2004 files and a comparative analysis of the characteristics of a random sample of 1,000 IMGs and a random sample of 1,000 USMGs using the 2004 file. MEASUREMENTS: Historical trends and characteristics of IMGs in the United States. RESULTS: Over the last 26 years, the number of IMGs in the United States grew by 4,873 per year reaching a total of 215,576 in 2004, about 2.4 times its size in 1978. The proportion of IMGs increased 0.12% per year, from 22.2% in 1978 to 25.6% in 2004. In 2004, compared with USMGs, IMGs were older, less likely to be board certified [Odds ratio (OR), 0.68: 95% CI, 0.53 to 0.86], less likely to work in group practice (OR, 0.60; 95% CI, 0.37 to 0.98), more likely to have Internal Medicine as practice specialty (OR, 2.10; 95% CI, 1.62 to 2.71) and more likely to be residents (OR, 1.52; 95% CI, 1.07 to 2.16). CONCLUSIONS: Over the last quarter century. the IMGs provided a significant and steady supply for the United States physician workforce that continues to grow. Policymakers should consider the consequences for both the United States and source countries. [ABSTRACT FROM AUTHOR]

Introduction: Few curricula train medical students to engage in health system reform.Aim: To develop physician activists by teaching medical students the skills necessary to advocate for socially equitable health policies in the U.S. health system.Setting: Montefiore Medical Center, the University Hospital of the Albert Einstein College of Medicine, Bronx, NY.Program Description: We designed a 1-month curriculum in research-based health activism to develop physician activists. The annual curriculum includes a student project and 4 course sections;health policy, research methods, advocacy, and physician activists as role models; taught by core faculty and volunteers from academic institutions, government, and nongovernmental organizations.Program Evaluation: From 2002 to 2005, 47 students from across the country have participated. Students reported improved capabilities to generate a research question, design a research proposal,and create an advocacy plan.Discussion: Our curriculum demonstrates a model for training physician activists to engage in health systems reform. [ABSTRACT FROM AUTHOR]

The article focuses on nuclear energy in biomedicine in relation to the U.S. Atomic Energy Commission's Radioisotope Program from 1946-1950. One of the major results of the physicists' war for life science,was the adoption of radioisotopes as tools of biomedical research. However, isotopes were not very successful in the treatment of cancer and other medical diagnostics. Biologists then got better equipped with new tools to trace molecular transformations by reactor-generated radioisotopes.

BACKGROUND: Work hour regulations for house staff were intended in part to improve resident clinical and educational performance. OBJECTIVE: To characterize the effect of work hour regulation on internal medicine resident inpatient clinical experience and didactic education. DESIGN: Cross-sectional mall survey. PARTICIPANTS: Chief residents at all accredited U.S. internal medicine residency, programs outside New York. MEASUREMENTS AND MAIN RESULTS: The response rate was 62% (202/324). Most programs (72%) reported no change in average patient load per intern after work hour regulation. Many programs (48%) redistributed house staff admissions through the call cycle. The number of admissions per intern on long can (the day interns have the most admitting responsibility) decreased in 31% of programs, and the number of admissions on other days increased in 21% of programs. Residents on outpatient rotations were given new ward responsibilities in 36% of programs. Third-year resident ward and float time increased in 34% of programs, while third-year elective time decreased in 22% of programs. The mean weekly hours allotted to educational activities did not change significantly (12.7 vs 12.4. P=. 12). but 56% of programs reported a decrease in intern attendance at educational activities. CONCLUSIONS: In response to work hour regulation, many internal medicine programs redistributed rather than reduced residents' inpatient clinical experience. Hours allotted to educational activities did not change: however, most programs saw a decrease in intern attendance at conferences, and many reduced third-year elective time. [ABSTRACT FROM AUTHOR]

Accreditation organizations such as the Liaison Committee for Medical Education (LCME), the Royal College of Physicians and Surgeons of Canada (RCPSC), and the Accreditation Council for Graduate Medical Education (ACGME) are charged with the difficult task of evaluating the educational quality of medical education programs in North America. Traditionally accreditation includes a more quantitative rather than qualitative judgment of the educational facilities, resources and teaching provided by the programs. The focus is on the educational process but the contributions of these to the outcomes are not at all clear. As medical education moves toward outcome-based education related to a broad and context-based concept of competence, the accreditation paradigm should change accordingly. [ABSTRACT FROM AUTHOR]

In the rich history of modern pharmaceutical advertising in the United States, few medical objects have been as controversial as contraceptives. Condemned in the 1870s as lascivious devices whose commercial visibility would tarnish female sexual purity, contraceptives have in the late twentieth century been repackaged by pharmaceutical companies as the smart, progressive, and fashion-conscious woman's ally. This article explores evolving perspectives on the place of birth control in public spaces from the mid-nineteenth century to the present. In so doing, it elucidates the changes and continuities in the long and contested history of marketing, medicine, sexuality, and reproductive control. [ABSTRACT FROM AUTHOR]

The article reports on the series of state-of-the-art (SOTA) conferences by the Veterans Health Administration (VHA). It is noted that the VHA SOTA concentrate on the improvement of the health care system in the U.S. The conferences, which include participants from North America, disseminated manuals containing clinical information.

Background: The persistence of a large quality gap between what we know about how to produce high quality clinical care and what the public receives has prompted interest in developing more effective methods to get evidence into practice. Implementation research aims to supply such methods.Purpose: This article proposes a set of recommendations aimed at establishing a common understanding of what implementation research is, and how to foster its development.Methods: We developed the recommendations in the context of a translation research conference hosted by the VA for VA and non-VA health services researchers.Impacts: Health care organizations, journals, researchers and academic institutions can use these recommendations to advance the field of implementation science and thus increase the impact of clinical and health services research on the health and health care of the public. [ABSTRACT FROM AUTHOR]

General internal medicine (GIM) has flourished in the United States (U.S.). Unlike other subspecialties of internal medicine, however, GIM's evolution has not been global in scope, but rather appears to have occurred in isolation within countries. Here, we describe international models of GIM from Canada, Switzerland, Australia/New Zealand, Argentina, and Japan, and compare these with the U.S. model. There are notable differences in the typical clinical roles assumed by General Internists across these 7 countries, but also important overlap in clinical and academic domains. Despite this overlap, there has been a relative lack of contact among General Internists from these and other countries at a truly international GIM meeting; the time is now for increased international exchange and the ‘globalization’ of GIM. [ABSTRACT FROM AUTHOR]

Features several symposia on quality of life and medicine in the U.S. in 2005. Range of issues and subject matter discussed by the symposia; Keynote speakers; Implications for studies of quality of life and medicine.

The jurors identified numerous problems with end of life in the ICU including variability in practice, inadequate predictive models for death, elusive knowledge of patient preferences, poor communication between staff and surrogates, insufficient or absent training of health-care providers, the use of imprecise and insensitive terminology, and incomplete documentation in the medical records. The jury strongly recommends that research be conducted to improve end-of-life care. The jury advocates a "shared" approach to end-of-life decision-making involving the caregiver team and patient surrogates. Respect for patient autonomy and the intention to honour decisions to decline unwanted treatments should be conveyed to the family. The process is one of negotiation, and the outcome will be determined by the personalities and beliefs of the participants. Ultimately, it is the attending physician's responsibility, as leader of the health-care team, to decide on the reasonableness of the planned action. In the event of conflict, the ICU team may agree to continue support for a predetermined time. Most conflicts can be resolved. If the conflict persists, however, an ethics consultation may be helpful. Nurses must be involved in the process. The patient must be assured of a pain-free death. The jury of the Consensus Conference subscribes to the moral and legal principles that prohibit administering treatments specifically designed to hasten death. The patient must be given sufficient analgesia to alleviate pain and distress; if such analgesia hastens death, this "double effect" should not detract from the primary aim to ensure comfort. [ABSTRACT FROM AUTHOR]

The article presents information on abstracts of the "Triannual Meeting of the European Federation of Conservative Dentistry," and "Annual Meeting of the German Society for Conservative Dentistry," held together under "ConsEuro2003," during June 5 -7, 2003, in Munich, Germany. The "ConsEuro2003," was opened with two precongress symposia about endodontics and ceramics, followed by a half-day session about clinical aspects of bleaching and long-term results. One of the main topics was minimally invasive therapy, cavity preparation and prevention, in which new preparation systems as well as chemomechanical removal of caries were discussed by speakers from Switzerland, Germany, Sweden, France and the United States.

Background: Although laparoscopic surgery has become widespread during the past decade, no systematic study of the training needs exists. To obtain guidance for planning, we analyzed the national resident operative experience during the past 8 years.Methods: The laparoscopic experiences of all surgical residents graduating between 1994 and 2001 were subjected to regression analysis. The laparoscopic volume of each trainee and change in ratio of laparoscopic/open operation over time were used to estimate the growth of individual laparoscopic operations in training programs.Results: Laparoscopic surgery constituted only 5.7% of a trainee's total surgical experience in 1994, but comprised 13% by 2001. A resident completing training in 1994 performed 53 laparoscopic operations, of which 79% (42) were cholecystectomies. By 2001, a graduate performed 126 laparoscopic operations, of which 68% (86) were cholecystectomies. During the interim, most laparoscopic operations exhibited growth. Trainee experience in some newer operations has also increased steadily but at a much slower rate.Conclusions: This descriptive statistical survey of training experience yields a comprehensive picture of the laparoscopic capability of the young surgeon. The growth potential of some newer operations has also been measured. Using these data, guidelines can be drawn as to which operation programs should focus resources on training residents. Since competence depends on exposure, residency training alone may not provide sufficient depth to allow recent graduates to perform the newer operations independently. [ABSTRACT FROM AUTHOR]

Policy is "essentially an ordering of priorities." Policy research purports to contribute to the ordering. Science policy researchers who so choose can cast aside their naivete and plunge into the world of bio-medicine. The choices, however, do not end there. For the sociologist of science who simply seeks to understand the effects of biomedical research Policy in the United States on the development of research. Such choices must necessarily be made prior to the assessment of empirical study itself. The choices of sociologists of science, however, have been virtually unanimous—keep the distance and adopt a framework that is socially impeccable—attentive to organizational structures, institutionalization, and the ethos of science—but impervious to intellectual content. Another choice, one that sociologists have spurned or avoided altogether, namely, the use of the structure of argumentation of a field to scrutinize the efficacy of its policies and their relation to the social setting of new research priorities, seems to be more realistic and helpful for the scientist and policy-maker.

Since the terms of the health policy debate in the United States and Canada are largely supplied by biomedicine, the current “crisis” in health care is, in part, a product of biomedical rhetoric. In this essay, three metaphors widely identified as being associated with biomedicine— the body is a machine, medicine is war, and medicine is a business—are examined with a view to the ways in which they influence the health policy debate, not only with respect to outcomes, but also with respect to what can be argued at all. The essay proposes that biomedical language itself be foregrounded as the constitutive material of public discourse on health policy. [ABSTRACT FROM AUTHOR]

The article reports on the failure of the second phase trial of the V520 HIV vaccine developed by Merck & Co. Inc. in the U.S. According to the author, the failure provides a destructing effect to the AIDS community which makes the patients that use the vaccine more susceptible to the disease and increases its immunity of cold viruses. In addition, the trial was specifically designed to animals that have low Ad5 level of immunity, but, its limitation was eliminated by its researchers when the outcome of the study reveals that it has higher tolerability. A table is presented that lists the alternative vector development, including the vector assays and types, trial status and its funders.

The article offers medical news briefs in the U.S. The increased funding of the government on stem cell technology research. Abraham Lincoln Center of Life LLC in Texas was considered the first commercial entity in the country that has produced embryos in advance for future use by unspecified recipients. Organ donor networks has able to supply human uteri for potential transplantation.

Reports developments in the field of medicine in the U.S. Success of a Phase III trial of Merck's vaccine for cervical cancer; Recognition of the recipient of the Nobel Prize in Chemistry for discovering a reaction that formed the way organic molecules are made; Launch of tests that can predict likely positive responders to Iressa and Tarceva for lung cancer by Genzyme Corp.

Presents comments on articles of the 'Journal of General Internal Medicine'. Criticisms on the views of authors about normative guidelines in improving end-of-life care; Acceptance on the limitations of traditional methodologies; Improvement of communication in advance care planning.

This article focuses on the need to control misconduct in medicine in the U.S. A perceived failure on the part of the medical profession to police itself has in recent years provoked legislative action on a number of fronts intended to increase the accountability and responsibilities of individual medical practitioners, health care institutions and related licensing boards and professional societies. Because such measures may affect the self-regulatory efforts of other professions, they were recently reported and reviewed by Amy Crumpton in the Professional Ethics Report, a newsletter of the American Association for the Advancement of Science. Many states--and now the federal government--have either enacted or strengthened reporting laws or are considering proposals to do so. The Medicare and Medicaid Patient and Program Protection Act of 1987 also provides for more stringent action against misconduct on the part of health care practitioners.