Gender is a significant determinant of health, yet the choice of topic for research, as well as the methodology, analysis, and interpretation, are often insensitive to the biologic, psychologic, social, economic, and cultural differences between men and women. Family medicine researchers could study a broad range of gender-related topics; such research could lead to improved family medicine. PMID:21229035
Green, Larry A.
This article characterizes the large research domain of family medicine. It is a domain that can be productively explored from different perspectives, including: (1) the ecology of medical care and its focus on the environments of health care and interactions among them; (2) the realm of causation and important opportunities to discover how people lose and regain their health; (3) knowing medicine in different ways, focusing on what things mean in the inner and outer realities of individuals and groups of individuals; (4) the nature of the work of family physicians, such as first-contact care for any type of problem, sticking with patients regardless of their diagnoses, incorporating context into decision making, development of relevant technologies, articulating useful theory, and measuring what happens in family medicine; (5) the standard research categories of basic, clinical, health services, health policy, and educational research; and (6) thinking of family medicine research as both a linear process of translation and a wheel of knowledge with iterative loops of discovery that come from within family medicine. The domain of family medicine research is important and ripe for fuller discovery, and it invites the thinking and imagination of the best investigators. It seems unlikely that medical research can ever be complete without a robust family medicine research enterprise. As the domain of family medicine research is explored, not a few, but billions of people will benefit. PMID:15655084
Wender, Richard C
National Institutes of Health (NIH) funding has contributed to improvements in the health of the nation, but the pace of progress, particularly in the war on cancer, has been frustratingly slow. Departments of family medicine receive less NIH funding than all other specialties. Although numerous factors contribute to low family medicine funding levels, persistent undervaluing of primary care plays a paramount role. Fueled by the harsh reality that our nation's health is unconscionably poor, we are entering a new era in our nation's research enterprise, a virtual research revolution. The 3 components of this revolution are the NIH roadmap, personalized medicine, and the Clinical and Translational Science Awards. Each of these elements will contribute to a growing emphasis on translational research. Translational research demands formation of innovative structures in academic health centers (AHCs) to enable them to address questions of vital relevance to improving public health. Service research, funded by the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and foundations, defines a new approach to research with high potential to improve the health of communities. To be a part of the research revolution, departments must rely on senior researchers to secure funding and provide mentorship for junior investigators. Junior investigators must relentlessly pursue answers to questions of direct relevance to improving health. Finally, department chairs have the obligation to identify research mentors, find ways to fund research gaps, and create a culture of scholarship and investigation. Advocating for AHCs to commit to improving the health of the regions they serve can have a substantial impact on the types of questions that centers choose to study and, ultimately, on the health of the communities they serve.
Talbot, Y. R.; Rosser, W. W.
PROBLEM BEING ADDRESSED: Research is not new to family medicine, yet it is pursued less than in other clinical disciplines. We need to establish a critical mass of family medicine researchers. OBJECTIVE OF PROGRAM: To establish a departmental research organization using a strategy implemented in 1995 by the Department of Family and Community Medicine at the University of Toronto. MAIN COMPONENTS OF PROGRAM: We set out to establish a critical mass of researchers. Applicants were required to complete credible and feasible 3- to 5-year research plans and to have formal support from their clinical chiefs. Once selected, researchers were supported for 40% of their time. Support was provided for 3 years and was renewable according to progress on their research plans. Researchers were expected to publish on average two papers yearly and be involved as principal investigator or co-principal investigator on at least one successful grant after the first 3 years. Since implementation in 1996, funded researchers have become principal investigators in 80% of the grants in which they are involved compared with 20% before the support program. Nine of 15 Medical Research Council grants held by family physicians in Canada have department members as principal investigators. Faculty-supported researchers contributed more than 200 peer-reviewed publications to the literature between 1996 and 2000. CONCLUSION: Four years of experience allows for early assessment of the first step taken to build a thriving family medicine research organization using limited departmental resources. PMID:11421055
Lin, Yi-Hsuan; Tseng, Yen-Han; Chang, Hsiao-Ting; Lin, Ming-Hwai; Tseng, Yen-Chiang; Chen, Tzeng-Ji; Hwang, Shinn-Jang
The family medicine researches flourished worldwide in the past decade. However, the collaborative patterns of family medicine publications had not been reported. Our study analyzed the collaborative activity of family medicine researchers in Taiwan. We focused on the types of collaboration among disciplines, institutions and countries. We searched "family medicine" AND "Taiwan" in address field from Web of Science and documented the disciplines, institutions and countries of all authors. We analyzed the collaborative patterns of family medicine researchers in Taiwan from 2010 to 2014. The journal's impact factor of each article in the same publication year was also retrieved. Among 1,217 articles from 2010 to 2014, interdisciplinary collaboration existed in 1,185 (97.3%) articles, interinstitutional in 1,012 (83.2%) and international in 142 (11.7%). Public health was the most common collaborative discipline. All international researches were also interdisciplinary and interinstitutional. The United States (75 articles), the United Kingdom (21) and the People's Republic of China (20) were the top three countries with which family medicine researchers in Taiwan had collaborated. We found a high degree of interdisciplinary and interinstitutional collaboration of family medicine researches in Taiwan. However, the collaboration of family medicine researchers in Taiwan with family medicine colleagues of other domestic or foreign institutions was insufficient. The future direction of family medicine studies could focus on the promotion of communication among family medicine researchers.
Slade, Steve; Ross, Shelley; Lawrence, Kathrine; Archibald, Douglas; Mackay, Maria Palacios; Oandasan, Ivy F.
Abstract Objective To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. Design Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. Setting Canada. Participants All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. Main outcome measures Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. Results The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. Conclusion New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS–Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of
Talbot, Yves R.; Tannenbaum, David
Teaching about the family has become an important part of the family medicine curriculum. The family orientation index, a 39-item questionnaire, was designed to evaluate the family orientation of services and care provided as well as the teaching and research. The questionnaire was distributed to 55 program directors at 16 Canadian universities. The response rate was 84%. The results indicate that the family orientation of services is less than optimal. PMID:21233938
Abdulmajeed, Abdulmajeed A.; Ismail, Mosleh A.; Nour-Eldein, Hebatallah
Background: Research in family medicine (FM) provides an important contribution to its discipline. Family medicine research can contribute to many areas of primary care, ranging from the early diagnosis to equitable health care. Publication productivity is important in academic settings as a marker for career advancement. Objective: To describe the publications by family medicine researcher authors between 1992 and 2013. Materials and Methods: All full text, original articles published by family medicine researcher; author with affiliation to the Suez Canal University were collected using the internet and hand search. The journals that published for family medicine researcher authors were identified. Author characteristics were described. The trend of publications was described. All articles were analyzed for their characteristics, including the themes and study designs according to predefined criteria. Results: Along 22 years, 149 research articles were published by 48 family medicine authors in 39 medical journals. The largest category in publications was related to Family physician/Health service (FP-HS, n = 52 articles), followed by ‘Patient’ category (n = 42). All the studies were quantitative; the largest group was represented by cross-sectional studies (76.5%). Conclusions: The publication productivity by family medicine researchers are going to be increased. FP-HS and patient topics were mostly addressed in publications. Cross-sectional studies exceeded any other designs. There is need to put more emphasis on intervention studies. Continuous assessment and improvement of FM research production and publication is recommended. PMID:25657945
Protecting participants in family medicine research: a consensus statement on improving research integrity and participants' safety in educational research, community-based participatory research, and practice network research.
Hueston, William J; Mainous, Arch G; Weiss, Barry D; Macaulay, Ann C; Hickner, John; Sherwood, Roger A
Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.
Klein, Douglas; Schipper, Shirley
PROBLEM ADDRESSED The Family Medicine Residency Program at the University of Alberta has used academic sessions and clinical-based teaching to prepare residents for private practice. Before the new curriculum, academic sessions were large group lectures given by specialists. These sessions lacked consistent quality, structured topics, and organization. OBJECTIVE OF PROGRAM The program was designed to improve the quality and consistency of academic sessions by creating a new curriculum. The goals for the new curriculum included improved organizational structure, improved satisfaction from the participants, improved resident knowledge and confidence in key areas of family medicine, and improved performance on licensing examinations. PROGRAM DESCRIPTION The new curriculum is faculty guided but resident organized. Twenty-three core topics in family medicine are covered during a 2-year rotating curriculum. Several small group activities, including problem-based learning modules, journal club, and examination preparation sessions, complement larger didactic sessions. A multiple-source evaluation process is an essential component of this new program. CONCLUSION The new academic curriculum for family medicine residents is based on a variety of learning styles and is consistent with the principles of adult learning theory. This structured curriculum provides a good basis for further development. Other programs across the country might want to incorporate these ideas into their current programming. PMID:18272637
Family Medicine first formally confronted systems thinking with the adoption of the biopsychosocial model for understanding disease in a holistic manner; this is a description of a natural system. More recently, Family Medicine has been consciously engaged in developing itself as a system for delivering health care, an artificial system. We make…
Thomas, Santosh Lional
Family Medicine in Singapore has its roots in a generalist ethos and found its origin as a counter culture movement to the increasing sub-specialisation of medicine which resulted in a complex healthcare system where that patients are often cared for by multiple specialists potentially resulting in fragmentation of care. The aim of the discipline of Family Medicine was to train and develop more generalist physicians so as to promote holistic care. Family physicians are the largest pool of generalists who are trained to provide general medical care to patients in the context of the person, the family and the community that they live in. PMID:24479066
Reflecting on the suicide of a close friend, this essay explores what comprises, and inspires a will to live, and how those in Family Medicine can address suicide risk even in the face of debilitating or terminal illness. Research indicates that the will to live is a measurable indicator of general well-being, distinct from depression, and an important predictor of a person's motivation to "hold on to life". As such, understanding what is at the heart of a desire to live should alter clinical practice. This essay offers ideas for ways in which to create bridges for patients that could help sustain life.
Renegar, G; Rieser, P; Manasco, P
Rapid changes in the science and technology related to genetic research are challenging scientists, health care providers, ethicists, regulators, patient groups, and the pharmaceutical industry to keep pace with ethically grounded, workable guidelines for both the research and clinical applications of human genetics. We describe the genetic research being conducted by one pharmaceutical company (GlaxoSmithKline) and how the company is addressing the ethical, legal, and social issues surrounding this research; discuss an industry working group's attempt to advance pharmacogenetic research by openly addressing and disseminating information on related ethical, legal, and regulatory issues; identify scientific and ethical differences among various types of genetic research; discuss potential implications of family consent on subject privacy and autonomy, data collection, and study conduct; and suggest points to consider when study sponsors, investigators, and ethics committees evaluate research proposals. Public and expert opinion regarding informed consent in genetic research is evolving as a result of increased education, discussion, and understanding of the relevant issues. Five years ago, there was strong support for anonymity in genetic research as a privacy safeguard. Now, an increasingly popular school of thought advocates against anonymity to preserve an individual's ability to withdraw and, if desired, access research results. It is important to recognize this evolution and address consent issues in a reasoned, practical, and consistent way, including input from patients and their families, health care providers, ethicists, scientists, regulatory bodies, research sponsors, and the lay community. Responsibility for assessing issues related to family consent for research should remain with local investigators, ethics boards, and study sponsors. A "one-size-fits-all" perspective in the form of new regulations, for example, would likely be a disservice to all.
Bischoff, Thomas; Junod, Michel; Cornuz, Jacques; Herzig, Lilli; Bonvin, Raphael
The Faculty of Biology and Medicine of Lausanne has integrated education of family medicine all along its new undergraduate medical curriculum. The Institute of general medicine is in charge to implement those offers among which two are presented hereafter. In the new module "Generalism" several courses cover the specificities of the discipline as for example medical decision in the practice. A mandatory one-month internship in the medical practice offers an experiential immersion into family medicine for all students. In a meeting at the end of their internship, students discuss in group with their peers their individual experiences and are asked to identify, based on their personal experience, the general concepts of the specialty of family medicine and general practice.
Hennen, Brian K. E.
In order for any discipline to remain current, and therefore to grow, it must constantly be aware of its own definition. From this definition will come the need for constant revision, exclusion of outdated or inappropriate material and inclusion of new knowledge. This article examines the principles by which family medicine can perform these functions. PMID:21301583
Talbot, Yves; Batty, Helen; Rosser, Walter W.
PROBLEM ADDRESSED Many faculty development programs are thought time-consuming and inaccessible to academic family physicians or physicians wanting to move into academic positions. This is largely due to difficulty in leaving their practices for extended periods. Canadian family medicine needs trained leaders who can work in teams and are well grounded in the principles of their discipline as they relate to education, management, research, and policy making. OBJECTIVE OF PROGRAM To develop a team of leaders in family medicine. MAIN COMPONENTS OF PROGRAM The Five Weekend National Family Medicine Fellowship Program focuses on the essentials of education, management, communication, critical appraisal skills, and the principles of family medicine to develop leadership and team-building skills for faculty and community-based family physicians entering academic careers. This unique 1-year program combines intensive weekend seminars with small-group projects between weekends. It emphasizes a broader set of skills than just teaching, has regional representation, and focuses on leadership and teamwork using a time-efficient format. CONCLUSION The program has graduated 34 Fellows over the last 3 years. More than 90% of the 35 projects developed through course work have been presented in national or provincial peer-reviewed settings. Quantitative ratings of program structure, course content, and course outcomes have been positive. PMID:9426934
van Royen, Paul; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri E J H; Topsever, Pinar; Ungan, Mehmet; Hummers-Pradier, Eva
The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and highlights related needs and implications for future research and policy. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In three subsequent, articles the results for the six core competencies of the European Definition of GP/FM were presented. This article formulates the common aims for further research and appropriate research methodologies, based on the missing evidence and research gaps identified form the comprehensive literature review. In addition, implications of this research agenda for general practitioners/family doctors, researchers, research organizations, patients and policy makers are presented. The concept of six core competencies should be abandoned in favour of a model with four dimensions, including clinical, person related, community oriented and management aspects. Future research and policy should consider more the involvement and rights of patients; more attention should be given to how new treatments or technologies are effectively translated into routine patient care, in particular primary care. There is a need for a European ethics board. The promotion of GP/FM research demands a good infrastructure in each country, including access to literature and databases, appropriate funding and training possibilities.
Labrecque, Michel; Ratté, Stéphane; Frémont, Pierre; Cauchon, Michel; Ouellet, Jérôme; Hogg, William; McGowan, Jessie; Gagnon, Marie-Pierre; Njoya, Merlin; Légaré, France
Abstract Objective To compare the ability of users of 2 medical search engines, InfoClinique and the Trip database, to provide correct answers to clinical questions and to explore the perceived effects of the tools on the clinical decision-making process. Design Randomized trial. Setting Three family medicine units of the family medicine program of the Faculty of Medicine at Laval University in Quebec city, Que. Participants Fifteen second-year family medicine residents. Intervention Residents generated 30 structured questions about therapy or preventive treatment (2 questions per resident) based on clinical encounters. Using an Internet platform designed for the trial, each resident answered 20 of these questions (their own 2, plus 18 of the questions formulated by other residents, selected randomly) before and after searching for information with 1 of the 2 search engines. For each question, 5 residents were randomly assigned to begin their search with InfoClinique and 5 with the Trip database. Main outcome measures The ability of residents to provide correct answers to clinical questions using the search engines, as determined by third-party evaluation. After answering each question, participants completed a questionnaire to assess their perception of the engine’s effect on the decision-making process in clinical practice. Results Of 300 possible pairs of answers (1 answer before and 1 after the initial search), 254 (85%) were produced by 14 residents. Of these, 132 (52%) and 122 (48%) pairs of answers concerned questions that had been assigned an initial search with InfoClinique and the Trip database, respectively. Both engines produced an important and similar absolute increase in the proportion of correct answers after searching (26% to 62% for InfoClinique, for an increase of 36%; 24% to 63% for the Trip database, for an increase of 39%; P = .68). For all 30 clinical questions, at least 1 resident produced the correct answer after searching with either
Hirsh, Michael; Wootton, J.S.C.
Recruitment of physicians for rural communities is a continuing problem in Canada. Medical schools can be involved through preferential admission policies. Departments of family medicine across the country are including on-site training in rural communities and are seeking to improve their rural program curriculum. The McGill rural program is described from its origins to its present state. A rural coordinator oversees 12 sites at which both residents and students are trained. One site at Shawville, Que, is described from a rural physician's point of view. Imagesp2011-ap2012-ap2014-a PMID:21233945
Barata, Ana N.; Rigon, Sara
Objective: The global world of the 21st century has created communities and cultures that are interconnected, thanks to the development both in the field of transportation and technology. In this global intercultural community, future physicians, and even more so future general practitioners (GPs)/family physicians (FPs), need to be clinically competent and culturally sensitive and flexible in order to adapt to different social settings while delivering holistic care in multiethnic teams and environments with professionalism. As such, exchange programs are exceptional opportunities for international collaboration and the development of personal and professional competencies of these health care professionals. Materials and Methods: This article presents a review of the literature on the value of exchanges as well as the results of exchange programs with educational content that are aimed at junior GPs/FPs. Results: Exchange programs have been growing in popularity, especially among junior GPs/FPs. Since its launch in 2013, The “Family Medicine 360° (FM360°) program has been receiving up to 163 inquires till date, promoting global cooperation among the World Organization of family Doctors (WONCA)'s Young Doctors’ Movementd (YDMs). Conclusions: By participating in an exchange program, future GPs/FPs are given the chance to experience intercultural communication and peer collaboration. They also develop personal and professional skills and thus, actively contribute to the growth and development of primary care all over the world. PMID:26288763
Gardiner, Paula; Filippelli, Amanda C.; Lebensohn, Patricia; Bonakdar, Robert
Context Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. Objective The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate with an online survey tool, whether residency programs are implementing such competencies into their curriculum. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. Design A survey was distributed by the CAFM (Council of Academic Family Medicine) Educational Research Alliance to RDs via email. The survey was distributed to 431 RDs. Of those who received it, 212 responded for a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into residency curriculum. Results Forty-five percent of RDs were aware of the competencies. In term of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included: time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%), and financial resources (29%). Conclusions While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers preventing residencies to implementing the STFM CAM/IM competencies. PMID:24021471
One of the objectives of the Paediatric Regulation (EC) No 1901/2006, is to foster high quality ethical research on medicinal products to be used in children. To achieve this objective, the EMA is responsible for developing a European paediatric network of existing national and European networks and centres with specific expertise in research and clinical trials relating to paediatric medicines. The purpose of this article is to disseminate knowledge of the structure and goals of ENPR-EMA and to highlight the cultural and organizational difficulties for its implementation.Following the publication of research quality requirements, a set of recognition criteria, which have to be fulfilled to become a member of ENPR-EMA were agreed. So far, 32 networks and centres (of 62 identified networks) submitted self-assessment reports indicating whether or not they fulfill the agreed minimum criteria. Sixteen networks (26% of 62 identified networks) fulfilled all minimum criteria and became therefore members of ENPR-EMA. The Family Paediatricians Medicines for Children Research Network (FIMP-MCRN), established with the aim of developing competence, infrastructure, networking and education for paediatric clinical trials, became member of the ENPR-EMA responding satisfactorily to all the points of the self-assessment report.
Dumas, Michel; Preux, Pierre-Marie
In France, research in tropical medicine is carried out by the Institute for Research and Development (IRD), university-affiliated institutes, and other research organizations such as INSERM, CNRS and the Pasteur Institute. Currently, this research is highly fragmented and therefore inefficient. As a result, despite significant financial means, French research in this field is not sufficiently competitive. This research activity should be coordinated by creating a "federation ", that would 1) facilitate the sharing of material and human resources, thereby improving efficiency and resulting in cost savings; 2) valorize French research in tropical medicine and its expert know-how, thus favoring the nomination of French experts in large international research programs (French experts in tropical medicine are currently under-recognized); 3) attract young researchers from France and elsewhere; and 4) adapt to the ongoing demographic and economic evolution of tropical countries. The creation of a Federation of French researchers would also make research in tropical medicine more visible. The objectives to which it leads already must include 1) a better understanding of the priorities of countries in the southern hemisphere, taking into account the social, cultural and economic contexts and ensuring the consistency of current and future projects ; 2) strengthening of research networks in close and equal partnership with researchers in the southern hemisphere, with pooling of resources (scientific, human and material) to reach the critical mass required for major projects ; 3) promoting the emergence of centers of excellence for health research in tropical countries ; and 4) contributing more effectively to training, because there can be no training without research, and no research without training This consolidation will help to empower research in tropical medicine, as in other Western countries, and will allow France to recover the place it deserves. The specific
Švab, Igor; Allen, Justin; Žebiene, Egle; Petek Šter, Marija; Windak, Adam
Family medicine teachers require specific educational skills. A framework for their professional development is essential for future development of the discipline in Europe. EURACT developed a framework on educational expertise, and subsequently applied it in a curriculum of teaching-skills courses of various levels. The aim of this article is to describe the development of the teaching framework, and of an international three-level course programme for 'teaching-the-teachers'. Furthermore, we describe our experiences and lessons learned, in particular with regard to the level-three programme for proficient teachers, which was new. We conclude that it is possible to develop a theoretical framework of family medicine teaching expertise and to apply it in an international high-level educational programme for future experts in family medicine education. Research evidence of the usefulness of this approach is needed, and the threats for its further development into a sustainable activity are its high teacher/student ratio associated with relatively high costs and difficulties in recruiting suitable participants.
BACKGROUND Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. METHODS A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. RESULTS The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine’s basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies
Behavioral medicine brings knowledge and skills from the social sciences to the practice of medicine. Modifying behavior which causes a health problem, disease prevention and health promotion, improving the relationship between patients and health professionals, understanding cultural and ethical issues, and the effect of illness on behavior are all aspects of behavioral medicine. Such `whole person' medicine fits well into family practice. However, careful consideration of the risks, challenges, opportunities and responsibilities of behavioral medicine is necessary. Academic family physicians must conduct research and help develop educational programs that will prepare graduates to deal with frustrating health problems which are affected by behavior. A division of behavioral medicine eventually may be established in the University of British Columbia's Department of Family Practice. PMID:20469407
Sng, Judy; Lee, See Muah; Koh, David
Family medicine and occupational medicine share close similarities in their focus on disease prevention and health promotion. The opportunities for mutual learning and collaboration in patient care abound, with far-reaching implications on the standard of patient care that can be offered. Unfortunately, a gap exists between family medicine and occupational medicine in dayto- day practice as well as in continuing medical education. It is important that we actively seek to bridge this gap. The workforce constitutes a significant part of the population and thus the patient load of a typical primary healthcare practice. Moreover, with an ageing population and rising retirement age, we can expect that there will be an increasing number of health issues to be addressed among older working people. Both occupational and non-occupational factors are important in determining an individual's health. Thus, family physicians need to adequately understand occupational medicine and vice versa.
Rouleau, Katherine; Janakiram, Praseedha; Nicolle, Eileen; Godoy-Ruiz, Paula; Pakes, Barry N.
Abstract Problem addressed Despite the rapid emergence of global health training across North American universities, there remains a gap in educational programs focusing on the unique role of family medicine and primary care in global health. Objective of program The objective of the Global Health in Family Medicine Summer Primer, developed in 2013 by the Department of Family and Community Medicine at the University of Toronto in Ontario, is to strengthen global health competencies among family medicine residents and faculty. Program description The course covers the meaning of global health; global health ethics; the place of family medicine, primary care, and primary health care in the global health context; epidemiology; infectious diseases; the social determinants of health; and care of vulnerable populations locally and globally. The course is delivered in an intensive 5-day format with didactic lectures, group discussions, interactive workshops, and lived-experience panels. Conclusion The Global Health in Family Medicine Summer Primer has proven to be a successful educational initiative and provides valuable lessons learned for other academic science centres in developing global health training programs for family medicine residents and faculty. PMID:26380854
Saultz, John W
Reform of the payment and delivery systems in American health care is now being discussed at the highest levels of business and government. Family medicine educators, researchers, and program leaders have an opportunity to provide substantial leadership to this process in their own communities and nationally. To do so, they must reconsider the assumptions made in creating our current systems of practice and education, and this will require new leadership skills that focus on innovation and adaptability. It will also require a more aggressive willingness to test new ideas and a new scientific method to prove or disprove their value. This essay outlines essential elements of such leadership for those responsible for the education of future generations of family physicians.
Studies have demonstrated the links between the family system and illness, emphasizing the importance of prevention on a family level for physical as well as psychological illness. Brief preventive counselling on routine visits is possible if the physician knows the family well and understands the principles of the family as a system. Periods of high risk when illness and family dysfunction increase in incidence are the normal “crises” of the family life cycle, medical crises of illness, hospitalization and death, and non-medical crises. High-risk families should be identified; secondary prevention is an important role for the family physician who sees family problems at a much earlier stage than the psychiatrist or marital or family therapist. PMID:21289689
Walters, David J.
This paper documents the career choices of a graduating class of family medicine residents at Queen's University. In the first post-graduation year, residents were evenly divided between those who undertook a third year of training and those who began practice. For those who began practice, a profile of their first year of experience demonstrates the excellent variety of opportunities awaiting family medicine graduates. PMID:21293605
Leung, Fok-Han; Herold, Jodi; Iglar, Karl
Abstract Objective To report the results of a pilot in-training progress test, the Family Medicine Mandatory Assessment of Progress, taken by first- and second-year postgraduate family medicine trainees. Design Assessment of resident performance on a key-features approach multiple-choice progress test. Test questions were developed by competency content area experts. Setting University of Toronto in Ontario. Participants First- and second-year family medicine residents. Main outcome measures Construct validity was assessed based on performance on the test by first- and second-year residents, Canadian and international medical graduates, and residents with more or less than 1 month of relevant clinical experience. Results Pilot progress testing of family medicine residents (N = 255) at the University of Toronto revealed a significant 1.6% difference (P < .01) in mean scores between first- and second-year postgraduate family medicine trainees and achieved construct validity across many parameters studied. The agreement coefficients for residents being identified as the poorest performers ranged from 0.88 to 0.90 depending on the domain of practice assessed. Conclusion Competency-based progress testing using the key-features model is a valid means of assessing the progress of family medicine residents.
Eckstein, T E; Teitelbaum, H S
Well-rounded instruction in occupational medicine as part of family medicine residency training is feasible through a program that balances a longitudinal curriculum of monthly occupational and environmental medicine (OEM) lectures, community-based OEM patient care, and worksite assessment. Such training would help equip family medicine residents to integrate occupational medicine into their practices, which, in light of a shortage of board-certified practitioners in OEM, would help fill community needs. The Intern-Resident Training Committee of Carson City Hospital in rural Michigan established both learner and institutional goals and objectives for such a program of instruction. A learner-needs assessment found appreciable interest among the residents for occupational medicine training. In addition, results of a survey of the occupational health community suggested there is inadequate coverage of OEM in medical schools and residencies. Furthermore, a focus group of occupational health managers revealed that clarity of communication and standardization of reporting were paramount concerns. Instruments for standardized OEM history and for OEM case management were developed for use within the residency continuity clinic. The curriculum was implemented with a variety of teaching strategies, including worksite assessment. Practice-based, case-oriented instruction was subsequently phased into the program as residents assumed responsibility for managing cases under the supervision of family medicine preceptors knowledgeable in OEM. An occupational medicine rotation was developed that included focused clinical exposure to OEM patients and studies that would lead to eligibility for a certificate of additional qualification in occupational medicine. Learner evaluations included chart reviews and patient satisfaction surveys. Program evaluations included interviews with occupational health managers. The residents were judged by their preceptors to have performed well. The
Van Royen, Paul; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri E J H; Topsever, Pinar; Ungan, Mehmet; Hummers-Pradier, Eva
The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In a second article, the results for the two core competencies 'primary care management' and 'community orientation' were presented. This article reflects on the three core competencies, which deal with person related aspects of GP/FM, i.e. 'person centred care', 'comprehensive approach' and 'holistic approach'. Though there is an important body of opinion papers and (non-systematic) reviews, all person related aspects remain poorly defined and researched. Validated instruments to measure these competencies are lacking. Concerning patient-centredness, most research examined patient and doctor preferences and experiences. Studies on comprehensiveness mostly focus on prevention/care of specific diseases. For all domains, there has been limited research conducted on its implications or outcomes.
Between psychosomatic medicine and psychiatry, FSS (functional somatic syndromes) patients are often visiting a family doctor. For FSS, the role of family physicians is large, but the family physicians are not required for the role of diagnosis and treatment of FSS. Rather, appropriate referral to a specialist to exclude organic disease is important and a role as the coordinator is large to the patient to refuse a psychiatric consultation. To serve as a role for such coordination, a family physician has to response the patient's emotional side and focus on the construction of the doctor-patient relationship and response. I also think of structuralism medicine approach to describe disease from the meta-level as a new procedure to the patient. This approach consists of 4 components, 'entity', 'phenomenon', 'words', and 'I'. This may be a useful approach to family physicians who coordinate the overall for FSS patients' management.
To address the problems of recruitment and retention of family physicians in various remote locations in northern Saskatchewan, the University of Saskatchewan became involved through Northern Medical Services, a division of the Department of Family Medicine. The University's involvement consists of the provision of resident family-physician services, visiting consultant services, family-practise resident training, research, and a consulting role of the Medical Health Officer. This paper reviews the context in which this program was created, its role in health care in the area, and its involvement with the communities in health promotion and research. PMID:21253032
Varela-Rueda, Carlos E; Reyes-Morales, Hortensia; Albavera-Hernández, Cidronio; Ochoa-Díaz-López, Héctor; Gómez-Dantés, Héctor; García-Peña, Carmen
Analyzing the challenges and the future scenario of Family Medicine is a priority to address challenges such as the reduction of benefits granted by social security; to adapt their practice to the changing health profile; and to curb demand for specialized services and contain the high costs of care in the second and third level. The program is aimed at three professional roles: medical care, research, and education. It is imperative review these in the light of changing demographic conditions, the type of health needs arising from new social determinants, the public expectations for greater participation in their care, and the evolution of the health system itself with the advancement of technology and a variety of organizational options with frequently limited resources. For primary care, as the core of a health system that covers principles of equity, solidarity, universality, participation, decentralization, and intra- and inter-sectorial coordination, it is necessary to put at the center of the primary care team the family doctor and not an administrator, who plays an important role in supporting the care team, but can not take the lead.
This article attempts to define and demystify hypnosis and to present the range of its applications in family medicine. The author reviews definitions and describes hypnotic phenomena, suggestibility, and the use of suggestion, as well as traditional, semitraditional, and Ericksonian induction methods, precautions, and dangers. Clinical uses are then presented for the family physician to apply to surgery, obstetrics, pain treatment, psychosomatic disorders, and psychotherapy. Imagesp2076-a PMID:21221278
Arnold, E; Lane, S
Transfusion medicine research has traditionally employed quantitative methods to answer clinical research questions. Increasingly, qualitative research methods are being used in the field to address a wide variety of research questions in areas such as blood donation, transfusion practices and policy development. This article describes the key characteristics, methodologies and methods of qualitative research and draws on examples to show how qualitative research approaches have been applied in the field of transfusion medicine. It is hoped that this overview will inform and encourage the application of qualitative research in the field of transfusion medicine.
Liepman, Michael R., Ed.; And Others
This curriculum guide on substance abuse is intended for teachers of family medicine. Comments, learning objectives, teaching hints, and evaluations of knowledge are provided for each area in all chapters. Chapter 1 focuses on the pharmacology of commonly abused drugs including depressants, opioids, stimulants, hallucinogens, inhalants, and…
Winter, Robin O.
According to the American Board of Family Medicine, "The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity." What makes the seemingly daunting task of practicing family medicine possible is that family physicians learn to utilize similar clinical reasoning for all of their patients regardless of…
Gordon, J S
The seven categories of alternative medicine, as established by the National Institutes of Health Office of Alternative Medicine, are mind-body interventions, bioelectromagnetic therapies, alternative systems of medical practice, manual healing methods, pharmacologic and biologic treatments, herbal medicine, and diet and nutrition. Mind-body approaches have been shown to be effective in a variety of conditions. Acupuncture and homeopathy are alternative systems of medical practice that may be beneficial. Chiropractic manipulation for low back pain and infant message for enhancing growth are two methods of manual healing. While the literature on herbal medicine is vast, most of it focuses on a single approach for a specific condition. Traditional herbalists use a combination of herbs individualized for the specific person. As more and more people turn to alternative therapies, it is important for family physicians to be open to their patients' interest in alternative approaches.
Álvarez Montero, Santiago
Family medicine has to continually reinvent itself around a core of values that constitutes its navigation system. But accurate data on its impact on the health of people will account for how far the values are actually being implemented. Thus, we can say that family medicine is a specialty based on values and as well as evidence based. The absence of a clarification system of values or its implementation threatens its very existence. Some of the values that are reviewed have shown great recognition and survival over time. Others are presented because they seem sufficiently significant. These are: people, comprehensiveness, trust relationship, patient-centred method, accessibility, continuity, family unity and the community, teamwork, sustainability of the health system, and continuous improvement.
Zildzić, M; Masić, I; Hasanović, M; Beganlić, A; Tulumović, A; Herenda, S; Salihefendić, N
The subject of the family medicine on the medical faculties in Bosnia and Herzegovina existed from recently as a separate curiculum of the medical study. Until recently the contents of this discipline interpreted within the subject of the social medicine or the object of the primary healthcare protection, and programs of teaching were based mainly on Anglosaxon experiences. The fact is that some teachers of the medical faculty in Sarajevo had their own visions and programs of the family medicine which by years were tested in the units of the family healthcare protection in Sarajevo, Mostar, and Banja Luka, about what was published in our and foreign literature. New approach from the family medicine should be based on as follows: greater use of the standardized procedures for the improvement of the communication skills; revised educational procedure of all the participants 6 interdisciplinaryilly in the education of the family medicine; improvement of knowledge about methodlogy and the principles of the research; improvement of the techniques and knowledge about the maipulatin of the medical informations; development of the skills of the continued studying through the total working aga; to the development of the capability of the critical estimation of the own work important; by the defining of the important educational goals in the curriculum of the urgent medicine; to the development and use of the methods feed-back informations from the students; to the modernizing of the methods of the evaluation of the educational process-adopted knowledge and the attitudes and the carrying out of the practice of the patients, and the ethic values in that process. In this work the authors consider the stated experiences in the education from the subject family medicine at our faculties realting to the foreign, and suggest that new concept of the education on the basis of these experiences in the practice.
Le Reste, Jean Yves; Nabbe, Patrice; Rivet, Charles; Lygidakis, Charilaos; Doerr, Christa; Czachowski, Slawomir; Lingner, Heidrun; Argyriadou, Stella; Lazic, Djurdjica; Assenova, Radost; Hasaganic, Melida; Munoz, Miquel Angel; Thulesius, Hans; Le Floch, Bernard; Derriennic, Jeremy; Sowinska, Agnieska; Van Marwijk, Harm; Lietard, Claire; Van Royen, Paul
Background Multimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review. Objective To translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research. Method Forward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reached Results 229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved. Conclusion A comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care. PMID:25607642
Casado Vicente, Verónica; Bonal Pitz, Pablo; Cucalón Arenal, José Manuel; Serrano Ferrández, Elena; Suárez Gonzalez, Félix
Family and community medicine is an academic subject, a medical specialty and a health profession with distinct dimensions: healthcare, teaching, research and management. In this discipline, the object of knowledge is the person, understood as a whole. Family medicine, as an academic subject, and primary care, as a health education setting, should be incorporated into the core graduate and postgraduate curricula. The absence of these elements leads to training bias and has major repercussions on quality, coordination and patient safety. The development of the Health Professions Act and the construction of the European Higher Education Area (EHEA) have created a favorable climate for the presence of this discipline in the university. Since the 1960s, family medicine has been consolidated as an academic subject with its own departments in almost all European universities, and a significant number of family physicians are teachers. A balance has been achieved between the hospital-based system (based on theory, disease, and the biological model) and the patient-centred model (based on problem solving, community-oriented and the bio-psycho-social model). The introduction of family and community medicine as a specific subject, and as a transverse subject and as an option in practicals, represents the adaptation of the educational system to social needs. This adaptation also represents a convergence with other European countries and the various legal requirements protecting this convergence. However, this new situation requires a new structure (departments) and faculty (professors and associate and assistant professors).
McMurray, S. J.
High altitude medicine deals with a continuum of diseases ranging from a mild discomfort to serious ailments affecting all organ systems, including the lungs, brain, and eyes. Decreased oxygen tension is the primary cause. The main principles of prevention are staging and graded ascent to allow acclimatization. Adventure travel to high altitude destinations is becoming increasingly popular; family physicians should be informed of the medical problems associated with such travel. Images p712-a p715-a p716-a PMID:8199523
Alic, Alma; Pranjic, Nurka; Selmanovic, Senada; Alibasic, Esad; Alic, Fahrudin; Ramic, Enisa; Spahic-Sarajlic, Selvedina
ABSTRACT Goal: The aims are to establish the prevalence of newfound, unidentified cases of depressive disorder by screening with the Becks Depression scale; To establish a comparative relationship with self-identified cases of depression in the patients in the family medicine; To assess the significance of the BDI in screening practice of family medicine. Patients and methods: A prospective study was conducted anonymously by Beck's Depression scale (Beck Depression Questionnaire org.-BDI) and specially created short questionnaire. The study included 250 randomly selected patients (20-60 years), users of services in family medicine in “Dom Zdravlja” Zenica, and the final number of respondents with included in the study was 126 (51 male, 75 female; response or response rate 50.4%). Exclusion factor was previously diagnosed and treated mental disorder. Participation was voluntary and respondents acknowledge the validity of completing the questionnaire. BDI consists of 21 items. Answers to questions about symptoms were ranked according to the Likert type scale responses from 0-4 (from irrelevant to very much). Respondents expressed themselves on personal perception of depression, whether are or not depressed. Results: Depression was observed in 48% of patients compared to 31% in self estimate depression analyzed the questionnaires. The negative trend in the misrecognition of depression is -17% (48:31). Depression was significantly more frequent in unemployed compared to employed respondents (p=0.001). The leading symptom in both sexes is the perception of lost hope (59% of cases). Conclusion: All respondents in family medicine care in Zenica showed a high percentage of newly detected (17%) patients with previously unrecognized depression. BDI is a really simple and effective screening tool for the detection and identification of persons with symptoms of depression. PMID:24783910
Al Muqarrabun, L M R; Ahmat, N
The family Sterculiaceae is one of the most important families among flowering plants. Many of its members demonstrate medicinal properties and have been used for the treatment of various ailments and wounds. A wide range of compounds including alkaloids, phenyl propanoids, flavonoids, terpenoids and other types of compounds including hydrocarbons, sugars, quinones, phenolic acids, lactones, lignans, amine and amides have been isolated from several species in this family. Few studies have reported that some extracts and single compounds isolated from this family exhibited several biological activities, such as antimicrobial, anti-inflammatory, antioxidant and cytotoxic activities. The present review is an effort to provide information about the traditional uses, phytochemistry and pharmacology of species from family Sterculiaceae, and to uncover the gaps and potentials requiring further research opportunities regarding the chemistry and pharmacy of this family.
This research investigates e-learning readiness level of family medicine physicians (FM) in Turkey. The study measures the level of e-learning readiness of Turkish FM physicians by an online e-learning readiness survey. According to results five areas are ready at Turkish FM physicians but need a few improvements:…
Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre
Abstract Objective To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. Design A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Setting Canada. Participants General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Main outcome measures Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Results Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. Conclusion General duty medical officers were satisfied with many aspects of
Kaphle, Krishna; Wu, Leang-Shin; Yang, Nai-Yen Jack; Lin, Jen-Hsou
Of all the countries in the world, why did you choose Taiwan to pursue your study? It is a question that I (comments of the first author) have answered a thousand times. My first visit to a laboratory at National Taiwan University opened my eyes to the possibilities of herbal medicine research, especially in the area of veterinary medicine. It became my ambition to link the knowledge of Traditional Chinese Medicine (TCM) and Ayurveda from the Indian subcontinent and their integration with other systems of medicine, including Western medicine (WM), to achieve the concept of Sustainable Medicine, firstly for animals and then for humans. The Ministry of Economic Affairs (MOEA) has implemented a technology development program to quickly establish the key technologies, and this is a moment of opportunity for Taiwan's traditional herbal medicine industry to upgrade and transform itself. This paper, initially intended to be a student's narration, has evolved into a multi-author treatise on the present state and likely future scenario of herbal medicine research in Taiwan. PMID:16550238
Chew, Boon-How; Yasin, Mazapuspavina Md; Cheong, Ai-Theng; Rashid, Mohd-Radzniwan A; Hamzah, Zuhra; Ismail, Mastura; Ali, Norsiah; Bashah, Baizury; Mohd-Salleh, Noridah
Perception of healthcare providers who worked with family medicine specialists (FMSs) could translate into the effectiveness of primary healthcare delivery in daily practices. This study examined perceptions of public healthcare providers/professionals (PHCPs) on FMSs at public health clinics throughout Malaysia. This was a cross-sectional study in 2012-2013 using postal method targeting PHCPs from three categories of health facilities, namely health clinics, health offices and hospitals. A structured questionnaire was developed to assess PHCP's perception of FMS's clinical competency, safety practice, ethical and professional values, and research involvement. It consists of 37 items with Likert scale of strongly disagree (a score of 1) to strongly agree (a score of 5). Interaction and independent effect of the independent variables were tested and adjusted means score were reported. The participants' response rate was 58.0% (780/1345) with almost equal proportion from each of the three public healthcare facilities. There were more positive perceptions than negative among the PHCPs. FMSs were perceived to provide effective and safe treatment to their patients equally disregards of patient's social background. However, there were some concerns of FMSs not doing home visits, not seeing walk-in patients, had long appointment time, not active in scientific research, writing and publication. There were significant differences in perception based on a respondent's health care facility (p < 0.0001) and frequency of encounter (p < 0.0001). PHCPs had overall positive perceptions on FMSs across all the domains investigated. PHCPs from different health care facilities and frequency of encounter with FMSs had different perception. Practicing FMSs could improve on the critical service areas that were perceived to be important but lacking. FMSs might need further support in conducting research and writing for publication.
Krueger, Paul; White, David; Meaney, Christopher; Kwong, Jeffrey; Antao, Viola; Kim, Florence
Abstract Objective To identify predictors of job satisfaction among academic family medicine faculty members. Design A comprehensive Web-based survey of all faculty members in an academic department of family medicine. Bivariate and multivariable analyses (logistic regression) were used to identify variables associated with job satisfaction. Setting The Department of Family and Community Medicine at the University of Toronto in Ontario and its 15 affiliated community teaching hospitals and community-based teaching practices. Participants All 1029 faculty members in the Department of Family and Community Medicine were invited to complete the survey. Main outcome measures Faculty members’ demographic and practice information; teaching, clinical, administration, and research activities; leadership roles; training needs and preferences; mentorship experiences; health status; stress levels; burnout levels; and job satisfaction. Faculty members’ perceptions about supports provided, recognition, communication, retention, workload, teamwork, respect, resource distribution, remuneration, and infrastructure support. Faculty members’ job satisfaction, which was the main outcome variable, was obtained from the question, “Overall, how satisfied are you with your job?” Results Of the 1029 faculty members, 687 (66.8%) responded to the survey. Bivariate analyses revealed 26 predictors as being statistically significantly associated with job satisfaction, including faculty members’ ratings of their local department and main practice setting, their ratings of leadership and mentorship experiences, health status variables, and demographic variables. The multivariable analyses identified the following 5 predictors of job satisfaction: the Maslach Burnout Inventory subscales of emotional exhaustion and personal accomplishment; being born in Canada; the overall quality of mentorship that was received being rated as very good or excellent; and teamwork being rated as very
The European Paediatric Regulation (EUPR) calls for the fostering of high quality ethical research and medicinal products to be used in children. The EUPR provides the background, goals, and requirements for paediatric clinical trials. Paediatric clinical trials in children are mandatory to generate data on new drugs as well as on drugs used off-label or for unlicensed indications. The Family Paediatricians Medicines for Children Research Network (FIMP-MCRN) was established in 2003 with the aim of developing competence, infrastructure, networking and education for paediatric clinical trials. The network, consisting of twenty Paediatric Regional Networks has progressed very well and has achieved valuable improvements concerning the conduct of paediatric clinical trials. Furthermore, ad hoc training programs have incremented knowledge about clinical trials in Family Paediatrician Investigators (FPI) and have made medical professionals as well as the public aware of the need and advantages of trials in children. PMID:20591168
Rollins, Lisa K.; Martirosian, Tovia; Gazewood, John D.
Approximately 19% to 20% of all family medicine office visits involve care to patients older than age 65, yet limited research addresses family medicine geriatric education in the outpatient setting. This study explored how geriatric content is incorporated into resident/attending precepting encounters, using direct observation. An observer…
Pust, Ronald E
North American family physicians leaving for less-developed countries (LDCs) may not be aware of internationally validated diagnostic and treatment technologies originating in LDCs. Thus they may bring with them inappropriate models and methods of medical care. More useful "exports" are based in sharing our collaborative vocational perspective with dedicated indigenous generalist clinicians who serve their communities. More specifically, Western doctors abroad can promote local reanalyses of international evidence-based medicine (EBM) studies, efficient deployment of scarce clinical resources, and a family medicine/generalist career ladder, ultimately reversing the "brain drain" from LDCs. Balancing these exports, we should import the growing number of EBM best practices originated in World Health Organization and other LDCs research that are applicable in developed nations. Many generalist colleagues, expatriate and indigenous, with long-term LDC experience stand ready to help us import these practices and perspectives.
Zhou, Gang; Wang, Ting; He, Yan-Ping
Medicinal materials research and development of new drug of traditional Chinese medicine (TCM) research is the premise and foundation of new drug research and development, it throughout the whole process of new drug research. Medicinal materials research is one of the main content of the pharmaceutical research of new drug of TCM, and it is also the focus of the new medicine pharmaceutical evaluation content. This article through the analysis of the present problems existing in the development of TCM research of new drug of TCM, from medicine research concept, quality stability, quality standard, etc are expounded, including medicine research idea value medicine study should focus on the important role and from the purpose for the top-level design of new drug research problem. Medicinal materials quality stability should pay attention to the original, medicinal part, origin, processing, storage, planting (breeding), and other aspects. Aspect of quality standard of medicinal materials should pay attention to establish the quality standards of conform to the characteristics of new drug of TCM. As the instruction of TCM new drug research and development and the scientific nature of the review, and provide the basis for medicinal material standards.
Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert
Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.
Pols, David H J; Bramer, Wichor M; Bindels, Patrick J E; van de Laar, Floris A; Bohnen, Arthur M
Physicians and researchers in the field of family medicine often need to find relevant articles in online medical databases for a variety of reasons. Because a search filter may help improve the efficiency and quality of such searches, we aimed to develop and validate search filters to identify research studies of relevance to family medicine. Using a new and objective method for search filter development, we developed and validated 2 search filters for family medicine. The sensitive filter had a sensitivity of 96.8% and a specificity of 74.9%. The specific filter had a specificity of 97.4% and a sensitivity of 90.3%. Our new filters should aid literature searches in the family medicine field. The sensitive filter may help researchers conducting systematic reviews, whereas the specific filter may help family physicians find answers to clinical questions at the point of care when time is limited.
Sheets, Kent J; Quirk, Mark E; Davis, Ardis K
Faculty development implications related to implementing the Family Medicine Curriculum Resource (FMCR) Project provide an opportunity to look at the recommendations of the Society of Teachers of Family Medicine's federally funded Faculty Futures Initiative (FFI) and the recent Future of Family Medicine (FFM) project. Implications for faculty development include the importance of the clerkship setting, originally defined in 1991, with new features added in today's practice environment as outlined by the FFM and the changing assumptions in approaching faculty development. Previously, faculty development focused on teaching learners to master current knowledge. Now, faculty must teach learners how to master new competencies throughout their lives; learners need to learn how they and others learn now. Teaching must focus on how to learn in the future as well as what to learn for the present. Competence ("what individuals know or are able to do in terms of knowledge, skills, and attitudes") has become the focus of curriculum development efforts over the last few years and most appropriately serves as the focus of curriculum development in the FMCR Project. Implications for developing teachers and preceptors focus on the skills and circumstances required to teach and evaluate all types (cognitive, metacognitive, and affective) of competence. In the new culture, novel teaching methods will serve as the focus of faculty development in teaching and of educational ("best practices") research.
Goh, Lee Gan; Ong, Chooi Peng
This review provides an update of education and training in family medicine in Singapore and worldwide. Family medicine has progressed much since 1969 when it was recognised as the 20th medical discipline in the United States. Three salient changes in the local healthcare landscape have been noted over time, which are of defining relevance to family medicine in Singapore, namely the rise of noncommunicable chronic diseases, the care needs of an expanding elderly population, and the care of a larger projected population in 2030. The change in the vision of family medicine into the future refers to a new paradigm of one discipline in many settings, and not limited to the community. Family medicine needs to provide a patient-centred medical home, and the discipline's education and training need to be realigned. The near-term training objectives are to address the service, training and research needs of a changing and challenging healthcare landscape.
Goh, Lee Gan; Ong, Chooi Peng
This review provides an update of education and training in family medicine in Singapore and worldwide. Family medicine has progressed much since 1969 when it was recognised as the 20th medical discipline in the United States. Three salient changes in the local healthcare landscape have been noted over time, which are of defining relevance to family medicine in Singapore, namely the rise of noncommunicable chronic diseases, the care needs of an expanding elderly population, and the care of a larger projected population in 2030. The change in the vision of family medicine into the future refers to a new paradigm of one discipline in many settings, and not limited to the community. Family medicine needs to provide a patient-centred medical home, and the discipline’s education and training need to be realigned. The near-term training objectives are to address the service, training and research needs of a changing and challenging healthcare landscape. PMID:24664375
Newton, Warren; Arndt, Jane E
The current renaissance of interest in primary care could benefit from reviewing the history of federal investment in academic family medicine. The authors review 30 years of experience with the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program, addressing three questions: (1) What Title VII grant programs were available to family medicine, and what were their goals? (2) How did Title VII change the discipline? and (3) What impact did Title VII family medicine programs have outside the discipline?Title VII grant programs evolved from broad support for the new discipline of family medicine to a sharper focus on specific national workforce objectives such as improving care for underserved and vulnerable populations and increasing diversity in the health professions. Grant programs were instrumental in establishing family medicine in nearly all medical schools and in supporting the educational underpinnings of the field. Title VII grants helped enhance the social capital of the discipline. Outside family medicine, Title VII fostered the development of innovative ambulatory education, institutional initiatives focusing on underserved and vulnerable populations, and primary care research capacity. Adverse effects include relative inattention to clinical and research missions in family medicine academic units and, institutionally, the development of medical education initiatives without core institutional support, which has put innovation and extension of education to communities at risk as grant funding has decreased. Reinvestment in academic family medicine can yield substantial benefits for family medicine and help reorient academic health centers. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
Campos-Outcalt, D; Senf, J H
Previous research has identified five characteristics of medical schools that are related to the choice of family medicine as a specialty: (1) the amount of time devoted to required training in family medicine, (2) the timing of the required family medicine training, (3) the type of ownership of the school (public or private), (4) the geographic location of the school, and (5) the administrative structure of family medicine within the school. These five characteristics of U.S. medical schools during the mid-1980s, together with the school tuition levels, were examined with both univariate and multivariate analysis to observe their relationships to the percentage of U.S. medical graduates entering family medicine between July 1986 and December 1987. With univariate analysis, each characteristic was significantly related to the percentage of graduates entering family medicine. Using multivariate analysis, only the number of weeks required and the type of ownership of the school were significantly related to the percentage of graduates entering family medicine, with the higher percentages related to greater numbers of required weeks of family medicine training and to public ownership of the school.
Stein, Howard F.
An ethnographic approach based on in-depth interviewing, naturalistic and participant observation, narrative description, and contextual interpretation is proposed as a tool for family health care research. The multiple meanings of family, both for research clinicians and for society, are considered. The problem of how a family orientation is incorporated into biomedical' health care is discussed. PMID:21229058
Government Medical College, Calicut, Kerala - the first medical college in India to start Doctor of Medicine (MD) in family medicine as a postgraduate course. This was in the year 2012. Till date, this is the only medical college to have MD Family Medicine program in India. The college was allowed two MD Family Medicine seats per year by the Medical Council of India, and this is a 3 year course. The first batch of MD Family Medicine students has passed out from the Government Medical College, Calicut in July 2015. In this article, the author, who has been working as an assistant professor in the Department of Family Medicine, ever since the department started in the year 2012, shares her experiences in setting up the department, its functioning and the achievement of bringing out the first batch of successful MD Family Medicine specialists. Another laurel, of which the institution is proud of, is that they were able to incorporate family medicine teaching program in the MBBS curriculum. A brief introduction about Government Medical College, Calicut, is also given. PMID:27843820
Geyman, John P.; Phillips, Theodore J.
The Department of Family Medicine at the University of Washington was started ten years ago after a major curriculum change in the medical school placed new emphasis on education and training of family physicians for the surrounding region in Washington, Alaska, Montana and Idaho (WAMI). This department has organized active programs in patient care, teaching and research at the university base and in a number of affiliated community sites throughout the region. The department is well accepted within the mission of the medical school. Almost a third of graduating medical students choose postgraduate training in family practice. Almost 90 percent of the graduates of the ten programs within the department's network of family practice residencies are established in active family practices, with more than two thirds settling in the WAMI region. Follow-up studies show that these graduates feel well prepared for their practices; are providing a broad range of services in rural, suburban and urban settings; are typically involved in partnership or group practice; and are generally well satisfied with their personal and professional lives. PMID:7064482
Chou, M C; Lee, M C
Undergraduate education is considered to be one of the main contributory factors for the development of family medicine through increasing the number of medical graduates opting for a career in family practice. To evaluate the effects of family medicine education on student's attitudes, 140 fifth year medical students were asked in 1989 to fill in a questionnaire both before and after their curricula. The average age of the 123 students who completed the questionnaire on both occasions was 24.9 years; 106 were males; 17 were tuition free and 26 took additional family medicine clerkships. On aggregate, the students' disposition toward family medicine before their curricula appeared to be uncertain. Mean scores on the attitude scale did not significantly differ between socioeconomic subgroups before the curricula. After the curricula, students' attitudes were significantly altered, especially toward the future development of family medicine in Taiwan. However, their disposition toward family practice as a career changed the least. The degree of alteration in students' attitude toward family medicine before and after the curricula was related to the intensity of the course and to their socioeconomic backgrounds.
Fox, T G; Cole, D R; Lieberman, J A
Recent studies have shown that students and residents choosing Family Medicine career orientations have attained an academic parity with their counterparts in other specialties which was not demonstrated by their general practitioner predecessors. Similarly, the advent of Family Practice residencies and undergraduate course work has significantly altered the educational experience of today's medical students. This study adds to the literature by comparing a third element, the social character of Family Medicine oriented students, residents and practicing physicians. Three subgroups of Family Medicine oriented individuals; students, residents, and physicians, were surveyed through a mailed questionnaire. A study population of 768 individuals yielded a 73% response rate. The findings show that students and residents share a common pattern of identities and that this pattern is not shared with the physician subgroup. This results in rejection of the cohort replication theory. It also suggests a need for Family Practice training to provide role models from the new and emerging generation of family physicians.
Chen, Bing-Chun; Zheng, Li-Li; Wang, Hai-Yan; Dong, Wei; Fu, Xian-Jun; Wang, Yu
Traditional mineral Chinese medicine is a characteristic part of Chinese medicine, in the development of traditional Chinese medicine has its unique role. With the development of science and technology and the increase of the medical level, traditional mineral medicine research is gradually thorough and wide-ranging. In recent years, traditional mineral Chinese medicine research mainly includes the physical properties of mineral medicine, structure, chemical composition, pharmacology and treatment mechanism research. The above several aspects of research in the mineral medicine has important practical and theoretical significance. The above several aspects of research status and the problems existing in the research were briefly summarized and reviewed in this paper, and its development were discussed, to provide reference for further studies in the future.
Fumagalli, Danielle C.; Gouw, Arvin M.
Given the current funding situation of the National Institutes of Health, getting funding for rare disease research is extremely difficult. In light of the enormous potential for research in the rare diseases and the scarcity of research funding, we provide a case study of a novel successful crowdfunding approach at a non-profit organization called Rare Genomics Institute. We partner with biotechnology companies willing to donate their products, such as mouse models, gene editing software, and sequencing services, for which researchers can apply. First, we find that personal stories can be powerful tools to seek funding from sympathetic donors who do not have the same rational considerations of impact and profit. Second, for foundations facing funding restrictions, company donations can be a valuable tool in addition to crowdfunding. Third, rare disease research is particularly rewarding for scientists as they proceed to be pioneers in the field during their academic careers. Overall, by connecting donors, foundations, researchers, and patients, crowdfunding has become a powerful alternative funding mechanism for personalized medicine. PMID:26604866
Fumagalli, Danielle C; Gouw, Arvin M
Given the current funding situation of the National Institutes of Health, getting funding for rare disease research is extremely difficult. In light of the enormous potential for research in the rare diseases and the scarcity of research funding, we provide a case study of a novel successful crowdfunding approach at a non-profit organization called Rare Genomics Institute. We partner with biotechnology companies willing to donate their products, such as mouse models, gene editing software, and sequencing services, for which researchers can apply. First, we find that personal stories can be powerful tools to seek funding from sympathetic donors who do not have the same rational considerations of impact and profit. Second, for foundations facing funding restrictions, company donations can be a valuable tool in addition to crowdfunding. Third, rare disease research is particularly rewarding for scientists as they proceed to be pioneers in the field during their academic careers. Overall, by connecting donors, foundations, researchers, and patients, crowdfunding has become a powerful alternative funding mechanism for personalized medicine.
Burman, Mary E.
Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…
Casas Patiño, Donovan; Jarillo Soto, Edgar; Rodríguez Torres, Alejandra
The central ideas of this research paper are related to the practice of family medicine as a specialty. It focuses in its origins, problems, unique characteristics, limitations, scope, management, and processes within the context of primary care of the Mexican Social Security System. This approach was based on a qualitative, hermeneutical study closely related to the Structural Functionalism Theory. Within this framework, medical practice is seen as an equation: Meaning = action + function/structure. This offers an approach to the understanding of reality through surveys and observations in five categories: identity, activity, purpose, values/norms, and power/relationship. The practice of family medicine is defined as a medical act in the Mexican Social Security Institute. This act is limited to a brief encounter and a prescription, which makes it a short, fleeting, medicalized interaction. The result is a negative social imaginary of the physician, the patient and the whole of society. Thus, individuals and society host a negative social imaginary bestowed on doctors and users of the health system.
Colwill, J M
Family practice residency programs differ fiscally from residency programs in most other specialties because they have limited income-generating potential. The present review demonstrates that the typical family practice residency program has been fiscally solvent as a result of receiving approximately one-third of its income from state and federal appropriations. The level of such support plateaued in the 1980s and programs have not continued to expand despite an ongoing shortage of family physicians. Today, declining Medicare payments to hospitals threaten hospitals' contributions to family practice residency programs. The ability of family practice residency programs to meet the continuing need for family physicians will depend upon the development of specific state and federal policies that provide fiscal incentives to maintain and expand family practice residencies.
Herman, James M.; And Others
A study assessed (1) the validity of the Bowman Gray School of Medicine evaluation instrument regarding the occurrence of halo effects and (2) possible relationships between the faculty's evaluations of the residents and the residents' cognitive knowledge and productivity. (MLW)
Ransom, Donald C.
Family practice and family-centered primary care have a special role in studying the family. A framework for conceptualizing research on families and health, illness, and care is presented. The author discusses ways in which families can influence the health of their members, current controversies about what family means, the logic of family research measurements, whether family research is warranted, and the question of variable-versus case- (person- versus family-) centered research design and analysis. PMID:21229057
Lebel, D.; Hogg, W.
A survey of family medicine residents trained at community-based or hospital-based centres suggested differences in experience and in career plans. Community-based residents saw more patients in the same family, believed they knew the community better, made more housecalls, expected to use allied health professionals more frequently, and were more likely to choose a small community practice. PMID:8499787
Rutherford, Kimberly; Oda, Joanna
Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218
Duke, Pauline; Curran, Vernon; Hollett, Ann
Abstract Problem addressed There is a lack of consensus around the optimal way to train family medicine residents to care for children. Objective of program Evaluation of an ambulatory versus an inpatient pediatrics rotation for family medicine residents. Program description A 4-week pediatrics rotation for second-year family medicine residents was introduced involving half-day ambulatory pediatric clinics. A nonequivalent control group evaluation study design was followed. Patient logbook entries, as well as residents’ satisfaction, knowledge, and self-reported confidence outcomes were compared between family medicine residents completing the new ambulatory rotation and those completing a traditional inpatient-ambulatory pediatrics rotation. Conclusion An ambulatory rotation in pediatrics is a feasible option for facilitating family medicine resident learning in child health care. Residents report exposure to more patient cases that reflect a family practice office setting and the same level of knowledge and confidence as residents completing an inpatient-ambulatory rotation. Intraprofessional collaboration, flexibility in scheduling, and the support of pediatric preceptors are key factors in the organization and implementation of an ambulatory rotation. PMID:21321160
Zweig, Steven; Ingman, Stanley
Focuses on the supports and impediments inherent in the provision of geriatric medical care by family physicians. Addresses providing a good educational program for medical students and residents who will be caring for the elderly and developing uniform access to quality care for the elderly, the community, and community institutions. (Author/ABB)
Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T
Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent.
Silk, Hugh; Shields, Sara
Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…
Phillips, Robert L.; Bazemore, Andrew W.; DeVoe, Jennifer E.; Weida, Thomas J.; Krist, Alex H.; Dulin, Michael F.; Biagioli, Frances E.
BACKGROUND AND OBJECTIVES Health information technology (health IT) and health technology, more broadly, offer tremendous promise for connecting, synthesizing, and sharing information critical to improving health care delivery, reducing health system costs, and achieving personal and community health. While efforts to spur adoption of electronic health records (EHRs) among US practices and hospitals have been highly successful, aspirations for effective data exchanges and translation of data into measureable improvements in health outcomes remain largely unrealized. There are shining examples of health enhancement through new technologies, and the discipline of family medicine is well poised to take advantage of these innovations to improve patient and population health. The Future of Family Medicine led to important family medicine health IT initiatives over the past decade. For example, the American Academy of Family Physicians (AAFP) Center for Health Information Technology and the Robert Graham Center provided important leadership for informing health IT policy and standard-setting, such as the Centers for Medicare and Medicaid Services EHR incentives programs (often referred to as “meaningful use.”). As we move forward, there is a need for a new and more comprehensive family medicine strategy for technology. To inform the Family Medicine for America’s Health (FMAHealth) initiative, this paper explores strategies and tactics that family medicine could pursue to improve the utility of technology for primary care and to help primary care become a leader in rapid development, testing, and implementation of new technologies. These strategies were also designed with a broader stakeholder audience in mind, intending to reach beyond the work being done by FMAHealth. Specific suggestions include: a shared primary care health IT center, meaningful primary care quality measures and capacity to assess/report them, increased primary care technology research, a
Madea, Burkhard; Saukko, Pekka; Musshoff, Frank
In the last years the research output of forensic medicine has sometimes been regarded as insufficient and as of poor quality, especially when parameters as impact factors and external funding were taken into account. However, forensic medicine has different tasks compared to clinical medicine. The main difference between basic subjects, clinical and forensic medicine is not a lack of scientific efficiency in forensic medicine but is a result of the questions asked, the available methods and specific aims. In contrast to natural-scientific research, forensic science has furthermore important intersections with arts and socio-scientific disciplines. Etiologic and pathogenetic research is of only limited relevance in forensic medicine. Thus, forensic medicine is excluded from these research fields, which are mainly supported by external funding. In forensic medicine research mainly means applied research regarding findings, the probative value and reconstruction as well as examination at different points of intersection between medicine and law. Clinical types of research such as controlled randomised, prospective cross-sectional, cohort or case-control studies can only rarely be applied in forensic medicine due to the area specific research fields (e.g. thantatology, violent death, vitality, traffic medicine, analytical toxicology, hemogenetics and stain analysis). The types of studies which are successfully established in forensic medicine are comparison of methods, sensitivity studies, validation of methods, kinetic examinations etc. Tasks of research in forensic medicine and study types, which may be applied will be addressed.
Cohen, Gerald; Cohen, May
Although patients frequently present with sexual concerns, family doctors generally do not handle them well. Sexual issues may present in many ways: as specific concerns; as a component of non-sexual complaints or as a factor in relationship or marital problems. The family doctor must include sexual enquiry and counselling as part of overall health care, and in the management of illnesses. In order to be effective counsellors, physicians must examine their own attitudes, and become knowledgeable about sexuality and myths influencing sexual behavior, and skillful at interviewing and sexual history-taking. The family doctor can become adept at giving patients permission to discuss their sexuality, and at providing information and strategies to enhance sensual enjoyment and communication with partners. Small group training sessions incorporating discussion and role-playing effectively teach physicians skills and strategies in sexual counselling. PMID:21274058
Frontera, Walter R.; Fuhrer, Marcus J.; Jette, Alan M.; Chan, Leighton; Cooper, Rory A.; Duncan, Pamela W.; Kemp, John D.; Ottenbacher, Kenneth J.; Peckham, P. Hunter; Roth, Elliot J.; Tate, Denise G.
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (a) researchers; (b) research culture, environment, and infrastructure;…
Lawrence, Kathrine; Allen, Tim; Brailovsky, Carlos; Crichton, Tom; Bethune, Cheri; Donoff, Michel; Laughlin, Tom; Wetmore, Stephen; Carpentier, Marie-Pierre; Visser, Shaun
Abstract Objective To develop key features for priority topics previously identified by the College of Family Physicians of Canada that, together with skill dimensions and phases of the clinical encounter, broadly describe competence in family medicine. Design Modified nominal group methodology, which was used to develop key features for each priority topic through an iterative process. Setting The College of Family Physicians of Canada. Participants An expert group of 7 family physicians and 1 educational consultant, all of whom had experience in assessing competence in family medicine. Group members represented the Canadian family medicine context with respect to region, sex, language, community type, and experience. Methods The group used a modified Delphi process to derive a detailed operational definition of competence, using multiple iterations until consensus was achieved for the items under discussion. The group met 3 to 4 times a year from 2000 to 2007. Main findings The group analyzed 99 topics and generated 773 key features. There were 2 to 20 (average 7.8) key features per topic; 63% of the key features focused on the diagnostic phase of the clinical encounter. Conclusion This project expands previous descriptions of the process of generating key features for assessment, and removes this process from the context of written examinations. A key-features analysis of topics focuses on higher-order cognitive processes of clinical competence. The project did not define all the skill dimensions of competence to the same degree, but it clearly identified those requiring further definition. This work generates part of a discipline-specific, competency-based definition of family medicine for assessment purposes. It limits the domain for assessment purposes, which is an advantage for the teaching and assessment of learners. A validation study on the content of this work would ensure that it truly reflects competence in family medicine. PMID:21998245
The most famous members of the Mozart family were musicians - not physicians. In spite of that, the family correspondence of the Mozarts contains much noteworthy information on 18th century medicine. It comes mainly from Leopold, the famous composer's father, which is why the vast majority of the medical data presented in the letters cannot be found in the popular editions of the correspondence. One of the medicine-related subjects usually omitted or presented briefly in such editions concerns the medicaments used in the Mozart family. Out of more than 100 remedies mentioned in the correspondence the article's author chose and described a few that seem to have played a particularly significant role in the life of the Mozart family.
Flinkenflögel, Maaike; Essuman, Akye; Chege, Patrick; Ayankogbe, Olayinka; De Maeseneer, Jan
Background. Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa. Objective. To explore the extent to which the Primafamed South–South cooperative project contributed to the development of family medicine in sub-Saharan Africa. Methods. The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed. Results. During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present. Conclusions. Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South–South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels. PMID:24857843
Wallace, Janice S.
A list is given of the publications of investigators supported by the Biomedical Research and Clinical Medicine Programs of the Space Medicine and Biology Branch, Life Sciences Division, Office of Space Science and Applications. It includes publications entered into the Life Sciences Bibliographic Database by the George Washington University as of December 31, 1986. Publications are organized into the following subject areas: Clinical Medicine, Space Human Factors, Musculoskeletal, Radiation and Environmental Health, Regulatory Physiology, Neuroscience, and Cardiopulmonary.
Family medicine (FM) is an independent and distinct medical specialty in the developed countries such as USA, UK, Australia, and Canada since 1960s. FM teaching is imparted at undergraduate and postgraduate levels in countries such as Nepal, Pakistan, and Sri Lanka. Family practice is the practicing vocation of the majority doctors in India. The practitioners of FM include general practitioners, family physicians, FM specialists, and medical officers in the public sector. Medical students are largely unaware about FM career as this concept is not introduced at MBBS level. Faculty and senior doctors from other disciplines are also not able to answer the queries related to FM as they themselves also have gone through the same education system for last three decades, largely unexposed to the concept of academic family medicine. This article is a compilation of frequently asked questions, and their appropriate responses, presented here to dispel myths and misinformation about FM specialty. The answers are deliberated upon by Dr. Raman Kumar the founder president of the Academy of Family Physicians of India and the chief editor of the Journal of Family Medicine and Primary Care. This article was originally published as an interview in Docplexus, a popular online network and website for medical doctors in November 2015. PMID:27453835
Family medicine (FM) is an independent and distinct medical specialty in the developed countries such as USA, UK, Australia, and Canada since 1960s. FM teaching is imparted at undergraduate and postgraduate levels in countries such as Nepal, Pakistan, and Sri Lanka. Family practice is the practicing vocation of the majority doctors in India. The practitioners of FM include general practitioners, family physicians, FM specialists, and medical officers in the public sector. Medical students are largely unaware about FM career as this concept is not introduced at MBBS level. Faculty and senior doctors from other disciplines are also not able to answer the queries related to FM as they themselves also have gone through the same education system for last three decades, largely unexposed to the concept of academic family medicine. This article is a compilation of frequently asked questions, and their appropriate responses, presented here to dispel myths and misinformation about FM specialty. The answers are deliberated upon by Dr. Raman Kumar the founder president of the Academy of Family Physicians of India and the chief editor of the Journal of Family Medicine and Primary Care. This article was originally published as an interview in Docplexus, a popular online network and website for medical doctors in November 2015.
Sankarapandian, Venkatesan; Christopher, Prince R H
The Medical Council of India has set appropriate and relevant objectives to train each medical student into a basic doctor for the country. Even though they envisage that these basic doctors would work as physicians of first contact, providing for the health needs of India at primary and secondary care level, the site of training and the context of clinical teaching do not seem to empower the students to become a basic doctor. 'Vision 2015', the document written by the board of governors of medical council of India suggests reforms in medical education such as early clinical exposure, integration of principles of family medicine, and clinical training in the secondary care level. Family medicine training with trained family medicine faculty might add this missing ingredient to our basic doctor training. This article discusses the role of family medicine in undergraduate medical training. We also propose the objectives of such training, the structure of the training process, and the road blocks with possible solutions to its implementation.
Varner, Derrick F; Foutch, Brian K
This study investigated the prevalence of depression and burnout symptoms among family medicine providers on active duty in the US Air Force. Results demonstrated that 84% of those surveyed scored positive for degrees of depression symptoms; only sex differences were significant.
Kates, Nick; Toews, John; Leichner, Pierre
Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement—particularly in finding psychiatrists with a better understanding of family practice, in integrating the teaching to a greater degree with clinical work, thereby increasing its relevance, and in utilizing more suitable clinical settings. PMID:21279156
Christensen, Mark; Christensen, Heidi K
Residency training clearly impacts physicians' approach toward fellowship in Primary Care Sports Medicine. Although the Accreditation Council for Graduate Medical Education sets strict standards for all programs, family medicine and emergency medicine training differ a great deal in general and provide physicians from both backgrounds varied perspectives and skill sets. The family physician acquires a substantial amount of experience in continuity of care and integration of health care into a patient's everyday life. On the other hand, the emergency physician receives exceptional training in the management of acutely ill and injured patients and leadership of a large health care team. Furthermore, while the emergency physician may be skilled in procedures such as fracture reduction and diagnostic ultrasound, the family physician is proficient in developing patient rapport and compliance with a treatment plan. Although physicians from different backgrounds may start with many differences, fellowship training is essential in bridging those gaps.
Sittikariyakul, Pat; Jaturapatporn, Darin; Kirshen, A. J.
Recent publications have confirmed the use of standardized patients (SPs) in improving clinical skills and enhancing competency. Little research has studied the benefits residents may themselves gain in palliative care playing the role of SPs. Nineteen Family Medicine residents were recruited as standardized patients (FMR-SPs) for a mandatory…
Lockhart, Ginger; MacKinnon, David P.; Ohlrich, Vanessa
This article presents an overview of statistical mediation analysis and its application to psychosomatic medicine research. The article begins with a description of the major approaches to mediation analysis and an evaluation of the strengths and limits of each. Emphasis is placed on longitudinal mediation models, and an application using latent growth modeling is presented. The article concludes with a description of recent developments in mediation analysis and suggestions for the use of mediation for future work in psychosomatic medicine research. PMID:21148809
Lewis-Stevenson, Sherri; Hueston, William J.; Mainous, Arch G., III; Bazell, Carol; Ye, Xiaobu
Surveyed departments of family medicine to determine workforce composition and rank of women and minority faculty. Found that while faculty were more likely to be female or minority than in other medical disciplines, women and minorities were less likely to be associate or full professors. Found no institutional or departmental characteristics…
Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R
The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area.
Kerby, Erin E.
Objective The study investigated veterinary medicine librarians' experience with and perceptions of research data services. Many academic libraries have begun to offer research data services in response to researchers' increased need for data management support. To date, such services have typically been generic, rather than discipline-specific, to appeal to a wide variety of researchers. Methods An online survey was deployed to identify trends regarding research data services in veterinary medicine libraries. Participants were identified from a list of contacts from the MLA Veterinary Medical Libraries Section. Results Although many respondents indicated that they have a professional interest in research data services, the majority of veterinary medicine librarians only rarely or occasionally provide data management support as part of their regular job responsibilities. There was little consensus as to whether research data services should be core to a library's mission despite their perceived importance to the advancement of veterinary research. Furthermore, most respondents stated that research data services are just as or somewhat less important than the other services that they provide and feel only slightly or somewhat prepared to offer such services. Conclusions Lacking a standard definition of “research data” and a common understanding of precisely what research data services encompass, it is difficult for veterinary medicine librarians and libraries to define and understand their roles in research data services. Nonetheless, they appear to have an interest in learning more about and providing research data services. PMID:27822153
Turnbull, Ann P.; Friesen, Barbara J.; Ramirez, Carmen
This article discusses a participatory action research (PAR) approach to conducting family research. It proposes a model of PAR implementation level including the options of family members as research leaders and researchers as ongoing advisors, researchers and family members as coresearchers, and researches as leaders, and family members as…
Rahmatullah, Mohammed; Jahan, Rownak; Azam, F M Safiul; Hossan, S; Mollik, M A H; Rahman, Taufiq
Folk medicinal practitioners form the first tier of primary health-care providers to most of the rural population of Bangladesh. They are known locally as Kavirajes and rely almost solely on oral or topical administration of whole plants or plant parts for treatment of various ailments. Also about 2% of the total population of Bangladesh are scattered among more than twenty tribes residing within the country's borders. The various tribes have their own tribal practitioners, who use medicinal plants for treatment of diseases. The objective of the present survey was to conduct an ethnomedicinal survey among the Kavirajes and tribal practitioners to determine which species of plants belonging to the Verbenaceae family are used by the practitioners. The Verbenaceae family plants are well known for constituents having important bio-active properties. The present survey indicated that 13 species belonging to 8 genera are used by the folk and tribal medicinal practitioners of Bangladesh. A comparison of their folk medicinal uses along with published reports in the scientific literature suggests that the Verbenaceae family plants used in Bangladesh can potentially be important sources of lead compounds or novel drugs for treatment of difficult to cure debilitating diseases like malaria and rheumatoid arthritis.
Alderfer, Melissa A
Family management styles (FMSs) explain some of the complexities embedded in a family with a child who has chronic illness. The FMS typologies provide descriptions of family adjustment and management of care. These 5 distinct patterns may be valuable in tailoring and evaluating family interventions in research.
Market research into contraceptive distribution (especially condoms) has been carried out in Britain by private manufacturers, but the results of this research are generally unavailable. Academics have not used the techniques of market research, preferring their own forms of sociological research and being hampered by limited resources. Attempts to design programs to introduce the provision of free family planning services proved unsuccessful, even though the programs offered supplies, sympathetic personnel, and publicity. Part of this failure is attributed to the lack of any baseline research on the demand for and acceptability of these services in the project areas. These failures are contrasted to a very successful commercial marketing campaign for a brand of condom, and with a commercially designed Dutch program aimed at teenagers. The author urges that those who have a message of social importance to deliver look into the techniques of market research used by industry to alter people's attitudes and buying habits. This will require the provision by local and central government of adequate funds for research into attitudes and needs, which ought to be essential before any family planning campaigns are launched.
Oliver, Doug; Emili, Anna; Chan, David; Taniguchi, Alan
Abstract Problem addressed Family medicine residents require more exposure to all aspects of care of the elderly in the community, including care in long-term care (LTC) homes. Objective of program To provide a framework for the development of integrated LTC rotations in family medicine programs. Program description Clear objectives for residents and clinical preceptors provided the foundation for the program. Rotations of 4 half days per year in LTC homes were integrated into core family medicine blocks. Residents worked with family physician preceptors providing LTC in the community. Teaching was case based and aligned with the core competencies set out in the CanMEDS (Canadian Medical Directives for Specialists) framework for medical education. The program was strongly supported by the university’s administration, clinical preceptors in the community, and LTC homes. Conclusion All the residents rated their LTC rotations as useful or extremely useful in preparing them to provide LTC in their future practices. Long-term care homes realized that investing in training medical residents in LTC could help improve care of the elderly in the community. PMID:21841091
Gallagher, Erin; Moore, Ainsley; Schabort, Inge
Abstract Objective To assess the current status of leadership training as perceived by family medicine residents to inform the development of a formal leadership curriculum. Design Cross-sectional quantitative survey. Setting Department of Family Medicine at McMaster University in Hamilton, Ont, in December 2013. Participants A total of 152 first- and second-year family medicine residents. Main outcome measures Family medicine residents’ attitudes toward leadership, perceived level of training in various leadership domains, and identified opportunities for leadership training. Results Overall, 80% (152 of 190) of residents completed the survey. On a Likert scale (1 = strongly disagree, 4 = neutral, 7 = strongly agree), residents rated the importance of physician leadership in the clinical setting as high (6.23 of 7), whereas agreement with the statement “I am a leader” received the lowest rating (5.28 of 7). At least 50% of residents desired more training in the leadership domains of personal mastery, mentorship and coaching, conflict resolution, teaching, effective teamwork, administration, ideals of a healthy workplace, coalitions, and system transformation. At least 50% of residents identified behavioural sciences seminars, a lecture and workshop series, and a retreat as opportunities to expand leadership training. Conclusion The concept of family physicians as leaders resonated highly with residents. Residents desired more personal and system-level leadership training. They also identified ways that leadership training could be expanded in the current curriculum and developed in other areas. The information gained from this survey might facilitate leadership development among residents through application of its results in a formal leadership curriculum. PMID:28292816
Stewart, Robert J; Reider, Bruce
This article explores the background and foundations of ethics in research. Some important documents and codes are mentioned, such as The Belmont Report and the International Conference of Harmonisation. Some influential historical events involving research ethics are recounted. The article provides a detailed discussion of the Declaration of Helsinki, which is considered the international standard for guidelines in medical research ethics. The most salient features of the Declaration are described and related to orthopaedic surgery and sports medicine. Some of the most controversial aspects of the Declaration are discussed, which helps examine contentious areas of research in sports medicine.
Wu, Dan; Lam, Tai Pong
China is engaged in efforts to train 300,000 family doctors by 2020 to meet its population's health care needs. This Article discusses the family doctor shortage, compares family medicine training programs, examines the distributional challenges faced by these programs, and proposes directions for further experimentation. Despite an increasing number of family doctors, they represented only 5.6% of all doctors in 2013. Currently, three training programs run concurrently-the post-transfer training, residency training, and designated family medicine undergraduate education programs. These programs face several challenges. First, the educational qualifications of primary care practitioners (PCPs) vary greatly between rural and urban regions. From 2005 to 2013, the percentage of PCPs with three or more years of medical training in urban areas was at least 20.0% higher than in rural areas. Second, regional disparities in the number of family doctors for every 10,000 people exist. The richer eastern part of China has a ratio of 1.51 family doctors for every 10,000 people, nearly double that of central (0.70) and western China (0.86). Third, better-educated doctors are most likely going to prefer to work in hospitals, which offer a lucrative career path with higher pay and social status. Intervention packages that combine student selection policies that look at place of origin and career intent with other incentive strategies are worth implementing. Adequate clinical exposure and regular, rigorous evaluations are crucial for enhancing training quality. China should strike a balance in the distribution of family doctors between the richer and poorer areas to ensure equity.
Halbert, Chanita Hughes; McDonald, Jasmine; Vadaparampil, Susan; Rice, LaShanta; Jefferson, Melanie
Importance Precision medicine is an approach to detecting, treating, and managing disease that is based on individual variation in genetic, environmental, and lifestyle factors. Precision medicine is expected to reduce health disparities, but this will be possible only if studies have adequate representation of racial minorities. Objective It is critical to anticipate the rates at which individuals from diverse populations are likely to participate in precision medicine studies as research initiatives are being developed. We evaluated the likelihood of participating in a clinical study for precision medicine. Design, Setting, Participants Observational study conducted between October 2010 and February 2011 in a national sample of African Americans. Main Outcome Measure Intentions to participate in a government sponsored study that involves providing a biospecimen and generates data that could be shared with other researchers to conduct future studies. Results One third of respondents would participate in a clinical study for precision medicine. Only gender had a significant independent association with participation intentions. Men had a 1.86 (95% CI = 1.11, 3.12, p = 0.02) increased likelihood of participating in a precision medicine study compared to women in the model that included overall barriers and facilitators. In the model with specific participation barriers, distrust was associated with a reduced likelihood of participating in the research described in the vignette (OR = 0.57, 95% CI = 0.34, 0.96, p = 0.04). Conclusion and Relevance African Americans may have low enrollment in PMI research. As PMI research is implemented, extensive efforts will be needed to ensure adequate representation. Additional research is needed to identify optimal ways of ethically describing precision medicine studies to ensure sufficient recruitment of racial minorities. PMID:27441706
Doctors Ashton Graybiel and Ross A. McFarland. The study explored the value of psychological and physiological testing in the prediction of success in the...AD-A258 198 NAVAL AEROSPACE MEDICAL RESEARCH LABORATORY NAVAL AIR STATION, PENSACOLA, FL 32508-5700 NAMRL Special Report 92-3 AVIATION MEDICINE... MEDICAL RESEARCH LABORATORY ............ 1 M ISSIO N .................................................................... 1 ASHTON GRAYBIEL LECTURE
Djalali, Sima; Senn, Oliver
Considering the trends in medicine, time just seems to move at a slower pace in general practice/family medicine than in the medical specialties. Novel medical drugs and therapeutic modalities appear to take longer to become well-established, and sometimes it never happens. There are obvious gaps between the requirements of the guidelines issued by scientific medical societies and the practical implementation of these guidelines by primary care physicians. In health services research this is known as the «evidence-performance gap». The aim of this narrative review is to outline the nature and the dynamics of trends in general practice/family medicine on the one hand and in the medical specialties on the other hand, and to elucidate the potential causes leading to the evidence-performance gaps observed.
Frontera, Walter R; Fuhrer, Marcus J; Jette, Alan M; Chan, Leighton; Cooper, Rory A; Duncan, Pamela W; Kemp, John D; Ottenbacher, Kenneth J; Peckham, P Hunter; Roth, Elliot J; Tate, Denise G
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called for to pursue the agendas outlined in this report.
Inubushi, Masayuki; Higashi, Tatsuya; Kuji, Ichiei; Sakamoto, Setsu; Tashiro, Manabu; Momose, Mitsuru
There were many interesting presentations of unique studies at the Annual Meeting of the Japanese Society of Nuclear Medicine, although there were fewer attendees from Europe than expected. These presentations included research on diseases that are more frequent in Japan and Asia than in Europe, synthesis of original radiopharmaceuticals, and development of imaging devices and methods with novel ideas especially by Japanese manufacturers. In this review, we introduce recent nuclear medicine research conducted in Japan in the five categories of Oncology, Neurology, Cardiology, Radiopharmaceuticals and Technology. It is our hope that this article will encourage the participation of researchers from all over the world, in particular from Europe, in scientific meetings on nuclear medicine held in Japan.
A list of publications of investigators supported by the Biomedical Research and Clinical Programs of the Life Sciences Division, Office of Space Science and Applications is given. Included are publications entered into the Life Sciences Bibliographic Database by the George Washington University as of 31 December 1988. Principal Investigators whose research tasks resulted in publication are identified by asterisk. Publications are organized into the following subject areas: space physiology and countermeasures (cardiopulmonary, musculoskeletal, neuroscience, and regulatory physiology), space human factors, environmental health, radiation health, clinical medicine, and general space medicine.
Taylor, Robert B; And Others
A 5-week family medicine clerkship is described that uses several innovative techniques: problem-based learning focusing on patient management tutorials; consultation with specialists; supervised patient care and a nursing home inpatient teaching service; and workshops on topics such as office-surgical techniques, practice management, and…
Veras, Mirella; Pottie, Kevin; Ramsay, Tim; Welch, Vivian; Tugwell, Peter
Background There is an increased interest in global health among medical students, family medicine residents, and medical educators. This paper is based on research to assess confidence in knowledge and skills in global health in family medicine residents in five universities across Ontario. Methods A web-based survey was sent to 166 first-year family medicine residents from five universities within Ontario. Descriptive statistics were used to analyze residents’ confidence in their knowledge and skills in global health. The strength of association between each of the self-perceived knowledge and skills variables was assessed by the Spearman correlation coefficient Results The response rate ranged from 29% to 66% across the five universities. Self-perceived knowledge scores revealed that 34.3% of the respondents were very confident, 51.9% were somewhat confident, and 13.8% were not at all confident about their global health knowledge. Participants’ confidence scores were lower in relation to knowledge of access to health care for low income nations (44.3%), and were better on their global health skills related to working in a team (70.9%) and listening actively to patients’ concerns (64.6%). Conclusions The global health competency scale has identified key areas of strengths and weaknesses of family medicine programs in global health education. This can be used to evaluate and analyze progress over time. PMID:26451209
Ganong, Lawrence H.; Coleman, Marilyn
Sees important aspect of graduate education as learning how to evaluate quality and validity of research. Notes that study of families presents particular challenges. Examines three methods to teach students to critique family research. Sees all three as holding promise in teaching students how to evaluate family research and notes that all three…
FitzGerald, Gerry; Codd, Catrina; Aitken, Peter; Sinnott, Michael
Development of any new profession is dependent on the development of a special body of knowledge that is the domain of the profession. Key to this is research. Following sustained lobbying, the Queensland Government agreed to establish an emergency medicine research fund as part of an Enterprise Bargaining Agreement in 2006. That fund is managed by the Queensland Emergency Medicine Research Foundation. The present article describes the strategic approaches of the Foundation in its first 3 years, the application of research funds, and foreshadows an evaluative framework for determining the strategic value of this investment. The Foundation has developed a range of personnel and project support funding programmes, and competition for funding has increased. Ongoing evaluation will seek to determine the effectiveness of the current funding strategy on improving the effectiveness of research performance. It will also evaluate the clinical and organizational outcomes.
Wald, Peter H; Stave, Gregg M
Occupational medicine is a key component of a comprehensive occupational health and safety program in support of laboratory animal research and production facilities. The mission of the department is to maximize employee health and productivity utilizing a population health management approach, which includes measurement and analysis of health benefits utilization. The department works in close cooperation with other institutional health and safety professionals to identify potential risks from exposure to physical, chemical, and biological hazards in the workplace. As soon as exposures are identified, the department is responsible for formulating and providing appropriate medical surveillance programs. Occupational medicine is also responsible for targeted delivery of preventive and wellness services; management of injury, disease, and disability; maintenance of medical information; and other clinic services required by the institution. Recommendations are provided for the organization and content of occupational medicine programs for animal research facilities.
Stubbs, Barbara; Krueger, Paul; White, David; Meaney, Christopher; Kwong, Jeffrey; Antao, Viola
Abstract Objective To collect information about the types, frequency, importance, and quality of mentorship received among academic family medicine faculty, and to identify variables associated with receiving high-quality mentorship. Design Web-based survey of all faculty members of an academic department of family medicine. Setting The Department of Family and Community Medicine of the University of Toronto in Ontario. Participants All 1029 faculty members were invited to complete the survey. Main outcome measures Receiving mentorship rated as very good or excellent in 1 or more of 6 content areas relevant to respondents’ professional lives, and information about demographic and practice characteristics, faculty ratings of their local departments and main practice settings, teaching activities, professional development, leadership, job satisfaction, and health. Bivariate and multivariate analyses identified variables associated with receiving high-quality mentorship. Results The response rate was 66.8%. Almost all (95.0%) respondents had received mentorship in several areas, with informal mentorship being the most prevalent mode. Approximately 60% of respondents rated at least 1 area of mentoring as very good or excellent. Multivariate logistic regression identified 5 factors associated with an increased likelihood of rating mentorship quality as very good or excellent: positive perceptions of their local department (odds ratio [OR] = 4.02, 95% CI 2.47 to 6.54, P < .001); positive ratings of practice infrastructure (OR = 1.86, 95% CI 1.23 to 2.80, P = .003); increased frequency of receiving mentorship (OR = 2.78, 95% CI 1.59 to 4.89, P < .001); fewer years in practice (OR = 1.93, 95% CI 1.19 to 3.12, P = .007); and practising in a family practice teaching unit (OR = 1.51, 95% CI 1.01 to 2.27, P = .040). Conclusion With increasing emphasis on distributed education and community-based teachers, family medicine faculties will need to develop strategies to support
Fradkin, Judith E; Hanlon, Mary C; Rodgers, Griffin P
In his January 2015 State of the Union address, President Barack Obama announced a new Precision Medicine Initiative (PMI) to personalize approaches toward improving health and treating disease (www.whitehouse.gov/precision-medicine). He stated that the goal of such an initiative was "to bring us closer to curing diseases like cancer and diabetes, and to give all of us access to the personalized information we need to keep ourselves and our families healthier." Since that time, the National Institutes of Health (NIH) has taken a leadership role in implementing the President's vision related to biomedical research (www.nih.gov/precisionmedicine). Here, we discuss the NIH component of the PMI, related ongoing diabetes research, and near-term research that could position the diabetes field to take full advantage of the opportunities that stem from the PMI.
Rourke, James T. B.; Incitti, Filomena; Rourke, Leslie L.; Kennard, MaryAnn
OBJECTIVE: To determine how family medicine residents and practising rural physicians rate possible solutions for recruiting and sustaining physicians in rural practice. DESIGN: Cross-sectional mailed survey. SETTING: Rural family practices and family medicine residency programs in Ontario. PARTICIPANTS: Two hundred seventy-six physicians and 210 residents. MAIN OUTCOME MEASURES Ratings of proposed solutions on a 4-point scale from "very unimportant" to "very important". RESULTS: Rural family physicians rated funding for learner-driven continuing medical education (CME) and limiting on-call duty to 1 night in 5 as the most important education and practice solutions, respectively. Residents rated an alternate payment plan to include time off for attending and teaching CME and comprehensive payment plans with a guaranteed income for locums as the most important education and practice solutions, respectively. CONCLUSION: Residents and physicians rated solutions very similarly. A comprehensive package of the highest-rated solutions could help recruit and sustain physicians in rural practice because the solutions were developed by experts on rural practice and rated by family medicine residents and practising rural physicians. PMID:14526866
Background Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. Methods A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training. Results The main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. Conclusions The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to
Emery, Beth C.; Lloyd, Sally A.
This review of methodological, theoretical, and topical trends in family studies research covers changes in definitions of family and in marriage, parent-child relationships, and family social ecology. Issues discussed include marital satisfaction, violence, social construction of gender, family-work relationship, parenting roles, socialization,…
Parkerson, George R., Jr.; And Others
Experience on the traditional internal medicine, surgery, pediatrics, obstetrics-gynecology, and psychiatry clerkships was compared with the experience on a family medicine clerkship. The family medicine clerkship offered the most experience with circulatory, respiratory, digestive, neurological, musculoskeletal, and skin problems and with…
Eczema is a chronic relapsing atopic dermatitis (AD) associated with pruritus, sleep disturbance and poor quality of life of the patient. Treatment of eczema includes use of emollient, topical and systemic antimicrobial agents, corticosteroid or immunomodulating agents. Many patients also seek alternative treatments such as dietary avoidance, supplementation or both. This article reviews the basic pathophysiology of eczema and clinical trials involving Chinese medicine in the treatment of eczema. Research reports on Chinese herbal medicine for eczema were retrieved from PubMed and the Cochrane Database for Systematic Reviews for this review. Only a few RCTs demonstrated the efficacy (or lack of efficacy) of Chinese medicinal herbs in treating atopic eczema. Further larger scale trials are warranted. PMID:21527032
Song, Peipei; Xia, Jufeng; Rezeng, Caidan; Tong, Li; Tang, Wei
As a form of traditional, complementary, and alternative medicine (TCAM), traditional Tibetan medicine has developed into a mainstay of medical care in Tibet and has spread from there to China and then to the rest of the world. Thus far, research on traditional Tibetan medicine has focused on the study of the plant and animal sources of traditional medicines, study of the histology of those plants and animals, chemical analysis of traditional medicines, pharmacological study of those medicines, and evaluation of the clinical efficacy of those medicines. A number of papers on traditional Tibetan medicines have been published, providing some evidence of the efficacy of traditional Tibetan medicine. However, many traditional Tibetan medicines have unknown active ingredients, hampering the establishment of drug quality standards, the development of new medicines, commercial production of medicines, and market availability of those medicines. Traditional Tibetan medicine must take several steps to modernize and spread to the rest of the world: the pharmacodynamics of traditional Tibetan medicines need to be determined, the clinical efficacy of those medicines needs to be verified, criteria to evaluate the efficacy of those medicines need to be established in order to guide their clinical use, and efficacious medicines need to be acknowledged by the pharmaceutical market. The components of traditional Tibetan medicine should be studied, traditional Tibetan medicines should be screened for their active ingredients, and techniques should be devised to prepare and manufacture those medicines.
Gossa, Weyinshet; Wondimagegn, Dawit; Mekonnen, Demeke; Eshetu, Wondwossen; Abebe, Zerihun; Fetters, Michael D
As a very low-income country, Ethiopia faces significant development challenges, though there is great aspiration to dramatically improve health care in the country. Family medicine has recently been recognized through national policy as one potential contributor in addressing Ethiopia’s health care challenges. Family medicine is a new specialty in Ethiopia emerging in the context of family medicine development in Sub-Saharan Africa. The Addis Ababa University family medicine residency program started in 2013 and is the first and the only family medicine program in the country as of March 2016. Stakeholders on the ground feel that family medicine is off to a good start and have great enthusiasm and optimism for its success. While the Ministry of Health has a vision for the development of family medicine and a plan for rapid upscaling of family medicine across the country, significant challenges remain. Continuing discussion about the potential roles of family medicine specialists in Ethiopia and policy-level strategic planning to place family medicine at the core of primary health care delivery in the country is needed. In addition, the health care-tier system needs to be restructured to include the family medicine specialists along with appropriately equipped health care facilities for training and practice. Key stakeholders are optimistic that family medicine expansion can be successful in Ethiopia through a coordinated effort by the Ministry of Health and collaboration between institutions within the country, other Sub-Saharan African countries, and international partners supportive of establishing family medicine in Ethiopia. PMID:27175100
Ben-Arye, Eran; Israely, Pesi; Baruch, Erez; Dagash, Jamal
In this paper, we describe the case study of a 27 year-old Arab female patient receiving palliative care for advanced breast cancer who was referred to complementary medicine (CM) consultation provided within a conventional oncology department. We explore the impact of the integrative CM practitioners' team of three family physicians and one Chinese medicine practitioner on the patient's well-being and specifically on the alleviation of her debilitating hot flashes and insomnia. This quality of life improvement is also affirmed by comparing the Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Well-being (MYCAW) questionnaires administered at the initial and follow-up assessment sessions. In conclusion, we suggest that family physicians trained in evidence-based complementary medicine are optimal integrators of holistic patient-centered supportive care. The inclusion of trained CM practitioners in a multi-disciplinary integrative team may enhance the bio-psycho-social-spiritual perspective, and provide additional practical therapies that improve the quality of life of patients confronting cancer.
Bernstein, Steven L; Stoney, Catherine M; Rothman, Richard E
Published medical research takes years to change clinical practice. The reasons for this evidence-to-practice gap are many. To address this gap, in recent years the field of dissemination and implementation (D&I) science has grown dramatically. D&I studies design and test strategies to accelerate the movement of new evidence-based diagnostic and therapeutic maneuvers into real-world clinical practice. This article summarizes the proceedings of sessions at the 2011 and 2012 annual meetings of the Society for Academic Emergency Medicine that discussed D&I studies in emergency medicine. Examples of current studies are provided, along with a review of D&I methods, funding opportunities, and suggestions for future research.
Plano Clark, Vicki L.; Huddleston-Casas, Catherine A.; Churchill, Susan L.; Green, Denise O'Neil; Garrett, Amanda L.
The complex phenomena of interest to family scientists require the use of quantitative and qualitative approaches. Researchers across the social sciences are now turning to mixed methods designs that combine these two approaches. Mixed methods research has great promise for addressing family science topics, but only if researchers understand the…
Cvetanovich, Gregory L.; Saltzman, Bryan M.; Chalmers, Peter N.; Frank, Rachel M.; Cole, Brian J.; Bach, Bernard R.
Background: Research productivity is considered an important factor in academic advancement in sports medicine. No study to date has evaluated academic productivity and correlates of academic rank for sports medicine fellowship faculty. Purpose: To describe the academic productivity of American Orthopaedic Society for Sports Medicine (AOSSM) fellowship program faculty and to determine the association between academic productivity, fellowship characteristics, and academic rank. Study Design: Descriptive epidemiology study. Methods: Characteristics of orthopaedic sports medicine fellowship programs were obtained from the AOSSM and program websites. Metrics of academic productivity (Hirsch index [h index], I-10 index, publications, citations, and number of publications in several journals) were obtained from Scopus. Statistical analyses were conducted to determine whether academic productivity differs with fellowship attributes and academic rank. Results: A total of 90 AOSSM sports medicine fellowship programs with 610 associated faculty members were identified. Faculty were predominantly male (94%), at academic medical centers (74%), members of AOSSM (71%), and sports medicine–fellowship trained (84%). Faculty had a median of 18 (range, 0-684) publications overall, including a median of 3 (range, 0-161) publications since 2012. All measures of academic productivity were significantly higher among faculty employed at academic medical centers compared with those not employed at academic centers (P < .05 in all cases). On multivariate ordinal regression analysis, the best correlates of higher academic rank were higher cumulative h index (1.22; P < .001) and longer time in practice since fellowship (1.14; P < .001), which predicted 63.8% of the variance in academic rank. Fellowships with a larger number of fellows had more publications and citations per faculty member, higher faculty cumulative h index, and more publications in the American Journal of Sports Medicine
PROBLEM: Integrating residents into community family practices can be challenging for busy doctors, especially when new preceptors have no formal preparation or teaching experience. OBJECTIVE OF PROGRAM: To develop an organized and practical approach to teaching residents in our busy rural group practice. Our seven northern Ontario family doctors have been training elective residents and clerks for 15 years. Recently, we have gone from hosting elective residents and students to teaching core family medicine residents. Our precepting plan allows us to dedicate a reasonable time to teaching while fulfilling our primary care duties. MAIN COMPONENTS: The program involves contracting, teaching, monitoring, feedback, and evaluation. CONCLUSION: We think we have developed a sustainable, workable set of teaching parameters that is applicable by various preceptors in different settings. It has simplified our teaching role and lessened our anxieties. Residents have benefited from the consistent protocol, which can be flexible enough to adapt to individual residents and preceptors, and have valued this teaching approach. Images p278-a p280-a PMID:9040915
Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars
Microgrants are a novel concept where small grants are used to facilitate research. The concept might have a place in developing emergency medicine research, especially in countries where emergency medicine is not established or in new areas of research. Two examples of the beneficial effects of microgrants in emergency medicine research are described. Emergency medicine interest groups and foundations should consider setting up microgrant schemes.
Myers, Nicholas D.; Brincks, Ahnalee M.; Ames, Allison J.; Prado, Guillermo J.; Penedo, Frank J.; Benedict, Catherine
The primary purpose of this manuscript is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The manuscript begins with a general introduction to multilevel modeling. Multilevel regression modeling at two-levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated datasets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including: communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive behavioral stress management intervention in prostate cancer. PMID:23107843
Myers, Nicholas D; Brincks, Ahnalee M; Ames, Allison J; Prado, Guillermo J; Penedo, Frank J; Benedict, Catherine
The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.
Fung, Daisy; Schabort, Inge; MacLean, Catherine A.; Asrar, Farhan M.; Khory, Ayesha; Vandermeer, Ben; Allan, G. Michael
Abstract Objective To determine which screening tests family medicine residents order as part of preventive health care. Design A cross-sectional survey. Setting Alberta and Ontario. Participants First- and second-year family medicine residents at the University of Alberta in Edmonton, the University of Calgary in Alberta, and McMaster University in Hamilton, Ont, during the 2011 to 2012 academic year. Main outcome measures Demographic information, Likert scale ratings assessing ordering attitudes, and selections from a list of 38 possible tests that could be ordered for preventive health care for sample 38-year-old and 55-year-old female and male patients. Descriptive and comparative statistics were calculated. Results A total of 318 of 482 residents (66%) completed the survey. Recommended or appropriate tests were ordered by 82% (for cervical cytology) to 95% (for fasting glucose measurement) of residents. Across the different sample patients, residents ordered an average of 3.3 to 5.7 inappropriate tests per patient, with 58% to 92% ordering at least 1 inappropriate test per patient. The estimated average excess costs varied from $38.39 for the 38-year-old man to $106.46 for the 55-year-old woman. More regular use of a periodic health examination screening template did not improve ordering (P = .88). Conclusion In general, residents ordered appropriate preventive health tests reasonably well but also ordered an average of 3.3 to 5.7 inappropriate tests for each patient. Training programs need to provide better education for trainees around inappropriate screening and work hard to establish good ordering behaviour in preparation for entering practice. PMID:25767171
Halas, Gayle; Singer, Alexander; Styles, Carol; Katz, Alan
Abstract Objective To capture users’ experiences with a newly implemented electronic medical record (EMR) in family medicine academic teaching clinics and to explore their perceptions of its use in clinical and teaching processes. Design Qualitative study using focus group discussions guided by semistructured questions. Setting Three family medicine academic teaching clinics in Winnipeg, Man. Participants Faculty, residents, and support staff. Methods Focus group discussions were audiorecorded and transcribed. Data were analyzed by open coding, followed by development of consensus on a final coding strategy. We used this to independently code the data and analyze them to identify salient events and emergent themes. Main findings We developed a conceptual model to reflect and summarize key themes that we identified from participant comments regarding EMR implementation and use in an academic setting. These included training and support, system design, information management, work flow, communication, and continuity. Conclusion This is the first specific analysis of user experience with a newly implemented EMR in urban family medicine teaching clinics in Canada. The experiences of our participants with EMR implementation were similar to those reported in earlier investigations, but highlight organizational influences and integration strategies. Learning how to use and transitioning to EMRs has implications for clinical learners. This points to the need for further research to gain a more in-depth understanding of the effects of EMRs on the learning environment. PMID:26167563
Price, David; Howard, Michelle; Hilts, Linda; Dolovich, Lisa; McCarthy, Lisa; Walsh, Allyn E.; Dykeman, Lynn
ABSTRACT PROBLEM ADDRESSED The new family health teams (FHTs) in Ontario were designed to enable interprofessional collaborative practice in primary care; however, many health professionals have not been trained in an interprofessional environment. OBJECTIVE OF PROGRAM To provide health professional learners with an interprofessional practice experience in primary care that models teamwork and collaborative practice skills. PROGRAM DESCRIPTION The 2 academic teaching units of the FHT at McMaster University in Hamilton, Ont, employ 6 types of health professionals and provide learning environments for family medicine residents and students in a variety of health care professions. Learners engage in formal interprofessional education activities and mixed professional and learner clinical consultations. They are immersed in an established interprofessional practice environment, where all team members are valued and contribute collaboratively to patient care and clinic administration. Other contributors to the success of the program include the physical layout of the clinics, the electronic medical record communications system, and support from leadership for the additional clinical time commitment of delivering interprofessional education. CONCLUSION This academic FHT has developed a program of interprofessional education based partly on planned activities and logistic enablers, and largely on immersing learners in a culture of long-standing interprofessional collaboration. PMID:19752260
Šter, Marija Petek; Švab, Igor; Klemenc-Ketiš, Zalika; Kersnik, Janko
The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students' attitudes towards family medicine and to evaluate the impact of the clerkship on students' attitudes regarding the competences of family doctor. In the pilot study, experienced family doctors were asked to describe their attitudes towards family medicine by using the Educational Agenda as a template for brainstorming. The statements were paraphrased and developed into a 164-items questionnaire, which was administered to 176 final-year students in academic year 2007/08. The third phase consisted of development of a final tool using statistical analysis, which resulted in the 60-items questionnaire in six domains which was used for the evaluation of students' attitudes. At the beginning of the clerkship, person-centred care and holistic approach scored lower than the other competences. Students' attitudes regarding the competences at the end of 7 weeks clerkship in family medicine were more positive, with exception of the competence regarding primary care management. The students who named family medicine as his or her future career choice, found holistic approach as more important than the students who did not name it as their future career. With the decision tree, which included students' attitudes to the competences of family medicine, we can successfully predict the future career choice in family medicine in 93.5% of the students. This study reports on the first attempt to develop a valid and reliable tool for measuring attitudes towards family medicine based on EURACT Educational Agenda. The questionnaire could be used for evaluating changes of students' attitudes in undergraduate curricula and for prediction of students' preferences regarding their future professional
Mehrabi, Saeed; Wang, Yanshan; Ihrke, Donna; Liu, Hongfang
In the era of precision medicine, accurately identifying familial conditions is crucial for providing target treatment. However, it is challenging to identify familial conditions without detailed family history information. In this work, we studied the documentation of family history of premature cardiovascular disease and hypercholesterolemia. The information on patients’ family history of stroke within the Patient-provided information (PPI) forms was compared with the information gathered by clinicians in clinical notes. The agreement between PPI and clinical notes on absence of family history information in PPI was substantially higher compared to presence of family history. PMID:27570664
Hu, Jian-Shan; Li, Pu; Yang, Yong; Chen, Xin-Chun; Lin, Li
To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research.
Pei, Miaorong; Duan, Xiujun; Pei, Xiangping; Xuan, Chunsheng; Wang, Xiaoying; Zhao, Lina; Zhang, Shurong; Liu, Bingchen; Wang, Shimin
Compatibility chemistry of acid-alkaline pair medicines in formulas of traditional Chinese medicine (TCM) is an important research field which should merit to pay attention. The ideas and methods in prescription compatibility research on formulas containing alkaline-acid pair medicines were summarized from the aspect of chemical groups of alkaline and acid ingredients; the research results were introduced and analyzed; the research meaning was elaborated; and the expectation of the field was viewed.
Standard-Goldson, A; Williams-Green, P; Smith, K; Segree, W; James, K; Eldemire-Shearer, D
This paper recounts the development of family medicine postgraduate training in Jamaica, the challenges faced and lessons learned. A self-administered questionnaire was completed by past trainees exploring the perceived usefulness, strengths and weaknesses of the programme. The results of this study helped guide the strengthening of family medicine training in a resource-limited setting.
Shabani, Jacob; Taché, Stephanie; Mohamoud, Gulnaz; Mahoney, Megan
Background and objectives Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support. Conclusions Our findings illustrate the expected learning outcomes and important community-based enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya. PMID:28155322
Nour-Eldein, Hebatallah; Mansour, Nadia M.; Abdulmajeed, Abdulmajeed A.
Background: The completion of a thesis is a significant requirement for both a Master's and a doctorate degree in general practice/family medicine (GP/FM). A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers. Objective: This study aimed to describe Master's and doctoral theses in family medicine and their publications between 1982 and 2014. Materials and Methods: GP/FM degree theses were reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described. Results: Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master's degrees (84.1%). Regarding the study design, most of the degree theses were cross-sectional studies (76.9%). The adult population was targeted in 33.7% of research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC)-based studies in 59.1%. The “Patient” category exceeded the other categories (28.4%). Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles. Conclusion: The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended. PMID:25949959
Neale, Anne Victoria; Bowman, Marjorie A; Seehusen, Dean A
Ringing in the new year 2017! This may finally be the year of real practice improvement after many false starts. Research into practice transformation has informed both local work and national policy. Human factors and payment structures are key. And payment structures depend on how quality is measured. Large gaps between practicing physician recommendations for the most important quality measures and those currently imposed externally are exposed in this issue. Also see information on in-practice social work consultations and their outcomes and recommendations from innovators in integrated care, and for chronic opioid therapy management based on visits to many family medicine offices. Visit entropy is negative for hospital readmissions. Another article reaffirms the importance of family physicians in rural obstetrics, including Cesarean deliveries. Two articles address changing Latino health care access. New Mexico's innovative health extension agent implementation now includes research in ways that benefit all. And a glass half-full: the growth in the diversity of family medicine faculty is above average, but is not occurring as quickly as in the general population.
Tamura, Yoshiyuki; Matsuda, Mika; Chiba, Shigeru
Actigraphy is a method that utilizes a miniaturized computerized wristwatch-like device to monitor and collect data generated by body movements over extended periods of time. It allows estimation of sleep and wakefulness based on motor activity. It provides a noninvasive, objective, and longitudinal method for the diagnostic and post-treatment evaluation of patients with sleep disorders in the ambulatory setting. It has been used for researchers to study sleep disturbances in a variety of populations, most frequently for the evaluation of insomnia, paradoxical insomnia, and circadian rhythm sleep disorders. In addition, it is particularly useful in populations where polysomnography would be difficult to record, such as in patients with dementia and delirium. Actigraphy should be extensively carried out in sleep medicine as well as sleep research.
Michalopoulos, Argyris; Bliziotis, Ioannis A; Rizos, Michael; Falagas, Matthew E
Introduction The number of publications and the impact factor of journals are accepted estimates of the quantity and quality of research productivity. The objective of the present study was to assess the worldwide scientific contribution in the field of critical care medicine. Method All research studies published between 1995 and 2003 in medical journals that were listed in the 2003 Science Citation Index (SCI®) of Journal Citation Reports under the subheading 'critical care' and also indexed in the PubMed database were reviewed in order to identify their geographical origin. Results Of 22,976 critical care publications in 14 medical journals, 17,630 originated from Western Europe and the USA (76.7%). A significant increase in the number of publications originated from Western European countries during the last 5 years of the study period was noticed. Scientific publications in critical care medicine increased significantly (25%) from 1995 to 2003, which was accompanied by an increase in the impact factor of the corresponding journals (47.4%). Canada and Japan had the better performance, based on the impact factor of journals. Conclusion Significant scientific progress in critical care research took place during the period of study (1995–2003). Leaders of research productivity (in terms of absolute numbers) were Western Europe and the USA. Publications originating from Western European countries increased significantly in quantity and quality over the study period. Articles originating from Canada, Japan, and the USA had the highest mean impact factor.. Canada was the leader in productivity when adjustments for gross domestic product and population were made. PMID:15987399
Schera, Fatima; Weiler, Gabriele; Neri, Elias; Kiefer, Stephan; Graf, Norbert
The European project p-medicine creates an information technology infrastructure that facilitates the development from current medical practice to personalised medicine. The main access point to this infrastructure is the p-medicine portal that provides clinicians, patients, and researchers a platform to collaborate, share data and expertise, and use tools and services to improve personalised treatments of patients. In this document, we describe the community-based structure of the p-medicine portal and provide information about the p-medicine security framework implemented in the portal. Finally, we show the user interface and describe the p-medicine tools and services integrated in the portal. PMID:24567755
Schera, Fatima; Weiler, Gabriele; Neri, Elias; Kiefer, Stephan; Graf, Norbert
The European project p-medicine creates an information technology infrastructure that facilitates the development from current medical practice to personalised medicine. The main access point to this infrastructure is the p-medicine portal that provides clinicians, patients, and researchers a platform to collaborate, share data and expertise, and use tools and services to improve personalised treatments of patients. In this document, we describe the community-based structure of the p-medicine portal and provide information about the p-medicine security framework implemented in the portal. Finally, we show the user interface and describe the p-medicine tools and services integrated in the portal.
Pritchard, Janet; Karampatos, Sarah; Ioannidis, George; Adachi, Jonathan; Thabane, Lehana; Nash, Lynn; Mehan, Upe; Kozak, Joseph; Feldman, Sid; Hirsch, Steve; Jovaisas, Algis V.; Cheung, Angela; Lohfeld, Lynne; Papaioannou, Alexandra
Abstract Objective To identify family physicians’ learning needs related to osteoporosis care; determine family physicians’ preferred modes of learning; and identify barriers to using electronic medical records (EMRs) to implement osteoporosis guidelines in practice. Design Web-based survey. Setting Ontario. Participants Family physicians. Main outcome measures Quantitative and qualitative data about learning needs related to osteoporosis diagnosis and management; preferred mode of learning about guidelines; and barriers to using EMRs to implement guidelines. Results Of the 12 332 family physicians invited to participate in the survey, 8.5% and 7.0% provided partial or fully completed surveys, respectively. More than 80% of respondents agreed that the priority areas for education were as follows: selecting laboratory tests for secondary osteoporosis and interpreting the test results; interpreting bone mineral density results; determining appropriate circumstances for ordering anterior-posterior lumbar spine x-ray scans; and understanding duration, types, and adverse effects of pharmacotherapy. Qualitative analysis revealed that managing moderate-risk patients was a learning need. Continuing medical education was the preferred mode of learning. Approximately 80% of respondents agreed that the scarcity of EMR tools to aid in guideline implementation was a barrier to using guidelines, and 50% of respondents agreed that if EMR-embedded tools were available, time would limit their ability to use them. Conclusion This survey identified key diagnostic- and treatment-related topics in osteoporosis care that should be the focus of future continuing professional development for family physicians. Developers of EMR tools, physicians, and researchers aiming to implement guidelines to improve osteoporosis care should consider the potential barriers indicated in this study.
Wang, Ji; Wang, Ting; Li, Ying-shuai; Zheng, Yan-fei; Li, Ling-ru; Wang, Qi
Translational medicine is a new concept presented in recent decades, the core of which is to build a bridge between basic medical research and clinical application. From the beginning of constitution of Chinese medicine, clinical application has been given priority. Therefore, the idea of translational medicine is fully demonstrated in the research into the three key scientific problems of "classification of constitution of Chinese medicine", "relationship between constitution and disease" and "adjustment of constitution". Under its guidance, not only was the systematic theory of constitution of Chinese medicine established, but also the Constitution of Chinese Medicine Scale and the Standards of Classification and determination of Constitution of Chinese Medicine were developed, which translates methods of classifying the nine constitutional types into guidance for prevention of disease, management of health and clinical application. The research findings of constitution of Chinese medicine have been applied in clinical practice and public health, establishing the diagnosis and treatment model of constitution-disease-syndrome differentiation. The nationwide application of constitution differentiation has shown good effect. In the future, constitution of Chinese medicine should strengthen the evidence-based research and multi-disciplinary cooperation, and establish a research team on comprehensive constitution of Chinese medicine and translational medicine, to translate the findings into clinical practice and public health more accurately and quickly.
Eubank, Daniel; Geffken, Dominic; Orzano, John; Ricci, Rocco
Health care reform calls for patient-centered medical homes built around whole person care and healing relationships. Efforts to transform primary care practices and deliver these qualities have been challenging. This study describes one Family Medicine residency's efforts to develop an adaptive leadership curriculum and use coaching as a teaching method to address this challenge. We review literature that describes a parallel between the skills underlying such care and those required for adaptive leadership. We address two questions: What is leadership? Why focus on adaptive leadership? We then present a synthesis of leadership theories as a set of process skills that lead to organization learning through effective work relationships and adaptive leadership. Four models of the learning process needed to acquire such skills are explored. Coaching is proposed as a teaching method useful for going beyond information transfer to create the experiential learning necessary to acquire the process skills. Evaluations of our efforts to date are summarized. We discuss key challenges to implementing such a curriculum and propose that teaching adaptive leadership is feasible but difficult in the current medical education and practice contexts.
objectives related to famil- ies. Second , an extensive review of the literature was conducted to identif( existing knowledge pertinent to each research ...evidence, and only a few have involved comparison groups or statistical controls. Most of the research suggests that spouses have difficulty in adjusting to...noted that partici- pants have not necessarily identified research areas within each of the five phases. Second , only brief descriptions of individual
Phillips, Theodore L
The advances brought about by research in radiation medicine over the past 50 years are presented. The era began with the atomic explosions in Hiroshima and Nagasaki and the establishment of the Atomic Bomb Casualty Commission to understand what damage was caused by exposure of a large population to radiation. A better understanding of the effects of whole-body exposure led to the development of whole-body radiation treatment techniques and to bone marrow transplantation in the treatment of leukemias. The field of diagnostic imaging was revolutionized by a series of inventions that included angiography, mammography, computed tomography, magnetic resonance imaging, magnetic resonance spectroscopy, and ultrasound imaging. The field of nuclear medicine came of age through new man-made radionuclides and the invention of scanning and imaging techniques including positron emission tomography. Radiotherapy, a minor sideline of radiology, developed into radiation oncology, an extremely important component of modern cancer therapy. The advances in clinical radiotherapy were made possible by discoveries and inventions in physics and engineering and by insights and discoveries in radiobiology. The result of the last 50 years of progress is a very powerful set of clinical tools.
Assadi, Majid; Afrasiabi, Kolsoom; Nabipour, Iraj; Seyedabadi, Mohammad
The birth of nanotechnology in human society was around 2000 years ago and soon found applications in various fields. In this article, we highlight the current status of research and preclinical applications and also future prospects of nanotechnology in medicine and in nuclear medicine. The most important field is cancer. A regular nanotechnology training program for nuclear medicine physicians may be welcome.
Masic, Izet; Hadziahmetovic, Miran; Donev, Doncho; Pollhozani, Azis; Ramadani, Naser; Skopljak, Amira; Pasagic, Almir; Roshi, Enver; Zunic, Lejla; Zildzic, Muharem
Introduction: Family medicine as a part of the primary health care is devoted to provide continuous and comprehensive health care to the individuals and families regardless of age, gender, types of diseases and affected system or part of the body. Special emphasis in such holistic approach is given to the prevention of diseases and health promotion. Family Medicine is the first step/link between doctors and patients within patients care as well as regular inspections/examinations and follow-up of the health status of healthy people. Most countries aspire to join the European Union and therefore adopting new regulations that are applied in the European Union. Aim: The aim of this study is to present the role and importance of family medicine, or where family medicine is today in 21 Century from the beginning of development in these countries. The study is designed as a descriptive epidemiological study with data from 10 countries of the former Communist bloc, Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, Bulgaria, Romania, Czech Republic, Slovakia and Hungary, just about half of them are members of the EU. We examined the following variables: socio-organizational indicators, health and educational indicators and health indicators. The data used refer to 2002 and as a source of data are used official data from reference WebPages of family medicine doctors associations, WONCA website (EURACT, EQuiP, EGPRN), WebPages of Bureau of Statistics of the countries where the research was conducted as well as the Ministries of Health. Results: Results indicates that the failures and shortcomings of health care organizations in Southeast Europe. Lack of money hinders the implementation of health care reform in all mentioned countries, the most of them that is more oriented to Bismarck financing system. Problems in the political, legal and economic levels are obstacles for efficient a problem reconstructing health care system toward
Shang, Er-Xin; Li, Wen-Lin; Ye, Liang; Zhou, Wei; Tang, Yu-Ping; Fan, Xin-Sheng
Data mining technology has become a powerful tool in traditional Chinese medicine (TCM) research. In this paper, based on the principle and basic requirements of data mining, the mining methods and procedures were described. And then the application of data mining technology in Chinese medicine pair research was classified and summarized, such as the compatibility characters, characteristic pairs, dosage-effect relationship and property compatibility, which provide the direction and data base for modern research of Chinese medicine pair.
Rowe, B H; Ryan, D T; Therrien, S; Mulloy, J V
OBJECTIVE: To identify the computer knowledge, skills and attitudes of first-year family medicine residents. DESIGN: Cross-sectional survey of family medicine residents during the academic year 1993-94; sampling began in July 1993 and ended in October 1993. SETTING: Canada. PARTICIPANTS: All 727 first-year family medicine residents, of whom 433 (60%) responded. OUTCOME MEASURES: Previous computer experience or training, current use, barriers to use, and comfort with and attitudes regarding computers. RESULTS: There was no difference in age or sex between the respondents and all first-year family medicine residents in Canada. French-speaking respondents from Quebec were underrepresented (p < 0.001). Only 56 respondents (13%) felt extremely or very comfortable with computer use. The most commonly cited barriers to obtaining computer training were lack of time (243 respondents [56%]) and the high cost of computers (214 [49%]) but not lack of interest (69 [16%]). Most residents wanted more computer training (367 [85%]) and felt that computer training should be a mandatory component of family medicine training programs (308 [71%]). CONCLUSIONS: Computer knowledge and skills and comfort with computer use appear low among first-year family medicine residents in Canada, and barriers to acquisition of computer knowledge are impressive. Computer training should become an integral part of family medicine training in Canada, and user-friendly applicable computer systems are needed. PMID:7614442
Ramanayake, R P J C
Sri Lankan health system consists of Allopathic, Ayurvedic, Unani, and several other systems of medicine and allopathic medicine is catering to the majority of the health needs of the people. As in many other countries, Sri Lankan health system consists of both the state and the private sector General practitioners, MOs in OPDs of hospitals and MOs of central dispensaries, provide primary medical care in Sri Lanka. Most of the general practices are solo practices. One does not need postgraduate qualification or training in general practice to start a general practice. There is no registered population for any particular health care institution in the state sector or in the private sector and there is no strict referral procedure from primary care to secondary or tertiary care. Family doctors have been practicing in Sri Lanka for well over 150 years. The first national organization of general practitioners was Independent Medical Practitioner (IMPA)'s organization which was founded in 1929 and the College of General Practitioners of Sri Lanka was founded in 1974. College conducts its own Membership Course and Examination (MCGP) since 1999. Family Medicine was introduced to undergraduate curriculum in Sri Lanka in early 1980s and now almost all the medical faculties in the country have included Family Medicine in their curricula. In 1979, General Practice/Family Medicine was recognized as a specialty in Sri Lanka by the postgraduate institute of Medicine. Diploma in Family Medicine (DFM) and MD Family Medicine are the pathways for postgraduate training in Sri Lanka. At present 50 to 60 doctors enroll for DFM every year and the country has about 20 specialists (with MD) in Family Medicine. The author's vision for the future is that all the primary care doctors to have a postgraduate qualification in Family Medicine either DFM, MD, or MCGP which is a far cry from the present status.
Spann, Stephen J.
PURPOSE To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. METHODS The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. RESULTS The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from $167,457 to $210,288 total annual compensation) for
Al-Turki, Nouf; Afify, Ayman AM; AlAteeq, Mohammed
Background Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. Objective To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. Methods A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants’ demographic and occupational data. Results A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Conclusion Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers. PMID:27330300
Green, Larry A.; Graham, Robert; Bagley, Bruce; Kilo, Charles M.; Spann, Stephen J.; Bogdewic, Stephen P.; Swanson, John
BACKGROUND To lay the groundwork for the development of a comprehensive strategy to transform and renew the specialty of family medicine, this Future of Family Medicine task force was charged with identifying the core values of family medicine, developing proposals to reform family medicine to meet consumer expectations, and determining systems of care to be delivered by family medicine in the future. METHODS A diverse, multidisciplinary task force representing a broad spectrum of perspectives and expertise analyzed and discussed published literature; findings from surveys, interviews, and focus groups compiled by research firms contracted to the Future of Family Medicine project; and analyses from The Robert Graham Center, professional societies in the United States and abroad, and others. Through meetings, conference calls, and writing, and revision of a series of subcommittee reports, the entire task force reached consensus on its conclusions and recommendations. These were reviewed by an external panel of experts and revisions were made accordingly. MAJOR FINDINGS After delivering on its promise to reverse the decline of general practice in the United States, family medicine and the nation face additional challenges to assure all people receive care that is safe, effective, patient-centered, timely, efficient, and equitable. Challenges the discipline needs to address to improve family physicians’ ability to make important further contributions include developing a broader, more accurate understanding of the specialty among the public and other health professionals, addressing the wide scope and variance in practice types within family medicine, winning respect for the specialty in academic circles, making family medicine a more attractive career option, and dealing with the perception that family medicine is not solidly grounded in science and technology. The task force set forth a proposed identity statement for family medicine, a basket of services that
Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross EG
Background The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour. PMID:12740025
Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne
Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Results Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Conclusions Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit. PMID:24883163
Ungar, Lea; Alperin, Mordechai; Amiel, Gilad E; Beharier, Zvi; Reis, Shmuel
Previous research has shown that physicians experience incompetence and difficulty in dealing with patients' feelings after they have broken bad news to them. During the past 10 years, we have implemented a longitudinal training program targeting these issues. The present article describes this training and discusses its contribution to doctors' skills at approaching distressed patients. In order to cope with breaking bad news to patients and their families, physicians should be skilled at crisis intervention and communication techniques. They should also be aware of their personal attitudes and emotional reactions when breaking bad news. Each session encompassed these areas, as well as the most prominent issues arising when breaking bad news. In a 1-5 Likert scale, the course received an overall score of 4.47 (S.D. 0.51). Participants noted that they had gained relevant communication skills for future patient encounters.
Samek, Diana; Rueter, Martha; Koh, Bibiana
This article provides an overview of the methods, assumptions, and key findings of behavioral genetics methodology for family researchers with a limited background. We discuss how family researchers can utilize and contribute to the behavioral genetics field, particularly in terms of conducting research that seeks to explain shared environmental effects. This can be done, in part, by theoretically controlling for genetic confounds in research that seeks to determine cause-and-effect relationships among family variables and individual outcomes. Gene–environment correlation and interaction are especially promising areas for the family researcher to address. Given the methodological advancements in the field, we also briefly comment on new methods in molecular genetics for studying psychological mental health disorders. PMID:24073018
Salihović, Habiba; Puvacić, Sandra; Masić, Izet
The family medicine as the determination of the reformators and the strategies of the action in BiH is given in the form of the legal solution in the organization of the primary healhtcare action in BiH given in the form of the legal solution in the organization of the primary healthcare protection (the law about the healthcare protection--official newspaper F/BiH No 29/97). The fact is given the alternative solution--the team of the family medicine or the team of the medicine. Besides this there exist also some essential questions about the registration of the patients for the family medicine teams make complex the forming of the next of the family medicine. Besides that there are also some essential questional about the registration of the patients for family medicine teams--whethers that they registrar all the citizens or only the insureds to which is insured the healthcare protection though the medicine--werther are being registered all the citizens, whom belong the active ensured whom is ensured the healthcare protection through the institutions for the work medicine, the students and sportsmen who also have their institution etc. The further problem, when is in questions the patients registration of the patients, is the nonexistence of the reliable statistical data about the number, sexual inhabitants, as is known all the estimates are being done on the basis of the estimation of the federal institution for statistics. Therefore the registration of the family and the individuals for the family medicine teams will be rather painstaking.
Research in Biological and Medical Sciences, Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 1
Contents: In-house laboratory independent research; Communicable diseases and immunology; Surgery, internal medicine , psychiatry, Biochemistry...surgery, military internal medicine , military psychiatry; Malaria prophylaxis; and Biosensor systems.
Research in Biological and Medical Sciences Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 2
preventive medicine; Military medical research program S. E. Asia; Combat surgery; Military internal medicine ; Military psychiatry; Ionizing radiation injury, prevention and treatment; Malaria prophyaxis; Biosensor systems.
Mitchell, Joan; Brown, Judith Belle; Smith, Carrie
This qualitative research paper describes a successful example of interprofessional education with family medicine residents (FMR) by a nurse practitioner (NP) colleague. The educational impact of the NP role in regard to smoking cessation counselling is revealed by the analysis of 16 semi-structured interviews using a phenomenological approach. The key themes depicted the NP as an educator and mentor, encourager and referral resource. Outcomes of improved knowledge, skills, and motivation towards providing smoking cessation counselling are described. This research provides some understanding of how professional students' learning and practice can be affected by a member of another profession through direct and indirect approaches. The experiences identified how interprofessional education and collaborative clinical practice can affect FMRs' attitudes, knowledge and behaviours. This learning can guide us in enhancing the quality of education provided to all health care professionals.
King, Richard V; Murphy-Cullen, Cassie L; Mayo, Helen G; Marcee, Alice K; Schneider, Gregory W
Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.
Occupational medicine has taken over from Family practice the treatment of work injuries and occupational diseases in the Republic of Croatia since January 1, 2008. The reason was too many long-lasting sick leaves which general practitioners were unable to curb adequately. The research objective was to show the results of the one-year follow-up of the carried out reform, i.e. the efficiency of Occupational medicine in the new function. The methods of data comparison and McNemar statistics were used of one-year follow-up in an Occupational medicine surgery that cares for 5800 employees in Littoral-Mountainous County. From 32 patients in February 2008, 30 work injuries and 2 occupational diseases, the overall number diminished in February 2009 to 13 patients with work injuries and no diagnosed occupational disease, p < 0.001 for work injuries. Also the number of patients on sick leave over three months fell from 14 to 4. Occupational medicine has proved to be more efficient than Family practice in assessing sick leave. This does not mean that family practice, due to a number of reasons mentioned in the research, is of less importance. For the patient can always return to his general practitioner for further treatment, and sick leave if necessary, but not on the grounds of work injury and occupational disease.
Han, Jia-yin; Yi, Yan; Liang, Ai-hua; Zhang, Yu-shi; Li, Chun-ying; Zhao, Yong; Wang, Lian-mei; Li, Gui-qin
Genotoxicity research takes an important place in traditional Chinese medicine safety evaluation. Genotoxicity test on traditional Chinese medicine has been paid great attention since 1970s. Currently, the most developed genotoxicity test methods included: bacterial reverse mutation test and mouse lymphoma assay which are used to detect relevant genetic changes, micronucleus test and chromosomal analysis which are used to measure chromosomal aberration, and single cell electrophoresis assay which is used to test DNA damage. This article reviews research progress on genotoxicity of traditional Chinese medicine, evaluation methods of genotoxicity, the problems and solutions on genotoxicity evaluation of traditional Chinese medicine, and new technique used in genotoxicity test.
Breton, Mylaine; Lévesque, Jean-Frédéric; Pineault, Raynald; Hogg, William
Canadian politicians, decision-makers, clinicians and researchers have come to agree that reforming primary care services is a key strategy for improving healthcare system performance. However, it is only more recently that real transformative initiatives have been undertaken in different Canadian provinces. One model that offers promise for improving primary care service delivery is the family medicine group (FMG) model developed in Quebec. A FMG is a group of physicians working closely with nurses in the provision of services to enrolled patients on a non-geographic basis. The objectives of this paper are to analyze the FMG's potential as a lever for improving healthcare system performance and to discuss how it could be improved. First, we briefly review the history of primary care in Quebec. Then we present the FMG model in relation to the four key healthcare system functions identified by the World Health Organization: (a) funding, (b) generating human and technological resources, (c) providing services to individuals and communities and (d) governance. Next, we discuss possible ways of advancing primary care reform, looking particularly at the family health team (FHT) model implemented in the province of Ontario. We conclude with recommendations to inspire other initiatives aimed at transforming primary care. PMID:23115575
Hungerford, Anne; Cox, Martha J
The purpose of this article is to review evidence concerning the joint impact of family characteristics and child care experiences in understanding children's development. Although child care experiences are related to children's development across a variety of domains, family characteristics, particularly socioeconomic status and parenting quality, are typically stronger predictors of children's outcomes. An important implication of these findings is that high-quality child care experiences are likely to have stronger effects on children who are at risk of poorer outcomes because of less optimal family environments; evidence from experimental and nonexperimental studies generally supports this conclusion. From a policy perspective, an important goal for future research is to identify subgroups of families within the heterogeneous low-income population that are in particular need of relatively more intensive services and to develop effective interventions that are tailored to their needs.
Solberg, J. L.; Pleasant, L. G.
A list of publications supported by the Space Medicine Program, Office of Space Science and Applications is given. Included are publications entered into the Life Sciences Bibliographic Database by The George Washington University as of October 1, 1984.
Wooten, F. T.
A program designed to find ways of transferring space technology to non-space medicine is discussed. The methodology used to attack the problem and several illustrative examples of the results are given.
Discussions about immigration, focused on such policy issues as labor force participation and use of welfare programs, frequently fail to include considerations of children's well-being. Even those debates which center on programs that benefit children--such as schools, public assistance, and social welfare programs--are often based on issues related to short-term costs and societal impacts, neglecting considerations of the well-being and future contributions of immigrant children. Hence, immigrant children have been rendered largely invisible in policy spheres. Yet first- and second-generation immigrant children are the fastest-growing segment of the U.S. population under age 15. In this context, the Board on Children and Families of the National Research Council and the Institute of Medicine convened a workshop on immigrant children and families to review what is known about this population and to identify issues that warrant further examination. This article is based on the discussions at the workshop. Several themes emerged from the workshop, including the value of looking at immigrant children in the context of their families; the importance of understanding public concerns over the costs of immigrants, coupled with the difficulty of pinpointing just what those costs are; and the need for policymakers to address such policy issues as education and health care. The article concludes by identifying a number of areas in which research is warranted as immigrant children and families grow to become a core part of American communities, schools, and society.
Jing, Chen; Xingqun, Cheng; Xin, Xu; Xuedong, Zhou; Yuqing, Li
As an interdisciplinary of stomatology and space medicine, space oral medicine focuses mainly on oral diseases happened under space environment. With the manned space technology stepping into the new era, space oral medicine has been put under the spotlight. This article will review the historical events on this subject, summarize the newly progress especially on craniomaxillofacial bone, tooth-derived stem cell and oral microbiology researches and still put forward future prospect.
Albert, Steven M.; Levine, Carol
Research in family caregiving recently has become more challenging because of the strict protection of privacy mandated in the Health Insurance Portability and Accountability Act (HIPAA) of 1996. We ask when should Institutional Review Boards (IRBs) follow HIPAA rules to the letter and when might they use the waiver option? What is the appropriate…
O'Neill, Thomas R.; Peabody, Michael R.; Stelter, Keith L.; Hagen, Michael D.
(Purpose) The purpose of our study was to assess the need for an external searchable resource to be used in conjunction with the American Board of Family Medicine's (ABFM) Maintenance of Certification for Family Physicians (MC-FP) Examination, discuss the philosophical question of whether an ESR should be allowed on the examination, and outline…
Jones, Betsy Goebel; Berk, Steven L
Meeting Texas' future health care needs will be challenging, including the goal for a physician workforce more balanced toward primary care. To help expand the primary care physician workforce, Texas Tech University Health Sciences Center (TTUHSC) School of Medicine developed the Family Medicine Accelerated Track (FMAT), a three-year curriculum that culminates in the MD degree and links medical students to family medicine residency programs at TTUHSC campuses in Lubbock, Amarillo, or the Permian Basin (Odessa and Midland). Twenty current family medicine residents are graduates of the FMAT program, and 30 medical students are enrolled in the program, which is charting a path for curricular innovation in medical education that will be increasingly competency-based.
It is my great pleasure to announce that we were able to publish the Japan Issue in Stem Cells and Development, especially in this year 2014. This year, 2014, is said to be the First Year of Regenerative Medicine in Japan. This movement is likely to be based on the establishment of a new law system regarding regenerative medicine (an Act for Ensuring the Safety of Regenerative Medicine or the so-called Regenerative Medicine Law) and the partial revision of the Pharmaceutical Affairs Law (PAL). Both laws will come into effect in 2014 in this country. These new law systems are expected to have a great impact on the facilitation of R&D related to regenerative medicine and stem cell biology. In the present Japan Issue, some excellent stem cell research in this country will be introduced to celebrate the First Year of Regenerative Medicine in Japan.
Abstract Introduction Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians’ competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. Methods A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. Results The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. Conclusions All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education. PMID:28289469
Coates, Ralph J.; Fennell, Mary L.; Glasgow, Russell E.; Scheuner, Maren T.; Schully, Sheri D.; Williams, Marc S.; Clauser, Steven B.
Advances in genomics and related fields promise a new era of personalized medicine in the cancer care continuum. Nevertheless, there are fundamental challenges in integrating genomic medicine into cancer practice. We explore how multilevel research can contribute to implementation of genomic medicine. We first review the rapidly developing scientific discoveries in this field and the paucity of current applications that are ready for implementation in clinical and public health programs. We then define a multidisciplinary translational research agenda for successful integration of genomic medicine into policy and practice and consider challenges for successful implementation. We illustrate the agenda using the example of Lynch syndrome testing in newly diagnosed cases of colorectal cancer and cascade testing in relatives. We synthesize existing information in a framework for future multilevel research for integrating genomic medicine into the cancer care continuum. PMID:22623603
Hammer, Marilyn J
President Barack Obama announced the launch of the National Institutes of Health Precision Medicine Initiative® (PMI) in January 2015. Precision medicine includes the concept of individualized or personalized medicine at a more exact level through advances in science and technology, such as genetics and genomics sequencing. Although many disease processes will be investigated through the precision medicine lens for greater understanding and improved treatment responses, oncology research and translation to practice is leading the initiative's debut, referred to as the near-term focus.
Cox, Timothy M
definitive treatment is otherwise available. Future glycolipid research in medicine will be directed to experiments that shed light on the role of sphingolipids in signalling pathways, and in the comprehensive characterization and their secretory products in relation to the molecular pathogenesis of the storage disorders; experiments of use to improve the efficiency of complementing enzymatic delivery to the lysosomal compartment of storage cells are also needed. Further systematic screening for inhibitory compounds with specific actions in the pathways of glycosphingolipid biosynthesis will undoubtedly lead to clinical trials in the neuronopathic storage disorders and to wider applications in the fields of immunity and cancer biology. PMID:12803931
Klemenc-Ketiš, Zalika; Kersnik, Janko
Primary health care is important item of political agendas since Alma Ata conference in 1978. West Balkans share common history in development of primary care since 1920s when Andrija Stampar introduced social and community based primary care concepts. The first known specialist training in general practice in the world started in former Yugoslavia in the early 1960s. Since then, much has been done in the field of general practice and family medicine and this is reflected in The European Academy of Teachers in General Practice and Family Medicine (EURACT), which is a network organisation within World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Region Europe (WONCA Europe). Its aim is to foster and maintain high standards of care in European general practice by promoting general practice as a discipline by learning and teaching. EURACT developed several documents and teachers courses which can serve the development of family medicine curricula in new established departments of medical schools. This is also the case at Maribor Medical School, where learning outcomes and teaching methods are in concordance with EURACT teaching agenda, but also some innovative approaches are used, such as art and e-learning environment as teaching methods.
Bazemore, Andrew; Wingrove, Peter; Peterson, Lars; Petterson, Stephen
Family physicians are increasingly incorporating other health care providers into their practice teams to better meet the needs of increasingly complex and comorbid patients. While a majority of family physicians report working with a nurse practitioner, only 21% work with a behavioral health specialist. A better understanding of optimal team composition and function in primary care is essential to realizing the promise of a patient-centered medical home and achieving the triple aim.
O'Neill, Thomas R.; Royal, Kenneth D.; Schulte, Bradley M.; Leigh, Terrence
Background: Two medical specialty boards offer certification in family medicine: the American Board of Family Medicine (ABFM) and the American Osteopathic Board of Family Physicians (AOBFP). The AOBFP certification is offered only to graduates of osteopathic colleges; however, graduates of both osteopathic and allopathic medical schools who have…
Wooten, F. T.
Discussion of a NASA-sponsored medical program under which work is done by multidiscipline teams to provide an interface between aerospace and medicine. A prosthetic urethral valve, an ear oximeter for measurement of oxygen content in the blood, a radiation dosimeter and an electromyographic muscle trainer are noted as the products of this program.
Cridland, Elizabeth K.; Jones, Sandra C.; Magee, Christopher A.; Caputi, Peter
A family member with an autism spectrum disorder presents pervasive and bidirectional influences on the entire family system, suggesting a need for family-focused autism spectrum disorder research. While there has been increasing interest in this research area, family-focused autism spectrum disorder research can still be considered relatively…
Kim, Jung G.; Morris, Carl G.; Heidrich, Fred E.
Background Secure messages exchanged between patients and family medicine residents via an electronic health record (EHR) could be used to assess residents' clinical and communication skills, but the mechanism is not well understood. Objective To design and test a secure messaging competency assessment for family medicine residents in a patient-centered medical home (PCMH). Methods Using the existing literature and evidence-based guidelines, we designed an assessment tool to evaluate secure messaging competency for family medicine residents training in a PCMH. Core faculty performed 2-stage validity and reliability testing (n = 2 and n = 9, respectively). A series of randomly selected EHR secure messages (n = 45) were assessed from a sample of 10 residents across all years of training. Results The secure message assessment tool provided data on a set of competencies and a framework for resident feedback. Assessment showed 10% (n = 2) of residents at the novice level, 50% (n = 10) as progressing, and 40% (n = 8) as proficient. The most common deficiencies for residents' secure messages related to communication rather than clinical competencies (n = 37 [90%] versus n = 4 [10%]). Interrater reliability testing ranged from 60% to 78% agreement and 20% to 44% disagreement. Disagreement centered on interpersonal communication factors. After 2 stages of testing, the assessment using residents' secure messages was incorporated into our existing evaluation process. Conclusions Assessing family medicine residents' secure messaging for patient encounters closed an evaluation gap in our family medicine program, and offered residents feedback on their clinical and communication skills in a PCMH. PMID:26692980
Wang, Jin; Wang, Qiang; Li, Peng; Liu, Si-Qi; Huang, Qin-Wan
Dryness is the inherent performance in traditional Chinese medicine. Dryness with a specific efficacy and side effect can be reduced suitably by processing and compatibility in the clinical application. Nowadays domestic scholars have developed research of dryness in traditional Chinese medicine. However, it remains problems such as evaluation index of dryness not clear. This paper takes medical literature mining technology to analyze the historical origin and features of dryness theory. Combing the modern literatures to explicate the dryness' research status and existing problems. Putting forward the traditional Chinese medicine and research should adopt multidisciplinary knowledge and study the system of comprehensive evaluation. Dryness is expected to further application in traditional Chinese medicine clinical research.
General Practice/Family Medicine is a specialty focused on the provision of comprehensive, continuing, and community oriented, person-centred care. The lack of prestige and the difficulty in attracting trainees to the specialty have been longstanding problems in most countries around the world. In Europe, General Practice/Family Medicine is also hampered for not being recognized as a specialty throughout Europe. As for Portugal, General Practice/Family Medicine is undergoing a massive organizational reform, as well as unprecedented levels of popularity among trainees. General Practice/Family holds tremendous latent potential, and is thus a specialty with a bright future ahead. It could well establish itself as the specialty of the future if it is able to overcome the barriers that currently make of General Practice/Family Medicine an unpopular career choice. It is important to train confident, competent and polyvalent family physicians, but it is also necessary to overhaul payment schemes, to invest in primary care infra-structure and organization, and to continue to attract more and more bright and motivated trainees. PMID:19906299
The Senate Human Resources Subcommittee under the chairmanship of Senator Alan Cranston has completed its work on the Family Planning Services and Population Research Amendments of 1973 (S. 1708) and has referred the bill to the Senate Labor and Public Welfare Committee. Right-to-Life activists are zeroing in on committee members in hopes of amending the bill to prohibit federal funds for sterilization and continued research on abortifacient drugs. If such provisions were to be approved, it would prohibit men from obtaining vasectomies with federal assistance and eliminate what has become a most popular birth control method for couples who have reached their desired family size. Such a prohibition would be especially discriminatory of low income males who cannot afford to finance a vasectomy through the private health care system. Banning use of IUDs by federal family planning agencies could also interfere with valuable cancer research and the treatment of such ailments as asthma and duodenal ulcers. The Senate Labor Committee needs to be fully advised as to the dangerous implications of these provisions and of the public opposition to their enactment. Vocalize your opposition today by urging the committee to exclude such amendments from the legislation they send to the Senate. The committee members are: Chairman: Williams, New Jersy; Randolph, West Virginia; Pell, Rhode Island; Kennedy, Massachusetts; Nelson, Vermont; Mondale, Minnesota; Eagleton, Missouri; Cranston, California; Hughes, Iowa; Hathaway, Maine; Javits, New York; Dominick, Colorado; Schweiker, Pennsylvania; Taft, Ohio; Beall, Maryland; and Stafford, Vermont.
Potts, Stacy E; Deligiannidis, Konstantinos E; Cashman, Suzanne B; Caggiano, Marie E; Carter, Lisa H; Haley, Heather-Lyn; Ferguson, Warren J
Policymakers and accrediting bodies have recognized the importance of integrating public health, population health, and prevention into graduate medical education programs. The high prevalence of chronic illness, coupled with the impact of behavioral and societal determinants of health, necessitate an urgent call for family medicine residencies to prepare future leaders to meet these challenges. The University of Massachusetts Worcester Family Medicine Residency recently developed an integrated curriculum that strives to develop a culture of incorporating fundamental public health principles into everyday practice. This public health curriculum was designed to integrate new topics within the current residency structure through longitudinal and concentrated experiences. This strategy has substantially improved public health and prevention education without substantial impact on the already strained residency curricular structure. This paper describes the integration of public health and prevention education into a family medicine residency to help residents acquire the fundamental skills necessary to improve a population's health.
Vitale, Ksenija; Munđar, Roko; Sović, Slavica; Bergman-Marković, Biserka; Janev Holcer, Nataša
The use of complementary and alternative medicine (CAM) is widespread around the world including Croatia. The number of studies that investigate both quantitative and qualitative use of CAM in Croatia is limited. The aim of this study was to investigate the use of CAM among family medicine patients in the town of Čakovec and the rate they report it to their family doctor. This was a cross-sectional study in a sample of 300 patients that visited primary health center for any reason. We used anonymous questionnaire already employed in a previous investigation (Čižmešija et al. 2008), which describes socioeconomic characteristics, modalities of CAM use, and reasons for use. We also added questions on the type of herbs used and use of over-the-counter vitamin and mineral supplements. On data analysis we used descriptive statistics, χ2-test and Fisher's exact test, while the level of statistical significance was set at p ≤ 0.05. The response rate was 76%. Out of the total number of patients, 82% used some modality of CAM. Women, patients with secondary school education, employed and retired persons used CAM more often. Students and pupils reported least use of CAM. The most commonly used were herbs (87%), bioenergy (29%), diet therapy (28%), chiropractics (22%), and homeopathy and acupuncture (11% each). Vitamin and mineral supplements were used by 77% of study subjects. CAM was most frequently used for respiratory, urinary and musculoskeletal problems, as well as to improve overall health condition. Of the respondents that reported CAM use, 55% believed it would help them, 43% used it because they wanted to try something new, while only 2% indicated dissatisfaction with their physician as the reason for using CAM. Statistically, there were more subjects that used CAM and did not notify their family doctor about it, which could indicate poor communication between family doctors and health care users. Our results are consistent with a previous quantitative study
Cridland, Elizabeth K; Jones, Sandra C; Magee, Christopher A; Caputi, Peter
A family member with an autism spectrum disorder presents pervasive and bidirectional influences on the entire family system, suggesting a need for family-focused autism spectrum disorder research. While there has been increasing interest in this research area, family-focused autism spectrum disorder research can still be considered relatively recent, and there are limitations to the existing literature. The purpose of this article is to provide theoretical and methodological directions for future family-focused autism spectrum disorder research. In particular, this article proposes Family Systems approaches as a common theoretical framework for future family-focused autism spectrum disorder research by considering theoretical concepts such as Boundaries, Ambiguous Loss, Resilience and Traumatic Growth. We discuss reasons why these concepts are important to researching families living with autism spectrum disorder and provide recommendations for future research. The potential for research grounded in Family Systems approaches to influence clinical support services is also discussed.
Klein, Douglas; Allan, G. Michael; Manca, Donna; Sargeant, Joan; Barnett, Carly
Introduction: Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for…
Sexual problems can be caused by organic or psychological factors, or a combination of the two. Deciding which leads to an appropriate management plan. This paper describes the current status of treatments for common sexual dysfunctions seen in family practice. PMID:8471907
Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael
Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…
Noah, Aggie J.
Neighborhood is an important context in which individuals and families are embedded. Yet family studies researchers have been relatively slow to incorporate spatial approaches into family science. Although limited theoretical and methodological attention has been devoted to families in neighborhood-effects research, family scholars can contribute greatly to theories about neighborhood effects, and neighborhood-effects research can help move the field of family studies forward. This article reviews the theories, applications, and limitations of research on neighborhood effects and discusses how family studies can benefit from incorporating a spatial perspective from neighborhood-effects research. I then present an innovative methodology—referred to as activity spaces—emerging in neighborhood-effects research, and I discuss how this approach can be used to better understand the complexity and heterogeneity of families. Last, I highlight ways to incorporate space into family studies by “putting families into place.” PMID:26681979
Institute of Family Studies, Melbourne (Australia).
Family life is the focus of this sixth volume in a series containing the proceedings of the 1983 Australian Family Research Conference. The papers are organized under two major sections: Children and Families and Family Environments. Papers and authors included are: "Family Conflict and Child Competence" (Gay Ochiltree and Paul Amato),…
Gadano, A B; Gurni, A A; Carballo, M A
Chenopodium ambrosioides L. and Chenopodium multifidum L. (Chenopodiaceae), common name: Paico, are medicinal plants. They are aromatic shrubs growing in South America. For centuries, they have been used due to its medicinal properties. However, there are few reports in literature about the genotoxic effects of these plants. There for, the aim of these work is the evaluation of genetic damage induced by decoction and infusion of this plants which were assayed in different concentrations (1, 10, 100, 1,000 microL extract/mL culture), by addition of the extract to human lymphocyte cell cultures, negative controls were included. The endpoints evaluated were chromosomal aberrations (CA), sister chromatid exchanges (SCE), cell proliferation kinetics (CPK) and mitotic index (MI). The repeated measure analysis of variance was used for statistic evaluation of the results. The results showed: (a) statistical increase in the percentage of cells with CA and in the frequency of SCE when cultures were exposed to both aromatic plants, (b) a decrease in MI of both Paicos assayed, although no modification in the CPK values was observed, (c) no effect was noticed in the analysis of Chenopodium album L., which was used as negative control of the essential oil. These results suggest a cyto and genotoxic effect of Chenopodium ambrosioides and Chenopodium multifidum aqueous extracts related to the essential oil of the plant (as Chenopodium album did not perform).
Honig, Alice Sterling
The Family Development Research Program (FDRP) was begun as an omnibus effort to serve low-income, low-education families by providing education, nutrition, health, safety, and human service resources for the 108 families initially recruited. Very deprived families were recruited early in the last trimester of pregnancy. All the families had an…
Wooten, F. T.
NASA has taken the lead in implementing the concept of technology utilization, and the Technology Utilization Program is the first vital step in the goal of a technological society to insure maximum benefit from the costs of technology. Experience has shown that the active approach to technology transfer is unique and is well received in the medical profession when appropriate problems are tackled. The problem solving approach is a useful one at the precise time when medicine is recognizing the need for new technology.
Matthews, H B; Lucier, G W; Fisher, K D
Virtually all cultures have, throughout history, used a variety of plants or materials derived from plants for the prevention and treatment of disease. Evidence of the beneficial therapeutic effects of these medicinal herbs is seen in their continued use. Additionally, the development of modern chemistry permitted the isolation of chemicals from medicinal herbs that have served as drugs or starting materials for the synthesis of many important drugs used today. Many more modern drugs have been synthesized as a result of knowledge gained from studies of mechanisms of actions of chemicals first isolated from medicinal herbs. Thus, medicinal herbs have played a major role in the development of modern medicine and continue to be widely used in their original form. Whereas it is generally agreed that most medicinal herbs are safe under the conditions used, some are toxic and should be avoided even though they are readily available, and others have significant adverse side effects when misused. Also, little has been done to investigate potential adverse effects that may be associated with extended or high-dose use of medicinal herbs. Thus, concern has been expressed that the lack of quality control used in the preparation of medicinal herbs, plus their unregulated sale and uninformed use, pose potential adverse health effects for consumers. There is also concern regarding potential herb/herb or herb/drug interactions and possible untoward health effects of medicinal herbs in sensitive subpopulations such as the young and the elderly and certain genetically predisposed individuals. In this paper, we discuss these concerns at some length and make recommendations for additional research and education discussed in the recent International Workshop to Evaluate Research Needs on the Use and Safety of Medicinal Herbs. PMID:10504141
Hertlein, Katherine M.; Lambert-Shute, Jennifer; Benson, Kristen
Postmodernism has influenced family therapy in significant ways, from clinical work to family therapy research. Little has been written, however, on how to conduct postmodern research in a manner reflecting marriage and family therapy inquiries. The present study seeks to investigate doctoral students understanding of postmodern family therapy…
Corfman, Eunice, Ed.
Science Monographs, published by the National Institute of Mental Health, are book-length, integrative state-of-the-art reviews, critical evaluations of findings, or program assessments of current research on topics related to the NIMH mandate. This set of articles concentrate on the family in changing times. Articles focus on the impact of the…
Corfman, Eunice, Ed.
Science Monographs, published by the National Institute of Mental Health, are book-length, integrative state-of-the-art reviews, critical evaluations of findings, or program assessments of current research on topics related to the NIMH mandate. This set of articles concentrate on mental illness in the family. "Depression and Low-Income,…
Puffer, James C
Considerable controversy about the value of participating in Maintenance of Certification has recently arisen within the medical community. Despite this controversy, large numbers of family physicians certified by the American Board of Family Medicine participate in Maintenance of Certification for Family Physicians. Surprisingly, a small but significant number of charter diplomats--those initially certified by the American Board of Family Medicine at its founding--are engaged in the process.
Pène, Frédéric; Ait-Oufella, Hafid; Taccone, Fabio Silvio; Monneret, Guillaume; Sharshar, Tarek; Tamion, Fabienne; Mira, Jean-Paul
Experimental research has always been the cornerstone of pathophysiological and therapeutic advances in critical care medicine, where clinical observations and basic research mutually fed each other in a so-called translational approach. The objective of this review is to address the different aspects of translational research in the field of critical care medicine. We herein highlighted some demonstrative examples including the animal-to-human approach to study host-pathogen interactions, the human-to-animal approach for sepsis-induced immunosuppression, the still restrictive human approach to study critical illness-related neuromyopathy, and the technological developments to assess the microcirculatory changes in critically ill patients. These examples not only emphasize how translational research resulted in major improvements in the comprehension of the pathophysiology of severe clinical conditions and offered promising perspectives in critical care medicine but also point out the obstacles to translate such achievements into clinical practice.
improve extremity function • Incorporate neural interface/feedback Pain Management: (Acute/Chronic/Battlefield) • Improve management of battlefield...acute and chronic pain • Establish safety margins for individual prescriptions • Identify and treat pain generators • Develop strategies to empower...patient in managing pain Regenerative Medicine and Transplants: • Improve speed of healing and decrease scarring • Regenerate missing tissue and repair
Denham, Sharon A
Three ethnographic studies investigated how families define and practice family health within their household and community settings. Synthesis of these findings prompted the Family Health Model. It suggests ways to dialogue about the complex variables associated with family health and approaches to family-focused practice.
Janke, Fred; Dobbs, Bonnie; McKay, Rhianne; Linsdell, Meghan; Babenko, Oksana
Background Sleep deprivation and fatigue are associated with long and irregular work hours. These work patterns are common to medical residents. Motor vehicle crashes (MVCs) are a leading cause of injury related deaths in Canada, with MVC fatality rates in rural areas up to three times higher than in urban areas. Objectives To: 1) examine the number of adverse motor vehicle events (AMVEs) in family medicine residents in Canada; 2) assess whether residents with rural placements are at greater risk of experiencing AMVEs than urban residents; and 3) determine if family medicine residency programs across Canada have travel policies in place. Methodology A prospective, cross-sectional study, using a national survey of second-year family medicine residents. Results A higher percentage of rural residents reported AMVEs than urban residents. The trend was for rural residents to be involved in more MVCs during residency, while urban residents were more likely to be involved in close calls. The majority of Canadian medical schools do not have resident travel policies in place. Conclusion AMVEs are common in family medicine residents, with a trend for the number of MVCs to be greater for rural residents. These data support the need for development and incorporation of travel policies by medical schools. PMID:26451211
Leung, Kai-Kuen; Wang, Wei-Dan; Chen, Yen-Yuan
There is a lack of information on the use of multi-source evaluation to assess trainees' interpersonal and communication skills in Oriental settings. This study is conducted to assess the reliability and applicability of assessing the interpersonal and communication skills of family medicine residents by patients, peer residents, nurses, and…
Lai, Pauline Siew Mei; Tan, Sing Yee; Liew, Su May
Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.
Stein, Howard F.
This paper describes an experiment in which Family Medicine residents composed, read, and discussed their poems as a way of bringing to life their often complex relationships with patients. It argues that this approach mobilizes the physicians' own creativity in the service of reflective practice and improved doctor-patient relationships. This…
Whitley, Heather P.
Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…
For graduate medical education trainees, as well as contemporary practitioners, developing skills in recognizing compassion fatigue and practising self-care is vital to professional sustainability. The field of palliative medicine is no exception. In our fellowship programme, we use John Stone's poem, 'Talking to the Family,' to engage trainees in a professional development workshop on personal experiences and strategies for self-care.
Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.
Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…
Coleman, Clifford A; Nguyen, Nancy T; Garvin, Roger; Sou, Channbunmorl; Carney, Patricia A
Health care providers, including medical residents, often lack adequate knowledge and skills to work effectively with patients who have limited health literacy. Little is known about the degree to which medical residents are trained to communicate effectively with people who have limited health literacy. This study aimed to assess the status of health literacy training for physicians in U.S. family medicine residency programs. We conducted an online survey of residency directors at 444 U.S. family medicine residencies. Among 138 respondents (31% response rate), 58 programs (42%) reported teaching residents about health literacy as part of the required curriculum. Most instruction occurred during the 1st year of training. Hours of instruction ranged from 2 to 5 during Years 1 through 3. Skills-based training (e.g., plain language techniques) was taught by most programs. Not having access to a faculty authority on health literacy was strongly associated with lack of a required health literacy curriculum. Respondents overwhelmingly agreed that increasing health literacy training for medical students and residents would help improve residents' clinical skills. This study provides a baseline snapshot of health literacy curricula in U.S. family medicine residencies and likely overestimates the prevalence of such curricula. Additional studies are needed to determine the quality of health literacy instruction in U.S. family medicine residencies and the most effective methods for teaching residents about health literacy.
Czabanowska, Katarzyna; Klemenc-Ketis, Zalika; Potter, Amanda; Rochfort, Andree; Tomasik, Tomasz; Csiszar, Judit; Van den Bussche, Piet
Objective: The aim of this study was to develop a comprehensive framework of quality improvement competencies for use in continuing professional development (CPD) and continuing medical education (CME) for European general practice/family medicine physicians (GPs/FDs). Methods: The study was carried out in three phases: literature review,…
Davis, Junius A.; And Others
Analysis of 61 successful grant applications for the federal Establishment of Departments of Family Medicine grants program identified three dimensions for classifying supported developmental activities: (1) the functional area of the activity; (2) the objectives of the activity; and (3) the strategies to be used to attain the objectives.…
Lee, M D; King, L S; Agre, P
The aquaporins are a family of membrane channel proteins that serve as selective pores through which water crosses the plasma membranes of many human tissues and cell types. The sites where aquaporins are expressed implicate these proteins in renal water reabsorption, cerebrospinal fluid secretion and reabsorption, generation of pulmonary secretions, aqueous humor secretion and reabsorption, lacrimation, and multiple other physiologic processes. Determination of the aquaporin gene sequences and their chromosomal locations has provided insight into the structure and pathophysiologic roles of these proteins, and primary and secondary involvement of aquaporins is becoming apparent in diverse clinical disorders. Aquaporin-1 (AQP1) is expressed in multiple tissues including red blood cells, and the Colton blood group antigens represent a polymorphism on the AQP1 protein. AQP2 is restricted to renal collecting ducts and has been linked to congenital nephrogenic diabetes insipidus in humans and to lithium-induced nephrogenic diabetes insipidus and fluid retention from congestive heart failure in rat models. Congenital cataracts result from mutations in the mouse gene encoding the lens homolog Aqp0 (Mip). The present understanding of aquaporin physiology is still incomplete; identification of additional members of the aquaporin family will affect future studies of multiple disorders of water distribution throughout the body. In some tissues, the aquaporins may participate in the transepithelial movement of fluid without being rate limiting, so aquaporins may be involved in clinical disorders without being causative. As outlined in this review, our challenge is to identify disease states in which aquaporins are involved, to define the aquaporins' roles mechanistically, and to search for ways to exploit this information therapeutically.
Research in Biological and Medical Sciences, Including Biochemistry, Communicable Disease and Immunology, Internal Medicine, Nuclear Medicine, Physiology, Psychiatry, Surgery, and Veterinary Medicine. Volume 2
Contents: Military preventive medicine; Military medical research program S. E. Asia; Military medical materiel; Combat surgery; Military internal ... medicine ; Military psychiatry; Ionizing radiation injury, prevention, and treatment; Malaria prophylaxis; and Biosensor systems.
Eve, David J; Fillmore, Randolph; Borlongan, Cesar V; Sanberg, Paul R
The increasing number of publications featuring the use of stem cells in regenerative processes supports the idea that they are revolutionizing regenerative medicine research. In an analysis of the articles published in the journal Cell Transplantation - The Regenerative Medicine Journal between 2008 and 2009, which reveals the topics and categories that are on the cutting edge of regenerative medicine research, stem cells are becoming increasingly relevant as the "runner-up" category to "neuroscience" related articles. The high volume of stem cell research casts a bright light on the hope for stem cells and their role in regenerative medicine as a number of reports deal with research using stem cells entering, or seeking approval for, clinical trials. The "methods and new technologies" and "tissue engineering" sections were almost equally as popular, and in part, reflect attempts to maximize the potential of stem cells and other treatments for the repair of damaged tissue. Transplantation studies were again more popular than non-transplantation, and the contribution of stem cell-related transplants was greater than other types of transplants. The non-transplantation articles were predominantly related to new methods for the preparation, isolation and manipulation of materials for transplant by specific culture media, gene therapy, medicines, dietary supplements, and co-culturing with other cells and further elucidation of disease mechanisms. A sizeable proportion of the transplantation articles reported on how previously new methods may have aided the ability of the cells or tissue to exert beneficial effects following transplantation.
Nye, F. Ivan
Examines family research and its cultural setting in 1937, then reports on changes and commonalities in research topics, research methods, and use of theory from 1937 through 1987. Offers general evaluations of current research and suggestions for changes that might increase productivity of family research. (Author)
individual characteristics; family variables, including composition and life cycle stage; member duty requirements and career history; conditions created by...Laboratory Zita M. Simutis, Director September 1990 DTIC ELECTE S 5Op CT 29 190L 28 0- i9 United States Army Research Institute for the Behavioral and...FROM86/II TO 88/03 1 1990 , September I 258 16. SUPPLEMENTARY NOTATION Contracting Officer’s Representative, D. Bruce Bell. Caliber Associates is a
Power, Carl; Rasko, John E J
In recent years, stem cells have generated increasing excitement, with frequent claims that they are revolutionizing medicine. For those not directly involved in stem cell research, however, it can be difficult to separate fact from fiction or realistic expectation from wishful thinking. This article aims to provide internists with a clear and concise introduction to the field. While recounting some scientific and medical milestones, the authors discuss the 3 main varieties of stem cells-adult, embryonic, and induced pluripotent-comparing their advantages and disadvantages for clinical medicine. The authors have sought to avoid the moral and political debates surrounding stem cell research, focusing instead on scientific and medical issues.
Yerby, Janet, Ed.
In a conference focusing on issues in research methods, family theory, and family therapy as they relate to family communication and on future research needs, this document consists of papers presented by the 12 participants. Specific titles and speakers were as follows: "Kinship Relationships," by Mary Anne Fitzpatrick; "Research Potentials in…
Institute of Family Studies, Melbourne (Australia).
Second in a series of seven volumes containing the proceedings of the 1983 Australian Family Research Conference, this publication deals with family law. Papers and authors included are: "Attitudes of Divorced Men and Women to the Family" (Margaret Harrison), "Dispute Resolution in Australian Family Law" (Henry Finlay),…
Clark, Rebecca L.; Glick, Jennifer E.; Bures, Regina M.
Family researchers and policy makers are giving increasing attention to the consequences of immigration for families. Immigration affects the lives of family members who migrate as well as those who remain behind and has important consequences for family formation, kinship ties, living arrangements, and children's outcomes. We present a selective…
Kashy, Deborah A.; Kenny, David A.
Presents both a conceptual model (which partitions family data into individual, dyadic, and family effects and permits examination of several types of interdependence between family members) and an analytical method (confirmatory factor analysis) that can be used in the evaluation of round-robin family research data. (SR)
Rankin, Wade M; Cochrane, Anneli; Puffer, James C
While family physicians holding certificates of added qualifications in sports medicine practice in multiple settings, little is currently known about the proportion of their time devoted exclusively to the practice of sports medicine. We found that most spend a majority of their time doing so, and this number has been increasing over the past decade.
Doohan, Noemi C; Duane, Marguerite; Harrison, Bridget; Lesko, Sarah; DeVoe, Jennifer E
The Future of Family Medicine (FFM) project has helped shape and direct the evolution of primary care medicine over the past decade. Pisacano Scholars, a group of leaders in family medicine supported by the American Board of Family Medicine, gathered for a 2-day symposium in April 2013 to explore the history of the FFM project and outline a vision for the next phase of this work-FFM version 2.0 (v2.0). After learning about the original FFM project (FFM v1.0), the group held interactive discussions using the World Café approach to conversational leadership. This commentary summarizes the discussions and highlights major themes relevant to FFM v2.0 identified by the group. The group endorsed the FFM v1.0 recommendations as still relevant and marvelled at the progress made toward achieving many of those goals. Most elements of FFM v1.0 have moved forward, and some have been incorporated into policy blueprints for reform. Now is the time to refocus attention on facets of FFM v1.0 not yet realized and to identify key aspects missing from FFM v1.0. The Pisacano Scholars are committed to moving the FFM goals forward and hope that this expression of the group's vision will help to do so.
Allen, Katherine R.; Demo, David H.
A review of 8,000 articles in family research journals revealed that research on lesbian and gay families is limited and that studies that do exist have been problematized and their diversity has been overlooked. Challenges the neglect of this population in family studies, and discusses theoretical implications. (JPS)
Song, Fengyu; Li, Bingbing
The ability to regenerate bone across a critical size defect would be a marked clinical advance over current methods for dealing with such structural gaps. Here, we briefly review the development of limb bones and the mandible, the regeneration of urodele limbs after amputation, and present evidence that urodele and anuran amphibians represent a valuable research model for the study of segment defect regeneration in both limb bones and mandible. PMID:21197215
Kuvlesky, William P.
The objective of this paper was to develop a broad, systematic conceptual framework for studying psychological and biological based disabilities of individual family members as attributes of the family unit and to direct attention to potentially useful research on the causes and social consequences of family disability. A research review…
Blood, Robert O.
The author, a family life educator, reviews the research literature on marriage and family indicating the neglected areas and stressing the need for cause and effect studies. He proposes a number of research approaches to achieve the latter. Speech presented at the annual meeting of the National Council on Family Relations, Salt Lake City, Utah,…
Rogler, Lloyd H.; And Others
This journal issue is a collection of papers describing research on Hispanic families conducted at the Hispanic Research Center, Fordham University, New York. The first article, "Research Issues concerning the Puerto Rican Child and Family," by Lloyd H. Rogler, reviews two research projects on health conditions and the plight of Puerto Rican…
Joos, Stefanie; Musselmann, Berthold; Szecsenyi, Joachim
More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners (“Heilpraktiker”). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned. PMID:19293252
Turkeshi, Eralda; Michels, Nele R; Hendrickx, Kristin; Remmen, Roy
Objective Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. Data sources Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. Review methods Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick’s levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings’ grades. Descriptive narrative synthesis applied. Results Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME’s grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students’ attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student’s presence and participation did not have a negative impact on patients. Conclusions Research quality on the impact of FM clerkships is still limited, yet across different settings and
Yang, Qian; Zhou, Xuanxuan; Zhang, Meng; Bi, Linlin; Miao, Shan; Cao, Wei; Xie, Yanhua; Sun, Jiyuan; Tang, Haifeng; Li, Ying; Miao, Qing; Wang, Siwang
There are currently 34 genera and 410 species of toads in the world. The medicinal parts of toads mainly include their venom, skin, and clothing. The toad’s venom and skin possess the same chemical components, mainly the toad venom lactone class, and their pharmacological effects primarily include the maintenance of strong heart, antitumor, antivirus, anti-infection, and analgesic effects. So far, the produces from the medicinal raw materials of the toad are widely used clinically around the world, especially in China, Japan, and South Korea. About 50 varieties of medicines are used in the clinical treatment of various complicated diseases in China, such as “Liushen pills” which was popular in the whole world. Toads are mainly used in treating malignant tumors (e.g., liver cancer, gastric cancer, esophageal cancer, colon cancer, cervical cancer, among others), and some major diseases such as hepatitis B. Despite the therapeutic effects of toad-derived medicines on human health, there is insufficient research and development of toad-derived medicines by leading drug companies. In order to harness the beneficial effects of the resources of the toad species, it is the responsibility of global pharmaceutical researchers to develop and generate economically feasible toad-derived therapeutic products, while promoting maximum protection to the resources of the toad species. PMID:25755824
Siegfried, Nandi; Johnson, Quinton
Abstract An electronic survey was used to assess the training needs of clinical and public health researchers who have been involved, and/or plan to become involved, in clinical trials of herbal medicines in Africa. Over 90 researchers were contacted through pre-existing networks, of whom 58 (64%) responded, from 35 institutions in 14 African countries. Over half (57%) had already been involved in a clinical trial of an herbal medicine, and gave information about a total of 23 trials that have already been completed. Of these, only five had been published, and only one had resulted in a licensed product. Fifty-four (54) of the researchers were planning to conduct a clinical trial of an herbal medicine in the future, and gave information about 54 possible trials. Respondents outlined the following most commonly encountered difficulties when conducting clinical trials: resource constraints (including lack of funding, equipment, staff, and infrastructure); social acceptance of the clinical trial (including difficulty recruiting enough patients, poor rapport with traditional healers, and willingness of biomedical staff to be involved); herbal medicine supply (including insufficient cultivation, production, and quality control); lack of trained staff; and logistical issues in conducting trials. The topics in which researchers were least confident were Intellectual Property Rights issues, statistical issues, and issues related to Good Clinical Practice guidelines. PMID:22784350
Smith, Robert J; Merchant, Raina M
Crowdsourcing presents a novel approach to solving complex problems within molecular medicine. By leveraging the expertise of fellow scientists across the globe, broadcasting to and engaging the public for idea generation, harnessing a scalable workforce for quick data management, and fundraising for research endeavors, crowdsourcing creates novel opportunities for accelerating scientific progress.
Medicinal plant research may be pursued with several goals: the understanding of a native medical system, the elucidation of the rational basis for the medicinal use of a certain plant species, the development of low cost phytotherapeutics, the discovery of prototypic drugs, and so on. More often than not, the research project starts with the collection of indigenous medical knowledge in various parts of the world and generates a dissertation, a scientific paper or a drug. Usually, indigenous knowledge was crucial to the development of such products; nevertheless, indigenous groups tend not to benefit from the achievements of research. Ethnopharmacology involves a series of sociopolitical, economic and ethical dilemmas, at various levels. Most research projects involve more than one country (e.g., field work in a remote part of an underdeveloped country). Frequently host country scientists, visiting scientists, and informants disagree about these dilemmas. As a result, such research efforts are perceived as scientific imperialism; scientists are accused of stealing plant materials and appropriating traditional plant knowledge for financial profit and/or professional advancement. Many governments, as well as indigenous societies are increasingly reluctant to permit such research. Increasingly, funding for field work utilizing indigenous informants is coming from industry. Historically neither native populations nor host countries have shared to a significant extent the financial benefits from any drug that reaches the market. Unless these issues are amply discussed and fairy resolved, medicinal plant research runs the risk of serving ethically questionable purposes.
Bond, William F; Lammers, Richard L; Spillane, Linda L; Smith-Coggins, Rebecca; Fernandez, Rosemarie; Reznek, Martin A; Vozenilek, John A; Gordon, James A
Medical simulation is a rapidly expanding area within medical education. In 2005, the Society for Academic Emergency Medicine Simulation Task Force was created to ensure that the Society and its members had adequate access to information and resources regarding this new and important topic. One of the objectives of the task force was to create a research agenda for the use of simulation in emergency medical education. The authors present here the consensus document from the task force regarding suggested areas for research. These include opportunities to study reflective experiential learning, behavioral and team training, procedural simulation, computer screen-based simulation, the use of simulation for evaluation and testing, and special topics in emergency medicine. The challenges of research in the field of simulation are discussed, including the impact of simulation on patient safety. Outcomes-based research and multicenter efforts will serve to advance simulation techniques and encourage their adoption.
Abu Zuhairah, Ammar R.; Al-Dawood, Kasim M.; Khamis, Amar H.
Aims: The aim was to compare Eastern, Makkah, and Asir regions in term of residents’ perception of the achievement of training objectives, and to assess various rotations based on residents’ perception. Settings and Design: This cross-sectional study was done among family medicine residents in the Eastern, Makkah, and Asir regions. Methodology: A questionnaire was developed by the investigator and validated by two experts. All residents, except R1 residents, were included. All data were collected by the investigator by direct contact with the residents. Statistical Analysis Used: Cronbach's alpha, analysis of variance, t-test, and univariate regression model as appropriate, were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven (response rate: 83.6%) residents completed the questionnaire. There were 51 (47.7%), 27 (25.2%), and 29 (27.1%) residents in the program in the Eastern region, Makkah, and Asir, respectively. The mean age was 29.1 ± 2.5 years; half of the residents were male, most of (83.2%) were married, and more than half (54.2%) of had worked in primary health care before joining the program. Overall, 45% of the residents perceived that they had achieved the training objectives. The highest rotations as perceived by the residents were psychiatry and otolaryngology while the lowest were orthopedics and ophthalmology. There were significant differences among the study regions with regard to the rotations in family medicine, internal medicine, orthopedics, general surgery, and emergency medicine. Conclusions: Overall, a good percentage of the residents perceived that they had achieved the training objectives. The rotations differed in the studied regions. Psychiatry and otolaryngology had the highest percentage of family medicine residents who perceived that they had achieved the training objectives while lowest was in internal medicine and obstetrics and gynecology. The highest rotations as perceived by the
Hixon, Allen L; Maskarinec, Gregory G
The Declaration of Alma Ata, issued on September 12, 1978, provides a moral vision for primary care that remains valuable today at a time of transformation of the specialty of family medicine. The Declaration asserts a comprehensive definition of health that recognizes health as a fundamental human right, argues persuasively that gross inequalities in health status are politically, socially, and economically unacceptable, and identifies primary health care as the key to improving health and reducing health status inequalities. The values of Alma Ata can guide the specialty of family medicine to lead positive health system change through renewed collaboration, addressing inequalities, efficient use of resources and appropriate technology, and advocacy in the spirit of social justice.
Douglas, William R.
An update of outer space medicine is given emphasizing main areas such as cardiopulmonary responses, vestibular functions, physiology, weightlessness, ecosystems, and radiation. A prospective view is also presented on the medical problems resulting from various hazards of outer space and planetary missions. Although an outgrowth of aviation and environmental medicine, this relatively new, special branch of medicine is currently undergoing an unprecedented rise as a vital modern specialty. The aims of the United States, Russia, and the nations of Europe in space research are shown to be in accord in learning how to live and work in space when confronted with the unique factors of zero gravity, cosmic radiation, and magnetic variations. PMID:439154
Schroeder, Steven A
A recurring conference theme was the essential place of social justice within family medicine, especially the need to focus on denominator populations, exalt the personal and caring qualities of doctoring, and address social determinants of health. Many expressed solidarity with "community," but it is not always easy to define community in our large and diverse nation. Exhortations for health advocacy were frequently voiced, but putting these into meaningful action agendas is a challenge. There was general agreement that medicine is in flux and that the many expressions of "commodity-centered consumerism" have altered organization and financing. The increasing demands by "consumers", who want low cost, instant availability, and shared decision-making, and yet change doctors when health plans alter coverage also differentially impact high-volume, low-margin specialties such as family medicine. Additional challenges were the electronic health record and calibrating an appropriate work/life balance. Five action steps are recommended: 1) speak out on the important social and moral issues; 2) be the experts on personal care; 3) make common cause with potential allies; 4) help institutions perceive the value of generalism; and 5) help find ways to enrich generalist disciplines to increase the joy of medicine and decrease the threat of burn out.
Wiederman, Michael W.; Sawyer, Robert J.
For most training programs, the development of research endeavors among trainees is an ongoing challenge. In this article, we review various considerations when attempting to undertake research activities within an internal medicine residency training program, including availability of institutional resources (eg, dedicated research time for trainees and faculty, available faculty mentors, accessible adjunctive personnel), engagement of residents into research, classic project quagmires in training programs, the institutional review board, publication options (eg, letters to the editor, case reports, literature reviews, original research reports), and journal submission strategies. Given that research entails multiple components and distinct skills, the overall program goal should be to make research an educationally understandable process for trainees. Research can be a rewarding activity when nurtured in a facilitating educational environment. PMID:26137359
Cousineau, Michael R; Flores, Hector; Cheng, Scott; Gates, Jerry D; Douglas, James H; Clute, Gerald B; Coan, Carl E
The authors describe a family medicine center before and after a merger between the Keck School of Medicine of the University of Southern California, the California Hospital Medical Center, and the Eisner Pediatric and Family Medical Center in 2012. The merger provided new opportunities to stabilize the financial base of a clinical practice struggling financially and to enhance the training of residents and other health professionals in primary care, which motivated the partners to consider this new model. After 18 months of negotiations, they were able to convert the family medicine center and residency program into a new federally qualified health center. The benefits to this new model include an increase in both patient volume and the quality of education, supporting residency accreditation; a greater number of residents from U.S. medical schools; enhanced education and preparation of primary care physicians for practice in medically underserved communities; enhanced reimbursements and new opportunities for state, local, and federal grants; and quality improvement and new information technology. The partners overcame academic, administrative, legal, and regulatory obstacles, communication barriers, and differences in culture and expectations to achieve this merger. Keys to their success include the commitment of the leaders at the three institutions to the goals of the merger, a dedicated project manager and consultants, opportunities for new revenue sources and reimbursements, and support from a pioneering charitable foundation. The authors conclude by discussing the implications of using community health centers as the focal point for training primary care clinicians and addressing workforce shortages.
Tshitenge, Stephane; Setlhare, Vincent; Tsima, Billy; Adewale, Ganiyu; Parsons, Luise
Background Family Medicine (FM) training is new in Botswana. No previous evaluation of the experiences and opinions of residents of the University of Botswana (UB) Family Medicine training programme has been reported. Aims This study explored and assessed residents’ experiences and satisfaction with the FM training programme at the UB and solicited potential strategies for improvement from the residents. Methods A descriptive survey using a self-administered questionnaire based on a Likert-type scale and open-ended questions was used to collect data from FM residents at the UB. Results Eight out the 14 eligible residents participated to this study. Generally, residents were not satisfied with the FM training programme. Staff shortage, inadequate supervision and poor programme organisation by the faculty were the main reasons for this. However, the residents were satisfied with weekly training schedules and the diversity of patients in the current training sites. Residents’ potential solutions included an increase in staff, the acquisition of equipment at teaching sites and emphasis on FM core topics teachings. They had different views regarding how certain future career paths will be. Conclusions Despite the general dissatisfaction among residents because of challenges faced by the training programme, we have learnt that residents are capable of valuable inputs for improvement of their programme when engaged. There is need for the Department of Family Medicine to work with the Ministry of Health to set a clear career pathway for future graduates and to reflect on residents’ input for possible implementation. PMID:27796117
Qin, C; Ma, X; Tian, J
In the medical imaging field, molecular imaging is a rapidly developing discipline and forms many imaging modalities, providing us effective tools to visualize, characterize, and measure molecular and cellular mechanisms in complex biological processes of living organisms, which can deepen our understanding of biology and accelerate preclinical research including cancer study and medicine discovery. Among many molecular imaging modalities, although the penetration depth of optical imaging and the approved optical probes used for clinics are limited, it has evolved considerably and has seen spectacular advances in basic biomedical research and new drug development. With the completion of human genome sequencing and the emergence of personalized medicine, the specific drug should be matched to not only the right disease but also to the right person, and optical molecular imaging should serve as a strong adjunct to develop personalized medicine by finding the optimal drug based on an individual's proteome and genome. In this process, the computational methodology and imaging system as well as the biomedical application regarding optical molecular imaging will play a crucial role. This review will focus on recent typical translational studies of optical molecular imaging for personalized medicine followed by a concise introduction. Finally, the current challenges and the future development of optical molecular imaging are given according to the understanding of the authors, and the review is then concluded.
Corfman, Eunice, Ed.
The first of two volumes, this book consists of 17 studies of children and families. Selections are intended to provide a representative sample of current research, including case studies and less formal reports. Volume I is divided into four sections. Part One considers the family as an enduring social unit. Families in hard times, Chicano…
Bi, Ying-fei; Mao, Jing-yuan
In recent years, Delphi method has been widely applied in traditional Chinese medicine (TCM) clinical research. This article analyzed the present application situation of Delphi method in TCM clinical research, and discussed some problems presented in the choice of evaluation method, classification of observation indexes and selection of survey items. On the basis of present application of Delphi method, the author analyzed the method on questionnaire making, selection of experts, evaluation of observation indexes and selection of survey items. Furthermore, the author summarized the steps of application of Delphi method in TCM clinical research.
Dong, Yan; Cui, Meng
Literature resource service was the main service that Chinese medicine (CM) information offered. But in recent years users have started to request the health information knowledge service. The CM information researches and application service mainly included: (1) the need of strength studies on theory, application of technology, information retrieval, and information standard development; (2) Information studies need to support clinical decision making, new drug research; (3) Quick response based on the network monitoring and support to emergency countermeasures. CM information researches have the following treads: (1) developing the theory system structure of CM information; (2) studying the methodology system of CM information; (3) knowledge discovery and knowledge innovation.
Hodgetts, Geoffrey; Broers, Teresa; Godwin, Marshall
Background Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. Methods The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Results Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two
Rempel, Gwen R; Neufeld, Anne; Kushner, Kaysi Eastlick
This article argues for the concurrent and comparative use of genograms and ecomaps in family caregiving research. A genogram is a graphic portrayal of the composition and structure of one's family and an ecomap is a graphic portrayal of personal and family social relationships. Although development and utilization of genograms and ecomaps is rooted in clinical practice with families, as research tools they provide data that can enhance the researcher's understanding of family member experiences. In qualitative research of the supportive and nonsupportive interactions experienced by male family caregivers, the interactive use of genograms and ecomaps (a) facilitated increased understanding of social networks as a context for caregiving, (b) promoted a relational process between researcher and participant, and (c) uncovered findings such as unrealized potential in the participant's social network that may not be revealed with the use of the genogram or ecomap alone, or the noncomparative use of both.
Methodological issues which confront researchers using the concept of the family career include the selection of appropriate dependent variables; the efficacy of historical versus immediate effects; and scaling the family career (a proposed replacement for the "family life cycle"). The issue of which dependent variables should be…
Administration for Children & Families, 2015
This report provides detailed summaries of major research investments by OPRE's Division of Family Strengthening (DFS) along with brief overviews of past projects. The featured projects cover topics that include strengthening relationships within families, supporting fatherhood, nurturing children through their families, reducing teen pregnancy,…
Bembry, James X.
Almost one third of all children in the United States are born to unmarried parents. This figure is even higher among poor and minority populations. Because of their heightened risk for economic and social problems and family dissolution, disadvantaged, unmarried parents have been called "fragile families." In 2002 the Bush administration…
This article offers a synthesis of the significant developments and progress of family nursing in Sweden. A review was conducted to locate Swedish family nursing research produced over the past 10 years. CINAHL, Medline, and PubMed were the primary databases used to locate approximately 75 family nursing studies conducted in Sweden. The majority of the studies used descriptive methods with data collected from surveys and interviews involving nurses and family members either together or individually. Only a few of the studies examined family nursing interventions. This article also reports the results of a recent survey of Swedish nurses that examined how family nursing is used in practice. After 10 years of creating a strong foundation for family-focused nursing in Sweden, there is still a need for nurse researchers, educators, and administrators to collaborate in the implementation of family nursing to practice.
Zhou, Wei; Zhang, Xiao-Yan
Radix isatidis (R. isatidis) (Banlangen) is a traditional Chinese medicine (TCM) famous for its broad antiviral activity. Its clinical medical history spans several thousands of years in China. Many scientists and scholars have conducted systematic research on this herb from its pharmacognosy to pharmaceuticals, especially in China. Through our research and literature reports, we inferred that the antiviral activity of R. isatidis mostly depended on the water-soluble part, including amino acids, IRPS, nucleosides, and sulfur-containing alkaloids. By playing a role in directly killing pathogenic viruses or regulating the immune system to enhance anti-virus ability, R. isatidis's biological activities mostly depend on the synergistic effect of its multiple components. This article aims to expand understanding of R. isatidis in the following aspects including medicinal resources, chemical constituents, pharmacological activities, clinical applications, and separation and analytical technologies.
Sahan, Kate M; Channon, Keith M; Choudhury, Robin P; Kharbanda, Rajesh K; Lee, Regent; Sheehan, Mark
Research in the emergency setting involving patients with acute clinical conditions is needed if there are to be advances in diagnosis and treatment. But research in these areas poses ethical and practical challenges. One of these is the general inability to obtain informed consent due to the patient’s lack of mental capacity and insufficient time to contact legal representatives. Regulatory frameworks which allow this research to proceed with a consent ‘waiver’, provided patients lack mental capacity, miss important ethical subtleties. One of these is the varying nature of mental capacity among emergency medicine patients. Not only is their capacity variable and often unclear, but some patients are also likely to be able to engage with the researcher and the context to varying degrees. In this paper we describe the key elements of a novel enrolment process for emergency medicine research that refines the consent waiver and fully engages with the ethical rationale for consent and, in this context, its waiver. The process is verbal but independently documented during the ‘emergent’ stages of the research. It provides appropriate engagement with the patient, is context-sensitive and better addresses ethical subtleties. In line with regulation, full written consent for on-going participation in the research is obtained once the emergency is passed. PMID:27499840
Bristowe, Katherine; Selman, Lucy; Murtagh, Fliss E M
Qualitative methodologies are becoming increasingly widely used in health research. However, within some specialties, including renal medicine, qualitative approaches remain under-represented in the high-impact factor journals. Qualitative research can be undertaken: (i) as a stand-alone research method, addressing specific research questions; (ii) as part of a mixed methods approach alongside quantitative approaches or (iii) embedded in clinical trials, or during the development of complex interventions. The aim of this paper is to introduce qualitative research, including the rationale for choosing qualitative approaches, and guidance for ensuring quality when undertaking and reporting qualitative research. In addition, we introduce types of qualitative data (observation, interviews and focus groups) as well as some of the most commonly encountered methodological approaches (case studies, ethnography, phenomenology, grounded theory, thematic analysis, framework analysis and content analysis).
Davis, Jeffrey R.
This viewgraph presentation describes the challenges that space exploration faces in terms of medicine, research and ethics. The topics include: 1) Effects of Microgravity on Human Physiology; 2) Radiation; 3) Bone; 4) Behavior and Performance; 5) Muscle; 6) Cardiovascular; 7) Neurovestibular; 8) Food and Nutrition; 9) Immunology and Hematology; 10) Environment; 11) Exploration; 12) Building Block Approach; 13) Exploration Issues; 14) Life Sciences Contributions; 15) Health Care; and 17) Habitability.
Marquet, Pierre; Longeray, Pierre-Henry; Barlesi, Fabrice; Ameye, Véronique; Augé, Pascale; Cazeneuve, Béatrice; Chatelut, Etienne; Diaz, Isabelle; Diviné, Marine; Froguel, Philippe; Goni, Sylvia; Gueyffier, François; Hoog-Labouret, Natalie; Mourah, Samia; Morin-Surroca, Michèle; Perche, Olivier; Perin-Dureau, Florent; Pigeon, Martine; Tisseau, Anne; Verstuyft, Céline
Personalized medicine is based on: 1) improved clinical or non-clinical methods (including biomarkers) for a more discriminating and precise diagnosis of diseases; 2) targeted therapies of the choice or the best drug for each patient among those available; 3) dose adjustment methods to optimize the benefit-risk ratio of the drugs chosen; 4) biomarkers of efficacy, toxicity, treatment discontinuation, relapse, etc. Unfortunately, it is still too often a theoretical concept because of the lack of convenient diagnostic methods or treatments, particularly of drugs corresponding to each subtype of pathology, hence to each patient. Stratified medicine is a component of personalized medicine employing biomarkers and companion diagnostics to target the patients likely to present the best benefit-risk balance for a given active compound. The concept of targeted therapy, mostly used in cancer treatment, relies on the existence of a defined molecular target, involved or not in the pathological process, and/or on the existence of a biomarker able to identify the target population, which should logically be small as compared to the population presenting the disease considered. Targeted therapies and biomarkers represent important stakes for the pharmaceutical industry, in terms of market access, of return on investment and of image among the prescribers. At the same time, they probably represent only the first generation of products resulting from the combination of clinical, pathophysiological and molecular research, i.e. of translational research.
Knafl, Kathleen; Leeman, Jennifer; Havill, Nancy; Crandell, Jamie; Sandelowski, Margarete
Synthesis of family research presents unique challenges to investigators who must delimit what will be included as a family study in the proposed review. In this paper, the authors discuss the conceptual and pragmatic challenges of conducting systematic reviews of the literature on the intersection between family life and childhood chronic conditions. A proposed framework for delimiting the family domain of interest is presented. The framework addresses both topical salience and level of relevance and provides direction to future researchers, with the goal of supporting the overall quality of family research synthesis efforts. For users of synthesis studies, knowledge of how investigators conceptualize the boundaries of family research is important contextual information for understanding the limits and applicability of the results.
Levasseur, G; Schweyer, F X
General practice doctors are naturally presented as being actors on the front lines of public health. The ability of general practitioners to be aware of and deal with public health questions largely depends upon their training. Perhaps one could consider the general practitioner's thesis as a preparatory analytical work within the area of their future field of practice. Do these theses serve to provide food for thought on general practice and its contribution to public health, and if not, could they? An analysis conducted within four medical schools in western France demonstrates that the work produced for general medicine identified as such only constitutes a fraction of the overall number of medical (non-university) theses (approximately 5%). Two possible explanations may be put forward. First, on the one hand, the theses highly depend on the context of the training and the work produced is a direct result of this. Second, on the other hand, the current methods of indexing notes in the university databases does not enable general medicine to be clearly seen and visibly recognised as an academic discipline. Two questions then remain: Can medical theses be considered as research? Should research in general medicine be carried out solely by general practitioners? It is vital that resources from outside the medical field be raised and mobilised for general practice research, whose themes are multi-disciplinary and not only clinical.
Ko, Kyungjin; Kim, Sungjong; Kim, Sang-Hyun; Son, Ki Young; Lee, Jungun
Background We investigated the knowledge, status, and barriers toward healthcare workers receiving vaccinations among Korean family medicine residents. To date, a systematic study has not been conducted among medical practitioners examining these variables. Methods A web-based, anonymous, self-administered questionnaire was distributed to all 942 family medicine residents working in 123 training hospitals in Korea. A multiple logistic regression analysis was performed to investigate factors affecting vaccination completion. Results Korean family medicine residents (N=242, 25.7%) from 54 training hospitals (43.9%) participated in the survey. Only 24 respondents (9.9%) had correct knowledge on all the recommended vaccinations by the Korean Society of Infectious Diseases. The complete vaccination rates against hepatitis B virus and influenza were relatively high (69.4% and 83.0%, respectively), whereas they were relatively low against other infections (e.g., 16.5%– 53.1%). The most common reason for not receiving a vaccination was the belief that there was little possibility of infection from the vaccine-preventable diseases. Conclusion Knowledge and vaccination coverage were poor among family medicine residents in Korea. Medical schools should provide vaccination information to healthcare workers as part of their mandatory curriculum. Further research should confirm these findings among primary care physicians and other healthcare workers. PMID:28197329
Liu, Changxiao; Fan, Huirong; Li, Yazhuo; Xiao, Xiaohe
In general, herbal medicines have been considered as safe by the general public, since they are naturally occurring and have been applied in treatment for over thousands of years. As the use of herbal medicine is rapidly increasing globally, the potential toxicity of herbal drugs, in particular drug-induced liver injury (DILI), has now become a serious medical issue. According to the literature, the authors analyzed and discussed the hepatotoxicity problem of Chinese herbal medicines (CHM), including global overview on herbal-induced liver injury (HILI), current research progress on toxic CHM, diagnosis and treatment of HILI, and modern approaches and technologies of study of hepatotoxicity. As to promote the recognition of HILI and tackle the issue, a guideline for the diagnosis and treatment of HILI has recently been drafted by Chinese scientists. As suggested by the guideline, the hepatotoxicity issue of CHM, as a matter of fact, is overestimated. Up to date, the investigation of hepatotoxicity of CHM is now booming with worldwide application of CHM. This review therefore provides useful information for investigating hepatotoxicity of herbal medicine and characterizing DILI caused by CHM. In addition, authors describe in which way further efforts should be made to study the rationale of CHM and liver injury.
Fan, Huirong; Li, Yazhuo; Xiao, Xiaohe
In general, herbal medicines have been considered as safe by the general public, since they are naturally occurring and have been applied in treatment for over thousands of years. As the use of herbal medicine is rapidly increasing globally, the potential toxicity of herbal drugs, in particular drug-induced liver injury (DILI), has now become a serious medical issue. According to the literature, the authors analyzed and discussed the hepatotoxicity problem of Chinese herbal medicines (CHM), including global overview on herbal-induced liver injury (HILI), current research progress on toxic CHM, diagnosis and treatment of HILI, and modern approaches and technologies of study of hepatotoxicity. As to promote the recognition of HILI and tackle the issue, a guideline for the diagnosis and treatment of HILI has recently been drafted by Chinese scientists. As suggested by the guideline, the hepatotoxicity issue of CHM, as a matter of fact, is overestimated. Up to date, the investigation of hepatotoxicity of CHM is now booming with worldwide application of CHM. This review therefore provides useful information for investigating hepatotoxicity of herbal medicine and characterizing DILI caused by CHM. In addition, authors describe in which way further efforts should be made to study the rationale of CHM and liver injury. PMID:28078299
Introduction: This paper reports on doctoral research which investigated the online research behaviour of family historians, from the overall perspective of local studies collections and developing online services for family historians. Method: A hybrid (primarily ethnographic) study was employed using qualitative diaries and shadowing, to examine…
Hohmann-Marriott, Bryndl E.
Research in the field of marriage and family therapy requires many ethical considerations due to the complexity of relationships among family members and the sensitive information involved. The AAMFT Code of Ethics and ethical standards for research attempt to address these concerns. The guidelines cover issues such as risk management, informed…
Glick, Jennifer E.
This review examines research on immigrant families in the United States from the past decade from multiple disciplinary perspectives. This work has used variations on assimilation and acculturation perspectives. In the case of the assimilation perspectives, the focus has largely been on family formation, whereas research using acculturation…
He, Wei; Xie, Yanming; Wang, Yongyan
The purpose of post-marketing Chinese medicine re-evaluation is to identify Chinese medicine clinical indications, while designing scientific and rational of Chinese medicine symptoms items are important to the result of symptoms re-evaluation. This study give screening of traditional Chinese medicine(TCM) symptoms item of post-marketing medicine Xuezhikang re-evaluation as example that reference to principle dyslipidemia clinical research, academic dissertations, Xuezhikang directions, clinical expert practice experience etc. while standardization those symptom names and screening 41 dyslipidemia common symptoms. Furthermore, this paper discuss about the accoerdance and announcements when screening symptoms item, so as to providing a research thread to manufacture PRO chart for post-marketing medicine re-evaluation.
Wong, Teck Yee; Chong, Phui Nah; Chng, Shih Kiat; Tay, Ee Guan
Postgraduate Family Medicine (FM) training is important to train future primary care doctors to provide accessible and cost effective healthcare. In Singapore, a structured postgraduate FM training programme has been available for 20 years. This programme is characterised by involvement of both FM and non-FM doctors, well written modules and a rigorous assessment process. However, challenges faced by both the current healthcare system and training structure underlie the need to review the training structure to ensure its relevancy for future Family Physicians (FPs) to manage the needs of their patients. A workgroup was formed to review the current FM postgraduate programme and to explore the possibility of using the Accreditation Council for Graduate Medical Education (ACGME) framework to enhance our current system. The workgroup felt that broad-based training and comprehensive coverage of topics are areas that are important to retain in any new FM residency programme. Weaknesses identified included a lack of early FM exposure and the need to strengthen formative assessments. New organisational structures such as Family Medicine Centres (FMC) need to be established and the involvement of the private sector in any FM residency progammes could be enhanced. The implementation of the FM Residency Programme in 2011 presented a unique opportunity to realign FM postgraduate education in line with the national objectives and to equip FPs with the necessary knowledge and skills for managing the future healthcare needs of Singaporeans.
Martin, Dawn; Nasmith, Louise; Takahashi, Susan Glover; Harvey, Bart J.
Background The shift from undergraduate to postgraduate education signals a new phase in a doctor’s training. This study explored the resident’s perspective of how the transition from undergraduate to postgraduate (PGME) training is experienced in a Family Medicine program as they first meet the reality of feeling and having the responsibility as a doctor. Methods Qualitative methods explored resident experiences using interpretative inquiry through monthly, individual in-depth interviews with five incoming residents during the first six months of training. Focus groups were also held with residents at various stages of training to gather their reflection about their experience of the first six months. Residents were asked to describe their initial concerns, changes that occurred and the influences they attributed to those changes. Results Residents do not begin a Family Medicine PGME program knowing what it means to be a Family Physician, but learn what it means to fulfill this role. This process involves adjusting to significant shifts in responsibility in the areas of Knowledge, Practice Management, and Relationships as they become more responsible for care outcomes. Conclusion This study illuminated the resident perspective of how the transition is experienced. This will assist medical educators to better understand the early training experiences of residents, how these experiences contribute to consolidating their new professional identity, and how to better align teaching strategies with resident learning needs. PMID:28344713
Background Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. Methods This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Results Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Conclusions Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human
Doane, J A
Recent family interaction studies are reviewed with an emphasis on looking for dimensions along which disturbed and normal families differ. Several areas of consistency in the literature were found, including: family coalition patterns, patterns of conflict, flexibility versus rigidity, family effectiveness and efficiency, and deviant styles of communication. It was concluded that several measures reliably discriminate disturbed from normal families and that one type of measure in particular is a reliable predictor of thought disorder in offspring. Implications for clinical practice and future research are discussed.
Pepper, L. J.
Space medicine research in the 21st century will continue to focus on the four major areas including: (1) expansion of the current incomplete knowledge base of clinical and subclinical physiological changes due to microgravity; (2) development of countermeasures to extend the capabilities of the human performance envelope in extended duration flights; (3) development of novel methods for delivering all aspects of a comprehensive health care system in extreme remote conditions: and (4) further research and application of systems for biological materials processing. New space transportation vehicles will place unique physiologic and human factors demands on the human system, while providing better access to platforms for materials processing. Success in meeting the demands in each of the noted research areas will require an extensive, interactive team approach. Personnel from the medical research,operational, developmental, and basic science communities will be essential to success.
Sy, Alice; Wong, Eric; Boisvert, Leslie
Abstract Objective To determine family medicine residents’ learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Design Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. Setting London, Ont. Participants All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Main outcome measures Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. Results A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians’ teaching sessions (20%), and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents’ homes (32%), and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Conclusion Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents’ various learning preferences and
Hofferth, Sandra L.
This article first provides an overview of the part that secondary data analysis plays in the field of family studies in the early 21st century. It addresses changes over time in the use of existing omnibus data sets and discusses their advantages and disadvantages. The second part of the article focuses on the elements that make a study a…
Bamm, Elena L; Rosenbaum, Peter
The concept of family-centered care was introduced to the public more than 4 decades ago, stressing the importance of the family in children's well being. Since then, family-centered values and practices have been widely implemented in child health. The purpose of this article is to offer an overview of the development and evolution of family-centered theory as an underlying conceptual foundation for contemporary health services. The focus includes key concepts, accepted definitions, barriers, and supports that can influence successful implementation, and discussion of the valid quantitative measures of family-centeredness currently available to evaluate service delivery. The article also provides the foundation, and proposes questions, for future research.
Pandolf, Kent B.; Francesconi, Ralph; Sawka, Michael N.; Cymerman, Allen; Hoyt, Reed W.; Young, Andrew J.; Zambraski, Edward J.
The United States Army Research Institute of Environmental Medicine (USARIEM) celebrated its 50th anniversary on July 1, 2011. This article reviews its history, evolution, and transition of its research programs as well as its scientific and military accomplishments, emphasizing the past 25 yr. During the 1990s, USARIEM published a series of…
Allen, D. G.
Echocardiography is the accepted term for the study of cardiac ultrasound. Although a relatively new tool for the study of the heart in man it has already found wide acceptance in the area of cardiac research and in the study of clinical cardiac disease. Animals had often been used in the early experiments with cardiac ultrasound, but only recently has echocardiography been used as a research and clinical tool in veterinary medicine. In this report echocardiography is used in the research of anesthetic effects on ventricular function and clinically in the diagnosis of congestive cardiomyopathy in a cat, ventricular septal defect in a calf, and pericardial effusion in a dog. Echocardiography is now an important adjunct to the field of veterinary cardiology. ImagesFigure 7.Figure 8.Figure 9.Figure 10. PMID:17422196
Duncan, J. Michael
The Vision for Exploration has been the catalyst for NASA to refocus its life sciences research. In the future, life sciences research funded by NASA will be focused on answering questions that directly impact setting physiological standards and developing effective countermeasures to the undesirable physiological and psychological effects of spaceflight for maintaining the health of the human system. This, in turn, will contribute to the success of exploration class missions. We will show how research will impact setting physiologic standards, such as exposure limits, outcome limits, and accepted performance ranges. We will give examples of how a physiologic standard can eventually be translated into an operational requirement, then a functional requirement, and eventually spaceflight hardware or procedures. This knowledge will be important to the space medicine community as well as to vehicle contractors who, for the first time, must now consider the human system in developing and constructing a vehicle that can achieve the goal of success.
Citation analysis is widely used to evaluate the performance of individual researchers, journals, and universities. Its outcome plays a crucial role in the decision-making process of ranking applicants for an academic position. A number of indicators, including the h-index reflecting both scientific productivity and its relevance in medical fields, are available through the Web of Knowledge( sm ) and Scopus®. In the field of occupational medicine, the adoption of the h-index in assessing the value of core journals shows some advantages compared with traditional bibliometrics and may encourage researchers to submit their papers. Although evaluation of the overall individual performance for academic positions should assess several aspects, scientific performance is usually based on citation analysis indicators. Younger researchers should be aware of the new approach based on transparent threshold rules for career promotion and need to understand the new evaluation systems based on metrics.
Zhang, Junhua; Zhang, Boli
With the advent of big data era, our thinking, technology and methodology are being transformed. Data-intensive scientific discovery based on big data, named "The Fourth Paradigm," has become a new paradigm of scientific research. Along with the development and application of the Internet information technology in the field of healthcare, individual health records, clinical data of diagnosis and treatment, and genomic data have been accumulated dramatically, which generates big data in medical field for clinical research and assessment. With the support of big data, the defects and weakness may be overcome in the methodology of the conventional clinical evaluation based on sampling. Our research target shifts from the "causality inference" to "correlativity analysis." This not only facilitates the evaluation of individualized treatment, disease prediction, prevention and prognosis, but also is suitable for the practice of preventive healthcare and symptom pattern differentiation for treatment in terms of traditional Chinese medicine (TCM), and for the post-marketing evaluation of Chinese patent medicines. To conduct clinical studies involved in big data in TCM domain, top level design is needed and should be performed orderly. The fundamental construction and innovation studies should be strengthened in the sections of data platform creation, data analysis technology and big-data professionals fostering and training.
Metodiev, Metodi V
The sixth annual European Biomarkers Summit took place in London, UK, on 18-19 May 2011. It was part of a larger event, organized by Select Biosciences, with meetings on molecular diagnostics, single cell analysis and theranostics for personalized medicine. The Biomarkers Summit featured 17 invited talks from academics and industry researchers, a number of poster presentations and exhibitions from several companies marketing biomarker-related technologies and consumables. The focus was broad, covering various aspects of biomarker discovery, qualification, and applications, and a variety of diseases including cancer, neurodegenerative conditions and infectious diseases. Gene-based, as well as protein-based, platforms for biomarkers identification and analysis were discussed.
Copello, F; Garbarino, S; Messineo, A; Campagna, M; Durando, P
The goal of Occupational Medicine and Hygiene is that of ensuring safety, health and well-being at workplaces, mainly assessing and preventing existing occupational risks. Scientific research in this field can provide useful arguments and further evidence upon which effective, efficient and sustainable policies and preventive measures have to be chosen and applied by the occupational physician in work-life. This paper summarizes four original studies, conducted in different professional settings across Italy, focusing on critical items, such as stress and violence, biological risks and sleep hygiene. The knowledge obtained can be useful to orientate proper preventive programs aimed at improving workplace health.
Ellenbogen, Kirsten M.; Luke, Jessica J.; Dierking, Lynn D.
Thomas Kuhn's notion of a disciplinary matrix provides a useful framework for investigating the growth of research on family learning in and from museums over the last decade. To track the emergence of this disciplinary matrix we consider three issues. First are shifting theoretical perspectives that result in new shared language, beliefs, values, understandings, and assumptions about what counts as family learning. Second are realigning methodologies, driven by underlying disciplinary assumptions about how research in this arena is best conducted, what questions should be addressed, and criteria for valid and reliable evidence. Third is resituating the focus of our research to make the family central to what we study, reflecting a more holistic understanding of the family as an educational institution within larger learning infrastructure. We discuss research that exemplifies these three issues and demonstrates the ways in which shifting theoretical perspectives, realigning methodologies, and resituating research foci signal the existence of a nascent disciplinary matrix.
Runyan, Christine; Savageau, Judith A.; Potts, Stacy; Weinreb, Linda
Background Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. Objectives The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. Methods The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Results Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. Conclusions This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction. PMID:27282276
Alsaad, Saad M.; Alshammari, Sulaiman A.; Almogbel, Turki A.
Objectives: To assess patients’ perceptions of the communication skills of family medicine residents. Methods: This is a cross-sectional study. Data were collected from patients, seeing 23 residents from 4 family medicine residency programs in Riyadh, Kingdom of Saudi Arabia namely, King Khalid University Hospital, Riyadh Military Hospital, Security Forces Hospital, and King Abdul-Aziz Medical City. The translated version of the Communication Assessment Tool (CAT) was used. Data were collected during January and February 2013. Results: A total of 350 patients completed the CAT, with an 87.5% response rate. Patients rated each resident differently, but the mean percentage of items, which residents rated as excellent was 71%. In general, male residents were rated higher 72.8 ± 27.2 than female residents 67.8 ± 32.2 with a significant difference; (p<0.005). Also, significant differences were found based on the gender of the residents, when each item of the CAT was compared. Comparing training centers, there were no significant differences found in the overall percentage of items rated as excellent or among items of the CAT. Conclusion: The study identified areas of strength and weaknesses that need to be addressed to improve communication skills of physicians. PMID:27381544
Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.
Corfman, Eunice, Ed.
The second of two volumes, this book contains 21 studies of children and families. Selections, grouped into three sections, are intended to provide a representative sample of current research, including case studies and less formal reports. The first section reports on families in distress. Articles focus on adults who were antisocial children,…
Dheensa, Sandi; Fenwick, Angela; Lucassen, Anneke
Objectives Clinical genetics guidelines from 2011 conceptualise genetic information as confidential to families, not individuals. The normative consequence of this is that the family's interest is the primary consideration and genetic information is shared unless there are good reasons not to do so. We investigated healthcare professionals' (HCPs') views about, and reasoning around, individual and familial approaches to confidentiality and how such views influenced their practice. Method 16 focus groups with 80 HCPs working in/with clinical genetics services were analysed, drawing on grounded theory. Results Participants raised seven problems with, and arguments against, going beyond the individual approach to confidentiality. These problems fell into two overlapping categories: ‘relationships’ and ‘structures’. Most participants had never considered ways to—or thought it was impossible to—treat familial genetic information and personal information differently. They worried that putting the familial approach into practice could disrupt family dynamics and erode patient trust in the health service. They also thought they had insufficient resources to share information and feared that sharing might change the standard of care and make them more vulnerable to liability. Conclusions A familial approach to confidentiality has not been accepted or adopted as a standard, but wider research suggests that some of the problems HCPs perceived are surmountable and sharing in the interest of the family can be achieved. However, further research is needed to explore how personal and familial genetic information can be separated in practice. Our findings are relevant to HCPs across health services who are starting to use genome tests as part of their routine investigations. PMID:28159847
Roosa, Mark W.; Deng, Shiying; Nair, Rajni L.; Lockhart Burrell, Ginger
Most family scholars take the concept of poverty for granted. The variety of ways people have chosen to define and measure this concept, however, often makes it difficult to interpret or compare research results. We review and critique the ways that poverty has been measured in the family and child literatures as well as the measures that have…
Berardo, Felix M.
Introduces special journal issue devoted to a review of research on marriage and the family over the past decade. Provides overview of marital issues, feminism, parent-child relationships, day care, divorce, remarriage, stepfamilies, adolescence, later life families, religion, Blacks, Hispanics, adolescent childbearing, health, employment,…
Lin, Ruozhu; Fan, Jianhua; Chen, Zhiduan
Many species of Schisandraceae are used in traditional Chinese medicine and are faced with contamination and substitution risks due to inaccurate identification. Here, we investigated the discriminatory power of four commonly used DNA barcoding loci (ITS, trnH-psbA, matK, and rbcL) and corresponding multi-locus combinations for 135 individuals from 33 species of Schisandraceae, using distance-, tree-, similarity-, and character-based methods, at both the family level and the genus level. Our results showed that the two spacer regions (ITS and trnH-psbA) possess higher species-resolving power than the two coding regions (matK and rbcL). The degree of species resolution increased with most of the multi-locus combinations. Furthermore, our results implied that the best DNA barcode for the species discrimination at the family level might not always be the most suitable one at the genus level. Here we propose the combination of ITS+trnH-psbA+matK+rbcL as the most ideal DNA barcode for discriminating the medicinal plants of Schisandra and Kadsura, and the combination of ITS+trnH-psbA as the most suitable barcode for Illicium species. In addition, the closely related species Schisandra rubriflora Rehder & E. H. Wilson and Schisandra grandiflora Hook.f. & Thomson, were paraphyletic with each other on phylogenetic trees, suggesting that they should not be distinct species. Furthermore, the samples of these two species from the southern Hengduan Mountains region formed a distinct cluster that was separated from the samples of other regions, implying the presence of cryptic diversity. The feasibility of DNA barcodes for identification of geographical authenticity was also verified here. The database and paradigm that we provide in this study could be used as reference for the authentication of traditional Chinese medicinal plants utilizing DNA barcoding. PMID:25938480
Murphy, P A; Kronenberg, F; Wade, C
Complementary and alternative medicine is becoming an established intervention modality within the contemporary health care system. Various forms of complementary and alternative medicine are used by patients and practitioners alike, including chiropractic, massage, botanical medicine, homeopathy, and energy therapies. The National Center for Complementary and Alternative Medicine was established within the National Institutes of Health to facilitate evaluation of these alternative therapies, establish an information clearinghouse, and promote research in the field. This article discusses several aspects of complementary and alternative medicine, relates them to women's health, and describes the need for a research agenda to evaluate the impact of the complementary and alternative medicine modalities used for important conditions affecting women.
Gibson, Christine; Ladak, Farah; Shrestha, Ashis; Yadav, Bharat; Thu, Kyaw; Aye, Tin
Family medicine is an integral part of primary care within health systems. Globally, training programmes exhibit a great degree of variability in content and skill acquisition. While this may in part reflect the needs of a given setting, there exists standard criteria that all family medicine programmes should consider core activities. WONCA has provided an open-access list of standards that their expert community considers essential for family medicine (GP) post-graduate training. Evaluation of developing or existing training programmes using these standards can provide insight into the degree of variability, gaps within programmes and equally as important, gaps within recommendations. In collaboration with the host institution, two family medicine programmes in Nepal and Myanmar were evaluated based on WONCA global standards. The results of the evaluation demonstrated that such a process can allow for critical review of curriculum in various stages of development and evaluation. The implications of reviewing training programmes according to WONCA standards can lead to enhanced training world-wide and standardisation of training for post-graduate family medicine.
Joo, Sunyoung; Ko, In Kap; Atala, Anthony; Yoo, James J; Lee, Sang Jin
The stem cells isolated from amniotic fluid present an exciting possible contribution to the field of regenerative medicine and amniotic fluid-derived stem (AFS) cells have significant potential for research and therapeutic applications. AFS cells are multipotent, showing the ability to differentiate into cell types from all three embryonic germ layers. They express both embryonic and adult stem cell markers, expand extensively without feeder cells, double in 36 h, and are not tumorigenic. The AFS cells can be maintained for over 250 population doublings and preserve their telomere length and a normal karyotype. They differentiate easily into specific cell lineages and do not require human embryo tissue for their isolation, thus avoiding the current controversies associated with the use of human embryonic stem (ES) cells. The discovery of the AFS cells has been recent, and a great deal of work remains to be performed on the characterization and use of these cells. This review describes the various differentiated lineages that AFS cells can form and the future of these promising new stem cells in regenerative medicine research.
Yegidis, B L
The purpose of this paper is to describe recent empirical research findings about family violence, and to explore selected social work treatment issues in the light of these findings. The last two decades has seen a proliferation of research about family violence. Most of the early research used small clinical samples and so generalizing findings to other groups has been difficult. However, the recent research has examined a number of important psychosocial correlates of family violence using more methodologically sound methods. As a result, we now know quite a bit about how and why family violence occurs. Also, within the last decade a number of studies have explicated the kinds of treatments and approaches that are most effective in dealing with abusive people. This paper summarizes these treatment strategies.
Sullivan, Susan, Ed.; Bose, Kathy, Ed.; Levesque, Lise, Ed.
Serving as a vehicle for raising the profile of and thereby gaining recognition for the important research and development work being conducted in Canada in support of children and families, the "Research Connections Canada" series compiles research and/or development papers as well as background papers, analytical literature reviews,…
Sullivan, Susan, Ed.; Bose, Kathy, Ed.; Levesque, Lise, Ed.
Serving as a vehicle for raising the profile of and thereby gaining recognition for the important research and development work being conducted in Canada in support of children and families, the "Research Connections Canada" series compiles research and/or development papers as well as background papers, analytical literature reviews,…
Lowe, Elaine, Ed.
Serving as a vehicle for raising the profile of and thereby gaining recognition for the important research and development work being conducted in Canada in support of children and families, the "Research Connections Canada" series compiles research and/or development papers as well as background papers, analytical literature reviews,…
Whitehead, Judith, Ed.
Whitehead, Judith, Ed.
Lowe, Elaine, Ed.
Lowe, Elaine, Ed.
Reflecting the change in funding strategies for European research projects, and the goal to jointly improve medical radiation protection through sustainable research efforts, five medical societies involved in the application of ionising radiation (European Association of Nuclear Medicine, EANM; European Federation of Organizations for Medical Physics. EFOMP; European Federation of Radiographer Societies, EFRS; European Society of Radiology, ESR; European Society for Radiotherapy and Oncology, ESTRO) have identified research areas of common interest and developed this first edition of the Common Strategic Research Agenda (SRA) for medical radiation protection. The research topics considered necessary and most urgent for effective medical care and efficient in terms of radiation protection are summarised in five main themes: 1. Measurement and quantification in the field of medical applications of ionising radiation 2. Normal tissue reactions, radiation-induced morbidity and long-term health problems 3. Optimisation of radiation exposure and harmonisation of practices 4. Justification of the use of ionising radiation in medical practice 5. Infrastructures for quality assurance The SRA is a living document; thus comments and suggestions by all stakeholders in medical radiation protection are welcome and will be dealt with by the European Alliance for Medical Radiation Protection Research (EURAMED) established by the above-mentioned societies.
Dorell, Åsa; Isaksson, Ulf; Östlund, Ulrika; Sundin, Karin
Background: Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurses during and after relocation to a residential home. A Family Systems Nursing intervention, “Family Health Conversations” (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people. Objectives: The aims of this study were to evaluate the responses to the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based. Methods: A mixed methods research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included 10 families comprising 22 family members. Result: Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families’ thinking in a new way. Conclusion: These findings showed that FamHC could be an important type of intervention to improve family functioning and enhance the emotional well-being.
Jia, Buyun; Li, Shanshan; Hu, Xuerui; Zhu, Guangyu; Chen, Weidong
Garcinia hanburyi, a tropical plant found in south Asia, has a special long history in the development of both medicine and art. This review mainly focuses on the pharmacy research of the bioactive compounds from the plant in recent years. Preparative and analysis separation methods were introduced. Moreover, the chemical structure of the isolated compounds was included. The studies of biological activities of the caged xanthones from the plant, including antitumor, anti-HIV-1, antibacterial, and neurotrophic activities, were reviewed in detail. Furthermore, the mechanisms of its antitumor activity were also reviewed. As mentioned above, some of the xanthones from G. hanburyi can be promising drug candidates, which is worth studying. However, we still need much evidence to prove their efficacy and safety. So, further research is critical for the future application of xanthones from G. hanburyi.
Askov, Eunice N.
A think tank on researching family literacy was held to brainstorm a national research agenda for family literacy. The think tank brought together 12 researchers, policymakers, and practitioners involved in family literacy. Key themes emerging during the think tank were as follows: (1) family literacy is difficult to research because it is…
Teng, Zhong-qiu; Shen, Ye
The application of genetic engineering technology in modern agriculture shows its outstanding role in dealing with food shortage. Traditional medicinal plant cultivation and collection have also faced with challenges, such as lack of resources, deterioration of environment, germplasm of recession and a series of problems. Genetic engineering can be used to improve the disease resistance, insect resistance, herbicides resistant ability of medicinal plant, also can improve the medicinal plant yield and increase the content of active substances in medicinal plants. Thus, the potent biotechnology can play an important role in protection and large area planting of medicinal plants. In the development of medicinal plant genetic engineering, the safety of transgenic medicinal plants should also be paid attention to. A set of scientific safety evaluation and judgment standard which is suitable for transgenic medicinal plants should be established based on the recognition of the particularity of medicinal plants.
Huang, He-Ping; Li, Jin-Cai; Huang, Lu-Qi; Wang, Dian-Lei; Huang, Peng; Nie, Jiu-Sheng
Breeding is not only an important area of medicinal plants research but also the foundation for the superior varieties acquirement of medicinal plants. The rise of modern biotechnology provides good opportunities and new means for medicinal plants breeding research in China. Biotechnology shows its technical advantages and new development prospects in breeding of new medicinal plants varieties with high and stable yield, good quality, as well as stress-resistance. In this paper, we describe recent advances, problems, and development prospects about the application of modern biotechnology in medicinal plants breeding research in China.
Mash, Robert; Essuman, Akye; Flinkenflögel, Maaike
Internationally, there is a move towards strengthening primary healthcare systems and encouraging community-based and socially responsible education. The development of doctors with an interest in primary healthcare and family medicine in the African region should begin during undergraduate training. Over the last few years, attention has been given to the development of postgraduate training in family medicine in the African region, but little attention has been given to undergraduate training. This article reports on the 8th PRIMAFAMED (Primary Care and Family Medicine Education) network meeting held in Nairobi from 21 to 24 May 2016. At this meeting the delegates spent time presenting and discussing the current state of undergraduate training at 18 universities in the region and shared lessons on how to successfully implement undergraduate training. This article reports on the rationale for, information presented, process followed and conclusions reached at the conference. PMID:28155289
Bradner, Melissa; Crossman, Steven H; Vanderbilt, Allison A; Gary, Judy; Munson, Paul
Background There are unique challenges to recruiting students into the specialty of family medicine within academic medical centers. Methods At Virginia Commonwealth University, we developed an advising framework to help students address institutional and personal obstacles to choosing family medicine as a career. Results The role of a faculty advisor is not to direct the student to a career choice but rather to foster a mentor relationship and help the student come to his or her own realizations regarding career choice. The faculty advisor/medical student interview is conceptualized as five discussion topics: self-knowledge, perception, organizational voice, cognitive dissonance, and anticipatory counseling. Conclusion This framework is intended to assist faculty in their efforts to encourage students to consider a career in family medicine.
Blau, Ashley; Brown, Alison; Mahanta, Lisa; Amr, Sami S
The Translational Genomics Core (TGC) at Partners Personalized Medicine (PPM) serves as a fee-for-service core laboratory for Partners Healthcare researchers, providing access to technology platforms and analysis pipelines for genomic, transcriptomic, and epigenomic research projects. The interaction of the TGC with various components of PPM provides it with a unique infrastructure that allows for greater IT and bioinformatics opportunities, such as sample tracking and data analysis. The following article describes some of the unique opportunities available to an academic research core operating within PPM, such the ability to develop analysis pipelines with a dedicated bioinformatics team and maintain a flexible Laboratory Information Management System (LIMS) with the support of an internal IT team, as well as the operational challenges encountered to respond to emerging technologies, diverse investigator needs, and high staff turnover. In addition, the implementation and operational role of the TGC in the Partners Biobank genotyping project of over 25,000 samples is presented as an example of core activities working with other components of PPM.
Blau, Ashley; Brown, Alison; Mahanta, Lisa; Amr, Sami S.
The Translational Genomics Core (TGC) at Partners Personalized Medicine (PPM) serves as a fee-for-service core laboratory for Partners Healthcare researchers, providing access to technology platforms and analysis pipelines for genomic, transcriptomic, and epigenomic research projects. The interaction of the TGC with various components of PPM provides it with a unique infrastructure that allows for greater IT and bioinformatics opportunities, such as sample tracking and data analysis. The following article describes some of the unique opportunities available to an academic research core operating within PPM, such the ability to develop analysis pipelines with a dedicated bioinformatics team and maintain a flexible Laboratory Information Management System (LIMS) with the support of an internal IT team, as well as the operational challenges encountered to respond to emerging technologies, diverse investigator needs, and high staff turnover. In addition, the implementation and operational role of the TGC in the Partners Biobank genotyping project of over 25,000 samples is presented as an example of core activities working with other components of PPM. PMID:26927185
Institute of Family Studies, Melbourne (Australia).
First in a series of seven volumes containing the proceedings of the 1983 Australian Family Research Conference, this publication deals with the formation, structure, and values of family life in Australia. Papers and authors included are: "Priorities in Family Research and Family Law" (Gareth Evans), "The Baby Boom Generation as…
Biesecker, Leslie G.; Mullikin, James C.; Facio, Flavia M.; Turner, Clesson; Cherukuri, Praveen F.; Blakesley, Robert W.; Bouffard, Gerard G.; Chines, Peter S.; Cruz, Pedro; Hansen, Nancy F.; Teer, Jamie K.; Maskeri, Baishali; Young, Alice C.; Manolio, Teri A.; Wilson, Alexander F.; Finkel, Toren; Hwang, Paul; Arai, Andrew; Remaley, Alan T.; Sachdev, Vandana; Shamburek, Robert; Cannon, Richard O.; Green, Eric D.
ClinSeq is a pilot project to investigate the use of whole-genome sequencing as a tool for clinical research. By piloting the acquisition of large amounts of DNA sequence data from individual human subjects, we are fostering the development of hypothesis-generating approaches for performing research in genomic medicine, including the exploration of issues related to the genetic architecture of disease, implementation of genomic technology, informed consent, disclosure of genetic information, and archiving, analyzing, and displaying sequence data. In the initial phase of ClinSeq, we are enrolling roughly 1000 participants; the evaluation of each includes obtaining a detailed family and medical history, as well as a clinical evaluation. The participants are being consented broadly for research on many traits and for whole-genome sequencing. Initially, Sanger-based sequencing of 300–400 genes thought to be relevant to atherosclerosis is being performed, with the resulting data analyzed for rare, high-penetrance variants associated with specific clinical traits. The participants are also being consented to allow the contact of family members for additional studies of sequence variants to explore their potential association with specific phenotypes. Here, we present the general considerations in designing ClinSeq, preliminary results based on the generation of an initial 826 Mb of sequence data, the findings for several genes that serve as positive controls for the project, and our views about the potential implications of ClinSeq. The early experiences with ClinSeq illustrate how large-scale medical sequencing can be a practical, productive, and critical component of research in genomic medicine. PMID:19602640
Vrijhoef, Bert; De Maeseneer, Jan; Vansintejan, Johan; Devroey, Dirk
Hypersexual disorder (HD) is not defined in a uniform way in the psychiatric literature. In the absence of solid evidence on prevalence, causes, empirically validated diagnostic criteria, instruments for diagnosis, consistent guidelines on treatment options, medical and psychosocial consequences, and type of caregivers that need to be involved, HD remains a controversial and relatively poorly understood chronic disease construct. The role of family medicine in the detection, treatment, and followup of HD is not well studied. The purpose of this paper is to describe the complexity of HD as a multidimensional chronic disease construct and its relevance to family medicine and primary care. PMID:24066230
Beitler, Jeremy R; Goligher, Ewan C; Schmidt, Matthieu; Spieth, Peter M; Zanella, Alberto; Martin-Loeches, Ignacio; Calfee, Carolyn S; Cavalcanti, Alexandre B
In the last 20 years, survival among patients with acute respiratory distress syndrome (ARDS) has increased substantially with advances in lung-protective ventilation and resuscitation. Building on this success, personalizing mechanical ventilation to patient-specific physiology for enhanced lung protection will be a top research priority for the years ahead. However, the ARDS research agenda must be broader in scope. Further understanding of the heterogeneous biology, from molecular to mechanical, underlying early ARDS pathogenesis is essential to inform therapeutic discovery and tailor treatment and prevention strategies to the individual patient. The ARDSne(x)t research agenda for the next 20 years calls for bringing personalized medicine to ARDS, asking simultaneously both whether a treatment affords clinically meaningful benefit and for whom. This expanded scope necessitates standard acquisition of highly granular biological, physiological, and clinical data across studies to identify biologically distinct subgroups that may respond differently to a given intervention. Clinical trials will need to consider enrichment strategies and incorporate long-term functional outcomes. Tremendous investment in research infrastructure and global collaboration will be vital to fulfilling this agenda.
Background During the last decade medical students from most Western countries have shown little interest in family practice. Understanding the factors that influence medical students to choose family medicine is crucial. Objective To systematically review and synthesize published evidence about medical students’ attitudes and perceptions towards family practice. Methods A qualitative systematic review. The literature search was undertaken in July 2010 in PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Social Science Citation Index (SSCI), and ProQuest Dissertations & Theses. Two authors independently selected the studies for their inclusion and assessed their quality. The selected studies were thoroughly read. Key themes and categories were identified. A matrix was created for allowing the comparison of each theme across studies. Results Ten studies were finally included. Seven broad themes were identified across them: 1) Scope and context of practice was a broad theme comprising linked sub-themes: perception of a varied specialty, broad practice, holistic perspective and flexibility that allows having a family; 2) Lower interest or intellectually less challenging: treating common disease, repetitive, quasi administrative job; 3) Influence of role models, either positive and negative, and society: negative comments from other professionals, peers and family; 4) Lower prestige; 5) Poor remuneration; 6) Medical school influences, being important both the length and quality of the exposure; 7) Post graduate training, where the shorter duration and the lower intensity were perceived as positive aspects. After identifying these seven key themes, were also looked into patterns in the distribution of these themes among studies. Conclusions Our qualitative review provides a comprehensive picture of medical students’ attitudes towards family practice in the available literature. In general, although some students find family medicine
Rahman, Sajitha M.F.; Angeline, Ruby P.; David, Kirubah V.; Christopher, Prince
India's commitment to universal health coverage has grown stronger with the submission of High Level Expert Group report by the Planning Commission in 2012. With this report comes the commitment to increase the primary health-care workforce to meet the population needs. However, the focus should not be just to increase the number of health workers, but to produce better health workers. Doctors, nurses and community health workers trained in primary and secondary health-care facilities can make a significant contribution in responding to the needs of the local community. The role of family medicine education is worth exploring in this context to equip the primary care health workers with the competencies of providing person-centered, comprehensive and continuous care. PMID:25374848
Turabián, José Luis; Pérez Franco, Benjamín; Turabián Fernández, José Luis; Pérez Franco, Benjamin
The symptoms in family medicine are not signs of disease, but "signs of life"; in the consultation "all patient life comes together with him". Every consultation is primarily a biopsicosocial problem: the person perceives a dysfunction or alteration in relation with himself and his context. To do a diagnosis only with physical symptoms, can be a mistake because these do not identify the real problem. The different types of symptoms are "entangled" or chained some in others: the symptoms can be fitted or inevitable; to be expressions of biochemical alterations, symbols for the patient, group context expressions, or kinds of facing the facts; and they depend on the previous psychological patient performance, the severity of the deficit of the psychological function associated with the disease, the residual skills, the adjustment and the confrontation of the functional limitations, the relation doctor-patient, as well as on the influence of the context.
Li, Qianquan; Zhou, Lishe; Guo, Lanping; Li, Minhui; Zhang, Na; Yuan, Qingjun; Yuan, Yuan
Molecular pharmacognosy has developed as a new borderline discipline. Using the method and technology of molecular pharmacognosy, a wide range of challenging problems were resolved, such as the identification of Mongolian medicinal raw materials, etiology of endangerment and protection of endangered Mongolian medicinal plants and animals, biosynthesis and bioregulation of active components in Mongolian medicinal plants, and characteristics and the molecular bases of Dao-di Herbs. So molecular pharmacognosy will provide the new methods and insights for modernization of Mongolian medicine.
Pagels, Patti; Kindratt, Tiffany B; Reyna, Guadalupe; Lam, Kenrick; Silver, Mandy; Gimpel, Nora E
In 2012, the USPSTF updated its guidelines and now recommends that all women of childbearing age be screened for IPV and services provided for women who screen positive. Based on these recommendations, objectives of this study were to (1) evaluate IPV knowledge, attitudes, and practices of physicians from different specialties and (2) determine significant differences by medical specialty. We recruited (n = 183) Internal Medicine, Emergency Medicine, Family Medicine (FM) and Obstetrics/Gynecology (OB/GYN) residents and attending physicians to complete a 15-question online survey assessing knowledge, attitudes and current IPV screening practices. We evaluated associations between medical specialty and knowledge, attitudes and practice measures before and after controlling for covariates. Knowledge of how often IPV occurs in society, community resources, and screening tools were significantly different by specialty (all p's < 0.05). A majority of FM physicians (88%) reported that it is a physician's responsibility to find and treat IPV and 97% reported that IPV should be included in their training. Compared to OB/GYN physicians in multivariate analyses, FM physicians were less likely to report they were comfortable discussing IPV with their patients in crude (OR = 0.35; 95% CI = 0.13, 0.94) and adjusted models (OR = 0.20; 95% CI = 0.06, 0.60). FM physicians were also less likely to report screening female patients for IPV before (OR = 0.25; 95% CI = 0.08, 0.86) and after adjusting for confounders (OR = 0.11; 95% CI = 0.03, 0.47). Our results indicate that FM physicians have positive attitudes towards finding and treating IPV yet need enhanced training to improve their comfort level with screening for and discussing IPV with their patients.
Ji, Qing; Luo, Yun-quan; Wang, Wen-hai; Liu, Xuan; Li, Qi; Su, Shi-bing
Traditional Chinese medicine (TCM) syndrome, also known as TCM ZHENG or TCM pattern, is an integral and essential part of TCM theory that helps to guide the design of individualized treatments. A TCM syndrome, in essence, is a characteristic profile of all clinical manifestations in one patient that can be readily identified by a TCM practitioner. In this article, the authors reviewed the presentations of TCM syndromes in seven common malignancies (liver, lung, gastric, breast, colorectal, pancreatic and esophageal cancers), the objectivity and the standardization of TCM syndrome differentiation, the evaluation of TCM syndrome modeling in cancer research, and syndrome differentiation-guided TCM treatment of cancers. A better understanding of TCM syndrome theory, as well as its potential biological basis, may contribute greatly to the clinical TCM diagnosis and the treatment of cancer.
Batic-Mujanovic, Olivera; Beganlic, Azijada; Salihefendic, Nizama; Pranjic, Nurka; Kusljugic, Zumreta
Smoking causes decrease of HDL-cholesterol (HDL-C) levels and increase of total cholesterol, triglyceride and LDL-cholesterol (LDL-C) levels. Low HDL-C levels and high cholesterol and LDL-C levels are associated with a higher risk for cardiovascular diseases. The aim of this study was to examine the effect of smoking status on serum lipid and lipoproteins levels among patients in family medicine practice. This trial was designed to detect differences in serum total cholesterol, triglyceride, LDL-C and HDL-C levels between smokers and non-smokers. We had placed a limit of 300 patients for data collection. We excluded 195 patients who met excluding criteria (diagnosis of diabetes mellitus, renal and hepatic failure, hypothyroidism; using beta blockers, thiazide diuretics, hormonal replacement therapy and corticosteroids; more than light physical activity; alcohol consumption and obesity), so the sample size included 105 randomly selected patients from Family Medicine Teaching Center Tuzla, mean age 52.05 +/- 11.61 years. Main outcomes were smoking status in all participants and serum total cholesterol, triglyceride, LDL-C and HDL-C levels in smokers and non-smokers. Our results showed that smoking prevalence was 49.52%. Smokers had significantly higher serum total cholesterol (P=0.01), triglyceride (P=0.002) and LDL-C level (P=0.03) and significantly lower HDL-C level (P=0.003) comparing with nonsmokers. There was no significant difference in serum lipid and lipoprotein levels between ex-smokers and never smokers. These results suggest that cigarette smoking adversely affects serum lipid and lipoprotein levels which further increases the risk for cardiovascular morbidity and mortality.
Musthafa, Khadar Syed; Sianglum, Wipawadee; Saising, Jongkon; Lethongkam, Sakkarin; Voravuthikunchai, Supayang Piyawan
Virulence factors regulated by quorum sensing (QS) play a critical role in the pathogenesis of an opportunistic human pathogen, Pseudomonas aeruginosa in causing infections to the host. Hence, in the present work, the anti-virulence potential of the medicinal plant extracts and their derived phytochemicals from Myrtaceae family was evaluated against P. aeruginosa. In the preliminary screening of the tested medicinal plant extracts, Syzygium jambos and Syzygium antisepticum demonstrated a maximum inhibition in QS-dependent violacein pigment production by Chromobacterium violaceum DMST 21761. These extracts demonstrated an inhibitory activity over a virulence factor, pyoverdin, production by P. aeruginosa ATCC 27853. Gas chromatography-mass spectrometric (GC-MS) analysis revealed the presence of 23 and 12 phytochemicals from the extracts of S. jambos and S. antisepticum respectively. Three top-ranking phytochemicals, including phytol, ethyl linoleate and methyl linolenate, selected on the basis of docking score in molecular docking studies lowered virulence factors such as pyoverdin production, protease and haemolytic activities of P. aeruginosa to a significant level. In addition, the phytochemicals reduced rhamnolipid production by the organism. The work demonstrated an importance of plant-derived compounds as anti-virulence drugs to conquer P. aeruginosa virulence towards the host.
Glynn, Thomas J.
Although there has been a significant amount of research on the families of drug abusers, this field has encountered a number of obstacles to its continued growth. Some of these problems include an emphasis of research on opiate use, methodological hindrances, and lack of a constituency. A review of two concurrent national processes, the White…
Research into the social history of African American men in deteriorating socioeconomic conditions has enhanced the understanding of the family. This research helps to understand the different experiences of diverse groups within the society and different group reactions to social change. Yet, social scientists and policymakers have shown a…
Nguyen, Jacqueline; Hernández, María G.; Saetermoe, Carrie L.; Suárez-Orozco, Carola
In this introduction, the editors give an overview of the ways the volume addresses the growing individual and institutional calls for increased clarity and rigor in methodological, ethical, and practical research policies and guidelines for conducting research with immigrant individuals, families, and communities. In addition to summarizing the…
This article provides an introduction to the special issue on intervention development and cultural adaptation research with diverse families. The need for research on intervention development and on cultural adaptation of interventions is presented, followed by a discussion of frameworks on treatment development. Seven articles included in this special issue serve as examples of the stages of treatment and intervention development, and of the procedures employed in the cultural adaptation with diverse families. An overview of the seven articles is provided to illustrate the treatment development process and the use of pluralistic research methods. We conclude with a call to the field for creative and innovative intervention development research with diverse families to contribute to the body of evidence-based practice with these populations. PMID:16768015
Holloway, R L; Hale, K L; Rakel, R E
The authors interviewed by telephone the heads (or their representatives) of 101 of the 120 family practice units in U.S. medical schools in 1987. Each respondent was asked for his or her personal perceptions of the relative importances of research, teaching, patient care, and administrative activities in the academic promotion process. Respondents were also asked for their views of their units' and institutions' perceptions of the importances of the same four activities in the promotion process, as well as other related questions about promotion and tenure. The findings indicate that there is still a significant incongruence between the value structure of most family practice units and that of their institutions but that many family practice units are beginning to achieve parity of promotion and tenure with other departments in their institutions.
Prochaska, James O
Given the disease and cost burdens, Multiple Health Behavior Research represents the future of preventive medicine. Growing evidence in this special issue and beyond indicates that simultaneous and sequential interventions can be effective. The challenge for the future is to make such interventions more effective, cost effective and less demanding. Co-variation represents one innovative approach in which effective change on one treated behavior increases the odds of effective action on a second targeted behavior. Co-variation can occur when all behaviors received full treatment, when one receives full treatment and the others receive minimal treatment and when only one behavior is treated and others co-vary without treatment. Integrative treatments represent another innovation in which higher order constructs drive change on multiple behaviors related to the construct and treatment has to be only on one higher order behavior. A more integrated approach to research and practice involves new paradigms complementing established paradigms. Multiple behaviors proactively treated in populations at home or work by computer-based and stage-based interventions designed to generate co-variation that produces greater impacts can complement traditional paradigms that treat single behaviors in individual patients in clinics by clinicians with action-oriented modular interventions designed for specific behaviors to produce significant efficacy. More inclusive research to support more inclusive practices can hopefully lead to more inclusive care.
Much of our understanding of human physiology, and of many aspects of pathology, has its antecedents in laboratory and clinical studies of hemoglobin. Over the last century, knowledge of the genetics, functions, and diseases of the hemoglobin proteins has been refined to the molecular level by analyses of their crystallographic structures and by cloning and sequencing of their genes and surrounding DNA. In the last few decades, research has opened up new paradigms for hemoglobin related to processes such as its role in the transport of nitric oxide and the complex developmental control of the α-like and β-like globin gene clusters. It is noteworthy that this recent work has had implications for understanding and treating the prevalent diseases of hemoglobin, especially the use of hydroxyurea to elevate fetal hemoglobin in sickle cell disease. It is likely that current research will also have significant clinical implications, as well as lessons for other aspects of molecular medicine, the origin of which can be largely traced to this research tradition. PMID:18988877
Kleist, David M.
The initial goals of IAMFC included conducting and fostering programs of education in the field of family counseling, and promoting and conducting programs of research in the field of marriage and family counseling (International Association of Marriage and Family Counselors, 1990). The goal of fostering program development shows signs of success,…
Nowik, N; Podlasz, P; Jakimiuk, A; Kasica, N; Sienkiewicz, W; Kaleczyc, J
The zebrafish (Danio rerio) has become known as an excellent model organism for studies of vertebrate biology, vertebrate genetics, embryonal development, diseases and drug screening. Nevertheless, there is still lack of detailed reports about usage of the zebrafish as a model in veterinary medicine. Comparing to other vertebrates, they can lay hundreds of eggs at weekly intervals, externally fertilized zebrafish embryos are accessible to observation and manipulation at all stages of their development, which makes possible to simplify the research techniques such as fate mapping, fluorescent tracer time-lapse lineage analysis and single cell transplantation. Although zebrafish are only 2.5 cm long, they are easy to maintain. Intraperitoneal and intracerebroventricular injections, blood sampling and measurement of food intake are possible to be carry out in adult zebrafish. Danio rerio is a useful animal model for neurobiology, developmental biology, drug research, virology, microbiology and genetics. A lot of diseases, for which the zebrafish is a perfect model organism, affect aquatic animals. For a part of them, like those caused by Mycobacterium marinum or Pseudoloma neutrophila, Danio rerio is a natural host, but the zebrafish is also susceptible to the most of fish diseases including Itch, Spring viraemia of carp and Infectious spleen and kidney necrosis. The zebrafish is commonly used in research of bacterial virulence. The zebrafish embryo allows for rapid, non-invasive and real time analysis of bacterial infections in a vertebrate host. Plenty of common pathogens can be examined using zebrafish model: Streptococcus iniae, Vibrio anguillarum or Listeria monocytogenes. The steps are taken to use the zebrafish also in fungal research, especially that dealing with Candida albicans and Cryptococcus neoformans. Although, the zebrafish is used commonly as an animal model to study diseases caused by external agents, it is also useful in studies of metabolic
Eisenberg, David S.
The UCLA-DOE Institute of Genomics and Proteomics is an organized research unit of the University of California, sponsored by the Department of Energy through the mechanism of a Cooperative Agreement. Today the Institute consists of 10 Principal Investigators and 7 Associate Members, developing and applying technologies to promote the biological and environmental missions of the Department of Energy, and 5 Core Technology Centers to sustain this work. The focus is on understanding genomes, pathways and molecular machines in organisms of interest to DOE, with special emphasis on developing enabling technologies. Since it was founded in 1947, the UCLA-DOE Institute has adapted its mission to the research needs of DOE and its progenitor agencies as these research needs have changed. The Institute started as the AEC Laboratory of Nuclear Medicine, directed by Stafford Warren, who later became the founding Dean of the UCLA School of Medicine. In this sense, the entire UCLA medical center grew out of the precursor of our Institute. In 1963, the mission of the Institute was expanded into environmental studies by Director Ray Lunt. I became the third director in 1993, and in close consultation with David Galas and John Wooley of DOE, shifted the mission of the Institute towards genomics and proteomics. Since 1993, the Principal Investigators and Core Technology Centers are entirely new, and the Institute has separated from its former division concerned with PET imaging. The UCLA-DOE Institute shares the space of Boyer Hall with the Molecular Biology Institute, and assumes responsibility for the operation of the main core facilities. Fig. 1 gives the organizational chart of the Institute. Some of the benefits to the public of research carried out at the UCLA-DOE Institute include the following: The development of publicly accessible, web-based databases, including the Database of Protein Interactions, and the ProLinks database of genomicly inferred protein function linkages
Tsujimura-Ito, Takako; Inoue, Yusuke; Yoshida, Ken-ichi
This study investigated the circumstances and problems that departments of forensic medicine encounter with bereaved families regarding samples obtained from medico-legal autopsies. A questionnaire was posted to all 76 departments of forensic medicine performing medico-legal autopsies in Japan, and responses were received from 48 (63.2%). Of the respondents, 12.8% had approached and communicated with bereaved families about collecting samples from the deceased person during an autopsy and the storage of the samples. In addition, 23.4% of these had informed families that samples might be used in research. Eighteen departments had received enquiries and requests from families about the samples, with most requests concerning their return. The response to such requests varied according to the department. Few departments interacted with the bereaved families regarding the procedure for obtaining autopsy samples, and their methods for handling family concerns differed depending on the person within the department authorised to contact the family. Moreover, the procedures for engaging in such communication have long been unclear, and no legal or ethical consensus or agreement with the general public has been established. It is important for researchers to further discuss the correct way for forensic medicine departments to communicate with bereaved families.
Khoja, Abdullah T.
Objectives: The study was conducted to evaluate the educational environment (EE) in Family Medicine Training Programs. Materials and Methods: A cross-sectional survey, The Postgraduate Hospital Educational Environment Measure (PHEEM), was distributed to all residents at the four training centers in the central region. Cronbach's alpha was used to test the reliability. The mean and standard deviation (SD) for each item, the overall score and the three domains were calculated. A multiple linear regression model was developed with PHEEM scores as an outcome. The Mann–Whitney–Wilcoxon test was used to compare each item based on the selected factors. Results: The overall score was 67.1/160 (SD: 20.1). The PHEEM's domains scores: 24.2/56 (SD: 7.13) for perception of role autonomy; 25.3/60 (SD: 8.88), for perception of teaching; and 17/44 (SD: 5.6), for perception of social support. Training center and Level of training were the significant outcome predictors. Centre 1 (Joint Program) significantly had better scores than Centre 2. The instrument showed great reliability with a Cronbach's alpha of 0.92. Conclusions: There are many problems in the training program. Urgent actions are needed to improve the residents' learning experience particularly during rotations. Also, the curriculum should be restructured, and effective training methods introduced using the Best Evidence in Medical Education to meet the expectations and learning needs of family physicians. PMID:25657612
Choi, Jiun; You, Je Sung; Joo, Young Seon; kong, Taeyoung; Ko, Dong Ryul; Chung, Sung Phil
Objective During the past 20 years, over 1,400 doctors have been certified as emergency physicians in Korea. The number of scientific publications in the field of emergency medicine has also increased. This study aims to evaluate the research productivity of academic emergency physicians in South Korea. Methods Articles published from 1996 to 2015 by authors affiliated with Korean emergency departments were retrieved using Pubmed, Embase, and Web of Science. Research productivity was analyzed quantitatively to ascertain the number of articles for publication type and year. The performance of these articles was also analyzed qualitatively using impact factor, citation number, and Hirsch index. Bibliometric analysis was performed by researching Web of Science, Scopus, and Google Scholar. Results A total of 858 articles with 293 Korean authors as the first or corresponding authors were published across 191 journals. The number of publications increased continuously. The most common publication type was original article (n=618), the most commonly studied research topic was resuscitation medicine (n=110), and the average impact factor of the original articles was 2.158. The highest h-index was 17 and, using Web of Science, the maximum number of citations was found to be 85. Conclusion This study suggests that the research productivity of Korean authors in the emergency medicine field has progressed steadily during the last 10 years. However, qualitative indexes, such as the number of citations and h-index value, remain low. PMID:28168231
Background Funders of medical research the world over are increasingly seeking, in research assessment, to complement traditional output measures of scientific publications with more outcome-based indicators of societal and economic impact. In the United Kingdom, the Higher Education Funding Council for England (HEFCE) developed proposals for the Research Excellence Framework (REF) to allocate public research funding to higher education institutions, inter alia, on the basis of the social and economic impact of their research. In 2010, it conducted a pilot exercise to test these proposals and refine impact indicators and criteria. Methods The impact indicators proposed in the 2010 REF impact pilot exercise are critically reviewed and appraised using insights from the relevant literature and empirical data collected for the University of Oxford’s REF pilot submission in clinical medicine. The empirical data were gathered from existing administrative sources and an online administrative survey carried out by the university’s Medical Sciences Division among 289 clinical medicine faculty members (48.1% response rate). Results The feasibility and scope of measuring research impact in clinical medicine in a given university are assessed. Twenty impact indicators from seven categories proposed by HEFCE are presented; their strengths and limitations are discussed using insights from the relevant biomedical and research policy literature. Conclusions While the 2010 pilot exercise has confirmed that the majority of the proposed indicators have some validity, there are significant challenges in operationalising and measuring these indicators reliably, as well as in comparing evidence of research impact across different cases in a standardised manner. It is suggested that the public funding agencies, medical research charities, universities, and the wider medical research community work together to develop more robust methodologies for capturing and describing impact
Hutchinson, Janis Faye; Sharp, Richard
Prior to the completion of the Human Genome Project, bioethicists and other academics debated the impact of this new genetic information on medicine, health care, group identification, and peoples' lives. A major issue is the potential for unintended and intended adverse consequences to groups and individuals. When conducting research in, for instance, American Indian and Alaskan native (AI/AN) populations, political, cultural, religious and historical issues must be considered. Among African Americans, the Tuskegee Syphilis Experiment is a reminder of racism and discrimination in this country. The goal of the current study is to understand reasons for participating, or not, in genetic research such as the HapMap project and other genetic/medical research from the perspective of the Indian American community in Houston, Texas. In this article, we report on a topic central to this discussion among Indian Americans: karma and reincarnation. Both concepts are important beliefs when considering the body and what should happen to it. Karma and reincarnation are also important considerations in participation in medical and genetic research because, according to karma, what is done to the body can affect future existences and the health of future descendants. Such views of genetic and medical research are culturally mediated. Spiritual beliefs about the body, tissue, and fluids and what happens to them when separated from the body can influence ideas about the utility and acceptability of genetic research and thereby affect the recruitment process. Within this community it is understood that genetic and environmental factors contribute to complex diseases such as diabetes, hypertension, and cancer; and acknowledgment of the significance of environmental stressors in the production of disease. A commitment to service, i.e. "betterment of humanity," karmic beliefs, and targeting environmental stressors could be prominent avenues for public health campaigns in this
Anandarajah, Gowri; Craigie, Frederic; Hatch, Robert; Kliewer, Stephen; Marchand, Lucille; King, Dana; Hobbs, Richard; Daaleman, Timothy P
Spiritual care is increasingly recognized as an important component of medical care. Although many primary care residency programs incorporate spiritual care into their curricula, there are currently no consensus guidelines regarding core competencies necessary for primary care training. In 2006, the Society of Teachers of Family Medicine's Interest Group on Spirituality undertook a three-year initiative to address this need. The project leader assembled a diverse panel of eight educators with dual expertise in (1) spirituality and health and (2) family medicine. The multidisciplinary panel members represented different geographic regions and diverse faith traditions and were nationally recognized senior faculty. They underwent three rounds of a modified Delphi technique to achieve initial consensus regarding spiritual care competencies (SCCs) tailored for family medicine residency training, followed by an iterative process of external validation, feedback, and consensus modifications of the SCCs. Panel members identified six knowledge, nine skills, and four attitude core SCCs for use in training and linked these to competencies of the Accreditation Council for Graduate Medical Education. They identified three global competencies for use in promotion and graduation criteria. Defining core competencies in spiritual care clarifies training goals and provides the basis for robust curricula evaluation. Given the breadth of family medicine, these competencies may be adaptable to other primary care fields, to medical and surgical specialties, and to medical student education. Effective training in this area may enhance physicians' ability to attend to the physical, mental, and spiritual needs of patients and better maintain sustainable healing relationships.
Spanagel, Rainer; Durstewitz, Daniel; Hansson, Anita; Heinz, Andreas; Kiefer, Falk; Köhr, Georg; Matthäus, Franziska; Nöthen, Markus M; Noori, Hamid R; Obermayer, Klaus; Rietschel, Marcella; Schloss, Patrick; Scholz, Henrike; Schumann, Gunter; Smolka, Michael; Sommer, Wolfgang; Vengeliene, Valentina; Walter, Henrik; Wurst, Wolfgang; Zimmermann, Uli S; Stringer, Sven; Smits, Yannick; Derks, Eske M
According to the World Health Organization, about 2 billion people drink alcohol. Excessive alcohol consumption can result in alcohol addiction, which is one of the most prevalent neuropsychiatric diseases afflicting our society today. Prevention and intervention of alcohol binging in adolescents and treatment of alcoholism are major unmet challenges affecting our health-care system and society alike. Our newly formed German SysMedAlcoholism consortium is using a new systems medicine approach and intends (1) to define individual neurobehavioral risk profiles in adolescents that are predictive of alcohol use disorders later in life and (2) to identify new pharmacological targets and molecules for the treatment of alcoholism. To achieve these goals, we will use omics-information from epigenomics, genetics transcriptomics, neurodynamics, global neurochemical connectomes and neuroimaging (IMAGEN; Schumann et al. ) to feed mathematical prediction modules provided by two Bernstein Centers for Computational Neurosciences (Berlin and Heidelberg/Mannheim), the results of which will subsequently be functionally validated in independent clinical samples and appropriate animal models. This approach will lead to new early intervention strategies and identify innovative molecules for relapse prevention that will be tested in experimental human studies. This research program will ultimately help in consolidating addiction research clusters in Germany that can effectively conduct large clinical trials, implement early intervention strategies and impact political and healthcare decision makers.
... better. In the United States, the Food and Drug Administration is in charge of assuring the safety ... prescription and over-the-counter medicines. Even safe drugs can cause unwanted side effects or interactions with ...
Background More involvement of sub-Saharan African countries in biomedical studies, specifically in genetic research, is needed to advance individualized medicine that will benefit non-European populations. Missing infrastructure, cultural and religious beliefs as well as lack of understanding of research benefits can pose a challenge to recruitment. Here we describe recruitment efforts for a large genetic study requiring three-generation pedigrees within the Yoruba homelands of Nigeria. The aim of the study was to identify genes responsible for keloids, a wound healing disorder. We also discuss ethical and logistical considerations that we encountered in preparation for this research endeavor. Methods Protocols for this bi-national intercultural study were approved by the Institutional Review Board (IRB) in the US and the ethics committees of the Nigerian institutions for consideration of cultural differences. Principles of community based participatory research were employed throughout the recruitment process. Keloid patients (patient advisors), community leaders, kings/chiefs and medical directors were engaged to assist the research teams with recruitment strategies. Community meetings, church forums, and media outlets (study flyers, radio and TV announcements) were utilized to promote the study in Nigeria. Recruitment of research participants was conducted by trained staff from the local communities. Pedigree structures were re-analyzed on a regular basis as new family members were recruited and recruitment challenges were documented. Results Total recruitment surpassed 4200 study participants over a 7-year period including 79 families with complete three-generation pedigrees. In 9 families more than 20 family members participated, however, in 5 of these families, we encountered issues with pedigree structure as members from different branches presented inconsistent family histories. These issues were due to the traditional open family structure amongst the
Withee, W. W.
RAM is a family of payload carriers, pressurized, unpressurized and pressurizable, that operate in conjunction with the Space Shuttle and associated space systems to provide modular facilities to conduct manned or man-tended research in low earth orbit. RAM family elements are discussed as the next step in evolution from the Sortie Laboratory required to provide a significant increase in experimental capability, flexibility, and economy necessary to meet the needs of an expanding program of research and applications activities. Examples of RAM missions and operations as sortie mission laboratories and observatories, and free-flying man-tended observatories are illustrated.
Farley, Eugene S.; Piemme, Thomas E.
Eugene Farley describes the University of Rochester and Highland Hospital Family Medicine Program for teaching of primary care internists, primary care pediatricians, and family doctors. Thomas Piemme presents the George Washington University School of Medicine alternative, a 2-year program in an ambulatory setting leading to broad eligibility in…
Pollack, Charles V; Hollander, Judd E; O'Neil, Brian J; Neumar, Robert W; Summers, Richard; Camargo, Carlos A; Younger, John G; Callaway, Clifton W; Gallagher, E John; Kellermann, Arthur L; Krause, Gary S; Schafermeyer, Robert W; Sloan, Edward; Stern, Susan
In Williamsburg, VA, April 17 to 20, 1994, the Josiah Macy, Jr. Foundation sponsored a conference entitled "The Role of Emergency Medicine in the Future of American Medical Care," a report on which was published in Annals in 1995. This report promulgated recommendations for the development and enhancement of academic departments of emergency medicine and a conference to develop an agenda for research in emergency medicine. The American College of Emergency Physicians' Research Committee, along with several ad hoc members, presents updates in several of the areas addressed by the Macy Report and subsequent conferences, as a status report for the development of emergency medicine research as a whole, as of late 2002.
Robison, Dorothy; Krauss, Marty Wyngaarden
This paper describes development of a study that includes participatory action research, specifically the establishment of a family advisory committee. The study involved a survey of Massachusetts families of children with disabilities. Suggestions for establishing and integrating the committee into the research enterprise are offered, as are…
Okada, Kiyoshi; Miyata, Toshio; Sawa, Yoshiki
In Japan, the Act on the Safety of Regenerative Medicine and the Pharmaceuticals, Medical Devices and Other Therapeutic Products Act were enacted in November 2014, creating a new framework for clinical research and products related to regenerative medicine. Together with these regulatory frameworks, new insurance procedures were created for handling regenerative medicine in Japan. For developing regenerative medicine in Japan, understanding medical insurance greatly influences funding and venture success, particularly in the stages between clinical research and market launch. The study aimed to identify the issues and examples surrounding Japan's present medical insurance system, especially for regenerative medicine. We believe that building stronger insurance systems for regenerative medicine is essential for internationally aligning and harmonizing the progress of regenerative medicine.
Zhou, Gang; He, Yan-Ping
The new traditional Chinese medicine compound is the main part of the research of new drug of traditional Chinese medicine (TCM), and the new Chinese herbal compound reflects the characteristics of TCM theory. The new traditional Chinese medicine compound quality standard research is one of the main content of pharmaceutical research, and is also the focus of the new medicine pharmaceutical evaluation content. Although in recent years the research level of new traditional Chinese medicine compound has been greatly improved, but the author during the review found still some common problems existing in new traditional Chinese medicine compound quality standard research data, this paper analyzed the current quality standards for new traditional Chinese medicine compound and the problems existing in the research data, respectively from measurement of the content of index selection, determine the scope of the content, and the quality standard design concept, the paper expounds developers need to concern. The quality of new traditional Chinese medicine compound quality standard is not only itself can be solved, but quality standards is to ensure the key and important content of product quality, improving the quality of products cannot do without quality standards. With the development of science and technology, on the basis of quality by design under the guidance of the concept, new traditional Chinese medicine compound quality standard system will be more scientific, systematic and perfect.
Kontogeorgis, Georgios M
Various disciplines of chemical engineering, especially thermodynamics and kinetics, play an important role in medicinal research and this has been particularly recognized during the last 10-15 years (von Stockar and van der Wielen, J Biotechnol 59:25, 1997; Prausnitz, Fluid Phase Equilib 53:439, 1989; Prausnitz, Pure Appl Chem 79:1435, 2007; Dey and Prausnitz, Ind Eng Chem Res 50:3, 2011; Prausnitz, J Chem Thermodynamics 35:21, 2003; Tsivintzelis et al. AIChE J 55:756, 2009). It is expected that during the twenty-first century chemical engineering and especially thermodynamics can contribute as significantly to the life sciences development as it has been done with the oil and gas and chemical sectors in the twentieth century. Moreover, it has during the recent years recognized that thermodynamics can help in understanding diseases like human cataract, sickle-cell anemia, Creuzfeldt-Jacob ("mad cow" disease), and Alzheimer's which are connected to "protein aggregation." Several articles in the Perspectives section of prominent chemical engineering journals have addressed this issue (Hall, AIChE J 54:1956, 2008; Vekilov, AIChE J 54:2508, 2008). This work reviews recent applications of thermodynamics (and other areas of chemical engineering) first in drug development and then in the understanding of the mechanism of Alzheimer's and similar diseases.
Wang, Pengcheng; Wang, Qiuhong; Yang, Bingyou; Zhao, Shan; Kuang, Haixue
Traditional Chinese medicine (TCM) has played important roles in health protection and disease treatment for thousands of years in China and has gained the gradual acceptance of the international community. However, many intricate issues, which cannot be explained by traditional methods, still remain, thus, new ideas and technologies are needed. As an emerging system biology technology, the holistic view adopted by metabolomics is similar to that of TCM, which allows us to investigate TCM with complicated conditions and multiple factors in depth. In this paper, we tried to give a timely and comprehensive update about the methodology progression of metabolomics, as well as its applications, in different fields of TCM studies including quality control, processing, safety and efficacy evaluation. The herbs investigated by metabolomics were selected for detailed examination, including Anemarrhena asphodeloides Bunge, Atractylodes macrocephala Kidd, Pinellia ternate, etc.; furthermore, some valuable results have been obtained and summarized. In conclusion, although the study of metabolomics is at the early phase and requires further scrutiny and validation, it still provides bright prospects to dissect the synergistic action of multiple components from TCM. Overall, with the further development of analytical techniques, especially multi-analysis techniques, we expect that metabolomics will greatly promote TCM research and the establishment of international standards, which is beneficial to TCM modernization.
Glynn, Thomas J.
The study of human development and behavior from a life-span perspective is an area of growing interest, and the family is a natural laboratory for this study. Research in the area of drug abuse demonstrates that drug use is not limited to any one population segment or age group, but is pervasive across population subgroups. More and more evidence…
Ellenbogen, Kirsten M.; Luke, Jessica J.; Dierking, Lynn D.
Thomas Kuhn's notion of a disciplinary matrix provides a useful framework for investigating the growth of research on family learning in and from museums over the last decade. To track the emergence of this disciplinary matrix we consider three issues. First are shifting theoretical perspectives that result in new shared language, beliefs, values,…
Matthews, Sarah H.
This paper aims to assist those who do qualitative research in the field of marriage and family to reduce the number of rejections received in response to article submissions. Recurring shortcomings identified by reviewers and suggestions made to authors about revising papers are organized using headings traditionally used in a research…
The Department of Energy (DOE) proposes to authorize the Indiana School of Medicine to proceed with the detailed design, construction and equipping of the proposed Cancer Research Center (CRC). A grant was executed with the University on April 21, 1992. A four-story building with basement would be constructed on the proposed site over a 24-month period. The proposed project would bring together, in one building, three existing hematology/oncology basic research programs, with improved cost-effectiveness through the sharing of common resources. The proposed site is currently covered with asphaltic pavement and is used as a campus parking lot. The surrounding area is developed campus, characterized by buildings, walkways, with minimal lawns and plantings. The proposed site has no history of prior structures and no evidence of potential sources of prior contamination of the soil. Environmental impacts of construction would be limited to minor increases in traffic, and the typical noises associated with standard building construction. The proposed CRC project operation would involve the use radionuclides and various hazardous materials in conducting clinical studies. Storage, removal and disposal of hazardous wastes would be managed under existing University programs that comply with federal and state requirements. Radiological safety programs would be governed by Nuclear Regulatory Commission (NRC) license and applicable Environmental Protection Agency (EPA) regulations. There are no other NEPA reviews currently active which are in relationship to this proposed site. The proposed project is part of a Medical Campus master plan and is consistent with applicable local zoning and land use requirements.
Daugird, Allen J; Arndt, Jane E; Olson, P Richard
The authors describe the development, implementation, and evaluation of a computerized faculty time-management system (FTMS) in the Department of Family Medicine at the University of North Carolina-Chapel Hill. The FTMS is presented as an integrated set of computerized spreadsheets used annually to allocate faculty time across all mission activities of the department. It was first implemented in 1996 and has been continuously developed since then. An iterative approach has been used to gain consensus among faculty about time resources needed for various tasks of all missions of the department. These time-resource assumptions are used in the computerized system. Faculty time is allocated annually by the department vice chair in negotiation with individual faculty, making sure that the activities planned do not exceed the work time each faculty member has available for the year. During this process, faculty preferences are balanced against department aggregate needs to meet mission commitments and obligations. The authors describe how the computerized FTMS is used for faculty time management and career development, department planning, budget planning, clinical scheduling, and mission cost accounting. They also describe barriers and potential abuses and the challenge of building an organizational culture willing to discuss faculty time openly and committed to developing a system perceived as fair and accurate. The spreadsheet file is available free from the authors for use in other departments.
ABSTRACT INTRODUCTION While the Chronic Care Model (CCM) has been shown to improve the care of patients with chronic illnesses, primary care physicians have been unprepared in its use, and residencies have encountered challenges in introducing it into the academic environment. AIM Our residency program has implemented a diabetes management program modeled on the CCM to evaluate its impact on health outcomes of diabetic patients and educational outcomes of residents. SETTING University-affiliated, community-based family medicine residency program. PROGRAM DESCRIPTION Six residents, two faculty clinicians, and clinic staff formed a diabetes management team. We redesigned the outpatient experience for diabetic patients by incorporating elements of the CCM: multidisciplinary team care through planned and group visits; creation of a diabetes registry; use of guidelines-based flow sheets; and incorporation of self-management goal-setting. Residents received extensive instruction in diabetes management, quality improvement, and patient self-management. PROGRAM EVALUATION We achieved overall improvement in all metabolic and process measures for patients, with the percentage achieving HbA1c, LDL, and BP goals simultaneously increasing from 5.7% to 17.1%. Educational outcomes for residents, as measured by compliance with review of provider performance reports and self-management goal-setting with patients, also significantly improved. DISCUSSION Through a learning collaborative experience, residency programs can successfully incorporate chronic care training for residents while addressing gaps in care for patients with diabetes. PMID:20737237
Herndon, Christopher M; Dankenbring, Dawn M
The use of acetaminophen is currently under increased scrutiny by the US Food and Drug Administration (FDA) due to the risk of intentional and more concerning, unintentional overdose-related hepatotoxicity. Acetaminophen is responsible for an estimated 48% of all acute liver failure diagnoses. The purpose of this study is to evaluate patient perception and knowledge of the safe use and potential toxicity of acetaminophen-containing products. The authors conducted a descriptive, 2-week study using a convenience sample from a large family medicine clinic waiting room. Survey questions assessed ability to identify acetaminophen, knowledge of the current recommended maximum daily dose, respondent acetaminophen use patterns, common adverse effects associated with acetaminophen, and respondent self-reported alcohol consumption. Acetaminophen safety information was provided to all persons regardless of participation in the study. Of the 102 patients who chose to participate, 79% recognized acetaminophen as a synonym of Tylenol, whereas only 9% identified APAP as a frequently used abbreviation. One third of respondents thought acetaminophen was synonymous with ibuprofen and naproxen. Approximately one fourth of patients correctly identified the then maximum recommended daily acetaminophen dose of 4 g. Seventy-eight percent of patients correctly identified hepatotoxicity as the most common serious adverse effect. We conclude that patient deficiencies in knowledge of acetaminophen recognition, dosing, and toxicity warrant public education by health professionals at all levels of interaction. Current initiatives are promising; however, further efforts are required.
MacLellan, Anne-Marie; Brailovsky, Carlos; Rainsberry, Paul; Bowmer, Ian; Desrochers, Micheline
ABSTRACT OBJECTIVE To review the success of international medical graduates (IMGs) who are pursuing or have completed a Quebec residency training program and examinations. DESIGN We retrospectively reviewed IMGs’ success rates on the pre-residency Collège des médecins du Québec medical clinical sciences written examination and objective structured clinical examination, as well as on the post-residency Certification Examination in Family Medicine. SETTING Quebec. PARTICIPANTS All IMGs taking their examinations between 2001 and 2008, inclusive, and Canadian and American graduates taking their examinations during this same period. MAIN OUTCOME MEASURES Success rates for IMGs on the pre-residency and post-residency examinations, compared with success rates for Canadian and American graduates. RESULTS Success rates on the pre-residency clinical examinations remained below 50% from 2001 to 2008 for IMGs. Similarly, during the same period, the average success rate on the Certification examination was 56.0% for IMGs, compared with 93.5% for Canadian and American medical graduates. CONCLUSION Despite pre-residency competency screening and in-program orientation and supports, a substantial number of IMGs in Quebec are not passing their Certification examinations. Another study is under way to analyze reasons for some IMGs’ lack of success and to find ways to help IMGs complete residency training successfully and pass the Certification examination. PMID:20841596
Zhao, Hua-ye; Yan, Pei-pei; Yang, Wen-hua; Li, Chao-feng; Qi, Shu-ya; Li, Yan-qi; Cao, Jun-ling
The commodity specification and grade of Chinese medicinal materials is a measure of the quality of traditional Chinese medicines (TCMs), which directly impacts on the safety and effectiveness of clinical medicines. It is an urgent problem to establish a set of standards which can both interpret the scientific connotation of the commodity specification and grade of Chinese medicinal materials and play a significant role on clinical medicines as well as markets. This paper reviews the research methods of the commodity specification and grade of Chinese medicinal materials such as sensory evaluation, chemical assessment, biological evaluation, and cited the applications of various methods for the classification of TCMs. It provides technical support for establishing standards of the commodity specification and grade of Chinese medicinal materials, and also constructs scientific basis for clinical rational drug use.
KOPČAVAR GUČEK, Nena; PETEK, Davorina; ŠVAB, Igor; SELIČ, Polona
Introduction In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. Methods In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. Results Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection. Conclusion All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection. PMID:27647084
Lima, Sônia Oliveira; Aragão, João Fernandes Britto; Machado Neto, José; de Almeida, Kaio Bernardes Santos; Menezes, Layla Melize Santos; Santana, Vanessa Rocha
BACKGROUND Hyperhidrosis or excessive sweat production occurs at 2.9-9% of the population. OBJECTIVE To estimate the prevalence and disorders due to primary hyperhidrosis (HP) in medicine students in the state of Sergipe. METHODS Cross-sectional study using individual interviews. RESULTS Hyperhidrosis was found in 14.76% of subjects, the most affected regions were palmar, plantar and axillary, causing prejudice in daily activities. Family history occurred in 45% and 22.72% was diagnosed by a physician. CONCLUSION The prevalence of hyperhidrosis in medicine students of Sergipe was high, with strong family and a small portion of diagnoses made by medical professionals. PMID:26560211
Lyme disease has become a global public health problem and a prototype of an emerging infection. Both treatment-refractory infection and symptoms that are related to Borrelia burgdorferi infection remain subject to controversy. Because of the absence of solid evidence on prevalence, causes, diagnostic criteria, tools and treatment options, the role of autoimmunity to residual or persisting antigens, and the role of a toxin or other bacterial-associated products that are responsible for the symptoms and signs, chronic Lyme disease (CLD) remains a relatively poorly understood chronic disease construct. The role and performance of family medicine in the detection, integrative treatment, and follow-up of CLD are not well studied either. The purpose of this paper is to describe insights into the complexity of CLD as a multidimensional chronic disease construct and its relevance to family medicine by means of a systematic literature review. PMID:25506429
Berry, Clifford R; Garg, Predeep
The concept of molecular imaging has taken off over the past 15 years to the point of the renaming of the Society of Nuclear Medicine (Society of Nuclear Medicine and Molecular Imaging) and Journals (European Journal of Nuclear Medicine and Molecular Imaging) and offering of medical fellowships specific to this area of study. Molecular imaging has always been at the core of functional imaging related to nuclear medicine. Even before the phrase molecular imaging came into vogue, radionuclides and radiopharmaceuticals were developed that targeted select physiological processes, proteins, receptor analogs, antibody-antigen interactions, metabolites and specific metabolic pathways. In addition, with the advent of genomic imaging, targeted genomic therapy, and theranostics, a number of novel radiopharmaceuticals for the detection and therapy of specific tumor types based on unique biological and cellular properties of the tumor itself have been realized. However, molecular imaging and therapeutics as well as the concept of theranostics are yet to be fully realized. The purpose of this review article is to present an overview of the translational approaches to targeted molecular imaging with application to some naturally occurring animal models of human disease.
Cross-national comparisons constitute a valuable strategy to assess how broader cultural, political, and institutional contexts shape family outcomes. One typical approach of cross-national family research is to use comparable data from a limited number of countries, fit similar regression models for each country, and compare results across country-specific models. Increasingly, researchers are adopting a second approach, which requires merging data from many more societies and testing multilevel models using the pooled sample. Although the second approach has the advantage of allowing direct estimates of the effects of nation-level characteristics, it is more likely to suffer from the problems of omitted-variable bias, influential cases, and measurement and construct nonequivalence. I discuss ways to improve the first approach's ability to infer macrolevel influences, as well as how to deal with challenges associated with the second one. I also suggest choosing analytical strategies according to whether the data meet multilevel models’ assumptions. PMID:25999603
Madea, Burkhard; Saukko, Pekka
Based on a short description of the areas of operation and competence of forensic medicine, current problems, structural deficits of the speciality and possible solutions are discussed. To give future to legal medicine as an academic discipline, research must be given priority over routine casework.
Leung, Kai-Kuen; Wang, Wei-Dan; Chen, Yen-Yuan
There is a lack of information on the use of multi-source evaluation to assess trainees' interpersonal and communication skills in Oriental settings. This study is conducted to assess the reliability and applicability of assessing the interpersonal and communication skills of family medicine residents by patients, peer residents, nurses, and teaching staffs and to compare the ratings with the objective structured clinical examination (OSCE). Our results revealed instruments used by staffs, peers, nurses, and self-evaluation have good internal consistency reliability (α > 0.90), except for the behavioral checklist (α = 0.57). Staffs', peers', and nurses' evaluations were highly correlated with one another (r = 0.722 for staff- and peer-rating, r = 0.734 for staff- and nurse-rating, r = 0.634 for peer- and nurse-rating). However, residents' self-rating and patients-rating were not correlated to ratings by any other raters. OSCE evaluation was correlated to peer-rating (r = 0.533) and staff-rating (r = 0.642), but not correlated to self- or patient-rating. The generalizability study revealed the major sources of variance came from the types of rater and the interaction of residents and types of rater. This study found self-rating and patient-rating were not consistent with other sources of rating on residents' interpersonal and communication skills. Whether variations among different types of rater in a multi-source evaluation should be regarded as measurement errors or complementary information is worth further study.
Berger, Sarah; Szecsenyi, Joachim; Marquard, Sabine
Introduction For the effective and safe management of complex care needs for patients in community settings, high quality family medicine (FM) training programmes are needed. In less primary care oriented countries, training standards statements for FM postgraduate training are less commonly found. The aim of this study was to review international training standards statements in FM postgraduate training and to catalogue these statements to be used as a best practice standard guide for FM training programs in Germany. Materials and Methods A structured three-tiered search was performed: a systematic literature search in MEDLINE®; a search of international indicator databases; and a search in grey literature, consisting of a survey of international experts and a search in “Google (Scholar)”. From all identified documents, training standards statements were extracted, translated and summarized into categories referring to the same quality aspect. Results The search strategy revealed 25 relevant documents (MEDLINE® n = 15, databases n = 2, experts n = 7, “Google” n = 1), containing 337 training standards statements. These were summarized into 80 statements. They covered structure quality (n = 35); process quality (n = 43); and two training standards statements referred to outcome quality (n = 2). Conclusion A broad range of internationally sourced training standards statements for FM postgraduate training could be identified from countries with well-established primary care systems. Only few statements internationally referred to outcome quality, expressing the difficulty in assessing outcome. The resulting inventory of training standards statements for FM postgraduate training can serve as a resource for institutions seeking to formalise and systematise FM training at regional or national levels. PMID:27459714
Background Family and community medicine (FM) became a recognized specialty in Spain in 1978; however, most medical schools in Spain still lack mandatory core courses in FM. In order to explore the perceptions, expectations and level of information amongst medical students in Spain in relation to FM and PC, and the training in these areas in the curriculum of the Medical Schools, a survey was developed to be administered in medical schools every two years. This article presents data from the first questionnaire administration. Methods The study population was all first-, third-, and fifth-year students (2009–2010) in 22 participating medical schools in Spain (of 27 total). The 83-item survey had three sections: personal data, FM training, professional practice expectations, and preferences). Chi-squared test or analyses of variance were used, as appropriate. Results We had a 41.8% response rate (n = 5299/12924); 89.8% considered the social role of FM to be essential, while only 20% believed the specialty was well respected within the medical profession. The appeal of FM increased with years of study, independent of student characteristics or medical school attended. Among third and fifth-year students, 54.6% said their specialty preferences had changed during medical school; 73.6% felt that FM specialists should teach FM courses, and 83.3% thought that FM rotations in primary care centres were useful. Conclusions Students valued the social role of FM more highly than its scientific standing. The vast majority believe that FM training should be mandatory. Only 25% of first-year students have clear preferences for a specialization. Interest in FM increases moderately over their years of study. Working conditions in FM have decisive influence in choosing a specialty. PMID:22642617
Fetters, Michael D.; Guetterman, Timothy C.; Power, Debra; Nease, Donald E.
PURPOSE When recruiting health care professionals to focus group interviews, investigators encounter challenges such as busy clinic schedules, recruitment, and a desire to get candid responses from diverse participants. We sought to overcome these challenges using an innovative, office-based, split-session focus group procedure in a project that elicited feedback from family medicine practices regarding a new preventive services model. This procedure entails allocating a portion of time to the entire group and the remaining time to individual subgroups. We discuss the methodologic procedure and the implications of using this approach for data collection. METHODS We conducted split-session focus groups with physicians and staff in 4 primary care practices. The procedure entailed 3 sessions, each lasting 30 minutes: the moderator interviewed physicians and staff together, physicians alone, and staff alone. As part of the focus group interview, we elicited and analyzed participant comments about the split-session format and collected observational field notes. RESULTS The split-session focus group interviews leveraged the naturalistic setting of the office for context-relevant discussion. We tested alternate formats that began in the morning and at lunchtime, to parallel each practice’s workflow. The split-session approach facilitated discussion of topics primarily relevant to staff among staff, topics primarily relevant to physicians among physicians, and topics common to all among all. Qualitative feedback on this approach was uniformly positive. CONCLUSION A split-session focus group interview provides an efficient, effective way to elicit candid qualitative information from all members of a primary care practice in the naturalistic setting where they work. PMID:26755786
Background It is increasingly becoming evident that a strong primary health care system is more likely to provide better population health, more equity in health throughout the population, and better use of economic resources, compared to systems that are oriented towards specialty care. Developing and maintaining a strong and sustainable primary health care requires that a substantial part of graduating doctors go into primary care. This in turn requires that general practice/family medicine (GP/FM) strongly influences the curricula in medical schools. In the present paper we aim at describing the extent of GP/FM teaching in medical schools throughout Europe, checking for the presence of GP/FM curricula and clinical teaching in GP offices. Methods A brief questionnaire was e-mailed to GP/FM or other professors at European medical universities. Results 259 out of 400 existing universities in 39 European countries responded to our questionnaire. Out of these, 35 (13.5%) reported to have no GP/FM curriculum. These 35 medical faculties were located in 12 different European countries. In addition, 15 of the medical schools where a GP/FM curriculum did exist, reported that this curriculum did not include any clinical component (n = 5), or that the clinical part of the course was very brief - less than one week, mostly only a few hours (n = 10). In total, 50 universities (19%) thus had no or a very brief GP/FM curriculum. These were mainly located in the Eastern or Southern European regions. Conclusion It is still possible to graduate from European medical universities without having been exposed to a GP/FM curriculum. The European Academy of Teachers in General Practice (EURACT) will launch efforts to change this situation. PMID:24289459
Iden, Kirstin; Nürnberger, Frank; Sader, Robert; Dittrich, Winand
Introduction: In this article the personal study and life situation of parents who are also medical students at the Medical School of the Goethe University Frankfurt am Main is discussed. There is a special focus on the topics “studying with children” and “family-friendly university”, which have been present in discussions about university development and in the daily life of academics, especially during the last decade. The workgroup “Individual Student Services” at the medical faculty at the Goethe University tries to meet the necessities of the individual study courses and to support the study success with a new counselling and student service concept. Methods: The experience of parents studying medicine was recorded in semi-structured interviews (Date: April 2010), which were held as part of the sponsored pilot project on part-time medical studies (“Pilot Project Part-time Medical Studies”). Additionally, study results from the Medical School of the Goethe University Frankfurt am Main were integrated as well as a literature analysis. Results: It was found that the teaching demands and support services, which have been suggested and needed for years now, have been partially implemented and are without sufficient support at the faculty level to date. Thus the current situation of medical students with children is still difficult and seems a big challenge for everyone involved. Solution: As part of the “Individual Student Services” a new pilot project on part-time medical studies was established in November 2009. Only the use of new, unconventional and innovative ideas allows universities to adequately support the changing and heterogeneous student population and support them to successfully completing their medical studies. PMID:22558026
Chase, Sabrina M.; Miller, William L.; Shaw, Eric; Looney, Anna; Crabtree, Benjamin F.
Purpose Incorporating quality improvement (QI) into resident education and clinical care is challenging. This report explores key characteristics shaping the relative success or failure of QI efforts in seven primary care practices serving as family medicine residency training sites. Method The authors used data from the 2002–2008 Using Learning Teams for Reflective Adaptation (ULTRA) study to conduct a comparative case analysis. This secondary data analysis focused on seven residency training practices' experiences with RAP (reflective adaptive process), a 12-week intensive QI process. Field notes, meeting notes, and audiotapes of RAP meetings were used to construct case summaries. A matrix comparing key themes across practices was used to rate practices' QI progress during RAP on a scale of 0 to 3. Results Three practices emerged as unsuccessful (scores of 0–1) and four as successful (scores of 2–3). Larger practices with previous QI experience, faculty with extensive exposure to QI literature, and an office manager, residency director, or medical director who advocated for the process made substantial progress during RAP, succeeding at QI. Smaller practices without these characteristics were unable to do so. Successful practices also engaged residents in the QI process and identified serious problems as potential crises; unsuccessful practices did not. Conclusions Larger residency training practices are more likely to have the resources and characteristics that permit them to create a QI-supportive culture leading to QI success. The authors suggest, however, that smaller practices may increase their chances of success by adopting a developmental approach to QI. PMID:22030767
Mohamed, K. G.; Hunskaar, S.; Abdelrahman, S. H.; Malik, E. M.
Information and communication technology (ICT) is progressively used in the health sector (e-health), to provide health care in a distance (telemedicine), facilitate medical education (e-learning), and manage patients' information (electronic medical records, EMRs). Gezira Family Medicine Project (GFMP) in Sudan provides a 2-year master's degree in family medicine, with ICT fully integrated in the project. This cross-sectional study describes ICT implementation and utilization at the GFMP for the years 2011-2012. Administrative data was used to describe ICT implementation, while questionnaire-based data was used to assess candidates' perceptions and satisfaction. In the period from April 2011 to December 2012, 3808 telemedicine online consultations were recorded and over 165000 new patients' EMRs were established by the study subjects (125 candidates enrolled in the program). Almost all respondents confirmed the importance of telemedicine. The majority appreciated also the importance of using EMRs. Online lectures were highly rated by candidates in spite of the few challenges encountered by combining service provision with learning activity. Physicians highlighted some patients' concerns about the use of telemedicine and EMRs during clinical consultations. Results from this study confirmed the suitability of ICT use in postgraduate training in family medicine and in service provision. PMID:26839704
Masic, Izet; Skopljak, Amira; Jatic, Zaim
Family Medicine as an independent medical discipline is relatively young in the countries of Southeast Europe. Still are used the old models of all forms of education in this module, although most countries accepted Bologna undergraduate teaching concept and already implement it with greater or lesser success. Measuring the effects of the qualities of these concepts and models is not done systematically nor in uniform manner, so it could not be compared by the unique variables measuring the quality of education curricula, and especially the quality of education level of the graduates at the first, second and third degree courses and other forms of education. This paper provides a comparative overview of the state of education in the area of family medicine in the region. It creates comparison according to the study duration for undergraduate and postgraduate studies, doctoral studies and specialized studies in specified areas. What stand out are the proposals to improve education in the field of family medicine in the region. PMID:25685090
Mash, Robert J; de Villiers, Marietjie R; Moodley, Kalay; Nachega, Jean B
Africa's health care challenges include a high burden of disease, low life expectancy, health workforce shortages, and varying degrees of commitment to primary health care on the part of policy makers and government officials. One overarching goal of the Medical Education Partnership Initiative (MEPI) is to develop models of medical education in Sub-Saharan Africa. To do this, MEPI has created a network of universities and other institutions that, among other things, recognizes the importance of supporting training programs in family medicine. This article provides a framework for assessing the stage of the development of family medicine training in Africa, including the challenges that were encountered and how educational organizations can help to address them. A modified "stages of change" model (precontemplation, contemplation, action, maintenance, and relapse) was used as a conceptual framework to understand the various phases that countries go through in developing family medicine in the public sector and to determine the type of assistance that is useful at each phase.
Liu, Jinxin; Liu, Xinxin; Gao, Lu; Wei, Yingqin; Meng, Fanyun; Wang, Yongyan
This paper describes the digital earth technology and its core technology-"3S" integration technology. The advance and promotion of the "3S" technology provide more favorable means and technical support for Chinese medicine resources survey, evaluation and appropriate zoning. Grid is a mature and popular technology that can connect all kinds of information resources. The author sums up the application of digital earth technology in the research of traditional Chinese medicine resources in recent years, and proposes the new method and technical route of investigation in traditional Chinese medicine resources, traditional Chinese medicine zoning and suitability assessment by combining the digital earth technology and grid.
Youns, M; Efferth, T; Hoheisel, J D
Expression profiling analysis offers great opportunities for the identification of novel molecular targets, drug discovery, development, and validation. The beauty of microarray analysis of gene expression is that it can be used to screen the expression of tens of thousands of genes in parallel and to identify appropriate molecular targets for therapeutic intervention. Toward identifying novel therapeutic options, natural products, notably from medicinal plants used in traditional Chinese medicine (TCM), have been thoroughly investigated. Increased knowledge of the molecular mechanisms of TCM-derived drugs could be achieved through application of modern molecular technologies including transcript profiling. In the present review, we introduce a brief introduction to the field of microarray technology and disclose its role in target identification and validation. Moreover, we provide examples for applications regarding molecular target discovery in medicinal plants derived TCM. This could be an attractive strategy for the development of novel and improved therapeutics.
Liao, Xing; Xie, Yan-Ming; Yang, Wei; Chang, Yan-Peng
There is a new research model named 'registry study/patient registry' in Western medicine, which could be referred to by Chinese medicine researchers, such as active safety surveillance. This article will introduce registry study from different aspects as the developing history, features, and application in order to inform Chinese medicine researchers of future studies.
Verona's School of Homeopathic Medicine (www.omeopatia.org) organized a day of full immersion in the field of homeopathy, focusing on the validity of this much-debated discipline. There is widespread consensus in the medical community that evidence-based medicine is the best standard for assessing efficacy and safety of healthcare practices, and systematic reviews with strict protocols are essential to establish proof for various therapies. Students, homeopathic practitioners, academic and business representatives, who are interested in or curious about homeopathic practices attended the conference.
Xie, Yan-jun; Kong, Wei-jun; Yang, Mei-hua; Yang, Shi-hai
Advocating green, nature, environmental protection, safety and the pursuit of efficacy are the trends of cosmetics in the world. In recent years, more and more Chinese herbal extracts with mild, high safety and small irritation are applied to cosmetics as the natural additives. This has become a new hot spot. The recent application advances of Chinese medicine raw materials in cosmetics are overviewed according to their main functions. This review will provide useful references for the future development and application of Chinese medicinal herbs cosmetics.
TAYMUR, İbrahim; ÖZDEL, Kadir; AYPAK, Cenk; DUYAN, Veli; TÜREDİ, Özlem; GÜNGÖR, Buket Belkız; SELVİ, Yavuz
Introduction We aimed to determine the level of bereavement and depression symptoms among elderly patients who experience the loss of a significant other and the relationship between depressive symptoms and bereavement symptoms. Methods The study sample consisted of elderly adults who lost a significant other at least 6 months prior to the submission time. Participants were recruited from patients who presented to either the psychiatry or family medicine outpatient unit of a Training and Research Hospital. Cognitive functions were assessed using Standardized Mini Mental Examinations for Educated and Uneducated People (SMME/SMME-U). Participants were excluded from the study if their SMME or SMME-U scores were lower than 23 points. To assess the severity of depressive and bereavement symptoms, the Geriatric Depression Scale (GDS) and Core Bereavement Items (CBI) scales were used, respectively. Results Overall, 33 out of 67 individuals (49.2%) who presented to the psychiatry unit and 7 out of the 43 individuals (16.3%) who presented to the family medicine unit were diagnosed with major depressive disorder (MDD). CBI scale score means were higher in the MDD groups than in the non-depressive groups (p=0.012 and p=0.001, respectively). CBI scores were significantly correlated to acute (p=0.047) and chronic stress (p=0.007) in the psychiatry group and to chronic stress in the family medicine group (p=0.001). Conclusion Probing loss experiences and reactions to them can be important to understand depression, to evaluate its symptoms, and to help manage the relevant symptoms. Considering the significant contributions of bereavement to depressive symptom severity in elders, interventions specific to bereavement symptoms should not be ignored. PMID:28360781
Young, Amber; Tordoff, June; Smith, Alesha
The design of medicine information leaflets can determine whether a leaflet will be read or discarded by patients. It may also influence patients' ability to understand the information about their medicines within the leaflet. Researchers compared regulatory agencies' recommendations for medicine information leaflet design from New Zealand, the United Kingdom, Europe, and the United States against recommended good design principles to determine the appropriateness, comprehensiveness, and consistency of their recommendations. Recommendations for medicine information leaflets varied between the regulatory agencies. There were some inconsistencies between the recommendations and some gaps were identified. There was little regulatory guidance given to creators of medicine information leaflets in New Zealand compared to other countries, and this could lead to manufacturer-produced information leaflets of a poorer quality. Up-to-date and enforceable guidance for creators of medicine information leaflets should be provided in all countries to ensure they are of an appropriate standard.
Smith, Donald F; Hagstrom, Melena R
This paper provides a 50-year overview of research and clinical advances in AAVMC member colleges in four representative fields of veterinary medicine: oncology, vaccine development, production medicine, and public health. Though emphasis is on the progress since the mid-1960s, the salient background and associated personnel in each field are also identified to the extent that their description informs more recent events. Advances in board certification and post-graduate clinical and research educational opportunities are also described.
Background As Family Medicine programs across Canada are transitioning into a competency-based curriculum, medical students and clinical teachers are increasingly incorporating tablet computers in their work and educational activities. The purpose of this pilot study was to identify how preceptors and residents use tablet computers to implement and adopt a new family medicine curriculum and to evaluate how they access applications (apps) through their tablet in an effort to support and enhance effective teaching and learning. Methods Residents and preceptors (n = 25) from the Family Medicine program working at the Pembroke Regional Hospital in Ontario, Canada, were given iPads and training on how to use the device in clinical teaching and learning activities and how to access the online curriculum. Data regarding the use and perceived contribution of the iPads were collected through surveys and focus groups. This mixed methods research used analysis of survey responses to support the selection of questions for focus groups. Results Reported results were categorized into: curriculum and assessment; ease of use; portability; apps and resources; and perceptions about the use of the iPad in teaching/learning setting. Most participants agreed on the importance of accessing curriculum resources through the iPad but recognized that these required enhancements to facilitate use. The iPad was considered to be more useful for activities involving output of information than for input. Participants’ responses regarding the ease of use of mobile technology were heterogeneous due to the diversity of computer proficiency across users. Residents had a slightly more favorable opinion regarding the iPad’s contribution to teaching/learning compared to preceptors. Conclusions iPad’s interface should be fully enhanced to allow easy access to online curriculum and its built-in resources. The differences in computer proficiency level among users should be reduced by sharing
Vasilevsky, Nicole; Schafer, Morgan; Tibbitts, Deanne; Wright, Kirsten; Zwickey, Heather
Training in fundamental laboratory methodologies is valuable to medical students because it enables them to understand the published literature, critically evaluate clinical studies, and make informed decisions regarding patient care. It also prepares them for research opportunities that may complement their medical practice. The National College of Natural Medicine's (NCNM) Master of Science in Integrative Medicine Research (MSiMR) program has developed an Introduction to Laboratory Methods course. The objective of the course it to train clinical students how to perform basic laboratory skills, analyze and manage data, and judiciously assess biomedical studies. Here we describe the course development and implementation as it applies to complementary and integrative medicine students. PMID:26500806
Fisher, A A; Carlaw, R W
This report discusses the experience of a two-year family planning and maternal/child health project in Nepal. Although the project was planned as an experimental field research endeavor, a series of unanticipated events repeatedly compromised the internal validity of the project and forced design changes. While unexpected events are common in the history of most field projects, they present the research evaluator with the fundamental dilemma of trying to maintain a high degree of internal validity without sacrificing external validity. Rigid research designs with tight control over the introduction and measurement of experimental variables may serve to increase internal validity but they may also create an atypical and artificial situation that fails to mirror real field conditions and thus threatens external validity.
Herwig, Anna; Viehmann, Anja; Thielmann, Anika; Gesenhues, Stefan; Weltermann, Birgitta
Objectives Exposure to family medicine (FM) can serve to promote students' interest in this field. This study aimed at identifying clerkship characteristics which decrease or increase students' interest in FM. Design This cross-sectional questionnaire study analysed students' clerkship evaluations between the years 2004 and 2014. Descriptive statistics were used to compare four predefined groups: (1) high interest in FM before and after the clerkship (Remained high), (2) poor interest before and after the clerkship (Remained low), (3) poor interest before the clerkship which improved (Increased) and (4) high interest before the clerkship which decreased (Decreased). Setting Students' evaluations of FM clerkships in the fourth of 6 years of medical school. Participants All questionnaires with complete answers on students' interest in FM and its change as a result of the clerkship (2382 of 3963; 60.1%). The students' mean age was 26 years (± 3.9), 62.7% (n=1505) were female. Outcome measure The outcome was a change in students' interest in FM after completing the clerkship. Results Interest in FM after the clerkship was as follows: 40.1% (n=954) Remained high, 5.5% (n=134) Remained low, 42.1% (n=1002) Increased and 12.3% (n=292) Decreased. Students with decreased interest had performed a below-average number of learning activities (4 vs 6 activities). A total of 45.9% (n=134 of 292) of the students with decreased interest reported that the difficulty of the challenge was inadequate for their educational level: 81.3% (n=109) felt underchallenged and 18.7% (n=25) overchallenged. Conclusions In more than 50% of cases, the clerkship changed the students' interest in FM. Those with decreased interest were more frequently underchallenged. We observed an increase in FM if at least six learning activities were trained. Our findings stress the importance of well-designed FM clerkships. There is a need for standardised educational strategies which enable teaching
Carlin, E M; Russell, J M; Sibley, K; Boag, F C
The objective was to evaluate an integrated family planning clinic (FPC) established by genitourinary medicine (GUM) staff held within a GUM women-only clinic at the John Hunter Clinic, London. A retrospective case note review of women attending the FPC during the first year January-December 1992 was performed. Data were extracted on: prior STDs, parity and pregnancies terminated; screening for STDs, serology and cervical cytology; contraception on first attendance, that supplied, and outcome over the subsequent year 1993. 113 women, 13-41 years old, attended the FPC. 45 were new attenders, 6 had previously tested antibody positive for the human immunodeficiency virus (HIV), 7 were intravenous drug users; 61 (54%) had a history of sexually transmitted disease (STD); 20 (17.7%) were using no contraception; 37 (32.7%) had previous termination of pregnancy (TOP) with 70 TOPs in total. Within 3 months of FPC attendance, 89 (78.8%) women had genital STD screening performed; syphilis, HIV and hepatitis B serology, together with cervical cytology were performed in 77, 18, 13, and 62 women, respectively. Infections identified were similar to those identified in the GUM clinic, although the prevalence of Chlamydia trachomatis in diagnosed infections was commoner in FPC attenders and epidemiological treatment commoner in GUM attenders. No high grade cytology abnormalities were detected. No positive syphilis or new HIV-positive results were identified; 5 women were found to be hepatitis B surface antibody positive. Contraception was changed in 60.8%. Most frequently supplied was the combined oral contraceptive pill (COCP). At the first FPC attendance 6 women required post coital contraception (PCC) and 5 were already pregnant: 3 suspected it, and 2 were unaware. During the year 3 women conceived; 2 used COCP, but were noncompliant; 1 used a diaphragm with unclear compliance. 7 of the 8 pregnancies were terminated. Over the following year, 1992-93, contraception was supplied
Background The application of new technologies to the education of health professionals is both a challenge and a necessity. Virtual worlds are increasingly being explored as a support for education. Aim: The aim of this work is to study the suitability of Second Life (SL) as an educational tool for primary healthcare professionals. Methods Design: Qualitative study of accredited clinical sessions in SL included in a continuing professional development (CPD) programme for primary healthcare professionals. Location: Zaragoza I Zone Family and Community Medicine Education Unit (EU) and 9 health centres operated by the Aragonese Health Service, Aragon, Spain. Method: The EU held two training workshops in SL for 16 healthcare professionals from 9 health centres by means of two workshops, and requested them to facilitate clinical sessions in SL. Attendance was open to all personnel from the EU and the 9 health centres. After a trail period of clinical sessions held at 5 health centres between May and November 2010, the CPD-accredited clinical sessions were held at 9 health centres between February and April 2011. Participants: 76 healthcare professionals attended the CPD-accredited clinical sessions in SL. Main measurements: Questionnaire on completion of the clinical sessions. Results Response rate: 42-100%. Questionnaire completed by each health centre on completion of the CPD-accredited clinical sessions: Access to SL: 2 centres were unable to gain access. Sound problems: 0% (0/9). Image problems: 0% (0/9). Voice/text chat: used in 100% (10/9); 0 incidents. Questionnaire completed by participants in the CPD-accredited clinical sessions: Preference for SL as a tool: 100% (76/76). Strengths of this method: 74% (56/76) considered it eliminated the need to travel; 68% (52/76) believed it made more effective use of educational resources; and 47% (36/76) considered it improved accessibility. Weaknesses: 91% (69/76) experienced technical problems, while; 9% (7/76) thought
Carlin, E M; Russell, J M; Sibley, K; Boag, F C
OBJECTIVE--To evaluate an integrated family planning clinic (FPC) established by genitourinary medicine (GUM) staff held within a GUM women-only clinic (WOC). DESIGN--A retrospective case note review of women attending the FPC during the first year January-December 1992. RESULTS--One hundred and thirteen women, aged 13-41 years, attended the FPC; 45 were new attenders, six had previously tested antibody positive for the human immunodeficiency virus (HIV), seven were intravenous drug users; 54% had a history of sexually transmitted disease (STD); 17.7% were using no contraception; 32.7% had previous termination of pregnancy (TOP) with 70 TOPs in total. Within three months of FPC attendance 89 (78.8%) women had genital STD screening performed; syphilis, HIV and hepatitis B serology, together with cervical cytology were performed in 77, 18, 13 and 62 women respectively. Infections identified were similar to those identified in the GUM clinic but the prevalence of Chlamydia trachomatis in diagnosed infections was commoner in FPC attenders and epidemiological treatment commoner in GUM attenders. No high grade cytology abnormalities were detected. No positive syphilis or new HIV positive results were identified; five women were found to be hepatitis B surface antibody positive. Contraception was changed in 60.8%. Most frequently supplied was the combined oral contraceptive pill (COCP). At the first FPC attendance six women required post coital contraception (PCC) and five were already pregnant, three suspected it, two were unaware. During the year three women conceived; two used COCP, but were non compliant; one used a diaphragm with unclear compliance. Seven of the eight pregnancies were terminated. Over the following year, 1992-93, contraception was supplied to 42 women; four required PCC; two intentional pregnancies occurred. Only one of the TOP women returned. CONCLUSION--An integrated FPC provides co-ordinated sexual health care. Pregnancy, TOP and FPC re
Ramaekers, J G
Medicinal drugs that cause drowsiness and inattentiveness may impair driving. The FDA recently emphasized that standardized procedures for measuring drug effects on driving are needed as part of drug registration. Here, I provide an overview of a standardized on-the-road driving test that offers maximal drug sensitivity and uses a real-life outcome measure of driver impairment that is strongly associated with crash risk.
McEwen, Laura A; Griffiths, Jane; Schultz, Karen
The use of portfolios in postgraduate medical residency education to support competency development is increasing; however, the processes by which these assessment systems are designed, implemented, and maintained are emergent. The authors describe the needs assessment, development, implementation, and continuing quality improvement processes that have shaped the Portfolio Assessment Support System (PASS) used by the postgraduate family medicine program at Queen's University since 2009. Their description includes the impetus for change and contextual realities that guided the effort, plus the processes used for selecting assessment components and developing strategic supports. The authors discuss the identification of impact measures at the individual, programmatic, and institutional levels and the ways the department uses these to monitor how PASS supports competency development, scaffolds residents' self-regulated learning skills, and promotes professional identity formation. They describe the "academic advisor" role and provide an appendix covering the portfolio elements. Reflection elements include learning plans, clinical question logs, confidence surveys, and reflections about continuity of care and significant incidents. Learning module elements cover the required, online bioethics, global health, and consult-request modules. Assessment elements cover each resident's research project, clinical audits, presentations, objective structured clinical exam and simulated office oral exam results, field notes, entrustable professional activities, multisource feedback, and in-training evaluation reports. Document elements are the resident's continuing medical education activities including procedures log, attendance log, and patient demographic summaries.The authors wish to support others who are engaged in the systematic portfolio-design process or who may adapt aspects of PASS for their local programs.
Pandolf, Kent B; Francesconi, Ralph; Sawka, Michael N; Cymerman, Allen; Hoyt, Reed W; Young, Andrew J; Zambraski, Edward J
The United States Army Research Institute of Environmental Medicine (USARIEM) celebrated its 50th anniversary on July 1, 2011. This article reviews its history, evolution, and transition of its research programs as well as its scientific and military accomplishments, emphasizing the past 25 yr. During the 1990s, USARIEM published a series of pocket guides providing guidance for sustaining Warfighter health and performance in Southwest Asia, Somalia, the former Republic of Yugoslavia, Rwanda, and Haiti. Issues identified during Operation Desert Storm elicited research that improved nutritional guidelines for protracted desert operations; safer use of nuclear, chemical, and biological protective clothing; equipment, development, and fielding of efficient microclimate cooling systems; and effective evaluation of pharmaceuticals to protect soldiers from chemical and biological threats. During the first decade of the 21st century, USARIEM and the Department of the Army published official medical/performance doctrines for operations in the heat and cold and at high altitude. The current Global War on Terrorism focused research to improve doctrines for hot, cold, and high-altitude operations, reduce musculoskeletal training injuries, provide improved field nutrition, more efficient planning for operational water requirements, and improve both military clothing and materiel. This article also describes the critically important interactions and communications between USARIEM and deployed units and the benefits to Warfighters from this association. This report presents USARIEM's unique and world-class facilities, organizational changes, scientific and support personnel, and major research accomplishments, including the publication of 2,200 scientific papers over the past 25 yr.
The most recent research developments in nuclear medicine and molecular imaging were presented at the 2010 Annual Congress of the EANM. This review summarizes some of the most relevant contributions made in the fields of oncology, cardiovascular science, neurology and psychiatry, technological innovation and novel tracers. Presentations covered basic and clinical research in nuclear medicine and molecular imaging, and diagnostic and therapeutic applications of radioisotopes and radiopharmaceuticals on a global scale. The results reported demonstrate that investigative strategies using nuclear medicine techniques facilitate effective diagnosis and management of patients with most prevalent disease states. At the same time novel tracers and technologies are being explored, which hold promise for future new applications of nuclear medicine and molecular imaging in research and clinical practice.
Contemporary Western medicine has witnessed a fragmentation of our conceptualization of the medical endeavor into ‘traditional medicine’ and ‘non-traditional medicine’. The former is meant to refer to the Western medical tradition, the latter encompasses both ‘complementary’ and ‘alternative’ medical practices. Complementary medicine complements conventional medical treatments, and alternative modes of medical interventions are meant to replace traditional Western medicine. Evidence-based research must be directed at establishing the best available evidence in complementary and alternative medicine. This paper is the first of a set of four ‘lectures’ that reviews the process of evidence-based research, and discusses its implications and applications for the early decades of the 21st century. The purpose of this paper is to introduce the series by examining some of the historical and philosophical foundations of this research endeavor. PMID:16322801
Kleist, David M.; Gompertz, Kelli
Explores recent use of qualitative methodology in research relating to marriage and family counseling. The seven research articles described highlight the potential benefits and challenges qualitative methodology can have for the field of marriage and family counseling. (Author/MKA)
Zaidi, Shehla; Bigdeli, Maryam; Aleem, Noureen; Rashidian, Arash
Introduction Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i) gaps related to access to essential medicine in Pakistan; and ii) prioritization of emerging policy and research concerns. Methods An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder’s Roundtable. Findings A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review. Conclusion Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda. PMID:23717442
Fioretti, Chiara; Mazzocco, Ketti; Oliveri, Serena; Masiero, Marianna; Pravettoni, Gabriella
Objective Since its birth about 30 years ago, Narrative Medicine approach has increased in popularity in the medical context as well as in other disciplines. This paper aims to review Narrative Medicine research studies on patients' and their caregivers' illness experience. Setting and participants MEDLINE, Psycinfo, EBSCO Psychological and Behavioural Science, The Cochrane Library and CINAHL databases were searched to identify all the research studies which focused on the Narrative Medicine approach reported in the title, in the abstract and in the keywords the words ‘Narrative Medicine’ or ‘Narrative-based Medicine’. Primary and secondary outcome measures: number of participants, type of disease, race and age of participants, type of study, dependent variables, intervention methods, assessment. Results Of the 325 titles screened, we identified 10 research articles fitting the inclusion criteria. Our systematic review showed that research on Narrative Medicine has no common specific methodology: narrative in Medicine is used as an intervention protocol as well as an assessment tool. Patients' characteristics, types of disease and data analysis procedures differ among the screened studies. Conclusions Narrative Medicine research in medical practice needs to find clear and specific protocols to deepen the impact of narrative on medical practice and on patients' lives. PMID:27417197
Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Toro-Cárdenas, Silvia; Luna del Castillo, Juan de Dios
Two components of professional success have been defined: objective career success (OCS) and subjective career success (SCS). Despite the increasing number of women practicing medicine, gender inequalities persist. The objectives of this descriptive, cross-sectional, and multicenter study were (a) to construct and validate OCS and SCS scales, (b) to determine the relationships between OCS and SCS and between each scale and professional/family characteristics, and (c) to compare these associations between male and female family physicians (FPs). The study sample comprised 250 female and 250 male FPs from urban health centers in Andalusia (Spain). Data were gathered over 6 months on gender, age, care load, professional/family variables, and family-work balance, using a self-administered questionnaire. OSC and SCS scales were examined by using exploratory factorial analysis and Cronbach's α, and scores were compared by gender-stratified bivariate and multiple regression analyses. Intraclass correlation coefficients were calculated using a multilevel analysis. The response rate was 73.6%. We identified three OCS factors and two SCS factors. Lower scores were obtained by female versus male FPs in the OCS dimensions, but there were no gender differences in either SCS dimension.
Bernal, Guillermo; And Others
Presents descriptive data on the treatment of families in family therapy at the Eastern Pennsylvania Psychiatric Institute (EPPI) reporting improvement rates for families with depression, school, family, marital, and situational problems. Those with family and situational problems improved most with many session, those with depression improved in…
This article reviews family nursing research published from 1996 to 2011. This is a follow-up to a review published in the Journal of Family Nursing in 1995. Findings from the first review are compared with this one, trends in family nursing scholarship are identified, and predictions and suggestions for future directions are offered. The latest generation of family nursing scholarship is conceptually and methodologically sound, and there is evidence of more multidisciplinary and interdisciplinary research conducted by family nursing researchers. Scholars are paying more attention to issues of diversity and family context at present than in the past, although there are still aspects of diversity that need more attention. Strong research programs in family nursing exist worldwide; an international synergism has helped promote rapid expansion of family nursing research and theory development. A vigorous movement to promote research to practice initiatives and greater attention to family interventions are exciting developments.
A new U.S. National Science Foundation (NSF) initiative aims to increase the participation of women and girls in the fields of science, technology, engineering, and math (STEM) over the next 10 years by providing more flexible research policies, promoting flexible workplace options, and supporting STEM careers for women, Obama administration officials announced on 26 September. Currently, women earn about 41% of STEM doctoral degrees awarded by U.S. educational institutions but make up only about 28% of tenure-track faculty in U.S. colleges and universities, the officials said. "Unfortunately, too many young women drop out of promising careers in science, engineering, and math because of conflicts between their desire to start families and the need to rapidly ramp up their careers," said John Holdren, director of the White House Office of Science and Technology Policy (OSTP). "The way to help women stay in the STEM jobs pipeline is to create and support more flexible workplace policies that allow a women's career—or a man's, for that matter, but as we know, it's more common for women to give up STEM careers for family reasons—to thrive even as time is allowed for important family responsibilities."
Coleman, David L.; Spira, Avrum; Ravid, Katya
We have sought to broaden our department's research capacity using two different interdisciplinary approaches. First, we created the Evans Center for Interdisciplinary Biomedical Research (ECIBR) — a virtual center that promotes and funds Affinity Research Collaboratives (ARCs) initiated by faculty from within and outside Boston University (BU). Of the 11 funded ARCs, the 4 ARCs in existence for a minimum of 3 years have a total of 37 participants, 93 co-authored publications, and 33 new grants. Second, the Department of Medicine (DOM) created a Section of Computational Biomedicine in 2009 to enhance analytical and computational expertise in the DOM. After 3 years, the section is comprised of 10 faculty members and 21 trainees. The faculty members have collaborated with 20 faculty members in other sections or departments and secured 12 extramural grants (totaling ∼$20 million in direct costs). The ECIBR and the Section of Computational Biomedicine represent new organizational approaches to stimulating innovation in research in a DOM. PMID:23874035
In the period between 1797 and 1848, German medicine was considerably influenced by philosophy. It absorbed ideas deriving from neo-Platonism and vitalism, as well as the modern philosophy of nature (Naturphilosophie), especially the ideas of Schelling. The article presents the main tendencies in the German medicine of that period: the distinct character of German medical thought as compared to the rest of Europe, the deductive character of medical theories, the grounding of medical thought in non-materialist philosophy and its close ties with the Protestant religion. The author's aim is investigate how German medicine of the period evolved away from European standards set by the model of medicine as an empirical science, based on the inductive method of research. The article presents the state of German medicine of the first half of the nineteenth century against the background of socio-cultural factors and relates German medical theory of the period to the social awareness of that time.
The Basque Museum of the History of Medicine was founded in 1982 to preserve the historic memory of medicine in the Basque Country and conserve its scientific heritage. Its permanent exposition comprises approx. 6,000 medical objects of the 19th and 20th centuries arranged, thematically in 24 rooms devoted to different medical specialities: folk medicine, unconventional medicine, pharmacy, weights and measures, asepsis and antisepsis, microscopes, laboratory material, X-rays, obstetrics and gynaecology, surgery, anesthesia, endoscope, odontology, cardiology, ophthalmology, electrotherapy, pathological anatomy and natural sciences. Temporary exhibitions are also held. The Museum is located on the university campus (UPV/EHU) and is important in the training of students in the Faculty of Medicine and the students coming from other faculties. Teaching and research constitute two of the pillars of the Museum that are complemented with publications and the organization of conferences, lectures and other activities.
Mai, Lan-Yin; Li, Yi-Xuan; Chen, Yong; Xie, Zhen; Li, Jie; Zhong, Ming-Yu
The compatibility of traditional Chinese medicines (TCMs) formulae containing enormous information, is a complex component system. Applications of mathematical statistics methods on the compatibility researches of traditional Chinese medicines formulae have great significance for promoting the modernization of traditional Chinese medicines and improving clinical efficacies and optimizations of formulae. As a tool for quantitative analysis, data inference and exploring inherent rules of substances, the mathematical statistics method can be used to reveal the working mechanisms of the compatibility of traditional Chinese medicines formulae in qualitatively and quantitatively. By reviewing studies based on the applications of mathematical statistics methods, this paper were summarized from perspective of dosages optimization, efficacies and changes of chemical components as well as the rules of incompatibility and contraindication of formulae, will provide the references for further studying and revealing the working mechanisms and the connotations of traditional Chinese medicines.
Mendez, Francisco; Lopez, Felipe; Brambila, Carlos; Burkhart, Marianne
Background Public sector health care providers in rural Guatemala have infrequently offered family planning information and services in routine visits. This operations research project tested a strategy to modify certain practices that prevent health workers from proactively screening clients' needs and meeting them. Methods The research design was quasi-experimental with a pretest-posttest-follow-up comparison group design. Health districts, which comprise health centers and posts, were purposively assigned to intervention or comparison groups to assure comparability of the two groups. The strategy was based on a job-aid designed to guide health workers in screening clients' reproductive intentions and family planning needs, help them to offer contraceptive methods if the woman expressed interest, and facilitate the provision of the method chosen at the time of the visit. The strategy was implemented at intervention sites during a period of six months. Upon completion of post-intervention measurements, the strategy was scaled up to the comparison sites, and a follow-up assessment was conducted nine months later. Results were evaluated by conducting three rounds of exit interviews with women exposed to the risk of unwanted pregnancy. Results Study results showed a two to five-fold increase in providers' screening of clients' reproductive intentions. The proportion of clients who received information about contraceptives increased from 8% at the baseline to 42% immediately post-intervention, and 36% at the follow-up survey. The intervention also proved successful in improving the role service providers play in offering women a chance to ask questions and assisting women in making a selection. The proportion of women who received a method, referral or appointment increased and remained high in the intervention group, although no change was seen in the comparison group after their participation in the strategy. Conclusion The easy-to-use job aid developed for this
The United States National Cancer Institute (NCI) supports complementary and alternative medicine (CAM) research which includes different methods and practices (such as nutrition therapies) and other medical systems (such as Chinese medicine). In recent years, NCI has spent around $120 million each year on various CAM-related research projects on cancer prevention, treatment, symptom/side effect management and epidemiology. The categories of CAM research involved include nutritional therapeutics, pharmacological and biological treatments, mind-body interventions, manipulative and body based methods, alternative medical systems, exercise therapies, spiritual therapies and energy therapies on a range of types of cancer. The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) supports various intramural and extramural cancer CAM research projects. Examples of these cancer CAM projects are presented and discussed. In addition, OCCAM also supports international research projects.
Yasuhara, Takao; Agari, Takashi; Kameda, Masahiro; Kondo, Akihiko; Kuramoto, Satoshi; Jing, Meng; Sasaki, Tatsuya; Toyoshima, Atsuhiko; Sasada, Susumu; Sato, Kenichiro; Shinko, Aiko; Wakamori, Takaaki; Okuma, Yu; Miyoshi, Yasuyuki; Tajiri, Naoki; Borlongan, Cesario V.; Date, Isao
Epilepsy is a chronic neurological disorder, which presents with various forms of seizures. Traditional treatments, including medication using antiepileptic drugs, remain the treatment of choice for epilepsy. Recent development in surgical techniques and approaches has improved treatment outcomes. However, several epileptic patients still suffer from intractable seizures despite the advent of the multimodality of therapies. In this article, we initially provide an overview of clinical presentation of epilepsy then describe clinically relevant animal models of epilepsy. Subsequently, we discuss the concepts of regenerative medicine including cell therapy, neuroprotective agents, and electrical stimulation, which are reviewed within the context of our data. PMID:24287913
Chen, Hui; Qu, Jing-Lian; Gong, Jie-Ning
Cancer metastasis is the most dangerous stage of tumorigenesis and evolution, the primary cause of death in cancer patients. Clinically, more than 60% of cancer patients have found metastasis at the time of examination. Modern medicine has made significant progress on the mechanisms of cancer metastasis in recent years, from the simple "anatomy and machinery" theory forward to the "seed and soil" theory, then to the "microenvironmental" theory and the "cancer stem cell" theory. The emerging "cancer stem cell" theory successfully explains phenomenon such as tumor genetic heterogeneity, anoikis resistance, tumor dormancy, providing more new targets and ideas for the diagnosis and treatment of cancer metastasis.
Klein, Michael; Reynolds, J. L.; Boucher, Francois; Malus, Michael; Rosenberg, Ellen
Family practice obstetricians are an endangered species. Our practices and teaching sites must provide the correct attitudinal as well as technical messages to result in a practitioner who will be able to meet the psychosocial and medical needs of the pregnant couple. Family practice obstetrics can be as safe as care given by obstetricians provided that the family practice group functions well, that obstetrical consultants are available and supportive, and assuming that technical approaches are reserved for those truly in need. In rural areas, obstetrical ability is essential, whilst in the urban setting it helps the family physician maintain a practice involving young families. Those trainees who fail to learn basic obstetrical skills (including family centered attitudes and approaches) may in any setting come to feel, belatedly, that their training programs failed in this respect. PMID:21279123
Background The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic. Methods Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship. Results External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01). Conclusion Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship. PMID:27900072
This paper examines the extent to which family medicine is prepared to face today's political and socioeconomic trends. A modest assumption is that most countries will avoid the threats of food and energy crisis, environmental disasters, social collapse and even wars. Given that privilege, family medicine is faced with recent trends of market liberalism throughout the world, giving rise to new perspectives of economic prosperity, as well as widening gaps between the rich and affluent, and a growing number of unemployed, poor, and 'marginalized'. The recent UN World Summit for Social Development in Copenhagen highlighted the fact that poverty and long-term unemployment is becoming a permanent problem even in the rich world. The distinction between rich and poor countries might be better understood as widening gaps between rich and poor people in both kinds of countries. The challenge to family medicine will be twofold: 1) To develop a broader understanding of the associations between social risk factors on a population level, and its clinical expressions in individual patients in terms of illness, sick role behaviour and manifest disease, as well as potentials for constructive coping; 2) To contribute to a universally available primary health care, meeting the needs also of those who are not in the best position to pay. We are reminded of the classic 1971 Lancet paper by Julian Tudor Hart on "The inverse care law", implying that "the availability of good medical care tends to vary inversely with the need for it in the population served". In a world plagued with unforeseen discontinuities, general practice will need to maintain its core of 'personal doctoring'. Meeting people at the primary care level provides unique opportunities of being sensitive and responsive also to unexpected changes in society, and in some areas even making contributions to the directions of change.
Jindal, A.K.; Singh, Gurpreet; Pandya, Kapil
To acquire complete knowledge on a subject both qualitative and quantitative research methods need to be perused by researchers. However, over the period of time qualitative research teaching among medical professionals has reduced. Wisdom amongst doctors seems getting muddled in ‘data’. Operational research as well as health systems research have been the basis of ‘key’ policy changes in situations and programmes including polio immunization to achieve desired objectives. Both qualitative and quantitative methods complement each other and cannot replace one another. We need to protect the 'endangered art' of qualitative research before it becomes extinct from medical schools. PMID:26663966
Ge, Jinwen; Wang, Dongsheng; He, Rong; Zhu, Huibin; Wang, Yuhong; He, Shilin
Serum pharmacological method has generally been used in herb studies. However, preparation of test serum for ex vivo experiment is an intricate process: besides pretreatment (heat or chemicals), it involves the proteolytic cascades of coagulation along with fibrinolysis, complement and kinin systems, as well as platelet and leukocyte activation resulting in release reactions. These processes deviate serum sample components away from the original in vivo state, and possibly also have effects on the absorbed herbal components and their downstream effectors in blood. The conclusions drawn from serum pharmacological method are at least partially uncertain in its validity. These processes can be avoided by anticoagulation. Compared to those of the serum, constituents of plasma are better reflectors of the in vivo physiological/pathological state and medicinal herb-induced changes. Therefore, we have advocated the adoption of plasma pharmacological method in ex vivo experiments of herb studies. Recent studies including our work demonstrated that the constituents and biological activities are partially different between absorbed medicinal herbs in plasma and serum. This review summarizes the experimental evidence supporting the feasibility of plasma pharmacological method and discusses the reasons and facts that flaw the serum pharmacological method. But serum pharmacological method can be used if anticoagulants interfere with experiments. It should be emphasized that the domination between plasma and serum pharmacological methods is different depending on the usage. Indeed, the pros and cons of both methods as well as the appropriate choices of coagulants in different ex vivo experimental settings remain to be further elucidated.
Tang, Tony Yuqi; Li, Fang-Zhou; Afseth, Janyne
In 2012, USA Food and Drug Administration (FDA) approved 39 new drugs, however, there are only two botanical drugs (one topical and one oral) approved by FDA since the publication of the FDA's industry guidelines for the botanical drug product in June 2004. The approval shows the Western guideline can be used for herbal medicines, authors investigate current regulation on herbal medicine clinical research, identify challenges conducting clinical trials, and seek to produce some guidance for potential investigators and sponsors considering a clinical trial in this area. Key words were formulated for searching on Medline and FDA website to locate relevant regulations for clinical research in herbal medicines to understand current environment for herbal medicine usage and examine the barriers affecting herbal medicine in clinical trials. Authors critically explore case study of the 1st FDA approved botanical drugs, Veregen (sinecatechins), green tea leaves extract, a topical cream for perianal and genital condyloma. In consideration of current regulation environment in USA, based on the findings and analysis through the literature review and Veregen case study, authors produce and propose a Checklist for New Drug Application of Herbal Medicines for potential investigators and sponsors considering in a herbal medicine clinical trial.
Wang, Cheng-cheng; Feng, Liang; Liu, Dan; Cui, Li; Tan, Xiao-bin; Jia, Xiao-bin
Traditional Chinese medicine(TCM) is a complex system, featured with integrity and characteristics. Structural component TCM is a well-organized integrity of traditional Chinese medicine, reflecting multi-component integration effect of TCM. It gives us a new view on the material basis of TCM. Currently, conventional researching strategies are not enough to deal with the relationship between material basis and efficacy, multi-composition, multi-targets, and multi-section mechanism. Post-genome area gives a birth to bioinformatics, which involves systematic biology, different levels of omics, corresponding mathematics and computer techniques. It increasingly becomes a powerful tool to understand complicated system and life essential laws. Research ideas, methods. and knowledge of data mining technology of bioinformatics combined with the theory of structural components of Chinese medicine bring a new opportunity for developing structural components of Chinese medicine, systematically exploring the essence of TCM and promoting the modernization of TCM.
Avery, Daniel M., Jr.; Wheat, John R.; Leeper, James D.; McKnight, Jerry T.; Ballard, Brent G.; Chen, Jia
Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural…
Magalhães, Teresa; Santos, Agostinho; Dinis-Oliveira, Ricardo Jorge
Forensic medicine deals with a wide variety of cases. To accomplish the main objectives, this professional field needs to adopt and apply findings from other sciences, namely, different medical specialties and other forensic sciences. The opposite is not yet entirely true due to the fact that forensic medicine deals with cases that are very far away from other medical and scientific interests. It is obvious that this forgotten world of forensic medicine … is also a new world of opportunities and challenges to research in all scientific areas.
Ingelfinger, Franz J.
Selected for discussion are certain advances in basic research and technologic innovation which shape the past, present, and future of medical care. Included are infectious diseases, especially hepatitis, immunology, clinical disorders of the immune system and the histocompatability system. (Author/SA)
Massele, Amos; Burger, Johanita; Kalemeera, Francis; Jande, Mary; Didimalang, Thatayaone; Kalungia, Aubrey Chichonyi; Matshotyana, Kidwell; Law, Michael; Malone, Brighid; Ogunleye, Olayinka; Oluka, Margaret; Paramadhas, Bene D; Rwegerera, Godfrey; Zinyowera, Sekesai; Godman, Brian
The second Medicines Utilization Research in Africa (MURIA) group workshop and symposium again brought researchers together from across Africa to improve their knowledge of drug utilization (DU) methodologies and exchange ideas to further progress DU research in Africa. This built on extensive activities from the first conference including workshops and multiple publications. Anti-infectives were again the principal theme for the 2016 symposium following the workshops. This included presentations regarding strategies to improve antibiotic utilization among African countries, such as point-prevalence studies, as well as potential ways to reduce self-purchasing of antibiotics. There were also presentations on antiretrovirals including renal function and the impact of policy changes. Concerns with adherence in chronic treatments as well as drug-drug interactions and their implications were also discussed. The deliberations resulted in a number of agreed activities including joint publications before the next MURIA conference in Namibia in 2017.
Tong, Yuanyuan; Yang, Jinsheng; Li, Changhong; He, Wei
The current status of the application of data mining in Chinese medicine (TCM) safety research are analyzed in this paper, and the future development trend are discussed, which include: to establish ADR (adverse drug reaction) signal detection and automatic warning system based on traditional Chinese medicine (TCM) adverse reaction database, to explore the characteristics and influencing factors of TCM safety problems, to devise appropriate new algorithm, and to develop TCM adverse reaction literature mining.
Seuc, Armando; Rahimi, Asma; Festin, Mario; Temmerman, Marleen
Abstract Objective To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning. Methods In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed – and the knowledge gaps that would have to be filled – to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked. Findings Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents. Conclusion Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative. PMID:24623902
Baker, David G; Kearney, Michael T
The present article describes a paradigm for evaluating the internal research funding program of a college or school of veterinary medicine, using as an example a similar exercise recently conducted at the Louisiana State University School of Veterinary Medicine (LSU SVM). The purpose of the exercise was to quantify and evaluate the effectiveness of the LSU SVM internal research funding mechanism known as the Competitive Organized Research Program (CORP). The evaluation resulted in several important observations that will allow us to further improve the effectiveness of our internal research funding program investment. Among the most important of these was the greater return on investment for CORP projects funded with smaller awards (approximately $10,000 US) compared to projects funded with larger awards (approximately $52,000 US). Other colleges and schools of veterinary medicine may find such an exercise similarly informative and beneficial.
This paper presents a review of commonly used family models which illustrate the wide range of differences in definition of the American family. Its purpose is to help assure that national family policy is based on a definition of family made in the broadest possible context. The major part of the paper discusses five commonly used models. The…
Ali, Ather; Vitulano, Lawrence A
The 2010 Yale Research Symposium on Complementary and Integrative Medicine highlighted original research in related areas by Yale faculty and provided a forum to discuss and debate issues of evidence and plausibility. In this brief report, we describe selected presentations on such diverse foci as nutritional influences on cancer, acupuncture for low back pain, protein intake's effects on bone consumption, Chinese herb-derived adjuvant chemotherapy, and the relationship between anger and cardiac arrhythmia. This symposium demonstrated that rigorous research methods are being used to study unconventional therapies and that an integrative medicine approach requires a solid scientific foundation.
Research on the history of medicine in Korea in the form of modern scholarship began with the publication in 1930 of Yi Neunghwa's "A History of the Development of Medicine in Korea." The purpose of the present study lies in surveying studies on the history of medicine in Korea in the past 80 years since the publication of Yi's paper. In terms of periodization, research on the history of medicine in Korea is bifurcated by the publication of two comprehensive histories-i. e., Miki Sakae's A History of Medicine and Disease in Korea (1963) and Kim Du-jong's The Complete History of Medicine in Korea (1966). Indeed, all earlier studies converged in these two books. Because Miki and Kim both had majored in Western medicine and conducted research based on similar perspectives, data, and methods, the two works overlap considerably, and Kim's book, as the later of the two, unfortunately lost the initiative to the former to a considerable extent. As a result of these two scholars' research, it became possible to trace the overall flow of the history of medicine in Korea. Following the publication of works by Miki and Kim and with the advent of the 1980's, research on the history of medicine in premodern Korea was renovated with the emergence of no fewer than some dozen new doctoral degree holders in the field. In fact, these young scholars went beyond surveying trends in each era to expand the scope of specific discussions and topics per era, to delve into the actual contents, and to elucidate the function of medicine in society. The fruits of studies conducted in the past 80 years on the history of medicine in premodern Korea can be summarized as follows. 1) before the 5th century AD: the existence of a comprehensive medical practice in regions inhabited by those considered to be the ancestors of the Korean people; and information on medication including ginseng. 2) 5th-10th centuries: the existence of professional medical posts; the management of medicine by the royal
Zhai, Haoran; Zhong, Wenzhao; Wu, Yilong
Major pioneering advances of medicine in history tend to manifest in two directions that seem divergent but actually unified with dialectics: one is the important biological principle revealed by in-depth studies from the clinic to the laboratory based on individual cases; the other is the colonial generality displayed by epidemiologic data from large-scale samples. Although advances predominated, we human beings were paying dearly for it due to serious incidents of endangering ourselves and defects of restrictions of laws and ethics. Subsequently, the Nuremberg Code, Declaration of Helsinki and Belmont Report came into light and constrained human experiments and clinical trials. However, the development of such laws and regulations in China is lagging behind and renders China as a breeding ground for gray medicine. There are three lessons we can learn from painful histories and apply to individualized treatment of lung cancer. Firstly, the abuse of Avastin beyond its indications reflected the similar situation of tyrosine kinase inhibitors in lung cancer due to different molecular types and stages of tumors; secondly, the black market of stem cell therapy in China reminds us how to identify the boundaries of clinical trials and clinical treatment, in similar to the cellular immunotherapy of tumors; thirdly, the theory of Xiao's Reflex Arc emerged us to rethink the level of the validity of clinical evidences, which can provide hints related to video-assisted thoracoscopic surgeries (VATSs). In conclusion, clinical applications of new techniques and treatment regimens should follow three points: identify indications and contraindications clearly, obtain informed consent and permission of patients and supervise effectively according to laws and ethics.
Zhai, Haoran; Wu, Yilong
Major pioneering advances of medicine in history tend to manifest in two directions that seem divergent but actually unified with dialectics: one is the important biological principle revealed by in-depth studies from the clinic to the laboratory based on individual cases; the other is the colonial generality displayed by epidemiologic data from large-scale samples. Although advances predominated, we human beings were paying dearly for it due to serious incidents of endangering ourselves and defects of restrictions of laws and ethics. Subsequently, the Nuremberg Code, Declaration of Helsinki and Belmont Report came into light and constrained human experiments and clinical trials. However, the development of such laws and regulations in China is lagging behind and renders China as a breeding ground for gray medicine. There are three lessons we can learn from painful histories and apply to individualized treatment of lung cancer. Firstly, the abuse of Avastin beyond its indications reflected the similar situation of tyrosine kinase inhibitors in lung cancer due to different molecular types and stages of tumors; secondly, the black market of stem cell therapy in China reminds us how to identify the boundaries of clinical trials and clinical treatment, in similar to the cellular immunotherapy of tumors; thirdly, the theory of Xiao’s Reflex Arc emerged us to rethink the level of the validity of clinical evidences, which can provide hints related to video-assisted thoracoscopic surgeries (VATSs). In conclusion, clinical applications of new techniques and treatment regimens should follow three points: identify indications and contraindications clearly, obtain informed consent and permission of patients and supervise effectively according to laws and ethics. PMID:25738135
Xuan, Nan-Xia; Ying, Song-Min; Li, Wen
Asthma is one of the most common chronic inflammatory disorders, associated with reversible airflow obstruction, airway hyperresponsiveness, and airway remodeling. This disease has a significant impact on individuals, their families, and society. Standardized therapeutics such as inhaled corticosteroid in combination with long acting β2 agonist have been applied for asthma control; however, complementary and alternative medicines, especially herbal medicines, are still widely used all over the world. A growing body of literature suggests that various herbals or related products might be effective in inhibiting asthmatic inflammation. In this review, we summarize recent advances about the mechanistic studies of herbal medicines on allergic airway inflammation in animal models and their potential application into clinic for asthma control. PMID:27478309
Stream, Glen; DeVoe, Jennifer E; Hughes, Lauren S; Phillips, Robert L
This paper was prepared in follow up to the G. Gayle Stephens Keystone IV Conference by authors who attended the conference and are also members of the Family Medicine for America's Health board of directors (FMAHealth.org). It connects the aspirations of the current strategic and communications efforts of FMAHealth with the ideas developed at the conference. The FMAHealth project is sponsored by 8 national family medicine organizations and seeks to build on the work of the original Future of Family Medicine project. Among its objectives are a robust family physician workforce practicing in a continually improving medical home model, supported by a comprehensive payment model sufficient to sustain the medical home and enable the personal physician relationship with patients.
Levey, Barbara A.; And Others
The study compared research activities of men and women from data obtained in a 1982-83 survey of 7,947 medical school faculty in departments of internal medicine. Among findings were that women researchers had significantly fewer National Institutes of Health grants as well as reduced laboratory space. (Author/DB)
Pennsylvania Univ., Philadelphia.
IN PLANNING A NEW RESEARCH AND TEACHING BUILDING FOR THE SCHOOL OF DENTAL MEDICINE, A PROGRAM WAS DEVELOPED OUTLINING THE DESIGN NEEDS AND THE SPACE AND FACILITY REQUIREMENTS. MAJOR AREAS OF THE PROGRAM WERE--(1) GENERAL DESIGN AND CONSTRUCTION COMPONENTS, (2) THE RESEARCH COMPONENT, AND (3) THE BASIC SCIENCE TEACHING COMPONENTS. SPACE…
Yin, Robert K.
The purpose of this paper is to indicate how the ambivalent posture of the government toward families has affected federal support of research on the family and studies of the family as educator. After an introductory section providing background information about American public policy, families, and education, the discussion centers on the…
Zhong, Ling-Yun; Wu, Hao
Plants in Acaceae family are often considered as ornamental and medicines. However many of them have irritation properties. As medicinal plants some of them are recorded in Chinese Pharmacopoeia and they are figured as poisonous. Through investigating the domestic and overseas studied paper, the needle-like calcium oxalate crystal exits in the plants of Acaceae family could be thought as irritation components of them. This conclusion is same with the studied conclusion of our study group in the medicines plant of Pinellia ternate belonging to the Acaceae family and our studies showed that the needle-like calcium oxalate crystal was the main irritation component of raw P. ternate. The irritated mechanism of raphides is relevant to its special shape, the protein enzyme adhering to it and idioblasts in plants.
Pagels, Patti; Kindratt, Tiffany; Arnold, Danielle; Brandt, Jeffrey; Woodfin, Grant; Gimpel, Nora
Introduction. Future health care providers need to be trained in the knowledge and skills to effectively communicate with their patients with limited health literacy. The purpose of this study is to develop and evaluate a curriculum designed to increase residents' health literacy knowledge, improve communication skills, and work with an interpreter. Materials and Methods. Family Medicine residents (N = 25) participated in a health literacy training which included didactic lectures and an objective structured clinical examination (OSCE). Community promotoras acted as standardized patients and evaluated the residents' ability to measure their patients' health literacy, communicate effectively using the teach-back and Ask Me 3 methods, and appropriately use an interpreter. Pre- and postknowledge, attitudes, and postdidactic feedback were obtained. We compared OSCE scores from the group that received training (didactic group) and previous graduates. Residents reported the skills they used in practice three months later. Results. Family Medicine residents showed an increase in health literacy knowledge (p = 0.001) and scored in the adequately to expertly performed range in the OSCE. Residents reported using the teach-back method (77.8%) and a translator more effectively (77.8%) three months later. Conclusions. Our innovative health literacy OSCE can be replicated for medical learners at all levels of training.
Madsen, Mia; Andersen, Per Kragh; Gerster, Mette; Andersen, Anne-Marie Nybo; Osler, Merete; Christensen, Kaare
Objectives Although well established, the association between socioeconomic position and health and health behaviour is not clearly understood, and it has been speculated that familial factors, for example, dispositional factors or exposures in the rearing environment, may be underlying the association. The objective was to compare prescription fillings within twin pairs who are partly or fully genetically identical and share childhood exposures. Design Twin cohort study. Setting Denmark. Participants Data from the Danish Twin Registry were linked to registers in Statistics Denmark and the Danish Registry of Medicinal Product statistics. A total of 8582 monozygotic (MZ) and 15 788 dizygotic same sex (DZSS) twins were included. Outcome measures Number of prescription fillings during follow-up (1995–2005) was analysed according to education and income. Results of unpaired and intrapair analyses were compared. Results An inverse social gradient in filling of prescriptions for all-purpose and system-specific drugs was observed in the unpaired analyses. In the intrapair analyses, associations were attenuated some in DZSS and more in MZ twins. Filling of drugs targeting the nervous system was still strongly associated with income in the intrapair analyses. Conclusions Familial factors seem to account for part of the observed social inequality in filling of prescription medicine. PMID:24227869
Manolio, Teri A
Increasing knowledge about the influence of genetic variation on human health and growing availability of reliable, cost-effective genetic testing have spurred the implementation of genomic medicine in the clinic. As defined by the National Human Genome Research Institute (NHGRI), genomic medicine uses an individual's genetic information in his or her clinical care, and has begun to be applied effectively in areas such as cancer genomics, pharmacogenomics, and rare and undiagnosed diseases. In 2011 NHGRI published its strategic vision for the future of genomic research, including an ambitious research agenda to facilitate and promote the implementation of genomic medicine. To realize this agenda, NHGRI is consulting and facilitating collaborations with the external research community through a series of "Genomic Medicine Meetings," under the guidance and leadership of the National Advisory Council on Human Genome Research. These meetings have identified and begun to address significant obstacles to implementation, such as lack of evidence of efficacy, limited availability of genomics expertise and testing, lack of standards, and difficulties in integrating genomic results into electronic medical records. The six research and dissemination initiatives comprising NHGRI's genomic research portfolio are designed to speed the evaluation and incorporation, where appropriate, of genomic technologies and findings into routine clinical care. Actual adoption of successful approaches in clinical care will depend upon the willingness, interest, and energy of professional societies, practitioners, patients, and payers to promote their responsible use and share their experiences in doing so.
Lowenthal, Justin; Sugarman, Jeremy
Stem cell research and related initiatives in regenerative medicine, cell-based therapy, and tissue engineering have generated considerable scientific and public interest. Researchers are applying stem cell technologies to chest medicine in a variety of ways: using stem cells as models for drug discovery, testing stem cell-based therapies for conditions as diverse as COPD and cystic fibrosis, and producing functional lung and tracheal tissue for physiologic modeling and potential transplantation. Although significant scientific obstacles remain, it is likely that stem cell-based regenerative medicine will have a significant clinical impact in chest medicine. However, stem cell research has also generated substantial controversy, posing a variety of ethical and regulatory challenges for research and clinical practice. Some of the most prominent ethical questions related to the use of stem cell technologies in chest medicine include (1) implications for donors, (2) scientific prerequisites for clinical testing and use, (3) stem cell tourism, (4) innovation and clinical use of emerging stem cell-based interventions, (5) responsible translation of stem cell-based therapies to clinical use, and (6) appropriate and equitable access to emerging therapies. Having a sense of these issues should help to put emerging scientific advances into appropriate context and to ensure the responsible clinical translation of promising therapeutics.
BOBOIA, ANAMARIA; GRIGORESCU, MARIUS RAREŞ; TURCU - ŞTIOLICĂ, ADINA
Background and aims The research aimed at investigating sales trends of angiotensin-converting enzyme inhibitors antihypertensive medicines, both in terms of quantity and value, in ten community pharmacies, for a period of three years. The research on the antihypertensive medicines consumption is important for highlighting the ever increasing impact of hypertension among the population. Methods The methods used in this research were the following: marketing research, method of sampling, descriptive methods, retrospective analysis, method of comparison. Results The results showed that the drugs containing the active substances of the angiotensin converting enzyme inhibitors class had had significant increases in quantitative and value sales, bringing substantial revenues to pharmacies. From the quantitative perspective, the best-selling products were those containing Enalaprilum, while in terms of value, the best-selling medicines were those containing Perindoprilum. We evidenced that spectacular sales were also achieved for products that have Lisinoprilum, respectively Captoprilum, as active substances. The largest quantities were marketed for the Captopril Terapia® product and the highest earnings were recorded for the Prestarium® medicine. Conclusion This paper approaches an interesting and topical issue, which can be helpful to professionals (pharmacists, doctors) and other categories, such as economists, statisticians, representatives of companies manufacturing medicines, as well as to hypertensive patients, as it could be used to warn population regarding the incidence of cardiovascular diseases, and, at the same time, trace sales trends in order to accomplish profitable business plans. PMID:28246502
Stem cell research and related initiatives in regenerative medicine, cell-based therapy, and tissue engineering have generated considerable scientific and public interest. Researchers are applying stem cell technologies to chest medicine in a variety of ways: using stem cells as models for drug discovery, testing stem cell-based therapies for conditions as diverse as COPD and cystic fibrosis, and producing functional lung and tracheal tissue for physiologic modeling and potential transplantation. Although significant scientific obstacles remain, it is likely that stem cell-based regenerative medicine will have a significant clinical impact in chest medicine. However, stem cell research has also generated substantial controversy, posing a variety of ethical and regulatory challenges for research and clinical practice. Some of the most prominent ethical questions related to the use of stem cell technologies in chest medicine include (1) implications for donors, (2) scientific prerequisites for clinical testing and use, (3) stem cell tourism, (4) innovation and clinical use of emerging stem cell-based interventions, (5) responsible translation of stem cell-based therapies to clinical use, and (6) appropriate and equitable access to emerging therapies. Having a sense of these issues should help to put emerging scientific advances into appropriate context and to ensure the responsible clinical translation of promising therapeutics. PMID:25732448
Zheng, Wen-ke; Liu, Zhi; Lei, Xiang; Tian, Ran; Zheng, Rui; Li, Nan; Ren, Jing-tian; Du, Xiao-xi; Shang, Hong-cai
The safety of Chinese patent medicine has become a focus of social. It is necessary to carry out work on post-marketing clinical safety evaluation for Chinese patent medicine. However, there have no criterions to guide the related research, it is urgent to set up a model and method to guide the practice for related research. According to a series of clinical research, we put forward some views, which contained clear and definite the objective and content of clinical safety evaluation, the work flow should be determined, make a list of items for safety evaluation project, and put forward the three level classification of risk control. We set up a model of post-marketing clinical safety evaluation for Chinese patent medicine. Based this model, the list of items can be used for ranking medicine risks, and then take steps for different risks, aims to lower the app:ds:risksrisk level. At last, the medicine can be managed by five steps in sequence. The five steps are, collect risk signal, risk recognition, risk assessment, risk management, and aftereffect assessment. We hope to provide new ideas for the future research.
Josephson, Cassandra D; Mondoro, Traci Heath; Ambruso, Daniel R; Sanchez, Rosa; Sloan, Steven R; Luban, Naomi L C; Widness, John A
There is concern at the National Heart, Lung, and Blood Institute (NHLBI) and among transfusion medicine specialists regarding the small number of investigators and studies in the field of pediatric transfusion medicine (PTM). Accordingly, the objective of this article is to provide a snapshot of the clinical and translational PTM research considered to be of high priority by pediatricians, neonatologists, and transfusion medicine specialists. Included is a targeted review of three research areas of importance: (i) transfusion strategies, (ii) short- and long-term clinical consequences, and (iii) transfusion-transmitted infectious diseases. The recommendations by PTM and transfusion medicine specialists represent opportunities and innovative strategies to execute translational research, observational studies, and clinical trials of high relevance to PTM. With the explosion of new biomedical knowledge and increasingly sophisticated methodologies over the past decade, this is an exciting time to consider transfusion medicine as a paradigm for addressing questions related to fields such as cell biology, immunology, neurodevelopment, outcomes research, and many others. Increased awareness of PTM as an important, fertile field and the promotion of accompanying opportunities will help establish PTM as a viable career option and advance basic and clinical investigation to improve the health and wellbeing of children.
The University of California, San Diego (UCSD) was established in 1961 as a new research university that emphasizes innovation, excellence, and interdisciplinary research and education. It has a School of Medicine (SOM) and the Jacobs School of Engineering (JSOE) in close proximity, and both schools have national rankings among the top 15. In 1991, with the support of the Whitaker Foundation, the Whitaker Institute of Biomedical Engineering was formed to foster collaborations in research and education. In 2008, the university extended the collaboration further by establishing the Institute of Engineering in Medicine (IEM), with the mission of accelerating the discoveries of novel science and technology to enhance health care through teamwork between engineering and medicine, and facilitating the translation of innovative technologies for delivery to the public through clinical application and commercialization.
Vandeweerd, Jean-Michel; Kirschvink, Nathalie; Clegg, Peter; Vandenput, Sandrine; Gustin, Pascal; Saegerman, Claude
Evidence-based medicine (EBM) refers to the conscientious, explicit and judicious use of current best evidence from research for the care of an individual patient. The concept of EBM was first described in human medicine in the early 1990s and was introduced to veterinary medicine 10 years later. However, it is not clear that the EBM approach promulgated in human medicine can be applied to the same extent to veterinary medicine. EBM has the potential to help veterinarians to make more informed decisions, but obstacles to the implementation of EBM include a lack of high quality patient-centred research, the need for basic understanding of clinical epidemiology by veterinarians, the absence of adequate searching techniques and accessibility to scientific data bases and the inadequacy of EBM tools that can be applied to the busy daily practise of veterinarians. This review describes the development of EBM in the veterinary profession, identifies its advantages and disadvantages and discusses whether and how veterinary surgeons should further adopt the EBM approach of human medicine.
Costello, Joseph T; Bieuzen, Francois; Bleakley, Chris M
The aim of this study is to estimate the ratio of male and female participants in Sports and Exercise Medicine research. Original research articles published in three major Sports and Exercise Medicine journals (Medicine and Science in Sports and Exercise, British Journal of Sports Medicine and American Journal of Sports Medicine) over a three-year period were examined. Each article was screened to determine the following: total number of participants, the number of female participants and the number of male participants. The percentage of females and males per article in each of the journals was also calculated. Cross tabulations and Chi-square analysis were used to compare the gender representation of participants within each of the journals. Data were extracted from 1382 articles involving a total of 6,076,580 participants. A total of 2,366,968 (39%) participants were female and 3,709,612 (61%) were male. The average percentage of female participants per article across the journals ranged from 35% to 37%. Females were significantly under-represented across all of the journals (χ(2) = 23,566, df = 2, p < 0.00001). In conclusion, Sports and Exercise Medicine practitioners should be cognisant of sexual dimorphism and gender disparity in the current literature.
Aznar, A. S.; Castanon, D. G.
Background: To date, little research has focused on what factors constitute a quality of life (QOL) among Latin American families with a member who is intellectually disabled. Method: Total 180 Latin American families cooperated in a participative research project. During 18 months, the families and a team exchanged information about their QOL by…
Seltzer, Marsha Mailick; Abbeduto, Leonard; Krauss, Marty Wyngaarden; Greenberg, Jan; Swe, April
This paper examines methodological challenges inherent in conducting research on families of children with autism and in comparing these families with others who are coping with different types of disabilities or who have nondisabled children. Although most comparative research has contrasted families whose child has autism with those whose child…
Societies in Latin America are not scientifically driven and therefore, the allocation of human and economic resources to research is meager, as a reflection of this as well as other cultural and economic realities.
Klemenc-Ketis, Zalika; Svab, Igor; Petek-Ster, Marija; Bulc, Mateja; Buchanan, Josephine; Finnegan, Henry; Correia de Sousa, Jaime; Yaphe, John
The international Bled course for teacher training has played a central role in faculty development in family medicine for the past 25 years. The course was originally designed to promote faculty development for family medicine teachers in the new academic discipline of family medicine in Slovenia in 1990 and to introduce new topics into the family medicine curriculum. In this background paper, we perform a SCOT analysis (strengths, challenges, opportunities, and threats) of the current course, evaluating participant feedback and reviewing past topics and their impact on local and international teaching programmes. We also review the place of the course in the context of other teacher-training programmes in family medicine in Europe. We found that the structure and learning aims of the Bled course have remained stable over 25 years. It provides a safe, well-structured learning environment for the participants even though the course topic is different every year. The course has had a significant impact on curriculum development and teacher training in Slovenia as well as in many other countries in Europe and beyond. Because of the positive impact of the course and the high degree of satisfaction of the participants and course directors, it seems worthwhile to continue this endeavour. New directions for the course will depend on the learning needs of the participants and the evolving medical curricula in the countries they represent.
Sipe, James W.; Doherty, William J.
Maintains that traditional training in research methods overlooks power of interactional dynamics in research process, preparing students inadequately for understanding obstacles to conducting research in community settings. Uses family systems theory to present and analyze ecological dynamics of research study of families and health conducted in…
Hertz, Thomas W., Ed.; Hertz, Susan, H., Ed.
This document is the product of the Conference of Family Research, a group convened by the Interagency Panel on Early Childhood Research and Development to provide an opportunity for researchers to meet with representatives of funding agencies in order to develop new commitments, interests and directions for family research. The document contains…
Rafiq, Qasim A; Ortega, Ilida; Jenkins, Stuart I; Wilson, Samantha L; Patel, Asha K; Barnes, Amanda L; Adams, Christopher F; Delcassian, Derfogail; Smith, David
Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in tissue engineering and regenerative medicine translation, we discuss common pitfalls associated with translational research, providing practical solutions and important considerations which will aid process and product development. Suggestions range from effective project management, consideration of key manufacturing, clinical and regulatory matters and means of exploiting research for successful commercialization.
Mintegi, Santiago; Lyttle, Mark D; Maconochie, Ian K; Benito, Javier; Gervaix, Alain; Moll, Henriette; Shavit, Itai; Da Dalt, Liviana; Waisman, Yehezkel
Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality research. Research in European Pediatric Emergency Medicine (REPEM) has developed a robust international structure involving clinicians, academics and national PEM research networks. This structure facilitates research collaboration within Europe and with PEM research networks from other continents. Multicentre research carried out in this way will bring about improvements in the quality of emergency care for children in European emergency departments, and result in a better quality of life for children and adolescents. This paper outlines the background and achievements of REPEM to date and describes the current structure and next steps.
Dehury, Ranjit Kumar
Introduction Indian system of medicine has its origin in India. The system is currently renamed as AYUSH, an acronym for Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homeopathy. These are the six Indian systems of medicine prevalent and practiced in India and in few neighboring Asian countries. Objective The primary objective of this review was to gain insight in to the prior and existing initiatives which would enable reflection and assist in the identification of future change. Materials and Methods A review was carried out based on the five year plan documents, obtained from the planning commission web portal of Govt. of India, on medical education, research and development of AYUSH systems of medicine. Results Post independence, the process of five year planning took its birth with the initiation of long term planning in India. The planning process embraced all the social and technology sectors in it. Since the beginning of five year planning, health and family welfare planning became imperative as a social sector planning. Planning regarding Indian Systems of Medicine became a part of health and family welfare planning since then. During the entire planning process a progressive path of development could be observed as per this evaluation. A relatively sluggish process of development was observed up to seventh plan however post eighth plan the growth took its pace. Eighth plan onwards several innovative development processes could be noticed. Despite the relative developments and growth of Indian systems of medicine these systems have to face lot of criticism and appraisal owing to their various characteristic features. In the beginning the system thrived with great degree of uncertainty, as described in 1st five year plan, however progressed ahead with a vision to be a globally accepted system, as envisaged in 11th five year plan. Conclusion A very strong optimistic approach in spreading India’s own medical heritage is the need of the hour. The efforts
Institute of Medicine (NAS), Washington, DC.
In 1997, the Board on Children, Youth, and Families launched the Frontiers of Research on Children, Youth, and Families Initiative to highlight recent policy-relevant research on children, youth, and families conducted by young and mid-career researchers. The initiative sought to encourage more sustained interactions between these researchers and…
Xu, Yun-xiang; Li, Li-jun; Chen, Gui-zhen
Photonics is a science which research light quantum as the carrier for energy and information. Photonic technology in the meridian and acupoints research has shown the unique advantages, by which the microcosmic material basis and macroscopic phenomena research can be integrated to interpret the occurrence of propagated sensation along meridian and its underling mechanism. This paper focuses on the investigation on heat sensing action along the meridian by photonic technology. The four items of heat sensing action were discussed, i.e. thermo-effects, heat sensing capability, laser induced heat effect, underling mechanism on heat sensing effect along the meridian. The authors point out that photonic technology, e.g. photonic imaging, and infrared spectrum analysis, biological photons detection and laser Doppler application, can achieve purpose of in vivo, dynamic, and multiple comparable studies. Thereby the effect of heat sensing along meridian can be detected and illustrated by the use of natural science. Heat information can be investigated to analyze the relationship between zang-fu organs, meridians, and the functional characteristics of the meridian. Hence, the effect of heat sensing along the meridian is the break point of the research of photonics in the meridian which is beneficial to further study the meridian optics.
Xu, Yun-xiang; Li, Li-jun; Chen, Gui-zhen
Photonics is a science which research light quantum as the carrier for energy and information. Photonic technology in the meridian and acupoints research has shown the unique advantages, by which the microcosmic material basis and macroscopic phenomena research can be integrated to interpret the occurrence of propagated sensation along meridian and its underling mechanism. This paper focuses on the investigation on heat sensing action along the meridian by photonic technology. The four items of heat sensing action were discussed, i.e. thermo-effects, heat sensing capability, laser induced heat effect, underling mechanism on heat sensing effect along the meridian. The authors point out that photonic technology, e.g. photonic imaging, and infrared spectrum analysis, biological photons detection and laser Doppler application, can achieve purpose of in vivo, dynamic, and multiple comparable studies. Thereby the effect of heat sensing along meridian can be detected and illustrated by the use of natural science. Heat information can be investigated to analyze the relationship between zang-fu organs, meridians, and the functional characteristics of the meridian. Hence, the effect of heat sensing along the meridian is the break point of the research of photonics in the meridian which is beneficial to further study the meridian optics.
Rodkey, W G; Steadman, J R; Ho, C P
The advent and advancement of MR imaging have provided an entire new dimension for medical imaging. MR imaging has been especially useful because of its capacity to image nonmineralized tissues with a very high degree of resolution. Although modalities such as ultrasound and scintigraphy have proven useful for specific purposes, it is MR imaging that has the most utility and capabilities, especially in the area of sports-induced injuries. The technology associated with MR imaging has expanded greatly, and it continues to evolve at a rapid pace. The result has been an ever-increasing diagnostic capability that has become more economic with time. As described previously, MR imaging is gaining importance in the area of comparative medicine for animal athletes as well. It is also interesting to note that MR imaging now has a greater potential for monitoring physiological and biochemical changes as well as anatomic ones. Some newer MR units actually include physiologic data acquisition components. Consequently, new bioassays and nondestructive tissue tests can be performed to further understand the molecular biology and ongoing cellular processes in any given condition. Coupled with MR spectroscopy, the enhanced MR techniques should continue to contribute to the overall information that will be integrated into the training and rehabilitation of patients with sports-induced inflammation and injuries. The authors support and encourage ongoing efforts in the area of MR imaging research, both basic science and clinical studies.
Sullivan, Barbara M.; Furner, Sylvia E.; Cramer, Gregory D.
The global need to develop clinician-scientists capable of using research in clinical practice, translating research knowledge into practice, and carrying out research that affects the quality, efficacy, and efficiency of health care is well-documented. The complementary and alternative medicine (CAM) professions embrace the call to develop physician-researchers to carry out translational and applied research for CAM modalities. CAM universities face unique challenges when implementing research training compared to traditional, research intensive (TRI) universities and medical centers where the majority of medical research is carried out. The authors present the development and outcomes of a mentored research program (MRP) between a CAM and a TRI institution, the National University of Health Sciences and the University of Illinois at Chicago School of Public Health, between 2006 and 2012. CAM pre-doctoral students engaged in a full-immersion semester at the TRI, including didactic courses and active research with a TRI faculty research mentor. Half of the participating doctor of chiropractic (DC) students continued on to PhD programs and half established integrative medicine, primary care clinical careers. Establishing rigorous criteria for mentors and mentees, communicating expectations, developing solid relationships between the mentor, mentee, and home school advisor, responding quickly to impediments, and providing adequate support from CAM and TRI investigators were key to the MRP success. To sustain research opportunities, coordinated degree programs for the DC and master of public health (DC/MPH) and master of clinical and translational research (DC/MS CTS) were established. PMID:24988423
Lee, Kuo-Hsiung; Morris-Natschke, Susan L; Yang, Xiaoming; Huang, Rong; Zhou, Ting; Wu, Shou-Fang; Shi, Qian; Itokawa, Hideji
This article will review selected herbal products used in traditional Chinese medicine, including medicinal mushrooms ( bā xī mó gū; Agaricus blazei, yún zhī; Coriolus versicolor, líng zhī; Ganoderma lucidum, xiāng xùn; shiitake, Lentinus edodes, niú zhāng zhī; Taiwanofungus camphoratus), Cordyceps ( dōng chóng xià cǎo), pomegranate ( shí liú; Granati Fructus), green tea ( lǜ chá; Theae Folium Non Fermentatum), garlic ( dà suàn; Allii Sativi Bulbus), turmeric ( jiāng huáng; Curcumae Longae Rhizoma), and Artemisiae Annuae Herba ( qīng hāo; sweet wormwood). Many of the discussed herbal products have gained popularity in their uses as dietary supplements for health benefits. The review will focus on the active constituents of the herbs and their bioactivities, with emphasis on the most recent progress in research for the period of 2003 to 2011.
Lee, Kuo-Hsiung; Morris-Natschke, Susan L.; Yang, Xiaoming; Huang, Rong; Zhou, Ting; Wu, Shou-Fang; Shi, Qian; Itokawa, Hideji
This article will review selected herbal products used in traditional Chinese medicine, including medicinal mushrooms (巴西蘑菇 bā xī mó gū; Agaricus blazei, 雲芝 yún zhī; Coriolus versicolor, 靈芝 líng zhī; Ganoderma lucidum, 香蕈 xiāng xùn; shiitake, Lentinus edodes, 牛樟芝 niú zhāng zhī; Taiwanofungus camphoratus), Cordyceps (冬蟲夏草 dōng chóng xià cǎo), pomegranate (石榴 shí liú; Granati Fructus), green tea (綠茶 lǜ chá; Theae Folium Non Fermentatum), garlic (大蒜 dà suàn; Allii Sativi Bulbus), turmeric (薑黃 jiāng huáng; Curcumae Longae Rhizoma), and Artemisiae Annuae Herba (青蒿 qīng hāo; sweet wormwood). Many of the discussed herbal products have gained popularity in their uses as dietary supplements for health benefits. The review will focus on the active constituents of the herbs and their bioactivities, with emphasis on the most recent progress in research for the period of 2003 to 2011. PMID:24716120
The development and clinical implementation of personalized medicine crucially depends on the availability of high-quality human biosamples; animal models, although capable of modeling complex human diseases, cannot reflect the large variation in the human genome, epigenome, transcriptome, proteome, and metabolome. Although the biosamples available from public biobanks that store human tissues and cells may represent the large human diversity for most diseases, these samples are not always sufficient for developing biomarkers for patient-tailored therapies for neuropsychiatric disorders. Postmortem human tissues are available from many biobanks; nevertheless, collections of neuronal human cells from large patient cohorts representing the human diversity remain scarce. Two tools are gaining popularity for personalized medicine research on neuropsychiatric disorders: human induced pluripotent stem cell-derived neurons and human lymphoblastoid cell lines. This review examines and contrasts the advantages and limitations of each tool for personalized medicine research.
The development and clinical implementation of personalized medicine crucially depends on the availability of high-quality human biosamples; animal models, although capable of modeling complex human diseases, cannot reflect the large variation in the human genome, epigenome, transcriptome, proteome, and metabolome. Although the biosamples available from public biobanks that store human tissues and cells may represent the large human diversity for most diseases, these samples are not always sufficient for developing biomarkers for patient-tailored therapies for neuropsychiatric disorders. Postmortem human tissues are available from many biobanks; nevertheless, collections of neuronal human cells from large patient cohorts representing the human diversity remain scarce. Two tools are gaining popularity for personalized medicine research on neuropsychiatric disorders: human induced pluripotent stem cell-derived neurons and human lymphoblastoid cell lines. This review examines and contrasts the advantages and limitations of each tool for personalized medicine research. PMID:27757061
Kakoma, Jean Baptiste
The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that.
Kakoma, Jean Baptiste
The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that. PMID:27303587
Falagas, Matthew E; Karavasiou, Antonia I; Bliziotis, Ioannis A
The field of tropical medicine has a long history due to the significance of the relevant diseases for the humanity. We estimated the contribution of different world regions to research published in the main journals of tropical medicine. Using the PubMed and the Institute for Scientific Information (ISI) "Web of Science" databases, we retrieved articles from 12 journals included in the "Tropical Medicine" category of the "Journal Citation Reports" database of ISI for the period 1995-2003. Data on the country of origin of the research were available for 11,860 articles in PubMed (98.1% of all articles from the tropical medicine category). The contribution of different world regions during the studied period, as estimated by the location of the affiliation of the first author, was: Western Europe 22.7%, Africa 20.9%, Latin America and the Caribbean 20.7%, Asia (excluding Japan) 19.8%, USA 10.6%, Oceania 2.1%, Japan 1.5%, Eastern Europe 1.3%, and Canada 0.6%. The contribution of regions, estimated by the location of the affiliation of at least one author of the published papers (retrieved from the ISI database), was similar: Western Europe 36.6%, Africa 27.7%, Latin America and the Caribbean 24.4%, and Asia 23.3%. The mean impact factor of articles published in tropical medicine journals was highest for the USA (1.65). Our analysis suggests that the developing areas of the world produce a considerable amount of research in tropical medicine; however, given the specific geographic distribution of tropical diseases they probably still need help by the developed nations to produce more research in this field.
O'Donnell, John C
The decade since the completion of the sequencing of the human genome has witnessed significant advances in the incorporation of genomic information in diagnostic, treatment, and reimbursement practices. Indeed, as case in point, there are now several dozen commercially available genomic tests routinely applied across a wide range of disease states in predictive or prognostic applications. Moreover, many involved in the advancement of personalized medicine would view emerging approaches to stratify patients in meaningful ways beyond genomic information as a signal of the progress made. Yet despite these advances, there remains a general sense of dissatisfaction about the progress of personalized medicine in terms of its contribution to the drug development process, to the efficiency and effectiveness of health care delivery, and ultimately to the provision of the right treatment to the right patient at the right time. Academicians, payers, and manufacturers alike are struggling not only with how to embed the new insights that personalized medicine promises but also with the fundamental issues of application in early drug development, implications for health technology assessment, new demands on traditional health economic and outcomes research methods, and implications for reimbursement and access. In fact, seemingly prosaic issues such as the definition and composition of the term "personalized medicine" are still unresolved. Regardless of these issues, practitioners are increasingly compelled to find practical solutions to the challenges and opportunities presented by the evolving face of personalized medicine today. Accordingly, the articles comprising this Special Issue offer applied perspectives geared toward professionals and policymakers in the field grappling with developing, assessing, implementing, and reimbursing personalized medicine approaches. Starting with a framework with which to characterize personalized medicine, this Special Issue proceeds to
Cummings, E Mark; Schatz, Julie N
The social problem posed by family conflict to the physical and psychological health and well-being of children, parents, and underlying family relationships is a cause for concern. Inter-parental and parent-child conflict are linked with children's behavioral, emotional, social, academic, and health problems, with children's risk particularly elevated in distressed marriages. Supported by the promise of brief psycho-educational programs (e.g., Halford et al. in Journal of Family Psychology 22:497-505, 2008; Sanders in Journal of Family Psychology 22:506-517, 2008), the present paper presents the development and evaluation of a prevention program for community families with children, concerned with family-wide conflict and relationships, and building on Emotional Security Theory (Davies and Cummings in Psychological Bulletin 116:387-411, 1994). This program uniquely focuses on translating research and theory in this area into brief, engaging programs for community families to improve conflict and emotional security for the sake of the children. Evaluation is based on multi-domain and multi-method assessments of family-wide and child outcomes in the context of a randomized control design. A series of studies are briefly described in the programmatic development of a prevention program for conflict and emotional security for community families, culminating in a program for family-wide conflict and emotional security for families with adolescents. With regard to this ongoing program, evidence is presented at the post-test for improvements in family-wide functioning, consideration of the relative benefits for different groups within the community, and preliminary support for the theoretical bases for program outcomes.
Choo, Esther K; Fernandez, Rosemarie; Hayden, Emily M; Schneider, Jeffrey I; Clyne, Brian; Ginsburg, Shiphra; Gruppen, Larry D
Funding is a perennial challenge for medical education researchers. Through a consensus process, the authors developed a multifaceted agenda for increasing funding of education research in emergency medicine (EM). Priority agenda items include developing resources to increase the competitiveness of medical education research faculty in grant applications, identifying means by which departments may bolster their faculty's grant writing success, taking long-term steps to increase the number of grants available to education researchers in the field, and encouraging a shift in cultural attitudes toward education research.
McCabe, Teri R; Wyon, Matthew; Ambegaonkar, Jatin P; Redding, Emma
DanceSport is the competitive form of ballroom dancing, and even though it has more participants worldwide than ballet and modern dance, there is less peer-reviewed research. A review was conducted to identify all relevant literature to help researchers and clinicians gain an enhanced understanding of dancesport. Eight databases were searched, with 34 articles found in topics including participation motives, psychology, exercise physiology, fitness training, injuries and injury prevention, biomechanics, menstrual dysfunction, and substance use. Our results indicate that researchers have been inconsistently recording and reporting anthropometric and dancesport data; for example, 31 studies separated participants by gender, 21 included the competition classification of dancers, 19 reported which style of dancesport participants competed in, and 13 described the participants as a dance couple. Common injuries affected the neck, shoulder, spine, knee, lower leg, and foot. Dancesport is in the very heavy to extremely heavy category in energy expenditure (mean heart rate: male 175.2 ± 10.7, female 178.6 ± 8.6 bpm) and utilizes both aerobic and anaerobic energy systems. Alpha-beta and heart rate variability intervention techniques are reported to successfully enhance performance in dancers. Dancesport participants also appear less likely to smoke cigarettes, but have little knowledge about anti-doping rules. During events, professionals danced farther (30 m) and faster (0.3 m/sec) than junior dancers. Female competitors were more likely to be eumenorrheic. Dancesport is a physically and mentally demanding competitive sport, but there is a need to standardize measurements in future studies to allow comparison.
Fischer Zellers, Darlene
This study examines the organizational and contextual factors associated with faculty mentoring programs in academic medicine within major research institutions in the United States, and explores the usefulness of organizational behavior theory in understanding these relationships. To date, many formal faculty mentoring programs are in operation…
Jacobs, Stanley S.; Zullo, Thomas G.
Curriculum innovation and research in the dental medicine field is addressed as a major area of concern to those faced with pressures to provide more efficient and effective health care services. A survey was undertaken to determine (1) the type of training and background desired and (2) recruitment procedures and employment prospects for persons…
Monach, Paul A
Researchers often decide whether to average multiple results in order to produce more precise data, and clinicians often decide whether to repeat a laboratory test in order to confirm its validity or to follow a trend. Some of the major sources of variation in laboratory tests (analytical imprecision, within-subject biological variation and between-subject variation) and the effects of averaging multiple results from the same sample or from the same person over time are discussed quantitatively in this article. This analysis leads to the surprising conclusion that the strategy of averaging multiple results is only necessary and effective in a limited range of research studies. In clinical practice, it may be important to repeat a test in order to eliminate the possibility of a rare type of error that has nothing to do analytical imprecision or within-subject variation, and for this reason, paradoxically, it may be most important to repeat tests with the highest sensitivity and/or specificity (i.e., ones that are critical for clinical decision-making).
Vladimir-Knežević, Sanda; Blažeković, Biljana; Kindl, Marija; Vladić, Jelena; Lower-Nedza, Agnieszka D; Brantner, Adelheid H
The present study aimed to evaluate acetylcholinesterase (AChE) inhibitory and antioxidant activities of Lamiaceae medicinal plants growing wild in Croatia. Using Ellman's colorimetric assay all tested ethanolic extracts and their hydroxycinnamic acid constituents demonstrated in vitro AChE inhibitory properties in a dose dependent manner. The extracts of Mentha x piperita, M. longifolia, Salvia officinalis, Satureja montana, Teucrium arduini, T. chamaedrys, T. montanum, T. polium and Thymus vulgaris at 1 mg/mL showed strong inhibitory activity against AChE. The antioxidant potential of the investigated Lamiaceae species was assessed by DPPH• scavenging activity and total antioxidant capacity assays, in comparison with hydroxycinnamic acids and trolox. The extracts differed greatly in their total hydroxycinnamic derivatives content, determined spectrophotometrically. Rosmarinic acid was found to be the predominant constituent in most of the investigated medicinal plants (by RP-HPLC) and had a substantial influence on their AChE inhibitory and antioxidant properties, with the exception of Teucrium species. These findings indicate that Lamiaceae species are a rich source of various natural AChE inhibitors and antioxidants that could be useful in the prevention and treatment of Alzheimer's and other related diseases.
Carr, Deborah; Springer, Kristen W.
We review research on families and health published between 2000 and 2009 and highlight key themes and findings from innovative, methodologically rigorous studies. Whereas research in prior decades focused primarily on whether family structure affects child and adult health, contemporary research examines the contextual and processual factors that…
This essay argues that individual-oriented informed consent is inadequate to protect human research subjects in mainland China. The practice of family-oriented decision-making is better suited to guide moral research conduct. The family's role in medical decision-making originates from the mutual benevolence that exists among family members, and is in accordance with family harmony, which is the aim of Confucian society. I argue that the practice of informed consent for medical research on human subjects ought to remain family-oriented in mainland China. This essay explores the main features of this model of informed consent and demonstrates the proper authority of the family. The family's participation in decision-making as a whole does not negate or deny the importance of the individual who is the subject of the choice, but rather acts more fully to protect research subjects.
Turabián, José Luis; Samarín-Ocampos, Elena; Minier, Luis; Pérez-Franco, Benjamín
We review the mechanisms of the mental operation to identify the disease in family medicine, using five cases where the diagnosis process began in "the trace that should not be there" or "Robinson sign" as happened to Robinson Crusoe when he saw a human footprint on the beach of the "desert island". How could it be there?; It was a mystery, and based on metaphors, we framed the mechanism of "the trace that should not be there" mainly in the first phase of clinical or intuitive reasoning, but this intuition of the doctor should be accompanied by the diagnostic process, like the "basso continuo" of Baroque music, allowing improvisation and personal style, and in this way, eventually observing the footprint "that should not have been there" that may arise in the analytical, as well as in the verification phase of the assumptions made.
Zhang, Wen; Xie, Yan-Ming; Yuwen, Ya
At present, a number of scientific research achievements has been formed. Scientific achievement is the crystallization of great efforts from scientific workers, and it's also the valuable treasure of human civilization. Standardization is an important way to promote the international communication of Chinese medicine, and it's significant in boosting China's scientific and technological progress, improving market competitiveness and promoting international trade. Transformation of scientific research to the guideline is not only beneficial to improving the technology content of the standard, but also to the conversion from scientific research achievements into productivity. Therefore, only by absorbing the advanced scientific and technological achievements, reproducing the theory of traditional Chinese medicine (TCM) and medical technology in standard form, can make TCM keep pace with the times. This study preliminarily explores for the method to transform scientific research achievements into guideline, in order to provide reference for the future technical specifications, thus to further the development of TCM.
Grotberg, E H
This paper examines research by Sudanese university students on: 1) indigenous childrearing practices and their implications for parent education; 2) female circumcision and changes in that practice; and 3) problems in providing adequate services for handicapped children. Various aspects of childrearing practices such as maternal warmth, feeding and weaning, toilet training, discipline, sex and sex roles, and maternal reactions to children's curiosity were observed. 150 mothers of 5-year-old children were studied using an interview schedule modeled after Robert Sears of Harvard University. The mothers were from 2 urban groups and 1 rural group. The research has led to development of parent education curricula. 150 third year urban high school girls were interviewed regarding female circumcision. The study found that although about 96% of the students had had some form of female circumcision performed on them, they opposed its being performed on sisters and other young girls (71.3% and 70%, respectively). The study (1983) shows that the most severe form, pharaonic circumcision, takes place 30% of the time, the intermediate form is done 60% of the time, while the Sunna, least radical form, accounts for 11% of circumcisions. There is a trend toward extinction of circumcision in urban areas while the direction of change in rural areas is not as clear. Interest in handicapped children is recent and much more work is needed to honor their rights adequately. Special education programs do exist for blind, physically handicapped, deaf, speech and hearing impaired children. A Directorate of Special Education was established in 1980 in the Ministry of Education. A survey of selected facilities reveals a need for more trained teachers and social workers, more services, better family-institution relationships, more financial resources and transportation, and more educational materials. Minimal government interest, inappropriate curriculum and insufficient number of special