Palliative medicine: a new specialty changes an old debate

The specialty of palliative care, of which palliative medicine is part, has developed from hospice care for the dying and aims to meet the various needs of those suffering from advanced incurable progressive disease. Specialist palliative care is not expensive and can be made available to all those who need it, at home, in hospital or in a hospice. Arguments in favour of permitting euthanasia for those dying as a result of a chronic disease are usually based on compassion respect for autonomy or perceived hypocrisy in existing medical practice. Each of these arguments is examined and found wanting.     

Rehabilitation psychologists in medical settings: A unique subspecialty or a redundant one?

A critique of the literature addressing functions of rehabilitation psychologists in medical settings was accomplished in order to determine the range of roles typically assumed by them. Although this search yielded relatively few citations that clearly outlined duties and functions commonly undertaken by them, it did provide evidence that many use a behavioral framework and that their incorporation of new technologies, such as biofeedback, has helped to mainstream them into medical practice. In addition, the current emphasis placed on cost containment suggests that many of the treatment modalities practiced by rehabilitation psychologists will be increasingly used in medical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alternative medicine: underevaluated or ineffective?

Treatment of WISH (human amnion) cells with interferon-gamma (IFN-gamma) inhibits their growth. Release of the cells from IFN-gamma-mediated growth inhibition led to a rapid and significant increase in DNA synthesis, followed by doubling of cell numbers. The DNA synthesis profile was strikingly similar to that shown by WISH cells released from growth arrest by the G1/S phase inhibitor, aphidicolin. This strongly suggested that IFN-gamma treatment leads to growth inhibition of WISH cells at the G1/S boundary of the cell cycle. In contrast, IFN-alpha blocked growth of these cells at the G0/G1 boundary.     

Aloe vera: magic or medicine?

Some recent studies appear to show topical and orally administered aloe vera preparations in patients with chronic venous leg ulcers may aid healing. Despite encouraging results, in the absence of larger research studies, the author cautions against generalisation of this complementary treatment.     

Rehabilitation as interdisciplinary responsibility--the medical specialty "physical and rehabilitative medicine"

Physical and rehabilitation medicine is an independent medical subspecialty and is not derived from "physics" but from "physis-nature". Beside the elements of specific movements, it does use physical components such as heat, cold, light, water, and electricity for therapeutic purposes. Physical medicine and rehabilitation has always been a discipline with own methods, issues, and own areas of research and theory. The treatment techniques of this specialty are summarized under the term "physiotherapy". Its methods, which also contain balneology and medical climatology, are using physical and physiological principles of order in the organism. The application of this therapy happens for the training of impaired functions, influence of pathogenetic processes causing pain, and for the activation of the body's regeneration capacities. Physiotherapy is not limited to certain diseases or stages of illness but may prevent, abolish, or weaken malregulation of functional units, especially when used in repetitions. A particular focus of the rehabilitation is to address the still remaining functional reserves of an injured organism in a way that a compensation can be reached as close a possible to the etiological point of the pathogenetic chain of causes. Declared goal of the physiotherapy is the induction and optimization of healing processes. Due to this interdisciplinary approach, physical and rehabilitation medicine is an essential part for almost every medical subspecialty. Because of the increasing importance of this discipline, the specialist for physicial and rehabilitation medicine was introduced in Germany in 1992.     

Bioethics in the medical subspecialty literature

The high affinity growth hormone-binding protein (GHBP) circulates in human blood and represents the extracellular domain of the growth hormone (GH) receptor. It is well known that repetitive bouts of endurance type exercise result in increased integrated GH secretion. As the effects of chronic exercise on plasma GHBP levels have never been studied systematically, we investigated the effect of 2 weeks of intense endurance training on plasma GHBP as well as on plasma insulin-like growth factor (IGF)-I levels in 10 healthy, young, non-obese men. IGF-I was measured as an indicator of the effects of GH release. We also studied 10 control subjects matched for sex, age and activity, who were instructed not to change their customary activities. GHBP was determined by FPLC size exclusion chromatography and subsequent Scatchard plot analysis of the binding data; IGF-I levels were measured by RIA. The results showed that plasma IGF-I and GHBP levels were increased in the subjects who followed the training program. IGF-I and GHBP changed from 252 +/- 56 ng/ml and 912 +/- 59 pmol/l before training, to 344 +/- 61 ng/ml (p < 0.01) and 1020 +/- 48 pmol/l (p < 0.01), respectively. Another effect of the training was that the aerobic capacity of these subjects was better utilized and endurance was improved. In contrast, plasma IGF-I, GHBP, utilization of aerobic capacity and endurance did not change significantly in the control subjects. We conclude that two weeks of strenuous endurance training lead to increased plasma IGF-I and high affinity GHBP levels.     

Diagnostic process in internal medicine: decision analysis or intuition?

The diagnostic process is a hypothesis-testing approach under conditions of uncertainty. Experience-based intuition plays an important role in complex clinical situations. Serious cognitive errors may be avoidable if possible heuristic problems are considered. Probabilistic reasoning according to Bayes' theorem, especially for determination of pretest probability, is crucial for coping with uncertainty and the myriad available diagnostic tests and procedures. Their proper interpretation depends on fundamental test variables such as sensitivity, specificity and likelihood ratio. Computers and neural networks cannot replace cognitive reasoning and probabilistic strategies in daily clinical practice. Decision analysis is pivotal, particularly when the aim is to maintain high-quality medical care at a time of limited resources.     

Decision to use complementary medicine: fact oriented or irrational?

PROBLEM AND OBJECTIVE: Complementary medicine is being used to varying extent in all industrial countries. There are incomplete data concerning efficacy, safety and costs of such treatment, while little is known about special features and motivation of those persons who choose complementary medicine. The aim of the study was to ascertain, among patients who use complementary medicine and those who prefer traditional medicine, any differences with regard to sociodemographic, disease-related and psychological characteristics and their life-style. PATIENTS AND METHODS: A total of 419 patients were studied by a standardised interview and questionnaire (168 items) and divided into two groups (group 1: those using conventional treatment [n - 197; 91 women, 106 men; average age 43.2 +/- 16.9 years]; group 2: those preferring complementary medicine [n = 222; 159 women, 63 men; average age 43.2 +/- 15.0 years]). They were recruited from specialist internal medical or generalist medical practice with or without offer of complementary medicine (additional term: natural healing methods). Statistical analysis was with Student's-t-test and the chi(2)-test [correction of gamma-test]. RESULTS: Those patients who chose to be treated by complementary medicine clearly differed from the others with respect to sociodemographic, disease-related and psychological characteristics, as well as life-style. The patient-doctor relationship also differed between the two groups. On average those of group 2 had a higher educational level (higher education: 10.3% in group 1; 15.9 in group 2) and lower risk factors (68.9% nonsmokers in group 1, 77.8% in group 2; alcohol abstinence: 33.2 vs 46.4%). Patients in both groups preferred conventional medicine for serious diseases (cardiac infarct; tumour; AIDS). CONCLUSIONS: In general, those patients who choose complementary medicine have a healthier life-style. As the number of these patients is on the increase. Since as yet the efficacy, risks and costs of complementary medicine have been inadequately investigated, research in this area should be intensified.     

Complementary or Alternative medicine and the Internet

Complementary or Alternative Medicine (CAM) is being used with increasing frequency in the United States. This paper describes what CAM is, and catalogues mainstream medical Web sites. These online resources contain extensive information on CAM, and will provide a means to stay current with this sometimes-new yet often ancient area of medicine.     

Scientific medicine or alternative healing--a basic question

PEG-ADA is a long-circulating form of adenosine deaminase (ADA) that has been in use for > 8 years as replacement therapy for severe combined immunodeficiency disease due to ADA deficiency. Treatment with PEG-ADA almost completely corrects metabolic abnormalities, allowing the recovery of a variable degree of immune function. Although not normal, the level of function achieved has in most cases been sufficient to protect against opportunistic and life-threatening infections. PEG-ADA has been used as an alternative for patients who lack an HLA-identical bone marrow donor, but are judged to be at too high a risk for undergoing HLA-haploidentical marrow transplantation. To date, mortality and morbidity with PEG-ADA have been less than for the latter procedure. PEG-ADA has also been an important adjunct to attempts to develop somatic cell gene therapy for ADA deficiency, although its continued use poses a problem for evaluation of the benefit of gene therapy. As a true "orphan drug" developed to treat a very small patient population, the cost per patient of PEG-ADA is very high.     

中医院校康复治疗学专业分化之探讨

总结经验,探讨在中医院校背景下康复治疗学专业分化的教学模式,首先在前两年完成医学基础课程后,在后期分化为物理治疗和作业治疗方向,课程的侧重点有所不同.其次,在重视学习现代康复医学的基础上,同时也要发挥中医特色,突出以针灸推拿为主要特色的技能学习,吸收中国传统康复的理论和技术精华,指导中西医结合康复的教育建设.     

Expanding the specialty of occupational and environmental medicine: the role of the chief health officer. The Sappington Lecture

Passage of the Occupational Safety and Health Act in 1971 represented a major milestone for occupational and environmental medicine. Creation of the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) flowed directly from the legislation, and the specialty of occupational medicine entered a new era. As the 25th anniversaries of OSHA and NIOSH are celebrated, consideration of the future of the specialty of occupational and environmental medicine seems timely. In this lecture, an expanded role for the specialty is proposed, based on an analysis of the forces shaping the practice of public health and the opportunities that these forces present. This analysis suggests considering the concept of a "Chief Health Officer" serving the broad health needs of the workplace.     

Cardiovascular prevention, primary or secondary, in high risk patients

Two groups of patients admitted to hospital consecutively for coronary artery disease in 36 university hospital departments were interrogated about the advice received and followed concerning cardiovascular prevention both before the clinical onset of the disease (Group I), those with disease of less than one month duration (primary prevention), or after this period (Group II), those with disease for over six months (secondary prevention). The follow-up of risk factors or medical advice concerning prevention (dietary and/or treatment) was more common, and compliance to the advice was better, in secondary prevention. However, in both groups, with the exception of hypertension, the diagnosis and follow-up of the risk factors were incomplete with 19% vs 41% (p < or = 0.001) of serum cholesterol levels unmeasured before the onset of clinical disease; during the last 5 years, 41% vs 12% (cholesterol, p < or = 0.001) and 27% vs 9% (serum glucose, p < or = 0.001) were not checked. At least one measure of prevention had been advised to 66% vs 80% (p < or = 0.001) of patients and the measures taken concern 53 vs 75% (p < or = 0.001) of patients: serum cholesterol 27% vs 51% (p < or = 0.001), hypertension 32% vs 36% (NS) and serum glucose 14% vs 21% (p < or = 0.05). Compliance with advice was mediocre with regards to diet and cholesterol lowering drugs. A large proportion of patients in both groups had higher than recommended levels, including those on diet or treatment. These observations, confirmed in France and abroad, suggest that cardiovascular prevention should be better organised.     

Meaning or medicine: The future of psychoanalysis in the professional schools.

Psychoanalysis is experiencing a decreasing presence in predoctoral education. The promotion by the American Psychological Association of so-called "evidence-based treatments" reflects the dominance of technocratic, positivistic epistemology, and cognitive-behavioral symptom-oriented approaches to psychotherapy fashioned in the medical model. In contrast, professional schools of psychology, most awarding the PsyD, are committed to epistemological and theoretical pluralisms more suited to psychoanalysis, essentially a humanistic and critical discipline concerned with human agency and language, not biological mechanisms. Psychoanalysis defines problems in terms of human meanings, rather than quasimedical procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)