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Biomedical subjects

Stephen J Genuis

Publications and source records attributed to Stephen J Genuis.

11 recordsLinked to original sources
PubMed2006

Diagnosis: contemporary medical hubris; Rx: a tincture of humility.

Despite increasing attention to evidence-based medicine, unprecedented advances in medical technology, and rapid diffusion of innovative information, there continues to be disturbing disclosures of widespread iatrogenic illness resulting from harmful medical interventions. The medical community at times displays a lethargic and lackluster response to important scientific and epidemiological data that challenges prevailing conventional wisdom or that elucidates existing medical miscalculations. To ensure that long-term health and well-being for patients and the community remains the primary goal of medicine, it is necessary to revisit the important issues of scientific integrity, health care objectives, and medical professionalism. Furthermore, to be trustworthy advisors for individual patients and credible advocates for the health of populations, the medical community needs to critically evaluate the profound influence of commercial interests on medical research, medical education and clinical practice.

Biomedical Research↗
PubMed2006

Exploring the continuum: medical information to effective clinical practice. Paper I: the translation of knowledge into clinical practice.

This paper investigates the translation of medical information into clinical practice and the role of thoughtful dissent by exploring the influence of sociological factors on change, the impact of evidence-based medicine (EBM), and the role of industry. Changing practice related to hormone therapy for menopausal and post-menopausal women provides context for this discussion. Medical change involves diffusion of ideas to potential users and ongoing reconciliation of new information with old ideas; this process is influenced by sociological factors including values and experiences, interpersonal relationships and local context. While EBM has alerted doctors to the importance of high quality research and theoretically provides a tool for translating research into practice, there are important problems with its application: (1) it has resulted in a reductionist approach to research and illness; (2) there is a considerable gap between research findings and the complex environment of clinical practice; and (3) EBM has been appropriated by experts, thus corporately developed 'standard-of-care' documents have become instruments of external regulation, and EBM has ceased to be a tool in the hand of individual clinicians. In addition, industry impacts the translation of knowledge by significantly influencing academia, researchers, medical publications, consensus conferences, and practising doctors. While questioning doctrinaire practices or directives is a daunting prospect for individual clinicians, the translation of knowledge into practice and evolution of medical thought is dependent on the progressive role of thoughtful dissent.

Biomedical Research↗
PubMed2006

Exploring the continuum: medical information to effective clinical practice. Paper II. Towards aetiology-centred clinical practice.

Contemporary clinical practice increasingly functions within a disease management paradigm aimed at finding and implementing therapeutic interventions that demonstrate efficacy in clinical trials. Disease prevention, elucidation of illness aetiology and proactive health promotion have taken a back seat. Current clinical care often includes a 'fast-food' type of medical encounter, which frequently neglects disease causality. The medical community is presently challenged by unique administrative and professional adversities as well as undue commercial influence; these factors contribute to a lethargic response to escalating rates of chronic illness and to mainstream medicine's relative inattention to emerging research about disease aetiology. Individual medical practitioners and the medical establishment must strategically seek to advance patient health and maintain professional relevancy by a renewed emphasis on the following principles: patient-based clinical care, aetiology-centred medicine, and proactive health promotion.

Chronic Disease↗
PubMed2006

The chemical erosion of human health: adverse environmental exposure and in-utero pollution - determinants of congenital disorders and chronic disease.

Epidemiological research designed to explore causality of illness has produced increasing evidence to verify that exposure to toxic agents is contributing to the escalating burden of chronic affliction, including congenital disorders. While endeavoring to facilitate optimal health and well-being for patients, the medical profession is currently challenged by the consequences of environmental factors unique to the modern era. In the last half century, there have been profound shifts in health-related habits of individuals and population groups, and recent research suggests that changes in the home and workplace environment are responsible for many common health problems including various congenital anomalies. As a result of increasing concern about environmental influences on health, 'Human Exposure Assessment,' the investigation and study of specific patient exposures and related health concerns, is a rapidly expanding area of scientific research. Practitioners of clinical medicine, including providers of maternity care, should acquire the skills to elicit a proper environmental exposure history and the necessary tools to implement proactive patient education relating to precautionary avoidance.

Abnormalities, Drug-Induced↗
PubMed2005

Implications of cyberspace communication: a role for physicians.

Through the presentation of three clinical case reports and subsequent discussion, it is demonstrated that physicians must begin to familiarize themselves with the health-related implications of online communication, and must proactively address Internet use as it relates to health and well-being. Included case presentations highlight the following: the established association between those seeking sexual partners through the Internet and an increased risk for sexually transmitted disease; the implications of cyber-communication for young people and concerns related to unsafe online behaviors including sharing identifying information with strangers; the potential use of strategically constructed virtual identities to facilitate sexual exploitation; the impact of accelerated intimacy and disinhibition evident in online communication; and the invasive nature of Internet sexual harassment or bullying. Although it is recognized that most online activities do not negatively affect health, doctors must be prepared to ask patients about Internet use and become involved in educating children, teenagers, and parents about safe online relationships to promote optimal physical, mental, and social health.

Adolescent↗
PubMed2004

Managing the sexually transmitted disease pandemic: a time for reevaluation.

The serious implications of the sexually transmitted disease (STD) pandemic that currently challenges educators, medical practitioners and governments suggest that prevention strategies, which primarily focus on barrier protection and the management of infection, must be reevaluated and that initiatives focusing on primary prevention of behaviors predisposing individuals to STD risk must be adopted. Human immunodeficiency virus/acquired immunodeficiency syndrome, human papillomavirus, genital herpes, and Chlamydia are used to illustrate the pervasive presence of STDs and their serious consequences for individuals and national infrastructures. Long-term sequelae are discussed, including the emerging link between various sexually transmitted infections and cancer, and the psychosexual and psychosocial factors which impact infected individuals. Although risk reduction and treatment of existing infection is critical, the promotion of optimal life-long health can be achieved most effectively through delayed sexual debut, partner reduction, and the avoidance of risky sexual behaviors.

Condoms↗
PubMedDate not supplied

Human exposure assessment and relief from neuropsychiatric symptoms: case study of a hairdresser.

Human exposure assessment and the results of implementing 'precautionary avoidance' suggested a relationship between a hairdresser's neuropsychiatric symptoms and occupational exposure to potentially hazardous chemicals. A variety of investigations in response to patient complaints of depression, emotional instability and various physical symptoms revealed no objective abnormality; the CH2OPD2 mnemonic (community, home, hobbies, occupation, personal habits, diet and drugs) recommended by the Ontario College of Family Physicians was used as a first-line screening tool to assess potential environmental exposure to toxins. After occupational leave of absence, the patient reported cessation of symptoms. Environmental causes for familiar medical problems are frequently undiagnosed; it is recommended that, where appropriate, a screening tool for evaluation of environmental exposure to toxics be incorporated into primary care assessment and management of patients.

Adult↗
PubMedDate not supplied

The proliferation of clinical practice guidelines: professional development or medicine-by-numbers?

In a medical milieu of extensive research, rapidly proliferating information, and a multitude of potential therapies, there has been an escalating trend toward the development and dissemination of clinical practice guidelines outlining investigative and management protocols for clinical problems. There are substantial benefits to providing educational directives and securing widespread adherence to specific clinical practice standards as a means to ensure a consistent acceptable standard-of-care. On the other hand, the increasing tendency to regard authoritative documents as dogma may hinder ongoing medical progress and facilitate the adoption of a "follow-the-recipe" approach to medical practice. A healthy tension between physician autonomy and recommended practice guidelines needs to be cultivated in primary care as well as in specialty clinical practice. In response to increasing concern surrounding issues of impartiality and commercial influence on the development of practice directives, a mechanism designed to assure integrity and credibility of guidelines is required.

Conflict of Interest↗