THE WRITING OF MEDICAL HISTORY.
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Pain has been a major medical problem from the beginning of recorded history. Since the earliest medical writings, there have been innumerable procedures designed to relieve pain and its suffering. In this study, we have reviewed both the early medical writings of various civilizations and the first modern publications, to compile a history of neurosurgical procedures for the relief of pain.
Just as literary conventions and styles evolve, so even do "styles" (acceptable form) in medical writing. The guidelines suggested in this paper for the preparation of various types of figures are based on current standards in scientific and, particularly, medical writing. However, since at any given time there may exist two or more equally acceptable variations of "standard" practice, it is to a physician-author's advantage to examine the particular stylistic preferences and format of the journal to which he will submit his manuscript. Hopefully he can thereby avoid later editorial requests to revise or even completely redesign figures in which he has already invested much time.
In the history of philosophy, theology, and medicine, Maimonides shares the limelight with Arabic scholars such as Ibn Rushd, Ibn Sinna and Ibn Zuhr, chronologically between the great intellectuals of classical Greece and Rome and those of the later Middle Ages and early Renaissance. Maimonides was a very great philosopher and theologian, usually underrated by the historians. He was also an outstanding medical practitioner and teacher. Moses Maimonides had an incredible literary ability and an encyclopedic knowledge. He wrote extensively in the fields of theology, mathematics, law, philosophy, astronomy, ethics, and, of course, medicine. His medical writings are varied, comprising extracts from Greek medicine, a series of monographs on health in general and several diseases in particular, and a pharmacopoiea. The present essay extracts, primarily from Maimonides' medical writings, his pronouncements dealing with headache. Since most of Maimonides' pronouncements about headache in his Medical Aphorisms were derived from Graeco-Roman medical writers such as Hippocrates, and especially Galen, in regard to these statements Maimonides was merely a compiler--not an innovator. Some of his concepts about the causes of headaches being related to a dysequilibrium of the body humors are clearly medieval in origin. Other statements demonstrate this concern with preventive medicine and the maintenance of a healthy regimen of daily living. Medications to treat illness should only be used if non-medicinal means such as diet and exercise are not effective. The heritage of Maimonides' writings is being more and more appreciated.(ABSTRACT TRUNCATED AT 250 WORDS)
The care of the blind, either as medical treatment or as divine therapy, has probably been the most ancient form of help for ill people. However, it was during the Byzantine Empire (325-1453 AD) that the state organized a 'blindness relief' plan as part of a widespread public health system. Our sources for the subject include medical writings, state decrees, Saint's 'vitae' and representations of relevant works of art. Based on the above data we classify the health care for the blind in Byzantium as: (a) support of ophthalmological education as evidenced by an abundance of medical writings on the subject; (b) establishment of charitable institutions exclusively or partially for the blind, where there was not only medical care but also provision for a wide range of social aid - the most advanced being specially trained escorts for each blind person; and (c) support by the state of an extended chain of religious institutions where miraculous help for the blind was promised. We conclude that the public health policy in Byzantium made adequate and very early provision for the blind.
The author describes the editorial rules of the different forms of articles published in medical journals: editorial, original article, review article, clinical observation, letter, clinicopathological discussion, pedagogic article. The majority of these forms of articles must follow a simple plan of writing ("the IMReD plan"), including introduction (why I did this study?), methods (how I did this study?), results (what were my observations?) and discussion (what do I think about these results?).
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OBJECTIVE: Using a Delphi Consultation process, a group of medical writers established by the European Medical Writers Association (EMWA) set out to determine the current thinking on the problems of ghostwriting in medical publications and what should be done about them. In this context, ghostwriting is where a professional medical writer prepares a manuscript on behalf of a named author, but the writer is not listed as an author. METHODS: A 4-round Delphi consultation process was conducted via email to generate statements about the main issues in ghostwriting. Participants rated their agreement with the statements on a scale of 0-10. RESULTS AND CONCLUSIONS: Members of the task force strongly believed that professional medical writers can improve the quality of scientific papers, but that fact is often not recognised outside the medical writing profession. At least in part, this is because of a perception that ghostwritten papers may have been inappropriately influenced by pharmaceutical companies. One theme that emerged strongly from the discussions was transparency. Members thought it very important that the existence of a ghostwriter should always be made clear to the reader. Another strong theme was the importance of defining in detail what practices relating to ghostwriting are ethical, and what practices are not. This definition of ethical ghostwriting should be widely known, and unethical ghostwriting should be strongly condemned. Use of the term 'ghostwriting' itself was questioned. Members of the task force felt that use of a more neutral term should be encouraged. The task force suggested various activities for ensuring that above the objectives could be met, including discussions with other interested parties, such as journal editors and pharmaceutical companies, educating medical writers about ethical practices, further research into ghostwriting, and developing guidelines for ethical medical writing.
UNLABELLED: Physicians participate in the legal process of appointing guardianship by writing medical certificates concerning guardianship. There are no instructions or clear-cut methods to examine how to determine a person's ability to handle his own affairs (estate and body), or to evaluate his ability to express his opinion concerning guardianship. There are, however, a number of ways to examine and analyze the subject. Our paper presents findings from 16 randomly collected medical certificates from diverse sources (13 different institutions, physicians from various specialties), for which the courts decision is known. We checked to see if the medical certificates relate to and fulfill basic medico-legal and clinical points referred to in the professional literature. RESULTS: We found that full demographic details were recorded in only one certificate (6.2%), the identity of the solicitor of the certificate was mentioned in 3 cases (18.7%) and the source/s of information in 6 cases (37.5%). Results of complete cognitive/mental examination (mental status) were mentioned in 4 cases (25%), psychiatric diagnoses in 12 cases (75%), level of severity in 9 cases (56.2%), reference to a temporary phenomenon in one case, and evaluation of basic daily functioning in 2 cases (12.5%). None of the cases included more complex daily functioning evaluations (instrumental). Similarly, none of the certificates mentioned whether or not legal criteria were used to evaluate the subjects ability to handle his estate or body or his ability to express his opinion concerning guardianship. On the other hand, formal reference to the ability to handle affairs (in 7 cases [43.7%] distinction between estate and body) and to express an opinion concerning guardianship was noted in 15 cases (93.75%). The length of the medical certificate averaged 13.8 lines (standard deviation 10.1, range 4-41); 13 of the certificates were written in public forums with an average length of 9.9 lines (standard deviation 4.6, range 4-20 lines), as opposed to 31 lines (standard deviation 9.5, range 22-41) for the private sector. Our findings suggest that the medical certificates were lacking in clinical facets examined, especially the medico-legal aspects. Despite these shortcomings, the courts accepted the overwhelming majority of the documents (15/16, 93.7%), perhaps because most of the certificates included formal reference to specific legal questions raised in the court (ability to handle affairs, ability to express opinion concerning guardianship). In our opinion, these findings, if validated in larger groups and in more courts, require multi-system re-evaluation of the subject of writing medical certificates for legal guardianship of the elderly.
Acquisition of an advanced medical degree beyond licensure and specialization is advantageous and encouraged in Swedish medical education. Since a thesis and a number of published works, usually in English are required, there is considerable interest in medical writing by doctors and medical scientists. A voluntary course in 'Biomedical Authorship' which included presentation of oral reports was offered by the Karolinska Institutes' Medical Faculty. This course was intended to prepare participants for their thesis work and for presentations at scientific congresses. The course revealed that the principle difficulty was not in English skills which were rather good, but in the students' inexperience in critically rereading what they had written and making suitable revisions. A case study method was used so that students acquired experience in critically reading and correcting their own work and that of others. An instructor who understood the evolution of academic Swedish was of considerable help in explaining some of the 'Swenglishisms' that arose during the course. The oral presentation portion, which used videotapes of students, showed the students as lacking experience in basic public speaking and as frequently being apprehensive. This was much improved by taped poetry readings, scientific reports and slide shows. This Swedish experience should apply to teaching biomedical writing in the other Scandinavian countries and in Northern Europe.
The medical training and skills of seafarers are rather limited. In Finland, the master is responsible for medical care of his crew members, having only a 5-day training in medical matters which is refreshed every year. As medical incidents are rather rare events on board ship, he has not many opportunities to increase his knowledge in this field. Highly educated and experienced medical doctors have written medical guides for ships, describing diseases and advising on their treatment. This advice is based on diagnoses made on board ship by masters. They are often incorrect, therefore the advice on treatment may also be not correct. Authors of medical guides for ships should take into consideration the limited skills and medical knowledge of persons responsible for providing health services for crews at sea. This service is usually limited to giving first aid in accidents and sudden diseases, and care of the injured or sick seafarer until he can be transported to a medical facility on shore. Long lists of possible diagnoses in the text of such a guide only cause confusion in situations on board ship. In the new edition of the guide published in Finland in 2002, the advice on treatment is based on symptoms rather than on diagnoses.
Unethical practices are not unusual in medical scientific articles, but they are not always recognized as being unethical. The author discusses both obvious unethical behavior, such as fraud, plagiarism, and conflict of interest, and a number of other practices, such as errors in citations, misuse of statistics, and wasteful publication, which are more widespread and generally accepted, but which may be considered unethical. Increased awareness of these issues could reduce the extent of these practices.
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