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PubMed1995

Making reaccreditation meaningful.

Reaccreditation is a well-accepted fact for many doctors outside the United Kingdom and is likely to become a reality for British general practitioners. The author'sabbatical year in the United States of America studying reaccreditation and its relationship to continuing medical education has enabled a critical analysis of recent proposals in the UK to be carried out. The aim of reaccreditation must be understood by the profession and must be clearly stated. To be credible it will have to be mandatory and linked to continuing medical education. Current types of continuing medical education must be developed so that they are meaningful, influence doctors' behaviour and include research, audit, training, reading and medical writing. The profession must confront the need to penalize the small number of doctors who have an unacceptable standard of practice. The potential benefits of an appropriate form of reaccreditation may include improved quality of care and patient outcome, enhanced job satisfaction and reduced rates of burnout.

Accreditation↗
PubMed1992

[Hippocratic concept of hysteria].

The Greek physicians of the fourth century B.C. painstakingly described a number of symptoms that they thought were caused by migrations of a restless uterus, said "wandering womb". According to this concept, we can use the term "hysteria", despite the fact that the noun itself never appears in any of the Hippocratic texts. We can determine its origin as being in ancient Egypt from the medical writings of the Egyptian papyri. In the same way, the therapy is mainly of Egyptian origin, using a combination of recipes to make the moving womb return to its proper place in the body cavity. However, we can also identify the rationality of the Greeks, in particular as regards mechanical physiopathology. Hippocratic authors are closely connected with presocratical physics, and manifest a distinct break with magic and religion. Furthermore, they claim that hysteria may result from prolonged sexual continence, an opinion which was to influence medical history for over two thousand years.

Egypt, Ancient↗
PubMed1995

[The German addendum to Hildegard von Bingen's 'Liber simplicis medicinae' in Codex 6952 of the Bibliothèque Nationale in Paris (fol. 232v-238v)].

The article contains an analysis and edition of the German appendix to Hildegard of Bingen's 'Liber simplicis medicinae' ('LSM', also known as 'Physica') in Codex 6952 of the Bibliothèque Nationale in Paris. Surprisingly, the German text is not based on the preceding Latin treatise, but on another unknown version of the 'LSM' which is closer to the archetype. The appendix thus has to be regarded as a new manuscript find, which also contains material found only in Hildegard's 'Liber compositae medicinae' ('LCM', also known as 'Causae et Curae'). This suggests that the translator had access to both texts, or that both once circulated as one treatise. In the reception of Hildegard's work, the 13-page German appendix is unique in that Hildegard's description of nature is transformed into three different types of medical writing: 1) a herbal, 2) a catalogue of diseases from head to toe and their remedies, and 3) a dietetic list of foodstuffs. To illustrate the technique applied by the compiler/translator, the edition of the Paris-appendix identifies all the quotes from the 'LSM' and 'LCM' which have so far been uncovered.

Germany↗
PubMed2003

[The prescription as literature].

In the medical writings of antiquity the recipe, a basic form of scientific writing, was considered a literary genre with conventions of its own. In texttype-linguistics, however, the recipe plays only a minor role; in studies on the history of literary short texts it is hardly ever mentioned and, furthermore, it has come to the conclusion that the recipe's function has lain solely in the curing of the sick. The present study focuses on its multifunctional character. A collection of widely scattered and hardly accessible recipes shows that the recipe adopted functions beyond giving technical directives. Its multifunctionality in the German literature of early modern times is manifest in medical and cooking jocular recipes, cooking recipes in minnesang, mock recipes aimed at physicians and astrologers, recipes of spiritual-religious content, recipes containing art and literary criticism as well as recipes in a moral-satirical or a political-agitative vein.

Cooking↗
PubMed2001

[The importance of feeling the pulse].

The physician Bordeu (1722-1776) is best known as a character in Diderot's Reve de d'Alembert. Yet his medical writings are worth studying for their synthesis of ancient and modern medicine. In particular, his "Recherches sur le pouls par rapport aux crises," published in 1756, is a valuable source for investigating subtle changes in the methods of and reasons for pulse taking. Bordeu proposed to read more from the pulse than the usual patient's temperament. He thought that the blood stream manifested bodily activities, indicated where diseases occurred, and predicted when and where crises took place, which could relieve morbid matters. The study of "Recherches sur le pouls" shows how he adapted traditional and current theories to his specific goals. In accord with the sensationists, he wanted to increase the use of touch to advance medical knowledge. Bordeu chose the pulse while Auenbrugger (1728-1809) turned his attention to percussion. Both physicians were striving for means to bring into focus a picture from inside the patient's body to the physician's mind. Bordeu's vitalist perspective used pulse feeling to reach functions; Auenbrugger's mechanistic bent applied percussion to reveal organs. Both correctly insisted that their method detected unsuspected pathologies; percussion is still widely used, while pulse feeling is often neglected.

France↗
PubMed1998

Infertility treatment: lack of consensus plagues an unregulated field.

Each year, in an attempt to stimulate journalism students' interest in medical writing, CMAJ sponsors the Amy Chouinard Memorial Essay Prize. The $750 award is in memory of Amy Chouinard, a longtime and valued contributor to CMAJ and the Canadian Journal of Surgery. Students from any recognized journalism program at a Canadian college or university are eligible to enter, and the deadline for 1998 entries is June 1. The 1997 winner, Megan Easton, presents a well-written and thorough account of the issues surrounding infertility treatment. Interest in the topic came naturally enough--her father, Dr. William Easton, is a urogynecologist in private practice in Scarborough, Ont.

Biomedical Research↗
PubMed2006

Challenges facing academic dermatology: survey data on the faculty workforce.

BACKGROUND: There is a perception among many academic dermatologists that departments of dermatology face severe challenges with recruitment and retention of faculty. In an era when evidence points to a shortage of dermatologists and residency graduates have plentiful private practice offers in almost every geographic area, some fear that academic programs will face even steeper challenges attracting and keeping enough dermatologists on staff. METHODS: To compare the practice patterns of academic dermatologists with those of the dermatology workforce in other settings, data from the American Academy of Dermatology 2002 Practice Profile Survey were analyzed (1425 respondents, 35% response rate). RESULTS: The mean age of academic dermatologists (45.6 years) was younger than that of those in other practice settings (51.9 years solo practice, 49.0 years multispecialty group), and older age cohorts were significantly less likely to be working in academics (P < .001). Academic physicians were much more likely than those in solo practice or dermatology-only groups (62.2% vs 18.3%-39.4%) to report that their institution or practice was seeking new dermatologists. The average waiting time for new patient appointments varied from a low of 31.1 days in solo practices to a high of 55.9 days in academic practices. Academic dermatologists saw 32% to 41% fewer patients per week, but spent much more time (24.1 vs 5.5-8.6 h/wk) participating in research, hospital consults, medical writing, administrative activities, and teaching than dermatologists in any other setting. LIMITATIONS: Academic dermatologists reflected a relatively small proportion of survey respondents, and may not be representative of the nation's dermatology faculty (although the percentage of academics in the survey was similar to that in the overall workforce). Possible response biases could also have affected the survey results. CONCLUSIONS: The survey results identify a number of differences between the practice patterns of academic dermatologists and their colleagues in other settings, and suggest that academic departments of dermatology may be facing unique workforce challenges.

Adult↗
PubMed1994

Analysis of the structure of original research papers: an aid to writing original papers for publication.

BACKGROUND: An increasing number of people involved in medicine are under pressure to publish research, but there is little understanding of how to describe structured writing. AIM: This paper aims to describe the structure of original research papers published in the British Journal of General Practice with a view to providing insight into the nature of such analyses, and particularly to help researchers and trainers to write and teach writing more successfully. METHOD: A sample of 50 original papers published in the Journal between January 1989 and March 1993 were examined. The papers were subjected to a form of 'move structure analysis', a technique used in applied linguistics; move structure analysis assigns a tentative function to a piece of text, and identifies words/phrases associated with it. To be recognized, moves thus identified had to occur in the same section of the paper in 65% of the corpus, and/or appear in the same order relative to other moves in 50%. RESULTS: Fifteen moves were identified, four in the introduction, three in the method, and four each in the results and discussion. These moves functioned, for example in the discussion, to state limitations and defend successes; describe achievements; contextualize procedures and findings; and offer recommendations. Frequency scores ranged from 66% to 100%, and order stability scores from 50% to 80%, with three moves being unordered. CONCLUSION: It is possible to derive from this study a template for structuring academic medical writing. This template may be built up from the exemplary quotations in the text, to provide assistance to educators and less experienced writers.

Publishing↗
PubMed1976

A mandatory course in scientific writing for undergraduate medical students.

All students at Mayo Medical School take a course in scientific writing during their sophomore and junior years. Early in the sophomore year they receive a self-instructional text designed to help them avoid 15 common writing faults. Comparison of pretest and posttest results for two classes, with a total of 89 students, indicates significant improvement (p less than .001). Later in his sophomore year, each student writes a minithesis; and during his junior year he reports on work done in a clinical or laboratory research project, preparing it as a paper submissible to a scientific journal. Professional editors work as preceptors with the students, critiquing their manuscripts, which are revised until they receive satisfactory ratings.

Education, Medical, Undergraduate↗
PubMed1977

The concept of childhood in the middle ages.

The question is raised of whether the Middle Ages held a view of the nature of childhood as distinct from adulthood. Evidence is offered from legal documents, medical writings, and church and monastic chronicles to support the viewpoint that the special nature of the child was perceived (although with great ambivalence) as being fragile, vulnerable, and naive, while also possessing a potential for closeness to God and the supernatural world.

Attitude↗
PubMed1991

Ophthalmological therapy in hospitals (xenones) in Byzantium.

Based on the typikon of the Imperial Monastery of the Pantocrator of Constantinople (12th century) and the manuscripts used in the Byzantine hospitals as well as the published Lives of the Saints and other related sources, it is undeniable that special ophthalmological departments existed in the xenones of Byzantium. It is also proven, that specific ophthalmological therapy was practised here including surgery and particularly in the cataract operation. This last operation is attested to, not only by the medical writings of Byzantine writers but also from the therapies of the physician-saints Cosmas and Damian.

History, Ancient↗
PubMed2006

Manufacturing consensus.

The Food and Drug Administration (FDA) has declared that it would be illegal to advertise as or in any way claim your drug to be superior to competitors on the market, which are up to 30 times cheaper. How does a pharmaceutical company market such a product? The answer is to enlist academics to form expert panels to construct guidelines and algorithms, or participate in Delphi panels and other exercises, which can be expected to prove that newer, more costly drugs produce cost savings. These academics do so on the basis of the existing clinical trial evidence--which supposedly the FDA has used to come to its verdict that the newer compound is no better than its competitors. However, where the FDA has seen the raw data, academics later see the published data. In between intervenes a medical writing exercise, which produces the first and most important piece of advertising for any pharmaceutical product--the randomized controlled trial infomercial. This paper explores how pharmaceutical companies manufacture an apparent academic consensus and, in so doing, gives a case study of the recent controversies surrounding the marketing of selective serotonin reuptake inhibitor (SSRI) drugs for adolescent depression.

Adolescent↗
PubMed1984

The case report. II. Style and form.

When you have completed the first draft of your manuscript, put it aside for a couple of weeks before you begin your critical review and revision, so that you will examine it with a fresh eye and renewed interest. Read your composition several times, concentrating on a specific criterion each time. Begin with the general principles of originality and validity; next move to structure and organization, then to grammatical propriety and usage, and finally to readability. Sensitize yourself to the recurrent maladies in medical writing--the verbosity, jargon, imprecision, barbarisms, stereotypy, illogical locutions, improper sequence of tenses, and generally unappealing style. Remember, you are writing to convey an important message, so make sure your style and form illumine rather than eclipse or becloud that message.

Humans↗
PubMed1986

Alcohol dependence: a biobehavioral perspective.

The behaviorally based constructs of DSM-III have differentiated alcohol abuse and dependence, wherein the latter has been characterized by: a history of tolerance and physical dependence; and a history of pathological drinking patterns and/or problems consequent to drinking behavior (APA-DSM III 1980). In contrast, ICD-9 refers to an alcohol dependence syndrome which follows the model proposed by Edwards and Gross in 1976. The WHO memorandum on nomenclature and classification of drug and alcohol related problems has further proposed that alcohol dependence be defined along a continuum of severity, and that dependence be differentiated from severity of alcohol related disabilities (Edwards et al. 1981). In many respects, the alcohol dependence syndrome construct is consistent with Jellinek's disease concept of alcoholism which had its antecedents in medical writings of the late eighteenth and early nineteenth centuries (Lender 1979). Commencing in the early 1960's, many behavioral and social scientists were critical of the disease model of alcoholism. Behavioral researchers found that the drinking behavior of alcoholic subjects could be controlled by its consequences in the laboratory, suggesting that drinking behavior was like any operant. Longitudinal studies of drinking practices suggested that relapse to dependent drinking did not appear to be inevitable. In general, these researchers have utilized behavioral and epidemiological data to prove the null hypothesis: that there was no biological disease behind alcohol addiction. In contrast to the operant studies which served to rebut the disease construct, Ludwig and associates employed a model of Pavlovian conditioning which suggested a relationship between an alcoholic's desire to drink and an increase in autonomic arousal associated with the presence of alcohol (Ludwig et al. 1977).(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholism↗
PubMed1991

Physical fitness, dynamic extra-arterial pressures, and the pathogenesis and distribution of atherosclerosis.

Medical writings on cardiovascular disease focus on intravascular pressures. Tissue pressure is assumed to be essentially atmospheric. Yet, under dynamic conditions of sitting, standing, walking, breathing, and the beating of the heart, significant pressures, both above and below atmospheric, do develop outside of important arteries. These dynamic extra-arterial pressures either decrease or increase the pressure gradients across arterial walls, i.e. the transmural pressures are changed. Physical fitness may either prevent the development of negative extra-arterial pressure or increase positive extra-arterial pressure, thereby protecting important arteries from high effective pressures. Deconditioning, old age, abdominal obesity, and other cardiovascular disease risk factors may do just the opposite, in effect, causing 'localized hypertension' in clinically important arteries. This, in turn, may lead to localized acceleration of atherosclerosis. The correlation of predictions made from this hypothesis with clinical findings is so remarkable that it suggests there is a direct cause and effect relationship between transmural arterial pressure and atherosclerosis. The concept of dynamic extra-arterial pressure seems to solve a number of puzzles and paradoxes in cardiovascular disease, it suggests key measurements that may be predictive of disease, and it offers new ideas for treatment and prevention.

Arteries↗
PubMed1979

La menespausie--the birth of a syndrome.

The prevalent assumption that climacteric disturbances appeared when the expectation of life of women assured survival past the menopause cannot be supported demographically. These disorders are largely conditioned by sociocultural factors and, therefore, may be expected to have been initiated when these factors became stressful. Historical examination shows that medicine, or its marginal practitioners, were always involved in the postponement of ageing whenever the status of women depended more on their attractiveness than other social determinants, a logical "geriatric" extension of its traditional cosmetic activities. No menopausal disturbances are however recorded until the social convulsions of the French Revolution, and the regimes which followed, seem to have crystalized the various complaints of the climacteric into a disease-expression, which reified the social stress to which women were subject. This is dramatically reflected, both in the medical writings published in France around the year 1800, and in the naming, for the first time, of this phase of woman's life: La Menespausie, soon shortened to Menopause.

Adaptation, Psychological↗
PubMed2004

Tackling the case report.

OBJECTIVE: Resuscitative measures are required to ensure the survival of the case report in medical writing. The aim of this study was to assess a series of case reports for quality improvement. METHODS: All articles pertaining to a single patient published in Auris Nasus Larynx and The Journal of Laryngology and Otology from January to December 2000 inclusive were examined. Data recorded included authorship numbers and origin of the report, pertinence of the accompanying abstract, length of the article, claims of a first and the number of references included in the bibliography. RESULTS: Twelve different countries produced 129 papers in the two journals. Author numbers ranged from 2 to 7 (mean 4.56) in Auris Nasus Larynx, and were 1 to 11 (mean 2.63) in The Journal of Laryngology and Otology. Overall, there were 45 articles of two pages or less. An appropriate summary existed in 79.6% of articles published in Auris Nasus Larynx and in 33.9% of abstracts located in The Journal of Laryngology and Otology. A unique occurrence was reported in 14 and 27.82%, respectively. The number of citations ranged from 3 to 28 (mean 12.4) in Auris Nasus Larynx and 2 to 28 (mean 10.2) in The Journal of Laryngology and Otology. CONCLUSION: Case reports require a more applicable summary with a limit on authors, pages and references.

Case-Control Studies↗
PubMed2006

The botanical materia medica of the Iatrosophikon--a collection of prescriptions from a monastery in Cyprus.

This article analyses the botanical material that is contained in the Iatrosophikon, a collection of prescriptions from a monastery in Cyprus written down during the island's Ottoman period (1571-1878). A total of 494 herbal prescriptions were detected in the record and 231 plants belonging to 70 different botanical families, as well as 21 various substances of botanical or mixed origin were identified. The distribution of the plants, the plant part used, the use of the material, and the mode of application are discussed. Parallels with other medical writings of the Greek-speaking Ottoman world suggest a local popular as well as a classical Greek and Byzantine influence. The latter is particularly supported by the relationship of the majority of the plants described to plants mentioned by Dioscorides. Additionally the question of what other sources might have contributed to this herbal knowledge is discussed. The results also show that most of the plants described originated from the island itself, only a minority of the botanical material presumably had to be imported. All the mentioned plants of local origin are also cited in modern ethnopharmacological studies on Cyprus, the Iatrosophikon demonstrates their use at a time from which no other written source of comparable detail exists.

Cyprus↗