Imaginative writing.
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Education, Medical↗
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Who made John Snow a hero?
This paper describes how and why John Snow's investigation of the transmission of cholera grew into an epidemiologic classic. The evolution of the interpretation of the work of John Snow was first studied in depth in the Dutch medical literature, and thereafter traced more superficially in the bacteriologic, hygienic, and epidemiologic literature of Germany, the United Kingdom, and the United States. From the oral tradition of teaching, as well as from the written sources, it is concluded that US epidemiologist W. H. Frost was responsible for the revival of the work of John Snow in the 1930s. Besides the obvious and enjoyable clarity of thinking and reasoning, epidemiologically and medically, of the writings of John Snow, his example well suited epidemiology of the 1930s since his convictions came very close to the bacteriologic paradigm of the day.
Cholera↗
Writing for each other.
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Manuscripts, Medical as Topic↗
"Respectful image": revenge of the barber surgeon.
Although some separation of surgery from the practice of medicine had begun to develop in early medieval times, this was accentuated in 1215 by the Fourth Lateran Council, a papal edict which forbade physicians (most of whom where clergy) from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men of the church. As a result, the practice of surgery was relegated to craft status with training by apprenticeship through guilds. Physicians followed a university-directed program of education, which involved knowledge of the classics and writings of ancient medical authors such as those by Galen, which allowed no independent thought or inquiry. Competition among physicians and surgeons, including the lowest group of surgical practitioners, the barbers, continued until Henry VIII signed a charter in 1540 uniting barbers and surgeons in London. This Guild of Barbers and Surgeons, forerunner of the Royal College of Surgeons, established a regulatory agency for training and certification of surgical practice, which set the stage for legitimizing surgery as a profession.
Barber Surgeons↗
Visual acuity and the ability of the visually impaired to read medication instructions.
BACKGROUND/AIMS: Although medical information is often communicated in writing, little attention is given as to whether patients can read it--for example, the miniscule writing on the side of the medication bottles (equivalent to 6/6 reduced Snellen). The authors wished to determine a distance visual acuity threshold, using routine assessments of visual acuity (VA), beyond which patients are unable to read their instructions. METHODS: 180 patients, subgrouped according to the best line of Snellen acuity (from 6/9 to 6/60) achieved in either eye were recruited. Subjects were asked to read the printed manufacturer's instructions on the side of the drops box without magnification. RESULTS: Those subjects with best corrected VA of lower than or equal to 6/24 showed a significantly diminished ability to read the instructions on their eye drops bottles (p<0.001 for each comparison). When this group selected a font size of their choosing, the mode for preferred Arial font sizes were 16 for the 6/24 group, 18 for 6/36, and 22 for 6/60. CONCLUSION: This study documents the inability of patients with visual impairment to read the instructions on their bottle of eye drops. There is evidence of a distance VA threshold effect such that, although the majority of patients with 6/18 VA are able to read their instructions, patients whose VA is worse cannot. This latter group would benefit from a larger font size, a size of Arial 22 being sufficient. We recommend that all printed information for patients with visual acuities between 6/24 and 6/60 be printed in font Arial 22 or equivalent.
Adult↗
Perceived clinical significance of consultant pharmacist recommendations in the skilled nursing facility.
In an attempt to determine if pharmacists could make significant contributions to SNF patient care in the area of disease management, the drug therapy of the residents of two SNFs was reviewed once monthly for six months by two clinical pharmacist consultants. Pharmacist-identified problems and recommendations were communicated in writing to the medical staff by means of a communication form attached to the patient's chart. Nearly 72 percent of the recommendations made were accepted by the SNF physicians. Descriptions of the cases and corresponding recommendations were distributed to review-panel physicians. These physicians were asked to agree or disagree with the pharmacists' suggestions, and to rate the clinical significance of each recommendation using a modified Likert scale. The clinical pharmacist-consultants were perceived to have had a significant input into disease management in SNF patients.
Aged↗
Speaking up for nurses. Concerted political action garners some relief for personnel shortage.
To better understand public opinion and encourage trustee and community support concerning the nursing shortage in central New Jersey, a major medical center surveyed 400 household heads in a two-county area with a population of approximately 1 million. The findings suggested that an effective political action plan requiring trustee, hospital, and community involvement could be developed. The survey revealed that 75 percent of the respondents knew about the area nursing shortage, 82 percent believed the shortage was genuine, 67 percent believed it was serious, 86 percent believed it would adversely affect the quality of healthcare, and the majority was willing to take some political action to relieve the shortage. The New Jersey Hospital Association ran a campaign to explain the impact of the nursing shortage and other problems hospitals were facing. This effort suggested hospitals encourage their trustees, employees, and medical staffs to write the governor and key state officials. Hospital administrators, association representatives, and nursing groups lobbied state legislators and attended Hospital Rate Setting Commission hearings. As a result, hospitals received a temporary increase in their reimbursement rates in 1988 specifically intended to raise nursing salaries. In addition, the New Jersey Department of Health promised to reevaluate the cost components on which the state's diagnosis-related group system is based.
Adult↗
Zakhira-e-Nizam Shahi: a medical manuscript of Nizam Shahi period.
Medical manuscripts are the great source of medical history. They show the names of medicine men, their contributions and indicate the worth of medical literature existed in a particular period. some times they revewl the medical knowledge of the kings and nobles, their medical status and activities performed in different periods. For example, it is said that Burhan Nizam Shah of Ahmed Nagar was an expert in medical science. Most of the physicians who had privilege of attending upon him were put to test by him. He used to encourage the medical scholars to write new books on medicine. This article deals with one of such manuscripts, viz., "Zakhira-e-Nizam Shahi', of Nizam Shahi period, compiled by Rustum Jurjani, which contains twenty chapters in two volumes. According to Hk. Zahoori, it is a valuable addition to the science of pharmacology and treatment.
History, 16th Century↗
Structure of a scholarly manuscript: 66 tips for what goes where.
OBJECTIVE: TO SHARE WITH POTENTIAL AUTHORS TIPS FOR CONSTRUCTING A SCHOLARLY MANUSCRIPT AND FOR ORGANIZING INFORMATION IN VARIOUS TYPES OF SCHOLARLY MANUSCRIPTS: experimental reports, literature reviews, case reports, and clinical techniques. DESCRIPTION: The goal of writing a scientific/technical/ medical article is to communicate new information that hopefully has clinical relevance and will improve health care. This information must be organized and presented clearly and logically. We present 66 tips for organizing a scholarly manuscript. We tell not only what goes where in the manuscript but also how to construct each of the elements so as to logically communicate the author's message. The tips are numbered to facilitate referencing. CONCLUSION: By becoming familiar with these tips, potential authors can avoid making mistakes that may hinder publication of their manuscripts.
Journal Article↗
Vinegar: medicinal uses and antiglycemic effect.
Vinegar folklore is as colorful as it is practical. Legend states that a courtier in Babylonia (c. 5000 BC) "discovered" wine, formed from unattended grape juice, leading to the eventual discovery of vinegar and its use as a food preservative. Hippocrates (c. 420 BC) used vinegar medicinally to manage wounds. Hannibal of Carthage (c. 200 BC), the great military leader and strategist, used vinegar to dissolve boulders that blocked his army's path. Cleopatra (c. 50 BC) dissolved precious pearls in vinegar and offered her love potion to Anthony. Sung Tse, the 10th century creator of forensic medicine, advocated hand washing with sulfur and vinegar to avoid infection during autopsies. Based on the writings of US medical practitioners dating to the late 18th century, many ailments, from dropsy to poison ivy, croup, and stomachache, were treated with vinegar, and, before the production and marketing of hypoglycemic agents, vinegar "teas" were commonly consumed by diabetics to help manage their chronic aliment. This review examines the scientific evidence for medicinal uses of vinegar, focusing particularly on the recent investigations supporting vinegar's role as an antiglycemic agent. Epidemiologic studies and clinical trials were identified by a MEDLINE title/abstract search with the following search terms: vinegar, glucose; vinegar, cancer; or vinegar, infection. All relevant randomized or case-control trials were included in this review.
Acetic Acid↗
Do physicians have an ethical obligation to care for patients with AIDS?
This paper responds to the question: Do physicians have an ethical obligation to care for patients with acquired immunodeficiency syndrome (AIDS)? First, the social and political milieu in which this question arises is sampled. Here physicians as well as other members of the community are found declaring an unwillingness to be exposed to people with AIDS. Next, laws, regulations, ethical codes and principles, and the history of the practice of medicine are examined, and the literature as it pertains to these areas is reviewed. The obligation to care for patients with AIDS, however, cannot be located in an orientation to morality defined in rules and codes and an appeal to legalistic fairness. By turning to the orientation to morality that emerges naturally from connection and is defined in caring, the physicians' ethical obligation to care for patients with AIDS is found. Through an exploration of the writings of modern medical ethicists, it is clear that the purpose of the practice of medicine is healing, which can only be accomplished in relationship to the patient. It is in relationship to patients that the physician has the opportunity for self-realization. In fact, the physician is physician in relationship to patients and only to the extent that he or she acts virtuously by being morally responsible for and to those patients. Not to do so diminishes the physician's ethical ideal, a vision of the physician as good physician, which has consequences for the physician's capacity to care and for the practice of medicine.
Acquired Immunodeficiency Syndrome↗
University of Virginia case conference. Macroamylase, macro creatine kinase, and other macroenzymes.
The importance of macroenzymes has become increasingly apparent in recent years (1,2). Macroamylase (EC 3.2.1.1) and macro CK (EC 2.7.3.2) are the macroenzymes most commonly noted in the clinical laboratory, and they are frequently responsible for diagnostic confusion. Several methods are available for the confirmation and analysis of macroenzymes, many of which require expensive equipment or complicated techniques. In this report we summarize two cases of macro creatine kinase and two cases of macroamylase that illustrate the clinical importance of recognizing these macroenzymes. We review the features of these macroenzymes, discuss their laboratory evaluation, and describe a simple method that we have used to detect the macroenzymes in these (and other) patients at our institution. Finally, we review the literature on other, less commonly observed macroenzymes in human blood. We stress (a) the impact of methodology on clinical impressions and (b) the importance of discussing laboratory observations with the patient's physician and communicating them to the patient's medical record in writing.
5'-Nucleotidase↗
[Normative and legal procedure prerequisites in the commitment of psychiatric patients in relation to Paragraph 6 of the Commitment Law of East Germany].
An analysis has revealed the following typical mistakes in the application of article 6 of the Commitment Act: Commitment is often not preceded by an interview with the patient. Many of the patients committed under article 6 would have agreed to hospitalisation anyway. In most cases, the reasons given for commitment under the Act are inadequate and too vague. The patients are not usually given the commitment order in writing. The district medical officers often fail to inform the local councils or the state attorney. The patients are very rarely instructed of their rights. In many cases the demands placed on the hospital responsible for treatment are inadmissible, such as commitment to closed wards or requests for indefinite hospitalisation.
Commitment of Persons with Psychiatric Disorders↗
On the need for a new, distinct terminology for inorganic fibres.
Existing definitions of 'asbestos' and 'mineral fibre' originate from industrial and mineralogical sources and may be confusing when applied to scientific or medical findings. For writing and applying regulations for handling asbestos and mineral fibres, there is a need for a distinct, descriptive and internationally accepted terminology based on properties such as morphology, size and solubility, which are more significant from a physiological point of view.
Asbestos↗
Surgery under siege.
In September of last year I accompanied a team of orthopaedic surgeons to Sarajevo in Bosnia. This followed an appeal from the doctors there, and was made through World Orthopaedic Concern. The purpose of our visit was two-fold. Firstly to write a detailed medical report highlighting the needs of the hospitals, and secondly to give support to the surgical and nursing staff.
Bosnia and Herzegovina↗
Pharmacist's management of drug-related problems: a tool for teaching and providing pharmaceutical care.
During the development of education and practice models based on the philosophy of pharmaceutical care (PC), six pharmacists worked with the University of Toronto Faculty of Pharmacy to implement the PC model in their practice sites. These pharmacists found it necessary to modify existing tools to create one that explicitly guided them through the PC process, including the phase of monitoring patients for desired outcomes. This resulted in the development of the Pharmacist's Management of Drug Related Problems. This tool requires pharmacists to collect patient drug and medical data and write responses to specific questions about the data to interpret their significance. As proficiency in providing PC is attained, the questions and space for written responses can be eliminated, leaving a comprehensive documentation system of patient outcomes and the data collected, recommendations made, and monitoring completed by the pharmacist. This tool has been adopted by the University of Toronto Faculty of Pharmacy and is being used in various continuing education programs and by practicing pharmacists across Canada.
Drug Monitoring↗
A study of some international medical journals aiming to elicit stylistic guidelines for writing publishable papers.
OBJECTIVE: To provide some indications and guidelines on style and presentation for those aiming to publish in selected international journals. SETTING: University library in the Istituto di Clinica Chirurgica, Bari University Hospital. METHODS: A single topic, portal hypertension, was chosen to ensure a certain homogenity for the purposes of comparison, and the three most recent articles on this topic were identified in six international journals (three published in England and three in the USA; three in the medical and three in the surgical field) and studied from the points of view of style and presentation. RESULTS: Strong similarities were found among the 18 selected articles. In the interests of brevity, all were characterized by compact statements, qualified by lists of examples, and strings of adjectival nouns. In all, the Introduction and Conclusions sections were relatively short, the main body of the article being reserved to the Patients and Methods, Results and Discussion/Comments sections. Apart from very slight spelling or grammar differences characterizing English or American usage, all the articles could, with slight alterations in format in some cases, equally well have been published in any other of the journals studied. CONCLUSIONS: Brevity, even at the expense of elegance, and a straightforward, unambiguous, to some extent standardized, approach to the presentation of a scientific study, are essentials for the acceptance of an article for publication in the selected temational journals.
England↗