Strategic choices for a primary care advantage: re-engineering osteopathic medicine for the 21st century.

The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called 'alternative', 'complementary' or 'holistic' medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?     

医学科技的负面效应

论述了近代以来医学技术进步带来的负面效应。这些负面影响的存在，说明加强医疗领域的科技行为规范与科学的社会控制，对医学技术加以改良，已势在必行。     

构建中国特色康复医学体系的研究

随着时代与我国经济社会事业的发展,康复医学与我国人民日益增长的健康需要有巨大的差距,其进一步发展遇到了亟待解决的瓶颈。面对国人对康复医疗的巨大需求,康复医学亟待解决健全机构、教育体制、人才培养、技术设备等诸多问题。因此应适应时代需要,改革创新,大力建设中国特色康复医学体系。     

人脸识别技术在医疗领域的应用前景及影响因素

随着计算机技术以及光学成像技术的发展,人脸识别技术是目前相关学科的研究热点,因其高效性和准确性,在多种行业中都已开展应用。本文就人脸识别的技术特点和应用进行了综述,介绍了一些常用的人脸识别算法,阐述了人脸识别技术相对于其他生物识别技术的优势和弊端。重点对该技术在医疗领域的应用进行了论述,并对未来的发展前景提出了展望。     

How ambulatory care is different: a paradigm for teaching and practice

Summary. This paper reviews the issues regarding an increased emphasis on medical education and practice in the ambulatory care setting. A paradigm for ambulatory medicine is offered which combines the elements of ‘traditional’ medical care and teaching with the more ‘distinctive’ elements representative of the ambulatory setting. The former includes aetiology, history, physical examination, laboratory tests and therapy; while the latter includes continuity, context, health education, economics and responsibility. The paradigm is illustrated in relation to the problem of hypertension. The ambulatory medicine paradigm is further discussed with respect to potential barriers to its acceptance. These include: (1) the assumption that ‘traditional’ medical education does teach all 10 elements of the paradigm; (2) the axiom that if one learns to care for the sickest patients, the less ill ones should be manageable; (3) the intuitive aspects of the ‘art’ of practising ambulatory medicine; (4) the recognition that this teaching will require a longitudinal experience; and (5) perception that the five distinctive elements are not ‘hard’ science and objectively measurable. Nevertheless, the changing face of medical practice requires the adoption of an ambulatory medicine paradigm in medical education.     

新一代高通量测序技术——检验医学发展的挑战与机遇

基因突变以及碱基修饰等可以导致相关疾病的发生发展。个体的基因型也影响个人罹患相关疾病的风险和药物代谢率。随着数据的积累,越来越多与疾病相关的基因突变被发现,DNA测序在疾病预测、诊断、个体化用药等方面显得日益重要。测序技术在短短的数十年间,取得了惊人的进步,从Sanger法为代表的第一代测序技术发展到了第三代高通量测序技术。在个体化用药、遗传病、肿瘤、产前诊断以及微生物的鉴定等领域,高通量测序技术显示出强大的功能,部分传统检验项目有可能被测序技术所取代,高通量测序技术给检验医学学科建设带来了新的契机,使得检验医学发展更加全面和深入。     

An e-health trend plan for the Jordanian health care system: a review

PURPOSE: The purpose of this research is to examine the potential of e-health by focusing explicitly on the delivery of health care products and services. The examination of e-health activity is guided by one broad research question, "What is the potential for constructing e-health strategy as an innovative health technology?". A great amount of attention has been given to e-health activity in the present day. However important this form of e-health is, this type of service simply does not face the same constraints that must be addressed by those actually delivering health care services. DESIGN/METHODOLOGY/APPROACH: The researchers employed a qualitative data collection technique to formulate more examples and cases to derive lessons for Jordan. Phone interviews in a random sample were conducted with corporate officers in Jordan in order to reveal the internal organizational structure and business trends, interface issues, marketing strategies, as well as comparing and contrasting the online health world to the traditional health care realm. FINDINGS: Internet-related projects is a top priority for health care information technology executives in the present day, with a cautious approach toward "e-health", as many products have yet to mature, and that the "click and mortar" model may perhaps be the optimal strategy for e-health in Jordan. RESEARCH LIMITATIONS/IMPLICATIONS: This paper reviews the e-health trends to demonstrate the tremendous potential for health-related commercial activity on the internet. However, the researcher examining the barriers facing e-health to the Jordanian health system also pointed out almost insurmountable challenges. PRACTICAL IMPLICATIONS: Despite the apparent promise of e-health, its instability is measured by its failure so far to systematically penetrate the organization of health care. Beyond the pragmatic negotiation of e-health in the immediate context of clinical practice, there are wider issues about how the development/implementation of e-health is funded, about its organization and management at the policy level; and about its potential medico-legal risks. ORIGINALITY/VALUE: It is hoped that the handful of ventures into cyber medicine appears to be coming from a few enterprising physicians who have set up medical practices on the Web.     

La inteligencia artificial y sus aplicaciones en medicina II: importancia actual y aplicaciones prácticas

Technology and medicine follow a parallel path during the last decades. Technological advances are changing the concept of health and health needs are influencing the development of technology.Artificial intelligence (AI) is made up of a series of sufficiently trained logical algorithms from which machines are capable of making decisions for specific cases based on general rules.This technology has applications in the diagnosis and follow-up of patients with an individualized prognostic evaluation of them.Furthermore, if we combine this technology with robotics, we can create intelligent machines that make more efficient diagnostic proposals in their work.Therefore, AI is going to be a technology present in our daily work through machines or computer programs, which in a more or less transparent way for the user, will become a daily reality in health processes. Health professionals have to know this technology, its advantages and disadvantages, because it will be an integral part of our work.In these two articles we intend to give a basic vision of this technology adapted to doctors with a review of its history and evolution, its real applications at the present time and a vision of a future in which AI and Big Data will shape the personalized medicine that will characterize the 21st century.     

Leaving the stethoscope behind: public health doctors and identity work

Public health medicine is distinct in two ways from most other forms of medical specialisation; firstly, it is predominantly non-clinical and secondly, its concern is with populations, rather than the more common individual physician–patient encounter. In spite of recent attempts to ‘mainstream’ public health approaches into medical training and practice, it remains a relatively low prestige medical specialty. In the face of the centrality of all things clinical in medical training, the identity work needed to think beyond this and into population health approaches is significant. In the face of public health physicians’ subaltern position within medicine, this research investigates the identity work doctors did as they made the transition into public health medicine and how they understood their positioning once they were within the specialty. The inductive thematic analysis conducted on the qualitative interview data generated for this research elicited three key themes of relevance for the 19 public health physicians in New Zealand who were interviewed. The calling into question of biomedical identities was evident and concomitant with this was a sense of loss of the satisfactions of clinical medicine including contact with patients and the ability to solve discrete clinical problems. The final theme revolved around how public health physician identities were felt by the participants to be discredited. Lack of attention to the identity work required to think beyond the individual in health terms may contribute to a slow pace of change.     

La inteligencia artificial y sus aplicaciones en medicina I: introducción antecedentes a la IA y robótica

Technology and medicine follow a parallel path during the last decades. Technological advances are changing the concept of health and health needs are influencing the development of technology.Artificial intelligence (AI) is made up of a series of sufficiently trained logical algorithms from which machines are capable of making decisions for specific cases based on general rules.This technology has applications in the diagnosis and follow-up of patients with an individualized prognostic evaluation of them.Furthermore, if we combine this technology with robotics, we can create intelligent machines that make more efficient diagnostic proposals in their work.Therefore, AI is going to be a technology present in our daily work through machines or computer programs, which in a more or less transparent way for the user, will become a daily reality in health processes. Health professionals have to know this technology, its advantages and disadvantages, because it will be an integral part of our work.In these two articles we intend to give a basic vision of this technology adapted to doctors with a review of its history and evolution, its real applications at the present time and a vision of a future in which AI and Big Data will shape the personalized medicine that will characterize the 21st century.     

虚拟实验室在《临床检验基础学》实验课中的应用

探讨高等教育医学检验技术专业《临床检验基础学》实验课教学改革问题。文章分析了实验教学中存在的困难及其对教学质量和培养目标的影响。通过构建一种基于网络和虚拟仿真技术的《临床检验基础学》虚拟实验室提供模拟的教学环境、各种虚拟化仪器设备、虚拟化实验过程和虚拟化的数据处理等,利用这种开放式网络化的实验教学平台作为现实实验教学的补充,学生随时可反复进行实验操作,提高教学质量。虚拟仿真实验室建设将是今后四年制医学检验技术专业实践教学改革提高教学质量的一个重要方向。     

Health care in America: lost opportunities amid plenty

Despite frequent breakthroughs in medicine, and in the face of an expenditure on health that is almost twice that of any other country in the world, there are significant problems with health care in the United States. Fundamental failings reflect the underuse, overuse, and misuse of resources, which result in inadequate care for important medical conditions. An apparent blind faith in the benefits of science and technology may help account for these startling inadequacies, as lavish funding of the biomedical research effort diverts attention from the fundamental matter of delivering care for common diseases. With a shift in research priorities, the United States could shape a health care system that is far more responsive to the needs of its people.     

浙江省三级公立医院综合技术效率及影响因素——基于DEA和Tobit回归分析

目的:测算浙江省三级公立医院综合技术效率,探讨其影响因素,并提出相应的政策建议.方法:采用数据包络分析方法测算医院综合技术效率,并以测算出的综合技术效率为因变量,相关指标为自变量,利用Tobit回归方法探讨其影响因素.结果:浙江省三级公立医院综合技术效率平均值为0.949,纯技术效率平均值为0.963,规模效率平均值为0.985.28.26％的医院DEA有效,29.35％的医院规模收益不变.综合效率与床位周转率、人均工作量呈正相关,与医疗业务成本比呈负相关.结论:研究对象的总体技术效率水平较高,床位周转率、医生人均工作量影响医院整体技术效率;面临规模过度扩张风险,西医与中医医院的规模效益差异较大.建议:严格控制大型医院规模扩张,西医与中医医院要采取差异化政策;实现粗放式发展向内涵式发展转变;推进质量管理和精细化管理,实现可持续发展.     

Medicine as a performing art: a worthy metaphor

PURPOSE: Despite numerous calls for reform over several decades, medical educators have been unable to address many significant challenges. Potentially, employing new metaphors and looking at the teaching and learning of medicine in a new way will facilitate the development of creative solutions. MAIN FINDINGS: In this paper we propose the metaphor of medicine as a performing art. Building on this metaphor, string music education is compared to medical education. PRINCIPAL CONCLUSIONS: Looking to string education as a model, suggestions for reorganisation of learning experiences, academic structure and assessment are discussed. Medical educators are encouraged to think about the challenges they face in creative ways. By looking outside traditional medical education, solutions may be found to new and old educational dilemmas.     

Equity in prevention and health care

STUDY OBJECTIVE: There is an increasing body of evidence about socioeconomic inequality in preventive use, mostly for cancer screening. But as far as needs of prevention are unequally distributed, even equal use may not be fair. Moreover, prevention might be unequally used in the same way as health care in general. The objective of the paper is to assess inequity in prevention and to compare socioeconomic inequity in preventive medicine with that in health care. DESIGN: A cross sectional Health Interview Survey was carried out in 1997 by face to face interview and self administered questionnaire. Two types of health care utilisation were considered (contacts with GPs and with specialists) and four preventive care mostly delivered in a GP setting (flu vaccination, cholesterol screening) or in a specialty setting (mammography and pap smear). SETTING: Belgium. PARTICIPANTS: A representative sample of 7378 residents aged 25 years and over (participation rate: 61%). Outcome measure: Socioeconomic inequity was measured by the HI(wvp) index, which is the difference between use inequality and needs inequality. Needs was computed as the expected use by the risk factors or target groups. MAIN RESULTS: There was significant inequity for all medical contacts and preventive medicine. Medical contacts showed inequity favouring the rich for specialist visits and inequity favouring the poor for contacts with GPs. Regarding preventive medicine, inequity was high and favoured the rich for mammography and cervical screening; inequity was lower for flu immunisation and cholesterol screening but still favoured the higher socioeconomic groups. In the general practice setting, inequity in prevention was higher than inequity in health care; in the specialty setting, inequity in prevention was not statistically different from inequity in health care, although it was higher than in the general practice setting. CONCLUSIONS: If inequity in preventive medicine is to be lowered, the role of the GP must be fostered and access to specialty medicine increased, especially for cancer screening.     

Study of business ethics in occupational medicine.

OBJECTIVE: To investigate the views of specialists in occupational medicine about business ethics in occupational medicine. METHOD: A qualitative study with face to face focus groups and successive reviews of the draft consensus was undertaken of all accredited specialists in occupational medicine who were members of the south Wales and west of England group of the Society of Occupational Medicine, and of all regional specialty advisers and deputies from the Faculty of Occupational Medicine. RESULTS: There was widespread agreement for the need of a code of business ethics. In all, during the four draft stages of preparing a consensus, 72% (28/39) of members of the south Wales and west of England group of the Society of Occupational Medicine, and 31% (20/64) of regional specialty advisers and deputies provided detailed comment for inclusion in it. CONCLUSIONS: Consensus of their views was reached among study participants for issues of business ethics involving advertising, competence, qualifications, fees, commitment, changes in provider contracts, regulation, and supervision of trainees. It provides a basis for further debate.     

Antibiomedicine belief and integrative health seeking in Taiwan

The newly emerged concept of integrative medicine may provoke a closer investigation into the pattern of biomedicine use in the context of medical pluralism. In this study, I propose two concepts to examine the complicated cognitive and behavioural responses to biomedicine (Western medicine, xi-yi) in relation to the use of non-biomedical therapies in Taiwan, a society with renowned medical pluralism. Data came from a nation-wide telephone survey conducted during September 2002 among community-resident population aged 20 and older. The sample includes 1517 respondents. The first concept--antibiomedicine--includes three indicators to measure an individual's negative stance on xi-yi: overall competence, capability to cure from within, and side effects. Combined, these three indicators were further constructed into a single composite index: antibiomedicine beliefs. Integrative health seeking tackled two aspects of health seeking: selective use and adaptive use. The former concerns particularly the use of specific ingredients of biomedicine. In this study, emphasis was placed on the diagnosis versus treatment of xi-yi. The latter was focussed on the strategic uses of xi-yi in the face of its limitation and incompetence. Three types of adaptive health use were identified: alternative type, complementary type, and exclusive type. Results of the analyses indicate that antibiomedicine belief held explanatory potential to selective use and adaptive use of xi-yi. The study sheds light on further exploring the blending of health-seeking practices and "hybrid" medicine. It is suggested that novel explanatory constructs and more sophisticated study designs should be developed to articulate the sequential of pluralistic health-seeking process.     

Chronologic history of occupational medicine

OBJECTIVES: To provide a chronologic review of growing knowledge in occupational medicine relating work and work hazards to health, and to provide a perspective on the lessons learned from the frequent inattention or misrepresentation of hazards. METHODS: Many books on the social and medical history of work including epidemiology and toxicology were reviewed, as well as published papers and interviews. RESULTS: Throughout history workplace hazards and occupational medicine have been shaped by the forces that shape work itself, social evolution, changing modes of production, shifting economic powers, and demographic changes in the workforce. Lest we think these changes are unique to the present time, this paper emphasizes the long-term and inevitable relationship between social structure and worker health. Hippocrates emphasized the relation between environment (air and water) and health, although he has less to say about the non-military work environment, perhaps because of the denigration of manual labor in Greece. The impact of work on health can be traced to the Edwin Smith Surgical Papyrus, written approximately 1700 BC. The earliest occupational physicians served military forces, and Galen was physician to Roman gladiators. Finger and wrist guards worn by Bronze Age archers represent early personal protective equipment. Writers of the classic period mention diseases and hazards of miners, and Pliny (1st century AD) mentions veils to cover the face. In the Middle East Rhazes included occupation in his case studies (9th century). Paracelsus, and Agricola were prominent, figures in the 15th century, with an emphasis on mining and health. Ramazzini's (c1700) work was widely translated in ensuing decades and is now well-known to all, but its influence between about 1800 and 1940 is inapparent. The emergence of a public health movement in the mid-1800s focused attention on the abominable conditions of many factories and on the living conditions, poor nutrition, high stress, poverty and ill health of the new factory working class, while paying scant attention to specific workplace hazards. CONCLUSIONS: The recognition of occupational diseases in the United States has often lagged by a generation behind the recognition of the same diseases in Europe. We are now into a second industrial revolution led by multinational corporations and information technology, shifting production facilities, and jobs moving around the world in search of cheap labor in the countries with the fastest growing population and the greatest poverty. Occupational medicine must be alert to the new challenges imposed by this revolution.     

Challenging integration: clinicians’ perspectives of communicating collaboration in a center for integrative medicine

A shift has occurred in the provision of health care to include a focus not just on biology and disease but also on the whole person, preventative care, and an array of healing modalities based on systems of beliefs and values not typically included within biomedical practice. This approach to health care, termed integrative medicine (IM), blends biomedicine with a broader understanding of patients and their illnesses, including elements of mind, body, and spirit that may be contributing to an ailment. While the use of integrative medicine has increased and centers for integrative medicine have proliferated within conventional health care organizations, distinct tensions arise from this amalgamation. The tensions between IM and biomedical clinicians often center on their differing training and philosophies, as well as on a larger system of health care that privileges biomedicine. As a result, this research is designed to explore the challenges IM clinicians face in collaborating with conventional practitioners to provide patient care. Analysis of interviews with 14 clinicians at one center for integrative medicine revealed four specific challenges they face in their attempt to co-practice IM with conventional medicine. The four challenges include (a) challenges to collaboration, (b) challenges to legitimacy, (c) challenges to consistency, and (d) challenges to unification. Future research should investigate the ways in which these challenges can be addressed so that collaboration throughout the system is facilitated. The professional training of clinicians, the structuring and institutionalization of integrative medicine, and enhanced systems for communicating patient information all play a significant role in this transformation.     

医学影像技术的主要进展及前瞻

医学影像学是当前临床医学中的一个重要学科。随着临床医学的发展，作为学科先导的影像技术．其发展现状及方向自然成为相关学科人士关注的热点。文中就近年来影像技术的主要进展及发展前景作一简要介绍。