Biological and internal dosimetry for radiation medicine: current status and future perspectives

The International Atomic Energy Agency (IAEA) and Hiroshima International Council for Health Care of the Radiation-Exposed (HICARE) jointly organized two relevant workshops in Hiroshima, Japan, i.e. a Training Meeting ‘Biodosimetry in the 21^st century’ (BIODOSE-21) on 10–14 June 2013 and a Workshop on ‘Biological and internal dosimetry: recent advance and clinical applications’ which took place between 17 and 21 February 2020. The main objective of the first meeting was to develop the ability of biodosimetry laboratories to use mature and novel techniques in biological dosimetry for the estimation of radiation doses received by individuals and populations. This meeting had a special focus on the Asia-Pacific region and was connected with the then on-going IAEA Coordinated Research Project (CRP) E35008 ‘Strengthening of “Biological dosimetry” in IAEA Member States: Improvement of current techniques and intensification of collaboration and networking among the different institutes’ (2012–17). The meeting was attended by 25 participants, which included 11 lecturers. The 14 trainees for this meeting came from India, Indonesia, Japan, Malaysia, Philippines, Republic of Korea, Singapore, Thailand and Vietnam. During the meeting 13 lectures by HICARE and IAEA invited lecturers were delivered besides eight research reports presented by the IAEA CRP E35008 network centers from the Asia-Pacific region. Two laboratory exercises were also undertaken, one each at Hiroshima University and the Radiation Effects Research Foundation (RERF). The second training workshop aimed to discuss with the participants the use of mature and novel techniques in biological and internal dosimetry for the estimation of radiation effects by accidental, environmental and medical exposures. The workshop was attended by 19 participants from Indonesia, Jordan, Oman, Philippines, Singapore, Syrian Arab Republic, Thailand, UAE, USA and Yemen. The main outcome of both meetings was a review of the state-of-the-art of biodosimetry and internal dosimetry and their future perspectives in medical management. This report highlights the learning outcome of two meetings for the benefit of all stake-holders in the field of biological and internal dosimetry.     

Fundamentals of internal medicine

The most important diagnostic tools of the internist are the patient history and physical examination, after which a plan must be made for further diagnostic evaluation and treatment. For this the internist uses clinical reasoning based on his or her knowledge of evidence-based medicine and pathobiology. Pathobiology is primarily concerned with the question of how something works; evidence-based medicine is concerned with whether something works, and if so, how often or how much on average. Diseases do not exist in their own right and diagnostic criteria are based on consensus. A diagnosis of a 'disease' is based on our observation of patients as well as our opinions, whether right or wrong, regarding its cause. It is important to distinguish between 'partial causes' and a 'causative complement'. As a result of this concept, the biological relevance of a partial cause in the development of a disease cannot be derived from the strength of the link between it and the disease. Our opinions regarding the cause of disease appear to be based on induction. However, induction is not a good foundation from which to determine causation. Hypotheses on the cause of disease cannot be proved. They can, however, be disproved. Education, training, research and patient care all depend on effective communication. Communication is enhanced if the thesis is given first and thereafter the arguments. Hence, transfer of patient information such as during a morning report should begin with a working diagnosis (the 'thesis') and thereafter the findings of patient history, et cetera (the 'arguments'). At this time, too little attention is given to these branches of clinical reasoning and communication in education and continuing education in internal medicine.     

Interrelationships of general internal medicine and preventive/community medicine

Clinical preventive medicine, efforts by clinicians to prevent disease in individual patients, is an important component of preventive medicine as a whole. Yet clinicians, including internists, apparently do not provide many preventive services of established effectiveness. This paper describes one approach to improving the practice of clinical preventive medicine: increased cooperation between general internists--one of the nation's largest groups of primary care physicians--and specialists in preventive/community medicine. The paper summarizes a larger report prepared by two societies representing these disciplines: the Society for Research and Education in Primary Care Internal Medicine and the Association of Teachers of Preventive Medicine. It was found that the two disciplines have many common goals, and much to offer each other, but do not often collaborate. The report concludes with 14 recommendations for improving the practice of clinical preventive medicine, which suggest that such improvement can be achieved in part through strengthening working relationships between general internists and preventive/community medicine specialists.     

The craft of intensive care medicine

The practice of medicine is often represented as a dualism: is medicine a ‘science’ or an ‘art’? This dualism has been long‐lasting, with evident appeal for the medical profession. It also appears to have been rhetorically powerful, for example in enabling clinicians to resist the encroachment of ‘scientific’ evidence‐based medicine into core areas of medical work such as individual clinical judgement. In this article I want to make the case for a more valid conceptualisation of medical practice: that it is a ‘craft’ activity. The case I make is founded on a theoretical synthesis of the concept of craft, combined with an analysis of ethnographic observations of routine medical practice in intensive care. For this context the craft aspects of medical work can be seen in how biomedical and other types of knowledge are used in practice, the embodied skills and practical judgement of practitioners and the technological and material environment. These aspects are brought together in two conceptual dimensions for ‘craft’: first, the application of knowledge; second, interaction with the material world. Some practical and political implications of a ‘craft’ metaphor for medical practice are noted.     

论中医治疗内科湿疹

在中医临床上湿疹是一种常见的内科类炎症性皮肤病,在其临床上来讲,湿疹皮肤病症特点是一种为多形性皮疹,它在发作时溺水向四周分布倾渗而出,使人体感到剧烈搔痒难受难忍.湿疹这类皮肤病很容易反反复复的发作,使用一般的治疗方法难于治愈,皮肤体内的病毒久经多年也不易死去,而愈染愈多,延续扩散,难于根除治疗的炎症性皮肤病.本篇深入分析湿疹的病因,其发病的症状和所诊断方法;从病例中进行辨证分析,鉴别诊断这几方面来论述湿疹的发病机理.通过本篇论述为我们对湿疹进一步了解,更深一层的去分析论证在中医上如何根治湿疹.     

Philosophy of medicine and health care: European perspectives

Medicine, Health Care and Philosophy -     

A resident's internal medicine practice

The decision-making experience of residents in a primary care internal medicine training practice was examined. The patient population provided residents appropriate training opportunities but the experience of many residents making decisions about prevalent primary care problems was often inadequate. The residents' evaluation of their educational experience with patients suggests that several elements of patient care affect their ability to learn. These include the occurrence of diseases in their patients, opportunities to treat and follow patients, the chance to use diagnostic procedures, and the option of reviewing their care with supervisors and consultants or through reading. The results of this study and the current understanding of the development of clinical judgment are discussed as arguments for evaluating internal medicine training programs in part by examining the content of residents' decision-making opportunities in their ambulatory patient practices.     

Sudden incapacitation: occupational aviation medicine perspectives

Within the aviation environment, occupational medicine tends to focus on pilots, because of the very great effects pilot injury or illness can have on public safety. However, medical conditions of other aviation workers can also endanger public and personal safety. Sudden incapacitation an abrupt loss or impairment of consciousness, control, or performance is the most important occupational concern in aviation medicine. The authors discuss the neurologic causes of sudden incapacitation and syncope, and evaluate the risks of returning affected pilots to duty. Also offered is a Controversy (Single Seizure: To Treat or Not To Treat).