Ideas and ideals in medicine: fruits of reason or props of power?

Editors of medical journals play a central role in the promotion – or suppression – of ideas and ideals in medicine. Recently eminent among these have been the advocacies of the Evidence-based Medicine (EBM) movement and colleagues concerned with evidence and guidelines for health care. With regard to these topics, it still remains for editors of journals either to advance or to retard even the consolidation of the associated core concepts, most notably those of evidence in medicine, scientific medicine, and rational medicine. I present, first, a case study on the conduct of the editors of three medical journals, specifically their assumption of the role of authority on the scholarly fundamentals of evidence in medicine and their responding to propositions on the topic with commentaries well below the intellectual standards that should prevail in the journals of a learned profession. Then, following a brief review of the Flexnerian and EBM ideas and ideals on the practice of medicine, supplemented by observations drawn from medical sociology and the precepts of the philosophy of science, I posit a way of understanding such behaviour by editors of medical journals. They can have a temptation, and apparently some propensity, to play a regressive role in the development of the fundamentals of medicine. This is prone to occur whenever reason constitutes a threat to power, whether solely to the editors' own or to that of the profession at large. A full realization of the dream of reason in medicine requires an immense integrity of its journal editors and of its other intellectual leaders.     

Differentiated nursing of traditional Chinese medicine and functional training in stroke patients during rehabilitation phase

INTRODUCTIONWeestablishdifferentiatedgroupingmethodsandnursingprotocolsaccordingtotheoryoftraditionalChinesemedicine，andpracticenursingandhealtheducationforstrokepatients．Duringtreatment，patientscomprehendself－regulation，andselfhealthcare，andtheirconditionswererelieveddramatically．DIFFERENTIATEDTYPESTypeofdeficiencyofqiandstagnationofbloodcirculationandstagnationofvesselsandchannelsThistypeincludedtheobstructedqiandbloodcirculation，defi－ciencyofblood，numbnessofvesselsand…     

Practitioners’ sources of clinical information on complementary and alternative medicine in oncology

Goals of work The use of complementary and alternative medicine (CAM) amongst oncology patients is widespread. There is little data regarding the sources of clinical information on CAM that oncology practitioners utilise. The aim of this study was to investigate the sources of clinical information on CAM utilised by Australian oncology practitioners.Methods A structured self-administered questionnaire was sent to Australian oncology practitioners, defined as oncologists, oncology pharmacists and pharmacists at drug information centres (DICs). Key information was sought on their level of satisfaction with the accessibility, reliability and usefulness of this information and the frequency of, and initiating factors for, seeking this information.Main results A substantial proportion of oncologists (57.1%) reported having never sought information on CAM, compared to 27.3% of oncology pharmacists, and 18.8% of DIC pharmacists. Oncologists most commonly reported seeking information on CAM one to three times per year compared to four to ten times per year for oncology pharmacists. Databases were the most common information source used by oncologists (48.1%) and oncology pharmacists (91.7%) and the second most common information source used by DICs (92.3%). There was wide variation in the source of clinical information on CAM used by the three different professional groups.Conclusion Oncology practitioners often seek information on CAM; however the frequency, nature and sources of information utilised varied widely. The usefulness and reliability of the sources utilised were inconsistent.     

The analysis of effects of combination of TCM and western medicine therapy in the treatment of evacuation of hematom,extremities function and amentia

Background：Therearemanysurgerymethodstoevacuatehematomwhencerebralhemorrhage，buttheyalsocancausesomesecondaryinjuries，whichareharmfultoearlyrehabilitation．WeusecombinationofTCMandwesternmedicaltherapytoevacuatehematomandafterdynamicobserving，analyzeitseffectsonex－tremitiesfunction，andamentia．Objective：ToanalyzetheeffectsofcombinationofTCMandwesternmedicinetherapyinthetreatmentofevacuationofhematom，extremitiesfunction，andamentia．Unit：DepartmentofNeurologyofAffiliatedHospitalof…     

Longitudinal analysis of the in vitro activity of ceftazidime-avibactam vs. Pseudomonas aeruginosa, 2012–2016

The in vitro activities of ceftazidime-avibactam and comparator agents were analyzed against 14,330 isolates of Pseudomonas aeruginosa from 188 centers distributed globally (except North America) from 2012 (2014 for colistin) to 2016 as part of the International Network for Optimal Resistance Monitoring (INFORM) global surveillance program. Susceptibility testing used in-house prepared broth microdilution panels following CLSI guidelines. Multiplex PCR assays identified the presence of β-lactamases. Ceftazidime-avibactam (MIC₉₀ 8 mg/L; 91.5% susceptibility) and colistin (N = 11,032; MIC₉₀ 2 mg/L, 96.2%) were the 2 most active agents. Susceptibility of multidrug-resistant isolates (N = 3770, 26.3%) was ≤54.4% to all agents except colistin (N = 2956; 95.2% susceptible) and ceftazidime-avibactam (68.2%). Metallo-β-lactamase–positive isolates (N = 621, 4.3%) were not susceptible to any agents except colistin (N = 504; 98.2% susceptible). Novel therapeutic options are needed for infections caused by P. aeruginosa–resistant phenotypes.     

A comparative analysis of ENP’s and SHO’s in the application of the Ottawa ankle rules

This study investigates the comparative effectiveness of Senior House Officers (SHOs) and Emergency Nurse Practitioners (ENPs) in the application of the Ottawa ankle rules, in a large inner city Emergency Department in the United Kingdom (UK). Sixty patients with ankle injuries were randomly included in this study which took place in the minor injuries unit of the ED over a 12 month period.Data were obtained retrospectively from the patients records relating to six individual aspects of the Ottawa ankle rules. Sixty patients were selected and divided equally between the ENPs and SHOs.The results show a variation between the ENPs and SHOs in application of individual criteria of the Ottawa ankle rules. ENPs more commonly documented bony tenderness to lateral and/or medial malleoli than the SHOs. However, the SHOs documentation of their diagnostic testing was superior with the ENPs failing to document what X-rays 17 patients received. The study demonstrates a statistically significant difference between the two groups of health practitioners. In all but one of the five subquestions of the Ottawa ankle rules there was a statistical significance of 0.053 or less. This clearly shows a difference in the documentation of the Ottawa ankle rules by the health practitioners questioning whether appropriate care is given.Both groups were poor at documenting negative findings and neither consistently documented their application of the Ottawa ankle rules either in part or its entirety.     

The role of dental evaluation and cephalometric analysis in the diagnosis of Williams–Beuren syndrome

Summary Williams–Beuren syndrome (WS) is a genetic condition with an incidence of 1 in 20,000–50,000 live births. The syndrome consists of supravalvular aortic stenosis, characteristic dysmorphic facial features named elf face and intellectual disability. Early diagnosis of the syndrome is important since many of its features require treatment, and the prognosis can be dramatically improved by early recognition and management. This developmental disorder is well known to be clinically heterogeneous, making diagnosis difficult if based on the clinical picture. However, genetic testing is expensive and it is not cost-effective to screen all patients based on clinical suspicion. Our goal was to develop a novel clinical screening method that would be sensitive, specific, inexpensive and readily available. We performed cephalometric analysis and dental evaluation of 33 patients with genetically proven WS. Cephalometric analysis of soft tissues showed that with normal SNA, SNB and ANB angles, the lips were in front of the line of harmony. This finding was present in all WS patients (n = 33) but in none of the age-matched controls (n = 100). No other differences were found between WS and control patients. This cephalometric finding is specific and sensitive for WS and can be used in the diagnostic procedure, whereas none of the conventional dental evaluations are useful.     

Abnormal behavior during influenza in Japan during the last seven seasons: 2006–2007 to 2012–2013

A few mortalities and cases of severe abnormal behavior have been reported after oseltamivir administration for influenza, thus increasing medical and public concerns regarding the drug's safety. We investigated the association between oseltamivir and abnormal behavior for seven years. All outpatient clinics and hospitals all over the country were requested to report severe abnormal behavior that could have resulted in a fatality if nobody intervened, such as abrupt running outside the home or intention of jumping off a building. The survey was performed prospectively between the 2007–2008 and 2012–2013 seasons, and retrospectively for the 2006–2007 season. As the result of the investigation, eight-hundred fifty-eight cases were reported and among of them 95.7% were positive by the influenza rapid diagnosis test. The epidemic curve of severe abnormal behavior showed a pattern similar to influenza-like illness. The same pattern was observed regardless of age group, gender, or timing of the incidents after waking. Consequently, specific association between the types of medications used or the types of antiviral and abnormal behavior was not observed clearly. The reported abnormal behaviors include fatal cases that would have died if nobody had stopped. This suggested that patients with influenza should be observed with caution for possible abnormal behavior whether taking oseltamivir or other neuraminidase inhibitor anti-influenza drugs.