An Evaluation on Levels of Knowledge,Attitude and Behavior of People at 65 Years and Above About Alternative Medicine Living in Ankara

The aim was to determine the knowledge, attitude and behavioral levels of people at and above 65 years of age, living in Ankara (Turkey) about alternative medicine. The study was carried out between March – April 2010 through survey application of 200 participants by selective random sampling from the population. Data obtained as a result of the survey were analyzed by SPSS program. The study revealed that 83.5% of the participants believed in alternative therapy methods but 16.5% of them did not. It is concluded that herbal therapy methods are the most frequently used methods with a 63% rate among other alternative therapy methods. When status of the participants was analyzed it was found that it was found that 69% received the information about alternative medicines from their family while 53.5% received it from television This study revealed that alternative medicine is profoundly used by people above 65 years of age in Ankara.     

Directing stem cell fate by controlled RNA interference

Directing stem cell fate remains a major area of interest and also a hurdle to many, particularly in the field of regenerative medicine. Unfortunately, conventional methods of over-expressing inductive factors through the use of biochemical induction cocktails have led to sub-optimal outcomes. A potential alternative may be to adopt the opposite by selectively silencing genes or pathways that are pivotal to stem cell differentiation. Indeed, over recent years, there have been an increasing number of studies on directing stem cell fate through gene knockdown via RNA interference (RNAi). While the effectiveness of RNAi in controlling stem cell differentiation is evident from the myriad of studies, a chaotically vast collection of gene silencing targets have also been identified. Meanwhile, variations in methods of transfecting stem cells have also affected silencing efficiencies and the subsequent extent of stem cell differentiation. This review serves to unite the pioneers who have ventured into the emerging field of RNAi-enhanced stem cell differentiation by summarizing and evaluating the current approaches adopted in utilizing gene silencing to direct stem cell fate and their corresponding outcomes.     

Core competencies in integrative medicine for medical school curricula: a proposal.

The authors present a set of curriculum guidelines in integrative medicine for medical schools developed during 2002 and 2003 by the Education Working Group of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) and endorsed by the CAHCIM Steering Committee in May 2003. CAHCIM is a consortium of 23 academic health centers working together to help transform health care through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing, and the rich diversity of therapeutic systems. Integrative medicine can be defined as an approach to the practice of medicine that makes use of the best-available evidence taking into account the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of both conventional and complementary/alternative approaches. The competencies described in this article delineate the values, knowledge, attitudes, and skills that CAHCIM believes are fundamental to the field of integrative medicine. Many of these competencies reaffirm humanistic values inherent to the practice of all medical specialties, while others are more specifically relevant to the delivery of the integrative approach to medical care, including the most commonly used complementary/alternative medicine modalities, and the legal, ethical, regulatory, and political influences on the practice of integrative medicine. The authors also discuss the specific challenges likely to face medical educators in implementing and evaluating these competencies, and provide specific examples of implementation and evaluation strategies that have been found to be successful at a variety of CAHCIM schools.     

Improvements in Chronic Diseases With a Comprehensive Natural Medicine Approach: A Review and Case Series

Abstract

Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multi-modality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson's disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program.     

数据挖掘技术在中医药领域的应用

本文概括地介绍了数据挖掘的概念、主要方法、步骤和医学数据挖掘的特殊性、关键技术，以及数据挖掘在中医药领域的应用现状，并提出了在中医药领域应用数据挖掘技术必须充分考虑到中医特色。     

A categorization and analysis of the criticisms of Evidence-Based Medicine

The major criticisms and limitations of Evidence-Based Medicine (EBM) appearing in the literature over the past decade can be summarized and categorized into five recurring themes. The themes include: reliance on empiricism, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship. Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities. To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.     

光子中医学研究概况

本文简要地论述了中医药学的基本特点及其优势,将现代光子学理论与技术纳入到中医学体系,提出了光子中医学的概念,对光子中医学的学科建设、研究领域及其前景进行了论述.在中医基础理论方面,光子中医学就阴阳的属性及判断、五行的划分及向五色的延伸、经络系统的穴位特征与效应特点等方面进行阐述;在中医临床应用上,研究了光生物效应的中医作用机理,对低强度激光照射治疗及激光针灸进行了初步临床疗效观察;在中药研究方面,对中药有效成分与药理分析提出了光子药理学分析.最后,总结了中医学现代化建设的光子学设备研究方向以及中医药学的现代建设的光子学方向.     

Health 2.0 and Medicine 2.0: tensions and controversies in the field

Background

The term Web 2.0 became popular following the O’Reilly Media Web 2.0 conference in 2004; however, there are difficulties in its application to health and medicine. Principally, the definition published by O’Reilly is criticized for being too amorphous, where other authors claim that Web 2.0 does not really exist. Despite this skepticism, the online community using Web 2.0 tools for health continues to grow, and the term Medicine 2.0 has entered popular nomenclature.

Objective

This paper aims to establish a clear definition for Medicine 2.0 and delineate literature that is specific to the field. In addition, we propose a framework for categorizing the existing Medicine 2.0 literature and identify key research themes, underdeveloped research areas, as well as the underlying tensions or controversies in Medicine 2.0’s diverse interest groups.

Methods

In the first phase, we employ a thematic analysis of online definitions, that is, the most important linked papers, websites, or blogs in the Medicine 2.0 community itself. In a second phase, this definition is then applied across a series of academic papers to review Medicine 2.0’s core literature base, delineating it from a wider concept of eHealth.

Results

The terms Medicine 2.0 and Health 2.0 were found to be very similar and subsume five major salient themes: (1) the participants involved (doctors, patients, etc); (2) its impact on both traditional and collaborative practices in medicine; (3) its ability to provide personalized health care; (4) its ability to promote ongoing medical education; and (5) its associated method- and tool-related issues, such as potential inaccuracy in enduser-generated content. In comparing definitions of Medicine 2.0 to eHealth, key distinctions are made by the collaborative nature of Medicine 2.0 and its emphasis on personalized health care. However, other elements such as health or medical education remain common for both categories. In addition, this emphasis on personalized health care is not a salient theme within the academic literature. Of 2405 papers originally identified as potentially relevant, we found 56 articles that were exclusively focused on Medicine 2.0 as opposed to wider eHealth discussions. Four major tensions or debates between stakeholders were found in this literature, including (1) the lack of clear Medicine 2.0 definitions, (2) tension due to the loss of control over information as perceived by doctors, (3) the safety issues of inaccurate information, and (4) ownership and privacy issues with the growing body of information created by Medicine 2.0.

Conclusion

This paper is distinguished from previous reviews in that earlier studies mainly introduced specific Medicine 2.0 tools. In addressing the field’s definition via empirical online data, it establishes a literature base and delineates key topics for future research into Medicine 2.0, distinct to that of eHealth.     

Quality indicators in Transfusion Medicine: the building blocks

Background Over the past two decades the quest for safe blood supply has led to tremendous growth in the content and scope of the science and practice of Transfusion Medicine (TM). The desire by the various stakeholders in the blood establishment for zero-risk blood transfusion has not only stretched the level of quality expected of the Transfusion Medicine Service to apical height, but has also resulted in the demand by these stakeholders for concrete proofs that expected degrees of quality have been met or preferably exceeded. Quality indicators (QIs) are a Quality Management System (QMS) tool that are instituted in an organization with intent on not just providing this much needed proof of the level of quality performance tenable in the organization, but they are also intent on utilizing the information gained to seek improving the quality of performance in the organization. In the last decade, huge efforts have been exerted by government and non-government hospital-based blood banks, national and international organizations to collate, select, establish and analyze quality QIs for several dimensions of healthcare quality. Notable contributions have been made by such eminent bodies as the Agency for Healthcare Research and Quality (AHRQ), the Organization for Economic Cooperation and Development (OECD) and the College of American Pathologists (CAP). Unfortunately these efforts have only sparsely addressed quality indicators for TM. A year ago, the International Society of Blood Transfusion (ISBT) instituted its Working Party on Quality Management (WPQM). Quality indicators for TM are of priority to the WPQM which presumably is intent on redressing this imbalance and providing robust and valid quality indicators to monitor quality performances in key processes and outcomes in TM practice, globally. Objective This paper therefore highlights some basic essentials for successful monitoring of quality of transfusion medicine service through appropriate selection and implementation of quality indicator projects. It is hoped the information shared through this medium might be of value to Transfusion Medicine practitioners as well as to the ISBT WPQM as they thinker with quality indicators for Transfusion Medicine. Material and Method Considerable review of published literature in the form of journal articles, books and online publications on quality management and quality indicators in Healthcare/Transfusion Medicine was performed with the view to extract essentials elements that could be considered building blocks for the selection, implementation, analysis and utilization of quality indicators in Transfusion Medicine. Result Elements deemed as essential building blocks that were appraised included, but were not limited to: understanding Transfusion Medicine terrain; concept of quality and quality indicators selection criteria; choice of improvement model, data analysis and manner of communication of findings as well as the role of effective education and leadership. Conclusion Quality indicators are indispensible tools which various stakeholders in the Blood Transfusion establishment now demand to adjudge and improve on quality performance. Practitioners as well as policy makers in Transfusion Medicine need to ensure that the quality indicators they institute are appropriately selected and analyzed to be effective and efficient monitors of quality. Knowledge of basic building blocks discussed here is therefore a fundamental prerequisite.     

Applications of cost-effectiveness methodologies in behavioral medicine

In 1996, the Panel on Cost-Effectiveness in Health and Medicine developed standards for cost-effectiveness analysis. The standards include the use of a societal perspective, that treatments be evaluated in comparison with the best available alternative (rather than with no care at all), and that health benefits be expressed in standardized units. Guidelines for cost accounting were also offered. Among 24,562 references on cost-effectiveness in Medline between 1995 and 2000, only a handful were relevant to behavioral medicine. Only 19 studies published between 1983 and 2000 met criteria for further evaluation. Among analyses that were reported, only 2 studies were found consistent with the Panel's criteria for high-quality analyses, although more recent studies were more likely to meet methodological standards. There are substantial opportunities to advance behavioral medicine by performing standardized cost-effectiveness analyses.     

Repaving the road to academic success: the IMeRGE approach to peer mentoring.

In recent years, academic health centers have made a considerable effort to encourage medical students and physicians-in-training to consider academic medicine as a career choice. For physicians, selecting a career in academic medicine may be the first hurdle, but the challenge of successfully maintaining an academic career is perhaps a more formidable task. Mentoring is a much-needed response to this challenge. But the success of traditional mentoring programs at academic institutions is often limited by, among other things, the availability of senior faculty who can serve as mentors. The authors describe the formation and organization of the Internal Medicine Research Group at Emory (IMeRGE), an innovative peer mentoring group within the Division of General Medicine at Emory University. This group, born partially out of the mentoring needs of our women and minority faculty, shared the primary goal of fostering a collaborative atmosphere among junior faculty, while simultaneously acquiring experience through advanced faculty development. The authors present our methods of garnering division support for designated time and financial resources, defining member responsibilities, developing a curriculum, providing peer support, and seeking advisors with expertise in the areas on which we wished to focus. In addition to the development of IMeRGE, the authors provide an overview of the pros and cons of traditional mentoring versus peer mentoring; discuss the challenges faced by IMeRGE and strategies for addressing these issues; and present the paradigm of IMeRGE as a template for alternative forms of academic mentorship.     

Crowdsourced health research studies: an important emerging complement to clinical trials in the public health research ecosystem

Background

Crowdsourced health research studies are the nexus of three contemporary trends: 1) citizen science (non-professionally trained individuals conducting science-related activities); 2) crowdsourcing (use of web-based technologies to recruit project participants); and 3) medicine 2.0 / health 2.0 (active participation of individuals in their health care particularly using web 2.0 technologies). Crowdsourced health research studies have arisen as a natural extension of the activities of health social networks (online health interest communities), and can be researcher-organized or participant-organized. In the last few years, professional researchers have been crowdsourcing cohorts from health social networks for the conduct of traditional studies. Participants have also begun to organize their own research studies through health social networks and health collaboration communities created especially for the purpose of self-experimentation and the investigation of health-related concerns.

Objective

The objective of this analysis is to undertake a comprehensive narrative review of crowdsourced health research studies. This review will assess the status, impact, and prospects of crowdsourced health research studies.

Methods

Crowdsourced health research studies were identified through a search of literature published from 2000 to 2011 and informal interviews conducted 2008-2011. Keyword terms related to crowdsourcing were sought in Medline/PubMed. Papers that presented results from human health studies that included crowdsourced populations were selected for inclusion. Crowdsourced health research studies not published in the scientific literature were identified by attending industry conferences and events, interviewing attendees, and reviewing related websites.

Results

Participatory health is a growing area with individuals using health social networks, crowdsourced studies, smartphone health applications, and personal health records to achieve positive outcomes for a variety of health conditions. PatientsLikeMe and 23andMe are the leading operators of researcher-organized, crowdsourced health research studies. These operators have published findings in the areas of disease research, drug response, user experience in crowdsourced studies, and genetic association. Quantified Self, Genomera, and DIYgenomics are communities of participant-organized health research studies where individuals conduct self-experimentation and group studies. Crowdsourced health research studies have a diversity of intended outcomes and levels of scientific rigor.

Conclusions

Participatory health initiatives are becoming part of the public health ecosystem and their rapid growth is facilitated by Internet and social networking influences. Large-scale parameter-stratified cohorts have potential to facilitate a next-generation understanding of disease and drug response. Not only is the large size of crowdsourced cohorts an asset to medical discovery, too is the near-immediate speed at which medical findings might be tested and applied. Participatory health initiatives are expanding the scope of medicine from a traditional focus on disease cure to a personalized preventive approach. Crowdsourced health research studies are a promising complement and extension to traditional clinical trials as a model for the conduct of health research.     

1993 Whitaker lecture: Biorheology in thrombosis research

A review is presented on biorheological studies of platelet activation and platelet-platelet binding events that play key roles in thrombosis and hemostasis. Rheological methods have been used by a number of workers to establish the importance of fluid mechanical shear stress as a determinate of platelet reactions. Fluid mechanical shear stress can be regarded as a platelet agonist that is always present in the circulation and that is synergistic in its actions with other agonists. Early biorheological studies were phenomenological in that they focused on stress effects on measures of platelet function. Subsequent studies have elucidated mechanisms and have shown that the biochemical pathways of platelet activation are very different at elevated shear stresses than in the low shear stress environment used in many platelet activation studies. This finding that biochemical pathways of platelet activations are different at different shear stress levels suggests that it may be possible to develop platelet inhibitors of highly specific action: it may be possible to inhibit pathways important in thrombosis in a partially occluded artery without seriously compromising the normal hemostatic function of platelets. Another aspect of the work suggests that the biorheological approach may make it possible to develop better methods for prediction of thrombotic tendencies in human subjects.     

Comparison of three methods for the derivation of a biologic scaffold composed of adipose tissue extracellular matrix

Extracellular matrix (ECM)-based scaffold materials have been used successfully in both preclinical and clinical tissue engineering and regenerative medicine approaches to tissue reconstruction. Results of numerous studies have shown that ECM scaffolds are capable of supporting the growth and differentiation of multiple cell types in vitro and of acting as inductive templates for constructive tissue remodeling after implantation in vivo. Adipose tissue represents a potentially abundant source of ECM and may represent an ideal substrate for the growth and adipogenic differentiation of stem cells harvested from this tissue. Numerous studies have shown that the methods by which ECM scaffold materials are prepared have a dramatic effect upon both the biochemical and structural properties of the resultant ECM scaffold material as well as the ability of the material to support a positive tissue remodeling outcome after implantation. The objective of the present study was to characterize the adipose ECM material resulting from three methods of decellularization to determine the most effective method for the derivation of an adipose tissue ECM scaffold that was largely free of potentially immunogenic cellular content while retaining tissue-specific structural and functional components as well as the ability to support the growth and adipogenic differentiation of adipose-derived stem cells. The results show that each of the decellularization methods produced an adipose ECM scaffold that was distinct from both a structural and biochemical perspective, emphasizing the importance of the decellularization protocol used to produce adipose ECM scaffolds. Further, the results suggest that the adipose ECM scaffolds produced using the methods described herein are capable of supporting the maintenance and adipogenic differentiation of adipose-derived stem cells and may represent effective substrates for use in tissue engineering and regenerative medicine approaches to soft tissue reconstruction.     

Poly(ethylene glycol)s generate complement activation products in human serum through increased alternative pathway turnover and a MASP-2-dependent process

Poly(ethylene glycol) (PEG) is receiving increasing attention as an intravenous therapeutic agent per se in a variety of experimental therapeutics and veterinary settings, such as spinal cord injury and traumatic axonal brain injury. PEG is often perceived to be immunologically safe, but here we demonstrate that near-monodisperse endotoxin-free PEGs, at concentrations relevant to above-mentioned settings, can generate complement activation products in human serum on a time scale of minutes (reflected in significant rises in serum levels of C4d, Bb, C3a-desArg and SC5b-9). With the aid of sera depleted from either C2 or C1q, and devoid of anti-PEG antibodies, we further demonstrate that, depending on PEG concentration and M(wt), generation of complement activation products occur either exclusively through the lectin pathway activation or through both the lectin pathway and increased fluid phase turnover of the alternative pathway. Inhibition of PEG-mediated C4d elevation in C1q-depleted serum by the broad serine protease inhibitor Futhan and anti-MASP-2 antibodies as well as competitive studies with d-mannose and N-acetylglucosamine indicated a likely role for ficolins/MASP-2 in PEG-mediated triggering of the lectin pathway and independent of calcium. PEG-mediated amplification of the alternative pathway is a complex process related to protein partitioning and exclusion effect, but factor H depletion/exclusion seems to play a minor role. Our results are relevant to the proposed potential therapeutic applications of intravenous PEG and warn about possible acute PEG infusion-related reactions in sensitive individuals and animals. PEG-mediated generation of complement activation products further provides a plausible explanation to the previously reported unexplained anaphylaxis or the referred cardiovascular collapse in sensitive animals that have received medicines containing high levels of PEG as solubilizer/carrier.     

Ansiedad comparada entre estudiantes de medicina y estudiantes de otros grados en el Área de la Salud en Coimbra

ObjectiveTo compare the prevalence of anxiety symptoms in medicine students and students attending other health related courses.Materials and methodsWe conducted an observational study, using a questionnaire of voluntary self full-filling, that included a section for sociodemographic characteristics, the Hospital Anxiety and Depression Scale (HADS) and Generalized Anxiety Disorder-7 (GAD-7) scales, and a section about studentś support means.ResultsWe verified that 82,2% of medical students and 91,4% of the other health related courses’ students, according to the GAD-7 scale and the HADS, respectively, had anxiety. In those with anxiety criteria 14,9% in HADS and 9,7% in GAD7 were on any professional help. In Medicine students a proportion of 12,6% and in other health students 11,5% were on anti-anxiety pharmacological therapy. An importante positive and significative correlation was found bettween GAD-7 and HADS-A (ρ=0.738, p< .001)DiscusionMedical students seem to have less anxiety and depression symptoms than other health related courses.ConclusionAnxiety seems to be less prevalente among Medicine students.     

Complement activation on surfaces carrying amino groups

The complement system is strongly activated by surfaces carrying nucleophilic groups, such as hydroxyl (OH) groups, and triggered by deposition of complement protein fragment, C3b. Surfaces carrying amino groups, the other representative nucleophilic group, are expected to be potential activators of the complement system through the alternative pathway. Few studies thus far have examined the potential of artificial materials carrying amino groups in activating the complement system. In this study, we employed a self-assembled monolayer (SAM) of 11-amino-1-undecanethiol (NH2-SAM) and a polyethyleneimine (PEI)-coated surface as model surfaces to study interactions between amino groups and serum complement pathway. SAMs of 11-mercaptoundecanol (OH-SAM) and 1-dodecanethiol (CH3-SAM) were used as control surfaces, respectively. Although much protein was adsorbed from serum solutions on the two types of amino surfaces, amounts of C3b deposition were much less than those observed on OH-SAM. Amounts of C3a released on the amino surfaces were same levels as that of CH3-SAM, but significantly smaller than that on OH-SAM. These facts suggest that the nucleophilic amino groups on NH2-SAM and PEI-coated surfaces do not directly activate the alternative pathway, but the protein adsorbed layers formed on amino surfaces activate it, but to an extent much smaller than that on OH-SAM. In addition, we found no deposition of C1q molecules on the amino surfaces, suggesting that these surfaces fail to activate the classical pathway. However, more careful studies are needed to conclude it, because it is known that C1q is only transiently detected at typical classical activation interfaces.     

Innate sensors for Gram-positive bacteria

More than half of invasive bacterial infections are Gram-positive in origin. This class of bacteria has neither endotoxins nor an outer membrane, yet it generates some of the most powerful inflammatory responses known in medicine. Some recent seminal studies go a long way toward settling the controversies that surround the process by which Gram-positive bacterial surfaces trigger the human immune system. Although the components of the cell wall are now chemically defined in exquisite detail and the interaction with the toll-like receptor 2 pathway has been discovered, it is only very recently that definitive studies combining these advanced biochemical and cell biological tools have been carried out. It is these breakthrough studies that have finally confirmed the paradigm of innate sensors for Gram-positive bacteria.     

Un vistazo al liderazgo de las mujeres mexicanas en la medicina

Throughout history women have been fighting to be included and recognized in the development of medical science. Actually, women have more participation not only in the study and practice of medicine, but in the leadership of various medical areas. This article provides a historical review of the first women it formed part of the National Academy of Medicine of Mexico as well as a compilation of the participation of women in management positions, from Headquarters of academic departments at the National Autonomous University of Mexico including health sector.