American Medical Associations Research Articles

Problems with Style Guides’ Lowercasing and Uppercasing of Racial Terms

Stylebooks are clashing over whether to uppercase certain racial descriptors and whether to even use other terms. While The Asso-ciated Press capitalizes Black when referring to people, it calls for avoiding the term brown as a descriptor unless used in quotes and has kept the term white lowercase. Meanwhile, other style-books (including those from the American medical and psycho-logical associations as well as Chicago style) provide guidance that conflicts with the AP. In addition, the National Association of Black Journalists as well as multiple leading news outlets have deviated from AP’s guidance. Using empirical tests of articles, this study found that publishers strongly aligned with stylebooks for academic and news professionals. And a review of exonyms and previous clashes shows how power and institutionalism can influence style.

Should Wellness Be a Core Competency for Physicians?

There has been a recent rise in calls for action around wellness and physician health. In medical education, wellness has been proposed as a physician competency. In this article, the authors review the history of the "wellness as a competency" concept within U.S. and Canadian residency programs and medical schools. Drawing from literature on the discourses of wellness and competence in medical education, they argue that operationalizing wellness as a physician competency holds profound implications for curricula, admissions, evaluation, and licensure. While many definitions of "wellness" and "competency" are used within medical training environments, the authors argue that the definitions institutions ultimately use will have significant impacts for trainees who are considered "unwell." In particular, medical learners with disabilities-including those with mental health, chronic health, learning, sensory, and mobility disabilities-may not conform to dominant conceptions of "wellness," and there is a risk they will become further stigmatized or even be considered unsuitable to practice in the profession. The authors conclude that framing wellness as a competency has the potential to legitimize support-seeking and prioritize physician health, yet it may also have the potential unintended effect of excluding certain learners from the profession. They propose a universal design approach to understand wellness at a systems level and to remove barriers to wellness for all medical learners.

Simulation Technologies in Training of Family Drivers

The objective: feasibility of introducing simulation technologies into the educational process of interns and cadets-doctors in the specialty «General Practice – Family Medicine».Materials and methods. The article presents the experience of applying the system of Body Interact – clinical clinical education, the educational program of virtual clinical scenarios at the Department of Family Medicine and Therapy, which allows to recreate a certain clinical situation with all necessary modern set of objective, laboratory and instrumental methods of examination and conduct treatment in accordance with modern protocols of European and American medical associations in real time.Results. The simulation training technologies implement more effective practical training of doctors on specialty «General practice – family medicine», improving the effectiveness of training in 2–3 times.Conclusions. The using of interactive techniques, including the «Virtual Patient», in the professional training of family doctors, allows to solve the problem situations through effective actions, intuition, training, and the development of communicative skills.

Veterinary antimicrobial stewardship in North America

Major changes are occurring in veterinary antimicrobial stewardship (AMS) in food animals in Canada and the USA. Advances have been ending the use of medically important antimicrobials (MIAs) as growth promoters and bringing all MIAs for food animals under veterinary prescription in Canada (2018) or MIAs in feed or water under veterinary prescription (2017) in the USA. The USA proposes bringing all MIAs for food and companion animals under veterinary oversight, to reduce the duration of preventive use for food animals and to develop a strategy for companion animals. Both countries are taking a 'One Health' approach as part of their national strategies on addressing AMS. Federal state or province jurisdictional issues have impeded development and implementation of regulation-based stewardship approaches. Veterinary regulatory bodies in some of the larger states and provinces are active in AMS. Both the American and Canadian veterinary medical associations are independently heavily engaged in promoting AMS, as are, variably, the different veterinary 'specialty' groups. Regulatory changes and market demand are markedly reducing the use of antimicrobials in food animals. The promotion of veterinary AMS is happening at an increasing pace.

ВПРОВАДЖЕННЯ ЄВРОПЕЙСЬКИХ СТРАТЕГІЙ НАВЧАННЯ СІМЕЙНИХ ЛІКАРІВ НА КАФЕДРІ СІМЕЙНОЇ МЕДИЦИНИ І ТЕРАПІЇ

У статті представлено досвід застосування системи Body Interact – clinical reasoning education, освітньої програми віртуальних клінічних сценаріїв, яка дає можливість у реальному режимі часу відтворити певну клінічну ситуацію з усім необхідним сучасним набором об’єктивних, лабораторних та інструментальних методів обстеження і провести лікування відповідно до сучасних протоколів європейських та американських медичних асоціацій. Для відпрацювання техніки серцево-легеневої реанімації лікарями-інтернами ми використовуємо манекен-систему GD/ALS10 750+ALS, яка забезпечує навчання щодо підтримки життєдіяльності і дотримується рекомендацій стосовно серцево-легеневої реанімації та невідкладної допомоги при серцево-судинних захворюваннях. Використання симуляційних технологій орієнтує лікаря на командну працю, вміння враховувати точку зору іншого спеціаліста, сприяє розвитку комунікативних навичок, формуванню інтелектуальної самостійності та професіоналізму.

Framing obesity a disease: Indirect effects of affect and controllability beliefs on weight bias.

Obesity has been declared a disease by the American and Canadian Medical Associations. Although these declarations sparked much debate as to the impact of framing obesity as a disease on weight bias, strong empirical research is needed to examine this impact. The current study examined the impact of framing obesity a disease on weight bias, focusing on moderating and mediating processes. A sample of 309 participants living in the United States or Canada was recruited from Crowdflower. Participants completed measures of demographics, ideology, general attitudes, and previous contact quality and quantity with people living with obesity. Participants then read one of three articles as part of an experimental manipulation framing obesity as a disease, obesity not as a disease, and a control article unrelated to obesity. Post-manipulation included measures of affect, disgust, empathy, blame, and weight bias. Orthogonal contrasts were used to compare the obesity-disease condition to the obesity-not-disease condition and control condition. The manipulation had a direct effect on affect (emotions), such that affect toward individuals with obesity was more positive in the obesity-disease condition than the obesity-not-disease and control condition combined. Exploration of moderating effects revealed that both the belief in a just world and weight satisfaction moderated the relationship between the obesity-disease manipulation and blame for obesity. Two models of indirect effects on weight bias were also examined, which demonstrated that the obesity-disease manipulation predicted less weight bias through more positive affect (model 1) as well as less weight bias through decreased blame among individuals high in belief in a just world (model 2). This study further highlights the complex effects of declaring obesity a disease, uncovering a new direction for future research into the role of affect as well as indirect effects of characterising obesity a disease on weight bias.

Why Australia needs to define obesity as a chronic condition

BackgroundIn Australia people with a diagnosed chronic condition can be managed on unique funded care plans that allow the recruitment of a multidisciplinary team to assist in setting treatment goals and adequate follow up. In contrast to the World Health Organisation, the North American and European Medical Associations, the Australian Medical Association does not recognise obesity as a chronic condition, therefore excluding a diagnosis of obesity from qualifying for a structured and funded treatment plan.BodyThe Australian guidelines for management of Obesity in adults in Primary Care are structured around a five step process -the ‘5As’: Ask & Assess, Advise, Assist and Arrange’. This article aims to identify the key challenges and successes associated with the ‘5As’ approach, to better understand the reasons for the gap between the high Australian prevalence of overweight and obesity and an actual diagnosis and treatment plan for managing obesity. It argues that until the Australian health system follows the international lead and defines obesity as a chronic condition, the capacity for Australian doctors to diagnose and initiate structured treatment plans will remain limited and ineffective.ConclusionAustralian General Practitioners are limited in their ability manage obesity, as the current treatment guidelines only recognise obesity as a risk factor rather than a chronic condition.

Steroid Use for Acute Spinal Cord Injury in Latin America: A Potentially Dangerous Practice Guided by Fear of Lawsuit

Current international guidelines do not recommend the routine administration of methylprednisolone (MP) in patients with acute spinal cord injury (SCI). Its use is known to be associated with complications and death. To identify patterns of practice and reasons for MP prescription for acute SCI in Latin America. Portuguese- and Spanish-modified versions of a previously published questionnaire were used to evaluate opinions about the administration of MP for acute SCI in Latin America. This Internet-based survey was conducted with members of AOSpine Latin America. A total of 970 AOSpine Latin America members from 20 countries answered the electronic questionnaire. Of the total sample, 834 surgeons (86%) reported that they routinely treat patients with acute SCI, and 56.1% of them reported routine administration of MP for these patients. Use of MP was associated with country, specialty, length of clinical practice, and number of SCI treated yearly. Among the 468 surgeons who report routine administration of MP, 56.1% believe in the clinical benefit, 29.3% do this because of fear of litigation, 27.1% because this is a protocol in their hospital, 3.5% because they believe that MP has no major adverse effects. Despite increasing evidence against the routine administration of MP in patients with SCI and international guidelines that do not recommend its use, this potentially dangerous practice remains common on this continent. The Latin American medical associations need to produce guidelines to standardize practices with acute SCI. Moreover, educational campaigns might reduce practices guided mainly by misperception of legal issues instead of clinical benefit.

Shame is not an effective diet plan.

This narrative symposium was inspired by the American Medical Associations (AMA) decision to label obesity a disease. How do people who have been classifi ed as obese feel this decision impacts on their lives? Personal narrative authors offer their experiences with obesity and healthcare. The symposium also hosts fi ve commentary articles from scholars and stakeholders with a wide range of perspectives. These articles pull from themes in the personal narratives and bring them into dialogue with the current scholarly literature on this topic.

Experiences of an obese patient.

This narrative symposium was inspired by the American Medical Associations (AMA) decision to label obesity a disease. How do people who have been classifi ed as obese feel this decision impacts on their lives? Personal narrative authors offer their experiences with obesity and healthcare. The symposium also hosts fi ve commentary articles from scholars and stakeholders with a wide range of perspectives. These articles pull from themes in the personal narratives and bring them into dialogue with the current scholarly literature on this topic.

Obesity.

This narrative symposium was inspired by the American Medical Associations (AMA) decision to label obesity a disease. How do people who have been classified as obese feel this decision impacts on their lives? Personal narrative authors offer their experiences with obesity and healthcare. The symposium also hosts five commentary articles from scholars and stakeholders with a wide range of perspectives. These articles pull from themes in the personal narratives and bring them into dialogue with the current scholarly literature on this topic.

Comparing policies on conscientious refusals: A feminist perspective

Many professional associations have policies explaining when it is or is not acceptable for health-care professionals to refuse to participate in the administration of certain interventions on grounds of conscience. In both Canada and the United States, nursing associations tend to have much more detailed, permissive policies than medical associations. There are reasons to think that this distinction is not justifiable, and I argue that some specific North American medical associations should endorse policies regarding conscientious refusals that are modeled on those endorsed by nursing associations and the United Kingdom’s General Medical Council.

Male versus female genital alteration: Differences in legal, medical, and socioethical responses

The different legal, social, and medical approaches to ritually based male and female genital circumcision in the United States are highlighted in this article. The religious and historical origins of these practices are briefly examined, as well as the effect of changing policy statements by American medical associations on the number of circumcisions performed. Currently, no state or federal laws single out male circumcision for regulation. The tolerant attitudes toward male circumcision in law, medicine, and societal opinion stand in striking contrast to the attitudes of those disciplines toward even the least invasive form of female genital alteration. US law tacitly condones male circumcision by providing exemptions that are not available for other medical procedures, while criminalizing any similar or even less extensive procedure on females. The increase in immigration, over the past few decades, of people from countries in which female genital alteration is a cultural tradition has brought the issue to the United States. The medical profession's changing approach over time toward male circumcision is primarily responsible for such different legal and societal reactions toward female genital alteration.

Congressional Action Freezes Physician Payments

Congressional Action Freezes Physician Payments

Alzheimer, famille, institution

Alzheimer's disease (AD) is a dementia in which symptoms include cognitive impairment and also behaviour and psychological disorders. A study on the family's responses to the AD of a relative, requires envisaging several points of view. a) The family's burden. The caregiver who is generally a spouse, a daughter or a daughter-in-law has to perform difficult tasks. Caring for a patient with AD the caregiver faces a loss of role and reference. The patient's child is often playing the role of parent of the parent. Dementia caregiving exposes to high levels of stress and has psychiatric and physical effects on the caregiver, who is likely to suffer from anxiety, depression, alcoholism, and have an increased risk of mortality. Institutionalisation is a step of critical importance in AD care; the decision has to be made by the family, at the right time; b) The family's responses to AD symptoms. The family has to bear the AD symptoms: cognitive symptoms and above all, behavioural and psychological symptoms. The family senses the diagnosis when the first disorders appear in daily life. Then a large part of the family's history is lost, as the patient becomes unable to talk about the present and the past experience. In AD, the psychological disorders are: depression, anxiety, psychotic disorders and delirium. And in several psychotic disorders, the family may be involved: hallucinations, delusions particularly with ideas of theft, abandonment, jealousy or misidentification. But the most difficult problems are those of behavioural disorders; the family has to face agitation, aggressiveness, apathy, eating disorders, sleeping disturbances, sphincter disorders. The family's responses may be: denial, overprotection, mothering and hyperactivity in caregiving; c) The relationships with the geriatric institution. They are not always peaceful. Conflicts among patient, family and institution may occur, when the family resents guilt and ambivalence about institutionalisation. A former family caregiver may compete with the institution, because he feels deprived of the caregiving role. So, professional caregivers and geriatricians have to propose a therapeutic plan in which family caregivers are implicated; d) The family-patient pathological relationships. The relationships between family and patient may be pathological, due to the caregiver's psychological pathology. The caregiver may suffer from psychiatric or personality disorders, worsened by the relative's AD. Sometimes, abuse by the family is a danger for the patient; e) The support to the family. Before institutionalisation, family caregiving must be helped and supported by professional caregivers and geriatricians. Some treatments reduce behavioural disorders: cognitive enhancement medication or psychotropic medication. But the most important help is provided by professional care at home, re-education, psychotherapies and, if possible, treatment in a day care centre. In practice, american medical associations have tried to design strategies (with guidelines) to support the family caregiver. After institutionalisation, the family must also be supported, so as to keep a pleasant relationship with the relative. The end-of-life and the death are especially difficult, because the feelings of a person with dementia remain partly misunderstood. And the bereavement of an institutionalised patient seems to be more painful than the bereavement after a long and stressful period of family caregiving.

Awareness of Emergency Contraception is Limited Among American Adults

Telephone surveys conducted among US adults and obstetricians-gynecologists revealed limited awareness or promotion of emergency contraception. In the first survey (1994) involving a nationally representative sample of 2002 male and female adults 36% were aware something can be done to prevent pregnancy within a few days after unprotected intercourse and 55% had heard of emergency contraceptive pills but only 9% of those aware of the method knew a woman has up to 72 hours after unprotected sex to initiate method use. Only 1% reported that they or their partner had used emergency contraception. Knowledge of this method was highest among those who had discussed birth control with a health care provider those with at least some college education older respondents and non-Hispanic Whites. The second survey (1995) involved 307 obstetricians and gynecologists randomly selected from the American Medical Associations master file. 70% had no objections or concerns about prescribing emergency contraception and 78% considered the method effective. Although 70% had prescribed emergency contraceptive pills in the past year 77% of these had done so no more than 5 times and only 7% regularly discussed the method with clients during routine contraceptive counseling. The findings of both these surveys point to a need for health care providers to take a more active role in offering information about postcoital contraception to their patients.

Radioiodine and the treatment of hyperthyroidism: the early history.

Little was known about iodine metabolism in the mid-1930s, but when Saul Hertz and his chief, J. Howard Means, at the Massachusetts General Hospital (MGH) realized in 1936 that radioiodine could be made and used as a tracer, they arranged with physicists Robley Evans and Arthur Roberts at the Massachusetts Institute of Technology (MIT) to make the short-lived 128I and study its physiology in rabbits. By 1938, they showed that the rabbit's thyroid gland rapidly took up 128I, especially when there was only a little non-radioactive iodine present. There was, however, no hope of using 128I as a treatment because of its brief half-life (25 minutes). In 1939, Joseph Hamilton and Mayo Soley, working with Ernest Lawrence's cyclotron in Berkeley, California, were able to make several radioiodines; one was 130I (12-hour half-life) and another 131I (8-day half-life). They were the first to give these radioiodines to humans to study iodine physiology. The MGH-MIT group also built a cyclotron and by 1940 had generated these two new radioiodines. One of the goals of both groups was the treatment of hyperthyroidism. Hertz and Roberts were the first to do so on March 31, 1941; Hamilton and John Lawrence, Ernest's brother, began on October 12, 1941. By 1942, the United States was actively fighting in World War II. That year both Boston and Berkeley groups have preliminary data on the treatment of hyperthyroidism in Atlantic City; both showed that it was effective and went on to treat more patients. In Berkeley the therapy was viewed cautiously, and, in many case, the physicists were mainly occupied with work for the Manhattan District. In Boston Hertz used the therapy as often as he could, emphasizing the use of 130I, until he joined the U.S. Navy in 1943. Earle Chapman, a clinician on the voluntary staff of the MGH, took over Hertz's practice in 1943; their later differences over the precise treatment and who was in charge led to their falling out. After Hertz's release from the Navy he was not permitted to return to the MGH and became quite bitter; Chapman stayed on at the MGH. After the war was over, both had acquired a sufficient number of patients--there was then no such thing as a controlled trial--and wrote up the results for publication. Each wrote a different physicist, Hertz with Roberts and Chapman with Evans. When Hertz learned that Chapman's paper was being considered by the Journal of the American Medical Associations, he quickly sent his manuscript to JAMA as well. Although the editor of JAMA was puzzled by two papers on the same topic from the same institution, both papers appeared in the same issue of JAMA on May 11, 1964, and announced the new therapy was effective treatment for hyperthyroidism.

Evidence-based medicine and “Médecine d'Observation”

It is a great pleasure to be surrounded by colleagues with whom I worked together in the Rotterdam Institute of Epidemiology during five very formative years, from 1981 to 1986, under the guidance of Professor Hans Valkenburg. To help celebrate the 25th anniversary of this Institute, I took the opportunity of the challenge put to me by the current chairman, Professor Albert Hofman, to think about the origins and recent history of clinical epidemiology. In preparing this talk I tried to come to better answers to questions that I had repeatedly asked myself over the past years; questions that have to do with the past but also bear on the future of clinical epidemiology. I would like to start with an historical observation; from that observation derive two almost paradoxical questions for your consideration, and then try to answer them as well as I can at present. The historical observation is the following: the great idea that started under the name of Clinical Epidemiology, two to three decades ago, has today generated an offshoot, called Evidence-Based Medicine. This name was made public in a paper in Journal of the American Medical Associations in 1992 [l]. The paper said, in essence, that all medical actions of diagnosis, prognosis, and therapy should rely on solid numerical evidence based on the best of clinical epidemiologic research. It said that we should be cautious about actions that are only based on experience or on extrapolation from basic science. Many of the best practicing physicians would immediately and spontaneously agree; yes, personal experience is too uncertain a guide and extrapolations from theoretical pathophysiologic insights have left medicine so often shamefaced in the past. Think about the monkey testicles that were implanted in Paris dignitaries in the 192Os, an action based on apparently sound endocrinologic theory derived from Brown-SCquard. Yet, the ideas of Evidence-Based Medicine, introduced in the 199Os, are a repetition of a similar movement that came into existence 160 years ago. The old movement, called “MCdecine d’Observation” was led by Pierre Charles Alexandre Louis in Paris in the 183Os, and issued the same warnings [2]. It also had a very parallel name. Physicians should not rely on speculation and theory about causes of disease, nor on single experiences, but they should make large series of observations and derive numerical summaries, from which real truth about the actual treatment of patients will emerge. This historical juxtaposition is to me a great source of questions, almost paradoxes. Of course, we all sympathize with the old “Medetine d’observation.” These good people were reacting against

In Search of Standards:

In academic medicine, the importance of geriatrics in the medical curriculum is disputed. Over the last two decades, the major medical organizations have drafted recommendations and statements advocating for geriatric training in the arena of medical education. Such actions have led to the development of geriatric curriculum in the medical schools. However, a consensus has not been reached on methods by which geriatric content should be introduced into the medical curriculum. This article provides an account of the major American medical associations' efforts to develop a systematic standard for geriatric education.

The Archives of Surgery, New England Surgical Society, and JAMA

The April issue of theArchives of Surgeryfeatures publication of the annual program of the New England Surgical Society (NESS). This initiates a formal relationship of the society and the journal that will bring the new and exciting developments in surgery from medical centers in the six New England states to our readers. Also, in April, the Journal of the American Medical Association is calling attention to theArchives of Surgery, one of the nine specialty journals in the American Medical Associations' (AMA) family of publications. This emphasizes the collegiality and strengths that emanate from these relationships and the continuing dedication of the AMA to education. The addition of the NESS to the organizations associated with theArchivesprovides representation from the breadth of the country, from New England to the West—the Western Surgical Association and Southern California. The March issue of theArchives of Surgeryincluded the best