Biomedical Communications Research Articles

Partial Orchiectomy for Presumed Malignancy in Patients With a Solitary Testis Due to a Prior Germ Cell Tumor: A Large North American Experience

Partial orchiectomy is becoming more accepted for indications such as a metachronous germ cell tumor due to reported oncological control, and minimal functional, physical and psychological morbidity. Most data originate from Europe. Thus, we reviewed our North American experience with such men who underwent partial orchiectomy for a presumed contralateral testicular malignancy. We identified demographic, clinical, pathological and outcome data on men in our institutional database who underwent partial orchiectomy for presumed testicular malignancy from 1994 to 2009 and had a prior germ cell tumor. Patients were followed with examination, markers and imaging. We identified 27 men, of whom 17 (63%) had malignancy, including seminoma in 9, teratoma in 3, embryonal lesion in 1, Leydig cell tumor in 3 and carcinoma in situ in 1, and 10 (37%) had benign lesions. Frozen section was accurate, no positive margins were reported and all tumors were stage 1. Carcinoma in situ was found in 9 patients (53%). No perioperative complications were recorded. Management after partial orchiectomy was observation in 12 of 17 cases. Two patients underwent completion orchiectomy for local recurrence of carcinoma in situ only, including chemotherapy in 1. A patient with seminoma elected radiation and 1 required retroperitoneal lymph node dissection for teratoma. The remaining 5 patients with carcinoma in situ were surveilled. Of the men 31% required testosterone substitution. All patients were disease free at a median 5.7-year followup with no local recurrences. Partial orchiectomy is an option to decrease morbidity in men with a metachronous germ cell tumor. Clearly a definite benefit of partial orchiectomy is that a significant proportion of patients with suspicious testicular lesions did not have malignancy and were definitively treated with an organ sparing approach. However, partial orchiectomy is potentially associated with the need for adjuvant treatment and androgen substitution, which should be discussed with all patients.

SFRP2 Suppression of Bone Morphogenic Protein (BMP) and Wnt Signaling Mediates Mesenchymal Stem Cell (MSC) Self-renewal Promoting Engraftment and Myocardial Repair

Transplantation of mesenchymal stem cells (MSCs) is a promising therapy for ischemic injury; however, inadequate survival of implanted cells in host tissue is a substantial impediment in the progress of cellular therapy. Secreted Frizzled-related protein 2 (sFRP2) has recently been highlighted as a key mediator of MSC-driven myocardial and wound repair. Notably, sFRP2 mediates significant enhancement of MSC engraftment in vivo. We hypothesized that sFRP2 improves MSC engraftment by modulating self-renewal through increasing stem cell survival and by inhibiting differentiation. In previous studies we demonstrated that sFRP2-expressing MSCs exhibited an increased proliferation rate. In the current study, we show that sFRP2 also decreased MSC apoptosis and inhibited both osteogenic and chondrogenic lineage commitment. sFRP2 activity occurred through the inhibition of both Wnt and bone morphogenic protein (BMP) signaling pathways. sFRP2-mediated inhibition of BMP signaling, as assessed by levels of pSMAD 1/5/8, was independent of its effects on the Wnt pathway. We further hypothesized that sFRP2 inhibition of MSC lineage commitment may reduce heterotopic osteogenic differentiation within the injured myocardium, a reported adverse side effect. Indeed, we found that sFRP2-MSC-treated hearts and wound tissue had less ectopic calcification. This work provides important new insight into the mechanisms by which sFRP2 increases MSC self-renewal leading to superior tissue engraftment and enhanced wound healing.

Wayne State University School of Medicine

Wayne State University School of Medicine

Personal Recollections of the Contributions of Estelle Brodman: An Enduring Legacy for Health Sciences Librarianship

Personal Recollections of the Contributions of Estelle Brodman: An Enduring Legacy for Health Sciences Librarianship

Laws, leaders, and legends of the modern National Library of Medicine.

The paper is an expanded version of the 2007 Joseph Leiter National Library of Medicine (NLM)/Medical Library Association Lecture presented at MLA '07, the Medical Library Association annual meeting in Philadelphia in May 2007. It presents an historical accounting of four major pieces of legislation, beginning with the NLM Act of 1956 up through the creation of the National Center for Biotechnology Information. The transition from the United States Armed Forces Medical Library to the United States National Library of Medicine in 1956 was a major turning point in NLM's history, scope, and direction. The succeeding landmark legislative achievements--namely, the 1965 Medical Library Assistance Act, the 1968 Joint Resolution forming the Lister Hill National Center for Biomedical Communications, and the 1988 authorization for the National Center for Biotechnology Information--transformed the library into a major biomedical communications institution and a leader and supporter of an effective national network of libraries of medicine. The leaders of the library and its major advocates--including Dr. Michael DeBakey, Senator Lister Hill, and Senator Claude Pepper-together contributed to the creation of the modern NLM.

Glenn Lowell Brudvig, 1931–2007

Glenn Lowell Brudvig, 1931–2007

Biomedical Communications: Collaborative Research in Scientific Visualization, Online Learning, and Knowledge Translation

Collaborative research in biomedical communications investigates the role of visual media in scientific discovery and in patient and health professional education. The spectrum of work is broad and includes the visualization of scientific knowledge and simulation of hypothetical models of health and disease, as well as the design of audience-centered interactive visual media. The work cited supports the notion that research-based visual media can contribute to the core missions of science: discovery, communication, collaboration, and education.

American College of Medical Informatics Fellows and International Associates, 2005

Alan R. Aronson “Lan” Aronson received his bachelor's degree in mathematics magna cum laude from the University of Washington in Seattle, a master's degree in mathematics, and both master's and Ph.D. degrees in computer science from the University of Maryland. He has been a computer scientist at the National Library of Medicine's (NLM) Lister Hill National Center for Biomedical Communications since 1988. In a highly productive research program, he has developed a broad array of applications that use the Metathesaurus and other UMLS (Unified Medical Language System) knowledge components. Among these are MetaMap, which is a program that automatically maps text to concepts in the Metathesaurus, and a Medical Text Indexer System, which produces automated MeSH indexing of meeting abstracts and suggests appropriate MeSH headings to NLM's MEDLINE indexers. He also developed a Natural Language Processing (NLP) subset tag that has been incorporated into the Metathesaurus assist NLP researchers. Dr. Aronson's election to the College recognizes the substantial impact his innovations have had on the productivity of other researchers, and the utility of NLM's global information services. Olivier Bodenreider Dr. Bodenreider received his MD degree from the University of Strasbourg, France; a research degree in informatics, statistics and epidemiology; a master's degree in computer science and another one in medical information; and a PhD in medical informatics, all from the Henri Poincare University. He began his career as a junior faculty member in France, working on the informatics of clinical toxicology and took a sabbatical year at the NLM. He has been there ever since, working as a staff scientist within the Lister Hill National Center for Biomedical Communications. His work has focused on applications of the UMLS. He has developed concept mapping algorithms that are used in national information resources, such as ClinicalTrials.gov, Genetics Home Reference, and Profiles in …

Scientific Illiteracy and the Partisan Takeover of Biology

Scientific Illiteracy and the Partisan Takeover of Biology

Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice

To identify communication patterns used by veterinarians during clinical appointments in companion animal practice. Cross-sectional descriptive study. A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. For each practitioner, 6 clinical appointments (3 wellness appointments and 3 appointments related to a health problem) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes, and cluster analysis was used to identify veterinarian communication patterns. 175 (58%) appointments were classified as having a biomedical communication pattern, and 125 (42%) were classified as having a biolifestyle-social communication pattern. None were classified as having a consumerist communication pattern. Twentythree (46%) veterinarians were classified as using a predominantly biomedical communication pattern, 19 (38%) were classified as using a mixed communication pattern, and 8 (16%) were classified as using a predominantly biolifestyle-social communication pattern. Pattern use was related to the type of appointment. Overall, 103 (69%) wellness appointments were classified as biolifestyle-social and 127 (85%) problem appointments were classified as biomedical. Appointments with a biomedical communication pattern (mean, 11.98 minutes) were significantly longer than appointments with a biolifestyle-social communication pattern (10.43 minutes). Median relationship-centered care score (ie, the ratio of client-centered talk to veterinarian-centered talk) was significantly higher during appointments with a biolifestyle-social communication pattern (1.10) than during appointments with a biomedical communication pattern (0.40). Results suggest that veterinarians in companion animal practice use 2 distinct patterns of communication. Communication pattern was associated with duration of visit, type of appointment, and relationship-centeredness. Recognition of these communication patterns has implications for veterinary training and client and patient outcomes.

Comments on “the corporate author”

To the Editor:—Fugh-Berman1 described the unethical practice of soliciting an author for a review prepared by an undisclosed writer. We agree with Tierney and Gerrity's2 characterization of the problem as failure to disclose the original author(s) and pertinent financial relationships. We also applaud the World Association of Medical Editors (WAME) for recommending that journal editors expand their Information for Authors to indicate that medical writers can be legitimate contributors to manuscripts and to encourage disclosure of their roles and affiliations.3 Put into practice, this recommendation empowers biomedical communicators to become part of the solution. We believe biomedical communicators are in an ideal position to help solve the problem. More than 5,000 biomedical communicators belong to the American Medical Writers Association (AMWA), an educational organization founded in 1940 to promote excellence in biomedical communication and to recommend principles of conduct for its members. The first principle in AMWA's Code of Ethics4 states, “Biomedical communicators should recognize and observe statutes and regulations pertaining to the materials they write, edit, or otherwise develop.” Principle 4 states, in part, “[Biomedical communicators] should refuse … assignments that require unethical or questionable practices.” AMWA's recently adopted position statement recommends acknowledgment of substantial contributions to scientific publications with disclosure of pertinent relationships.5 Biomedical communicators who contribute substantially to manuscripts should join the author-writer team at the inception of the project. Under these circumstances, biomedical communicators can encourage authors to adhere to ethical standards while following a logical process—beginning with identifying the main message to be conveyed, targeting the audience, and determining the most appropriate journal for conveying the message. One of us (C.W.H.) recently conducted a pilot survey to identify practices of biomedical communicators who contribute substantially to manuscripts submitted to biomedical journals. Seventy-three of 221 eligible advertisers in AMWA's freelance directory (33%) participated. More than half indicated that they followed guidelines from AMWA4,5 (59%) and the International Committee of Medical Journal Editors6 (ICMJE) (56%) and encouraged authors and other contributors to follow guidelines from AMWA (56%) and the ICMJE (54%). We plan to expand this survey to assess the experience of more biomedical communicators, the frequency of practices such as those described by Fugh-Berman,1 and the impact of AMWA's ongoing educational campaign on that frequency. We encourage authors, editors, and writers to continue working together to eliminate unethical practices in the writing of scientific manuscripts. Sincerely

‘She gave it her best shot right away’: Patient experiences of biomedical and patient-centered communication

Objective Medical educators and researchers recommend a patient-centered interviewing style, but little empirical data exists regarding what aspects of physician communication patients like and why. We investigated patient responses to videotaped doctor–patient vignettes to ascertain what they liked about patient-centered and biomedical communication. Methods We conducted semi-structured interviews with 230 adult medicine patients who viewed videotapes depicting both patient-centered and biomedical physician communication styles. We used a mixed methods approach to derive a “ground-up” framework of patient communication preferences. Results Respondents who preferred different communication styles articulated different sets of values, important physician behaviors, and physician–patient role expectations. Participants who preferred the patient-centered physician (69%) liked that she worked with and respected patients and explored what the patient wanted. Participants who preferred the biomedical physician (31%) liked that she prevented harm, demonstrated medical authority, and delivered information clearly. Conclusions Patients like (and dislike) patient-centered communication for thoughtful, considered reasons that appear grounded in their values and expectations about physicians, patients, and the clinical encounter. Practice implications Better understanding the diversity of patient communication preferences may lead to more effective and individualized care.

On the Applicability of Simplified Spherical Human Heads for Implanted Antennas in Biomedical Communications

The spherical dyadic Green's function (DGF) simulations of the interactions between an implanted antenna and a human head are performed with an emphasis on a biomedical communication link between an antenna implanted in a human head and an exterior antenna. Suitability of the spherical head model for characterization of implanted antennas in a human head is tested using the finite difference time domain (FDTD) simulation based on an anatomical head model. The near-field distributions, the far-field patterns, and the radiation power from dipoles in three different types of spherical heads (homogeneous, three-layered, and six-layered heads) are compared to estimate the dependency of implanted antennas on the head configurations. To analyze the performance of the wireless link and to estimate the minimum sensitivity requirements, the maximum available powers are obtained at various locations on the inside and exterior antennas.

Image informatics at a national research center

Image informatics at the Communications Engineering Branch of the Lister Hill National Center for Biomedical Communications (LHNCBC), an R&D division of the National Library of Medicine (NLM), includes document and biomedical images. In both domains, research into computer-assisted methods for information extraction, and the implementation of prototype systems incorporating such methods, is central to our mission. Current document image research focuses on extracting bibliographic data from scanned journal articles. Current biomedical imaging work focuses on content-based image retrieval (CBIR) and related problems in segmentation, indexing, and classifying collections of images of the spine and of the uterine cervix.

Patient-centered communication

To investigate patient preferences for a patient-centered or a biomedical communication style. Randomized study. Urgent care and ambulatory medicine clinics in an academic medical center. We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82% [51/62] for age < 30; 68% [100/148] for ages 30-59; 55% [21/38] for age > 59; P < .03), more educated (76% [54/71] for postcollege education; 73% [94/128] for some college; 49% [23/47] for high school only; P= .003), use CAM (75% [140/188] vs. 55% [33/60] for nonusers; P= .006), and have a patient-centered physician (88% [74/84] vs. 30% [16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a "doctor's interest in you as a person" as "very important." Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication.

Evaluation of shape similarity measurement methods for spine X-ray images

Efficient content-based image retrieval (CBIR) of biomedical images is a challenging problem. Feature representation algorithms used in indexing medical images on the pathology of interest have to address conflicting goals of reducing feature dimensionality while retaining important and often subtle biomedical features. At the Lister Hill National Center for Biomedical Communications, an intramural R&D division of the U.S. National Library of Medicine, we are developing CBIR prototype for digitized images of a collection of 17,000 cervical and lumbar spine X-rays taken as a part of the second National Health and Nutrition Examination Survey (NHANES II). The vertebra shape effectively describes various pathologies identified by medical experts as being consistently and reliably found in the image collection. A suitable shape algorithm must represent shapes in low dimension, be invariant to rotation, translation, and scale transforms, and retain relevant pathology. Additionally, supported similarity algorithms must be useful in retrieving images that are relevant to the queries posed by the intended target community, viz. medical researchers, physicians, etc. This paper describes an evaluation of two popular shape similarity methods from the literature on a set of 250 vertebra boundary shapes. The polygon approximation method achieved a performance score of 55.94% and bettered the Fourier descriptor algorithm which had a performance score of 46.96%.

Mala conducta científica en la comunicación de resultados biomédicos, ¿costumbre consagrada por el uso o laxitud de la ética?

The generically known as poor scientific behavior exists in different degrees with regard to biomedical communications and publications. From authentic fraud in the data up to the called "tricks" for curriculum fattening. The objective of this work is to review the works presented in the XVIII Congress of the Andalusian Society of Internal Medicine (Marbella, October 2001), comparing them with the abstracts books of six more scientific meetings and congresses both regional and national. Of the 183 works evaluated in this review, 22 (12.02%) were doubled and 13 (7.10%) fragmented, in other words, a total of 35 (19.33%). The groups that presented communications were 36, and 17 of them (47.22%) carried out one or both fraudulent tactics. Despite the little bibliographic reference, in our environment exists the duplication and the fragmentation of works presented, in general as a system for curriculum increase. We advocate a higher clarity and commitment in the relationship between editors and authors, and an upsurge of the aspects of punishable deontological regulation on the one hand and of the ethics or a priori commitment on the other one.

The Use of Video in Infection Control

BACKGROUND: Our institution, a 1200-bed teaching hospital in New York City, mobilized in response to the threat of SARS in 2003. PROJECT: The New York-Presbyterian Hospital SARS Task Force decided to develop a videotape that depicts the step-by-step technique for donning and removing the personal protective equipment worn during the care of SARS patients. This videotape was written and performed by hospital staff members, and produced in conjunction with Columbia University, Center for Biomedical Communications. RESULTS: A video format was chosen as the best way to demonstrate visual techniques that are difficult to show via written materials. We wrote a script, built a set to replicate a negative-pressure isolation room, and had staff members from the Department of Epidemiology take prominent roles. The videotape opens with a brief introduction to the global SARS situation in 2002-2003 utilizing a voice-over and graphics. The action then transitions to the set where a narrator provides the necessary explanations. The viewers see the role of the “Observer,” a nurse whose task it is to enforce the SARS policies, and watch a social worker, housekeeper, and physician step through the techniques of donning and removing personal protective gear. LESSONS LEARNED: Through this collaborative effort, our facility has a highly effective tool that educates our staff in the steps required to themselves and their colleagues from a life-threatening illness.

Informatics Research, Development, and Training at the Lister Hill National Center for Biomedical Communications

Informatics Research, Development, and Training at the Lister Hill National Center for Biomedical Communications

Communicating fatigue in general practice and the role of gender

The aim of this study has been to obtain more insight into the health condition of fatigued patients, their expectations when visiting the general practitioner (GP), the way they communicate, and possible gender differences. Data consisted of 579 patient questionnaires and 440 video-observations of these patients and 31 GPs. Results showed that fatigue is a common health problem but seldom on the agenda in general practice. More women indicated symptoms of fatigue than men did. Fatigued patients’ health was worse than that of non-fatigued patients, and they expected more biomedical and especially psychosocial communication. Furthermore, male fatigued patients expected more biomedical communication than fatigued female patients did. While the GPs accommodated their verbal behavior to fatigued patients by giving more psychosocial information and more counseling, they were not more affective towards the fatigued than towards the non-fatigued patients. Female GPs were more affective than their male colleagues, and they used gender-specific communication strategies to explore the patient’s agenda. It seems necessary to use a gender-sensitive approach in communication research.