Distinct Specialty Research Articles

Nucleating emergency radiology specialization in India.

Emergency radiology is being recognized as an important and distinct specialty of radiology which merits utmost attention of educators, radiology program curricula committees, and radiology practices in India. Providing an accurate but timely diagnosis requires a skilled judgement and a strong process framework, particularly in acute trauma setting or a life-threatening acute illness. However, due to a shortage of radiologists in India and lack of awareness and suitable opportunities, there has been no concerted movement towards emergency radiology subspecialty training or dedicated emergency radiology positions. It was with these gaps in mind that the Society for Emergency Radiology was envisioned in 2012 and formulated in 2013. The proposed role of the Society for Emergency Radiology is to identify deficiencies in the field, namely, lack of adequate exposure, lack of mentorship by experienced emergency radiologists, lack of suitable opportunities for emergency radiologists; establish standards of practice; and promote education and implementation research to bridge the gaps. Through collaboration with other societies and partnership with the journal Emergency Radiology, the Society for Emergency Radiology hopes to promote a free exchange of ideas, protocols, and multi-institutional trials across continents.

Editor-in-Chief’s Top Picks From 2015: Part Two

Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become very familiar with every paper that we publish. Thus, I have personally selected the papers (both original investigations and review articles) from 13 distinct specialties for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. There are approximately 130 articles selected across this 2-part series, which represent less than 3% of the papers submitted to the Journal in 2015. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts over the course of 2 issues in JACC. Part One includes the sections: Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Cardiac Failure, Cardiomyopathies, Genetics, Omics, & Tissue Regeneration, and Hypertension. Part Two includes the sections: Imaging, Metabolic Disorders & Lipids, Rhythm Disorders, Statistics, Valvular Heart Disease, and Vascular Medicine (1-63).

Editor-in-Chief’s Top Picks From 2015: Part One

Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become very familiar with every paper that we publish. Thus, I have personally selected the papers (both original investigations and review articles) from 13 distinct specialties for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. There are approximately 130 articles selected across this 2-part series, which represent less than 3% of the papers submitted to the Journal in 2015. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts over the course of 2 issues in JACC. Part One includes the sections: Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Cardiac Failure, Cardiomyopathies, Genetics, Omics, & Tissue Regeneration, and Hypertension (1-60). Part Two includes the sections: Imaging, Metabolic Disorders & Lipids, Rhythm Disorders, Statistics, Valvular Heart Disease, and Vascular Medicine.

Frequently asked questions about family medicine in India.

Family medicine (FM) is an independent and distinct medical specialty in the developed countries such as USA, UK, Australia, and Canada since 1960s. FM teaching is imparted at undergraduate and postgraduate levels in countries such as Nepal, Pakistan, and Sri Lanka. Family practice is the practicing vocation of the majority doctors in India. The practitioners of FM include general practitioners, family physicians, FM specialists, and medical officers in the public sector. Medical students are largely unaware about FM career as this concept is not introduced at MBBS level. Faculty and senior doctors from other disciplines are also not able to answer the queries related to FM as they themselves also have gone through the same education system for last three decades, largely unexposed to the concept of academic family medicine. This article is a compilation of frequently asked questions, and their appropriate responses, presented here to dispel myths and misinformation about FM specialty. The answers are deliberated upon by Dr. Raman Kumar the founder president of the Academy of Family Physicians of India and the chief editor of the Journal of Family Medicine and Primary Care. This article was originally published as an interview in Docplexus, a popular online network and website for medical doctors in November 2015.

The dynamic evolution of rheumatology in Korea.

Rheumatology was first recognized as a distinct clinical specialty in Korea just 35 years ago. Young professors who were trained in rheumatology in the USA and afterwards returned to Korea contributed substantially to advances in rheumatology clinical practice, educational programmes and research activities. They also established the Korean Rheumatism Association, later renamed the Korean College of Rheumatology. These young rheumatologists had a major role not only in raising the level of clinical and scientific activities, but also in promoting academic exchanges around the Asia-Pacific region, the USA and Europe. Subsequently, Korea's rapid economic growth and high education level enabled rheumatology to advance rapidly. Today, continued efforts are required to raise the standard of clinical and basic research, to optimize clinical practice with regard to new biologic agents, to exploit personalized and targeted therapies for the rheumatic diseases, and to meet the medical demands of Korea's ageing society.

The Future of Gero-Oncology Nursing.

To project the future of gero-oncology nursing as a distinct specialty, framed between analysis of current challenges and explication of prospective solutions. Peer-reviewed literature, policy directives, web-based resources, and author expertise. Oncology nursing faces several challenges in meeting the needs of older people living with cancer. Realigning cancer nursing education, practice, and research to match demographic and epidemiological realities mandates redesign. Viewing geriatric oncology as an optional sub-specialty limits oncology nursing, where older people represent the majority of oncology patients and cancer survivors. The future of gero-oncology nursing lies in transforming oncology nursing itself. Specific goals to achieve transformation of oncology nursing into gero-oncology nursing include assuring integrated foundational aging and cancer content across entry-level nursing curricula; assuring a gero-competent oncology nursing workforce with integrated continuing education; developing gero-oncology nurse specialists in advanced practice roles; and cultivating nurse leadership in geriatric oncology program development and administration along with expanding the scope and sophistication of gero-oncology nursing science.

The Evolution of The American Journal of Psychology 1, 1887-1903: A Network Investigation.

The American Journal of Psychology (AJP) was the first academic journal in the United States dedicated to the "new" scientific form of the discipline. But where did the journal's founding owner/editor, G. Stanley Hall, find the "psychologists" he needed to fill the pages of such a venture 1887, when he was still virtually the only professor of psychology in the country? To investigate this question we used the substantive vocabularies of every full article published in AJP's first 14 volumes to generate networks of verbally similar articles. These networks reveal the variety of research communities that Hall drew on to launch and support the journal. Three separate networks, corresponding to 3 successive time blocks, show how Hall's constellation of participating research communities changed over AJP's first 17 years. Many of these communities started with rather nebulous boundaries but soon began to differentiate into groups of more distinct specialties. Some topics declined over time, but new ones regularly appeared to replace them. We sketch a quasievolutionary model to describe the intellectual ecology of AJP's early years.

Gene-environment interactions.

Gene-environment interactions.

Establishment of the Department of Anaesthesia at Harvard Medical School—1969

BackgroundThe first academic departments of anesthesia were established in the United States at the University of Wisconsin–Madison in 1927, with Ralph M. Waters named as chairman, and in the UK at Oxford University in 1937, with Robert Macintosh as chairman. Compared to these early departments, more than 3 decades would pass before Harvard Medical School decided it was time to establish a department of anaesthesia, in 1969. We examine the forces on both sides of the issue, for and against, and how they played out in the late 1960s. MethodsPublished articles, books, interviews, and biographical and autobiographical notes as well as primary source documents such as reports of department and medical school committee meetings were examined to obtain information relevant to our investigation. ResultsThe late 1960s were an ideal time for the chiefs of anesthesia at the various Harvard teaching hospitals to make a strong argument in favor of establishment of an independent department of anaesthesia. Although strongly opposed by Francis Daniels Moore, Chief of Surgery at Peter Bent Brigham Hospital, an independent department at Harvard was established in 1969. ConclusionsThe recognition of anesthesia as a distinctive specialty at universities across the country as well as the specific concerns over administration, hiring, and the future of the clinical service in the 1960s provided overwhelming support for the establishment of a separate, free-standing department of anaesthesia at one of the most tradition-bound universities in the United States—Harvard.

Prevalence and Intensity of Pain and Other Physical and Psychological Symptoms in Adolescents and Young Adults Diagnosed with Cancer on Referral to a Palliative Care Service.

While adolescent and young adult (AYA) oncology is recognized as a distinct specialty, there remains a paucity of literature documenting symptomatology in this cohort. This study aimed to identify the prevalence, severity, and mechanism of pain and other symptoms in AYA patients referred to a palliative care service in a specialist Australian cancer center. A retrospective design analyzed the case file data of 33 eligible AYA patients aged 15-25 years old at diagnosis and two randomly selected control groups of patients >25 years old: unmatched and matched for diagnosis and sex. All cases were referred to the palliative care service between July 2009 and June 2012. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS) and Edmonton Classification System of Cancer Pain (ECS-CP) data, and non-parametric tests were performed. The most common malignancies among the AYA patients were sarcoma and hematological cancers. All AYA patients reported pain syndrome on the ECS-CP compared with 85% of the matched controls (p=0.018). An age group effect was found for mechanisms of pain (p=0.035). A trend toward more neuropathic pain among AYA cases was also found (59% vs. 39%). The most common ESAS symptoms in AYAs were pain (91%), diminished well-being (76%), fatigue (75%), and decreased appetite (67%). AYA cancer patients appear to experience a unique symptom profile with high symptom prevalence and complexity. Further research is warranted to identify determinants and inform integration of supportive and palliative care services for this unique patient cohort.

COMPONENTS AND PRINCIPLES OF A PAEDIATRIC PALLIATIVE CARE CONSULTATION: RESULTS OF A DELPHI STUDY

Abstract Background: Pediatric palliative care is a distinct specialty that requires input from pediatric and palliative medicine specialists to provide comprehensive high-quality care. Consultations undertaken early in a child's illness trajectory, when end-of-life care is not anticipated to be required, enables relationships to be established and may enhance the quality of care provided. Objective: To define optimal components of an early pediatric palliative care consultation. Design: Consensus of an expert group was sought in a five-round Delphi study. Setting/Participants: Based on the literature and existing standards for specialist palliative care, components of an early pediatric palliative care consultation were derived. In rounds 2 and 3, experts from around Australia participated in online surveys to review and prioritize the components and principles. Consensus of survey items was determined by defined criteria. A flowchart was developed in the fourth round and the final round involved review ...

G405 Defining healthcare professional competence for working with teenagers and young adults with cancer – a brightlight study

Aims Teenage and young adult (TYA) medicine is emerging as a distinct speciality, acknowledging the core tasks required to enable a young person to transition successfully to adulthood. As healthcare education is subdivided into adult or child focused-training, a framework is needed to reflect the specific competencies required to care for this population. The aim was to provide international consensus on the competencies required by healthcare professionals to provide specialist cancer care for TYA. Methods A modified, international e-Delphi survey was conducted over 2 rounds. Experts were defined as professionals having worked in TYA cancer care for more than 12 months. They were identified through publications and invitations via professional organisations. The content of round 1 was informed by UK pilot work and a workshop undertaken by the professional organisation, TYAC. There were 87 closed-ended questions with responses on a 9-point Likert scale and further open-ended responses to identify other skills, knowledge and attitudes. Round 2 contained only items with no consensus in round 1 and suggestions of additional items of competency. Consensus was defined as a median score ranging from 7–9. Results A total of 179 registered to be members of the expert panel, of which valid responses were available for 158 (88%) in round 1 and 136 (86%) for round 2. The majority of participants were nurses (35%) or doctors (39%) from Europe (55%) or North America (35%). All 87 items in round 1 reached consensus with an additional 15 items identified for round 2. The most important skill was reported as “being able to identify the impact of disease on young people’s life”; the most important area of knowledge was “know about side-effects of treatment and how this might be different to those experienced by children or older adults”; “ability to talk about difficult issues” was the most important communication skill and honesty the highest rated attitude. Conclusions The process has been successful in identifying a high degree of consensus for competencies and skills to be used of training for professionals working with TYA.

Editor-in-Chief's Picks From 2014: Part One

As I spent countless hours pouring over hundreds of manuscripts to select those that rose to the top over the past year, Ibecame incredibly excited about being part of a Journal that produces such wonderfully rich and diverse content each year. I have personally selected the papers (both original investigations and review articles) from 13 distinct specialties for your review. There are approximately 150 articles selected across this 2-part series, which represents less than 3% of the papers submitted to JACC in 2014. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts over the course of 2 issues of JACC. Part One includes the sections: Congenital Heart Disease, Coronary Disease & Interventions, Genetics, Omics, & Tissue Regeneration, CV Prevention & Health Promotion, Cardiac Failure, and Cardiomyopathies (1-70). Part Two includes the sections: Hypertension, Imaging, Metabolic Disorders & Lipids, Neurovascular & Neurodegenerative Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine.

Comprehensive CT Cardiothoracic Imaging: A New Challenge for Chest Imaging

In the past, thoracic and cardiac imaging were two distinct specialties of radiology. The technical evolution, however, has changed their boundaries with an important impact on CT imaging practices and has opened the new era of "cardiothoracic" imaging, due to the strong anatomic, mechanical, physiologic, physiopathologic, and therapeutic cardiopulmonary correlations. Modern thoracic radiologists can no longer avoid the assessment of heart and coronary arteries, as they used to do with earlier generations of CT scanner. The advent of ECG gating and state-of-art CT scanner faster rotation speed, high spatial and temporal resolution, high-pitch mode, shorter acquisition time, and dedicated cardiac reconstruction algorithms has opened new possibilities for chest imaging, integrating cardiac morphologic and even functional information within a diagnostic chest CT scan. The aim of this review is to briefly show and summarize the concept of integrated cardiothoracic imaging, which redefines the boundaries of chest CT imaging, opening the door to a new radiologic specialty.

The commissioning of all believers: Toward a more holistic model of global discipleship

In the last 150 years, “missions” has become a distinctive specialty often separated from the normal work of the normal church. This article examines that break and how it impacts the way in which the concept of “missions” is being communicated among academics and practitioners. This article will first look at two reasons for the separation: the historical break and the cognitive compartmentalization that results. After examining the damage done by this separation, a new holistic model for understanding the church’s mission will be presented along with the benefits that this model can bring to the church.

Components and principles of a pediatric palliative care consultation: results of a Delphi study.

Pediatric palliative care is a distinct specialty that requires input from pediatric and palliative medicine specialists to provide comprehensive high-quality care. Consultations undertaken early in a child's illness trajectory, when end-of-life care is not anticipated to be required, enables relationships to be established and may enhance the quality of care provided. To define optimal components of an early pediatric palliative care consultation. Consensus of an expert group was sought in a five-round Delphi study. Based on the literature and existing standards for specialist palliative care, components of an early pediatric palliative care consultation were derived. In rounds 2 and 3, experts from around Australia participated in online surveys to review and prioritize the components and principles. Consensus of survey items was determined by defined criteria. A flowchart was developed in the fourth round and the final round involved review and refinement of the flowchart by the expert group. Nineteen experts participated and prioritized 34 components and principles in the first survey round, and 36 statements in the second survey round. There was consensus from all participants that the first priority of a consultation was to establish rapport with the family, and examples of how to achieve this were defined. Other components of a consultation included: establishing the family's understanding of palliative care; symptom management; an emergency plan; discussion of choices for location of care, and a management plan. Components considered suitable to defer to later consultations, or appropriate to address if initiated by family members, included: spiritual or religious issues; discussion around resuscitation and life-sustaining therapies; end-of-life care; and the dying process. We have provided the first published framework from expert consensus that defines the components and principles of an early pediatric palliative care consultation. This framework will provide guidance for clinical practice as well as being useful for education and research in this area.

Specialty status for interventional radiology: the time is now.

The rapid growth of interventional radiology (IR) during the past 20 years has led to the formation of IR societies in most European countries. However, in many European countries, IR is hampered by a lack of specialty status, which would allow it to determine its own future in terms of clinical practice, governance, training, and certification. In 2009, the Union of European Medical Specialists (UEMS) recognized IR as a distinct specialty of radiology. This landmark vote by the UEMS to recognize IR as a specialty has resulted in a number of European countries pursuing the same objective. Now is the time to seek specialty status for IR throughout Europe, within the house of radiology. Internationally, specialty status for IR was achieved in the United States some years ago and, more recently, specialty status has been granted to IR in Canada. Specialty recognition for IR is now a truly global phenomenon, giving IR the opportunity to shape and control its own destiny. Appropriate training in IR, certification of training, and clinical practice are now a reality for IR. Specialty status also helps to highlight the need for more IRs to allow safe and effective delivery of service, especially out of hours. This need must be met by increasing the quotas of dedicated IR trainees, which is difficult whilst IR is not recognized as a distinct specialty. The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) together with the Interventional Radiology Division of Radiology at UEMS are working closely to pave the way for IR specialty recognition in all EU countries. Applications for specialty status must demonstrate that curriculum-based training and certification of training are in place. CIRSE has already introduced an IR curriculum (www.cirse.org/curriculum_syllabus), which has been adopted by many European countries as the training standard for IR. Training in IR, as in any other training program, should be certified to ensure that the trainee has reached a certain standard and is safe to practice IR. The European Board of Interventional Radiology (EBIR), which was developed by CIRSE in 2010 and endorsed by the ESR and the IR Division of the UEMS, is rapidly becoming adopted as the certification standard for European IRs (www.cirse.org/ebir). Application for specialty status in IR occurs through the Medical Chamber or Council in each European country. CIRSE has published some general guidelines and directions on how to proceed with the application process on its website (www.cirse.org/specialtystatus). CIRSE, together with the IR Division of Radiology at UEMS, encourages all National IR Societies to apply for IR specialty status, within the house of Radiology. Specialty status for IR throughout Europe will eventually allow harmonization of training and certification throughout Europe, which will enhance patient care and safety.

The Medical Genetics Residency Milestones

Medical genetics has been recognized as a distinct medical specialty by the American Board of Medical Specialties since 1991, and as such, medical genetics residency programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME). As a component of the ACGME's Next Accreditation System (NAS), a process was initiated in 2011 to formulate Milestones for medical genetics residents. As with Milestone projects in other accredited specialties, the intent was to provide a system for evaluation of resident performance over the course of training, which also would serve as an indicator of the educational effectiveness of residency programs. The project was initiated at a propitious time in the history of medical genetics, as the discipline is experiencing a period of rapid expansion since the sequencing of the human genome. In 2011, the American College of Medical Genetics (ACMG) published a document, “Competencies for the Physician Geneticist in the 21st Century,” that was intended to help prepare the medical genetics community for the new era of genomic medicine.1 This document served as a template to guide the efforts of the Medical Genetics Milestone Project.

Remembrances of 5 Leaders and Contributors in Vascular Surgery

In September 2011, the Society for Vascular Surgery (SVS) sponsored a series of audiovisual interviews with leaders and contributors in vascular surgery to preserve the archives of SVS and chronicle vascular surgery as a distinct surgical specialty. A committee called the History Project Work Group was formed with James Yao as Chair. The members are Norman Rich, Roger Gregory, Peter Lawrence, Mark Eskandari, Melina Kibbe, Walter McCarthy, William Pearce, Ken Cherry, and Bill Baker, with Calvin Ernst as a Consultant.

Core Specialty Collaboration and Integrated Subject Formation of Cosmetic Medicine

In her January 2013 article in Aesthetic Surgery Journal entitled, “Why Should We Foster Core Specialty Collaboration in Cosmetic Medicine?” Dr Laurie Casas stated, “To better understand the scope of current research and clinical evidence, it is necessary to familiarize myself with the work coming from 4 distinct specialty groups: plastic surgery, dermatology, facial plastic surgery, and oculoplastic surgery.”1 Later, she remarked, “I remain frustrated by the lack of widespread collaboration among the specialties to achieve standardized outcome measures that are both safety- and patient-centric driven.”1 This particular viewpoint is scientific acknowledgment, based on Dr Casas's specialty practice, that several areas of cosmetic medicine should be integrated. We believe this represents an ongoing need not only in Dr Casas's own practice but also in cosmetic medicine throughout the United States. In this Letter to the Editor, we discuss trends of Chinese cosmetic medicine compared with American methods in terms of integrated care. In 1988, the Tianjin Technology Publishing House in China published research by Qiu Linzhi and Peng Qingxing proposing the concept of integrated care in cosmetic medicine. Branches of cosmetic surgery include plastic surgery, cosmetic dermatology, cosmetic dentistry, and traditional Chinese physical cosmetic techniques, among others, the approaches of which must all be integrated for the most efficacious and safe outcomes.2–14 Because of this integrated approach begun 25 years ago, China is becoming one …