Future Practice Of Medicine Research Articles

Implications of PET based molecular imaging on the current and future practice of medicine

The last quarter century has witnessed the introduction of a variety of powerful techniques that have allowed visualization of organ structure and function with exquisite detail. This in turn has brought about a true revolution in the day-to-day practice of medicine. Structural imaging with x-ray computerized tomography and magnetic resonance imaging has added tremendously to many areas of medicine, including preoperative evaluation of patients. Many surgical procedures have been replaced by minimally invasive techniques, which have become a reality only because of the availability of modern imaging modalities. However, despite such accomplishments, structural imaging is quite insensitive for detecting early disease in which there often are no gross structural alterations in organ anatomy. Therefore, these modalities should be complemented by methodologies that can detect abnormalities at the molecular and cellular levels. The introduction of [ 18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) in 1976 as a molecular imaging technique clearly has shown the power of this approach for treating a multitude of serious disorders. The impact of FDG-PET has been particularly impressive in patients with cancer diagnosis, for whom it has become important in staging, monitoring response to treatment, and detecting recurrence. In this review, we emphasize the role of FDG-PET in the assessment of central nervous system maladies, malignant neoplastic processes, infectious and inflammatory diseases, and cardiovascular disorders. New radiotracers are being developed and promise to expand further the list of indications for PET. These include novel tracers for cancer diagnosis and treatment capable of detecting hypoxia and angiogenesis. Prospects for developing new tracers for imaging other organ diseases also appear very promising.

Pharmacogenomics in anticoagulant drug development.

The emergence of pharmacogenomic-guided anticoagulant drug development has unraveled novel approaches in the management of patients and ensured individualized therapy to one and all. Gene expression profiling will be useful in the diagnoses of various diseases, in preclinical phases of drug development and in developing markers for adverse drug reactions and desired pharmacological effects. Hence, the adverse drug reactions can be avoided by withdrawing a particular drug. Through cheminformatics, decisions could be made in anticoagulant drug discovery, tailored to the individual needs of the patient at the right dosage and right time. As the human genome is now completely mapped, gene-based single nucleotide polymorphism will be valuable in the diagnosis of diseases. In this review, various polymorphism of coagulation factors will be discussed. Newer anticoagulant drugs could be withdrawn from drug discovery and development pipelines should they exhibit hepatic metabolism requiring CYP450 enzymes known to manifest single nucleotide polymorphism resulting in adverse drug reactions. Pharmacogenomics and cheminformatics should be incorporated in the current study designs of prospective clinical trials. Pharmacogenomic and pharmacogenetic data should be included in the Investigational New Drug (IND) applications, which would enable the FDA to better understand its true impact on pharmacoeconomics. Pharmacogenomics will eventually revolutionize anticoagulant drug development and future practice of medicine.

"Advising Oliver Mann"--a case-based, small-group orientation to medical school.

In 1998, the authors implemented a new academic orientation built around a problem-based clinical exercise for entering medical students, to prepare them for a curriculum emphasizing active learning in small groups. The exercise enables students to begin their professional studies with a "hands on" understanding of two major emphases of the curriculum: (1) the process of small-group learning that will guide their medical education and (2) the principles of patient care that will guide their future practice of medicine. Called "Advising Oliver Mann," this orientation presents students with a clinical problem that they must work in small groups to solve. By collaborating in teams of ten, they become acquainted with the small-group learning methods at the heart of the school's curriculum. Through solving a clinical problem, they discover vital principles of patient care, such as the need in clinical decision making to integrate the scientific perspective with the perspective of patient and family. In developing "Oliver Mann," the authors came to realize that orientations can be much more than introductions. They can be reflective moments in a busy curriculum, a time for students and faculty to step back and take stock of important issues in education and doctoring. The authors are currently experimenting with exercises linking their freshman orientation with orientations in the second and third years so participants can reflect on the challenges of each new year and carry forward the small-group methods and practice of medicine themes of the new curriculum.

Current status and future advances of digital radiography and PACS.

Describes the current status and future advances of two components in a large-scale digital healthcare delivery system: digital radiography (DR) and PACS, as well as their relationship with other healthcare information systems, hospital information systems (HIS), and electronic patient records (EPR). In DR, the authors review computed radiography and describe the current advances in DR technology. The measurements of spatial resolution, image contrast, and signal-to-noise ratio (SNR) of DR are given. In PACS, the authors emphasise DR and PACS integration and its utilization in several applications, including outpatient clinics, emergency rooms, imaging centers, and teleradiology. The importance of medical imaging informatics in the future practice of medicine based on integrated PACS is also outlined.

Integrating Home Health Care into Managed Care: Getting the Physician Involved

The importance of developing a partnership to establish a health system that will improve the health of individuals in the home, and in the community, is presented from three perspectives: payer, home health care provider, and physician. From all perspectives, physician involvement is necessary for the success of home health care. Strategies to increase physicians' involvement include physician education and enhanced reimbursement, key components to improving their use of home health care services. These two factors were not adequately addressed in the past and must be the focus for the future. However, bringing the partnership of payer, provider, and physician to a reality is not the sole responsibility of just one group. Rather, all participants working together within the system are responsible for the evolution of a new and better health system. Technology will also impact the future practice of medicine and home health care, and will allow providers and patients to have better access to each other. Improved access will ultimately result in increased satisfaction and better outcomes for patients.

Impact of a preventive cardiology curriculum on knowledge and attitudes of first‐year medical students

This study examined the impact of a preventive cardiology curriculum on the knowledge and attitudes of first‐year medical students. Questionnaires assessing knowledge and attitudes were self‐administered to classes entering in 1988 and 1989 at the beginning and end of each academic year. Data from 54 students were analyzed. All statistical analyses were significant, indicating that students showed increases in both knowledge and attitudes regarding preventive cardiology. We concluded that the preventive cardiology curriculum had a significant impact on student learning. Future research is needed to address the long‐term effect of the increases in knowledge and attitudes on the future practice of medicine.

The New Zealand Report of the cervical cancer inquiry: significance for medical education.

The New Zealand Cervical Cancer Inquiry has elicited considerable interest in Australia as well as in New Zealand. However, relatively little attention has been paid to the future practice of medicine with regard to the relevance of the Inquiry's findings for medical education, although it did recommend the incorporation of ethics teaching into all stages of the medical curriculum, and also urged that attention be paid to communication skills within the curriculum. In this article, I argue that medical ethics teaching should be seen as an essential part of the medical curriculum, with the teaching being integrated closely with the other disciplines that comprise the medical course. To illustrate one possible approach, I have outlined elements of current ethics teaching at the University of Otago. I also have raised what I regard as wider issues for the medical curriculum. These include the need for students to develop a critical facility and an ability to handle conflicting data and attitudes (fostered principally by an understanding of research methods), to appreciate the importance of accountability (fostered in part through group learning activities) and to be aware of the impact of community concerns on the practice of medicine. Another issue which I consider is raised indirectly by the Inquiry concerns the procedures that are used for the selection of students into medical courses.

Southwestern Internal Medicine Conference: Medical Telecommunications — Fundamental Changes in the Art and Science of Medicine

The availability of easy to use microcomputers and medical information retrieval systems will result in fundamental and important changes in medical practice. The acquisition of information literacy and fluency will be mandatory techniques for the future practice of medicine and should be taught at the institutional level by faculty sophisticated in the use of information retrieval systems. The resulting improvements in the practice of medicine go beyond simple cost savings to fundamentally alter the ways patients and their disorders are looked upon and handled.

Brain Peptides as Intercellular Messengers

THE FOLLOWING discussion examines the unique features of peptides as intercellular messengers. An<i>intercellular messenger</i>is defined as a substance released from one cell that is capable of modifying the functional activity of another neighboring or distant cell.¹The roles that particular brain peptides may play in regulating anterior pituitary and autonomic nervous system functions, and the potential impact of peptide biology on the future practice of medicine will also be considered. Peptides are now recognized to be a class of intercellular messengers widely distributed throughout the nervous system, gastrointestinal (GI) tract, and pancreas of both vertebrate and invertebrate animals.¹During the last 20 years, the number of peptides identified within the brain and gut of animals has increased enormously (Table 1). The discovery of these peptides in animals has resulted from improved methods of biologic assay and the development of techniques for the isolation, purification, and microsequencing

Shattuck lecture--the increasing supply of physicians, the changing structure of the health-services system, and the future practice of medicine.

This paper describes the social processes that promoted a doubling of the capacity of the medical schools between 1965 and 1980 and a projected doubling of the number of actively practicing physicians between 1970 and 2000. This rapid increase in the supply of physicians is analyzed within the framework of other forces for change in the health-care system. Health care in the 1990s will be provided within a more formalized and structured health-services system. Medical practice will be affected greatly.In this presentation facts will be presented and observable trends will be described. Changes in the characteristics of the overall . . .

The future practice of medicine

Abstract Three global issues are considered of paramount importance in determining what should be the future of medicine: population growth (with the concomitant issues of ageing, unemployment, and food shortages); energy supplies; and nuclear weapons. Yet the future practice of medicine may lie through adopting a community-oriented approach, as against adopting more high-technology methods.

The Emergency Medical Service Systems Act of 1973

THE Emergency Medical Service Systems Act of 1973 became Public Law 93-154 on Nov 16, 1973. It promises to have a significant impact on the future practice of medicine. This law adds a section to the Public Health Services Act of 1944 (PL 78-410), "to provide assistance and encouragement for the development of comprehensive area-wide emergency medical systems." These systems are defined as the arrangement of personnel, facilities, and equipment for effective coordination and delivery in an appropriate geographical area of health care services under emergency conditions by a public or a nonpublic or private entity which has the authority and resources to provide effective administration. The law demands that a local plan be developed, and it provides monies for feasibility and planning studies, initial establishment of operational systems, expansion of acceptable existing systems, and researches in emergency medical techniques and devices. It mandates local planning that will include consumers,

DEMONSTRATION TO MEDICAL STUDENTS OF PLACEBO RESPONSES AND NON-DRUG FACTORS

A class experiment for medical students Summary was devised to demonstrate the influence of the placebo effect and non-drug factors on response to drugs. The subjects were conditioned to expect sedative or stimulant effects, but all received placebo in one or two blue or pink capsules. Predictions about the size and nature of the placebo response and influence of the non-drug factors were made before the experiment and discussed afterwards. Four of six predictions were fully confirmed. Drug- associated changes were reported by 30% of the subjects and were severe in 1 or 2 individuals. Two capsules produced more noticeable changes than one, and blue capsules were associated with more sedative effects than pink capsules. Students rated the experiment highly both as a learning experience and for its relevance to their future practice of medicine.

Beth Israel Hospital Seminars in Medicine.

In an era of rapid change and increasing specialization there is constant need to relate recent advances in biologic science to the immediate and future practice of medicine. The periodic publication in the New England Journal of Medicine of Seminars from the Beth Israel Hospital (Boston) represents one of the more successful attempts to bridge the gap between medical scientists and practicing physicians. For the first time, 13 such seminars have been revised and published in bound form under the editorial supervision of Feingold and Hiatt. The diversity of subjects provides both the strength and weakness of the volume. The broad approach to the frontiers of medicine is illustrated by a brief listing of seminar topics: oncogenic virology, cancer chemotherapy, hypothalamic/pituitary function, disorders of sexual development, radioimmunoassay of peptide hormones in plasma, interferon, infectious drug resistance, thrombogenesis, thalassemic syndromes, inborn errors of the complement system, immunologic mechanisms of penicillin allergy,