General Medical Societies Research Articles

General practitioner assessment and management of insomnia in adults.

Sleep disturbance is among the most prevalent presentations in Australian general practice. Insomnia, the most common sleep disorder, is associated with impaired daytime, social and occupational function, reduced quality of life and substantially increased risk of future depression. Guidelines from Australian and international general practice, sleep and medical societies strongly recommend cognitive behavioural therapy for insomnia (CBT-i) as the first-line treatment for chronic insomnia. This is because CBT-i targets the underlying causes of insomnia, results in sustained improvements and commonly improves comorbid conditions such as depression and pain. This article aims to provide an overview of evidence-based assessment, management and referral options for insomnia in Australian general practice. Access to brief insomnia assessment andevidenced-based treatments are becoming increasingly available to Australian general practitioners. CBT-i can be delivered through self-guided online programs or by suitably trained general practitioners and psychologists.

The Psychotherapist and Neurologist Ernst Jolowicz (1882-1958): An International Career in the Shadow of Anti-semitism and Emigration

The study focuses on the life and work of the German-Jewish neurologist Dr. Ernst Jolowicz who was born in 1882. Originally from Poznan in present-day Poland, Jolowicz had gained his initial professional experience in the German Empire before serving as a neurologist at the Western Front during the First World War. After the war, he opened a private psychotherapeutic practice in Leipzig, published numerous scientific papers and was involved in the General Medical Society for Psychotherapy. In his writings, Jolowicz appeared as an undogmatic adherent of suggestive techniques and came up with his own methods for a patient-centered, psychagogic psychotherapy. In addition, he wrote numerous cultural and social scientific essays showing a wide range of interest. Shortly after the seizure of power by the National Socialists, he emigrated to Paris and supported the anti-fascist resistance in a Strasbourg radio station. After the occupation of France, Jolowicz fled to the United States in 1941 and gained a foothold there once more before he died of a heart disease in New York City in 1958.

The Case of Dr. Carl Gustav Jung

ABSTRACT In 1933, C. G. Jung became president of the “Nazified” General Medical Society of Psychotherapy and editor of its publication, the Zentralblatt für Psychotherapie. As a result of his work with the Germans during this turbulent period, Maurice Léon, who worked for a prestigious New York City Wall Street law firm, accused Jung of being a Nazi auxiliary who should be placed on trial in Nuremberg. Newly released and declassified government documents from the Central Intelligence Agency (CIA) in the National Archives in Washington DC and the British Foreign Office (BFO) in the UK National Archives, which highlight Léon’s claims for the first time, are presented and analyzed.

The tardy development of UK neurology

This carefully planned and well-organized volume, presented in lucid, readable prose, arose out of a doctoral thesis presented by Dr Stephen Casper, an American, while he worked at the Wellcome Trust Centre for the History of Medicine at University College London, and publication was supported by a grant from the Association of British Neurologists (ABN). There is a suitably analytical and complimentary foreword by Robert Y. Moore, the Love Family Professor Emeritus of Neurology at the University of Pittsburgh, and the author has provided a comprehensive preface, in which he pays tribute to the many historians and others who have guided him, and also lists many British neurologists, including myself, whom he interviewed. It is some years since I met him, so that the gestation period leading to publication has been lengthy; but, having read the book, I believe that it has been worth waiting for. Following an introduction entitled From Physician to Neurologist , there are five major chapters, the first dealing with physicians in neurological societies and neurologists in general medical societies, the second with World War I and the transformation of neurology, the third with neurology in inter-war Britain, the fourth with neurology and state medicine, and finally a comment upon the integrated legacy of contemporary specialists in neurology up until the year 2000. One major topic recurs in many different guises, namely the pervasive conflict between the generalists on the one hand and the specialists on the other; the dead hand of the former plainly delayed the development of neurology as a specialty in Britain, much more so than in much of continental Europe and in North America. In the author’s view, the eventual victory of the specialists shed light on a phenomenon which emerged in the last decades of the 20th century—the rise of a …

From Copenhagen to the consulting room: Pauli and Jung in Copenhagen

In this paper the city of Copenhagen is used as a starting point to highlight some critical historical events, both concerning the exchange of ideas between the physicist Wolfgang Pauli and C.G. Jung and the history of psychotherapy in Scandinavia. Pauli's years in Copenhagen under the influence of Niels Bohr and his philosophy prepared him mentally to receiveC.G. Jung's ideas. The paper also recounts the one occasion that Jung was in Scandinavia, attending the 9th conference of the General Medical Society for Psychotherapy in Copenhagen, just before going to New York in 1937 to give his final seminars on Pauli's dreams. The reason for focusing on these particular events is that they also constitute part of the history of the reception of psychodynamic psychology in Sweden and Scandinavia.

Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

Jung's Presidency of the International General Medical Society of Psychotherapy

Jung’s activities during the Thirties in the institutional field of psychotherapy as well as some affirmations concerning the Jewish and German collective mentality have given rise to a historiographical debate that is today still very live and controversial. Often the debate is polarized between accusers and defenders on the basis of a rather static historical investigation of the primary sources. This paper deals, with the help of some unpublished material, mainly with Jung’s activity in the AAGP – the IAAGP (1933–1939/40). In his position as president of the Society, Jung faced difficulties due to the strong political presence of the German psychotherapeutic Society, and he tried to create other national groups in the framework of a Federal supernational or international and neutral Society. The main focus here is given to the initial phase of the Jung’s presidency in 1933, his initial position when faced with the question of the Gleichschaltung of the German Group (DAAGP), and then to the Congresses of the following years and the development of psychotherapy in Europe before the Second World War.

Professional relationships in dangerous times: C. G. Jung and the Society for Psychotherapy

Relying in part on previously unpublished documents of the 1930s, this paper(1) describes the origins and mission of the General Medical Society for Psychotherapy, both as it existed before Hitler's rise to power and as it was transformed afterward. Jung accepted the Society's presidency in 1933-34, on condition that it be restructured as an international, politically neutral organization, free from the laws of Gleichschaltung (Nazi conformity). The paper also contains a close study of Jung's collaboration with one interesting German colleague, Walter Cimbal. Cimbal, a neurologist, was briefly a member of the Nazi Party and, judging from his early letters to Jung, a Hitler enthusiast. Yet he also seems to have tried, together with Jung, to alleviate the difficulties of German Jewish colleagues whose lives were disrupted by the Hitler revolution. The paper includes translated passages from Cimbal's previously unpublished letters from 1933-36 and the post-war years. It also includes a first-person account by Wladimir Rosenbaum, the Zurich lawyer who assisted Jung in 1934, when Jung tried to mitigate the impact of anti-Jewish laws on his German Jewish colleagues. In the primary materials of this period one discovers more evidence of moral shadow-and also less-than is sometimes assumed.

A new partnership between Acta Radiologica and Royal Society of Medicine Press

A new partnership between <i>Acta Radiologica</i> and Royal Society of Medicine Press

The Role of Physicians and Medical Organizations in the Development, Analysis, and Implementation of Health Care Policy

Health policy is developed in the United States through a complicated interplay of governmental and private agencies and businesses, physician organizations, and societies as well as a host of other private ventures. The end result is rarely precisely what any individual or group may desire as the consequences of any action are never entirely predictable. There are many pathways to influence policy development within this system, and many of these are influenced by physicians as individuals and through organized medical societies. Opportunities abound to constructively engage the system, and it is important that physicians operating within this system understand where and how they may influence policy development. Changes are made or considered on a daily basis that impact patient's access to care, implementation and access to technological and biological innovation, reporting requirements, insurance, physician's reimbursement, and so on. This article reviews the most important channels by which physician input is incorporated in the system. The role of specialty societies, general medical societies, Congress, and Centers for Medicare and Medicaid Services are reviewed. The role of other players will also be addressed to show the many routes by which policy may evolve. Much of the discussion revolves around reimbursement because reimbursement often determines the availability and use of procedures and technology for our patients.

Implementierung der multizentrischen Basisdokumentation CL-BaDo für den Konsiliarund Liaisondienst: Generierung von Daten für internes Qualitätsmanagement und Kostenkalkulation/ Implementation of the multi-center basis documentation CL-BaDo for conciliar and liaison services: Generating data for internal quality management and cost calculation

In the German DRG system the funding of CL services is not ensured. The documentation of psychiatric comorbidity and CL care delivery is a pre-condition to the development of funding models for CL-services. A task force of several German psychosomatic associations (German College of Psychosomatic Medicine, German Society of Psychosomatic Medicine and Psychotherapy, General Medical Society for Psychotherapy) developed a new documentation form for CL-services (CL-BaDo). The pilot study explored the multicenter implementation of CL-BaDo and the use of the documentation form for quality management and cost calculation. Over a period of at least three months, participating CL-services documented all CL cases consecutively with the CL-BaDo. One site applied full electronic data processing. 2116 CL cases from eight psychosomatic CL-services were analysed. The CL-BaDo is a time-efficient, feasible and acceptable documentation form for CL-service delivery. The full electronic data processing enables networking with a hospital information system to produce higher data quality. The data of CL-BaDo can be used locally for quality management, development of management strategies and communication with consultants, as well as nationwide for health policy questions and research.

Basisdokumentation für den Konsiliar-Liaison-Dienst: Entwicklung der CL-BaDo/ A Documentation Form for the Consultation-Liaison Service: Development of the CL-BaDo

In consultation liaison (CL) psychiatry and psychosomatics a multicenter documentation form for the assessment of clinical characteristics of patients and CL service delivery is urgently needed for health care planning and future mental health research. In several steps a joint working party of the psychosomatic and psycho-therapeutic societies in Germany (German College for Psychosomatic Medicine, German Society of Psychosomatic Medicine and Psychotherapy, General Medical Society for Psychotherapy) developed a documentation form for C-L service (CL-BaDo). The goals and quality criteria of the patient registration form are defined in an extended consensus process of C-L experts. A pool of formerly 60 items was reduced to 36 items collecting data concerning sociodemographic characteristics, referral information, anamneses, actual psychiatric and somatic status and diagnoses, C-L interventions and treatment recommendations. To enable comparisons, the formulation of items are adapted to existing inpatient and outpatient documentation forms (Psy-BaDo,EuroQA-CL). A special manual guides the coding of the CL-BaDo. 16 CL services in Germany and Austria participated in the testing and pilot study of six months demonstrating the comprehensibility and fast completion of CL-BaDo and consultants' high acceptance of the form. A time-saving and user-friendly electronic version for data entry and data analyses was developed using hand-held technology. The data of the CL-BaDo can be used for 1) quality management and communication purposes with referring departments and 2) for multicenter collaborative studies, mental health care management and care planning.

Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature.

Practice guidelines play an important role in medicine. Methodological principles have been formulated to guide their development. To determine whether practice guidelines in peer-reviewed medical literature adhered to established methodological standards for practice guidelines. Structured review of guidelines published from 1985 through June 1997 identified by a MEDLINE search. Mean number of standards met based on a 25-item instrument and frequency of adherence. We evaluated 279 guidelines, published from 1985 through June 1997, produced by 69 different developers. Mean overall adherence to standards by each guideline was 43.1% (10.77/25). Mean (SD) adherence to methodological standards on guideline development and format was 51.1% (25.3%); on identification and summary of evidence, 33.6% (29.9%); and on the formulation of recommendations, 46% (45%). Mean adherence to standards by each guideline improved from 36.9% (9.2/25) in 1985 to 50.4% (12.6/25) in 1997 (P<.001). However, there was little improvement over time in adherence to standards on identification and summary of evidence from 34.6% prior to 1990 to 36.1 % after 1995 (P = .11). There was no difference in the mean number of standards satisfied by guidelines produced by subspecialty medical societies, general medical societies, or government agencies (P = .55). Guideline length was positively correlated with adherence to methodological standards (P = .001). Guidelines published in the peer-reviewed medical literature during the past decade do not adhere well to established methodological standards. While all areas of guideline development need improvement, greatest improvement is needed in the identification, evaluation, and synthesis of the scientific evidence.

The Innocuousness of the Specialist.

Cleveland, Ohio, Dec. 19, 1899. <h3>To the Editor:</h3> While it is perhaps natural that in general medical societies there has grown up a tradition that the chief offices shall be held by a general practitioner or a general surgeon, there is room for doubt as to the expediency of adhering too rigidly to such a rule. Certainly it may be permitted a general practician to advocate that occasionally an office of some consequence should be bestowed on a specialist. This would tend to broaden the professional horizon and to unify the different existing branches of medicine. It must not be overlooked that the specialists, because of their specialism, are none the less members of the great profession of medicine. It is proper that they should not be permitted to monopolize the offices, for the reason that they appeal for support to the profession itself; but entirely shutting them out from

RADICALISM AND CONSERVATISM IN GYNECOLOGIC SOCIETIES.

An address by the retiring President seems to be one of the leading features of the annual meeting of this Society, and I see by the program that I am not to be spared this year. Gynecologic societies are generally organizations of comparatively recent nativity, and are the result of the recognition of gynecology as a distinct and all-important branch of medical science. I am not in possession of facts by which I could outline to you the history of these societies generally, but the work they accomplish is so important that I thought I might entertain you upon their peculiarities and their field of usefulness. Previous to the last two or three decades, the work now accomplished by these associations was made a part of the transactions of the general medical societies, and later on, of the obstetrical societies. As gynecology developed, however, and the womb of alma mater