Independent Medical Discipline Research Articles

Klinička farmakologija - razvojni put, propisi, obrazovanje, praktični menadžment - u svetu i u Srbiji

Introduction: After searching literature, Professor of Pharmacology at Cornell University Harry Gold was the first to use the name Clinical Pharmacology in the late 1930s and early 1940s. Topic: Clinical pharmacology is a medical discipline created in the middle of the 20th century, it implies the most effective application of medicine, and it could be said that it is the culmination of all therapeutic approaches in medicine, or simply in the preservation of human health. It is a field that spontaneously appeared in the medical field and from the first moment has the only perspective in the unity of practice and science. The second half of the last century is the time of the beginning of the recognition of specialization in clinical pharmacology as an independent medical discipline, in Europe - first in Sweden, England, Switzerland, Norway in the fifties of the last century, in America also in the same period. In Serbia and Montenegro, we noted the beginning in 1981. Clinical pharmacology is a hospital medical specialization; specialists in clinical pharmacology are doctors who know the most adequate use of drugs, which achieves an optimal therapeutic effect. The basis of clinical pharmacology is pharmacokinetics and pharmacodynamics. The development path of clinical pharmacology spans more than seven decades, and the key moments are the following: concept of bioavailability (Oser et all, 1945), pharmacokinetics (Friedrich Hartmut Dost, 1953), pharmacokinetics / pharmacodynamics (PK/PD) model (De Jongh and Wijnans and Van Gemert and Duyff, 1950), 1960 - 1980 explosion of pharmacokinetic studies and dramatic progress in the field. Pharmacokinetic interactions between drugs become evident and become the subject of many studies: in the 1970s, drug-level monitoring for digoxin, aminoglycosides, phenytoin, theophylline and other drugs began to be implemented in many hospitals. The 1980 - 2000 period is characterized by the advancement of technology, including liquid chromatography, liquid chromatography with a mass detector, and the development of computer technology. What makes clinical pharmacology attractive is the concept of the connection between drug concentration and pharmacodynamic effect, which unites science and practice in achieving a therapeutic effect and more successful medical treatment patients, appeared in the eighties of the last century. In the mid-1980s, Yusko and Boudinot began research linking biochemical mechanisms with pharmacokinetic/pharmacodynamic techniques and leading to their refinement. Conclusion: The development of pharmacology as a profession and science related to the use of drugs spontaneously moved from experimental pharmacology to clinical pharmacology to hospital pharmacology. In order for a clinical pharmacology specialist to really show and prove the useful value of this knowledge, the cooperation of all doctors in teamwork is necessary, as well as cooperation with scientists and cooperation with pharmaceutical magnates. If they find a way for a positive dialogue, the results will become a daily practice. Underline the letter to editors of journals, and alert letters via professional community, meaning be supported and informed. The main developmental goal of hospital pharmacology is to encompass a wide vaiety of specialists and subspecialists, together with strict demands in respecting pharmacoterapy choice, clinical trials law, monitoring side effects of drugs and medical devices. Ffrom authors's experience clinical pharmacologists' duties are clear, however, clinical pharmacology specialists and subspecialists are insufficient. Educating more colleagues is necessery for the future in order to increase presence of clinical pharmacology

A Survey of Surgical Patient's Perception about Anesthesiologist in a Large Scale Comprehensive Hospital in China.

Objectives This study aim to evaluate patient's perception about anesthesiologists' job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery. We collected information of respondents' demographic data, education background, health literacy and previous experience of anesthesia, perception of anesthesiologist's job, the expectation on anesthesia care. Descriptive analyses, χ [2] test and multiple linear regression analysis were used for data analysis. Results Of 550 participants, 521（94.7%）completed the questionnaire. In these respondents, 335 (64.3%) considered anesthesiology as an independent medical discipline, 225 (43.2%) believed that anesthesiology department was an independent clinical department, and 243 (46.6%) recognized anesthesiologists as qualified doctors. Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well. Younger patients (β=-0.044, P<0.001), those with higher education (β=1.200, P<0.001), or with better health literacy (β=0.781, P=0.005) had significant more knowledge about the job roles of anesthesiologists. Most patients demanded pre-anesthetic visit (80.5%), expected availability of preoperative anesthetic clinic (74.1%), wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients' perception about anesthesiologists might be limited. Efforts should be made on education about anesthesia, especially for elderly patients and those under-educated patients. Preoperative anesthetic clinic is expected by most in-patients.

Abe Baker: Visionary and organizational leader of the American Academy of Neurology

ABSTRACTAmerican neurologist and neuropathologist Abraham Bert (Abe) Baker (1908–1988) was instrumental in founding the American Academy of Neurology and served as a catalyst for the emergence of neurology as a strong, independent medical discipline in the United States in the second half of the twentieth century. Baker served as the first president of the Academy from 1948 to 1951. He was also instrumental in garnering support for the National Institute of Neurological Diseases and Blindness, which was founded in 1950 and later evolved into the National Institute of Neurological Disorders and Stroke. Baker’s leadership was also essential in developing continuing medical education for neurologists at a national level and in garnering federal financial support for neurology training programs.

The State of Ethnic Dermatology in Canada.

Approximately 30% of Canadians will be members of a visible minority by 2031. When dermatology became an independent medical discipline in the late 18th and early 19th centuries, most residents of Canada and the United States were of Northern European descent. Morphology and descriptions of dermatoses are based on patients with light skin. Skin of colour dermatology refers to a unique field in dermatology dedicated to the diagnosis and management of disorders that are more prevalent in patients with moderately to richly pigmented skin. Important differences in the presentation of common dermatoses such as seborrheic dermatitis and acne exist in patients with darker skin types. The effect of traditional treatments for common and uncommon dermatoses is also an important consideration in managing patients with skin of colour. Such treatments may result in adverse effects such as postinflammatory hyperpigmentation or keloid scarring at a higher rate. Most respondents from a 2013 UK study of dermatology residents and consultants agreed that individuals with 'ethnic skin' had specific and unique dermatological problems. The Royal College of Physician and Surgeons of Canada's Objectives of Training in Dermatology states that residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centred care and service to a diverse population. Future steps include creating a national society of dermatologists interested in clinical and academic aspects of ethnic dermatology. As well, presentations on skin of colour dermatology could be encouraged at major Canadian dermatology meetings.

[Hans Franz Edmund Killian - nestor of German anesthesia : Critical appraisal on the 125th anniversary of his birth].

The surgeon Hans Killian was born on 5 August 1892 in Freiburg im Breisgau, Germany. Together with the pharmacologist Hellmut Weese and the surgeon Helmut Schmidt he was one of the nestors of modern German anesthesia. Early on during his scientific and clinical career, he addressed problems of surgical anesthesia and in 1928 he became one of the editors of the first German journal of anesthesia Narcosis and Anesthesia ("Narkose und Anästhesie"). In 1934 he published the textbook Anesthesia for Surgical Purposes ("Narkose zu operativen Zwecken"). Between World WarsI andII, he campaigned for anesthesia to become an independent medical discipline comparable to the situation in the Anglo-Saxon countries at that time. Because of his merits in the foundation of the German Society of Anesthesia on 10 April 1953 he became its first honorary member. Killian died on 7 March 1982 in Freiburg, Germany. Excerpts of his autobiography which he wrote afew years before his death and which were part of his inheritance are published here for the first time.

Nuclear medicine training and practice in Turkey.

Nuclear medicine applications in Turkey started in the early 1950s, grew as an independent medical discipline and finally were recognized by the Ministry of Health in 1973. Later on, the professional organization of nuclear medicine physicians and other related professionals including radiopharmacists and technologists under the Turkish Society of Nuclear Medicine were established in 1975. Recently after completing more than a half century in Turkey, nuclear medicine has proved to be a strong and evolving medical field with more than 600 physicians serving for the changing needs of clinical practice throughout these years. This article describes past and present facts in this field and attempts to provide insights into the future which hopefully will be brighter than before.

A review of Heinrich Obersteiner's 1888 textbook on the central nervous system by the neurologist Sigmund Freud

In 1888, the Austrian neuroanatomist Heinrich Obersteiner, founder of Vienna's Neurological Institute, published his "Introduction to the Study of the Structure of the Central Nervous Organs in Health and Disease", a fundamental textbook in which he summarised the state-of-the-art knowledge available then on the normal and pathological anatomy of the human nervous system, incorporating many of his original research findings. The book became "the Bible for generations of budding neurologists" worldwide and was crucial for the eventual development of neurology as an independent medical discipline. In his early career as a neuroanatomist, Sigmund Freud wrote a review of Obersteiner's book for the Wiener Medizinische Wochenschrift. That review was not included in the "Standard Edition of the Complete Psychological Works". The present article provides an English translation of Freud's review and further discusses its historical context, especially regarding the influence of Theodor Meynert on his two illustrious students, Freud and Obersteiner.

The Knud Krabbe (1885–1961)–Henry Alsop Riley (1887–1966) letters (1929–59): transatlantic friendship fostered by the International Neurological Congresses

The correspondence between Dr Knud Krabbe in Denmark and Dr Henry Alsop Riley in the USA, archived at Columbia University, provides valuable insight into the friendship that arose between these two early leaders in neurology who lived on opposite sides of the Atlantic. Comprised of 15 surviving letters, the correspondence began in 1929 but primarily spanned the period from 1954 to 1959 and during that time showed a very familiar tone between the two men. Their correspondence is not only about work but the range of topics evidences the warmth that evolved between the two men. Their friendship likely originated at the International Neurological Congresses (INCs), which occurred every four years. This paper serves to bring this correspondence, previously not well known, into the historical literature and includes personal and biographical information. It shows how the INCs, on a human level, resulted in links between the vanguards of neurology in different countries, thus helping to foster the development of neurology as an independent medical discipline during the 20th century.

The first recordings of pharmacological effects

In mid-nineteenth century Germany, the graphic recording of drug effects began simultaneously with the development of pharmacology as an independent science. With the first recording device, the kymograph, drug effects were recorded and compared. A new method for keeping an isolated organ alive facilitated research into the organ's modes of action. Together, these two physiological methods facilitated study of the effects of drugs on organ function. Drug characteristics were discovered and many crude drugs were standardized. Many physiological processes were discovered using these innovative methods. A good example is provided by digitalis, the potency of which varied widely. Digitalis was of great importance in the discovery and treatment of cardiac arrhythmias. Subsequently, many physiological processes were discovered using these innovative approaches to drug research. Pharmacology is a relatively young science, arising from the great progress in chemistry and physiology of the nineteenth century [1, 2]. At the start of the nineteenth century, chemistry made it possible to isolate active substances from medicinal plants, starting with morphine in 1806 [3]. Physiology provided the methodology for pharmacology to become an independent medical discipline. The French physiologist Francois Magendie performed one the first pharmacological experiments with the strychnos tree, from which he isolated the alkaloid strychnine. His successor, Claude Bernard, used active substances, e.g. the Indian arrow poison, curare, as ‘scalpels chimique’ for the ‘dissection’ of physiological processes. In this way he demonstrated that curare acted upon the connection of the nerve with the muscle, the neuromuscular junction [4, 5]. Knowledge from chemistry and physiology together formed the basis for experimental pharmacology. Rudolf Buchheim, the first professor of pharmacology, turned drug discovery from an empirical search for cures into a science [6]. He claimed that the effects of a drug could best be studied by isolating the substance, investigating its chemical composition and correlating the chemistry of the drug with the changes it caused in the function of organs. He also formulated the two main questions for drug research: ‘in which way and to what extent are drugs altered by the body, and in which way and to what extent do they in turn alter the body's function?’ [7]. Such examinations were to be carried out with the same methods as were used in physiology [8]. Oswald Schmiedeberg, Buchheim's most prominent disciple, set up a new laboratory for experimental pharmacology in Strasbourg, then a German city. He was recommended for his post by Carl Ludwig, the great physiologist from Leipzig. Preceding his appointment in Strasbourg, Schmiedeberg had been trained in experimental methodology in Ludwig's institute in Leipzig [9, 10]. Buchheim, Schmiedeberg and Ludwig adapted the research methods of physiology and brought modern pharmacology into being. The two most important physiological methods introduced in early pharmacology were the use of the kymograph and the method of keeping an isolated organ alive. The kymograph was the first device used to document records of experiments, contributing critically to the emergence of pharmacology as an independent science. Pharmacologists adopted the new kymographic methods of conducting physiological experiments for the recording of drug effects, registering changes in physiological function caused by the administration of drugs as a variable in time. This was a great improvement for experimental pharmacology. Carl Ludwig designed the kymograph, or wave writer, in 1847 (Figure 1). Its initial purpose was to improve Poiseuille's manometer, which Ludwig used for the registration of blood pressure in experimental animals [11]. Ludwig was mainly interested in the physiological relation between respiration rate and blood pressure. He measured blood pressure with a mercury-filled manometer attached by a catheter to the artery of an animal. Ludwig experienced difficulties in reading the level of mercury on the manometer accurately, due to the continuous fluctuations. He needed to register the changes of blood pressure and air pressure in the thoracic cavity at exactly the same time. Therefore he put a float on the surface of the mercury and attached a stylus to it. A sheet of smoked paper was placed around the revolving drum of the kymograph. The blood pressure was graphically recorded by the stylus scratching on the paper (Figure 2). In this way the variations in blood pressure were recorded on paper and could be determined exactly. Moreover, the experiment could be reproduced, and the curves could be compared with results from experiments under different conditions. Actually, the kymograph is a universal recording device. Attached to a measuring apparatus, it can record any movement in experimental settings. Figure 1 The Ludwig kymograph and manometer used to record blood pressure (Cyon E. Atlas zur Methodik der Physiologischen Experimente und Vivisectionen. 1876) Figure 2 Curves registered by Carl Ludwig in his experiments on the relation between respiration (thoracic pressure) and blood pressure (Archiv fur Anatomie. Physiologie und wissenschaftliche Medizin. Berlin. 1847) The second contribution of Carl Ludwig was the method of keeping an isolated organ alive by perfusing it in an oxygenated nutrient solution. Ludwig and his co-worker Elias Cyon isolated and cannulated a frog heart, as seen in Figure 3[12]. They used serum obtained from rabbit blood as the perfusion fluid. After the circulation was initiated, the heart started to beat in a very regular rhythm. Ludwig also experimented with an isolated kidney, describing the renal circulation and formulating a filtration–reabsorption hypothesis of urine formation [13]. Figure 3 The isolated perfused frog heart as developed by E. Cyon and Carl Ludwig (Cyon E. Atlas zur Methodik der Physiologischen Experimente und Vivisectionen. 1876) The method of perfusing an isolated heart was improved by Oscar Langendorff for the perfusion of the mammalian heart in 1897 [14]. Langendorff inserted the cannula in the aorta ascendens to effectuate retrograde perfusion. The reverse flow in the aorta closed the aortic valve. In this way, the perfusate flowed through the coronary arteries in order to provide the heart with oxygen and nutrients. Brought together, the kymograph and the isolated perfused frog heart of Carl Ludwig proved to be most useful for experimental research on the effects of drugs on organ function. The drug that was to be studied could easily be added to the perfusion fluid, and the kymograph would record the results. The kymograph was connected to the heart atria and/or ventricles with a string. A lever transferred contractions of the heart to the stylus. The stylus scratched the results on smoked paper on the revolving drum of the kymograph. Because most drugs in Ludwig's time were isolated from plants, any single preparation varied from the others in strength and potency. Assays for determining maximally safe and effective doses had to be developed. The physiological methods of Carl Ludwig were used for these assessments. The first drugs studied in this way were digitalis glycosides.

[Progress in radiotherapy and current status].

Within the first decade of the 20th century, years after the discovery of X-rays, radiotherapy was established as an independent medical discipline. Since then, the knowledge of and the applications in radiotherapy have grown enormously. In the year of 1994 the clinical disciplines radiology and radiooncology finally became separate clinical specialities in Austria. Radiotherapy plays an important role in the curative and palliative setting of oncologic therapy. Tridimensional volumetric definition of the tumor and the proximity to organs at risk are based on high precision technique like ultrasound sonography, computerised tomography, magnetic resonance imaging and positron emission tomography. The main goal of radiation therapy is the successful sterilization of tumor cells in a carefully defined target volume considering adequate safety margins. The volume of the irradiation is often irregular and therefore shaped fields were used, which minimise the amount of radiosensitive normal tissue within the radiation fields. In this way, it is possible to decrease acute and late radiation induced complications. Dose-volume histograms ascertain irradiated volumes and dose distributions of the target and critical organs. The key breakthrough development of computer-controlled multi-leaf-collimators enables time-saving and precise irradiation of a target (macroscopic tumor and an adequate safety margin), permitting a dose distribution that confirms exactly to the intended target volume. The procedures of 3D conformal radiotherapy are more complex and expensive than conventional radiotherapy, but are essential for assuring high quality of modern cancer treatment.

Curriculum for Medical Informatics at the University of Heidelberg/School of Technology Heilbronn

The specialized university curriculum for medical informatics at the University of Heidelberg/School of Technology Heilbronn described in this paper is one of the oldest educational approaches in the field of medical informatics, and has been successful for more than 20 years with more than 600 graduates (Diplom-Informatiker der Medizin). It is based on the concept of medical informatics as an independent medical discipline, and covers the total spectrum ranging from health care economics, biosignal and medical image processing, model building in medicine, to information and knowledge processing in medicine. It is a program of 4.5 years duration with a strong emphasis on the methodological foundations of medical informatics and on practical education in a number of specific laboratories. Thirty-five students are admitted each semester, and in total about 390 students enrolled. The faculty consists of 17 full-time members and about 25 part-time lecturers.

Fundamentals of general medical practice.

In many countries there is a recognized specialist education for general practice, corresponding to those offered for organ specialties. Why, then, is general practice not recognized everywhere as a full specialty? It has been suggested that general practice is characterized by an easily available, continuous, personal, binding and comprehensive care. However, there are also other aspects which characterize this discipline. Firstly it is based on an overall view of health and disease, in which physical, mental, and social factors must be taken into account simultaneously. Secondly the epidemiological world, as seen by the primary physician, is different from those of all traditional specialties. This gives rise to considerable consequences in diagnostic and therapeutic work, as reflected in the predictive values of tests and for symptoms in general practice, when contrasted with specialist practice. Thirdly, the approach to problem solving is also very different. In general practice, it is characterized by thinking in terms of possibility or probability, whereas in specialist practice the reductionistic method is used. A fourth factor can also be pin-pointed. Although the primary physician is responsible for the greater part of diagnosis and treatment of illness in the population, he also co-ordinates the patient's contact with the second and third line services in the hospital and in specialized medicine. Therefore, general practice is an independent medical discipline, which demands its own specialist education.