Lifelong Challenge Research Articles

Effective leadership today – character not just competence

Purpose – Three recent publications by noted authors offer valuable insights into the new directions that leadership development thinking and practice now need to take, with all of three books placing particular emphasis on the importance of character, identity and values, not just competence. Design/methodology/approach – Organizational psychologist Fred Kiel’s book, Return On Character sets out to show that the strength of a leader’s character is an important driver of business success and to examine the implications for leadership development. Discover Your True North by Harvard professor and former CEO of Medtronic Bill George examines why the self-development process of discovering one’s core values and passion (authenticity) to lead is essential to becoming an engaging and empowering leader. The theme of leadership as a life-long developmental challenge is Robert Kaplan’s primary focus in What You Really Need to Lead. Findings – Kiel’s data revealed a clear relationship between the strength of a leader’s character and demonstrated mastery of these key skills, with virtuosos “consistently” outperforming their more self-focused peers. Originality/value – One of the reasons that character matters is that leaders who more consciously and persistently search for greater self-awareness over the course of their careers tend to become ever more capable of questioning “not only the ideas of others” but even their “own most cherished beliefs,” and as a result, their understanding of their life, their business, their marketplace, and the global forces that shape them “enters a state of continual growth and development.”

Cerebral Palsy: A Lifelong Challenge Asks for Early Intervention.

One of the oldest and probably well-known examples of cerebral palsy is the mummy of the Pharaoh Siptah about 1196–1190 B.C., and a letter from Hippocrates (460–390 B.C.). Cerebral palsy (CP) is one of the most common congenital or acquired neurological impairments in paediatric patients, and refers to a group of children with motor disability and related functional defects. The visible core of CP is characterized by abnormal coordination of movements and/or muscle tone which manifest very early in the development. Resulting from pre- or perinatal brain damage CP is not a progressive condition per se. However, without systematic medical and physiotherapeutic support the dystonia leads to muscle contractions and to deterioration of the handicap. Here we review the three general spastic manifestations of CP hemiplegia, diplegia and tetraplegia, describe the diagnostic procedures and delineate a time schedule for an early intervention.

Gilbert Stuart and the Impact of Manic Depression by Dorinda Evans (review)

Reviewed by: Gilbert Stuart and the Impact of Manic Depression by Dorinda Evans Ellen G. Miles (bio) Gilbert Stuart and the Impact of Manic Depression Dorinda Evans Farnham, England: Ashgate, 2013 204 pp. Dorinda Evans is one of a small number of art historians (including this reviewer) who have recently written about Gilbert Stuart and his memorable portraits of the political and social leaders of the early years of the American Republic. Employing her expertise in late eighteenth- and nineteenth-century American and British art, she has considered his work in differing contexts for more than forty years. In her book-length study, The Genius of Gilbert Stuart (1999), she demonstrated in detail his approach to portraiture, and also documented his interactions with his contemporaries, including patrons and other artists. In the last chapter of this book she first proposed that he suffered throughout his life from manic depression, or bipolarity. In this new book, she has marshaled evidence for her theory, which seeks to understand the unevenness of his work, including portraits left unfinished and compositions awkwardly realized, contrasted with exceptionally successful characterizations. This unevenness has resulted in major disagreements among art historians about the reliable visual characteristics of his technique on which to base attributions. Evans carefully bases her discussion on paintings that she has seen, in order to avoid problematic works. She concentrates particularly on eight paintings about which she had discussions with conservators and for which she could consult x-rays, some reproduced here. These close examinations [End Page 571] are presented within a broader study that draws heavily on a wide range of documentation. No one knows Stuart’s work better or has been as thorough in locating the many references to him, including comments found in unpublished letters and diaries as well as in contemporary newspaper articles or books. Evans’s description of his awareness of his condition conveys a view of the artist that leads the reader to admire and sympathize with him. The book is an outstanding accomplishment, focused and purposeful, carefully researched, and with telling use of the written sources. Evans bases her analysis of Stuart’s behavior and the varied manner of his paintings on known characteristics of bipolarity, frequently citing important medical sources on the condition and its effects: all with the stated goal of better understanding the paintings themselves. Her argument begins with “The Case for Bipolarity,” a chapter largely based on descriptions by contemporaries that successfully brings Stuart to life. It shows him to be irregular in his habits, “cyclical” (painting in the morning only, or in the spring and not the winter), and given to excuses about uncompleted paintings. When discussing his bipolarity, for example, she notes that he adopted “a few crutches,” including the use of life masks of a sitter’s face “so that he could work on the picture at any time” (18). She notes that contemporaries saw his work as uneven, unfinished, and cold in coloring. She wonders why he delayed in arranging sittings with George Washington, “with perhaps some self-doubt … waiting for the right mood swing” (19). She quotes many contemporary observations about his swings in mood, including two that appeared in William Dunlap’s early biography, published in 1834, only six years after his death. Stuart’s lifelong friend Benjamin Waterhouse described Stuart as never having an “evenness of spirits” because “with Stuart it was either high tide or low tide,” and Dunlap wrote that “Stuart’s passions and appetites were of a kind said to be uncontrollable” (9, 17). In the second chapter, “Marked Pictures,” Evans concentrates on individual paintings. She writes about his lifelong challenge with group portraits and full lengths, inconsistencies and awkward proportions in completing pictures, delays in arranging sittings, choice of colors ranging from pale or monochromatic to bright, and inconsistent advice to students about painting flesh. Among the paintings that she relates to his bipolarity are a very early work, Mrs. Christian Banister and Son, which she discusses using an x-ray detail; the painting of George Washington known as the “Vaughan” [End Page 572] portrait, long thought to be the first life portrait, again discussed with reference to an x-ray; three...

Aquatic Exercises were Associated with an Acceptable State of Symptoms in Patients with Inflammatory Rheumatic Diseases: Results from a Study with Interrupted Time-Series Design.

The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises. Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks. There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p > 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises. Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John Wiley & Sons, Ltd.

Transitional Urology: an Evolving Paradigm for Care of the Aging Adolescent

Congenital genitourinary anomalies present an interesting challenge to many pediatric urologists. Patients with these conditions require complex care early in life and continued urologic follow-up into adulthood to optimize their function and quality of life. There is a growing awareness that continuity of care beginning in adolescence and progressing through adulthood can have a positive impact on these patients in a number of domains. This may include condition-specific surgical reconstruction, psychosocial development, health economics, and health policy. The process of transitioning care between adolescence and adulthood is evolving as a unique opportunity in urology as congenital genitourinary conditions pose a lifelong challenge for patients, families, caregivers, and health systems. This manuscript highlights the current state of development for this niche as well as future opportunities for education, discovery, and delivery of care for transitional urology.

Psychosocial aspects on the treatment of HIV-infection

Psychological and social factors have a deep impact on the treatment of HIV-infection, from the readiness to start antiretroviral therapy to treatment adherence over time. Among psychological factors, anxiety may affect HIV-infected persons in all stages of disease, from the disclosure of HIV diagnosis to the decision to start and maintain treatment. This is a lifelong challenge for both patients and doctors. Psychiatric comorbidities (depression, addiction) may enhance negative psychological effects of HIV. Among social factors, stigma and discrimination may occur in families and at work, leading to a loss of social support resulting in isolation and poverty. This may prevent HIV-positive individuals from seeking medical care. These aspects are particularly important in some groups of patients as injecting drug users and migrants. Acknowledgment and consideration of psychosocial factors are therefore essential for the long term success of antiretroviral therapy.

DeWater fluoridation and oral health

Water fluoridation, is the controlled addition of fluoride to the water supply, with the aim of reducing the prevalence of dental caries. Current estimates suggest that approximately 370 million people in 27 countries consume fluoridated water, with an additional 50 million consuming water in which fluoride is naturally occurring. A pre-eruptive effect of fluoride exists in reducing caries levels in pit and fissure surfaces of permanent teeth and fluoride concentrated in plaque and saliva inhibits the demineralisation of sound enamel and enhances the remineralisation of demineralised enamel. A large number of studies conducted worldwide demonstrate the effectiveness of water fluoridation. Objections to water fluoridation have been raised since its inception and centre mainly on safety and autonomy. Systematic reviews of the safety and efficacy of water fluoridation attest to its safety and efficacy; dental fluorosis identified as the only adverse outcome. Water fluoridation is an effective safe means of preventing dental caries, reaching all populations, irrespective of the presence of other dental services. Regular monitoring of dental caries and fluorosis is essential particularly with the lifelong challenge which dental caries presents.

Gluten Free Diet, Perceptions and Concerns of People Living with Celiac Disease in India: Internet-based Survey of Members of ‘Zero Gluten’ on Facebook

ABSTRACT Introduction Gluten free diet (GFD) for the treatment of celiac disease (CD) remains a lifelong challenge for patients and their parents in India. There is little knowledge available about how these patients experience and cope with their dietary needs in India. Aims (i) To assess the status of gluten free diet and problems faced while managing GFD. (ii) To get an incite about their perceptions and concerns. Study design Cross-sectional descriptive internet-based survey. Materials and methods A predesigned semistructured questionnaire was prepared and mailed to members of ‘zero gluten’ on Facebook; an internet-based social support group for Indian CD patients, who were on GFD for a variable period of time. Those who decided to participate returned the filled questionnaire along with consent, which were analyzed. Results Out of 120 members, 32 filled the questionnaire and returned back. These computer literate CD patients were from different Northern states of India. Age ranged from 3 to 36 years with mean age 20.75 years. Mean duration of GFD was 3 years and average age at diagnosis was 13.7 years. Knowledge about possible options in GFD was limited. Branded GF products were in demand; 71.9% were buying them. Follow-up was poor and involvement of dieticians while managing GFD was rare. Their major concerns were professional needs, transmission to kids, marriage and peer pressure. Conclusion Managing GFD in India is difficult; help of trained dieticians, regular follow-up and psychological support is needed to sustain these dietary changes for life. How to cite this article Verma S. Gluten Free Diet, Perceptions and Concerns of People Living with Celiac Disease in India: Internet-based Survey of Members of ‘Zero Gluten’ on Facebook. J Postgrad Med Edu Res 2013;47(2):107-111.

Critical Analysis of Remedies for Torture Victims

Torture constitutes a serious crime with traumatic physical and psychological consequences. The ban on torture and other cruel, inhuman or degrading treatment or punishment is well articulated in national and international instruments. For those who have suffered torture and their families, finding ways to move forward with their lives and forget about the trauma inflicted on them is a lifelong challenge and the only way to find closure is to ensure that perpetrators are brought to justice. The importance of justice and reparation is recognised as a right of victims. Against this backdrop, the article analyses remedial approaches available to the victims that seek for redress against torture and injustice. The article concludes by advocating for total eradication of torture and adequate compensation for the victims of torture.

Safety, Tolerability, and Efficacy of KP-1461 as Monotherapy for 124 Days in Antiretroviral-Experienced, HIV Type 1-Infected Subjects

Treatment of HIV infection with conventional antiretroviral therapy (ART) is a lifelong challenge with significant long-term risks of adverse events and treatment failure-induced HIV resistance being major concerns. One potential alternative to standard treatment is the use of viral decay accelerators, antiviral agents that theoretically can drive the rate of viral mutation beyond the compensatory capacity of the virus, thereby inducing viral extinction. One such drug, KP-1461, was tested in a population of HIV-infected persons not receiving ART to assess the safety, tolerability, and efficacy of the strategy in vivo. Of 24 highly treatment-experienced HIV-infected patients who received at least one dose of KP-1461, 13 completed the planned 4 months of monotherapy. The drug was generally well tolerated; it did not significantly affect either HIV viral load or CD4 lymphocyte count over the period of dosing. Pharmacokinetic sampling suggested adequate drug exposure was achieved. There were no new mutations induced by KP-1461 that changed viral susceptibility to standard antiretroviral agents. After the study was completed, analysis of more than 7 million base pairs of HIV samples from study patients and controls demonstrated changes in the pattern of viral mutations that differed significantly from what would be encountered naturally. The identified alterations were consistent with an effect resulting from KP-1461's proposed mechanism of action. These findings suggest that the novel antiretroviral approach illustrated by this study should be further investigated, particularly given the relatively good tolerability and the demonstrated excellent safety in this limited cohort study.

Oral and dental management for head and neck cancer patients treated by chemotherapy and radiotherapy

The incidence of head and neck cancer is rising. The attendant oral complications of cancer management make oral health maintenance a lifelong challenge for these patients. Holistic management in the context of a core multidisciplinary team is essential in optimizing outcomes. Predicting the risk of adverse oral outcomes is difficult. Effective communication between healthcare professionals in the core and extended teams and with the patient is essential. Primary care dental teams will be involved in the long-term management of oral care for head and cancer patients. A broad understanding of the management of head and neck cancer, consequences of treatment and the need for good communication is key to good quality patient care.

Review of Verbal behavior analysis: Inducing and expanding new verbal capabilities in children with language delays.

Greer &. Ross (2007): Verbal Behavior Analysis: Inducing and Expanding New Verbal Capabilities in Children with Language Delays Language impairments affect 7% of preschool children (Ziegler, 2005). Some of these children will catch up to their peers, but many will continue to have problems at school age. For example, Paul (2000) found that 16% of children with expressive language delays at age 2 continued to present with language impairments at the age of 7. Additionally there is evidence that early problems with oral language are related to later problems with the development of literacy skills (Bartlett, et al., 2002). Moreover, when language impairments accompany developmental disabilities (e.g., autism, mental retardation), they are likely to remain a life-long challenge. Professionals from a variety of disciplines have developed approaches to language intervention over the past 80 years (Paul, 2007). Within that context, behavioral approaches have emerged among the most effective, especially for teaching children with autism and related disabilities (Goldstein & Hockenberry, 1991). Traditionally, behavioral approaches emphasized modeling, imitation, systematic prompting, differential reinforcement and discrete trial instruction as a primary instructional format (e.g., Lovaas, 1981). However, more recently the behavioral framework has been expanded to include an emphasis on functional analysis and especially Skinner's (1957) functional analysis of verbal behavior. Additionally, natural environmental teaching (NET) strategies (e.g., incidental teaching, mand-model) were added to the repertoire of important instructional formats, and a review of recent studies supports the effectiveness of these formats (Petersen, 2006 for children with language delays. Skinner (1957) originally developed the verbal behavior model to account for the continuity between operant behavior and language. Others are responsible for applying the model to language instruction (e.g., Sundberg & Partington, 1998; Greer & Ross, 2007). These applications have gradually come to be known as the verbal behavior (VB) approach. Carr and Firth (2005) recently reviewed the published literature on VB practices and pointed to the need for additional research. We believe that his call for research has been addressed in part by Greer and Ross's (2007) book: Verbal Behavior Analysis: Inducing and Expanding New Verbal Capabilities in Children with Language Delays. This book represents the culmination of considerable research, practice, and critical thinking by a Greer and his colleagues (e.g., Greer & Keohane, 2006; Greer, Keohane, & Healy, 2002; Tsai, & Greer, 2006). It addresses many interesting and important questions about the verbal behavior approach, and it offers an evidence-based framework for best practices in behavioral language intervention, including detailed information about assessment, instructional strategies, and procedures for evaluating treatment efficacy. It is highly engaging and conveys complex theoretical information in a clear and reader-friendly style. It is an excellent source of information for students planning a career in communicative disorders, for behavior analysts who wish to enhance their understanding of Skinner's verbal behavior framework, for parents of children with communicative disorders, and for professionals in the fields of developmental disabilities and early intervention. An important feature of this book is that it includes an empirical account of verbal behavior development, and it t may be the first comprehensive account of language development that incorporates Skinner's (1957) verbal behavior model. It describes a developmental trajectory marked by developmental cusps (Rosales-Ruiz & Baer, 1966; Bosh & Hixson, 2004). In some linguistic and cognitive accounts of language development, stages of language growth have been attributed to neurological factors such as a language acquisition device (e. …

Conversion And The Religious Market: A Theological Perspective

AbstractThis article wants first of all to describe, which historical-theological factors contributed to an important shift of meaning of the concept of conversion from the 18th and 19th century onwards. A more communal and covenantal, theocentric and ecclesial understanding of religious belonging has gradually shifted towards an individual personal, experiential, anthropocentric and charismatic interpretation. Evangelicals and Pentecostals share the idea of 'heartfelt religion', interpreting conversion as a sudden and momentous event, usually after a personal crisis. The historical churches rather stress the lifelong challenge of conversion, related to participation in church life, the liturgy and the sacraments.The second part deals with a series of Roman Catholic-Pentecostal ecumenical dialogues about the problems arising between these rather opposite ideas of Christian conversion. Different ecclesiological and pneumatological points of view are at stake here. Major problems arise when people from the older churches are invited to change their affiliation and want to renew their baptismal votes with the 'baptism in the Holy Spirit'. Dialogue partners tend to avoid all forms of proselytism, but common evangelisation and common witness, let alone ecumenical cooperation toward church unity or ecclesial communion still seem to be a bridge too far.

Gender as a Barrier for Women With Children in Academe

This research involved in-depth interviews with nineteen women professors, drawn from across various faculties and ranks at one Canadian university, and was intended to explore the interconnections between the women's personal and professional lives. The women in this study chose to combine having children with an academic career. Most of them depicted their career trajectory as a lifelong challenge, one that was both fulfilling and prestigious. In contrast, the women reported a number of obstacles in their career paths that served to prevent them from gaining full membership in academic life. This study probes the nature of such obstacles that are grouped into two categories: the child-related time crunch and the career-related time crunch. As a result of these obstacles, the women encountered childbearing/childrearing problems, research dilemmas, a willingness to leave the academy, and denial of tenure and promotion. Findings call for a restructuring of academic careers in order to effectively accommodate women with children in the profession.

The facts and doubts about beginning of the human life and personality.

“What a piece of work is a man!” William Shakespeare, Hamlet“To those of average curiosity about the wonders of nature, it is likely that two great mysteries have stirred the imagination; and each concerns a birth. Who has not gazed into the heavens on the starlit night and wondered about the birth of the universe? And who has not been stimulated by the sight of the newly born baby to the marvel at the unseen events within the mother’s uterus that have led to the birth of such a perfect creation?”(1) These words written by the Professor Sir Graham (Mont) Liggins open Pandora’s box of questions, dilemmas, doubts and controversies about human life and its beginning offering everybody lifelong challenge to solve mystery of life.Entering this filed scientists have been remiss in failing to translate science into the terms that allow mankind to share their excitement of discovering life before birth. Regardless to remarkable scientific development, curiosity, and speculations dating back to Hippocrates, life before birth still remains a big secret. Different kinds of intellectuals involved themselves trying to contribute to the solution of human life puzzle. They are led by the idea that each newborn child will only reach its full potential if its development in uterus is free from any adverse influence, providing the best possible environment for the embryo/foetus. Considering embryo/foetus, it should be always kept in mind amazing aspect of these parts of human life in which the mother and the embryo/foetus, although locked in the most intimate relationships, are at ALL TIMES two separate people. Accepting embryo/foetus as the person opened new set of questions about its personality and human rights. Today, synthesis between scientific data and hypotheses, philosophical thought, and issues in the humanities, has become pressing necessity in order to deal with ethical, juridical and social problems arising from man’s interference in many aspects and stages of life. (2)

Does my child really need to wear these glasses? a review of retinopathy of prematurity and long-term outcomes

Technological advances in neonatology create new challenges for patients, their families, and health care providers. Retinopathy of prematurity (ROP), a condition frequently seen in the premature infant, remains one of these challenges. Physiological stressors cause abnormal growth of retinal blood vessels and may result in vision loss. Common long-term sequelae include myopia, strabismus, and amblyopia; visual difficulties range from minor, correctible deficits to blindness. While research related to ROP continues, the question regarding long-term outcomes is a difficult one to answer for those families in the midst of this life-long challenge.

Update your knowledge and skills at the NFOG Helsinki Congress, June 12-15, 2004

Continuous medical education (CME) is mandatory for all those who want to be professionals in any branch of modern medicine. This demand focuses most strongly on obstetricians and gynecologists, or on those who would like to become such, because this speciality covers such a large field of expertise. For instance, one can hardly see anything in common between colleagues who treat infertility with modern assisted reproductive techniques and those who treat gynecologic cancer with an updated surgical approach and cytostatic regimens, or between colleagues who practice modern obstetrics with sophisticated fetal surveillance or those who treat menopausal complaints and consequences. Yet all obstetricians and gynecologists have a common rationale in promoting women's health. Our CME is a lifelong challenge for all of us. As gynecologists, we want to meet and treat our patients in a comprehensive way. Therefore, ambitious colleagues want to learn – and they should learn – what is new both in our field as a whole and within everyone's own subspeciality. This goal can best be reached in a congress that covers the most relevant topics for the whole area of obstetrics and gynecology. It is also vital for this branch of science that basic and clinical research are active; otherwise our speciality does not develop and progress. It is a huge challenge to organize a good congress that pleases all participants. Fortunately, we have received the full support of the board of the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG) as well as some economic funding. A number of pharmaceutical companies have also joined us to build a professional congress; their names can be found on our website:http://www.nfog2004.com. The final announcement and call for abstracts will be in November 2003. Abstracts and registrations will be processed electronically through our website, which also gives you the news on the latest progress in our scientific, social and sponsor programs. Please visit our website regularly to keep yourself updated regarding the Helsinki Congress 2004. A congress also provides an excellent opportunity for young scientists to present their new data to an audience that is highly appreciative of these contributions. The best presentations, both oral and poster, will be awarded each day. The 34th Congress of NFOG will take place in Helsinki, Finland on June 12–15, 2004. The scientific program will consist of the latest breakthroughs, from genes to newest treatments, and old dilemmas that have been explored through evidence-based medicine. I am positive that the program under preparation will please everyone who seeks CME regardless of their background. The official language will be English, along the lines introduced in the Umeå Congress 2002, as it allows full participation for our colleagues from non-Nordic countries. The Helsinki Congress has indeed aroused great interest outside of the Nordic countries, if judged by the number of visits to our website. The young also have a future in our field, and it was encouraging to see that in the Umeå Congress in 2002 young colleagues showed up in such large numbers. We trust they will also come to the Helsinki Congress in 2004. The social program will offer insights into Finnish culture, and it culminates in a festive banquet that will be conducted in the old Nordic style. See you in Helsinki!

A call for papers on physician well-being

Managed care, advances in medical technology, higher public expectations for health, and political debates about the equitable distribution of health care resources are all placing new demands on physicians. The pressures to achieve better outcomes in health care, contain costs, maintain productivity, master an expanding knowledge base, and relate to patients with compassion and presence tax the ability of many physicians to cope. Their risk of job dissatisfaction, burn-out, family problems, and more serious impairment is enormous.1,2,3 The challenges of this era are superimposed on the personal vulnerabilities of physicians.4 The qualities that allow physicians to succeed in training and practice are often maladaptive in their personal lives. Many physicians have a compulsive style that is reinforced in their training and leads to chronic doubt, guilt, and an excessive sense of responsibility accompanied by the feeling that “my work is never done.”5,6 Sir William Osler addressed this occupational hazard in a talk to medical students in 1899: “Engrossed late and soon in professional cares—you may so lay waste that you may find, too late, with hearts given way, that there is no place in your habit-stricken souls for those gentler influences which make life worth living.”7 In the face of these challenges, more physicians are seeking ways to uphold the ideals that brought them into medicine while balancing their other interests and values. The search for this balance is a lifelong challenge, from medical school to retirement.8 Health care institutions are developing a strong interest in physicians' well-being. Managed care organizations are beginning to see a relationship between physicians and patient, or customer, satisfaction and are more willing to attend to the well-being of physicians. Group practices spend about $150,000 on average to replace a physician who leaves the practice due to professional dissatisfaction. More practices are looking for specific ways to enhance the well-being of their physicians, such as reviewing the incentives for work. Malpractice insurers view professional burn-out as increased risk, and disability insurance companies are concerned about the increase in disability claims being filed by physicians, a trend that may reflect an erosion of professional well-being and satisfaction. Promoting satisfaction and well-being among health care professionals not only enhances the work environment but is good for the financial health of the corporation. In this respect, medicine as a business is beginning to emulate the success of other businesses that are worker friendly.9 The Western Journal of Medicine is devoting an entire issue to the subject of physician well-being. We are interested in articles that address the components of personal well-being, the organizational and workplace factors that promote or erode well-being, specific practices that physicians use to promote their well-being and satisfaction, the political dimensions of physician well-being, and cultural factors (inside and outside of medicine) that affect physicians' wellness. We are looking for Op-Eds, original research, letters, review articles, and personal stories or essays. Topics of special interest include: Well-being throughout the physician's life cycle The well-being of physicians' relationships and families Personal practices that promote well-being Well-being in the workplace Gender issues in physician well-being The role of personal philosophy and spirituality in well-being Descriptions of specific programs that promote physicians' well-being Training physicians to lead healthy lives Political action to promote physicians' well-being Models of excellence (both personal and organizational) in which well-being is manifest Research into the factors that lead to happy, satisfied physicians In addition to scholarly pieces, we also welcome artistic expressions related to physicians' well-being, including poems, photographs, and cartoons. All manuscripts submitted to wjm will go through a peer review process. The deadline for submission is August 1, 2000.

Managing the changes inherent in developing the Learning Society: issues, choices and strategies

The range of items included within the lifelong learning challenge is substantial – pre‐entry activities, widening access, multiple entry points, interrupted study, continuing personal education, continuing professional development. This article discusses some of the implications for higher education arising from lifelong learning including: definition of levels, of progression, of curriculum design and assessment, of record‐keeping and management, of quality assurance and of staff, educational and organizational development. The concept of “innovative universities” is discussed as a possible guide for short‐term institutional strategies. In the longer term, as students want their qualifications to have international portability and recognition, lifelong learning will need a supportive, coherent climate involving government, institutions, employers, trade unions, professional and voluntary bodies, the media and other shapers of attitudes, opinions and values.

Teaching clinical pharmacology and therapeutics: selective for fourth-year medical students.

Teaching clinical pharmacology remains both a lifelong learning process and a lifelong challenge for clinical pharmacologists and other medical educators. In the current information age, with an explosion of drug-related data, the prime topic for discussion is how to teach clinical pharmacology. This article describes our response to the challenges in developing a selective course in clinical pharmacology, and our experience from the first 2 years of the course. Our emphasis is on how to provide in an efficient way knowledge, skills, and attitudes students will need as physicians in the coming decades. Faculty from the Center for Clinical Pharmacology at the University of Pittsburgh in conjunction with faculty from the University of Pittsburgh School of Medicine have developed a one-month intensive course in clinical pharmacology. The integrated course program consists of four overlapping components: 1) general clinical pharmacology (focused on individualization of drug therapy); 2) rational prescribing principles (general principles of drug selection, how to prepare a personal formulary); 3) disease-specific clinical topics (pharmacotherapy of diseases and medical conditions most commonly seen in routine medical practice); and 4) workshops for special attention topics (pharmacokinetics, pain treatment, toxicology, dialysis). In congruence with established educational goals, the course includes drug-, patient-, and disease-oriented concepts. A variety of learning formats (didactic and interactive lectures, one-day problem-based learning sessions, small group case discussions, self-directed and small group directed learning, quizzes, and computer-assisted learning) are used to teach students how to apply the general concepts of clinical pharmacology and rational pharmacotherapy to clinical medicine, and to prepare them to become independent lifelong learners in therapeutics. Student feedback from the first 2 years of this course indicates that this multi-modal teaching format is effective. The majority of students who took the course in clinical pharmacology in 1997 found it to be very beneficial.