Office Of Medicine Research Articles

Leveraging socio-technical processes to support researchers

Purpose The purpose of this project was to develop research support services that address local and external research data management (RDM) support drivers within the existing organizational culture at the University of Florida. The goal was to prompt organization change to support a campus-wide electronic lab notebook. Design/methodology/approach This project used a mixed-methods research approach to cultivate an organizational change program that support technological infrastructure to benefit researchers. The mixed-methods research involved participation action research integrated with a stakeholder approach. Findings The development of the grant proposal which was unfunded led to development of continued project goals. This project confirmed the development for support for an institution-wide electronic research notebook (ERN) solution requires adherence to the summary of five key actions for developing RDM services. Failure to complete all of the key actions engenders fragmentation culture. Research limitations/implications This project includes implications for institutions to develop grant proposals with integrated budgets for research support services of funded projects; and to use the summary of key actions for developing RDM services articulated by Jones et al. (2013) in “How to Develop RDM Services – a guide for HEIs.” Both are need to support findable, accessible, interoperable and reusable data for researchers. Practical implications This project has practical implications for higher education institutions interested in leveraging socio-technical processes to advance the role of libraries as collaborator, partner and stakeholder in developing institution-wide adoption, support and training for ERN as a research support service to RDM. Social implications This paper contributes to the body of developing literature on ERN as support services to RDM lead by academic research libraries. Originality/value This project contributed to the change in organization culture resulting in the successful collaboration between the Research Office and College of Medicine to support an institution-wide ERN technological infrastructure for one year as a pilot at a large academic research institution in the southeast USA.

Integrative Oncology's 30-Year Anniversary: What Have We Achieved? A North American Naturopathic Oncology Perspective.

In 1991 the U.S. Congress mandated that the National Institutes of Health (NIH) form the Office of Alternative Medicine to study alternative medical therapies, especially in oncology care. Shortly after, the National Cancer Institute (NCI) created its own division of complementary and alternative medicine (Office of Complementary and Alternative Medicine). At the genesis of the field 30 years ago, what were we hoping to see accomplished by now? In this article we take a look back at milestones, shortfalls and future directions. Exciting opportunities exist to direct our established subspeciality's future directions and we have made valuable advances the field of integrative oncology over the last 30 years: 1, IV high dose ascorbate has clinical research-based applications when used concurrently with some chemotherapeutic agents. 2. Whole body, extracorporeal and locoregional hyperthermia are being applied in treating solid tumors, including brain tumors. 3. PDL-1 tumor microenvironment testing and PDL-1 inhibitor immunotherapies have surprisingly excellent outcomes in a subgroup of cancer patients. 4. Tumor DNA sequencing (resected tumor and circulating tumor DNA in blood) has led to personalized precision targeted treatments. 5. Glucose metabolism's role in cancer progression is better understood and better therapies are available (e.g., intermittent fasting, metformin). 6. Medical cannabis has a larger role in treating chemotherapy-related side effects and shows promise for anti-proliferative effects. 8. Greater understanding has been gained of the interdependence and mutual regulation of processes in psychoneuroendocrinoimmunology (PNEI). The burgeoning field of PNEI has exponentially expanded the discussion of tumorigenesis, apoptosis, and introduced to the field the investigation of more holistic approaches to immune regulation and cancer care. 8. Psychedelic-assisted psychotherapy is gaining traction especially for cancer patients facing demoralization, existential and spiritual distress, anxiety, depression and trauma related to the diagnosis and treatment of their cancer. 9. Spiritual health of cancer patients is more commonly addressed and measurable with an NIH validated scale. 10. Mind-Body therapies are efficacious for reducing cancer-related distress and are included in many cancer care programs.

Efekat metaboličkog sindroma na incidencu i stepen hipertrofije miokarda leve komore kod hipertenzivnih pacijenata

Metabolic syndrome (MetS) is characterized by the simultaneous presence of obesity, hypertension, dyslipidemia and hyperglycemia in an individual, which leads to an increased risk of cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) is thickening of the heart muscle wall -hypertrophy of cardiomyocytes in concentric and/or elongation of cardiomyocytes and hyperplasia of connective tissue in eccentric hypertrophy with the participation of hemodynamic and non-hemodynamic factors (genetics, stress, other external factors). MetS, which essentially includesinsulin resistance, hyperinsulinemia, and hyperglycemia, alters myocardial metabolism and promotes myocardial inflammation, fibrosis, hypertrophy, and left ventricular remodeling. OBJECTIVE: To determine the impact of MetS, that is, obesity to the incidence and degree of severity of LVH in hypertensive patients with metabolic syndrome in comparison with the control group -hypertensive patients without metabolic syndrome. PATIENTS AND METHODS: Consecutive patients of the Office of Internal Medicine "Dr. Bastać" were examined, a total of 55 patients with hypertension, who were divided into two groups: the first group with MetS, 22 people, average age 56±8.5 years with BMI>30kg /m 2 and waist circumference more than 80 cm for women and >94 cm for men, the second control group without MetS-33 people, average age 52±14 years, with BMI<30kg/m 2 . Echocardiography was done for all subjects on a Power Vision 6000 Toshiba echo camera with standard echocardiographic measurements in the M, B and Doppler technique, and the mass of the left ventricular myocardium was determined for them using the Devereux formula. RESULTS: The prevalence of LVH in group 1 with metabolic syndrome (MetS) was 64%, while in the control group without (MetS) it was 36%. There was a statistically significantly higher number of patients with LVH in hypertension with MetS compared to hypertensive patients of the control group without MetS (X2, p=0.027). In the group of hypertensive patients with MetS, the degree of severity of myocardial hypertrophy, that is, the myocardial mass , was statistically significantly higher compared to the control group (respectively 302±84g versus 224±89g, p=0.0002). Arterial pressure values were higher for both systolic and diastolic blood pressure 168/106 mmHg in hypertensive patients with MetS, but did not reach statistical significance in relation to blood pressure values in hypertensive patients without MetS (156/95 mmHg, p=0.16). CONCLUSION. Patients with metabolic syndrome and hypertension have a statistically significantly higher prevalence of left ventricular myocardial hypertrophy and a highly statistically significant degree of left ventricular hypertrophy compared to the control group of hypertensive individuals without MetS. Given that mean values of arterial pressure do not differ between groups, it can be concluded that non-hemodynamic factors for the development of LVH have an important role in the induction of a more severe degree of LVH in hypertensive patients with metabolic syndrome.

Interview with Gregory G. Maskarinec

Professor Gregory G. Maskarinec (May 16, 1951-June 16, 2022) was a member of the International Advisory Board of the Dhaulagiri Journal of Sociology and Anthropology and Professor and Director at the Office of Global Health and International Medicine, Departments of Native Hawaiian Health and Family Medicine and Community Health John A. Burns School of Medicine, University of Hawai'i. He came to Nepal, in 1977, as a Peace Corps Volunteer and served as a mathematics teacher in a school in the Jajarkot District. He explored Nepali society and culture and received his MA and PhD in shamanism. He has published several books and papers on shamanism, including "The Rulings of the Night: An Ethnography of Nepalese Shaman Oral Texts". In 1981, he won Tribhuvan University's Mahendra Scholarship and received a highly prestigious prize (the Birendra Pranyalankar) from the late King Birendra Bir Bikram Shah Dev. In addition to his significant contributions to Medical Anthropology, Prof. Gregory was a nature-lover, peaceful, devoted to generating and sharing knowledge, and supportive. He had good relationships with high-level scholars, literature artists, and politicians of Nepal. He also participated in literature festivals in rural areas and promoted local arts and artists. He had visited more than 70 districts of Nepal. Prof. Gregory suffered from cancer and had several operations done. In August 2020, he passed away from COVID-19. We are grateful to him for allowing us to publish his interview in our Journal. The interview captured his ideas, thoughts, understanding of anthropology, works in Nepal, and personal life. For the sustainability of the Dhaulagiri Journal of Sociology and Anthropology, at the end of his life, he donated US$ 5000. The journal family is always grateful for his invaluable contribution

A trend of Medical Negligence in Laser Therapy in the Capital City: A Nine-Year Survey.

Introduction: The purpose of the present study is to investigate the common causes of injuries, claims, and decisions related to laser therapy medical malpractice during a nine-year survey. Methods: The legal documents in the Coroner's Office of Forensic Medicine were investigated in a national database from 2012 to 2020 in Tehran, Iran. The frequency and nature of the cases, including the year of litigation, the location and certificate of the provider, the injury sustained, and the cause of legal action and judgment were collected. Results: Three hundred and eighty-three cases related to injury from laser therapy were registered in the coroner's Office of Forensic Medicine during the study period. The incidence of litigation related to laser surgery showed an increasing trend, with a peak occurrence in 2020. Laser hair removal was the most common (51.2%) litigated procedure. General practice operators (48%) recorded the highest rate of laser-related medical complaints. Lack of skill was the most common reason for failure. Among 383 cases with public decisions, 62.4% of them were fault liability in paid judgment. Conclusion: Medical claims related to laser application are increasing. However, as it is clear, the growth of laser technology and the increasing demand for lasers in medical science require more surveillance to avoid probable injuries and improve patient safety, especially surveillance of the physicians who work outside the scope of their specialty.

Značaj oralne antikoagulantne terapije u prevenciji tromboembolijskih komplikacija kod pacijenta sa atrijalnom fibrilacijom tokom 14-togodišnjeg praćenja - prikaz slučaja

INTRODUCTION. Atrial fibrillation (AF) is the most common long-term arrhythmia and represents one of the main public health problems primarily due to the aging of the general population, in which this arrhythmia occurs more often and causes thromboembolic stroke. Cardioembolic stroke associated with AF is usually severe, highly recurrent, and often fatal or with permanent disability of specific stroke risk factors/modifiers. Common risk factors are summarized in a risk factor-based clinical score called the CHA2DS2-VASc Score. Poor INR control increases the risk of both thromboembolic and hemorrhagic complications, and the optimal balance between the benefits and risks of using oral VKAs is achieved when the TTR, or time in the therapeutic range, is ≥ 70% [9]. We present the case of a female patient that confirms the importance of oral anticoagulant therapy when the INR is in the therapeutic range between 2-3, in the largest number of measurements in the successful prevention of recurrent thromboembolic complications during a 14-year follow-up. CASE REPORT: We present a 60-year-old MD patient who first came to the Office of Internal Medicine "Dr. Bastać" in 2008 due to a feeling of instability and heart palpitations. Due to grade II hypertension, which is not well regulated, she has been taking antihypertensive therapy for the past two years, treats elevated cholesterol with statins, and states that in two years and a year before her first examination at the Office of Internal Medicine "Dr. Bastać", she had two minor strokes verified by MSCT of the endocranium. In our patient, a high CHA2DS2-VASc score of 4 was calculated (hypertension, female gender and previous stroke) and the estimated annual risk for stroke is 9.27% (TABLE 2). Her bleeding risk - HAS BLED Score is moderate and is 2 (hypertension, CVI). Based on CHA2DS2-VASc, the risk of adverse thromboembolic events is high and requires the introduction of oral anticoagulant therapy. The patient in therapy receives acenocoumarol according to the scheme so that the value of PT/INR is between 2.0 and 3.0. Good anticoagulation is defined as having 3 to 4 PT/INR values in the therapeutic range (similar to TTR 50 to 60% of the time), while poor anticoagulation is: 0-2 measured INR values in the therapeutic range (TTR <50%) [3]. In our patient, the TTR is about 70%, which represents excellent anticoagulation. During 14 years of monitoring for three months, as well as at the recent control on 04/29/2022. the patient feels well, with no new thromboembolic complications and no bleeding episodes. CONCLUSION. Antithrombotic therapy with vitamin K antagonists can achieve good anticoagulation and long-term successful prevention of repeated cardioembolic strokes in patients with atrial fibrillation. We emphasize the need for highly motivated patients to regularly monitor the level of anticoagulation via INR and the full engagement of the prescribing physician. In this case, we emphasize the frequent problem of delays in the introduction of anticoagulation therapy in atrial fibrillation. Stroke prevention is the cornerstone of care for patients with atrial fibrillation.

Hospitalised heat-related acute kidney injury in indoor and outdoor workers in the USA

ObjectivesTo characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries.MethodsTwo data sources were analysed: archived case files of the Occupational Safety and Health Administration’s (OSHA)...

Leonard Jack, Jr: Preventing Chronic Disease Through Statistical Rigor

As Editor-in-Chief of the Centers for Disease Control and Prevention’s journal Preventing Chronic Disease, Dr Leonard Jack, Jr, PhD, MSc, knows that disseminating the best thinking and evidence around how to help people and communities prevent chronic diseases and promote health and wellness for all individuals around the world requires careful, rigorous peer review. A core component of this review at his journal involves a team of dedicated statistical reviewers who can thoroughly evaluate the complicated statistical analysis and methods underpinning the articles they publish. Recently, Science Editor’s Anna Jester spoke with Leonard about his creation of a statistics review committee, his path toward becoming an editor, and the importance of publishing science the public can trust. Science Editor: Please tell us about your job and organization. Leonard Jack, Jr: I have the privilege of working for The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. I have been with CDC for 23 years and in my current capacity as Editor-in-Chief of the journal Preventing Chronic Disease (PCD) for four years. CDC is the leading science-based data-driven service organization committed to promoting the health of the nation. The CDC is rather large and I’m housed in the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) within the Office of Medicine and Science. As Editor-in-Chief, I have the responsibility of leading this peer-reviewed journal and ensuring the content we publish helps promote dialogue between researchers, evaluators, and practitioners while disseminating best practice around prevention of chronic diseases. […]

Savremeni kritički pristup dijagnozi akutnih virusnih miokardita i inflamatornih kardiomiopatija u kliničkoj praksi - fokus na uloge ehokardiografije i antivirusnih antitela

SIGNIFICANCE OF THE PROBLEM: The diagnosis of acute viral myocarditis is one of the diagnoses most difficult to make in cardiology and medicine in general. Echocardiography and cardiomagnetic resonance play a crucial role in the clinical diagnosis and the serum titer of antiviral antibodies to cardiotropic viruses is still unjustifiably used for the diagnosis of myocarditis in everyday practice. RESEARCH OBJECTIVES: To analyze the frequency and significance of echocardiographic parameters in the diagnosis of clinically suspected acute viral myocarditis, to determine the role of antiviral antibody titer (AVA) dynamics for the diagnosis of myocarditis and to compare viral serology and echocardiographic function versus echocardiographic function. METHODOLOGY: A retrograde transverse study was performed in the ten-year period from 2006. to 2015, where 126 consecutive patients from the database of the Office of Internal medicine ''Dr. Bastać'' were analyzed, with a working diagnosis of clinically suspected viral myocarditis. They were clinically, ECG, echocardiographically and serologically monitored for 4 to 8 weeks due to the dynamics of AVA titer. The examined group (A) was divided into subgroups: A1 with elevated AVA class IgM titer in 43 (32%) subjects and subgroup A2 without elevated IgM titer in 83 (68%) patients. The control group of healthy (B) of 103 subjects was comparable.Statistical processing was done in the EXCELL database via descriptive statistics, Student's-T test and Chi2 test. RESULTS: 126 patients had clinically suspected myocarditis (≥2 ESC criteria). Diastolic left ventricular dysfunction in 39/126 (31%) patients was the dominant echocardiographic criterion for clinically suspected myocarditis. Reduced ejection fraction (EF <50%) was measured at 19/126 (15%), followed by left ventricular dilatation. Regional systolic dysfunction was found in 21/126 (17%) and changes in myocardial texture in 17 (13%) subjects. The clinical probability of viral etiology was diagnostically supported by elevated titer of IgM antibodies in 43 (32%) subjects (subgroup A1) where IgM antibodies to Parvo B 19 virus predominate in 36/43 patients (84%). Most were without elevated titer of IgM antibodysubgroup A2 83 (68%). Clear dynamics of IgM antibody titer was observed in 23 persons, a decrease in IgM titer with an increase in IgG titer (seroconversion) in 13 patients. Determination of anti-heart autoantibodies (AHA) was done in 17 severe cases, of which 9 had positive AHA. A comparison of subgroups A1 and A2 did not reveal a statistically significant difference in echocardiographic parameters. The whole group A of clinically suspected myocarditis compared to control group B has statistically highly significantly lower parameters of global systolic (EF=8,7±4,6 vs. 63±7,9; p<0,001), longitudinal systolic (S'=6,9±1,3 vs. 9,9±2,1) and diastolic function (E/e'11,9±4,8 vs. 8,7±4,6; p<0,001), and a highly statistically significant increase in left ventricular telediastolic dimension, myocardial mass index, and left atrial size. CONCLUSION: The diagnosis of acute viral myocarditis in clinical practice is made on the basis of the clinical picture, ECG and echocardiography that indicate myocarditis with the exclusion of cardiac comorbidities, based on the ESC criteria for suspected clinical myocarditis. The whole group A had highly statistically significantly lower parameters of systolic and diastolic function compared to control group B. Normal ECG and echocardiography cannot serve to exclude the diagnosis of myocarditis. Comparison of subgroups A1 and A2 did not reveal a statistically significant difference in echocardiographic parameters.

The Trials (and Tribulations) of Complementary and Alternative Medicine in Oncology.

Two decades following the creation of the Office of Cancer Complementary and Alternative Medicine at the National Cancer Institute, the status of complementary and alternative medicine (CAM) research within oncology remains opaque. To better understand the landscape of CAM studies in oncology, we identified CAM-related phase III randomized controlled trials (RCTs) through ClinicalTrials.gov and compared these CAM trials to all non-CAM oncologic RCTs. Pearson χ2 testing was used to compare proportions across groups; all tests were two-sided. Comparing the 25 identified CAM RCTs with 739 non-CAM RCTs, CAM studies were more likely to be sponsored by a cooperative group (64.0% vs 28.6%, P < .001) and less likely to be industry funded (8.0% vs 76.5%, P < .001). CAM trials disproportionately excluded disease-related outcomes as endpoints (8.0% vs 84.6%, P < .001), were unsupported by prior early-phase data (55.0% vs 96.1%, P < .001), and did not meet the primary endpoint (8.7% vs 53.0%, P < .001). Given the observed relationship between encouraging pilot data and subsequent phase III trial success, we contend that future CAM RCTs may yield more promising findings if better supported by appropriately designed and well-characterized early-phase signals.

Research funding’s ‘endorsement effect’ on scientific boundary work and research production: Government legitimization of alternative medicine

This article demonstrates how science and technology policy can have an ‘endorsement effect’ that legitimizes and increases the salience of scientific research areas. The validation and increased attention provided by state funding policies can support the discursive boundary work of interested parties as they seek to situate research fields within mainstream science. Increased validity and attention can subsequently lead to increased research activity, above and beyond that funded by the state. This article demonstrates the endorsement effect by examining how the founding of the NIH’s Office of Alternative Medicine affected both the discourse surrounding the legitimacy of alternative medicine, and the production of alternative medicine-related patents. The existence of this endorsement effect suggests that policymakers should consider both the direct effects that innovation policy might have on researchers’ incentives as well as the endorsement effects it can have on the research system.

Improvements in Infant Sleep Position: We Can Do Better!

* Abbreviations: AAP — : American Academy of Pediatrics SIDS — : sudden infant death syndrome SUID — : sudden unexpected infant death On the basis of the New Zealand Cot Study and European data, in 1992 the American Academy of Pediatrics (AAP) recommended that infants no longer sleep in the prone position.1 By 1994, the National Institutes of Health, with other stakeholders, introduced the Back to Sleep campaign. Over the next 10 years, the sudden infant death syndrome (SIDS) rate in the United States fell 53%, correlating with an increase in exclusive supine sleep from <10% to 78%.2 The AAP considers this 1 of the 7 great achievements in pediatric research in the last 40 years.3 But since 2002, the story has become more complicated. The AAP recommendations evolved to back is better than side and then back only in 2005. Other risk factors emerged, such as soft bedding and bed-sharing, and the education campaign became Safe to Sleep in 2012.4 And although the incidence of SIDS continued to decline, other deaths (including accidental suffocation and strangulation in bed and undetermined deaths) began to increase, suggesting a possible “diagnostic coding shift.”5 These sleep-related deaths became … Address correspondence to Michael Goodstein, MD, Office of Newborn Medicine, York Hospital, 1001 S. George St, York, PA 17403. E-mail: mgoodstein{at}wellspan.org

FDA will vet Emulate’s organ chip

Emulate, the developer of chips that simulate the physiology of human and animal tissues and organs, has signed a multiyear cooperative R&D agreement with the U.S. FDA’s Office of Foods & Veterinary Medicine. The partners will evaluate Emulate’s technology for toxicological testing of chemicals used in foods, dietary supplements, and cosmetics. They will initially use human, dog, and rat liver chips to assess the cross-species differences in toxicology data between humans and animals.

Cardiovascular risk factors, nonvalvular atrial fibrillation and retinal vein occlusion

ObjectivesTo analyze the importance of cardiovascular risk factors, ultrasound findings in the supra-aortic trunk and the presence of anticoagulated nonvalvular atrial fibrillation (NVAF) in patients with retinal vein occlusion (RVO) and in a control group. Patients and methodsA cross-sectional study was conducted of all patients with RVO consecutively referred to the office of internal medicine, comparing them with a control group. We analyzed clinical, electrocardiographic and ultrasound variables. ResultsWe studied 212 patients (114 men and 98 women) with RVO and 212 controls (95 men and 117 women) of similar ages. Arterial hypertension, dyslipidaemia and diabetes mellitus were significantly more prevalent in the patients with RVO than in the controls (73.6 vs. 50%, 64.6 vs. 48.6% and 27.8 vs. 12.3%, respectively). We observed arteriosclerotic lesions in the supra-aortic trunk in 55% of the patients with RVO. The patients with RVO and NVAF had a greater burden of cardiovascular risk factors than the controls with NVAF. There were no differences in terms of the international normalized ratio or in the use of direct anticoagulants between the cases and controls with NVAF. ConclusionsCardiovascular risk factors (especially arterial hypertension) and arteriosclerotic involvement of the supra-aortic trunk are highly prevalent in RVO. Anticoagulation does not appear to be effective in preventing RVO.

Factores de riesgo vascular, fibrilación auricular no valvular y obstrucción venosa retiniana

ObjectivesTo analyse the importance of cardiovascular risk factors, ultrasound findings in the supra-aortic trunk and the presence of anticoagulated nonvalvular atrial fibrillation (NVAF) in patients with retinal vein occlusion (RVO) and in a control group. Patients and methodsA cross-sectional study was conducted of all patients with RVO consecutively referred to the office of internal medicine, comparing them with a control group. We analysed clinical, electrocardiographic and ultrasound variables. ResultsWe studied 212 patients (114 men and 98 women) with RVO and 212 controls (95 men and 117 women) of similar ages. Arterial hypertension, dyslipidaemia and diabetes mellitus were significantly more prevalent in the patients with RVO than in the controls (73.6 vs. 50%, 64.6 vs. 48.6% and 27.8 vs. 12.3%, respectively). We observed arteriosclerotic lesions in the supra-aortic trunk in 55% of the patients with RVO. The patients with RVO and NVAF had a greater burden of cardiovascular risk factors than the controls with NVAF. There were no differences in terms of the international normalised ratio or in the use of direct anticoagulants between the cases and controls with NVAF. ConclusionsCardiovascular risk factors (especially arterial hypertension) and arteriosclerotic involvement of the supra-aortic trunk are highly prevalent in RVO. Anticoagulation does not appear to be effective in preventing RVO.

Proceedings of the Strategy Meeting for the Development of an International Consortium for Chinese Medicine and Cancer.

On November 3, 2014, in Bethesda, MD, the Office of Cancer Complementary and Alternative Medicine of the National Cancer Institute held a meeting to examine the potential utility and feasibility of establishing an international consortium for Chinese medicine and cancer. There is significant interest in the West in using components of Chinese medicine (CM) —such as botanicals and herbal medicines, acupuncture and acupressure, and qigong—in the field of oncology, as potential anticancer agents, for symptom management, and to improve quality of life. The proposal for a consortium on CM came from the Chinese Academy of Chinese Medical Sciences, with the aims of improving scientific communications and collaborations and modernizing the studies of CM for cancer. The US National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine agreed to work with Chinese Academy of Chinese Medical Sciences to explore the feasibility of establishing an international consortium for Chinese medicine and cancer. At the meeting, participants from the United States, China, Canada, Australia, and Korea discussed issues in CM and cancer research, treatment, and management, including potential mechanisms of action, proof of efficacy, adverse effects, regulatory issues, and the need for improving the quality of randomized clinical trials of CM treatments and supportive care interventions. Presented in these proceedings are some of the main issues and opportunities discussed by workshop participants.

A collaborative case study: The Office of Native Medicine.

National concerns about reducing the persistent health disparities found among varying racial and ethnic populations have led to initiatives to improve health care delivery systems. Many of these initiatives also promote the cultural competence of health care providers as a way to meet unique patient needs that go beyond immediate health problems, and to account for other critical components of patient care, such as health literacy, health beliefs and behaviors, and cultural practices. This case study describes a patient-centered care model developed by the Chinle Comprehensive Health Care Facility on the Navajo Reservation in Arizona, a model that has added a cadre of traditional tribal practitioners as part of its hospital and other clinical service resources.

Quantitative Analysis of Nitrofuran Metabolites and Chloramphenicol in Shrimp Using Acetonitrile Extraction and Liquid Chromatograph-Tandem Mass Spectrometric Detection: A Single Laboratory Validation.

A method was developed and validated for the simultaneous analysis of chloramphenicol and nitrofuran metabolites in shrimp according to the guideline established by the U.S. Food and Drug Administration Office of Foods and Veterinary Medicine. The extraction steps following the overnight hydrolysis and derivatization are simpler than the conventional ethyl acetate extraction method. The main steps are neutralization of hydrolysates, addition of acetonitrile for extraction, and salting out of organic phase from the acetonitrile-aqueous mixture. Extracts are analyzed for chloramphenicol and nitrofuran metabolites by LC-MS/MS in a single injection with polarity switching between the positive electrospray ionization (ESI) mode for the nitrofurans and the negative ESI mode for chloramphenicol. Recoveries calculated using an extracted matrix calibration curve and labeled internal standards for chloramphenicol and nitrofurans ranged from 98.6 to 109.2% with RSDs less than 18%. This method that combines the analysis of chloramphenicol with the nitrofurans was shown to generate analytical results similar to those obtained using the individual drug-class analytical methods currently used for the analysis of chloramphenicol or nitrofurans in shrimp.

Traditional and Complementary Medicine, Yes or No?

Traditional and complementary medicine (T and CM) are significant parts of health services and the need for their services are always increasing (1). The National Center for Complementary and Alternative Medicine (NCCAM) has stated that because T and CM beliefs about etiology and treatments of diseases are different, conventional medicine does not consider them as classical approaches (2). There is a deep belief about T and CM application in health maintenance and disease treatment, especially about chronic diseases. Such health services are utilized in different countries like Switzerland, South Korea, China, and India. Rapid increase in T and CM application among the general public in recent years led congress to establish the Office of Alternative Medicine under the National Institutes of Health in 1992. In 1998, NCCAM was established to use delicate scientific research for evaluation of its practices and products (3). Nowadays, the use of T and CM among patients with dermatologic conditions has not been well studied. In a study, which was conducted in the Department of Dermatology in America, about 78% of patients expressed that physicians should consider incorporating T and CM approaches into their treatment and most of them believed in the value of clinical studies to further refine the role of T and CM (4). Therefore, rigorous scientific research must be done to evaluate the safety and efficacy of these specific health services to ensure that patients receive care with the most favorable risk/benefit ratio (3). According to the community request, there is a tendency to incorporate integrative and complementary medicine into health professions education (5). Additionally in the field of dermatology, the above-mentioned remedies may cause adverse reactions, which alter diagnostic skin findings and interfere with the efficacy of other medical therapies. Therefore, during data collection, physicians should be aware of their patient’s opinion about using such methods (6). Accordingly, a comprehensive strategy for supervision will be needed to those countries that are planning to develop their policies about this important part of health care (1). Traditional Persian Medicine (TPN) has gained lots of popularity in the last decade due to its effectiveness and low costs. Faculties of Traditional Persian medicine in Iran are planning to make logical connections between the native traditional medicines and conventional medicine in order to hire the best approaches for using this ancient treasure.

Building the evidence base for integrative approaches to care of cancer survivors.

Like hospice and palliative care, the integrative medicine movement began as edgy outsiders. But in the last 10–15 years, integrative oncology practices, often tied with integrative medicine programs, are being established in major medical institutions across the country. Many are embedded in medical centers that are leaders in the development and provision of the most advanced modern technologies for cancer care. This issue of JNCI Monographs focuses on the role of integrative oncology in care of cancer survivors; the editors have brought together commentaries on the “state of the science.” We at the National Center for Complementary and Alternative Medicine together with our partners in the Office of Cancer Complementary and Alternative Medicine at the National Cancer Institute are the main National Institutes of Health supporters of that science. Our shared goal is a rigorous evidence base to guide patient decisions and to help providers make sensible recommendations: a solid scientific basis, assessing both risks and benefits. Not surprisingly, since integrative oncology is a relatively new movement, the science is just beginning. It is already very clear that approaches that fall under the general rubric “integrative oncology” are meeting important and often neglected needs. Two things are driving change. In part, the integrative oncology movement is a response to patient demand. Patients are asking for change—for access to an approach to care that is seen as more “holistic,” perhaps gentler, perhaps more optimistic. Change is also being driven by providers. Some physicians, including a number of oncologists, see in the integrative medicine movement an opportunity to develop a style of practice that will facilitate changed relationships with patients: less emphasis on technical advice, more emphasis on healing, defined broadly, on provision of emotional and spiritual supports, on creation of positive expectations, on encouragement to healthy living. By and large, when integrative practitioners offer “alternative” practices, it is as a complement to modern “mainstream medicine.” And by and large, patients interested in integrated approaches, do not want (and are not well-served by) care that does not integrate effective mainstream techniques for cure, prolongation of life, or substantive palliation. National Center for Complementary and Alternative Medicine has decided, through a year-long strategic planning process (1), to focus our resources on research on benefits and risk of complementary health practices for symptom management, particularly pain management, but also fatigue, loss of sleep, loss of appetite. A variety of complementary approaches and a number of practitioners from disciplines outside mainstream medicine are increasingly part of the integrative approach to symptom management. This monograph will, we hope, stimulate continued interest in testing these approaches and in their continued improvement. Our patients deserve nothing less.