Children fire up the cannons as wards become science labs.

PATIENTS AT the Royal London Children's Hospital got the chance to take part in a fun science laboratory day.

El método clínico frente a las nuevas tecnologías / Clinical method versus new technologies

El desarrollo de la técnica en las Ciencias Médica pudiera llevar a la falsa idea de que en esta época de tanto adelanto tecnológico el interrogatorio, el examen físico minucioso, el diagnóstico de síntomas y signos, el planteamiento de síndromes y de entidades nosológicas en la cabecera del enfermo resultan obsoletos y que el método científico aplicado al proceso salud-enfermedad, o sea, el método clínico resultan inadecuado. En este trabajo el autor se propuso como objetivo analizar la influencia indiscriminada de la tecnología en el diagnóstico médico en detrimento de la aplicación del método clínico. El método clínico no es más que el método científico aplicado al trabajo con los pacientes. Es un sistema de reglas para ordenar los procedimientos de que se vale el médico para obtener síntomas y signos; con ello elabora diagnósticos, que consiste en conocer, denominar y catalogar de forma precisa una enfermedad, perfeccionar la práctica médica y mejorar la enseñanza y educación profesional. Sus etapas son: el problema, la búsqueda de la información básica, la hipótesis, la contrastación del diagnóstico presuntivo y el diagnóstico de certeza. Muchos médicos en el mundo han desarrollado una dependencia de los análisis de laboratorio, de imagenología y electrocardiogramas para incrementar sus ingresos y otros están “colonizados” por la técnica y han atrofiado por desuso o mal uso, sus habilidades de interrogar, examinar, emitir diagnósticos de síntomas, de síndromes, de enfermedad y diferenciales y la capacidad de razonamiento. El método clínico no es obsoleto, la tecnología si envejece y está sujeta a errores lo cual no le resta valor como complementario, de manera que lo más racional es que a partir de un juicio diagnóstico adecuado se formulen las hipótesis y se diseñe un plan de investigaciones que tenga en cuenta las características propias del paciente, la relación costo beneficio, la disponibilidad, la accesibilidad y los riesgos(AU)

Technological development in medical sciences could lead professionals to the false idea that in an era of so much technological advance, questioning, thorough medical examination, symptoms and sign diagnosis, syndromes and nosological entities establishment at the patients bed are obsolete, and that the scientific method applied to the process health-disease, that is, the clinical method is inadequate. In this term the author´s aim was analyzing the indiscriminate influence of the technology in medical diagnosing in disadvantage of the clinical method usage. The clinical method is the scientific method applied to work with patients. It is a system of rules to order procedures the physician uses to bring together symptoms and signs; with them the physician works out diagnoses, consisting in accurately knowing, denominating and classifying a disease, improving medical practice and professional teaching and education. The clinical method stages are problem, searching for basic information, hypothesis, comparing presumptive diagnosis with the definitely-set diagnosis. Many physicians in the world have developed dependence on the laboratory analyses, image techniques and electrocardiograms to increase their incomes, and others are “colonized” by techniques and have weakened, by misuse or bad use, their abilities for questioning, examining, arriving to diagnoses from symptoms, syndromes, diseases and differentials and their reasoning capacity. The clinical method is not obsolete; technology does get obsolete, and may fails, but it is not less important as a complementary, so the most rational way is, making hypotheses and drawing a plan of research beginning from an adequate diagnosis judgment and taking into account the patient´s own characteristics, cost-benefit relation, availability, accessibility and risks(AU)

Qualitative screening for adulterants in weight-loss supplements by ion mobility spectrometry.

Ion mobility spectrometry (IMS) served as a rapid, qualitative screening tool for the analysis of adulterated weight-loss products. We have previously shown that sibutramine extracted into methanol from dietary supplements can be detected at low levels (2ng) using a portable IMS spectrometer, and have adapted a similar method for the analysis of additional weight-loss product adulterants. An FDA collaborative study helped to define the limits for fluoxetine with a limit of detection of 2ng. We also evaluated more readily available, less toxic extraction solvents and found isopropanol and water were comparable to methanol. Isopropanol was favored over water for two reasons: (1) water increases the analysis time and (2) aqueous solutions were more susceptible to pH change, which affected the detection of sibutramine. In addition to sibutamine and fluoxetine, we surveyed 11 weight-loss adulterants; bumetanide, fenfluramine, furosemide, orlistat, phenolphthalein, phentermine, phenytoin, rimonabant, sertraline and two sibutramine analogs, desmethylsibutramine and didesmethylsibutramine, using portable and benchtop ion mobility spectrometers. Out of these 13 active pharmaceutical ingredients (APIs), portable and benchtop ion mobility spectrometers were capable of screening products for 10 of these APIs. The developed procedure was applied to two weight-loss dietary supplements using both portable and benchtop instruments. One product contained didesmethylsibutramine while the other contained didesmethylsibutramine and phenolphthalein.

[What medical technologists can do in disaster...--experiences and prospects--introduction].

Disasters in medical treatment are defined as, "Huge numbers of casualties are generated who cannot be accepted by regional medical facilities", and when more casualties are generated than the regions can accept it is a "Disaster", e.g. earthquake, typhoon or bus, train and aircraft accidents. Although the definition of disasters is invariable, recently, the actual disaster scale has been increasing along with changes in the living environment. Therefore, we should think seriously about what medical technologists should do first at a disaster base hospital in order to provide accurate lab data immediately after a disaster in which many patients are transported in a short time. In this symposium, the experiences and preliminary conditions in disasters were presented from the medical technologists' point of view at a disaster base hospital. Needless to say, the purpose of this symposium is to learn from simulations and experiences of disasters, to think what we should do under limited conditions, and to share information obtained from our experiences.

Progress in nanotechnology for healthcare.

This review based on the Wickham lecture given by AC at the 2009 SMIT meeting in Sinaia outlines the progress made in nano-technology for healthcare. It describes in brief the nature of nano-materials and their unique properties which accounts for the significant research both in scientific institutions and industry for translation into new therapies embodied in the emerging field of nano-medicine. It stresses that the potential of nano-medicine to make significant inroads for more effective therapies both for life-threatening and life-disabling disorders will only be achieved by high-quality life science research. The first generation of passive nano-diagnostics based on nanoparticle contrast agents for magnetic resonance imaging is well established in clinical practice and new such contrast agents are undergoing early clinical evaluation. Likewise active (second generation) nano-therapies, exemplified by targeted control drug release systems are undergoing early clinical evaluation. The situation concerning other nano-materials such as carbon nanotubes (CNTs) and boron nitride nanotubes (BNNTs) is less advanced although considerable progress has been made on their coating for aqueous dispersion and functionalisation to enable carriage of drugs, genes and fluorescent markers. The main problem related to the clinical use of these nanotubes is that there is no consent among scientists on the fate of such nano-materials following injection or implantation in humans. Provided carbon nanotubes are manufactured to certain medical criteria (length around 1 mum, purity of 97-99% and low Fe content) they exhibit no cytotoxicity on cell cultures and demonstrate full bio-compatibility on in vivo animal studies. The results of recent experimental studies have demonstrated the potential of technologies based on CNTs for low voltage wireless electro-chemotherapy of tumours and for electro-stimulation therapies for cardiac, neurodegenerative and skeletal and visceral muscle disorders.

[Practical side of teamwork-based training--practice and evaluation in Gunma University].

In Gunma University, the School of Health Sciences was integrated with the Junior College Department into the Faculty of Medicine in 1996. For faculty integration, one of the most fundamental aspects of education was set as interprofessional education (IPE) in this school. To enhance collaboration between health professionals and overcome the fragmented nature of specialized medicine, the school has developed a curriculum, fundamentally based on holistic medicine and interprofessional work (IPW). The original and distinctive IPE was first introduced to 3rd grade students in 1999. The mandatory IPE practice training curriculum, designated as IPE, with multi-disciplinary students following a simulation training approach, has been implemented continuously for over 10 years. The major advantage of the curriculum lies in the training program, "a simulated interprofessional training", where students work in groups and perform a series of activities, including group discussions, clinical training at facilities, general meetings, and reporting. To assess the efficacy of IPE, a questionnaire survey was conducted for 11 years from 1999/2009. Students were asked to complete a short questionnaire with 10 questions and 2 or 3 open ended questions at the end of each IPE module. This systemic assessment of achievement has been developed independent of those described elsewhere, revealing the efficacy of the curriculum from a team building point of view. In this article, we introduce the results of the questionnaire survey in 2009. We hope that this article help in the teamwork-based training of students aiming to be medical technologists.

Integrating outcomes assessment and research into clinical care in inpatient adult psychiatric treatment.

The authors describe an evolving outcomes project implemented across the adult inpatient programs at The Menninger Clinic. In the inpatient phase of the project, patients complete a computerized battery of standardized scales at admission, at biweekly intervals throughout treatment, and at discharge. In addition to providing aggregate data for outcomes research, these assessments are incorporated into routine clinical care, with results of each individual assessment provided to the treatment team and to the patient. The inpatient phase of the project employs Web-based software in preparation for a forthcoming follow-up phase in which patients will continue after discharge to complete assessments on the same computer platform. This article begins with a brief overview of related research at the Clinic to place the current project in local historical context. Then the authors describe the assessment instruments, the ways in which the assessments are integrated into clinical care, plans for follow-up assessments, the central role of information technology in the development and implementation of the project, the primary research questions, and some of the major challenges in implementing the project. The article concludes with a discussion of the ways in which the project can serve as a platform for a broad future research agenda.

[Daedalus sive mechanicus--automated equipment and machines at the interface between mechanics and medicine]. / Daedalus sive mechanicus-- Automaten und Maschinen an der Schnittstelle zwischen Mechanik und Medizin.

Automata have always held a particular fascination. Their history leads back to their mythical ancestors, whose destinies raise considerable ethical questions about the sense of technology and about the boundaries between nature and art. In the 16th century engineers, architects and also physicians discussed the status of the ,artes mechanicae' and the machines they produced or used. Useful, sometimes dangerous, amusing and elaborate artefacts liven up their texts. Together with wonderful automata we find there also orthopaedic stretching machines and artificial limbs, whose acceptance by medical practice was anything but a matter of course.

Advances in the application of technology to epilepsy: the CIMIT/NIO Epilepsy Innovation Summit.

In 2008, a group of clinicians, scientists, engineers, and industry representatives met to discuss advances in the application of engineering technologies to the diagnosis and treatment of patients with epilepsy. The presentations also provided a guide for further technological development, specifically in the evaluation of patients for epilepsy surgery, seizure onset detection and seizure prediction, intracranial treatment systems, and extracranial treatment systems. This article summarizes the discussions and demonstrates that cross-disciplinary interactions can catalyze collaborations between physicians and engineers to address and solve many of the pressing unmet needs in epilepsy.

Proposals for a phased evaluation of medical tests.

BACKGROUND: In drug development, a 4-phase hierarchical model for the clinical evaluation of new pharmaceuticals is well known. Several comparable phased evaluation schemes have been proposed for medical tests. PURPOSE: To perform a systematic search of the literature, a synthesis, and a critical review of phased evaluation schemes for medical tests. DATA SOURCES: Literature databases of Medline, Web of Science, and Embase. STUDY SELECTION AND DATA EXTRACTION: Two authors separately evaluated potentially eligible papers and independently extracted data. RESULTS: We identified 19 schemes, published between 1978 and 2007. Despite their variability, these models show substantial similarity. Common phases are evaluations of technical efficacy, diagnostic accuracy, diagnostic thinking efficacy, therapeutic efficacy, patient outcome, and societal aspects. CONCLUSIONS: The evaluation frameworks can be useful to distinguish between study types, but they cannot be seen as a necessary sequence of evaluations. The evaluation of tests is most likely not a linear but a cyclic and repetitive process.

Utilization of health technologies-Do not look where there is a light; shine your light where there is a need to look! Relating national health goals with resource allocation decision-making; illustration through examining the Israeli healthcare system.

Innovative health technologies are often the focus of attention. However, in the allocation of public resources for improving health, the focus should be on the health needs of the population. It is the need that should be analyzed first, and decision makers should then evaluate the full range of interventions available, whether new or old, to meet this need. This is in contrast to analyzing the technology first and then characterizing the need it meets, which is the current practice in reimbursement decision-making in several countries. The identified health need should define national health goals, and these goals should be proactively assimilated into the reimbursement decision-making process. Differential reimbursement rates could reflect the relative contribution of the technology to the unmet health need.