General practitioners' perceptions of effective health care

Objectives: To explore general practitioners' perceptions of effective health care and its application in their own practice; to examine how these perceptions relate to assumptions about clinicians' values and behaviour implicit in the evidence based medicine approach. Design: A qualitative study using semistructured interviews. Setting: Eight general practices in North Thames region that were part of the Medical Research Council General Practice Research Framework. Participants: 24 general practitioners, three from each practice. Main outcome measures: Respondents' definitions of effective health care, reasons for not practising effectively according to their own criteria, sources of information used to answer clinical questions about patients, reasons for making changes in clinical practice. Results: Three categories of definitions emerged: clinical, patient related, and resource related. Patient factors were the main reason given for not practising effectively; others were lack of time, doctors' lack of knowledge and skills, lack of resources, and "human failings." Main sources of information used in situations of clinical uncertainty were general practitioner partners and hospital doctors. Contact with hospital doctors and observation of hospital practice were just as likely as information from medical and scientific literature to bring about changes in clinical practice. Conclusions: The findings suggest that the central assumptions of the evidence based medicine paradigm may not be shared by many general practitioners, making its application in general practice problematic. The promotion of effective care in general practice requires a broader vision and a more pragmatic approach which takes account of practitioners' concerns and is compatible with the complex nature of their work

Trend and impact of international collaboration in clinical medicine papers published in Malaysia

Research collaboration is the way forward in order to improve quality and impact of its research findings. International research collaboration has resulted in international co-authorship in scientific communications and publications. This study highlights the collaborating research and authorship trend in clinical medicine in Malaysia from 2001 to 2010. Malaysian-based author affiliation in the Web of Science (Science Citation Index Expanded) and clinical medicine journals (n = 999) and articles (n = 3951) as of 30th Oct 2011 were downloaded. Types of document analyzed were articles and reviews, and impact factors (IF) in the 2010 Journal Citation Report Science Edition were taken to access the quality of the articles. The number of publications in clinical medicine increased from 4.5 % (n = 178) in 2001 to 23.9 % (n = 944) in 2010. The top three contributors in the subject categories are Pharmacology and Pharmacy (13.9 %), General and Internal Medicine (13.6 %) and Tropical Medicine (7.3 %). By journal tier system: Tier 1 (18.7 %, n = 738), Tier 2 (22.5 %, n = 888), Tier 3 (29.6 %, n = 1170), Tier 4 (27.2 %, n = 1074), and journals without IF (2.1 %, n = 81). University of Malaya was the most productive. Local collaborators accounted for 60.3 % and international collaborations 39.7 %. Articles with international collaborations appeared in journals with higher journal IFs than those without international collaboration. They were also cited more significantly than articles without international collaborations. Citations, impact factor and journal tiers were significantly associated with international collaboration in Malaysia’s clinical medicine publications. Malaysia has achieved a significant number of ISI publications in clinical medicine participation in international collaboration

Clinical Pharmacology in the UK, c.1950-2000: Industry and Regulation

Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.First published by the Wellcome Trust Centre for the History of Medicine at UCL, 2008. ©The Trustee of the Wellcome Trust, London, 2008.All volumes are freely available online at: www.history.qmul.ac.uk/research/modbiomed/wellcome_witnesses/Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.Annotated and edited transcript of a Witness Seminar held on 25 September 2007. Introduction by Professor Parveen Kumar, Barts and the London School of Medicine and Dentistry, University of London.Clinical pharmacology in the UK in the 1950s and 1960s was an exciting profession. Many important new drugs were developed and brought to market and a more systematic knowledge of drug effects in humans was needed, as well as ensuring the safety and efficacy of new and existing drugs, especially following the unexpected problems arising from the use of thalidomide. This Witness Seminar followed an earlier meeting on the history of the general development of clinical pharmacology and focuses on the development of clinical pharmacology in pharmaceutical companies and drug regulation. Professor Rod Flower chaired the meeting of clinical pharmacologists and others who shaped the discipline, which discussed the main centres of influence; the attraction to clinical pharmacologists of working in industry; whether the decline in the number of academic clinical pharmacologists was paralleled in drug companies; what drove drug regulation; and the relationships between companies and regulatory authorities. Participants included Dr Jeffrey Aronson, Professor Nigel Baber, Sir Alasdair Breckenridge, Sir Iain Chalmers, Professor Joe Collier, Professor Donald Davies, Dr Peter Fletcher, Dr Arthur Fowle, Professor Sir Charles George, Professor David Grahame-Smith, Professor John Griffin, Dr Andrew Herxheimer, Professor Ray Hill, Dr Peter Lewis, Dr Tim Mant, Professor Denis McDevitt, Professor Michael Orme, Dr Anthony Peck, Professor Brian Prichard, Professor Sir Michael Rawlins, Professor John Reid, Professor Philip Routledge, Dr Julian Shelley, Dr Robert Smith, Professor Cameron Swift, Professor Tilli Tansey, Dr Duncan Vere, and the late Professor Owen Wade. Reynolds L A, Tansey E M. (eds) (2008) Clinical pharmacology in the UK, c. 1950–2000: Industry and regulation. Wellcome Witnesses to Twentieth Century Medicine, vol. 34. London: The Wellcome Trust Centre for the History of Medicine at UCL.The Wellcome Trust Centre for the History of Medicine at UCL is funded by the Wellcome Trust, which is a registered charity, no. 210183

Translational Oncogenomics and Human Cancer Interactome Networks

An overview of translational, human oncogenomics, transcriptomics and cancer interactomic networks is presented together with basic concepts and potential, new applications to Oncology and Integrative Cancer Biology. Novel translational oncogenomics research is rapidly expanding through the application of advanced technology, research findings and computational tools/models to both pharmaceutical and clinical problems. A self-contained presentation is adopted that covers both fundamental concepts and the most recent biomedical, as well as clinical, applications. Sample analyses in recent clinical studies have shown that gene expression data can be employed to distinguish between tumor types as well as to predict outcomes. Potentially important applications of such results are individualized human cancer therapies or, in general, ‘personalized medicine’. Several cancer detection techniques are currently under development both in the direction of improved detection sensitivity and increased time resolution of cellular events, with the limits of single molecule detection and picosecond time resolution already reached. The urgency for the complete mapping of a human cancer interactome with the help of such novel, high-efficiency / low-cost and ultra-sensitive techniques is also pointed out

Integrative Medicine In Health and Well-Being

For integrative approaches to become part of standard care, research is required to understand clinical effects. Clinical data needs to be supplemented by mechanistic studies. Integrative medicine and general medicine have multiple areas of intersection. Studies can evaluate mental and physical disorders such as depression or anxiety or chronic pain and fatigue. Studies can evaluate psychological symptoms associated with other medical and neurological disorders. It is important to establish efficacy and also mechanism. Future collaborations are very welcome

Cancer Clinical Trials Optimization and Pharmacogenomics

A critical overview of recent clinical trials in cancer is presented focused on signaling pathways blockers or inhibitors with a view to developing successful clinical trials employing personalized cancer therapies. Rational, pharmacogenomic strategies in cancer trials should be adopted that include specific molecular targeting based on adequate data for, and detailed modeling of, cancer cell genomes, modifications of cancer signaling pathways and epigenetic mechanisms. Novel translational oncogenomics research is rapidly expanding through the application of highly sensitive and specific advanced technology, research findings and computational tools and complex models to both pharmaceutical and clinical problems. Multiple sample analyses from several recent clinical studies have shown that gene expression data for cancer cells can be employed to distinguish between tumor types as well as to predict outcomes. Potentially important applications of such results are individualized human cancer therapies or, in general,'personalized medicine' that will have to be validated through optimally designed clinical trials in cancer. A Human Cancer Genomes and Epigenetics Project is proposed that can provide the essential data required for the optimal design of clinical trials with the goal of achieving significant improvements of the survival rates of cancer patients participating in clinical trials for advanced cancer stages. The results of such a six-year Human Cancer Genomes and Epigenetics Project should also greatly aid with the accelerated, rational development of effective anti-cancer medicines and the chemoprevention of cancers

Application of Kampo Medicines for Treatment of General Fatigue Due to Long COVID

Evidence regarding treatment for the acute phase of COVID-19 has been accumulating, but specific treatment for long COVID/post-COVID-19 condition has not yet been established. Treatment with herbal medicine might be one treatment option for long COVID, but there has been little research on the effectiveness of herbal medicine for long COVID. The aim of this study was to clarify the prescription patterns of Kampo medicines, which are herbal medicines that originated in China and were developed in Japan, for the treatment of general fatigue due to long COVID. A retrospective descriptive study was performed for patients who visited a COVID-19 aftercare clinic established in Okayama University Hospital during the period from Feb 2021 to Dec 2021 with a focus on symptoms accompanying general fatigue and prescriptions of Kampo medicine. Among the clinical data obtained from medical records of 195 patients, clinical data for 102 patients with general fatigue and accompanying symptoms were analyzed. The patients had various symptoms, and the most frequent symptoms accompanying general fatigue were dysosmia, dysgeusia, headache, insomnia, dyspnea, and hair loss. Prescriptions of Kampo medicine accounted for 24.1% of the total prescriptions (n = 609). The most frequently prescribed Kampo medicine was hochuekkito (71.6%) and other prescribed Kampo medicines were tokishakuyakusan, ryokeijutsukanto, juzentaihoto, hangekobokuto, kakkonto, ninjin'yoeito, goreisan, rikkunshito, and keishibukuryogan. Since the pathophysiology of general fatigue after an infectious disease is, in general, considered a qi deficiency in Kampo medicine, treatments with such compensation agents can be the major prescription as a complement for the qi. In conclusion, Kampo medicine can be one of the main pharmacological treatments for long COVID accompanying general fatigue