Epistemological Beliefs and Knowledge among Physicians: A Questionnaire Survey

Background: All sciences share a common underlying epistemological domain, which gives grounds to and characterizes their nature and actions. Insofar as physicians depend on scientific knowledge, it would be helpful to assess their knowledge regarding some theoretical foundations of science. Objectives: 1.To assess resident physicians' knowledge of concepts and principles underlying all sciences. 2. To determine, to what extent physicians' epistemological beliefs and attitudes are compatible with the scientific paradigm. Design: A questionnaire was administered to 161 resident physicians at three hospitals in Lima, Peru. Results: 237 resident physicians were selected, 161 (68%) of whom agreed to answer the survey. 67% of respondents indicated they did not know what epistemology is, 21% were able to correctly define epistemology; 24% of the residents knew the appropriate definition of scientific theory. No respondents knew the philosophical presumptions of science; and 48% took a relativistic stand towards knowledge. Conclusions: There appear to be deficiencies in the knowledge of scientific theoretical foundations among physicians

The general concept of disease. Revision, criticism and proposal. First part

El presente es el primero de una serie de tres artículos dedicados a analizar uno de los conceptos centrales de la medicina: la enfermedad. Nuestra misión primera será realizar una revisión de las diversas y dispersas propuestas de definición. Esta revisión, ejecutada bajo una perspectiva histórica y epistemológica, hará hincapié sobre la dicotomía naturalista-valorativa y la novedosa propuesta matemática de Sadegh-Zadeh.This is the first of a three part series dedicated to analyze one of the central concepts of medicine: disease. Our first mission will be to revise the diverse and disperse disease definitions. This historical and epistemological revision will stress the naturalist-normativistic dichotomy and Sadegh-Zadeh’s novel mathematical proposal

A theoretical model of disease

Se plantea el concepto de enfermedad como modelo teórico, es decir, como una representación conceptual esquemática, la cual representará la enfermedad en términos teóricos de alto grado de abstracción. Nos serviremos de conceptos matemáticos tales como los de conjunto y función, y de teorías muy generales, como la teoría general de sistemas y el materialismo emergentista.This paper outlines the concept of disease as a theoretical model, that is, a schematic conceptual representation to describe disease in theoretical terms (of high generality). We will utilize mathematical concepts, such as set and function, and general theories like the general systems theory and emergentist materialism

Alternative medicine: Intent of analysis

Por medicina alternativa se considera al conjunto de disciplinas terapéuticas y diagnósticas que existen fuera de las instituciones del sistema de salud convencional. El uso actual de esta 'clase' de medicina está muy extendido, tanto en el mundo industrial como el preindustrial. Parte del creciente uso de las terapias alternativas se debe a su reciente validación profesional; muchos textos de divulgación general claman y justifican su uso, basándose en información académica no necesariamente de rigor científico. En este ensayo, se analizará la evidencia científica disponible, así como también se analizará las bases lógicas y filosóficas de la medicina en cuestión.Alternative medicine is considered a set of therapeutic and diagnostic disciplines that exist outside the conventional health system. Current use of this 'class' of medicine is amply extended in both developed and undeveloped world. One of the causes of increasing use of alternative medicine is recent professional validation. Many general divulgation texts claim and justify its use based on academic information without scientific quality. In this essay we will analyze the available scientific evidence as well as logical and philosophical bases of this so called medicine

Lacks and defects in the intents to achieve a general definition of disease

Esta segunda entrega está dedicada a señalar y esclarecer algunas omisiones que, a nuestra opinión, exhiben las diversas propuestas de definición de enfermedad. Nuestra crítica espera revirar el interés hacia el uso de diversos conceptos, teorías y metateorías que bien pueden contribuir a la mejor ejecución de un modelo teórico de la enfermedad. El análisis de los conceptos, el uso de la teoría general de sistemas, de la modelización matemática y del materialismo emergentista, mostrarán que alcanzar un concepto general de enfermedad no es posible sólo acudiendo a la parcela de la investigación empírica (científica).This second delivery is dedicated to point out and clarify some omissions that to our opinion the diverse proposals of disease concept exhibit. This critic hopes to orientate the interest toward the use of diverse concepts, theories, and metatheories that may contribute to the best execution of a theoretical model of disease. The analysis of the concepts, the utilization of the general theory of systems, mathematical models, and emergentism theory will demonstrate that to reach a general concept of disease is not possible only by going to the parcel of empiric investigation

Immune response generated with the administration of autologous dendritic cells pulsed with an allogenic tumoral cell lines lysate in patients with newly diagnosed DIPG

Background and objective. Diffuse intrinsic pontine glioma (DIPG) is a lethal brainstem tumor in children. Dendritic cells (DCs) have T-cell stimulatory capacity and, therefore, potential antitumor activity for disease control. DCs vaccines have been shown to reactivate tumor-specific T cells in both clinical and pre-clinical settings. We designed a phase Ib immunotherapy (IT) clinical trial with the use of autologous dendritic cells (ADCs) pulsed with an allogeneic tumors cell-lines lysate (ATCL) in patients with newly diagnosed DIPG after irradiation (RT). Methods. Nine patients with newly diagnosed DIPG met enrollment criteria. Autologous dendritic cell vaccines (ADCV) were prepared from monocytes obtained by leukapheresis. Five ADCV doses were administered intradermally during induction phase. In the absence of tumor progression, patients received 3 boosts of tumor lysate every three months during the maintenance phase. Results. Vaccine fabrication was feasible in all patients included in the study. Non-specific KLH (9/9 patients) and specific (8/9 patients) antitumor response was identified by immunologic studies in peripheral blood mononuclear cells (PBMC). Immunological responses were also confirmed in the T lymphocytes isolated from the cerebrospinal fluid (CSF) of 2 patients. Vaccine administration resulted safe in all patients treated with this schema. Conclusions. These preliminary results demonstrate that ADCV preparation is feasible, safe and generate a DIPG-specific immune response detected in PBMC and CSF. This strategy shows a promising backbone for future schemas of combination immunotherapy

El concepto general de enfermedad: revisión, crítica y propuesta Tercera parte: un modelo teórico de enfermedad

Se plantea el concepto de enfermedad como modelo teórico, es decir, como una representación conceptual esquemática, la cual representará la enfermedad en términos teóricos de alto grado de abstracción. Nos serviremos de conceptos matemáticos tales como los de conjunto y función, y de teorías muy generales, como la teoría general de sistemas y el materialismo emergentista

Medicina alternativa: intento de análisis

Por medicina alternativa se considera al conjunto de disciplinas terapéuticas y diagnósticas que existen fuera de las instituciones del sistema de salud convencional. El uso actual de esta 'clase' de medicina está muy extendido, tanto en el mundo industrial como el preindustrial. Parte del creciente uso de las terapias alternativas se debe a su reciente validación profesional; muchos textos de divulgación general claman y justifican su uso, basándose en información académica no necesariamente de rigor científico. En este ensayo, se analizará la evidencia científica disponible, así como también se analizará las bases lógicas y filosóficas de la medicina en cuestión

Immune Response Generated With the Administration of Autologous Dendritic Cells Pulsed With an Allogenic Tumoral Cell-Lines Lysate in Patients With Newly Diagnosed Diffuse Intrinsic Pontine Glioma

Background and objectiveDiffuse intrinsic pontine glioma (DIPG) is a lethal brainstem tumor in children. Dendritic cells (DCs) have T-cell stimulatory capacity and, therefore, potential antitumor activity for disease control. DCs vaccines have been shown to reactivate tumor-specific T cells in both clinical and preclinical settings. We designed a phase Ib immunotherapy (IT) clinical trial with the use of autologous dendritic cells (ADCs) pulsed with an allogeneic tumors cell-lines lysate in patients with newly diagnosed DIPG after irradiation (radiation therapy).MethodsNine patients with newly diagnosed DIPG met enrollment criteria. Autologous dendritic cell vaccines (ADCV) were prepared from monocytes obtained by leukapheresis. Five ADCV doses were administered intradermally during induction phase. In the absence of tumor progression, patients received three boosts of tumor lysate every 3 months during the maintenance phase.ResultsVaccine fabrication was feasible in all patients included in the study. Non-specific KLH (9/9 patients) and specific (8/9 patients) antitumor response was identified by immunologic studies in peripheral blood mononuclear cells (PBMC). Immunological responses were also confirmed in the T lymphocytes isolated from the cerebrospinal fluid (CSF) of two patients. Vaccine administration resulted safe in all patients treated with this schema.ConclusionThese preliminary results demonstrate that ADCV preparation is feasible, safe, and generate a DIPG-specific immune response detected in PBMC and CSF. This strategy shows a promising backbone for future schemas of combination IT