Council on Medical Services says medical rehabilitation must be under MD direction

The 1976-77 statistical study of medical school enrollment by the Association of Canadian Medical Colleges shows that total enrollment in Canadian medical schools had increased 103.8% since 1960-61, although the rate of increase had decreased to almost zero by 1976-77. Women accounted for 30.3% of the total enrollment in 1976-77 (for all years of the course), which represents an increase of more than 550% in the 17-year period; for the 16 schools the proportion ranged between 23.9% and 43.8%. Enrollment of foreign students had decreased from 340 in 1966-67 to 90 (1.2%) in 1976-77; 71 of the 90 students were American. For the entire nation the mean number of medical students per 10 000 population was 3.1, but in British Columbia the figure was only 1.5. Of the Canadian and landed immigrant students 94.5% were attending medical school in their home province.     

Attempts to use computers as diagnostic aids in medical decision making: a thirty-year experience.

For more than 30 years our group of physicians, statisticians, and computer scientists has worked toward developing a computer program with the capability of a trained physician to make diagnostic decisions in the relatively broad medical subspecialty of hematology. We devised and tested many programs, none of which have been sufficiently useful to warrant carrying beyond the pilot-study stage. We analyzed the reasons for this failure. Our experience confirms the great difficulty, and even the impossibility, of incorporating the complexity of human thought into a system that can be handled by a computer. We concluded that we should stop trying to make a computer act like a diagnostician and concentrate instead on ways of making computer-generated relevant information available to physicians as they make decisions.     

Functional evaluation and rehabilitation engineering

Life is complex and all about movement, which allows us to interact with the environment and communicate with each other. The human nervous system is capable of performing a simultaneous and integrated control of 100-150 mechanical degrees of freedom of movement in the body via tensions generated by about 700 muscles. In its widest context, movement is carried out by a sensory motor system comprising multiple sensors (visual,auditory, and proprioceptive),multiple actuators (muscles acting on the skeletal system),and an intermediary processor that can be summarized as a multiple-input–multiple-output nonlinear dynamic time-varying control system. This grand control system is capable of responding with remarkable accuracy,speed, appropriateness,versatility, and adaptability to a wide spectrum of continuous and discrete stimuli and conditions and is certainly orders of magnitude more complex and sophisticated than the most advanced robotic systems currently available. In the last decades,a great deal of research has been carried out in the fields of functional evaluation of human performance and rehabilitation engineering. These fields combine knowledge, concepts, and methods from across many disciplines (e.g., biomechanics,neuroscience, and physiology), with the aim of developing apparatuses and methods fort he measurement and analysis of complex sensory motor performance and the ultimate goal of enhancing the execution of different tasks in both healthy people and persons with reduced capabilities from different causes (injury, disease, amputation,and neural degeneration).     

Stop and be fair: DLPFC development contributes to social decision making

In this issue of Neuron,Steinbeis et al. (2012) show that DLPFC structure and functions are associated with strategic social choices during an economic task and relate to impulse control abilities in both age dependent and independent manners.     

The aged: medical and social aspects

Physical health is affected by physiological aging that impacts on all tissues and organs, notably sensorial systems (hearing, sight), the locomotory and the immunological systems (lowering of resistance to infections). There is an increase with age in the incidence of many cancers (particularly breast, prostate, and colon cancers) and cardiovascular diseases. Regular check-ups are useful in order to take appropriate measures in time. It is important that people maintain regular physical activity and a balanced diet even up to an advanced age and the elderly must learn to adapt themselves to the ever-changing abilities of their organism. It is possible to slow down the aging process through good hygiene and often to maintain autonomy until the end of life. Mental health is threatened by impairment of mental functions, depressive tendencies, and the risk of senile dementia that cannot be foreseen or avoided. It appears that keeping intellectually active and having a good level of education impact favorably on mental aging. Social health depends, for a large part, on the way society accepts and treats the elderly. They must be kept integrated into society and allowed to live at home for as long as possible. Any measures of rejection, discrimination, and exclusion should be opposed. The dignity of the elderly must be respected and activities giving them a feeling of usefulness should be encouraged. It is important to help families who care for their parents at home, to develop and evaluate healthcare networks, and encourage medical professionals and social services to work together. The change in the demographic structure of France is a considerable phenomenon requiring a long-term strategy and not only superficial and cosmetic measures.     

Coral transplantation as an aid to reef rehabilitation: evaluation of a case study in the Maldive Islands

As part of a study of reef rehabilitation, whole coral colonies (primarily Acropora, Pocillopora, Porites, Eavia and Favites) were transplanted and cemented in place onto three approximately 20 m² areas of Armorflex concrete mats on a 0.8–1.5 m deep reef-flat in the Maldives which had been severely degraded by coral mining. Growth, in situ mortality, and losses from mats due to wave action of a total of 530 transplants were monitored over 28 months. Natural recruitment of corals to both the transplanted Armorflex areas and concrete mats without transplants was also studied. Overall survivorship of corals 28 moths after transplantation was 51%. Most losses of transplants due to wave action occurred during the first 7 months when 25% were lost, with only a further 5% of colonies being lost subsequently. Within 16 months most colonies had accreted naturally to the concretemats. Thirty-two percent of transplants which remained attached died with Acropora hyacinthus and Pocillopora perrucosa having the highest mortality rates (approx. 50% nortality over two years) and Porites lobata and P. lutea the lowest (2.8 and 8.1% mortality respectively over two years). Growth rates were very variable with a quarter to a third of transplants showing negative growth during each inter-survey period. Acropora hyacinthus, A. cytherea and A. divaricata transplants had the highest growth rates (colony mean linear radial extension 4.15–5.81 cm y^-1), followed by Pocillopora verrucosa (mean 2.51 cm y^-1). Faviids and poritids had lowest growth rates. Favia and Favites showed the poorest response to transplantation whilst Acropora divaricata, which combined a high growth rate with relatively low mortality, appeared particularly amenable to transplantation. Natural recruitment did not differ significantly between concrete mats with and without transplanted corals. Visible recruits wer first recorded 10 months after emplacement of the mats and were predominantly Acropora and Pocillopora. On near vertical surfaces their density was almost 18 m^-2. Recruits grew fast producing many 20–30 cm diameter colonies on the mats within 3.5 years. Growth and survival of transplants are compared with results of transplantation studies in other locations. We conclude: (1) species transplanted should be selected with care as certain species are significantly more amenable than others to transplantation, (2) the choice of whether fragments or whole colonies are transplanted may profoundly influence survival, (3) considerable loss of transplants is likely from higher energy sites whatever method of attachment, (4) transplantation should, in general, be undertaken only if recovery following natural recruitment is unlikely.     

Medical decision making and medical education: challenges and opportunities

The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include the physician's own decision skills, the ability to guide patients in shared decisions, and knowledge of health policy decisions at the societal level. Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.     

Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation

Netherlands Heart Journal - Multidisciplinary cardiac rehabilitation (CR) reduces morbidity and mortality and increases quality of life in cardiac patients. However, CR utilisation rates are low,...     

The HIV epidemic: medical and social challenges

The sudden appearance, rapid spread, and devastating clinical impact of HIV infection in Africa, Europe and North America has created a medical problem unprecedented in the modern era. HIV is sexually transmitted, afflicts sexual and racial minorities in developed countries, and appears likely to be fatal and incurable in a majority of infected people. Its epidemiology (transmission and natural history) and clinical manifestations have been well described, but treatment of HIV remains minimally effective, creating only a short respite from progressive deterioration. In the absence of effective vaccination, HIV will continue to spread, abetted by a long period of asymptomatic carriage during which carriers are infectious. It has spread internationally to most undeveloped countries aided by fear and ignorance. The problem will resist simple technological solutions and adversely impact the lives of tens of millions of people in these areas over the next several decades. In developed countries HIV will strain medical resources and kill several million people before the end of the century. Despite the tremendous problems created by the AIDS epidemic, it has driven a remarkable expansion of virologic and immunologic understanding which promises to ultimately lead to control of not only AIDS, but a variety of other serious diseases. The following reviews of pivotal issues in AIDS research document this progress.     

Shaping the social and welfare security in Indonesia through implementing macro-ergonomics

Ergonomics as a scientific method was familiar in industrial regimes. Its trajectories have rapidly grown up to multiple dimensions in which the socio-technical aspects are inherent. Since ergonomics has promoted a new perspective in view of the relationships among the man-machine-systems, it has brought the remarkable progress compared with mono-spectrum in a mechanistic perspective. In the case of Indonesia, the functioning of ergonomics is urgent as the national productivity level is still less optimal. Since Indonesia has no established policies in societal life quality empowerment, it is important to overcome the insecurity on social welfare for securing sustainability. Since the ergonomics philosophy has promoted a humanity perspective in the country, it is necessary to use it as a means of enhancing productivity in order to achieve societal prosperity. Nevertheless, shaping the social prosperity by counting on ergonomics is insufficient, the development of policies and strategic plans should be addressed by identifying existing mapping of the roles of stakeholders in multiple perspectives. This paper is focused on describing ergonomics-based foresight and its prospectus for shaping the social and welfare security in Indonesia by analyzing its roles in social development.