other, care as well, and most recently, a search for meaning, specifically, wisdom (cf.Kleinman 2014a, b; 2015a, b). Fieldwork, Research and TeachingHe has conducted long term research in China, in Taiwan, from 1969-1970, 1975 and 1977-1978.In addition, he has conducted short-term research during some 22 sojourns in Taiwan, Hong Kong, and other sites in China, as well as a stint in East Africa.In addition, medicine in his home turf was the subject of research from 1983-1986.His earliest published work focused on biological aspects of neonates (Yang and Kleinman 1970;Yang et al. 1971) and immunological aspects of toxemia (Yang and Kleinman 1974), work rather unknown to his followers today.His widely known research initially focused on the shape of psychiatry in China (1972) and illness experiences, which led to comparisons with US psychiatry and the development of a central critique thereof (Manschreck and Kleinman 1977; Kleinman 1977a, b) as well as its diagnostic entities, especially depression (Good and Kleinman 1995; Kleinman 1977a Kleinman , b, 1980a, b), b).Having been concerned with the construction and experience of illness in the 1970s, in 1980 Kleinman produced one of the most influential books in the history of medical anthropology and the social sciences of medicine, his Patients and Healers in the Context of Culture (1980).This work quickly became the standard text for medical anthropology globally and garnered the Welcome Medal for Medical Anthropology.It provided a number of key and influential theories as well as methodologies for medical anthropology (and other social sciences of medicine).These include the Illness/Disease distinction, the Explanatory Model construct (soon reified and rigidified even by anthropologists) and the dynamics of illness conceptions, the notion of the Local Health Care System, and the Semantic Sickness Network (based on Byron Good's classic, ''The Heart of What's the Matter'' and his Semantic Illness Network (1976) 1(1) of Culture, Medicine and Psychiatry, it is worth noting).Arthur Kleinman has solo authored six published books including Patients and Healers.These include, the Social Origins of Distress and Disease, Depression, Neurasthenia and Pain in Modern China, The Illness Narratives, Writing at the Margin; and more recently, What Really Matters.He has also co-written and co-
Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? 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Psikoterapilerdeki Dini İzler15 December 2018 | Cumhuriyet İlahiyat Dergisi, Vol. 22, No. 3Women's Perceptions of Using Short Films to Integrate Spirituality in TherapyJournal of Systemic Therapies, Vol. 37, No. 4Content Validation of Advanced Illness Criteria of a Palliative Care Screening Tool Lauren C. DiLello, Karen Mulvihill, Jennifer Delli Carpini, Riddhi Shah, Julia Hermanowski, and Damanjeet Chaubey29 October 2018 | Journal of Palliative Medicine, Vol. 21, No. 11Understanding, assessing, and in the spiritual of medical and October 2018 | Theology, Vol. 11, No. and of in Living with October 2018 | Journal of & Social Services, Vol. No. for the spirituality as October 2018 | Revista de Vol. 71, No. An of an aged psychiatry March 2018 | Psychiatry, Vol. 26, No. de de vida de de Vol. 25, No. support and with in Care in the Care A Narrative June | Journal of Care Medicine, Vol. No. Care in Cancer: in the of of Clinical Oncology Educational Vol. 3, No. religion/spirituality in clinical practice: A among social and and October | Journal of Clinical Psychology, Vol. 74, No. Spirituality in Care December | Journal of Religion and Health, Vol. 57, No. of to spiritual care at the of a phenomenological exploration from the of palliative care February 2018 | Journal for the Study of Spirituality, Vol. 8, No. Existential Distress in Pediatric Cancer December and Patient Spiritual in the through October of Spirituality in November Psychological/Psychiatric, Social, and Spiritual Problems and July and End-of-Life Care in Cancer in Oncology Nursing, Vol. No. Care in Hospice and Palliative Journal of Hospice and Palliative Care, Vol. 20, No. and Spirituality: Literature review and Journal of Counseling, Vol. 18, No. of the tool existential communication between and cancer August | European Journal of General Practice, Vol. 23, No. Education and of Christian Nursing, Vol. 34, No. Care Interventions in to and Therapy C. and D. September | Journal of Palliative Medicine, Vol. 20, No. in Patients with A Qualitative September | Journal of Research in Nursing and Vol. 14, No. theory on the and in an exploratory case study September | Vol. 69, No. of the of Spirituality and Palliative Care Research and of Pain and Symptom Management, Vol. No. of a spiritual care training program for staff on November | Palliative and Supportive Care, Vol. 15, No. 4Spiritual distress and spiritual care in advanced heart July | Reviews, Vol. and Spiritual Patient Simulation in Nursing, Vol. No. Vol. 42, No. 4The impact of a spiritual in patients with and and their support December | Vol. 26, No. 3The Importance of a Spiritual History in Healthcare Vol. No. About Substance Use DisordersJournal of Psychosocial Nursing and Mental Health Services, Vol. No. and Spiritual Beliefs of April | Journal of Religion and Health, Vol. No. Care Perceptions of and With of Hospice & Palliative Nursing, Vol. 19, No. in Substance Use What to Know to Practice30 November | in Mental Health Nursing, Vol. 38, No. End-of-Life Care to Religious and Vol. No. of Social Education, Vol. 53, No. Nursing Care and of Christian Nursing, Vol. 34, No. 1The of taking a religious and spiritual July | Psychiatry, Vol. 24, No. religion and spirituality in Vol. No. the role of religious in the at the of of Vol. No. care spiritual March | Supportive Care in Cancer, Vol. 24, No. Spiritual Care and the Role of An Review of Literature and April | Journal of Religion and Health, Vol. No. of the Spiritual Needs of of with Is in the June | Journal of Palliative Medicine, Vol. 19, No. Impact of a Tool for Comprehensive Assessment of Palliative Care on Assessment at and of Pain and Symptom Management, Vol. No. from Healthcare Students to Understand Spiritual Assessment in Clinical Practice29 October | Journal of Religion and Health, Vol. No. Spirituality in January | Journal of Religion and Health, Vol. No. 3Development and of to Assess Nurse Provision of Spiritual August 2014 | Journal of Holistic Nursing, Vol. 34, No. and Validation of the Practice Assessment September 2014 | Research on Social Practice, Vol. 26, No. and the Medical A of July | Journal of Health Care Chaplaincy, Vol. 22, No. history taking in palliative care: A controlled September | Palliative Medicine, Vol. 30, No. Is Is Using A and the Life With American in Spiritual March | Journal of in Mental Health, Vol. 11, No. and spiritual in September | International Journal of and Mental Health, Vol. No. 1The of Hospital to and Patients’ Spiritual A May | Journal for the Study of Spirituality, Vol. No. 1The and to March End-of-Life Spiritual March in Holistic Patient Journal of Nursing, Vol. No. of spiritual assessment for older September 2014 | and Vol. No. und der der Care, Vol. No. Spirituality and A for Holistic January | Journal of Religion and Health, Vol. No. and Belief, in Care spiritual history tool by C. M. Puchalski as an for an interdisciplinary in January | Journal for of and Social Vol. 21, No. the of Spiritual A Pain and Palliative Care Service Quality of Pain and Symptom Management, Vol. No. of Spiritual Assessment in September | Vol. No. the of Christian Nursing, Vol. 32, No. 4Spiritual care: is the assessment tool for palliative Journal of Palliative Nursing, Vol. 21, No. und Spiritualität in der September | Vol. 60, No. of September of spirituality assessment in palliative care patients in November 2014 | Progress in Palliative Care, Vol. 23, No. 4The for Spiritual A Mixed-Methods July | Oncology Nursing Vol. 42, No. 4The Integration of Religion and Spirituality in Social Practice: A May | Social Vol. 60, No. 3The and Educational of a Spiritual Life Review for Patients with and June 2014 | Journal of Cancer Education, Vol. 30, No. in Geriatric Palliative in Geriatric Medicine, Vol. No. An for Spiritual Well-Being May | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 34, No. Spiritual Assessment March | Journal of Health Care Chaplaincy, Vol. 21, No. American on Mental Health, and Help April | and Vol. 60, No. of Christian Nursing, Vol. 32, No. the Spiritual Needs and of Oncology Patients in Nursing Practice, Vol. 29, No. Care Training to Healthcare Professionals: A Systematic April | Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications, Vol. 69, No. analysis of spiritual
Perspectives5 February 2002Medical Professionalism in the New Millennium: A Physician CharterFREEProject of the ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine*Project of the ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-3-200202050-00012 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To our readers: I write briefly to introduce the Medical Professionalism Project and its principal product, the Charter on Medical Professionalism. The charter appears in print for the first time in this issue of Annals and simultaneously in The Lancet. I hope that we will look back upon its publication as a watershed event in medicine. Everyone who is involved with health care should read the charter and ponder its meaning.The charter is the product of several years of work by leaders in the ABIM Foundation, the ACP–ASIM Foundation, and the European Federation of Internal Medicine. The charter consists of a brief introduction and rationale, three principles, and 10 commitments. The introduction contains the following premise: Changes in the health care delivery systems in countries throughout the industrialized world threaten the values of professionalism. The document conveys this message with chilling brevity. The authors apparently feel no need to defend this premise, perhaps because they believe that it is a universally held truth. The authors go further, stating that the conditions of medical practice are tempting physicians to abandon their commitment to the primacy of patient welfare. These are very strong words. Whether they are strictly true for the profession as a whole is almost beside the point. Each physician must decide if the circumstances of practice are threatening his or her adherence to the values that the medical profession has held dear for many millennia.Three Fundamental Principles set the stage for the heart of the charter, a set of commitments. One of the three principles, the principle of primacy of patient welfare, dates from ancient times. Another, the principle of patient autonomy, has a more recent history. Only in the later part of the past century have people begun to view the physician as an advisor, often one of many, to an autonomous patient. According to this view, the center of patient care is not in the physician's office or the hospital. It is where people live their lives, in the home and the workplace. There, patients make the daily choices that determine their health. The principle of social justice is the last of the three principles. It calls upon the profession to promote a fair distribution of health care resources.There is reason to expect that physicians from every point on the globe will read the charter. Does this document represent the traditions of medicine in cultures other than those in the West, where the authors of the charter have practiced medicine? We hope that readers everywhere will engage in dialogue about the charter, and we offer our pages as a place for that dialogue to take place. If the traditions of medical practice throughout the world are not congruent with one another, at least we may make progress toward understanding how physicians in different cultures understand their commitments to patients and the public.Many physicians will recognize in the principles and commitments of the charter the ethical underpinning of their professional relationships, individually with their patients and collectively with the public. For them, the challenge will be to live by these precepts and to resist efforts to impose a corporate mentality on a profession of service to others. Forces that are largely beyond our control have brought us to circumstances that require a restatement of professional responsibility. The responsibility for acting on these principles and commitments lies squarely on our shoulders.–Harold C. Sox, MD, EditorPhysicians today are experiencing frustration as changes in the health care delivery systems in virtually all industrialized countries threaten the very nature and values of medical professionalism. Meetings among the European Federation of Internal Medicine, the American College of Physicians–American Society of Internal Medicine (ACP–ASIM), and the American Board of Internal Medicine (ABIM) have confirmed that physician views on professionalism are similar in quite diverse systems of health care delivery. We share the view that medicine's commitment to the patient is being challenged by external forces of change within our societies.Recently, voices from many countries have begun calling for a renewed sense of professionalism, one that is activist in reforming health care systems. Responding to this challenge, the European Federation of Internal Medicine, the ACP–ASIM Foundation, and the ABIM Foundation combined efforts to launch the Medical Professionalism Project (www.professionalism.org) in late 1999. These three organizations designated members to develop a “charter” to encompass a set of principles to which all medical professionals can and should aspire. The charter supports physicians' efforts to ensure that the health care systems and the physicians working within them remain committed both to patient welfare and to the basic tenets of social justice. Moreover, the charter is intended to be applicable to different cultures and political systems.PreambleProfessionalism is the basis of medicine's contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. The principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession.At present, the medical profession is confronted by an explosion of technology, changing market forces, problems in health care delivery, bioterrorism, and globalization. As a result, physicians find it increasingly difficult to meet their responsibilities to patients and society. In these circumstances, reaffirming the fundamental and universal principles and values of medical professionalism, which remain ideals to be pursued by all physicians, becomes all the more important.The medical profession everywhere is embedded in diverse cultures and national traditions, but its members share the role of healer, which has roots extending back to Hippocrates. Indeed, the medical profession must contend with complicated political, legal, and market forces. Moreover, there are wide variations in medical delivery and practice through which any general principles may be expressed in both complex and subtle ways. Despite these differences, common themes emerge and form the basis of this charter in the form of three fundamental principles and as a set of definitive professional responsibilities.Fundamental PrinciplesPrinciple of primacy of patient welfare. This principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician–patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.Principle of patient autonomy. Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients' decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.Principle of social justice. The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.A Set of Professional ResponsibilitiesCommitment to professional competence. Physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care. More broadly, the profession as a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.Commitment to honesty with patients. Physicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy. Physicians should also acknowledge that in health care, medical errors that injure patients do sometimes occur. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patient and societal trust. Reporting and analyzing medical mistakes provide the basis for appropriate prevention and improvement strategies and for appropriate compensation to injured parties.Commitment to patient confidentiality. Earning the trust and confidence of patients requires that appropriate confidentiality safeguards be applied to disclosure of patient information. This commitment extends to discussions with persons acting on a patient's behalf when obtaining the patient's own consent is not feasible. Fulfilling the commitment to confidentiality is more pressing now than ever before, given the widespread use of electronic information systems for compiling patient data and an increasing availability of genetic information. Physicians recognize, however, that their commitment to patient confidentiality must occasionally yield to overriding considerations in the public interest (for example, when patients endanger others).Commitment to maintaining appropriate relations with patients. Given the inherent vulnerability and dependency of patients, certain relationships between physicians and patients must be avoided. In particular, physicians should never exploit patients for any sexual advantage, personal financial gain, or other private purpose.Commitment to improving quality of care. Physicians must be dedicated to continuous improvement in the quality of health care. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals to reduce medical error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care. Physicians must actively participate in the development of better measures of quality of care and the application of quality measures to assess routinely the performance of all individuals, institutions, and systems responsible for health care delivery. Physicians, both individually and through their professional associations, must take responsibility for assisting in the creation and implementation of mechanisms designed to encourage continuous improvement in the quality of care.Commitment to improving access to care. Medical professionalism demands that the objective of all health care systems be the availability of a uniform and adequate standard of care. Physicians must individually and collectively strive to reduce barriers to equitable health care. Within each system, the physician should work to eliminate barriers to access based on education, laws, finances, geography, and social discrimination. A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession.Commitment to a just distribution of finite resources. While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources. They should be committed to working with other physicians, hospitals, and payers to develop guidelines for cost-effective care. The physician's professional responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures. The provision of unnecessary services not only exposes one's patients to avoidable harm and expense but also diminishes the resources available for others.Commitment to scientific knowledge. Much of medicine's contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.Commitment to maintaining trust by managing conflicts of interest. Medical professionals and their organizations have many opportunities to compromise their professional responsibilities by pursuing private gain or personal advantage. Such compromises are especially threatening in the pursuit of personal or organizational interactions with for-profit industries, including medical equipment manufacturers, insurance companies, and pharmaceutical firms. Physicians have an obligation to recognize, disclose to the general public, and deal with conflicts of interest that arise in the course of their professional duties and activities. Relationships between industry and opinion leaders should be disclosed, especially when the latter determine the criteria for conducting and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.Commitment to professional responsibilities. As members of a profession, physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self-regulation, including remediation and discipline of members who have failed to meet professional standards. The profession should also define and organize the educational and standard-setting process for current and future members. Physicians have both individual and collective obligations to participate in these processes. These obligations include engaging in internal assessment and accepting external scrutiny of all aspects of their professional performance.SummaryThe practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients' interests. To maintain the fidelity of medicine's social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose. Comments0 CommentsSign In to Submit A Comment Dr.Tanu Pramanik PhD(Social Psychology) Principal,Dr.Jogenananda Pramanik MD Executive Dean, Careers Abroad Institute School of Medicine, Mandeville, Jamaica.WI. Principal, Careers Abroad Institute School of Medicine,Hatfield, Mandeville, Manchester, Jamaica, WI.,16 October 2017 Humanise health care- A major concern workdwide The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies(1).We applauded current initiative to review and humanise health care.In the recent past,we responded to the editorial in British Medical Journal, emphasising impact of behavioural science curriculum in medical education.We are painfully concerned that most of our medical students are unfortunate that they did not get an opportunity to learn about behavioural science as a part of their curriculum during their medical school training program. They were never been exposed to the local community for a supervised health screening program with a mission to develop doctor-patient relationship and professional communication skills in real life scenarioRef: 1.Medical Professionalism in the New Millennium: A Physician Charter.Impact of behavioural science curriculum in medical education 2016; 355 doi: https://doi.org/10.1136/bmj.i6262 (Published 13 December 2016)Cite this as: BMJ 2016;355:i6262Re: Humanising healthcare Author, Article, and Disclosure InformationAffiliations: Corresponding Author: Linda Blank, ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106-3699; e-mail, [email protected]org.*This charter was written by the members of the Medical Professionalism Project: ABIM Foundation: Troy Brennan, MD, JD (Project Chair), Brigham and Women's Hospital, Boston, Massachusetts; Linda Blank (Project Staff), ABIM Foundation, Philadelphia, Pennsylvania; Jordan Cohen, MD, Association of American Medical Colleges, Washington, DC; Harry Kimball, MD, American Board of Internal Medicine, Philadelphia, Pennsylvania; and Neil Smelser, PhD, University of California, Berkeley, California. ACP–ASIM Foundation: Robert Copeland, MD, Southern Cardiopulmonary Associates, LaGrange, Georgia; Risa Lavizzo-Mourey, MD, MBA, Robert Wood Johnson Foundation, Princeton, New Jersey; and Walter McDonald, MD, American College of Physicians–American Society of Internal Medicine, Philadelphia, Pennsylvania. European Federation of Internal Medicine: Gunilla Brenning, MD, University Hospital, Uppsala, Sweden; Christopher Davidson, MD, FRCP, FESC, Royal Sussex County Hospital, Brighton, United Kingdom; Philippe Jaeger, MB, MD, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Alberto Malliani, MD, Università di Milano, Milan, Italy; Hein Muller, MD, PhD, Ziekenhuis Gooi-Noord, Rijksstraatweg, the Netherlands; Daniel Sereni, MD, Hôpital Saint-Louis, Paris, France; and Eugene Sutorius, JD, Faculteit der Rechts Geleerdheid, Amsterdam, the Netherlands. Special Consultants: Richard Cruess, MD, and Sylvia Cruess, MD, McGill University, Montreal, Canada; and Jaime Merino, MD, Universidad Miguel Hernández, San Juan de Alicante, Spain. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCharter on Medical Professionalism: Putting the Charter into Practice Sadeq A. Quraishi and Ayesha N. Khalid Charter on Medical Professionalism: Putting the Charter into Practice Neil J. Smelser Charter on Medical Professionalism: Putting the Charter into Practice Charles M. Haskell Charter on Medical Professionalism: Putting the Charter into Practice Neil J. Smelser Charter on Medical Professionalism: Putting the Charter into Practice Donatella Lippi , GianFranco Gensini , and Andrea A. Conti Charter on Medical Professionalism: Putting the Charter into Practice Neil J. Smelser Charter on Medical Professionalism: Putting the Charter into Practice Jerome C. Arnett Jr. Charter on Medical Professionalism: Putting the Charter into Practice Sylvia L. Cruess and Richard L. Cruess Charter on Medical Professionalism: Putting the Charter into Practice Robert Feldman Charter on Medical Professionalism: Putting the Charter into Practice Walter J. McDonald Charter on Medical Professionalism: Putting the Charter into Practice Steven A. Wartman Charter on Medical Professionalism: Putting the Charter into Practice Jordan J. Cohen Charter on Medical Professionalism: Putting the Charter into Practice Yevgeniya Nusinovich Charter on Medical Professionalism: Putting the Charter into Practice Risa Lavizzo-Mourey Charter on Medical Professionalism: Putting the Charter into Practice Richard L. Cruess and Sylvia L. Cruess Charter on Medical Professionalism: Putting the Charter into Practice Christopher J. Lyons Professionalism and the Medical Student Nancy R. Angoff Providing High-Value, Cost-Conscious Care Christine K. Cassel Providing High-Value, Cost-Conscious Care Steven E. Weinberger Can the Practice of Retainer Medicine Improve Primary Care? Martin T. Donohoe Metrics Cited byA scoping review on the relationship between mental wellbeing and medical professionalismEmergency physician professionalism versus wellness: A conceptual modelSystem Citizenship: Re-Envisioning the Physician Role as Part of the Sixth Wave of ProfessionalismRECALMIN IV. Evolución de la actividad de las unidades de medicina interna del Sistema Nacional de Salud (2008-2021)RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008–2021)Should a patient’s socioeconomic status count in decisions about treatment in medical care? A longitudinal study of Norwegian doctorsValidity and reliability of the Professionalism Assessment Scale in Turkish medical studentsRelevance of Bone Marrow Biopsies for Response Assessment in US National Cancer Institute National Clinical Trials Network Follicular Lymphoma Clinical Trials“It really puts me in a bind”, professionalism dilemmas reported by Chinese residentsShared Decision MakingLos fundamentos del profesionalismo en medicinaImplementation of an Online Reporting System to Identify Unprofessional Behaviors and Mistreatment Directed at Trainees at an Academic Medical CenterNational Health Policy Leadership Program for General InternistsProfessionalism in dentistry: deconstructing common terminologyMedical in the Program during the a study about and the development of new and a of the for patient assessment of medical professionalism a setting how of medical professional are The of a a study on in beyond integrity and curriculum on informed toward persons with of or A into medical professionalism among medical students and new physicians in a of a based clinical program to reduce professional and social a in of the on Medical of Professionalism: A on on the of Physician care in a clinical and informed Professionalism in Medical and Medical of in of current and for the de las en de la de Physician to the of Health and with for medical school after in A and in Policy for of the A me do change and the different of a to Health for Health in the and ethical systems for but to The of Medical the and among of a Cancer the Relationships between the and and or to Care views and of professionalism mental health services patients and of at the of by of and The of A to Professional and to Clinical Practice and and Medical and Society Each A on Medical Society and is A the Role in a Leadership The de de and of medical professionalism for and de do a de of the of and in of a Medical School in Medicine of to Medical in Clinical A Professionalism in the of Clinical Care in Medical More Academic A by and Unprofessional on for Health Care and of the of Health for the and health patient and as an in Medical and and of role of social in the relationship between physician and professionalism of of Unprofessional by Physicians and Practice of in a based on clinical role of medical students training in respect for patient and a of the Care a and of for among medical and in medical a study of its with professionalism are the of Care and of Health for in Health a of Health Medical Society for Medicine Principles for the of Medicine in of Medical Professionalism among Medical in of a of in clinical learning on Medical Board as a for of Professionalism in Medical care needs of persons with and their A scoping of of Professional professionalism and a of from to of healthcare leaders in with physicians an of in Medical of in Medical a Medical students American Association and American College of on Professionalism
While many ancient cultures contributed to our current knowledge about medicine and psychiatry origins, Ancient Greeks were among the best observers of feelings and moods patients could express toward medicine and toward what today referred as "psychopathology". Myths and religious references were used to explain what elsewhere impossible to understand or easily communicated. Most of ancient myths focus on ambiguous feelings patients could have towards drugs, especially psychotropic ones. Interestingly, such prejudices are common yet today. Recalling ancient findings and descriptions made using myths, should represent a valuable knowledge for modern physicians, especially for psychiatrists, and their patients, with the aim of better understanding each other and therefore achieving a better clinical outcome. The paper explores many human aspects and feelings toward doctors and their cures, referring to ancient myths, focusing on the perception of mental illness.
A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.
BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING: Bill & Melinda Gates Foundation.
Artificial Intelligence (AI) has revolutionized various fields, including medicine and mental health support. One promising application is ChatGPT, an advanced conversational AI model that uses deep learning techniques to provide human-like responses. This review paper explores the potential impact of ChatGPT in psychiatry and its various applications, highlighting its role in therapy and counseling techniques, self-help and coping strategies, mindfulness and relaxation techniques, screening and monitoring, education and information dissemination, specialized support, group and family support, learning and training, expressive and artistic therapies, telepsychiatry and online support, and crisis management and prevention. While ChatGPT offers personalized, accessible, and scalable support, it is essential to emphasize that it should not replace the expertise and guidance of qualified mental health professionals. Ethical considerations, such as user privacy, data security, and human oversight, are also discussed. By examining the potential and challenges, this paper sheds light on the responsible integration of ChatGPT in psychiatric research and practice, fostering improved mental
Medicine, including fields in healthcare and life sciences, has seen a flurry of quantum-related activities and experiments in the last few years (although biology and quantum theory have arguably been entangled ever since Schrödinger's cat). The initial focus was on biochemical and computational biology problems; recently, however, clinical and medical quantum solutions have drawn increasing interest. The rapid emergence of quantum computing in health and medicine necessitates a mapping of the landscape. In this review, clinical and medical proof-of-concept quantum computing applications are outlined and put into perspective. These consist of over 40 experimental and theoretical studies. The use case areas span genomics, clinical research and discovery, diagnostics, and treatments and interventions. Quantum machine learning (QML) in particular has rapidly evolved and shown to be competitive with classical benchmarks in recent medical research. Near-term QML algorithms have been trained with diverse clinical and real-world data sets. This includes studies in generating new molecular entities as drug candidates, diagnosing based on medical image classification, predicting patient pe
Model Medicine is the science of understanding, diagnosing, treating, and preventing disorders in AI models, grounded in the principle that AI models -- like biological organisms -- have internal structures, dynamic processes, heritable traits, observable symptoms, classifiable conditions, and treatable states. This paper introduces Model Medicine as a research program, bridging the gap between current AI interpretability research (anatomical observation) and the systematic clinical practice that complex AI systems increasingly require. We present five contributions: (1) a discipline taxonomy organizing 15 subdisciplines across four divisions -- Basic Model Sciences, Clinical Model Sciences, Model Public Health, and Model Architectural Medicine; (2) the Four Shell Model (v3.3), a behavioral genetics framework empirically grounded in 720 agents and 24,923 decisions from the Agora-12 program, explaining how model behavior emerges from Core--Shell interaction; (3) Neural MRI (Model Resonance Imaging), a working open-source diagnostic tool mapping five medical neuroimaging modalities to AI interpretability techniques, validated through four clinical cases demonstrating imaging, compari
During the last decade, there has been heated debate regarding whether compulsive sexual behaviour should be classified as a mental/behavioural disorder. Compulsive sexual behaviour disorder has been proposed for inclusion as an impulse control disorder in the ICD-111. It is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern is manifested in one or more of the following: a) engaging in repetitive sexual activities has become a central focus of the person's life to the point of neglecting health and personal care or other interests, activities and responsibilities; b) the person has made numerous unsuccessful efforts to control or significantly reduce repetitive sexual behaviour; c) the person continues to engage in repetitive sexual behaviour despite adverse consequences (e.g., repeated relationship disruption, occupational consequences, negative impact on health); or d) the person continues to engage in repetitive sexual behaviour even when he/she derives little or no satisfaction from it. Concerns about overpathologizing sexual behaviours are explicitly addressed in the diagnostic guidelines proposed for the disorder. Individuals with high levels of sexual interest and behaviour (e.g., due to a high sex drive) who do not exhibit impaired control over their sexual behaviour and significant distress or impairment in functioning should not be diagnosed with compulsive sexual behaviour disorder. The diagnosis should also not be assigned to describe high levels of sexual interest and behaviour (e.g., masturbation) that are common among adolescents, even when this is associated with distress. The proposed diagnostic guidelines also emphasize that compulsive sexual behaviour disorder should not be diagnosed based on psychological distress related to moral judgments or disapproval about sexual impulses, urges or behaviours that would otherwise not be considered indicative of psychopathology. Sexual behaviours that are egodystonic can cause psychological distress; however, psychological distress due to sexual behaviour by itself does not warrant a diagnosis of compulsive sexual behaviour disorder. Careful attention must be paid to the evaluation of individuals who self-identify as having the disorder (e.g., calling themselves “sex addicts” or “porn addicts”). Upon examination, such individuals may not actually exhibit the clinical characteristics of the disorder, although they might still be treated for other mental health problems (e.g., anxiety, depression). Additionally, individuals often experience feelings such as shame and guilt in relationship to their sexual behaviour2, but these experiences are not reliably indicative of an underlying disorder. The proposed diagnostic guidelines also assist the clinician in differentiating compulsive sexual behaviour disorder from other mental disorders and other health conditions. For example, although bipolar disorder has been found at elevated rates among individuals with compulsive sexual behaviour disorder3, sexual behaviours must be persistent and occur independently of hypomanic or manic episodes to provide a basis for a possible diagnosis of the disorder. A diagnosis of compulsive sexual behaviour disorder should not be made when the behaviour can be explained by other medical conditions (e.g., dementia) or by the effects of certain medications prescribed to treat specific medical conditions (e.g., Parkinson's disease)4 or is entirely attributable to the direct effects of illicit substances on the central nervous system (e.g., cocaine, crystal methamphetamine). Currently, there is an active scientific discussion about whether compulsive sexual behaviour disorder can constitute the manifestation of a behavioural addiction5. For ICD-11, a relatively conservative position has been recommended, recognizing that we do not yet have definitive information on whether the processes involved in the development and maintenance of the disorder are equivalent to those observed in substance use disorders, gambling and gaming6. For this reason, compulsive sexual behaviour disorder is not included in the ICD-11 grouping of disorders due to substance use and addictive behaviours, but rather in that of impulse control disorders. The understanding of compulsive sexual behaviour disorder will evolve as research elucidates the phenomenology and neurobiological underpinnings of the condition7. In the absence of consistent definitions and community-based epidemiological data, determining accurate prevalence rates of compulsive sexual behaviour disorder has been difficult. Epidemiological estimates have ranged up to 3-6% in adults8, though recent studies have produced somewhat lower estimates of 1 to 3%9. The more restrictive diagnostic requirements proposed for ICD-11 would be expected to produce lower prevalence rates. In general, men exhibit the disorder more frequently than women, although robust data examining gender differences are lacking. Additionally, higher rates of the disorder have been noted among individuals with substance use disorders. Among treatment seekers, the disorder negatively impacts occupational, relationship, physical health and mental health functioning. However, systematic data are lacking regarding the prevalence of the disorder across different populations and associated socio-cultural and socio-demographic factors, including among non-treatment seekers. Growing evidence suggests that compulsive sexual behaviour disorder is an important clinical problem with potentially serious consequences if left untreated. We believe that including the disorder in the ICD-11 will improve the consistency with which health professionals approach the diagnosis and treatment of persons with this condition, including consistency regarding when a disorder should not be diagnosed. Legitimate concerns about overpathologizing sexual behaviours have been carefully addressed in the proposed diagnostic guidelines. We posit that inclusion of this category in the ICD-11 will provide a better tool for addressing the unmet clinical needs of treatment seeking patients as well as possibly reduce shame and guilt associated with help seeking among distressed individuals. The proposed diagnostic guidelines will be tested in international multilingual Internet-based field studies using standardized case material, which will help to assess the generalizability of the construct across different regions and cultures, and clinicians’ ability to distinguish it from normal variations in sexual behaviour and from other disorders. Additional field studies in clinical settings will provide further information about the clinical utility of the proposed diagnostic guidelines for the disorder among clinical populations. Shane W. Kraus1, Richard B. Krueger2, Peer Briken3, Michael B. First2, Dan J. Stein4, Meg S. Kaplan2, Valerie Voon5, Carmita H.N. Abdo6, Jon E. Grant7, Elham Atalla8, Geoffrey M. Reed9,10 1Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; 2Department of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA; 3Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 4Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; 5Department of Psychiatry, University of Cambridge, Cambridge, UK; 6Department of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 7Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA; 8Primary Care and Public Health Directorate, Ministry of Health, Manama, Bahrain; 9Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; 10Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
Introduction and background. An Overview of Transcultural Psychiatry. Transcultural psychiatry: A note on origins and definitions. Recollections of culture and personality. Psychological and clinical aspects of immigration and mental health. Cultural Psychiatry and Mental Health Services. Cultural epistemology and value orientations: clinical applications in transcultural psychiatry. Healing systems in a multicultural setting. The New Zealand Maori and the contemporary health system: response of an indigenous people to mainstream medicine. Negotiating across class, culture, and religion: psychiatry in the English inner city. Clinical applications of cultural psychiatry in Arabian Gulf communities. Ethnicity and psychopharmacology: the experience of Southeast Asians. Religion and mental health: the need for cultural sensitivity and synthesis. Treatment Approaches. Culture's role in clinical psychiatric assessment. Somatization and psychologization: understanding cultural idioms of distress. The therapeutic alliance across cultures. Commonsense reasoning in the transcultural psychotherapy process. Recent Research and Special Topics. Somatization patterns in Mediterranean migrants. Cohabiting with magic and religion in Italy: cultural and clinical results. Education and Training. Developing curricula for transcultural mental health for trainees and trainers. Women and Children. Children and families in cultural transition. Psychological consequences of torture: clinical needs of refugee women. Culture and psychiatry: an Indian overview of issues in women and children. Epilogue. Index.
As the emerging field of predictive analytics in psychiatry generated and continues to generate massive interest overtime with its major promises to positively change and revolutionize clinical psychiatry, health care and medical professionals are greatly looking forward to its integration and application into psychiatry. However, by directly applying predictive analytics to the practice of psychiatry, this could cause detrimental damage to those that use predictive analytics through creating or worsening existing medical issues. In both cases, medical ethics issues arise, and need to be addressed. This paper will use literature to provide descriptions of selected stages in the treatment of mental disorders and phases in a predictive analytics project, approach mental disorder diagnoses using predictive models that rely on neural networks, analyze the complexities in clinical psychiatry, neural networks and predictive analytics, and conclude with emphasizing and elaborating on limitations and medical ethics issues of applying neural networks and predictive analytics to clinical psychiatry.
This study examines the clinical decision-making processes in Traditional East Asian Medicine (TEAM) by reinterpreting pattern identification (PI) through the lens of dimensionality reduction. Focusing on the Eight Principle Pattern Identification (EPPI) system and utilizing empirical data from the Shang-Han-Lun, we explore the necessity and significance of prioritizing the Exterior-Interior pattern in diagnosis and treatment selection. We test three hypotheses: whether the Ext-Int pattern contains the most information about patient symptoms, represents the most abstract and generalizable symptom information, and facilitates the selection of appropriate herbal prescriptions. Employing quantitative measures such as the abstraction index, cross-conditional generalization performance, and decision tree regression, our results demonstrate that the Exterior-Interior pattern represents the most abstract and generalizable symptom information, contributing to the efficient mapping between symptom and herbal prescription spaces. This research provides an objective framework for understanding the cognitive processes underlying TEAM, bridging traditional medical practices with modern computat
What does Artificial Intelligence (AI) have to contribute to health care? And what should we be looking out for if we are worried about its risks? In this paper we offer a survey, and initial evaluation, of hopes and fears about the applications of artificial intelligence in medicine. AI clearly has enormous potential as a research tool, in genomics and public health especially, as well as a diagnostic aid. It's also highly likely to impact on the organisational and business practices of healthcare systems in ways that are perhaps under-appreciated. Enthusiasts for AI have held out the prospect that it will free physicians up to spend more time attending to what really matters to them and their patients. We will argue that this claim depends upon implausible assumptions about the institutional and economic imperatives operating in contemporary healthcare settings. We will also highlight important concerns about privacy, surveillance, and bias in big data, as well as the risks of over trust in machines, the challenges of transparency, the deskilling of healthcare practitioners, the way AI reframes healthcare, and the implications of AI for the distribution of power in healthcare ins
In the much-celebrated book Deep Medicine, Eric Topol argues that the development of artificial intelligence for health care will lead to a dramatic shift in the culture and practice of medicine. In the next several decades, he suggests, AI will become sophisticated enough that many of the everyday tasks of physicians could be delegated to it. Topol is perhaps the most articulate advocate of the benefits of AI in medicine, but he is hardly alone in spruiking its potential to allow physicians to dedicate more of their time and attention to providing empathetic care for their patients in the future. Unfortunately, several factors suggest a radically different picture for the future of health care. Far from facilitating a return to a time of closer doctor-patient relationships, the use of medical AI seems likely to further erode therapeutic relationships and threaten professional and patient satisfaction.
The Oxford English Dictionary defines precision medicine as "medical care designed to optimize efficiency or therapeutic benefit for particular groups of patients, especially by using genetic or molecular profiling." It is not an entirely new idea: physicians from ancient times have recognized that medical treatment needs to consider individual variations in patient characteristics. However, the modern precision medicine movement has been enabled by a confluence of events: scientific advances in fields such as genetics and pharmacology, technological advances in mobile devices and wearable sensors, and methodological advances in computing and data sciences. This chapter is about bandit algorithms: an area of data science of special relevance to precision medicine. With their roots in the seminal work of Bellman, Robbins, Lai and others, bandit algorithms have come to occupy a central place in modern data science ( Lattimore and Szepesvari, 2020). Bandit algorithms can be used in any situation where treatment decisions need to be made to optimize some health outcome. Since precision medicine focuses on the use of patient characteristics to guide treatment, contextual bandit algorith
3D data from high-resolution volumetric imaging is a central resource for diagnosis and treatment in modern medicine. While the fast development of AI enhances imaging and analysis, commonly used visualization methods lag far behind. Recent research used extended reality (XR) for perceiving 3D images with visual depth perception and touch but used restrictive haptic devices. While unrestricted touch benefits volumetric data examination, implementing natural haptic interaction with XR is challenging. The research question is whether a multisensory XR application with intuitive haptic interaction adds value and should be pursued. In a study, 24 experts for biomedical images in research and medicine explored 3D medical shapes with 3 applications: a multisensory virtual reality (VR) prototype using haptic gloves, a simple VR prototype using controllers, and a standard PC application. Results of standardized questionnaires showed no significant differences between all application types regarding usability and no significant difference between both VR applications regarding presence. Participants agreed to statements that VR visualizations provide better depth information, using the hand
Computational psychiatry is a field aimed at developing formal models of information processing in the human brain, and how alterations in this processing can lead to clinical phenomena. Despite significant progress in the development of tasks and how to model them, computational psychiatry methodologies have yet to be incorporated into large-scale research projects or into clinical practice. In this viewpoint, we explore some of the barriers to incorporation of computational psychiatry tasks and models into wider mainstream research directions. These barriers include the time required for participants to complete tasks, test-retest reliability, limited ecological validity, as well as practical concerns, such as lack of computational expertise and the expense and large sample sizes traditionally required to validate tasks and models. We then discuss solutions, such as the redesigning of tasks with a view toward feasibility, and the integration of tasks into more ecologically valid and standardized game platforms that can be more easily disseminated. Finally, we provide an example of how one task, the conditioned hallucinations task, might be translated into such a game. It is our h
With the growing interest in using AI and machine learning (ML) in medicine, there is an increasing number of literature covering the application and ethics of using AI and ML in areas of medicine such as clinical psychiatry. The problem is that there is little literature covering the economic aspects associated with using ML in clinical psychiatry. This study addresses this gap by specifically studying the economic implications of using ML in clinical psychiatry. In this paper, we evaluate the economic implications of using ML in clinical psychiatry through using three problem-oriented case studies, literature on economics, socioeconomic and medical AI, and two types of health economic evaluations. In addition, we provide details on fairness, legal, ethics and other considerations for ML in clinical psychiatry.
There has been a surge of interest in the last 20 years in the mental health effects of conflict and other major disasters in lowand middle-income countries (LAMIC). In particular, post-traumatic stress disorder (PTSD) and major depression have received substantial attention. It has become evident that there are large, unexplained variations in prevalence rates identified through trauma-focused psychiatric epidemiology in such settings. For example, Mollica et al.’s classic study found prevalence rates of PTSD of 15% among genocide-exposed Cambodians, while Neugebauer et al.’s sophisticated report in this issue of the Journal identifies rates of 53–62% of PTSD in genocide-exposed Rwandans. The wide variation in the prevalence rates in studies of PTSD and depression may be attributable to differences in context, methodology or both. Discussion sections of reports often highlight only a few factors that could explain the size of obtained rates. Although peer review helps shape discussion sections, authors usually have enormous discretion in deciding what factors to report. Readers are left with the challenge of tracking all reported and unreported methodological and contextual factors that could explain a study’s results. We have developed a scheme that may help to systematically identify factors influencing the size of observed prevalence rates of disorders in populations affected by major emergencies in LAMIC. The scheme may prove useful for readers and journal peer reviewers alike. The scheme, which we will apply below to Neugebauer et al.’s study, was built as follows. We searched the following medical, psychiatry and speciality journal websites: American Journal of Psychiatry; Archives of General Psychiatry; British Journal of Psychiatry; British Medical Journal; Culture Medicine and Psychiatry; JAMA, Journal of Traumatic Stress, Lancet, Psychological Medicine; Social Science and Medicine; and Transcultural Psychiatry for studies published after 1998 with data collected on depression or PTSD among civilians after major emergencies in LAMIC (references available upon request). Of 43 studies, 11 (26%) pertained to major natural disasters and 32 (74%) pertained to major human-made disasters (e.g. war). All articles were original contributions, and 40 (93%) made comments explaining the magnitude of findings in the articles’ discussion sections. In addition, we reviewed editorials, commentaries and letters to the editor linked to the identified articles. We thematically analysed discussion sections of all papers. We categorized authors’ explanations for observed rates as (i) either methodological or contextual in nature and (ii) explaining either relatively higher or lower observed rates. In addition, we categorized some explanations as (iii) reflecting general methodological limitations causing uncertainty in the validity of the study, with unknown impact on the magnitude of observed rates. Table 1 provides an overview of the explanations for relatively high or low rates ascribed in these studies. We studied the research reported in this issue of the Journal and rated different methodological and contextual factors in the study from 1 (not a factor in explaining size of obtained rate) to 5 (definitive factor in explaining size of obtained rate) (see bracketed numbers in Table 1). If no information was available in the paper on an element, then we rated it 3. Starting with the cell in the bottom left, we will discuss here ratings of 4 and 5, which are of main interest in explaining findings. The study took place in 1995 in a context (recent genocide that was preceded and followed by violence, fears of revenge killings, ongoing mass displacements, risk of cholera outbreaks, etc.) that not only involved mass loss and trauma but also a highly stressful recovery * Corresponding author. Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. E-mail: vanommerenm@who.int 1 Faculty of Medicine, University of Toronto, Toronto, Canada. 2 Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. Published by Oxford University Press on behalf of the International Epidemiological Association