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In the 2009 edition of the New Oxford Textbook of Psychiatry, where the discipline presents itself impressively on more than 2000 pages, P. Pichot, Past President of the WPA and a long-time authority on the history of psychiatry, devotes the last few paragraphs of his chapter “History of psychiatry as a medical specialty” to the discussion of a potential crisis in psychiatry. Psychiatry, as he concludes, is threatened by either being incorporated in other medical specialties or being deprived of its medical character 1. In psychiatric journals, the question is being discussed whether and how psychiatry will “survive into the second half of the 21st century” 2, and the presence of “considerable pessimism and a sense of foreboding among psychiatrists” is being described 3. In many countries, a shortage of psychiatrists is reported 4–5. The question has even been asked whether psychiatry should “exist” 6. And we are being advised by our neurological colleagues to abandon the term “mental illness” and replace it by “brain illness” 7. What is behind such messages? Are they indicating only personal views or local problems? This is improbable. Why should the WPA have recently launched activities and projects on such topics as stigmatization of psychiatry and psychiatrists, furthering the choice of psychiatry as a career by medical students, and improving the prospect for early careers in psychiatry 8–9? So, 200 years after its birth 10, is there something wrong with psychiatry? And, if so, what is it? In order to shed some light on this issue, I have listened around, looked back on my own forty years as a psychiatrist and searched the literature for signs of a crisis, including the literature on professions in general. Psychiatry as a profession can be looked at with the eyes of the sociology of professions, which analyses the relationship of professions with society at large. In times of crisis, this can usefully supplement the inside views of the professions themselves, which tend to focus on the relationship between a profession and its clients, including the professional value systems defining this relationship 11. From the viewpoint of sociology, professions in general are characterized by: a) ownership of a specialized body of knowledge and skills, which defines the field of competence and the scope of potential clients, including the demarcation from other professions; b) holding a high status in society (both through financial and other rewards); c) being granted autonomy (and thereby power) by society, e.g. in recruiting and excluding members; d) being obliged, in return for the above, to guarantee high quality standards in providing services (being “professional”) and following ethical rules 12–13. I will discuss here six challenges which are related to the first two of the above criteria: three challenges “from inside”, basically referring to the decreasing confidence about the knowledge base of psychiatry and to the lack of a coherent theoretical basis; and three “from out-side”, including client discontent, competition from other professions, and the negative image of psychiatry. There are certainly other challenges — such as increasing state and insurance interventions, asking for improved quality of care despite growing restrictions — but they mostly concern medicine as a whole and will not be discussed here. Disease categories and their classification are the pervasive organizing principle for most aspects of medicine, including psychiatry as a medical specialty. Diagnoses are meant to be used for making therapeutic decisions, for teaching purposes, for reimbursement, for defining patient populations for research, and for statistical returns. In psychiatry we have the confusing situation of two different internationally used diagnostic systems. In any member state of the World Health Organization (WHO), on discharge of a patient from hospital, a diagnosis from chapter V of the International Classification of Diseases (ICD-10) must be selected. However, for psychiatric research to be published in a high impact factor journal, it is advisable to use the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association (APA). The parallelism of these two major diagnostic systems exists since nearly 60 years. In 1949, the sixth revision of the International Classification of Diseases (ICD-6, 14) included for the first time mental disorders (earlier versions covered only mortality). Three years later, the APA launched its own classification system (DSM-I, 15). We have now arrived at ICD-10 (1992) and DSM-IV (1994), and the next revisions of the “big two” are due in a few years (DSM-V in 2013; ICD-11 in 2014). There will thus be still two systems in parallel. Such parallelism is possible because of the very nature of the definitions of most psychiatric diagnoses: they consist of combinations of phenomenological criteria, such as signs and symptoms and their course over time, combined by expert committees in variable ways into categories of mental disorders, which have been defined and redefined again and again over the last half century. The majority of these diagnostic categories are not validated by biological criteria, as most medical diseases are; however, although they are called “disorders”, they look like medical diagnoses and pretend to represent medical diseases. In fact, they are embedded in top-down classifications, comparable to the early botanic classifications of plants in the 17th and 18th centuries, when experts decided a priori about which classification criterion to use, for instance, whether fruiting bodies or the shape of leaves were the essential criterion for classifying plants 16. The DSM-III approach of creating “operational definitions” (e.g., “2 out of 5 symptoms” of a list must be present) has certainly rendered the process of arriving at a diagnosis more reliable, in the sense that we can be more sure that, if different psychiatrists assess a patient diagnostically, they will, after evaluating symptoms and other criteria, come more often to the same result. But reliability is different from validity. Psychopathological phenomena certainly exist and can be observed and experienced as such. However, psychiatric diagnoses are arbitrarily defined and do not exist in the same sense as psychopathological phenomena do. This is not new. However, whereas psychiatric diagnostic classification systems and disease definitions have long been criticized, the character of the attacks has changed. Half a century ago, they came mainly from outside psychiatry (e.g., 17–18). Today, while these assaults continue 19, discussions about the validity of psychiatric diagnoses are also getting momentum within our profession (certainly fuelled by the imminent revisions of the “big two”) 20–21. It is no longer just the “usual suspects” who criticize psychiatric diagnosis and classification systems; the discussion has arrived at the heart of our profession. For instance, psychiatrists talk about the “genetic deconstruction of psychosis” 22, the lack of validity of psychiatric diagnoses despite their utility 23, and the poor diagnostic stability of psychiatric disorders 24. From psychiatric geneticists one hears that they have to use “star war technology on bow and arrow diagnosis”. Recently, a prominent psychiatric researcher commented: “It has been suggested that the debate is political. This is not the case however, as solid scientific evidence pointing to the absence of nosological validity of diagnostic categories that nevertheless invariably are subject to paradoxical psychiatric reification, lies at the heart of the argument” 25. The sociologist A. Abbott has observed that the control that professions have over their body of knowledge allows them to seize new problems and redefine their scope of interest 26. With this perspective in mind, it can be argued that, while some psychiatric disorders have some kind of “clinical validity” (e.g., bipolar disorder), the DSM has “fabricated non-validated psychiatric diagnoses out of the general human predicament” 27. Psychiatry “abandoned the island of psychiatric disease and was thus engulfed in the boundless sea of human troubles”, as F. Redlich has put it more than 50 years ago when referring to psychoanalysis (28, quoted in 17). The issue whether we are able to “differentiate between true mental disorders and homeostatic reactions to adverse life events” 29 is more pressing than ever. All kinds of rescue efforts are under way in relation to these threats to the diagnostic knowledge base of psychiatry, and a plethora of suggestions are being made: to identify “metastructures” 30, to supplement diagnostic categories with dimensional measures 21 or a “cross-diagnostic approach” 31, to use “epistemic iteration” 16, or to provide a “person-centered integrative diagnosis” 32. Recently, a group of psychiatrists has asked for the establishment of a conceptual working group for DSM-V, pointing out that in past DSM revisions conceptual questions were considered only on an ad-hoc basis by individual workgroups and the task force 33. Eve rything seems open. It has also been proposed to put more emphasis on the clinical utility of diagnosis, such as ease of usage, communication, and treatment planning 34. However, in clinical practice, the selection of medication is only vaguely related to diagnosis (e.g., antidepressants are used across a wide range of conditions) 35, and in community mental health services, diagnoses are mainly used for channelling resources, and different classifications are employed for dealing with clients in everyday work 36. The threatening bottom line of these discussions is that, if our diagnostic categories have not been valid until now, then research of any type – epidemiological, etiological, pathogenetic, therapeutic, biological, psychological or social — if carried out with these diagnoses as inclusion criterion, is equally invalid. We are living in the era of evidence-based medicine 37. Based on meta-analyses and systematic reviews of carefully selected methodologically sound studies, guidelines for practice are prepared and become prescriptive — we can no longer accept clinical experience alone. But how sure can we really be of our treatment decisions? When in 2008 a meta-analysis of antidepressant medication studies was published 38, with the main message that in mild and moderate depression antidepressants are no better than placebo, the result went around the world immediately — the special “kick” for the media being that the authors had included in their meta-analysis also those studies which had not been published (but submitted to the US Food and Drug Administration). A related study corroborated these findings 39, leading to some discussion within psychiatry 40. The fact that trials with positive findings are published more often and more quickly than those with negative findings has become a serious concern not only in psychiatry, but in the whole field of medicine 41. In a different development, the randomized controlled drug trials in schizophrenia had been criticized for their limitations, and “pragmatic” or “real world” trials had been proposed 42. When such real world pragmatic trials were carried out, the superiority of the second over the first generation antipsychotics could not be reproduced 43–44. It is evident that such results increase uncertainty, even more because — the lack of validity of psychiatric diagnoses and the in of — they do not that the studies were wrong and the new are When to evidence-based guidelines for clinical practice, we an in the of randomized controlled for validity to selected that the results be to the real while for a high of the study It has been suggested in this to have two of the evidence of of studies, and evidence the of results into the real world A related issue is that and combinations of are in clinical practice whereas most evidence is only for In to these the of interest from the relationship between and 50 are creating has recently as a issue, in the scientific community as as in the media and from we about and their our and the must about the of the that our professional work three psychiatrists and I have this in many from and health as an for I to them to psychiatric care and increase and are not in medicine, but do many different as in psychiatry. It is a that psychiatry is into many and of that a knowledge base is a defining criterion of any this is a to the of our profession. aspects and is but not in any There are for biological psychiatry, and social psychiatry which better patient care as their main with to or with and approach has its own body of and The with other is getting not the also because of and for some time with a and only of it is or to This was true also for our who their in — for working mainly with in mental and working mostly with in practice, of them with no or very experience of the other — and came with different It is to of aspects of psychiatry, although the professional as the where kind of professional knowledge is The of or being by other professions is for US psychiatry by the between the of biological psychiatry and as described by a from outside and by the of and the of but systems do not such of psychiatry by has been around for a long time and still with our profession is been also by our the within a profession can be as to its development, of clients with a profession be the last few I have new for our it was then that one to or a term which is to from into many other but seems to be in the also among and even in in a in the relationship between and with the being by more the and by the these are indicating a to and of came on the indicating from psychiatry. a from the of which that psychiatry should not exist at to other of discontent, psychiatry it the allows psychiatric treatment to their And there are a few negative in to positive which are in personal (e.g., are and range from diagnosis to from measures to of quality of life the world now called with psychiatry, although often from a different perspective than the on mental health are by and by Such have become not only in of and of their which is also in and in creating and (e.g., but also at the on the of health and they can in the planning and focus on the of which is as the principle for mental health in many experts this is only a and to the of and as as when the is into other The focus on and inclusion is now by of such as the the the of and the The psychiatric profession has also to this for instance, guidelines for mental health have been to and including the experience of and the quality of life issue has been But client Abbott has professions, in to defining their knowledge base and their scope of are In the with its of a of professional there are more and more into the which psychiatry for And, or in order to they often use of the with being by the medical it is general and who practice medicine who with For instance, in many countries, the of of antidepressants is in general practice than in psychiatry. for themselves, but on the system they also psychiatric in many and clinical social professional who with In there are around times as many as In the by clinical social were in the psychiatric a of them in practice 1. do not only in the psychological and in the for instance, to the since to to have been considered one times in different have been but New and have There are also more systematic such as the to in where are being in a in on of psychiatrists more of a while other professions in the mental health services with to patient the lack of psychiatrists in countries, this is proposed for them This a by an psychiatrist as must continue to also in the first line and not just as as a of while who are more than it is only a of time we and do we to these to the between our own and the of other professions, in a field where is and can be in a come such as group and as as community work special I of as a and In social with new outside my professional it after some time to my profession. And I often with are a I not sure what by but I have come to it as a What on do they a psychiatrist like and psychiatrist it and has experienced there is something special about our in of how The of psychiatric in are positive and a of about not in such as the the and the of these back to a time when psychiatrists were still mainly working in mental from and it was that by this they become and not very different from their It has been suggested that such image a in the of medical not to psychiatry as a or for early from a psychiatric career who had a career as a psychiatrist in but had it most with the that psychiatry had a poor image and that they were not by in other patient with psychiatry, a case general study in that only a of to a psychiatrist as the first choice results were reported in and that, after been in with they be and if this There is a in the general for social from with mental disorders and and are This is by who psychological problems and to for professional that psychiatrists to and will them mainly with and the majority in the the majority even for where this to The of psychiatrists is if to the stigmatization of our There also be a more relationship between these two It has been suggested that the of the psychiatric profession can be and of With many it is that the WPA is a research on of psychiatry and psychiatrists” to from the WPA there are more than psychiatrists around the world in There are a between and It is to a general of a for the of the psychiatric which it are and in are very In however, a of into the profession seems to And while in many that the for psychiatrists or at for psychiatric services will above also in there are whether we as a profession will be able to this The WPA has activities in order to the choice of psychiatry as a career by medical and to the more by improving the prospect for early careers in psychiatry In the the of medical psychiatry as a career had been in over more than two in a study published in A 2009 a more but over of psychiatrists in are medical In in general psychiatrists were on the shortage of the and of on the were medical The of in the into psychiatry at a crisis In countries, there is a shortage of psychiatrists, with for only one psychiatrist for in A WPA task force has discussed the “brain from to the the and In to other it is that a shortage of psychiatrists in this for a in be only of local such as in the long working or with The between the and the with the getting more and more in many countries, become in the In it seems to be the lack of psychiatrists in the which has to an of psychiatrists from and In a shortage of psychiatrists working in has because the and better working into psychiatry is a on of medical students, the image of psychiatry, the of and other for the of into psychiatry, which again and again is medical and early negative of the field of psychiatry, to lack of about the of psychiatric poor of and about psychiatry, and of psychiatry within medicine, while of also be an issue In a medical who psychiatry but not it as a reported status of psychiatry within the medical or no in many and the lack of an evidence base for diagnosis and treatment as for that could be improved by psychiatry a But it can also be argued that the be true the of a profession and its status within medicine and in society are and – the of this is psychiatry and who is from an in into US psychiatry to its and to the of its conceptual But where is psychiatry that our discipline has in status by a increase of knowledge over the past However, there are that diagnostic and therapeutic knowledge base is in a crisis and that the of our discipline is threatened by the of In we are criticized by our and their the new for that other professions are more and more of our field of and our image in society and in medicine is positive than many of for an outside many of the which a profession are in some authors are that psychiatry will P. 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Editorials21 September 2004Clinical Trial Registration: A Statement from the International Committee of Medical Journal EditorsFREECatherine De Angelis, MD, MPH, Jeffrey M. Drazen, MD, Frank A. Frizelle, MBChB, MMedSc, FRACS, Charlotte Haug, MD, PhD, MSc, John Hoey, MD, Richard Horton, FRCP, Sheldon Kotzin, MLS, Christine Laine, MD, MPH, Ana Marusic, MD, PhD, A. John P.M. Overbeke, MD, PhD, Torben V. Schroeder, MD, DMSc, Harold C. Sox, MD, and Martin B. Van Der Weyden, MDCatherine De Angelis, MD, MPH, Jeffrey M. Drazen, MD, Frank A. Frizelle, MBChB, MMedSc, FRACS, Charlotte Haug, MD, PhD, MSc, John Hoey, MD, Richard Horton, FRCP, Sheldon Kotzin, MLS, Christine Laine, MD, MPH, Ana Marusic, MD, PhD, A. John P.M. Overbeke, MD, PhD, Torben V. Schroeder, MD, DMSc, Harold C. Sox, MD, and Martin B. Van Der Weyden, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-6-200409210-00109 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Altruism and trust lie at the heart of research on human subjects. Altruistic individuals volunteer for research because they trust that their participation will contribute to improved health for others and that researchers will minimize risks to participants. In return for the altruism and trust that make clinical research possible, the research enterprise has an obligation to conduct research ethically and to report it honestly. Honest reporting begins with revealing the existence of all clinical studies, even those that reflect unfavorably on a research sponsor's product.Unfortunately, selective reporting of trials does occur, and it distorts the body of evidence available for clinical decision making. Researchers (and journal editors) are generally most enthusiastic about the publication of trials that show either a large effect of a new treatment (positive trials) or equivalence of two approaches to treatment (noninferiority trials). Researchers (and journals) typically are less excited about trials that show that a new treatment is inferior to standard treatment (negative trials) and even less interested in trials that are neither clearly positive nor clearly negative, since inconclusive trials will not in themselves change practice. Irrespective of their scientific interest, trial results that place financial interests at risk are particularly likely to remain unpublished and hidden from public view. The interests of the sponsor or authors notwithstanding, anyone should be able to learn of any trial's existence and its important characteristics.The case against selective reporting is particularly compelling for research that tests interventions that could enter mainstream clinical practice. Rather than a single trial, it is usually a body of evidence, consisting of many studies, that changes medical practice. When research sponsors or investigators conceal the presence of selected trials, these studies cannot influence the thinking of patients, clinicians, other researchers, and experts who write practice guidelines or decide on insurance-coverage policy. If all trials are registered in a public repository at their inception, every trial's existence is part of the public record and the many stakeholders in clinical research can explore the full range of clinical evidence. We are far from this ideal at present, since trial registration is largely voluntary, registry data sets and public access to them vary, and registries contain only a small proportion of trials. In this editorial, published simultaneously in all member journals, the International Committee of Medical Journal Editors (ICMJE) proposes comprehensive trials registration as a solution to the problem of selective awareness and announces that all 11 ICMJE member journals will adopt a trials-registration policy to promote this goal.The ICMJE member journals will require, as a condition of consideration for publication, registration in a public trials registry. Trials must register at or before the onset of patient enrollment. This policy applies to any clinical trial starting enrollment after July 1, 2005. For trials that began enrollment prior to this date, the ICMJE member journals will require registration by September 13, 2005, before considering the trial for publication. We speak only for ourselves, but we encourage editors of other biomedical journals to adopt similar policies. For this purpose, the ICMJE defines a clinical trial as any research project that prospectively assigns human subjects to intervention or comparison groups to study the cause-and-effect relationship between a medical intervention and a health outcome. Studies designed for other purposes, such as to study pharmacokinetics or major toxicity (for example, phase I trials), would be exempt.The ICMJE does not advocate one particular registry, but its member journals will require authors to register their trial in a registry that meets several criteria. The registry must be accessible to the public at no charge. It must be open to all prospective registrants and managed by a not-for-profit organization. There must be a mechanism to ensure the validity of the registration data, and the registry should be electronically searchable. An acceptable registry must include at minimum the following information: a unique identifying number, a statement of the intervention (or interventions) and comparison (or comparisons) studied, a statement of the study hypothesis, definitions of the primary and secondary outcome measures, eligibility criteria, key trial dates (registration date, anticipated or actual start date, anticipated or actual date of last follow-up, planned or actual date of closure to data entry, and date trial data considered complete), target number of subjects, funding source, and contact information for the principal investigator. To our knowledge, at present, only www.clinicaltrials.gov, sponsored by the United States National Library of Medicine, meets these requirements; there may be other registries, now or in the future, that meet all these requirements.Registration is only part of the means to an end; that end is full transparency with respect to performance and reporting of clinical trials. Research sponsors may argue that public registration of clinical trials will result in unnecessary bureaucratic delays and destroy their competitive edge by allowing competitors full access to their research plans. We argue that enhanced public confidence in the research enterprise will compensate for the costs of full disclosure. Patients who volunteer to participate in clinical trials deserve to know that their contribution to improving human health will be available to inform health care decisions. The knowledge made possible by their collective altruism must be accessible to everyone. Required trial registration will advance this goal.Catherine De Angelis, MD, MPH, Editor-in-Chief, Journal of the American Medical AssociationJeffrey M. Drazen, MD, Editor-in-Chief, The New England Journal of MedicineProfessor Frank A. Frizelle, MBChB, MMedSc, FRACS, Editor, The New Zealand Medical JournalCharlotte Haug, MD, PhD, MSc, Editor-in-Chief, Norwegian Medical JournalJohn Hoey, MD, Editor, Canadian Medical Association JournalRichard Horton, FRCP, Editor, The LancetSheldon Kotzin, MLS, Executive Editor, MEDLINE; National Library of MedicineChristine Laine, MD, MPH, Senior Deputy Editor, Annals of Internal MedicineAna Marusic, MD, PhD, Editor, Croatian Medical JournalA. John P.M. Overbeke, MD, PhD, Executive Editor, Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine)Torben V. Schroeder, MD, DMSc, Editor, Journal of the Danish Medical AssociationHarold C. Sox, MD, Editor, Annals of Internal MedicineMartin B. Van Der Weyden, MD, Editor, The Medical Journal of AustraliaCatherine De Angelis, MD, MPHEditor-in-Chief, Journal of the American Medical AssociationJeffrey M. Drazen, MDEditor-in-Chief, The New England Journal of MedicineProfessor Frank A. Frizelle, MBChB, MMedSc, FRACSEditor, The New Zealand Medical JournalCharlotte Haug, MD, PhD, MScEditor-in-Chief, Norwegian Medical JournalJohn Hoey, MDEditor, Canadian Medical Association JournalRichard Horton, FRCPEditor, The LancetSheldon Kotzin, MLSExecutive Editor, MEDLINE; National Library of MedicineChristine Laine, MD, MPHSenior Deputy Editor, Annals of Internal MedicineAna Marusic, MD, PhDEditor, Croatian Medical JournalA. John P.M. Overbeke, MD, PhDFrom Executive Editor, Nederlands Tijdschrift voor Geneeskunde.Torben V. Schroeder, MD, DMScEditor, Journal of the Danish Medical AssociationHarold C. Sox, MDEditor, Annals of Internal MedicineMartin B. Van Der Weyden, MDEditor, The Medical Journal of Australia Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Catherine De Angelis, MD, MPH; Jeffrey M. Drazen, MD; Frank A. Frizelle, MBChB, MMedSc, FRACS; Charlotte Haug, MD, PhD, MSc; John Hoey, MD; Richard Horton, FRCP; Sheldon Kotzin, MLS; Christine Laine, MD, MPH; Ana Marusic, MD, PhD; A. John P.M. Overbeke, MD, PhD; Torben V. Schroeder, MD, DMSc; Harold C. Sox, MD; Martin B. Van Der Weyden, MDAffiliations: Corresponding Author: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRegistration of Clinical Trials Alain Braillon , Gérard Dubois , and Michel Slama Registration of Clinical Trials Christine Laine and Harold C. Sox International Committee of Medical Journal Editors' Definition of a Clinical Trial Christine Laine Metrics Cited byHas the degree of outcome reporting bias in surgical randomized trials changed? 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No AccessWorld Development Report1 Feb 2013World Development Report 1993Investing in Health, Volume1Authors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1952-0890-0AboutView ChaptersPDF (6.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This is the sixteenth in the annual series and examines the interplay between human health, health policy and economic development. Because good health increases the economic productivity of individuals and the economic growth rate of countries, investing in health is one means of accelerating development. More important, good health is a goal in itself. During the past forty years life expectancy in the developing world has risen and child mortality has decreased, sometimes dramatically. But progress is only one side of the picture. The toll from childhood and tropical diseases remains high even as new problems - including AIDS and the diseases of aging populations - appear on the scene. And all countries are struggling with the problems of controlling health expenditures and making health care accessible to the broad population. This report examines the controversial questions surrounding health care and health policy. Its findings are based in large part on innovative research, including estimation of the global burden of disease and the cost-effectiveness of interventions. These assessments can help in setting priorities for health spending. The report advocates a threefold approach to health policy for governments in developing countries and in the formerly socialist countries. First, to foster an economic environment that will enable households to improve their own health. Policies for economic growth that ensure income gains for the poor are essential. So, too, is expanded investment in schooling, particulary for girls. Second, redirect government spending away from specialized care and toward such low-cost and highly effective activities such as immunization, programs to combat micronutrient deficiencies, and control and treatment of infectious diseases. By adopting the packages of public health measures and essential clinical care dsecribed in the report, developing countries could reduce their burden of disease by 25 percent. Third, encourage greater diversity and competition in the provision of health services by decentralizing government services, promoting competitive procurement practices, fostering greater involvement by nongovernmental and other private organizations, and regulating insurance markets. These reforms could translate into longer, healthier, and more productive lives for people around the world, and especially for the more than 1 billion poor. As in previous editions, this report includes the World Development Indicators, which give comprehensive, current data on social and economic development in more than 200 countries and territories. Previous bookNext book FiguresreferencesRecommendeddetailsCited byLatin America at the margins? 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Cyberpsychology, Behavior, and Social NetworkingVol. 23, No. 7 EditorialConnecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:10 Jul 2020https://doi.org/10.1089/cyber.2020.29188.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”." 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Ryan Wagner, and Jack Tsai11 July 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. 7The Influence of E-Scaffolding Sources in a Mobile Learning Environment on Students’ Design Skills and the Technology Fatigue Associated with a 3D Virtual Environment11 July 2022 | Electronics, Vol. 11, No. 14INVESTIGATION OF PARENTS’ VIEWS ON THE DISTANCE EDUCATION PROCESS DURING THE PANDEMIC22 June 2022 | Journal of Advanced Education Studies, Vol. 4, No. 1DATA COLLECTION BY ONLINE IN-DEPTH INTERVIEW IN QUALITATIVE RESEARCH: A POSTGRADUATE THESIS EXAMPLE14 June 2022 | Pamukkale University Journal of Social Sciences InstituteTwelve tips to enhance student engagement in synchronous online teaching and learning20 April 2021 | Medical Teacher, Vol. 44, No. 6Current and future influences of COVID-19 on the knowledge management function of conventions and exhibitions15 March 2022 | Service Business, Vol. 16, No. 2Robust Institutional Support and Collaboration Between Summer Training Programs in Cancer and Biomedicine Drive the Pivot to a Virtual Format in Response to the COVID January 2022 | Journal of Cancer Education, Vol. 37, No. of a Social Virtual Reality into the Vol. 29, No. Work Meetings During the COVID-19 Pandemic: The and May 2021 | Group Research, Vol. No. of in in the for New in for Use by May 2022 | Journal of Cognitive and Vol. 16, No. Online during COVID-19 Is Scientific February 2022 | Vol. 13, No. the Is and to It and K. June 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. learning Review of Education, Vol. May 2022 | Vol. 12, No. in the experiences and to and reflections the year of January 2022 | The Clinical Vol. 36, No. Psychological and Academic M. and May 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. of via videoconference on fatigue and Implications for the March 2022 | Healthcare Management Vol. No. Policy of Technology April 2022 | Education Sciences, Vol. 12, No. under A July 2021 | Journal of Family Vol. 44, No. Strategies During the COVID-19 Pandemic: Virtual Learning for Public Health and Cancer Health April 2022 | Frontiers in Public Health, Vol. during How a to online interaction and social April 2022 | Journal of Research on Vol. 16, No. a Roadmap for Technology in Social Training the of Social February 2022 | in Social Vol. No. Psychological for with Learning during the Pandemic: The Experiences of in the March 2022 | Journal of Mental Health Research in Vol. 15, No. to education and communication the and intensive community during the COVID-19 Vol. No. to education and communication the and intensive community during the COVID-19 Vol. No. and implementation of a virtual pain management programme to COVID-19: a September 2021 | British Journal of Vol. 16, No. Video Conference Fatigue of in the on Video Conference Social and April 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. of in during the COVID‐19 pandemic: the and of and challenges and the of mental health and in December 2021 | Journal of Research in Educational Vol. 22, No. New with COVID-19 and A Qualitative Study on Zoom Fatigue30 March 2022 | Vol. 19, No. distance une No. Social in Remote Social A for of When the Social of Interactions via Videoconferencing March 2022 | Frontiers in Psychology, Vol. the stress of and of Zoom December 2021 | Electronic Vol. 32, No. social as of A study under in Human Behavior, Vol. the of to an online in to February 2022 | Sciences Education, Vol. 15, No. changes in social during COVID pandemic in the United December 2021 | Vol. 29, No. in Journal of and Vol. 13, No. or How online February 2022 | PLOS Vol. No. in Zoom Fatigue B. and February 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. of on mental August 2021 | Vol. 19, No. 1Videoconference Fatigue: A February 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 4The Use of Videoconferencing in Higher January and digital communication in Australian December 2021 | Journal of the International for Business, Vol. No. and in Industry August Zoom Learning February and in During Coronavirus January of Leadership on June Online Social a from a of February An Approach to Social During Online June Virtual Reality August in a Mediated July – und February Teaching as an for Vol. 22, No. Video During the COVID-19 Pandemic and Effects on May 2021 | and Vol. No. During Remote Teaching in through a pandemic: impact of on and of Clinical Medicine, Vol. 18, No. during the pandemic A Systematic Review using April 2022 | Information Science, Vol. 6, No. Hybrid Learning Challenges and February de de de December 2022 | Vol. 4, No. of COVID‐19 with and variables in An analysis of September 2021 | The International Journal of Health and Management, Vol. 37, No. Design With Research for the Development of a Digital for and August 2022 | Journal of Research Vol. No. to Equity, and in Science and December 2021 | Frontiers in Science, Vol. December 2021 | Vol. 25, No. reality during the COVID-19 pandemic: A and and Vol. for study for a randomized controlled September 2021 | Pilot and Studies, Vol. 7, No. and A Design December in social of and mothers during the COVID-19 Vol. “Zoom A November 2021 | Applied Psychology, Vol. The from to of Human - 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Medical Writings7 August 2001"Let Me See If I Have This Right …": Words That Help Build EmpathyJohn L. Coulehan, MD, Frederic W. Platt, MD, Barry Egener, MD, Richard Frankel, PhD, Chen-Tan Lin, MD, Beth Lown, MD, and William H. Salazar, MDJohn L. Coulehan, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Frederic W. Platt, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Barry Egener, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Richard Frankel, PhDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Chen-Tan Lin, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, Beth Lown, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902, and William H. Salazar, MDDr. Coulehan: State University of New York at Stony Brook; Stony Brook, NY 11794-8036Dr. Platt: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Egener: American Academy on Physician and Patient; Portland, OR 97210Dr. Frankel: Highland Hospital; Rochester, NY 14620Dr. Lin: University of Colorado Health Sciences Center; Denver, CO 80222Dr. Lown: Mount Auburn Hospital; Cambridge, MA 02238Dr. Salazar: Medical College of Georgia; Augusta, GA 30902Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-3-200108070-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Consider these two physician–patient dialogues:1. Patient: You know, when you discover a lump in your breast, you kind of feel—well, kind of—(her speech tapers off; she looks down; tears form in her eyes).Dr. A: When did you actually discover the lump?Patient: (absently) I don't know. It's been a while.2. Patient: (same as above)Dr. B: That sounds frightening.Patient: Well, yeah, sort of.Dr. B: Sort of frightening?Patient: Yeah … and I guess I'm feeling like my life is over.Dr. B: I see. Worried and sad too.Patient: That's it, Doctor.Dr. A's patient ...References1. Konrad TR, Williams ES, Linzer M, McMurray J, Pathman DE, Gerrity M, et al . Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care. 1999;37:1174-82. [PMID: 10549620] CrossrefMedlineGoogle Scholar2. Donelan K, Blendon RJ, Lundberg GD, Calkins DR, Newhouse JP, Leape LL, et al . The new medical marketplace: physicians' views. Health Aff Millwood. 1997;16:139-48. [PMID: 9314685] CrossrefMedlineGoogle Scholar3. Bates AS, Harris LE, Tierney WM, Wolinsky FD. Dimensions and correlates of physician work satisfaction in a midwestern city. Med Care. 1998;36:610-7. 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Coulehan, MD, Department of Preventive Medicine, HSC L3-086, State University of New York at Stony Brook, Stony Brook, NY 11794-8036; e-mail, [email protected]sunysb.edu.Current Author Addresses: Dr. Coulehan: Department of Preventive Medicine, HSC L3-086, State University of New York at Stony Brook, Stony Brook, NY 11794-8036.Drs. Platt and Lin: University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80222.Dr. Egener: American Academy on Physician and Patient, Legacy Clinic Northwest, 1130 NW 22nd Avenue, Suite 220, Portland, OR 97210.Dr. Frankel: Highland Hospital, 1000 South Avenue, Rochester, NY 14620.Dr. Lown: Mount Auburn Hospital, 300 Mt. Auburn Street, Cambridge, MA 02238.Dr. Salazar: Medical College of Georgia, 1120 15th Street, HS2010, Augusta, GA 30902. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHow does narrative medicine impact medical trainees' learning of professionalism? 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PhD, M. MD, and and role in education about care in Competencies in Care for and Communication in patients with in the Care of Cancer in of and of Empathic during When Being Not empathy learning for be and for effective the role of care in with and in the of the medicine and outcomes of physician empathy in A structural focus study of and perceptions of the of of Medical Student role of empathy in in the a new and in the a of the An or Do You to to Patients Do Not or with Challenges and a of of the of a for children with Care. A to in care: The role of perceptions in Older in Clinical during Health and H. or Not to Is That the Right empathy and sympathy: responses to troubles on a health care with to make the patient the Communication and With Patients in Your as a of The of Medicine, and How to and A Patient-Centered Communication Illness Using to Communication Care and Social in the office approach to the Words That in to and MD, M. MD, and Frederic Platt, I Student August August August by American College of

The Journal of Bone and Joint Surgery. British volumeVol. 70-B, No. 1 ArticlesFree AccessPelvic ring fractures: should they be fixed?M TileM TileSearch for more papers by this authorPublished Online:1 Jan 1988https://doi.org/10.1302/0301-620X.70B1.3276697AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byPreoperative CT simulation of iliosacral screws for treating unstable posterior pelvic ring injury8 March 2022 | BMC Musculoskeletal Disorders, Vol. 23, No. 1Functional outcome of unstable pelvic fractures treated in a level III hospital in a developing country: a 10-year prospective observational study4 April 2022 | Journal of Orthopaedic Surgery and Research, Vol. 17, No. 1Percutaneous posterior transiliac plate versus iliosacral screw fixation for posterior fixation of Tile C-type pelvic fractures: a retrospective comparative study16 June 2022 | BMC Musculoskeletal Disorders, Vol. 23, No. 1Equestrian-Related Pelvic Trauma in Women of Childbearing Age — a Review of the Experience of a National Pelvic & Acetabular Referral Centre27 July 2022 | SN Comprehensive Clinical Medicine, Vol. 4, No. 1CT of Sacral Fractures: Classification Systems and ManagementRadioGraphics, Vol. 42, No. 7Moving forward with the management of minimally displaced lateral compression pelvic ring injuries18 June 2022 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 32, No. 7Biomechanical Comparison of 4 Transsacral Fixation Constructs in a Type 61C, Zone II Pelvic Fracture ModelJournal of Orthopaedic Trauma, Vol. 36, No. 10Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress RadiographsJournal of Orthopaedic Trauma, Vol. 36, No. 10Surgical management of paediatric pelvic fractures: a prospective case series and early experience from a level one Egyptian trauma centre23 July 2022 | International Orthopaedics, Vol. 46, No. 10A Review on Management of Insufficiency Fractures of the Pelvis and AcetabulumOrthopedic Clinics of North America, Vol. 53, No. 4Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler’s Classification Revisited – A Narrative Review22 February 2022 | Global Spine Journal, Vol. 12, No. 8Prolonged ileus in traumatic pelvic ring injury patients who underwent arterial angio-embolization: A retrospective studyMedicine, Vol. 101, No. 39Surgical Versus Non-surgical Treatment of Unstable Lateral Compression Type I (LC1) Injuries of the Pelvis With Complete Sacral Fractures in Non-fragility Fracture Patients: A Systematic ReviewCureus, Vol. 15Analysis of Postoperative Gait, Hip Strength, and Patient-Reported Outcomes After OTA/AO 61-B and 61-C Pelvic Ring InjuriesJournal of Orthopaedic Trauma, Vol. 36, No. 9Dual-Energy CT and Cinematic Rendering to Improve Assessment of Pelvic Fracture InstabilityRadiology, Vol. 304, No. 2Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study1 December 2021 | European Journal of Trauma and Emergency Surgery, Vol. 48, No. 4Pelvic Fracture Urethral Distraction DefectUrologic Clinics of North America, Vol. 49, No. 3Paediatric pelvic fractures – an updated literature review3 July 2022 | ANZ Journal of Surgery, Vol. 36Sakrumfrakturen beim geriatrischen Patienten1 June 2022 | Zeitschrift für Gerontologie und Geriatrie, Vol. 55, No. 4Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic reviewJournal of Neurosurgery: Spine, Vol. 78Nonoperative Management of Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries With and Without Occult InstabilityJournal of Orthopaedic Trauma, Vol. 36, No. 6Reliability and reproducibility analysis of the AOSpine Sacral Fractures Classification System by spinal and pelvic surgeonsInjury, Vol. 53, No. 6Outcomes and complications of the INFIX technique for unstable pelvic ring injuries with high-velocity trauma: a systematic review and meta-analysis11 January 2021 | Archives of Orthopaedic and Trauma Surgery, Vol. 142, No. 5Anatomic reduction of the sacroiliac joint in unstable pelvic ring injuries and its correlation with functional outcome30 September 2020 | European Journal of Trauma and Emergency Surgery, Vol. 48, No. 2Emergency Department Stress Radiographs of Lateral Compression Type-1 Pelvic Ring Injuries Are Safe, Effective, and Reliable17 December 2021 | Journal of Bone and Joint Surgery, Vol. 104, No. 4Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review25 August 2021 | Neurosurgical Review, Vol. 45, No. 1Pelvic ring and acetabular fracture: Concepts of traumatological forensic interestInjury, Vol. 53, No. 2Danger zone - 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Management of the Unstable Anterior Pelvic of Orthopaedic Trauma, Vol. 32, No. and of Tile C pelvic ring injuries using a external fixation December | European Journal of Orthopaedic Surgery & Traumatology, Vol. 28, No. of After Operative Treatment of Pelvic Ring InjuriesJournal of Orthopaedic Trauma, Vol. 32, No. 7Biomechanical of fixation techniques in sacrum type II fracture with December | Journal of Orthopaedic Vol. 36, No. for Injury after Pelvic Ring Vol. No. of Fractures Using a Clinical and Operative June 2018 | Journal of Orthopaedics, Trauma and Rehabilitation, Vol. No. 1The trauma from a A case study the of vertical Science International, Vol. Posterior Pelvic for Unstable Sacral Fractures: A Fixation of Orthopaedic Trauma, Vol. 32, No. compression type pelvic ring fractures in young patients do May | European Journal of Trauma and Emergency Surgery, Vol. 44, No. analysis of anterior ring fixation of the ramus in type C pelvis April | European Journal of Trauma and 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treated with open reduction and internal of Clinical and Trauma, Vol. e do de Vol. 52, No. of pelvic ring fractures and de Ortopedia Vol. 52, No. and of after acetabular fractures October | Vol. 101, No. reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring & Traumatology: Surgery & Research, Vol. No. Stress Pelvic Ring Without DisplacementJournal of Orthopaedic Trauma, Vol. 31, No. of in Analysis on Pelvic Biomechanical March | Orthopaedic Surgery, Vol. 9, No. spine and for or A Case for Care in the August of the internal fixator as an of pelvic ring March outcome of patients with unstable pelvic ring January | Journal of Orthopaedic Surgery, Vol. 25, No. en - Vol. 49, No. AND A FOR November | Journal of in and Vol. 16, No. MDCT Instability in Pelvic Ring Journal of Vol. No. de la Vol. 40, No. of the posterior Vol. 40, No. of Pelvic Ring and Acetabular in Vol. No. Surgery on with Pelvic Ring A Case of Trauma and Injury, Vol. No. 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No AccessHealth, Nutrition, and Population1 Feb 2013Better Health Systems for India's PoorFindings, Analysis, and OptionsAuthors/Editors: David H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam WagstaffDavid H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam Wagstaffhttps://doi.org/10.1596/0-8213-5029-3SectionsAboutPDF (1.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India ' s future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. 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No AccessEducationJul 2010Design Thinking for Social InnovationAuthors/Editors: Tim Brown, Jocelyn WyattTim BrownSearch for more papers by this author, Jocelyn WyattSearch for more papers by this authorhttps://doi.org/10.1596/1020-797X_12_1_29SectionsAboutView ChaptersPDF (0.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Designers have traditionally focused on enchancing the look and functionality of products. Previous articleNext article FiguresreferencesRecommendeddetailsCited byFive components of social design: A unified framework to support research and practiceThe Design Journal, Vol.26, No.227 June 2022Youth Perspectives on Barriers and Opportunities for the Development of a Peer Support Model to Promote Mental Health and Prevent SuicideWestern Journal of Nursing Research, Vol.45, No.32 August 2022Designing for Trust in Blockchain PlatformsIEEE Transactions on Engineering Management, Vol.70, No.3Industrial verification of egg handling for meal preparation: a case study of professional engagement with application of remote design thinking during the COVID ‐19 pandemicInternational Journal of Food Science & Technology, Vol.58, No.318 January 2023Making design thinking for education sustainable: Training preservice teachers to address practice challengesThinking Skills and Creativity, Vol.47Interactive technologies through the lens of team effectiveness: an interdisciplinary systematic literature reviewEuropean Journal of Work and Organizational Psychology, Vol.1023 February 2023Developing a design thinking engagement scale for early childhood teachersInternational Journal of Technology and Design Education, Vol.1039 February 2023#OPENFORBUSINESS: STUDENT PROMOTION OF COMMUNITY ORGANIZATIONS AND BUSINESSES ON SOCIAL MEDIAMarketing Education Review, Vol.189 February 2023Does maturity level influence the use of Agile UX methods by digital startups? 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Innovation and Development, Vol.13, August the of service in tourism and Vol.31, August Research A Design Thinking Approach to on Journal of Environmental Research and Public Health, Vol.18, September Innovation Design and Sustainability of in Vol.13, No.173 September of in the design thinking of a Skills and Creativity, Sosyal August 2021Design thinking and innovation: the of Business July 2020Design thinking approach to for the Journal of August Uygulamaları Bilimler August 2021Innovating for through collaborative innovation of Cleaner Production, OF DESIGN AND OF AND of the Design Society, July of Social Innovation through The Case of in Vol.13, August COVID-19 as a for public and The need for robust governance to turbulent Management Review, Vol.23, September and practice of Design Thinking: of and business Journal of Design Creativity and Innovation, Vol.9, May Learning to Support Decision-Making and Creative in Instructional Design Vol.65, No.46 April in Learning through the of Design Thinking in a Vol.13, July methodology design: participatory processes for of Research, a approach to food as in Student case of using a to support Technology as an The and of in Regional Open Innovation Vol.13, June Services during the in of Design, December 2022Supporting and Living through Journal of Environmental Research and Public Health, Vol.18, April de Vol.26, the new on the in public & a April of Design Thinking to in a Vol.13, April Courses of Design on the Light on to Social and Vol.13, April 2021Using human-centred design to develop an female Vol.7, January case study of an of Business No.214 May Innovation in Education and Social Service and Approaches to Social in Education, March Design Thinking Approach for March to the of energy in Research & Social Science, A Conceptual Framework for the and of Youth of and Health, Vol.18, evaluation of innovation: A case of for in Journal of Science, Technology, Innovation and Development, Vol.13, July Novel for Digital Assessment Using A Human-Centered Design Approach (Preprint)JMIR February mental health and in and mental framework for in of Cleaner Production, to Design Thinking to Creative and in Journal of & Design Education, August Theory in An Journal, March 2021Designing and for with January with design thinking: a case study from Journal of Environmental Education, Vol.52, January and the of Design: of Design and Design in No.122 May to Design with A for Design and July Case and the of Design Thinking in Public Education in August to Co-Created Digital to Support Activities for Socially Youth in February Innovation and Exchange a Lessons Learned from a Design Thinking Challenge in May October Sustainable Business and January Analysis of Agile Development Methodology Through Design June Sustainable Design to Environmental of Design November Case for Design May Learning in Design Thinking to April 2021Design Thinking as a Strategy to Learning in Education Across South April Inspection Management with October design methodology for A to community health and health in the Health of and Science, Vol.5, February 2021Using Design Thinking to the Educational of August factors of service design methodology for manufacturing Business & Management, Vol.8, February 2021Design and of an app for September 2021Design Innovation Methodology – Design in Journal, of the Health Mental Health Intervention for in and for a Research Vol.10, June Design Approach to Social a of Public and October Design Thinking in an Interdisciplinary Learning December Design Thinking to Design Thinking to Food Innovation for January of Design Thinking and to Food and January 2021Design Thinking to Engage in Food The January 2021Systemic and Design Towards Participatory The Journal of Design, and Innovation, Vol.7, Design Thinking October Research and Design Thinking for the Health and Social A para de de Vol.16,

Editorials20 June 2000The Informationist: A New Health Profession?Frank Davidoff, MD and Valerie Florance, PhDFrank Davidoff, MD and Valerie Florance, PhDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-12-200006200-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians have always had a professional obligation to base their decisions on the best available information, an assumption now explicitly embodied in the concept of evidence-based medicine (1). For decades, when physicians wanted information from the published literature, they relied heavily on medical librarians or office assistants to do the searches. The advent of computer-based indexes such as MEDLINE promised to change all that by putting the basic information retrieval tools directly into physicians' hands. The disappointing reality, however, is that physicians still don't regularly search the medical literature themselves, nor do they ask for professional help in searching nearly ...References1. Davidoff F. In the teeth of the evidence: the curious case of evidence-based medicine. Mt Sinai J Med. 1999;66:75-83. MedlineGoogle Scholar2. Smith R. What clinical information do physicians need? BMJ. 1996;313:1062-8. CrossrefMedlineGoogle Scholar3. Ely JW, Osheroff JA, Ebell MH, Bergus GR, Levy BT, Chambliss ML, Evans ER. Analysis of questions asked by family physicians regarding patient care. BMJ. 1999;319:358-61. CrossrefMedlineGoogle Scholar4. Funk ME, Reid CA. Indexing consistency in MEDLINE. Bull Med Libr Assoc. 1983;71:176-83. MedlineGoogle Scholar5. Purcell GP, Rennels GD, Shortliffe EH. Development and evaluation of a context-based document representation for searching the medical literature. International Journal on Digital Libraries. 1997;1:288-96. CrossrefGoogle Scholar6. McKibbon KA, Haynes RB, Dilks CJ, Ramsden MF, Ryan NC, Baker L, Flemming T, et al . How good are clinical MEDLINE searches? A comparative study of clinical end-user and librarian searches. Comput Biomed Research. 1990;23:583-93. CrossrefMedlineGoogle Scholar7. Medical School Graduation Questionnaire. All Schools Report. Question 20. Association of American Medical Colleges, 1999. www.aamc.org/meded/gq. Accessed 6 March 2000. Google Scholar8. Florance V. Clinical extracts of biomedical literature for patient-centered problem solving. Bull Med Libr Assoc. 1996;84:375-85. MedlineGoogle Scholar9. Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the “evidence cart.”. JAMA. 1998;280:1336-8. CrossrefMedlineGoogle Scholar10. Cimino JJ, Elhanan G, Zeng Q. Supporting infobuttons with terminological knowledge. Proc AMIA Annu Fall Symp. 1997;:528-32. MedlineGoogle Scholar11. Lamb G. A decade of clinical librarianship. Clinical Librarian Quarterly. 1982;1:2-4. Google Scholar12. Scura G, Davidoff F. Case-related use of the medical literature. Clinical librarian services for improving patient care. JAMA. 1981;245:50-2. CrossrefMedlineGoogle Scholar13. Marshall JG. The impact of the hospital library on clinical decision making: the Rochester study. Bull Med Libr Assoc. 1992;80:169-78. MedlineGoogle Scholar14. Veenstra RJ. Clinical medical librarian impact on patient care: a one-year analysis. Bull Med Libr Assoc. 1992;80:19-22. MedlineGoogle Scholar15. Giuse NB, Kafantaris SR, Miller MD, Wilder KS, Martin SL, Sathe NA, et al . Clinical medical librarianship: the Vanderbilt experience. Bull Med Libr Assoc. 1998;86:412-6. MedlineGoogle Scholar16. Giuse NB. Advancing the practice of clinical medical librarianship. Bull Med Libr Assoc. 1997;85:437-8. MedlineGoogle Scholar17. Dodson S. A clinical medical librarian program into the next millennium. healthlinks.washington.edu/hsl/liaisons/dodson. Accessed 2 March 2000. Google Scholar18. van Walraven C, Naylor CD. Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA. 1998;280:550-8. CrossrefMedlineGoogle Scholar19. Crenner CW. Introduction of the blood pressure cuff into U.S. medical practice: technology and skilled practice. Ann Intern Med. 1998;128:488-93. LinkGoogle Scholar20. Clinical Evidence: A Compendium of the Best Available Evidence for Effective Health Care. London: BMJ; Issue 2, December 1999. Google Scholar Author, Article, and Disclosure InformationAuthors: Frank Davidoff, MD; Valerie Florance, PhDAffiliations: Corresponding Author: Frank Davidoff, MD, American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Current Author Addresses: Dr. Davidoff: American College of Physicians–American Society for Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Dr. Florance: Association of American Medical Colleges, 2450 N Street NW, Room 419, Washington, DC 20037. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Informationist Deborah B. Root Jorgensen The Informationist Stephen Sandroni The Informationist Bruce Houghton and Eugene C. Rich The Informationist Michael J. Schott The Informationist Frank Davidoff and Valerie Florance Metrics Cited byDeveloping a Competency-Based Curriculum for Clinical InformationistsPromoting new and expanded roles for librarians and information specialistsTranslating Liaison Librarians to the Scientific CommunitySkills and key education needed for clinical librarians: an exploratory study from the librarians' perspectivesClinical Informationist Services Challenges: A Qualitative Content Analysis of the LiteratureThe Presence of a Clinical Informationist on Ward Rounds: An Action Research StudyHealth Information Work: A Scoping ReviewInformacionista de Pesquisa: oportunidades para bibliotecários na era do big dataAccessTraining for Research Careers in Biomedical Informatics and Data Science Supported by the National Library of MedicineTranslating Clinical Questions by Physicians Into Searchable Queries: Analytical Survey StudyDeveloping Specialized Graduate Curricula for Health Information Professionals: Integrated Findings of a Scoping Review and an Employer SurveyThe clinical informationist as a new member of clinical teamWelServe: The DBMS for Capturing and Tracking Welch Medical Library’s Embedded Informationist Service Delivery at Johns Hopkins Medical InstitutionsInvolving Clinical Librarians in Clinical Settings: Skills, Roles, Advantages and BarriersHealth Libraries and Information Services in Tanzania: A Strategic AssessmentDisaster and Digital Libraries in Developing CountriesThrough the eyes of the Informationist: Identifying information needs of the Breast Imaging Service at a tertiary medical center specializing in cancerA Librarian’s Role in Improving Rigor in Research—AlzPED: Alzheimer’s Disease Preclinical Efficacy DatabaseAn Embedded Librarian Program: Eight Years OnLibrarians in the Lab: Toward Radically Re-Engineering Data Curation Services at the Research CoalfaceBarriers to the use of the library service amongst clinical staff in an acute hospital setting: an evaluationDisaster and Digital Libraries in Developing CountriesA study comparing public and medical librarians’ perceptions of the role and duties of health information-providing librariansIntegrating an Informationist Into Graduate Education: Case Study With Preliminary ResultsA review of competencies needed for health librarians - a comparison of Irish and international practiceEnvisioning the Academic Library: A Reflection on Roles, Relevancy and RelationshipsReferencesResearch Embedded Health Librarianship: The Canadian LandscapeAdapting an Embedded Model of Librarianship, College by CollegeEstablishing a New Clinical Informationist Role in an Academic Health Sciences CenterRetaining students by embedding librarians into undergraduate research experiences‘Personalised evidence’ for personalised healthcare: integration of a clinical librarian into mental health services – a feasibility studyExploring New Roles for LibrariansEvolving academic library specialtiesSustaining Librarian Vitality: Embedded Librarianship Model for Health Sciences LibrariesBoredom among psychiatric in-patients: does it matter?Bridging Paradigms: Hybrid Mechanistic-Discriminative Predictive ModelsHow Work-Related and Personal Motivated Information Needs Shape Trust Towards Government-Sponsored Medical Information Sources?Information professionals' participation in interdisciplinary research: a preliminary study of factors affecting successful collaborationsThe Disaster Information Specialist: An Emerging Role for Health LibrariansHealth education for Somali Bantu refugees via home visitsPlugging the “whole”: librarians as interdisciplinary facilitatorsExpert searching in health librarianship: a literature review to identify international issues and Australian concernsEffectiveness of bibliographic searches performed by paediatric residents and interns assisted by librarians. A randomised controlled trialInformation Needs and Barriers to Accessing Electronic Information: Hospital-Based Physicians Compared to Primary Care PhysiciansTechnology MediatorHospital clinicians’ information behaviour and attitudes towards the ‘Clinical Informationist’: an Irish surveyEvaluating clinical librarian services: a systematic reviewThe Informatics Imperative in Veterinary Medicine: Collaboration across DisciplinesClinical librarians as facilitators of nurses’ evidence-based practiceThe Informationist: Ten Years LaterCompetency-based continuing professional developmentClinical Library Services: Outreach to Enhance Patient CareWelServe: The DBMS for Capturing and Tracking Welch Medical Library's Embedded Informationist Service Delivery at Johns Hopkins Medical InstitutionsA clinical librarian pilot project in psychiatryResearch Support in an Academic Medical CenterInformation Takeout and Delivery: A Case Study Exploring Different Library Service Delivery ModelsHealth Sciences Librarians in Academic Libraries: A Brief Review of Their Developing RoleBuilding PROMIS item banks: librarians as co-investigatorsEvaluation of a New Clinical Librarian ServiceKnowledge Workers, Librarians, and SafetyAnalysis of queries sent to PubMed at the point of care: Observation of search behaviour in a medical teaching hospitalDeveloping research capacity in health librarians: a review of the evidenceInformationist EducationDo bibliotecário médico ao informacionista: traços semânticos de seus perfis e competênciasInformationist programme in support of biomedical research: a programme description and preliminary findings of an evaluationKorean medical libraries and professional associations: changing services and rolesA Randomized Effectiveness Trial of a Clinical Informatics Consult Service: Impact on Evidence-based Decision-making and Knowledge ImplementationBuilding a statewide knowledge network for clinicians in intensive care units: Knowledge brokering and the NSW Intensive Care Coordination and Monitoring Unit (ICCMU)Education for information scienceThe potential role of ILS schools in educating medical informationists 1The perioperative librarian: luxury or necessity?Informationists or Information Specialists in Context (ISIC): six years after conceptionThe education and training needs of health librarians?the generalist versus specialist dilemmaIntegrating Knowledge-Based Resources into the Electronic Health RecordCollaborative information synthesis II: Recommendations for information systems to support synthesis activitiesWhat do clinicians want from us? 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What We Know and Should KnowLibrarians, Surgeons, and KnowledgeEvidence-Based Resources and the Role of Librarians in Developing Evidence-Based Practice CurriculaFacilitating Patient Centeredness Through Information WorkInformation needs of United Kingdom primary care clinicians1Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision MakingSteven H. Woolf, MD, MPH, Evelyn C.Y. Chan, MD, MS, Russell Harris, MD, MPH, Stacey L. Sheridan, MD, MPH, Clarence H. Braddock III, MD, MPH, Robert M. Kaplan, PhD, Alex Krist, MD, Annette M. O'Connor, RN, MScN, PhD, and Sean Tunis, MD, MScEffect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical CareUndertaking an information-needs analysis of the emergency-care physician to inform the role of the clinical librarian: a Greek perspectiveManaging knowledge to support the patient journey in NHS Scotland: strategic vision and practical realityManaging and leveraging organizational knowledgeLibrarians, Informaticists, Informationists, and Other Information Professionals in Biomedicine and the Health SciencesThe John Eisenberg Lecture: Health Services Research as a Citizen in ImprovementA survey of UK clinical librarianship: February 2004Answering Physicians' Clinical Questions: Obstacles and Potential SolutionsUsing Information Technology To Transfer Knowledge: A Medical Institution Steps Up to the PlateRobert Badgett, MD and Cynthia Mulrow, MD, MSc, Deputy EditorLibrarians as Hidden Gems in a Clinical TeamFellowship Training at Johns HopkinsProviding Evidence-Based Answers to Complex Clinical Questions: Evaluating the Consistency of Article SelectionToward continuous medical educationClinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarianEffect of an evidence-based answering service on GPs and their patients: a pilot studyThe informationist in Australia: a feasibility studyThe InformationistInformationist? Internal Medicine Rounds with a Clinical Medical LibrarianWhy emerging roles for health sciences librarians?Clinical medical librarian to clinical informationistBioterrorism alert: reference and literature support for the CDC Director’s Emergency Operations Center (DEOC) and investigative field teamsPhysicians' Internet information-seeking behaviorsWeb-Enabled Medicine: The Challenge of Ensuring Quality Information and CareUsing Clinical Vignette Assignments to Teach Medical InformaticsClinical librarianship: a systematic review of the literatureThe role of the information specialist in the systematic review process: a health information case studyIncorporating the views of obstetric clinicians in implementing evidence-supported labour and delivery suite ward rounds: a case studyCase Studies from Morning ReportOp zoek naar bewijs; een vraag- en antwoorddienst voor de huisartsFinding your place in the information age libraryPerson-centered approach to care, teaching, and research in fibromyalgia syndrome: Justification from biopsychosocial perspectives in populationsThe Impact of Medical Informatics on LibrarianshipClinical focus and patient management in the XXI century within the context of the advances in medicineKnowledge Resources: Finding Answers to Primary Care QuestionsAplicación de la gestión por procesos a las unidades De atención al usuarioA clinical librarian can support clinical governanceFrom Artisan To Architect: The Specialist And Systems Of Provision Of Diabetes Care In 2001Clinical Medical LibrariansThe InformationistDeborah B. Root Jorgensen, PharmD CandidateThe InformationistStephen Sandroni, MDThe InformationistBruce Houghton, MD and Eugene C. Rich, MDThe InformationistMichael J. Schott, MS, MLSProgress in Health Sciences Librarianship: 1970–2005The Development and Impact of Digital Library Funding in the United StatesUbiquitous Information Therapy Service through Social Networking LibrariesUbiquitous Information Therapy Service through Social Networking Libraries 20 June 2000Volume 132, Issue 12Page: 996-998KeywordsClinical epidemiologyGraduate medical educationHealth careHealth informaticsHealth information technologyInformation retrievalInformation technologyLibrariesPatientsTechnicians ePublished: 15 August 2000 Issue Published: 20 June 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. 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“Compulsion” in mental health care is a reasonably straightforward notion: the use of force, one hopes always governed by law, to make a person accept treatment that has been refused. The term “coercion” is usually taken to include “compulsion”, but encompasses a broader range of practices. Sometimes it is used almost synonymously with treatment pressures, including “interpersonal leverage”, and even “persuasion”. I believe that, if we are to take our thinking — including research ideas — forward, we need a more precise understanding of “coercion” 1. Most accepted is the definition proposed by Wertheimer 2, who includes “threats” as coercive. A “threat” is a conditional proposal (“if …, then …”) that, if rejected by the person, leaves him/her worse off according to a “moral baseline” (“if you refuse the medication, you will be detained in hospital”). The moral baseline is that one is normally entitled not to be deprived of one's liberty. That is not to say that it can never be justified, but a special case needs to be made. Wertheimer contrasts a “threat” with an “offer” (or inducement). An example: “if you take the prescribed medication, you will receive a payment” 3. Here a rejection of the proposal does not leave the person worse off, as he/she is not entitled to a payment. Nevertheless, such an inducement can be problematic, for example, by undermining the patient's sense of agency or through corrupting the value of the treatment 4. I take coercion to cover both compulsion and threats. A further consideration is the difference between “objective” coercion and “perceived” coercion. The former follows the definitions given above. The latter is a person's perception of threat, even where no threat may be intended. A disquieting problem facing psychiatry is its “coercive shadow”, the fear many patients have that non-compliance may lead to the use of compulsion. Patients may agree to treatment, including admission to hospital, “voluntarily” to avoid the humiliation and stigma of a compulsory order. Research shows this is very common, even though in most places threats are regarded as ethically unacceptable. There has been little discussion of this topic, but I suggest that, given the uncertainty of whether a proposition is a threat or not, we might look at ways of “regulating” threats: for example, making them transparent – their only being made in “good faith” (that is, the threatener really means it)— and clarifying practice in codes of practice or professional ethics. Apart from the problem of definition, research on coercion is dogged by the problem of context. There is a large variation in the rates of compulsory admission to hospital, both between countries (even without outliers, 3- to 4-fold) 5 and within countries 6. The use of seclusion, restraint and forced medication may vary hugely 7, even 10-fold from hospital to hospital in the same country 8. The sources of variation can be attributed to different service configurations, different mental health laws, different social policies (for example, the rate and extent of bed reductions; the degree of emphasis on risk and public protection), and, crucially, culture. In some countries physical restraints are regarded as unacceptable and are rarely or not at all used; in others chemical restraints are thus regarded. Furthermore, the use of compulsion may change significantly over time according to changes in policy and practice. In England, there has been a doubling over the past 20 years 9. Even if well-designed self-report or interview measures are used, ones that are interpreted similarly from place to place, the results of any one study on coercion will likely have limited generalizability. Thus, perhaps more than in any other field of health services research, international collaborative studies are needed. The EUNOMIA programme is a good example 10. Further points to be considered are where (in the community or in the hospital) and when (before discharge or after) the assessment is made, and by whom. Service user researchers may get different responses from conventional researchers. Variations here may lead to different results. Research ethics committees often struggle with research in this area. It is sensitive, and there may be concerns about consent and the “voluntariness” of participation, which may lead to bias due to the exclusion of important subgroups of patients. With careful thought these problems can be overcome. A huge challenge to involuntary treatment comes from the United Nations (UN) Convention on the Rights of Persons with Disabilities 11. By April 2015, 159 states were signatories. The elimination of discrimination by ensuring that rights may be enjoyed “on an equal basis with others” is a fundamental aim. Persons with serious mental illness are considered by the UN Committee for the Rights of Persons with Disabilities, the authoritative body set up by the UN to interpret and monitor compliance with the Convention, to fall under the characterization of “disability” (sometimes referred to as “psychosocial” disabilities). Article 14 states that “the existence of a disability shall in no case justify a deprivation of liberty”, meaning that “mental disorder” or “mental illness”, even if it represents only one of a number of criteria for involuntary detention in a mental health law, renders such a law non-compliant with the Convention. Article 12 recognizes that all persons enjoy “legal capacity” in all aspects of life on an “equal basis with others”. The Committee, in a recent “General Comment” on this article, states that “substitute decision-making”, where someone decides for the person with a disability (as opposed to “supported decision-making”), is non-compliant 12. Over twenty “concluding observations” made thus far by the Committee, following its monitoring of reports on progress from States in implementing the Convention, conclude that they must “take action to develop laws and policies to replace regimes of substitute decision-making by supported decision-making, which respects the person's autonomy, will and preferences” 13. It is hard to imagine a society in which it would be seen as right that persons who are seriously incapable of exercising autonomy or expressing their will and preferences would be allowed to act so as to incur grave harms, including death. Where the UN Convention is valuable, apart from its clear articulation of a host of other rights for people with disabilities, is in making us scrutinize in depth our justifications for coercive interventions. Together with colleagues, we 14, 15 have argued that conventional mental health law discriminates against persons with a mental disorder since it does not respect such persons’ autonomy (or rights to self-determination or self-governance) in the same way as in the rest of medicine. In the latter, considerations such as impaired “decision-making capacity” and treatment needing to be in the person's “best interests” justify the over-riding of a treatment refusal. In the mental health field, a diagnosis of a “mental disorder” – usually vaguely defined – and the presence of some kind of risk to self or others comprise the criteria. The rules are entirely different. Furthermore, the “protection of others” permits the preventive detention of persons with mental disorder on the basis of the risk they are deemed to pose before they have actually committed an offence. This group is unique in this regard. The many more persons without a mental disorder who are equally or more risky are not liable to such detention. In this regard, non-discrimination means either having generic “dangerousness” legislation equally applicable to all who present an unacceptable level of risk, or no preventive detention for anyone. Thus we 14 have argued for a non-discriminatory, generic, “fusion law” that would apply to all persons, whatever their diagnosis — medical, surgical or psychiatric — and whatever the setting. Involuntary interventions would only be justified for those who lack decision-making capability (unable to understand and retain the relevant information, to appreciate its pertinence to their situation, to reason with it in the light of what is important to themselves, and to evidence a choice) and only where it would be in their “best interests” (essentially what that person would have chosen if he/she had retained capacity in the current circumstances). Advance statements or directives (see 16 in this issue of the journal) could play an important role here. Northern Ireland is currently proposing to legislate along these principles. Bach and Kerzner 17, attentive to the “legal capacity” standard of the UN Convention, have proposed three levels of “decision-making capability”. The first is “legally independent”, having full decision-making ability as outlined above. The next level is where varying degrees of support — informal or formal — would be required to assist the person to arrive at a decision based on the person's will and preferences. The third level, “facilitated” decision-making, would represent a last resort and would be restricted to instances where it is impossible to arrive at a settled understanding or interpretation of the person's will and preferences and where decisions are made by another person. However, as part of this action, the facilitator would continue to work with the person to establish with time what are the person's will and preferences. An approach that combines both of the above could be developed. “Decision-making capacity” and “best interests”, both terms criticized by the UN Convention Committee, can be helpfully reconceptualized in terms of the person's “real” or “authentic” will and preferences 15. The huge variation in rates of involuntary treatment suggests that in many countries there is considerable scope for a reduction. From an ethical point of view, a randomized controlled trial (RCT) of involuntary inpatient treatment is hardly possible. We accept that it can be morally justified, indeed obligatory, to treat people involuntarily under certain circumstances. However, there have been three RCTs of involuntary outpatient treatment (or community treatment orders). While each has its flaws, none has shown a clearly significant improvement in any of a range of outcomes 18. I have argued that an alternative approach, consistent with the “fusion” proposal, would conceive of community treatment orders in a different way and would look for different, individual, patient-preferred, outcomes 19. There is reasonably consistent evidence, even when involuntary treatment has been authorized, that “perceived coercion” is less when the relationship between patient and clinicians is good, and when patients believe their “voice” has been heard 20. A promising means of reducing the need for coercion at times of crisis, especially a relapse of illness, might be an advance directive, or the less legally formal “joint crisis plan” (see 16 and 21 in this issue of the journal). There is evidence in the case of the former that, when helped by a facilitator in drawing up the directive, in the short term at least, patients may experience their care as better 22. Joint crisis plans have been more extensively studied. An earlier, sizeable, RCT found a significant reduction in involuntary admissions when a joint crisis plan had been agreed between patient and clinical team. However, a much larger RCT involving 569 patients found no difference in involuntary admissions or any other outcome 23. A lack of treatment fidelity or clinician “buy-in”, a problem for any multicentre complex intervention, may have been responsible. A joint crisis plan pilot study for patients who self-harm also found no benefit 24. However, 85% of patients who had a joint crisis plan said they would recommend it to others. Perhaps this reflects the respect accorded to the patient's “voice” in the joint crisis plan negotiation. In conclusion, there are considerable conceptual and practical difficulties in understanding and researching compulsion and coercion. Nevertheless, it is hugely important to our patients and, indeed, for the status of psychiatry that we do all that is possible to reduce recourse to these measures to a minimum.

The aim of the recognition task (Duda et al., 2001) is to classify a given object of interest by assigning it to some predefined category, on the basis of observing the features of the object. Depending on the practical application, these objects (so-called patterns) can be images, signal waveforms or any type of measurements that need to be classified (Theodoridis and Koutroumbas, 2003). Pattern recognition has a long history, properly becoming a scientific discipline at the end of the 1950s with the publication of Frank Rosenblatt's work devoted to the perceptron (Rosenblatt, 1958). Since that time, the progress of computer technology has increased the demand for practical applications of pattern recognition and caused the development of new efficient theoretical methods of recognition required by more and more sophisticated decision problems. Nowadays, the worldwide economy is a knowledge economy (Drucker, 1969), which needs the discovery, transfer and better utilization of knowledge, and pattern recognition methods are widely used by today's engineering applications and research. They are an integral part in most machine intelligence systems built for decision making. There is much current research into developing even more efficient and accurate recognition algorithms, based on technologies such as neural networks, statistical and symbolic learning and fuzzy methods to name but a few. Such methods are implemented in the form of computer software and applied in many practical areas, such as character and speech recognition, machine vision, computer-aided medical diagnosis, prediction of customer behaviour, fraud detection and so on. As a result of the call for papers for this issue entitled ‘Computer Recognition Systems’, the articles were submitted and reviewed through a rigorous peer-review process. In the end, four contributions were selected. We hope that the selected papers provide the reader with an excellent discussion of the current issues of computer recognition systems. The selected topics cover the vital parts of modern recognition systems such as information fusion, bioprosthesis decision control, biometrics, and medical decision support. Proença (2010), in his paper ‘An iris recognition approach through structural pattern analysis methods’, proposes a method based on structural (syntactic) pattern recognition. Iris recognition is at present used in several scenarios (airport check-in, refugee control etc.) with good results. In order to achieve acceptable error rates several imaging constraints are enforced, which reduce the fluidity of iris recognition systems. The related papers existing in the literature use statistical pattern recognition and encode iris texture information through phase, zero-crossing or texture analysis based methods. In this report of the experiments performed, three well-known iris image data sets (CASIA, ICE and UBIRIS) are used. The variability of error rates regarding the amount of noise that images contain is also analysed. The experiments show that the proposed method behaves comparably to the statistical approach that constitutes the basis of nearly all deployed systems. Pietka et al. (2010), in their paper ‘Open architecture computer-aided diagnosis system’, extend the traditional goal of a computer-aided diagnosis (CAD) system to assist physicians in performing diagnosis and treatment. The presented platform helps the system designer in developing a new CAD workflow by implementing general-purpose modules as well as problem-dependent procedures. The CAD environment is validated through its use in three systems – a multiple sclerosis CAD, a lung nodule CAD and a pneumothorax CAD – by which it is shown that the various procedures (fuzzy c-means, fuzzy connectedness, labelling, filters) are developed once but employed by many CADs. The results obtained during the CAD evaluation demonstrate the high flexibility of the infrastructure. The trade-offs, well known to CAD designers (e.g. computational cost versus segmentation accuracy), can easily be handled by the operators in a user-friendly manner by choosing various workflow paths. Straszecka (2010), in her paper ‘Combining knowledge from different sources’, deals with the problem of an assessment of symptoms in medical diagnosis. A unified interpretation of symptoms is often necessary to estimate their significance in a diagnosis. This paper shows how to combine evaluations that may originate from an expert or from statistical features of data for diagnostic cases. A new model of diagnostic inference is proposed in the framework, based on Dempster–Shafer theory extended by fuzzy focal elements. An algorithm of the basic probability assignment calculation is suggested and tested for medical data. Wołczowski and Kurzyński (2010), in their paper ‘Human–machine interface in bioprosthesis control using EMG signal classification’, discuss EMG signal characteristics and the problem of processing them, including acquisition, feature extraction and classification. On the basis of a learning set, a fuzzy relation is determined as a solution of an appropriate optimization problem and then the relation in the form of a matrix of membership degrees is used at successive instants of the sequential decision process. The authors describe three algorithms of sequential classification, which differ from one another in the sets of input data and procedure, and infer that the combination of sequential recognition and fuzzy relation brings new possibilities to EMG signal analysis. We would like to thank the Editor-in-Chief of Expert Systems, Jon G. Hall, for his enthusiasm and continuing support for this special issue. Many of the original reviewers helped in the preparation of the special issue, and we thank them greatly for their help. Thanks also to Wiley-Blackwell's Expert Systems' office, who have made this special issue available in good time. Michal Wozniak Michal Wozniak is Professor of Computer Science in the Department of Systems and Computer Networks, Faculty of Electronics, Wroclaw University of Technology, Poland. He received an MS degree in biomedical engineering in 1992 from the Wroclaw University of Technology, and PhD and DSc (habilitation) degrees in computer science in 1996 and 2007, respectively, from the same university. His research focuses on multiple classifier systems, machine learning, data and web mining, Bayes compound theory, distributed algorithms, computer and networks security and teleinformatics. Professor Wozniak has published over 120 papers and two books, and has edited three books. He is Editor-in-Chief of International Journal of Computer Networks and Communications and associate editor of several international journals including Pattern Analysis and Applications, Expert Systems and International Journal of Communication Networks and Distributed Systems. He serves on the program committees of numerous international conferences. His works have been transitioned into commercial applications. Professor Wozniak has been involved in many research projects related to machine learning, computer networks and telemedicine. Moreover, he has been a consultant on several commercial projects for well-known Polish companies and for the Polish public administration. Professor Wozniak is a member of the IEEE (Computational Intelligence Society and Systems, Man and Cybernetics Society) and IBS (International Biometric Society). For a more detailed profile see http://www.kssk.pwr.wroc.pl/pracownicy/michal.wozniak-en. Elif Derya Übeyli Elif Derya Übeyli (http://edubeyli.etu.edu.tr/) is an Associate Professor at the Department of Electrical and Electronics Engineering, TOBB University of Economics and Technology. She obtained her PhD degree in electronics and computer technology from Gazi University in 2004. She has worked on a variety of topics including biomedical signal processing, neural networks, optimization and artificial intelligence. She has worked on several projects related to biomedical signal acquisition, processing and classification. Dr Übeyli has served (or is currently serving) as a program organizing committee member of many national and international conferences. She is editorial board member of several scientific journals (Journal of Engineering and Applied Sciences, International Journal of Soft Computing, Research Journal of Applied Sciences, Research Journal of Medical Sciences, Scientific Journals International/Electrical, Mechanical, Manufacturing, and Aerospace Engineering, The Open Medical Informatics Journal, Bulletin of the International Scientific Surgical Association, International Journal of Real-Time Systems, Journal of Biomedical Science and Engineering, International Journal of Engineering and Applied Sciences). She is Associate Editor of Expert Systems. She has served as a guest editor to Expert Systems on a special issue on ‘Advances in medical decision support systems’. Moreover, she is voluntarily serving as a technical publication reviewer for many respected scientific journals and conferences. She has also published 118 journal and 44 conference papers on her research areas.

Position Papers1 February 1986Guidelines on Authorship of Medical PapersEDWARD J. HUTH, M.D.EDWARD J. HUTH, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-104-2-269 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the belief that authors and potential authors may be helped by explicit statements of justification for authorship, the following guidelines are offered for research papers, case-series analyses, case reports, review articles, and editorials. These guidelines are based on statements issued by the International Committee of Medical Journal Editors (ICMJE) that were published recently (1-3) and will eventually be incorporated into the Committee's document, "Uniform Requirements for Manuscripts Submitted to Biomedical Journals" (4, 5).The ICMJE statements on authorship represent five principles that are applied below in the specific guidelines. (These principles have been developed directly from the ICMJE statements...References1. . Guidelines on authorship. Br Med J. 1985;291:722. CrossrefMedlineGoogle Scholar2. Editorial consensus on authorship and other matters. Lancet. 1985;2:595. MedlineGoogle Scholar3. HUTH E. Standards on authors' responsibilities. Ann Intern Med. 1985;103:797. LinkGoogle Scholar4. . Uniform requirements for manuscripts submitted to biomedical journals. Ann Intern Med. 1982;96:766-71. LinkGoogle Scholar5. . Uniform requirements for manuscripts submitted to biomedical journals. Br Med J. 1982;284:1766-70. CrossrefMedlineGoogle Scholar6. HEWITT R. The Physician-Writer's Book: Tricks of the Trade of Medical Writing. Philadelphia: W. B. Saunders Company; 1957:312-3. Google Scholar7. Ethical conduct in authorship and publication. In: CBE Style Manual: A Guide for Authors, Editors, and Publishers in the Biological Sciences. 5th ed. Bethesda, Maryland: Council of Biology Editors, Inc.; 1983:1-2. Google Scholar8. HUTH E. Critical argument: the basic structure of papers. In: HUTH EJ. How to Write and Publish Papers in the Medical Sciences. Philadelphia: ISI Press; 1982:47-9. Google Scholar9. RELMAN A. Responsibilities of authorship: where does the buck stop? N Engl J Med. 1984;310:1048-9. CrossrefMedlineGoogle Scholar10. HUTH E. Preparing to write. In: HUTH EJ. How to Write and Publish Papers in the Medical Sciences. Philadelphia: ISI Press; 1982:37-46. Google Scholar11. CANNON W. The Way of an Investigator. New York: W. W. Norton; 1945:93. Google Scholar12. ALEXANDER R. Trends in authorship. Circ Res 1953;1:281-3. (Reprinted in Arch Intern Med. 1970;125:771-2). CrossrefMedlineGoogle Scholar13. SPIEGELKEITH-SPIEGEL DP. Assignment of publication credits; ethics and practices of psychologists. Am Psychol. 1970;25:738-47. CrossrefGoogle Scholar14. RELMAN A. Publication and promotions for the clinical investigator. Clin Pharmacol Ther. 1979;25:673-6. CrossrefMedlineGoogle Scholar15. HUTH E. Authorship from the reader's side. Ann Intern Med. 1982;97:613-4. LinkGoogle Scholar16. Author! Lancet. 1982;2:1199. MedlineGoogle Scholar17. . Characteristics of authorship and articles. In: Publication Manual of the American Psychological Association. Washington, D.C: American Psychological Association; 1983. Google Scholar18. BISHOP C. Ethics. In: BISHOP CT. HOW to Edit a Scientific Journal. Philadelphia: ISI Press; 1984:76-8. Google Scholar19. JACKSON C. Honor in Science. New Haven: Sigma Xi, The Scientific Research Society; 1984:23-7. Google Scholar20. KENNEDY D. On Academic Authorship. Stanford: Stanford University; 1985. Google Scholar21. . ACS ethical guidelines to publication of chemical research. In: The ACS Style Guide. Washington, D.C: American Chemical Society; 1986:217-22. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: ▸ From the American College of Physicians, Philadelphia, Pennsylvania. 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Huth, MD and Kathleen Case, MSIntegrity in ResearchTitle, Authors, and AbstractResearch Fundamentals: Choosing an Appropriate Journal, Manuscript Preparation, and Interactions with EditorsWriting Manuscripts Describing Clinical Trials: A Guide for Pharmacotherapeutic ResearchersData Presentation: How to Write and Submit Abstracts and PapersAuthorshipAuthorship, dissemination of research findings, and related mattersAuthorship: "Law" and OrderAuthorshipMultiple authorship revisited: How much is enough?Principles of Authorship in Health Promotion ResearchReporting and Interpreting of ResultsA proposal for a new system of credit allocation in scienceThe Responsibilities of AuthorshipMultiple authorship: Issues and recommendationsIs It Time for a New Approach to Authorship?Proliferation of authors on research reports in medicineEthical Responsibilities in Scientific PublicationPolicies and perspectives on authorshipWho qualifies as a coauthor?Ethical considerations relating to writing a medical scientific paper for publicationCritical evaluation of clinical researchTom Hamilton Lecture: 1994. Research and academic emergency medicinePublication of Research: The Ethical DimensionAuthorship ethics in the radiological sciencesEquity in authorship: A strategy for assigning credit when publishingWriting and Guidelines for Nurse Authors and EditorsAre academic institutions corrupt?Coauthorship Trends in the Leading Radiological JournalsAnimals in Biomedical Research: The Undermining Effect of the Rhetoric of the BesiegedWriting Your First Scientific PaperAbstract Creep and Author InflationMedical Authorship: Traditions, Trends, and TribulationsW. Bruce Fye, MD, MAAuthorship patterns in life sciences, preclinical basic and clinical research papersEthical Issues in Research and PublicationMultiple authorship, basic research, and other trends in the emergency medicine literature (1975 to 1986)Trends, truth, and consequences in the emergency medicine literatureInvestigating Peer ReviewDrummond Rennie, MD, Elizabeth Knoll, PhDMisrepresentation and Responsibility in Medical ResearchAuthorship and Clinical TrialsZALMEN A. ARLIN, M.D.Some problems encountered in reviewing clinical microbiology manuscriptsEditor's Report—On Decisions and AuthorshipsLetter to the reader: 1986Who should be an author?Fraud and Irresponsible AuthorshipL. A. HEALEY, M.D.Abuses and Uses of Authorship 1 February 1986Volume 104, Issue 2Page: 269-274KeywordsResearch and reporting methodsResearch reporting guidelines Issue Published: 1 February 1986 Copyright©1986 American College of PhysiciansPDF DownloadLoading ...

AbstractThe focus of the paper is the optimization of condition-based maintenance decisions within the contexts of physical asset management. In particular, the analysis of a preventive replacement policy of the control-limit type for a deteriorating system subject to inspections at discrete points of time is presented. Cox's PHM with a Weibull baseline hazard function and time dependent stochastic covariates is used to describe the failure rate of the system. The methods of estimating model parameters and the calculation of the optimal policy are given. The structure of the decision-making software EXAKT is presented. Experience with collecting, preprocessing and using real oil and vibration data is reported.RésuméDans ce rapport il s'agit de l'optimisation du processus décisionnel par rapport à un programme de l'entretien par surveillance de la condition des machines. Plus spécifiquement on décrit l'analyse d'une politique de maintenance préventive appliqué à un système qui se détériore mais qui est sujet aux inspections aux moments précis. Le modèle par Cox qui si traite aux risques proportionnelles (PHM) comprennant une ligne de base Wiebull ainsi que des co-variants stochastiques est employé dans le bût de décrire le taux de défaults du système. Des méthodes pour effectuer l'estimation des paramètres du modèle ainsi que le calcul de la politque optimale sont présentés. L'architecture du logiciel décisionnel, EXAKT, est décrit. On inclut, également, dans ce rapport, de l'experience sur le collecte, le traitement, et l'usage des données provenant d'un programme d'analyse d'huile et de la vibration.Key words:: condition-based maintenanceproportional-hazards modelMarkov processcost minimizationdecision softwareMots-clés:: programme de l'entretien par surveillance de la condition des machinesmodelisation des risques proportionnelles (PHM)processus Marcovminimisation des coûtslogiciel décisionnel Additional informationNotes on contributorsD. BanjevicDragan Banjevic is a Research Associate in the Department of Mechanical and Industrial Engineering and Visiting Professor in the Department of Statistics, University of Toronto. His research interests are in theoretical and applied probability, especially in reliability. His papers have appeared in Statistics and Probability Letters, Journal of Applied Probability, Theory of Probability and its Applications and other journals.A.K.S. JardineAndrew Jardine is a Professor in the Department of Mechanical and Industrial Engineering at the University of Toronto. His teaching and research interests lie in the general area of Engineering Management with a special interest in maintenance. He has had practical experience in devising maintenance and replacement procedures for a number of national and international organizations. He is author of Maintenance, Replacement and Reliability and co-editor of Maintenance Excellence: Optimizing Life Cycle Deicisions.V. MakisViliam Makis is a Professor in the Department of Mechanical and Industrial Engineering, University of Toronto. His teaching and research areas include quality and reliability engineering with special interest in modeling and optimization of stochastic systems. His articles have appeared in Mathematics of Operations Research, Technometrics, IIE Transactions, IEEE Transactions on Reliability, Journal of Applied Probability, Naval Research Logistics, EJOR, INFOR, Journal of the OR Society, International Journal of Production Economics, IMA Journal, Kybernetika, etc. He is a Senior Member of the Institute of Industrial Engineers and of the American Society for Quality.M. EnnisMarguerite Ennis obtained her B.Sc. in Statistics at the University of Stellenbosch in South Africa and her M.Sc. and Ph.D. degrees at the University of Toronto. She is interested in the application of statistics in both the medical and industrial fields and works as a freelance consultant. in data analysis and statistical graphics.

BACKGROUND: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING: Bill & Melinda Gates Foundation.

Elder abuse, the mistreatment of older people, though a manifestation of the timeless phenomenon of inter-personal violence, is now achieving due recognition Prevalence studies concerning abuse of older persons have so far been restricted to developed nations. In developing countries, though, there is no systematic collection of statistics or prevalence studies, crime records, journalistic reports, social welfare records and small scale studies to provide evidence that abuse, neglect and financial exploitation of elders are widely prevalent. The World Health Organization(WHO) has recognised the need to develop a global strategy for the prevention of the abuse of older people. This strategy is being developed within the framework of a working partnership between the WHO Ageing and Life Course unit of the Department of Noncommunicable Disease Prevention and Health Promotion, the WHO Department of Injuries and Violence Prevention, the International Network for the Prevention of Elder Abuse(INPEA), HelpAge International and partners from academic institutions in a range of countries. The initial step towards developing the global strategy was the set up of a study in eight countries: Argentina, Austria, Brazil, Canada, India, Kenya, Lebanon and Sweden. The study`s main approach involved the conduct of focus groups with older persons in the community, and with primary health care workers, in order to establish components of elder abuse as identified by older people themselves and by those forming the primary health care teams. A focus on primary health care context was chosen as it is within this context that elder abuse can first be identified - or overlooked altogether. Making primary health care workers aware of the problem is thus a crucial step in preventing and/or managing elder abuse. This report presents the design and findings of the study, and the conclusions of a meeting(Geneva 11-13 October 2001) aimed at identifying the indications for policy, research and action emerging from these study findings. Reports from each country prepared by the national teams were reviewed and analysed at the meeting. Analysis of the major themes revealed remarkable similarities across the participating countries. Older people perceived abuse under three broad areas: ·Neglect - isolation, abandonment and social exclusion ·Violation - of human, legal and medical rights ·Deprivation - of choices, decisions, status, finances and respect The conclusions contain recommendations for action, some of which are already being implemented, with others to follow in the near future. These recommendations can be summarised as follows: ·To develop a screening and assessment tool for use in primary health care settings ·To develop an education package on elder abuse for primary health care professionals ·To develop and disseminate a research methodology `kit` to study elder abuse ·To develop a Minimum Data Set concerning violence and older people ·To ensure dissemination of the research findings through scientific journals ·To develop a global inventory of good practice ·To mobilize civil society through raising awareness of the widespread magnitude of elder abuse

Transparency in health economic decision modelling is important for engendering confidence in the models and in the reliability of model-based cost-effectiveness analyses. The Mount Hood Diabetes Challenge Network has taken a lead in promoting transparency through validation with biennial conferences in which diabetes modelling groups meet to compare simulated outcomes of pre-specified scenarios often based on the results of pivotal clinical trials. Model registration is a potential method for promoting transparency, while also reducing the duplication of effort. An important network initiative is the ongoing construction of a diabetes model registry (https://www.mthooddiabeteschallenge.com). Following the 2012 International Society for Pharmacoeconomics and Outcomes Research and the Society of Medical Decision Making (ISPOR-SMDM) guidelines, we recommend that modelling groups provide technical and non-technical documentation sufficient to enable model reproduction, but not necessarily provide the model code. We also request that modelling groups upload documentation on the methods and outcomes of validation efforts, and run reference case simulations so that model outcomes can be compared. In this paper, we discuss conflicting definitions of transparency in health economic modelling, and describe the ongoing development of a registry of economic models for diabetes through the Mount Hood Diabetes Challenge Network, its objectives and potential further developments, and highlight the challenges in its construction and maintenance. The support of key stakeholders such as decision-making bodies and journals is key to ensuring the success of this and other registries. In the absence of public funding, the development of a network of modellers is of huge value in enhancing transparency, whether through registries or other means.

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.

Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias. A group of scientists and editors developed the CONSORT (Consolidated Standards of Reporting Trials) statement to improve the quality of reporting of RCTs. It was first published in 1996 and updated in 2001. The statement consists of a checklist and flow diagram that authors can use for reporting an RCT. Many leading medical journals and major international editorial groups have endorsed the CONSORT statement. The statement facilitates critical appraisal and interpretation of RCTs. During the 2001 CONSORT revision, it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports. A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement. After an expert meeting in January 2007, the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement. This update improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition, such as selective outcome reporting bias. This explanatory and elaboration document-intended to enhance the use, understanding, and dissemination of the CONSORT statement-has also been extensively revised. It presents the meaning and rationale for each new and updated checklist item providing examples of good reporting and, where possible, references to relevant empirical studies. Several examples of flow diagrams are included. The CONSORT 2010 Statement, this revised explanatory and elaboration document, and the associated website (www.consort-statement.org) should be helpful resources to improve reporting of randomised trials.