A delayed inheritance: The Medical Board of Victoria's 75-year wait to find doctors guilty of "infamous conduct in a professional respect"

The Medical Board of Victoria (Board) was created in 1844 to register “legally qualified medical practitioners”. It was not until 1933, however, that the Board attained the power to remove from its register a doctor who had engaged in “infamous conduct in a professional respect” (the power), even though the General Council of Medical Education and Registration of the United Kingdom on which the Board was modelled had been granted the power 75 years earlier. This article argues that the delay in the Board’s inheritance was attributable to successive Victorian Parliaments’ distrust of the Board and that this attitude was unwarranted, at least from early in the 20th century. The article maintains that the granting of the power to the Board was a crucial event in the history of the regulation of the Victorian medical profession. This is illustrated both by the difficulty encountered by the medical profession in dealing with doctors’ unethical conduct before 1933, and the Board’s concern to use its new authority responsibly and appropriately to protect the public and the profession in the three years after it attained the power.

Patient self-management in chronic heart failure – establishing concordance between guidelines and practice

 Chronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, self- management interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future.

Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition

BACKGROUND: previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. OBJECTIVE: to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. METHODS: six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. RESULTS: of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. CONCLUSION: dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital.

Patterns of general practitioner usage among Pacific people: indicative results from the Waikato Medical Care Survey 1991-2

AIMS: To report patterns of medical contact in a representative sample of Pacific people attending the general practitioner. METHODS: The data were drawn from a survey of general practice in the Waikato region representing a one per cent sample of all weekday encounters. In total, 12,833 patient encounter forms were completed. Just over one per cent of all encounters were recorded for patients of Pacific Islands background. RESULTS: Rates of medical contact for Pacific patients were lower-3.4 visits per year versus 4.5 for the whole sample-fewer follow up visits were requested (71% versus 76.2%), presentation was delayed (4.9 days from onset versus 3.7 for the sample) and there was an apparently lower level of rapport achieved. CONCLUSION: Overall levels of medical contact and return visits among Pacific patients appear to be lower and presentation delayed in this Waikato sample.

All in the blood: a review of Aboriginal Australians' cultural beliefs about blood and implications for biospecimen research

Public participation in medical research and biobanking is considered key to advances in scientific discovery and translation to improved health care. Cultural concerns relating to blood have been found to affect the participation of indigenous peoples and minorities in research, but such concerns are rarely specified in the literature. This article presents a review of the role of blood in Australian Aboriginal cultures. We discuss the range of meanings and uses of blood in traditional culture, including their use in ceremonies, healing, and sorcery. We draw on more recent literature on Aboriginal Australians and biomedicine to consider how traditional beliefs may be changing over time. These findings provide an empirical basis for researchers and bioethicists to develop culturally grounded strategies to boost the participation of Aboriginal Australians in biomedical research. They also serve as a model for integrating anthropological literature with bioethical concerns that could be applied to other indigenous and minority groups.

Autoethnography: introducing 'I' into medical education research

Context: Autoethnography is a methodology that allows clinician-educators to research their own cultures, sharing insights about their own teaching and learning journeys in ways that will resonate with others. There are few examples of autoethnographic research in medical education, and many areas would benefit from this methodology to help improve understanding of, for example, teacher-learner interactions, transitions and interprofessional development. Objectives: We wish to share this methodology so that others may consider it in their own education environments as a viable qualitative research approach to gain new insights and understandings. Methods: This paper introduces autoethnography, discusses important considerations in terms of data collection and analysis, explores ethical aspects of writing about others and considers the benefits and limitations of conducting research that includes self. Results: Autoethnography allows medical educators to increasingly engage in self-reflective narration while analysing their own cultural biographies. It moves beyond simple autobiography through the inclusion of other voices and the analytical examination of the relationships between self and others. Autoethnography has achieved its goal if it results in new insights and improvements in personal teaching practices, and if it promotes broader reflection amongst readers about their own teaching and learning environments. Conclusions: Researchers should consider autoethnography as an important methodology to help advance our understanding of the culture and practices of medical education. Discuss ideas arising from the article at www.mededuc.com discuss. © 2015 John Wiley

Understanding toxicities and complications of cancer treatment: a data mining approach

Cancer remains a major challenge in modern medicine. Increasing prevalence of cancer, particularly in developing countries, demands better understanding of the effectiveness and adverse consequences of different cancer treatment regimes in real patient population. Current understanding of cancer treatment toxicities is often derived from either “clean” patient cohorts or coarse population statistics. It is difficult to get up-to-date and local assessment of treatment toxicities for specific cancer centres. In this paper, we applied an Apriori-based method for discovering toxicity progression patterns in the form of temporal association rules. Our experiments show the effectiveness of the proposed method in discovering major toxicity patterns in comparison with the pairwise association analysis. Our method is applicable for most cancer centres with even rudimentary electronic medical records and has the potential to provide real-time surveillance and quality assurance in cancer care.

Fusing data mining, machine learning and traditional statistics to detect biomarkers associated with depression

BACKGROUND: Atheoretical large-scale data mining techniques using machine learning algorithms have promise in the analysis of large epidemiological datasets. This study illustrates the use of a hybrid methodology for variable selection that took account of missing data and complex survey design to identify key biomarkers associated with depression from a large epidemiological study.

METHODS: The study used a three-step methodology amalgamating multiple imputation, a machine learning boosted regression algorithm and logistic regression, to identify key biomarkers associated with depression in the National Health and Nutrition Examination Study (2009-2010). Depression was measured using the Patient Health Questionnaire-9 and 67 biomarkers were analysed. Covariates in this study included gender, age, race, smoking, food security, Poverty Income Ratio, Body Mass Index, physical activity, alcohol use, medical conditions and medications. The final imputed weighted multiple logistic regression model included possible confounders and moderators.

RESULTS: After the creation of 20 imputation data sets from multiple chained regression sequences, machine learning boosted regression initially identified 21 biomarkers associated with depression. Using traditional logistic regression methods, including controlling for possible confounders and moderators, a final set of three biomarkers were selected. The final three biomarkers from the novel hybrid variable selection methodology were red cell distribution width (OR 1.15; 95% CI 1.01, 1.30), serum glucose (OR 1.01; 95% CI 1.00, 1.01) and total bilirubin (OR 0.12; 95% CI 0.05, 0.28). Significant interactions were found between total bilirubin with Mexican American/Hispanic group (p = 0.016), and current smokers (p<0.001).

CONCLUSION: The systematic use of a hybrid methodology for variable selection, fusing data mining techniques using a machine learning algorithm with traditional statistical modelling, accounted for missing data and complex survey sampling methodology and was demonstrated to be a useful tool for detecting three biomarkers associated with depression for future hypothesis generation: red cell distribution width, serum glucose and total bilirubin.

Simplifying medical additive manufacturing: making the surgeon the designer

Additive Manufacturing, a technology which has been in existence since three decades, is now successfully being transitioned from a research setting to finding technologically and financially viable end-user applications. A key sector in which Additive Manufacturing is being used is the medical devices and healthcare sector. Drivers in this sector include the ability to create customized, patient specific devices and implants with quick turnaround time in a cost-effective manner. Doctors and surgeons are important change agents and innovators in the creation of new healthcare devices as well as surgical methods. Often times, they may find it necessary at first to build devices and plan surgeries which are not even being thought of or acted upon by the major healthcare companies. In this sense, they perform the roles of designers, creating new ideas and improving on them until they can be implemented and adopted by others. However, the scope for performing this creative activity is often limited in their workplaces, with resource, time and financial impediments often being present. Additive Manufacturing can be helpful to speed up the iterative process of designing such medical devices or planning surgeries as well as help convince people outside of the surgery room of the feasibility and business case for such innovations. This paper proposes to introduce a framework of design, processes and tools which will enable non-engineers (specifically surgeons) to create custom-built products. It is hoped that this paper will motivate more surgeons and non-engineers to get involved in the process of designing for additive manufacturing.