Whither our Art? Clinical Wisdom & Evidence-based Medicine

The relationship between evidence-based medicine (EBM) and clinical judgement is the subject of conceptual and practical dispute. For example, EBM and clinical guidelines are seen to increasingly dominate medical decision-making at the expense of other, human elements, and to threaten the art of medicine. Clinical wisdom always remains open to question. We want to know why particular beliefs are held, and the epistemological status of claims based in wisdom or experience. The paper critically appraises a number of claims and distinctions, and attempts to clarify the connections between EBM, clinical experience and judgement, and the objective and evaluative categories of medicine. I conclude that to demystify clinical wisdom is not to devalue it. EBM ought not be conceived as needing to be limited or balanced by clinical wisdom, since if its language is translatable into terms comprehensible and applicable to individuals, it helps constitute clinical wisdom. Failure to appreciate this constitutive relation will help perpetuate medical paternalism and delay the adoption of properly evidence-based practice, which would be both unethical and unwise.

Militares Medici in Nummis Repraesentati: The heritage of military

Coins and commemorative medals constitute one special repository of the history of military medicine. The numismatic record has proven to be the most enduring, albeit one of the most selective, records of the progress of history. Matters of health, and especially of military medicine, have been central to the endeavors and indeed the survival of many cultures and societies. Many such themes in the national and international history of military medicine are preserved in the medallic record. Coins and medallions thus constitute one record of the chronology of this profession, one parallel to that of the more traditional history to be found in oral and written records. This account presents a four-part classification of medical coins and medals of military interest. These examples include (1) medals that portray military surgeons and physicians; (2) medals that commemorate special events of military medicine; (3) coins that portray the themes of the discipline of military medicine and health; and (4) a miscellaneous group that includes such examples as disease touch pieces and the militarily worn medals of such bodies as the International Red Cross and the Order of St. John, the latter of which are awarded inter alia for contributions to prehospital care in the field. A representative photo archive of such exemplars is included in this account.

Parallel simulation system for earthquake generation: Fault analysis modules and parallel coupling analysis

Solid earth simulations have recently been developed to address issues such as natural disasters, global environmental destruction and the conservation of natural resources. The simulation of solid earth phenomena involves the analysis of complex structures including strata, faults, and heterogeneous material properties. Simulation of the generation and cycle of earthquakes is particularly important, but such simulations require the analysis of complex fault dynamics. GeoFEM is a parallel finite-element analysis system intended for solid earth field phenomena problems. This paper describes recent development in the GeoFEM project for the simulation of earthquake generation and cycles.

The medicine and epidemiology of bovine respiratory disease in feedlots

Bovine Respiratory Disease (BRD) results from a complex, multifactorial interaction of stressors, animal susceptibility, and respiratory pathogens. The infectious agents associated with BRD are ubiquitous among cattle populations. Typically, one or a combination of stressors are necessary to initiate BRD. Prevention of BRD should, therefore, address management procedures to minimise stressors. Administration of vaccines against BRD agents may help reduce the incidence of BRD but is unlikely to eliminate the condition. The effectiveness of antimicrobials in the treatment of BIRD depends primarily on early recognition and treatment. The use of antioxidant vitamins, minerals or other agents in the prevention and treatment of BRD warrants further research.

3: Rehabilitation principles for treating chronic musculoskeletal injuries

Evaluation of patients for rehabilitation after musculoskeletal injury involves identifying, grading and assessing the injury and its impact on the patient's normal activities. Management is guided by a multidisciplinary team, comprising the patient, doctor and physical therapist, with other health professionals recruited as required. Parallel interventions involving the various team members are specified in a customised management plan. The key component of the plan is active mobilisation utilising strengthening, flexibility and endurance exercise programs. Passive physical treatments (heat, ice, and manual therapy), as well as drug therapy and psychological interventions, are used as adjunctive therapy. Biomechanical devices or techniques (eg, orthotic devices) may also be helpful. Coexisting conditions such as depression and drug dependence are treated at the same time as the injury. Effective team communication, simulated environmental testing and, for those employed, contact with the employer facilitate a staged return to normal living, sports and occupational activities.

Analysis of antidiarrhoeic effect of plants used in popular medicine

People customarily use the extracts of plants known to have antidiarrhoeal effects without any scientific base to explain the action of the extract. For this reason, an investigation was undertaken with a view to determining the efficacy of the effects of the brute aqueous extract (BAE) of the leaves of Psidium guajava (guava), Stachytarpheta cayenensis (bastard vervain), Polygonum punctatum (water. smartweed), Eugenia uniflora (Brazil or Surinam cherry) and Aster squamatus (zé-da-silva) on the intestinal transport of water in rats and on the gastrointestinal propulsion in mice. With the exception of the BAE of S. cayenensis, all other BAE's have increased the absorption of water in one or more intestinal portion in relation to the control group. All tested BAE, except that of P. punctatum, reduced the gastrointestinal propulsion in relation to that of the control group. The results indicate that the BAE of the leaves of P. guajava, S. cayenensis, P. punctatum, E. uniflora and A. squamatus have a potential antidiarrhoeic effect to be confirmed by additional investigations in animals infected with enteropathogenic agents.