[Legal framework of the medical profession and of the neurology speciality]

The law on the general organization of Health Care Professionals (GOHCP) and the Framework Statute make up a new regulatory framework for the practice of medicine, which is completed with the legal debate on the obligatory association to the medical college, pending in the Constitutional Court based on certain regional legal developments. The GOHCP defines the functions of the different professions according to degree, establishes a public registry of physicians, converts the obligation of practicing according to the state of the art into law and updates the training, introduces the Resident core training program and opens the door to superspecialities. It also regulates the professional career, in order to establish a common body of four grades to which the health services can add a fifth one with previous character. Among the novelties of the Framework Statute, there is extensive updating of the offences and sanctions -- that include aspects such as work harassment and adaptation of the workday to the European guidelines, so that the maximum workday is established in 48 hours per week and the complementary (having a voluntary character) cannot exceed 150 hours per year. Lowering retirement age to 65 years foreseen in this guideline will require planning of human resources and has already generated suits in the courts. The obligatory nature of belonging to the medical college has also been modified, this time by some guidelines on the regional level. They would require a decision by the Constitutional Court on whether the college members can be exempted in some cases.

Recommendations of the International Medical Informatics Association (IMIA) on education in health and medical informatics

The International Medical Informatics Association (IMIA) agreed on international recommendations in health informatics / medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop existing educational activities in the various nations and to support international initiatives concerning education in health and medical informatics (HMI), particularly international activities in educating HMI specialists and the sharing of courseware. The IMIA recommendations centre on educational needs for health care professionals to acquire knowledge and skills in information processing and information and communication technology. The educational needs are described as a three-dimensional framework. The dimensions are: 1) professionals in health care (physicians, nurses, HMI professionals, ...), 2) type of specialisation in health and medical informatics (IT users, HMI specialists) and 3) stage of career progression (bachelor, master, ...). Learning outcomes are defined in terms of knowledge and practical skills for health care professionals in their role (a) as IT user and (b) as HMI specialist. Recommendations are given for courses/course tracks in HMI as part of educational programs in medicine, nursing, health care management, dentistry, pharmacy, public health, health record administration, and informatics/computer science as well as for dedicated programs in HMI (with bachelor, master or doctor degree). To support education in HMI, IMIA offers to award a certificate for high quality HMI education and supports information exchange on programs and courses in HMI through a WWW server of its Working Group on Health and Medical Informatics Education (http://www.imia.org/wg1).

A gower maneuver: the American Society for Bioethics and Humanities' resolution of the "Taking Stands" debate

The American Society for Bioethics and Humanities debated for several years about whether it should adopt positions and, if so, on what range of issues. The membership recently approved an amendment to its bylaws permitting the Society to adopt positions on matters related to academic freedom and professionalism but not on substantive moral and policy issues. This resolution is problematic for a number of reasons, including the lack of a categorical difference between these types of claims and the Society's inability to speak on behalf of patients and research subjects. The implementation of the amendment also raises several issues. The Society will need to refrain from speaking too specifically and to articulate the responsibilities of its members. If the Society fails to address these concerns, it runs the risk of denigrating its public image and that of the profession.

Medical Considerations in the Use of Helicopters in Mountain Rescue

The outcome of patient care can be dramatically improved by bringing rapid rescue and medical care to the mountain rescue scene and by rapid transport to a medical facility. The use of a helicopter for these purposes is common. It is necessary when it has clear advantages for victims in comparison with ground rescue and transport. Helicopters should work within the existing emergency medical system and must be staffed by appropriate mountain rescue and medically trained personnel. Activation time should be as short as possible. Activation of a helicopter for a mountain rescue should primarily include indication and assessment of flight and safety conditions. No other mediators or delaying factors should be permitted. The main safety criteria are appropriate mountain rescue and flight training, competence of air and ground crews, radio communication between the air and ground crews, and mission briefing before the rescue. Criteria for a helicopter used for mountain rescue are proper medical and rescue equipment, load capacity, adequate space, and others. There are two main groups of indications for use of a helicopter for mountain rescue: the patient's condition and the circumstances at the site of the accident. All persons responsible for the activation of the helicopter rescue operation should be aware of specific problems in the mountains or wilderness.

Historical review of RF exposure standards and the International Committee on Electromagnetic Safety (ICES)

Focused research on the biological effects of exposure of humans and animals to radio frequency (RF) and microwave energy goes back at least five decades. The history of committees that develop safety standards based on the results of this research goes back almost as far. One such committee that has played a major role in developing such standards is the International Committee on Electromagnetic Safety (ICES), which began in 1960 as the American Standards Association C95 Committee. This paper briefly reviews the history of this committee and its role in the development of RF safety standards. The process now being followed by ICES and its sponsor, the IEEE Standards Association Standards Board (SASB), is discussed, as are a number of issues related to standards setting, such as the poor quality of much of the research and the seemingly endless speculation and search for mechanisms of interaction other than heating. Finally, a tribute is given to Dr. Eleanor Adair, a long-time researcher and supporter of science-based standards. As Chairman of ICES, she makes it clear that her goal and the goal of ICES is to establish rational standards that will make future beneficial applications of RF energy credible to humanity.

Health and Safety Advisory Committee (HASAC) of the International Embryo Transfer Society (IETS) has managed critical challenges for two decades

The International Embryo Transfer Society (IETS) was founded in 1974. Early members used the society as a forum for the exchange of scientific and technical information relevant to a newly emerging embryo transfer industry. The impact that embryo transfer could have on the international trade of livestock genetics was clear by 1982, so the IETS commissioned the Import/Export Committee. The initial challenge for this Committee was to deal with concerns about disease transmission via embryo transfer. Many of the early concerns have been dispelled, but at the time they threatened the continued development of a fledgling industry. Over the past two decades, many new critical challenges have been met and managed by this Committee, which was recently renamed the Health and Safety Advisory Committee (HASAC). Assessing risks of animal disease transmission via reproductive technologies and establishing protocols for managing these risks are still major issues for HASAC. However, additional concerns have developed as views of the society changed and as novel applications of biotechnology in farm animals were identified. This paper is intended to chronicle some of the major changes and challenges that were managed by members of the HASAC and its Subcommittees from the early years of embryo transfer to the current millennium with technological advances in molecular biology.

The present ICRP protection quantitites are seriously flawed. Opposing the proposition

Our debaters have agreed to defend positions that appear to be diametrically opposed; nevertheless, they have acknowledged some common ground. Although it was not explicitly stated, they would no doubt agree that workers and the public are adequately protected by our present system of radiation regulations. Our debaters have overtly agreed that it would be desirable to have measurable radiation protection quantities. Whether or not this is advantageous, or even possible, will depend upon which argument swayed your opinion. The ICRP is presently examining its recommendations and will, over the next few years, update those recommendations. Therefore, the contributions of our debaters will surely be relevant to this process.

[Limited relevance of veterinary disciplinary regulations]

After several years of pressure on the part of the KNMvD to establish disciplinary regulations for veterinarians, these were at last incorporated in the Veterinary Practice Act of 1992. This article discusses the extent to which veterinary disciplinary regulations actually meet the expectations of legislators. On the basis of an investigation of the parliamentary passage of the Act, the flood of complaints before disciplinary judges, the nature and magnitude of jurisprudence of the veterinary disciplinary committee, and interviews with those involved, it would appear that results are disappointing. These disappointing results, in particular the one-sided emphasis on companion animals and the continuing misunderstanding about the prescription of veterinary medicines, lead to the conclusion that veterinary disciplinary regulations are currently of limited relevance. The authors consider that insufficient use is made of the potential of disciplinary measures to contribute to the monitoring of the quality of veterinary practice and give recommendations about this.

The Italian way to Continuing Education in Medicine

BACKGROUND

Continuing education is a right and a duty for all professionals working in the healthcare system, and the Ministry of Health, has recently developed and introduced an experimental program for Continuing Education in Medicine (ECM) throughout Italy.

METHODS

The guiding principles and values of ECM are to assure the quality of educational events and to ensure that professionals can choose from among several opportunities for gaining credits. Although promoted by regional healthcare authorities, the educational program must be homogeneous throughout the national territory.

RESULTS

Over the last few months, the National Commission for ECM has defined the role and responsibilities of different organisms and authorities involved in the ECM program. Each professional is expected to gain a total score of at least 150 credits over a 5-year timespan. Moreover, the Commission has established criteria for the accreditation of educational initiatives, the verification of their quality, and the evaluation of the educational benefit participants have from them.

CONCLUSIONS

The ECM program in Italy is here to stay. It provides professionals with the opportunity to improve the quality of their knowledge, competence, and skills. Medical associations can now reevaluate their role and commitment to improving the quality of healthcare by providing all professionals with a better education and qualifications.

The Glaxo Award: is the American Public Health Association moving toward corporate governance?

The author, member of the American Public Health Association, questions the wisdom of the association's accepting donations from corporate sponsors, whose primary responsibility is not to public health but to their stockholders.

Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care

An Expert Working Group was convened under the auspices of the Steering Committee of the Research Network of the European Association of Palliative Care to review the status of the use of pain measurement tools (PMTs) in palliative care research conducted in a multilingual-multicenter setting. Based on a literature review and on the experts' opinion, the present work recommends that standardized methods should be applied for the use of PMTs in research in palliative care. Visual analogue scales, numerical rating scales, and verbal rating scales are considered valid to assess pain intensity in clinical trials and in other types of studies. Among the multidimensional questionnaires designed to assess pain, the McGill Pain Questionnaire and Brief Pain Inventory are valid in many multilingual versions. Specific recommendations for PMT use and administration, depending on the study type and aim, are reviewed. Special population requirements specific of clinical situations encountered in palliative care (elderly, terminal, cognitively impaired patients, pediatric patients) are also considered.

Future directions in engineering ethics research: microethics, macroethics and the role of professional societies

Three frames of reference for engineering ethics are discussed--individual, professional and social--which can be further broken down into "microethics" concerned with individuals and the internal relations of the engineering profession and "macroethics" referring to the collective social responsibility of the engineering profession and to societal decisions about technology. Few attempts have been made at integrating microethical and macroethical approaches to engineering ethics. The approach suggested here is to focus on the role of professional engineering societies in linking individual and professional ethics and in linking professional and social ethics. A research program is outlined using ethics support as an example of the former, and the issuance of position statements on product liability as an example of the latter.

Complementary therapies courses for the 21st century

Over the past 5 years, an innovative portfolio of degrees in complementary therapies has been developed at the University of Westminster. Most of the degrees were the first of their kind in the UK, and the provision is now the widest range of complementary therapies courses in Europe. With an intake of 80 students in 1996, the provision has grown rapidly to a total of over 500 in 2000. The opening of the unique multidisciplinary Polyclinic in 1998 marked the beginning of an exciting clinical training and research dimension. The context that has lead to the growth of mainstream higher education provision of complementary therapies is explored. The current offer is reviewed, and criteria for degree provision and the role of the professional bodies discussed. The development of the University of Westminster's provision is described, including the early collaboration with established providers, design, influence of nursing and midwifery, experiences with the professional bodies, development of the unique Polyclinic and the plans for the future.

Need for comprehensive women's health continuing medical education among primary care physicians

BACKGROUND

The Council on Graduate Medical Education's (COGME) Fifth Report on Women and Medicine states that "changes in undergraduate and graduate medical education, in addition to continuing medical education, are needed to address adequately the comprehensive health needs of women." Primary care physicians (PCPs) who completed residency training prior to the establishment of new guidelines for women's health education are dependent on continuing medical education (CME) to update their knowledge and skills.

METHODS

Primary care physicians attending a university-based CME program in family medicine were surveyed (n = 300) about their need for CME in women's health topics. Responses were analyzed using chi-square analysis and Pearson correlations. Topics of interest were compared with women's health competencies published in 1997 by the American Board of Internal Medicine (ABIM) and in 1997 by the American Academy of Family Physicians (AAFP).

RESULTS

Of 30 women's health topics listed, 22 were of interest to 50% or more of respondents and 11 were of very high interest (p < .05). Respondents most interested in women's health CME were most likely to believe CME would reduce the number of referrals currently required to evaluate women's breast problems. Topics of interest also align well with ABIM and AAFP competencies in women's health. CME in comprehensive women's health care is therefore of high interest to our respondents and topics of greatest interest are identified.

IMPLICATIONS

Areas of interest correlate well with new requirements by ABIM and AAFP and should be targeted by CME programs.

Ethical guidance in the era of managed care: an analysis of the American College of Healthcare Executives' Code of Ethics

Market competition and the rise of managed care are transforming the healthcare system from a physician-dominated cottage industry into a manager-dominated corporate enterprise. The managed care revolution is also undermining the safe-guards offered by medical ethics and raising serious public concerns. These trends highlight the growing importance of ethical standards for managers. The most comprehensive ethical guidance for health service managers is contained in the American College of Healthcare Executives' (ACHE) Code of Ethics. An analysis of the ACHE Code suggests that it does not adequately address several ethical concerns associated with managed care. The ACHE may wish to develop a supplemental statement regarding ethical issues in managed care. A supplemental statement that provides more specific guidance in the areas of financial incentives to reduce utilization, social mission, consumer/patient information, and the health service manager's responsibility to patients could be extremely valuable in today's complex and rapidly changing environment. More specific ethical guidelines would not ensure individual or organizational compliance. However, they would provide professional standards that could guide decision making and help managers evaluate performance in managed care settings.

Dissatisfaction is high--but we're listening

Results of the membership services survey conducted at the 19th conference of the HIMAA, Brisbane, October 1998

Culturally competent research: an ethical perspective

This article addresses the perspective of the Ethical Principles and Guidelines for Providers regarding issues affecting research with ethnic minority populations. Issues such as failure to report or give informed consent to research participants, lack of diversity among researchers, inappropriate study of ethnic minority populations, and culturally insensitive assessment instruments are discussed. Examples of recommended responsibilities and criteria for culturally competent research are provided, including increased involvement of minorities in research, both as investigators and concerned citizens. In sum, the recommendations address the larger problem of failure to acknowledge people in their cultural context. Finally, implications for the Ethical Principles and Guidelines for Providers are considered.