Saturday, July 23, 2011

BioMed Central

BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model

All original research articles published by BioMed Central are made freely and permanently accessible online immediately upon publication. BioMed Central views open access to research as essential in order to ensure the rapid and efficient communication of research findings.

The research articles in all journals published by BioMed Central are 'Open Access'. They are immediately and permanently available online without charge. A number of journals require an institutional or a personal subscription to view other content, such as reviews or paper reports. Free trial subscriptions to these journals are available.

DOAJ -- Directory of Open Access Journals

Free, full text, quality controlled scientific and scholarly journals, covering all subjects and many languages.

The proliferation of freely accessible online journals, the development of subject specific pre- and e-print archives and collections of learning objects provides a very valuable supplement of scientific knowledge to the existing types of published scientific information (books, journals, databases etc.). However these valuable collections are difficult to overview and integrate in the library and information services provided by libraries for their user constituency. 

Allergy and Immunology (30 journals) 
Anesthesiology (14 journals) 
Cardiovascular (73 journals) 
Dermatology (23 journals) 
Gastroenterology (38 journals) 
Gynecology and Obstetrics (36 journals) 
Internal medicine (269 journals) 
Neurology (105 journals) 
Oncology (77 journals) 
Ophthalmology (26 journals)

Otorhinolaryngology (20 journals) 
Pathology (36 journals) 
Pediatrics (58 journals) 
Pharmacy and materia medica (77 journals) 
Psychiatry (49 journals) 
Sports Medicine (20 journals) 
Surgery (87 journals) 
Therapeutics (84 journals) 
Urology (26 journals)

Journal of Medical Internet Research

The "Journal of Medical Internet Research" (JMIR; ISSN 1438-8871, Medline-abbreviation: J Med Internet Res), founded in 1999, is a leading health informatics and health services/health policy journal (ranked first by impact factor in these disciplines). JMIR was the first open access journal covering health informatics, and the first international scientific peer-reviewed journal on all aspects of research, information and communication in the healthcare field using Internet and Intranet-related technologies; a broad field, which is nowadays called "eHealth" [see also What is eHealth and What is eHealth (2)]. This field has also significant overlaps with what is called "consumer health informatics.", health 2.0/medicine 2.0, or participatory medicine. This focus makes JMIR unique among other medical or medical informatics journals, which tend to focus on clinical informatics or clinical applications. As eHealth is a highly interdisciplinary field we are not only inviting research papers from the medical sciences, but also from the computer, behavioral, social and communication sciences, psychology, library sciences, informatics, human-computer interaction studies, and related fields. Manuscripts are invited which deal for example with

  • studies evaluating the impact of Internet use or specific eHealth interventions on individual health-related or social outcomes
  • descriptions of the design and impact of Internet applications and websites for consumers/patients or medical professionals
  • use of the Internet in the context of clinical information and communication, including telemedicine
  • use of the Internet in medical research and the basic sciences such as molecular biology or chemistry (e.g. bioinformatics, online factual databases)
  • medical information management and librarian sciences
  • e-learning and knowledge translation, online-courses, web-based programs for undergraduate and continuing education,
  • eHealth applications for public health and population health technology (disease monitoring, teleprevention, teleepidemiology)
  • evidence-based medicine and the Internet (e.g. online development or dissemination of clinical guidelines, measuring agreement about management of a given clinical problem among physicians, etc.)
  • the impact of eHealth, the Internet, or health care technology on public health, the health care system and policy
  • methodological aspects of doing Internet research, e.g. methodology of web-based surveys
  • design and validation of novel web-based instruments
  • analysis of e-communities or virtual social networks
  • comparisons of effectiveness of health communication and information on the Internet compared with other methods of health communication,
  • effects of the Internet and information/communication technology on the patient-physician relationship and impact on public health, e.g. the studies investigating how the patient-physician relationship changes as a result of the new ways of getting medical information
  • ethical and legal problems as well as cross-border and cross-cultural issues of eHealth
  • systematic studies examining the quality of medical information available in various online venues
  • methods of evaluation, quality assessment and improvement of Internet information or eHealth applications
  • proposals for standards in the field of medical publishing on the Internet, including self-regulation issues, policies and guidelines to provide reliable healthcare information
  • results and methodological aspects of Internet-based studies, including medical surveys, psychological tests, quality-of-life studies, gathering and/or disseminating epidemiological data, use of the Internet for clinical studies (e-trials), drug reaction reporting and surveillance systems etc.
  • electronic medical publishing, Open Access publishing, and use of the Internet for traditional scholarly publishing (e.g. collaborative peer review)
  • information needs of patients, consumers and health professionals, including studies evaluating search and retrieval behavior of patients
  • web-based studies, e.g. online psychological experiments
  • evaluations of mhealth (mobile) applications, as well as ambient / ubiquitous computing approaches, sensors, domotics, and other cutting edge technologies

Friday, July 22, 2011

Why Would Anyone Choose to Become a Doctor? -

You hear it all the time from doctors — they would never choose medicine if they had it to do all over again. It's practically a mantra, with the subtle implication that the current generation of doctors consists of mere technicians.

When I first started in practice, I found such comments both perplexing and annoying. I loved medicine and was excited to come to work every day. I considered those naysayers jaded has-beens, fusty old-timers pining away for the nonexistent "days of the giants."

However, as the years have passed, the warts of medicine have grown more conspicuous to me. During some of the more stressful days — crushed by impossible time constraints and ever more onerous bureaucratic demands — I can't deny that the thought of giving up clinical practice has crossed my mind. Life would be so much easier….

Yet, each year, a new wave of enthusiastic medical students floods our clinics and our wards. Part of me always wonders: Why do these students still choose to become doctors?

It certainly can't be the money — Wall Street is the faster and more reliable route to wealth, as evidenced by the skyrocketing of applications to M.B.A. programs.

Applications to medical schools, surprisingly, have held steady over all, despite an exodus of top students to finance and banking. According to the American Association of Medical Colleges, about 40,000 students apply to medical school each year, with some 17,000 matriculating. (For comparison, there are about 45,000 students starting law school each year, and 100,000 starting business school.)

Incoming medical students, while steady in their numbers, have had a major shift in their demography. In 1970, medical students were nearly entirely white men. Now half are women, and a third are Asian, black or Hispanic.

I recently worked with a third-year student who'd just interviewed a patient with chest pain. The chest pain turned out to be nothing serious, just some acid reflux — a fairly ho-hum case in a medical clinic. But the student's eyes were ablaze with fervor. "This was such an exciting case," she said. "I had the chance to figure out whether or not the chest pain was life-threatening. And the patient was so happy when I reassured him that it wasn't."

The awe of discovering the human body. The honor of being trusted to give advice. The gratitude for helping someone through a difficult illness. These things never grow old.

But the frustrations of daily clinical life continue to mount. Administrative requirements increase exponentially, while the time allotted for the patient visit remains 15 to 20 minutes. The additional paperwork, electronic documentation, phone calls, insurance forms and quality assurance measures are all expected to be subsumed into the same workday.

I once tried to calculate how many thoughts a primary care doctor has to juggle on a given day. (My tabulations came to 550; you can read about it in an article I wrote for The Lancet.) We keep pushing so many more balls into the air that there's no doubt a few will fall. It's this feeling of not being able to do as good a job as I'd like that makes me consider walking away from clinical medicine. I can't countenance mediocrity, and I cringe whenever I feel that I can't get it all done.

But then I cringe when I think about what it would mean for patients if doctors walked away from medicine because of the frustrations.

On top of that, I have to wonder about the alternatives if I gave up clinical medicine — pushing papers, sitting in endless PowerPoint meetings, crunching numbers — and realize that I am lucky and immensely privileged to be able to work directly with patients.

When I close the door to the exam room and it's just the patient and me, with all the bureaucracy safely barricaded outside, the power of human connection becomes palpable. I can't always make my patients feel better, but the opportunity to try cannot be underestimated.

If I'm having a really rotten day in clinic, all I need is one of these new medical students to pop in, even if they make a long day even longer. The fact that medicine is still compelling enough for 17,000 people each year to commit a decade or more of their life to training is inspirational.

And when my students and I have our inevitable "career talk," I tell them that there is nothing else I'd rather do in my life than medicine. If I had it to do all over again, I'd end up right here in this office — telling them that there's nothing else I'd rather be doing.

Sunday, July 17, 2011

Patrolling Cancer’s Borderlands -

Three  recent events highlight the extraordinary task that lies ahead for cancer prevention.

First: in late May, a World Health Organization panel added cellphones to a list of things that are "possibly carcinogenic" — a category that also includes pickles and coffee.

Second: in mid-June, the National Toxicology Program, countering years of lobbying by certain industries, finally classified formaldehyde (used in plywood manufacturing and embalming) as a carcinogen.

And third: in late June, the Food and Drug Administration issued newer and more graphic warning labels for cigarette packages. These include deliberately disturbing images of a patient with mouth cancer and of a man with tobacco smoke coming out of a tracheotomy stoma.

What connects these events? Together, they serve to remind us of three of the most potent challenges that cancer-control agencies face today. Indeed, it is essential to recognize these events as representing a progression: each corresponds to a crucial stage in the process of patrolling the borderlands of cancer. Effective cancer control depends on successful action at each of these complex stages.

The first challenge is scientific. It concerns the complexity of identifying new carcinogens, and the need for consistent standards for doing so. Take the purported link between cellphone radiation and brain cancer. This link is based largely on the so-called Interphone study. In Interphone, men and women with a variant of brain cancer (called glioma) were asked to recall their level of exposure to cellphone radiation. The results, at first glance, were provocative. Men and women who recalled moderate phone use seemed to havedecreased rates of brain cancer compared to those who rarely used cellphones. In contrast, men and women with the highest usage seemed to have an increased rate of brain cancer.

But pivotal uncertainties remain. Trials like Interphone depend on the ability of subjects to recall their prior exposures. Such recollections can be surprisingly inconsistent. Indeed, when some subjects' actual phone use was logged, there were broad discrepancies between actual and reported usage.

There are other difficulties. Despite a drastic increase in cellphone usage over the past decades, there has been no significant change in glioma cancer rates across the nation. Perhaps it is too early to judge, but the enormous increase in phone usage should have caused at least a minor blip in glioma rates over 20 years — but no such increase is apparent.

And finally, the kind of radiation emitted by cellphones — unlike the radiation emitted by X-rays or nuclear bombs — cannot directly damage DNA. X-rays and nuclear radiation possess the energy required to alter genes and thereby cause cancer. But the frequency of cellphone radiation is more than a million-fold lower. If cellphone radiation is causing cancer, it is doing so through a mechanism that defies our current understanding of carcinogenesis.

Brain cancer is a devastating illness, and it's worth being cautious, but the current data supporting the link between phone radiation and glioma are weak. The cellphone case is a reminder of how difficult it is to identify a new carcinogen — and how important it therefore is to have standards to make such classifications possible.

Discrepancies in standards for classifying carcinogens have led to confusion and turmoil in the public realm. In contrast to the World Health Organization, many agencies, including the National Cancer Institute, remain skeptical about the link between phone radiation and cancer, and are awaiting more definitive studies to clarify the issue. In part, the problem is semantic: the W.H.O.'s definition of "possibly carcinogenic" is much looser; coffee and pickles are included, even though the evidence for their carcinogenicity remains weak. But the split between the W.H.O. and other agencies on cellphones — emblematic of the split within the scientific community — has had the unfortunate effect of confounding the public, which now does not know which faction to believe.

The second challenge facing cancer control agencies is political. The formaldehyde case illustrates this. Unlike phone radiation, formaldehyde has a well-established mechanism to cause cancer: it is a strikingly reactive chemical that can directly attack DNA. Experiments performed in the 1970s demonstrated that the chemical causes cancer in mice and rats. Following this data, sophisticated trials showed that men and women exposed to formaldehyde — morticians, for instance — had higher rates of leukemia than unexposed people.

But some of these studies were performed three decades ago. Why have 30 years elapsed between them and the National Toxicology Program announcement? In part, because of active lobbying by various industries, in particular, plywood manufacturers, who have tried to thwart this classification.

Identifying a carcinogen, in short, isn't sufficient. Beyond the science — which, as the cellphone example shows, can be hard enough — cancer-control agencies need to bolster political support, and neutralize lobbying interests, before a culprit carcinogen can be revealed to the public.

The third challenge for the cancer community is social. The F.D.A.'s new labels on cigarette packages are a case in point. The human trials that established that tobacco smoke is a carcinogen were initially performed in the mid-1950s (some even earlier). The tobacco industry mounted an aggressive campaign to discredit the data, and continued marketing tobacco to the public. The landmark Surgeon General's Report on smoking and cancer was released in 1964. And it took yet another decade of innovative strategies, including powerful antitobacco advertisements and tort cases against tobacco companies, to alter the trajectory of smoking behavior in America.

But young men and women in some parts of the nation are smoking again: consumption in certain regions has been rising, and cancer rates will rise concomitantly. Evidently, identifying a carcinogen or advertising the risk to the public is not enough: cancer-control agencies need to invent and reinvent strategies continuously. Old warning labels generate habitual responses, so new, more disturbing labels are needed to invigorate attention.

Patrolling the world for real carcinogens, in short, is a complex task. Scientific challenges morph into political challenges that lead to social challenges. If reducing the incidence of cancer is a national goal — as it surely must be — then it is essential to recognize the many-dimensional nature of countering carcinogens.

Siddhartha Mukherjee is an assistant professor of medicine at Columbia University and the author of "The Emperor of All Maladies: A Biography of Cancer."