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PubMed2001

Ethics seminars: beyond authorship requirements-ethical considerations in writing letters of recommendation.

Letters of recommendation may serve a number of vital functions related to the evaluation, selection, and promotion of candidates. The lure of academic celebrity or the desire of an individual candidate for a flattering letter must not threaten the veracity of the content. Letters of recommendation should be appropriately authored to meet the needs of the institution or individual requesting the letter, while keeping authenticity paramount. Length and content should be complete but not overly verbose. Relevant elements suggested by standardized formats should typically be included, such as nature of contact with the applicant, commitment to emergency medicine, work ethic, ability to develop a differential and treatment plan, personality, interpersonal interactions, and an overall comparative ranking. The seven cardinal elements of an exemplary letter of recommendation are that it should be: 1) authentic (based on adequate first-hand knowledge of the candidate's skills); 2) honest (accurate; avoiding exaggeration or hyperbole); 3) explicit (avoidance of veiled omissions); 4) balanced (taking care to incorporate both strengths and weaknesses); 5) confidential (avoiding unnecessary or unanticipated disclosure); 6) of appropriate detail and length (content relevant to the institutional or individual requests); and 7) technically clear (avoidance of unnecessary abbreviations and jargon). The implied duty to future students, colleagues, researchers, and patients who might come in contact with the applicant should motivate authors to write honest, explicit, appropriate, and complete letters.

Authorship↗

PubMed2002

The effect of computer-assisted prescription writing on emergency department prescription errors.

OBJECTIVE: To determine whether computer-assisted prescription writing reduces the frequency of prescription errors in the emergency department (ED). METHODS: A pre-post retrospective analysis was used to compare errors between handwritten (HW) and computer-assisted (CA) ED prescriptions. Prescriptions were reviewed for pharmacist clarifications. A clarification was defined as an error if missing information, incorrect information, incorrect dose, non-formulary medication, or illegibility was the reason for clarification. The HW and CA error rates were compared using odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: During the pre-intervention period, there were 7,036 patient visits with 2,326 HW ED prescriptions filled for 1,459 patients. There were 91 clarifications, with a rate of 3.9%. There were 54 HW errors, for an error rate of 2.3%. During the post-intervention period, there were 7,845 patient visits with 1,594 CA prescriptions filled for 1,056 patients. There were 13 clarifications, with a clarification rate of 0.8%, and 11 errors, for a CA error rate of 0.7%. The CA prescriptions were substantially less likely to contain an error [OR 0.31 (95% CI = 0.10 to 0.36)] or to require pharmacist clarification [OR 0.19 (95% CI = 0.10 to 0.36)] than were the HW prescriptions. CONCLUSIONS: Computer-assisted prescriptions were more than three times less likely to contain errors and five times less likely to require pharmacist clarification than handwritten prescriptions.

Clinical Pharmacy Information Systems↗

PubMed2006

An evaluation of matching unknown writing inks with the United States International Ink Library.

Utilizing a database of standards for forensic casework is a valuable resource. Undoubtedly, as more standards (and corresponding information about the specimens) are collected, there is a greater certainty of identification when a questioned and a known item cannot be distinguished after a series of analyses. The United States Secret Service and the Internal Revenue Service National Forensic Laboratory jointly maintain the largest known forensic collection of writing inks in the world, which is comprised of over 8500 ink standards collected worldwide, dating back to the 1920s. This study was conducted to evaluate the reliability of matching arbitrarily purchased pens with known inks from a database. One hundred pens were randomly obtained from a variety of sources and their respective ink compositions were compared with standards. Eighty-five of the inks were determined to be suitable for comparison utilizing optical examinations and thin-layer chromatography. Three of the inks did not match any of the specimens on record; one of these inks was similar to an ink from an identical brand of pen that was in the database, but had a modified formulation.

Journal Article↗

PubMed2003

Should patient consent be required to write a do not resuscitate order?

Consent ought to be required to withhold treatment that is in a patient's best interests to receive. Do not resuscitate (DNR) orders are examples of best interests assessments at the end of life. Such assessments represent value judgments that cannot be validly ascertained without patient input. If patient input results in that patient dissenting to the DNR order then individual physicians are not justified in overriding such dissent. To do so would give unjustifiable primacy to the values of the individual physician. Therefore patient consent is effectively required to write a DNR order. Patient dissent to a DNR order should trigger a fair process mechanism to resolve the dispute.

Aged↗

PubMed2000

Information age testing: making rigorous exams fun to write and easy to grade.

This essay discusses methods by which an exam writer can achieve three objectives: 1) producing questions that test a student's understanding, defined as the ability to apply knowledge in a novel context; 2) writing questions that require minimal grading time; and 3) keeping current and excited about the field, which is critical for transmitting personal enthusiasm to students. Included are descriptions of practical, time-saving methods for processing and filing examination material; ways to use readily available databases for quickly generating rigorous, interesting questions, with examples of questions generated in this way; suggestions for structuring questions so that they are easily graded; and general advice for preparing students to take this kind of examination.

Databases, Factual↗

PubMed1986

Direct-writing recorder of the frequency dependence of dynamic compliance analyzed from one cycle of breathing and pulmonary resistance: effect of fenoterol on asthmatic subjects.

We developed a new method of direct-writing recording of the frequency dependence of dynamic compliance analysed from one cycle of breathing and pulmonary resistance. Both pulmonary resistance (RL) and frequency dependence of dynamic compliance (Cdyn.f) are calculated by Fourier-series analysis of flow and transpulmonary pressure in a single cycle of breathing. RL was obtained from fundamental harmonics. Cdyn.f was calculated from 1st and 2nd harmonics and estimated by the ratio of Cdyn at 0.5 Hz to Cdyn at zero frequency, C0.5/C0. We used fenoterol aerosol which contained 0.2 mg of fenoterol with one puff of aerosol. Two puffs of fenoterol aerosol were used in each subject and followed changes of RL, C0 and C0.5 as long as 30 min. After fenoterol inhalation RL decreased considerably and C0.5/C0 cont [C0.5/(control C0)] increased. With time, while RL was kept stable, C0.5/C0 cont increased further. We suggest that fenoterol has a potent effect on the small airways which is enhanced with time.

Administration, Inhalation↗

PubMed2002

Criticism of authority in the writings of Moses Maimonides and Fakhr Al-Dīn Al-Rāzī.

Criticism of authority was a prominent feature of medieval philosophical writing. In this study the critiques of two contemporaneous scholars, Moses Maimonides and Fakhr al-Dīn al-Rāzī, are compared. Maimonides criticized Hellenistic authorities, mainly Aritotle. However, the starting point for his critique was Aristotle's admission of the limitations of his own inquiries. Maimonides admired Aristotle's questioning of his own conclusions, indeed, his own thought was characterized by constant selfdoubt. Al-Rāzī criticized an earlier Muslim scholar, Ibn Sinā (Avicenna), an intellectual giant whose imprint was strongly felt in philosophy and medicine. Al Rāzī used his commentaries on a number of Ibn Sīnā's books as a stage for criticizing the master and for arguing for his own, alternative viewpoints.

Arab World↗

PubMed2004

Writing about patients: I. Ways of protecting confidentiality and analysts' conflicts over choice of method.

Thirty American psychoanalysts who have published articles using clinical material from their patients were interviewed about their method for ensuring confidentiality. Almost twice as many analysts chose to disguise material as regularly requested permission for the use of patients' material. The other analysts in the sample varied their approach, depending on circumstances, between using disguise alone and using disguise but also requesting consent. Methods of disguise, the timing of request for permission in relation to the phase of analysis, and changes in analysts' ideas about the benefits and detrimental effects of these choices are discussed and illustrated. Each decision is reconsidered in light of its potential effect on patients and their analysis. The dilemma posed by the importance of writing about patients for the health and growth of psychoanalysis as a field and the potential negative consequences for patients and their analyses is considered.

Choice Behavior↗

PubMed1990

The transference neurosis in Freud's writings.

This paper reviews the evolution of the concept of transference neurosis in Freud's writings. It suggests that the language in which the concept of the transference neurosis is originally expressed by Freud includes an idea of the analyst as aggressively pursuing the analytic cure by waging a solitary battle against the patient's disease. With the representation of the death drive and the larger role accorded to sadism as its external manifestation in Freud's revised drive theory of 1920, the patient becomes the ally; resistance, in the sense of the conservative forces, not disease, in the sense of libidinal conflict, becomes the enemy. It is thus difficult to speak of a transference neurosis in the circumscribed way Freud originally meant it, and he ceased to use the term after 1926 rather than redefine it to fit his broader perspective. In this broader perspective, relative resolution of conflict replaced radical liberation of the patient from disease. That Freud did not redefine the term does not imply that he discarded it, or that we necessarily should. This paper suggests that Freud implied a functional distinction between transference as transforming agent and transference neurosis as result of that transformation. That distinction defines psychoanalytic cure in terms of the understanding of a symbolic transformation which is, through the transference neurosis, reexperienced as part of the psychoanalytic process.

Countertransference↗

PubMed2001

Social constructions of femaleness in writing about cancer.

This article uses a qualitative content analysis of writing about cancer since 1900, with numeric summaries from Medline/PubMed searches, to propose that there is an implicit reliance in biomedicine on the idea that femaleness is pathological hence carcinogenic. Numeric summaries of rates of use of search terms for men and women and their sexual attributes are a backdrop for text sources that illustrate a greater tendency to see women in sexual terms and pathologize aspects of femaleness. This even extends into more frequent use of the term estrogen than testosterone in exclusively male cancer sites such as prostate and testicle. The analysis suggests that female focus and pathologization of femaleness come from social sex differentiation, heterosexual bias, and objectification of women as sex objects. This may be detrimental to both women and men because these social constructions may have focused cancer research on social classifications that are not physically relevant.

Bibliometrics↗

PubMed1992

A computerized intensive care unit order-writing protocol.

OBJECTIVE: To present a computerized intensive care unit order-writing protocol. DESIGN: Descriptive report. SETTING: Eight-bed surgical intensive care unit, Department of Surgery, Department of Veterans Affairs Medical Center, Bronx, NY. METHODS: IBM-based, computer network program that provides user-friendly, logical, and comprehensive organ-system order sequences for patient management. RESULTS: Since July 1988, an order program that stresses (1) improved and more efficient patient care, (2) the use of program-integrated automatic safety features, (3) the substitution of computer entry for handwriting, and (4) the assurance that physicians deliver obligatory care in a logical organ-system-based progression has been implemented. CONCLUSIONS: The order protocol system presented is simple to introduce and operate, has minimal training and technical requirements, and is demonstrably reliable.

Computer Security↗

PubMed1985

The denial of the institution. A critical review of Franco Basaglia's writings.

The writings of Franco Basaglia are critically reviewed, both from a technical psychiatric point of view and from a general political and social one. Basaglia maintained that the causes of psychiatric disorder are essentially social in nature, and that the only valid treatments are political struggle and the revival of the patient's aggressiveness. Therefore, no institution can be therapeutic for the patient, since its aim must be his custody and violent destruction. These statements are considered in the light of the need for institutions which are a therapeutic alternative to the mental hospital. Basaglia's 'liberal' defence of the individual against society is analysed, in relation to the negative consequences that the Italian Law 180 of 1978 is having on the care of long-term psychiatric patients. This law 'forgot' such patients, as well as adversely affecting the treatment of acute patients, for whom an insufficient number of psychiatric beds was permitted in general hospitals. A revision is proposed of Law 180 that would make possible the setting up of alternative institutions to outdated mental hospitals, but at the same time allow a transformation of their old structures.

Economics↗

PubMed2003

Reading, writing, and modulating genetic information with boranophosphate mimics of nucleotides, DNA, and RNA.

The P-boranophosphates are efficient and near perfect mimics of natural nucleic acids in permitting reading and writing of genetic information with high yield and accuracy. Substitution of a borane (-BH3) group for oxygen in the phosphate ester bond creates an isoelectronic and isosteric mimic of natural nucleotide phosphate esters found in mononucleotides, i.e., AMP and ATP, and in RNA and DNA polynucleotides. Compared to natural nucleic acids, the boranophosphate RNA and DNA analogs demonstrate increased lipophilicity and resistance to endo- and exonucleases, yet they retain negative charge and similar spatial geometry. Borane groups can readily be introduced into the NTP and dNTP nucleic acid monomer precursors to produce alpha-P-borano nucleoside triphosphate analogs (e.g., NTPalphaB and dNTPalphaB). The NTPalphaB and dNTPalphaB are, in fact, good to excellent substrates for RNA and DNA polymerases, respectively, and allow ready enzymatic synthesis of RNA and DNA with P-boranophosphate linkages. Further, boranophosphate polymer products are good templates for replication, transcription, and gene expression; boronated RNA products are also suitable for reverse transcription to cDNA. Fully substituted boranophosphate DNA can activate the RNase H cleavage of RNA in RNA:DNA hybrids. Moreover, certain dideoxy-NTPalphaB analogs appear to be better substrates for viral reverse transcriptases than the regular ddNTPs, and may offer promising prodrug alternatives in antiviral therapy. These properties make boranophosphates promising candidates for diagnostics; aptamer selection; gene therapy; and antiviral, antisense, and RNAi therapeutics. The boranophosphates constitute a versatile family of phosphate mimics for processing genetic information and modulating gene function.

Antiviral Agents↗

PubMed1982

Primary writing tremor: a selective action tremor.

Progressive difficulty in handwriting due to jerking movements precipitated by the act of writing beginning between the ages of 8 to 54 is reported in six patients. There was no rest tremor, but three had mild postural tremor. Specific muscle activity (especially pronation of the wrist or abduction of the fingers) elicited the tremors that persisted as long as the evocative posture or muscle activity was maintained. None had a family history of tremors, but two had a history suggestive of hypoxia at birth. Unlike benign essential tremor, the movements did not respond to propranolol HCl, but most patients were benefited both acutely and chronically by centrally active anticholinergic agents.

Adolescent↗

PubMed2005

Implementation of an intuitive writing interface and a laparoscopic robot for gynaecological laser assisted surgery.

The research reported in this paper aims at applying the human handwriting skill to improve and facilitate the control of laser-assisted laparoscopic surgery operations performed by gynaecological surgeons. For the purpose, a laparoscopic robot was interfaced with a digitizing tablet. This interface, further called the intuitive writing interface (IWI), directly converts the hand trajectory, handwritten on the tablet, into an input signal to the robot. It replaces the traditional complex manipulations performed by the surgeon during manual laparoscopic surgery by natural handwriting. It provides the surgeon with an intuitive 'what-you-draw-is-what-you-cut' control facility by employing his/her familiar handwriting skills to control the laser ablation process accurately. The system was successfully built and tested in vitro. Performance tests on the robot resulted in tracking errors in the order of 1 mm in the target plane at an ablation speed of 20 mm/s. The high accuracy of the system was successfully demonstrated by cutting characters 4 mm high on an apple. These results indicate that laser ablation performance is upgraded by the IWI to the accuracy levels of human handwriting, which is much higher than can be obtained with manual laser laparoscopy. Safety features include the use of pen contact with the tablet as a safety switch, and back drivability in the robot joints for easy manual positioning and evacuation in case of emergency.

Computer Peripherals↗

PubMed2000

Writing a case report: an editor's eye view.

'That was a nice presentation. Why not write it up for a journal?' With such words a thousand case reports are born. But they are like birds tossed over a stormy ocean: only a few gain a foothold in the rigging of passing ships--for the rest, oblivion. So, how do you persuade an editor to accept your wonderful case report? Here are some reflections from the editor's standpoint.

Evidence-Based Medicine↗

PubMed2001

How to write a critical letter and respond to one.

Critical letters are important. They correct the published record. To write a critical letter requires tact; to respond to one requires tact--and the humility that comes with the realisation that belief in an observation or an idea does not make it true.

Correspondence as Topic↗

PubMed1996

"Masculine love," Renaissance writing, and the "new invention" of homosexuality: an addendum.

Joseph Cady's recent article, "Masculine Love," Renaissance Writing, and the "New Invention' of Homosexuality," Journal of Homosexuality 23.1-2 (1992): 9-40, did much to shed new light on the controversial issue of whether homosexual identity is a relatively late phenomenon (late seventeenth- or early eighteenth-century at the earliest according to scholars of the "constructivist" persuasion) or already existed in the age of the Renaissance and before. Cady argues that homosexual identity is at least as old as the Elizabethan age, and cites from widely divergent sources several early modern instances of the term "masculine love," a term that seems to have been used exclusively to refer to the sexual preference of men for members of their own gender. The present note adds a further example to buttress Cady's case-namely the term "masculine conversation" from Arthur Wilson's History of Great Britain (1653), an account of the reign of James I (who was widely recognized to be sexually attracted to men). The term "conversation" often referred to sexual intercourse, being used in legal discourse to define adultery, and therefore constitutes an even more explicit example of denotative language than those Cady cites. Since Wilson discusses Sir Francis Bacon as well as James I, this brief article explores the historically documentable sexual preferences of these two figures in addition to that of the dramatist Christopher Marlowe and of Bacon's brother Anthony, a diplomat, all of whom seem to have been strongly oriented to "masculine love" and "masculine conversation".

Historiography↗