Last year was an important year in the field of public health. In 2014, West Africa, particularly Sierra Leone, Liberia, and Guinea, experienced the worst outbreak of the Ebola virus in history, and with devastating effects. Debates around e-cigarettes and vaping became central, as more research was published about their health implications. Conversations surrounding nutrition and the spread of disease through travel and migration continued in the media and among experts.
We’ve chosen a selection of articles that discuss public health issues that arose in 2014, their effects on the present and implications for the future.
Header image: US specialist helping Afghan nomads by Sfc. Larry Johns (US Army). Public domain via Wikimedia Commons.
The post Public health in 2014: a year in review appeared first on OUPblog.
By Béla Büki
Benign paroxysmal positional vertigo (BPPV) is a very frequent cause of harmless but unpleasant vertigo and dizziness complaints. It is caused by dislodged otoconia floating into the semicircular canals, which measure angular accelerations of the head and initiate corrective eye movements during fast head movements. Otoconia are calcium-carbonate crystals functioning as weights in the miniature acceleration sensors in the inner ear, informing us about gravity and linear accelerations. If they fall into the canals, their erratic movements produce false information of angular accelerations when the head position is changed, and then we feel dizziness.
Currently, the diagnosis of BPPV depends on the presentation of jerking eye movements (nystagmus) in the provoking positions, for example head-hanging. Nystagmus is elicited when the fluid in the semicircular canal deflects the sensory cells by deforming the cupula, a soft diaphragm at one end of the canals. During the routine clinical examination of BPPV, the patient’s head is brought into hanging position (the “Dix-Hallpike maneuver”). Should there be any otoconia in the canal, this allows them and their movements to be registered by observing the elicited eye movements.
Last year, I tried to design a table about BPPV and its different forms when different semicircular canals are involved. Filling in the table, I noticed that a form that was probably very frequent had not been satisfactorily examined and explained in literature. I wondered what happens when otoconia dislodge but do not fall into the one of the semicircular canals. This might be a frequent scenario, if, for example, the patient is upright or the dislodged debris misses the canal openings. The debris should sink to the most inferior part, which is, by chance, the cupula, the structure housing the sensory cells of one of the canals, the inferior canal. The deflection of the cupula informs the nervous system about fluid movements in the canal, thereby measuring angular accelerations. When the otoconia fall into this space and attach themselves to the cupula, thereby loading it and causing chronic, unpleasant dizziness with every head movement, they, in fact should not cause any nystagmus when the patient is moved from sitting into the head hanging position. This is because the head hanging position does not change the position of the cupula at all.
I realized that I discovered a possible mechanism for a frequent type of BPPV, with typical positional complaints but without nystagmus. This variant, although frequently encountered, has not been acknowledged so far. In theory it should be frequent, because, when dislodged in upright position (not in sleep but during daily activities), the otoconia should sink into the most inferior part of the vestibulum (which are the sensory cells of the inferior canal). This concept has been mentioned (but not explained) in literature. In a recent paper, for instance, South Korean doctors wanted to recruit a hundred patients with a diagnosis of BPPV for a study about vitamin D. During selection, 84 patients who reported a typical history suggestive of BPPV but did not exhibit nystagmus were excluded. This would mean that in the paper, 40% of patients with typical BPPV symptoms may have had complaints elicited by the mechanism described above. Currently, according to the classical criteria, in these cases, no diagnosis was possible.
Since I had not previously matched the theory against the opinion of peer-reviewers, we included this theory in a chapter with a title “Controversial issues” that was published in Otology Neurotology, the journal of the American Otological Society.
When verified by other authors, these ideas will be accepted and it will be possible to make diagnosis in cases which seem to be mysterious today. Although not so dramatic as overt BPPV with nystagmus, the patients with slight, chronic BPPV complaints feel ill enough to see a doctor and these cases may be frequent, considering the how frequent BPPV is.
Béla Büki is an ENT-specialist at Krems County Hospital, Austria. He is co-author of Vertigo and Dizziness, and his special interests include otoacoustic emissions, electrocochleography, non-invasive intracranial pressure measurements and neurotology.
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Image: Vertigo 08018, by Nevit Dilmen. CC BY-SA 3.0. Public domain via Wikimedia Commons.
The post How medical publishing can drive research and care appeared first on OUPblog.
Few fields develop as rapidly as medicine, with new breakthroughs in research, tools, and techniques happening everyday. This presents an interesting challenge for many medical publishers — trying to get the latest information to students, practitioners, and researchers as quickly and accurately as possible. So we are delighted to present a Q&A with Associate Editorial Director of Medicine Books, Craig Panner. Craig began his career at Oxford University Press eight years ago, and currently works across Oxford University Press’s medicine titles. In the interview below, Craig talks not only about his role, but also the medical publishing landscape in general, both past and future.
Could you tell us about your position as Associate Editorial Director?
My role is something of an interdepartmental liaison between the Medicine UK office and the psychology and social work group here at Oxford University Press. Collectively, we all work very closely together and when you have departments on both sides of the Atlantic, I think it is imperative to maintain and promote open lines of communication which is what I strive to do on a daily basis. Additionally, as Associate Editorial Director, I am also the commissioning editor for neurology and neuroscience, a role which I not only love, but I think helps keep me connected to, and informed about, what the other commissioning editors encounter on a daily basis.
In your experience, what are some of the challenges of transitioning medical books to an online environment?
I think one of the biggest challenges is that everyone has ideas of what they want, what functionality they expect, and how to be able to use that material. But like many things, we can’t please everyone so it becomes a matter of identifying the greatest common need and how to meet those requirements. Another large challenge is that the online environment is a constantly moving target, if you will: new functionalities are introduced, the “it” product is rolled out, and other similar bells and whistles are discovered and customers often want that too. But when we’re talking about a platform product like Oxford Medicine Online and the huge amount of data that is available, it’s often too difficult to demonstrate why instant changes can’t be incorporated.
What was the state of medical publishing when you began your career vs. how it is done now?
When I started in the publishing world (as a proofreader) back in 1992, everything was print. I remember when the company received its first apple computer: it was kept in an open office and you had to sign up to book time to use it. And, oddly, it was never in use: everyone was more comfortable using the mimeograph machine and the typewriters by their desk. But, in about the next five or six years, the online explosion happened and journals suddenly became available electronically, first via consortia only, then as individual subscriptions, and then individual articles.
Could you discuss Oxford’s relationship with the Mayo Clinic, and how it has grown or changed over the years?
Mayo Clinic is the largest integrated, not-for-profit group practice in the world, with nearly 4000 physicians and scientists at their three primary sites in Minnesota, Florida, and Arizona. And given that Oxford University Press is the largest and oldest university press in the world, it seemed like a natural fit for the two organizations to work together. For almost five years now, Mayo Clinic and Oxford University Press have continued to work together to create, prepare, and disseminate medical reference works that any practicing clinician, anywhere in the world, would find useful for their continued professional development. When we first began working together, the Mayo Clinic Scientific Press series of books was predominantly print. But with the launch of Oxford Medicine Online, and the subsequent development of the Oxford eLearning Platform, the Mayo titles now have the added functionality of utilizing the questions and answers that accompany many of the Mayo Clinic Board Review books for a truly interactive experience that more fully prepares doctors preparing to take their board exam, as well as doctors maintaining their certification, in a real time environment.
What are some of the greatest challenges of medical publishing?
Everyone is busy and everyone works more than a 40-hour week. Finding the time to develop and undertake, much less publish, a medical text is a real juggling act. Thankfully, with the history of Oxford University Press and the quality publications that we produce, we are a trusted publishing house where authors and editors can go with confidence. Another challenge in medical publishing is the time that it takes to produce a work. Not only does it take a fair amount of time to develop, to write or collate chapters, and to deliver the work, but in the old days, it would take a year to publish a book. Medical research and techniques move far more quickly than that time-frame would permit which is why the Medicine group now publishes works between 3.5 months to 5.5 months from receipt. All to better meet the needs of our readers.
Where do you think medical publishing is headed in the future?
I wish I knew! The electronic environment will obviously play a huge role for the rest of my career but given that it, literally, changes daily and the needs and expectations of our readers changes with it, it is impossible to guess where things are going. And that’s what makes publishing so much fun. I can say that I think that immediate access to point of care information, along with suggested secondary and tertiary information will become second nature. The online environment won’t do the thinking for the clinician, but it will certainly supplement their decision making and knowledge base far more completely than anything that we’ve had previously.
How has the process of actually doing medical research changed over the years? In other words, how are people accessing the content then vs. now?
Medical research has definitely changed over the years. When I first started out, clinicians and researchers had offices lined with books and journals, filing cabinets filled with journal reprints, and personal databases (for the electronically savvy) of key articles. Much of that is gone now and when you speak with a junior doc they will often say that everything they need is available to them electronically. Searching the web is obviously faster but the ability to utilize the web to link journals, books, databases, and the like has expanded the available knowledge base of today’s clinician, no matter where in the world they are located. And because of how we do research and how we follow up with patients, a doctor can now check up on, and advise upon, a patient from anywhere that they are traveling to. Geographic boundaries really no longer exist.
How have extra online features, like multimedia, changed the way medical research is done?
The various additional features that the online environment facilitates are amazingly useful in this busy world we live in. Not only do these extra features teach the reader on their own schedule, but these features can help facilitate the decision making process. If we are talking about videos that show two different, but somewhat similar, symptoms the multimedia material can help show, literally, how the two disorders are different. Likewise, being able to quickly reference additional material via a third party database–let’s say genotypes, for instance–you negate the need to stop what you’re doing, go to a book, a journal, or even the library but, instead, go directly to the source, find what you need, make the judgment and continue with your work. Medical research really is nothing like it was five years ago and will not be the same five years from now.
Craig Panner is the Associate Editorial Director of Medicine Books, and works in Oxford’s New York office.
Oxford Medicine Online is an interconnected collection of over 500 online medical resources which cover every stage in a medical career. Our aim is to ensure that the site delivers the highest quality Oxford content whilst meeting the requirements of the busy student, doctor, or health professional working in a digital world.
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The post A conversation with Craig Panner, Associate Editorial Director of Medicine Books appeared first on OUPblog.
