Perspective: One Health: a compelling convergence.

One Health has been defined as "the collaborative effort of multiple disciplines--working locally, nationally, and globally--to attain optimal health for people, animals, plants, and our environment." The broadly based One Health movement includes domains as diverse as agricultural and animal science, environmental science, climatology, veterinary medicine, human medicine, and public health. One Health, previously espoused by Virchow, Osler, and other pioneers in medical education, is not a new idea, but, as an approach for dealing with the many global health problems in an increasingly interconnected world, it has become more important than ever.

Commentary: preparing for health care reform: ten recommendations for academic health centers.

Health care reform, the subject of intense national debate and discussion during the presidential campaign and the first year of the Obama presidency, is now reality. The Patient Protection and Affordable Care Act of 2010 (PPACA) became law in March 2010. Despite efforts by the new Republican majority in the House of Representatives of the 112th Congress to repeal the bill, some aspects of PPACA have already taken effect, and the majority of the remainder are scheduled to be implemented by 2014.

Five Challenges Facing the US Physician Workforce (And What to Do About Them).

This article outlines 5 major challenges facing the US physician workforce that are especially important in the context of health care reform but have not been featured in the reform debate. Without assuring that sufficient numbers of the right types of physicians are available, reform efforts may not result in increased access to health care. Policy options for addressing these challenges are an important national priority in the context of effective reform of the US health care system.

Commentary: health care payment reform and academic medicine: threat or opportunity?

Discussion of the flaws of the current fee-for-service health care reimbursement model has become commonplace. Health care costs cannot be reduced without moving away from a system that rewards providers for providing more services regardless of need, effectiveness, or quality. What alternatives are likely under health care reform, and how will they impact the challenged finances of academic medical centers? Bundled payment methodologies, in which all providers rendering services to a patient during an episode of care split a global fee, are gaining popularity.

For-profit undergraduate medical education: back to the future?

One hundred years ago, Abraham Flexner wrote a report that profoundly influenced U.S. medical education.

The Texas physician workforce: current status and future direction.

The United States is facing serious physician workforce challenges. These include a shortage of physicians; declining interest in primary care; a maldistribution of doctors, particularly in inner-city and rural areas; the lack of a coherent workforce planning mechanism; and a workforce that does not reflect the diversity of the general population. Texas has many of the same issues, but problems are magnified by a historically low physician-to-population ratio; a rapidly growing and increasingly diverse population; and significant access-to-care issues, driven by a large uninsured population.

Microarray technology in biomedical research.

Microarrays have dozens to millions of probes attached to an inert surface allowing high-throughput analyses of many biologic processes to be performed simultaneously on the same sample. Microarrays with nucleic acid probes are now widely used for gene expression analysis, DNA re-sequencing, single nucleotide polymorphism genotyping, and comparative genomic hybridization. This technology is accelerating research in many fields and now microarrays are moving into clinical application.

Use of provider delivered complementary and alternative therapies in Hawai'i: results of the Hawai'i Health Survey.

Background: Provider delivered complementary and alternative medicine (CAM) is used increasingly as a treatment option. Nevertheless, data related to the prevalence of provider delivered CAM (or PDCAM) use in diverse racial and ethnic populations is limited. The purpose of this investigation was to describe the use of provider delivered CAM in Hawaiian, Asian, and other Pacific Island populations in Hawai'i.

The research subject advocate at the University of Hawai'i Clinical Research Center: an added resource for protection of human subjects.

In early 2001 the National Institutes of Health (NIH) created the Research Subject Advocate (RSA) position as an additional resource for human subjects protection at NIH-funded Clinical Research Centers (CRCs) to enhance the protection of human subjects participating in clinical research studies. The purpose of this article is to describe the RSA position in the context of clinical research, with a particular emphasis upon the role of the RSA in one of the five CRCs funded by the NIH Research Centers in Minority Institutions (RCMI) program. Through participation in protocol development, informed consent procedures, study implementation and follow-up with adverse events, the RSA works closely with research investigators and their staff to protect study participants.

Community outreach, training, and research: the Hawai'i/Pacific Basin area Health Education Center of the University of Hawai'i, John A. Burns SChool of Medicine.

The Hawai'i/Pacific Basin AHEC is a federal grant program that utilizes academic/community partnerships to recruit students to health careers, train students in rural and underserved areas, and assist with workforce development across the region. Ongoing activities and programs include 1) Outreach for recruitment to health careers for students from kindergarten through adulthood; 2) Individual and interdisciplinary health professions student training in rural and underserved areas; 3) Community health education using distance learning; 4) Assessment of and efforts to improve recruitment and retention of providers in rural areas including continuing education; and 5) Health disparities research. The AHEC programs reach more than 4,000 individuals annually, helps to train more than 1,000 individuals a year and assist with placement of up to 20 providers a year in rural and underserved healthcare practices.

Oral health disparities and periodontal disease in Asian and Pacific Island populations.

Introduction: While oral health disparities exist in many ethnic groups in Hawaii, the challenge of developing research and intervention programs is hampered by the lack of a dental school and adequate state resources.

Objective: To use a collaboration model to establish a mentoring relationship with a research-intensive school of dentistry to reduce oral health disparities in Hawaii.

Methods: Collaborative interactions with the University of Hawaii School of Medicine (UH) and the University of North Carolina School of Dentistry at Chapel Hill (UNC) included bimonthly teleconferences, on-site planning and mentoring sessions, yearly conferences in Hawaii open to the community using UNC faculty, and on-site skills training sessions.

Growth in clinical research productivity and funding at the University of Hawaii's John A. Burns School of Medicine: the past 10 years.

Over the last ten years, faculty at the John A. Burns School of Medicine (JABSOM) and the University of Hawaii (UH) have been actively engaged in ongoing efforts to increase the quantity and improve the quality of biomedical research in the State of Hawaii. JABSOM's Clinical Research Center (CRC), funded in 1995 by the National Center for Research Resources (NCRR) and the Research Centers in Minority Institutions (RCMI) of the National Institutes of Health, has provided research infrastructure that has been essential to these efforts.

The legal implications of healthcare communications: what every pain physician needs to know.

Accurate and sensitive communication of health care information is essential to effective patient management in the pain clinic, operating room, other health care settings. However, information relating to the health care status of a patient is sensitive and may be embarrassing or damaging if it falls into the wrong hands. Ethical cannons of medicine and statutory provisions have emphasized the obligation of the physician to safeguard patient confidences.

Fraud and abuse: a pain physician's guide.

The growing burden of regulations and statutes that physicians in the United States must comply with has become an inescapable aspect of the practice of medicine. With the advent of this heightened regulation has also come a new governmental commitment to discover and punish fraud and abuse in the practice of medicine. It is thus incumbent upon pain practitioners to be aware of the basic principles in fraud and abuse law so as to avoid obvious situations of legal liability and to know when to seek expert legal advice in the structuring of business transactions affecting their practice.

Assessing the impact of heat on the systemic delivery of fentanyl through the transdermal fentanyl delivery system.

Objectives: To examine the effects of locally applied heat on the systemic delivery of fentanyl through the Transdermal Fentanyl Delivery System.

Design: Open, 2-period crossover randomized study conducted in the anesthesia department of a university teaching hospital.

Method: Six healthy adult volunteers received a fentanyl 25-microg/h patch with and without local heat for 240 minutes followed by administration without heat for an additional 20 hours.

A prospective, randomized controlled study of computer-assisted learning in parasitology.

Purpose: To compare, using a prospective, randomized controlled study, three methods of teaching a medical school parasitology course: computer-based instruction, traditional lecture-based instruction, and a combination of computer-based and lecture-based instruction.

Method: A single class of the University of Utah School of Medicine was randomized into three study groups for the second-year parasitology course. The computer group (n = 29) used a locally developed interactive parasitology computer program; the lecture group (n = 32) had traditional lectures, and the combined group (n = 33) used both the computer program and lectures.

The feasibility and acceptability of implementing formal evaluation sessions and using descriptive vocabulary to assess student performance on a clinical clerkship.

Background: A systematized approach to descriptive evaluation of clinical performance using a vocabulary of global descriptors in the setting of formal evaluation and feedback sessions has been shown to be reliable and valid. The feasibility of this method beyond the institution at which it was developed has not been studied.

Purpose: To determine the feasibility and acceptability of implementing formal evaluation and feedback sessions, using a vocabulary of global descriptors, in a third-year core clinical clerkship.