Wednesday, February 01, 2006

NEW ENGLAND JOURNAL OF MEDICINE: A Virtual Library On Healthcare

When I was a young child, I used to wonder why my father, who was a country doctor practicing in rural Virginia subscribed to and read the New England Journal of Medicine (NEJM). I knew we were not leaving Virginia for New England, and I did not see how he could learn anything by reading about medicine in a place so far away.

Today, I am a "Registered Guest" to the online version of the NEJM even though I, like my father, live in Virginia. But unlike my father, I practice law, not medicine. But now I know what a useful tool the NEJM is for someone who is interested in quality of life issues.

NGOs concerned about such issues as HIV/AIDS, cancer, smallpox and other dangers that weigh heavily upon developing countries can find extremely useful information in the NEJM. Not only are the articles themselves useful, but the references found in a scholarly journal such as this are true treasures. And I will come back to these references later.

While one must subscribe to the magazine to receive the full benefits, I want to take a few moments to review just some of the articles that are available in their full text FREE at the NEJM online.

The articles range from issues dealing with volunteering overseas for healthcare professionals to public health and HIV/AIDS to the brain drain from developing countries of both doctors and nurses and much, much more.

These articles can be of great use to any NGO that is dealing with Health Care issues. And as I said, I am going to review some of them. But first, I would like to point out that these articles are copyrighted and should not be abused. If there is any question about what can or cannot be done with these articles, there is a link to the copyright policy at the bottom of each article.

The first article I want to discuss is: Volunteering Overseas - Lessons from Surgical Brigades by Adam J. Wolfberg, M.D., M.P.H. This article focuses on physicians who volunteer their talents in developing countries, (usually in rural areas). It points out the rewards as well as the difficulties of this type of volunteerism. It talks about some of the unique examples of this volunteer work as well. For example, it mentions an international eye-health group called Orbis, that used a DC-8 airplane outfitted with an operating room when it launched its volunteer operations in 1982. Another interesting fact found in the article is that the Majority Leader of the U.S. Senate, Bill Frist (R-Tenn.), "travels to Africa annually to participate in medical volunteer work." Dr. Wolfberg also points out that while "many groups collaborate with one another and with host governments, there is no formal system for coordinating or evaluating the work of so many volunteers." This observation should give rise to some motivation to initiate such a coordinating effort.

Applying Public Health Principles to the HIV Epidemic by several physicians is a well written well thought out work that cites 30 references sources. Many of the references are works for which links to Abstracts and/or Full Texts versions are provided. This article also has a table that can be converted to a Power Point slide by clicking the link provided. After introducing the subject, this article goes into:
- Case Finding and Surveillance
- Interrupting Transmission
- Systematic Treatment and Case Management
- Population-Based Monitoring and Evaluation, and its
- Conclusion

In Aiding and Abetting - Nursing Crises at Home and Abroad , one of the very arresting facts presented is that while the National Health Service of the United Kingdom relied heavily on the direct recruitment of nurses from African countries for years. Those countries affected, which are former U.K. colonies such as Botswana, Ghana, Malawi, Nigeria, Kenya, South Africa, Zambia, and Zimbabwe are those very countries that have been among those hardest hit by the HIV pandemic. This article by Sreekanth Chaguturu, M.D., and Snigdha Vallabhaneni, B.A. presents statistics, analysis and data in a very concise manner. I would like to point out also that many of these articles have triggered responses in the form of letters from the journal's readers. And these letters, with their often insightful commentary and/or factual presentations, may be viewed as well.

Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries - The five countries referenced in this article are: India, Kenya, Peru, South Africa, and Thailand, and the authors are so numerous that I will leave it to you to go to the article to see all of their names. This article is so impressive in its detail. Again, there are charts and graphs that can be converted into Power Point presentations and a gold mine of references. Not only does this article give a scholarly treatment of its subject, but it also illustrates how such a study should be conducted and the results presented.

Antiretroviral Therapy in a Thousand Patients with AIDS in Haiti is an excellent article that has an abstract as a forward. In fact many of the articles have abstracts that can be accessed for FREE even if the full text of the article itself may only be viewed by subscribers. But in this case, this article has the full text provided for free. Also, I have not yet mentioned that each article may be viewed in a PDF format. The articles may be emailed to a friend, you can ask the NEJM to email you if a letter is posted in relation to a particular article, and there are many other features as well. Again, this article was authored by so many physicians and other health care professionals that the authors cite would like like the faculty roster of a medical school.

Not all of the articles are clinical studies are analyses of medical cases. Glimpses of Guantanamo - Medical Ethics and the War on Terror is a case in point. This is a discussion of a medical ethics issue. This is not a political thesis, but thoughtful analysis of the issues by Susan Okie, M.D., as well as a first-hand account of her visit to the prison. The article treats on the issues of forced feeding, and questions concerning allegations of abusive and inhumane interrogation techniques, among other things. In addition to her own observations, Dr. Okie cites Army Regulations, the Army's Intelligence Interrogation Field Manual, a Memorandum from the U.S. Secretary of Defense, Donald Rumsfeld and Newspaper accounts. This article may be of particular interest to those NGO workers concerned with Human Rights issues.

Health Care Reform and the Crisis of HIV and AIDS in South Africa is practically a book with eighty source cites from other medical journals, books, newspapers and web sites. The email address for the author, Solomon R. Benatar, M.B., Ch.B. can be found at the end of the article - as is usually the case for all of the articles. Also, each article has a listing of where the article has been cited as reference material for other articles, thus providing the reader a trail to follow in order to investigate where there has is any additional or updated information available.

The Metrics of the Physician Brain Drain has been cited by five other articles, which are listed with links at the end of the article. There are also letters relating to this article and it cites several other articles that treat with this very serious problem for developing countries. This article also prompted an editorial that can be accessed by the link provided. And there is a link to an audio file of an interview with the author, Fitzhugh Mullan, M.D. Finally, I should indicate that there are usually translations of the abstracts of these articles available in various languages. For example, there are links to German, Italian, French and Spanish translations for the abstract of this article. This article also has tables and a chart that can be converted to a Power Point slide.

Current Concepts: Diagnosis and Management of Smallpox by Joel G. Breman, M.D., D.T.P.H., and D.A. Henderson, M.D., M.P.H. must be quite well respected because it has been cited by no less than 26 other works. This article has several graphic files that can be accessed. These files contain tables and graphics of "Clinical Manifestations and Pathogenesis of Smallpox and the Immune Response" and "Electron Micrographs of Variola Virus and Varicella-Zoster Virus." With over 40 reference cites and links to "Related Articles" this article (as well as many of the others found in the NEJM) is as valuable as a library on the subject.

Well, I am way over my limit, but you will have to agree that there was little chance that I could make this article shorter and give you a clear idea of what you can find if you subscribe to the New England Journal of Medicine . If health care is a concern of your NGO, I think it is worth it to ask one of your donors to provide you with the funds to subscribe.

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