Clinical and Investigative Medicine 

About: Clinical and Investigative Medicine is an academic journal published by The Canadian Society for Clinical Investigation. The journal publishes majorly in the area(s): Population & Diabetes mellitus. It has an ISSN identifier of 0147-958X. Over the lifetime, 1953 publications have been published receiving 33881 citations. The journal is also known as: CIM & Médecine clinique et experimentale.

Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness.

Abstract: Background/purpose Teamwork involving multiple disciplines is increasingly emphasized in health research, services, education and policy. The terms multidisciplinary, interdisciplinary and transdisciplinary are increasingly used in the literature, but are ambiguously defined and interchangeably used. This paper is the first of two in a series. It discusses the definitions, objectives, and evidence of effectiveness of such teamwork. Methods The paper is a literature review based on dictionaries, and Google and MEDLINE (1982-2006) searches. Results Multidisciplinarity draws on knowledge from different disciplines but stays within their boundaries. Interdisciplinarity analyzes, synthesizes and harmonizes links between disciplines into a coordinated and coherent whole. Transdisciplinarity integrates the natural, social and health sciences in a humanities context, and transcends their traditional boundaries. The objectives of multiple disciplinary approaches are to resolve real world or complex problems, to provide different perspectives on problems, to create comprehensive research questions, to develop concensus clinical definitions and guidelines, and to provide comprehensive health services. Multiple disciplinary teamwork has both benefits and drawbacks. Conclusion The three terms refer to the involvement of multiple disciplines to varying degrees on the same continuum. The common words for multidisciplinary, interdisciplinary and transdisciplinary are additive, interactive, and holistic, respectively. With their own specific meanings, these terms should not be used interchangeably. The more general term "multiple disciplinary" is suggested for when the nature of involvement of multiple disciplines is unknown or unspecified. While multiple disciplinary teamwork is appropriate for complex problems, it is not always necessary in every single project.

Measurement of cortisol in human Hair as a biomarker of systemic exposure

Abstract: Purpose: Current methods for measuring long-term endogenous production of cortisol can be challenging due to the need to take multiple urine, saliva or serum samples. Hair grows approximately 1 centimeter per month, and hair analysis accurately reflects exposure to drug abuse and environmental toxins. Here we describe a new assay for measurement of cortisol in hair, and determined a reference range for non-obese subjects. Methods: For measurement of cortisol in hair we modified an immunoassay originally developed for measuring cortisol in saliva. We compared hair samples obtained from various parts of the head, and assessed the effect of hair dying. We analyzed hair samples from non-obese subjects, in whom we also obtained urine, saliva and blood samples for cortisol measurements. Results: The mean extraction recovery for hair cortisol standards of 100 ng/ml, 50 ng/ml and 2 ng/ml (n=6) was 87.9%, 88.9% and 87.4%, respectively. Hair cortisol levels were not affected by hair color or by dying hair samples after they were obtained. Cortisol levels were decreased in hair that was artificially colored before taking the sample. The coefficient of variation was high for cortisol levels in hair from different sections of the head (30.5 %), but was smaller when comparing between hair samples obtained from the vertex posterior (15.6%). The reference range for cortisol in hair was 17.7-153.2 pg/mg of hair (median 46.1 pg/mg). Hair cortisol levels correlated significantly with cortisol in 24-hour urine (r=0.33; P=0.041). Conclusion: The correlation of hair cortisol with 24-hour urine cortisol supports its relevance as biomarker for long-term exposure.

The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies.

Abstract: Purpose: To review the reliability and validity of the CAGE questionnaire across different patient populations and discuss its role in the detection of alcohol-related problems. Methods: The Cochrane Database for Systematic Reviews, Medline, Embase, and Psychinfo were searched. No systematic reviews were found on the Cochrane Database. Search of the other databases yielded one systematic review and one meta-analysis, on different aspects of CAGE. Three articles on reliability and 16 on validity of CAGE were found and used. Studies generally yielded Level II evidence. Results: CAGE has demonstrated high test-retest reliability (0.80-0.95), and adequate correlations (0.48-0.70) with other screening instruments. The questionnaire is a valid tool for detecting alcohol abuse and dependence in medical and surgical inpatients, ambulatory medical patients, and psychiatric inpatients (average sensitivity 0.71, specificity 0.90). Its performance in primary care patients has been varied, while it has not performed well in white women, prenatal women, and college students. Furthermore, it is not an appropriate screening test for less severe forms of drinking. Conclusions: CAGE is short, feasible to use, and easily applied in clinical practice. However, users should be aware of its limitations when interpreting the results. A positive screen should be followed by a proper diagnostic evaluation using standard clinical criteria.

Measurement of quality of life in end-stage renal disease: the time trade-off approach.

Abstract: The quality of life of patients with end-stage renal disease was estimated using the time trade-off technique. The sample included 103 transplant, 60 hospital hemodialysis, 57 home/self-care, and 52 continuous ambulatory peritoneal dialysis patients. Test-retest reliability was high: intra-class correlation coefficient 0.81 (p less than 0.001). The correlations of the time trade-off with the Spitzer Quality of Life index and a visual analogue scale completed by the nephrologists, nurses, friends/relatives, and the patient were positive and statistically significant, but still relatively low (r = 0.22-0.43; p less than 0.01). The time trade-off demonstrated evidence for discriminative construct validity by ordering treatment groups according to a priori prediction. The mean time trade-off values and standard deviations (where death is 0 and full health is 1) were 0.43 (0.26) for hospital hemodialysis 0.49 (0.23) for home/self-care hemodialysis, 0.56 (0.29) for continuous ambulatory peritoneal dialysis, and 0.84 (0.24) for transplant. Analysis of variance showed transplant to be different from all other groups (p less than 0.001) with age, sex, time with end-stage renal disease, and work status making no significant independent contribution. The partial correlation coefficients between time trade-off score and items in the physical, social, and emotional functioning sub-scales of the Rand questionnaire showed that physical functioning was far more important than social or emotional functioning. The time trade-off is reliable, demonstrates evidence for validity, and suggests that the quality of life for patients with end-stage renal disease is much poorer than that reported previously.

Multidisciplinarity, interdisciplinarity, and transdisciplinarity in health research, services, education and policy: 2. Promotors, barriers, and strategies of enhancement

Abstract: Background/Purpose. Multidisciplinary, interdisciplinary and transdisciplinary teams are increasingly encouraged in health research, services, education and policy. This paper is the second in a series. The first discussed the definitions, objectives, and evidence of effectiveness of multiple disciplinary teamwork. This paper continues to examine the promotors, barriers, and ways to enhance such teamwork. Methods. The paper is a literature review based on Google and MEDLINE (1982-2007) searches. “Multidisciplinarity”, “interdisciplinarity”, “transdisciplinarity” and “definition” were used as keywords to identify the pertinent literature. Results. The promotors of teamwork success include: good selection of team members, good team leaders, maturity and flexibility of team members, personal commitment, physical proximity of team members, the Internet and email as a supporting platform, incentives, institutional support and changes in the workplace, a common goal and shared vision, clarity and rotation of roles, communication, and constructive comments among team members. The barriers, in general, reflect the situation in which the promotors are lacking. They include: poor selection of the disciplines and team members, poor process of team functioning, lack of proper measures to evaluate success of interdisciplinary work, lack of guidelines for multiple authorship in research publications, language problems, insufficient time or funding for the project, institutional constraints, discipline conflicts, team conflicts, lack of communication between disciplines, and unequal power among disciplines. Conclusion. Not every health project needs to involve multiple disciplines. Several questions can help in deciding whether a multiple disciplinary approach is required. If multiple disciplinarity is called for, eight strategies to enhance multiple disciplinary teamwork are proposed. They can be summarised in the acronym TEAMWORK - Team, Enthusiasm, Accessibility, Motivation, Workplace, Objectives, Role, Kinship.