Representation of dark skin tones in foundational nursing textbooks: An image analysis

PURPOSE

This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts.

BACKGROUND

The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice.

METHODS

Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone).

RESULTS

Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks.

CONCLUSIONS

Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark.

RELEVANCE TO CLINICAL PRACTICE

All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.

Data-rich textbook figures promote core competencies: Comparison of two textbooks

Many molecular biology and biochemistry instructors have altered their classroom behavior in favor of evidence-based, active learning instructional strategies. Overwhelming evidence confirms that lecture-only classrooms are detrimental to student learning outcomes, but we know less about the impact textbooks have on students outside the classroom. Two influential projects, the AP Biology redesign and Vision and Change, called for extensive restructuring of course content and hoped that textbooks would be restructured accordingly. This study evaluated all figures and tables from two introductory biology textbooks to quantify how well they implement recommendations from Vision and Change and AP Biology redesign. We documented significant differences among figures and tables when looking for experimental data, questions for students to answer, and quantitative interpretation. Using think-aloud interviews, we interrogated whether students engage differently with figures from the two textbooks. When figures provided take-home messages, students relied on written text rather than analyzing the graphical information for their understanding. Students frequently employed words from summaries within the figures to construct "inflated explanations" that mimicked comprehension.

Preserving Abstinence and Preventing Rape: How Sex Education Textbooks Contribute to Rape Culture

Recent academic and popular conversations regarding #MeToo, sexual violence and harassment, and rape culture have begun to focus on K-12 educational spaces in the U.S., but they rarely examine how educational curricula actually foster or combat these dynamics. In this article, we present a qualitative content analysis of health education textbooks, which explores the following question: What implicit and explicit messages do youth receive about sexual violence, and specifically, sexual violence prevention in health education textbooks? As we explored this question, we analyzed the roles that sex education curricula may play in shaping (e.g., contributing to, intervening upon) rape culture. We found the following messages across textbooks: abstinence is the only way to preserve one's safety; lack of abstinence increases risks, including the risk of being raped; and girls/women must assume personal responsibility and enact strategies that preserve one's abstinence and prevent them from being raped. This article concludes by teasing out how curricula can shape interactions, relationships, and culture, and by offering recommendations for improving sex education curricula.

A comprehensive validation of the novel 8th edition of American Joint Committee on Cancer staging manual for the long-term survivals of patients with non-functional pancreatic neuroendocrine neoplasms

Histologically, the World Health Organization has classified pancreatic neuroendocrine neoplasms (p-NENs) into well-differentiated pancreatic neuroendocrine tumors (G1/G2 p-NETs) and poorly-differentiated pancreatic neuroendocrine carcinoma (G3 p-NECs) based on tumor mitotic counts and Ki-67 index. Recently, the 8th edition of American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging manual has incorporated some major changes in 2017 that the TNM staging system for p-NENs should only be applied to well-differentiated G1/G2 p-NETs, while poorly-differentiated G3 p-NECs be classified according to the new system for pancreatic exocrine adenocarcinomas. However, this new manual for p-NENs has seldom been evaluated.Data of patients with both G1/G2 and G3 non-functional p-NENs (NF-p-NENs) from our institution was retrospectively collected and analyzed using 2 new AJCC 8th staging systems. We also made survival comparisons between the 8th and 7th edition system separately for different subgroups.For G1/G2 NF-p-NETs, there were 52 patients classified in AJCC 8th edition stage I, 40 in stage II, 41 in stage III and 19 in stage IV. As for G3 NF-p-NECs, 17, 19, 24, and 18 patients were respectively defined from AJCC 8th edition stage I to stage IV. In terms of the AJCC 7th staging system, the 230 patients with NF-p-NENs were totally distributed from stage I to stage IV (94, 63, 36, 37, respectively). For the survival analysis of both G1/G2 NF-p-NETs and G3 NF-p-NECs, the AJCC 7th edition system failed to discriminate the survival differences when compared stage III with stage II or stage IV (P > .05), while the 8th edition ones could perfectly allocate patients into 4 statistically different groups (P < .05). The HCIs of AJCC 8th stage for G1/G2 NF-p-NETs [HCI=0.658, 95% confidence interval (CI)=0.602-0.741] and stage for G3 NF-p-NECs (HCI=0.704, 95% CI=0.595-0.813) was both statistically larger than those of AJCC 7th stage for different grading NF-p-NENs [(HCI=0.578, 95% CI=0.557-0.649; P=.031), (HCI=0.546, 95% CI=0.531-0.636; P = .019); respectively], indicating a more accurate predictive ability for the survivals of NF-p-NENs.Our data suggested the 2 new AJCC 8th staging systems were superior to its 7th edition for patients with both G1/G2 NF-p-NETs and G3 NF-p-NECs.

Analysis of type 2 diabetes mellitus and arterial hypertension content in exercise physiology textbooks

The textbook is a pedagogical tool that provides students and professionals with scientific information. As exercise is an important strategy for the prevention and treatment of noncommunicable diseases, such as type 2 diabetes mellitus (T2DM) and arterial hypertension, the presence of correct and up-to-date scientific information in exercise physiology textbooks is important. Our aim was to analyze T2DM and arterial hypertension content in exercise physiology textbooks and compare this content with the American College of Sports Medicine (ACSM) position stands. Comparative descriptions were made between information regarding T2DM and arterial hypertension found in textbooks (n = 10) and similar information contained in the official ACSM position stands. The quality of the content was compared with current scientific information present in the ACSM position stands. In regards to T2DM, eight textbooks provided information regarding the purpose and benefits of exercise, two provided information regarding exercise prescription, seven provided information regarding the type of exercise, six provided information regarding general care and recommendations, and five provided information regarding the mechanisms involved. In regards to arterial hypertension, all textbooks provided information regarding the purpose and benefit of exercise, six provided information regarding exercise prescription, nine provided information regarding the type of exercise, two provided information regarding general care and recommendations, and seven provided information regarding the mechanisms involved. All textbooks analyzed contained information related to physical exercise for patients with T2DM and arterial hypertension. However, the textbooks differed in terms of the quality of the contents, especially in regard to exercise prescription.

Gender perspectives in medical education

Medical students have to go through an incredibly vast number of voluminous textbooks in their undergraduate years. But most of us learn next to nothing about the intricacies of the social determinants of health and the larger socio-political-cultural spaces we will have to negotiate. Without any exposure to the larger patriarchal, economic and historical systems, which are bound to collide with our textbook learning, we will be highly unprepared to locate our own biomedical skills within the larger context. The objective of this article is to analyse the current level of gender sensitivity in the textbooks being used for undergraduate medical training, and the potential impact that this has on developing attitudes towards a gender and rights-based approach.

Inconsistencies in some common terms and notations in enzymology: Textbook examples and suggestions

A number of terms have been defined and inconsistently used across various texts in enzymology which may attract the attention of undergraduate students and instructors. At some places, inconsistent use results in confusions as well as leads to the misuse of these terms. Although it is difficult to resolve such inconsistencies, attempts have constantly been made by international regulatory forums such as International Union of Biochemistry and Molecular Biology (IUBMB) and other similar organizations to abolish the inconsistencies. This article highlights some of the most commonly occurring confusing and inconsistent terms in enzymology. We have gathered shreds of evidences and provide here possible suggestions and caution for readers and instructors, so that mistakes can be minimized and possible guidelines can be prepared for their usage. A few inconsistencies observed and discussed here include different notations of activation energy, differences in terms uncompetitive and noncompetitive in enzyme inhibition, classification of cofactors and definitions of their sub-types, and confusing usage of the enzyme-inhibitor dissociation constant. Besides this, we have also highlighted the inconsistencies in the enzyme nomenclature. © 2018 International Union of Biochemistry and Molecular Biology, 47(2): 140-144, 2019.

[Ivory-Coast: Textbooks Misinform on HIV]

Schools are considered as one of the most effective vectors for education on sexually transmitted diseases among young people. We report here the results of a study of HIV infection as presented in school textbooks in Ivory Coast, conducted in June 2018 as part of the development of a communication strategy to increase demand for HIV infection testing, especially among young people. Surprisingly, even though the textbooks studied were published between 2007 and 2017, almost all of them stated that HIV infection leads to death, with no mention of the existence of treatments that make it possible to live in good health. Some textbooks even stated that no treatment is available. These findings highlight one cause - perhaps major - for the reluctance of young people to get tested. The misrepresentation of HIV infection, reinforced by education, hampers incentive campaigns for HIV testing, for which the best argument is that awareness of a positive HIV status makes it possible to benefit from treatment. The present study included textbooks from the French educational program, used throughout French-speaking Africa, and from the Ivory Coast program. It would be interesting to conduct a similar study in other French-speaking and English-speaking African countries. Adapting the presentation of HIV in school textbooks to reflect the current situation in the fight against HIV infection should be a priority.

Palliative and end of life care content within common pharmacy textbooks

INTRODUCTION

This study compared the end-of-life care (EOLC) content in pharmacy-related textbooks to textbooks evaluated in a comparable 2003 study.

METHODS

Six common pharmacy-related textbooks were reviewed for content relating to EOLC. Five of the textbooks were the newest editions of the same texts reviewed in a similar 2003 study, and one focused primarily on clinical ethics, a topic that was underrepresented in the previous study. The six texts were searched for a list of 33 keywords or phrases pertaining to EOLC. Entries containing any of these 33 keywords were assigned a domain and scored using a simple scoring system of one if minimally helpful content was present or two if helpful content was present. The total number of entries and their average scores were compared to the results of the previous study.

RESULTS

The average number of entries per textbook was 154, which represents an increase from the 110.1 average number of entries in the 2003 study. However, one of the textbooks had a total of 470 entries alone. Of a total number of 78 possible domains, 40 had either zero or one entries. The average ratings for each book ranged from 0.5 to 1.6, whereas they ranged from 0.9 to 1.6 in 2003. Four of six books in this study had average rating of less than 0.9.

CONCLUSION

Although certain texts have made strides to include more EOLC content, overall, EOLC content in pharmacy textbooks may still be improved.

Neuroimmune Pharmacology, 2nd Edition - A Perspective

It has been almost nine years since the 1st edition of Neuroimmune Pharmacology was published on May 23rd, 2008. The 2nd edition of Neuroimmune Pharmacology by Ikezu and Gendelman (Editors) with Przedborski, Masliah and Cosentino (Associate Editors) manages to fulfill two separate missions: to provide comprehensive, but highly topical access to a rapidly evolving field and to serve as a standalone reference for scientists and clinicians in need of guidance regarding questions pertinent to neuroimmune pharmacology. Doing a PubMed search on the terms neuroimmune and pharmacology yields 1090 publications, with a first publication by Dougherty and Dafny, published in the Journal of Neuroscience Research in 1988, entitled "Neuroimmune intercommunication, central opioids, and the immune response to bacterial endotoxin." Since 2000, there have been 979 publications using these search terms, with 137 published since the beginning of 2016. The obvious conclusion to be drawn is that this is a burgeoning field that represents the cusp between our understanding of relationships between the immune and nervous systems and how we might treat disease with pharmacologic approaches when normal homeostatic mechanisms go awry.

[Doubting the twirling angle of filiform needle in Science of Acupuncture and Moxibustion textbooks and National Standards]

In National Standards (GB) as well as the textbooks used in TCM universities, the twirling angles of acupuncture manipulation vary a lot. By reviewing the previous editions of textbooks from 3 publication houses and comparing the relevant contents, the author calculated the arc lengths of various twirling angles based on the specification of filiform needle in National Standards (GB) and International Standards (ISO). The conclusion is that the twirling angles mentioned in National Standards (GB) and textbooks are too small and not in compliance with the clinical practice. Hence, it is not advisable to propose a rigid specific provision of twirling angle in acupuncture manipulation.

[Hygienic Assesment of Educational Texts: Methodical Approaches and Evaluation of Difficulties for Children of Secondary Textbooks]

BACKGROUND

The understandability and readability of the text are significant indicators of evaluation of textbooks.

OBJECTIVE

The aim of the study - rationale of improving the readability and understandability of textbooks.

METHODS

60 modern textbooks for 5-11th classes on History, Physics, Biology and 23 textbooks of 1960-1980's edition. Flesch index was used to assess the readability, Fogh index - to evaluate understandability.

RESULTS

The readability and understandability of texts in textbooks of 1960-1980's and modern editions have no differences and show the same complexity of old and modern textbooks for students. The indicator of understandability of textbooks for primary classes corresponds to age norm and is 4.4±0.2 points. The indicator of readability for these books is less age norm and is 53.8±2.9 points, which increases the physiological cost of educational activities of children of primary school age. Children's readability and understandability of school textbooks are a significant factor of intensity of training activities and can be objectively assessed by Flesch and Fogh indices, that it is appropriate for an objective hygienic assessment of the tension of the educational activities for children.

CONCLUSION

The main direction of optimization of the tension of educational activity is to reduce the intellectual and emotional loads in children by increasing the easiness of reading textbooks due to their compliance with the age peculiarities of students.

Accuracy and completeness of drug information in Wikipedia: a comparison with standard textbooks of pharmacology

The online resource Wikipedia is increasingly used by students for knowledge acquisition and learning. However, the lack of a formal editorial review and the heterogeneous expertise of contributors often results in skepticism by educators whether Wikipedia should be recommended to students as an information source. In this study we systematically analyzed the accuracy and completeness of drug information in the German and English language versions of Wikipedia in comparison to standard textbooks of pharmacology. In addition, references, revision history and readability were evaluated. Analysis of readability was performed using the Amstad readability index and the Erste Wiener Sachtextformel. The data on indication, mechanism of action, pharmacokinetics, adverse effects and contraindications for 100 curricular drugs were retrieved from standard German textbooks of general pharmacology and compared with the corresponding articles in the German language version of Wikipedia. Quantitative analysis revealed that accuracy of drug information in Wikipedia was 99.7% ± 0.2% when compared to the textbook data. The overall completeness of drug information in Wikipedia was 83.8 ± 1.5% (p < 0.001). Completeness varied in-between categories, and was lowest in the category "pharmacokinetics" (68.0% ± 4.2%; p < 0.001) and highest in the category "indication" (91.3% ± 2.0%) when compared to the textbook data overlap. Similar results were obtained for the English language version of Wikipedia. Of the drug information missing in Wikipedia, 62.5% was rated as didactically non-relevant in a qualitative re-evaluation study. Drug articles in Wikipedia had an average of 14.6 ± 1.6 references and 262.8 ± 37.4 edits performed by 142.7 ± 17.6 editors. Both Wikipedia and textbooks samples had comparable, low readability. Our study suggests that Wikipedia is an accurate and comprehensive source of drug-related information for undergraduate medical education.

In accordance with a "more majestic order". The new math and the nature of mathematics at midcentury

The "new math" curriculum, one version of which was developed in the 1950s and 1960s by the School Mathematics Study Group under the auspices of the National Science Foundation, occasioned a great deal of controversy among mathematicians. Well before its rejection by parents and teachers, some mathematicians were vocal critics, decrying the new curriculum because of the way it described the practice and history of the discipline. The nature of mathematics, despite the field's triumphs in helping to win World War II and its midcentury promotion as the key to a modern technological society, was surprisingly contested in this period. Supporters of the School Mathematics Study Group, like its director, Edward Begle, emphasized the importance of portraying mathematics as a system of abstract structures, while opponents like Morris Kline argued that math was essentially a tool for understanding the natural world. The debate about the curriculum--and the role of mathematicians in its design--was also a debate about the underlying identity of the subject itself.

Misrepresentations of evolutionary psychology in sex and gender textbooks

Evolutionary psychology has provoked controversy, especially when applied to human sex differences. We hypothesize that this is partly due to misunderstandings of evolutionary psychology that are perpetuated by undergraduate sex and gender textbooks. As an initial test of this hypothesis, we develop a catalog of eight types of errors and document their occurrence in 15 widely used sex and gender textbooks. Consistent with our hypothesis, of the 12 textbooks that discussed evolutionary psychology, all contained at least one error, and the median number of errors was five. The most common types of errors were "Straw Man," "Biological Determinism," and "Species Selection." We conclude by suggesting improvements to undergraduate sex and gender textbooks.

Comparison of textbook to fmCases on family medicine clerkship exam performance

BACKGROUND AND OBJECTIVES

The use of online learning with virtual cases has become commonplace in medical education. A series of fmCASES has been developed to assist with learning for clerkship students in family medicine. It has not been shown whether this series of cases improves student learning during their clerkship compared to traditional learning modalities.

METHODS

We designed an intervention study to replace the traditional family medicine clerkship textbook with the fmCASES curriculum at one medical school. We then compared two consecutive cohorts of family medicine clerkship students by examining their performance on overall and small groups of exam questions at the end of the clerkship.

RESULTS

Data were obtained for 95% of students across the 2-year study. Overall performance on the end of clerkship exam was unchanged with the transition to fmCASES. Student performance was variable based on subject area and source of examination question.

CONCLUSIONS

Using a set of online cases to replace a traditional textbook did not change overall performance on the end-of-clerkship assessment. However, our findings suggest that students demonstrated proficiency in answering questions that came from the sources they studied from. This finding should be considered when curricula transition to greater use of online learning resources.

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

BACKGROUND

Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.

METHODS

We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.

RESULTS

The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as "too esoteric", the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.

CONCLUSIONS

Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and "fitness for purpose", and avoid omission of vital knowledge.

Medical education teaching resources

OBJECTIVE

Numerous monographs on psychiatry education have appeared without a review specifically intended to assist psychiatry faculty and trainees in the selection of appropriate volumes for study and reference. The authors prepared this annotated bibliography to fill that gap.

METHODS

The authors identified titles from web-based searches of the topics "academic psychiatry," "psychiatry education," and "medical education," followed by additional searches of the same topics on the websites of major publishers. Forty-nine titles referring to psychiatry education specifically and medical education generally were identified. The authors selected works that were published within the last 10 years and remain in print and that met at least one of the following criteria: (1) written specifically about psychiatry or for psychiatric educators; (2) of especially high quality in scholarship, writing, topic selection and coverage, and pertinence to academic psychiatry; (3) covering a learning modality deemed by the authors to be of particular interest for psychiatry education.

RESULTS

The authors reviewed 19 books pertinent to the processes of medical student and residency education, faculty career development, and education administration. These included 11 books on medical education in general, 4 books that focus more narrowly on the field of psychiatry, and 4 books addressing specific learning modalities of potential utility in the mental health professions.

CONCLUSION

Most of the selected works proved to be outstanding contributions to the medical education literature.

[Actual state and problems in neurology training in medical schools]

To investigate the need for pre- and post-graduate education for neurologists, the subcommittee of the Japanese Society of Neurology for education performed a questionnaire-based survey in 80 medical universities throughout Japan. The response rate to the questionnaire was 82.5%. Textbooks for lectures for medical students were used in only 22.7% of those universities. If the Japanese Society of Neurology (JSN) made a standard text, 77.8% of universities would like to use it. Most of the training programs for residents were compatible with the minimum requirements of the JSN. Just 66.7% of those training programs were completed in their own institute, and 77.3% of universities required help from the JSN.

QRAC-the-Code: a comprehension monitoring strategy for middle school social studies textbooks

Requirements for reading and ascertaining information from text increase as students advance through the educational system, especially in content-rich classes; hence, monitoring comprehension is especially important. However, this is a particularly challenging skill for many students who struggle with reading comprehension, including students with learning disabilities. A randomized pre-post experimental design was employed to investigate the effectiveness of a comprehension monitoring strategy (QRAC-the-Code) for improving the reading comprehension of 323 students in grades 6 and 7 in inclusive social studies classes. Findings indicated that both general education students and students with learning disabilities who were taught a simple comprehension monitoring strategy improved their comprehension of textbook content compared to students who read independently and noted important points. In addition, students in the comprehension monitoring condition reported using more reading strategies after the intervention. Implications for research and practice are discussed.

Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources

BACKGROUND

Although mental health information on the internet is often of poor quality, relatively little is known about the quality of websites, such as Wikipedia, that involve participatory information sharing. The aim of this paper was to explore the quality of user-contributed mental health-related information on Wikipedia and compare this with centrally controlled information sources.

METHOD

Content on 10 mental health-related topics was extracted from 14 frequently accessed websites (including Wikipedia) providing information about depression and schizophrenia, Encyclopaedia Britannica, and a psychiatry textbook. The content was rated by experts according to the following criteria: accuracy, up-to-dateness, breadth of coverage, referencing and readability.

RESULTS

Ratings varied significantly between resources according to topic. Across all topics, Wikipedia was the most highly rated in all domains except readability.

CONCLUSIONS

The quality of information on depression and schizophrenia on Wikipedia is generally as good as, or better than, that provided by centrally controlled websites, Encyclopaedia Britannica and a psychiatry textbook.

The first anatomy professors in the medical school of the University of Athens

The purpose of this historical review is to add new elements to the international literature in relation to the birth and progress of the science of anatomy in modern Greece. Step by step, it outlines the efforts of prominent Greek anatomists to establish the course of the basic science of anatomy in the newly founded Medical School, the laborious effort to collect cadaveric material to compile museum anatomical collections and to gradually build the foundations of modern anatomy science at the Medical School of the Athenian University.

Unsupported labeling of race as a risk factor for certain diseases in a widely used medical textbook

PURPOSE

Confounding of racial, socioeconomic, and behavioral characteristics may lead to the misidentification of race as a risk factor for certain diseases. The authors evaluated the validity of attributing race as a risk factor in a widely used pathology textbook.

METHOD

In 2009-2010, the authors searched Robbins and Cotran Pathologic Basis of Disease, Professional Edition (8th ed) for assertions that African Americans have a different disease profile than do individuals of other races. They evaluated the references cited in the textbook, assessing the quality of the sources and whether those authors controlled for confounding variables, such as socioeconomic status and behavioral characteristics. For statements that remained unconfirmed, the authors searched the literature for evidence supporting or contradicting the claims made in the textbook. The authors classified each statement from the textbook as supported, unconfirmed, or contradicted.

RESULTS

Of the 31 relevant statements, 11 were supported by the literature review, 17 remained unconfirmed, and three were contradicted.

CONCLUSIONS

About two-thirds of the assertions that different risk factors exist for African Americans found in a widely used pathology textbook could not be supported by the published literature. Failure to separate race from other socioeconomic and behavioral characteristics as risk factors for certain diseases may contribute to the misdiagnosis of patients and interfere with efforts to identify and remove causes of health disparities.

The importance of having medical knowledge as a layman. The Hippocratic treatise affections in the context of the Hippocratic corpus

The aim of this paper is to explore various aspects regarding the Hippocratic treatise Affections, mainly its relationships to other Hippocratic treatises concerning genre and the ideology of the author, with the aim of placing this work within its scientific and sociocultural context.

Do textbooks used in university reading education courses conform to the instructional recommendations of the national reading panel?

Two reasons may be responsible for the poor grasp of the linguistic concepts related to literacy acquisition by preservice and in-service teachers: a lack of attention given to such concepts by teacher educators (college faculty members) and a lack of relevant information provided in the textbooks used in college courses. In an earlier study, the authors found that many teacher educators involved in the training of preservice and in-service teachers were not well acquainted with these concepts. In this study, the authors examined the extent to which textbooks used in reading education courses contain the information about the five components of literacy instruction (phonemic awareness, phonics, fluency, vocabulary, and text comprehension) recommended by the National Reading Panel. Such scrutiny shows that many textbooks do not adequately cover these five components and the related instructional procedures for teaching them. In addition to the paucity of information about teaching the five components, some textbooks present inaccurate information.

Gender bias in medical textbooks: examples from coronary heart disease, depression, alcohol abuse and pharmacology

OBJECTIVES

This study aimed to review the availability and accessibility of gender-specific knowledge in current medical textbooks used in Dutch medical schools. Medicine has been criticised as being gender-biased by assuming male and female bodies to be generally the same. The authors wondered whether current nationally and internationally accepted medical textbooks reflect the state of the art on gender-specific knowledge.

METHODS

The authors selected medical textbooks recommended by at least two medical schools in the Netherlands in the academic years 2004-05 and 2005-06. Investigated disciplines were internal medicine/cardiology, psychiatry and pharmacology. The textbooks were screened on the following topics: coronary heart disease; depressive disorders; alcohol abuse, and pharmacology. We defined evidence-based, gender-specific aspects of each of the topics on which information should be accessible in current textbooks for medical students.

RESULTS

Eleven textbooks were screened, including four on internal medicine/cardiology, four on pharmacology and three on psychiatry. Results show that gender-specific information is scarce or absent, and hardly accessible via index or layout. The scarce gender-specific information mainly applies to epidemiological data and reproductive items.

CONCLUSIONS

Current medical textbooks are still gender-biased. They lack somatic and psychosocial information relevant to good medical practice. As a consequence, future doctors will be unaware of relevant differences between men and women in the presentation, diagnosis and treatment of illnesses.

[Discussion on the citation of acu-moxibustion treatment verses in textbook acupuncturology]

Verses on Acu-moxibustion Treatment have played an important role in the pervasion and spread of indications of acupoints. Abundant verses are widely cited in different versions of the textbook Acupuncturology for university and college students in China. Some contents about clinical indications of acupoints are even listed in partial verses. However, one important issue should be noted that the source of some indications of acupoints summarized in these verses needs being investigated, and the indications of some acupoints have been seldom mentioned in literature. For example, Sizhukong (TE 23) is used to treat toothache, Diwuhui (GB 42) used to treat tinnitus, Shangqiu (SP 5) used to treat jaundice, Chongmen (SP 12) selected to treat metrorrhagia, metrostaxis and abnormal vaginal discharge, Sanjiaoshu (BL 22) chosen to treat dysentery, etc. These descriptions (indications of these acupoints) need being verified in clinical practice, and thus should be used cautiously. Moreover, the verse is a type of barriers of literature in which some errors may occur in the course of spread from generation to generation and are also inherited in verses. For instance, Fubai (GB 10) is employed to treat scrofula, Yanggang (BL 48) employed to treat jaundice, Yishe (BL 49) used to treat vomiting and difficulty in swallowing, Shiguan (KI 18) taken to treat sterility, Yamen (GV 15) taken to treat epilepsy, etc. Therefore, the editors of teaching materials for acu-moxibustion should take a very cautious attitude when using such kinds of contents in verses.

Textbook coverage of a common topic: fluid management of patients after surgery

CONTEXT

Maintenance fluid therapy is a protean topic but is clinically often mismanaged. Our teaching of medical students led us to suspect that textbooks provide limited information about the topic, so we set out to verify this possibility by reviewing the content of books written in English that covered perioperative care.

METHODS

We reviewed publishers' lists of textbooks and found 22 suitable books. After compiling a standard list of questions on intravenous therapy, we read each book to find out to what extent it delivered the answers, and listed the information obtained.

RESULTS

Only 13 books answered more than half of the questions. The information varied considerably. Suggested quantities of daily fluid, sodium and potassium requirements varied hugely.

CONCLUSIONS

Information provided in standard textbooks to guide fluid prescription is scant and variable. This could be a cogent reason why junior doctors prescribe postoperative fluids badly: the information in textbooks is inadequate and varies from book to book. The reasons for the poor coverage are not clear. Perhaps other common topics that are often poorly managed are also badly addressed by standard books.

Practical strategies for becoming a successful medical book author

OBJECTIVE

The authors, all senior editors in the Books Division of American Psychiatric Publishing, Inc., provide practical advice to authors who may be considering writing or editing a medical book.

METHODS

The authors summarize strategies for developing a book proposal and outline an approach to developing a focus for a book. They also list a number of common errors that authors frequently make when they develop a book proposal. The authors provide guidance on publishing research and discuss how authors can collaborate with a publisher's marketing department to publicize their book.

RESULTS

By employing a systematic and well-considered approach to preparing a book proposal and writing or editing a book, authors may achieve professional success and personal satisfaction.

CONCLUSION

Writing or editing a medical book requires a different series of steps than authoring a journal article.

Peer reviewing e-learning: opportunities, challenges, and solutions

Peer review is the foundation of academic publication and a necessary step in the scrutiny of any scholarly work. Simply defined, peer review is the attentive, unbiased assessment of any scholarly work that is submitted for formal scrutiny. Although medical school faculty increasingly use technology in clinical teaching, e-learning materials are often not subjected to a rigorous peer review process. The authors contrast peer review of e-learning materials with that of print materials, describe peer review issues regarding e-learning materials, propose approaches to address the challenges of peer review of e-learning materials, and outline directions for refinement of the e-learning peer review process. At its core, the peer review of e-learning materials should not differ substantially from that of traditional manuscripts. However, e-learning introduces new demands that impel reviewers to consider aspects that are unique to educational technology, including pedagogy, format, usability, navigation, interactivity, delivery, ease of updating, distribution, and access. Four approaches are offered to ease the burden and improve the quality of e-learning peer review: develop peer review training, embrace multidisciplinary peer review, develop guidelines, and provide incentives and compensation. The authors conclude with suggestions about peer review research.

Impact of the design of U.S. history textbooks on content acquisition and academic engagement of special education students: an experimental investigation

We used randomized controlled trials to compare the impact of the designs of 2 United States history textbooks on the content acquisition and behavior of 8th-grade students identified for special education services or identified as low achieving. We also investigated whether teachers differed in their use of instructional activities and questioning strategies based on the type of text used. Our findings suggest that students learned more history content, were more actively engaged, and answered more questions correctly when using the experimental textbook. Teachers used different activities depending on which textbook they used, but did not differ in types of questions asked.

Fehlinformation zum Tabakrauchen in deutschen Medizin-Lehrbüchern

BACKGROUND AND OBJECTIVE

Smoking is a major risk factor for coronary heart disease and lung cancer. While nicotine causes addiction, heart and lung diseases are caused by other substances contained in tobacco smoke. This study assessed whether these facts are adequately portrayed in German medical textbooks.

METHODS

The sections on cardiovascular and lung cancer risk factors in 28 German textbooks of internal medicine, available in two bookstores as well as the library of Göttingen University (Germany), were scanned for the words "smoking" and "nicotine" as risk factors for coronary artery disease and lung cancer.

RESULTS

In 12 of the 25 textbooks covering cardiovascular disease, smoking was mentioned as a risk factor for coronary artery disease; another 12 textbooks listed nicotine or nicotine addiction. In one textbook both terms were used. While smoking was referred to in all 21 textbooks that also discussed risk factors for lung cancer, nicotine was not mentioned in this context.

CONCLUSION

Many German textbooks of internal medicine contain misleading terms for the health effects of smoking, which may influence the thoughts and possibly also the behaviour of their readers. The use of the words "smoking" and "nicotine" as synonymous within the context of cardiovascular risk factors, suggesting a causal relationship between nicotine and coronary heart disease, is incorrect and should be removed from the specialist medical literature.

Recurring errors among recent history of psychology textbooks

Five recurring errors in history of psychology textbooks are discussed. One involves an identical misquotation. The remaining examples involve factual and interpretational errors that more than one and usually several textbook authors made. In at least 2 cases some facts were fabricated, namely, so-called facts associated with Pavlov's mugging and Descartes's reasons for choosing the pineal gland as the locus for mind-body interaction. A fourth example involves Broca's so-called discovery of the speech center, and the fifth example involves misinterpretations of Lloyd Morgan's intentions regarding his famous canon. When an error involves misinterpretation and thus misrepresentation, I will show why the misinterpretation is untenable.

Constancy and characteristics of the anterior cutaneous branch of the first intercostal nerve: Correcting the descriptions in human anatomy texts

Human anatomy texts state that the anterior cutaneous branch of the first intercostal nerve (Rca-Th1) does not exist or that, even if it does, it is poorly developed. However, an anterior cutaneous branch in the first intercostal space (Rca-1) was observed in 74.8% of cases examined (104/139 sides) and was not poorly developed at all. Some of the observed Rca-I were even larger than the anterior cutaneous branches in the second intercostal space (Rca-ll). The segment of origin of the Rca-I was analyzed in 37 sides and 66.2% (49/74 branches) were confirmed to be from Th1. As a result, in contrast with traditional beliefs, it was shown that Rca-Th1 exists. The Rca-I was classified into two types according to the course and distribution: (i) an anterior cutaneous branch that appeared at the anterior end of the first intercostal space (ICS), ran through the pectoralis major muscle and extended in the first ICS (Rca-1); and (ii) another branch that appeared at the same place but ran downward along the anterior surface of the second costal cartilage, deep to the pectoralis major muscle, to reach the inferior edge of the second costal cartilage or the second ICS, passed through the pectoralis major muscle and extended to the second rib or the second ICS (pseudo Rca-2). It was found that 77.8% (35/45 branches) of Rca-1 and 48.3% (14/29 branches) of pseudo Rca-2 were derived from Th1. Accordingly, the author suggests that the description in human anatomy texts should be revised to read, '... the Rca-Th1 exists quite constantly and some of appear at a position resembling Rca-Th2'.

[Hygienic assessment of textbooks for educational establishments of different types]

The role of hygienic parameters of prints in the development of fatigue and this or that abnormality in schoolchildren of today has been inadequately studied. Practically every three or two textbooks on the humanities, analyzed by the authors, show breaches of the orders of educational publishing products; they are much less significantly encountered in the textbooks on natural sciences and, in isolated instances, in those on mathematical sciences. Thus, due to the variations in their weight, the lettering of a body text, high component complexity and abstractedness, the textbooks are a risk factor for visual, nervous, and musculoskeletal diseases among pupils of educational establishments, particularly those of the innovation type. The problems associated of the present-day textbook are of no hygienic order, although they may exert a considerable impact on pupils' efficiency.