Sunday, April 24, 2016

"Any health care 'reform' that intensifies government regulation or enlarges the role of insurance companies only makes a bad system worse."

JEFF JACOBY

Let the patient pay the piper, and the price of health care will fall


"Americans are forever being told that health care costs are out of control and that only sweeping government intervention can bring them back to earth. Obamacare was supposed to make medical plans more affordable, but premiums are higher than ever . Bernie Sanders campaigns on a platform of “Medicare for all” — single-payer socialized health care — yet any such system would inevitablylower the quality of care while raising prices still higher.
Any health care “reform” that intensifies government regulation or enlarges the role of insurance companies only makes a bad system worse. Like the woman described above, for most Americans, even their most routine and predictable medical costs must be routed through the maddening labyrinth of insurance procedures.
But nothing could be more counterproductive."


Surrey on...childhood obesity - five different viewpoints

Surrey on...childhood obesity - five different viewpoints


"What can be done to tackle the problem and how can habits be changed for good? Should the schools, families or the government take the lead in implementing a solution? Are parents to blame and should it be up to ministers to tell us how and what we should be eating?"

The Last Theme Song -UNT's One O'Clock Lab Band

Morality and Intimate Partner Violence: Do Men in Court-Mandated Psychological Treatment Hold a Sacred Moral Vision of the World and Themselves?

 2016 Apr 8. [Epub ahead of print]

Morality and Intimate Partner Violence: Do Men in Court-Mandated Psychological Treatment Hold a Sacred Moral Vision of the World and Themselves?

Abstract

This article examines the characterization of men in a court-mandated treatment for violence against their partners as holding a sacred vision of the 5 moral foundations and of their own morality. This characterization is compatible with the assumption that a sacred moral world is easily threatened by reality and that may be associated to violent defensive actions. The results from latent class analyses reveal (a) a 4-class distribution depending exclusively on the intensity with which all participants (violent and nonviolent) tend to sacralize the actions proposed in the Moral Foundations Sacredness Scale and (b) a greater prevalence of the violent participants among the classes that are more prone to sacralize. They also show that they hold an inflated moral vision of themselves: They think they are much more moral than intelligent than others who have never been charged with criminal behavior (Muhammad Ali effect).

Strength training for older adults promotes longevity

Strength training for older adults promotes longevity


"The researchers looked at data from the National Health Interview Survey (NHIS) where nine percent of participants reported meeting the twice-a-week guidelines for strength training. “That’s only a small fraction of the population, but it’s actually higher than we had anticipated,” Kraschnewski said.
The respondents were followed for 15 years through their death certificate data. The researchers found that those who partook in strength training at least twice a week had a 46 percent lower risk of death, 41 percent lower risk of cardiac death, and 19 percent lower risk of death by cancer."

Saturday, April 23, 2016

Aca-awesome: AcoUstiKats - Amazed

AcoUstiKats - Amazed

Starts at 1:40


ObamaCare Suffers Three Major Blows In One Week

ObamaCare Suffers Three Major Blows In One Week


"ObamaCare rates will skyrocket next year, according to its former chief. Enrollment is tumbling this year. And a big insurer is quitting most exchanges. That’s what we learned in just the past few days."

Assessing the New American Society of Clinical Oncology/College of American Pathologists Guidelines for HER2 Testing by Fluorescence In Situ Hybridization: Experience of an Academic Consultation Practice

Michael F. Press MD, PhDIvonne Villalobos MHAAngela Santiago BSRoberta Guzman Monica Cervantes BAArmen Gasparyan Anaamika Campeau BAYanling Ma MDDenice D. Tsao-Wei MSSusan Groshen PhD
From the Departments of Pathology (Drs Press and Ma; Mss Villalobos, Santiago, Guzman, Cervantes, and Campeau; and Mr Gasparyan) and Preventive Medicine (Ms Tsao-Wei and Dr Groshen), Norris Comprehensive Cancer Center, University of Southern California, Los Angeles.
Reprints: Michael F. Press, MD, PhD, Department of Pathology, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, NOR5409, Los Angeles, CA 90033 (email: ).
Context.—Evaluation of HER2 gene amplification by fluorescence in situ hybridization (FISH) was changed by recent American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines.
Objective.—To determine frequencies and assess patterns of HER2 protein expression for each ASCO-CAP guideline FISH category among 7526 breast cancers accrued to our consultation practice.
Design.—We retrospectively reevaluated the HER2 FISH status of breast cancers in our consultation practice according to ASCO-CAP FISH guidelines, and documented HER2 protein levels in each category.
Results.—According to new guidelines, 17.7% of our consultation breast cancers were “ISH-positive” with HER2:CEP17 FISH ratios ≥2.0 and average HER2 gene copies per cell ≥4.0 (group 1); 0.4% were “ISH-positive” with ratios ≥2.0 and average copies <4.0 (group 2); 0.6% were “ISH-positive” with ratios <2.0 and average copies ≥6.0 (group 3); 4.6% were “ISH-equivocal” with ratios <2.0 and average copies ≥4.0 and <6.0 (group 4); and 76.7% were “ISH-negative” with ratios <2.0 and average copies <4.0 (group 5). However, only groups 1 (HER2 amplified) and 5 (HER2 not amplified) agreed with our previously reported status, and only these groups demonstrated the expected immunohistochemistry status, overexpression and low expression, respectively. Groups 2 and 4 breast cancers lacked overexpression, whereas group 3 was not significantly associated with either increased or decreased HER2 expression.
Conclusions.—Although the status of approximately 95% of our cases (groups 1 and 5) is not affected by the new guidelines, those of the other 5% (groups 2–4) conflict with previous HER2 gene amplification status and with HER2 status by immunohistochemistry.

"The problem with ­science is that so much of it simply isn’t."

SCIENTIFIC REGRESS


by William A. WilsonMay 2016


"The problem with ­science is that so much of it simply isn’t. Last summer, the Open Science Collaboration announced that it had tried to replicate one hundred published psychology experiments sampled from three of the most prestigious journals in the field. Scientific claims rest on the idea that experiments repeated under nearly identical conditions ought to yield approximately the same results, but until very recently, very few had bothered to check in a systematic way whether this was actually the case. The OSC was the biggest attempt yet to check a field’s results, and the most shocking. In many cases, they had used original experimental materials, and sometimes even performed the experiments under the guidance of the original researchers. Of the studies that had originally reported positive results, an astonishing 65 percent failed to show statistical significance on replication, and many of the remainder showed greatly reduced effect sizes."

Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society

Sinchita Roy-Chowdhuri MD, PhDDara L. Aisner MDTimothy Craig Allen MD, JDMary Beth Beasley MDAlain Borczuk ,MDPhilip T. Cagle MDVera Capelozzi MD, PhDSanja Dacic MD, PhDGilda da Cunha Santos MD, PhDLida P. Hariri MD, PhDKeith M. Kerr BSc, MBChB, FRCPath, FRCPESylvie Lantuejoul MD, PhDMari Mino-Kenudson MDAndre Moreira ,MD, PhDKirtee Raparia MDNatasha Rekhtman MD, PhDLynette Sholl MDEric Thunnissen MD, PhDMing Sound Tsao ,MDMarina Vivero MDYasushi Yatabe MD, PhD
From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada (Drs da Cunha Santos and Tsao); the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School, and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University, Institut National de la Santé et de la Recherche Médicale-Institut Albert Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, New York University, New York (Dr Moreira); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (Dr Rekhtman); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston (Drs Sholl and Vivero); the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).
The advent of targeted therapy in lung cancer has heralded a paradigm shift in the practice of cytopathology with the need for accurately subtyping lung carcinoma, as well as providing adequate material for molecular studies, to help guide clinical and therapeutic decisions. The variety and versatility of cytologic-specimen preparations offer significant advantages to molecular testing; however, they frequently remain underused. Therefore, evaluating the utility and adequacy of cytologic specimens is critical, not only from a lung cancer diagnosis standpoint but also for the myriad ancillary studies that are necessary to provide appropriate clinical management. A large fraction of lung cancers are diagnosed by aspiration or exfoliative cytology specimens, and thus, optimizing strategies to triage and best use the tissue for diagnosis and biomarker studies forms a critical component of lung cancer management. This review focuses on the opportunities and challenges of using cytologic specimens for molecular diagnosis of lung cancer and the role of cytopathology in the molecular era.

"Chronic obesity comes with price ‘we are going to pay for ... one day’" "The long-term costs are staggering."

Chronic obesity comes with price ‘we are going to pay for ... one day’


"Richardson is right to point out the challenges that communities large or small face with a generation of young people getting larger all the time.
The long-term costs are staggering. We encourage government at every level, whether in city or country, to look at ways to promote healthier diets and lifestyles for the young.
Lower medical costs later will repay these investments a thousandfold."

Tuesday, April 19, 2016

Senator Says He May Back Bill Exposing Saudis to 9/11 Lawsuits

Senator Says He May Back Bill Exposing Saudis to 9/11 Lawsuits

By MARK MAZZETTI and JENNIFER STEINHAUERAPRIL 19, 2016

"Those cases, some of which have tried to hold members of the Saudi royal family and Saudi charities liable for what the plaintiffs allege was financial support for terrorism, have been largely stymied because of a 1976 law that gives foreign nations broad immunity from American lawsuits. The current legislation would amend the law, allowing for nations to be sued in American courts if they are found to have played any role in terrorist attacks that killed Americans on home soil."



HT:SD

State Pathology Societies Unite Urging Repeal of NY Ban on Pathologist Conferrals

In an April 13 resolution affirmed by 44 state pathology societies, pathologists nationwide called for New York State to repeal the regulation that prohibits pathologists from conferring with patients on laboratory and pathology test results.
"Pathologists in every other state in the United States are able to fully exercise our medical discretion in answering patient questions, without the dictate or constraint of state regulation, and conferring with patients based upon our medical judgment as physicians," the RESOLUTION STATED. "The New York regulation represents an unwarranted and deleterious intrusion into the physician practice of medicine by pathologists to the detriment of quality, patient care, and patient empowerment in understanding their diagnosis."
The CAP and New York State Society of Pathologists (NYSSPATH) have strongly advocated for the NYS Department of Health (DOH) to remove the outdated prohibition on discussions between patients and pathologists. Regulatory impediments to patient discussions with pathologists should be removed as pathologists are legally and ethically obligated to communicate with their patients, the CAP and NYSSPATH have said.
The DOH is meeting with stakeholders to decide whether to take any action to repeal or change the regulation. The NY Public Health Planning Council, following testimony by pathologists, set a deadline of July 2016 for the DOH to make a determination.
The state DOH has been conducting calls with external stakeholders to determine their respective positions on the issue. A DOH stakeholder call in February included Emily Volk, MD, FCAP, chair of the CAP Council on Government and Professional Affairs (CGPA), and Patrick Godbey, MD, FCAP, vice chair of the CGPA.
Recently, six national pathology organizations and the New York chapters of the AARP and the American College of Radiology (ACR) also have urged the DOH to repeal the prohibition.

Judging the Past: How History Should Inform Bioethics

 2016 Apr 19;164(8):553-557. doi: 10.7326/M15-2642.

Judging the Past: How History Should Inform Bioethics.

Abstract

Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the "bad old days" of physicians behaving immorally. Bioethical discourse-both in the classroom and in practice-should be accompanied by efforts to historicize but not minimize pastethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.

Assessing the New American Society of Clinical Oncology/College of American Pathologists Guidelines for HER2 Testing by Fluorescence In Situ Hybridization: Experience of an Academic Consultation Practice

Michael F. Press MD, PhDIvonne Villalobos MHAAngela Santiago BSRoberta Guzman Monica Cervantes BAArmen Gasparyan Anaamika Campeau BAYanling Ma MDDenice D. Tsao-Wei MSSusan Groshen PhD
From the Departments of Pathology (Drs Press and Ma; Mss Villalobos, Santiago, Guzman, Cervantes, and Campeau; and Mr Gasparyan) and Preventive Medicine (Ms Tsao-Wei and Dr Groshen), Norris Comprehensive Cancer Center, University of Southern California, Los Angeles.
Reprints: Michael F. Press, MD, PhD, Department of Pathology, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, NOR5409, Los Angeles, CA 90033 (email: ).
Context.—Evaluation of HER2 gene amplification by fluorescence in situ hybridization (FISH) was changed by recent American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines.
Objective.—To determine frequencies and assess patterns of HER2 protein expression for each ASCO-CAP guideline FISH category among 7526 breast cancers accrued to our consultation practice.
Design.—We retrospectively reevaluated the HER2 FISH status of breast cancers in our consultation practice according to ASCO-CAP FISH guidelines, and documented HER2 protein levels in each category.
Results.—According to new guidelines, 17.7% of our consultation breast cancers were “ISH-positive” with HER2:CEP17 FISH ratios ≥2.0 and average HER2 gene copies per cell ≥4.0 (group 1); 0.4% were “ISH-positive” with ratios ≥2.0 and average copies <4.0 (group 2); 0.6% were “ISH-positive” with ratios <2.0 and average copies ≥6.0 (group 3); 4.6% were “ISH-equivocal” with ratios <2.0 and average copies ≥4.0 and <6.0 (group 4); and 76.7% were “ISH-negative” with ratios <2.0 and average copies <4.0 (group 5). However, only groups 1 (HER2 amplified) and 5 (HER2 not amplified) agreed with our previously reported status, and only these groups demonstrated the expected immunohistochemistry status, overexpression and low expression, respectively. Groups 2 and 4 breast cancers lacked overexpression, whereas group 3 was not significantly associated with either increased or decreased HER2 expression.
Conclusions.—Although the status of approximately 95% of our cases (groups 1 and 5) is not affected by the new guidelines, those of the other 5% (groups 2–4) conflict with previous HER2 gene amplification status and with HER2 status by immunohistochemistry.

Saturday, April 16, 2016

Teenage obesity linked to mental health issues

Teenage obesity linked to mental health issues


"New research in the BMJ Open Medical Journal shows the wasitlines, eating patterns and exercise routines of high school students could have a major bearing on their mental health.
The research shows a link between teenage girls consuming too many sweet drinks and takeaway foods, and becoming depressed."

“Trouble is going to come up, when patients say, ‘What the hell? I had a doctor,’ ” he says, if hospitals jettison physicians as a result of a lapse in MOC."

Maintenance of certification: inside the physician revolt

Physicians will pressure hospitals to change their bylaws to get rid of recertification requirements , predicts Paul Kempen, MD, an anesthesiologist with Trinity Health System in Steubenville, Ohio. “Trouble is going to come up, when patients say, ‘What the hell? I had a doctor,’ ” he says, if hospitals jettison physicians as a result of a lapse in MOC. “There will be a big, freaking lawsuit, not against ABIM but against the hospital ordering [MOC].” 

CHUCK NORRIS FIGHTS INCREASING DIABETES, OBESITY

CHUCK NORRIS FIGHTS INCREASING DIABETES, OBESITY



"As noted last week, global obesity has more than tripled among men and doubled among women in the past four decades. In the face of such a global health threat, equally shocking is the number of roadblocks faced in confronting the issue. Not the least of which is a constant upward spiraling cost of medication needed to treat the broad spectrum of diseases brought on by seriously excessive weight gain."



Read more at http://www.wnd.com/2016/04/chuck-norris-fights-increasing-diabetes-obesity/#jWwHL80x4G8Ce4Y3.99

What factors affect evidence-informed policymaking in public health?

 2016 Apr 14;5(1):61. doi: 10.1186/s13643-016-0240-6.

What factors affect evidence-informed policymaking in public health? Protocol for a systematic review of qualitative evidence using thematic synthesis.

Author information

  • 1Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 3DW, UK. benjamin.verboom@spi.ox.ac.uk.
  • 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205, MD, USA. benjamin.verboom@spi.ox.ac.uk.
  • 3Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 3DW, UK.
  • 4Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205, MD, USA.

Abstract

BACKGROUND:

Claims of and calls for evidence-informed policymaking pervade public health journals and the literature of governments and global health agencies, yet our knowledge of the arrangements most conducive to the appropriate use of evidence is incomplete and fragmented. Designing interventions to encourage evidence use by policymakers requires an understanding of the processes through which officials access, assess and use research, including technical and political factors related to evidence uptake, and the ways in which the policymaking context can affect these processes. This review aims to systematically locate, synthesise and interpret the existing qualitative work on the process of evidence use in public health policymaking, with the aim of producing an empirically derived taxonomy of factors affecting evidence use.

METHODS/DESIGN:

This review will include primary qualitative studies that examined the use of research evidence by policymakers to inform decisions about public health. To locate studies, we will search nine bibliographic databases, hand-search nine public health and policy journals and scan the websites of relevant organisations and the reference lists of previous reviews of evidence use in policymaking. Two reviewers will independently screen studies, apply inclusion criteria and appraise the quality of included studies. Data will be coded inductively and analysed using thematic synthesis. An augmented version of the CASP Qualitative Checklist will be used to appraise included studies, and the CERQual tool will be used to assess confidence in the review's findings. The review's results will be presented narratively and in tabular form. Synthesis findings will be summarised as a taxonomy of factors affecting evidence use in public health policymaking. A conceptual framework explaining the relationships between key factors will be proposed. Implications and recommendations for policy, practice and future research will be discussed.

DISCUSSION:

This review will be the most comprehensive to date to synthesise the qualitative literature on evidence use by public health policymakers and will be the first to apply a formal method of qualitative metasynthesis to this body of evidence. Its results will be useful both to scholars of evidence use and knowledge translation and to decision-makers and academics attempting to influence public health policy.

Ethical issues in using Twitter for population-level depression monitoring: a qualitative study

 2016 Apr 14;17(1):22. doi: 10.1186/s12910-016-0105-5.

Ethical issues in using Twitter for population-level depression monitoring: a qualitative study.

Author information

  • 1Minnesota Population Center, University of Minnesota, Twin Cities, 50 Willey Hall, 225 - 19th Avenue South, Minneapolis, MN, 55455, USA.
  • 2Department of Family Medicine & Public Health, University of California, San Diego, MTF 162E, 9500 Gilman Drive, La Jolla, CA, USA.
  • 3Department of Biomedical Informatics, University of Utah, Rm 2008, 421 Wakara Way, #140, Salt Lake City, UT, USA. mike.conway@utah.edu.

Abstract

BACKGROUND:

Recently, significant research effort has focused on using Twitter (and other social media) to investigate mental health at the population-level. While there has been influential work in developing ethical guidelines for Internet discussion forum-based research in public health, there is currently limited work focused on addressing ethical problems in Twitter-based public health research, and less still that considers these issues from users' own perspectives. In this work, we aim to investigate public attitudes towards utilizing public domain Twitter data for population-level mental health monitoring using a qualitative methodology.

METHODS:

The study explores user perspectives in a series of five, 2-h focus group interviews. Following a semi-structured protocol, 26 Twitter users with and without a diagnosed history of depression discussed general Twitter use, along with privacy expectations, and ethical issues in using social media for health monitoring, with a particular focus on mental health monitoring. Transcripts were then transcribed, redacted, and coded using a constant comparative approach.

RESULTS:

While participants expressed a wide range of opinions, there was an overall trend towards a relatively positive view of using public domain Twitter data as a resource for population level mental health monitoring, provided that results are appropriately aggregated. Results are divided into five sections: (1) a profile of respondents' Twitter use patterns and use variability; (2) users' privacy expectations, including expectations regarding data reach and permanence; (3) attitudes towards social media based population-level health monitoring in general, and attitudes towards mental health monitoring in particular; (4) attitudes towards individual versus population-level health monitoring; and (5) users' own recommendations for the appropriate regulation of population-level mental health monitoring.

CONCLUSIONS:

Focus group data reveal a wide range of attitudes towards the use of public-domain social media "big data" in population health research, from enthusiasm, through acceptance, to opposition. Study results highlight new perspectives in the discussion of ethical use of public data, particularly with respect to consent, privacy, and oversight.

OK SB 1148

SB 1148

Oklahoma Senate Bill
Physician licensure; relating to Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act; prohibiting certain construction. 

Oklahoma Bans Forced MOC, Becomes the First “Right to Care” State

Oklahoma Bans Forced MOC, Becomes the First “Right to Care” State



“Nothing in the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act shall be construed as to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in this state. For the purposes of this subsection, “Maintenance of Certification (MOC)” shall mean a continuing education program measuring core competencies in the practice of medicine and surgery and approved by a nationally recognized accrediting organization.”

From the Times of India: New weapon in war against obesity


New weapon in war against obesity



"The study suggests that impaired brown adipose tissue (BAT), otherwise known as 'brown fat', drives obesity, and by stimulating heat production in this fatty tissue, weight-management and glucose tolerance can be improved."

Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society

 2016 Apr 15. [Epub ahead of print]

Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society.

Author information

  • 1From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada (Drs da Cunha Santos and Tsao); the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School, and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University, Institut National de la Santé et de la Recherche Médicale-Institut Albert Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, New York University, New York (Dr Moreira); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (Dr Rekhtman); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston (Drs Sholl and Vivero); the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

Abstract

The advent of targeted therapy in lung cancer has heralded a paradigm shift in the practice of cytopathology with the need for accurately subtyping lung carcinoma, as well as providing adequate material for molecular studies, to help guide clinical and therapeutic decisions. The variety and versatility of cytologic-specimen preparations offer significant advantages to molecular testing; however, they frequently remain underused. Therefore, evaluating the utility and adequacy of cytologic specimens is critical, not only from a lung cancer diagnosis standpoint but also for the myriad ancillary studies that are necessary to provide appropriate clinical management. A large fraction of lung cancers are diagnosed by aspiration or exfoliative cytology specimens, and thus, optimizing strategies to triage and best use the tissue for diagnosis and biomarker studies forms a critical component of lung cancer management. This review focuses on the opportunities and challenges of using cytologic specimens for molecular diagnosis of lung cancer and the role of cytopathology in the molecular era.

Tuesday, April 12, 2016

Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children

 2016 Mar;19(1):12-19. Epub 2016 Mar 22.

Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children.

Author information

  • 1Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
  • 2Division of Pediatric Gastroenterology, Ohio State University, Columbus, OH, USA.
  • 3Department of Pediatrics,Nationwide Children's Hospital, Columbus, OH, USA.
  • 4Department of Pediatrics, Ohio State University, Columbus, OH, USA.

Abstract

PURPOSE:

This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children.

METHODS:

Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals.

RESULTS:

Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux.

CONCLUSION:

The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA.