Twitter touted as tool to sway minds
Wednesday, October 22, 2014
Chest. 2014 Oct 1;146(4_MeetingAbstracts):593A. doi: 10.1378/chest.1994637.
Lung Cancer Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Lung cancer is the leading cause of mortality from cancer worldwide. Current lung screening guidelines recommend annual screening with low-dose computed tomography in 55 - 80 year old individuals with a 30 pack-year smoking history, who are currently smoking or have quit within the past 15 years. We applied the current guidelines to lung cancer cases diagnosed at an urban medical center over a 5-year time frame to determine the fraction of lung cancer cases that would be missed.
METHODS: Retrospective analysis of electronic medical record data from a tertiary teaching hospital in Georgia was used to evaluate all patients diagnosed with lung cancer between 2007 and 2012. Lung cancer cases staged IA, IB, IIA, IIB, IIIA, IIIB, IV were included.RESULTS: Of 843 lung cancer cases diagnosed in 2007 - 2012, the subjects were primarily African American and male. Racial and gender distributions are as follows: African Americans, n = 726 (86.1%) vs. 89 (10.5%) cases in non-Hispanic Whites vs. others 28 (3.3%); 338 (40.1%) females and 505 (59.9%) males. There were 5 (0.5%) lung cancer diagnoses in individuals aged 20 - 29 yrs; 16 (1.8%) diagnoses in ages 30 - 39 yrs; 93 (11%) cases in ages 40 - 49 yrs; 304 (36%) cases in ages 50-59; 272 (32.2%) cases in ages 60-69 yrs; 117 (13.8%) cases in ages 70-79 yrs; and 36 (4.2%) cases in subjects > 80 years of age. 150 (17.7%) cases would not have been captured by the current guidelines for lung cancer screening.
CONCLUSIONS: In this high-risk population, application of the current lung cancer screening guidelines would not have detected 17.7% of the cancers, as the majority (62%) occurred in 40-49 year-olds. As the mortality for lung cancer is high for African Americans, a one-size-fits-all screening policy may not be appropriate. Further research to determine screening guidelines for targeted groups, as indicated by our data, is warranted.
CLINICAL IMPLICATIONS: Early detection of lung cancer improves outcomes and the use of its screening methods can reduce mortality. Based on our data, current guidelines might have to be applicable on an individual basis so that we can incorporate factors such as race.
From Cook Co. Chief Medical Examiner Steve Cina and colleagues: Suggested guidelines for the management of high-profile fatality cases
Arch Pathol Lab Med. 2008 Oct;132(10):1630-4. doi: 10.1043/1543-2165(2008)132[1630:SGFTMO]2.0.CO;2.
The investigation of high-profile fatalities poses special challenges to medical examiners and coroners. Most high-profile cases can be readily recognized early in the course of the investigation. Commonly encountered examples include police-related fatalities or deaths in custody, deaths of celebrities, and mass fatalities or clustered deaths (eg, serial killers). Medical examiner and coroner offices should have policies and procedures in place for adequately handling such cases. A rational approach to these high-profile cases includes activating medical examiner or coroner investigative teams, preplanning before the autopsy, using special autopsy techniques and toxicology procedures, skillful questioning of key witnesses, preparing detailed and comprehensive reports, and planning effective communication with the media.
The investigation of the sudden and unexpected death of Anna Nicole Smith, an entertainment personality, is presented as an example of how to address the challenging issues inherent in high-profile fatalities and how to adequately prepare for the forensic investigation of high-profile cases.
This article presents a methodical approach to the investigation of high-profile deaths.
A comprehensive, preplanned forensic investigation and autopsy (including use of adjunctive studies) following the death of Anna Nicole Smith resulted in the accurate determination of the cause and manner of her death while adequately convincing the public of the objectivity and reliability of the Medical Examiners Office with respect to its conclusions.
The forensic investigation of death in high-profile cases can be much more tedious and demanding than the investigation of routine cases. It requires more stringent safekeeping of the body and its evidence, more extensive and sophisticated dissection techniques on occasion, and exhaustive toxicologic analysis to exclude low-probability allegations. Procedures for honest, unbiased, and judicious communication with outside agencies and the media must be followed. Failure to follow such procedures might have serious consequences for the medical examiner, the family of the deceased, and the community at large. Adherence to these suggested guidelines may resolve most of the intricate problems involved in the investigation of these types of cases.
Tuesday, October 21, 2014
For the fifth straight year, Tufts Medical Center will host See, Test, & Treat®, a free cervical and breast cancer screening program, funded through grants from the College of American Pathologists (CAP) Foundation. The event features same-day test results, diagnoses, and follow-up care for uninsured and underserved women ages 21 and older. Dr. Michael J. Misialek, an associate chair of pathology at Newton-Wellesley Hospital and the medical director of the Vernon Cancer Center, attended See, Test, & Treat® at Rhode Island Hospital and filled us in on what it’s like from a doctor’s point of view.
Med Confl Surviv. 2014 Oct 13:1-19. [Epub ahead of print]
This article compares the gender and health politics of the German and the French medical professions, which incorporated military command structures into their civilian self-conception. Mobilized doctors committed themselves to the new circumstances and opportunities offered by the war. They applied the established military spatial 'map' which distinguished between the male-dominated front and the female-dominated home front and turned it into an epidemiological map, identifying danger zones which arose from points of contact between men and women. The analysis singles out two case studies: the rapid spread of venereal disease and psychiatric disorders. These case studies allow for a comparative analysis of the following questions: How did doctors assess the impacts of the war on the individual and the society as a whole? How did they view the war's impact on conventional gender orders, individual and national health? And how did they see their own role as a part of an independent civilian profession?
Global Bioethics and Culture in a Pluralistic World: How does Culture influence Bioethics in Africa?
Ann Med Health Sci Res. 2014 Sep;4(5):672-5. doi: 10.4103/2141-9248.141495.
Global Bioethics and Culture in a Pluralistic World: How does Culture influence Bioethics in Africa?
Bioethics principles and practice can be influenced by different cultural background. This is because the four globally accepted bioethics principles are often based on basic ethical codes such as autonomy, beneficence, nonmaleficence and justice. Beneficence/nonmaleficence requires us to maximize possible benefits, while minimizing possible harms and consequently secure the well-being of others by refraining from harming them. Autonomy gives individuals the right to self-actualization and decision-making, while justice is concerned with the fair selection and distribution of the burdens and benefits of research among participants. Applications of these principles in cultural settings vary more often from one cultural perspective to the other because of the different understanding and practices of "what is good." The proponents of global ethics may argue that these principles should be universally generalizable and acceptable, but this is not possible because of the existing cultural diversities. In the African set-up, despite the existence of major common cultural practices, there are other norms and practices, which differ from one society to the other within the communities. Therefore, the word "global" bioethics may not be applicable generally in practice except if it can account for the structural dynamics and cultural differences within the complex societies in which we live in. However, the extent to which cultural diversity should be permitted to influence bioethical judgments in Africa, which at present is burdened with many diseases, should be of concern to researchers, ethicist and medical experts taking into considerations the constantly transforming global society. This topic examines the cultural influence on principles and practice of bioethics in Africa.
Am J Public Health. 2014 Oct 16:e1-e8. [Epub ahead of print]
The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.
The Origins of Minnesota's Mid-Level Dental Practitioner: Alignment of Problem, Political, and Policy Streams
J Dent Hyg. 2014 Oct;88(5):292-301.
The Origins of Minnesota's Mid-Level Dental Practitioner: Alignment of Problem, Political and Policy Streams.
Using John Kingdon's agenda-setting model, this paper explores how Minnesota came to legislate a mid-level dental practitioner to its oral health workforce. Using a pluralist framework embracing the existence of various interests and convictions, this analysis highlights the roles of issue formation, agenda setting and politics in policymaking.
Using Kingdon's agenda-setting model as a theoretical lens, and applying case study methodology, this paper analyzes how Minnesota came to legislate a mid-level dental practitione to its oral health workforce. Data have come from scholarly research, governmental and foundation agency reports, interviews with leaders involved in the mid-level dental practitioner initiative, news articles, and Minnesota statute.
After 2 years of contentious and challenging legislative initiatives, the problem, policy and political streams converged and aligned with the compromise passage of a bill legalizing mid-level dental practitioner practice. The Minnesota Dental Therapist Law was the first-in-the-nation licensing law to develop a new dental professional workforce model to address access to oral health care.
The Minnesota mid-level dental practitioner initiative demonstrates the important convergence and alignment of the access to oral health care problem and the subsequent collaboration between political interest groups and policymakers. Through partnerships and pluralist compromise, mid-level dental practitioner champions were able to open the policy window to move this legislation to law, enhancing the oral health workforce in Minnesota.
PLoS One. 2014 Oct 16;9(10):e110139. doi: 10.1371/journal.pone.0110139. eCollection 2014.
Improving the informed consent process in clinical research is of constant concern to regulatory authorities in the field and presents a challenge for both the specialists and patients involved. Informed consent is a process that should adequately match the complexity of clinical research. In analyzing the behaviour of 68 patients during the informed consent process related to the clinical research performed at Neomed Clinical Center in Brasov, we found that many patients do not ask any questions (35.3%). From those who do, part of the questions (20,6%) referred to general aspects (addressed the form but not the gist) of the clinical trial, some (72,8%) referred to specific aspects of the clinical trial they will attend and others (6,6%) unrelated to the clinical trial. These results suggest a lack of interest, awareness, and understanding of the information presented in the informed consent form. The possible underlying causes of this attitude and its bureaucratic, ethic, and legal implications are discussed.
Monday, October 20, 2014
Philos Ethics Humanit Med. 2014 Oct 18;9(1):14. [Epub ahead of print]
Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model - the specificity triad - that draws on late philosopher and physician Ludwik Fleck's concept of "style of thought" to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine--psychiatry and regenerative medicine--this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology -- historically relatively disjointed from biomedical enterprise -- and the burgeoning field of regenerative medicine.
Wednesday, October 15, 2014
Tuesday, October 14, 2014
Handb Exp Pharmacol. 2014;225:217-235.
Clinical and Ethical Implications of Placebo Effects: Enhancing Patients' Benefits from Pain Treatment.
Expectancy and learning are the core psychological mechanisms of placebo analgesia. They interact with further psychological processes such as emotions and motivations (e.g., anxiety, desire for relief), somatic focus, or cognitions (e.g., attitudes toward the treatment). The development of placebo responsiveness and the actual placebo response in a person is the result of the complex interaction between factors traced back to the individual learning history related to analgesic drugs or treatments and factors of the current context referring to the analgesic or placebo treatment. The aim of this chapter is to depict these complex interactions in a new model of analgesic placebo effects. It joins aspects of the learning history (preexisting experiences and preexisting expectations) of a patient with aspects of the current context (current expectation as a result of external and internal situation in which a pain medication/treatment/placebo is taken, e.g., current information about pain medication, current specific context/cues, desire for pain relief, certainty about upcoming pain relief, current expectation about pain reducing course, current selective attention, increased pain experience, or decreased pain experience). In order to exploit placebo efficacy for an analgesic treatment it is worthwhile to assess in which direction each of these factors exerts its influence in order to maximize placebo effects for a specific patient. By applying placebo mechanisms in this differentiated way, the efficacy of pain treatment can be deliberately boosted.
Friday, October 10, 2014
J Law Med Ethics. 2014 Sep;42 Suppl 1:51-66. doi: 10.1111/jlme.12162.
Next-generation sequencing broadens the debate about appropriate regulatory oversight of genetic testing and may force scholars to move beyond familiar privacy and health and safety regulatory issues to address new problems with industry structure and economic regulation. The genetic testing industry is passing through a period of profound structural change in response to shifts in technology and in the legal environment. Making genetic testing safe and effective for consumers increasingly requires access to comprehensive genomic data infrastructures that can support accurate, state-of-the-art interpretation of genetic test results. At present, there are significant barriers to access and there is no sector-specific regulator with power to ensure appropriate data access. Without it, genetic testing will not be safe for consumers even when it is performed at CLIA-certified laboratories using tests that have been FDA-cleared or approved. This article explores the emerging structure of the genetic testing industry and describes its present economic regulatory vacuum. In view of this gap in regulation, the article explores whether generally applicable law, particularly antitrust law, may offer solutions to the industry's data access problems. It concludes that courts may have a useful role to play, particularly in Europe and other jurisdictions where the essential facilities doctrine enjoys continued vitality. After Verizon Communications v. Law Offices of Curtis V. Trinko, the role of U.S. federal courts is less certain. Congress has demonstrated willingness to address access issues as they emerged in other infrastructure industries in recent decades. This article expresses no preference between legislative and judicial solutions. Its aim is simply to highlight an emerging economic regulatory issue which, if left unresolved, presents real health and safety concerns for consumers who receive genetic tests.
Thursday, October 9, 2014
Meat morals: relationship between meat consumption consumer attitudes towards human and animal welfare and moral behavior
Meat Sci. 2014 Aug 28;99C:68-74. doi: 10.1016/j.meatsci.2014.08.011. [Epub ahead of print]
Meat morals: relationship between meat consumption consumer attitudes towards human and animal welfare and moral behavior.
The aim of this work is to explore the relation between morality and diet choice by investigating how animal and human welfare attitudes and donation behaviors can predict a meat eating versus flexitarian versus vegetarian diet. The results of a survey study (N=299) show that animal health concerns (measured by the Animal Attitude Scale) can predict diet choice. Vegetarians are most concerned, while full-time meat eaters are least concerned, and the contrast between flexitarians and vegetarians is greater than the contrast between flexitarians and full-time meat eaters. With regards to human welfare (measured by the Moral Foundations Questionnaire), results show that attitudes towards human suffering set flexitarians apart from vegetarians and attitudes towards authority and respect distinguish between flexitarians and meat eaters. To conclude, results show that vegetarians donate more often to animal oriented charities than flexitarians and meat eaters, while no differences between the three diet groups occur for donations to human oriented charities.
The law firm said complainant Benjamin Careathers alleged Red Bull was “misleading customers” by making claims about the “functional beverage” and its ability to “give you wings” despite reports concluding energy drinks had the same benefit as he the average dose of caffeine consumed in coffee.
Bioethics. 2014 Sep 24. doi: 10.1111/bioe.12114. [Epub ahead of print]
In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision-making and policy-formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non-bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error.
Nurs Res Pract. 2014;2014:575130. doi: 10.1155/2014/575130. Epub 2014 Sep 9.
Study Objectives. In response to the 2010 New York State HIV testing law, we sought to understand the contextual factors that influence HIV testing rates in the emergency department (ED).
Methods. We analyzed electronic health record logs from 97,655 patients seen in three EDs in New York City. We used logistic regression to assess whether time of day, day of the week, and season significantly affected HIV testing rates.
Results. During our study period, 97,655 patients were evaluated and offered an HIV test. Of these, 7,763 (7.9%) agreed to be tested. Patients arriving between 6 a.m. and 7:59 p.m. were significantly (P < 0.001) more likely to be tested for HIV, followed by patients arriving between 8:00 p.m. and 9:59 p.m. (P < 0.01) and followed by patients arriving between 5-5:59 a.m. and 10-10:59 p.m. (P < 0.05) compared to patients arriving at midnight. Seasonal variation was also observed, where patients seen in July, August, and September (P < 0.001) were more likely to agree to be tested for HIV compared to patients seen in January, while patients seen in April and May (P < 0.001) were less likely to agree to be tested for HIV.
Conclusion. Time of day and season affect HIV testing rates in the ED, along with other factors such as patient acuity and completion of other blood work during the ED visit. These findings provide useful information for improving the implementation of an HIV testing program in the ED.
Psychol Sci. 2014 Oct 6. pii: 0956797614545132. [Epub ahead of print]
Rietveld CA1, Conley D2, Eriksson N3, Esko T4, Medland SE5, Vinkhuyzen AA6, Yang J6, Boardman JD7, Chabris CF8, Dawes CT9, Domingue BW10, Hinds DA3, Johannesson M11, Kiefer AK3, Laibson D12, Magnusson PK13, Mountain JL3, Oskarsson S14, Rostapshova O12, Teumer A15, Tung JY3, Visscher PM16,Benjamin DJ17, Cesarini D18, Koellinger PD19; the Social Science Genetics Association Consortium; the Social Science Genetics Association Consortium.
A recent genome-wide-association study of educational attainment identified three single-nucleotide polymorphisms (SNPs) whose associations, despite their small effect sizes (each R2 ≈ 0.02%), reached genome-wide significance (p < 5 × 10-8) in a large discovery sample and were replicated in an independent sample (p < .05). The study also reported associations between educational attainment and indices of SNPs called "polygenic scores." In three studies, we evaluated the robustness of these findings. Study 1 showed that the associations with all three SNPs were replicated in another large (N = 34,428) independent sample. We also found that the scores remained predictive (R2 ≈ 2%) in regressions with stringent controls for stratification (Study 2) and in new within-family analyses (Study 3). Our results show that large and therefore well-powered genome-wide-association studies can identify replicable genetic associations with behavioral traits. The small effect sizes of individual SNPs are likely to be a major contributing factor explaining the striking contrast between our results and the disappointing replication record of most candidate-gene studies.
Diabetes Educ. 2014 Oct 2. pii: 0145721714551992. [Epub ahead of print]
How Do Mobile Phone Diabetes Programs Drive Behavior Change? Evidence From a Mixed Methods Observational Cohort Study.
The purpose of this study was to investigate the behavioral effects of a theory-driven, mobile phone-based intervention that combines automated text messaging and remote nursing, using an automated, interactive text messaging system.
This was a mixed methods observational cohort study. Study participants were members of the University of Chicago Health Plan (UCHP) who largely reside in a working-class, urban African American community. Surveys were conducted at baseline, 3 months (mid-intervention), and 6 months (postintervention) to test the hypothesis that the intervention would be associated with improvements in self-efficacy, social support, health beliefs, and self-care. In addition, in-depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention.
The intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating) and improvements in 1 or more measures of self-efficacy, social support, and health beliefs (perceived control). Qualitatively, participants reported that knowledge, attitudes, and ownership were also affected by the program. Together these findings were used to construct a new behavioral model.
This study's findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change.