Saturday, February 28, 2015

8 things millennials want—and don’t want—show how different they are from their parents

8 things millennials want—and don’t want—show how different they are from their parents

From U Utah: The Master Diagnostic Anatomic Pathologist

Christopher A. GarciaMDMichael B. CohenMD
From the Department of Pathology, University of Utah School of Medicine, Salt Lake City.

"Pathology groups may be forced, perhaps for the first time, to engage in high-level business strategic planning,"

David A. NovisMDMichelle Mudge-RileyDOMarko RaichBA
From Novis Consulting, LLC, Lee, New Hampshire (Dr Novis); Physicians Helping Physicians, Glen Allen, Virginia (Dr Mudge-Riley); and Vachette Pathology, Palmyra, Michigan (Mr Raich).

"Until a few years ago, the business environment for the practice of pathology was robust: stable third-party reimbursement, high revenues, content customers, and negligible competition. However, that environment is changing and the future does not look so favorable. Reduced federal and third-party reimbursements will diminish practice revenues.1 Fee-for-service is on track to morph into value-based remuneration,2 a paradigm shift that will likely have pathologists bickering with their colleagues for a fair share of the reimbursement check. The proliferation of pathology specialty training programs3 will likely escalate customers’ demand for specialized pathology expertise, diverting yet more work from generalist pathologists who never dreamed that work to be at risk. Mergers, consolidations, and acquisitions may eliminate pathology positions altogether. 

Pathology groups may be forced, perhaps for the first time, to engage in high-level business strategic planning, the stakes of which are the very preservation of their livelihoods. In many practices, several partners hold equal equity and hence equal voices in decision making. Finalizing strategic business decisions requires group consensus. For some groups, reaching consensus decisions may be difficult."

The Pathology Residency Program of the Johns Hopkins University School of Medicine: A Model of Its Kind

Patrizio CaturegliMD, MPHEdward F. McCarthyMDJ. Brooks JacksonMDRalph H. HrubanMD
From the Department of Pathology, Johns Hopkins University, Baltimore, Maryland.
Context.— The Department of Pathology of the Johns Hopkins University pioneered in the late 19th century the application of the scientific method to the study of medicine and fostered the development of residency training programs.
Objective.— To trace the history of the Johns Hopkins Pathology Residency Program and assess with quantifiable outcomes the performance of former residents.
Design.— We reviewed archival and departmental records from September 1899 to June 2014 to create a database of pathology residents. We then analyzed resident in-service examinations, American Board of Pathology examinations, and career paths.
Results.— In 115 years the department trained 555 residents who came from 133 medical schools located in 23 countries. Residents performed well on the in-service examinations, obtaining mean scaled total scores that were significantly better (P= .02) than those of the national peer groups. Residents (371 of 396, 94%) passed their boards typically at the first attempt, a percentage pass that was higher than the national average for both anatomic (P < .001) and clinical (P = .002) pathology. Approximately half of the residents went into private practice, whereas a third followed an academic career. Of the latter group, 124 (75%) became professors of pathology, 31 (19%) chairs of pathology departments, 10 (6%) deans of medical schools, 5 (3%) were elected into the National Academy of Sciences, and 1 won the Nobel prize.
Conclusions.— While maintaining its original core values, the Johns Hopkins Pathology Residency Program has trained physicians to be outstanding researchers, diagnosticians, and leaders in pathology.

From Alberto Marchevsky and Mark Wick: Evidence-Based Pathology: Systematic Literature Reviews as the Basis for Guidelines and Best Practices

Alberto M. MarchevskyMDMark R. WickMD
From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Dr Marchevsky);
and the Department of Pathology, University of Virginia Medical School, Charlottesville (Dr Wick).
Context.— Evidence-based medicine has been proposed as a new paradigm for the identification and evaluation of medical information. Best available evidence or data are identified and used as the basis for the diagnosis and treatment of individual patients. Evidence-based pathology has adapted basic evidence-based medicine concepts to the specific needs of pathology and laboratory medicine.
Objectives.— To briefly review the history and basic concepts of evidence-based medicine and evidence-based pathology, describe how to perform and interpret systematic reviews, and discuss how to integrate best evidence into guidelines.
Data Sources.— PubMed (National Library of Medicine, Washington, DC) and Web of Science (Thompson Reuters, New York, New York) were used.
Conclusions.— Evidence-based pathology provides methodology to evaluate the quality of information published in pathology journals and apply it to the diagnosis of tissue samples and other tests from individual patients. Information is gathered through the use of systematic reviews, using a method that is less biased and more comprehensive than ad hoc literature searches. Published data are classified into evidence levels to provide readers with a quick impression about the quality and probable clinical validity of available information. Best available evidence is combined with personal experience for the formulation of evidence-based, rather than opinion-based, guidelines that address specific practice needs.

From John Sinard and colleagues: Pathologists as Stewards of Laboratory Information

Walter H. HenricksMDMyra L. WilkersonMDWilliam J. CastellaniMDMark S. WhitsittPhDJohn H. SinardMD, PhD
From the Center for Pathology Informatics, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Henricks);
the Division of Laboratory Medicine, Geisinger Medical Laboratories, Danville, Pennsylvania (Dr Wilkerson);
the Department of Pathology and Laboratory Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (Dr Castellani);
the Diagnostic Intelligence and Health Information Technology Committee, College of American Pathologists, Northfield, Illinois (Dr Whitsitt);
and the Informatics Program, Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Sinard).
Just as electronic health records are transforming the practice of medicine and health care information management, practicing in the era of the electronic health record offers opportunities, if not imperatives, for pathologists to take on new and “transformative” professional and leadership roles for the organizations they serve. Experience indicates that clinicians will perceive pathologists and laboratories as responsible for all aspects of laboratory testing and information management, including order entry and results reporting, even though such functions may fall beyond the control of the laboratory. As described and expanded upon in the previous 4 articles of this series, the use of electronic health records dictates changes in how clinicians interact with laboratory information. In this environment, pathologists are uniquely positioned to act as the stewards for laboratory information in electronic health records and throughout health care organizations.

Friday, February 27, 2015

Payment for Cancer Biomarker Testing

Payment for Cancer Biomarker Testing

"At a time when payers, struggling to thrive in the current dynamic health care environment, must clearly understand the cost of patient care,3 they ‘‘are definitely on board with biomarker tests, particularly when it means that they are paying for drugs that patients will likely respond to—and conversely are not paying for several months of drugs or chemotherapy that will have little positive effect.’’ 8 But it has been difficult to ‘‘get a handle’’ on biomarker test payment because payment requirements evolve and change over time, payers approach payment in different ways for different technologies,9 and the majority of payers pay for diagnostic molecular tests separately from the associated therapy.10 In fact, payment for cancer biomarker tests may be a more difficult issue than payment for new oncology treatments themselves."

The Political Use of the Cancer Metaphor

 2015 Feb 27. [Epub ahead of print]

The Political Use of the Cancer Metaphor: Negative Consequences for the Public and the Cancer Community.

Author information

  • 1DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, MD, 21401, USA,


There has been an increase in the use of cancer as a political metaphor, most recently to describe the threat of international terrorism. The powerful cancer metaphor implies a particular political problem is serious, progressive and deadly. As such to use a cancer metaphor prepares the public for a set of serious, intense and prolonged actions. While politically useful for a governmental to communicate policy, there are negative consequences to the use of the cancer metaphor. It perpetuates among the public and patients old stereotypes of cancer prognosis and therapies that oncologists have tried to combat through education. These education efforts are designed to help patients avoid overly aggressive treatments, surveillance, monitoring and surgeries. It is hard to successfully educate the general public and patients when they continuously receive alternative messages from political leaders who use the cancer metaphor for a different purpose. Professional cancer educators and clinicians should be aware of this trend and redouble efforts to educate that the political metaphor is for politicsonly and misleading in the public health and clinical arenas.

New and emerging therapeutic options for malignant pleural mesothelioma: review of early clinical trials

 2015 Jan 23;7:51-63. doi: 10.2147/CMAR.S72814. eCollection 2015.

New and emerging therapeutic options for malignant pleural mesothelioma: review of early clinical trials.

Author information

  • 1Veterans Affairs Greater Los Angeles Healthcare System, Division of Thoracic Surgery, Los Angeles, CA, USA ; UCLA Division of Thoracic Surgery and Comprehensive Mesothelioma Program, Los Angeles, CA, USA.
  • 2Veterans Affairs Greater Los Angeles Healthcare System, Division of Thoracic Surgery, Los Angeles, CA, USA ; UCLA Division of Thoracic Surgery and Comprehensive Mesothelioma Program, Los Angeles, CA, USA ; Pacific Meso Center at the Pacific Heart, Lung and Blood Institute, Los Angeles, CA, USA.


Malignant pleural mesothelioma (MPM) is a rare tumor that is challenging to control. Despite some benefit from using the multimodality-approach (surgery, combination chemotherapy and radiation), survival remains poor. However, current research produced a list of potential therapies. Here, we summarize significant new preclinical and early clinical developments in treatment of MPM, which include mesothelin specific antibody and toxin therapies, interleukin-4 (IL-4) receptor toxins, dendritic cell vaccines, immune checkpoint inhibitors, and gene-based therapies. In addition, several local modalities such as photodynamic therapy, postoperative lavage using betadine, and cryotherapy for local recurrence, have also shown to be effective for local control of disease.

DNA hypermethylation analysis in sputum for the diagnosis of lung cancer: training validation set approach

 2015 Feb 26. doi: 10.1038/bjc.2014.636. [Epub ahead of print]

DNA hypermethylation analysis in sputum for the diagnosis of lung cancer: training validation set approach.

Author information

  • 1Department of Pathology, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands.
  • 2Department of Thoracic Oncology, NKI-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
  • 3Department of Pulmonary Diseases, Sint Antonius Hospital, Nieuwegein, The Netherlands.
  • 4Department of Pulmonary Diseases, Academic Medical Center, Amsterdam, The Netherlands.
  • 5Department of Pulmonary Diseases, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
  • 6Department of Pulmonary Diseases, Spaarne Hospital, Hoofddorp, The Netherlands.
  • 7Department of Pulmonary Diseases, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
  • 8Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
  • 9Department of Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
  • 10Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands.


Background:Lung cancer has the highest mortality of all cancers. The aim of this study was to examine DNA hypermethylation in sputum and validate its diagnostic accuracy for lung cancer.Methods:DNA hypermethylation of RASSF1A, APC, cytoglobin, 3OST2, PRDM14, FAM19A4 and PHACTR3 was analysed in sputum samples from symptomatic lung cancer patients and controls (learning set: 73 cases, 86 controls; validation set: 159 cases, 154 controls) by quantitative methylation-specific PCR. Three statistical models were used: (i) cutoff based on Youden's J index, (ii) cutoff based on fixed specificity per marker of 96% and (iii) risk classification of post-test probabilities.Results:In the learning set, approach (i) showed that RASSF1A was best able to distinguish cases from controls (sensitivity 42.5%, specificity 96.5%). RASSF1A, 3OST2 and PRDM14 combined demonstrated a sensitivity of 82.2% with a specificity of 66.3%. Approach (ii) yielded a combination rule of RASSF1A, 3OST2 and PHACTR3 (sensitivity 67.1%, specificity 89.5%). The risk model (approach iii) distributed the cases over all risk categories. All methods displayed similar and consistent results in the validation set.Conclusions:Our findings underscore the impact of DNA methylation markers in symptomatic lung cancerdiagnosis. RASSF1A is validated as diagnostic marker in lung cancer.

Why Is Therapeutic Misconception So Prevalent?

 2015 Apr;24(2):231-241.

Why Is Therapeutic Misconception So Prevalent?


Therapeutic misconception (TM)-when clinical research participants fail to adequately grasp the difference between participating in a clinical trial and receiving ordinary clinical care-has long been recognized as a significant problem in consent to clinical trials. We suggest that TM does not primarily reflect inadequate disclosure or participants' incompetence. Instead, TM arises from divergent primary cognitive frames. The researchers' frame places the clinical trial in the context of scientific designs for assessing intervention efficacy. In contrast, most participants have a cognitive frame that is personal and focused primarily on their medical problems. To illustrate this, we draw on interview material from both clinical researchers and participants in clinical trials. We suggest that reducing TM requires encouraging subjects to adjust their frame, not just add information to their existing frame. What is necessary is a scientific reframing of participation in a clinical trial.

Why women are lifting weights

Why women are lifting weights

The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria

 2015 Jan 31;9(1):6. doi: 10.1186/s13037-014-0053-2. eCollection 2015.

The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria.

Author information

  • 1National Orthopaedic Hospital, Enugu, Nigeria.



Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame.


This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit.


There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.

'Less ticking the boxes, more providing support': A qualitative study on health professionals' concerns towards the Liverpool Care of the Dying Pathway

 2015 Feb 17. pii: 0269216315570408. [Epub ahead of print]

'Less ticking the boxes, more providing support': A qualitative study on health professionals' concerns towards the Liverpool Care of the Dying Pathway.

Author information

  • 1Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
  • 2Regional Palliative Care Network, IRCCS AOU San Martino-IST, Genoa, Italy.
  • 3King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
  • 4Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy.
  • 5Istituto di Tanatologia e Medicina Psicologica, Bologna, Italy.
  • 6Departments of Mental Health and Clinical and Biological Sciences, University of Turin, Turin, Italy Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy.
  • 7Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.



Despite being widely used, research into the effectiveness of the Liverpool Care of the Dying Pathway (LCP) and associated cases of malpractice does not match dissemination. No study exists focusing on concerns voiced by professionals.


To explore the views of professionals who, during the hospital implementation of the Italian version of the Liverpool Care of the Dying Pathway (LCP-I), voiced or showed concerns towards it.


A qualitative study nested within the LCP-I randomized cluster trial, with semi-structured interviews analysed using thematic analysis.


Six nurses and five physicians from six out of the eight hospital wards who completed the LCP-I implementation were interviewed. Eligibility criteria were having taken part in all steps of the LCP-I Programme, voiced or somehow shown concerns, or failed to fully engage with the implementation process.


A total of 12 categories were identified, referring to four topics: the Implementation Programme, the LCP-I clinical documentation, the hospital environment and the educational and professional background of hospital healthcare staff. Issues raised by participants concerned both 'real' characteristics of the LCP-I and a misinterpretation of the LCP-I approach and clinical documentation. Furthermore, difficulties were reported which were not linked to the Programme but rather to end-of-life care.


This study provides insights into the experience of professionals with negative opinions of or concerns with the LCP-I. A more comprehensive approach to professional training in palliative care is needed and may envisage the development of new interventions aimed at improving the quality of care throughout the illness trajectory.

The Evolving Idea of Social Responsibility in Bioethics

 2015 Apr;24(2):204-213.

The Evolving Idea of Social Responsibility in Bioethics.


This article discusses the notion of social responsibility for personal health and well-being in bioethics. Although social responsibility is an intrinsic aspect of bioethics, and its role is increasingly recognized in certain areas, it can still be claimed that bioethics in general is committed to an individualistic theoretical framework that disregards the social context in which decisions, health, and well-being are situated. The philosophical premises of this framework regard individuals as rational decisionmakers who can be held accountable for their health conditions and who should be the primary objects of intervention in attempts to reduce lifestyle-associated chronic diseases. There are, however, social determinants of health that challenge this conclusion. Because their impact can be controlled, to a certain extent, by social and public policy decisions, their existence shows the inadequacy of the purely individualistic approach. I suggest, accordingly, that bioethics would benefit, both academically and societally, from a more social perspective. Bioethical studies that acknowledge, from the start, the social determinants of health would be more amenable to constructive multi- and interdisciplinarity, and a more balanced account of responsibility would further the contribution of sound bioethical work to sensible public policies.

Should America go vegan?

Should America go vegan to ward off obesity and save the environment?

Reflections on discrimination and health in India

 2015 Jan-Mar;12(1):13-7.

Reflections on discrimination and health in India.

Author information

  • 1Senior Fellow, Anveshi Research Centre for Women's Studies, Durgabai Deshmukh Colony, Bagh Amberpet, Hyderabad, Telangana 500 013; Co-convener, Medico Friend Circle, 11, Archana, kanchanjunga Arcade, 163, Solapur Road, Hadapsar, Pune 411 028 India.


This is a speculative paper on the structure of caste-based discrimination in India. It sketches the field by a) proposing four empirical and historical examples of discrimination in different medical situations; b) suggesting an analytical framework composed of domain, register, temporality and intensity of discrimination; c) proposing that in the Indian historical context, discrimination masks itself, hiding its character behind the veneer of secular ideas; d) arguing that discrimination is not some unfortunate residue of backwardness in modern society that will go away, but is the force of social hierarchy transforming itself into a fully modern capitalist culture. The paper then arrives at the understanding that discrimination is pandemic across India. The conclusion suggests that in India today, we need proposals, hypotheses and arguments that help us establish the ethical framework for meaningful empirical research that sociological studies of medical ethics and the epidemiology of discrimination can pursue. Its method is that of logical and speculative argument based on experience, with examples of different forms of discrimination to clarify the point being made. No specific research was undertaken for this purpose since the paper is not empirically based.

"Social media provides opportunities to share expertise and disseminate information globally, transcending geographical boundaries."

 2015 Mar;5(1):120. doi: 10.1136/bmjspcare-2014-000838.48.

International palliative care journal club on twitter: experience so far.

Author information

  • 1King's College London, Cicely Saunders Institute, Dept. of Palliative care, Policy and Rehabilitation, Bessemer Road, London SE5 9PJ.
  • 2International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster LA1 4YG.



@hpmJC (hospice and palliative medicine Journal Club, #hpmJC) was launched in February 2014 on the social networking service Twitter, as a regular international journal club for palliative care. The journal club aims to encourage critical analysis of research methods and findings, and to promote evidence based practice, by providing a forum to discuss latest research findings.


To analyse the use and reach of #hpmJC, from the first journal club in February 2014, to date. All data on Twitter posts (tweets) using #hpmJC were extracted from Twitter using analytic tools Sysomos and Symplur. Outcomes included number of tweets, number of unique users, users' designated country, and impressions (potential number of accounts reached).


7 journal clubs have taken place. 2360 tweets were sent, from 230 individual Twitter accounts and with contributions from people in 17 countries. For contributors whose country of origin is known (59%), most were based in the UK (41%) or USA (26%).Tweets from resource-poor countries were initially uncommon but increased over the time period. The mean number of contributors at each journal club was 32. The potential reach of #hpmJC varied, but for the most recent journal club was 290,802 unique users.


Social media provides opportunities to share expertise and disseminate information globally, transcending geographical boundaries. @hpmJC has been used to start a viable and sustainable online multidisciplinary journal club with wider geographical spread and potential reach than a traditional journal club. Strategies to increase participation in resource-poor countries are being developed.

Wednesday, February 25, 2015

Just released: FDA draft guidance: Technical Performance Assessment of Digital Pathology Whole Slide Imaging Devices

Technical Performance Assessment of Digital Pathology Whole Slide Imaging Devices

"Recent technological advances in digital microscopy, in particular the development of whole slide scanning systems, have accelerated the adoption of digital imaging in pathology, similar to the digital transformation that radiology departments have experienced over the last decade. The FDA regulates WSI systems manufacturers to ensure that the images produced for clinical intended uses are safe and effective for such "


Tuesday, February 24, 2015

Xenotransplantation from the perspective of moral theology

 2015 Feb 23. doi: 10.1111/xen.12157. [Epub ahead of print]

Xenotransplantation from the perspective of moral theology.

Author information

  • 1Professorship of Moral Theology with special consideration of Moral Psychology, Faculty of Catholic Theology, Ludwig Maximilian University, Munich, Germany.



Current medical research in the area of xenotransplantation is driven by the aim to save human lives and to improve the quality of life of those suffering from organ insufficiencies.


This study reflects the therapeutic intent of xenotransplantation from a theological-ethical perspective. Regarding statements of Christian communities, the analysis focuses mainly on catholic documents. This study takes into account the document on Prospects for Xenotransplantation by the Pontifical Academy for Life as well as a position paper on xenotransplantation released as a collaboration between the German Bishops Conference (Catholic) and the Evangelical Church in Germany (Protestant). Documents of other Christian denominations will be discussed in a separate paper. Aspects concerning the areas of medicine, social ethics and animal ethics are considered as well as biographical, psychosocial, culture-bound and ideological preconditions of acceptability. These aspects also include consequences for the construction of personal identity.


With regard to an anthropocentrism that is based theologically and relationally, xenotransplantation-in general-can be viewed as a permissible form of therapy, given that the principles of biomedical ethics will be observed and that animals are treated with respect.

Friday, February 20, 2015

Obesity Tzar

Julian Robertson’s Dream Of Being Appointed Obesity Czar So Close He Can Taste It

Clostridium difficile Recurrence Is a Strong Predictor of 30-Day Rehospitalization Among Patients in Intensive Care

 2015 Mar;36(3):273-279.

Clostridium difficile Recurrence Is a Strong Predictor of 30-Day Rehospitalization Among Patients in Intensive Care.

Author information

  • 11EviMedResearch Group,LLC,Goshen,MA.
  • 23Washington Hospital Center,Washington,DC.
  • 34St. Louis College of Pharmacy,St. Louis,MO.
  • 45Barnes-Jewish Hospital,St. Louis,MO.



While incidence, mortality, morbidity, and recurrence rates of C. difficile infection (CDI) among the critically ill have been investigated, the impact of its recurrence on 30-day rehospitalization (ReAd), an important policy focus, has not been examined.


Secondary analysis of a multicenter retrospective cohort study Patients Adult critically ill patients who survived their index hospitalization complicated by CDI METHODS: CDI was defined by diarrhea or pseudomembranous colitis and a positive assay for C. difficile toxins A and/or B. CDI recurrence (rCDI) was defined as diarrhea, positive C. difficile toxin and need for retreatment after cessation of therapy. Descriptive statistics and a logistic regression examined ReAd rates and characteristics, and factors that impact it.


Among 287 hospital survivors, 76 (26.5%) required ReAd (ReAd+). At baseline, the ReAd+ group did not differ significantly from the ReAd- group based on demographics, comorbidities, APACHE II scores, or ICU type. ReAd+ patients were more likely to have hypotension at CDI onset (48.7% vs 34.1%, P=.025) and to require vasopressors (40.0% vs 27.1%, P=.038); they were less likely to require mechanical ventilation (56.0% vs 77.3%, P<.001). A far greater proportion of ReAd+ than ReAd- had developed a recurrence either during the index hospitalization or within 30 days after discharge (32.89% vs 2.84%, P<.001). In a logistic regression, rCDI was a strong predictor of ReAd+ (adjusted odd ratio, 15.33, 95% confidence interval, 5.68-41.40).


Greater than 25% of all survivors of critical illness complicated by CDI require readmission within 30 days of discharge. CDI recurrence is a strong predictor of such rehospitalizations. 

"In this bewildering world we have to decide what to believe and how to act on that. In principle that’s what science is for...But that method doesn’t come naturally to most of us."

Why Do Many Reasonable People Doubt Science?

We live in an age when all manner of scientific knowledge—from climate change to vaccinations—faces furious opposition.
Some even have doubts about the moon landing.

By Joel Achenbach

"In this bewildering world we have to decide what to believe and how to act on that. In principle that’s what science is for. “Science is not a body of facts,” says geophysicist Marcia McNutt, who once headed the U.S. Geological Survey and is now editor ofScience, the prestigious journal. “Science is a method for deciding whether what we choose to believe has a basis in the laws of nature or not.” But that method doesn’t come naturally to most of us. And so we run into trouble, again and again."

"Still there are many thousands of diseases without treatments and with only fragmented research efforts."

 2014 Oct 31;3:261. doi: 10.12688/f1000research.5564.1. eCollection 2014.

Collaboration for rare disease drug discovery research.

Author information

  • 1Collaborative Drug Discovery, Inc., Burlingame, CA, 94010, USA.
  • 2National Brain Tumor Society, Newton, MA, 02458, USA.
  • 3Institute for Rare and Neglected Diseases Drug Discovery (iRND3), Mountain View, CA, 94043, USA.
  • 4Collaborative Drug Discovery, Inc., Burlingame, CA, 94010, USA ; Collaborations in Chemistry, Fuquay Varina, NC, 27526, USA ; Phoenix Nest Inc., Brooklyn, NY, 11215, USA ; Hereditary Neuropathy Foundation, New York, NY, 10016, USA ; Hannah's Hope Fund, Rexford, NY, NY 12148, USA.


Rare disease research has reached a tipping point, with the confluence of scientific and technologic developments that if appropriately harnessed, could lead to key breakthroughs and treatments for this set of devastating disorders. Industry-wide trends have revealed that the traditional drug discovery research and development (R&D) model is no longer viable, and drug companies are evolving their approach. Rather than only pursue blockbuster therapeutics for heterogeneous, common diseases, drug companies have increasingly begun to shift their focus to rare diseases. In academia, advances in genetics analyses and disease mechanisms have allowed scientific understanding to mature, but the lack of funding and translational capability severely limits the rare disease research that leads to clinical trials. Simultaneously, there is a movement towards increased research collaboration, more data sharing, and heightened engagement and active involvement by patients, advocates, and foundations. The growth in networks and social networking tools presents an opportunity to help reach other patients but also find researchers and build collaborations. The growth of collaborative software that can enable researchers to share their data could also enable rare disease patients and foundations to manage their portfolio of funded projects for developing new therapeutics and suggest drug repurposing opportunities. Still there are many thousands of diseases without treatments and with only fragmented research efforts. We will describe some recent progress in several rare diseases used as examples and propose how collaborations could be facilitated. We propose that the development of a center of excellence that integrates and shares informatics resources for rare diseases sponsored by all of the stakeholders would help foster these initiatives.