Anna Ivey: Is That MBA Worth The Money? (HT: MN)

Anna Ivey: Is That MBA Worth The Money?

Bacillus vampiris

Med Mal Infect. 2012 Sep;43(9):363-7. doi: 10.1016/j.medmal.2013.06.014. Epub 2013 Aug 3.

Bacteria and vampirism in cinema.

Castel O, Bourry A, Thévenot S, Burucoa C.

Source

Laboratoire de bactériologie et d'hygiène, UBM, CHU de Poitiers, BP 577, 86021 Poitiers cedex, France. Electronic address: o.castel@chu-poitiers.fr.

Abstract

A vampire is a non-dead and non-alive chimerical creature, which, according to various folklores and popular superstitions, feeds on blood of the living to draw vital force. Vampires do not reproduce by copulation, but by bite. Vampirism is thus similar to a contagious disease contracted by intravascular inoculation with a suspected microbial origin. In several vampire films, two real bacteria were staged, better integrated than others in popular imagination: Yersinia pestis and Treponema pallidum. Bacillus vampiris was created for science-fiction. These films are attempts to better define humans through one of their greatest fears: infectious disease.

Pinker's argument is strong--all of medical practice invokes medical humanities...

Pinker's argument is strong--all of medical practice invokes medical humanities, and any separation of the practice of medicine and medical humanities is artificial, distancing humanities from its necessary central position in patient care.   However Wieseltsier's very practical fear of humanities corruption resonates deeply.  The solution demands stronger, better financed, independent humanities departments (hard to get in today's academic financial environment), infusing them into medicine's day-to-day workings more than ever before.

Outcome of patients with interstitial lung disease admitted to the ICU (Drug-induced ILD pts do a little better)

Sarcoidosis Vasc Diffuse Lung Dis. 2013 Aug 1;30(2):134-142.

Outcome of patients with interstitial lung disease admitted to the intensive care unit.

Vial-Dupuy A, Sanchez O, Douvry Et Al B.

Source

. dominique.israel-biet@egp.aphp.fr.

Abstract

Introduction: The outcome of acute respiratory failure (ARF) affecting patients with various interstitial lung diseases (ILD) is poorly defined particularly in those with drug-induced ILD (DI-ILD). We investigated this issue focusing on fibrosing idiopathic interstitial pneumonitis (FIIP) and DI-ILD. Methods: We carried out a retrospective study of patients with ILD admitted in a single center ICU. The primary end-point was in-hospital mortality. Results: We included 72 subjects who fell into 3 diagnostic groups: DI-ILD (n=20), FIIP (n=28) and miscellaneous (M-ILD) (n=24). In-hospital mortality rates were 40% (n=8/20), 68% (n=19/28), and 25% (n=6/24) for DI-ILD, FIIP and M-ILD, respectively, (p=0.006). It reached, 64% (n=7/11), 100% (n=17/17) and 60% (n=6/10), respectively, in subjects on mechanical ventilation (p=0.007). In multivariate analysis, the need for mechanical ventilation (OR= 35; [95% CI, 5-255]), the type of ILD (FIIP vs miscellaneous) (OR=22; [95% CI, 3-147]) and high-dose steroids during ICU stay (OR=0.19; [95% CI, 0.04-0.99]) were independent determinants of in-hospital mortality. Conclusion: This study, while confirming the poor prognosis of FIIP patients in ICU, highlights the better prognosis of DI-ILD and M-ILD even though severity criteria on admission are similar in these 3 groups. These data impact on the management of these patients in ICU in whom a proper diagnostic of the underlying condition is crucial.

Int J Behav Med. 2013 Sep 26. [Epub ahead of print]

Morality, Responsibility and Risk: The Importance of Alternative Perspectives in Vaccination Research.

Lyons AC.

Source

School of Psychology, Massey University, Mt Cook, PO Box 756, Wellington, 6140, New Zealand, a.lyons@massey.ac.nz.

Abstract

BACKGROUND:

The four papers presented in this special section together provide a striking example of the importance of eliciting people's understandings and meanings of vaccinations, from parents and children to health and medical professionals.

PURPOSE:

This commentary reflects on the findings of the papers in this special section and considers them within a broader sociocultural view on vaccination research.

METHODS:

The four papers in the special section were integrated with previous research and scholarship on public health and vaccinations.

RESULTS:

The studies demonstrate how both uptake of vaccinations and their meanings vary by cultural context, most notably across Eastern and Western Europe, and the fundamental role that political, economic and healthcare systems play. Nevertheless, there are many similarities across seemingly diverse contexts. Three specific tensions are apparent across the findings (and within other vaccination research). These tensions revolve around (1) responsible citizen versus responsible individual, (2) scientific knowledge versus lay understandings and (3) uncertainty and risk versus certainty and trust.

CONCLUSION:

Threaded through these tensions are discourses around citizenship, trust, morality, gender and power that are important to consider in research on vaccinations.

"U.S. medical schools should commit to sustained involvement" in global health

Acad Med. 2013 Sep 25. [Epub ahead of print]

Medical Student in Global Health-Just One Part of a Larger Commitment.

Scott J.

Source

Dr. Scott is professor of emergency medicine and health policy and former dean, George Washington University School of Medicine and Health Sciences, Washington, DC.

Abstract

Across U.S. medical schools, the interest in global health is rapidly growing. Medical schools are challenged by the sheer numbers of students requesting or independently arranging educational experiences in the developing world. The logistics, legalities, and ethical issues have led to the development of a variety of models that enable student participation in safe and educationally enriching experiences. A major challenge is providing for the educational needs of the students within the medical and cultural environment of the host country without being culturally insensitive or disruptive. While not all of these programs will be successful, some models, like those described in this issue of Academic Medicine, are instructive. The educational experience of the U.S. medical students should not be the only measured outcome however. In exchange for the educational opportunities provided to medical students, U.S. medical schools should commit to sustained involvement in these countries, ensuring a meaningful experience for students and value added to the host countries.

From Uppsala U-Sweden: Incidental findings: the time is not yet ripe for a policy for biobanks

Eur J Hum Genet. 2013 Sep 25. doi: 10.1038/ejhg.2013.217. [Epub ahead of print]

Incidental findings: the time is not yet ripe for a policy for biobanks.

Viberg J, Hansson MG, Langenskiöld S, Segerdahl P.

Source

Department of Public Health and Caring Sciences, Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden.

Abstract

Incidental findings (IFs) are acknowledged to be among the most important ethical issues to consider in biobank research. Genome-wide association studies and disease-specific genetic research might reveal information about individual participants that are not related to the research purpose, but may be relevant to those participants' future health. In this article, we provide a synopsis of arguments for and against the disclosure of IFs in biobank research. We argue that arguments that do not distinguish between communications about pathogenic conditions and complex genetic risk for diseases fail, as preferences and decisions may be far more complex in the latter case. The principle of beneficence, for example, often supports the communication of incidentally discovered diseases, but if communication of risk is different, the beneficence of such communication is not equally evident. By conflating the latter form of communication with the former, the application of ethical principles to IFs in biobank research sometimes becomes too easy and frictionless. Current empirical surveys of people's desire to be informed about IFs do not provide sufficient guidance because they rely on the same notion of risk communication as a form of communication about actual health and disease. Differently designed empirical research and more reflection on biobank research and genetic risk information is required before ethical principles can be applied to support the adoption of a reasonable and comprehensive policy for handling IFs.

Arch Pathol Lab Med. 2013 Jun 19. [Epub ahead of print]

Interleukin 8 and Acute Lung Injury.

Allen TC, Kurdowska A.

Source

From the Departments of Pathology (Dr Allen) and Biochemistry (Dr Kurdowska), University of Texas Health Science Center at Tyler.

Abstract

Acute lung injury is a complex clinical syndrome involving acute inflammation, microvascular damage, and increased pulmonary vascular and epithelial permeability, frequently resulting in acute respiratory failure culminating in often-fatal acute respiratory distress syndrome. Interleukin 8 (IL-8), a potent neutrophil attractant and activator, plays a significant role in acute lung injury via the formation of anti-IL-8 autoantibody:IL-8 complexes and those complexes' interaction with FcγRIIa receptors, leading to the development of acute lung injury by, among other possible mechanisms, effecting neutrophil apoptosis. These complexes may also interact with lung endothelial cells in patients with acute respiratory distress syndrome. Continuing research of the role of neutrophils, IL-8, anti-IL-8 autoantibody:IL-8 complexes, and FcγRIIa receptors may ultimately provide molecular therapies that could lower acute respiratory distress syndrome mortality, as well as reduce or even prevent the development of acute lung injury altogether.

N Engl J Med. 1990 May 17;322(20):1462-4.

The Nazi hypothermia experiments and unethical research today.

Angell M.

"For nearly 50 years there has been debate about whether anyone should use information gained from Nazi experimentation on concentration camp victims. Those opposed to making any use of such data believe that it would tend to blunt the horror of what happened and thus in a sense dishonor those who died and offend the sensibilities of those who survived. According to this view, nothing should be seen as offsetting, even in the smallest way, the evil of the Nazi experiments."

"Retired Japanese army officer, Mustsuo Inuoe, who worked at unit 8604 in Guangzho from February, 1943, to July, 1945, says his team was culturing fleas as vectors of the plague bacillus..."

Lancet. 1995 Aug 26;346(8974):566.

Japanese war-time experiments come to light.

Rich V.

Shmatsu Yokoyama "was called to Ko-1855 Unit in 1944 and ordered to carry out living-body experiments by his superior officer. He disregarded the order, remembering Kawamura's words. As a result, he was dispatched to the dangerous frontlines."

Nihon Ishigaku Zasshi. 2008 Sep;54(3):239-48.

[Shomatsu Yokoyama, a physiologist who refused to conduct experiments on living human bodies].

[Article in Japanese]

Suenaga K.

Source

Fukushima Medical University, Department of Human Science.

Abstract

This article introduces the life of Shomatsu Yokoyama (1913-1992), a physiologist and military doctor, to the reader. During the Sino-Japanese war, Yokoyama disobeyed orders given by his superior officer to conduct inhumane medical experiments on humans. Not only in Unit 731, but also in other units, many military doctors were involved in medical crimes against residents of the areas invaded by the Japanese Army. Inhumane living-body experiments and vivisections were widely conducted at that time. There were, however, a small number of researchers who did not follow the orders to perform human-body experiments. Highlighting the life of such a rare researcher for the purpose of ascertaining the reason for his noncompliance with the order will provide us with insights on medical ethics. When Yokoyama was a student, his teacher, Professor Rinya Kawamura, informed him that he had been requested by the army to conduct special experiments. The remuneration for conducting such experiments was over 10 times more than the research fund allocated to the professor. Kawamura declined the request on the grounds that accepting it was against humanity. Kawamura warned Yokoyama that he might face the same situation in the future and asked Yokoyama to mark his words. Yokoyama was called to Ko-1855 Unit in 1944 and ordered to carry out living-body experiments by his superior officer. He disregarded the order, remembering Kawamura's words. As a result, he was dispatched to the dangerous frontlines. This article explores why Yokoyama was able to disobey the order to conduct inhumane experiments while shedding light on his personal background and his relationship with Rinya Kawamura. This article chronicles the life of one medical researcher who followed the dictates of his conscience during and after the war.

"For prisoners, too, the Japanese commonly regarded sickness as a crime...From this attitude to experimentation on prisoners is a small step..."

Br Med J (Clin Res Ed). 1985 Aug 24;291(6494):530-1.

Experimentation on prisoners by the Japanese during World War II.

Girdwood RH.

Med J Aust. 2013 Sep 2;199(5):326-7.

German doctors apologise for the crimes perpetrated by Nazi doctors.

Winterton PM.

Source

Child Protection Unit, Princess Margaret Hospital, Perth, WA, Australia. peter.winterton@uwa.edu.au

"To the Editor: In his article on the German Medical Association’s apology for medical crimes under Nazism, Weisz states “One can but hope that it will be soon followed by an apology from the Austrian Medical Association”.1Having been in Vienna on the 75th anniversary of the Anschluss (the annexation of Austria by Germany in March 1938), I would like to comment as to why I believe such an apology will be some time."

J Med Ethics. 2013 Sep 7. doi: 10.1136/medethics-2013-101320. [Epub ahead of print]

What's trust got to do with it? Revisiting opioid contracts.

Buchman DZ, Ho A.

Source

Interdisciplinary Studies Graduate Program and National Core for Neuroethics, The University of British Columbia, , Vancouver, British Columbia, Canada.

Abstract

Prescription opioid abuse (POA) is an escalating clinical and public health problem. Physician worries about iatrogenic addiction and whether patients are 'drug seeking', 'abusing' and 'diverting' prescription opioids exist against a backdrop of professional and legal consequences of prescribing that have created a climate of distrust in chronic pain management. One attempt to circumvent these worries is the use of opioid contracts that outline conditions patients must agree to in order to receive opioids. Opioid contracts have received some scholarly attention, with trust and trustworthiness identified as key values and virtues. However, few articles have provided a critical account of trust and trustworthiness in this context, particularly when there exists disagreement about their role in terms of enhancing or detracting from the patient-physician relationship. This paper argues that opioid contracts represent a misleading appeal to patient-physician trust. Assuming the patient is untrustworthy may wrongfully undermine the credibility of the patient's testimony, which may exacerbate certain vulnerabilities of the person in pain. However, misplaced trust in certain patients may render the physician vulnerable to the potential harms of POA. If patients distrust their physician, or feel distrusted by them, this may destabilise the therapeutic relationship and compromise care. A process of epistemic humility may help cultivate mutual patient-physician trust. Epistemic humility is a collaborative effort between physicians and patients that recognises the role of patients' subjective knowledge in enhancing physicians' self-understanding of their theoretical and practice frameworks, values and assumptions about the motivations of certain patients who report chronic pain.

Crank up the bass and learn some economics

Hayek vs. Keynes: Round 1 and Round 2

Need another reason to work out? "...running alone was not sufficient to prevent the loss in muscle strength (dynapenia) with aging."

J Strength Cond Res. 2013 Sep 14. [Epub ahead of print]

Leg Strength Declines with Advancing Age Despite Habitual Endurance Exercise in Active Older Adults.

Marcell TJ, Hawkins SA, Wiswell RA.

Source

1Department of Kinesiology, California State University Stanislaus, Turlock, CA 95382, 2Department of Exercise Science, California Lutheran University, Thousand Oaks, CA 91360, 3Department of Biokinesiology, University of Southern California, Los Angeles, CA 90033.

Abstract

Age-associated loss of muscle mass (sarcopenia) and strength (dynapenia) is associated with a loss of independence that contributes to falls, fractures, and nursing home admissions, while regular physical activity has been suggested to offset these losses. The purpose of this study was to evaluate the effect of habitual endurance exercise on muscle mass and strength in active older adults. A longitudinal analysis of muscle strength (≈ 4.8 yrs apart) was performed on 59 men (age at start of study: 58.6±7.3 yr) and 35 women (56.9±8.2 yr) who used endurance running as their primary mode of exercise. There were no changes in fat-free mass while body fat increased minimally (1.0-1.5%). Training volume (km•wk, d•wk) decreased in both the men and women. There was a significant loss of both isometric knee extension (≈5%/yr) and knee flexion (≈3.6%/yr) strength in both the men and women. However, there was no significant change in either isokinetic concentric or eccentric torque of the knee extensors. Our data demonstrated a significant decline in isometric knee extensor and knee flexor strength while there were no changes in LBM in this group of very active older men and women. Our data support newer exercise guidelines for older Americans suggesting resistance training be an integral component of a fitness program, and that running alone was not sufficient to prevent the loss in muscle strength (dynapenia) with aging.

PLoS One. 2013 Sep 20;8(9):e75184. doi: 10.1371/journal.pone.0075184.

Differential Stability of Cell-Free Circulating microRNAs: Implications for Their Utilization as Biomarkers.

Köberle V, Pleli T, Schmithals C, Augusto Alonso E, Haupenthal J, Bönig H, Peveling-Oberhag J, Biondi RM, Zeuzem S, Kronenberger B, Waidmann O, Piiper A.

Source

Department of Medicine I, University Hospital Frankfurt, Frankfurt, Germany.

Abstract

BACKGROUND:

MicroRNAs circulating in the blood, stabilized by complexation with proteins and/or additionally by encapsulation in lipid vesicles, are currently being evaluated as biomarkers. The consequences of their differential association with lipids/vesicles for their stability and use as biomarkers are largely unexplored and are subject of the present study.

METHODS:

The levels of a set of selected microRNAs were determined by quantitative reverse-transcription PCR after extraction from sera or vesicle- and non-vesicle fractions prepared from sera. The stability of these microRNAs after incubation with RNase A or RNase inhibitor, an inhibitor of RNase A family enzymes was studied.

RESULTS:

The levels of microRNA-1 and microRNA-122, but not those of microRNA-16, microRNA-21 and microRNA-142-3p, declined significantly during a 5-h incubation of the sera. RNase inhibitor prevented the loss of microRNAs in serum as well as the degradation of microRNA-122, a microRNA not expressed in blood cells, in whole blood. Stabilization of microRNA-122 was also achieved by hemolysis. Prolonged incubation of the sera led to enrichment of vesicle-associated relative to non-vesicle-associated microRNAs. Vesicle-associated microRNAs were more resistant to RNase A treatment than the respective microRNAs not associated with vesicles.

CONCLUSIONS:

Serum microRNAs showed differential stability upon prolonged incubation. RNase inhibitor might be useful to robustly preserve the pattern of cell-free circulating microRNAs. In the case of microRNAs not expressed in blood cells this can also be achieved by hemolysis. Vesicle-associated microRNAs appeared to be more stable than those not associated with vesicles, which might be useful to disclose additional biomarker properties of miRNAs.

J Child Psychol Psychiatry. 2013 May 23. doi: 10.1111/jcpp.12085. [Epub ahead of print]

Diagnosing Autism Spectrum Disorder: who will get a DSM-5 diagnosis?

G Kent R, J Carrington S, Le Couteur A, Gould J, Wing L, Maljaars J, Noens I, van Berckelaer-Onnes I, R Leekam S.

Source

Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK.

Abstract

BACKGROUND:

Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD-10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new criteria have been inconsistent across studies. No study has yet considered how changes at the 'sub domain' level might affect overall sensitivity and specificity, and few have included individuals of different ages and ability levels.

METHODS:

A set of DSM-5 ASD algorithms were developed using items from the Diagnostic Interview for Social and Communication Disorders (DISCO). The number of items required for each DSM-5 subdomain was defined either according to criteria specified by DSM-5 (Initial Algorithm), a statistical approach (Youden J Algorithm), or to minimise the number of false positives while maximising sensitivity (Modified Algorithm). The algorithms were designed, tested and compared in two independent samples (Sample 1, N = 82; Sample 2, N = 115), while sensitivity was assessed across age and ability levels in an additional dataset of individuals with an ICD-10 PDD diagnosis (Sample 3, N = 190).

RESULTS:

Sensitivity was highest in the Initial Algorithm, which had the poorest specificity. Although Youden J had excellent specificity, sensitivity was significantly lower than in the Modified Algorithm, which had both good sensitivity and specificity. Relaxing the domain A rules improved sensitivity of the Youden J Algorithm, but it remained less sensitive than the Modified Algorithm. Moreover, this was the only algorithm with variable sensitivity across age. All versions of the algorithm performed well across ability level.

CONCLUSIONS:

This study demonstrates that good levels of both sensitivity and specificity can be achieved for a diagnostic algorithm adhering to the DSM-5 criteria that is suitable across age and ability level.

Drugs (Abingdon Engl). 2012 Dec 1;19(6):462-473.

Consumption, drugs and style: Constructing intra-ethnic boundaries in Asian American youth cultures.

Moloney M, Hunt GP.

Source

Institute for Scientific Analysis, 1150 Ballena Boulevard, Alameda, CA 94501, USA.

Abstract

Based on 250 qualitative interviews with Asian American young men and women in the dance/club scenes in the San Francisco area, we examine the interplay between consumption, style and taste cultures with issues of ethnic identity, gender and acculturation. We explore the ways that consumption and taste markers (e.g. fashion, cars, music and drugs) are used to establish or negotiate symbolic boundaries between groups in this youth culture. The picture they paint of the dance scene is one less about cohesiveness and unity and more about divisions and boundaries, not only between but also significantly within ethnic groupings. The choice of drugs and ways of exhibiting intoxication are among the types of consumption that the young people drew upon to mark symbolic boundaries and establish identities. The young men and women in this study discuss a number of key boundaries in the scene, e.g. between FOBs and twinkies, between pretty boys and thugs, as they attempt to establish the cultural legitimacy of their own styles of Asian American identities.

"...the main objective of self-defense is self-preservation."

Learning ‘pasuntad’ for self-defense

"The U.S. Supreme Court has cited Internet materials 555 times since 1996, but tracking down the information isn’t always easy."

Link rot in SCOTUS decisions documented; half don’t go to original material

"In the trenches of everyday practice, it’s not working (or, if you’re more suspicious, it’s working perfectly by cutting doctors’ pay)."

Focus On Obamacare Ignores The Other Healthcare Revolution

The level of health education in the Polish population (probably similar to the rest of Europe and the US)

Ann Agric Environ Med. 2013 Sep 20;20(3):559-65.

The level of health education in the Polish population.

Olszanecka-Glinianowicz M, Chudek J.

Source

Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.

Abstract

Background: The study assessed factors influencing awareness of Poles concerning lifestyle factors that affect development of obesity, type 2 diabetes and cardiovascular diseases (CVD). 

Methods: A questionnaire survey covering awareness of lifestyle factors performed by general practitioners in 37,557 unselected patients. 

Results: 96.1% of respondents believed that lifestyle has an impact on the occurrence of CVDs, especially: tobacco smoking (91.4%), excessive intake of fat (81.3%), alcohol (67.5%), salt (64.9%), and stress (64.9%). 79.0% respondents believed the smoking cessation, 77.5% weight loss and 66.8% healthy diet are most important to prevent diseases. Additionally, the belief in the need for an early weight reduction decreased with increasing BMI (82.9% with normal weight vs. 77.5% overweight and 70.4% obese). The most common source of health education was a physician (75.8%), the mass media, such as television and the press (62.0% and 64.8%, respectively), less often were educational materials (37.8%) and books (20.3 %), the Internet (3.8%) and radio (0.8%). Younger respondents presented a higher level of awareness about all analysed aspects of healthy lifestyle. The multiple regression analysis revealed that low education level and rural residence are the most important factors decreasing awareness of the lifestyle effect on health. 

Conclusions: 1. The level of knowledge about non-pharmacological methods of preventing lifestyle diseases in the Polish population is high except of the role of physical activity and daily vegetables consumption. This, however, has no impact on reducing the percentage of overweight and obese people and on increasing the tendency to pursue lifestyle changes. 2. Frustrating is the fact that more than one fifth of the study population is unaware that excessive weight reduction prevents development of cardiovascular diseases. Moreover, the convince to early weight decreases with increasing BMI. 3. The highest level of the knowledge among younger subjects reflect improvement of health education in Polish population. 4. In addition to education performed by physician the main sources of patients knowledge are television and the press with the growing role of the Internet among younger. 5. Further health education programs are necessary, which should include not only activities that increase the level of health education and health awareness, but also aspects such as changes in beliefs, sense of self-efficacy and social support.

NICE guidance on organ retrieval: misguided or not?

Clin Med. 2012 Dec;12(6):513-6.

Misguided presumptions: British Medical Association (BMA) and National Institute for Health and Clinical Excellence (NICE) guidance on organ retrieval and 'opt out' or 'presumed consent'

Randall F, Downie R.

Source

Isle of Wight NHS Trust. fiona.randall@iow.nhs.uk

Abstract

Three documents have been produced in an attempt to increase the number of organs available for transplant: a National Institute for Health and Clinical Excellence (NICE) clinical guideline, a British Medical Association (BMA) report and a Welsh Government white paper. All three are ethically flawed: NICE and the BMA recommend that whenever there is intention to withdraw life-sustaining treatment and death is expected, patients should instead be stabilised to assess for donation. This is contrary to patients' best interests, the principles of mental capacity legislation and current criteria for accessing intensive care units. Regarding consent, the BMA and Welsh Government recommend an 'opt-out' policy, but consent in law requires information and cannot be 'presumed' or 'deemed' on the basis of failure to express or register 'opting out'. The language of all three proposals is manipulative, and patient trust may be undermined because the doctor's attention must move from the interests of the patient to those of the unknown organ recipients.

___________________________________________

Clin Med. 2012 Dec;12(6):517-9.

BMA and NICE guidance on organ retrieval: neither misguided nor presumptuous.

Neuberger J.

Source

NHS Blood and Transplant, Birmingham. James.Neuberger@nhsbt.nhs.uk

Abstract

Organ donation from deceased donors should occur whenever appropriate: that is, when there is evidence, belief or understanding that donation was the stated wish of the potential donor or would be in accordance with their wishes, is lawful and in line with current guidelines and will not add further distress to the family. This is the underlying assumption of the British Medical Association (BMA) report, National Institute for Health and Clinical Excellence (NICE) Guideline and Welsh Government Assembly Report. For potential donors after circulatory death, it might be necessary to support the potential donor until the wishes of the person and their family are ascertained. Provided that such interventions are reasonable, explained and do not cause distress to the patient and their family, such measures are surely suitable and will also enable donation to occur when appropriate. Publication and adherence to guidelines that have clinical, legal and ethical validity will reassure the public. Organ donation not only improves the length and quality of life of recipients, but also saves resources for the NHS and provides benefit to the donor family.

Health Aff (Millwood). 2013 Sep 25. [Epub ahead of print]

Understanding State Variation In Health Insurance Dynamics Can Help Tailor Enrollment Strategies For ACA Expansion.

Graves JA, Swartz K.

Source

1John A.

Abstract

The number and types of people who become eligible for and enroll in the Affordable Care Act's (ACA's) health insurance expansions will depend in part on the factors that cause people to become uninsured for different lengths of time. We used a small-area estimation approach to estimate differences across states in percentages of adults losing health insurance and in lengths of their uninsured spells. We found that nearly 50 percent of the nonelderly adult population in Florida, Nevada, New Mexico, and Texas-but only 18 percent in Massachusetts and 22 percent in Vermont-experienced an uninsured spell between 2009 and 2012. Compared to people who lost private coverage, those with public insurance were more likely to experience an uninsured spell, but their spells of uninsurance were shorter. We categorized states based on estimated incidence of uninsured spells and the spells' duration. States should tailor their enrollment outreach and retention efforts for the ACA's coverage expansions to address their own mix of types of coverage lost and durations of uninsured spells.

Coming soon to an Obamacare hospital near you

Br J Nurs. 2013 Sep 12;22(16):976-7.

Why the Liverpool Care Pathway should be replaced.

Tingle J.

Source

Reader in Health Law, Nottingham Law School, Nottingham Trent University.

Abstract

In recent months the Liverpool Care Pathway (LCP) has been the object of substantial criticism in the media and elsewhere. Alarming news stories have circulated about the LCP and the care of the elderly in acute hospitals. The stories share common themes with the complaints that led to the Mid Staffordshire public inquiry.

New perspectives in Respiratory Syncitial Virus infection

New perspectives in Respiratory Syncitial Virus infection

"The clinical picture of dementia portrayed in fictional movies is mild and may be misleading."

"The clinical picture of dementia portrayed in fictional movies is mild and may be misleading."

Lung cancer biomarker testing "has forever altered the role of pathologists in the management of patients with lung cancer"

Arch Pathol Lab Med. 2013 Sep;137(9):1191-8. 

Lung cancer biomarkers: present status and future developments.

Cagle PT, Allen TC, Olsen RJ.

Source

From the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas, and the Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York (Drs Cagle and Olsen); and.

Abstract

The publication of the "Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors: Guideline From the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology" has now provided a guideline for biomarker testing for first-generation lung cancer tyrosine kinase inhibitors. Biomarker testing has forever altered the role of pathologists in the management of patients with lung cancer. Current, unresolved issues in the precision medicine of lung cancer will be addressed by the development of new biomarker tests, new drugs, and new test technologies and by improvement in the cost to benefit ratio of biomarker testing.

Curr Probl Diagn Radiol. 2013 Sep-Oct;42(5):220-30. 

Effective use of low-dose computed tomography lung cancer screening.

Jeffers CD, Pandey T, Jambhekar K, Meek M.

Source

University of Arkansas for Medical Sciences, Little Rock, ARUniversity of Arkansas for Medical Sciences. Electronic address: cjeffers@uams.edu.

Abstract

Lung cancer screening programs for high-risk populations using low-dose computed tomography (LDCT) have been shown by a class I clinical trial to reduce lung cancer mortality by 20%. We present an overview of randomized and nonrandomized lung cancer screening trials and review some of the arguments advocating for or against the widespread implementation of such a screening program. Concerns regarding the use of LDCT screening forlung cancer include increased risk from radiation exposure, overdiagnosis of indolent tumors, and high numbers of false-positive results, which may increase patient anxiety and result in unnecessary procedures with potential complications. Current recommendations regarding diagnostic criteria and workup of positive screens as well as the risks and benefits of using LDCT for lung cancer screening are provided.

Video games and making good choices: "...even when risky choices did not pay off, individuals who spent more time gaming and endorsed more symptoms of pathological gaming continued to make these choices." Limit screen time

http://www.ncbi.nlm.nih.gov/pubmed/24058356

Front Psychol. 2013 Sep 10;4:609. doi: 10.3389/fpsyg.2013.00609.

What would my avatar do? Gaming, pathology, and risky decision making.

Bailey K, West R, Kuffel J.

Source

Social Cognitive Neuroscience Laboratory, Department of Psychological Sciences, University of Missouri Columbia, MO, USA.

Abstract

Recent work has revealed a relationship between pathological video game use and increased impulsivity among children and adolescents. A few studies have also demonstrated increased risk-taking outside of the video game environment following game play, but this work has largely focused on one genre of video games (i.e., racing). Motivated by these findings, the aim of the current study was to examine the relationship between pathological and non-pathological video game use, impulsivity, and risky decision making. The current study also investigated the relationship between experience with two of the most popular genres of video games [i.e., first-person shooter (FPS) and strategy] and risky decision making. Consistent with previous work, ~7% of the current sample of college-aged adults met criteria for pathological video game use. The number of hours spent gaming per week was associated with increased impulsivity on a self-report measure and on the temporal discounting (TD) task. This relationship was sensitive to the genre of video game; specifically, experience with FPS games was positively correlated with impulsivity, while experience with strategy games was negatively correlated with impulsivity. Hours per week and pathological symptoms predicted greater risk-taking in the risk task and the Iowa Gambling task, accompanied by worse overall performance, indicating that even when risky choices did not pay off, individuals who spent more time gaming and endorsed more symptoms of pathological gaming continued to make these choices. Based on these data, we suggest that the presence of pathological symptoms and the genre of video game (e.g., FPS, strategy) may be important factors in determining how the amount of game experience relates to impulsivity and risky-decision making.