Thomas W. Bauer and Renee J. Slaw, (2014) Validating Whole-Slide Imaging for Consultation Diagnoses in Surgical Pathology. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Validating Whole-Slide Imaging for Consultation Diagnoses in Surgical Pathology

Thomas W. Bauer MD, PhD; Renee J. Slaw, MBA

From the Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio. Supplemental digital content is available for this article. See text for hyperlink.

Context.— The interpretation of scanned whole-slide images (WSI) offers some theoretical advantages for long-distance, consultative diagnosis in surgical pathology. Few WSI validation studies have focused on difficult consultation cases.

Objective.— To test intraobserver variability of WSI interpretations in cases that had been submitted for consultation using the same hardware and software configuration selected by a client.

Design.— The 217 cases (approximately 20 nearly consecutive cases received in consultation for each of 11 subspecialty groups) were scanned, uploaded to an image-distribution application, and interpreted by 26 pathologists who had reviewed the microscope slides an average of 47 days earlier. Independent pathologists identified and classified discrepancies between microscope slide and WSI diagnoses.

Results.— There were 2 major discrepancies (0.92%) and 8 minor discrepancies (3.7%). One major discrepancy reflected atypical versus nonatypical endometrial hyperplasia; the other related to reactive squamous changes versus carcinoma. Strengths of the study include the large sample size, the many pathologists involved, the degree of difficulty of the cases, and the duplication of scanning and software configuration projected to be used by a client. Although the average 43-day washout exceeds the 2-week interval recommended by an expert panel of the College of American Pathologists, an important limitation in this study was that pathologists commonly remember consultation cases for a long time.

Conclusion.— Our results help support the safety and efficacy of WSI for surgical pathology diagnoses.

Med Law Rev. 2014 Spring;22(2):255-73. doi: 10.1093/medlaw/fwu009.

Market competition in health care markets in the Netherlands: some lessons for England?

den Exter AP1, Guy MJ2.

Author information

• 1Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
• 2UEA Law School and Centre for Competition Policy (CCP), University of East Anglia, Norwich NR4 7TJ, UK mary.guy@uea.ac.uk.

Abstract

This article seeks to establish what lessons might be available to the English health care sector following enactment of the Health and Social Care Act 2012 from the Dutch experience of introducing market competition into health care via a mandatory health insurance scheme implemented by for-profit insurance companies. The existence of the Beveridge NHS model in England, and a Bismarckian insurance system in The Netherlands perhaps suggest that a comparison of the two countries is at best limited, and reinforced by the different Enthoven-inspired competitive models each has adopted. However, we contend that there are positive and negative issues arising from introducing competition into health care-, e.g. concerns about equity and benefits of efficiencies-which go beyond national boundaries and different systems and reflect the global paradigm shift towards the use of market forces in previously non-market areas such as health. The article examines the situation in England following the HSCA 2012 and The Netherlands following the 2006 reforms before analysing two areas of common ground: the focus in both countries on competition on quality (as opposed to price) and integrated care, which is assuming ever greater significance. We suggest that our combined insights (as a health lawyer and competition lawyer respectively) coupled with a comparative approach create a novel contribution to current calls for a wider public debate about the real role of markets in health care over and above simple characterisation as a force for good or bad.

J Pediatric Infect Dis Soc. 2014 Jun;3(2):112-118. Epub 2013 Nov 13.

A National Study of the Impact of Rapid Influenza Testing on Clinical Care in the Emergency Department.

Blaschke AJ1, Shapiro DJ2, Pavia AT1, Byington CL1, Ampofo K1, Stockmann C3, Hersh AL1.

Author information

• 1Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
• 2Department of Pediatrics ; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
• 3Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City ; Department of Pharmacology and Toxicology, University of Utah College of Pharmacy, Salt Lake City.

Abstract

BACKGROUND:

Rapid influenza diagnostic tests (RIDT) may influence physician decision-making. Single-center studies suggest that influenza diagnosed in association with RIDT reduces ancillary testing and antibiotic prescribing. The extent of RIDT use in US emergency departments (EDs) and their impact on patient management are unknown. We examined the use of RIDT and its effect on influenza management, using a national sample of ED visits.

METHODS:

We performed a retrospective study using data from the National Hospital Ambulatory Medical Care Survey, an annually administered survey capturing a nationally representative sample of visits to US EDs. We identified patient visits in which RIDT was performed and/or influenza was diagnosed across 3 influenza seasons (2007-2009). Ancillary testing and antibiotic and antiviral prescribing were evaluated for 2 groups of patients in whom RIDT was performed (those given or not given a diagnosis of influenza) and a third group in whom influenza was diagnosed but RIDT was not performed.

RESULTS:

Rapid influenza diagnostic tests were performed during 4.2 million visits. Forty-two percent of influenza diagnoses were made in association with RIDT. For patients diagnosed with influenza, ancillary test ordering was lower (45% vs 53% of visits) and there were fewer antibiotic prescriptions (11% vs 23%), and antiviral use was higher (56% vs 19%) when the diagnosis was made in association with RIDT.

CONCLUSIONS:

Influenza diagnoses made in association with RIDT resulted in fewer tests and antibiotic prescriptions and more frequent use of antivirals. This finding suggests that test results influence physician behavior.

J Med Ethics. 2014 May 21. pii: medethics-2013-101780. doi: 10.1136/medethics-2013-101780. [Epub ahead of print]

Ethics and end of life care: the Liverpool Care Pathway and the Neuberger Review.

Wrigley A.

Abstract

The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication and ethical decision-making, without the added demand to end the Liverpool Care Pathway, would have resulted in a genuine advance in end of life care.

From U Michigan: Outcomes of third heart transplants in pediatric and young adult patients

J Heart Lung Transplant. 2014 Apr 19. pii: S1053-2498(14)01092-4. doi: 10.1016/j.healun.2014.04.009. [Epub ahead of print]

Outcomes of third heart transplants in pediatric and young adult patients: Analysis of the United Network for Organ Sharing database.

Friedland-Little JM1, Gajarski RJ2, Yu S2, Donohue JE2, Zamberlan MC2, Schumacher KR2.

Author information

• 1Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan. Electronic address: jmfriedl@med.umich.edu.
• 2Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan.

Abstract

BACKGROUND:

Repeat heart transplantation (re-HTx) is standard practice in many pediatric centers. There are limited data available on outcomes of third HTx after failure of a second graft. We sought to compare outcomes of third HTx in pediatric and young adult patients with outcomes of second HTx in comparable recipients.

METHODS:

All recipients of a third HTx in whom the primary HTx occurred before 21 years of age were identified in the United Network for Organ Sharing database (1985 to 2011) and matched 1:3 with a control group of second HTx patients by age, era and re-HTx indication. Outcomes including survival, rejection and cardiac allograft vasculopathy (CAV) were compared between groups.

RESULTS:

There was no difference between third HTx patients (n = 27) and control second HTx patients (n = 79) with respect to survival (76% vs 80% at 1 year, 62% vs 58% at 5 years and 53% vs 34% at 10 years, p = 0.75), early (<1 year from HTx) rejection (33.3% vs 44.3%, p = 0.32) or CAV (14.8% vs 30.4%, p = 0.11). Factors associated with non-survival in third HTx patients included mechanical ventilation at listing or HTx, extracorporeal membrane oxygenation support at listing or HTx, and elevated serum bilirubin at HTx.

CONCLUSIONS:

Outcomes among recipients of a third HTx are similar to those with a second HTx in matched patients, with no difference in short- or long-term survival and comparable rates of early rejection and CAV. Although the occurrence of a third HTx remains relatively rare in the USA, consideration of a third HTx appears reasonable in appropriately selected patients.

"...an essential prerequisite for the pursuit of the common good is the creation of adequate constraints on state power."

Camb Q Healthc Ethics. 2014 May 27:1-16. [Epub ahead of print]

China's One-Child Policy, a Policy without a Future.

Nie JB.

Abstract

The Chinese Communist Party government has been forcefully promoting its jihua shengyu (planned fertility) program, known as the "one-child policy," for more than three decades. A distinctive authoritarian model of population governance has been developed. A pertinent question to be asked is whether China's one-child policy and the authoritarian model of population governance have a future. The answer must be no; they do not. Although there are many demographic, economic, and social rationales for terminating the one-child policy, the most fundamental reason for opposing its continuation is drawn from ethics. The key ethical rationale offered for the policy is that it promotes the common social good, not only for China and the Chinese people but for the whole human family. The major irony associated with this apparently convincing justification is that, although designed to improve living standards and help relieve poverty and underdevelopment, the one-child policy and the application of the authoritarian model have instead caused massive suffering to Chinese people, especially women, and made them victims of state violence. A lesson from China-one learned at the cost of individual and social suffering on an enormous scale-is that an essential prerequisite for the pursuit of the common good is the creation of adequate constraints on state power.

J Appl Psychol. 2014 May 26. [Epub ahead of print]

The Slippery Slope: How Small Ethical Transgressions Pave the Way for Larger Future Transgressions.

Welsh DT, Ordóñez LD, Snyder DG, Christian MS.

Abstract

Many recent corporate scandals have been described as resulting from a slippery slope in which a series of small infractions gradually increased over time (e.g., McLean & Elkind, 2003). However, behavioral ethics research has rarely considered how unethical behavior unfolds over time. In this study, we draw on theories of self-regulation to examine whether individuals engage in a slippery slope of increasingly unethical behavior. First, we extend Bandura's (1991, 1999) social-cognitive theory by demonstrating how the mechanism of moral disengagement can reduce ethicality over a series of gradually increasing indiscretions. Second, we draw from recent research connecting regulatory focus theory and behavioral ethics (Gino & Margolis, 2011) to demonstrate that inducing a prevention focus moderates this mediated relationship by reducing one's propensity to slide down the slippery slope. We find support for the developed model across 4 multiround studies. 

Psychol Serv. 2014 May 26. [Epub ahead of print]

To Treat or Not to Treat: Should Psychologists Treat Tobacco Use Disorder?

Bodie LP.

Abstract

The author presented this Presidential Address for Divison18, Psychologists in Public Service, at the 2012 American Psychological Association Convention in Orlando, Florida. The address challenges public service psychologists to reduce the tobacco disease burden through their roles as researchers, leaders, educators, and practitioners and explains why treating tobacco use disorder is important and relevant for psychologists. The address discusses the prevalence and the resulting mortality and morbidity rates of tobacco use disorder, which call for effective evidence-based interventions that can be integrated by psychologists into other ongoing treatments. Treatment of the underserved populations, including those with serious mental illness and/or substance use disorders, presents many barriers. In addition, education and training for tobacco use disorder in undergraduate and graduate clinical psychology programs present further barriers for psychology trainees. However, progress is being made because of the numerous resources and psychology leaders who are advocates for tobacco use disorder treatment and research. Challenges for the future include increasing awareness of the importance of treatment for tobacco use disorder, finding innovative ways to increase access to comprehensive evidence-based treatment, and acknowledging that psychologists can make a difference in reducing the tobacco use disorder disease burden. Psychologists have an ethical and professional responsibility to treat tobacco use disorder.

Lancet. 2014 May 19. pii: S0140-6736(14)60750-9. doi: 10.1016/S0140-6736(14)60750-9. [Epub ahead of print]

From evidence to action to deliver a healthy start for the next generation.

Mason E1, McDougall L2, Lawn JE3, Gupta A4, Claeson M5, Pillay Y6, Presern C2, Lukong MB7, Mann G8, Wijnroks M9, Azad K10, Taylor K11, Beattie A8, Bhutta ZA12, Chopra M13; for The Lancet Every Newborn Study Group; on behalf of the Every Newborn Steering Committee.

Author information

• 1World Health Organization, Geneva, Switzerland. Electronic address: masone@who.int.
• 2The Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
• 3MARCH, London School of Hygiene and Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Cape Town, South Africa; Research and Evidence Division, Department for International Development, London, UK.
• 4Ministry of Health and Family Welfare, Government of India, New Delhi, India.
• 5Bill & Melinda Gates Foundation, Seattle, WA, USA.
• 6Department of Health, Government of South Africa, Pretoria, South Africa.
• 7Ministry of Public Health, Government of Cameroon, Yaoundé, Cameroon.
• 8Research and Evidence Division, Department for International Development, London, UK.
• 9The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.
• 10Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh.
• 11United States Agency for International Development, Washington, DC, USA.
• 12Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Center for Global Child Health Hospital for Sick Children, Toronto, ON Canada.
• 13UNICEF, New York, NY, USA.

Abstract

Remarkable progress has been made towards halving of maternal deaths and deaths of children aged 1-59 months, although the task is incomplete. Newborn deaths and stillbirths were largely invisible in the Millennium Development Goals, and have continued to fall between maternal and child health efforts, with much slower reduction. This Series and the Every Newborn Action Plan outline mortality goals for newborn babies (fewer than ten per 1000 livebirths) and stillbirths (fewer than ten per 1000 total births) by 2035, aligning with A Promise Renewed target for children and the vision of Every Woman Every Child. To focus political attention and improve performance, goals for newborn babies and stillbirths must be recognised in the post-2015 framework, with corresponding accountability mechanisms. The four previous papers in this Every Newborn Series show the potential for a triple return on investment around the time of birth: averting maternal and newborn deaths and preventing stillbirths. Beyond survival, being counted and optimum nutrition and development is a human right for all children, including those with disabilities. Improved human capital brings economic productivity. Efforts to reach every woman and every newborn baby, close gaps in coverage, and improve equity and quality for antenatal, intrapartum, and postnatal care, especially in the poorest countries and for underserved populations, need urgent attention. We have prioritised what needs to be done differently on the basis of learning from the past decade about what has worked, and what has not. Needed now are four most important shifts: (1) intensification of political attention and leadership; (2) promotion of parent voice, supporting women, families, and communities to speak up for their newborn babies and to challenge social norms that accept these deaths as inevitable; (3) investment for effect on mortality outcome as well as harmonisation of funding; (4) implementation at scale, with particular attention to increasing of health worker numbers and skills with attention to high-quality childbirth care for newborn babies as well as mothers and children; and (5) evaluation, tracking coverage of priority interventions and packages of care with clear accountability to accelerate progress and reach the poorest groups. The Every Newborn Action Plan provides an evidence-based roadmap towards care for every woman, and a healthy start for every newborn baby, with a right to be counted, survive, and thrive wherever they are born.

Lancet. 2014 May 19. pii: S0140-6736(14)60792-3. doi: 10.1016/S0140-6736(14)60792-3. [Epub ahead of print]

Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

Bhutta ZA1, Das JK2, Bahl R3, Lawn JE4, Salam RA2, Paul VK5, Sankar JM5, Blencowe H6, Rizvi A2, Chou VB7, Walker N7; for The Lancet Newborn Interventions Review Group; The Lancet Every Newborn Study Group.

Author information

• 1Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. Electronic address: zulfiqar.bhutta@sickkids.ca.
• 2Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
• 3World Health Organization, Geneva, Switzerland.
• 4Maternal, Adolescent Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA; Research and Evidence Division, UK AID, London, UK.
• 5All India Institute of Medical Sciences, New Delhi, India.
• 6Maternal, Adolescent Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
• 7Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of fewer than 12 neonatal deaths and fewer than 12 stillbirths per 1000 births in every country by 2030 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6-2·1 million]), 33% of stillbirths (0·82 million [0·60-0·93 million]), and 54% of maternal deaths (0·16 million [0·14-0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality-preterm, intrapartum, and infection-related deaths-by 58%, 79%, and 84%, respectively.

J Med Libr Assoc. 2014 Apr;102(2):87-91. doi: 10.3163/1536-5050.102.2.005.

The ethics of scholarly publishing: exploring differences in plagiarism and duplicate publication across nations.

Amos KA.

Author information

• kamos@phf.org, Project Manager , Council on Linkages Between Academia and Public Health Practice, Public Health Foundation, 1300 L Street Northwest, Suite 800, Washington, DC 20005.

Abstract

This study explored national differences in plagiarism and duplicate publication in retracted biomedical literature. The national affiliations of authors and reasons for retraction of papers accessible through PubMed that were published from 2008 to 2012 and subsequently retracted were determined in order to identify countries with the largest numbers and highest rates of retraction due to plagiarism and duplicate publication. Authors from more than fifty countries retracted papers. While the United States retracted the most papers, China retracted the most papers for plagiarism and duplicate publication. Rates of plagiarism and duplicate publication were highest in Italy and Finland, respectively. Unethical publishing practices cut across nations.

Patient Educ Couns. 2014 May 9. pii: S0738-3991(14)00181-5. doi: 10.1016/j.pec.2014.05.002. [Epub ahead of print]

The experience of people with lung cancer with a volunteer-based lay navigation intervention at an outpatient cancer center.

Lorhan S1, Dennis D2, van der Westhuizen M2, Hodgson S2, Berrang T2, Daudt H2.

Author information

• 1BC Cancer Agency, Victoria, Canada. Electronic address: slorhan@bccancer.bc.ca.
• 2BC Cancer Agency, Victoria, Canada.

Abstract

OBJECTIVE:

To describe the experiences of patients with lung cancer with a volunteer-based lay navigation intervention.

METHODS:

Forty patients with newly diagnosed lung cancer enrolled in a three-step navigation intervention delivered by trained volunteer laynavigators (VLNs), beginning prior to their first oncologist's appointment and ending before the start of treatment. Methodological triangulation of data was used in a mixed method study design. Cases were categorized based on the predominant needs met by the VLN: emotional, practical/informational, family, and complex. Data were analyzed using framework analysis.

RESULTS:

The provision of emotional support, information, and referrals to other services by the VLN were of particular benefit to the patient and their families. Satisfaction with the program and its timing was high; it was considered an effective means for patients to share concerns and have their needs attended to before starting treatment.

CONCLUSION:

This study demonstrates capacity for lay volunteers to address the multifaceted needs of lung cancer patients during their transition from primary care in the diagnosis to treatment phase.

PRACTICE IMPLICATIONS:

Using volunteers as navigators offers an opportunity to meet patient needs with minimal resources, increase access to services for patients, and improve the sustainability of the program.

Int J Health Policy Manag. 2014 May 14;2(4):155-7. doi: 10.15171/ijhpm.2014.47. eCollection 2014.

Patient mobility in the global marketplace: a multidisciplinary perspective.

Lunt N1, Mannion R2.

Author information

• 1Department of Social Policy and Social Work, University of York, UK.
• 2Health Services Management Center, University of Birmingham, UK.

Abstract

There is a growing global market in healthcare and patients. And while there is a small body of evidence emerging around this phenomenon commonly known as medical tourism there remain significant unanswered policy and research questions which need to be addressed. We outline some of the key issues set against the six key disciplinary preoccupations of the journal: epidemiology, health economics, health policy ethics,politics of health, health management, and health policy.

Med Law Rev. 2014 May 27. pii: fwu016. [Epub ahead of print]

IS EUROPE 'GIVING IN TO BABY MARKETS?' REPRODUCTIVE TOURISM IN EUROPE AND THE GRADUAL EROSION OF EXISTING LEGAL LIMITS TO REPRODUCTIVE MARKETS.

van Beers BC.

Author information

Abstract

The main question in this article is how national legal orders in Europe, given their often restrictive laws on reproductive markets and assisted reproductive technologies (ARTs), are currently responding and should respond to reproductive tourism, in light of the fact that access to foreign reproductive markets seems to be making these national laws 'merely symbolic'. Although many national governments have finally managed after many years of political and legal struggles to establish a carefully balanced legal framework for the regulation of these often ethically and religiously sensitive matters, ironically reproductive travel seems to be turning national reproductive laws into a dead letter. Currently, as a reaction to these developments, new legal strategies are being proposed and explored. Within the European context, the view is gaining ground that laws that curb international reproductive markets and their accompanying streams of fertility tourism have become ineffective, meaningless, and even harmful. As a result, a certain tendency towards tolerance of reproductive markets and reproductive travel can be detected in both politics and academia. According to this line of reasoning, restrictive and prohibitive legislation should be replaced by more pragmatic policies that take the realities of reproductive markets as a starting point. From this perspective, the legal restrictions within the country of origin, rather than the lack of regulation in the country of destination, should be regarded as the core of the problem. As a result, an increasing number of scholars and policy makers are arguing for more lenient national policies towards ARTs, hoping to thereby remove the main incentive for aspiring parents to resort to foreign reproductive services. This emerging pragmatic strategy of tolerance towards reproductive tourism and international reproductive markets rests on three arguments, which are each critically examined in this article. Although these arguments offer valuable insights, several disadvantages and weaknesses tend to be overlooked. The critical examination of these pragmatic arguments is followed by a plea for a more positive understanding and recognition of the symbolic dimensions of reproductive legislation. It is argued that ART laws also have an important communicative, expressive and anthropological meaning and function, which surpass these laws' practical effectiveness. Alternatively, policies based on the pragmatic tolerance of reproductive markets show significant shortcomings, which also need to be taken into consideration by national governments when evaluating existing ART laws.

Science. 2014 May 23;344(6186):862-7. doi: 10.1126/science.1232491.

On the psychology of poverty.

Haushofer J1, Fehr E2.

Author information

• 1Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology, 30 Wadsworth Street, Cambridge, MA 02142, USA. Program in Economics, History, and Politics, Harvard University, Cambridge, MA 02138, USA. Department of Economics, University of Zürich, Blümlisalpstrasse 10, Zürich 8006, Switzerland. Department of Psychology and Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA. joha@mit.edu ernst.fehr@econ.uzh.ch.
• 2Department of Economics, University of Zürich, Blümlisalpstrasse 10, Zürich 8006, Switzerland. joha@mit.edu ernst.fehr@econ.uzh.ch.

Abstract

Poverty remains one of the most pressing problems facing the world; the mechanisms through which poverty arises and perpetuates itself, however, are not well understood. Here, we examine the evidence for the hypothesis that poverty may have particular psychological consequences that can lead to economic behaviors that make it difficult to escape poverty. The evidence indicates that poverty causes stress and negative affective states which in turn may lead to short-sighted and risk-averse decision-making, possibly by limiting attention and favoring habitual behaviors at the expense of goal-directed ones. Together, these relationships may constitute a feedback loop that contributes to the perpetuation of poverty. We conclude by pointing toward specific gaps in our knowledge and outlining poverty alleviation programs that this mechanism suggests.

Intern Med J. 2014 May 27. doi: 10.1111/imj.12480. [Epub ahead of print]

The Undivided Patient.

Brown MG1, Campbell D, Maydom BW.

Author information

• 1Monash Health, Melbourne Victoria. Megan.Brown@monashhealth.org.au.

Abstract

AIMS:

This study aims to describe and compare the rate of specialty referrals from inpatient general medical units in a regional general and a metropolitan tertiary hospital and review associated outcomes.

METHODS:

Retrospective cohort analysis of general medical admissions over the ten week period extending from 28th March to 5th of June 2011. Two hospitals were included in the study; West Gippsland Hospital (WGH) and Monash Medical Centre (MMC). For all admissions details of patient demographics, episode of care, and number of inpatient referrals made per admission were extracted from the medical records. Rates and outcomes of inpatient referrals were calculated and compared.

RESULTS:

There were 116 admissions to MMC and 108 (107 available for analysis) to WGH during the study period. There were no significant differences in patient demographics between the two sites. There were however significantly fewer active conditions (2.87 vs 4.01, P<0.01), fewer specialty fields represented (2.50 vs 3.51, P<0.01), and fewer specialty referrals made per admission at WGH compared with MMC (0.69 vs 1.74, p<0.01). The referral rate per diagnosis and the rate of referrals per specialty field represented were significantly higher at MMC compared with WGH, (P<0.01).

CONCLUSION:

This preliminary study suggests that patients admitted to rural hospital general medical units have fewer active conditions with fewer specialty referrals made per admission, compared with a comparator metropolitan hospital general medical unit. Further research is required to investigate the reasons for such differences and implications for policy and practice.

Brave new world from 1921: "That was well enough for determining men capable of becoming front line troops. But we need to select the best, not the average."

Eugen Rev. 1922 Oct;14(3):174-86.

The true aristocracy: An address contributed to the international eugenics congress held in New York in September, 1921.

Adami G.

GEORGE ADAMI, C.B.E., M.D., F.R.S., Vice-Chancellor of the University of Liverpool.

"For eugenic purposes, however, it will never do to take over the National Service grading. We do not want to clump together the average, those just below and all above the average into one common
group. That was well enough for determining men capable of becoming front line troops. But we need to select the best, not the average. Thus as I suggested three years ago,* just as the army for its purposes recognised the categories below the mean, so for our purposes we might well establish, as shown in the diagram, three classes above, making in all seven classes.

In this way Class A would contain the very pick of manhood, a select class of some 2 per cent. of the whole body, men of exceptional all round physical development."

Am Soc Clin Oncol Educ Book. 2014;34:e146-9. doi: 10.14694/EdBook_AM.2014.34.e146.

Value of cancer care: ethical considerations for the practicing oncologist.

Jagsi R, Sulmasy DP, Moy B.

Author information

• From the University of Michigan, Ann Arbor, MI; The University of Chicago, Chicago, IL; Massachusetts General Hospital, Boston, MA.

Abstract

The value of cancer care has emerged at the center of a national discourse on fiscal responsibility and resource allocation. The cost of cancer care is rising at a higher pace than any other area of health care. As we struggle to address this unsustainable rise in cancer expenditures, oncology providers are forced to examine our practice patterns and our contributions to the overall health care cost burden. This article provides an oncologist-centered examination of our duties to individual patients and how they may seem at odds with our duties to society. It also discusses how oncology providers can do their part to contain health care costs while honoring their professional obligation to do their best for each patient.