From Brian Liang and Tim Mackey: After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mayo Clin Proc. 2016 Jun;91(6):701-6. doi: 10.1016/j.mayocp.2016.02.024. Epub 2016 Apr 12.

After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mackey TK1, Liang BA2.

Author information

• 1Department of Anesthesiology, Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA; Joint Masters Program in Health Policy and Law, University of California, San Diego School of Medicine and California Western School of Law, San Diego, CA; Global Health Policy Institute, La Jolla, CA. Electronic address: tmackey@ucsd.edu.
• 2Global Health Policy Institute, La Jolla, CA.

"Although the Food, Drug, and Cosmetic Act (FDCA) does not specifically delineate FDA powers to prohibit off-label promotion, the FDA has maintained that by marketing offlabel, a manufacturer violates the FDCA by introducing a 'misbranded' drug into interstate commerce."

Obesity and Hiring: Steering Clear of Legal Trouble

Obesity and Hiring: Steering Clear of Legal Trouble

Despite a recent court ruling that finds an obese candidate who was not hired for a machinist job did not qualify for protection under the Americans with Disabilities Act, experts are still warning employers to be careful with their hiring practices so they don't get sued in the first place.

By Lin Grensing-Pophal

Monday, October 31, 2016

It's important, says Long, for employers to have written job descriptions that clearly outline the essential functions of a job before hiring for a position. "Employers should make all applicants follow the same steps in the selection process and only require a medical examination if there is a job-related reason for the medical examination," she says. Such an exam can only be required after an offer has been made, however.

"The old adage 'Don't judge a book by its cover' is good advice when it comes to high-stake employment decisions," says Lindner. "Keep personal biases out of the hiring decision process. Focus instead on candidates' qualifications rather than their weight and height, unless, of course, job requirements otherwise dictate. Employers do have a responsibility to maintain safe work environments and, where height and weight restrictions exist, candidates exceeding those requirements will be denied employment for their own safety."

Pain Med. 2016 Oct 29. pii: pnw251. [Epub ahead of print]

Clinicians' Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making.

Leichtling GJ1, Irvine JM2, Hildebran C3, Cohen DJ4, Hallvik SE3, Deyo RA4,5,6,7.

Author information

• 1*HealthInsight Oregon, Portland, Oregon gleichtling@healthinsight.org.
• 2OCHIN, Inc., Portland, Oregon.
• 3*HealthInsight Oregon, Portland, Oregon.
• 4Departments of Family Medicine.
• 5Medicine, Preventive Medicine, Oregon Health and Science University, Portland, Oregon.
• 6Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon.
• 7Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, USA.

Abstract

OBJECTIVES:

 Little is known about clinicians' use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. DESIGN : Qualitative interviews of clinician PDMP users.

SETTING:

 Oregon registrants in the state's PDMP.

SUBJECTS:

 Thirty-three clinicians practicing in primary care, emergency medicine, pain management, psychiatry, dentistry, and surgery.

METHODS:

 We conducted semistructured telephone interviews with PDMP users. A multidisciplinary team used a grounded theory approach to identify patterns of PDMP use and how PDMP profiles influence clinical decisions.

RESULTS:

 PDMP use varied from consistent monitoring to checking the PDMP only on suspicion of misuse, with inconsistent use reported particularly among short-term prescribers. Primary care clinicians reported less routine use with existing pain patients than with new patients. In response to worrisome PDMP profiles with new patients, participants reported declining to prescribe, except in the case of acute, verifiable conditions. Long-term prescribers reported sometimes continuing prescriptions for existing patients depending on perceived patient intent, honesty, and opioid misuse risk. Some long-term prescribers reported discharging patients from their practices due to worrisome PDMP profiles; others expressed strong ethical grounds for retaining patients but discontinuing controlled substances.

CONCLUSION:

 Greater consistency is needed in use of PDMP in monitoring existing patients and in conformity to guidelines against discharging patients from practice. Research is needed to determine optimal approaches to interpreting PDMP profiles in relation to clinical judgment, patient screeners, and other information.

The Kaepernick-National Anthem Debacle

Wes Keefer- Chief Keefe , Goal Line Stand on October 29

"We have the right to free speech and the players in the NFL aren't causing any harm or breaking any rules or laws. While I feel that Colin Kaepernick was endearing in his protest, I also think there is a part of him that did it in desperation of keeping his job. It's just too much of a coincidence. This protest has raised money for those affected by these tragic events and has also gained support and awareness. I recently attended a NFL game and during the anthem, not one person in the stadium knelt or sat throughout the performance. Even though everyone has stated that it is in no way will-ill towards our military and veterans, our flag does still represents our freedom and those who provide it. Doing anything that slightly disrespects the flag, disrespects our soldiers."

Tin ear: "The San Francisco 49ers have a bit of a turnstile problem...[because] "the team is not managed properly and they're not being successful out on the field."

Santa Clara City Council concerned about 49ers attendance

"The San Francisco 49ers have a bit of a turnstile problem. As the team continues to struggle, more people are likely to want to stay home. Levi’s Stadium is sold out, and while plenty of people will sell their tickets on the secondary ticket market, there will continue to be quite a few no-shows."

.......................

"How many will default on their tickets? We've seen a large amount that have defaulted already. How many will continue to default if the team is not managed properly and they're not being successful out on the field."

Ghana: Traders say nay to looming sugar tax

"Ghanaian traders have expressed their concern about a possible tax on sugar- sweetened beverages, an intervention proposed by the World Health Organization aimed at reducing the increasing cases of chronic diseases including diabetes,cardiovascular diseases and obesity."

"We simply cannot probe the universe at these scales using current methods, because it would require a particle accelerator the size of a small galaxy."

Has this physicist found the key to reality?

Whenever we have ventured into new experimental territory, we’ve discovered that our previous “knowledge” was woefully incomplete. So what to make of Italian physicist Carlo Rovelli?

"We simply cannot probe the universe at these scales using current methods, because it would require a particle accelerator the size of a small galaxy. So – for now, at least – our search for the nature of reality is in the hands of the mathematicians and theorists. And, as Einstein would tell us, that is far from ideal."

Transplant Medicine in China: "...premature to include China as an ethical partner in the international transplant community."

Am J Transplant. 2016 Nov;16(11):3115-3120. doi: 10.1111/ajt.14014. Epub 2016 Sep 19.

Transplant Medicine in China: Need for Transparency and International Scrutiny Remains.

Trey T1, Sharif A1,2, Schwarz A3, Fiatarone Singh M1,4, Lavee J5,6.

Author information

• 1Doctors Against Forced Organ Harvesting, Washington, DC.
• 2Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, United Kingdom.
• 3Independent China researcher, Munich, Germany.
• 4Exercise, Health and Performance, Faculty of Health Sciences and Sydney Medical School, University of Sydney, Sydney, Australia.
• 5Doctors Against Forced Organ Harvesting, Washington, DC. jaylavee@netvision.net.il.
• 6Heart Transplantation Unit, Department of Cardiac Surgery, Sheba Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. jaylavee@netvision.net.il.

Abstract

Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor has the government initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes, and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals.

Kirtee Raparia, Dara L. Aisner, Timothy Craig Allen, Mary Beth Beasley, Alain Borczuk, Philip T. Cagle, Vera Capelozzi, Sanja Dacic, Lida P. Hariri, Keith M. Kerr, Sylvie Lantuejoul, Mari Mino-Kenudson, Natasha Rekhtman, Anja C. Roden, Sinchita Roy-Chowdhuri, Lynette Sholl, Maxwell L. Smith, Eric Thunnissen, Ming Sound Tsao, and Yasushi Yatabe (2016) Transbronchial Lung Cryobiopsy for Interstitial Lung Disease Diagnosis: A Perspective From Members of the Pulmonary Pathology Society. Archives of Pathology & Laboratory Medicine: November 2016, Vol. 140, No. 11, pp. 1281-1284.

SPECIAL ARTICLES

Transbronchial Lung Cryobiopsy for Interstitial Lung Disease Diagnosis: A Perspective From Members of the Pulmonary Pathology Society

Kirtee Raparia , MD; Dara L. Aisner , MD; Timothy Craig Allen , MD, JD; Mary Beth Beasley , MD; Alain Borczuk , MD; Philip T. Cagle , MD; Vera Capelozzi , MD, PhD; Sanja Dacic , MD, PhD; Lida P. Hariri , MD, PhD; Keith M. Kerr , BSc, MB, ChB, FRCPath, FRCPE; Sylvie Lantuejoul , MD, PhD; Mari Mino-Kenudson , MD; Natasha Rekhtman , MD, PhD;; Anja C. Roden , MD; Sinchita Roy-Chowdhuri , MD, PhD; Lynette Sholl , MD; Maxwell L. Smith , MD; Eric Thunnissen , MD, PhD; Ming Sound Tsao , MD; Yasushi Yatabe, MD, PhD

From the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University–INSERM U 823-Institut A Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota (Dr Roden); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Dr Sholl); the Department of Laboratory Medicine and Pathology, Mayo Clinic Scottsdale, Scottsdale, Arizona (Dr Smith); the Department of Pathology, VU Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada (Dr Tsao); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 (email: tcallen@utmb.edu).

The authors have no relevant financial interest in the products or companies described in this article.

Transbronchial lung cryobiopsy involves using a cryoprobe rather than forceps to obtain a bronchoscopic biopsy. Recent studies have shown that transbronchial cryobiopsy provides a larger specimen than conventional transbronchial forceps biopsy, and that the interobserver agreement in the interpretation of cryobiopsy specimens is comparable to that of a surgical lung biopsy. This is encouraging, and transbronchial lung cryobiopsy clearly has a role in the workup and diagnosis of interstitial lung diseases. However, very few patients who have been studied underwent both transbronchial lung cryobiopsy and surgical lung biopsy, and the available data suggest that the diagnostic accuracy of cryobiopsy may not be similar to that of surgical lung biopsy. Further study is needed before transbronchial lung biopsy can be recommended as a replacement for surgical lung biopsy.

Zika and the Blood Supply

Louis M. Katz and Susan N. Rossmann (2016) Zika and the Blood Supply: A Work in Progress. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Zika and the Blood Supply: A Work in Progress

Louis M. Katz , MD; Susan N. Rossmann , MD, PhD

From America's Blood Centers, Washington DC, and the Department of Medicine, Division of Infectious Diseases, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa (Dr Katz); and the Gulf Coast Regional Blood Center, Houston, Texas (Dr Rossmann).

Corresponding author: Susan N. Rossmann, MD, PhD, Gulf Coast Regional Blood Center, 1400 La Concha Ln, Houston, TX 77054 (email: srossman@giveblood.org).

Zika virus can be transmitted by transfusion, but the harm caused to recipients is not clear in most cases. It is very likely that the virus could also be transmitted by transplanted organs. Sensitivity to the risk from transfusion is elevated by consideration of possible severe neurologic damage in fetuses. Strategies for dealing with transfusion risk vary with the presence of Zika in the region. In nonendemic areas, risks can be reduced by excluding donors who have exposure through travel or sexual contact with someone at risk. In both endemic and nonendemic areas, the risk can be further reduced by nucleic acid testing of donors, or pathogen reduction of platelet and plasma products. The real risk to the population depends on the frequency of infection as well as the efficacy of these interventions. The interventions chosen will depend on the risk assessment for any situation; in the United States at this time, a combination of travel deferrals, testing, and, to a lesser extent, pathogen reduction is being used, but universal testing of US blood donors under investigational use has been mandated by the US Food and Drug Administration, beginning with states most at risk of local transmission. Canada is largely using travel deferrals. A precautionary approach may be taken; however, a formal decision-making framework has been suggested. The situation globally is clearly very fluid, as the epidemic continues to spread and we continue to learn how to best protect recipients of blood and transplants.

PD-L1: "...there is far more to immune-response damping than one receptor and one ligand."

Ross A. Miller, Tara N. Miller, and Philip T. Cagle (2016) PD-1/PD-L1, Only a Piece of the Puzzle. Archives of Pathology & Laboratory Medicine: November 2016, Vol. 140, No. 11, pp. 1187-1188.

EDITORIAL

PD-1/PD-L1, Only a Piece of the Puzzle

Ross A. Miller , MD; Tara N. Miller , MD; Philip T. Cagle , MD

From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.

"PD-1/PD-L1 blockade undoubtedly provides an exciting therapeutic approach in malignancy. However, there is far more to immune-response damping than one receptor and one ligand. The control behind T-cell activation is a complex process requiring 2 distinct signaling pathways,¹³ and numerous molecules are involved. The first signal required for T-cell activation is antigen presentation via the major histocompatibility complex on antigen-presenting cells (APCs). The APCs interact with major histocompatibility complex via T-cell receptors. The second required signal is activation of CD28 (on the T cell). Ligands for CD28 include the B7 family of molecules.¹³ Some of the molecules in the B7/CD28 family include PD-1, PD-L1, PD-L2, CD80, and CTLA-4."

From Dara Aisner and colleagues: Maximizing Small Biopsy and Cytology Specimens for Molecular and Ancillary Testing

Dara L. Aisner, Mathew D. Rumery, Daniel T. Merrick, Kimi L. Kondo, Hala Nijmeh, Derek J. Linderman, Robert C. Doebele, Natalie Thomas, Patrick C. Chesnut, Marileila Varella-Garcia, Wilbur A. Franklin, and D. Ross Camidge (2016) Do More With Less: Tips and Techniques for Maximizing Small Biopsy and Cytology Specimens for Molecular and Ancillary Testing: The University of Colorado Experience. Archives of Pathology & Laboratory Medicine: November 2016, Vol. 140, No. 11, pp. 1206-1220.

SPECIAL SECTION—MOLECULAR CYTOPATHOLOGY: UPDATE ON MOLECULAR AND CYTOGENETIC APPLICATIONS OF CYTOLOGIC SPECIMENS—PART I

Do More With Less: Tips and Techniques for Maximizing Small Biopsy and Cytology Specimens for Molecular and Ancillary Testing: The University of Colorado Experience

Dara L. Aisner , MD, PhD; Mathew D. Rumery , MD; Daniel T. Merrick , MD; Kimi L. Kondo , DO; Hala Nijmeh , PhD; Derek J. Linderman , MD; Robert C. Doebele , MD, PhD; Natalie Thomas , MPhil; Patrick C. Chesnut , BA; Marileila Varella-Garcia , PhD; Wilbur A. Franklin , MD; D. Ross Camidge , MD, PhD

From the Departments of Pathology (Drs Aisner, Rumery, Merrick, Nijmeh, and Franklin, Ms Thomas, and Mr Chesnut), Radiology (Dr Kondo), and Medicine (Drs Linderman, Doebele, Varella-Garcia, and Camidge), University of Colorado, Aurora. Dr Rumery is now with Colorado Pathology Consultants, Denver.

Reprints: Dara L. Aisner, MD, PhD, Department of Pathology, University of Colorado, Mail Stop F768, 12605 E 16th Ave, Aurora, CO 80045 (email: dara.aisner@ucdenver.edu).

This work was supported in part by the Molecular Pathology Shared Resource and the Tissue Biobanking and Processing Shared Resource of Colorado's NIH/NCI Cancer Center Support Grant P30CA046934. Drs Aisner and Franklin disclose partial ownership of patent number PCT/US13/38284, describing a pneumatic cell collection device that can be used for microdissection. This device was not used for any of the microdissections presented in this manuscript. Dr Merrick received honoraria for preceptorship (March 2016) from ARIAD Pharmaceuticals Inc, Cambridge, Massachusetts. The other authors have no relevant financial interest in the products or companies described in this article.

Context.— In an era in which testing of patient tumor material for molecular and other ancillary studies is of increasing clinical importance for selection of therapy, the ability to test on small samplings becomes critical. Often, small samplings are rapidly depleted in the diagnostic workup or are insufficient for multiple ancillary testing approaches.

Objective.— To describe technical methodologies that can be implemented to preserve and maximize tissue for molecular and other ancillary testing.

Data Sources.— Retrospective analysis of a case cohort from the University of Colorado, description of techniques used at the University of Colorado, and published literature.

Conclusions.— Numerous techniques can be deployed to maximize molecular and other ancillary testing, even when specimens are from small samplings. A dedicated process for molecular prioritization has a high success rate, but also increases workload, which must be factored into establishing such a process. Additionally, establishing high-fidelity communication strings is critical for success of dedicated molecular prioritization of samples. Numerous approaches can be deployed for alternative specimen types, and several technical approaches can also aid in maximizing small specimens.

Up Periscope

Maren Y. Fuller, Sanjay Mukhopadhyay, and Jerad M. Gardner (2016) Using the Periscope Live Video-Streaming Application for Global Pathology Education: A Brief Introduction. Archives of Pathology & Laboratory Medicine: November 2016, Vol. 140, No. 11, pp. 1273-1280.

doi: http://dx.doi.org/10.5858/arpa.2016-0268-SA

SPECIAL ARTICLES

Using the Periscope Live Video-Streaming Application for Global Pathology Education: A Brief Introduction

Maren Y. Fuller , MD; Sanjay Mukhopadhyay , MD; Jerad M. Gardner , MD

From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Fuller); the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Dr Mukhopadhyay); and the Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner).

Reprints: Jerad M. Gardner, MD, Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, 4301 W Markham St, No. 517, Room S4/11, Little Rock, AR 72205 (email: JMGardnerMD@gmail.com; Twitter: @JMGardnerMD).

The authors have no relevant financial interest in the products or companies described in this article.

Periscope is a live video-streaming smartphone application (app) that allows any individual with a smartphone to broadcast live video simultaneously to multiple smartphone users around the world. The aim of this review is to describe the potential of this emerging technology for global pathology education. To our knowledge, since the launch of the Periscope app (2015), only a handful of educational presentations by pathologists have been streamed as live video via Periscope. This review includes links to these initial attempts, a step-by-step guide for those interested in using the app for pathology education, and a summary of the pros and cons, including ethical/legal issues. We hope that pathologists will appreciate the potential of Periscope for sharing their knowledge, expertise, and research with a live (and potentially large) audience without the barriers associated with traditional video equipment and standard classroom/conference settings.

Sinchita Roy-Chowdhuri, Dara L. Aisner, Timothy Craig Allen, Mary Beth Beasley, Alain Borczuk, Philip T. Cagle, Vera Capelozzi, Sanja Dacic, Gilda da Cunha Santos, Lida P. Hariri, Keith M. Kerr, Sylvie Lantuejoul, Mari Mino-Kenudson, Andre Moreira, Kirtee Raparia, Natasha Rekhtman, Lynette Sholl, Eric Thunnissen, Ming Sound Tsao, Marina Vivero, and Yasushi Yatabe (2016) Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society. Archives of Pathology & Laboratory Medicine: November 2016, Vol. 140, No. 11, pp. 1267-1272.

SPECIAL ARTICLES

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

Sinchita Roy-Chowdhuri , MD, PhD; Dara L. Aisner , MD; Timothy Craig Allen , MD, JD; Mary Beth Beasley , MD; Alain Borczuk , MD; Philip T. Cagle , MD; Vera Capelozzi , MD, PhD; Sanja Dacic , MD, PhD; Gilda da Cunha Santos , MD, PhD; Lida P. Hariri , MD, PhD; Keith M. Kerr , BSc, MBChB, FRCPath, FRCPE; Sylvie Lantuejoul , MD, PhD; Mari Mino-Kenudson , MD; Andre Moreira , MD, PhD; Kirtee Raparia , MD; Natasha Rekhtman , MD, PhD; Lynette Sholl , MD; Eric Thunnissen , MD, PhD; Ming Sound Tsao , MD; Marina Vivero , MD; Yasushi Yatabe , MD, PhD

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

Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0609 (email: tcallen@utmb.edu).

The authors have no relevant financial interest in the products or companies described in this article.

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

"Health experts still suggest that dinner table and bedrooms should be media-free spaces."

How Important Are New Guidelines Issued by American Academy of Pediatrics on Screen Time

"Health experts still suggest that dinner table and bedrooms should be media-free spaces. Also, media time shouldn’t be used by parents to sooth upset children as this can impact their coping skills. The guidelines suggest that parents can ideally watch high-quality programming along with kids for up to one hour per day."

Despite the news heading: "...it is not possible to conclude that sweetened beverages are the direct cause of the relationship they have shown."

Drinking two sweetened drinks per day? You could be doubling your risk of diabetes

"A most interesting finding was that the higher risk was the same for both sweetened and artificially sweetened beverages, suggesting that greater risk of diabetes was not directly related to higher calorie intake, or adverse metabolic effects of sugar (in the form of sucrose) from the sweetened drinks," Christine Williams, professor of human nutrition at the University of Reading in the UK, said in a statement. She was not involved in the research.

"The study suffers from the same limitations as apply to most association studies. Even after controlling for effects of many other possible factors, including poor diet and heavier body weight, it is not possible to conclude that sweetened beverages are the direct cause of the relationship they have shown."

Starbucks' tea lattes are shockingly calorific!

Health activists say that by selling such sugary and high-cal beverages, the coffee giant is triggering obesity epidemic in UK.

"Health activists say that by selling such sugary and high-cal beverage, the US coffee giant is triggering the obesity epidemic in the UK.

The amount of calories this tea contains has been described as "shocking" by Kawther Hashem, a nutritionist from health pressure group Action on Sugar.

"Coffee shop chains must immediately reduce the amount of sugar in these hot drinks, improve their labelling and stop selling the extra-large serving sizes," Hashem was quoted as saying by The Sun."

Soc Neurosci. 2016 Oct 19. [Epub ahead of print]

Does empathy predict altruism in the wild?

Bethlehem RA1, Allison C1, van Andel EM1, Coles AI1, Neil K1, Baron-Cohen S1.

Author information

• 1a Department of Psychiatry, Autism Research Centre , University of Cambridge , Douglas House, 18B Trumpington Road, Cambridge CB2 8AH , UK.

Abstract

Why do people act altruistically? One theory is that empathy is a driver of morality. Experimental studies of this are often confined to laboratory settings, which often lack ecological validity. In the present study we investigated whether empathy traits predict if people will act altruistically in a real-world setting, 'in the wild'. We staged a situation in public that was designed to elicit helping, and subsequently measured empathic traits in those who either stopped to help or walked past and did not help. Results show that a higher number of empathic traits are a significant and positive predictor for altruistic behavior in a real-life situation. This supports the theory that the act of doing good is correlated with empathy.

Social media ‘experts’ and even doctors spread misinformation about health and fitness

"From crazy diets to dangerous gym routines, the web is awash with pseudo-experts offering advice that’s at best untested and possibly lethal. No wonder doctors want us to check in with them first.

But here’s the thing, when it comes to diet and fitness advice, they, too, may be peddling nonsense.

More than perhaps any other area of modern medicine, nutrition and exercise has repeatedly fallen prey to unproven claims, dodgy practices and pure myth."

An American airline wins right to weigh passengers to prevent crash landings

American airline wins right to weigh passengers to prevent crash landings

Hawaiian Airlines implemented the new policy to distribute weight evenly around planes and save fuel

• Rachael Revesz New York

"An American airline will begin to weigh its passengers to save fuel after it discovered its average passenger and carry-on luggage was heavier than expected.

Hawaiian Airlines will force people to step on the scales if they want to fly the 2,600-mile route between Honolulu and American Samoa, and they will not be able to pre-book seats." 

"...ARDS remains a significant complication in current combat casualty care."

J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S150-S156.

Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combatcasualty care.

Park PK1, Cannon JW, Ye W, Blackbourne LH, Holcomb JB, Beninati W, Napolitano LM.

Author information

• 1From the Division of Acute Care Surgery, Dept of Surgery, University of Michigan, Ann Arbor, Michigan (P.K.P., L.M.N.); School of Public Health, University of Michigan, Ann Arbor, Michigan (W.Y.); US Army Institute of Surgical Research, Fort Sam Houston, Texas (L.H.B., J.B.H.); Pulmonary/Critical Care Medicine, Wilford Hall Medical Center, Lackland AFB, Texas (W.B.); and Department of Surgery, Wilford Hall Medical Center, Lackland AFB, Texas and Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland (J.W.C.).

Abstract

BACKGROUND:

The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care.

METHODS:

This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality.

RESULTS:

Of 18,329 US Department of Defense Trauma Registry encounters, 4,679 (25.5%) required mechanical ventilation; ARDS was identified in 156 encounters (3.3%). On multivariate logistic regression, ARDS was independently associated with female sex (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.21-5.71; p = 0.02), higher military-specific Injury Severity Score (Mil ISS) (OR, 4.18; 95% CI, 2.61-6.71; p < 0.001 for Mil ISS ≥25 vs. <15), hypotension (admission systolic blood pressure <90 vs. ≥90 mm Hg; OR, 1.76; 95% CI, 1.07-2.88; p = 0.03), and tachycardia (admission heart rate ≥90 vs. <90 beats per minute; OR, 1.53; 95% CI, 1.06-2.22; p = 0.02). Explosion injury was not associated with increased risk of ARDS. Critical care resource utilization was significantly higher in ARDS patients as was all-cause hospital mortality (ARDS vs. no ARDS, 12.8% vs. 5.9%; p = 0.002). After adjustment for age, sex, injury severity, injury mechanism, Mil ISS, hypotension, tachycardia, and admission Glasgow Coma Scale score, ARDS remained an independent risk factor for death (OR, 1.99; 95% CI, 1.12-3.52; p = 0.02).

CONCLUSIONS:

In this large cohort of modern combat casualties, ARDS risk factors included female sex, higher injury severity, hypotension, and tachycardia, but not explosion injury. Patients with ARDS also required more medical resources and were at greater risk of death compared with patients without ARDS. Thus, ARDS remains a significant complication in current combat casualty care.

LEVEL OF EVIDENCE:

Prognostic/epidemiologic study, level III.

Medicine (Baltimore). 2016 Sep;95(38):e4953. doi: 10.1097/MD.0000000000004953.

Transcendence, religion and spirituality in medicine: Medical students' point of view.

Rassoulian A1, Seidman C, Löffler-Stastka H.

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• 1aDepartment of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria bEmory University, Atlanta, Georgia.

Abstract

To explore how medical students-the doctors of tomorrow-reflect upon meeting the spiritual needs of their patients, and whether they have reflected on their own religious or spiritual beliefs, or not. The study also investigates to what extent the students feel comfortable with addressing spiritual issues in their patient care, and whether they feel this is beyond their role as medical doctors.A self-administered questionnaire was developed. The survey was administered in teaching classes at the medical university of Vienna. One thousand four hundred (836 women and 564 men) students responded, laying the foundation for a thorough statistical analysis.59.5% of the students had reflected on their own belief concepts, 21.9% consider themselves religious, and 20.1% see themselves as spiritual individuals. 75.6% of the students agreed with the statement that religious conviction/spirituality might have an effect on how cancer patients cope. 85.9% would consider talking with their patients about religious/spiritual issues if patients wish to do so. 86.3% would involve chaplains if they feel it is necessary.The results of this study suggest that future doctors want to see the patient in a wider scope than the bio-psycho-social one, by including the meta-dimension of transcendence.