Sunday, October 29, 2017

Synthetic Fentanyl Deaths Rise in America's Opioid Epidemic

Synthetic Fentanyl Deaths Rise in America's Opioid Epidemic


"And people are mixing drugs. 'The increased mixing or co-use of fentanyl, heroin, cocaine, and varying fentanyl analogs might contribute to increased risk for overdose because persons misusing opioids and other drugs are exposed to drug products with substantially varied potency,' the team said."


Transition from video-assisted thoracic surgery to robotic pulmonary surgery

 2017 Apr 10;3:55. doi: 10.21037/jovs.2017.03.04. eCollection 2017.

Transition from video-assisted thoracic surgery to robotic pulmonary surgery.

Author information

1
Division of Thoracic Surgery, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan.

Abstract

The "da Vinci Surgical System" is a robotic surgical system that utilizes multi-jointed robotic arms and a high-resolution three-dimensional video-monitoring system. We report on the state of transition from video-assisted thoracoscopic surgery (VATS) to robotic pulmonary surgery, the surgical outcomes of robotic surgery compared to VATS, and the future of robotic surgery. Surgery utilizing the da Vinci Surgical System requires a console surgeon and assistant who have been certified by Intuitive Surgical, Inc., the system manufacturer. On the basis of the available medical literature, a robotic lobectomy has a learning curve that extends over approximately 20 cases for a surgeon who has mastered VATS. Surgery using the da Vinci System is safe, is associated with lower morbidity and mortality rates than thoracotomy, leads to shorter postoperative hospital stays, and ensures improved postoperative quality of life. Currently, no prospective studies comparing it to VATS have been conducted. The various studies that have compared robotic surgery and VATS have reported different results. At the present time, the benefits to patients of robotic surgery compared to VATS remain unclear. Areas in which robotic surgery may be superior to VATS include the superior operability of robotic surgery that improves safety and decreases the incidence of complication. To show that the costly robotic surgery is superior to VATS, prospective multicenter randomized studies need to be conducted. The da Vinci robot-assisted surgical system has already been highly evaluated for its safety, with recent studies reporting satisfactory outcomes. It remains necessary to verify whether the benefits to patients justify the higher cost of robotic surgery. Future developments in the field of robotic engineering will likely lead to the creation of systems that are even less invasive and allow for more advanced surgical techniques.

Lab Industry Fears Consolidation and Further Price Erosion if PAMA Prices Stick

Lab Industry Fears Consolidation and Further Price Erosion if PAMA Prices Stick


"There is a misconception that all laboratories are the same, and that the void left by one will be taken up by the others. This is not the case," he wrote. "Labs servicing the [skilled nursing facility] and [assisted-living] populations are already the last line of defense in geriatric healthcare, and a drastic cut to the Medicare CLFS will create a hole that cannot be filled."

Mark Twain’s Get-Rich-Quick Schemes

Mark Twain’s Get-Rich-Quick Schemes


"Only in retrospect does the appearance of Twain’s first writings seem like a historic occasion. He never viewed them as such, because he was not aware, then or for years to come, of any great literary calling. Self-styled “thought leaders” who say great success depends on finding one’s passion in life and pursuing it like a honey badger with a really nasty disposition will find little support in these pages. Twain’s passion wasn’t to work in a print shop, pilot riverboats, write for newspapers, or even—as he would do in his twenties—prospect for gold and silver out West. Twain’s goal was to make money and then make even more money. Writing books was just a means to an end, and in 1886, when he wrote that check for $200,000 to General Grant’s widow, he was well on his way to realizing his dream."

The disvalue of death in the global burden of disease

 2017 Oct 27. pii: medethics-2017-104365. doi: 10.1136/medethics-2017-104365. [Epub ahead of print]

The disvalue of death in the global burden of disease.

Author information

1
Department of Global Public Health and Primary Care, Global Health Priorities, University of Bergen, Bergen, Norway.
2
Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.

Abstract

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that happens to an individual, loss of life itself (YLL) occurs when that individual's life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. This casts doubt on whether the YLL is an individual burden at all. If not, then YLDs and YLLs are incommensurable. There are at least three responses to this problem, only one of which is tenable: a counterfactual account of harm. Taking this strategy necessitates a re-examination of how we count YLLs, particularly at the beginning of life.

"Unfortunately, the addiction treatment industry is fraught with questionable practices..."

Are implants for opioid addicts a new hope or a new scam?


“Unfortunately, the addiction treatment industry is fraught with questionable practices, and we have encountered similar requests or demands in the past—which have all been rejected.”

"Like many theorists and researchers, Afridi blames the origin of weight bias on the media, which has played a big role in promoting a thin ideal."

Obesity stigma is a real problem in societies, expert says

Weight bias occurs in employment, education, the media, and health care settings say those impacted by it

"Like many theorists and researchers, Afridi blames the origin of weight bias on the media, which has played a big role in promoting a thin ideal. Compounding this issue is social media, that has opened more doors in perpetuating biases of what is attractive and unattractive."

Saturday, October 28, 2017

Body Weight Can Change How Your Emotions Are Perceived

 2016 Nov 21;11(11):e0166753. doi: 10.1371/journal.pone.0166753. eCollection 2016.

Body Weight Can Change How Your Emotions Are Perceived.

Author information

1
Department of Psychology, University of Missouri - Kansas City, Kansas City, Missouri, United States of America.

Abstract

Accurately interpreting other's emotions through facial expressions has important adaptive values for social interactions. However, due to the stereotypical social perception of overweight individuals as carefree, humorous, and light-hearted, the body weight of those with whom we interact may have a systematic influence on our emotion judgment even though it has no relevance to the expressed emotion itself. In this experimental study, we examined the role of body weight in faces on the affective perception of facial expressions. We hypothesized that the weight perceived in a face would bias the assessment of an emotional expression, with overweight faces generally more likely to be perceived as having more positive and less negative expressions than healthy weight faces. Using two-alternative forced-choice perceptual decision tasks, participants were asked to sort the emotional expressions of overweight and healthy weight facial stimuli that had been gradually morphed across six emotional intensity levels into one of two categories-"neutral vs. happy" (Experiment 1) and "neutral vs. sad" (Experiment 2). As predicted, our results demonstrated that overweight faces were more likely to be categorized as happy (i.e., lower happy decision threshold) and less likely to be categorized as sad (i.e., higher sad decision threshold) compared to healthy weight faces that had the same levels of emotional intensity. The neutral-sad decision threshold shift was negatively correlated with participant's own fear of becoming fat, that is, those without a fear of becoming fat more strongly perceived overweight faces as sad relative to those with a higher fear. These findings demonstrate that the weight of the face systematically influences how its emotional expression is interpreted, suggesting that being overweight may make emotional expressions appear more happy and less sad than they really are.

The war on obesity may, ironically, promote unhealthy habits

The war on obesity may, ironically, promote unhealthy habits

The failure to view this epidemic and eating disorders as integrated means that we miss valuable opportunities for health promotion

"Another problem arising from our failure to view obesity and eating disorders as an integrated spectrum of food and weight loss problems is the conflicting messages people receive as part of disjointed preventative initiatives. For example, the overly zealous anti-obesity campaign might unintentionally promote excessive weight and shape concern, also providing the individual with a rationale for unhealthy weight loss practices, for example, pseudo-veganism. Who could insist on their child finishing a meal when the child (secretly an aspirant cat-walk model) is claiming diabetes-prevention as the rationale for her ever-decreasing portion sizes and her born-again veganism? An integrated approach to food and weight-loss problems would be better able to address these issues, preventing the iatrogenic effects associated with having separate programmes of prevention."

FDA Can Help Vulnerable Patients Take 'Last-Resort' Medications

FDA Can Help Vulnerable Patients Take 'Last-Resort' Medications


"Some members of Congress believe the FDA should be taken out of the equation. They complain that the agency bogs down the review process and prevents terminally ill patients from accessing potentially lifesaving treatments.  They recently introduced the Trickett Wendler Right to Try Act of 2017, which would allow 'unrestricted possession and use' of experimental drugs. It passed the Senate in early August."

Five-year change in morale is associated with negative life events in very old age

 2017 Oct 27:1-8. doi: 10.1080/13607863.2017.1393795. [Epub ahead of print]

Five-year change in morale is associated with negative life events in very old age.

Author information

1
a Faculty of Education and Welfare Studies, Social Policy Unit , Åbo Akademi University , Vaasa , Finland.
2
b Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit , Umeå University , Umeå , Sweden.
3
c Faculty of Education and Welfare studies, Demography Unit , Åbo Akademi University , Vaasa , Finland .
4
d Department of Nursing , Umeå University , Umeå , Sweden.
5
e Department of Community Medicine and Rehabilitation, Geriatric Medicine , Umeå University , Umeå , Sweden.

Abstract

OBJECTIVES:

The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.

METHOD:

The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.

RESULTS:

The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.

CONCLUSION:

Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.

Tips to help children maintain a healthy weight

Tips to help children maintain a healthy weight



"What can parents and caregivers do to help prevent childhood obesity?
To help your child maintain a healthy weight, balance the calories your child consumes from foods and beverages with calories your child uses through physical activity and normal growth.
The goal for children who are overweight is to reduce the rate of weight gain while allowing normal growth and development. Children should not be placed on a weight reduction diet without consulting a health care provider."

The Aviation Paradox: Why We Can 'Know' Jetliners But Not Reactors

 2017;55(2):229-248. doi: 10.1007/s11024-017-9322-4. Epub 2017 Jun 7.

The Aviation Paradox: Why We Can 'Know' Jetliners But Not Reactors.

Author information

1
School of Sociology, Politics and International Studies (SPAIS), University of Bristol, 11 Priory Road, Bristol, BS8 1TU UK.

Abstract

Publics and policymakers increasingly have to contend with the risks of complex, safety-critical technologies, such as airframes and reactors. As such, 'technological risk' has become an important object of modern governance, with state regulators as core agents, and 'reliability assessment' as the most essential metric. The Science and Technology Studies (STS) literature casts doubt on whether or not we should place our faith in these assessments because predictively calculating the ultra-high reliability required of such systems poses seemingly insurmountable epistemological problems. This paper argues that these misgivings are warranted in the nuclear sphere, despite evidence from the aviation sphere suggesting that such calculations can be accurate. It explains why regulatory calculations that predict the reliability of new airframes cannot work in principle, and then it explains why those calculations work in practice. It then builds on this explanation to argue that the means by which engineers manage reliability in aviation is highly domain-specific, and to suggest how a more nuanced understanding of jetliners could inform debates about nuclear energy.

"Involving patients and the public in clinical trials design can be beneficial but requires resources, preparation, training, flexibility, and time."

 2017 Oct 27. doi: 10.1111/jep.12805. [Epub ahead of print]

Patient and public involvement in the design of clinical trials: An overview of systematic reviews.

Author information

1
University of Oxford, UK.
2
Empower-2-Go, UK and USA.
3
Bond University, Faculty of Health Sciences and Medicine, Gold Coast Australia, Australia.
4
Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, UK.
5
University of Malaya, Malaysia.
6
Bodleian Health Care Libraries, University of Oxford, UK.
7
City, University of London, UK.

Abstract

BACKGROUND:

Funders encourage lay-volunteer inclusion in research. There are controversy and resistance, given concerns of role confusion, exploratory methods, and limited evidence about what value lay-volunteers bring to research. This overview explores these areas.

METHODS:

Eleven databases were searched without date or language restrictions for systematic reviews of public and patient involvement (PPI) in clinical trials design. This systematic overview of PPI included 27 reviews from which areas of good and bad practice were identified. Strengths, weaknesses, opportunities, and threats of PPI were explored through use of meta-narrative analysis.

RESULTS:

Inclusion criteria were met by 27 reviews ranging in quality from high (n = 7), medium (n = 14) to low (n = 6) reviews. Reviews were assessed using CERQUAL NICE, CASP for qualitative research and CASP for systematic reviews. Four reviews report risk of bias. Public involvement roles were primarily in agenda setting, steering committees, ethical review, protocol development, and piloting. Research summaries, follow-up, and dissemination contained PPI, with lesser involvement in data collection, analysis, or manuscript authoring. Trialists report difficulty in finding, retaining, and reimbursing volunteers. Respectful inclusion, role recognition, mutual flexibility, advance planning, and sound methods were reported as facilitating public involvement in research. Public involvement was reported to have increased the quantity and quality of patient relevant priorities and outcomes, enrollment, funding, design, implementation, and dissemination. Challenges identified include lack of clarity within common language, roles, and research boundaries, while logistical needs include extra time, training, and funding. Researchers report struggling to report involvement and avoid tokenism.

CONCLUSIONS:

Involving patients and the public in clinical trials design can be beneficial but requires resources, preparation, training, flexibility, and time. Issues to address include reporting deficits for risk of bias, study quality, and conflicts of interests. We need to address these tensions and improve dissemination strategies to increase PPI and health literacy.

More teens than ever aren't getting enough sleep

More teens than ever aren't getting enough sleep

A new study finds young people are likely sacrificing sleep to spend more time on their phones and tablets


"Teens' sleep began to shorten just as the majority started using smartphones," said Twenge, author of iGen: Why Today's Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy -- And Completely Unprepared for Adulthood. "It's a very suspicious pattern."
Students might compensate for that lack of sleep by dozing off during daytime hours, adds Krizan.
"Our body is going to try to meet its sleep needs, which means sleep is going to interfere or shove its nose in other spheres of our lives," he said. "Teens may catch up with naps on the weekend or they may start falling asleep at school."

"...it turns out that standing all day isn’t that much healthier than sitting all day and can cause similar health effects."

The science of why sitting all day is bad for your health



"Sitting in a stationary position every day can increase your risk of high blood pressure and abnormal cholesterol levels. It may even cause premature death due to cardiovascular disease or certain types of cancer.
Also, it turns out that standing all day isn’t that much healthier than sitting all day and can cause similar health effects. But there is a silver lining: it’s not that hard to counteract."

Thursday, October 26, 2017

Taste for carbs linked to waist size

Taste for carbs linked to waist size

"Interestingly, what we found in the fat taste studies was that the people who were more sensitive to fat consumed less fatty foods, but it's the other way around for carbohydrates," Professor Keast said.

Saturday, October 21, 2017

"...one of the finest science fiction novellas ever written."

John W. Campbell's Who Goes There


"In 1973, the story was voted by the Science Fiction Writers of America as one of the finest science fiction novellas ever written."

"...our children may live less healthy and shorter lives than their parents..."

Nearly 4 in 10 U.S. Adults Now Obese


Obesity is defined as a body mass index of 30 or more. A 6-foot-tall man weighing 221 pounds is considered obese, as is a 5-foot-9 woman weighing 203 pounds.
The increase in youth obesity is of particular concern because these children are at greater risk for lifelong health problems, said Dr. Seema Kumar, a childhood obesity specialist with the Mayo Clinic.
Kumar said she regularly sees children with diseases that used to be considered adult-only, including type 2 diabetes, high blood pressure, high cholesterol and fatty liver disease.
"Because rates of obesity are so high, despite all the advances we're seeing, our children may live less healthy and shorter lives than their parents," Kumar said. "We're going to have a much higher number of adults with diabetes, high blood pressure and heart disease down the line."

"The consequences of obesity in children are immediate, and future health risks include high blood pressure, high cholesterol, breathing problems, diabetes, etc."

Why is childhood obesity on the rise?

According to the World Health Organization, children are 10 times more obese than kids 40 years ago.  


"The consequences of obesity in children are immediate, and future health risks include high blood pressure, high cholesterol, breathing problems, diabetes, etc."





Diabetes boosts risk of cognitive issues after surgery, especially in seniors, study finds

Diabetes boosts risk of cognitive issues after surgery, especially in seniors, study finds


After adjusting for age, sex, surgery type, randomization, obesity and hypertension, the researchers determined diabetes was associated with an 84 percent higher risk of POCD. Patients age 65 or older were at particularly high risk.
"Our findings suggest that consideration of diabetes status may be helpful for the assessment of POCD risk among patients undergoing surgery," said Dr. Lachmann. "Further studies are warranted to examine the potential mechanisms of this association, to ultimately help in the development of potential strategies for prevention."

Michelle Mello and colleagues: Patients' Experiences With Communication-and-Resolution Programs After Medical Injury

 2017 Oct 9. doi: 10.1001/jamainternmed.2017.4002. [Epub ahead of print]

Patients' Experiences With Communication-and-Resolution Programs After Medical Injury.

Author information

1
Faculty of Law, University of New South Wales, Sydney, Australia.
2
School of Population and Global Health, University of Melbourne, Melbourne, Australia.
3
Stanford Law School, Stanford University, Stanford, California.
4
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.

Abstract

IMPORTANCE:

Dissatisfaction with medical malpractice litigation has stimulated interest by health care organizations in developing alternatives to meet patients' needs after medical injury. In communication-and-resolution programs (CRPs), hospitals and liability insurers communicate with patients about adverse events, use investigation findings to improve patient safety, and offer compensation when substandard care caused harm. Despite increasing interest in this approach, little is known about patients' and family members' experiences with CRPs.

OBJECTIVE:

To explore the experiences of patients and family members with medical injuries and CRPs to understand different aspects of institutional responses to injury that promoted and impeded reconciliation.

DESIGN, SETTING, AND PARTICIPANTS:

From January 6 through June 30, 2016, semistructured interviews were conducted with patients (n = 27), family members (n = 3), and staff (n = 10) at 3 US hospitals that operate CRPs. Patients and families were eligible for participation if they experienced a CRP, spoke English, and could no longer file a malpractice claim because they had accepted a settlement or the statute of limitations had expired. The CRP administrators identified hospital and insurer staff who had been involved in a CRP event and had a close relationship with the injured patient and/or family. They identified patients and families by applying the inclusion criteria to their CRP databases. Of 66 possible participants, 40 interviews (61%) were completed, including 30 of 50 invited patients and families (60%) and 10 of 16 invited staff (63%).

MAIN OUTCOMES AND MEASURES:

Patients' reported satisfaction with disclosure and reconciliation efforts made by hospitals.

RESULTS:

A total of 40 participants completed interviews (15 men and 25 women; mean [range] age, 46 [18-67] years). Among the 30 patients and family members interviewed, 27 patients experienced injuries attributed to error and received compensation. The CRP experience was positive overall for 18 of the 30 patients and family members, and 18 patients continued to receive care at the hospital. Satisfaction was highest when communications were empathetic and nonadversarial, including compensation negotiations. Patients and families expressed a strong need to be heard and expected the attending physician to listen without interrupting during conversations about the event. Thirty-five of the 40 respondents believed that including plaintiffs' attorneys in these discussions was helpful. Sixteen of the 30 patients and family members deemed their compensation to be adequate but 17 reported that the offer was not sufficiently proactive. Patients and families strongly desired to know what the hospital did to prevent recurrences of the event, but 24 of 30 reported receiving no information about safety improvement efforts.

CONCLUSIONS AND RELEVANCE:

As hospitals strive to provide more patient-centered care, opportunities exist to improve institutional responses to injuries and promote reconciliation.

A Decade of War: Prospective Trajectories of Post-Traumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure

 2017 Sep 27. doi: 10.1093/aje/kwx318. [Epub ahead of print]

A Decade of War: Prospective Trajectories of Post-Traumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure.

Abstract

Post-traumatic stress disorder (PTSD) is a common psychiatric disorder among service members and veterans. The clinical course of PTSD varies across individuals, and patterns of symptom development have yet to be clearly delineated. Previous studies have been limited by convenience sampling, short follow-up periods, and inability to account for combat-related trauma. To determine the trajectories of PTSD symptoms among deployed military personnel with and without combat exposure, we used data from a population-based representative sample of 8,178 US service members participating in the Millennium Cohort Study from 2001-2011. Using latent class growth mixture modeling, trajectories of PTSD symptoms were determined in the total sample and in individuals with and without combat exposure. Four trajectories of PTSD were characterized: resilient, pre-existing, new-onset, and moderate-stable. Across all trajectories combat deployed service members diverged from non-combat deployed service members after a single deployment, and generally had higher PTSD symptoms. Based on the models, nearly 90% of those without combat and 80% of those with combat exposure remained resilient over the 10-year period. Findings demonstrate the clinical course of PTSD symptoms have heterogeneous patterns of development, but that combat exposure is uniformly associated with poorer mental health.

Weight loss medications in Canada - a new frontier or a repeat of past mistakes?

 2017 Oct 4;10:413-417. doi: 10.2147/DMSO.S141571. eCollection 2017.

Weight loss medications in Canada - a new frontier or a repeat of past mistakes?

Author information

1
The Wharton Medical Clinic, Hamilton, ON, Canada.
2
School of Kinesiology and Health Science, York University, Toronto, ON, Canada.

Abstract

Current methods for the treatment of excess weight can involve healthy behavior changes, pharmacotherapy, and surgical interventions. Many individuals are able to lose some degree of weight through behavioral changes; however, they are often unable to maintain their weight loss long-term. This is in part due to physiological processes that cannot be addressed through behavioral changes alone. Bariatric surgery, which is the most successful treatment for excess weight to date, does result in physiological changes that can help with weight loss and weight maintenance. However, many patients either do not qualify or elect to not have this procedure. Fortunately, research has recently identified changes in neurochemicals (i.e., orexigens and anorexigens) that occur during weight loss and contribute to weight regain. The neurochemicals and hormones may be able to be targeted by medications to achieve greater and more sustained weight loss. Two medications are approved in adjunction to lifestyle management for weight loss in Canada: orlistat and liraglutide. Both medications are able to target physiological processes to help patients lose weight and maintain a greater amount of weight loss than with just behavioral modifications alone. Two other weight management medications, which also target specific physiological processes to aid in weight loss and its maintenance, a bupropion/naltrexone combination and lorcaserin, are currently pending approval in Canada. Nonetheless, there remain significant barriers for health care professionals to prescribe medications for weight loss, such as a lack of training and knowledge in the area of obesity. Until this has been addressed, and we begin treating obesity as we do other diseases, we are unlikely to combat the increasing trend of obesity in Canada and worldwide.

A Big Test of Police Body Cameras Defies Expectations (HT:DC)

A Big Test of Police Body Cameras Defies Expectations


"Usually, we behave better when we know we’re being watched. According to decades of research, the presence of other people, cameras or even just a picture of eyes seems to nudge us toward civility: We become more likely to give to charity, for example, and less likely to speed, steal or take more than our fair share of candy.
But what happens when the cameras are on the chests of police officers? The results of the largest, most rigorous study of police body cameras in the United States came out Friday morning, and they are surprising both police officers and researchers."


HT:DC

"...the authors estimate a lower bound of over 32,000 papers that have worked on the wrong cells, compared to what they report."

Bad Cells. So Many Bad Cells.


"Here’s a new paper in PLoS ONE that tries to get a handle on the problem. The real kicker is that some of these cell lines became contaminated along the way, so that earlier papers and later ones in the field are actually referring to different cells. And others became contaminated (or mis-identified) so early that basically all of the literature on them is mistaken. Warnings have taken place about this stuff again and again, and the current literature is surely cleaner than the older papers. But how bad is it in the published record?
By correlating the literature with a list of known contaminated cell lines (many of them invaded by HeLa cells), the authors estimate a lower bound of over 32,000 papers that have worked on the wrong cells, compared to what they report. In turn, these papers are cited by at least 500,000 more articles, and that total excludes self-citations. And as the authors note, they were quite conservative with their name strings in the searches, so although there are also still a few false positives in those numbers, they are surely tiny compared to the false negatives – the mistaken papers that haven’t been flagged yet." 

"...children from the most deprived areas more than twice as likely to be obese..."

Obesity in schools continuing to rise

The report also found that obesity prevalence for children living in the most deprived areas was more than double that of those living in the least deprived areas for both reception and year six.
Obesity also varied by local authority. For reception this ranged from 4.8% in Kingston-upon-Thames to 13.5% in Wolverhampton.
“The latest data also shows that inequalities are widening, with children from the most deprived areas more than twice as likely to be obese as those from the least deprived,” said Buck.

Friday, October 20, 2017

"Art must be dangerous. Once it has ceased to be dangerous it is no use."

In the loop


This is the edited text of a speech given in June at the annual dinner of the Royal Academy of Arts in London.
"Anthony Burgess wrote 'There can be no art till craft has been mastered. Art must be dangerous. Once it has ceased to be dangerous it is no use'. Burgess was born a century ago, 1917 – the year that Marcel Duchamp changed forever the face of urinals. His tiresome schoolboy jest has spawned numberless hackneyed imitations which are far from dangerous. And no use."

Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing

 2017 Oct 16. doi: 10.1001/jamainternmed.2017.5152. [Epub ahead of print]

Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing.

Author information

1
Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
2
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
3
Division of General Internal Medicine, Department of Medicine, Sinai Health System, Toronto, Ontario, Canada.
4
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
5
Division of General Internal Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
6
The Michigan Medicine/Institute for Healthcare Policy and Innovation for Program on Value Enhancement, Ann Arbor.
7
Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
8
Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
9
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
10
Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland.
11
Section of Hospital Medicine, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.

Abstract

Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.