Coming to America
A review of Letters from America, by Alexis de Tocqueville, translated by Frederick Brown; andTocqueville's Discovery of America, by Leo Damrosch.
Monday, April 30, 2012
From the Claremont Institute: "We are all Tocquevilleans now"
http://www.claremont.org/publications/crb/id.1929/article_detail.asp
"Americans have always loved Tocqueville. We recall fondly, if somewhat inaccurately, his optimistic assessment of our enterprising spirit, social mobility, and all-around "exceptionalism." But thinking of Tocqueville as a friendly travel-writer is one thing; taking him seriously as a political thinker is something entirely different. By the 1930s, Democracy in America was nearly 100 years old, and whatever wisdom it might have contained for the still largely unsettled, relatively homogenous, agrarian America of the 1830s no longer seemed relevant to the hyper-industrialized nation, which was teeming with newly arrived immigrants from all parts of the globe—and poised to assume world leadership.
From Olga Pozdnyakova, Jeffery Kutok, and Scott Rodig: Emerging Targeted Therapies for Lymphoid Malignancies
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2010-0391-RA
Context.—Our understanding of molecular events in the pathogenesis of hematologic malignancies has evolved substantially. The research data gathered in the past 3 decades have led to the definition of neoplastic disorders based on specific genetic and molecular alterations, which is reflected in the current World Health Organization's classification of tumors of hematopoietic and lymphoid tissues. Moreover, there have been dramatic successes in the development and implementation of therapies that specifically target the proteins and signaling cascades affected by tumor-specific genetic alterations.
Objective.—To review the development of select, novel therapies for lymphoid malignancies.
Data Sources.—We examine examples from the recent literature in targeting 4 major regulatory pathways: tyrosine kinase activation, transcription factor activity, apoptotic signaling, and histone acetylation in both preclinical models and early-stage (stage 1 and 2) clinical trials.
Conclusion.—Given the successes of novel compounds that target signaling pathways critical to the growth and survival of lymphoid tumor cells, the routine clinical use of molecularly targeted therapies for the treatment of lymphoid malignancies is likely in the near future.
SPECIAL SECTION–PERSPECTIVES ON TARGETED THERAPIES FOR TREATMENT OF HUMAN CANCERS
Emerging Targeted Therapies for Lymphoid Malignancies
Olga Pozdnyakova, MD, PhD; Jeffery L. Kutok, MD, PhD; Scott J. Rodig, MD, PhD
Context.—Our understanding of molecular events in the pathogenesis of hematologic malignancies has evolved substantially. The research data gathered in the past 3 decades have led to the definition of neoplastic disorders based on specific genetic and molecular alterations, which is reflected in the current World Health Organization's classification of tumors of hematopoietic and lymphoid tissues. Moreover, there have been dramatic successes in the development and implementation of therapies that specifically target the proteins and signaling cascades affected by tumor-specific genetic alterations.
Objective.—To review the development of select, novel therapies for lymphoid malignancies.
Data Sources.—We examine examples from the recent literature in targeting 4 major regulatory pathways: tyrosine kinase activation, transcription factor activity, apoptotic signaling, and histone acetylation in both preclinical models and early-stage (stage 1 and 2) clinical trials.
Conclusion.—Given the successes of novel compounds that target signaling pathways critical to the growth and survival of lymphoid tumor cells, the routine clinical use of molecularly targeted therapies for the treatment of lymphoid malignancies is likely in the near future.
From Andrea Marrari, Andrew Wagner, and Jason Hornick: Predictors of Response to Targeted Therapies for Gastrointestinal Stromal Tumors
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2011-0082-RA
Context.—The inhibition of oncogenic kinase signaling is a successful strategy to treat both hematologic and solid malignancies. Patients with chronic myelogenous leukemia, lung adenocarcinoma, renal cell carcinoma, and gastrointestinal stromal tumors are experiencing tremendous clinical benefits from targeted therapies in the form of kinase inhibitors. These drugs marked a revolution in cancer treatment, not only for their safety and efficacy, but also because they continue to expand our knowledge of the pathophysiology of cancer.
Objective.—To provide a summary of the biologic predictors of gastrointestinal stromal tumor behavior and response to targeted therapies that currently help guide clinical decision making.
Data Sources.—Published articles pertaining to the diagnosis, molecular genetics, prognostication, clinical behavior, and treatment of gastrointestinal stromal tumors, as well as experiences in a multidisciplinary sarcoma clinic.
Conclusions.—In gastrointestinal stromal tumors, the strongest predictor of response to targeted therapies is the mutational status of KIT or PDGFRA. Patients whose tumors harbor a KIT exon 11 mutation benefit the most from imatinib mesylate therapy, in terms of response rate, progression-free survival, and overall survival. Conversely, tumors without detectable mutations in either gene (“wild-type” gastrointestinal stromal tumors) are generally not responsive to imatinib mesylate.
SPECIAL SECTION–PERSPECTIVES ON TARGETED THERAPIES FOR TREATMENT OF HUMAN CANCERS
Predictors of Response to Targeted Therapies for Gastrointestinal Stromal Tumors
Andrea Marrari, MD; Andrew J. Wagner, MD, PhD; Jason L. Hornick, MD, PhD
Context.—The inhibition of oncogenic kinase signaling is a successful strategy to treat both hematologic and solid malignancies. Patients with chronic myelogenous leukemia, lung adenocarcinoma, renal cell carcinoma, and gastrointestinal stromal tumors are experiencing tremendous clinical benefits from targeted therapies in the form of kinase inhibitors. These drugs marked a revolution in cancer treatment, not only for their safety and efficacy, but also because they continue to expand our knowledge of the pathophysiology of cancer.
Objective.—To provide a summary of the biologic predictors of gastrointestinal stromal tumor behavior and response to targeted therapies that currently help guide clinical decision making.
Data Sources.—Published articles pertaining to the diagnosis, molecular genetics, prognostication, clinical behavior, and treatment of gastrointestinal stromal tumors, as well as experiences in a multidisciplinary sarcoma clinic.
Conclusions.—In gastrointestinal stromal tumors, the strongest predictor of response to targeted therapies is the mutational status of KIT or PDGFRA. Patients whose tumors harbor a KIT exon 11 mutation benefit the most from imatinib mesylate therapy, in terms of response rate, progression-free survival, and overall survival. Conversely, tumors without detectable mutations in either gene (“wild-type” gastrointestinal stromal tumors) are generally not responsive to imatinib mesylate.
From Laurie Eisengart, Gary MacVicar, & Ximing Yang: Predictors of Response to Targeted Therapy in Renal Cell Carcinoma
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2010-0308-RA
Context.—The prognosis for patients with metastatic renal cell carcinoma is poor, with an average 5-year survival of approximately 10%. Use of traditional cytokine therapy, specifically high-dose interleukin 2, is limited by significant toxicity. Better understanding of the molecular pathogenesis of renal cell carcinoma has led to the development of targeted therapies to inhibit specific cellular pathways leading to tumorigenesis. These drugs provide improved survival with a more favorable toxicity profile. There is ongoing investigation of markers that predict response of an individual patient to different targeted therapies.
Objective.—To explain the molecular basis for vascular endothelial growth factor inhibitor (antiangiogenic) and mammalian target of rapamycin inhibitor therapies for renal cell carcinoma, summarize the clinical trials demonstrating the effectiveness of these drugs, and describe the biomarkers shown to correlate with outcome in patients treated with targeted therapy.
Data Sources.—All included sources are from peer-reviewed journals in PubMed (US National Library of Medicine).
Conclusion.—Emerging evidence shows promise that biomarkers will be useful for predicting an individual patient's response to targeted therapy, leading to a more personalized approach to treating renal cell carcinoma.
SPECIAL SECTION–PERSPECTIVES ON TARGETED THERAPIES FOR TREATMENT OF HUMAN CANCERS
Predictors of Response to Targeted Therapy in Renal Cell Carcinoma
Laurie J. Eisengart, MD; Gary R. MacVicar, MD; Ximing J. Yang, MD, PhD
Context.—The prognosis for patients with metastatic renal cell carcinoma is poor, with an average 5-year survival of approximately 10%. Use of traditional cytokine therapy, specifically high-dose interleukin 2, is limited by significant toxicity. Better understanding of the molecular pathogenesis of renal cell carcinoma has led to the development of targeted therapies to inhibit specific cellular pathways leading to tumorigenesis. These drugs provide improved survival with a more favorable toxicity profile. There is ongoing investigation of markers that predict response of an individual patient to different targeted therapies.
Objective.—To explain the molecular basis for vascular endothelial growth factor inhibitor (antiangiogenic) and mammalian target of rapamycin inhibitor therapies for renal cell carcinoma, summarize the clinical trials demonstrating the effectiveness of these drugs, and describe the biomarkers shown to correlate with outcome in patients treated with targeted therapy.
Data Sources.—All included sources are from peer-reviewed journals in PubMed (US National Library of Medicine).
Conclusion.—Emerging evidence shows promise that biomarkers will be useful for predicting an individual patient's response to targeted therapy, leading to a more personalized approach to treating renal cell carcinoma.
From Maria McIntire and Mark Redston: Targeted Therapies and Predictive Markers in Epithelial Malignancies of the Gastrointestinal Tract
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2011-0167-RA
Context.—In recent years, there has been a tremendous amount of interest in the development of targeted therapies for the treatment of human cancers. Increased understanding of the specific molecular pathways and driver mutations critical to cancer cell growth have allowed the development of these advanced therapeutics. Among these, inhibitors of the epidermal growth factor receptor and HER2/neu pathways now play a major role in the management of gastrointestinal cancers in addition to other solid malignancies. In colorectal and gastric cancers, the use of epidermal growth factor receptor inhibitors and HER2/neu inhibitors has increased the available treatment options for patients with advanced disease.
Objective.—To focus on the current targeted therapies and predictors of response in malignancies of the gastrointestinal tract.
Data Sources.—Medical literature searchable on PubMed (US National Library of Medicine) as well as older studies revealed by the literature review were used as the source of data.
Conclusion.—Gene testing of critical elements of the pathways targeted by these agents (such as KRAS mutational analysis in colorectal tumors and HER2/neu testing in gastric cancers) allows the ability to predict which patients will respond to these treatments. As the molecular profiling of tumors and our understanding of cancer genomics and epigenetic alterations continues to grow, it is expected that these personalized targeted therapies will form one of the mainstays of gastrointestinal cancer treatment.
SPECIAL SECTION–PERSPECTIVES ON TARGETED THERAPIES FOR TREATMENT OF HUMAN CANCERS
Targeted Therapies and Predictive Markers in Epithelial Malignancies of the Gastrointestinal Tract
Maria McIntire, MD; Mark Redston, MD
Context.—In recent years, there has been a tremendous amount of interest in the development of targeted therapies for the treatment of human cancers. Increased understanding of the specific molecular pathways and driver mutations critical to cancer cell growth have allowed the development of these advanced therapeutics. Among these, inhibitors of the epidermal growth factor receptor and HER2/neu pathways now play a major role in the management of gastrointestinal cancers in addition to other solid malignancies. In colorectal and gastric cancers, the use of epidermal growth factor receptor inhibitors and HER2/neu inhibitors has increased the available treatment options for patients with advanced disease.
Objective.—To focus on the current targeted therapies and predictors of response in malignancies of the gastrointestinal tract.
Data Sources.—Medical literature searchable on PubMed (US National Library of Medicine) as well as older studies revealed by the literature review were used as the source of data.
Conclusion.—Gene testing of critical elements of the pathways targeted by these agents (such as KRAS mutational analysis in colorectal tumors and HER2/neu testing in gastric cancers) allows the ability to predict which patients will respond to these treatments. As the molecular profiling of tumors and our understanding of cancer genomics and epigenetic alterations continues to grow, it is expected that these personalized targeted therapies will form one of the mainstays of gastrointestinal cancer treatment.
From Phil Cagle and Lucien Chirieac: Advances in Treatment of Lung Cancer With Targeted Therapy
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2011-0618-RA
Context.—Ongoing preclinical investigations and clinical trials involving new targeted therapies promise to improve survival for patients with lung cancer. Targeted therapeutic agents, based on genetic mutations and signaling pathways altered in lung cancer, have added significantly to our armamentarium for lung cancer treatment while minimizing drug toxicity. To date, 4 targeted therapies have been approved for treatment of lung cancer by the US Food and Drug Administration: gefitinib in 2002, erlotinib in 2003, bevacizumab in 2006, and crizotinib in 2011.
Objective.—To review targeted therapies in lung cancer, the molecular biomarkers that identify patients likely to benefit from these targeted therapies, the basic molecular biology principles, selected molecular diagnostic techniques, and pathologic features correlated with molecular abnormalities in lung cancer. To review new molecular abnormalities described in lung cancer that are predictive for response to novel promising targeted agents in various phases of clinical trials.
Data Sources.—Review of the literature covering the molecular abnormalities of lung cancer with a focus on the molecular diagnostics and targeted therapy. Special emphasis is placed on summarizing evolving technologies useful in the diagnosis and characterization of lung cancer.
Conclusions.—Molecular testing of lung cancer expands the expertise of the pathologist, who will identify the tumor markers that are predictive of sensitivity or resistance to various targeted therapies and allow patients with cancer to be selected for highly effective and less toxic therapies.
SPECIAL SECTION–PERSPECTIVES ON TARGETED THERAPIES FOR TREATMENT OF HUMAN CANCERS
Advances in Treatment of Lung Cancer With Targeted Therapy
Philip T. Cagle, MD; Lucian R. Chirieac, MD, PhD
Context.—Ongoing preclinical investigations and clinical trials involving new targeted therapies promise to improve survival for patients with lung cancer. Targeted therapeutic agents, based on genetic mutations and signaling pathways altered in lung cancer, have added significantly to our armamentarium for lung cancer treatment while minimizing drug toxicity. To date, 4 targeted therapies have been approved for treatment of lung cancer by the US Food and Drug Administration: gefitinib in 2002, erlotinib in 2003, bevacizumab in 2006, and crizotinib in 2011.
Objective.—To review targeted therapies in lung cancer, the molecular biomarkers that identify patients likely to benefit from these targeted therapies, the basic molecular biology principles, selected molecular diagnostic techniques, and pathologic features correlated with molecular abnormalities in lung cancer. To review new molecular abnormalities described in lung cancer that are predictive for response to novel promising targeted agents in various phases of clinical trials.
Data Sources.—Review of the literature covering the molecular abnormalities of lung cancer with a focus on the molecular diagnostics and targeted therapy. Special emphasis is placed on summarizing evolving technologies useful in the diagnosis and characterization of lung cancer.
Conclusions.—Molecular testing of lung cancer expands the expertise of the pathologist, who will identify the tumor markers that are predictive of sensitivity or resistance to various targeted therapies and allow patients with cancer to be selected for highly effective and less toxic therapies.
From Lucien Chirieac: Emerging Targeted Therapies in Cancer
http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2012-0684-ED
"The development of target-based therapies has dramatically changed the outlook of cancer treatment and increased the expectations for patients with cancer. Cancers that contain multiple genetic and epigenetic abnormalities are addicted to genes that promote their malignant behavior and cell survival. Targeted cancer therapies with monoclonal antibodies or small-molecule inhibitors interfere with cell proliferation and tumor spread to distant organs. Many of these therapies target proteins that are involved in cell signaling pathways, which form an intricate communication system that controls basic cellular functions, such as cell division, motility, responses to specific extracellular signals, and cell death."
SPECIAL SECTION–PERSPECTIVES ON TARGETED THERAPIES FOR TREATMENT OF HUMAN CANCERS
Emerging Targeted Therapies in Cancer
Lucian R. Chirieac, MD
"The development of target-based therapies has dramatically changed the outlook of cancer treatment and increased the expectations for patients with cancer. Cancers that contain multiple genetic and epigenetic abnormalities are addicted to genes that promote their malignant behavior and cell survival. Targeted cancer therapies with monoclonal antibodies or small-molecule inhibitors interfere with cell proliferation and tumor spread to distant organs. Many of these therapies target proteins that are involved in cell signaling pathways, which form an intricate communication system that controls basic cellular functions, such as cell division, motility, responses to specific extracellular signals, and cell death."
Friday, April 27, 2012
From Newsmax: Obamacare to Herd Disabled Seniors to Bare-Bones Medicaid Plans
http://www.newsmax.com/US/obamacare-medicaid-disabled-seniors/2012/04/27/id/437318
“Care is likely to suffer. Many of these elderly poor also suffer from a lot of chronic ailments like diabetes and lung disease. [T]hese people have diverse medical problems, and have been most successfully served by Medicare programs that tailored services to their specific needs.”
Read more on Newsmax.com: Expert: Obamacare to Herd Disabled Seniors to Bare-Bones Medicaid Plans
Expert: Obamacare to Herd Disabled Seniors to Bare-Bones Medicaid Plans
Friday, 27 Apr 2012 11:13 AM
“Care is likely to suffer. Many of these elderly poor also suffer from a lot of chronic ailments like diabetes and lung disease. [T]hese people have diverse medical problems, and have been most successfully served by Medicare programs that tailored services to their specific needs.”
Read more on Newsmax.com: Expert: Obamacare to Herd Disabled Seniors to Bare-Bones Medicaid Plans
From Forbes: After Obamacare: More For The Supreme Court To Throw Out
http://www.forbes.com/sites/aroy/2012/04/27/after-obamacare-more-for-the-supreme-court-to-throw-out/
After Obamacare: More For The Supreme Court To Throw Out
John R. Graham, Contributor
"We need to get rid of the very notion that the federal government should direct or regulate private health insurance for working-age people. Whether Medicare or Medicaid are constitutional is surely a political step too far. But private insurance? The argument for federal regulation is very weak – and the evidence of its consequences damning."
"The odds ratio of reporting a suicide attempt approximately doubled for every additional substance used."
http://www.ncbi.nlm.nih.gov/pubmed/22535305
Eur Child Adolesc Psychiatry. 2012 Apr 26. [Epub ahead of print]
Multiple substance use and self-reported suicide attempts by adolescents in 16 European countries.
Source
Department of Psychiatry, Medical School, Athens University, Athens, Greece, akokkevi@med.uoa.gr.
Abstract
Substance use and suicide attempts are high-risk behaviors in adolescents, with serious impacts on health and well-being. Although multiple substance use among young people has become a common phenomenon, studies of its association with suicide attempts are scarce. The present study examines the association between multiple substance use and self-reported suicide attempts in a large multinational sample of adolescent students in Europe. Data on multiple substance use (tobacco, alcohol, tranquillizers/sedatives, cannabis, other illegal drugs) and self-reported suicide attempts were drawn from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). The ESPAD survey follows a standardized methodology in all participating countries. The present study is based on 45,086 16-year-old adolescents from 16 countries that had used the optional "psychosocial module" of the questionnaire, thereby including the question on suicide attempts. Logistic regression analyses were performed to examine the associations of any self-reported suicide attempt (dependent variable) with substance use controlling for country and gender. The strongest association with self-reported suicide attempts was for any lifetime tranquillizer or sedative use (odds ratio 3.34, 95 % confidence interval 3.00-3.71) followed by any lifetime use of illegal drugs other than cannabis (2.41, 2.14-2.70), 30-day regular tobacco use (2.02, 1.84-2.21), 30-day frequent alcohol use (1.47, 1.32-1.63) and any 30-day cannabis use (1.37, 1.18-1.58). The odds ratio of reporting a suicide attempt approximately doubled for every additional substance used. These findings on the association between multiple substance use, including legal drugs (tranquillizers or sedatives and tobacco), and the life-threatening behavior of suicide attempts provide important cues for shaping prevention policies.
Successful and Unsuccessful Clinical Nursing Students
http://www.ncbi.nlm.nih.gov/pubmed/22533497
J Nurs Educ. 2012 Apr 27:1-7. doi: 10.3928/01484834-20120427-01. [Epub ahead of print]
Successful and Unsuccessful Clinical Nursing Students.
Abstract
This study describes the characteristics of successful and unsuccessful clinical performance in prelicensure nursing students. Clinical evaluation is an important role of nurse educators; however, many feel uncomfortable with its subjective nature, and commonly used criteria for successful and unsuccessful clinical performance are not available in the literature. Using a qualitative descriptive design, we analyzed telephone interviews with 24 nurse educators. Educators indicated successful students were positive and eager to learn, built relationships, communicated well, think critically, prepared for the clinical experience and showed progress, accepted feedback, and adapted to the clinical setting. Unsuccessful students were unprepared for the clinical experience, were unable to function in the clinical area, were unsafe, violated legal-ethical principles, and had difficulty with communication skills. Specific characteristics differentiated students who are considered satisfactory in the clinical area and those who are not. These behaviors may identify students at risk of failure in clinical courses.
Grassley Will Lift Hold on FCC Nominees Pai and Rosenworcel (HT: SD)
http://www.broadcastingcable.com/article/483733-Grassley_Will_Lift_Hold_on_FCC_Nominees.php
Sen. Charles Grassley (R-Iowa), who had placed a hold on the nominations of Ajit Pai and Jessica Rosenworcel to fill two vacant FCC commission seats, said Friday that while he is not yet satisfied with the FCC's handling of the LightSquared waiver, now that a process is in place for him to get the documents he wants from the FCC, he is ready to let the nominees proceed to a floor vote."
Grassley Will Lift Hold on FCC Nominees
Says he is not yet satisfied with FCC's handling of LightSquared waiver
By John Eggerton -- Broadcasting & Cable, 4/27/2012 2:55:10 PM
"The FCC could get two new commissioners by Memorial Day.Sen. Charles Grassley (R-Iowa), who had placed a hold on the nominations of Ajit Pai and Jessica Rosenworcel to fill two vacant FCC commission seats, said Friday that while he is not yet satisfied with the FCC's handling of the LightSquared waiver, now that a process is in place for him to get the documents he wants from the FCC, he is ready to let the nominees proceed to a floor vote."
From U Lubeck-Germany: Falls prevention for the elderly
http://www.ncbi.nlm.nih.gov/pubmed/22536299
GMS Health Technol Assess. 2012;8:Doc01. Epub 2012 Apr 12.
Falls prevention for the elderly.
Source
Nursing research group, Institute for Social Medicine, University of Lübeck, Lübeck, Germany.
Abstract
BACKGROUND:
An ageing population, a growing prevalence of chronic diseases and limited financial resources for health care underpin the importance of prevention of disabling health disorders and care dependency in the elderly. A wide variety of measures is generally available for the prevention of falls and fall-related injuries. The spectrum ranges from diagnostic procedures for identifying individuals at risk of falling to complex interventions for the removal or reduction of identified risk factors. However, the clinical and economic effectiveness of the majority of recommended strategies for fall prevention is unclear. Against this background, the literature analyses in this HTA report aim to support decision-making for effective and efficient fall prevention.
RESEARCH QUESTIONS:
The pivotal research question addresses the effectiveness of single interventions and complex programmes for the prevention of falls and fall-related injuries. The target population are the elderly (> 60 years), living in their own housing or in long term care facilities. Further research questions refer to the cost-effectiveness of fall prevention measures, and their ethical, social and legal implications.
METHODS:
Systematic literature searches were performed in 31 databases covering the publication period from January 2003 to January 2010. While the effectiveness of interventions is solely assessed on the basis of randomised controlled trials (RCT), the assessment of the effectiveness of diagnostic procedures also considers prospective accuracy studies. In order to clarify social, ethical and legal aspects all studies deemed relevant with regard to content were taken into consideration, irrespective of their study design. Study selection and critical appraisal were conducted by two independent assessors. Due to clinical heterogeneity of the studies no meta-analyses were performed.
RESULTS:
Out of 12,000 references retrieved by literature searches, 184 meet the inclusion criteria. However, to a variable degree the validity of their results must be rated as compromised due to different biasing factors. In summary, it appears that the performance of tests or the application of parameters to identify individuals at risk of falling yields little or no clinically relevant information. Positive effects of exercise interventions may be expected in relatively young and healthy seniors, while studies indicate opposite effects in the fragile elderly. For this specific vulnerable population the modification of the housing environment shows protective effects. A low number of studies, low quality of studies or inconsistent results lead to the conclusion that the effectiveness of the following interventions has to be rated unclear yet: correction of vision disorders, modification of psychotropic medication, vitamin D supplementation, nutritional supplements, psychological interventions, education of nursing personnel, multiple and multifactorial programs as well as the application of hip protectors. For the context of the German health care system the economic evaluations of fall prevention retrieved by the literature searches yield very few useful results. Cost-effectiveness calculations of fall prevention are mostly based on weak effectiveness data as well as on epidemiological and cost data from foreign health care systems. Ethical analysis demonstrates ambivalent views of the target population concerning fall risk and the necessity of fall prevention. The willingness to take up preventive measures depends on a variety of personal factors, the quality of information, guidance and decision-making, the prevention program itself and social support. THE ANALYSIS OF PAPERS REGARDING LEGAL ISSUES SHOWS THREE MAIN CHALLENGES: the uncertainty of which standard of care has to be expected with regard to fall prevention, the necessity to consider the specific conditions of every single case when measures for fall prevention are applied, and the difficulty to balance the rights to autonomous decision making and physical integrity.
DISCUSSION AND CONCLUSIONS:
The assessment of clinical effectiveness of interventions for fall prevention is complicated by inherent methodological problems (esp. absence of blinding) and meaningful clinical heterogeneity of available studies. Therefore meta-analyses are not appropriate, and single study results are difficult to interpret. Both problems also impair the informative value of economic analyses. With this background it has to be stated that current recommendations regarding fall prevention in the elderly are not fully supported by scientific evidence. In particular, for the generation of new recommendations the dependency of probable effects on specific characteristics of the target populations or care settings should be taken into consideration. This also applies to the variable factors influencing the willingness of the target population to take up and pursue preventive measures. In the planning of future studies equal weight should be placed on methodological rigour (freedom from biases) and transferability of results into routine care. Economic analyses require input of German data, either in form of a "piggy back study" or in form of a modelling study that reflects the structures of the German health care system and is based on German epidemiological and cost data.
Perfectionism in doctors
http://www.ncbi.nlm.nih.gov/pubmed/22427311
"People who are perfectionists strive for flawlessness, set excessively high standards of performance, and tend to be overly critical of their behaviour.4 5Perfectionism can have some important benefits—not least, attention to detail, a deep sense of responsibility, and maintenance of high standards. It could be asked, “Would patients want anything less?” There is continuing debate about whether perfectionism is “good” or “healthy,” with the understandable view from the medical profession and the public that perfectionism is an essential driver of high quality patient care. But herein lies the rub: current pressures to do more, faster, and with fewer resources all militate against …"
BMJ. 2012 Mar 16;344:e1674. doi: 10.1136/bmj.e1674.
Perfectionism in doctors.
"People who are perfectionists strive for flawlessness, set excessively high standards of performance, and tend to be overly critical of their behaviour.4 5Perfectionism can have some important benefits—not least, attention to detail, a deep sense of responsibility, and maintenance of high standards. It could be asked, “Would patients want anything less?” There is continuing debate about whether perfectionism is “good” or “healthy,” with the understandable view from the medical profession and the public that perfectionism is an essential driver of high quality patient care. But herein lies the rub: current pressures to do more, faster, and with fewer resources all militate against …"
Prostitutes and criminals: beginnings of eugenics in Croatia in the works of Fran Gundrum from Oriovac (1856-1919)
http://www.ncbi.nlm.nih.gov/pubmed/22522997
Croat Med J. 2012 Apr 15;53(2):185-97.
Prostitutes and criminals: beginnings of eugenics in Croatia in the works of Fran Gundrum from Oriovac (1856-1919).
Source
Martin Kuhar, The Institute for the History and Philosophy of Science, The Division for the History of Medical Sciences of the Croatian Academy of Sciences and Arts, Zagreb, Croatia, mkuhar@hazu.hr.
Abstract
Fran Gundrum (1856-1919) was a Croatian physician, encyclopedist, and an advocate of medical enlightenment and healthy lifestyle. In order to identify and analyze Gundrum's ideas about the problems of prostitution and criminality, we studied all of his books, booklets, and articles published between 1905 and 1914. We showed that Gundrum's theories of heredity,morality, and sexual hygiene incorporated many of the important discussions of his time, especially those related to the Darwinian paradigm. Gundrum's project of collecting statistics on prostitutes was the first such study published on the territory of today's Croatia. Although he rejected the notions of born prostitutes and born criminals, defended by Italian criminal anthropologist Cesare Lombroso, he still regarded eugenics as a convenient method of dealing with the ills of society. He believed that criminals were degenerate individuals representing a violent threat to the society and that it was legitimate to use radical means, such as sterilization and deportation, to deal with this problem. Organicistic view of the society prevented him from seeing the individual rights as important as that of the society to protect itself. Nevertheless, this view led to many humanistic ideas, such as the binomial illness/poverty in case of prostitution, which influenced many prominent works of social medicine movement.
Sad. True.
http://www.commentarymagazine.com/article/how-highbrows-killed-culture/
How Highbrows Killed Culture
From U Colorado: Crizotinib for the treatment of patients with advanced non-small cell lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22536569
Drugs Today (Barc). 2012 Apr;48(4):271-82.
Crizotinib for the treatment of patients with advanced non-small cell lung cancer.
Source
University of Colorado School of Medicine, Division of Medical Oncology, Aurora, Colorado, USA. antonio.jimeno@ucdenver.edu.
Abstract
Crizotinib is a potent small-molecule inhibitor of ALK tyrosine kinase receptor (anaplastic lymphoma kinase; ALK) and hepatocyte growth factor receptor (HGF receptor, proto-oncogene c-Met). A range of tumors, including subsets of non-small cell lung cancer (NSCLC), anaplastic large cell lymphoma and inflammatory myofibroblastic tumors harbor an ALK rearrangement that leads to oncogenic activation of ALK. Crizotinib has demonstrated preclinical and clinical activity against such malignancies through inhibition of ALK, and patients harboring ALK- rearranged NSCLC have demonstrated high response rates and prolonged progression-free survival in phase I and II studies. In August 2011, crizotinib was approved for the treatment of advanced ALK-positive NSCLC.
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