From UC San Diego: Diagnosis of autism spectrum disorders in 2-year-olds: a study of community practice

http://www.ncbi.nlm.nih.gov/pubmed/22905987

J Child Psychol Psychiatry. 2012 Aug 20. doi: 10.1111/j.1469-7610.2012.02607.x. [Epub ahead of print]

Diagnosis of autism spectrum disorders in 2-year-olds: a study of community practice.

Corsello CM, Akshoomoff N, Stahmer AC.

Source

Rady Children's Hospital San Diego, San Diego, CA University of California, San Diego, CA, USA.

Abstract

Background:  Longitudinal research studies have demonstrated that experienced clinicians using standardized assessment measures can make a reliable diagnosis of autism spectrum disorders (ASDs) in children under age 3. Limited data are available regarding the sensitivity and specificity of these measures in community settings. The aims of this study were to determine how well a standardized diagnostic observational measure (Autism Diagnostic Observation Schedule - ADOS) functions alone, and with a brief parent measure within a community setting when administered by community clinicians. 

Methods:  Clinical records for 138 children between the ages of 24 and 36 months of age who were evaluated for possible ASD or social/language concerns at a hospital-based developmental evaluation clinic were examined. Evaluations were conducted by community-based clinical psychologists. Classification results obtained from standardized diagnostic measures were compared with case reviewer diagnosis, by reviewers blind to scores on diagnostic measures, using The Records-based Methodology for ASD Case Definition that was developed by the Metropolitan Atlanta Developmental Disabilities Surveillance Program. 

Results:  When compared with case review diagnosis, the ADOS demonstrated strong sensitivity and specificity for both Autism versus Not Autism and ASD versus Nonspectrum (NS) diagnoses in this young sample. The Social Communication Questionnaire (SCQ), using the lower cutoff of ≥12, had adequate sensitivity when differentiating Autism from Not Autism, but weak sensitivity when differentiating ASD from NS, missing about 80% of the children with pervasive developmental disorder - not otherwise specified. Using either the Modified Checklist for Autism in Toddlers or the SCQ in combination with the ADOS did not result in improved specificity over the ADOS alone and led to a drop in sensitivity when differentiating ASD from NS disorders. 

Conclusions:  These results demonstrate that following best practice guidelines, the ADOS can be successfully incorporated into clinical practice with relatively good sensitivity and specificity, and worked well with a referred sample of 2-year-olds. A parent questionnaire did not lead to any improvement in diagnostic classification above the ADOS used in isolation.

http://www.ncbi.nlm.nih.gov/pubmed/22929426

Acad Med. 2012 Sep;87(9):1159-1160.

Commentary: Educating the Present and Future Health Care Workforce to Provide Care to Populations.

Garr DR, Margalit R, Jameton A, Cerra FB.

Source

Dr. Garr is professor of family medicine, Department of Family Medicine, and executive director, South Carolina Area Health Education Consortium, Medical University of South Carolina, Charleston, South Carolina. Dr. Margalit is associate professor, Department of Health Promotion, Social and Behavioral Health, and director, Service Learning Academy, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. Dr. Jameton is professor, Department of Health Promotion, Social and Behavioral Health, and director, Center for Humanities, Ethics, and Society, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. Dr. Cerra is professor of surgery, McKnight Presidential Leadership Chair, and former senior vice president for health sciences and dean of the medical school, University of Minnesota, Minneapolis, Minnesota.

Abstract

The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

Disappointing: "pairing newly recruited medical journal peer reviewers with senior reviewer mentors did not improve the quality of their subsequent reviews"

http://www.ncbi.nlm.nih.gov/pubmed/22928960

BMC Med Educ. 2012 Aug 28;12(1):83. [Epub ahead of print]

Does mentoring new peer reviewers improve review quality? A randomized trial.

Callaham M, Green S, Houry D.

Abstract

ABSTRACT:

BACKGROUND:

Prior efforts to train medical journal peer reviewers have not improved subsequent review quality, although such interventions were general and brief. We hypothesized that a manuscript-specific and more extended intervention pairing new reviewers with high-quality senior reviewers as mentors would improve subsequent review quality.

METHODS:

Over a four-year period we randomly assigned all new reviewers for Annals of Emergency Medicine to receive our standard written informational materials alone, or these materials plus a new mentoring intervention. For this program we paired new reviewers with a high-quality senior reviewer for each of their first three manuscript reviews, and asked mentees to discuss their review with their mentor by email or phone. We then compared the quality of subsequent reviews between the control and intervention groups, using linear mixed effects models of the slopes of review quality scores over time.

RESULTS:

We studied 490 manuscript reviews, with similar baseline characteristics between the 24 mentees who completed the trial and the 22 control reviewers. Mean quality scores for the first 3 reviews on our 1 to 5 point scale were similar between control and mentee groups (3.4 versus 3.5), as were slopes of change of review scores (-0.229 versus -0.549) and all other secondary measures of reviewer performance.

CONCLUSIONS:

A structured training intervention of pairing newly recruited medical journal peer reviewers with senior reviewer mentors did not improve the quality of their subsequent reviews.

"stressful habits and type A behaviour are associated with high risk of stroke"

http://www.ncbi.nlm.nih.gov/pubmed/22930814

J Neurol Neurosurg Psychiatry. 2012 Aug 27. [Epub ahead of print]

Is psycho-physical stress a risk factor for stroke? A case-control study.

Egido JA, Castillo O, Roig B, Sanz I, Herrero MR, Garay MT, Garcia AM, Fuentes M, Fernandez C.

Source

Stroke Unit, Department of Neurology, Hospital Clinico Universitario San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

Abstract

BACKGROUND:

Chronic stress is associated with cardiovascular diseases, but the link with stroke has not been well established. Stress is influenced by life-style habits, personality type and anxiety levels. We sought to evaluate psycho-physical stress as a risk factor for stroke, while assessing gender influences.

METHODS:

Case-control study. Cases: patients (n=150) aged 18-65, admitted consecutively to our Stroke Unit with the diagnosis of incident stroke. Controls: (n=300) neighbours (paired with case ±5 years) recruited from the census registry. Study variables: socio-demographic characteristics, vascular risk factors, psychophysical scales of H&R (Holmes & Rahe questionnaire of life events), ERCTA (Recall Scale of Type A Behaviour), SF12 (QoL scale), GHQ28 (General Health Questionnaire). Statistical analyses included conditional multiple logistic regression models.

RESULTS:

Mean age was 53.8 years (SD: 9.3). Compared with controls, and following adjustment for confounding variables, significant associations between stroke and stress were: H&R values >150 OR=3.84 (95% CI 1.91 to 7.70, p<0.001); ERCTA (values >24) OR=2.23 (95% CI 1.19 to 4.18, p=0.012); mental SF12 (values >50) OR=0.73 (95% CI 0.39 to 1.37, p=0.330); psychological SF12 (values >50) OR=0.66 (95% CI 0.33 to 1.30, p=0.229), male gender OR=9.33 (95% CI 4.53 to 19.22, p<0.001), high consumption of energy-providing beverages OR=2.63 (95% CI 1.30 to 5.31, p=0.007), current smoker OR=2.08 (95% CI 1.01 to 4.27, p=0.046), ex-smoker OR=2.35 (95% CI 1.07 to 5.12, p=0.032), cardiac arrhythmia OR=3.18 (95% CI 1.19 to 8.51, p=0.022) and Epworth scale (≥9) OR=2.83 (95% CI 1.03 to 7.78, p=0.044).

CONCLUSIONS:

Compared with healthy age-matched individuals, stressful habits and type A behaviour are associated with high risk of stroke. This association is not modified by gender.

Richard Posner: The Incoherence of Antonin Scalia (HT: AP)

http://www.tnr.com/article/magazine/books-and-arts/106441/scalia-garner-reading-the-law-textual-originalism#.UD7Y0HxG-IM.twitter

The Incoherence of Antonin Scalia

• Richard A. Posner

Reading Law: The Interpretation of Legal Texts
By Antonin Scalia and Bryan A. Garner
(Thomson/West, 567 pp., $49.95)

"According to William Blackstone, whom Scalia and Garner treat as an authority on American law at the time of the Constitution, freedom of speech forbids censorship in the sense of prohibiting speech in advance, but does not prohibit punishment after the fact of speech determined by a jury to be blasphemous, obscene, or seditious. And so an understanding of free speech that embraces flag burning is exceedingly unoriginalist. It is the product of freewheeling Supreme Court decisions within the last century."

http://www.ncbi.nlm.nih.gov/pubmed/22929331

Radiology. 2012 Aug 28. [Epub ahead of print]

Pulmonary Perifissural Nodules on CT Scans: Rapid Growth Is Not a Predictor of Malignancy.

de Hoop B, van Ginneken B, Gietema H, Prokop M.

Source

Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands; Department of Radiology and Image Sciences Institute, University Medical Center, Utrecht, the Netherlands.

Abstract

Purpose:To assess the prevalence, natural course, and malignancy rate of perifissural nodules (PFNs) in smokers participating in a lung cancerscreening trial.

Materials and Methods:As part of the ethics-committee approved Dutch-Belgian Randomised Lung Cancer Multi-Slice Screening Trial (NELSON), computed tomography (CT) was used to screen 2994 current or former heavy smokers, aged 50-74 years, for lung cancer. CT was repeated after 1 and 3 years, with additional follow-up CT scans if necessary. All baseline CT scans were screened for nodules. Nodule volume was determined with automated volumetric analysis. Homogeneous solid nodules, attached to a fissure with a lentiform or triangular shape, were classified as PFNs. Nodules were considered benign if they did not grow during the total follow-up period or were proved to be benign in a follow-up by a pulmonologist. Prevalence, growth, and malignancy rate of PFNs were assessed.

Results:At baseline screening, 4026 nodules were detected in 1729 participants, and 19.7% (794 of 4026) of the nodules were classified as PFNs. The mean size of the PFNs was 4.4 mm (range: 2.8-10.6 mm) and the mean volume was 43 mm(3) (range: 13-405 mm(3)). None of the PFNs were found to be malignant during follow-up. Between baseline and the first follow-up CT scan, 15.5% (123 of 794) were found to have grown, and 8.3% (66 of 794) had a volume doubling time of less than 400 days. One PFN was resected and proved to be a lymph node.

Conclusion:PFNs are frequently found at CT scans for lung cancer. They can show growth rates in the range of malignant nodules, but none of the PFNs in the present study turned out to be malignant. Recognition of PFNs can reduce the number of follow-up examinations required for the workup of suspicious nodules.

From Paul Bunn and colleagues: Non-invasive Breath Analysis of Pulmonary Nodules

http://www.ncbi.nlm.nih.gov/pubmed/22929969

J Thorac Oncol. 2012 Aug 27. [Epub ahead of print]

Non-invasive Breath Analysis of Pulmonary Nodules.

Peled N, Hakim M, Bunn PA Jr, Miller YE, Kennedy TC, Mattei J, Mitchell JD, Hirsch FR, Haick H.

Source

*Thoracic Cancer Research and Detection Center, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; †Division of Medical Oncology, Department of Medicine and Pathology, University of Colorado Cancer Center, UC Denver, Aurora, Colorado; ‡Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel; §Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, UC Denver, Aurora, Colorado; ║Department of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Cancer Center, UC Denver, Aurora, Colorado; ¶Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado; and #Division of Medical Oncology, Department of Medicine and Pathology, University of Colorado School of Medicine, Aurora, Colorado.

Abstract

INTRODUCTION:

The search for non-invasive diagnostic methods of lung cancer (LC) has led to new avenues of research, including the exploration of the exhaled breath. Previous studies have shown that LC can, in principle, be detected through exhaled-breath analysis. This study evaluated the potential of exhaled-breath analysis for the distinction of benign and malignant pulmonary nodules (PNs).

METHODS:

Breath samples were taken from 72 patients with PNs in a prospective trial. Profiles of volatile organic compounds were determined by (1) gas chromatography/mass spectrometry (GC-MS) combined with solid-phase microextraction and (2) a chemical nanoarray.

RESULTS:

Fifty-three PNs were malignant and 19 were benign with similar smoking histories and comorbidities. Nodule size (mean ± SD) was 2.7 ± 1.7 versus 1.6 ± 1.3 cm (p = 0.004), respectively. Within the malignant group, 47 were non-small-cell lung cancer and six were small-cell lung cancer. Thirty patients had early-stage disease and 23 had advanced disease. Gas chromatography/mass spectrometry analysis identified a significantly higher concentration of 1-octene in the breath of LC, and the nanoarray distinguished significantly between benign versus malignant PNs (p < 0.0001; accuracy 88 ± 3%), between adeno- and squamous-cell carcinomas (p < 0.0001; 88 ± 3%) and between early stage and advanced disease (p < 0.0001; 88 ± 2%).

CONCLUSIONS:

In this pilot study, breath analysis discriminated benign from malignant PNs in a high-risk cohort based on LC-related volatile organic compound profiles. Furthermore, it discriminated adeno- and squamous-cell carcinoma and between early versus advanced disease. Further studies are required to validate this noninvasive approach, using a larger cohort of patients with PNs detected by computed tomography.

From U Kentucky: Compassionate Care: The Burn Survivor's Perspective

http://www.ncbi.nlm.nih.gov/pubmed/22929523

J Burn Care Res. 2012 Aug 27. [Epub ahead of print]

Compassionate Care: The Burn Survivor's Perspective.

Badger K, Royse D.

Source

From the College of Social Work, University of Kentucky, Lexington, Kentucky.

Abstract

Compassion is vital in burn care and some may consider its delivery a moral responsibility-a view supported by various healthcare professionals' codes of ethics. However, there is limited information about compassionate care in the burn literature. This study investigates the concept of compassionate care and how it is described by the burn survivor. A qualitative design with two focus groups at the World Burn Congress was used to examine views of compassionate care through 31 burn survivors' accounts to better understand the concept and its delivery within the context of burn care. Discussions were recorded, and transcripts were analyzed for prominent themes and descriptive components. Participants were primarily Caucasian (77%), female (60%), with an average age of 47.6 years and an average TBSA burn of approximately 49% sustained approximately 12 years previously. Qualitative data analysis yielded the primary themes of 1) respect the person, 2), communication, and 3) provision of competent care, with the first two categories additionally described by subcomponents. The three primary themes are all necessary to comprehensively describe compassionate care; it is not defined by a single characteristic, behavior, or skill but best understood as the convergence of the three themes. Challenges to the delivery of compassionate care despite its centrality in health care and ethical practice are also discussed. Considering the perspective of the burn survivor would assist in the provision of compassionate care.

http://www.ncbi.nlm.nih.gov/pubmed/22930675

J Med Ethics. 2012 Aug 28. [Epub ahead of print]

Scarce vaccine supplies in an influenza pandemic should not be distributed randomly: reply to McLachlan.

Wardrope A.

Abstract

In a recent paper, Hugh McLachlan argues from a deontological perspective that the most ethical means of distributing scarce supplies of an effective vaccine in the context of an influenza pandemic would be via an equal lottery. I argue that, even if one accepts McLachlan's ethical theory, it does not follow that one should accept the vaccine lottery. McLachlan's argument relies upon two suppressed premises which, I maintain, one need not accept; and it misconstrues vaccination programmes as clinical interventions targeted solely at protecting the health of vaccinated individuals, rather than as public health interventions targeted at protecting the health of the population as a whole.

In the South African military, "the fight against obesity is now official"

http://mg.co.za/article/2012-08-30-army-tells-obese-soldiers-to-shape-up

Army tells obese soldiers to shape up

Nearly 10% of SA's 60 000 soldiers are overweight or obese, according to the findings of a report being circulated among all army personnel.

"Beeld reported on Thursday that percentages in the provisional report were based on information gathered by the South African Military Health Service (SAMHS) between April 2011 and March 2012.

Soldiers are being warned that they face potentially life-threatening lifestyle diseases such as diabetes and cardiovascular issues if they don't slim down.

In addition, "the army can simply not be battle-ready with overweight soldiers. Everyone has to know that the fight against obesity is now official," the report states.

The soldiers are being encouraged to visit dieticians and establish a healthy eating plan and lifestyle."

http://www.ncbi.nlm.nih.gov/pubmed/22928484

Arch Pathol Lab Med. 2012 Aug 28. [Epub ahead of print]

Accurate Diagnosis of Mesothelioma: More Important Than Ever.

Allen TC.

There are few diagnoses more difficult to make with certainty, and carrying more prognostic and legal
weight, than the diagnosis of diffuse malignant mesothelioma (DMM). Diffuse malignant mesothelioma’s extremely limited therapeutic options, dismal prognosis, and serious legal implications make it a disease for which misdiagnosis carries grave and far-reaching medical, legal, and social consequences. At the same time, DMM’s rarity, and the commonness of its mimics, makes it a diagnosis with which few pathologists attain familiarity. Indeed, a pathologist can spend a career having never diagnosed DMM. Moreover, the diagnosis of DMM is often difficult to make, and even pathologists expert in the diagnosis of DMM find some cases extremely challenging. 

Zombie allusions: They just keep on coming-In Japan, "[]he traditional way to kill a zombie is to put salt in its mouth and sew its lips shut" Now Japanese companies...

http://in.reuters.com/article/2012/08/30/sharp-japanese-banks-restructuring-idINL2E8JU10620120830

COMMENT-Japanese banks should kill the Sharp zombie

Japanese banks should let Sharp go bankrupt

* Sharp shows all that is wrong with Japanese business

* Bailing out Sharp may not turn company around

By Nachum Kaplan

"Aug 30 (IFR) - The traditional way to kill a zombie is to put salt in its mouth and sew its lips shut. In the case of Japanese zombie companies, a better approach would be for creditor banks to stop bailing them out and let them go bankrupt. Electronics maker Sharp Corp looks just like a zombie in need of such slaying.

..........

Everything about Sharp and its relationship with its banks shows what is wrong with business in Japan."

Obesity: Need to avoid moral arguments and stick with medical evidence regarding physical fitness

http://www.huffingtonpost.com/2012/08/29/anti-obesity-the-new-homo_n_1839626.html

Anti-obesity: The New Homophobia?

"This week a Boston-area doctor revealedshe will no longer accept patients who weigh more than 200 pounds, because fat people are dangerous deviants who should go to "obesity centers" to get treated for their "disease." Earlier this summer, a gay man accused a New Jersey doctor of refusing to treat him because, allegedly, she attributed his need for medical care to "going against God's will."

"Homosexuality" and "obesity" are both diseases invented around the turn of the previous century. Prior to that time, being sexually attracted to someone of the same gender or having a larger than average body were, to the extent they were thought of as social problems, considered moral rather than medical issues: That is, they were seen as manifestations of morally problematic appetites, rather than disease states."

http://www.ncbi.nlm.nih.gov/pubmed/22918925

Ann Oncol. 2012 Sep;23 Suppl 8:viii28-viii34.

What future opportunities may immuno-oncology provide for improving the treatment of patients with lung cancer?

Reck M.

Source

Department of Thoracic Oncology, Hospital Grosshansdorf, Grosshansdorf, Germany.

Abstract

Lung cancer is the leading cause of cancer-related mortality worldwide, with non-small-cell lung cancer (NSCLC) accounting for approximately 85% of all cases. Most patients with NSCLC are diagnosed at an advanced stage and have a poor prognosis, with a 5-year survival rate of <5%. Despite the introduction of new chemotherapeutic agents and molecularly targeted drugs, outcomes remain poor, emphasising the need for new treatment approaches. Inducing or potentiating immune responses via immunotherapeutic manipulation is a viable treatment approach for lung cancer. Antigen-specific, tumour-cell, and dendritic cell-based vaccines have all been evaluated in lung cancer, and some have shown promising clinical activity in phase II trials. These include liposomal BLP25 vaccine (L-BLP25), which targets mucin 1, and melanoma-associated antigen 3 (MAGE-A3) antigen-specific cancer immunotherapeutic (ASCI), which targets MAGE-A3, a peptide expressed almost exclusively on tumour cells. MAGE-A3 ASCI is being evaluated in the adjuvant setting in a phase III trial of patients with early-stage NSCLC, while a phase III trial of L-BLP25 is enrolling patients with unresectable stage III NSCLC. T-cell modulating agents (e.g. antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen-4 [CTLA-4]) are also being investigated. For example, in patients with NSCLC treated with paclitaxel and carboplatin, the phased administration of ipilimumab (an antibody against CTLA-4) resulted in substantial improvements in immune-related progression-free survival compared with chemotherapy alone (5.7 versus 4.6 months; P = 0.05). Immunotherapy in lung cancer is starting to deliver promising results in clinical trials. However, further research will be required to establish the optimal timing of therapy (i.e. in the adjuvant or metastatic settings). In addition, it will be important to determine if immunotherapies are most effective when used alone or in combination with other agents.

Howard Davies: Economics in Denial

http://www.project-syndicate.org/commentary/economics-in-denial-by-howard-davies

Economics in Denial

Howard Davies

"On the contrary, the University of Chicago’s Eugene Fama has described the notion that finance theory was at fault as “a fantasy,” and argues that “financial markets and financial institutions were casualties rather than causes of the recession.” And the efficient-market hypothesis that he championed cannot be blamed, because “most investing is done by active managers who don’t believe that markets are efficient.”

CommentsThis amounts to what we might call an “irrelevance” defense: Finance theorists cannot be held responsible, since no one in the real world pays attention to them!"

From U Leeds: Patient perceptions of their role in undergraduate medical education within a primary care teaching practice

http://www.ncbi.nlm.nih.gov/pubmed/22925960

Educ Prim Care. 2012 Jul;23(4):277-85.

Patient perceptions of their role in undergraduate medical education within a primary care teaching practice.

Lucas B, Pearson D.

Source

Honorary Senior Lecturer Primary Care Education, Academic Unit of Primary Care, University of Leeds, UK.

Abstract

CONTEXT:

The importance of patient involvement as a positive contribution to both undergraduate and postgraduate medical education is now widely acknowledged. Patient contact has become an integral component of teaching, learning and assessment strategies. Research has considered the pedagogic advantage; however, a view from the patient on structure, process and outcome of their contribution has gone largely unexplored. The role of real patients in medical education is changing from passive to a more active involvement. Various commentators have called for more research into patients' perceptions of their role and involvement across a spectrum of educational activities and settings. This study offers an in-depth exploration of the patient perspective from primary care; a setting increasingly important for undergraduate medical education. The aim of this study is to explore patients' perceptions of their role in undergraduate medical education within a UK primary care setting.

METHOD:

A case study approach with an emphasis on data from in-depth interviews of 18 volunteer patients conducted within a purposively selected single teaching practice. The study captures patient perceptions of their experience, process and an evaluation of their involvement in medical studenteducation.

RESULTS:

Findings highlight four key themes of involvement that reflect the existing literature but provide additional insights. The themes are; reflections on level of involvement and organisational support; benefits to students; perceived benefits to patients themselves; and wider benefits tomedical education and educators.

CONCLUSION:

Patient perceptions of their involvement in clinical teaching support their key intended role within the educational process. Patients identified perceptions of benefit for students, educators and themselves. The implications of these findings are explored within the context of educational practice.

From U Michigan: Sham surgery controls in Parkinson's disease clinical trials: Views of participants

http://www.ncbi.nlm.nih.gov/pubmed/22927064

Mov Disord. 2012 Aug 23. doi: 10.1002/mds.25155. [Epub ahead of print]

Sham surgery controls in Parkinson's disease clinical trials: Views of participants.

Kim SY, De Vries R, Holloway RG, Wilson R, Parnami S, Kim HM, Frank S, Kieburtz K.

Source

Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA. scottkim@med.umich.edu.

Abstract

BACKGROUND:

Sham surgery controls are increasingly used in neurosurgical clinical trials in Parkinson's disease (PD) but remain controversial. We interviewed participants of such trials, specifically examining their understanding and attitudes regarding sham surgery.

METHODS:

We conducted semistructured qualitative interviews with participants of 3 sham surgery-controlled trials for PD, focusing on their understanding of sham design, their reactions to it, its impact on decision making, and their understanding of posttrial availability of the experimental intervention and its impact on decisions to participate.

RESULTS:

All subjects (n = 90) understood the 2-arm design; most (86%) described the procedural differences between the arms accurately. Ninety-two percent referred to scientific or regulatory reasons as rationales for the sham control, with 62% specifically referring to the placebo effect. Ninety-one percent said posttrial availability of the experimental intervention had a strong (48%) or some (43%) influence on their decision to participate, but only 68% understood the conditions for posttrial availability.

CONCLUSIONS:

Most subjects in sham surgery-controlled PD trials comprehend the sham surgery design and its rationale. Although there is room for improvement, most subjects of sham surgery trials appear to be adequately informed. 

From U Pittsburgh: Gender differences in young children's temperament traits: Comparisons across observational and parent-report methods

http://www.ncbi.nlm.nih.gov/pubmed/22924826

J Pers. 2012 Aug 28. doi: 10.1111/jopy.12000. [Epub ahead of print]

Gender differences in young children's temperament traits: Comparisons across observational and parent-report methods.

Olino TM, Durbin CE, Klein DN, Hayden EP, Dyson MW.

Source

University of Pittsburgh School of Medicine.

Abstract

Objective: Evidence supporting the continuity between child temperament and adult personality traits is accumulating. One important indicator of continuity is the presence of reliable gender differences in traits across the lifespan. A substantial literature demonstrates gender differences on certain adult personality traits and recent meta-analytic work on child samples suggests similar gender differences for some broad and narrow domains of temperament. However, most existing studies of children rely only on parent-report measures. The present study investigated gender differences in temperament traits assessed by laboratory observation, maternal-report, and paternal-report measures. Methods: Across three independent samples, behavioral observations, maternal-report, and paternal-report measures of temperament were collected on 463 boys and 402 girls. Results: Across all three methods, girls demonstrated higher positive affect and fear and lower activity level than boys. For laboratory measures, girls demonstrated higher levels of sociability and lower levels of overall negative emotionality (NE), sadness, anger and impulsivity than boys. However, girls demonstrated higher levels of overall NE and sadness than boys when measured by maternal reports. Finally, girls demonstrated lower levels of sociability based on paternal reports. Conclusions: Results are discussed in relation to past meta-analytic work and developmental implications of the findings.

http://www.ncbi.nlm.nih.gov/pubmed/22896799

ACS Chem Neurosci. 2012 Jul 18;3(7):494-504. Epub 2012 Apr 16.

Neurochemical and neurostructural plasticity in alcoholism.

Gass JT, Olive MF.

Abstract

The behavioral manifestations of alcoholism are primarily attributable to the numerous and lasting adaptations that occur in the brain as a result of chronic heavy alcohol consumption. As will be reviewed here, these adaptations include alcohol-induced plasticity in chemical neurotransmission, density and morphology of dendritic spines, as well as neurodegeneration and cerebral atrophy. Within the context of these neuroadaptations that have been observed in both human and animal studies, we will discuss how these changes potentially contribute to the cognitive and behavioral dysfunctions that are hallmark features of alcoholism, as well as how they reveal novel potential pharmacological targets for the treatment of this disorder.

http://www.ncbi.nlm.nih.gov/pubmed/22927839

Gastroenterol Res Pract. 2012;2012:890450. Epub 2012 Aug 8.

Adjuvant Bidirectional Chemotherapy with Intraperitoneal Pemetrexed Combined with Intravenous Cisplatin for Diffuse Malignant Peritoneal Mesothelioma.

Bijelic L, Stuart OA, Sugarbaker P.

Source

Department of Surgery, Washington Hospital Center, 110 Irving Street, Washington, DC 20010, USA.

Abstract

Cytoreductive surgery (CRS) with heated intraoperative intraperitoneal chemotherapy (HIPEC) has emerged as optimal treatment for diffuse malignant peritoneal mesothelioma (DMPM) showing median survivals of 36-92 months. However, recurrences occur frequently even in patients undergoing optimal cytreduction and are often confined to the abdomen. We initiated a Phase II study of adjuvant intraperitoneal pemetrexed combined with intravenous cisplatin for patients undergoing CRS and HIPEC for DMPM. The treatment consisted of pemetrexed 500 mg/m(2) intraperitoneally and cisplatin 50 mg/m(2) intravenously given simultaneously on day 1 of every 21 day cycle for 6 cycles. The primary endpoint of the study was treatment related toxicity. From July 2007 until July 2009 ten patients were enrolled. Nine of 10 completed all 6 cycles of adjuvant treatment per protocol. The most common toxicities were fatigue, nausea and abdominal pain grade 1 or 2. There was one grade 3 toxicity consisting of a catheter infection. The median survival for all 10 patients was 33.5 months. Pharmacokinetic analysis of intraperitoneal pemetrexed showed a peritoneal to plasma area under the curve ratio of 70. Our study shows that adjuvant intravenous cisplatin and intraperitoneal pemetrexed can be used following CRS and HIPEC for DMPM with low morbidity.

http://www.ncbi.nlm.nih.gov/pubmed/22927485

Clin Cancer Res. 2012 Aug 27. [Epub ahead of print]

Increasing use of radical prostatectomy for non-lethal prostate cancer in Sweden.

Etzioni R, Mucci LA, Chen S, Johansson JE, Fall K, Adami HO.

Source

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center.

Abstract

PURPOSE:

The number of patients in Sweden treated with radical prostatectomy for localized prostate cancer has increased exponentially. The extent to which this increase reflects treatment of non-lethal disease detected through PSA screening is unknown. Experimental design: We undertook a nationwide study of all 18,837 prostate cancer patients treated with radical prostatectomy in Sweden from 1988 to 2008 with complete follow-up through 2009. We compared cumulative incidence curves, fit Cox regression and cure models, and performed a simulation study to determine changes in treatment, cancer-specific survival over time, and effect of lead-time due to PSA screening.

RESULTS:

The annual number of radical prostatectomies increased 25-fold during the study. Five-year cancer-specific mortality decreased from 3.9% (95% CI 2.5 to 5.3) among patients diagnosed between 1988 and 1992 to 0.7% (95% CI 0.4-1.1) among those diagnosed between 1998 and 2002 (p for trend < 0.001). According to the cure model, the risk of not being cured declined by 13% (95% CI 12-14%) with each calendar year. The simulation study indicated that only half of the improvement in disease-specific survival could be accounted for by lead-time.

CONCLUSION:

Patients overdiagnosed with non-lethal prostate cancer appear to account for a substantial and growing part of the dramatic increase in radical prostatectomies in Sweden but increasing survival rates are likely due to true reductions in risk of disease-specific death over time. Because the magnitude of harm and costs due to overtreatment can be considerable, identification of men who likely benefit from radical prostatectomy is urgently needed.