http://www.ncbi.nlm.nih.gov/pubmed/23645869

J Health Polit Policy Law. 2013 May 3. [Epub ahead of print]

The Twenty-Year War over England's National Health Service: A Report from the Battlefield.

Klein R.

Abstract

This article analyzes the latest battle in the twenty-year war to change England's National Health Service (NHS), starting with the internal market reforms introduced by the Thatcher government and now carried one step farther by David Cameron's coalition government. The government's program of change is characterized by (1) its wide scope and the organizational upheavals involved and (2) the fact that it is being introduced at a time when the NHS faces unprecedented fiscal pressures. The legislation faced strong political, public, and professional hostility both from those who saw it as a crime against the founding principles of the NHS and from those who saw it as a disruptive blunder that created more problems than it solved. This article asks three questions. Why did the coalition government embark on a policy course guaranteed to lose it votes? How will the much-amended legislation work out in practice: what are the risks and uncertainties? What will be the program's impact: will it, like previous waves of change, disappoint both the prophets of doom and the visionaries of transformation? The conclusion drawn is that the essential, defining characteristics of the NHS are not under threat. It continues to be a publicly funded service, freely available to all. It is not being privatized. But it is moving toward the kind of pluralistic system that would have been established by Britain's last, wartime coalition government, had not Aneurin Bevan nationalized the hospital service in 1948.

http://www.ncbi.nlm.nih.gov/pubmed/23713135

Commun Integr Biol. 2013 May 1;6(3):e23819. doi: 10.4161/cib.23819.

How fairly do chimpanzees play the ultimatum game?

Proctor D, Brosnan SF, de Waal FB.

Source

Living Links; Yerkes National Primate Research Center; Emory University; Atlanta, GA USA.

Abstract

Humans can behave fairly, but can other species? Recently we tested chimpanzees on a classic human test for fairness, the Ultimatum Game, and found that they behaved similarly to humans. In humans, Ultimatum Game behavior is cited as evidence for a human sense of fairness. By that same logic, we concluded that chimpanzees behaved fairly in our recent study. However, we make a distinction between behavior and motivation. Both humans and chimpanzees behaved fairly, but determining why they did so is more challenging.

From Stanford U: Can a collapse of global civilization be avoided?

http://www.ncbi.nlm.nih.gov/pubmed/23303549

Proc Biol Sci. 2013 Jan 8;280(1754):20122845. doi: 10.1098/rspb.2012.2845. Print 2013 Mar 7.

Can a collapse of global civilization be avoided?

Ehrlich PR, Ehrlich AH.

Source

Department of Biology, Stanford University, Stanford, CA 94305, USA. pre@stanford.edu

Abstract

Environmental problems have contributed to numerous collapses of civilizations in the past. Now, for the first time, a global collapse appears likely. Overpopulation, overconsumption by the rich and poor choices of technologies are major drivers; dramatic cultural change provides the main hope of averting calamity.

http://www.ncbi.nlm.nih.gov/pubmed/23687232

Anesth Analg. 2013 May 17. [Epub ahead of print]

The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees.

de Oliveira GS Jr, Chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, McCarthy RJ.

Source

From the *Department of Anesthesiology, Northwestern University Feinberg School of Medicine; and †Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois.

Abstract

BACKGROUND:The prevalence of burnout and depression in anesthesiology residents has not been determined. It is also unknown whether anesthesiology resident burnout/depression may affect patient care and safety. The primary objective of this study was to determine the prevalence ofburnout and depression in anesthesiology residents in the United States. We hypothesized that residents at high risk of burnout and/or depression would report more medical errors as well as a lower rate of following principles identified as the best practice of anesthesiology.

METHODS:A cross-sectional survey was sent to 2773 anesthesiology residents in the United States. The questionnaire was divided into 5 parts examining trainees' demographic factors, burnout (Maslach Burnout Inventory), depression (Harvard depression scale), 10 questions designed to evaluate best practice of anesthesiology, and 7 questions evaluating self-reported errors. Best practices and self-reported error rates were compared among subjects with a high risk of burnout only, high risk of depression only, high risk of burnout and depression, and low risk of burnout and depression. Pairwise comparisons were considered significant at P < 0.004 and confidence intervals (CIs) reported at 99.6%.

RESULTS:There were 1508 (54%) resident responds. High burnout risk was found in 41% (575 of 1417) of respondents. Working >70 hours per week, having >5 drinks per week, and female gender were associated with increased burnout risk. Twenty-two percent (298 of 1384) screened positive for depression. Working >70 hours of work per week, smoking, female gender, and having >5 drinks per week were associated with increased depression risk. Two hundred forty (17%) respondents scored at high risk of burnout and depression, 321 (23%) at high risk of burnout, 58 (4%) at high risk of depression only, and 764 (56%) at low risk of burnout or depression. Median best practice scores (maximum = 30) for residents at high risk of burnout (difference -2; 99.6% CI, -1 to -2; P < 0.001) or high risk of burnout and depression (difference -4; 99.6% CI, -3 to -6; P < 0.001) were lower than scores of residents at low risk forburnout or depression. Thirty-three percent of respondents with high burnout and depression risk reported multiple medication errors in the last year compared with 0.7% of the lower-risk responders (P < 0.001).

CONCLUSION:Burnout, depression, and suicidal ideation are very prevalent in anesthesiology residents. In addition to effects on the health of anesthesiology trainees, burnout and depression may also affect patient care and safety.

http://www.ncbi.nlm.nih.gov/pubmed/23625529

QJM. 2013 Apr 25. [Epub ahead of print]

Finding horse meat in beef products--a global problem.

O'Mahony PJ.

Source

From the Food Safety Authority of Ireland, Abbey Court, Lower Abbey Street, Dublin 1, Ireland.

Abstract

The Food Safety Authority of Ireland (FSAI) oversees the implementation of food safety controls in Ireland which are set out in EU and Irish law. The FSAI, a science-based consumer protection organization, has nurtured a close relationship with the scientific community allowing it to utilize the best scientific advice available to underpin risk assessments. In early 2013, a 2-month long investigation in to the authenticity of beef products culminated in the publication of results that demonstrated the presence of horse meat in a frozen burger produced in Ireland. The events that followed revealed a pan-European food fraud which will likely result in significant changes in the way this small section of the meat industry will be regulated in the future in the EU. Although revelations of implicated products and food businesses have relented, the EU-wide investigation is continuing in an effort to determine how a food fraud of this scale could have occurred in such a highly regulated industry and who was involved. The FSAI initially received some criticism after publication of the results, but was also commended for its scientific approach as well as its openness and transparency. The end result of this incident is likely to be that the complexity of the food chain will be addressed again and DNA-based or similar methods will become a regular feature in verifying the authenticity of meat-based foods.

http://www.ncbi.nlm.nih.gov/pubmed/23709125

Interact J Med Res. 2013 May 24;2(1):e10. doi: 10.2196/ijmr.2541.

Growing concerns with the flow of misinformation from electronic books.

Takahashi K, Kanda H, Mizushima S.

Source

Department of Epidemiology and Public Health, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. kt_intl_@ja2.so-net.ne.jp.

Abstract

In 2012, several kinds of electronic books (e-books) became available in Japan. Since several major book retailers launched e-book businesses, it is expected that e-books will become a popular source of information in the country. However, we are concerned that e-books may also be a source of misinformation. In examining 24 available materials published by anti-vaccinists, "atopy businesses", and "wellness maintenance" authors, each was found to contain inaccuracies or misinformation. Thus far, such information is only available in printed books. If these books are scanned and circulated, or published in e-book format, this misinformation may circulate rapidly as e-book devices are becoming popular, and, consequently, harm people's health. We think that it is important for the government to formulate ethical guidelines for the publishing e-books with due consideration to freedom of expression.

http://www.ncbi.nlm.nih.gov/pubmed/23690650

J Exp Soc Psychol. 2013 Jan;49(1):42-57.

'This will bring shame on our nation': The role of anticipated group-based emotions on collective action.

Shepherd L, Spears R, Manstead AS.

Source

Department of Psychology, School of Natural Sciences, University of Stirling, Scotland, UK ; School of Psychology, Cardiff University, Wales, UK.

Abstract

In three studies we examined whether the anticipation of group-based guilt, shame and anger predicts the desire to undertake collective action against a proposed ingroup transgression. In Studies 1 (N = 179) and 2 (N = 186), the relation between appraising a proposed ingroup transgression as illegitimate and collective action was mediated (or partially mediated) by anticipated group-based shame and anger. In Study 3 (N = 128) participants with high self-investment group identification were less willing to engage in collective action against the prospective ingroup transgression when aversive anticipated group-based emotions were made salient. This effect was mediated by anticipated group-based shame. We discuss the implications of these results with regard to collective action and the morality of intergroup behavior.

"The better the story, the bigger the serving"

http://www.ncbi.nlm.nih.gov/pubmed/23680389

Int J Behav Nutr Phys Act. 2013 May 16;10:60. doi: 10.1186/1479-5868-10-60.

The better the story, the bigger the serving: narrative transportation increases snacking during screen time in a randomized trial.

Lyons EJ, Tate DF, Ward DS.

Source

Department of Nutrition, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. ellyons@utmb.edu.

Abstract

BACKGROUND:

Watching television and playing video games increase energy intake, likely due to distraction from satiety cues. A study comparing one hour of watching TV, playing typical video games, or playing motion-controlled video games found a difference across groups in energy intake, but the reasons for this difference are not clear. As a secondary analysis, we investigated several types of distraction to determine potential psychosocial mechanisms which may account for greater energy intake observed during sedentary screen time as compared to motion-controlled video gaming.

METHODS:

Feelings of enjoyment, engagement (mental immersion), spatial presence (the feeling of being in the game), and transportation (immersion in a narrative) were investigated in 120 young adults aged 18 - 35 (60 female).

RESULTS:

Only narrative transportation was associated with total caloric intake (ρ = .205, P = .025). Transportation was also higher in the TV group than in the gaming groups (P = .002) and higher in males than in females (P = .003). Transportation mediated the relationship between motion-controlled gaming (as compared to TV watching) and square root transformed energy intake (indirect effect = -1.34, 95% confidence interval -3.57, -0.13). No other distraction-related variables were associated with intake.

CONCLUSIONS:

These results suggest that different forms of distraction may differentially affect eating behavior during screen time, and that narrative appears to be a particularly strong distractor. Future studies should further investigate the effects of narrative on eating behavior.

http://www.ncbi.nlm.nih.gov/pubmed/23709338

Med Health Care Philos. 2013 May 25. [Epub ahead of print]

Quality in ethics consultations.

Magill G.

Source

Center for Healthcare Ethics, Duquesne University, 600 Forbes Ave., Pittsburgh, PA, 15282, USA, magillg@duq.edu.

Abstract

There is an increasing need for quality in ethics consultations, though there have been significant achievements in the United States and Europe. However, fundamental concerns that place the profession in jeopardy are discussed from the perspective of the U.S. in a manner that will be helpful for other countries. The descriptive component of the essay (the first two points) explains the achievements in ethics quality (illustrated by the IntegratedEthics program of the Veterans Health Administration) and the progress on standards and competencies for ethics consultations (represented by the Core Competencies of the American Society for Bioethics and Humanities). Based on these achievements, the analytical component of the essay (the final three points) identifies and seeks to resolve three fundamental concerns (with increasing levels of importance) that compromise quality in ethics consultations: standards of quality; professionalism; and credentialing. The analysis argues for clearer standards of quality in ethics consultation and urges further professionalism by explaining the need for the following: interpreting the ASBH core competencies in a normative manner, developing a Code of Ethics, and clarifying the meaning of best practices. However, the most serious concern that threatens quality in ethics consultations is the lack of a credentialing process. This concern can be resolved effectively by developing an independent EthicsConsultation Accreditation Council to accredit and standardize graduate degree programs, fellowship experiences, and qualifying examinations. This credentialing process is indispensable if we are to strategically enhance quality in ethics consultations.

FDA deja vu

http://www.fiercepharmamanufacturing.com/story/fda-tracking-down-new-outbreak-tied-compounded-drug/2013-05-28

FDA tracking down new outbreak tied to compounded drug

May 28, 2013 | By Eric Palmer

Call it FDA déjà vu. While Congress continues to spar with the FDA over its oversight of compounding pharmacies, agency officials are running down yet another outbreak of possible infections tied to a potentially contaminated steroid manufactured by a compounding pharmacy.

The agency said in an alert that there have been 7 reports of adverse reactions after patients received injections of preservative-free methylprednisolone acetate, manufactured by Main Street Family Pharmacy, a compounding pharmacy in Newbern, TN. That is the same drug at the heart of the fungal meningitis outbreak that began last year and at last count had sickened 741 people, 55 fatally. The FDA is still figuring out what has caused the recent reactions but told providers to quarantine the drug because it is a "potentially contaminated medication."






Read more: FDA tracking down new outbreak tied to compounded drug - FiercePharma Manufacturing http://www.fiercepharmamanufacturing.com/story/fda-tracking-down-new-outbreak-tied-compounded-drug/2013-05-28#ixzz2UgNxCZfZ
Subscribe at FiercePharma Manufacturing

http://www.bizjournals.com/houston/news/2013/05/28/cprit-funding-in-governors-hands.html

May 28, 2013, 12:41pm CDT

CPRIT funding in Gov. Perry's hands

Bayan Raji

Reporter-Houston Business Journal

Funding for the Cancer Prevention and Research Institute of Texas is now in the hands of Gov. Rick Perry after the Texas Senate unanimously passed the House's version of a bill that would revamp the agency.

The bill, which passed May 24, sets CPRIT's funding for 2014 through 2015 at nearly $600 million, The Texas Tribune reports. In addition, the bill removes the $3 billion agency's governing board, theHouston Chronicle reports.

Bataan Death March survivor recalls being ‘lucky’ to live

http://www.tylerpaper.com/article/20130526/NEWS01/130529828

Bataan Death March survivor recalls being ‘lucky’ to live

“The nightmare began. The Bataan Death March. Death and suffering. Suffering that brought death. Prolonged death. Sudden death. Suffering that made some wish for death.”

From “Abandoned on Bataan,” by Mildred Allen as told by Oliver “Red” Allen, Bataan Death March survivor. 

http://www.ncbi.nlm.nih.gov/pubmed/23698451

Palliat Med. 2013 May 22. [Epub ahead of print]

Dying at home - is it better: A narrative appraisal of the state of the science.

Higginson IJ, Sarmento VP, Calanzani N, Benalia H, Gomes B.

Source

King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.

Abstract

Background:Achieving home care and home death is increasingly used as an outcome measure of palliative care services.Aim:To appraise the state of the science on dying at home.Methods:Appraisal and narrative review developed from a plenary presentation at the European Association for Palliative Care (EAPC) 2012 meeting examining the research on variations and trends in place of death, factors associated with dying in the preferred place, presenting evidence on outcomes for those dying at home and suggesting future research questions.Results:Meeting patients' preferences and creating home-like environments has been a major concern for hospice and palliative care since its inception. During the 20^th century, in many countries, hospital deaths increased and home deaths reduced. Despite the fact that this trend has been halted or reversed in some countries (notably the United States, Canada and, more recently, the United Kingdom) in the last 5-20 years, a home death is still a distant reality for the majority, even though evidence shows it is the most commonly preferred place to die. Epidemiological studies identified factors associated with home death, including affluence, patients' preferences, provision of home care and extended family support. Evidence about the benefits of home care is conflicting, but recent data suggest that holistic well-being may be greater at home.Implications:We call for further analyses of variations in place of care and place of death and robust studies on how patients and families formulate and change preferences over time. Regular monitoring of outcomes, quality and costs of palliative home care is urged.

http://www.ncbi.nlm.nih.gov/pubmed/23647529

Drug Alcohol Rev. 2013 May 6. doi: 10.1111/dar.12050. [Epub ahead of print]

Attitudes of regular injecting drug users towards the legal status of the major illicit drugs.

Darke S, Torok M.

Source

National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

Abstract

INTRODUCTION AND AIMS:

The study aimed to determine injecting drug users' (IDU) attitudes, and correlates of attitudes, towards continued prohibition, decriminalisation or legalisation of the major illicit drugs.

DESIGN AND METHODS:

This study used structured interview with 300 IDUs who had injected on at least a weekly basis over the preceding 12 months.

RESULTS:

Methamphetamine was rated the most harmful of the five illicit substances and cannabis the lowest. By far the highest level of support for legislative change was for cannabis, with only 8.7% supporting continued prohibition. While there was majority support for change to the legal status of heroin, the modal position was for decriminalisation. Support for changing the status of the three illicit psychostimulants was low, with the majority believing that methamphetamine (63.3%), cocaine (53.3%) and 3,4-methylenedioxy-N-methylamphetamine (53.3%) should remain illegal. Demographic characteristics were largely unrelated to attitudes. Lower levels of perceived harm were associated with increased likelihood of support for legalisation of all substances. Recent use was positively related to support for both decriminalisation and legality of heroin, but was not associated with views on other substances. Higher lifetime polydrug use was associated with support for the legalisation of heroin, methamphetamine, cocaineand 3,4-methylenedioxy-N-methylamphetamine.

DISCUSSION AND CONCLUSIONS:

IDUs expressed nuanced views on different substances. In policy debates, care should be taken not to speak for IDUs by imputing their beliefs. It is clear that the fact that a group uses illegal drugs does not necessarily imply that they support changes to their legal status.

From Chest: When Your Heart Says No but the Law Says Yes: The Unethical ICU Admission

http://www.ncbi.nlm.nih.gov/pubmed/23699638

Chest. 2012 Oct 1;142(4_MeetingAbstracts):358A.

When Your Heart Says No but the Law Says Yes: The Unethical ICU Admission.

Chaudhry A, Koenig S.

Abstract

SESSION TYPE: Critical Care Student/Resident Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Often times critically ill patients are admitted to the ICU without known advance directives. These situations present unwarranted stress to the physicians, the family members and most importantly the patient themselves. Despite initiatives to promote discourse between physicians and patients, there still remains an inequity that needs to be further addressed.

CASE PRESENTATION: A 95 year old man who had a witnessed seizure at home was brought to the ED by his home health aide. She handed the ED with a copy of his advance directives which unambiguously declared he did not want to be intubated or resuscitated. The health aide verified that these were indeed his wishes. However, the ED called his daughter who was the health care proxy. She instructed the ED to intubate the patient who was subsequently admitted to the ICU. After discussion with the daughter, she stated she knew her father did not want to be intubated but was not comfortable making the decision. An EEG showed the patient suffered anoxic brain injury and had a poor prognosis. After this discussion, the family decided to withdraw care. The patient was extubated 5 days after admission and died hours later.

DISCUSSION: This case highlights the ethical dilemma that ICU physicians must often confront. From a medical ethics outlook, this circumstance presented an ethically inappropriate ICU admission as it violated all four principles of ethics. Firstly, patient autonomy was dishonored by the family who deliberately went against their father's wishes. The notion of "primum non nocere" or "do no harm" was violated. Intubation and central line placement harmed the patient as the risks associated with these procedures outweighed any benefit this patient would receive. The notion of beneficence was violated as the physician did not act in the best interest of the patient. Finally distributive justice was violated as these resources should be allocated for a patient with a better prospect of recovery.CONCLUSIONS: Physicians at times forget that they too have autonomy and I would argue it should be the fifth principle of medical ethics. The Texas Advance Directives Act allows physicians this opportunity. It allows the physician to dictate patient care in the best interest of the patient, not the best interest of the family, without fear of litigation. Ethical care is in the best interest of the patient and provides a cost effective approach to ICU care that should not be ignored.

From the Chronicle of Higher Education: Where Thomas Nagel Went Wrong

http://chronicle.com/article/Where-Thomas-Nagel-Went-Wrong/139129/

Where Thomas Nagel Went Wrong

The philosopher's critique of evolution wasn't shocking. So why is he being raked over the coals?

By Michael Chorost

"Still other scientists have asked how we could measure increases in complexity without being biased by our human-centric perspective. Robert Hazen, working with the Nobel Prize winner Jack Szostak, has proposed a metric he calls "functional information," which measures the number of functions and relationships an organism has relative to its environment. The Harvard astrophysicist Eric Chaisson has proposed measuring a quantity that he calls "energy-rate density": how much energy flows through one gram of a system per second. He argues that when he plots energy-rate density against the emergence of new species, the clear result is an overall increase in complexity over time."

Smoking, patient autonomy, and nudging

http://www.ncbi.nlm.nih.gov/pubmed/23699871

Chest. 2012 Oct 1;142(4_MeetingAbstracts):1089A.

Ethics and Smoking Cessation: Should the Medical Treatment Be a "Freewill" Choice or a Mandatory Issue for Hospitalized COPD Patients?

Tilea L, Postolache P, Lica F, Ciobanu M.

Abstract

SESSION TYPE: Tobacco Cessation and Prevention PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To identify the results of respecting the free-choice of COPD-related hospitalized patients regarding the method for smoking cessation

METHODS: All smokers hospitalized for COPD exacerbation in a Pneumology hospital received the same intensive counseling, consisting in motivational and behavioral counseling, specific education regarding smoking-related influences on COPD, the role of medication for cessation. It was emphasized the opportunity to start medication during hospitalization and to continue after discharge, free-of-charge. After one day, the patients were asked if they wish to follow the medical treatment for smoking cessation with varenicline or if they want to quit "cold turkey". The treatment was initiated after all the possible drug interactions were evaluated. The smoker status was determined by CO measurement. A final evaluation was made at discharge. Evaluations at 3, 6 and 12 months will follow.

RESULTS: In the first 2 months of our study, 56 smokers with COPD-related exacerbations were admitted. 35 out of 56 patients (62,5%) considered sufficient the specific counseling for smoking cessation, while 21 patients (37,5%) expressed their wish to start medical treatment. From the 21 patients receiving medication, only one discontinued medication due to complications of COPD, meaning that 95.2% were non-smokers at discharge. From the 35 patients receiving only specific counseling, 19 (representing 54.3%) were non-smokers at discharge. This means that almost a third (30.3%) of all COPD patients were still smokers at discharge.

CONCLUSIONS: Despite their precarious physical and psychological status, intensive psychological counseling and free-of-charge, efficient treatment, almost one third of patients hospitalized for COPD exacerbation are reluctant to choose the evidence-based recommendation for quitting smoking and continue to smoke.

CLINICAL IMPLICATIONS: Taking into account the evidences about the effects of smoking on the evolution and prognosis of COPD, the efficacy of the medication for smoking cessation, these preliminary results could contribute to give an answer to the ethical issue: should we or should we not introduce the treatment for tobacco addiction in the regular treatment of COPD exacerbation, regardless the opinion of the patient.

DISCLOSURE: The following authors have nothing to disclose: Lavinia Tilea, Florentina Lica, Magdalena CiobanuNo Product/Research Disclosure InformationNational Institute of Pneumology "Marius Nasta", Bucharest, Romania.

"Lopez saw and felt it all in Iraq and Afghanistan, but in so doing, the trauma of it all is implanted in his mind's eye as well."

http://www.kionrightnow.com/story/22401699/a-new-generation-of-vets-with-post-traumatic-stress

CIA: A New Generation of Vets with Post Traumatic Stress

By Jon K. Brent

"Monterey, Calif. - A new generation of Americans, bout 2.4 million, who fought in Iraq and Afghanistan are now coming home, thousands to the central coast. Estimates are showing 20 to 30 percent of those are being diagnosed with post traumatic stress disorder or PTSD. This is the first in a three part Center For Investigative action series on what these young soldiers are facing as they come home and how it will impact the central coast.

Former Combat Photographer Efren Lopez shares his experience documenting war on a camera, "Watching these soldiers die in front of you as I'm documenting as they're treating them at the medical facility there..the smell is still there, you hear what they're saying and that's the part that they tell you not to talk about..because that's where the symptoms of PTSD come." Lopez saw and felt it all in Iraq and Afghanistan, but in so doing, the trauma of it all is implanted in his mind's eye as well."

http://www.ncbi.nlm.nih.gov/pubmed/23695761

Orthop Nurs. 2013 May/June;32(3):155-164.

Creating a Culture of Safety for Safe Patient Handling.

Stevens L, Rees S, Lamb KV, Dalsing D.

Source

Linda Stevens, DNP, RN-BC, CPHQ, CSPHP, Director, Nursing Quality & Safety, University of Wisconsin Hospital and Clinics, Madison. Susan Rees, DNP, RN, CPHQ, CENP, Vice President, Development, Nursing and Patient Care Services, University of Wisconsin Hospital and Clinics, Madison. Karen V. Lamb, DNP, RN, GCNS-BC, Associate Professor, College of Nursing, Rush University Medical Center, Chicago, IL. Deborah Dalsing, MS, RN, Nurse Manager, Acute Medical/Progressive Care Unit, University of Wisconsin Hospital and Clinics, Madison.

Abstract

Healthcare workers who handle patients have little guidance to help them identify when to use the existing equipment for moving patients. Manual lifting of patients and healthcare worker injuries continue despite equipment installation and training. The purpose of this project was to decrease the number and severity of healthcare worker injuries by implementing a culture of safety for safe patient handling. A multicomponent safe patient handling program was deployed on one inpatient unit at a Midwest academic acute care hospital. There was a 36% decrease in the number of patient handling injuries, a 71% reduction in the number of lost work days, and a 60% reduction in costs in 1 year related to patient handling injuries. The RN Satisfaction Survey question regarding having enough help to lift/move on last shift improved from 41% presurvey to 69% postsurvey.

http://www.ncbi.nlm.nih.gov/pubmed/23688590

Health Econ Policy Law. 2013 May 21:1-24. [Epub ahead of print]

Informal payments for health care services in Russia: old issue in new realities.

Gordeev VS, Pavlova M, Groot W.

Source

Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Abstract

Informal payments can be found across Europe, Africa, Asia and South America. Despite its hidden nature, they pose an important policy issue. Reported as being widespread, the true scale and scope of informal payment are unknown, and estimations differ among studies. We look at the Russian health care sector where the existence of informal payments has persisted for decades. We present the scale and scope of informal payments, as well as patterns of informal payments and their determinants. We discuss the reasons for discrepancies in estimations and implications for the ongoing reforms.

Zombie allusions: They just keep on coming-the achromatic "philosophical zombie"

http://www.ncbi.nlm.nih.gov/pubmed/23687498

Case Rep Neurol. 2013 Apr 19;5(1):98-103. doi: 10.1159/000351027. Print 2013 Jan.

The achromatic 'philosophical zombie', a syndrome of cerebral achromatopsia with color anopsognosia.

Carota A, Calabrese P.

Source

GSMN Neurocenter, Genolier Clinic, Genolier, Basel University, Basel, Switzerland.

Abstract

We describe a patient with persistent cerebral achromatopsia occurring after bilateral occipital strokes. Blinded color recognition was assessed with a computerized experimental paradigm and the patient reported the degree of confidence in the response exactness on a visual percent scale. Color recognition was accurate and above chance (Fisher's exact test, p < 0.002). The degree of confidence in the answers showed a significant correlation with recognition scores (Spearman rank order correlation, p < 0.0001). These findings constitute the exceptional condition of what we called color anopsognosia (not knowing of seeing colors) and recall the theoretic figure of the 'philosophical zombie'. However, the cognitive mechanisms of the dissociation between a subjective colorless vision and good performance for color naming still remain poorly understood.

http://www.ncbi.nlm.nih.gov/pubmed/23526368

Drugs R D. 2013 Mar;13(1):1-8. doi: 10.1007/s40268-013-0005-9.

Potential risks of pharmacy compounding.

Gudeman J, Jozwiakowski M, Chollet J, Randell M.

Source

Ther-Rx Corporation, 2280 Schuetz Road, St. Louis, MO, 63146, USA.

Abstract

Pharmacy compounding involves the preparation of customized medications that are not commercially available for individual patients with specialized medical needs. Traditional pharmacy compounding is appropriate when done on a small scale by pharmacists who prepare the medication based on an individual prescription. However, the regulatory oversight of pharmacy compounding is significantly less rigorous than that required for Food and Drug Administration (FDA)-approved drugs; as such, compounded drugs may pose additional risks to patients. FDA-approved drugs are made and tested in accordance with good manufacturing practice regulations (GMPs), which are federal statutes that govern the production and testing of pharmaceutical products. In contrast, compounded drugs are exempt from GMPs, and testing to assess product quality is inconsistent. Unlike FDA-approved drugs, pharmacy-compounded products are not clinically evaluated for safety or efficacy. In addition, compounded preparations do not have standard product labeling or prescribing information with instructions for safe use. Compounding pharmacies are not required to report adverse events to the FDA, which is mandatory for manufacturers of FDA-regulated medications. Some pharmacies engage in activities that extend beyond the boundaries of traditional pharmacy compounding, such as large-scale production of compounded medications without individual patient prescriptions,compounding drugs that have not been approved for use in the US, and creating copies of FDA-approved drugs. Compounding drugs in the absence of GMPs increases the potential for preparation errors. When compounding is performed on a large scale, such errors may adversely affect many patients. Published reports of independent testing by the FDA, state agencies, and others consistently show that compounded drugs fail to meet specifications at a considerably higher rate than FDA-approved drugs. Compounded sterile preparations pose the additional risk of microbial contamination to patients. In the last 11 years, three separate meningitis outbreaks have been traced to purportedly 'sterile' steroid injections contaminated with fungus or bacteria, which were made by compounding pharmacies. The most recent 2012 outbreak has resulted in intense scrutiny of pharmacy compounding practices and increased recognition of the need to ensure that compounding is limited to appropriate circumstances. Patients and healthcare practitioners need to be aware that compounded drugs are not the same as generic drugs, which are approved by the FDA. The risk-benefit ratio of using traditionally compounded medicines is favorable for patients who require specialized medications that are not commercially available, as they would otherwise not have access to suitable treatment. However, if an FDA-approved drug is commercially available, the use of an unapproved compounded drug confers additional risk with no commensurate benefit.

http://www.tennessean.com/article/20130522/NEWS07/305220152/Meningitis-Compounding-bill-emerges-from-Senate

Meningitis: Compounding bill emerges from Senate

A proposed law to set clear oversight authority over compounding pharmacies that make medicine on a large scale is on its way to a vote before the full Senate.

The legislation, which is intended to prevent another fungal meningitis outbreak, emerged from the Senate Health, Education, Labor and Pensions Committee on a voice vote Wednesday morning without any amendments. Infections linked to contaminated medicine made by New England Compounding Center last year have sickened 741 people across the nation with 55 deaths.

Under the proposed legislation, compounding manufacturers must register with the U.S. Food and Drug Administration and comply with good manufacturing processes. Traditional compounding pharmacies that mix smaller batches of drugs would remain under the purview of state regulators.

Is thug lit losing its soul?

http://observer.com/2013/05/holler-if-ya-read-me-african-american-writers-and-writers-fret-over-the-future-of-thug-lit/

Holler If Ya Read Me: African-American Writers—and Readers—Fret Over the Future of Thug Lit

Will success undo the authenticity of a genre that prizes it?

By Darren Sands 5/15 6:53pm

The genre, with its allegiance to all-or-nothing street politics and a firebrand code of ethics, was initially fostered by a cadre of authors like Ms. Clark who had actually lived the lives they narrated on the page.

Now that street lit seems poised to jump from the ghetto into the mainstream, it’s an open question whether that authenticity can survive. A major record label has snapped up several of the most popular authors, including Ms. Clark. Reality stars are co-authoring books.

Suddenly, a genre that built its cachet in the hearts and minds of voracious readers is wondering if it’s losing its soul.