Good example of the problem with healthcare apps: "Most diabetes apps do not conform to evidence-based recommendations..."

http://www.ncbi.nlm.nih.gov/pubmed/24073179

Transl Behav Med. 2013 Sep;3(3):277-86. doi: 10.1007/s13142-013-0205-4.

Adherence to evidence-based guidelines among diabetes self-management apps.

Breland JY, Yeh VM, Yu J.

Source

Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854 USA ; Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson Street, New Brunswick, NJ 08901 USA.

Abstract

Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term "diabetes" identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs.

"...unexpected complexity in the modern evolution of drug-resistant tuberculosis..."

http://www.ncbi.nlm.nih.gov/pubmed/24071843

Nat Genet. 2013 Sep 26;45(10):1107-8. doi: 10.1038/ng.2769.

Complex genetics of drug resistance in Mycobacterium tuberculosis.

Warner DF, Mizrahi V.

Source

Medical Research Council (MRC)-National Health Laboratory Service (NHLS)-University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Technology (DST)-National Research Foundation (NRF) Centre of Excellence for Biomedical Tuberculosis Research, Institute of Infectious Disease and Molecular Medicine, and the Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa.

Abstract

Three new studies have used whole-genome sequencing of M. tuberculosis to demonstrate unexpected complexity in the modern evolution of drug-resistant tuberculosis, and a fourth study suggests a close evolutionary relationship between the pathogen and its human host over a period of 70,000 years. Collectively, the observations in these studies suggest that future strategies to tackle drug-resistant tuberculosis must integrate host genetics with detailed strain epidemiology.

CPRIT: "Texas’ scandal-ridden cancer research agency has six members of its new governing board...Under a state law...the entire board had to be reappointed"

http://www.statesman.com/news/news/new-appointees-named-to-cprit-board/nZ9Gk/

Posted: 4:21 p.m. Friday, Sept. 27, 2013

CONTINUING COVERAGE: CANCER INSTITUTE

New appointees named to CPRIT board

By Mike Ward

American-Statesman Staff

"Texas’ scandal-ridden cancer research agency has six members of its new governing board, with appointments announced Thursday by Gov. Rick Perry and Lt. Gov. David Dewhurst.

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

Under a state law passed earlier this year after a headline-grabbing scandal over grant irregularities, questionable spending and findings of mismanagement by auditors, the entire board had to be reappointed.

Perry named Angelos Angelou of Austin, Gerry Geistweidt of Mason and William Rice of Austin. Angelou and Geistweidt previously served on the board, officials said."

Ugly: Ghost writing meets research integrity

http://www.scientificamerican.com/article.cfm?id=mystery-over-obesity-fraud

Mystery over Obesity "Fraud"

A researcher is baffled after his results on metabolism appeared in a bogus publication, authored by people who seem to be phantoms

By Declan Butler and Nature magazine

"Spiegelman says that he smelt a rat as soon as he saw the paper. Meteorin and metrnl have been little studied, and no previous paper has shown a role for them in obesity. It was therefore suspicious, he says, to see a paper published out of the blue reporting that they were novel adipo­kines and that their overexpression in adipose cells led to improvements in diabetes and obesity in mice — exactly the same findings as the work he had presented.

On 20 July, he e-mailed Ernesto Carafoli, BBRC’s editor-in-chief, to air his concerns. “The authors on this paper have apparently never published a single academic paper before and they list a non-academic e-mail address,” he wrote. “Odder still, upon looking for them on Google, PubMed or on the website of the university they list, there is no mention of any of the authors as being at that university.”

Carafoli, along with Elsevier, launched an investigation. Elsevier temporarily withdrew the paper from the journal website on 8 August, and, after the University of Thessaly confirmed that none of the researchers listed on the paper had ever worked there, now intends to withdraw it permanently."

Zombie allusions: They just keep on coming-Just say no

http://consumerist.com/2013/09/27/great-now-theres-an-actual-zombie-drug-eating-its-way-through-human-flesh/

Great, Now There’s An Actual Zombie Drug Eating Its Way Through Human Flesh

By Mary Beth Quirk September 27, 2013

"Now that that whole bath salts craze has died down, we’d expect the zombification of our population to sputter out as well. But kids these days, well they keep finding new ways to freak everyone out. Namely a new designer drug that’s eating its way through human flesh and turning people into stumbling, incoherent zombies. Sigh.

It’s called krokodil, or Desomorphine, reportsMother Jones, and it’s highly addictive and unfortunately, it’s catching on stateside.

Two cases just this week were called into a local poison control center in Phoenix, reportsKLTV.com. And it sounds really, really awful. To wit: A doctor at the center said he and his colleagues were “extremely frightened” by the aggressive, flesh-devouring drug. And if doctors are scared, you know it can’t be good."

Knowledge and ethical perception regarding organ donation among medical students at Ziauddin University

http://www.ncbi.nlm.nih.gov/pubmed/24070261

BMC Med Ethics. 2013 Sep 27;14(1):38. [Epub ahead of print]

Knowledge and ethical perception regarding organ donation among medical students.

Ali NF, Qureshi A, Jilani BN, Zehra N.

Abstract

BACKGROUND:

To determine the knowledge and ethical perception regarding organ donation amongst medical students in Karachi- Pakistan.

METHODS:

Data of this cross sectional study was collected by self administered questionnaire from MBBS students of Ziauddin University from 2010 to 2011. Sample size of 158 (83 First years and 75 Fourth years) were selected by convenient sampling and those students who were present and gave consent were included in the study. The data was analyzed by SPSS version 20.

RESULTS:

A total of 158 participants from Ziauddin Medical University filled out the questionnaire out of which 83(52.5%) were first years and 75(47.5%) were fourth year medical students. Mean age of sample was 20 +/- 1.7. Majority of students were aware about organ donation with print and electronic media as the main source of information. 81.6% agreed that it was ethically correct to donate an organ. In the students' opinion, most commonly donated organs and tissues were kidney, cornea, blood and platelet. Ideal candidates for donating organ were parents (81%). Regarding list of options for preference to receive an organ, most of the students agreed on young age group patients and persons with family. Willingness to donate was significantly associated with knowledge of allowance of organ donation in religion (P=0.000).

CONCLUSION:

Both 1st year and 4th year students are aware of Organ Donation, but there is a significant lack of knowledge regarding the topic.

Global medicine. Would "intermediary, third-party organization" help, or merely distance MDs from their patients by taking over the MD's responsibility of understanding and honoring the patient?

http://www.ncbi.nlm.nih.gov/pubmed/24072106

Acad Med. 2013 Sep 25. [Epub ahead of print]

Global Health Educational Engagement-A Tale of Two Models.

Rassiwala J, Vaduganathan M, Kupershtok M, Castillo FM, Evert J.

Source

Ms. Rassiwala is a medical student, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Dr. Vaduganathan is a resident, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. Ms. Kupershtok is a medical student, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Dr. Castillo is assistant professor, Department of Family and Community Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Dr. Evert is executive director, Child Family Health International, and clinical faculty, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California.

Abstract

Global health learning experiences for medical students sit at the intersection of capacity building, ethics, and education. As interest in global health programs during medical school continues to rise, Northwestern University Alliance for International Development, a student-led and -run organization at Northwestern University Feinberg School of Medicine, has provided students with the opportunity to engage in two contrasting models of global health educational engagement.Eleven students, accompanied by two Northwestern physicians, participated in a one-week trip to Matagalpa, Nicaragua, in December 2010. This model allowed learning within a familiar Western framework, facilitated high-volume care, and focused on hands-on experiences. This approach aimed to provide basic medical services to the local population.In July 2011, 10 other Feinberg students participated in a four-week program in Puerto Escondido, Mexico, which was coordinated by Child Family Health International, a nonprofit organization that partners with native health care providers. A longer duration, homestays, and daily language classes hallmarked this experience. An intermediary, third-party organization served to bridge the cultural and ethical gap between visiting medical students and the local population. This program focused on providing a holistic cultural experience for rotating students.Establishing comprehensive global health curricula requires finding a balance between providing medical students with a fulfilling educational experience and honoring the integrity of populations that are medically underserved. This article provides a rich comparison between two global health educational models and aims to inform future efforts to standardize global health education curricula.

Medical humanities and promoting professionalism (vitally important; challenge is succeeding with continuously decreasing funding)

http://www.ncbi.nlm.nih.gov/pubmed/24072126

Acad Med. 2013 Sep 25. [Epub ahead of print]

The Challenge of Promoting Professionalism Through Medical Ethics and Humanities Education.

Doukas DJ, McCullough LB, Wear S, Lehmann LS, Nixon LL, Carrese JA, Shapiro JF, Green MJ, Kirch DG; for the Project to Rebalance and Integrate Medical Education (PRIME) Investigators.

Source

Dr. Doukas is William Ray Moore Endowed Chair of Family Medicine and Medical Humanism and director, Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, Louisville, Kentucky. Dr. McCullough is Dalton Tomlin Chair in Medical Ethics and Health Policy, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas. Dr. Wear is codirector, Center for Clinical Ethics and Humanities in Healthcare, and associate professor, Departments of Medicine, Gynecology-Obstetrics, and Philosophy, University at Buffalo, Buffalo, New York. Dr. Lehmann is associate professor, Harvard Medical School, and director, Center for Bioethics, Brigham and Women's Hospital, Boston, Massachusetts. Dr. Nixon is professor, Morsani College of Medicine, University of South Florida, Tampa, Florida. Dr. Carrese is director, Program on Ethics in Clinical Practice, Johns Hopkins Berman Institute of Bioethics, and associate professor, Johns Hopkins University, Baltimore, Maryland. Dr. Shapiro is director, Program in Medical Arts and Humanities, and professor of family medicine, University of California-Irvine School of Medicine, Irvine, California. Dr. Green is professor, Departments of Humanities and Medicine, Penn State College of Medicine, Hershey, Pennsylvania. Dr. Kirch is president and CEO, Association of American Medical Colleges, Washington, DC.

Abstract

Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education. The authors present three overarching themes that resulted from the PRIME II discussions: transformation, question everything, and unity of vision and purpose.The first theme highlights that education toward professionalism requires transformational change, whereby medical ethics and humanities educators would make explicit the centrality of professionalism to the formation of physicians. The second theme emphasizes that the flourishing of professionalism must be based on first addressing the dysfunctional aspects of the current system of health care delivery and financing that undermine the goals of medical education. The third theme focuses on how ethics and humanities educators must have unity of vision and purpose in order to collaborate and identify how their disciplines advance professionalism. These themes should help shape discussions of the future of medicalethics and humanities teaching.The authors argue that improvement of the ethics and humanities-based knowledge, skills, and conduct that fosters professionalism should enhance patient care and be evaluated for its distinctive contributions to educational processes aimed at producing this outcome.

From MD Anderson: "...some hereditary cancer patients may find preimplantation genetic diagnosis more acceptable than others."

http://www.ncbi.nlm.nih.gov/pubmed/24072553

Fam Cancer. 2013 Sep 26. [Epub ahead of print]

Comparison of attitudes regarding preimplantation genetic diagnosis among patients with hereditary cancer syndromes.

Rich TA, Liu M, Etzel CJ, Bannon SA, Mork ME, Ready K, Saraiya DS, Grubbs EG, Perrier ND, Lu KH, Arun BK, Woodard TL, Schover LR, Litton JK.

Source

Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA, tarich@mdanderson.org.

Abstract

Preimplantation genetic diagnosis (PGD) allows couples to avoid having a child with an inherited condition, potentially reducing cancer burden in families with a hereditary cancer predisposition. This study investigated and compared awareness and acceptance of PGD among patients with different hereditary cancer syndromes. Questionnaires were mailed to 984 adults with hereditary breast and ovarian cancer, Lynch syndrome, familial adenomatous polyposis, or multiple endocrine neoplasia type 1 or 2. Associations between clinical, demographic, and psychosocial factors and awareness and acceptance of PGD were examined. Of 370 respondents (38 % return rate), 28 % felt their syndrome impacted family planning, 24 % were aware of PGD, 72 % felt that PGD should be offered, 43 % would consider using PGD, and 29 % were uncertain. Family experience and syndrome-specific characteristics, such as disease severity, quality of life and availability of medical interventions as well as gender, family planning stage, and religiosity impact perceptions of the acceptability of PGD, though a high level of uncertainty exists. Hereditary cancer patients lack awareness of PGD despite feeling that PGD should be offered, highlighting the need for education on this topic. While we found attitudes about the acceptability of PGD to be generally similar to those reported in the literature and of genetics and ethics experts, we observed similarities and differences between syndromes that provide insight into why some hereditary cancer patients may find PGD more acceptable than others.

Authenticity: "highly problematic to use as a criterion for autonomous decision-making in healthcare"

http://www.ncbi.nlm.nih.gov/pubmed/24072638

Med Health Care Philos. 2013 Sep 26. [Epub ahead of print]

Authenticity and psychiatric disorder: does autonomy of personal preferences matter?

Sjöstrand M, Juth N.

Source

Department of Learning, Informatics, Management and Ethics, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Tomtebodavägen 17A, 171 77, Stockholm, Sweden, manne.sjostrand@ki.se.

Abstract

In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients' decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients' with anorexia nervosa where issues related to authenticity seem particularly relevant. The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare.

Standardizing biospecimen collection

http://www.ncbi.nlm.nih.gov/pubmed/24067073

Arch Pathol Lab Med. 2013 Sep 25. [Epub ahead of print]

The Devil's in the Biorepository Details.

Allen TC.

In ‘‘A Call to Standardize Preanalytic Data Elements for Biospecimens,’’ Dr James Robb and colleagues1 begin the journey to uniformity by presenting 170 preanalytic variables that might be useful in standardizing biospecimen collection. They note that institution of such a high level of biospecimen standardization will require significant information technology support and substantially automated collection. Their detailed list of variables, ranging from as basic as ‘‘arm from which blood drawn’’ to as complex as ‘‘oxygenation status of the donor,’’ provides pathologists an invaluable guide for establishing tissue biorepositories designed to ‘‘achieve measurable improvements in biospecimen quality and patient care.’’ 1

"Brazilian science is steadily improving in quality and quantity..."

http://www.ncbi.nlm.nih.gov/pubmed/24067701

Nature. 2013 Sep 26;501(7468):492. doi: 10.1038/501492b.

Citations: Ethical ways to grow impact.

Loyola RD, Diniz Filho JA.

Comment on

• Brazilian citation scheme outed. [Nature. 2013]

"Brazilian science is steadily improving in quality and quantity, thanks in part to strong support from two national funding agencies, the National Council for Scientific and Technological Development and the Coordination for the Improvement of Higher Education Personnel (R. D. Loyola et al.Trends Ecol. Evol. 27, 585; 2012).

These agencies have set up committees of researchers from different fields to determine how impact factors can be used effectively to evaluate graduate programmes and to rank journals. In the process, they have standardized mean impact factors to take into account impact-factor variations between subdisciplines, thereby rendering comparisons between journals more meaningful."

http://www.ncbi.nlm.nih.gov/pubmed/24066412

Int J Health Serv. 2013;43(3):389-413.

Social-democratic government and health policy in Europe: a quantitative analysis.

Mackenbach JP, McKee M.

Source

Department of Public Health, Erasmus MC, Rotterdam, Netherlands. j.mackenbach@erasmusmc.nl

Abstract

Although health policy ultimately depends on political decision making, empirical evidence of the impact of politics on implementation of health policies and their population health outcomes is scarce. In this study, we assess the effects of social-democratic government participation on indicators of preventive health policy (tobacco, alcohol, food, mother and child health, infectious diseases, hypertension, cancer screening, road traffic safety, air pollution) in Europe. Cumulative years of social-democratic government differed widely between European countries, as did indicators of current health policy performance, but the latter are not associated with recent social-democratic government. However, there is a positive association with social-democratic government cumulated over five decades. Positive effects of social-democratic government are mainly seen on indicators of tobacco and alcohol control. We conclude that long-term social-democratic government participation may have had a positive impact on some areas of preventive health policy, perhaps through the creation of strong public health institutions or a strong public health workforce.

"Turkish cancer patients are coping with cancer in different means and ways than we expected of them"

http://www.ncbi.nlm.nih.gov/pubmed/24065496

J BUON. 2013 Jul-Sep;18(3):760-6.

An evaluation of lifestyle changes in cancer patients after diagnosis.

Turhal NS, Koyyeri M, Kahraman B, Binici M, Yilmaz M, Kocar M.

Source

Department of Internal Medicine, Division of Oncology, Marmara University Medical Faculty, Istanbul, Turkey.

Abstract

Purpose: Cancer is an increasingly important health problem, and is second only to cardiovascular disease as cause of death. Cancer diagnosis causes significant changes in patients and their families, and social relationships are affected. For this reason, we examined the lives of patients subsequent to their diagnosis and sought to determine any changes in their lifestyles.

Methods: Between March 16th and September 30th, 2011, a questionnaire consisting of 20 questions was distributed via a face-to-face interview to 150 patients at the Marmara University Hospital Oncology Unit. Each patient was queried during the administration of his/her chemotherapy. Six of the questions were independent choices, and 14 were dependent (multiple choice). A Local Ethics Committee approval was obtained.

Results: Of the 150 patients, 70 (46%) were male and 80 female, and their median age was 55 years (range: 22-82). Following their diagnosis, 71% of males and 50% of females reported that they were complying with guidelines for a healthy lifestyle, and 19% of the patients said that they were eating healthier food. At the time they filled in the questionnaire, 61% said that they were hopeful; however, close to 10% said that they felt hopeless. Approximately 53% of the participants said that following their diagnosis they had a more sympathetic view of the underserved and underprivileged.

Conclusions: It was surprising that an unexpectedly high percentage of the respondents reported that they did not make any changes in their lifestyles after their diagnosis of cancer, including eating healthier food. It appears Turkish cancer patients are coping with cancer in different means and ways than we expected of them.

Bryan Liang: An addiction to unsafe injection medication practices?

http://www.ncbi.nlm.nih.gov/pubmed/24008195

J Clin Anesth. 2013 Sep 2. pii: S0952-8180(13)00210-9. doi: 10.1016/j.jclinane.2013.05.003. [Epub ahead of print]

An addiction to unsafe injection medication practices?

Liang BA.

Source

Institute of Health Law Studies, California Western School of Law, San Diego, CA 92101, USA; Department of Anesthesiology, University of California, San Diego, School of Medicine, San Diego, CA 92103, USA; San Diego Center for Patient Safety, University of California, San Diego, School of Medicine, San Diego, CA 2103, USA. 

"The issue of unsafe injection medication practices is longstanding. Efforts throughout medicine involving physicians, nurses, and pharmacists have identified unsafe injection practices as a continuing concern for patient safety around the world [1], [2], [3] and [4]. Despite well recognized risks and concerns regarding unsafe medication practices across settings and healthcare providers, the incidences and practices continue." 

Congratulations to Jeff Brown, Governor Perry's excellent choice to serve on the Texas Supreme Court

http://blog.chron.com/bigjolly/2013/09/justice-jeff-brown-appointed-to-texas-supreme-court/

Justice Jeff Brown appointed to Texas Supreme Court

Thursday, September 26, 2013

Gov. Rick Perry has appointed Jeff Brown of Houston as a justice of the Supreme Court of Texas for a term to expire at the next general election.

“Jeff is an outstanding and accomplished jurist whose highest priority on the bench is preservation of the rule of law,” Gov. Perry said. “Jeff is a staunch defender of the constitutional freedoms our state and our nation are founded upon and he will uphold these values with honor, dignity and integrity as a Supreme Court justice. I am pleased he will continue his lifelong commitment to public service and the people of Texas by accepting this appointment.”

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2013-0459-ED

Timothy Craig Allen (2013) The Devil's in the Biorepository Details. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

The Devil's in the Biorepository Details

Timothy Craig Allen , MD, JD
Clearly a uniform approach to biospecimen handling and biorepository use is overdue.3 After all, without accuratediagnoses, future research is at risk of yielding inaccurate and perhaps dangerous therapeutic outcomes.4 Further,payers are increasingly demanding evidence of test accuracy (and utility) before paying for increasingly expensivemolecular tests, and journal editors are increasingly demanding evidence of proper biospecimen handling formolecular research publications.

"...the crisis of the West ‘is internally generated’: ‘it lies in Western heads’."

http://www.spiked-online.com/newsite/article/frank_on_the_clash_of_civilisations/14059#.UkQlqyqF971

THE REAL CLASH ISWITHIN CIVILISATIONS

FRANK FUREDI

"Anti-Americanism and contempt for aspects of the so-called Western way of life exercise widespread influence in many European countries. These sentiments are most systematically expressed through cultural critiques of consumerism, capitalist selfishness, greed and ambition. Ideas that denounce Western arrogance and its belief in science and progress are actually generated from within the societies of Europe and America. As the authors of the book Suicide of the Westnoted, the crisis of the West ‘is internally generated’: ‘it lies in Western heads’. Sadly, far too many people can only make sense of a problem of their own making when it assumes the form of an exotic threat from abroad."