http://www.ncbi.nlm.nih.gov/pubmed/21285393
Oncologist. 2011 Feb 1. [Epub ahead of print]
Measuring the Symptom Burden of Lung Cancer: The Validity and Utility of the Lung Cancer Module of the M. D. Anderson Symptom Inventory.
Mendoza TR, Wang XS, Lu C, Palos GR, Liao Z, Mobley GM, Kapoor S, Cleeland CS.
Departments of Symptom Research (Unit 1450).
Abstract
Abstract We conducted a study to establish the psychometric properties of a module of the M. D. Anderson Symptom Inventory (MDASI) developed specifically for patients with lung cancer (MDASI-LC). The MDASI measures 13 common "core" symptoms of cancer and its treatment. The MDASI-LC includes the 13 core MDASI symptom items and three lung cancer-specific items: coughing, constipation, and sore throat. MDASI-LC items were administered to three cohorts of patients with lung cancer undergoing either chemotherapy or chemoradiotherapy. Known-group validity and criterion (concurrent) validity of the MDASI-LC were evaluated using the Eastern Cooperative Oncology Group performance status and the 12-item Short-Form Health Survey. The internal consistency and test-retest reliability of the module were adequate, with Cronbach coefficient α-values of 0.83 or higher for all module items and subscales. The sensitivity of the MDASI-LC to changes in patient performance status (disease progression) and to continuing cancer treatment (effects of treatment) was established. Cognitive debriefing of a subset of participants provided evidence for content validity and indicated that the MDASI core items and three additional lung cancer-specific items were clear, relevant to patients, and easy to understand; only two patients suggested additional symptom items. As expected, the item "sore throat" was sensitive only for patients receiving chemoradiotherapy. The MDASI-LC is a valid, reliable, and sensitive symptom-assessment instrument whose use can enhance clinical studies of symptom status in patients with lung cancer and epidemiological and prevalence studies of symptom severity across various cancer types.
Thursday, February 3, 2011
From University of Turin, Italy: Lifestyle contributions to obesity and hyperglycemia
http://www.ncbi.nlm.nih.gov/pubmed/21285941
Int J Obes (Lond). 2011 Feb 1. [Epub ahead of print]
Contributors to the obesity and hyperglycemia epidemics. A prospective study in a population-based cohort.
Bo S, Ciccone G, Durazzo M, Ghinamo L, Villois P, Canil S, Gambino R, Cassader M, Gentile L, Cavallo-Perin P.
Department of Internal Medicine, University of Turin, Turin, Italy.
Abstract
Objective:Relatively unexplored contributors to the obesity and diabetes epidemics may include sleep restriction, increased house temperature (HT), television watching (TW), consumption of restaurant meals (RMs), use of air conditioning (AC) and use of antidepressant/antipsychotic drugs (ADs).
Design and Subjects:In a population-based cohort (n=1597), we investigated the possible association among these conditions, and obesity or hyperglycemia incidence at 6-year follow-up. Subjects with obesity (n=315) or hyperglycemia (n=618) at baseline were excluded, respectively, 1282 and 979 individuals were therefore analyzed.
Results:At follow-up, 103/1282 became obese; these subjects showed significantly higher body mass index, waist circumference, saturated fat intake, RM frequency, TW hours, HT, AC and AD use, and lower fiber intake, metabolic equivalent of activity in h per week (METS) and sleep hours at baseline. In a multiple logistic regression model, METS (odds ratio=0.94; 95% confidence interval (CI) 0.91-0.98), RMs (odds ratio=1.47 per meal per week; 1.21-1.79), being in the third tertile of HT (odds ratio=2.06; 1.02-4.16) and hours of sleep (odds ratio=0.70 per h; 0.57-0.86) were associated with incident obesity. Subjects who developed hyperglycemia (n=174/979; 17.8%) had higher saturated fat intake, RM frequency, TW hours, HT, AC and AD use at baseline and lower METS and fiber intake. In a multiple logistic regression model, fiber intake (odds ratio=0.97 for each g per day; 0.95-0.99), RM (1.49 per meal per week; 1.26-1.75) and being in the third tertile of HT (odds ratio=1.95; 1.17-3.26) were independently associated with incident hyperglycemia.
Conclusions:Lifestyle contributors to the obesity and hyperglycemia epidemics may be regular consumption of RM, sleep restriction and higher HT, suggesting potential adjunctive non-pharmacological preventive strategies for the obesity and hyperglycemia epidemics.
Int J Obes (Lond). 2011 Feb 1. [Epub ahead of print]
Contributors to the obesity and hyperglycemia epidemics. A prospective study in a population-based cohort.
Bo S, Ciccone G, Durazzo M, Ghinamo L, Villois P, Canil S, Gambino R, Cassader M, Gentile L, Cavallo-Perin P.
Department of Internal Medicine, University of Turin, Turin, Italy.
Abstract
Objective:Relatively unexplored contributors to the obesity and diabetes epidemics may include sleep restriction, increased house temperature (HT), television watching (TW), consumption of restaurant meals (RMs), use of air conditioning (AC) and use of antidepressant/antipsychotic drugs (ADs).
Design and Subjects:In a population-based cohort (n=1597), we investigated the possible association among these conditions, and obesity or hyperglycemia incidence at 6-year follow-up. Subjects with obesity (n=315) or hyperglycemia (n=618) at baseline were excluded, respectively, 1282 and 979 individuals were therefore analyzed.
Results:At follow-up, 103/1282 became obese; these subjects showed significantly higher body mass index, waist circumference, saturated fat intake, RM frequency, TW hours, HT, AC and AD use, and lower fiber intake, metabolic equivalent of activity in h per week (METS) and sleep hours at baseline. In a multiple logistic regression model, METS (odds ratio=0.94; 95% confidence interval (CI) 0.91-0.98), RMs (odds ratio=1.47 per meal per week; 1.21-1.79), being in the third tertile of HT (odds ratio=2.06; 1.02-4.16) and hours of sleep (odds ratio=0.70 per h; 0.57-0.86) were associated with incident obesity. Subjects who developed hyperglycemia (n=174/979; 17.8%) had higher saturated fat intake, RM frequency, TW hours, HT, AC and AD use at baseline and lower METS and fiber intake. In a multiple logistic regression model, fiber intake (odds ratio=0.97 for each g per day; 0.95-0.99), RM (1.49 per meal per week; 1.26-1.75) and being in the third tertile of HT (odds ratio=1.95; 1.17-3.26) were independently associated with incident hyperglycemia.
Conclusions:Lifestyle contributors to the obesity and hyperglycemia epidemics may be regular consumption of RM, sleep restriction and higher HT, suggesting potential adjunctive non-pharmacological preventive strategies for the obesity and hyperglycemia epidemics.
Zzzzzzzz
http://www.ncbi.nlm.nih.gov/pubmed/21286279
Curr Cardiol Rev. 2010 Feb;6(1):54-61.
Sleep duration as a risk factor for cardiovascular disease- a review of the recent literature.
Nagai M, Hoshide S, Kario K.
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi, Japan.
Abstract
Sleep loss is a common condition in developed countries, with evidence showing that people in Western countries are sleeping on average only 6.8 hour (hr) per night, 1.5 hr less than a century ago. Although the effects of sleep deprivation on our organs have been obscure, recent epidemiological studies have revealed relationships between sleep deprivation and hypertension (HT), coronary heart disease (CHD), and diabetes mellitus (DM). This review article summarizes the literature on these relationships. Because sleep deprivation increases sympathetic nervous system activity, this increased activity serves as a common pathophysiology for HT and DM. Adequate sleep duration may be important for preventing cardiovascular diseases in modern society.
Curr Cardiol Rev. 2010 Feb;6(1):54-61.
Sleep duration as a risk factor for cardiovascular disease- a review of the recent literature.
Nagai M, Hoshide S, Kario K.
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi, Japan.
Abstract
Sleep loss is a common condition in developed countries, with evidence showing that people in Western countries are sleeping on average only 6.8 hour (hr) per night, 1.5 hr less than a century ago. Although the effects of sleep deprivation on our organs have been obscure, recent epidemiological studies have revealed relationships between sleep deprivation and hypertension (HT), coronary heart disease (CHD), and diabetes mellitus (DM). This review article summarizes the literature on these relationships. Because sleep deprivation increases sympathetic nervous system activity, this increased activity serves as a common pathophysiology for HT and DM. Adequate sleep duration may be important for preventing cardiovascular diseases in modern society.
From Yale Med-Pregnancy in cystic fibrosis patients
http://www.ncbi.nlm.nih.gov/pubmed/21277453
Clin Chest Med. 2011 Mar;32(1):111-20.
Pregnancy in cystic fibrosis.
McArdle JR.
Section of Pulmonary & Critical Care Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
Abstract
The challenges posed by cystic fibrosis (CF), including poor nutrition and progressive lung function decline, may pose problems for pregnancy for both mother and child. A multidisciplinary team of providers is optimal to help address the variety of issues that might arise in such a pregnancy. Careful attention to maternal weight gain, pulmonary function and exacerbations, and screening for gestational diabetes is necessary. Pregnancies among women with CF are associated with more frequent use of intravenous antibiotics and hospitalization than is seen in nonpregnant CF women. This article reviews maternal and fetal outcomes for CF in pregnancy.
Clin Chest Med. 2011 Mar;32(1):111-20.
Pregnancy in cystic fibrosis.
McArdle JR.
Section of Pulmonary & Critical Care Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
Abstract
The challenges posed by cystic fibrosis (CF), including poor nutrition and progressive lung function decline, may pose problems for pregnancy for both mother and child. A multidisciplinary team of providers is optimal to help address the variety of issues that might arise in such a pregnancy. Careful attention to maternal weight gain, pulmonary function and exacerbations, and screening for gestational diabetes is necessary. Pregnancies among women with CF are associated with more frequent use of intravenous antibiotics and hospitalization than is seen in nonpregnant CF women. This article reviews maternal and fetal outcomes for CF in pregnancy.
Dealing with conflicts of interest in medicine
http://www.ncbi.nlm.nih.gov/pubmed/21240805
Am J Bioeth. 2011 Jan;11(1):33-4.
Taking a lesson from the lawyers: defining and addressing conflict of interest.
Morreim EH.
University of Tennessee Health Science Center.
PMID: 21240805 [PubMed - in process]
Am J Bioeth. 2011 Jan;11(1):33-4.
Taking a lesson from the lawyers: defining and addressing conflict of interest.
Morreim EH.
University of Tennessee Health Science Center.
PMID: 21240805 [PubMed - in process]
The new lung adenocarcinoma classification system
http://www.ncbi.nlm.nih.gov/pubmed/21252716
J Thorac Oncol. 2011 Feb;6(2):244-85.
International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D.
J Thorac Oncol. 2011 Feb;6(2):244-85.
International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D.
Lung cancer histology in an emerging molecular age: more important that ever
http://www.ncbi.nlm.nih.gov/pubmed/21284271
Med Health R I. 2010 Oct;93(10):317-9.
The evolving role of histology in the treatment of non-small cell lung cancer.
Rana N, Khurshid H.
Boston University School of Medicine, Division of Hematology and Oncology, Roger Williams Medical Center, USA.
PMID: 21284271 [PubMed - in process]
Med Health R I. 2010 Oct;93(10):317-9.
The evolving role of histology in the treatment of non-small cell lung cancer.
Rana N, Khurshid H.
Boston University School of Medicine, Division of Hematology and Oncology, Roger Williams Medical Center, USA.
PMID: 21284271 [PubMed - in process]
Saturday, January 29, 2011
Research integrity. That is what it is ALL about.
http://www.ncbi.nlm.nih.gov/pubmed/21275037
Pharm Stat. 2011 Jan;10(1):74-79. doi: 10.1002/pst.429.
The potential for bias in reporting of industry-sponsored clinical trials.
Pyke S, Julious SA, Day S, O'Kelly M, Todd S, Matcham J, Seldrup J.
Pfizer Ltd, Sandwich, UK. stephen.pyke@pfizer.com.
Abstract
Concerns about potentially misleading reporting of pharmaceutical industry research have surfaced many times. The potential for duality (and thereby conflict) of interest is only too clear when you consider the sums of money required for the discovery, development and commercialization of new medicines. As the ability of major, mid-size and small pharmaceutical companies to innovate has waned, as evidenced by the seemingly relentless decline in the numbers of new medicines approved by Food and Drug Administration and European Medicines Agency year-on-year, not only has the cost per new approved medicine risen: so too has the public and media concern about the extent to which the pharmaceutical industry is open and honest about the efficacy, safety and quality of the drugs we manufacture and sell. In 2005 an Editorial in Journal of the American Medical Association made clear that, so great was their concern about misleading reporting of industry-sponsored studies, henceforth no article would be published that was not also guaranteed by independent statistical analysis. We examine the precursors to this Editorial, as well as its immediate and lasting effects for statisticians, for the manner in which statistical analysis is carried out, and for the industry more generally.
Pharm Stat. 2011 Jan;10(1):74-79. doi: 10.1002/pst.429.
The potential for bias in reporting of industry-sponsored clinical trials.
Pyke S, Julious SA, Day S, O'Kelly M, Todd S, Matcham J, Seldrup J.
Pfizer Ltd, Sandwich, UK. stephen.pyke@pfizer.com.
Abstract
Concerns about potentially misleading reporting of pharmaceutical industry research have surfaced many times. The potential for duality (and thereby conflict) of interest is only too clear when you consider the sums of money required for the discovery, development and commercialization of new medicines. As the ability of major, mid-size and small pharmaceutical companies to innovate has waned, as evidenced by the seemingly relentless decline in the numbers of new medicines approved by Food and Drug Administration and European Medicines Agency year-on-year, not only has the cost per new approved medicine risen: so too has the public and media concern about the extent to which the pharmaceutical industry is open and honest about the efficacy, safety and quality of the drugs we manufacture and sell. In 2005 an Editorial in Journal of the American Medical Association made clear that, so great was their concern about misleading reporting of industry-sponsored studies, henceforth no article would be published that was not also guaranteed by independent statistical analysis. We examine the precursors to this Editorial, as well as its immediate and lasting effects for statisticians, for the manner in which statistical analysis is carried out, and for the industry more generally.
From Bryan Liang and colleagues: But will hospitals take advantage of AHRQ?
http://www.ncbi.nlm.nih.gov/pubmed/21249996
Patient Safety Data Sharing and Protection from Legal Discovery.
Suydam S, Liang BA, Anderson S, Weinger MB.
In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.
Excerpt
The Institute of Medicine report, To Err Is Human, recommended that collaborative networks of health care organizations should exchange information regarding medical errors to prevent the same errors from being repeated. Another recommendation, that Congress enact legislation protecting such exchanged information from legal discovery, has not occurred. Even if such legislation does pass, it may conflict with existing Federal discovery requirements. Nevertheless, existing State and Federal law may offer some protection. The most promising source of existing protection for all members of patient safety collaboratives is 42 U.S.C. §299c-3(c), which extends protection to data collection sponsored by the Agency for Healthcare Research and Quality (AHRQ). The Department of Health and Human Services' confidentiality certificates and State peer review protection laws may offer little if any protection. However, with AHRQ sponsorship and the proper structure, health care organizations may be able to safely exchange information with one another without fear of liability or disclosure of sensitive information.
Patient Safety Data Sharing and Protection from Legal Discovery.
Suydam S, Liang BA, Anderson S, Weinger MB.
In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.
Excerpt
The Institute of Medicine report, To Err Is Human, recommended that collaborative networks of health care organizations should exchange information regarding medical errors to prevent the same errors from being repeated. Another recommendation, that Congress enact legislation protecting such exchanged information from legal discovery, has not occurred. Even if such legislation does pass, it may conflict with existing Federal discovery requirements. Nevertheless, existing State and Federal law may offer some protection. The most promising source of existing protection for all members of patient safety collaboratives is 42 U.S.C. §299c-3(c), which extends protection to data collection sponsored by the Agency for Healthcare Research and Quality (AHRQ). The Department of Health and Human Services' confidentiality certificates and State peer review protection laws may offer little if any protection. However, with AHRQ sponsorship and the proper structure, health care organizations may be able to safely exchange information with one another without fear of liability or disclosure of sensitive information.
Cystic fibrosis: Depression and anxiety in adolescent and young adult patients
http://www.ncbi.nlm.nih.gov/pubmed/21259449
Pediatr Pulmonol. 2011 Feb;46(2):153-9. doi: 10.1002/ppul.21334. Epub 2010 Nov 17.
Screening for symptoms of depression and anxiety in adolescents and young adults with cystic fibrosis.
Modi AC, Driscoll KA, Montag-Leifling K, Acton JD.
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio. avani.modi@cchmc.org.
Abstract
BACKGROUND: Although studies have assessed symptoms of depression and anxiety in individuals with cystic fibrosis (CF), few have been conducted since the advent of new medical treatments (e.g., nebulized antibiotics, ThAIRpy Vest). Study objectives were to: (1) document symptoms of depression and anxiety for adolescents and young adults with CF and compare with normative values, (2) examine the associations among depressive/anxiety symptoms and gender, age, lung function, and body mass index, and (3) determine the relations between adolescent and caregiver symptoms of depression and anxiety.
METHODS: Patients and caregivers completed the Hospital Anxiety and Depression Scale (HADS) anytime (e.g., beginning or end) during routine CF clinic appointments.
RESULTS: Participants included 59 adolescents/young adults with CF (M(age) = 15.8 years, 54% female, 98% Caucasian, M(FEV1% predicted) = 84.6) and caregivers of 40 adolescents. Although symptom scores were in the normative range for patients with CF (M(Depression) = 2.27 and M(Anxiety) = 5.59), 3% and 32% exhibited clinically elevated symptoms of depression and anxiety, respectively. Symptoms of depression and anxiety were significantly associated with age (r = 0.28, 0.36). Symptoms of depression and anxiety were also positively correlated (r = 0.48). Females endorsed higher anxiety symptoms than males. While adolescent and caregiver anxiety scores were not related, higher caregiver depressive symptoms were associated with older patient age and worse lung function.
CONCLUSIONS: Data from the current study suggest low levels of depressive symptoms and substantial levels of anxiety symptoms in adolescents and young adults with CF. Consistent with prior literature, depressive symptoms appear higher in older patients and are significantly associated with anxiety symptoms. Caregiver symptomology appears to be more affected by an adolescent's health status, suggesting a need to screen caregivers when health begins to decline.
Pediatr Pulmonol. 2011 Feb;46(2):153-9. doi: 10.1002/ppul.21334. Epub 2010 Nov 17.
Screening for symptoms of depression and anxiety in adolescents and young adults with cystic fibrosis.
Modi AC, Driscoll KA, Montag-Leifling K, Acton JD.
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio. avani.modi@cchmc.org.
Abstract
BACKGROUND: Although studies have assessed symptoms of depression and anxiety in individuals with cystic fibrosis (CF), few have been conducted since the advent of new medical treatments (e.g., nebulized antibiotics, ThAIRpy Vest). Study objectives were to: (1) document symptoms of depression and anxiety for adolescents and young adults with CF and compare with normative values, (2) examine the associations among depressive/anxiety symptoms and gender, age, lung function, and body mass index, and (3) determine the relations between adolescent and caregiver symptoms of depression and anxiety.
METHODS: Patients and caregivers completed the Hospital Anxiety and Depression Scale (HADS) anytime (e.g., beginning or end) during routine CF clinic appointments.
RESULTS: Participants included 59 adolescents/young adults with CF (M(age) = 15.8 years, 54% female, 98% Caucasian, M(FEV1% predicted) = 84.6) and caregivers of 40 adolescents. Although symptom scores were in the normative range for patients with CF (M(Depression) = 2.27 and M(Anxiety) = 5.59), 3% and 32% exhibited clinically elevated symptoms of depression and anxiety, respectively. Symptoms of depression and anxiety were significantly associated with age (r = 0.28, 0.36). Symptoms of depression and anxiety were also positively correlated (r = 0.48). Females endorsed higher anxiety symptoms than males. While adolescent and caregiver anxiety scores were not related, higher caregiver depressive symptoms were associated with older patient age and worse lung function.
CONCLUSIONS: Data from the current study suggest low levels of depressive symptoms and substantial levels of anxiety symptoms in adolescents and young adults with CF. Consistent with prior literature, depressive symptoms appear higher in older patients and are significantly associated with anxiety symptoms. Caregiver symptomology appears to be more affected by an adolescent's health status, suggesting a need to screen caregivers when health begins to decline.
More needs to be done to study this: Diabetes treatment by HDAC inhibition
http://www.ncbi.nlm.nih.gov/pubmed/21274504
Mol Med. 2011 Jan 25. doi: 10.2119/molmed.2011.00021. [Epub ahead of print]
HDAC inhibition as a novel treatment for diabetes mellitus.
Christensen DP, Dahllöf M, Lundh M, Rasmussen DN, Nielsen MD, Billestrup N, Grunnet LG, Mandrup-Poulsen T.
Center for Medical Research Methodology, Dept. of Biomedical Sciences, University of Copenhagen, Denmark.
Abstract
Both common forms of diabetes have an inflammatory pathogenesis in which immune and metabolic factors converge on IL-1β as a key mediator of insulin resistance and beta-cell failure. In addition to improving insulin resistance and preventing β-cell inflammatory damage there is evidence of genetic association between diabetes and histone deacetylases (HDACs), and HDAC inhibitors promote b-cell development, proliferation, differentiation and function and positively impact on late diabetic microvascular complications. Here we review this evidence and propose that there is a strong rationale for preclinical studies and clinical trials with the aim of testing the utility of HDACi as a novel therapy for diabetes.
Mol Med. 2011 Jan 25. doi: 10.2119/molmed.2011.00021. [Epub ahead of print]
HDAC inhibition as a novel treatment for diabetes mellitus.
Christensen DP, Dahllöf M, Lundh M, Rasmussen DN, Nielsen MD, Billestrup N, Grunnet LG, Mandrup-Poulsen T.
Center for Medical Research Methodology, Dept. of Biomedical Sciences, University of Copenhagen, Denmark.
Abstract
Both common forms of diabetes have an inflammatory pathogenesis in which immune and metabolic factors converge on IL-1β as a key mediator of insulin resistance and beta-cell failure. In addition to improving insulin resistance and preventing β-cell inflammatory damage there is evidence of genetic association between diabetes and histone deacetylases (HDACs), and HDAC inhibitors promote b-cell development, proliferation, differentiation and function and positively impact on late diabetic microvascular complications. Here we review this evidence and propose that there is a strong rationale for preclinical studies and clinical trials with the aim of testing the utility of HDACi as a novel therapy for diabetes.
From Harvard: Recruitment maneuvers for ARDS patients
http://www.ncbi.nlm.nih.gov/pubmed/21273969
Minerva Anestesiol. 2011 Jan;77(1):85-89.
Lung recruitment maneuvers during acute respiratory distress syndrome: is it useful?
Kacmarek RM, Villar J.
Department of Anesthesiology, Harvard Medical School, Boston, MA, USA - rkacmarek@partners.org.
Abstract
Although significant advances have been made in approaches to manage the acute respiratory distress syndrome (ARDS), reported overall mortality for ARDS is still high. Recruitment maneuvers (RM) have been recommended by some as potential adjuncts to lung protective ventilatory approaches in ARDS. In this point of view issues surrounding the use of RM in ARDS are addressed. Specifically, the ability of RM to open the lung, the safety of RM, and their affect on outcome are addressed. Finally, a specific approach to performing RM with the use of a decremental PEEP trial is outlined.
Minerva Anestesiol. 2011 Jan;77(1):85-89.
Lung recruitment maneuvers during acute respiratory distress syndrome: is it useful?
Kacmarek RM, Villar J.
Department of Anesthesiology, Harvard Medical School, Boston, MA, USA - rkacmarek@partners.org.
Abstract
Although significant advances have been made in approaches to manage the acute respiratory distress syndrome (ARDS), reported overall mortality for ARDS is still high. Recruitment maneuvers (RM) have been recommended by some as potential adjuncts to lung protective ventilatory approaches in ARDS. In this point of view issues surrounding the use of RM in ARDS are addressed. Specifically, the ability of RM to open the lung, the safety of RM, and their affect on outcome are addressed. Finally, a specific approach to performing RM with the use of a decremental PEEP trial is outlined.
Related: Fragmentation of care and future physicians' skills
http://www.ncbi.nlm.nih.gov/pubmed/21270552
Acad Med. 2011 Feb;86(2):158-160.
Commentary: Health Care Reform and Primary Care: Training Physicians for Tomorrow's Challenges.
Caudill TS, Lofgren R, Jennings CD, Karpf M.
Dr. Caudill is chief of internal medicine and associate professor of medicine, UK HealthCare, University of Kentucky, Lexington, Kentucky. Dr. Lofgren is vice president for health care operations and chief clinical officer, UK HealthCare, University of Kentucky, Lexington, Kentucky. Dr. Jennings is senior associate dean for medical education, UK HealthCare, University of Kentucky, Lexington, Kentucky. Dr. Karpf is executive vice president for health affairs, UK HealthCare, University of Kentucky, Lexington, Kentucky.
Abstract
Although Congress recently passed health insurance reform legislation, the real catalyst for change in the health care delivery system, the author's argue, will be changes to the reimbursement model. To rein in increasing costs, the Centers for Medicare and Medicaid aims to move Medicare from the current fee-for-service model to a reimbursement approach that shifts the risk to providers and encourages greater accountability both for the cost and the quality of care. This level of increased accountability can only be achieved by clinical integration among health care providers.Central to this reorganized delivery model are primary care providers who coordinate and organize the care of their patients, using best practices and evidence-based medicine while respecting the patient's values, wishes, and dictates. Thus, the authors ask whether primary care physicians will be available in sufficient numbers and if they will be adequately and appropriately trained to take on this role.Most workforce researchers report inadequate numbers of primary care doctors today, a shortage that will only be exacerbated in the future. Even more ominously, the authors argue that primary care physicians being trained today will not have the requisite skills to fulfill their contemplated responsibilities because of a variety of factors that encourage fragmentation of care. If this training issue is not debated vigorously to determine new and appropriate training approaches, the future workforce may eventually have the appropriate number of physicians but inadequately trained individuals, a situation that would doom any effort at system reform.
Acad Med. 2011 Feb;86(2):158-160.
Commentary: Health Care Reform and Primary Care: Training Physicians for Tomorrow's Challenges.
Caudill TS, Lofgren R, Jennings CD, Karpf M.
Dr. Caudill is chief of internal medicine and associate professor of medicine, UK HealthCare, University of Kentucky, Lexington, Kentucky. Dr. Lofgren is vice president for health care operations and chief clinical officer, UK HealthCare, University of Kentucky, Lexington, Kentucky. Dr. Jennings is senior associate dean for medical education, UK HealthCare, University of Kentucky, Lexington, Kentucky. Dr. Karpf is executive vice president for health affairs, UK HealthCare, University of Kentucky, Lexington, Kentucky.
Abstract
Although Congress recently passed health insurance reform legislation, the real catalyst for change in the health care delivery system, the author's argue, will be changes to the reimbursement model. To rein in increasing costs, the Centers for Medicare and Medicaid aims to move Medicare from the current fee-for-service model to a reimbursement approach that shifts the risk to providers and encourages greater accountability both for the cost and the quality of care. This level of increased accountability can only be achieved by clinical integration among health care providers.Central to this reorganized delivery model are primary care providers who coordinate and organize the care of their patients, using best practices and evidence-based medicine while respecting the patient's values, wishes, and dictates. Thus, the authors ask whether primary care physicians will be available in sufficient numbers and if they will be adequately and appropriately trained to take on this role.Most workforce researchers report inadequate numbers of primary care doctors today, a shortage that will only be exacerbated in the future. Even more ominously, the authors argue that primary care physicians being trained today will not have the requisite skills to fulfill their contemplated responsibilities because of a variety of factors that encourage fragmentation of care. If this training issue is not debated vigorously to determine new and appropriate training approaches, the future workforce may eventually have the appropriate number of physicians but inadequately trained individuals, a situation that would doom any effort at system reform.
Good study on the elderly from USC, but the conclusion carries no surprises
http://www.ncbi.nlm.nih.gov/pubmed/21274456
Cardiol Res Pract. 2011 Jan 9;2011:983764.
Lifestyle Practices and Cardiovascular Disease Mortality in the Elderly: The Leisure World Cohort Study.
Paganini-Hill A.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
Abstract
Modifiable behavioral risk factors are major contributing causes of death, but whether the effects are maintained in older adults is uncertain. We explored the association of smoking, alcohol consumption, caffeine intake, physical activity, and body mass index on cardiovascular disease (CVD) mortality in 13,296 older adults and calculated risk estimates using Cox regression analysis in four age groups (<70, 70-74, 75-79, and 80+ years). The most important factor was current smoking, which increased risk in all age-sex groups. In women, alcohol consumption (≤3 drinks/day) was related to decreased (15-30%) risk in those <80 years old; in men, 4+ drinks/day was associated with reduced (15-30%) risk. Active 70+ year olds had 20-40% lower risk. Both underweight and obese women were at increased risk. Lifestyle practices impact CVD death rates in older adults, even those aged 80+ years. Not smoking, moderate alcohol consumption, physical activity, and normal weight are important health promoters in our aging population.
Cardiol Res Pract. 2011 Jan 9;2011:983764.
Lifestyle Practices and Cardiovascular Disease Mortality in the Elderly: The Leisure World Cohort Study.
Paganini-Hill A.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
Abstract
Modifiable behavioral risk factors are major contributing causes of death, but whether the effects are maintained in older adults is uncertain. We explored the association of smoking, alcohol consumption, caffeine intake, physical activity, and body mass index on cardiovascular disease (CVD) mortality in 13,296 older adults and calculated risk estimates using Cox regression analysis in four age groups (<70, 70-74, 75-79, and 80+ years). The most important factor was current smoking, which increased risk in all age-sex groups. In women, alcohol consumption (≤3 drinks/day) was related to decreased (15-30%) risk in those <80 years old; in men, 4+ drinks/day was associated with reduced (15-30%) risk. Active 70+ year olds had 20-40% lower risk. Both underweight and obese women were at increased risk. Lifestyle practices impact CVD death rates in older adults, even those aged 80+ years. Not smoking, moderate alcohol consumption, physical activity, and normal weight are important health promoters in our aging population.
Will non-platinum-based chemotherapy for lung cancer become common?
http://www.ncbi.nlm.nih.gov/pubmed/21273617
Anticancer Res. 2011 Jan;31(1):317-323.
Randomized Phase II Study of Paclitaxel and Carboplatin or Vinorelbine in Advanced Non-small Cell Lung Cancer.
Jahnke K, Keilholz U, Lüftner D, Thiel E, Schmittel A.
Department of Hematology and Oncology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. kristoph.jahnke@charite.de.
Abstract
BACKGROUND: A randomized phase II trial was conducted to determine if two non-platinum protocols are able to yield a similar efficacy and toxicity profile as compared to two platinum-based doublets in advanced non-small cell lung cancer (NSCLC).
PATIENTS AND METHODS: A total of 61 patients were randomly assigned to a reference regimen of carboplatin and paclitaxel (repeated every 3 weeks) or to one of three experimental regimens: paclitaxel plus vinorelbine (repeated every 3 or 4 weeks) and carboplatin plus paclitaxel (repeated every 4 weeks).
RESULTS: The objective remission rate for all the patients was 34.1%. The median progression-free survival for all the patients was 3 months. The median overall survival and one-year overall survival were 6 months and 21.5%, respectively. Toxicity was moderate and manageable. Response, survival and toxicity did not significantly differ between the four treatment groups.
CONCLUSION: The efficacy and toxicity profile of platinum-free combinations is comparable to that of platinum-based doublets.
Anticancer Res. 2011 Jan;31(1):317-323.
Randomized Phase II Study of Paclitaxel and Carboplatin or Vinorelbine in Advanced Non-small Cell Lung Cancer.
Jahnke K, Keilholz U, Lüftner D, Thiel E, Schmittel A.
Department of Hematology and Oncology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. kristoph.jahnke@charite.de.
Abstract
BACKGROUND: A randomized phase II trial was conducted to determine if two non-platinum protocols are able to yield a similar efficacy and toxicity profile as compared to two platinum-based doublets in advanced non-small cell lung cancer (NSCLC).
PATIENTS AND METHODS: A total of 61 patients were randomly assigned to a reference regimen of carboplatin and paclitaxel (repeated every 3 weeks) or to one of three experimental regimens: paclitaxel plus vinorelbine (repeated every 3 or 4 weeks) and carboplatin plus paclitaxel (repeated every 4 weeks).
RESULTS: The objective remission rate for all the patients was 34.1%. The median progression-free survival for all the patients was 3 months. The median overall survival and one-year overall survival were 6 months and 21.5%, respectively. Toxicity was moderate and manageable. Response, survival and toxicity did not significantly differ between the four treatment groups.
CONCLUSION: The efficacy and toxicity profile of platinum-free combinations is comparable to that of platinum-based doublets.
Wednesday, January 26, 2011
Smoking is associated with lung diseases other than cancer
http://www.ncbi.nlm.nih.gov/pubmed/21233262
Eur Respir J. 2011 Jan 13. [Epub ahead of print]
Interstitial lung diseases in a lung cancer screening trial.
Sverzellati N, Guerci L, Randi G, Calabrò E, La Vecchia C, Marchianò A, Pesci A, Zompatori M, Pastorino U.
University of Parma Italy.
Abstract
We assessed the prevalence of interstitial lung disease (ILD) in a cohort of smokers included in a lung cancer screening trial. Two observers independently reviewed for the presence of the CT findings consistent with ILD the CT examinations of 692 heavy smokers recruited by the Multicentric Italian Lung Detection (MILD) trial. Four CT patterns were considered: usual interstitial pneumonia (UIP), other chronic interstitial pneumonia (OCIP), respiratory bronchiolitis (RB) and indeterminate. Subsequently, the evolution of ILD in those subjects undergone a repeat CT examination after three years was assessed. The UIP pattern and the OCIP pattern were identified in 2/692 (0.3%) and 26/692 (3.8%) patients, respectively; 109/692 (15.7%) patients showed CT abnormalities consistent with RB, while an indeterminate CT pattern was reported in 21/692 (3%) subjects Age, male sex and current smoking status were factors associated with the presence of OCIP and UIP (combined) pattern, although such relationship did not attain statistical significance. A progression of the disease was observed in 3/12 (25%) subjects with OCIP undergone repeat CT after three years. Thin-section CT features of ILD, probably representing smoking-related ILD, are not uncommon in a lung cancer screening population and should not be overlooked.
Eur Respir J. 2011 Jan 13. [Epub ahead of print]
Interstitial lung diseases in a lung cancer screening trial.
Sverzellati N, Guerci L, Randi G, Calabrò E, La Vecchia C, Marchianò A, Pesci A, Zompatori M, Pastorino U.
University of Parma Italy.
Abstract
We assessed the prevalence of interstitial lung disease (ILD) in a cohort of smokers included in a lung cancer screening trial. Two observers independently reviewed for the presence of the CT findings consistent with ILD the CT examinations of 692 heavy smokers recruited by the Multicentric Italian Lung Detection (MILD) trial. Four CT patterns were considered: usual interstitial pneumonia (UIP), other chronic interstitial pneumonia (OCIP), respiratory bronchiolitis (RB) and indeterminate. Subsequently, the evolution of ILD in those subjects undergone a repeat CT examination after three years was assessed. The UIP pattern and the OCIP pattern were identified in 2/692 (0.3%) and 26/692 (3.8%) patients, respectively; 109/692 (15.7%) patients showed CT abnormalities consistent with RB, while an indeterminate CT pattern was reported in 21/692 (3%) subjects Age, male sex and current smoking status were factors associated with the presence of OCIP and UIP (combined) pattern, although such relationship did not attain statistical significance. A progression of the disease was observed in 3/12 (25%) subjects with OCIP undergone repeat CT after three years. Thin-section CT features of ILD, probably representing smoking-related ILD, are not uncommon in a lung cancer screening population and should not be overlooked.
Diabetes and cognitive function in the elderly
http://www.ncbi.nlm.nih.gov/pubmed/21263438
Nat Rev Endocrinol. 2011 Feb;7(2):108-114.
Cognitive function, dementia and type 2 diabetes mellitus in the elderly.
Strachan MW, Reynolds RM, Marioni RE, Price JF.
Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Abstract
Increasing numbers of people are developing type 2 diabetes mellitus, but interventions to prevent and treat the classic microvascular and macrovascular complications have improved, so that people are living longer with the condition. This trend means that novel complications of type 2 diabetes mellitus, which are not targeted by current management strategies, could start to emerge. Cognitive impairment and dementia could come into this category. Type 2 diabetes mellitus is associated with a 1.5-2.5-fold increased risk of dementia. The etiology of dementia and cognitive impairment in people with type 2 diabetes mellitus is probably multifactorial. Chronic hyperglycemia is implicated, perhaps by promoting the development of cerebral microvascular disease. Data suggest that the brains of older people with type 2 diabetes mellitus might be vulnerable to the effects of recurrent, severe hypoglycemia. Other possible moderators of cognitive function include inflammatory mediators, rheological factors and dysregulation of the hypothalamic-pituitary-adrenal axis. Cognitive function should now be included as a standard end point in randomized trials of therapeutic interventions in patients with type 2 diabetes mellitus.
Nat Rev Endocrinol. 2011 Feb;7(2):108-114.
Cognitive function, dementia and type 2 diabetes mellitus in the elderly.
Strachan MW, Reynolds RM, Marioni RE, Price JF.
Metabolic Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Abstract
Increasing numbers of people are developing type 2 diabetes mellitus, but interventions to prevent and treat the classic microvascular and macrovascular complications have improved, so that people are living longer with the condition. This trend means that novel complications of type 2 diabetes mellitus, which are not targeted by current management strategies, could start to emerge. Cognitive impairment and dementia could come into this category. Type 2 diabetes mellitus is associated with a 1.5-2.5-fold increased risk of dementia. The etiology of dementia and cognitive impairment in people with type 2 diabetes mellitus is probably multifactorial. Chronic hyperglycemia is implicated, perhaps by promoting the development of cerebral microvascular disease. Data suggest that the brains of older people with type 2 diabetes mellitus might be vulnerable to the effects of recurrent, severe hypoglycemia. Other possible moderators of cognitive function include inflammatory mediators, rheological factors and dysregulation of the hypothalamic-pituitary-adrenal axis. Cognitive function should now be included as a standard end point in randomized trials of therapeutic interventions in patients with type 2 diabetes mellitus.
From Harvard: Cystic fibrosis and illness perception
http://www.ncbi.nlm.nih.gov/pubmed/21262419
Associations between illness perceptions and health-related quality of life in adults with cystic fibrosis.
Sawicki GS, Sellers DE, Robinson WM.
Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Abstract
OBJECTIVE: The objective of this work was to examine the relationship between illness perception, health status, and health-related quality of life (HRQOL) in a cohort of adults with cystic fibrosis (CF).
METHODS: In the Project on Adult Care in Cystic Fibrosis, we administered five subscales (Illness Consequences, Illness Coherence, Illness Timeline-Cyclical, Personal Control, and Treatment Control) of the Illness Perception Questionnaire-Revised (IPQ-R). Multivariable linear regression analyses explored the associations between illness perception, health status, symptom burden, and physical and psychosocial HRQOL, as measured by various domains of the Cystic Fibrosis Questionnaire-Revised (CFQ-R).
RESULTS: Among the 199 respondents (63% female; mean age, 36.8±10.2 years), IPQ-R scores did not differ on age, gender, or lung function. In multivariable regression models, neither clinical characteristics nor physical or psychological symptom burden scores were associated with CFQ-R physical domains. In contrast, higher scores on Illness Consequences were associated with lower psychosocial CFQ-R scores. Higher scores on the Illness Coherence and Personal Control scales were associated with higher psychosocial CFQ-R scores.
CONCLUSION: Adults with CF report a high understanding of their disease, feel that CF has significant consequences, and endorse both personal and treatment control over their outcomes. Illness perceptions did not vary with increased age or worsening disease severity, suggesting that illness perceptions may develop during adolescence. Illness perceptions were associated with psychosocial, but not physical, aspects of HRQOL. Efforts to modify illness perceptions as part of routine clinical care and counseling may lead to improved quality of life for adults with CF.
Associations between illness perceptions and health-related quality of life in adults with cystic fibrosis.
Sawicki GS, Sellers DE, Robinson WM.
Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Abstract
OBJECTIVE: The objective of this work was to examine the relationship between illness perception, health status, and health-related quality of life (HRQOL) in a cohort of adults with cystic fibrosis (CF).
METHODS: In the Project on Adult Care in Cystic Fibrosis, we administered five subscales (Illness Consequences, Illness Coherence, Illness Timeline-Cyclical, Personal Control, and Treatment Control) of the Illness Perception Questionnaire-Revised (IPQ-R). Multivariable linear regression analyses explored the associations between illness perception, health status, symptom burden, and physical and psychosocial HRQOL, as measured by various domains of the Cystic Fibrosis Questionnaire-Revised (CFQ-R).
RESULTS: Among the 199 respondents (63% female; mean age, 36.8±10.2 years), IPQ-R scores did not differ on age, gender, or lung function. In multivariable regression models, neither clinical characteristics nor physical or psychological symptom burden scores were associated with CFQ-R physical domains. In contrast, higher scores on Illness Consequences were associated with lower psychosocial CFQ-R scores. Higher scores on the Illness Coherence and Personal Control scales were associated with higher psychosocial CFQ-R scores.
CONCLUSION: Adults with CF report a high understanding of their disease, feel that CF has significant consequences, and endorse both personal and treatment control over their outcomes. Illness perceptions did not vary with increased age or worsening disease severity, suggesting that illness perceptions may develop during adolescence. Illness perceptions were associated with psychosocial, but not physical, aspects of HRQOL. Efforts to modify illness perceptions as part of routine clinical care and counseling may lead to improved quality of life for adults with CF.
Primary care and health care reform
http://www.ncbi.nlm.nih.gov/pubmed/21261124
Issue Brief (Commonw Fund). 2011 Jan;1:1-28.
Realizing health reform's potential: how the Affordable Care Act will strengthen primary care and benefit patients, providers, and payers.
Abrams M, Nuzum R, Mika S, Lawlor G.
Patient-Centered Coordinated Care, The Commonwealth Fund. mka@cmwf.org
Abstract
Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America's primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The health reform law includes numerous provisions for improving primary care: temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary care providers; and investment in the continued development of the primary care workforce.
Issue Brief (Commonw Fund). 2011 Jan;1:1-28.
Realizing health reform's potential: how the Affordable Care Act will strengthen primary care and benefit patients, providers, and payers.
Abrams M, Nuzum R, Mika S, Lawlor G.
Patient-Centered Coordinated Care, The Commonwealth Fund. mka@cmwf.org
Abstract
Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America's primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The health reform law includes numerous provisions for improving primary care: temporary increases in Medicare and Medicaid payments to primary care providers; support for innovation in the delivery of care, with an emphasis on achieving better health outcomes and patient care experiences; enhanced support of primary care providers; and investment in the continued development of the primary care workforce.
Pediatrics fellowship-Worth it?
http://www.ncbi.nlm.nih.gov/pubmed/21262882
Does Fellowship Pay: What Is the Long-term Financial Impact of Subspecialty Training in Pediatrics?
Rochlin JM, Simon HK.
Abstract
Objectives: To (1) analyze the financial returns of fellowship training in pediatrics and to compare them with those generated from a career in general pediatrics and (2) evaluate the effects of including the newly enacted federal loan-repayment program and of changing the length of fellowship training. Background: Although the choice to enter fellowship is based on many factors, economic considerations are important. We are not aware of any study that has focused on the financial impact of fellowship training in pediatrics. Methods: Using standard financial techniques, we estimated the financial returns that a graduating pediatric resident might anticipate from additional fellowship training followed by a career as a pediatric subspecialist and compared them with the returns that might be expected from starting a career as a general pediatrician immediately after residency. Results: The financial returns of pediatric fellowship training varied greatly depending on which subspecialty fellowship was chosen. Pursuing a fellowship in most pediatric subspecialties was a negative financial decision when compared with pursuing no fellowship at all and practicing as a general pediatrician. Incorporating the federal loan-repayment program targeted toward pediatric subspecialists and decreasing the length of fellowship training from 3 to 2 years would substantially increase the financial returns of the pediatric subspecialties. Conclusions: Pediatric subspecialization yielded variable financial returns. The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, our study may be valuable to policy makers evaluating health care reform and pediatric workforce-allocation issues.
Does Fellowship Pay: What Is the Long-term Financial Impact of Subspecialty Training in Pediatrics?
Rochlin JM, Simon HK.
Abstract
Objectives: To (1) analyze the financial returns of fellowship training in pediatrics and to compare them with those generated from a career in general pediatrics and (2) evaluate the effects of including the newly enacted federal loan-repayment program and of changing the length of fellowship training. Background: Although the choice to enter fellowship is based on many factors, economic considerations are important. We are not aware of any study that has focused on the financial impact of fellowship training in pediatrics. Methods: Using standard financial techniques, we estimated the financial returns that a graduating pediatric resident might anticipate from additional fellowship training followed by a career as a pediatric subspecialist and compared them with the returns that might be expected from starting a career as a general pediatrician immediately after residency. Results: The financial returns of pediatric fellowship training varied greatly depending on which subspecialty fellowship was chosen. Pursuing a fellowship in most pediatric subspecialties was a negative financial decision when compared with pursuing no fellowship at all and practicing as a general pediatrician. Incorporating the federal loan-repayment program targeted toward pediatric subspecialists and decreasing the length of fellowship training from 3 to 2 years would substantially increase the financial returns of the pediatric subspecialties. Conclusions: Pediatric subspecialization yielded variable financial returns. The results from this study can be helpful to current pediatric residents as they contemplate their career options. In addition, our study may be valuable to policy makers evaluating health care reform and pediatric workforce-allocation issues.
From Mayo: Lung cancer treatment and quality of life
http://www.ncbi.nlm.nih.gov/pubmed/21263269
Cancer J. 2011 January/February;17(1):63-67.
Metrics to Assess Quality of Life After Management of Early-Stage Lung Cancer.
Sloan JA.
From the Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Abstract
Quality of life (QOL) is a key clinical outcome in patients with lung cancer because of the debilitating nature of the disease and its treatments. In recent years, advances have been made in the assessment of QOL via patient-reported outcomes. A brief history of the evolution of QOL measures in oncology clinical trials and practice is given with specific reference to early-stage lung cancer. The role that QOL can play as a prognostic factor, especially among lung cancer patients, is delineated. The most commonly seen symptoms among lung cancer patients are listed. This review is intended to provide the clinical researcher with a summary of the alternative measures that are both valid and reasonable to consider when assessing QOL in early-stage lung cancer patients. Suggestions for QOL assessment in both a research setting and clinical environment are considered. A review of the most popular QOL assessments in general application to lung cancer and disease-specific measures is provided. An algorithm for selecting appropriate QOL assessments for lung cancer clinical research is provided. The primary conclusion from this work is that scientifically sound investigations into the QOL of early-stage lung cancer patients are feasible and encouraged so that the care of these patients can be optimized.
Cancer J. 2011 January/February;17(1):63-67.
Metrics to Assess Quality of Life After Management of Early-Stage Lung Cancer.
Sloan JA.
From the Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Abstract
Quality of life (QOL) is a key clinical outcome in patients with lung cancer because of the debilitating nature of the disease and its treatments. In recent years, advances have been made in the assessment of QOL via patient-reported outcomes. A brief history of the evolution of QOL measures in oncology clinical trials and practice is given with specific reference to early-stage lung cancer. The role that QOL can play as a prognostic factor, especially among lung cancer patients, is delineated. The most commonly seen symptoms among lung cancer patients are listed. This review is intended to provide the clinical researcher with a summary of the alternative measures that are both valid and reasonable to consider when assessing QOL in early-stage lung cancer patients. Suggestions for QOL assessment in both a research setting and clinical environment are considered. A review of the most popular QOL assessments in general application to lung cancer and disease-specific measures is provided. An algorithm for selecting appropriate QOL assessments for lung cancer clinical research is provided. The primary conclusion from this work is that scientifically sound investigations into the QOL of early-stage lung cancer patients are feasible and encouraged so that the care of these patients can be optimized.
Socioeconomic factors, race, and cancer treatment and survival
http://www.ncbi.nlm.nih.gov/pubmed/21264829
Cancer. 2011 Jan 24. doi: 10.1002/cncr.25854. [Epub ahead of print]
Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival: Findings from the National Longitudinal Mortality Study, 1979-2003.
Du XL, Lin CC, Johnson NJ, Altekruse S.
University of Texas School of Public Health, Division of Epidemiology, Houston, Texas. Xianglin.L.Du@uth.tmc.edu.
Abstract
BACKGROUND: This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual-level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival.
METHODS: This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥25 years, identified from the National Longitudinal Mortality Study-SEER data during 1973 to 2003. Kaplan-Meier methods and Cox regression models were used for survival analysis.
RESULTS: Three-year all-cause observed survival for cases diagnosed with local-stage cancers of the 8 leading tumors combined was ≥82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first-course cancer-directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer-specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1-1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9-1.1). HRs for all-cause mortality among patients with breast cancer and for cancer-specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics.
CONCLUSIONS: Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual-level socioeconomic factors and treatment for patients with breast and prostate cancer.
Cancer. 2011 Jan 24. doi: 10.1002/cncr.25854. [Epub ahead of print]
Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival: Findings from the National Longitudinal Mortality Study, 1979-2003.
Du XL, Lin CC, Johnson NJ, Altekruse S.
University of Texas School of Public Health, Division of Epidemiology, Houston, Texas. Xianglin.L.Du@uth.tmc.edu.
Abstract
BACKGROUND: This is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results (SEER) data to determine the effects of individual-level socioeconomic factors (health insurance, education, income, and poverty status) on racial disparities in receiving treatment and in survival.
METHODS: This study included 13,234 cases diagnosed with the 8 most common types of cancer (female breast, colorectal, prostate, lung and bronchus, uterine cervix, ovarian, melanoma, and urinary bladder) at age ≥25 years, identified from the National Longitudinal Mortality Study-SEER data during 1973 to 2003. Kaplan-Meier methods and Cox regression models were used for survival analysis.
RESULTS: Three-year all-cause observed survival for cases diagnosed with local-stage cancers of the 8 leading tumors combined was ≥82% regardless of race/ethnicity. More favorable survival was associated with higher socioeconomic status. Compared with whites, blacks were less likely to receive first-course cancer-directed surgery, perhaps reflecting a less favorable stage distribution at diagnosis. Hazard ratio (HR) for cancer-specific mortality was significantly higher among blacks compared with whites (HR, 1.2; 95% confidence interval [CI], 1.1-1.3) after adjusting for age, sex, and tumor stage, but not after further controlling for socioeconomic factors and treatment (HR, 1.0; 95% CI, 0.9-1.1). HRs for all-cause mortality among patients with breast cancer and for cancer-specific mortality in patients with prostate cancer were significantly higher for blacks compared with whites after adjusting for socioeconomic factors, treatment, and patient and tumor characteristics.
CONCLUSIONS: Favorable survival was associated with higher socioeconomic status. Racial disparities in survival persisted after adjusting for individual-level socioeconomic factors and treatment for patients with breast and prostate cancer.
Tuesday, January 25, 2011
Another obstacle to improving patient care?
http://www.ncbi.nlm.nih.gov/pubmed/21249987
Does Medical Error Disclosure Violate the Medical Malpractice Insurance Cooperation Clause?.
Banja JD.
In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.
Excerpt
Medical malpractice insurance policies customarily contain a “cooperation” clause requiring insureds to cooperate with the insurer's efforts to defend the insured against a claim. A common stipulation in this clause forbids the insured from “admitting liability” to an injured or harmed party. Health professionals often understand this clause to have a chilling effect on the truthful disclosure of medical error, which is morally required of physicians when they know that a harm-causing error has occurred. This paper offers a two-part response to the fear that medical error disclosure might result in a denial of malpractice insurance coverage. Part one describes various legal precedents wherein insurers successfully invoked the cooperation clause to deny coverage in instances of liability admission. This paper shows, however, that the legally sanctioned reasons for denying coverage in these cases address factors other than an insured's truthful and honest disclosure of what happened to a claimant. Consequently, these cases do not support the belief that legal precedents discourage the truthful disclosure of harm-causing medical errors. Part two of this paper proposes that the cooperation clause's prohibition of admission of liability in instances of medical error disclosure might well be unenforceable, and that the clause might not even be actuarially sound.
Does Medical Error Disclosure Violate the Medical Malpractice Insurance Cooperation Clause?.
Banja JD.
In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.
Excerpt
Medical malpractice insurance policies customarily contain a “cooperation” clause requiring insureds to cooperate with the insurer's efforts to defend the insured against a claim. A common stipulation in this clause forbids the insured from “admitting liability” to an injured or harmed party. Health professionals often understand this clause to have a chilling effect on the truthful disclosure of medical error, which is morally required of physicians when they know that a harm-causing error has occurred. This paper offers a two-part response to the fear that medical error disclosure might result in a denial of malpractice insurance coverage. Part one describes various legal precedents wherein insurers successfully invoked the cooperation clause to deny coverage in instances of liability admission. This paper shows, however, that the legally sanctioned reasons for denying coverage in these cases address factors other than an insured's truthful and honest disclosure of what happened to a claimant. Consequently, these cases do not support the belief that legal precedents discourage the truthful disclosure of harm-causing medical errors. Part two of this paper proposes that the cooperation clause's prohibition of admission of liability in instances of medical error disclosure might well be unenforceable, and that the clause might not even be actuarially sound.
Treating lung cancer in the elderly
http://www.ncbi.nlm.nih.gov/pubmed/21258243
J Thorac Oncol. 2011 Jan 20. [Epub ahead of print]
Treatment of the Elderly When Cure is the Goal: The Influence of Age on Treatment Selection and Efficacy for Stage III Non-small Cell Lung Cancer.
Coate LE, Massey C, Hope A, Sacher A, Barrett K, Pierre A, Leighl N, Brade A, de Perrot M, Waddell T, Liu G, Feld R, Burkes R, Cho BC, Darling G, Sun A, Keshavjee S, Bezjak A, Shepherd FA.
Departments of *Medical Oncology and Hematology, †Biostatistics, ‡Radiation Oncology, and §Thoracic Surgery, University Health Network, Princess Margaret Hospital and Toronto General Hospitals Sites and the University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Treatment of elderly patients with stage III NSCLC is controversial. Limited data exist, as the elderly are underrepresented in clinical trials.
METHODS: After ethics approval, we performed a retrospective review of 1372 stage III NSCLC patients treated at our institution during the period 1997-2007. Patients with malignant effusions and microscopic N2 discovered only postoperatively were excluded, leaving 740 who were classified by treatment plan: palliative (palliative chemotherapy or radiation [≤40 Gy]); nonsurgical multimodality (>40 Gy radiation ± chemotherapy); or surgical multimodality (chemotherapy, radiation, and surgery). Demographics, treatment, toxicity, and survival were analyzed by age, 0 to 65 years, n = 384; 66 to 75 years, n = 256; 76+ years, n = 100, and compared using log-rank, univariate, and multivariate statistical tests.
RESULTS: Patients older than 65 years were more likely to have poor performance status (p < 0.0001), multiple comorbidities (p < 0.0001), and to receive palliative therapy only (p < 0.0001). Older and younger patients treated with curative intent with nonsurgical bimodality therapy or trimodality therapy including surgery had similar rates of grade 3/4 toxicity (0-65 years, 39%; 66-75 years, 43%; 76+ years, 5%; p = 0.18) and toxic death (0-65 years, 4%; 66-75 years, 4%; 76+ years, 0%; p = 0.76). Survival was worse with increasing age (p < 0.0001), likely due to greater use of palliative treatment in the elderly. When survival was analyzed for patients treated with curative intent, there was no difference between age groups for nonsurgical (p = 0.32) or surgical (p = 0.53) therapy.
CONCLUSION: In select fit elderly patients, combined modality therapy is tolerable and is associated with survival similar to that of younger patients.
J Thorac Oncol. 2011 Jan 20. [Epub ahead of print]
Treatment of the Elderly When Cure is the Goal: The Influence of Age on Treatment Selection and Efficacy for Stage III Non-small Cell Lung Cancer.
Coate LE, Massey C, Hope A, Sacher A, Barrett K, Pierre A, Leighl N, Brade A, de Perrot M, Waddell T, Liu G, Feld R, Burkes R, Cho BC, Darling G, Sun A, Keshavjee S, Bezjak A, Shepherd FA.
Departments of *Medical Oncology and Hematology, †Biostatistics, ‡Radiation Oncology, and §Thoracic Surgery, University Health Network, Princess Margaret Hospital and Toronto General Hospitals Sites and the University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Treatment of elderly patients with stage III NSCLC is controversial. Limited data exist, as the elderly are underrepresented in clinical trials.
METHODS: After ethics approval, we performed a retrospective review of 1372 stage III NSCLC patients treated at our institution during the period 1997-2007. Patients with malignant effusions and microscopic N2 discovered only postoperatively were excluded, leaving 740 who were classified by treatment plan: palliative (palliative chemotherapy or radiation [≤40 Gy]); nonsurgical multimodality (>40 Gy radiation ± chemotherapy); or surgical multimodality (chemotherapy, radiation, and surgery). Demographics, treatment, toxicity, and survival were analyzed by age, 0 to 65 years, n = 384; 66 to 75 years, n = 256; 76+ years, n = 100, and compared using log-rank, univariate, and multivariate statistical tests.
RESULTS: Patients older than 65 years were more likely to have poor performance status (p < 0.0001), multiple comorbidities (p < 0.0001), and to receive palliative therapy only (p < 0.0001). Older and younger patients treated with curative intent with nonsurgical bimodality therapy or trimodality therapy including surgery had similar rates of grade 3/4 toxicity (0-65 years, 39%; 66-75 years, 43%; 76+ years, 5%; p = 0.18) and toxic death (0-65 years, 4%; 66-75 years, 4%; 76+ years, 0%; p = 0.76). Survival was worse with increasing age (p < 0.0001), likely due to greater use of palliative treatment in the elderly. When survival was analyzed for patients treated with curative intent, there was no difference between age groups for nonsurgical (p = 0.32) or surgical (p = 0.53) therapy.
CONCLUSION: In select fit elderly patients, combined modality therapy is tolerable and is associated with survival similar to that of younger patients.
Smoking and lung cancer recurrence in Japan
http://www.ncbi.nlm.nih.gov/pubmed/21258254
J Thorac Oncol. 2011 Jan 20. [Epub ahead of print]
The Prognostic Impact of Cigarette Smoking on Patients with Non-small Cell Lung Cancer.
Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K.
*Department of Thoracic Oncology, National Cancer Center Hospital East; and †Department of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Abstract
INTRODUCTION: The purposes of this study are to investigate the association between cigarette smoking and clinicopathological characteristics of patients with non-small cell lung cancer (NSCLC) and to evaluate its significance as a predictor of recurrence after resection.
METHODS: A total of 2295 consecutive patients with NSCLC underwent complete resection with systematic node dissection between August 1992 and December 2006 at the National Cancer Center Hospital East.
RESULTS: A statistically significant difference in the 5-year overall survival rate was observed between never and ever smokers in patients with stage I (92% and 76%, respectively, p < 0.001) NSCLC, whereas no difference was observed in stage II (57% and 52%, respectively, p = 0.739) and stage III (30% and 33%, respectively, p = 0.897). In patients with stage I NSCLC, 5-year recurrence-free proportions (RFPs) for never and ever smokers were 89% and 80%, respectively (p < 0.001). In contrast, the 5-year RFPs for never smokers were lower than those for ever smokers in stage II (44% and 60%, respectively, p = 0.049) and stage III (17% and 31%, respectively, p = 0.004). In stage I patients, significant difference in 5-year RFP was observed between never and ever smokers (89% and 83%, respectively) in patients with adenocarcinoma, but not in patients with nonadenocarcinoma (82% and 76%, respectively).
CONCLUSIONS: Smoking history showed different impact on postoperative recurrence in patients with NSCLC between stage I and stages II and III, and depending on histology in stage I patients. Disease stages should be considered while evaluating smoking history as a predictor of recurrence.
J Thorac Oncol. 2011 Jan 20. [Epub ahead of print]
The Prognostic Impact of Cigarette Smoking on Patients with Non-small Cell Lung Cancer.
Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K.
*Department of Thoracic Oncology, National Cancer Center Hospital East; and †Department of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Abstract
INTRODUCTION: The purposes of this study are to investigate the association between cigarette smoking and clinicopathological characteristics of patients with non-small cell lung cancer (NSCLC) and to evaluate its significance as a predictor of recurrence after resection.
METHODS: A total of 2295 consecutive patients with NSCLC underwent complete resection with systematic node dissection between August 1992 and December 2006 at the National Cancer Center Hospital East.
RESULTS: A statistically significant difference in the 5-year overall survival rate was observed between never and ever smokers in patients with stage I (92% and 76%, respectively, p < 0.001) NSCLC, whereas no difference was observed in stage II (57% and 52%, respectively, p = 0.739) and stage III (30% and 33%, respectively, p = 0.897). In patients with stage I NSCLC, 5-year recurrence-free proportions (RFPs) for never and ever smokers were 89% and 80%, respectively (p < 0.001). In contrast, the 5-year RFPs for never smokers were lower than those for ever smokers in stage II (44% and 60%, respectively, p = 0.049) and stage III (17% and 31%, respectively, p = 0.004). In stage I patients, significant difference in 5-year RFP was observed between never and ever smokers (89% and 83%, respectively) in patients with adenocarcinoma, but not in patients with nonadenocarcinoma (82% and 76%, respectively).
CONCLUSIONS: Smoking history showed different impact on postoperative recurrence in patients with NSCLC between stage I and stages II and III, and depending on histology in stage I patients. Disease stages should be considered while evaluating smoking history as a predictor of recurrence.
TAZ and lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/21258416
Oncogene. 2011 Jan 24. [Epub ahead of print]
TAZ is a novel oncogene in non-small cell lung cancer.
Zhou Z, Hao Y, Liu N, Raptis L, Tsao MS, Yang X.
Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.
Abstract
Transcriptional coactivator with PDZ-binding motif (TAZ) is a transcriptional coactivator involved in the differentiation of stem cell as well as the development of multiple organs. Recently, TAZ has also been identified as a major component of the novel Hippo-LATS tumor suppressor pathway and to function as an oncogene in breast cancer. We show for the first time that TAZ is an oncogene in non-small cell lung cancer (NSCLC). Our results show that TAZ is overexpressed in NSCLC cells and that lentivirus-mediated overexpression of TAZ in HBE135 immortalized human bronchial epithelial cells causes increased cell proliferation and transformation, which can be restored back to its original levels by knockdown of TAZ. In addition, short-hairpin RNA (shRNA)-mediated knockdown of TAZ expression in NSCLC cells suppresses their proliferation and anchorage-independent growth in vitro, and tumor growth in mice in vivo, which can be reversed by re-introduction of shRNA-resistant TAZ into TAZ-knockdown NSCLC cells. These results indicate that TAZ is an oncogene and has an important role in tumorigenicity of NSCLC cells. Therefore, TAZ may present a novel target for the future diagnosis, prognosis and therapy of lung cancer.
Oncogene. 2011 Jan 24. [Epub ahead of print]
TAZ is a novel oncogene in non-small cell lung cancer.
Zhou Z, Hao Y, Liu N, Raptis L, Tsao MS, Yang X.
Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada.
Abstract
Transcriptional coactivator with PDZ-binding motif (TAZ) is a transcriptional coactivator involved in the differentiation of stem cell as well as the development of multiple organs. Recently, TAZ has also been identified as a major component of the novel Hippo-LATS tumor suppressor pathway and to function as an oncogene in breast cancer. We show for the first time that TAZ is an oncogene in non-small cell lung cancer (NSCLC). Our results show that TAZ is overexpressed in NSCLC cells and that lentivirus-mediated overexpression of TAZ in HBE135 immortalized human bronchial epithelial cells causes increased cell proliferation and transformation, which can be restored back to its original levels by knockdown of TAZ. In addition, short-hairpin RNA (shRNA)-mediated knockdown of TAZ expression in NSCLC cells suppresses their proliferation and anchorage-independent growth in vitro, and tumor growth in mice in vivo, which can be reversed by re-introduction of shRNA-resistant TAZ into TAZ-knockdown NSCLC cells. These results indicate that TAZ is an oncogene and has an important role in tumorigenicity of NSCLC cells. Therefore, TAZ may present a novel target for the future diagnosis, prognosis and therapy of lung cancer.
Mor Baan in Southern Thailand
http://www.ncbi.nlm.nih.gov/pubmed/21259036
J Community Health. 2011 Jan 23. [Epub ahead of print]
Existing Roles of Traditional Healers (mor baan) in Southern Thailand.
Suwankhong D, Liamputtong P, Rumbold B.
School of Public Health, La Trobe University, Bundoora, VIC, 3086, Australia.
Abstract
Traditional healers ( mor baan ) played an important role in Thai health long before the introduction of Western medicine. Although modern health professional play a key role of health care provider of Thai health care system, traditional healers and their practice still exist in most rural areas of Thailand. In this article, we address the roles and practices of traditional healers in southern Thailand. An ethnographic method was employed. This approach is the hallmark method used to describe the role and the practice of traditional healers and to grasp in-depth understanding of their everyday life. Participation observation and unstructured interview with 18 traditional healers were conducted. Thematic analysis method was used to analyse the data. Most of the traditional healers chose their role because they were influenced by their ancestors, although a few others chose it because of individual interests and a desire to help ill people. All are trained in multiple skills, using supernatural spirits, ceremonies and natural plant products as resources for counteracting various health problems. They refer patients to modern hospitals or other healers if they cannot adequately manage illness themselves. Their service provision is flexible and based on a holistic approach that suits people's lifestyles and needs. The role of traditional healer tends not to attract the interest of younger generations, although traditional healers have contributed greatly to people's health. Their presence improves people's access to healthcare and offers an alternative to modern medicine, which often has a limited role. We conclude that the services of traditional healers should be incorporated into contemporary healthcare provision of Thai health care system.
J Community Health. 2011 Jan 23. [Epub ahead of print]
Existing Roles of Traditional Healers (mor baan) in Southern Thailand.
Suwankhong D, Liamputtong P, Rumbold B.
School of Public Health, La Trobe University, Bundoora, VIC, 3086, Australia.
Abstract
Traditional healers ( mor baan ) played an important role in Thai health long before the introduction of Western medicine. Although modern health professional play a key role of health care provider of Thai health care system, traditional healers and their practice still exist in most rural areas of Thailand. In this article, we address the roles and practices of traditional healers in southern Thailand. An ethnographic method was employed. This approach is the hallmark method used to describe the role and the practice of traditional healers and to grasp in-depth understanding of their everyday life. Participation observation and unstructured interview with 18 traditional healers were conducted. Thematic analysis method was used to analyse the data. Most of the traditional healers chose their role because they were influenced by their ancestors, although a few others chose it because of individual interests and a desire to help ill people. All are trained in multiple skills, using supernatural spirits, ceremonies and natural plant products as resources for counteracting various health problems. They refer patients to modern hospitals or other healers if they cannot adequately manage illness themselves. Their service provision is flexible and based on a holistic approach that suits people's lifestyles and needs. The role of traditional healer tends not to attract the interest of younger generations, although traditional healers have contributed greatly to people's health. Their presence improves people's access to healthcare and offers an alternative to modern medicine, which often has a limited role. We conclude that the services of traditional healers should be incorporated into contemporary healthcare provision of Thai health care system.
From Harvard: Direct to consumer advertising and cancer
http://www.ncbi.nlm.nih.gov/pubmed/21258398
Nat Rev Cancer. 2011 Feb;11(2):142-50.
Cancer-related direct-to-consumer advertising: a critical review.
Kontos EZ, Viswanath K.
Lung Cancer Disparities Center, Harvard University, School of Public Health Department of Society, Human Development and Health, 401 Park Drive, Room 403F, Boston MA 02215, USA.
Abstract
The direct-to-consumer advertising (DTCA) phenomenon has received attention because of its attempt to reach out to consumers by bypassing important gatekeepers such as physicians. The emergence of new information platforms and the introduction of genetic tests directly to the consumer have heightened the concern with DTCA and its potential consequences. These effects of DTCA are particularly important given the communication inequalities among social groups, with class, race and ethnicity influencing how people access, seek, process and act on information. This Science and Society article reviews the major issues regarding general and cancer-related DTCA and also offers data from a national survey in the United States as an example of the communication inequalities in genetic testing awareness.
Nat Rev Cancer. 2011 Feb;11(2):142-50.
Cancer-related direct-to-consumer advertising: a critical review.
Kontos EZ, Viswanath K.
Lung Cancer Disparities Center, Harvard University, School of Public Health Department of Society, Human Development and Health, 401 Park Drive, Room 403F, Boston MA 02215, USA.
Abstract
The direct-to-consumer advertising (DTCA) phenomenon has received attention because of its attempt to reach out to consumers by bypassing important gatekeepers such as physicians. The emergence of new information platforms and the introduction of genetic tests directly to the consumer have heightened the concern with DTCA and its potential consequences. These effects of DTCA are particularly important given the communication inequalities among social groups, with class, race and ethnicity influencing how people access, seek, process and act on information. This Science and Society article reviews the major issues regarding general and cancer-related DTCA and also offers data from a national survey in the United States as an example of the communication inequalities in genetic testing awareness.
From NIOSH: Occupational lung cancer in women
http://www.ncbi.nlm.nih.gov/pubmed/21259296
Am J Ind Med. 2011 Feb;54(2):102-17. doi: 10.1002/ajim.20905. Epub 2010 Oct 28.
Occupational lung cancer in US women, 1984-1998.
Robinson CF, Sullivan PA, Li J, Walker JT.
Surveillance Branch, Division of Surveillance, Hazard Evaluations, and Field Studies, The National Institute for Occupational Safety and Health, Cincinnati, Ohio. CFRobinson@cdc.gov.
Abstract
BACKGROUND: Lung cancer is the leading cause of cancer death in US women, accounting for 72,130 deaths in 2006. In addition to smoking cessation, further reduction of the burden of lung cancer mortality can be made by preventing exposure to occupational lung carcinogens. Data for occupational exposures and health outcomes of US working women are limited.
METHODS: Population-based mortality data for 4,570,711 women who died between 1984 and 1998 in 27 US States were used to evaluate lung cancer proportionate mortality over time by the usual occupation and industry reported on death certificates. Lung cancer proportionate mortality ratios were adjusted for smoking, using data from the National Health Interview Survey (NHIS) and the American Cancer Society's Cancer Prevention Study II.
RESULTS: Analyses revealed that 194,382 white, 18,225 Black and 1,515 Hispanic women died 1984-1998 with lung cancer reported as the underlying cause of death. Following adjustment for smoking, significant excess proportionate lung cancer mortality was observed among US women working in the US manufacturing; transportation; retail trade; agriculture, forestry, and fishing; and nursing/personal care industries. Women employed in precision production, technical, managerial, professional specialty, and administrative occupations experienced some of the highest significantly excess proportionate lung cancer mortality during 1984-1998.
CONCLUSIONS: The results of our study point to significantly elevated risks for lung cancer after adjustment for smoking among women in several occupations and industries. Because 6-17% of lung cancer in US males is attributable to known exposures to occupational carcinogens, and since synergistic interactions between cigarette smoke and other occupational lung carcinogens have been noted, it is important to continue research into the effects of occupational exposures on working men and women.
Am J Ind Med. 2011 Feb;54(2):102-17. doi: 10.1002/ajim.20905. Epub 2010 Oct 28.
Occupational lung cancer in US women, 1984-1998.
Robinson CF, Sullivan PA, Li J, Walker JT.
Surveillance Branch, Division of Surveillance, Hazard Evaluations, and Field Studies, The National Institute for Occupational Safety and Health, Cincinnati, Ohio. CFRobinson@cdc.gov.
Abstract
BACKGROUND: Lung cancer is the leading cause of cancer death in US women, accounting for 72,130 deaths in 2006. In addition to smoking cessation, further reduction of the burden of lung cancer mortality can be made by preventing exposure to occupational lung carcinogens. Data for occupational exposures and health outcomes of US working women are limited.
METHODS: Population-based mortality data for 4,570,711 women who died between 1984 and 1998 in 27 US States were used to evaluate lung cancer proportionate mortality over time by the usual occupation and industry reported on death certificates. Lung cancer proportionate mortality ratios were adjusted for smoking, using data from the National Health Interview Survey (NHIS) and the American Cancer Society's Cancer Prevention Study II.
RESULTS: Analyses revealed that 194,382 white, 18,225 Black and 1,515 Hispanic women died 1984-1998 with lung cancer reported as the underlying cause of death. Following adjustment for smoking, significant excess proportionate lung cancer mortality was observed among US women working in the US manufacturing; transportation; retail trade; agriculture, forestry, and fishing; and nursing/personal care industries. Women employed in precision production, technical, managerial, professional specialty, and administrative occupations experienced some of the highest significantly excess proportionate lung cancer mortality during 1984-1998.
CONCLUSIONS: The results of our study point to significantly elevated risks for lung cancer after adjustment for smoking among women in several occupations and industries. Because 6-17% of lung cancer in US males is attributable to known exposures to occupational carcinogens, and since synergistic interactions between cigarette smoke and other occupational lung carcinogens have been noted, it is important to continue research into the effects of occupational exposures on working men and women.
Sunday, January 23, 2011
Cystic fibrosis: Liver disease and biopsy
http://www.ncbi.nlm.nih.gov/pubmed/21254170
Hepatology. 2011 Jan;53(1):193-201. doi: 10.1002/hep.24014. Epub 2010 Nov 17.
Importance of hepatic fibrosis in cystic fibrosis and the predictive value of liver biopsy.
Lewindon PJ, Shepherd RW, Walsh MJ, Greer RM, Williamson R, Pereira TN, Frawley K, Bell SC, Smith JL, Ramm GA.
Gastroenterology, Royal Children's Hospital, Brisbane, Queensland, Australia; Hepatic Fibrosis Group, Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
Abstract
Cystic fibrosis liver disease (CFLD), which results from progressive hepatobiliary fibrosis, is an important cause of morbidity and mortality, but it is difficult to identify before portal hypertension (PHT) ensues. Clinical signs, serum alanine aminotransferase (ALT) levels, and ultrasound (US) are widely applied, but their value in predicting the presence of cirrhosis, the development of PHT, or adverse outcomes is undetermined. The potential gold standard, liver biopsy, is not standard practice and, notwithstanding sampling error considerations, has not been systematically evaluated. Forty patients with cystic fibrosis (median age = 10.6 years) with abnormal clinical, biochemical, and US findings were subjected to dual-pass percutaneous liver biopsy. Clinical outcomes were recorded over 12 years of follow-up (median = 9.5 years for survivors). Logistic regression and receiver operating characteristic analyses were applied to predict hepatic fibrosis (which was assessed by fibrosis staging and quantitative immunohistochemistry) and the occurrence of PHT. PHT occurred in 17 of 40 patients (42%), including 6 of 7 (17%) who died during follow-up. Clinical examination, serum ALT levels, and US findings failed to predict either the presence of liver fibrosis or the development of PHT. Fibrosis staging on liver biopsy, where the accuracy was improved by dual passes (P = 0.002, nonconcordance = 38%), predicted the development of PHT (P < 0.001), which occurred more frequently and at a younger age in those with severe fibrosis. Conclusion: Clinical modalities currently employed to evaluate suspected CFLD help to identify a cohort of children at risk for liver disease and adverse outcomes but do not predict an individual's risk of liver fibrosis or PHT development. Liver fibrosis on biopsy predicts the development of clinically significant liver disease. Dual passes help to address sampling concerns. Liver biopsy has a relevant role in the management of patients with suspected CFLD and deserves more widespread application.
Hepatology. 2011 Jan;53(1):193-201. doi: 10.1002/hep.24014. Epub 2010 Nov 17.
Importance of hepatic fibrosis in cystic fibrosis and the predictive value of liver biopsy.
Lewindon PJ, Shepherd RW, Walsh MJ, Greer RM, Williamson R, Pereira TN, Frawley K, Bell SC, Smith JL, Ramm GA.
Gastroenterology, Royal Children's Hospital, Brisbane, Queensland, Australia; Hepatic Fibrosis Group, Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
Abstract
Cystic fibrosis liver disease (CFLD), which results from progressive hepatobiliary fibrosis, is an important cause of morbidity and mortality, but it is difficult to identify before portal hypertension (PHT) ensues. Clinical signs, serum alanine aminotransferase (ALT) levels, and ultrasound (US) are widely applied, but their value in predicting the presence of cirrhosis, the development of PHT, or adverse outcomes is undetermined. The potential gold standard, liver biopsy, is not standard practice and, notwithstanding sampling error considerations, has not been systematically evaluated. Forty patients with cystic fibrosis (median age = 10.6 years) with abnormal clinical, biochemical, and US findings were subjected to dual-pass percutaneous liver biopsy. Clinical outcomes were recorded over 12 years of follow-up (median = 9.5 years for survivors). Logistic regression and receiver operating characteristic analyses were applied to predict hepatic fibrosis (which was assessed by fibrosis staging and quantitative immunohistochemistry) and the occurrence of PHT. PHT occurred in 17 of 40 patients (42%), including 6 of 7 (17%) who died during follow-up. Clinical examination, serum ALT levels, and US findings failed to predict either the presence of liver fibrosis or the development of PHT. Fibrosis staging on liver biopsy, where the accuracy was improved by dual passes (P = 0.002, nonconcordance = 38%), predicted the development of PHT (P < 0.001), which occurred more frequently and at a younger age in those with severe fibrosis. Conclusion: Clinical modalities currently employed to evaluate suspected CFLD help to identify a cohort of children at risk for liver disease and adverse outcomes but do not predict an individual's risk of liver fibrosis or PHT development. Liver fibrosis on biopsy predicts the development of clinically significant liver disease. Dual passes help to address sampling concerns. Liver biopsy has a relevant role in the management of patients with suspected CFLD and deserves more widespread application.
JAMA: Physician choice. Worth bothering with?
http://www.ncbi.nlm.nih.gov/pubmed/21224462
JAMA. 2011 Jan 12;305(2):195-6.
Is choice of physician and hospital an essential benefit?
Brook RH.
RAND Corporation, PO Box 2138, Santa Monica, CA 90407, USA. robert_brook@rand.org
PMID: 21224462 [PubMed - indexed for MEDLINE]
JAMA. 2011 Jan 12;305(2):195-6.
Is choice of physician and hospital an essential benefit?
Brook RH.
RAND Corporation, PO Box 2138, Santa Monica, CA 90407, USA. robert_brook@rand.org
PMID: 21224462 [PubMed - indexed for MEDLINE]
From Howard Brody and colleague: Possible med mal reforms
http://www.ncbi.nlm.nih.gov/pubmed/21246303
J Gen Intern Med. 2011 Jan 19. [Epub ahead of print]
Professionally Responsible Malpractice Reform.
Brody H, Hermer LD.
Institute for the Medical Humanities, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1311, USA, habrody@utmb.edu.
Abstract
Medical malpractice reform is both necessary and desirable, yet certain types of reform are clearly preferable to others. We argue that "traditional" tort reform remedies such as stringent damage caps not only fail to address the root causes of negligence and the adverse effects that fear of suit can have on physicians, but also fail to address the needs of patients. Physicians ought to view themselves as professionals who are dedicated to putting patients' interests ahead of their own. Professionally responsible malpractice reform should therefore be at least as patient-centered as it is physician-centered. Examples of more professionally responsible malpractice reform exist where institutions take a pro-active approach to identification, investigation, and remediation of possible malpractice. Such programs should be implemented more generally, and state laws enacted to facilitate them.
J Gen Intern Med. 2011 Jan 19. [Epub ahead of print]
Professionally Responsible Malpractice Reform.
Brody H, Hermer LD.
Institute for the Medical Humanities, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1311, USA, habrody@utmb.edu.
Abstract
Medical malpractice reform is both necessary and desirable, yet certain types of reform are clearly preferable to others. We argue that "traditional" tort reform remedies such as stringent damage caps not only fail to address the root causes of negligence and the adverse effects that fear of suit can have on physicians, but also fail to address the needs of patients. Physicians ought to view themselves as professionals who are dedicated to putting patients' interests ahead of their own. Professionally responsible malpractice reform should therefore be at least as patient-centered as it is physician-centered. Examples of more professionally responsible malpractice reform exist where institutions take a pro-active approach to identification, investigation, and remediation of possible malpractice. Such programs should be implemented more generally, and state laws enacted to facilitate them.
Medical malpractice: Educating residents
http://www.ncbi.nlm.nih.gov/pubmed/21248606
Acad Med. 2011 Jan 18. [Epub ahead of print]
Perspective: Malpractice in an Academic Medical Center: A Frequently Overlooked Aspect of Professionalism Education.
Hochberg MS, Seib CD, Berman RS, Kalet AL, Zabar SR, Pachter HL.
Dr. Hochberg is professor and vice chairman of surgery, New York University School of Medicine, New York, New York. Dr. Seib is a resident in surgery, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Berman is associate professor of surgery and surgical residency program director, New York University School of Medicine, New York, New York. Dr. Kalet is associate professor of medicine and surgery, New York University School of Medicine, New York, New York. Dr. Zabar is associate professor of medicine, New York University School of Medicine, New York, New York. Dr. Pachter is professor and chairman of surgery, New York University School of Medicine, New York, New York.
Abstract
Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician's career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents' understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention.
Acad Med. 2011 Jan 18. [Epub ahead of print]
Perspective: Malpractice in an Academic Medical Center: A Frequently Overlooked Aspect of Professionalism Education.
Hochberg MS, Seib CD, Berman RS, Kalet AL, Zabar SR, Pachter HL.
Dr. Hochberg is professor and vice chairman of surgery, New York University School of Medicine, New York, New York. Dr. Seib is a resident in surgery, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. Berman is associate professor of surgery and surgical residency program director, New York University School of Medicine, New York, New York. Dr. Kalet is associate professor of medicine and surgery, New York University School of Medicine, New York, New York. Dr. Zabar is associate professor of medicine, New York University School of Medicine, New York, New York. Dr. Pachter is professor and chairman of surgery, New York University School of Medicine, New York, New York.
Abstract
Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician's career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents' understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention.
Obstetrics and fear of litigation
http://www.ncbi.nlm.nih.gov/pubmed/21249618
Am J Perinatol. 2011 Jan 19. [Epub ahead of print]
Effect of Fear of Litigation on Obstetric Care: A Nationwide Analysis on Obstetric Practice.
Zwecker P, Azoulay L, Abenhaim HA.
Department of Family Medicine, Saint-Mary's Hospital, McGill University, Québec, Canada.
Abstract
The aim of our study was to investigate the influence of malpractice premiums paid by obstetricians on obstetric care across the United States. We conducted a retrospective cross-sectional population-based study using patient-level data obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample on every woman who delivered in 2006. Mode of delivery was compared with the average state medical liability insurance premium paid by obstetricians (Medical Liability Monitor and the National Association of Insurance Commissioners) using a generalized estimating equation to calculate crude and adjusted odds ratios. Our cohort included 890,266 women who delivered across 37 states in 2006. Average state malpractice premium of over $100,000 was associated with higher incidences of total cesarean deliveries (odds ratio [OR] 1.17, 95% confidence interval [CI]: 1.02, 1.35); lower incidences of vaginal births after cesarean deliveries (OR 0.60, 95% CI: 0.37, 0.98); and lower rates of instrumental deliveries (OR 0.72, 95% CI: 0.63, 0.83) compared with when the average state malpractice premium was less than $50,000. Fear of litigation appears to have a marked effect on obstetric practice, particularly total cesarean delivery, vaginal birth after cesarean, and instrumental delivery, when malpractice premiums rise above $100,000 per annum.
Am J Perinatol. 2011 Jan 19. [Epub ahead of print]
Effect of Fear of Litigation on Obstetric Care: A Nationwide Analysis on Obstetric Practice.
Zwecker P, Azoulay L, Abenhaim HA.
Department of Family Medicine, Saint-Mary's Hospital, McGill University, Québec, Canada.
Abstract
The aim of our study was to investigate the influence of malpractice premiums paid by obstetricians on obstetric care across the United States. We conducted a retrospective cross-sectional population-based study using patient-level data obtained from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample on every woman who delivered in 2006. Mode of delivery was compared with the average state medical liability insurance premium paid by obstetricians (Medical Liability Monitor and the National Association of Insurance Commissioners) using a generalized estimating equation to calculate crude and adjusted odds ratios. Our cohort included 890,266 women who delivered across 37 states in 2006. Average state malpractice premium of over $100,000 was associated with higher incidences of total cesarean deliveries (odds ratio [OR] 1.17, 95% confidence interval [CI]: 1.02, 1.35); lower incidences of vaginal births after cesarean deliveries (OR 0.60, 95% CI: 0.37, 0.98); and lower rates of instrumental deliveries (OR 0.72, 95% CI: 0.63, 0.83) compared with when the average state malpractice premium was less than $50,000. Fear of litigation appears to have a marked effect on obstetric practice, particularly total cesarean delivery, vaginal birth after cesarean, and instrumental delivery, when malpractice premiums rise above $100,000 per annum.
From Bryan Liang and colleagues: Legal implications of "electronic signatures"
http://www.ncbi.nlm.nih.gov/pubmed/21249995
Looking for Trouble in All the Right Places: The Legal Implications Associated with “Electronic Signatures” and High-risk Clinical Situations.
Escobar GJ, Folck BF, Gardner MN, Ma J, Palmer LI, Liang B, Nozick LK.
In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.
Excerpt
Background: Voluntary reporting systems identify only a fraction of medical errors. Electronic identification mechanisms, which are more efficient, have been defined for adverse drug events. However, similar systems are lacking for other types of errors. Objective: The investigators sought to define probabilistic strategies that could support quality improvement and medical error detection by decreasing the need for unselected manual chart review. Design: Combinations of administrative data and laboratory test results (“electronic signatures”) were employed to identify discrete, high-risk clinical situations among health plan members of a large managed care organization. The design used was a retrospective cohort study linking hospitalization records, outpatient records, and laboratory results that were formatted using approaches developed for physiologic severity scoring. The original outcomes of interest for the study were clinical situations (e.g., birth injuries or delayed diagnosis of myocardial infarction) that have a strong association with human error. Results: When presented with preliminary results, senior leaders in the investigators' parent organizations raised a number of objections to any public presentation or publication of the results. Because of these objections, the quantitative results presented in this report focus on rapid detection of one outcome—prolonged neonatal assisted ventilation—that has a weak association with human error. Using recursive partitioning, the investigators were able to define subsets of newborns for whom the frequency of the outcome of interest was substantially higher than in the general population (1 percent). For example, an electronic signature identified a subset of infants (comprising 4 percent of the birth cohort) in which the outcome of interest occurred in 22 percent of the newborns. Conclusions: Use of probabilistic electronic strategies could yield significant benefits in medical error research as well as major operational improvements in medical error detection and reporting, quality assurance, and quality improvement. However, three barriers are likely to limit the use of such “electronic signatures”—fear of malpractice litigation, fear of lawsuits invoking “enterprise liability,” and high development costs. Entities most likely to benefit from these approaches are those with a critical mass of experienced personnel, a circumstance that can spread the development costs over a large number of hospitals and/or clinics.
Looking for Trouble in All the Right Places: The Legal Implications Associated with “Electronic Signatures” and High-risk Clinical Situations.
Escobar GJ, Folck BF, Gardner MN, Ma J, Palmer LI, Liang B, Nozick LK.
In: Henriksen K, Battles JB, Marks ES, Lewin DI, editors. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
Advances in Patient Safety.
Excerpt
Background: Voluntary reporting systems identify only a fraction of medical errors. Electronic identification mechanisms, which are more efficient, have been defined for adverse drug events. However, similar systems are lacking for other types of errors. Objective: The investigators sought to define probabilistic strategies that could support quality improvement and medical error detection by decreasing the need for unselected manual chart review. Design: Combinations of administrative data and laboratory test results (“electronic signatures”) were employed to identify discrete, high-risk clinical situations among health plan members of a large managed care organization. The design used was a retrospective cohort study linking hospitalization records, outpatient records, and laboratory results that were formatted using approaches developed for physiologic severity scoring. The original outcomes of interest for the study were clinical situations (e.g., birth injuries or delayed diagnosis of myocardial infarction) that have a strong association with human error. Results: When presented with preliminary results, senior leaders in the investigators' parent organizations raised a number of objections to any public presentation or publication of the results. Because of these objections, the quantitative results presented in this report focus on rapid detection of one outcome—prolonged neonatal assisted ventilation—that has a weak association with human error. Using recursive partitioning, the investigators were able to define subsets of newborns for whom the frequency of the outcome of interest was substantially higher than in the general population (1 percent). For example, an electronic signature identified a subset of infants (comprising 4 percent of the birth cohort) in which the outcome of interest occurred in 22 percent of the newborns. Conclusions: Use of probabilistic electronic strategies could yield significant benefits in medical error research as well as major operational improvements in medical error detection and reporting, quality assurance, and quality improvement. However, three barriers are likely to limit the use of such “electronic signatures”—fear of malpractice litigation, fear of lawsuits invoking “enterprise liability,” and high development costs. Entities most likely to benefit from these approaches are those with a critical mass of experienced personnel, a circumstance that can spread the development costs over a large number of hospitals and/or clinics.
The 1935-1936 National Health Survey
http://www.ncbi.nlm.nih.gov/pubmed/21233434
Am J Public Health. 2011 Jan 13. [Epub ahead of print]
Epidemiology and Health Care Reform: The National Health Survey of 1935-1936.
Weisz G.
McGill University.
Abstract
The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens. (Am J Public Health. 2010;101(3):XXX-XXX. doi:10.2105/AJPH.2010.196519.).
Am J Public Health. 2011 Jan 13. [Epub ahead of print]
Epidemiology and Health Care Reform: The National Health Survey of 1935-1936.
Weisz G.
McGill University.
Abstract
The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens. (Am J Public Health. 2010;101(3):XXX-XXX. doi:10.2105/AJPH.2010.196519.).
Doughnuts? Donuts?
http://www.ncbi.nlm.nih.gov/pubmed/21247308
N Engl J Med. 2011 Jan 19. [Epub ahead of print]
Time to Fill the Doughnuts - Health Care Reform and Medicare Part D.
Shrank WH, Choudhry NK.
From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
Abstract
The passage of the Affordable Care Act (ACA) in March 2010 promised to put an end to the "doughnut hole," the gap in prescription-drug coverage that is the most controversial component of the Medicare Part D benefit.(1) Several months ago, seniors who had reached the spending threshold that marked the beginning of their doughnut hole began to receive their $250 rebate checks. Incrementally between now and 2020, the coverage gap will be filled with subsidies from manufacturers of brand-name drugs and from the federal government. Thus, the ACA, like Part D itself, has expanded coverage for prescription medications - but . . .
N Engl J Med. 2011 Jan 19. [Epub ahead of print]
Time to Fill the Doughnuts - Health Care Reform and Medicare Part D.
Shrank WH, Choudhry NK.
From the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
Abstract
The passage of the Affordable Care Act (ACA) in March 2010 promised to put an end to the "doughnut hole," the gap in prescription-drug coverage that is the most controversial component of the Medicare Part D benefit.(1) Several months ago, seniors who had reached the spending threshold that marked the beginning of their doughnut hole began to receive their $250 rebate checks. Incrementally between now and 2020, the coverage gap will be filled with subsidies from manufacturers of brand-name drugs and from the federal government. Thus, the ACA, like Part D itself, has expanded coverage for prescription medications - but . . .
"Aftercare" in the UK
http://www.ncbi.nlm.nih.gov/pubmed/21253881
J Cancer Surviv. 2011 Jan 21. [Epub ahead of print]
Towards a personalised approach to aftercare: a review of cancer follow-up in the UK.
Davies NJ, Batehup L.
National Cancer Survivorship Initiative, Self-Management Workstream, Macmillan Cancer Support, London, England, NDavies@macmillan.org.uk.
Abstract
INTRODUCTION: Due to growth in cancer survivorship and subsequent resource limitations, the current UK position of follow-up services is unsustainable. With people living longer after a cancer diagnosis, supported self-management for ongoing treatment-related chronic conditions is a fundamental component of aftercare services. Alternative models to traditional hospital aftercare require consideration in terms of clinical effectiveness and cost-effectiveness.
METHODS: 'Evidence to Inform the Cancer Reform Strategy: The Clinical Effectiveness of Follow-Up Services after Treatment for Cancer' (Centre for Reviews and Dissemination 2007) has been updated using a number of quality-controlled databases. Correspondence with experts was also sought to identify current initiatives.
RESULT: The review highlights a shift towards patient empowerment via individualised and group education programmes aimed at increasing survivor's ability to better manage their condition and the effects of treatment, allowing for self-referral or rapid access to health services when needed. The role of specialist nurses as key facilitators of supportive aftercare is emphasised, as is a move towards technology-based aftercare in the form of telephone or web-based services.
CONCLUSIONS: The challenge will be replacing traditional clinic follow-up with alternative methods in a cost-effective way that is either as equally effective, or more so. To establish this, more rigorous trials are needed, with larger sample sizes and longer follow-up assessments. IMPLICATIONS FOR CANCER SURVIVORS: Increasing patient confidence to initiate follow-up specific to their needs is likely to increase the workload of primary care providers, who will need training for this.
J Cancer Surviv. 2011 Jan 21. [Epub ahead of print]
Towards a personalised approach to aftercare: a review of cancer follow-up in the UK.
Davies NJ, Batehup L.
National Cancer Survivorship Initiative, Self-Management Workstream, Macmillan Cancer Support, London, England, NDavies@macmillan.org.uk.
Abstract
INTRODUCTION: Due to growth in cancer survivorship and subsequent resource limitations, the current UK position of follow-up services is unsustainable. With people living longer after a cancer diagnosis, supported self-management for ongoing treatment-related chronic conditions is a fundamental component of aftercare services. Alternative models to traditional hospital aftercare require consideration in terms of clinical effectiveness and cost-effectiveness.
METHODS: 'Evidence to Inform the Cancer Reform Strategy: The Clinical Effectiveness of Follow-Up Services after Treatment for Cancer' (Centre for Reviews and Dissemination 2007) has been updated using a number of quality-controlled databases. Correspondence with experts was also sought to identify current initiatives.
RESULT: The review highlights a shift towards patient empowerment via individualised and group education programmes aimed at increasing survivor's ability to better manage their condition and the effects of treatment, allowing for self-referral or rapid access to health services when needed. The role of specialist nurses as key facilitators of supportive aftercare is emphasised, as is a move towards technology-based aftercare in the form of telephone or web-based services.
CONCLUSIONS: The challenge will be replacing traditional clinic follow-up with alternative methods in a cost-effective way that is either as equally effective, or more so. To establish this, more rigorous trials are needed, with larger sample sizes and longer follow-up assessments. IMPLICATIONS FOR CANCER SURVIVORS: Increasing patient confidence to initiate follow-up specific to their needs is likely to increase the workload of primary care providers, who will need training for this.
Lung cancer histologic type--impact on clinical trials of advanced lung cancers
http://www.ncbi.nlm.nih.gov/pubmed/21252724
J Thorac Oncol. 2011 Feb;6(2):405.
Histologic Type Definition in Clinical Trials on Advanced Non-small Cell Lung Cancer.
Rossi G, Cavazza A.
Section of Pathologic Anatomy, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy (Rossi) Operative Unit of Pathology, Azienda Ospedaliera St. Maria Nuova, Reggio Emilia, Italy (Cavazza)
J Thorac Oncol. 2011 Feb;6(2):405.
Histologic Type Definition in Clinical Trials on Advanced Non-small Cell Lung Cancer.
Rossi G, Cavazza A.
Section of Pathologic Anatomy, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy (Rossi) Operative Unit of Pathology, Azienda Ospedaliera St. Maria Nuova, Reggio Emilia, Italy (Cavazza)
From Psychooncology--Predictors of finding benefit after lung cancer diagnosis
http://www.ncbi.nlm.nih.gov/pubmed/21254308
Psychooncology. 2011 Jan 20. doi: 10.1002/pon.1904. [Epub ahead of print]
Predictors of finding benefit after lung cancer diagnosis.
Thornton AA, Owen JE, Kernstine K, Koczywas M, Grannis F, Cristea M, Reckamp K, Stanton AL.
Divisions of Psychology and Behavioral Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Los Angeles, CA, USA. athornton@mednet.ucla.edu.
Abstract
Objective: We examined benefit finding in patients with lung cancer, including level of benefit finding and change in benefit finding over time, and tested a predictive model postulating that greater impact of and engagement with the stressor promotes benefit finding. Methods: Patients diagnosed with a primary lung cancer within the past 6 months (M=16 weeks post-diagnosis) completed measures of benefit finding, cancer-related intrusions, perceived stressfulness, coping, and demographic and medical information at study entry (T1; n = 118) and 3 months later (T2; n = 79). Results: Level of benefit finding at both assessments was to a 'mild-to-moderate degree'. Benefit finding increased over time for patients with small cell carcinoma, but not for those with nonsmall cell carcinoma. The proposed model explained 33% of the variance in T1 benefit finding, and 64% (using T1 coping measures) and 71% (using T2 coping measures) of the variance in T2 benefit finding. Greater benefit finding was associated with having small cell lung cancer, higher cancer-related intrusions, lower perceived cancer-related stress, and greater approach-oriented coping. Positive reframing coping emerged as the single unique approach-oriented coping scale predicting benefit finding at T1, and emotional approach coping was the single unique approach-oriented coping scale predicting benefit finding at T2. Conclusion: Findings provide general support for a theoretical model positing that stressor impact and engagement with the stressor contribute to the development of benefit finding after cancer. Future research with larger, more diverse samples is needed to confirm and extend these findings.
Psychooncology. 2011 Jan 20. doi: 10.1002/pon.1904. [Epub ahead of print]
Predictors of finding benefit after lung cancer diagnosis.
Thornton AA, Owen JE, Kernstine K, Koczywas M, Grannis F, Cristea M, Reckamp K, Stanton AL.
Divisions of Psychology and Behavioral Oncology, City of Hope Comprehensive Cancer Center and Beckman Research Institute, Los Angeles, CA, USA. athornton@mednet.ucla.edu.
Abstract
Objective: We examined benefit finding in patients with lung cancer, including level of benefit finding and change in benefit finding over time, and tested a predictive model postulating that greater impact of and engagement with the stressor promotes benefit finding. Methods: Patients diagnosed with a primary lung cancer within the past 6 months (M=16 weeks post-diagnosis) completed measures of benefit finding, cancer-related intrusions, perceived stressfulness, coping, and demographic and medical information at study entry (T1; n = 118) and 3 months later (T2; n = 79). Results: Level of benefit finding at both assessments was to a 'mild-to-moderate degree'. Benefit finding increased over time for patients with small cell carcinoma, but not for those with nonsmall cell carcinoma. The proposed model explained 33% of the variance in T1 benefit finding, and 64% (using T1 coping measures) and 71% (using T2 coping measures) of the variance in T2 benefit finding. Greater benefit finding was associated with having small cell lung cancer, higher cancer-related intrusions, lower perceived cancer-related stress, and greater approach-oriented coping. Positive reframing coping emerged as the single unique approach-oriented coping scale predicting benefit finding at T1, and emotional approach coping was the single unique approach-oriented coping scale predicting benefit finding at T2. Conclusion: Findings provide general support for a theoretical model positing that stressor impact and engagement with the stressor contribute to the development of benefit finding after cancer. Future research with larger, more diverse samples is needed to confirm and extend these findings.
Tuesday, January 18, 2011
Texas higher ed: budget cuts coming. From the Austin Statesman.
http://www.statesman.com/blogs/content/shared-gen/blogs/austin/politics/entries/2011/01/18/conservatives_lay_out_plan_for.html
Revolution in lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/21204716
Arch Pathol Lab Med. 2011 Jan;135(1):110-6.
Revolution in lung cancer: new challenges for the surgical pathologist.
Cagle PT, Allen TC, Dacic S, Beasley MB, Borczuk AC, Chirieac LR, Laucirica R, Ro JY, Kerr KM.
Abstract
Abstract Context-Traditionally, lung cancer has been viewed as an aggressive, relentlessly progressive disease with few treatment options and poor survival. The traditional role of the pathologist has been primarily to differentiate small cell carcinoma from non-small cell carcinoma on biopsy and cytology specimens and to stage non-small cell carcinomas that underwent resection. In recent years, our concepts of lung cancer have undergone a revolution, including (1) the advent of successful, new, molecular-targeted therapies for lung cancer, many of which are associated with specific histologic cell types and subtypes; (2) new observations on the natural history of lung cancer derived from ongoing high-resolution computed tomography screening studies and recent histologic findings; and (3) proposals to revise the classification of lung cancers, particularly adenocarcinomas, in part because of the first 2 developments. Objective-To summarize the important, new developments in lung cancer, emphasizing the role of the surgical pathologist in personalized care for patients with lung cancer. Data Sources-Information about the new developments in lung cancer was obtained from the peer-review medical literature and the authors' experiences. Conclusions-For decades, we have perceived lung cancer as a relentlessly aggressive and mostly incurable disease for which the surgical pathologist had a limited role. Today, surgical pathologists have an important and expanding role in the diagnosis and treatment of lung cancer, and it is essential to keep informed of new advances.
Arch Pathol Lab Med. 2011 Jan;135(1):110-6.
Revolution in lung cancer: new challenges for the surgical pathologist.
Cagle PT, Allen TC, Dacic S, Beasley MB, Borczuk AC, Chirieac LR, Laucirica R, Ro JY, Kerr KM.
Abstract
Abstract Context-Traditionally, lung cancer has been viewed as an aggressive, relentlessly progressive disease with few treatment options and poor survival. The traditional role of the pathologist has been primarily to differentiate small cell carcinoma from non-small cell carcinoma on biopsy and cytology specimens and to stage non-small cell carcinomas that underwent resection. In recent years, our concepts of lung cancer have undergone a revolution, including (1) the advent of successful, new, molecular-targeted therapies for lung cancer, many of which are associated with specific histologic cell types and subtypes; (2) new observations on the natural history of lung cancer derived from ongoing high-resolution computed tomography screening studies and recent histologic findings; and (3) proposals to revise the classification of lung cancers, particularly adenocarcinomas, in part because of the first 2 developments. Objective-To summarize the important, new developments in lung cancer, emphasizing the role of the surgical pathologist in personalized care for patients with lung cancer. Data Sources-Information about the new developments in lung cancer was obtained from the peer-review medical literature and the authors' experiences. Conclusions-For decades, we have perceived lung cancer as a relentlessly aggressive and mostly incurable disease for which the surgical pathologist had a limited role. Today, surgical pathologists have an important and expanding role in the diagnosis and treatment of lung cancer, and it is essential to keep informed of new advances.
AAA and the Science War-from the Chronicle of Higher Education
http://chronicle.com/article/What-if-They-Had-a-Science-War/125828
From Francisco Cigarroa: Reform of Texas health care
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014124/?tool=pubmed
Tex Heart Inst J. 2010;37(6):665-6.
The University of Texas system: leadership for reform and rejuvenation of Texas health care.
Cigarroa FG.
Office of the Chancellor, The University of Texas System, Austin, Texas 78701.
Tex Heart Inst J. 2010;37(6):665-6.
The University of Texas system: leadership for reform and rejuvenation of Texas health care.
Cigarroa FG.
Office of the Chancellor, The University of Texas System, Austin, Texas 78701.
Cystic fibrosis and CFTR modulators
http://www.ncbi.nlm.nih.gov/pubmed/21240931
ChemMedChem. 2011 Jan 14. [Epub ahead of print]
Combating Cystic Fibrosis: In Search for CF Transmembrane Conductance Regulator (CFTR) Modulators.
Noy E, Senderowitz H.
Department of Chemistry, Bar Ilan University, Ramat-Gan 52900 (Israel)
ChemMedChem. 2011 Jan 14. [Epub ahead of print]
Combating Cystic Fibrosis: In Search for CF Transmembrane Conductance Regulator (CFTR) Modulators.
Noy E, Senderowitz H.
Department of Chemistry, Bar Ilan University, Ramat-Gan 52900 (Israel)
Lung cancer: Interventional bronchoscopy
http://www.ncbi.nlm.nih.gov/pubmed/21234532
Internist (Berl). 2011 Jan 15. [Epub ahead of print]
[Interventional bronchoscopy in lung cancer.]
[Article in German]
Bergner A, Huber RM.
Pneumologie, Klinikum der Universität München - Innenstadt, Ziemssenstraße 1, 80336, München, Deutschland, albergner@web.de.
Abstract
Stenosis of central airways or hemoptysis are classical indications for interventional bronchoscopy in lung cancer. In the case of endoluminal tumor growth cryo-, laser- or brachytherapy are widely used. In the case of airway stenosis due to compression by extraluminal tumor masses balloon-dilatation and/or stenting and - with delayed effect - brachytherapy are first-choice therapies. Carcinoma in situ and early stage tumors can be treated curatively with brachytherapy or photodynamic therapy. Recently introduced bronchoscopic techniques like electro-magnetic navigation may result in new curative options for peripheral lung tumors.
Internist (Berl). 2011 Jan 15. [Epub ahead of print]
[Interventional bronchoscopy in lung cancer.]
[Article in German]
Bergner A, Huber RM.
Pneumologie, Klinikum der Universität München - Innenstadt, Ziemssenstraße 1, 80336, München, Deutschland, albergner@web.de.
Abstract
Stenosis of central airways or hemoptysis are classical indications for interventional bronchoscopy in lung cancer. In the case of endoluminal tumor growth cryo-, laser- or brachytherapy are widely used. In the case of airway stenosis due to compression by extraluminal tumor masses balloon-dilatation and/or stenting and - with delayed effect - brachytherapy are first-choice therapies. Carcinoma in situ and early stage tumors can be treated curatively with brachytherapy or photodynamic therapy. Recently introduced bronchoscopic techniques like electro-magnetic navigation may result in new curative options for peripheral lung tumors.
NEJM: the Sentinel System
http://www.ncbi.nlm.nih.gov/pubmed/21226658
N Engl J Med. 2011 Jan 12. [Epub ahead of print]
Developing the Sentinel System - A National Resource for Evidence Development.
Behrman RE, Benner JS, Brown JS, McClellan M, Woodcock J, Platt R.
From the Food and Drug Administration, Silver Spring, MD (R.E.B., J.W.); the Engelberg Center for Health Care Reform, Brookings Institution, Washington, DC (J.S. Benner, M.M.); and the Department of Population Medicine, Harvard Pilgrim Health Care Institute, and Harvard Medical School - both in Boston (J.S. Brown, R.P.).
Abstract
The Food and Drug Administration (FDA) now has the capacity to "query" the electronic health information of more than 60 million people, posing specific questions in order to monitor the safety of approved medical products. This pilot program, called Mini-Sentinel, uses a distributed data network (rather than a centralized database) that allows participating health plans and other organizations to create data files in a standard format and to maintain possession of those files. These organizations perform most analyses of their own data by running computer programs distributed by a coordinating center, and they provide consistent summarized results for the FDA's . . . .
N Engl J Med. 2011 Jan 12. [Epub ahead of print]
Developing the Sentinel System - A National Resource for Evidence Development.
Behrman RE, Benner JS, Brown JS, McClellan M, Woodcock J, Platt R.
From the Food and Drug Administration, Silver Spring, MD (R.E.B., J.W.); the Engelberg Center for Health Care Reform, Brookings Institution, Washington, DC (J.S. Benner, M.M.); and the Department of Population Medicine, Harvard Pilgrim Health Care Institute, and Harvard Medical School - both in Boston (J.S. Brown, R.P.).
Abstract
The Food and Drug Administration (FDA) now has the capacity to "query" the electronic health information of more than 60 million people, posing specific questions in order to monitor the safety of approved medical products. This pilot program, called Mini-Sentinel, uses a distributed data network (rather than a centralized database) that allows participating health plans and other organizations to create data files in a standard format and to maintain possession of those files. These organizations perform most analyses of their own data by running computer programs distributed by a coordinating center, and they provide consistent summarized results for the FDA's . . . .
Monday, January 17, 2011
Cystic fibrosis: organisms and adaptation
http://www.ncbi.nlm.nih.gov/pubmed/21233507
Clin Microbiol Rev. 2011 Jan;24(1):29-70.
Clinical significance of microbial infection and adaptation in cystic fibrosis.
Hauser AR, Jain M, Bar-Meir M, McColley SA.
Department of Microbiology/Immunology, Northwestern University, 303 E. Chicago Ave., Searle 6-495, Chicago, IL 60611. ahauser@northwestern.edu.
Abstract
Summary: A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.
Clin Microbiol Rev. 2011 Jan;24(1):29-70.
Clinical significance of microbial infection and adaptation in cystic fibrosis.
Hauser AR, Jain M, Bar-Meir M, McColley SA.
Department of Microbiology/Immunology, Northwestern University, 303 E. Chicago Ave., Searle 6-495, Chicago, IL 60611. ahauser@northwestern.edu.
Abstract
Summary: A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.
Osteopenia: What is it, how to treat it
http://www.ncbi.nlm.nih.gov/pubmed/21234807
Rev Endocr Metab Disord. 2011 Jan 14. [Epub ahead of print]
Diagnosis and treatment of osteopenia.
Karaguzel G, Holick MF.
Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, MA, USA.
Abstract
Osteopenia is a term to define bone density that is not normal but also not as low as osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score -1 to -2.5. There are many causes for osteopenia including calcium and vitamin D deficiency and inactivity. Genetics plays an important role in a person's bone mineral density and often Caucasian women with a thin body habitus who are premenopausal are found to have osteopenia. Correction of calcium and vitamin D deficiency and walking 3 to 5 miles a week can often improve bone density in the hip and spine. There are a variety of pharmaceutical agents that have been recommended for the treatment of osteopenia and osteoporosis including hormone replacement therapy, selective estrogen receptor modulator therapy, anti-resorptive therapy. In addition patients with osteoporosis who have failed anti-resorptive therapy can have a significant improvement in their bone density with anabolic therapy.
Rev Endocr Metab Disord. 2011 Jan 14. [Epub ahead of print]
Diagnosis and treatment of osteopenia.
Karaguzel G, Holick MF.
Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Center, Boston, MA, USA.
Abstract
Osteopenia is a term to define bone density that is not normal but also not as low as osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score -1 to -2.5. There are many causes for osteopenia including calcium and vitamin D deficiency and inactivity. Genetics plays an important role in a person's bone mineral density and often Caucasian women with a thin body habitus who are premenopausal are found to have osteopenia. Correction of calcium and vitamin D deficiency and walking 3 to 5 miles a week can often improve bone density in the hip and spine. There are a variety of pharmaceutical agents that have been recommended for the treatment of osteopenia and osteoporosis including hormone replacement therapy, selective estrogen receptor modulator therapy, anti-resorptive therapy. In addition patients with osteoporosis who have failed anti-resorptive therapy can have a significant improvement in their bone density with anabolic therapy.
Diabetics and fad diets
http://www.ncbi.nlm.nih.gov/pubmed/21234818
Curr Diab Rep. 2011 Jan 15. [Epub ahead of print]
Fad Diets in the Treatment of Diabetes.
Feinman RD.
Department of Cell Biology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA, richard.feinman@downstate.edu.
Abstract
Use of the term "fad diet" reflects the contentious nature of the debate in the treatment of diabetes and generally targets diets based on carbohydrate restriction, the major challenge to traditional dietary therapy. Although standard low-fat diets more accurately conform to the idea of a practice supported by social pressure rather than scientific data, it is suggested that we might want to give up altogether unscientific terms like "fad" and "healthy." Far from faddish, diets based on carbohydrate restriction have been the historical treatment for diabetes and are still supported by basic biochemistry, and it is argued that they should be considered the "default" diet, the one to try first, in diseases of carbohydrate intolerance or insulin resistance. The barrier to acceptance of low-carbohydrate diets in the past has been concern about saturated fat, which might be substituted for the carbohydrate that is removed. However, recent re-analysis of much old data shows that replacing carbohydrate with saturated fat is, if anything, beneficial. The dialectic of impact of continued hemoglobin A(1c) versus effect of dietary saturated fat in the risk of cardiovascular disease is resolved in direction of glycemic control. Putting biased language behind us and facing the impact of recent results that point to the value of low-carbohydrate diets would offer patients the maximum number of options.
Curr Diab Rep. 2011 Jan 15. [Epub ahead of print]
Fad Diets in the Treatment of Diabetes.
Feinman RD.
Department of Cell Biology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA, richard.feinman@downstate.edu.
Abstract
Use of the term "fad diet" reflects the contentious nature of the debate in the treatment of diabetes and generally targets diets based on carbohydrate restriction, the major challenge to traditional dietary therapy. Although standard low-fat diets more accurately conform to the idea of a practice supported by social pressure rather than scientific data, it is suggested that we might want to give up altogether unscientific terms like "fad" and "healthy." Far from faddish, diets based on carbohydrate restriction have been the historical treatment for diabetes and are still supported by basic biochemistry, and it is argued that they should be considered the "default" diet, the one to try first, in diseases of carbohydrate intolerance or insulin resistance. The barrier to acceptance of low-carbohydrate diets in the past has been concern about saturated fat, which might be substituted for the carbohydrate that is removed. However, recent re-analysis of much old data shows that replacing carbohydrate with saturated fat is, if anything, beneficial. The dialectic of impact of continued hemoglobin A(1c) versus effect of dietary saturated fat in the risk of cardiovascular disease is resolved in direction of glycemic control. Putting biased language behind us and facing the impact of recent results that point to the value of low-carbohydrate diets would offer patients the maximum number of options.
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