NPJ Prim Care Respir Med. 2014 Oct 23;24:14090. doi: 10.1038/npjpcrm.2014.90.

A prospective cohort study of the use of domiciliary intravenous antibiotics in bronchiectasis.

Bedi P1, Sidhu MK1, Donaldson LS1, Chalmers JD1, Smith MP2, Turnbull K2, Pentland JL3, Scott J4, Hill AT5.

Author information

• 1Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK.
• 2Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
• 3Department of Physiotherapy (Respiratory Medicine), Royal Infirmary of Edinburgh, Edinburgh, UK.
• 4Department of Pharmacy (Respiratory Medicine), Royal Infirmary of Edinburgh, Edinburgh, UK.
• 51] Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK [2] Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

Abstract

Background:We introduced domiciliary intravenous (IV) antibiotic therapy in patients with bronchiectasis to promote patient-centred domiciliary treatment instead of hospital inpatient treatment.

Aim:To assess the efficacy and safety of domiciliary IV antibiotic therapy in patients with non-cystic fibrosis bronchiectasis.

Methods:In this prospective study conducted over 5 years, we assessed patients' eligibility for receiving domiciliary treatment. All patients received 14 days of IV antibiotic therapy and were monitored at baseline/day 7/day 14. We assessed the treatment outcome, morbidity, mortality and 30-day readmission rates.

Results:A total of 116 patients received 196 courses of IV antibiotics. Eighty courses were delivered as inpatient treatment, 32 as early supported discharge (ESD) and 84 as domiciliary therapy. There was significant clinical and quality of life improvement in all groups, with resolution of infection in 76% in the inpatient group, 80% in the ESD group and 80% in the domiciliary group. Morbidity was recorded in 13.8% in the inpatient group, 9.4% in the ESD group and 14.2% in the domiciliary IV group. No mortality was recorded in either group. Thirty-day readmission rates were 13.8% in the inpatient group, 12.5% in the ESD group and 14.2% in the domiciliary group. Total bed days saved was 1443.

Conclusion:Domiciliary IV antibiotic therapy in bronchiectasis is clinically effective and was safe in our cohort of patients.

Hum Reprod. 2014 Oct 21. pii: deu265. [Epub ahead of print]

Ovarian reserve screening: a scientific and ethical analysis.

Tremellen K1, Savulescu J2.

Author information

• 1Repromed, 180 Fullarton Road, Dulwich, South Australia, Australia Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK ktremellen@repromed.com.au.
• 2Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.

Abstract

Ovarian reserve (OR) screening of the general population is generally not advocated as it has not been conclusively established to reflect immediate potential for natural conception, while it may also potentially create anxiety for women. However, in this paper, we argue in support of screening of the general population for diminished OR. First, OR tests such as measurements of anti-Müllerian hormone and antral follicle count are predictive of the chances of IVF conception, and therefore predict a woman's total fertility potential (i.e. chances of natural and IVF-related conceptions). Since the requirement for assisted conception increases with age, this is an important point. Secondly, women identified as having low OR are at increased risk of early loss of fertility potential in the longer term, limiting their reproductive life span and the size of their family if they delay conception. Thirdly, women often disregard generic advice to avoid delaying conception beyond 30 years of age, yet studies suggest that personalized risk assessment tools such as OR testing can actually increase an individual's motivation for positive change. A poor OR screening test result is more likely to convince a woman to bring forward her plans for natural conception, or alternatively explore oocyte vitrification, at a stage when these approaches still have reasonable prospects of success. Finally, we believe that women have a right, based on the ethical concept of autonomy, to be made aware of OR screening, so that they themselves can determine if OR testing is useful in assisting them with reproductive life planning.

Int J Med Educ. 2014 Apr 10;5:63-72.

The ethics and safety of medical student global health electives.

Dell EM1, Varpio L2, Petrosoniak A1, Gajaria A3, McMcarthy AE4.

Author information

• 1Department of Medicine, Emergency Medicine, University of Toronto, Toronto, Canada.
• 2Department of Medicine, University of Ottawa, Academy for Innovation of Medical Education, Canada.
• 3Department of Medicine, Psychiatry, University of Toronto, Canada.
• 4Department of Medicine, Infectious Disease/Global Health, University of Ottawa, Canada.

Abstract

OBJECTIVE:

To explore and characterize the ethical and safety challenges of global health experiences as they affect medical students in order to better prepare trainees to face them.

METHODS:

Semi-structured interviews were conducted with 23 Canadian medical trainees who had participated in global health experiences during medical school. Convenience and snowball sampling were utilized. Using Moustakas's transcendental phenomenological approach, participant descriptions of ethical dilemmas and patient/trainee safety problems were analyzed. This generated an aggregate that illustrates the essential meanings of global health experience ethical and safety issues faced.

RESULTS:

We interviewed 23 participants who had completed 38 electives (71%, n=27, during pre-clinical years) spending a mean 6.9 weeks abroad, and having visited 23 countries. Sixty percent (n=23) had pre-departure training while 36% (n=14) had post-experience debriefing. Three macro-level themes were identified: resource disparities and provision of care; navigating clinical ethical dilemmas; and threats to trainee safety.

CONCLUSIONS:

Medical schools have a responsibility to ensure ethical and safe global health experiences. However, our findings suggest that medical students are often poorly prepared for the ethical and safety dilemmas they encounter during these electives. Medical students require intensive pre-departure training that will prepare them emotionally to deal with these dilemmas. Such training should include discussions of how to comply with clinical limitations.

From Dartmouth: Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube

PLoS One. 2014 Oct 15;9(10):e110171. doi: 10.1371/journal.pone.0110171. eCollection 2014.

Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube.

Naslund JA1, Grande SW2, Aschbrenner KA3, Elwyn G4.

Author information

• 1The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America.
• 2The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, United States of America.
• 3The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America.
• 4The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, United States of America; The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, United States of America.

Abstract

Increasingly, people with diverse health conditions turn to social media to share their illness experiences or seek advice from others with similar health concerns. This unstructured medium may represent a platform on which individuals with severe mental illness naturally provide and receive peer support. Peer support includes a system of mutual giving and receiving where individuals with severe mental illness can offer hope, companionship, and encouragement to others facing similar challenges. In this study we explore the phenomenon of individuals with severe mental illness uploading videos to YouTube, and posting and responding to comments as a form of naturally occurring peer support. We also consider the potential risks and benefits of self-disclosure and interacting with others on YouTube. To address these questions, we used qualitative inquiry informed by emerging techniques in online ethnography. We analyzed n = 3,044 comments posted to 19 videos uploaded by individuals who self-identified as having schizophrenia, schizoaffective disorder, or bipolar disorder. We found peer support across four themes: minimizing a sense of isolation and providing hope; finding support through peer exchange and reciprocity; sharing strategies for coping with day-to-day challenges of severe mental illness; and learning from shared experiences of medication use and seeking mental health care. These broad themes are consistent with accepted notions of peer support in severe mental illness as a voluntary process aimed at inclusion and mutual advancement through shared experience and developing a sense of community. Our data suggest that the lack of anonymity and associated risks of being identified as an individual with severe mental illness on YouTube seem to be overlooked by those who posted comments or uploaded videos. Whether or not this platform can provide benefits for a wider community of individuals with severe mental illness remains uncertain.

“One of the hangups for a lot of doctors is this inherent assumption with social media that it only exists to engage with patients. Nothing could be further from the truth”

Twitter touted as tool to sway minds

Dr. Vartabedian, associate professor of pediatrics at Baylor College of Medicine, has spoken about social media at meetings of the American College of Physicians and other physician organizations. In a forthcoming ebook, The Public Physician—Practical Wisdom for Life in a Connected, Always-On World, he offers detailed advice to help doctors thrive in the age of Twitter and tablet computers. He notes that social-media engagement’s greatest value may come in sparking communication with fellow health care professionals.

“One of the hangups for a lot of doctors is this inherent assumption with social media that it only exists to engage with patients. Nothing could be further from the truth,” Dr. Vartabedian says. “In fact, when you look at the public stream and then tens of thousands of doctors on there now—a lot of the conversation is professional to professional.”

Dallas nurse's dog, Bentley, doesn't have Ebola

Chest. 2014 Oct 1;146(4_MeetingAbstracts):593A. doi: 10.1378/chest.1994637.

Current Lung Cancer Screening Guidelines May Exclude High Risk Populations.

Ravipati HP, Mankikar R, Charaf C, Foreman M, Flenaugh E.

Abstract

SESSION TITLE:

Lung Cancer Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Lung cancer is the leading cause of mortality from cancer worldwide. Current lung screening guidelines recommend annual screening with low-dose computed tomography in 55 - 80 year old individuals with a 30 pack-year smoking history, who are currently smoking or have quit within the past 15 years. We applied the current guidelines to lung cancer cases diagnosed at an urban medical center over a 5-year time frame to determine the fraction of lung cancer cases that would be missed.

METHODS: Retrospective analysis of electronic medical record data from a tertiary teaching hospital in Georgia was used to evaluate all patients diagnosed with lung cancer between 2007 and 2012. Lung cancer cases staged IA, IB, IIA, IIB, IIIA, IIIB, IV were included.RESULTS: Of 843 lung cancer cases diagnosed in 2007 - 2012, the subjects were primarily African American and male. Racial and gender distributions are as follows: African Americans, n = 726 (86.1%) vs. 89 (10.5%) cases in non-Hispanic Whites vs. others 28 (3.3%); 338 (40.1%) females and 505 (59.9%) males. There were 5 (0.5%) lung cancer diagnoses in individuals aged 20 - 29 yrs; 16 (1.8%) diagnoses in ages 30 - 39 yrs; 93 (11%) cases in ages 40 - 49 yrs; 304 (36%) cases in ages 50-59; 272 (32.2%) cases in ages 60-69 yrs; 117 (13.8%) cases in ages 70-79 yrs; and 36 (4.2%) cases in subjects > 80 years of age. 150 (17.7%) cases would not have been captured by the current guidelines for lung cancer screening.

CONCLUSIONS: In this high-risk population, application of the current lung cancer screening guidelines would not have detected 17.7% of the cancers, as the majority (62%) occurred in 40-49 year-olds. As the mortality for lung cancer is high for African Americans, a one-size-fits-all screening policy may not be appropriate. Further research to determine screening guidelines for targeted groups, as indicated by our data, is warranted.

CLINICAL IMPLICATIONS: Early detection of lung cancer improves outcomes and the use of its screening methods can reduce mortality. Based on our data, current guidelines might have to be applicable on an individual basis so that we can incorporate factors such as race.

From Cook Co. Chief Medical Examiner Steve Cina and colleagues: Suggested guidelines for the management of high-profile fatality cases

Arch Pathol Lab Med. 2008 Oct;132(10):1630-4. doi: 10.1043/1543-2165(2008)132[1630:SGFTMO]2.0.CO;2.

Suggested guidelines for the management of high-profile fatality cases.

Perper JA1, Juste GM, Schueler HE, Motte RW, Cina SJ.

Author information

• 1Broward County Medical Examiners Office, Fort Lauderdale, Florida 33315, USA.

Abstract

CONTEXT:

The investigation of high-profile fatalities poses special challenges to medical examiners and coroners. Most high-profile cases can be readily recognized early in the course of the investigation. Commonly encountered examples include police-related fatalities or deaths in custody, deaths of celebrities, and mass fatalities or clustered deaths (eg, serial killers). Medical examiner and coroner offices should have policies and procedures in place for adequately handling such cases. A rational approach to these high-profile cases includes activating medical examiner or coroner investigative teams, preplanning before the autopsy, using special autopsy techniques and toxicology procedures, skillful questioning of key witnesses, preparing detailed and comprehensive reports, and planning effective communication with the media.

OBJECTIVE:

The investigation of the sudden and unexpected death of Anna Nicole Smith, an entertainment personality, is presented as an example of how to address the challenging issues inherent in high-profile fatalities and how to adequately prepare for the forensic investigation of high-profile cases.

DESIGN:

This article presents a methodical approach to the investigation of high-profile deaths.

RESULTS:

A comprehensive, preplanned forensic investigation and autopsy (including use of adjunctive studies) following the death of Anna Nicole Smith resulted in the accurate determination of the cause and manner of her death while adequately convincing the public of the objectivity and reliability of the Medical Examiners Office with respect to its conclusions.

CONCLUSION:

The forensic investigation of death in high-profile cases can be much more tedious and demanding than the investigation of routine cases. It requires more stringent safekeeping of the body and its evidence, more extensive and sophisticated dissection techniques on occasion, and exhaustive toxicologic analysis to exclude low-probability allegations. Procedures for honest, unbiased, and judicious communication with outside agencies and the media must be followed. Failure to follow such procedures might have serious consequences for the medical examiner, the family of the deceased, and the community at large. Adherence to these suggested guidelines may resolve most of the intricate problems involved in the investigation of these types of cases.

Michael Misialek: See, Test, and Treat Is Coming to Tufts Medical Center

See, Test, and Treat Is Coming to Tufts Medical Center

For the fifth straight year, Tufts Medical Center will host See, Test, & Treat®, a free cervical and breast cancer screening program, funded through grants from the College of American Pathologists (CAP) Foundation. The event features same-day test results, diagnoses, and follow-up care for uninsured and underserved women ages 21 and older. Dr. Michael J. Misialek, an associate chair of pathology at Newton-Wellesley Hospital and the medical director of the Vernon Cancer Center, attended See, Test, & Treat® at Rhode Island Hospital and filled us in on what it’s like from a doctor’s point of view.

Med Confl Surviv. 2014 Oct 13:1-19. [Epub ahead of print]

Mapping the war: gender, health, and the medical profession in France and Germany, 1914-1918.

Michl S.

Author information

• a Institute for History, Philosophy and Ethics of Medicine , Johannes-Gutenberg University , Mainz , Germany.

Abstract

This article compares the gender and health politics of the German and the French medical professions, which incorporated military command structures into their civilian self-conception. Mobilized doctors committed themselves to the new circumstances and opportunities offered by the war. They applied the established military spatial 'map' which distinguished between the male-dominated front and the female-dominated home front and turned it into an epidemiological map, identifying danger zones which arose from points of contact between men and women. The analysis singles out two case studies: the rapid spread of venereal disease and psychiatric disorders. These case studies allow for a comparative analysis of the following questions: How did doctors assess the impacts of the war on the individual and the society as a whole? How did they view the war's impact on conventional gender orders, individual and national health? And how did they see their own role as a part of an independent civilian profession?

Ann Med Health Sci Res. 2014 Sep;4(5):672-5. doi: 10.4103/2141-9248.141495.

Global Bioethics and Culture in a Pluralistic World: How does Culture influence Bioethics in Africa?

Chukwuneke F1, Umeora O2, Maduabuchi J3, Egbunike N4.

Author information

• 1Department of Oral and Maxillofacial Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria ; Department of Public Health, Scholars of the South African Research Ethics Training Initiative, School of Health Sciences and Public Health University of Pretoria, Pretoria, South Africa.
• 2Department of Public Health, Scholars of the South African Research Ethics Training Initiative, School of Health Sciences and Public Health University of Pretoria, Pretoria, South Africa ; Department of Obstetrics and Gynecology, Federal Medical Centre Abakaliki, Ebonyi State, Nigeria.
• 3Department of Public Health, University of Ibadan Scholar of West African Bioethics Training, Ibadan, Oyo State, Nigeria.
• 4Department of Oral and Maxillofacial Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.

Abstract

Bioethics principles and practice can be influenced by different cultural background. This is because the four globally accepted bioethics principles are often based on basic ethical codes such as autonomy, beneficence, nonmaleficence and justice. Beneficence/nonmaleficence requires us to maximize possible benefits, while minimizing possible harms and consequently secure the well-being of others by refraining from harming them. Autonomy gives individuals the right to self-actualization and decision-making, while justice is concerned with the fair selection and distribution of the burdens and benefits of research among participants. Applications of these principles in cultural settings vary more often from one cultural perspective to the other because of the different understanding and practices of "what is good." The proponents of global ethics may argue that these principles should be universally generalizable and acceptable, but this is not possible because of the existing cultural diversities. In the African set-up, despite the existence of major common cultural practices, there are other norms and practices, which differ from one society to the other within the communities. Therefore, the word "global" bioethics may not be applicable generally in practice except if it can account for the structural dynamics and cultural differences within the complex societies in which we live in. However, the extent to which cultural diversity should be permitted to influence bioethical judgments in Africa, which at present is burdened with many diseases, should be of concern to researchers, ethicist and medical experts taking into considerations the constantly transforming global society. This topic examines the cultural influence on principles and practice of bioethics in Africa.

Am J Public Health. 2014 Oct 16:e1-e8. [Epub ahead of print]

A Public Health Achievement Under Adversity: The Eradication of Poliomyelitis From Peru, 1991.

Sobti D1, Cueto M, He Y.

Author information

• 1At the time of the study, Deepak Sobti was a chief resident and Yuan He was a medical and public health student at the University of Arizona, Tucson. Marcos Cueto is with the Casa de Oswaldo Cruz, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.

Abstract

The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

J Dent Hyg. 2014 Oct;88(5):292-301.

The Origins of Minnesota's Mid-Level Dental Practitioner: Alignment of Problem, Political and Policy Streams.

Gwozdek AE, Tetrick R, Shaefer HL.

Abstract

PURPOSE:

Using John Kingdon's agenda-setting model, this paper explores how Minnesota came to legislate a mid-level dental practitioner to its oral health workforce. Using a pluralist framework embracing the existence of various interests and convictions, this analysis highlights the roles of issue formation, agenda setting and politics in policymaking.

METHODS:

Using Kingdon's agenda-setting model as a theoretical lens, and applying case study methodology, this paper analyzes how Minnesota came to legislate a mid-level dental practitione to its oral health workforce. Data have come from scholarly research, governmental and foundation agency reports, interviews with leaders involved in the mid-level dental practitioner initiative, news articles, and Minnesota statute.

RESULTS:

After 2 years of contentious and challenging legislative initiatives, the problem, policy and political streams converged and aligned with the compromise passage of a bill legalizing mid-level dental practitioner practice. The Minnesota Dental Therapist Law was the first-in-the-nation licensing law to develop a new dental professional workforce model to address access to oral health care.

CONCLUSION:

The Minnesota mid-level dental practitioner initiative demonstrates the important convergence and alignment of the access to oral health care problem and the subsequent collaboration between political interest groups and policymakers. Through partnerships and pluralist compromise, mid-level dental practitioner champions were able to open the policy window to move this legislation to law, enhancing the oral health workforce in Minnesota.

From Transilvania U and UC-Irvine: Informed Consent: How Much Awareness Is There?

PLoS One. 2014 Oct 16;9(10):e110139. doi: 10.1371/journal.pone.0110139. eCollection 2014.

Informed Consent: How Much Awareness Is There?

Purcaru D1, Preda A2, Popa D3, Moga MA4, Rogozea L5.

Author information

• 1Department of Medical Ethics, Transilvania University, Brasov, Romania; Department of Clinical Research, Neomed Medical Center, Brasov, Romania.
• 2Department of Psychiatry and Human Behavior, University of California Irvine School of Medicine, Irvine, California, United States of America; University of California Irvine Neuropsychiatric Center, Orange, California, United States of America.
• 3Faculty of Psychology and Sciences of Education, Transilvania University, Brasov, Romania.
• 4Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University, Brasov, Romania.
• 5Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University, Brasov, Romania.

Abstract

Improving the informed consent process in clinical research is of constant concern to regulatory authorities in the field and presents a challenge for both the specialists and patients involved. Informed consent is a process that should adequately match the complexity of clinical research. In analyzing the behaviour of 68 patients during the informed consent process related to the clinical research performed at Neomed Clinical Center in Brasov, we found that many patients do not ask any questions (35.3%). From those who do, part of the questions (20,6%) referred to general aspects (addressed the form but not the gist) of the clinical trial, some (72,8%) referred to specific aspects of the clinical trial they will attend and others (6,6%) unrelated to the clinical trial. These results suggest a lack of interest, awareness, and understanding of the information presented in the informed consent form. The possible underlying causes of this attitude and its bureaucratic, ethic, and legal implications are discussed.

Philos Ethics Humanit Med. 2014 Oct 18;9(1):14. [Epub ahead of print]

The specificity triad: notions of disease and therapeutic specificity in biomedical reasoning.

Mulinari S.

Abstract

Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model - the specificity triad - that draws on late philosopher and physician Ludwik Fleck's concept of "style of thought" to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine--psychiatry and regenerative medicine--this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology -- historically relatively disjointed from biomedical enterprise -- and the burgeoning field of regenerative medicine.

Arch Pathol Lab Med. 2014 Aug;138(8):1000-1. doi: 10.5858/arpa.2014-0071-ED.

Social media: pathologists' force multiplier.

Allen TC.

Author information

• From the Department of Pathology, University of Texas Medical Branch, Galveston.

Clinical and Ethical Implications of Placebo Effects

Handb Exp Pharmacol. 2014;225:217-235.

Clinical and Ethical Implications of Placebo Effects: Enhancing Patients' Benefits from Pain Treatment.

Klinger R1, Flor H.

Author information

• 1Outpatient Clinic of Behavior Therapy, Department of Psychology, University of Hamburg, Hamburg, Germany, rklinger@uni-hamburg.de.

Abstract

Expectancy and learning are the core psychological mechanisms of placebo analgesia. They interact with further psychological processes such as emotions and motivations (e.g., anxiety, desire for relief), somatic focus, or cognitions (e.g., attitudes toward the treatment). The development of placebo responsiveness and the actual placebo response in a person is the result of the complex interaction between factors traced back to the individual learning history related to analgesic drugs or treatments and factors of the current context referring to the analgesic or placebo treatment. The aim of this chapter is to depict these complex interactions in a new model of analgesic placebo effects. It joins aspects of the learning history (preexisting experiences and preexisting expectations) of a patient with aspects of the current context (current expectation as a result of external and internal situation in which a pain medication/treatment/placebo is taken, e.g., current information about pain medication, current specific context/cues, desire for pain relief, certainty about upcoming pain relief, current expectation about pain reducing course, current selective attention, increased pain experience, or decreased pain experience). In order to exploit placebo efficacy for an analgesic treatment it is worthwhile to assess in which direction each of these factors exerts its influence in order to maximize placebo effects for a specific patient. By applying placebo mechanisms in this differentiated way, the efficacy of pain treatment can be deliberately boosted.

J Law Med Ethics. 2014 Sep;42 Suppl 1:51-66. doi: 10.1111/jlme.12162.

Economic regulation of next-generation sequencing.

Evans BJ.

Author information

• Professor of Law, the George Butler Research Professor, and the Director of the Center for Biotechnology & Law at the University of Houston Law Center.

Abstract

Next-generation sequencing broadens the debate about appropriate regulatory oversight of genetic testing and may force scholars to move beyond familiar privacy and health and safety regulatory issues to address new problems with industry structure and economic regulation. The genetic testing industry is passing through a period of profound structural change in response to shifts in technology and in the legal environment. Making genetic testing safe and effective for consumers increasingly requires access to comprehensive genomic data infrastructures that can support accurate, state-of-the-art interpretation of genetic test results. At present, there are significant barriers to access and there is no sector-specific regulator with power to ensure appropriate data access. Without it, genetic testing will not be safe for consumers even when it is performed at CLIA-certified laboratories using tests that have been FDA-cleared or approved. This article explores the emerging structure of the genetic testing industry and describes its present economic regulatory vacuum. In view of this gap in regulation, the article explores whether generally applicable law, particularly antitrust law, may offer solutions to the industry's data access problems. It concludes that courts may have a useful role to play, particularly in Europe and other jurisdictions where the essential facilities doctrine enjoys continued vitality. After Verizon Communications v. Law Offices of Curtis V. Trinko, the role of U.S. federal courts is less certain. Congress has demonstrated willingness to address access issues as they emerged in other infrastructure industries in recent decades. This article expresses no preference between legislative and judicial solutions. Its aim is simply to highlight an emerging economic regulatory issue which, if left unresolved, presents real health and safety concerns for consumers who receive genetic tests.

Meat Sci. 2014 Aug 28;99C:68-74. doi: 10.1016/j.meatsci.2014.08.011. [Epub ahead of print]

Meat morals: relationship between meat consumption consumer attitudes towards human and animal welfare and moral behavior.

De Backer CJ1, Hudders L2.

Author information

• 1Department of Communication Studies, University of Antwerp, Sint-Jacobstraat 2, 2000 Antwerp, Belgium.
• 2Department of Communication Studies, Ghent University, Korte Meer 7-11, 9000 Ghent, Belgium. Electronic address: Liselot.Hudders@Ugent.be.

Abstract

The aim of this work is to explore the relation between morality and diet choice by investigating how animal and human welfare attitudes and donation behaviors can predict a meat eating versus flexitarian versus vegetarian diet. The results of a survey study (N=299) show that animal health concerns (measured by the Animal Attitude Scale) can predict diet choice. Vegetarians are most concerned, while full-time meat eaters are least concerned, and the contrast between flexitarians and vegetarians is greater than the contrast between flexitarians and full-time meat eaters. With regards to human welfare (measured by the Moral Foundations Questionnaire), results show that attitudes towards human suffering set flexitarians apart from vegetarians and attitudes towards authority and respect distinguish between flexitarians and meat eaters. To conclude, results show that vegetarians donate more often to animal oriented charities than flexitarians and meat eaters, while no differences between the three diet groups occur for donations to human oriented charities.

Sheesh

Red Bull Drinkers Can Claim $10 Over 'Gives You Wings' Lawsuit

The law firm said complainant Benjamin Careathers alleged Red Bull was “misleading customers” by making claims about the “functional beverage” and its ability to “give you wings” despite reports concluding energy drinks had the same benefit as he the average dose of caffeine consumed in coffee.

Bioethics. 2014 Sep 24. doi: 10.1111/bioe.12114. [Epub ahead of print]

The Nature and Value of Bioethics Expertise.

Vogelstein E.

Abstract

In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision-making and policy-formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non-bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error.

From Columbia U: Timing Matters: HIV Testing Rates in the Emergency Department

Nurs Res Pract. 2014;2014:575130. doi: 10.1155/2014/575130. Epub 2014 Sep 9.

Timing Matters: HIV Testing Rates in the Emergency Department.

Schnall R1, Liu N2.

Author information

• 1School of Nursing, Columbia University, New York, NY 10032, USA.
• 2Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.

Abstract

Study Objectives. In response to the 2010 New York State HIV testing law, we sought to understand the contextual factors that influence HIV testing rates in the emergency department (ED). 

Methods. We analyzed electronic health record logs from 97,655 patients seen in three EDs in New York City. We used logistic regression to assess whether time of day, day of the week, and season significantly affected HIV testing rates. 

Results. During our study period, 97,655 patients were evaluated and offered an HIV test. Of these, 7,763 (7.9%) agreed to be tested. Patients arriving between 6 a.m. and 7:59 p.m. were significantly (P < 0.001) more likely to be tested for HIV, followed by patients arriving between 8:00 p.m. and 9:59 p.m. (P < 0.01) and followed by patients arriving between 5-5:59 a.m. and 10-10:59 p.m. (P < 0.05) compared to patients arriving at midnight. Seasonal variation was also observed, where patients seen in July, August, and September (P < 0.001) were more likely to agree to be tested for HIV compared to patients seen in January, while patients seen in April and May (P < 0.001) were less likely to agree to be tested for HIV. 

Conclusion. Time of day and season affect HIV testing rates in the ED, along with other factors such as patient acuity and completion of other blood work during the ED visit. These findings provide useful information for improving the implementation of an HIV testing program in the ED.