http://www.ncbi.nlm.nih.gov/pubmed/22099717
Gastrointest Endosc Clin N Am. 2012 Jan;22(1):109-20. Epub 2011 Oct 20.
The impact of health care reform on innovation and new technology.
Ganz RA.
Source
Minnesota Gastroenterology, PA, Old Shakopee Road, Bloomington, MN, USA; University of Minnesota, Minneapolis, MN, USA.
Abstract
Health care reform has created special challenges and hurdles to the introduction of new technology and innovative medical devices in gastroenterology and other medical fields. The implication of new regulations will be enormous as we begin to see venture-capital funding flee our specialty for more lucrative and "sure bets." This article, written by an experienced entrepreneur and practicing gastroenterologist, outlines some of the implications of this emerging challenge. Few other sources of information are available that truly articulate the insider view of coming changes.
Monday, November 28, 2011
From Johns Hopkins: Quality and safety in anesthesiology
http://www.ncbi.nlm.nih.gov/pubmed/22099921
Best Pract Res Clin Anaesthesiol. 2011 Dec;25(4):557-67.
A novel approach to implementation of quality and safety programmes in anaesthesiology.
Schwengel DA, Winters BD, Berkow LC, Mark L, Heitmiller ES, Berenholtz SM.
Source
Department of Anesthesiology, Critical Care and Pediatrics, Johns Hopkins University, 600 N. Wolfe St., Blalock 1412, Baltimore, MD 21287, USA.
Abstract
Far too many patients suffer preventable harm from medical errors that add to needless suffering and cost of care. Underdeveloped residency training programmes in patient safety are a major contributor to preventable harm. Consequently, the Institute of Medicine has called for health professionals to reform their educational programmes to advance health-care safety and quality. Additionally, the Accreditation Council for Graduate Medical Education (ACGME) now requires education in 'systems-based practice' and 'practice-based learning and improvement' as core competencies of residency training programmes. The specific aim of this article is to describe the implementation of a novel programme designed to enhance residency education, meet ACGME core competencies and improve quality and safety education in one residency programme at an academic medical institution.
Best Pract Res Clin Anaesthesiol. 2011 Dec;25(4):557-67.
A novel approach to implementation of quality and safety programmes in anaesthesiology.
Schwengel DA, Winters BD, Berkow LC, Mark L, Heitmiller ES, Berenholtz SM.
Source
Department of Anesthesiology, Critical Care and Pediatrics, Johns Hopkins University, 600 N. Wolfe St., Blalock 1412, Baltimore, MD 21287, USA.
Abstract
Far too many patients suffer preventable harm from medical errors that add to needless suffering and cost of care. Underdeveloped residency training programmes in patient safety are a major contributor to preventable harm. Consequently, the Institute of Medicine has called for health professionals to reform their educational programmes to advance health-care safety and quality. Additionally, the Accreditation Council for Graduate Medical Education (ACGME) now requires education in 'systems-based practice' and 'practice-based learning and improvement' as core competencies of residency training programmes. The specific aim of this article is to describe the implementation of a novel programme designed to enhance residency education, meet ACGME core competencies and improve quality and safety education in one residency programme at an academic medical institution.
From Brown U: Cardiovascular disease and risk in primary care settings
http://www.ncbi.nlm.nih.gov/pubmed/22112741
Am J Cardiol. 2011 Nov 21. [Epub ahead of print]
Cardiovascular Disease and Risk in Primary Care Settings in the United States.
Ndumele CD, Baer HJ, Shaykevich S, Lipsitz SR, Hicks LS.
Source
Program in Public Health, Alpert School of Medicine, Brown University, Providence, Rhode Island.
Abstract
Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. In this study, a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (NHANES; 1999 to 2008) using multivariate logistic regression was conducted to assess the relation between site of usual care and disease prevalence. Patients' self-reported histories of several chronic conditions (hypertension, diabetes, and hypercholesterolemia), awareness of chronic conditions, and associated cardiovascular events (angina, coronary heart disease, cardiovascular disease, myocardial infarction, and stroke) were examined. After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients receiving usual care at private doctors' offices, hospital outpatient clinics, community-based clinics, and emergency rooms (ER). However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions than participants at other sites. The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs relative to private doctors' offices. In conclusion, participants who report using ERs as their usual sites of care are disproportionately more likely to have histories of poor cardiovascular outcomes and are more likely to be unaware of having hypertension or hypercholesterolemia. As health care reform takes place and millions more begin seeking care, it is imperative to ensure access to longitudinal care sites designed for continuous disease management.
Am J Cardiol. 2011 Nov 21. [Epub ahead of print]
Cardiovascular Disease and Risk in Primary Care Settings in the United States.
Ndumele CD, Baer HJ, Shaykevich S, Lipsitz SR, Hicks LS.
Source
Program in Public Health, Alpert School of Medicine, Brown University, Providence, Rhode Island.
Abstract
Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. In this study, a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (NHANES; 1999 to 2008) using multivariate logistic regression was conducted to assess the relation between site of usual care and disease prevalence. Patients' self-reported histories of several chronic conditions (hypertension, diabetes, and hypercholesterolemia), awareness of chronic conditions, and associated cardiovascular events (angina, coronary heart disease, cardiovascular disease, myocardial infarction, and stroke) were examined. After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients receiving usual care at private doctors' offices, hospital outpatient clinics, community-based clinics, and emergency rooms (ER). However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions than participants at other sites. The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs relative to private doctors' offices. In conclusion, participants who report using ERs as their usual sites of care are disproportionately more likely to have histories of poor cardiovascular outcomes and are more likely to be unaware of having hypertension or hypercholesterolemia. As health care reform takes place and millions more begin seeking care, it is imperative to ensure access to longitudinal care sites designed for continuous disease management.
Childhood obesity: Parents fear being blamed. MDs must be sensitive and nonjudgmental
http://www.ncbi.nlm.nih.gov/pubmed/22117082
Fam Pract. 2011 Nov 24. [Epub ahead of print]
Parents' views and experiences of childhood obesity management in primary care: a qualitative study.
Turner KM, Salisbury C, Shield JP.
Source
Academic Unit of Primary Health Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS.
Abstract
BACKGROUND:
Primary care has been viewed as an appropriate setting for childhood obesity management. Little is known about parents' views and experiences of obesity management within this clinical setting. These views and experiences need to be explored, as they could affect treatment success.
OBJECTIVE:
To explore parents' views and experiences of primary care as a treatment setting for childhood obesity.
METHODS:
In-depth interviews were held with 15 parents of obese children aged 5-10 years, to explore their views and experiences of primary care childhood obesity management. Parents were contacted via a hospital-based childhood obesity clinic, general practices and Mind, Exercise, Nutrition … Do it! (MEND) groups based in Bristol, England. The interviews were audio-taped transcribed verbatim and analysed thematically.
RESULTS:
Parents viewed primary care as an appropriate setting in which to treat childhood obesity but were reluctant to consult due to a fear of being blamed for their child's weight and a concern about their child's mental well-being. They also questioned whether practitioners had the knowledge, time and resources to effectively manage childhood obesity. Parents varied in the extent to which they had found consulting a practitioner helpful, and their accounts suggested that GPs and school nurses offer different types of support.
CONCLUSIONS:
Parents need to be reassured that practitioners will address their child's weight in a non-judgemental sensitive manner and are able to treat childhood obesity effectively. A multidisciplinary team approach might benefit a child, as different practitioners may vary in the type of care they provide.
Fam Pract. 2011 Nov 24. [Epub ahead of print]
Parents' views and experiences of childhood obesity management in primary care: a qualitative study.
Turner KM, Salisbury C, Shield JP.
Source
Academic Unit of Primary Health Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS.
Abstract
BACKGROUND:
Primary care has been viewed as an appropriate setting for childhood obesity management. Little is known about parents' views and experiences of obesity management within this clinical setting. These views and experiences need to be explored, as they could affect treatment success.
OBJECTIVE:
To explore parents' views and experiences of primary care as a treatment setting for childhood obesity.
METHODS:
In-depth interviews were held with 15 parents of obese children aged 5-10 years, to explore their views and experiences of primary care childhood obesity management. Parents were contacted via a hospital-based childhood obesity clinic, general practices and Mind, Exercise, Nutrition … Do it! (MEND) groups based in Bristol, England. The interviews were audio-taped transcribed verbatim and analysed thematically.
RESULTS:
Parents viewed primary care as an appropriate setting in which to treat childhood obesity but were reluctant to consult due to a fear of being blamed for their child's weight and a concern about their child's mental well-being. They also questioned whether practitioners had the knowledge, time and resources to effectively manage childhood obesity. Parents varied in the extent to which they had found consulting a practitioner helpful, and their accounts suggested that GPs and school nurses offer different types of support.
CONCLUSIONS:
Parents need to be reassured that practitioners will address their child's weight in a non-judgemental sensitive manner and are able to treat childhood obesity effectively. A multidisciplinary team approach might benefit a child, as different practitioners may vary in the type of care they provide.
Annual CT screening for lung cancer: This study shows 20% reduced mortality
http://www.ncbi.nlm.nih.gov/pubmed/22117150
Expert Rev Anticancer Ther. 2011 Dec;11(12):1833-6.
Finding needles in a haystack: annual low-dose computed tomography screening reduces lung cancer mortality in a high-risk group.
Duke SL, Eisen T.
Source
Department of Oncology, Cambridge University Health Partners, Hills Road, Cambridge, CB2 0QQ, UK.
Abstract
Evaluation of: Aberle DR, Adams AM, Berg CD et al.; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med. 365(5), 395-409 (2011). Lung cancer is a global health issue. Compared with other common malignancies, the prognosis is poor as many patients present with advanced disease. The National Lung Screening Trial (NLST) aimed to identify and treat early lung cancers using annual low-dose computed tomography (CT) screening in a high-risk group. When compared with chest x-ray screening, low-dose CT screening reduced lung cancer mortality by 20%; the NLST is the first lung cancer screening trial to demonstrate such a mortality benefit. However, we must wait for cost-effectiveness data from the NLST, as well as the results of ongoing European studies comparing low-dose CT with observation alone, before firm conclusions can be drawn regarding the overall benefits of introducing a CT screening program to clinical practice.
Expert Rev Anticancer Ther. 2011 Dec;11(12):1833-6.
Finding needles in a haystack: annual low-dose computed tomography screening reduces lung cancer mortality in a high-risk group.
Duke SL, Eisen T.
Source
Department of Oncology, Cambridge University Health Partners, Hills Road, Cambridge, CB2 0QQ, UK.
Abstract
Evaluation of: Aberle DR, Adams AM, Berg CD et al.; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med. 365(5), 395-409 (2011). Lung cancer is a global health issue. Compared with other common malignancies, the prognosis is poor as many patients present with advanced disease. The National Lung Screening Trial (NLST) aimed to identify and treat early lung cancers using annual low-dose computed tomography (CT) screening in a high-risk group. When compared with chest x-ray screening, low-dose CT screening reduced lung cancer mortality by 20%; the NLST is the first lung cancer screening trial to demonstrate such a mortality benefit. However, we must wait for cost-effectiveness data from the NLST, as well as the results of ongoing European studies comparing low-dose CT with observation alone, before firm conclusions can be drawn regarding the overall benefits of introducing a CT screening program to clinical practice.
Treating facial trauma: The otolaryngologists' experience
http://www.ncbi.nlm.nih.gov/pubmed/22095952
Otolaryngol Head Neck Surg. 2011 Nov 16. [Epub ahead of print]
The Otolaryngologist's Cost in Treating Facial Trauma: American Academy of Otolaryngology--Head and Neck Surgery Survey.
McCusker SB, Schmalbach CE.
Source
Yokota Air Base, Japan.
Abstract
Objectives. (1) To define practice patterns and perceptions of junior otolaryngologists treating maxillofacial/neck trauma. (2) To identify manners in which the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) can meet future trauma needs.Study Design. Cross-sectional survey.Setting. Academic and private otolaryngology practices.
Methods. A 26-question survey was designed to identify demographics, practice patterns, perceptions, and areas for improvement in maxillofacial/neck trauma care. It was distributed anonymously to AAO-HNS members completing residency from 2005 to 2009. Analysis included descriptive statistics and χ(2) comparisons.
Results. Of 1343 otolaryngologists, 444 (33%) responded. A total of 85% of responding physicians treat maxillofacial/neck trauma, and 64% identify trauma as an ideal part of their practice. Sense of duty (54%), institutional requirements (33%), and enjoyment (32%) are the most common reasons for treating trauma. Major deterrents include patient noncompliance (60%) and lifestyle limitations (47%). Five respondents (3.1%) have been involved in a trauma-related lawsuit. While insufficient reimbursement is a major deterrent to treating trauma (52%), only 36% would increase their volume if reimbursement improved. Increased educational opportunities represent the most common request to the AAO-HNS (59%), followed by AAO-HNS focus on improved reimbursement and tort reform (28%).
Conclusion. Most junior otolaryngologists treat maxillofacial/neck trauma on a monthly basis. A total of 64% identify trauma as a component of their ideal practice. They report being well to very well trained in all facets of trauma, with the exception of vascular and laryngotracheal injuries; but they desire additional education, such as courses and panels. Universal concerns include inadequate reimbursement, limited pool of treating physicians, and lack of practice guidelines.
Otolaryngol Head Neck Surg. 2011 Nov 16. [Epub ahead of print]
The Otolaryngologist's Cost in Treating Facial Trauma: American Academy of Otolaryngology--Head and Neck Surgery Survey.
McCusker SB, Schmalbach CE.
Source
Yokota Air Base, Japan.
Abstract
Objectives. (1) To define practice patterns and perceptions of junior otolaryngologists treating maxillofacial/neck trauma. (2) To identify manners in which the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) can meet future trauma needs.Study Design. Cross-sectional survey.Setting. Academic and private otolaryngology practices.
Methods. A 26-question survey was designed to identify demographics, practice patterns, perceptions, and areas for improvement in maxillofacial/neck trauma care. It was distributed anonymously to AAO-HNS members completing residency from 2005 to 2009. Analysis included descriptive statistics and χ(2) comparisons.
Results. Of 1343 otolaryngologists, 444 (33%) responded. A total of 85% of responding physicians treat maxillofacial/neck trauma, and 64% identify trauma as an ideal part of their practice. Sense of duty (54%), institutional requirements (33%), and enjoyment (32%) are the most common reasons for treating trauma. Major deterrents include patient noncompliance (60%) and lifestyle limitations (47%). Five respondents (3.1%) have been involved in a trauma-related lawsuit. While insufficient reimbursement is a major deterrent to treating trauma (52%), only 36% would increase their volume if reimbursement improved. Increased educational opportunities represent the most common request to the AAO-HNS (59%), followed by AAO-HNS focus on improved reimbursement and tort reform (28%).
Conclusion. Most junior otolaryngologists treat maxillofacial/neck trauma on a monthly basis. A total of 64% identify trauma as a component of their ideal practice. They report being well to very well trained in all facets of trauma, with the exception of vascular and laryngotracheal injuries; but they desire additional education, such as courses and panels. Universal concerns include inadequate reimbursement, limited pool of treating physicians, and lack of practice guidelines.
From Sarah Feldman: Making sense of cervical cancer screening guidelines
http://www.ncbi.nlm.nih.gov/pubmed/22111669
N Engl J Med. 2011 Nov 23. [Epub ahead of print]
Making Sense of the New Cervical-Cancer Screening Guidelines.
Feldman S.
From the Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston.
"Health care is a limited resource, and providing the best care at the best price will become increasingly important. We need to use and understand actual data about risk and the long-term effects and costs of various strategies. Experts are often in the best position to review the data and make recommendations, but different expert panels may interpret data differently and emphasize different results in making their decisions. And even with the best consensus guidelines, some clinical judgment and personalized attention to each patient remains necessary."
N Engl J Med. 2011 Nov 23. [Epub ahead of print]
Making Sense of the New Cervical-Cancer Screening Guidelines.
Feldman S.
From the Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston.
"Health care is a limited resource, and providing the best care at the best price will become increasingly important. We need to use and understand actual data about risk and the long-term effects and costs of various strategies. Experts are often in the best position to review the data and make recommendations, but different expert panels may interpret data differently and emphasize different results in making their decisions. And even with the best consensus guidelines, some clinical judgment and personalized attention to each patient remains necessary."
Friday, November 18, 2011
Reforming Big Pharma-Physician Financial Relationships
http://www.ncbi.nlm.nih.gov/pubmed/22084852
J Law Med Ethics. 2011 Dec;39(4):662-670. doi: 10.1111/j.1748-720X.2011.00633.x.
Reforming Pharmaceutical Industry-Physician Financial Relationships: Lessons from the United States, France, and Japan.
Rodwin MA.
Source
Edmond J. Safra Research Lab Fellow at Harvard University and Professor of Law at Suffolk University Law School, is the author of Conflicts of Interest and the Future of Medicine: The United States, France and Japan (Oxford, 2011) and Medicine, Money and Morals: Physicians' Conflicts of Interest (1993).
Abstract
This article compares the means that the United States, France, and Japan use to oversee pharmaceutical industry-physician financial relationships. These countries rely on professional and/or industry ethical codes, anti-kickback laws, and fair trade practice laws. They restrict kickbacks the most strictly, allow wide latitude on gifts, and generally permit drug firms to fund professional activities and associations. Consequently, to avoid legal liability, drug firms often replace kickbacks with gifts and grants. The paper concludes by proposing reforms that address problems that persist when firms replace kickbacks with gifts and grants based on the experience of the three countries.
© 2011 American Society of Law, Medicine & Ethics, Inc.
J Law Med Ethics. 2011 Dec;39(4):662-670. doi: 10.1111/j.1748-720X.2011.00633.x.
Reforming Pharmaceutical Industry-Physician Financial Relationships: Lessons from the United States, France, and Japan.
Rodwin MA.
Source
Edmond J. Safra Research Lab Fellow at Harvard University and Professor of Law at Suffolk University Law School, is the author of Conflicts of Interest and the Future of Medicine: The United States, France and Japan (Oxford, 2011) and Medicine, Money and Morals: Physicians' Conflicts of Interest (1993).
Abstract
This article compares the means that the United States, France, and Japan use to oversee pharmaceutical industry-physician financial relationships. These countries rely on professional and/or industry ethical codes, anti-kickback laws, and fair trade practice laws. They restrict kickbacks the most strictly, allow wide latitude on gifts, and generally permit drug firms to fund professional activities and associations. Consequently, to avoid legal liability, drug firms often replace kickbacks with gifts and grants. The paper concludes by proposing reforms that address problems that persist when firms replace kickbacks with gifts and grants based on the experience of the three countries.
© 2011 American Society of Law, Medicine & Ethics, Inc.
COPD and Hypoxemia
http://www.ncbi.nlm.nih.gov/pubmed/21660297
Int J Chron Obstruct Pulmon Dis. 2011;6:199-208. Epub 2011 Mar 14.
Hypoxemia in patients with COPD: cause, effects, and disease progression.
Kent BD, Mitchell PD, McNicholas WT.
Source
Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland. brian.kent@ucd.ie
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.
Int J Chron Obstruct Pulmon Dis. 2011;6:199-208. Epub 2011 Mar 14.
Hypoxemia in patients with COPD: cause, effects, and disease progression.
Kent BD, Mitchell PD, McNicholas WT.
Source
Pulmonary and Sleep Disorders Unit, St. Vincent's University Hospital, Dublin, Ireland. brian.kent@ucd.ie
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.
Delivering mental health services within primary care: Best practices
http://www.ncbi.nlm.nih.gov/pubmed/22090609
Clin Med Res. 2011 Nov;9(3-4):171.
PS1-32: Psychology in Primary Care: An Evaluation of Best Practices.
Phillips K, Smith E, Stevens A.
Abstract
Background/Aims
Integrating psychology and mental health professionals into primary care settings has emerged as a means to improve the access to and utilization of mental health services. Three main delivery models of psychology in primary care settings have emerged: referring a patient to a psychologist/mental health professional located in a facility outside of the primary care physician's (PCP) office; referring a patient to a co-located psychologist/mental health professional who does not directly interface with PCP; integrated and co-located model where the PCP and the psychologist/ mental health professional discuss the patient's health. The overall purpose of this project was to compare patient utilization of psychology/mental health services across the Scott & White Health care system.
Methods
Using electronic medical records and the virtual data warehouse (VDW), mental health clinics/facilities were categorized into one of the three main psychology models. Patients that had depression, anxiety or ADHD DRG codes in their EMR and were aged 18 and older (n=37,310) were included in the analysis. The following additional variables were controlled for: gender, race/ethnicity, and chronic physical health conditions (i.e. arthritis, lung disease, heart disease, diabetes, hypertensive disease, and osteoporosis). ANOVA/ANCOVA analyses were performed to determine the differences across the three models in the length of time between the PPC referral and the first appointment with the psychologist/mental health professional.
Results
Patients that were seen by psychologist in facilities with integrated co-located models of care experienced a shorter amount of time between their referral and their first appointment with the psychologist/mental health professional, compared to the other two models of care.
Conclusions
These initial results begin to inform best practices for delivering mental health services within primary care and provide physicians and health care systems with data on issues that facilitate integrated, person-centered care.
Clin Med Res. 2011 Nov;9(3-4):171.
PS1-32: Psychology in Primary Care: An Evaluation of Best Practices.
Phillips K, Smith E, Stevens A.
Abstract
Background/Aims
Integrating psychology and mental health professionals into primary care settings has emerged as a means to improve the access to and utilization of mental health services. Three main delivery models of psychology in primary care settings have emerged: referring a patient to a psychologist/mental health professional located in a facility outside of the primary care physician's (PCP) office; referring a patient to a co-located psychologist/mental health professional who does not directly interface with PCP; integrated and co-located model where the PCP and the psychologist/ mental health professional discuss the patient's health. The overall purpose of this project was to compare patient utilization of psychology/mental health services across the Scott & White Health care system.
Methods
Using electronic medical records and the virtual data warehouse (VDW), mental health clinics/facilities were categorized into one of the three main psychology models. Patients that had depression, anxiety or ADHD DRG codes in their EMR and were aged 18 and older (n=37,310) were included in the analysis. The following additional variables were controlled for: gender, race/ethnicity, and chronic physical health conditions (i.e. arthritis, lung disease, heart disease, diabetes, hypertensive disease, and osteoporosis). ANOVA/ANCOVA analyses were performed to determine the differences across the three models in the length of time between the PPC referral and the first appointment with the psychologist/mental health professional.
Results
Patients that were seen by psychologist in facilities with integrated co-located models of care experienced a shorter amount of time between their referral and their first appointment with the psychologist/mental health professional, compared to the other two models of care.
Conclusions
These initial results begin to inform best practices for delivering mental health services within primary care and provide physicians and health care systems with data on issues that facilitate integrated, person-centered care.
Does PPACA disincentivize comprehensive primary care?
http://www.ncbi.nlm.nih.gov/pubmed/22086805
J Am Board Fam Med. 2011 Nov;24(6):637-638.
Rewarding Family Medicine While Penalizing Comprehensiveness? Primary Care Payment Incentives and Health Reform: the Patient Protection and Affordable Care Act (PPACA).
Petterson S, Bazemore AW, Phillips RL, Xierali IM, Rinaldo J, Green LA, Puffer JC.
Source
The Robert Graham Center.
Abstract
Family physicians' scope of work is exceptionally broad, particularly with increasing rurality. Provisions for Medicare bonus payment specified in the health care reform bill (the Patient Protection and Affordable Care Act) used a narrow definition of primary care that inadvertently offers family physicians disincentives to delivering comprehensive primary care.
J Am Board Fam Med. 2011 Nov;24(6):637-638.
Rewarding Family Medicine While Penalizing Comprehensiveness? Primary Care Payment Incentives and Health Reform: the Patient Protection and Affordable Care Act (PPACA).
Petterson S, Bazemore AW, Phillips RL, Xierali IM, Rinaldo J, Green LA, Puffer JC.
Source
The Robert Graham Center.
Abstract
Family physicians' scope of work is exceptionally broad, particularly with increasing rurality. Provisions for Medicare bonus payment specified in the health care reform bill (the Patient Protection and Affordable Care Act) used a narrow definition of primary care that inadvertently offers family physicians disincentives to delivering comprehensive primary care.
From LA Review of Books: Steven Brint's The Education Lottery
http://lareviewofbooks.org/post/12835528594/the-educational-lottery
"The American education gospel is built around four core beliefs. First, it teaches that access to higher levels of education should be available to everyone, regardless of their background or previous academic performance. Every educational sinner should have a path to redemption. (Most of these paths now run through community colleges.) Second, the gospel teaches that opportunity for a better life is the goal of everyone and that education is the primary — and perhaps the only — road to opportunity. Third, it teaches that the country can solve its social problems — drugs, crime, poverty, and the rest — by providing more education to the poor. Education instills the knowledge, discipline, and the habits of life that lead to personal renewal and social mobility. And, finally, it teaches that higher levels of education for all will reduce social inequalities, as they will put everyone on a more equal footing."
"...we will need to turn our backs on assumptions of our most fervent boosters of universal higher education: that access alone is the primary purpose, and that when students and teachers are co-present, education occurs..."
"The American education gospel is built around four core beliefs. First, it teaches that access to higher levels of education should be available to everyone, regardless of their background or previous academic performance. Every educational sinner should have a path to redemption. (Most of these paths now run through community colleges.) Second, the gospel teaches that opportunity for a better life is the goal of everyone and that education is the primary — and perhaps the only — road to opportunity. Third, it teaches that the country can solve its social problems — drugs, crime, poverty, and the rest — by providing more education to the poor. Education instills the knowledge, discipline, and the habits of life that lead to personal renewal and social mobility. And, finally, it teaches that higher levels of education for all will reduce social inequalities, as they will put everyone on a more equal footing."
"...we will need to turn our backs on assumptions of our most fervent boosters of universal higher education: that access alone is the primary purpose, and that when students and teachers are co-present, education occurs..."
Federal health care reform and the Necessary and Proper Clause
http://yalelawjournal.org/the-yale-law-journal-pocket-part/supreme-court/bad-news-for-professor-koppelman:-the-incidental-unconstitutionality-of-the-individual-mandate/
Bad News for Professor Koppelman: The Incidental Unconstitutionality of the Individual Mandate
Gary Lawson & David B. Kopel
Tuesday, 08 November 2011
In Bad News for Mail Robbers: The Obvious Constitutionality of Health Care Reform, Professor Andrew Koppelman argues that the individual mandate in the Patient Protection and Affordable Care Act is constitutionally authorized by the Necessary and Proper Clause. This view is fundamentally wrong. The Necessary and Proper Clause is based on eighteenth-century agency law, including the fundamental agency doctrine of principals and incidents. Accordingly, the Clause only allows Congress to exercise powers that are incident to—meaning subordinate to or less “worthy” than—its principal enumerated powers. The power to compel private persons to engage in commercial transactions with other private persons is not an incidental power. Thus, the mandate is not authorized by the Necessary and Proper Clause, whether or not such a power is “necessary and proper for carrying into Execution” other powers. In addition, eighteenth-century public law carried administrative law principles—including the fiduciary norms at the heart of agency law—into delegations of power to political actors. One of the most basic of these fiduciary norms is the obligation to treat multiple principals equally. That equal treatment requirement is violated by the individual mandate, which compels transactions with a favored oligopoly of insurance companies. In short, the mandate is not an exercise of incidental power within the scope of the Necessary and Proper Clause, nor is the mandate “proper.”
Preferred citation: Gary Lawson & David B. Kopel, Bad News for Professor Koppelman: The Incidental Unconstitutionality of the Individual Mandate, 121 YALE L.J. ONLINE 267 (2011), http://yalelawjournal.org/2011/11/08/lawson&kopel.html.
Bad News for Professor Koppelman: The Incidental Unconstitutionality of the Individual Mandate
Gary Lawson & David B. Kopel
Tuesday, 08 November 2011
In Bad News for Mail Robbers: The Obvious Constitutionality of Health Care Reform, Professor Andrew Koppelman argues that the individual mandate in the Patient Protection and Affordable Care Act is constitutionally authorized by the Necessary and Proper Clause. This view is fundamentally wrong. The Necessary and Proper Clause is based on eighteenth-century agency law, including the fundamental agency doctrine of principals and incidents. Accordingly, the Clause only allows Congress to exercise powers that are incident to—meaning subordinate to or less “worthy” than—its principal enumerated powers. The power to compel private persons to engage in commercial transactions with other private persons is not an incidental power. Thus, the mandate is not authorized by the Necessary and Proper Clause, whether or not such a power is “necessary and proper for carrying into Execution” other powers. In addition, eighteenth-century public law carried administrative law principles—including the fiduciary norms at the heart of agency law—into delegations of power to political actors. One of the most basic of these fiduciary norms is the obligation to treat multiple principals equally. That equal treatment requirement is violated by the individual mandate, which compels transactions with a favored oligopoly of insurance companies. In short, the mandate is not an exercise of incidental power within the scope of the Necessary and Proper Clause, nor is the mandate “proper.”
Preferred citation: Gary Lawson & David B. Kopel, Bad News for Professor Koppelman: The Incidental Unconstitutionality of the Individual Mandate, 121 YALE L.J. ONLINE 267 (2011), http://yalelawjournal.org/2011/11/08/lawson&kopel.html.
Tuesday, November 15, 2011
Sarcopenia and genetics
http://www.ncbi.nlm.nih.gov/pubmed/22037866
Age (Dordr). 2011 Oct 27. [Epub ahead of print]
Genes and the ageing muscle: a review on genetic association studies.
Garatachea N, Lucía A.
Source
University of Zaragoza, Huesca, Spain, nuria.garatachea@unizar.es.
Abstract
Western populations are living longer. Ageing decline in muscle mass and strength (i.e. sarcopenia) is becoming a growing public health problem, as it contributes to the decreased capacity for independent living. It is thus important to determine those genetic factors that interact with ageing and thus modulate functional capacity and skeletal muscle phenotypes in older people. It would be also clinically relevant to identify 'unfavourable' genotypes associated with accelerated sarcopenia. In this review, we summarized published information on the potential associations between some genetic polymorphisms and muscle phenotypes in older people. A special emphasis was placed on those candidate polymorphisms that have been more extensively studied, i.e. angiotensin-converting enzyme (ACE) gene I/D, α-actinin-3 (ACTN3) R577X, and myostatin (MSTN) K153R, among others. Although previous heritability studies have indicated that there is an important genetic contribution to individual variability in muscle phenotypes among old people, published data on specific gene variants are controversial. The ACTN3 R577X polymorphism could influence muscle function in old women, yet there is controversy with regards to which allele (R or X) might play a 'favourable' role. Though more research is needed, up-to-date MSTN genotype is possibly the strongest candidate to explain variance among muscle phenotypes in the elderly. Future studies should take into account the association between muscle phenotypes in this population and complex gene-gene and gene-environment interactions.
Age (Dordr). 2011 Oct 27. [Epub ahead of print]
Genes and the ageing muscle: a review on genetic association studies.
Garatachea N, Lucía A.
Source
University of Zaragoza, Huesca, Spain, nuria.garatachea@unizar.es.
Abstract
Western populations are living longer. Ageing decline in muscle mass and strength (i.e. sarcopenia) is becoming a growing public health problem, as it contributes to the decreased capacity for independent living. It is thus important to determine those genetic factors that interact with ageing and thus modulate functional capacity and skeletal muscle phenotypes in older people. It would be also clinically relevant to identify 'unfavourable' genotypes associated with accelerated sarcopenia. In this review, we summarized published information on the potential associations between some genetic polymorphisms and muscle phenotypes in older people. A special emphasis was placed on those candidate polymorphisms that have been more extensively studied, i.e. angiotensin-converting enzyme (ACE) gene I/D, α-actinin-3 (ACTN3) R577X, and myostatin (MSTN) K153R, among others. Although previous heritability studies have indicated that there is an important genetic contribution to individual variability in muscle phenotypes among old people, published data on specific gene variants are controversial. The ACTN3 R577X polymorphism could influence muscle function in old women, yet there is controversy with regards to which allele (R or X) might play a 'favourable' role. Though more research is needed, up-to-date MSTN genotype is possibly the strongest candidate to explain variance among muscle phenotypes in the elderly. Future studies should take into account the association between muscle phenotypes in this population and complex gene-gene and gene-environment interactions.
From U Mich and Western Mich U: Gender-related differences among med school faculty
http://www.ncbi.nlm.nih.gov/pubmed/22042141
Health Care Manag (Frederick). 2011 Oct;30(4):334-41.
An empirical investigation of the differences between male and female medical school physicians.
Deshpande SS, Deshpande SP.
Source
Author Affiliations: Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor (S. S. Deshpande), and Department of Management, Haworth College of Business, Western Michigan University, Kalamazoo (Dr S. P. Deshpande).
Abstract
The purpose of this research was to investigate gender-related differences among medical school faculty in a variety of areas such as information technology, medical malpractice, compensation, patient care, and carrier satisfaction. The Center for Studying Health System Change's 2008 Health Tracking Physician survey data consisting of 326 medical school faculty belonging to the American Medical Association were used in this study. t Tests indicate that female physicians practicing in medical schools were younger, had less experience, reported lower compensation, and were more likely to be primary care physicians. Male medical school physicians were significantly more concerned about being involved in a malpractice lawsuit. They reported a significantly higher percentage on income based on productivity-related factors. Male physicians also reported getting a significantly higher level of goods and services from drug companies. They also provided more hours of medical service for no or reduced fee in the previous month and higher levels of career satisfaction. Implications of this research are discussed.
Health Care Manag (Frederick). 2011 Oct;30(4):334-41.
An empirical investigation of the differences between male and female medical school physicians.
Deshpande SS, Deshpande SP.
Source
Author Affiliations: Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor (S. S. Deshpande), and Department of Management, Haworth College of Business, Western Michigan University, Kalamazoo (Dr S. P. Deshpande).
Abstract
The purpose of this research was to investigate gender-related differences among medical school faculty in a variety of areas such as information technology, medical malpractice, compensation, patient care, and carrier satisfaction. The Center for Studying Health System Change's 2008 Health Tracking Physician survey data consisting of 326 medical school faculty belonging to the American Medical Association were used in this study. t Tests indicate that female physicians practicing in medical schools were younger, had less experience, reported lower compensation, and were more likely to be primary care physicians. Male medical school physicians were significantly more concerned about being involved in a malpractice lawsuit. They reported a significantly higher percentage on income based on productivity-related factors. Male physicians also reported getting a significantly higher level of goods and services from drug companies. They also provided more hours of medical service for no or reduced fee in the previous month and higher levels of career satisfaction. Implications of this research are discussed.
From U Milan: Time for new performance classification for high level male marathon runners?
http://www.ncbi.nlm.nih.gov/pubmed/22080326
J Strength Cond Res. 2011 Nov 10. [Epub ahead of print]
Is It Time to Consider a New Performance Classification for High-Level Male Marathon Runners?
Torre AL, Vernillo G, Agnello L, Berardelli C, Rampinini E.
Source
1Department of Sport, Nutrition and Health Sciences, University of Milan, Milan, Italy; 2Faculty of Exercise Sciences, University of Milan, Milan, Italy; 3Department of Basic and Applied Medical Sciences, Chieti-Pescara University, Chieti Pescara, Italy; and 4Human Performance Laboratory, Mapei Sport Research Center, Castellanza, Varese, Italy.
Abstract
Studies have attempted to describe human running performances by the analysis of world-record times. However, to date, no study has analyzed the evolution of high-level marathon performances over time. Thus, the purpose of this study was to analyze these performances across the past 42 years with the aim of delineating a time-based classification. To identify the nature of the phenomenon represented by the sequence of observations, we examined the data collected (i.e., 8,400 times from 1969 to 2010) as a time series. The leading time (LT) and the mean 200 times (T200) per year underwent a nonlinear but significant decrement (r = -0.92, p < 0.001 and r = -0.98, p < 0.001, respectively). In fact, from 1969 to 2010, the mean time differences were 3 minutes 20 seconds ± 1 minute 59 seconds and 7 minutes 1 second ± 2 minutes 48 seconds, corresponding to an improvement of 5 and 10 seconds per year for LT and T200, respectively. Furthermore, trend analysis suggested a disruption in marathon time improvements, indicating the presence of 3 points in the time series in which the performance significantly improved with respect to that of the previous years, corresponding to the years 1983-1984 (p < 0.001), 1997-1998 (p < 0.003), and 2003 (p < 0.001). In conclusion, despite the trend in high-level marathon performances being better explained by a nonlinear tendency, significant improvements in the ability of the high-level marathon runners to complete the distance were observed. These improvements are likely to be related to sociological, environmental, physiological, and training-method factors. Researchers and coaches should take into account these enhancements by using the time classification proposed in this study to better reflect the marathon performance profile of their athletes.
J Strength Cond Res. 2011 Nov 10. [Epub ahead of print]
Is It Time to Consider a New Performance Classification for High-Level Male Marathon Runners?
Torre AL, Vernillo G, Agnello L, Berardelli C, Rampinini E.
Source
1Department of Sport, Nutrition and Health Sciences, University of Milan, Milan, Italy; 2Faculty of Exercise Sciences, University of Milan, Milan, Italy; 3Department of Basic and Applied Medical Sciences, Chieti-Pescara University, Chieti Pescara, Italy; and 4Human Performance Laboratory, Mapei Sport Research Center, Castellanza, Varese, Italy.
Abstract
Studies have attempted to describe human running performances by the analysis of world-record times. However, to date, no study has analyzed the evolution of high-level marathon performances over time. Thus, the purpose of this study was to analyze these performances across the past 42 years with the aim of delineating a time-based classification. To identify the nature of the phenomenon represented by the sequence of observations, we examined the data collected (i.e., 8,400 times from 1969 to 2010) as a time series. The leading time (LT) and the mean 200 times (T200) per year underwent a nonlinear but significant decrement (r = -0.92, p < 0.001 and r = -0.98, p < 0.001, respectively). In fact, from 1969 to 2010, the mean time differences were 3 minutes 20 seconds ± 1 minute 59 seconds and 7 minutes 1 second ± 2 minutes 48 seconds, corresponding to an improvement of 5 and 10 seconds per year for LT and T200, respectively. Furthermore, trend analysis suggested a disruption in marathon time improvements, indicating the presence of 3 points in the time series in which the performance significantly improved with respect to that of the previous years, corresponding to the years 1983-1984 (p < 0.001), 1997-1998 (p < 0.003), and 2003 (p < 0.001). In conclusion, despite the trend in high-level marathon performances being better explained by a nonlinear tendency, significant improvements in the ability of the high-level marathon runners to complete the distance were observed. These improvements are likely to be related to sociological, environmental, physiological, and training-method factors. Researchers and coaches should take into account these enhancements by using the time classification proposed in this study to better reflect the marathon performance profile of their athletes.
"The especially high rates of obesity in Texas have a profound impact on personal health and may result in increased health care costs that threaten public programs as well."
http://www.ncbi.nlm.nih.gov/pubmed/22080703
J Health Care Poor Underserved. 2011;22(4):1190-204.
Predictors of Body Mass Index among Low-Income Community-Dwelling Older Adults.
Ahn S, Huber C, Smith ML, Ory MG, Phillips CD.
Abstract
Abstract:This study investigated demographic, behavioral, and functional predictors of overweight and obesity, using secondary data from 705 community-dwelling individuals aged 65 years and older receiving or seeking Medicaid personal care services. Half of the participants were obese, while an additional 28% were overweight. The relationships between body mass index (BMI) levels and selected independent variables were analyzed. Females were more likely to be obese, while those who were older (75 years or older), more cognitively impaired, and smoked were less likely to obese. Comparing obesity with being overweight, being female and reporting more pain symptoms increased the odds of being obese, whereas being older (75 years or older) and being more cognitively impaired decreased the odds. The especially high rates of obesity in Texas have a profound impact on personal health and may result in increased health care costs that threaten public programs as well.
J Health Care Poor Underserved. 2011;22(4):1190-204.
Predictors of Body Mass Index among Low-Income Community-Dwelling Older Adults.
Ahn S, Huber C, Smith ML, Ory MG, Phillips CD.
Abstract
Abstract:This study investigated demographic, behavioral, and functional predictors of overweight and obesity, using secondary data from 705 community-dwelling individuals aged 65 years and older receiving or seeking Medicaid personal care services. Half of the participants were obese, while an additional 28% were overweight. The relationships between body mass index (BMI) levels and selected independent variables were analyzed. Females were more likely to be obese, while those who were older (75 years or older), more cognitively impaired, and smoked were less likely to obese. Comparing obesity with being overweight, being female and reporting more pain symptoms increased the odds of being obese, whereas being older (75 years or older) and being more cognitively impaired decreased the odds. The especially high rates of obesity in Texas have a profound impact on personal health and may result in increased health care costs that threaten public programs as well.
From U Wisc-Madison: 14 factors causing a missed diagnosis of Cystic Fibrosis on newborn screening
http://www.ncbi.nlm.nih.gov/pubmed/22081556
Pediatr Pulmonol. 2011 Dec;46(12):1166-74. doi: 10.1002/ppul.21509. Epub 2011 Aug 24.
Factors accounting for a missed diagnosis of cystic fibrosis after newborn screening.
Rock MJ, Levy H, Zaleski C, Farrell PM.
Source
School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. mjrock@wisc.edu.
Abstract
Newborn screening is a public health policy program involving the centralized testing laboratory, infant and their family, primary care provider, and subspecialist for confirmatory testing and follow-up of abnormal results. Cystic fibrosis (CF) newborn screening has now been enacted in all 50 states and the District of Columbia and throughout many countries in the world. Although CF neonatal screening will identify the vast majority of infants with CF, there are many factors in the newborn screening system that can lead to a missed diagnosis of CF. To inform clinicians, this article summarizes the CF newborn screening system and highlights 14 factors that can account for a missed diagnosis of CF. Care providers should maintain a high suspicion for CF if there are compatible symptoms, regardless of the results of the newborn screening test. These factors in newborn screening programs leading to a missed diagnosis of CF present opportunities for quality improvement in specimen collection, laboratory analysis of immunoreactive tryspinogen (IRT) and CF mutation testing, communication, and sweat testing. Pediatr Pulmonol. 2011; 46: 1166-1174. © 2011 Wiley Periodicals, Inc.
Pediatr Pulmonol. 2011 Dec;46(12):1166-74. doi: 10.1002/ppul.21509. Epub 2011 Aug 24.
Factors accounting for a missed diagnosis of cystic fibrosis after newborn screening.
Rock MJ, Levy H, Zaleski C, Farrell PM.
Source
School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. mjrock@wisc.edu.
Abstract
Newborn screening is a public health policy program involving the centralized testing laboratory, infant and their family, primary care provider, and subspecialist for confirmatory testing and follow-up of abnormal results. Cystic fibrosis (CF) newborn screening has now been enacted in all 50 states and the District of Columbia and throughout many countries in the world. Although CF neonatal screening will identify the vast majority of infants with CF, there are many factors in the newborn screening system that can lead to a missed diagnosis of CF. To inform clinicians, this article summarizes the CF newborn screening system and highlights 14 factors that can account for a missed diagnosis of CF. Care providers should maintain a high suspicion for CF if there are compatible symptoms, regardless of the results of the newborn screening test. These factors in newborn screening programs leading to a missed diagnosis of CF present opportunities for quality improvement in specimen collection, laboratory analysis of immunoreactive tryspinogen (IRT) and CF mutation testing, communication, and sweat testing. Pediatr Pulmonol. 2011; 46: 1166-1174. © 2011 Wiley Periodicals, Inc.
Trauma networks and the reform of trauma care in England
http://www.ncbi.nlm.nih.gov/pubmed/22078223
BMC Med. 2011 Nov 11;9(1):121. [Epub ahead of print]
Trauma networks: present and future challenges.
Kanakaris NK, Giannoudis PV.
Abstract
ABSTRACT: In England, trauma is the leading cause of death across all age groups, with over 16,000 deaths per year. Major trauma implies the presence of multiple, serious injuries that could result in death or serious disability. Successive reports have documented the fact that the current ad hoc unstructured management of this patient group is associated with considerable avoidable death and disability. The reform of trauma care in England, especially of the severely injured patient, has already begun. Strong clinical leadership is embraced as the way forward. The present article summarises the steps that have been made over the last decade that led to the recent decision to move towards a long anticipated restructure of the National Health Service (NHS) trauma services with the introduction of Regional Trauma Networks (RTNs). While, for the first time, a genuine political will and support exists, the changes required to maintain the momentum for the implementation of the RTNs needs to be marshalled against arguments, myths and perceptions from the past. Such an approach may reverse the disinterest attitude of many, and will gradually evolve into a cultural shift of the public, clinicians and policymakers in the fullness of time.
BMC Med. 2011 Nov 11;9(1):121. [Epub ahead of print]
Trauma networks: present and future challenges.
Kanakaris NK, Giannoudis PV.
Abstract
ABSTRACT: In England, trauma is the leading cause of death across all age groups, with over 16,000 deaths per year. Major trauma implies the presence of multiple, serious injuries that could result in death or serious disability. Successive reports have documented the fact that the current ad hoc unstructured management of this patient group is associated with considerable avoidable death and disability. The reform of trauma care in England, especially of the severely injured patient, has already begun. Strong clinical leadership is embraced as the way forward. The present article summarises the steps that have been made over the last decade that led to the recent decision to move towards a long anticipated restructure of the National Health Service (NHS) trauma services with the introduction of Regional Trauma Networks (RTNs). While, for the first time, a genuine political will and support exists, the changes required to maintain the momentum for the implementation of the RTNs needs to be marshalled against arguments, myths and perceptions from the past. Such an approach may reverse the disinterest attitude of many, and will gradually evolve into a cultural shift of the public, clinicians and policymakers in the fullness of time.
From SUNY Downstate: Med mal from failure to notify test results
http://www.ncbi.nlm.nih.gov/pubmed/22051461
J Am Coll Radiol. 2011 Nov;8(11):776-9.
Failure to notify reportable test results: significance in medical malpractice.
Gale BD, Bissett-Siegel DP, Davidson SJ, Juran DC.
Source
Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York.
Abstract
BACKGROUND:
Diagnostic physicians generally acknowledge their responsibility to notify referring clinicians whenever examinations demonstrate urgent or unexpected findings. During the past decade, clinicians have ordered dramatically greater numbers of diagnostic examinations. One study demonstrated that between 1996 and 2003, malpractice payments related to diagnosis increased by approximately 40%. Communication failures are a prominent cause of action in medical malpractice litigation. The aims of this study were to (1) define the magnitude of malpractice costs related to communication failures in test result notification and (2) determine if these costs are increasing significantly.
EVALUATION:
Linear regression analysis of National Practitioner Data Bank claims data from 1991 to 2009 suggested that claims payments increased at the national level by an average of $4.7 million annually (95% confidence interval, $2.98 million to $6.37 million). Controlled Risk Insurance Company/Risk Management Foundation claims data for 2004 to 2008 indicate that communication failures played a role, accounting for 4% of cases by volume and 7% of the total cost.
DISCUSSION:
Faile communication of clinical data constitutes an increasing proportion of medical malpractice payments. The increase in cases may reflect expectations of more reliable notification of medical data. Another explanation may be that the remarkable growth in diagnostic test volume has led to a corresponding increase in reportable results. If notification reliability remained unchanged, this increased volume would predict more failed notifications.
CONCLUSIONS:
There is increased risk for malpractice litigation resulting from diagnostic test result notification. The advent of semiautomated critical test result management systems may improve notification reliability, improve workflow and patient safety, and, when necessary, provide legal documentation.
J Am Coll Radiol. 2011 Nov;8(11):776-9.
Failure to notify reportable test results: significance in medical malpractice.
Gale BD, Bissett-Siegel DP, Davidson SJ, Juran DC.
Source
Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York.
Abstract
BACKGROUND:
Diagnostic physicians generally acknowledge their responsibility to notify referring clinicians whenever examinations demonstrate urgent or unexpected findings. During the past decade, clinicians have ordered dramatically greater numbers of diagnostic examinations. One study demonstrated that between 1996 and 2003, malpractice payments related to diagnosis increased by approximately 40%. Communication failures are a prominent cause of action in medical malpractice litigation. The aims of this study were to (1) define the magnitude of malpractice costs related to communication failures in test result notification and (2) determine if these costs are increasing significantly.
EVALUATION:
Linear regression analysis of National Practitioner Data Bank claims data from 1991 to 2009 suggested that claims payments increased at the national level by an average of $4.7 million annually (95% confidence interval, $2.98 million to $6.37 million). Controlled Risk Insurance Company/Risk Management Foundation claims data for 2004 to 2008 indicate that communication failures played a role, accounting for 4% of cases by volume and 7% of the total cost.
DISCUSSION:
Faile communication of clinical data constitutes an increasing proportion of medical malpractice payments. The increase in cases may reflect expectations of more reliable notification of medical data. Another explanation may be that the remarkable growth in diagnostic test volume has led to a corresponding increase in reportable results. If notification reliability remained unchanged, this increased volume would predict more failed notifications.
CONCLUSIONS:
There is increased risk for malpractice litigation resulting from diagnostic test result notification. The advent of semiautomated critical test result management systems may improve notification reliability, improve workflow and patient safety, and, when necessary, provide legal documentation.
Lung cancer and methylation profiling
http://www.ncbi.nlm.nih.gov/pubmed/22076605
Int J Oncol. 2011 Nov 7. doi: 10.3892/ijo.2011.1253. [Epub ahead of print]
Methylation profiling in non-small cell lung cancer: Clinical implications.
Morán A, Fernández-Marcelo T, Carro J, De Juan C, Pascua I, Head J, Gómez A, Hernando F, Torres AJ, Benito M, Iniesta P.
Source
Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, 28040-Madrid, Spain.
Abstract
The aim of this study was to identify a panel of methylation markers that distinguish non-small cell lung cancers (NSCLCs) from normal lung tissues. We also studied the relation of the methylation profile to clinicopathological factors in NSCLC. We collected a series of 46 NSCLC samples and their corresponding control tissues and analyzed them to determine gene methylation status using the Illumina GoldenGate Methylation bead array, which screens up to 1505 CpG sites from 803 different genes. We found that 120 CpG sites, corresponding to 88 genes were hypermethylated in tumor samples and only 17 CpG sites (16 genes) were hypomethylated when compared with controls. Clustering analysis of these 104 genes discriminates almost perfectly between tumors and normal samples. Global hypermethylation was significantly associated with a worse prognosis in stage IIIA NSCLC patients (P=0.012). Moreover, hypermethylation of the CALCA and MMP-2 genes were statistically associated to a poor clinical evolution of patients, independently of TNM tumor stage (P=0.06, RR=2.64; P=0.04, RR=2.96, respectively). However, hypermethylation of RASSF1 turned out to be a protective variable (P=0.02; RR=0.53). In conclusion, our results could be useful for establishing a gene methylation pattern for the detection and prognosis of NSCLC.
Int J Oncol. 2011 Nov 7. doi: 10.3892/ijo.2011.1253. [Epub ahead of print]
Methylation profiling in non-small cell lung cancer: Clinical implications.
Morán A, Fernández-Marcelo T, Carro J, De Juan C, Pascua I, Head J, Gómez A, Hernando F, Torres AJ, Benito M, Iniesta P.
Source
Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Complutense University, 28040-Madrid, Spain.
Abstract
The aim of this study was to identify a panel of methylation markers that distinguish non-small cell lung cancers (NSCLCs) from normal lung tissues. We also studied the relation of the methylation profile to clinicopathological factors in NSCLC. We collected a series of 46 NSCLC samples and their corresponding control tissues and analyzed them to determine gene methylation status using the Illumina GoldenGate Methylation bead array, which screens up to 1505 CpG sites from 803 different genes. We found that 120 CpG sites, corresponding to 88 genes were hypermethylated in tumor samples and only 17 CpG sites (16 genes) were hypomethylated when compared with controls. Clustering analysis of these 104 genes discriminates almost perfectly between tumors and normal samples. Global hypermethylation was significantly associated with a worse prognosis in stage IIIA NSCLC patients (P=0.012). Moreover, hypermethylation of the CALCA and MMP-2 genes were statistically associated to a poor clinical evolution of patients, independently of TNM tumor stage (P=0.06, RR=2.64; P=0.04, RR=2.96, respectively). However, hypermethylation of RASSF1 turned out to be a protective variable (P=0.02; RR=0.53). In conclusion, our results could be useful for establishing a gene methylation pattern for the detection and prognosis of NSCLC.
From U Exeter: Radon gas and skin cancer?
http://www.ncbi.nlm.nih.gov/pubmed/22081061
Epidemiology. 2011 Nov 10. [Epub ahead of print]
Radon and Skin Cancer in Southwest England: An Ecologic Study.
Wheeler BW, Allen J, Depledge MH, Curnow A.
Source
From the European Centre for Environment & Human Health, Peninsula College of Medicine & Dentistry, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom.
Abstract
BACKGROUND:
Radon, a naturally occurring radioactive gas, is a carcinogen that causes a small proportion of lung cancers among exposed populations. Theoretical models suggest that radon may also be a risk factor for skin cancer, but epidemiologic evidence for this relationship is weak. In this study, we investigated ecologic associations between environmental radon concentration and the incidence of various types of skin cancer.
METHODS:
We analyzed data for 287 small areas (postcode sectors) in southwest England for the years 2000-2004. Poisson regression was used to compare registration rates of malignant melanoma, basal cell carcinoma, and squamous cell carcinoma across mean indoor radon concentrations from household surveys. Analyses were adjusted for potentially confounding factors, including age, sex, population socioeconomic status, and mean hours of bright sunshine.
RESULTS:
No association was observed between mean postcode sector radon concentration and either malignant melanoma or basal cell carcinoma registration rates. However, sectors with higher radon levels had higher squamous cell carcinoma registration rates, with evidence of an exposure-response relationship. Comparing highest and lowest radon categories, postcode sectors with mean radon ≥230 Bq/m had registration rates 1.76 (95% confidence interval = 1.46-2.11) times those with mean radon 0-39 Bq/m. Associations persisted after adjustment for potential confounders.
CONCLUSIONS:
This ecologic study suggests that environmental radon exposure may be a risk factor for squamous cell carcinoma. Further study is warranted to overcome ecologic design limitations and to determine whether this relationship is generalizable to national and international settings.
Epidemiology. 2011 Nov 10. [Epub ahead of print]
Radon and Skin Cancer in Southwest England: An Ecologic Study.
Wheeler BW, Allen J, Depledge MH, Curnow A.
Source
From the European Centre for Environment & Human Health, Peninsula College of Medicine & Dentistry, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom.
Abstract
BACKGROUND:
Radon, a naturally occurring radioactive gas, is a carcinogen that causes a small proportion of lung cancers among exposed populations. Theoretical models suggest that radon may also be a risk factor for skin cancer, but epidemiologic evidence for this relationship is weak. In this study, we investigated ecologic associations between environmental radon concentration and the incidence of various types of skin cancer.
METHODS:
We analyzed data for 287 small areas (postcode sectors) in southwest England for the years 2000-2004. Poisson regression was used to compare registration rates of malignant melanoma, basal cell carcinoma, and squamous cell carcinoma across mean indoor radon concentrations from household surveys. Analyses were adjusted for potentially confounding factors, including age, sex, population socioeconomic status, and mean hours of bright sunshine.
RESULTS:
No association was observed between mean postcode sector radon concentration and either malignant melanoma or basal cell carcinoma registration rates. However, sectors with higher radon levels had higher squamous cell carcinoma registration rates, with evidence of an exposure-response relationship. Comparing highest and lowest radon categories, postcode sectors with mean radon ≥230 Bq/m had registration rates 1.76 (95% confidence interval = 1.46-2.11) times those with mean radon 0-39 Bq/m. Associations persisted after adjustment for potential confounders.
CONCLUSIONS:
This ecologic study suggests that environmental radon exposure may be a risk factor for squamous cell carcinoma. Further study is warranted to overcome ecologic design limitations and to determine whether this relationship is generalizable to national and international settings.
From UNC: Cancer staging and grading
http://www.ncbi.nlm.nih.gov/pubmed/22081335
Methods Mol Biol. 2012;823:1-18.
Tumor staging and grading: a primer.
Cowherd SM.
Source
Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA, SCowherd@unch.unc.edu.
Abstract
Cancer staging and grading are used to predict the clinical behavior of malignancies, establish appropriate therapies, and facilitate exchange of precise information between clinicians. The internationally accepted criteria for cancer staging, the tumor-node-metastasis (TNM) system, includes: (1) tumor size and local growth (T); (2) extent of lymph node metastases (N); and (3) occurrence of distant metastases (M). Clinical stage is established before initiation of therapy and depends on the physical examination, laboratory findings, and imaging studies. Pathologic stage is determined following surgical exploration of disease spread and histological examination of tissue. The TNM classification system has evolved over 50 years to accommodate increasing knowledge about cancer biology. Efforts are ongoing to keep the system both synchronized with the most sophisticated cancer technology and simple for ease of clinician/patient use. Upcoming molecular technologies, such as genomic and proteomic profiling of tumors, microRNA profiling, and even ex vivo living tumor tissue treatment, could improve the current TNM staging system. This chapter describes the current TNM system using breast, lung, ovarian, and prostate cancer examples.
Methods Mol Biol. 2012;823:1-18.
Tumor staging and grading: a primer.
Cowherd SM.
Source
Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA, SCowherd@unch.unc.edu.
Abstract
Cancer staging and grading are used to predict the clinical behavior of malignancies, establish appropriate therapies, and facilitate exchange of precise information between clinicians. The internationally accepted criteria for cancer staging, the tumor-node-metastasis (TNM) system, includes: (1) tumor size and local growth (T); (2) extent of lymph node metastases (N); and (3) occurrence of distant metastases (M). Clinical stage is established before initiation of therapy and depends on the physical examination, laboratory findings, and imaging studies. Pathologic stage is determined following surgical exploration of disease spread and histological examination of tissue. The TNM classification system has evolved over 50 years to accommodate increasing knowledge about cancer biology. Efforts are ongoing to keep the system both synchronized with the most sophisticated cancer technology and simple for ease of clinician/patient use. Upcoming molecular technologies, such as genomic and proteomic profiling of tumors, microRNA profiling, and even ex vivo living tumor tissue treatment, could improve the current TNM staging system. This chapter describes the current TNM system using breast, lung, ovarian, and prostate cancer examples.
Tuesday, November 8, 2011
From U Texas Southwestern Med: Molecular biology of lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22054881
Clin Chest Med. 2011 Dec;32(4):703-40. Epub 2011 Oct 7.
Molecular biology of lung cancer: clinical implications.
Larsen JE, Minna JD.
Source
Hamon Center for Therapeutic Oncology Research, Simmons Cancer Center, 6000 Harry Hines Boulevard, University of Texas Southwestern Medical Center, Dallas, TX 75390-8593, USA.
Abstract
Lung cancer is a heterogeneous disease clinically, biologically, histologically, and molecularly. Understanding the molecular causes of this heterogeneity, which might reflect changes occurring in different classes of epithelial cells or different molecular changes occurring in the same target lung epithelial cells, is the focus of current research. Identifying the genes and pathways involved, determining how they relate to the biological behavior of lung cancer, and their utility as diagnostic and therapeutic targets are important basic and translational research issues. This article reviews current information on the key molecular steps in lung cancer pathogenesis, their timing, and clinical implications.
Clin Chest Med. 2011 Dec;32(4):703-40. Epub 2011 Oct 7.
Molecular biology of lung cancer: clinical implications.
Larsen JE, Minna JD.
Source
Hamon Center for Therapeutic Oncology Research, Simmons Cancer Center, 6000 Harry Hines Boulevard, University of Texas Southwestern Medical Center, Dallas, TX 75390-8593, USA.
Abstract
Lung cancer is a heterogeneous disease clinically, biologically, histologically, and molecularly. Understanding the molecular causes of this heterogeneity, which might reflect changes occurring in different classes of epithelial cells or different molecular changes occurring in the same target lung epithelial cells, is the focus of current research. Identifying the genes and pathways involved, determining how they relate to the biological behavior of lung cancer, and their utility as diagnostic and therapeutic targets are important basic and translational research issues. This article reviews current information on the key molecular steps in lung cancer pathogenesis, their timing, and clinical implications.
From Yale: Revised staging system for lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22054882
Clin Chest Med. 2011 Dec;32(4):741-8.
The revised stage classification system for primary lung cancer.
Boffa DJ.
Source
Thoracic Surgery, Yale University School of Medicine, 330 Cedar Street, BB205, 208062, New Haven, CT 06520, USA.
Abstract
The revised stage classification system has improved the ability of clinicians to estimate prognosis based on specific staging determinations. Several important questions have been addressed, although many remain and will likely fuel the discussion for subsequent revisions. Perhaps more than previous revisions, the current iteration may cause confusion because of the emphasis on stage-specific treatment recommendations. However, prognosis is only 1 of the factors in a multidisciplinary treatment plan, and clinicians are encouraged to apply randomized trial data whenever possible. This global staging effort is testament to the progress that is possible through international collaboration.
Clin Chest Med. 2011 Dec;32(4):741-8.
The revised stage classification system for primary lung cancer.
Boffa DJ.
Source
Thoracic Surgery, Yale University School of Medicine, 330 Cedar Street, BB205, 208062, New Haven, CT 06520, USA.
Abstract
The revised stage classification system has improved the ability of clinicians to estimate prognosis based on specific staging determinations. Several important questions have been addressed, although many remain and will likely fuel the discussion for subsequent revisions. Perhaps more than previous revisions, the current iteration may cause confusion because of the emphasis on stage-specific treatment recommendations. However, prognosis is only 1 of the factors in a multidisciplinary treatment plan, and clinicians are encouraged to apply randomized trial data whenever possible. This global staging effort is testament to the progress that is possible through international collaboration.
From Keck Med: Lung cancer-use/misuse of PET scans
http://www.ncbi.nlm.nih.gov/pubmed/22054883
Clin Chest Med. 2011 Dec;32(4):749-62.
The use and misuse of positron emission tomography in lung cancer evaluation.
Chang CF, Rashtian A, Gould MK.
Source
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Keck School of Medicine of USC, 2020 Zonal Avenue, IRD Room 723, Los Angeles, CA 90033, USA.
Abstract
This article discusses the potential benefits and limitations of positron emission tomography (PET) for characterizing lung nodules, staging the mediastinum, identifying occult distant metastasis, determining prognosis and treatment response, guiding plans for radiation therapy, restaging during and after treatment, and selecting targets for tissue sampling. The key findings from the medical literature are presented regarding the capabilities and fallibilities of PET in lung cancer evaluation, including characterization of pulmonary nodules and staging in patients with known or suspected non-small-cell lung cancer. The discussion is limited to PET imaging with fluorodeoxyglucose.
Clin Chest Med. 2011 Dec;32(4):749-62.
The use and misuse of positron emission tomography in lung cancer evaluation.
Chang CF, Rashtian A, Gould MK.
Source
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Keck School of Medicine of USC, 2020 Zonal Avenue, IRD Room 723, Los Angeles, CA 90033, USA.
Abstract
This article discusses the potential benefits and limitations of positron emission tomography (PET) for characterizing lung nodules, staging the mediastinum, identifying occult distant metastasis, determining prognosis and treatment response, guiding plans for radiation therapy, restaging during and after treatment, and selecting targets for tissue sampling. The key findings from the medical literature are presented regarding the capabilities and fallibilities of PET in lung cancer evaluation, including characterization of pulmonary nodules and staging in patients with known or suspected non-small-cell lung cancer. The discussion is limited to PET imaging with fluorodeoxyglucose.
From Yale: Lung cancer-diagnostic/therapeutic interventions
http://www.ncbi.nlm.nih.gov/pubmed/22054884
Clin Chest Med. 2011 Dec;32(4):763-71. Epub 2011 Oct 7.
The Pulmonologist's Diagnostic and Therapeutic Interventions in Lung Cancer.
Puchalski J, Feller-Kopman D.
Source
Division of Pulmonary and Critical Care Medicine, Yale University School of Medicine, Boardman Building 205, 330 Cedar Street, New Haven, CT 06510, USA.
Abstract
Diagnostic and therapeutic strategies for lung cancer have improved with advancing technology and the acquisition of the necessary skills by bronchoscopists to fully use these advanced techniques. The diagnostic yield for lung cancer has significantly increased with the advent of technologies such as endobronchial ultrasound, navigational systems, and improved imaging modalities. Similarly, the therapeutic benefit of bronchoscopy in advanced lung cancer has begun to be understood for its impact on quality and quantity of life. This article highlights the pulmonologists' diagnostic advances and therapeutic options, with an emphasis on outcomes.
Clin Chest Med. 2011 Dec;32(4):763-71. Epub 2011 Oct 7.
The Pulmonologist's Diagnostic and Therapeutic Interventions in Lung Cancer.
Puchalski J, Feller-Kopman D.
Source
Division of Pulmonary and Critical Care Medicine, Yale University School of Medicine, Boardman Building 205, 330 Cedar Street, New Haven, CT 06510, USA.
Abstract
Diagnostic and therapeutic strategies for lung cancer have improved with advancing technology and the acquisition of the necessary skills by bronchoscopists to fully use these advanced techniques. The diagnostic yield for lung cancer has significantly increased with the advent of technologies such as endobronchial ultrasound, navigational systems, and improved imaging modalities. Similarly, the therapeutic benefit of bronchoscopy in advanced lung cancer has begun to be understood for its impact on quality and quantity of life. This article highlights the pulmonologists' diagnostic advances and therapeutic options, with an emphasis on outcomes.
From U Stellenbosch-SA: Functional evaluation before lung resection
http://www.ncbi.nlm.nih.gov/pubmed/22054885
Clin Chest Med. 2011 Dec;32(4):773-82.
Functional Evaluation before Lung Resection.
von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT.
Source
Division of Pulmonology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa.
Abstract
Lung cancer is the leading cause of cancer-related death worldwide, and lung resection remains the only curative approach. In the Western world, lung cancer is one of the main indications for lung resection, despite only 15% to 25% of all lung cancers being operable at the time of presentation. In most cases of operable lung cancer, a substantial part of functional lung tissue has to be resected, leading to a permanent loss of pulmonary function. Resection in patients with insufficient pulmonary reserves can result in permanent respiratory disability. This article reviews the current standards of preoperative assessment.
Clin Chest Med. 2011 Dec;32(4):773-82.
Functional Evaluation before Lung Resection.
von Groote-Bidlingmaier F, Koegelenberg CF, Bolliger CT.
Source
Division of Pulmonology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa.
Abstract
Lung cancer is the leading cause of cancer-related death worldwide, and lung resection remains the only curative approach. In the Western world, lung cancer is one of the main indications for lung resection, despite only 15% to 25% of all lung cancers being operable at the time of presentation. In most cases of operable lung cancer, a substantial part of functional lung tissue has to be resected, leading to a permanent loss of pulmonary function. Resection in patients with insufficient pulmonary reserves can result in permanent respiratory disability. This article reviews the current standards of preoperative assessment.
From U S Carolina: High risk patients with early stage lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22054886
Clin Chest Med. 2011 Dec;32(4):783-97. Epub 2011 Oct 7.
Evaluation and treatment of high-risk patients with early-stage lung cancer.
Mehta HJ, Ross C, Silvestri GA, Decker RH.
Source
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA.
Abstract
Standard therapy for early-stage non-small cell lung cancer is lobectomy for patients who are able to tolerate such surgery. However, the risk of postoperative morbidity is not trivial, with a 30% to 40% incidence of postoperative complications and a 1% to 5% incidence of operative mortality. Some patients, though technically resectable, refuse surgery or are considered medically inoperable because of insufficient respiratory reserve, cardiovascular disease, or general frailty. This group is considered either "high risk" or "medically inoperable."
Clin Chest Med. 2011 Dec;32(4):783-97. Epub 2011 Oct 7.
Evaluation and treatment of high-risk patients with early-stage lung cancer.
Mehta HJ, Ross C, Silvestri GA, Decker RH.
Source
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA.
Abstract
Standard therapy for early-stage non-small cell lung cancer is lobectomy for patients who are able to tolerate such surgery. However, the risk of postoperative morbidity is not trivial, with a 30% to 40% incidence of postoperative complications and a 1% to 5% incidence of operative mortality. Some patients, though technically resectable, refuse surgery or are considered medically inoperable because of insufficient respiratory reserve, cardiovascular disease, or general frailty. This group is considered either "high risk" or "medically inoperable."
From Yale: Additional lung nodules in the patient with lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22054888
Clin Chest Med. 2011 Dec;32(4):811-25.
Additional pulmonary nodules in the patient with lung cancer: controversies and challenges.
Kim AW, Cooke DT.
Source
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB 205, New Haven, CT 06520, USA.
Abstract
The optimal management of an additional pulmonary nodule in a patient with a known primary lung cancer is unclear. Additional pulmonary nodules are often identified during pathologic evaluation after resection of a primary tumor rather than before surgery. Although correlating these pathologic data with preoperative information can be useful, their applicability to management and decision making is often limited. This article focuses on the malignant additional pulmonary nodule in the same lobe as the known primary tumor, in a different lobe in the same lung as the known primary tumor, and in the contralateral lung.
Clin Chest Med. 2011 Dec;32(4):811-25.
Additional pulmonary nodules in the patient with lung cancer: controversies and challenges.
Kim AW, Cooke DT.
Source
Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB 205, New Haven, CT 06520, USA.
Abstract
The optimal management of an additional pulmonary nodule in a patient with a known primary lung cancer is unclear. Additional pulmonary nodules are often identified during pathologic evaluation after resection of a primary tumor rather than before surgery. Although correlating these pathologic data with preoperative information can be useful, their applicability to management and decision making is often limited. This article focuses on the malignant additional pulmonary nodule in the same lobe as the known primary tumor, in a different lobe in the same lung as the known primary tumor, and in the contralateral lung.
From U S Carolina: Advances in treatment for early stage lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22054889
Clin Chest Med. 2011 Dec;32(4):827-38. Epub 2011 Oct 7.
A decade of advances in treatment of early-stage lung cancer.
Paoletti L, Pastis NJ, Denlinger CE, Silvestri GA.
Source
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 812, Charleston, SC 29425, USA.
Abstract
Emerging from the past decade, there has been a diversification of options for the treatment of early-stage lung cancer. Video-assisted thoracoscopic surgery is now more widely performed, with oncologic outcomes equivalent to those with open thoracotomy. Although lobectomy remains the standard approach to surgical resection, lesser resections, such as segmentectomy and wedge resection, are considerations for some patients. Advances in surgical, radiation, and medical therapies continue to evolve. Future research questions will focus on comparing long-term outcomes with these modalities, including survival, as well as patient-centered endpoints, such as quality of life.
Clin Chest Med. 2011 Dec;32(4):827-38. Epub 2011 Oct 7.
A decade of advances in treatment of early-stage lung cancer.
Paoletti L, Pastis NJ, Denlinger CE, Silvestri GA.
Source
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 812, Charleston, SC 29425, USA.
Abstract
Emerging from the past decade, there has been a diversification of options for the treatment of early-stage lung cancer. Video-assisted thoracoscopic surgery is now more widely performed, with oncologic outcomes equivalent to those with open thoracotomy. Although lobectomy remains the standard approach to surgical resection, lesser resections, such as segmentectomy and wedge resection, are considerations for some patients. Advances in surgical, radiation, and medical therapies continue to evolve. Future research questions will focus on comparing long-term outcomes with these modalities, including survival, as well as patient-centered endpoints, such as quality of life.
From Yale: Advances in treatment for advanced lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22054890
Clin Chest Med. 2011 Dec;32(4):839-51.
A decade of advances in treatment for advanced non-small cell lung cancer.
Gettinger S, Lynch T.
Source
Division of Medical Oncology, Yale University School of Medicine, 333 Cedar Street, FMP 127, New Haven, CT 06520, USA.
Abstract
The last decade has heralded a paradigm shift in the evaluation and treatment of advanced non-small cell lung cancer (NSCLC). No longer are patients with NSCLC considered a homogeneous population treated in the same way; rather, clinical characteristics, histology, and an expanding array of molecular markers are increasingly being used to individualize therapy. Both histology and tumor epidermal growth factor receptor mutational status currently have firmly established roles in determining initial and salvage therapy for advanced NSCLC. Several other biomarkers are the focus of ongoing prospective randomized clinical trials customizing both traditional chemotherapy and newer molecularly targeted agents.
Clin Chest Med. 2011 Dec;32(4):839-51.
A decade of advances in treatment for advanced non-small cell lung cancer.
Gettinger S, Lynch T.
Source
Division of Medical Oncology, Yale University School of Medicine, 333 Cedar Street, FMP 127, New Haven, CT 06520, USA.
Abstract
The last decade has heralded a paradigm shift in the evaluation and treatment of advanced non-small cell lung cancer (NSCLC). No longer are patients with NSCLC considered a homogeneous population treated in the same way; rather, clinical characteristics, histology, and an expanding array of molecular markers are increasingly being used to individualize therapy. Both histology and tumor epidermal growth factor receptor mutational status currently have firmly established roles in determining initial and salvage therapy for advanced NSCLC. Several other biomarkers are the focus of ongoing prospective randomized clinical trials customizing both traditional chemotherapy and newer molecularly targeted agents.
From Stanford: Small cell lung cancer treatment
http://www.ncbi.nlm.nih.gov/pubmed/22054891
Clin Chest Med. 2011 Dec;32(4):853-63. Epub 2011 Sep 28.
Current management of small cell lung cancer.
Neal JW, Gubens MA, Wakelee HA.
Source
Stanford Cancer Institute, Department of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5826, USA.
Abstract
Confined to one side of the chest, limited stage small cell lung cancer is treated with a combination of chemotherapy and radiotherapy, yet has a long-term survival rate of only 15%. Extensive stage disease has initial response rates to chemotherapy exceeding 70%. However, the disease almost invariably progresses and becomes fatal. Many recent clinical trials have failed to show superiority of newer chemotherapeutics or targeted therapies compared with the standard chemotherapy backbone of platinum plus etoposide. Numerous promising targeted therapies and other agents are still in development.
Clin Chest Med. 2011 Dec;32(4):853-63. Epub 2011 Sep 28.
Current management of small cell lung cancer.
Neal JW, Gubens MA, Wakelee HA.
Source
Stanford Cancer Institute, Department of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5826, USA.
Abstract
Confined to one side of the chest, limited stage small cell lung cancer is treated with a combination of chemotherapy and radiotherapy, yet has a long-term survival rate of only 15%. Extensive stage disease has initial response rates to chemotherapy exceeding 70%. However, the disease almost invariably progresses and becomes fatal. Many recent clinical trials have failed to show superiority of newer chemotherapeutics or targeted therapies compared with the standard chemotherapy backbone of platinum plus etoposide. Numerous promising targeted therapies and other agents are still in development.
From U Penn: Gene therapy for lung neoplasms--includes other thoracic neoplasms
http://www.ncbi.nlm.nih.gov/pubmed/22054892
Clin Chest Med. 2011 Dec;32(4):865-85. Epub 2011 Oct 7.
Gene therapy for lung neoplasms.
Vachani A, Moon E, Wakeam E, Haas AR, Sterman DH, Albelda SM.
Source
Division of Pulmonary, Allergy & Critical Care Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Abstract
Both advanced-stage lung cancer and malignant pleural mesothelioma are associated with a poor prognosis. Advances in treatment regimens for both diseases have had only a modest effect on their progressive course. Gene therapy for thoracic malignancies represents a novel therapeutic approach and has been evaluated in several clinical trials. Strategies have included induction of apoptosis, tumor suppressor gene replacement, suicide gene expression, cytokine-based therapy, various vaccination approaches, and adoptive transfer of modified immune cells. This review considers the clinical results, limitations, and future directions of gene therapy trials for thoracic malignancies.
Clin Chest Med. 2011 Dec;32(4):865-85. Epub 2011 Oct 7.
Gene therapy for lung neoplasms.
Vachani A, Moon E, Wakeam E, Haas AR, Sterman DH, Albelda SM.
Source
Division of Pulmonary, Allergy & Critical Care Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Abstract
Both advanced-stage lung cancer and malignant pleural mesothelioma are associated with a poor prognosis. Advances in treatment regimens for both diseases have had only a modest effect on their progressive course. Gene therapy for thoracic malignancies represents a novel therapeutic approach and has been evaluated in several clinical trials. Strategies have included induction of apoptosis, tumor suppressor gene replacement, suicide gene expression, cytokine-based therapy, various vaccination approaches, and adoptive transfer of modified immune cells. This review considers the clinical results, limitations, and future directions of gene therapy trials for thoracic malignancies.
From U Utah: More on the hot topic of lung cancer screening
http://www.ncbi.nlm.nih.gov/pubmed/22056830
Hosp Pract (Minneap). 2011 Nov;39(4):107-12.
Lung cancer screening: a review of available data and current guidelines.
Reddy C, Chilla D, Boltax J.
Source
University of Utah Health Sciences Center, Salt Lake City, UT. c.reddy@hci.utah.edu.
Abstract
Lung cancer is the leading cause of cancer mortality worldwide. A lack of clinical symptoms in early-stage disease frequently leads to diagnosis at a late stage, and a 15% 5-year survival rate in all patients so diagnosed. This has led to significant interest in effective screening methods to detect early-stage cancers, particularly for high-risk groups, such as current or former smokers. Early clinical trials focused on chest radiograph with or without sputum cytology and failed to show an improvement in mortality with screening. A meta-analysis also failed to show a difference in all-cause mortality. Subsequent protocols compared low-dose computed tomography (LDCT) scan with chest radiograph and documented increased detection of early-stage disease; however, they were not designed to prove a reduction in mortality. The most recent trials have focused on LDCT scans, including the National Lung Screening Trial. Data released from the National Lung Screening Trial demonstrated a statistically significant reduction in lung cancer deaths in patients screened with LDCT scans. When data from the study, including cost-effectiveness, are completely analyzed, they may lead to revision of current lung cancer screening recommendations to include LDCT scans in specific populations at high risk of developing lung cancer.
Hosp Pract (Minneap). 2011 Nov;39(4):107-12.
Lung cancer screening: a review of available data and current guidelines.
Reddy C, Chilla D, Boltax J.
Source
University of Utah Health Sciences Center, Salt Lake City, UT. c.reddy@hci.utah.edu.
Abstract
Lung cancer is the leading cause of cancer mortality worldwide. A lack of clinical symptoms in early-stage disease frequently leads to diagnosis at a late stage, and a 15% 5-year survival rate in all patients so diagnosed. This has led to significant interest in effective screening methods to detect early-stage cancers, particularly for high-risk groups, such as current or former smokers. Early clinical trials focused on chest radiograph with or without sputum cytology and failed to show an improvement in mortality with screening. A meta-analysis also failed to show a difference in all-cause mortality. Subsequent protocols compared low-dose computed tomography (LDCT) scan with chest radiograph and documented increased detection of early-stage disease; however, they were not designed to prove a reduction in mortality. The most recent trials have focused on LDCT scans, including the National Lung Screening Trial. Data released from the National Lung Screening Trial demonstrated a statistically significant reduction in lung cancer deaths in patients screened with LDCT scans. When data from the study, including cost-effectiveness, are completely analyzed, they may lead to revision of current lung cancer screening recommendations to include LDCT scans in specific populations at high risk of developing lung cancer.
From U Adelaide: 1/3 of men diagnosed with cancer modify diet and/or seek spiritual guidance
http://www.ncbi.nlm.nih.gov/pubmed/22056972
Ann Oncol. 2011 Nov 5. [Epub ahead of print]
Prevalence and predictors of complementary and alternative medicine (CAM) use by men in Australian cancer outpatient services.
Klafke N, Eliott JA, Wittert GA, Olver IN.
Source
School of Psychology, The University of Adelaide, Adelaide.
Abstract
BACKGROUND:
Although studies have shown that complementary and alternative medicine (CAM) use is common in cancer patients, no survey has assessed CAM use in men with a variety of cancers. In Australia, no data exist about male cancer patients' use of CAM.
PATIENTS AND METHODS:
A self-administered questionnaire was completed by 403 men attending four cancer outpatient services in Metropolitan Adelaide. Data were analyzed using Pearson's χ(2) tests and multivariate logistic regression analysis.
RESULTS:
CAMs were currently used by 52.9%, or used at some point by 61.5%, of respondents. The most popular CAM treatments were dietary supplements (36.1%), prayer (25.9%), herbs and botanicals (21.4%), and relaxation techniques/meditation (15.2%). CAM use was directed by a cancer specialist in 9.9% of respondents. Independent predictors of CAM use were metastatic cancer (P = 0.022), actively practicing religion (P = 0.008), and tertiary education (P = 0.007).
CONCLUSIONS:
CAM use in males is equally common across all cancer diagnoses, namely prostate, hematological malignancies, colorectal, lung, and other cancers. Oncologists should be aware that one-third of male patients modify their diet and/or search for spiritual guidance, particularly when diagnosed with metastatic cancer.
Ann Oncol. 2011 Nov 5. [Epub ahead of print]
Prevalence and predictors of complementary and alternative medicine (CAM) use by men in Australian cancer outpatient services.
Klafke N, Eliott JA, Wittert GA, Olver IN.
Source
School of Psychology, The University of Adelaide, Adelaide.
Abstract
BACKGROUND:
Although studies have shown that complementary and alternative medicine (CAM) use is common in cancer patients, no survey has assessed CAM use in men with a variety of cancers. In Australia, no data exist about male cancer patients' use of CAM.
PATIENTS AND METHODS:
A self-administered questionnaire was completed by 403 men attending four cancer outpatient services in Metropolitan Adelaide. Data were analyzed using Pearson's χ(2) tests and multivariate logistic regression analysis.
RESULTS:
CAMs were currently used by 52.9%, or used at some point by 61.5%, of respondents. The most popular CAM treatments were dietary supplements (36.1%), prayer (25.9%), herbs and botanicals (21.4%), and relaxation techniques/meditation (15.2%). CAM use was directed by a cancer specialist in 9.9% of respondents. Independent predictors of CAM use were metastatic cancer (P = 0.022), actively practicing religion (P = 0.008), and tertiary education (P = 0.007).
CONCLUSIONS:
CAM use in males is equally common across all cancer diagnoses, namely prostate, hematological malignancies, colorectal, lung, and other cancers. Oncologists should be aware that one-third of male patients modify their diet and/or search for spiritual guidance, particularly when diagnosed with metastatic cancer.
From Pozan U-Poland: Quality of life in patients with advanced lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22057209
Am J Hosp Palliat Care. 2011 Nov 3. [Epub ahead of print]
Quality of Life in Patients With Advanced Lung Cancer Treated at Home and at a Palliative Care Unit.
Leppert W, Turska A, Majkowicz M, Dziegielewska S, Pankiewicz P, Mess E.
Source
Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.
Abstract
Background: To assess quality of life (QOL) in patients with advanced lung cancer. Patients and
METHODS:
A prospective study of 78 patients cared at home and at a palliative care unit (PCU) with 2 QOL assessments was conducted.
RESULTS:
Fifty patients completed the study. In the EORTC QLQ-C30 role, cognitive, social functioning, global QOL, fatigue, pain, dyspnea, and appetite deteriorated; nausea/vomiting improved; dyspnea was more intense in the case of in-home patients. In the EORTC QLQ-LC13 hemoptysis improved; pain in other parts was more intense in the PCU patients. Pain (Visual Analogue scale) was more intense in the PCU patients; the level of activity (Karnofsky) decreased in the case of patients treated at home.
CONCLUSIONS:
QOL deteriorated with few differences between home and the PCU patients.
Am J Hosp Palliat Care. 2011 Nov 3. [Epub ahead of print]
Quality of Life in Patients With Advanced Lung Cancer Treated at Home and at a Palliative Care Unit.
Leppert W, Turska A, Majkowicz M, Dziegielewska S, Pankiewicz P, Mess E.
Source
Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.
Abstract
Background: To assess quality of life (QOL) in patients with advanced lung cancer. Patients and
METHODS:
A prospective study of 78 patients cared at home and at a palliative care unit (PCU) with 2 QOL assessments was conducted.
RESULTS:
Fifty patients completed the study. In the EORTC QLQ-C30 role, cognitive, social functioning, global QOL, fatigue, pain, dyspnea, and appetite deteriorated; nausea/vomiting improved; dyspnea was more intense in the case of in-home patients. In the EORTC QLQ-LC13 hemoptysis improved; pain in other parts was more intense in the PCU patients. Pain (Visual Analogue scale) was more intense in the PCU patients; the level of activity (Karnofsky) decreased in the case of patients treated at home.
CONCLUSIONS:
QOL deteriorated with few differences between home and the PCU patients.
From Thorax: Therapeutic advances in lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22058187
Thorax. 2011 Nov 5. [Epub ahead of print]
Therapeutic advances in non-small cell lung cancer.
Vallières E, Peters S, Van Houtte P, Dalal P, Lim E.
Source
Department of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington, USA.
Abstract
Despite decades of research, therapeutic advances in non-small cell lung cancer (NSCLC) have progressed at a painstaking slow rate with few improvements in standard surgical resection for early stage disease and chemotherapy or radiotherapy for patients with advanced disease. In the past 18 months, however, we seemed to have reached an inflexion point: therapeutic advances that are centred on improvements in the understanding of patient selection, surgery that is undertaken through smaller incisions, identification of candidate mutations accompanied by the development of targeted anticancer treatments with a focus on personalised medicine, improvements to radiotherapy technology, emergence of radiofrequency ablation (RFA), and last but by no means least, the recognition of palliative care as a therapeutic modality in its own right. The contributors to this review are a distinguished international panel of experts who highlight recent advances in each of the major disciplines.
Thorax. 2011 Nov 5. [Epub ahead of print]
Therapeutic advances in non-small cell lung cancer.
Vallières E, Peters S, Van Houtte P, Dalal P, Lim E.
Source
Department of Thoracic Surgery, Swedish Cancer Institute, Seattle, Washington, USA.
Abstract
Despite decades of research, therapeutic advances in non-small cell lung cancer (NSCLC) have progressed at a painstaking slow rate with few improvements in standard surgical resection for early stage disease and chemotherapy or radiotherapy for patients with advanced disease. In the past 18 months, however, we seemed to have reached an inflexion point: therapeutic advances that are centred on improvements in the understanding of patient selection, surgery that is undertaken through smaller incisions, identification of candidate mutations accompanied by the development of targeted anticancer treatments with a focus on personalised medicine, improvements to radiotherapy technology, emergence of radiofrequency ablation (RFA), and last but by no means least, the recognition of palliative care as a therapeutic modality in its own right. The contributors to this review are a distinguished international panel of experts who highlight recent advances in each of the major disciplines.
Monday, October 31, 2011
Archives of Pathology and Laboratory Medicine--Special Section on Quality
http://www.ncbi.nlm.nih.gov/pubmed/22032561
Arch Pathol Lab Med. 2011 Nov;135(11):1384-6.
Quality: walk the walk.
Allen TC.
Abstract
The College of American Pathologists (CAP) is dedicated to pathology and laboratory medicine quality. The CAP's Laboratory Accreditation Program, Proficiency Testing Program, Q-Probes and Q-Tracks, site-specific cancer checklists, webinars, annual meetings, and Advanced Practical Pathology series are all focused on providing superior patient quality. The CAP is synonymous with quality in pathology and laboratory medicine. As pathology practice becomes more sophisticated, the CAP's many programs will increasingly help pathologists provide appropriate, personalized care.
http://www.ncbi.nlm.nih.gov/pubmed/22032562
Arch Pathol Lab Med. 2011 Nov;135(11):1387-90.
Quality improvement in cytology: where do we go from here?
Renshaw AA.
Abstract
Context.-Cytology is a success because of the many quality controls used to ensure the accuracy of its results. Nevertheless, additional information is becoming available to the cytologist, often from untraditional sources, and the best way to use that information to improve the quality of cytology is not yet known. Objective.-To review ways to use new information to improve the quality of cytology. Data Sources.-Review of relevant literature. Results.-Information contained in many sources can be used in new ways to improve the quality of cytology. These include the timing of cytologic and histologic correlation, electronic medical records, workload information, prior aspirations, and molecular tests. Conclusions.-To maintain their high standard of excellence, cytologists should seek to define the most appropriate way to incorporate this new information into their interpretation of individual cases.
http://www.ncbi.nlm.nih.gov/pubmed/22032563
Arch Pathol Lab Med. 2011 Nov;135(11):1391-3.
Unexpected expectations in critical values in anatomic pathology: improving agreement between pathologists and nonpathologists with the treatable immediately, life-threatening terminology.
Renshaw SA, Gould EW, Renshaw AA.
Abstract
Context.-The degree to which critical values in anatomic pathology are understood in the nonpathology community is not know. Objective.-To measure the degree of agreement between pathologists and nonpathologists regarding critical values in anatomic pathology. Design.-A survey containing 15 anatomic pathologic diagnoses was given to a group of pathologists and nonpathologists who were then asked to state whether they should be regarded as critical values. Results.-Nonpathologists thought that a significantly greater percentage of diagnoses were critical than did pathologists, (49% versus 12%, P < .001). If the term critical value was changed to treatable immediately, life threatening, there was no significant difference between the responses of nonpathologists and pathologists (20% versus 12%, P = .06). Conclusions.-There is considerable disagreement between pathologists and nonpathologists concerning which diagnoses are critical values in anatomic pathology. Use of the term treatable immediately, life threatening significantly improves agreement.
http://www.ncbi.nlm.nih.gov/pubmed/22032564
Arch Pathol Lab Med. 2011 Nov;135(11):1394-7.
Quality in surgical pathology communication and reporting.
Nakhleh RE.
Abstract
Context.-Communication in surgical pathology is complex and includes multiple facets. Objective.-To discuss different aspects of pathology practice that represent quality communication in surgical pathology. Data Sources.-Literature review. Conclusions.-Achieving quality communication in surgical pathology is dependent on pathologists addressing multiple situations including managing physicians' expectations for turnaround time and ancillary testing, understanding what information is needed to manage the patient at intraoperative consultation and in the final report, assuring adequate report content with the use of synoptic checklist reports, and using report formatting suggestions that aid report comprehension. Finally, the pathologists' availability to answer questions and discuss cases is an important factor in effective communication, including their willingness to verbally report urgent and significant unexpected diagnoses to ensure that important diagnoses are not overlooked.
http://www.ncbi.nlm.nih.gov/pubmed/22032565
Arch Pathol Lab Med. 2011 Nov;135(11):1398-404.
Evidence-based principles in pathology: existing problem areas and the development of "quality" practice patterns.
Wick MR, Marchevsky AM.
Abstract
Context.-Contrary to the intuitive impressions of many pathologists, several areas exist in laboratory medicine where evidence-based medicine (EBM) principles are not applied. These include aspects of both anatomic and clinical pathology. Some non-EBM practices are perpetuated by clinical "consumers" of laboratory services because of inadequate education, habit, or overreliance on empirical factors. Other faulty procedures are driven by pathologists themselves. Objectives.-To consider (1) several selected problem areas representing non-EBM practices in laboratory medicine; such examples include ideas and techniques that concern metastatic malignancies, "targeted" oncologic therapy, general laboratory testing and data utilization, evaluation of selected coagulation defects, administration of blood products, and analysis of hepatic iron-overload syndromes; and (2) EBM principles as methods for remediation of deficiencies in hospital pathology, and implements for the construction of "quality" practices in our specialty. Data Sources.-Current English literature relating to evidence-based principles in pathology and laboratory medicine, as well as the authors' experience. Conclusions.-Evidence-based medicine holds the promise of optimizing laboratory services to produce "quality" practices in pathology. It will also be a key to restraining the overall cost of health care.
http://www.ncbi.nlm.nih.gov/pubmed/22032566
Arch Pathol Lab Med. 2011 Nov;135(11):1405-14.
Assuring Quality in Point-of-Care Testing: Evolution of Technologies, Informatics, and Program Management.
Lewandrowski K, Gregory K, Macmillan D.
Abstract
Context.-Managing the quality of point-of-care testing (POCT) is a continuing challenge. Advances in testing technologies and the development of specialized informatics for POCT have greatly improved the ability of hospitals to manage their POCT program. Objectives.-To present the evolving role of technology improvement, informatics, and program management as the key developments to ensure the quality of POCT. Data Sources.-This presentation is based on a review of the literature and on our experiences with POCT at the Massachusetts General Hospital (Boston). Conclusions.-Federal and state regulations, along with accreditation standards developed by the College of American Pathologists and The Joint Commission, have established guidelines for the performance of POCT and have provided a strong incentive to improve the quality of testing. Many instruments for POCT have incorporated advanced design features to prevent analytic and operator errors. This, along with the development of connectivity standards and specialized data management software, has enabled remote review of test data and electronic flow of information to hospital information systems. However, documentation of manually performed, visually read tests remains problematic and some POCT devices do not have adequate safeguards to prevent significant errors. In the past 2 decades the structure of a successful POCT management program has been defined, emphasizing the role of POCT managers working in conjunction with a pathology-based medical director. The critical skill set of POCT managers has also been identified. The POCT manager is now recognized as a true specialist in laboratory medicine.
http://www.ncbi.nlm.nih.gov/pubmed/22032567
Arch Pathol Lab Med. 2011 Nov;135(11):1415-24.
Managing transfusion service quality.
Blaylock RC, Lehman CM.
Abstract
Context.-Providing blood products for transfusions is a complex process subject to errors both within and outside the transfusion service. Transfusion-related errors can have grave consequences for the patient undergoing transfusion. As with many processes performed within health care systems, there is an expectation of error-free practice. Although this is an unobtainable goal, a focused quality-management plan, employing a medical event reporting system in a just working environment, can effect measurable system-quality improvement. Objective.-To illustrate the intrinsic value of quality-improvement activities through discussion of examples of quality misadventures from our transfusion service during the past 20 years. Data Sources.-Examples of quality-improvement activities were extracted from our quality-system archives. The published literature on transfusion quality was reviewed. Conclusions.-Active reporting, structured investigation, and systematic resolution of transfusion-related errors are effective methods for improving and maintaining transfusion quality.
http://www.ncbi.nlm.nih.gov/pubmed/22032568
Arch Pathol Lab Med. 2011 Nov;135(11):1425-31.
Quality and safety in medical care: what does the future hold?
Liang BA, Mackey T.
Abstract
Context.-The rapid changes in health care policy, embracing quality and safety mandates, have culminated in programs and initiatives under the Patient Protection and Affordable Care Act. Objective.-To review the context of, and anticipated quality and patient safety mandates for, delivery systems, incentives under health care reform, and models for future accountability for outcomes of care. Design.-Assessment of the provisions of Patient Protection and Affordable Care Act, other reform efforts, and reform initiatives focusing on future quality and safety provisions for health care providers. Results.-Health care reform and other efforts focus on consumerism in the context of price. Quality and safety efforts will be structured using financial incentives, best-practices research, and new delivery models that focus on reaching benchmarks while reducing costs. In addition, patient experience will be a key component of reimbursement, and a move toward "retail" approaches directed at the individual patient may supplant traditional "wholesale" efforts at attracting employers. Conclusions.-Quality and safety have always been of prime importance in medicine. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.
http://www.ncbi.nlm.nih.gov/pubmed/22032569
Arch Pathol Lab Med. 2011 Nov;135(11):1432-5.
College of american pathologists proposal for the oversight of laboratory-developed tests.
Vance GH.
Abstract
Context.-The US Food and Drug Administration (FDA) announced it will exercise authority over laboratory-developed tests (LDTs). Laboratory-developed tests have traditionally been developed and offered in laboratories as a service to patients and regulated under the Clinical Laboratory Improvement Amendments of 1988 (Clinical Laboratory Improvements Act). Laboratories now face potential dual regulatory oversight from both the Centers for Medicare and Medicaid Services (CMS) and the FDA. The College of American Pathologists (CAP) constructed a proposal to minimize redundancy of agency oversight and burden to laboratories. Modifications to the proposal continue while the laboratory community awaits release of the guidance documents that will stipulate FDA requirements. Objective.-To describe the historical context framing the entry of FDA into the oversight of LDTs and outline the CAP LDT Proposal in its current form. Data Sources.-PubMed review of published literature; United States Constitution; and online information resources from the National Institutes of Health, FDA, and US Government. Conclusion.-The College of American Pathologists is a leader in laboratory quality and has unique insights into the benefits and risks to patients presented by LDTs. Continued dialog with officials from the FDA and CMS will promote public and private collaborative efforts to assure innovation of diagnostic testing, public information, and patient safety for clinical diagnostic testing.
http://www.ncbi.nlm.nih.gov/pubmed/22032570
Arch Pathol Lab Med. 2011 Nov;135(11):1436-40.
Assessment of latent factors contributing to error: addressing surgical pathology error wisely.
Smith ML, Raab SS.
Abstract
Context.-Methods to improve surgical pathology patient safety include measuring the frequency of error in specific steps of the surgical pathology testing process, root cause analysis of active and latent components, and implementation of quality improvement initiatives. Objective.-To determine the frequency and cause of near-miss events in the specimen accessioning, setup, and biopsy-only gross examination testing steps of anatomic pathology. Design.-We used an observational checklist method to identify near-miss events. We performed root cause analysis to determine latent factors contributing to near-miss events. We conducted observations for 45 hours during 5 days, involving the accessioning and processing of 335 specimens. Results.-We detected a total of 2310 process-dependent and 266 operator-dependent near-miss events, resulting in a near-miss-event frequency of 5.5 per specimen. Root cause analysis showed that all process and operator near-miss events were associated with multiple system latent factors, including lack of standardized protocols, appropriate knowledge transfer, and focus on safety culture. Conclusion.-We conclude that the increased focus on surgical pathology near-miss events will reveal latent factors that may be targeted for improvement.
http://www.ncbi.nlm.nih.gov/pubmed/22032571
Arch Pathol Lab Med. 2011 Nov;135(11):1441.
Quality and the college of american pathologists.
Allen TC, Hammond ME, Robboy SJ.
Abstract
The College of American Pathologists (CAP) is dedicated to pathology and laboratory medicine quality. The CAP's Laboratory Accreditation Program, Proficiency Testing Program, Q-Probes and Q-Tracks, site-specific cancer checklists, webinars, annual meetings, and Advanced Practical Pathology series are all focused on providing superior patent quality. The CAP is synonymous with quality in pathology and laboratory medicine. As pathology practice becomes more sophisticated, the CAP's many programs will increasingly help pathologists provide appropriate, personalized patient care.
Arch Pathol Lab Med. 2011 Nov;135(11):1384-6.
Quality: walk the walk.
Allen TC.
Abstract
The College of American Pathologists (CAP) is dedicated to pathology and laboratory medicine quality. The CAP's Laboratory Accreditation Program, Proficiency Testing Program, Q-Probes and Q-Tracks, site-specific cancer checklists, webinars, annual meetings, and Advanced Practical Pathology series are all focused on providing superior patient quality. The CAP is synonymous with quality in pathology and laboratory medicine. As pathology practice becomes more sophisticated, the CAP's many programs will increasingly help pathologists provide appropriate, personalized care.
http://www.ncbi.nlm.nih.gov/pubmed/22032562
Arch Pathol Lab Med. 2011 Nov;135(11):1387-90.
Quality improvement in cytology: where do we go from here?
Renshaw AA.
Abstract
Context.-Cytology is a success because of the many quality controls used to ensure the accuracy of its results. Nevertheless, additional information is becoming available to the cytologist, often from untraditional sources, and the best way to use that information to improve the quality of cytology is not yet known. Objective.-To review ways to use new information to improve the quality of cytology. Data Sources.-Review of relevant literature. Results.-Information contained in many sources can be used in new ways to improve the quality of cytology. These include the timing of cytologic and histologic correlation, electronic medical records, workload information, prior aspirations, and molecular tests. Conclusions.-To maintain their high standard of excellence, cytologists should seek to define the most appropriate way to incorporate this new information into their interpretation of individual cases.
http://www.ncbi.nlm.nih.gov/pubmed/22032563
Arch Pathol Lab Med. 2011 Nov;135(11):1391-3.
Unexpected expectations in critical values in anatomic pathology: improving agreement between pathologists and nonpathologists with the treatable immediately, life-threatening terminology.
Renshaw SA, Gould EW, Renshaw AA.
Abstract
Context.-The degree to which critical values in anatomic pathology are understood in the nonpathology community is not know. Objective.-To measure the degree of agreement between pathologists and nonpathologists regarding critical values in anatomic pathology. Design.-A survey containing 15 anatomic pathologic diagnoses was given to a group of pathologists and nonpathologists who were then asked to state whether they should be regarded as critical values. Results.-Nonpathologists thought that a significantly greater percentage of diagnoses were critical than did pathologists, (49% versus 12%, P < .001). If the term critical value was changed to treatable immediately, life threatening, there was no significant difference between the responses of nonpathologists and pathologists (20% versus 12%, P = .06). Conclusions.-There is considerable disagreement between pathologists and nonpathologists concerning which diagnoses are critical values in anatomic pathology. Use of the term treatable immediately, life threatening significantly improves agreement.
http://www.ncbi.nlm.nih.gov/pubmed/22032564
Arch Pathol Lab Med. 2011 Nov;135(11):1394-7.
Quality in surgical pathology communication and reporting.
Nakhleh RE.
Abstract
Context.-Communication in surgical pathology is complex and includes multiple facets. Objective.-To discuss different aspects of pathology practice that represent quality communication in surgical pathology. Data Sources.-Literature review. Conclusions.-Achieving quality communication in surgical pathology is dependent on pathologists addressing multiple situations including managing physicians' expectations for turnaround time and ancillary testing, understanding what information is needed to manage the patient at intraoperative consultation and in the final report, assuring adequate report content with the use of synoptic checklist reports, and using report formatting suggestions that aid report comprehension. Finally, the pathologists' availability to answer questions and discuss cases is an important factor in effective communication, including their willingness to verbally report urgent and significant unexpected diagnoses to ensure that important diagnoses are not overlooked.
http://www.ncbi.nlm.nih.gov/pubmed/22032565
Arch Pathol Lab Med. 2011 Nov;135(11):1398-404.
Evidence-based principles in pathology: existing problem areas and the development of "quality" practice patterns.
Wick MR, Marchevsky AM.
Abstract
Context.-Contrary to the intuitive impressions of many pathologists, several areas exist in laboratory medicine where evidence-based medicine (EBM) principles are not applied. These include aspects of both anatomic and clinical pathology. Some non-EBM practices are perpetuated by clinical "consumers" of laboratory services because of inadequate education, habit, or overreliance on empirical factors. Other faulty procedures are driven by pathologists themselves. Objectives.-To consider (1) several selected problem areas representing non-EBM practices in laboratory medicine; such examples include ideas and techniques that concern metastatic malignancies, "targeted" oncologic therapy, general laboratory testing and data utilization, evaluation of selected coagulation defects, administration of blood products, and analysis of hepatic iron-overload syndromes; and (2) EBM principles as methods for remediation of deficiencies in hospital pathology, and implements for the construction of "quality" practices in our specialty. Data Sources.-Current English literature relating to evidence-based principles in pathology and laboratory medicine, as well as the authors' experience. Conclusions.-Evidence-based medicine holds the promise of optimizing laboratory services to produce "quality" practices in pathology. It will also be a key to restraining the overall cost of health care.
http://www.ncbi.nlm.nih.gov/pubmed/22032566
Arch Pathol Lab Med. 2011 Nov;135(11):1405-14.
Assuring Quality in Point-of-Care Testing: Evolution of Technologies, Informatics, and Program Management.
Lewandrowski K, Gregory K, Macmillan D.
Abstract
Context.-Managing the quality of point-of-care testing (POCT) is a continuing challenge. Advances in testing technologies and the development of specialized informatics for POCT have greatly improved the ability of hospitals to manage their POCT program. Objectives.-To present the evolving role of technology improvement, informatics, and program management as the key developments to ensure the quality of POCT. Data Sources.-This presentation is based on a review of the literature and on our experiences with POCT at the Massachusetts General Hospital (Boston). Conclusions.-Federal and state regulations, along with accreditation standards developed by the College of American Pathologists and The Joint Commission, have established guidelines for the performance of POCT and have provided a strong incentive to improve the quality of testing. Many instruments for POCT have incorporated advanced design features to prevent analytic and operator errors. This, along with the development of connectivity standards and specialized data management software, has enabled remote review of test data and electronic flow of information to hospital information systems. However, documentation of manually performed, visually read tests remains problematic and some POCT devices do not have adequate safeguards to prevent significant errors. In the past 2 decades the structure of a successful POCT management program has been defined, emphasizing the role of POCT managers working in conjunction with a pathology-based medical director. The critical skill set of POCT managers has also been identified. The POCT manager is now recognized as a true specialist in laboratory medicine.
http://www.ncbi.nlm.nih.gov/pubmed/22032567
Arch Pathol Lab Med. 2011 Nov;135(11):1415-24.
Managing transfusion service quality.
Blaylock RC, Lehman CM.
Abstract
Context.-Providing blood products for transfusions is a complex process subject to errors both within and outside the transfusion service. Transfusion-related errors can have grave consequences for the patient undergoing transfusion. As with many processes performed within health care systems, there is an expectation of error-free practice. Although this is an unobtainable goal, a focused quality-management plan, employing a medical event reporting system in a just working environment, can effect measurable system-quality improvement. Objective.-To illustrate the intrinsic value of quality-improvement activities through discussion of examples of quality misadventures from our transfusion service during the past 20 years. Data Sources.-Examples of quality-improvement activities were extracted from our quality-system archives. The published literature on transfusion quality was reviewed. Conclusions.-Active reporting, structured investigation, and systematic resolution of transfusion-related errors are effective methods for improving and maintaining transfusion quality.
http://www.ncbi.nlm.nih.gov/pubmed/22032568
Arch Pathol Lab Med. 2011 Nov;135(11):1425-31.
Quality and safety in medical care: what does the future hold?
Liang BA, Mackey T.
Abstract
Context.-The rapid changes in health care policy, embracing quality and safety mandates, have culminated in programs and initiatives under the Patient Protection and Affordable Care Act. Objective.-To review the context of, and anticipated quality and patient safety mandates for, delivery systems, incentives under health care reform, and models for future accountability for outcomes of care. Design.-Assessment of the provisions of Patient Protection and Affordable Care Act, other reform efforts, and reform initiatives focusing on future quality and safety provisions for health care providers. Results.-Health care reform and other efforts focus on consumerism in the context of price. Quality and safety efforts will be structured using financial incentives, best-practices research, and new delivery models that focus on reaching benchmarks while reducing costs. In addition, patient experience will be a key component of reimbursement, and a move toward "retail" approaches directed at the individual patient may supplant traditional "wholesale" efforts at attracting employers. Conclusions.-Quality and safety have always been of prime importance in medicine. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.
http://www.ncbi.nlm.nih.gov/pubmed/22032569
Arch Pathol Lab Med. 2011 Nov;135(11):1432-5.
College of american pathologists proposal for the oversight of laboratory-developed tests.
Vance GH.
Abstract
Context.-The US Food and Drug Administration (FDA) announced it will exercise authority over laboratory-developed tests (LDTs). Laboratory-developed tests have traditionally been developed and offered in laboratories as a service to patients and regulated under the Clinical Laboratory Improvement Amendments of 1988 (Clinical Laboratory Improvements Act). Laboratories now face potential dual regulatory oversight from both the Centers for Medicare and Medicaid Services (CMS) and the FDA. The College of American Pathologists (CAP) constructed a proposal to minimize redundancy of agency oversight and burden to laboratories. Modifications to the proposal continue while the laboratory community awaits release of the guidance documents that will stipulate FDA requirements. Objective.-To describe the historical context framing the entry of FDA into the oversight of LDTs and outline the CAP LDT Proposal in its current form. Data Sources.-PubMed review of published literature; United States Constitution; and online information resources from the National Institutes of Health, FDA, and US Government. Conclusion.-The College of American Pathologists is a leader in laboratory quality and has unique insights into the benefits and risks to patients presented by LDTs. Continued dialog with officials from the FDA and CMS will promote public and private collaborative efforts to assure innovation of diagnostic testing, public information, and patient safety for clinical diagnostic testing.
http://www.ncbi.nlm.nih.gov/pubmed/22032570
Arch Pathol Lab Med. 2011 Nov;135(11):1436-40.
Assessment of latent factors contributing to error: addressing surgical pathology error wisely.
Smith ML, Raab SS.
Abstract
Context.-Methods to improve surgical pathology patient safety include measuring the frequency of error in specific steps of the surgical pathology testing process, root cause analysis of active and latent components, and implementation of quality improvement initiatives. Objective.-To determine the frequency and cause of near-miss events in the specimen accessioning, setup, and biopsy-only gross examination testing steps of anatomic pathology. Design.-We used an observational checklist method to identify near-miss events. We performed root cause analysis to determine latent factors contributing to near-miss events. We conducted observations for 45 hours during 5 days, involving the accessioning and processing of 335 specimens. Results.-We detected a total of 2310 process-dependent and 266 operator-dependent near-miss events, resulting in a near-miss-event frequency of 5.5 per specimen. Root cause analysis showed that all process and operator near-miss events were associated with multiple system latent factors, including lack of standardized protocols, appropriate knowledge transfer, and focus on safety culture. Conclusion.-We conclude that the increased focus on surgical pathology near-miss events will reveal latent factors that may be targeted for improvement.
http://www.ncbi.nlm.nih.gov/pubmed/22032571
Arch Pathol Lab Med. 2011 Nov;135(11):1441.
Quality and the college of american pathologists.
Allen TC, Hammond ME, Robboy SJ.
Abstract
The College of American Pathologists (CAP) is dedicated to pathology and laboratory medicine quality. The CAP's Laboratory Accreditation Program, Proficiency Testing Program, Q-Probes and Q-Tracks, site-specific cancer checklists, webinars, annual meetings, and Advanced Practical Pathology series are all focused on providing superior patent quality. The CAP is synonymous with quality in pathology and laboratory medicine. As pathology practice becomes more sophisticated, the CAP's many programs will increasingly help pathologists provide appropriate, personalized patient care.
Friday, October 28, 2011
My Archives of Pathology and Laboratory Medicine Special Section on Quality is out
http://www.archivesofpathology.org/toc/arpa/135/11
Thursday, October 27, 2011
From UNC: Genetics and obesity
http://www.ncbi.nlm.nih.gov/pubmed/22005399
Br J Nutr. 2011 Oct;106 Suppl 1:S1-S10.
Advances in comparative genetics: influence of genetics on obesity.
Mathes WF, Kelly SA, Pomp D.
Source
Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abstract
Obesity has reached epidemic proportions and is recognised as a significant global health problem. Increased food intake and decreased physical activity are traditionally to blame for the development of obesity; however, many variables such as behaviour, diet, environment, social structures and genetics also contribute to this multifactorial disease. Complex interactions among these variables (for example, gene-environment, gene-diet and gene-gene) contribute not only to individual differences in the development of obesity, but also in treatment response. Mouse models have historically played valuable roles in understanding the genetics of traits related to energy balance and obesity. In the present review, we survey past use and examine new advances in mouse models designed to uncover the genetic architecture of obesity and its component traits. We discuss traditional models such as inbred strains and selectively bred lines and their contributions and shortcomings. We consider the evolution of mouse models into more informative resources such as outbred crosses and the Hybrid Mouse Diversity Panel, as well as novel next-generation approaches such as the Collaborative Cross. Moreover, the genetic architecture of voluntary exercise and the interactive relationship between host genetics and the gut microbiome are presented as novel phenotypes that augment studies using body weight and body fat percentage as endpoints. Understanding the intricate network of phenotypic, genotypic and environmental variables that predispose individuals to obesity will elucidate biological networks involved in the development of obesity. Knowledge obtained from advances in mouse models will inform human health and provide insight into inter-individual variability in the aetiology of obesity-related diseases.
Br J Nutr. 2011 Oct;106 Suppl 1:S1-S10.
Advances in comparative genetics: influence of genetics on obesity.
Mathes WF, Kelly SA, Pomp D.
Source
Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abstract
Obesity has reached epidemic proportions and is recognised as a significant global health problem. Increased food intake and decreased physical activity are traditionally to blame for the development of obesity; however, many variables such as behaviour, diet, environment, social structures and genetics also contribute to this multifactorial disease. Complex interactions among these variables (for example, gene-environment, gene-diet and gene-gene) contribute not only to individual differences in the development of obesity, but also in treatment response. Mouse models have historically played valuable roles in understanding the genetics of traits related to energy balance and obesity. In the present review, we survey past use and examine new advances in mouse models designed to uncover the genetic architecture of obesity and its component traits. We discuss traditional models such as inbred strains and selectively bred lines and their contributions and shortcomings. We consider the evolution of mouse models into more informative resources such as outbred crosses and the Hybrid Mouse Diversity Panel, as well as novel next-generation approaches such as the Collaborative Cross. Moreover, the genetic architecture of voluntary exercise and the interactive relationship between host genetics and the gut microbiome are presented as novel phenotypes that augment studies using body weight and body fat percentage as endpoints. Understanding the intricate network of phenotypic, genotypic and environmental variables that predispose individuals to obesity will elucidate biological networks involved in the development of obesity. Knowledge obtained from advances in mouse models will inform human health and provide insight into inter-individual variability in the aetiology of obesity-related diseases.
Fructose and blood pressure
http://www.ncbi.nlm.nih.gov/pubmed/21792388
Int J Nephrol. 2011;2011:315879. Epub 2011 Jul 17.
The impact of fructose on renal function and blood pressure.
Kretowicz M, Johnson RJ, Ishimoto T, Nakagawa T, Manitius J.
Source
Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Abstract
Fructose is a sugar present in sucrose, high-fructose corn syrup, honey, and fruits. Fructose intake has increased markedly in the last two centuries, primarily due to increased intake of added sugars. Increasing evidence suggests that the excessive intake of fructose may induce fatty liver, insulin resistance, dyslipidemia, hypertension, and kidney disease. These studies suggest that excessive intake of fructose might have an etiologic role in the epidemic of obesity, diabetes, and cardiorenal disease.
Int J Nephrol. 2011;2011:315879. Epub 2011 Jul 17.
The impact of fructose on renal function and blood pressure.
Kretowicz M, Johnson RJ, Ishimoto T, Nakagawa T, Manitius J.
Source
Department of Nephrology, Hypertension and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
Abstract
Fructose is a sugar present in sucrose, high-fructose corn syrup, honey, and fruits. Fructose intake has increased markedly in the last two centuries, primarily due to increased intake of added sugars. Increasing evidence suggests that the excessive intake of fructose may induce fatty liver, insulin resistance, dyslipidemia, hypertension, and kidney disease. These studies suggest that excessive intake of fructose might have an etiologic role in the epidemic of obesity, diabetes, and cardiorenal disease.
Cystic fibrosis and pain
http://www.ncbi.nlm.nih.gov/pubmed/22025449
Physiother Res Int. 2011 Oct 25. doi: 10.1002/pri.524. [Epub ahead of print]
Pain Impacts on Quality of Life and Interferes with Treatment in Adults with Cystic Fibrosis.
Kelemen L, Lee AL, Button BM, Presnell S, Wilson JW, Holland AE.
Source
Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.
Abstract
BACKGROUND AND PURPOSE:
Pain has been reported in cystic fibrosis (CF), but its clinical significance and the physical and psychosocial impact in adults who are clinically stable and acutely unwell have not been well described. The aim of this study was to describe the intensity and location of pain and its relationship with health-related quality of life (HRQOL) and pain catastrophizing in adults with CF.
METHODS:
This study was an observational study of adults with CF. Participants completed three questionnaires, the Brief Pain Inventory, Pain Catastrophizing Scale and the CF-Quality of Life questionnaire, when clinically stable and during an acute exacerbation.
RESULTS:
A total of 73 participants were included during a period of clinical stability, with 33 repeating the measurements during an acute illness, with a mean (SD) age of 29 (9) years and forced expiratory volume (FEV(1) ) of 60.5 (24.9)% predicted. Mild pain was reported by 89% of stable participants and 79% of those with exacerbations. Severity of lung disease did not affect prevalence or intensity of pain. Pain interfered with airway clearance therapy during exacerbations (p < 0.012) and exercise regimens when participants were clinically stable (p < 0.002) and was related to a poorer physical function, regardless of clinical status (p < 0.05). Although pain intensity was associated with reduced HRQOL (p < 0.001), only FEV(1) and the degree of pain catastrophizing were independent predictors of poorer HRQOL.
CONCLUSIONS:
Pain is common in adults with CF, irrespective of clinical status, and may interfere with important physiotherapy treatments. Although pain intensity is generally mild, those with a negative emotional response to pain have significantly impaired HRQOL.
Copyright © 2011 John Wiley & Sons, Ltd.
Physiother Res Int. 2011 Oct 25. doi: 10.1002/pri.524. [Epub ahead of print]
Pain Impacts on Quality of Life and Interferes with Treatment in Adults with Cystic Fibrosis.
Kelemen L, Lee AL, Button BM, Presnell S, Wilson JW, Holland AE.
Source
Physiotherapy, La Trobe University, Bundoora, Victoria, Australia.
Abstract
BACKGROUND AND PURPOSE:
Pain has been reported in cystic fibrosis (CF), but its clinical significance and the physical and psychosocial impact in adults who are clinically stable and acutely unwell have not been well described. The aim of this study was to describe the intensity and location of pain and its relationship with health-related quality of life (HRQOL) and pain catastrophizing in adults with CF.
METHODS:
This study was an observational study of adults with CF. Participants completed three questionnaires, the Brief Pain Inventory, Pain Catastrophizing Scale and the CF-Quality of Life questionnaire, when clinically stable and during an acute exacerbation.
RESULTS:
A total of 73 participants were included during a period of clinical stability, with 33 repeating the measurements during an acute illness, with a mean (SD) age of 29 (9) years and forced expiratory volume (FEV(1) ) of 60.5 (24.9)% predicted. Mild pain was reported by 89% of stable participants and 79% of those with exacerbations. Severity of lung disease did not affect prevalence or intensity of pain. Pain interfered with airway clearance therapy during exacerbations (p < 0.012) and exercise regimens when participants were clinically stable (p < 0.002) and was related to a poorer physical function, regardless of clinical status (p < 0.05). Although pain intensity was associated with reduced HRQOL (p < 0.001), only FEV(1) and the degree of pain catastrophizing were independent predictors of poorer HRQOL.
CONCLUSIONS:
Pain is common in adults with CF, irrespective of clinical status, and may interfere with important physiotherapy treatments. Although pain intensity is generally mild, those with a negative emotional response to pain have significantly impaired HRQOL.
Copyright © 2011 John Wiley & Sons, Ltd.
Unintended?
http://www.ncbi.nlm.nih.gov/pubmed/21962782
J Am Coll Radiol. 2011 Oct;8(10):687-91.
Unintended consequences of health care legislation.
Thrall JH.
Source
Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
Abstract
Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders.
J Am Coll Radiol. 2011 Oct;8(10):687-91.
Unintended consequences of health care legislation.
Thrall JH.
Source
Department of Radiology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
Abstract
Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders.
From Boston U: Waiting for health care at the VA
http://www.ncbi.nlm.nih.gov/pubmed/21989621
J Gen Intern Med. 2011 Nov;26 Suppl 2:676-82.
What are the consequences of waiting for health care in the veteran population?
Pizer SD, Prentice JC.
Source
Department of Health Policy and Management, Boston University School of Public Health, VA Boston Health Care System, 150 South Huntington Avenue; Mail Stop 152H, Boston, MA, 02130, USA, pizer@bu.edu.
Abstract
National health reform is expected to increase how long individuals have to wait between requests for appointments and when their appointment is scheduled. The increase in demand for care due to more widespread insurance will result in longer waits if there is not also a concomitant increase in supply of healthcare services. Long waits for healthcare are hypothesized to compromise health because less frequent outpatient visits result in delays in diagnosis and treatment. Research testing this hypothesis is scarce due to a paucity of data on how long individuals wait for healthcare in the United States. The main exception is the Veterans Health Administration (VA) that has been routinely collecting data on how long veterans wait for outpatient care for over a decade. This narrative review summarizes the results of studies using VA wait time data to answer two main questions: 1) How much do longer wait times decrease healthcare utilization and 2) Do longer wait times cause poorer health outcomes? Longer VA wait times lead to small, yet statistically significant decreases in utilization and are related to poorer health in elderly and vulnerable veteran populations. Both long-term outcomes (e.g. mortality, preventable hospitalizations) and intermediate outcomes such as hemoglobin A1C levels are worse for veterans who seek care at facilities with longer waits compared to veterans who visit facilities with shorter waits. Further research is needed on the mechanisms connecting longer wait times and poorer outcomes including identifying patient sub-populations whose risks are most sensitive to delayed access to care. If wait times increase for the general patient population with the implementation of national reform as expected, U.S. healthcare policymakers and clinicians will need to consider policies and interventions that minimize potential harms for all patients.
J Gen Intern Med. 2011 Nov;26 Suppl 2:676-82.
What are the consequences of waiting for health care in the veteran population?
Pizer SD, Prentice JC.
Source
Department of Health Policy and Management, Boston University School of Public Health, VA Boston Health Care System, 150 South Huntington Avenue; Mail Stop 152H, Boston, MA, 02130, USA, pizer@bu.edu.
Abstract
National health reform is expected to increase how long individuals have to wait between requests for appointments and when their appointment is scheduled. The increase in demand for care due to more widespread insurance will result in longer waits if there is not also a concomitant increase in supply of healthcare services. Long waits for healthcare are hypothesized to compromise health because less frequent outpatient visits result in delays in diagnosis and treatment. Research testing this hypothesis is scarce due to a paucity of data on how long individuals wait for healthcare in the United States. The main exception is the Veterans Health Administration (VA) that has been routinely collecting data on how long veterans wait for outpatient care for over a decade. This narrative review summarizes the results of studies using VA wait time data to answer two main questions: 1) How much do longer wait times decrease healthcare utilization and 2) Do longer wait times cause poorer health outcomes? Longer VA wait times lead to small, yet statistically significant decreases in utilization and are related to poorer health in elderly and vulnerable veteran populations. Both long-term outcomes (e.g. mortality, preventable hospitalizations) and intermediate outcomes such as hemoglobin A1C levels are worse for veterans who seek care at facilities with longer waits compared to veterans who visit facilities with shorter waits. Further research is needed on the mechanisms connecting longer wait times and poorer outcomes including identifying patient sub-populations whose risks are most sensitive to delayed access to care. If wait times increase for the general patient population with the implementation of national reform as expected, U.S. healthcare policymakers and clinicians will need to consider policies and interventions that minimize potential harms for all patients.
From University College London: Smoking and death certificates
http://www.ncbi.nlm.nih.gov/pubmed/22024242
J Clin Pathol. 2011 Oct 24. [Epub ahead of print]
Does smoking kill? A study of death certification and smoking.
Proctor I, Sharma V, Khoshzaban M, Winstanley A.
Source
Department of Pathology, University College London, London, UK.
Abstract
AimTo assess how frequently smoking is cited as a cause of death (COD) on death certificates.MethodsA retrospective study of 2128 death certificates and 236 postmortem reports issued at a large teaching hospital between 2003 and 2009.ResultsSmoking was identified as the underlying COD on only 2 (0.1%) death certificates and included in part II of the death certificate on 10 (0.5%). The two death certificates citing smoking as the underlying COD were in cases of lung cancer and chronic obstructive pulmonary disease. The study included 279 deaths in which these diagnoses were cited on the death certificate and in the majority of these cases the deceased was a smoker or ex-smoker. A review of postmortem reports from the same period failed to identify a single case in which the pathologist cited smoking as causing or contributing to death. In marked contrast to smoking, 57.4% (vs 0.5%) of death certificates, which included diagnoses linked to alcohol use, cited alcohol in part I of the death certificate.ConclusionThis study demonstrates that smoking is rarely cited on death certificates, even in cases where the causal link with smoking is very strong. There are many reasons why smoking is not cited on death certificates. One frequently cited reason is the reluctance of doctors to stigmatise the deceased. Interestingly, such reluctance did not extend to citing alcohol as a COD. By not recording smoking on death certificates doctors are failing to gather important epidemiological and pathological data.
J Clin Pathol. 2011 Oct 24. [Epub ahead of print]
Does smoking kill? A study of death certification and smoking.
Proctor I, Sharma V, Khoshzaban M, Winstanley A.
Source
Department of Pathology, University College London, London, UK.
Abstract
AimTo assess how frequently smoking is cited as a cause of death (COD) on death certificates.MethodsA retrospective study of 2128 death certificates and 236 postmortem reports issued at a large teaching hospital between 2003 and 2009.ResultsSmoking was identified as the underlying COD on only 2 (0.1%) death certificates and included in part II of the death certificate on 10 (0.5%). The two death certificates citing smoking as the underlying COD were in cases of lung cancer and chronic obstructive pulmonary disease. The study included 279 deaths in which these diagnoses were cited on the death certificate and in the majority of these cases the deceased was a smoker or ex-smoker. A review of postmortem reports from the same period failed to identify a single case in which the pathologist cited smoking as causing or contributing to death. In marked contrast to smoking, 57.4% (vs 0.5%) of death certificates, which included diagnoses linked to alcohol use, cited alcohol in part I of the death certificate.ConclusionThis study demonstrates that smoking is rarely cited on death certificates, even in cases where the causal link with smoking is very strong. There are many reasons why smoking is not cited on death certificates. One frequently cited reason is the reluctance of doctors to stigmatise the deceased. Interestingly, such reluctance did not extend to citing alcohol as a COD. By not recording smoking on death certificates doctors are failing to gather important epidemiological and pathological data.
Prognostic significance of lymphovascular invasion in Stage I lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22025080
Eur Surg Res. 2011 Oct 21;47(4):211-217. [Epub ahead of print]
Prognostic Significance of Lymphovascular Invasion for Patients with Stage I Non-Small Cell Lung Cancer.
Hanagiri T, Takenaka M, Oka S, Shigematsu Y, Nagata Y, Shimokawa H, Uramoto H, Yamada S, Tanaka F.
Source
Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Abstract
Aims: This study retrospectively investigated the clinical significance of lymphovascular invasion (LVI) following a complete resection for stage I non-small cell lung cancer (NSCLC). Methods: A total of 226 patients who underwent a complete resection for pathological stage I NSCLC were examined. Results: Lymphatic invasion was pathologically diagnosed as ly0 in 156 patients, ly1 in 65, and ly2 in 5 patients. The pathological vascular invasion was diagnosed as v0 in 178 patients, v1 in 35, v2 in 10, and v3 in 3 patients. The 5-year survival rate after surgery of the patients with and without lymphatic invasion was 76.8 and 90.6%, respectively. There was a significantly more unfavorable prognosis in patients with lymphatic invasion (p = 0.042). The 5-year survival rate of the patients with vascular invasion was also significantly more unfavorable (67.8%) than that of patients without vascular invasion (90.4%; p = 0.004). LVI was found to significantly correlate with tumor size and the presence of pleural invasion. Conclusion: The LVI of NSCLC is a significant prognostic factor in patients with stage I tumors. In future clinical trials, it is necessary to evaluate the efficacy of adjuvant therapy for the selection of patients according to this criterion.
Eur Surg Res. 2011 Oct 21;47(4):211-217. [Epub ahead of print]
Prognostic Significance of Lymphovascular Invasion for Patients with Stage I Non-Small Cell Lung Cancer.
Hanagiri T, Takenaka M, Oka S, Shigematsu Y, Nagata Y, Shimokawa H, Uramoto H, Yamada S, Tanaka F.
Source
Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Abstract
Aims: This study retrospectively investigated the clinical significance of lymphovascular invasion (LVI) following a complete resection for stage I non-small cell lung cancer (NSCLC). Methods: A total of 226 patients who underwent a complete resection for pathological stage I NSCLC were examined. Results: Lymphatic invasion was pathologically diagnosed as ly0 in 156 patients, ly1 in 65, and ly2 in 5 patients. The pathological vascular invasion was diagnosed as v0 in 178 patients, v1 in 35, v2 in 10, and v3 in 3 patients. The 5-year survival rate after surgery of the patients with and without lymphatic invasion was 76.8 and 90.6%, respectively. There was a significantly more unfavorable prognosis in patients with lymphatic invasion (p = 0.042). The 5-year survival rate of the patients with vascular invasion was also significantly more unfavorable (67.8%) than that of patients without vascular invasion (90.4%; p = 0.004). LVI was found to significantly correlate with tumor size and the presence of pleural invasion. Conclusion: The LVI of NSCLC is a significant prognostic factor in patients with stage I tumors. In future clinical trials, it is necessary to evaluate the efficacy of adjuvant therapy for the selection of patients according to this criterion.
Richard Epstein holds court on economic fundamentals
http://ricochet.com/main-feed/Richard-Epstein-Behind-Enemy-Lines
As one comment on the website reads: "I do wish our friend from PBS had called me up prior to his appointment with Professor Epstein. I would have been happy to have told him that interviewing Richard -- particularly with such a facile line of questioning -- is like drinking from a fire hose."
As one comment on the website reads: "I do wish our friend from PBS had called me up prior to his appointment with Professor Epstein. I would have been happy to have told him that interviewing Richard -- particularly with such a facile line of questioning -- is like drinking from a fire hose."
Thursday, October 20, 2011
From MoneyTalks: Health Care Reform's "Free" Preventative Care
http://www.moneytalksnews.com/2011/10/20/health-care-reform-free-preventive-care-not-exactly/
Health Care Reform = Free Preventive Care? Not Exactly
Under President Obama's new health care law, "preventive care" is supposed to be free with no deductible or co-pay. So I went for a physical last month – and got billed $730.
"I got my “free” physical last month. But a few days ago, the bills started coming in: $600 worth of “laboratory services,” $70 for “radiology services,” and $60 for “diagnostic services.” Since this was obviously an error, I called my insurance company. What did they say? That much of what constituted my preventive care wasn’t covered by the new law."
Health Care Reform = Free Preventive Care? Not Exactly
Under President Obama's new health care law, "preventive care" is supposed to be free with no deductible or co-pay. So I went for a physical last month – and got billed $730.
"I got my “free” physical last month. But a few days ago, the bills started coming in: $600 worth of “laboratory services,” $70 for “radiology services,” and $60 for “diagnostic services.” Since this was obviously an error, I called my insurance company. What did they say? That much of what constituted my preventive care wasn’t covered by the new law."
Zombie nation: Antidepressant use up 400% since 1988!
http://yourlife.usatoday.com/health/story/2011-10-19/CDC-Antidepressant-use-skyrocketed-in-past-20-years/50826442/1?loc=interstitialskip
"Use of antidepressant drugs has soared nearly 400% since 1988, making the medication the most frequently used by people ages 18-44, a report from the Centers for Disease Control and Prevention shows. Eleven percent of Americans ages 12 years and older took antidepressants during the 2005-08 study period, the authors write."
Plus this: "The survey also found that nearly one in four women ages 40 to 59 are taking antidepressants."
Also worrisome: "In fact, less than one-third of Americans taking one antidepressant and less than one-half of those taking multiple antidepressants have seen a mental-health professional in the past year, the report shows."
"Use of antidepressant drugs has soared nearly 400% since 1988, making the medication the most frequently used by people ages 18-44, a report from the Centers for Disease Control and Prevention shows. Eleven percent of Americans ages 12 years and older took antidepressants during the 2005-08 study period, the authors write."
Plus this: "The survey also found that nearly one in four women ages 40 to 59 are taking antidepressants."
Also worrisome: "In fact, less than one-third of Americans taking one antidepressant and less than one-half of those taking multiple antidepressants have seen a mental-health professional in the past year, the report shows."
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