http://www.ncbi.nlm.nih.gov/pubmed/21794997
Eur J Radiol. 2011 Jul 25. [Epub ahead of print]
Intraobserver and interobserver agreement of volume perfusion CT (VPCT) measurements in patients with lung lesions.
Sauter AW, Merkle A, Schulze M, Spira D, Hetzel J, Claussen CD, Horger MS.
Source
Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Abstract
OBJECTIVES:
To evaluate intraobserver and interobserver agreement of manually encompassed lung lesions for perfusion measurements using volume-perfusion computed tomography (VPCT).
MATERIALS AND METHODS:
Institutional review board approval and informed consent were obtained. HIPAA guidelines were followed. A 65-s dynamic study was acquired with scan parameters 80kV, 60mAs (80mAs for patients ≥70kg), 128×0.6mm collimation. Blood flow (BF), blood volume (BV) and K(trans) parameters were determined by syngo volume perfusion CT body with 88 lesions analyzed retrospectively.
RESULTS:
Within-subject coefficients of variation for intraobserver agreement (range 6.59-12.82%) were superior to those for interobserver agreement (range 21.75-38.30%). Size-dependent analysis revealed lower agreements for lesions <4cm as compared to larger lesions. Additionally, agreements of the upper, middle and lower lung zones were different.
CONCLUSIONS:
Intraobserver agreement was substantial for VPCT lung cancer perfusion measurements encouraging the use for tumor characterization and therapy response monitoring. Interobserver agreement is limited and unexperienced readers should be trained before using this new method.
Friday, February 24, 2012
From Lida Hariri and colleagues: Acute onset of hypersensitivity pneumonitis
http://www.ncbi.nlm.nih.gov/pubmed/21855112
Hum Pathol. 2011 Aug 18. [Epub ahead of print]
Distinct histopathology of acute onset or abrupt exacerbation of hypersensitivity pneumonitis.
Hariri LP, Mino-Kenudson M, Shea B, Digumarthy S, Onozato M, Yagi Y, Fraire AE, Matsubara O, Mark EJ.
Source
Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
Abstract
Hypersensitivity pneumonitis is an inflammatory lung disease that develops in response to exposure to antigen. Cases can be stratified by the duration of exposure and speed of symptom progression into acute, subacute, and chronic hypersensitivity pneumonitis. Although the pathologic features of subacute hypersensitivity pneumonitis are well established and those of chronic hypersensitivity pneumonitis have been reported, little is known about the histopathology of acute hypersensitivity pneumonitis. We evaluated the pathologic features of 5 patients with clinically confirmed hypersensitivity pneumonitis and rapid onset of symptoms and 3 patients with subacute or chronic hypersensitivity pneumonitis with symptom exacerbation. Histopathologic features assessed in each case included those characteristic of subacute hypersensitivity pneumonitis (bronchiolocentric chronic inflammation, histiocytic aggregates, and bronchiolitis obliterans), those associated with acute inflammation (fibrin deposition and neutrophilic infiltrate), and fibrosis. The classic features of hypersensitivity pneumonitis were identified in all 8 cases, with 1 also exhibiting fixed fibrosis confirming underlying chronic hypersensitivity pneumonitis. Fibrin deposition was present in 8 (100%) of 8 cases, and its extent was significant (28% surface area fibrin deposition/total disease area on average). Two had intra-alveolar fibrin so marked that it resembled acute fibrinous and organizing pneumonia. In addition, prominent interstitial neutrophilic infiltrate (≥5 cells/high-power field) was seen in all cases. These features have not been reported as characteristics of subacute or chronic hypersensitivity pneumonitis. Increased fibrin deposition and neutrophilic infiltrate may characterize acute hypersensitivity pneumonitis or abrupt exacerbation of hypersensitivity pneumonitis, and these along with characteristic features of subacute hypersensitivity pneumonitis (granulomatous inflammation and bronchiolocentricity) are sufficient to establish a morphologic diagnosis, particularly in conjunction with clinicoradiologic features.
Hum Pathol. 2011 Aug 18. [Epub ahead of print]
Distinct histopathology of acute onset or abrupt exacerbation of hypersensitivity pneumonitis.
Hariri LP, Mino-Kenudson M, Shea B, Digumarthy S, Onozato M, Yagi Y, Fraire AE, Matsubara O, Mark EJ.
Source
Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
Abstract
Hypersensitivity pneumonitis is an inflammatory lung disease that develops in response to exposure to antigen. Cases can be stratified by the duration of exposure and speed of symptom progression into acute, subacute, and chronic hypersensitivity pneumonitis. Although the pathologic features of subacute hypersensitivity pneumonitis are well established and those of chronic hypersensitivity pneumonitis have been reported, little is known about the histopathology of acute hypersensitivity pneumonitis. We evaluated the pathologic features of 5 patients with clinically confirmed hypersensitivity pneumonitis and rapid onset of symptoms and 3 patients with subacute or chronic hypersensitivity pneumonitis with symptom exacerbation. Histopathologic features assessed in each case included those characteristic of subacute hypersensitivity pneumonitis (bronchiolocentric chronic inflammation, histiocytic aggregates, and bronchiolitis obliterans), those associated with acute inflammation (fibrin deposition and neutrophilic infiltrate), and fibrosis. The classic features of hypersensitivity pneumonitis were identified in all 8 cases, with 1 also exhibiting fixed fibrosis confirming underlying chronic hypersensitivity pneumonitis. Fibrin deposition was present in 8 (100%) of 8 cases, and its extent was significant (28% surface area fibrin deposition/total disease area on average). Two had intra-alveolar fibrin so marked that it resembled acute fibrinous and organizing pneumonia. In addition, prominent interstitial neutrophilic infiltrate (≥5 cells/high-power field) was seen in all cases. These features have not been reported as characteristics of subacute or chronic hypersensitivity pneumonitis. Increased fibrin deposition and neutrophilic infiltrate may characterize acute hypersensitivity pneumonitis or abrupt exacerbation of hypersensitivity pneumonitis, and these along with characteristic features of subacute hypersensitivity pneumonitis (granulomatous inflammation and bronchiolocentricity) are sufficient to establish a morphologic diagnosis, particularly in conjunction with clinicoradiologic features.
From James Jett and colleague: Screening for lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/21893615
Ann Intern Med. 2011 Oct 18;155(8):540-2. Epub 2011 Sep 5.
Screening for lung cancer: for patients at increased risk for lung cancer, it works.
Jett JR, Midthun DE.
Source
National Jewish Health, Denver, Colorado 80206, USA. jettj@njhealth.org
Abstract
Screening for lung cancer is not currently recommended, even in persons at high risk for this condition. Most patients with lung cancer present with symptomatic disease that is usually at an incurable, advanced stage. The recently reported NLST (National Lung Screening Trial) showed a 20% decrease in deaths from lung cancer in high-risk persons undergoing screening with low-dose computed tomography of the chest compared with chest radiography. The high-risk group included in the trial comprised asymptomatic persons aged 55 to 74 years, with smoking history of at least 30 pack-years. Screening with low-dose computed tomography detected more cases of early-stage lung cancer and fewer cases of advanced-stage cancer, confirming that screening has shifted the stage of cancer at diagnosis and provides more persons with the opportunity for curative treatment. Although computed tomography screening has risks and limitations, the 20% decrease in deaths is the single most dramatic decrease ever reported for deaths from lung cancer, with the possible exception of smoking cessation. Physicians should offer computed tomography screening for lung cancer to patients who fit the high-risk profile defined in the NLST.
Ann Intern Med. 2011 Oct 18;155(8):540-2. Epub 2011 Sep 5.
Screening for lung cancer: for patients at increased risk for lung cancer, it works.
Jett JR, Midthun DE.
Source
National Jewish Health, Denver, Colorado 80206, USA. jettj@njhealth.org
Abstract
Screening for lung cancer is not currently recommended, even in persons at high risk for this condition. Most patients with lung cancer present with symptomatic disease that is usually at an incurable, advanced stage. The recently reported NLST (National Lung Screening Trial) showed a 20% decrease in deaths from lung cancer in high-risk persons undergoing screening with low-dose computed tomography of the chest compared with chest radiography. The high-risk group included in the trial comprised asymptomatic persons aged 55 to 74 years, with smoking history of at least 30 pack-years. Screening with low-dose computed tomography detected more cases of early-stage lung cancer and fewer cases of advanced-stage cancer, confirming that screening has shifted the stage of cancer at diagnosis and provides more persons with the opportunity for curative treatment. Although computed tomography screening has risks and limitations, the 20% decrease in deaths is the single most dramatic decrease ever reported for deaths from lung cancer, with the possible exception of smoking cessation. Physicians should offer computed tomography screening for lung cancer to patients who fit the high-risk profile defined in the NLST.
From Phil Cagle, Stephen Wong, and colleagues: Toward point-of-care lung cancer diagnoses
http://www.ncbi.nlm.nih.gov/pubmed/21950918
J Biomed Opt. 2011 Sep;16(9):096004.
On-the-spot lung cancer differential diagnosis by label-free, molecular vibrational imaging and knowledge-based classification.
Gao L, Li F, Thrall MJ, Yang Y, Xing J, Hammoudi AA, Zhao H, Massoud Y, Cagle PT, Fan Y, Wong KK, Wang Z, Wong ST.
Source
Weill Cornell Medical College, The Methodist Hospital Research Institute, Department of Systems Medicine and Bioengineering, Houston, Texas 77030, USA.
Abstract
We report the development and application of a knowledge-based coherent anti-Stokes Raman scattering (CARS) microscopy system for label-free imaging, pattern recognition, and classification of cells and tissue structures for differentiating lung cancer from non-neoplastic lung tissues and identifying lung cancer subtypes. A total of 1014 CARS images were acquired from 92 fresh frozen lung tissue samples. The established pathological workup and diagnostic cellular were used as prior knowledge for establishment of a knowledge-based CARS system using a machine learning approach. This system functions to separate normal, non-neoplastic, and subtypes of lung cancer tissues based on extracted quantitative features describing fibrils and cell morphology. The knowledge-based CARS system showed the ability to distinguish lung cancer from normal and non-neoplastic lung tissue with 91% sensitivity and 92% specificity. Small cell carcinomas were distinguished from nonsmall cell carcinomas with 100% sensitivity and specificity. As an adjunct to submitting tissue samples to routine pathology, our novel system recognizes the patterns of fibril and cell morphology, enabling medical practitioners to perform differential diagnosis of lung lesions in mere minutes. The demonstration of the strategy is also a necessary step toward in vivo point-of-care diagnosis of precancerous and cancerous lung lesions with a fiber-based CARS microendoscope.
J Biomed Opt. 2011 Sep;16(9):096004.
On-the-spot lung cancer differential diagnosis by label-free, molecular vibrational imaging and knowledge-based classification.
Gao L, Li F, Thrall MJ, Yang Y, Xing J, Hammoudi AA, Zhao H, Massoud Y, Cagle PT, Fan Y, Wong KK, Wang Z, Wong ST.
Source
Weill Cornell Medical College, The Methodist Hospital Research Institute, Department of Systems Medicine and Bioengineering, Houston, Texas 77030, USA.
Abstract
We report the development and application of a knowledge-based coherent anti-Stokes Raman scattering (CARS) microscopy system for label-free imaging, pattern recognition, and classification of cells and tissue structures for differentiating lung cancer from non-neoplastic lung tissues and identifying lung cancer subtypes. A total of 1014 CARS images were acquired from 92 fresh frozen lung tissue samples. The established pathological workup and diagnostic cellular were used as prior knowledge for establishment of a knowledge-based CARS system using a machine learning approach. This system functions to separate normal, non-neoplastic, and subtypes of lung cancer tissues based on extracted quantitative features describing fibrils and cell morphology. The knowledge-based CARS system showed the ability to distinguish lung cancer from normal and non-neoplastic lung tissue with 91% sensitivity and 92% specificity. Small cell carcinomas were distinguished from nonsmall cell carcinomas with 100% sensitivity and specificity. As an adjunct to submitting tissue samples to routine pathology, our novel system recognizes the patterns of fibril and cell morphology, enabling medical practitioners to perform differential diagnosis of lung lesions in mere minutes. The demonstration of the strategy is also a necessary step toward in vivo point-of-care diagnosis of precancerous and cancerous lung lesions with a fiber-based CARS microendoscope.
From Ignacio Wistuba, Elizabeth Brambilla, and colleagues: VEGF in early squamous cell lung cancers
http://www.ncbi.nlm.nih.gov/pubmed/22355056
J Clin Oncol. 2012 Feb 21. [Epub ahead of print]
Expression of Tumor-Derived Vascular Endothelial Growth Factor and Its Receptors Is Associated With Outcome in Early Squamous Cell Carcinoma of the Lung.
Pajares MJ, Agorreta J, Larrayoz M, Vesin A, Ezponda T, Zudaire I, Torre W, Lozano MD, Brambilla E, Brambilla C, Wistuba II, Behrens C, Timsit JF, Pio R, Field JK, Montuenga LM.
Source
María J. Pajares, Jackeline Agorreta, Marta Larrayoz, Teresa Ezponda, Isabel Zudaire, Wenceslao Torre, María D. Lozano, Ruben Pio, and Luis M. Montuenga, Center for Applied Medical Research (CIMA) and Clinica Universidad de Navarra (CUN), University of Navarra, Pamplona, Spain; Aurélien Vesin, Elisabeth Brambilla, Christian Brambilla, and Jean-Francois Timsit, Institut Albert Bonniot, Centre Hospitalier Universitaire Albert Michallon, Institut National de la Santé et de la Recherche Médicale (INSERM) U823, and Université Joseph Fourrier, Grenoble, France; Ignacio I. Wistuba and Carmen Behrens, The University of Texas MD Anderson Cancer Center, Houston, TX; and John K. Field, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
Abstract
PURPOSEAntiangiogenic therapies targeting the vascular endothelial growth factor (VEGF) pathway have yielded more modest clinical benefit to patients with non-small-cell lung cancer (NSCLC) than initially expected. Clinical data suggest a distinct biologic role of the VEGF pathway in the different histologic subtypes of lung cancer. To clarify the influence of histologic differentiation in the prognostic relevance of VEGF-mediated signaling in NSCLC, we performed a concomitant analysis of the expression of three key elements of the VEGF pathway in the earliest stages of the following two principal histologic subtypes: squamous cell carcinoma (SCC) and adenocarcinoma (ADC).
PATIENTS AND METHOD
We evaluated tumor cell expression of VEGF, VEGF receptor (VEGFR) 1, and VEGFR2 using automatic immunostaining in a series of 298 patients with early-stage NSCLC recruited as part of the multicenter European Early Lung Cancer Detection Group project. A score measuring the VEGF signaling pathway was calculated by adding the tumor cell expression value of VEGF and its two receptors. The results were validated in two additional independent cohorts of patients with NSCLC.
Results
The combination of high VEGF, VEGFR1, and VEGFR2 protein expression was associated with lower risk of disease progression in early SCC (univariate analysis, P = .008; multivariate analysis, hazard ratio, 0.62; 95% CI, 0.42 to 0.92; P = .02). The results were validated in two independent patient cohorts, confirming the favorable prognostic value of high VEGF signaling score in early lung SCC.
CONCLUSION
Our results clearly indicate that the combination of high expression of the three key elements in the VEGF pathway is associated with a good prognosis in patients with early SCC but not in patients with ADC.
J Clin Oncol. 2012 Feb 21. [Epub ahead of print]
Expression of Tumor-Derived Vascular Endothelial Growth Factor and Its Receptors Is Associated With Outcome in Early Squamous Cell Carcinoma of the Lung.
Pajares MJ, Agorreta J, Larrayoz M, Vesin A, Ezponda T, Zudaire I, Torre W, Lozano MD, Brambilla E, Brambilla C, Wistuba II, Behrens C, Timsit JF, Pio R, Field JK, Montuenga LM.
Source
María J. Pajares, Jackeline Agorreta, Marta Larrayoz, Teresa Ezponda, Isabel Zudaire, Wenceslao Torre, María D. Lozano, Ruben Pio, and Luis M. Montuenga, Center for Applied Medical Research (CIMA) and Clinica Universidad de Navarra (CUN), University of Navarra, Pamplona, Spain; Aurélien Vesin, Elisabeth Brambilla, Christian Brambilla, and Jean-Francois Timsit, Institut Albert Bonniot, Centre Hospitalier Universitaire Albert Michallon, Institut National de la Santé et de la Recherche Médicale (INSERM) U823, and Université Joseph Fourrier, Grenoble, France; Ignacio I. Wistuba and Carmen Behrens, The University of Texas MD Anderson Cancer Center, Houston, TX; and John K. Field, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
Abstract
PURPOSEAntiangiogenic therapies targeting the vascular endothelial growth factor (VEGF) pathway have yielded more modest clinical benefit to patients with non-small-cell lung cancer (NSCLC) than initially expected. Clinical data suggest a distinct biologic role of the VEGF pathway in the different histologic subtypes of lung cancer. To clarify the influence of histologic differentiation in the prognostic relevance of VEGF-mediated signaling in NSCLC, we performed a concomitant analysis of the expression of three key elements of the VEGF pathway in the earliest stages of the following two principal histologic subtypes: squamous cell carcinoma (SCC) and adenocarcinoma (ADC).
PATIENTS AND METHOD
We evaluated tumor cell expression of VEGF, VEGF receptor (VEGFR) 1, and VEGFR2 using automatic immunostaining in a series of 298 patients with early-stage NSCLC recruited as part of the multicenter European Early Lung Cancer Detection Group project. A score measuring the VEGF signaling pathway was calculated by adding the tumor cell expression value of VEGF and its two receptors. The results were validated in two additional independent cohorts of patients with NSCLC.
Results
The combination of high VEGF, VEGFR1, and VEGFR2 protein expression was associated with lower risk of disease progression in early SCC (univariate analysis, P = .008; multivariate analysis, hazard ratio, 0.62; 95% CI, 0.42 to 0.92; P = .02). The results were validated in two independent patient cohorts, confirming the favorable prognostic value of high VEGF signaling score in early lung SCC.
CONCLUSION
Our results clearly indicate that the combination of high expression of the three key elements in the VEGF pathway is associated with a good prognosis in patients with early SCC but not in patients with ADC.
From Maureen Zakowski and colleagues: Cytology's role in managing lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/21768461
J Clin Oncol. 2011 Aug 20;29(24):3331-2; author reply 3332-3. Epub 2011 Jul 18.
Role of cytology in the management of non-small-cell lung cancer.
Fischer AH, Cibas ES, Howell LP, Kurian EM, Laucirica R, Moriarty AT, Renshaw AA, Zakowski MF, Young NA.
Comment on
J Clin Oncol. 2010 Dec 20;28(36):5311-20.
"The morphologic features that distinguish squamous cell carcinoma (predominantly keratinized cytoplasm and intercellular bridges) from adenocarcinoma (mucin vacuoles and gland formation) span less than the 250-μm inner diameter of a 25-gauge fine needle. These features are apparent in cytology samples without histologic sectioning, and they can certainly be identified in cell block sections. International consensus criteria for lung cancer diagnosis have been developed by a multidisciplinary group that included pathologists, and these criteria encompass cytology samples.2 As noted by Langer et al,1 immunohistochemical markers may be required for subclassification of non–small-cell carcinoma in biopsies, and these immunohistochemical markers have been widely applied to cytologic samples."
J Clin Oncol. 2011 Aug 20;29(24):3331-2; author reply 3332-3. Epub 2011 Jul 18.
Role of cytology in the management of non-small-cell lung cancer.
Fischer AH, Cibas ES, Howell LP, Kurian EM, Laucirica R, Moriarty AT, Renshaw AA, Zakowski MF, Young NA.
Comment on
J Clin Oncol. 2010 Dec 20;28(36):5311-20.
"The morphologic features that distinguish squamous cell carcinoma (predominantly keratinized cytoplasm and intercellular bridges) from adenocarcinoma (mucin vacuoles and gland formation) span less than the 250-μm inner diameter of a 25-gauge fine needle. These features are apparent in cytology samples without histologic sectioning, and they can certainly be identified in cell block sections. International consensus criteria for lung cancer diagnosis have been developed by a multidisciplinary group that included pathologists, and these criteria encompass cytology samples.2 As noted by Langer et al,1 immunohistochemical markers may be required for subclassification of non–small-cell carcinoma in biopsies, and these immunohistochemical markers have been widely applied to cytologic samples."
From Goeffrey Oxnard and colleagues: EGFR exon 19 insertions and lung adenocarcinoma
http://www.ncbi.nlm.nih.gov/pubmed/22190593
Clin Cancer Res. 2011 Dec 21. [Epub ahead of print]
EGFR Exon 19 Insertions: A New Family of Sensitizing EGFR Mutations in Lung Adenocarcinoma.
He M, Capelletti M, Nafa K, Yun CH, Arcila ME, Miller VA, Ginsberg MS, Zhao B, Kris MG, Eck MJ, Janne PA, Ladanyi M, Oxnard GR.
Source
Department of Pathology, Brown University Warren Alpert Medical School.
Abstract
PURPOSE:
EGFR genotyping is now standard in the management of advanced lung adenocarcinoma, as this biomarker predicts marked benefit from treatment with EGFR tyrosine kinase inhibitors (TKIs). EGFR exon 19 insertions are a poorly described family of EGFR mutations, and their association with TKI-sensitivity in lung adenocarcinoma is uncertain.
EXPERIMENTAL DESIGN:
Patients from two institutions with lung cancers harboring EGFR exon 19 insertions were studied. The predicted effects of the insertions on the structure of the EGFR protein were examined, and EGFR exon 19 insertions were introduced into Ba/F3 cells to assess oncogenicity and in vitro sensitivity to TKIs. In patients receiving TKI, response magnitude was assessed with serial CT measurement.
RESULTS:
Twelve cases harboring EGFR exon 19 insertions were identified; patients were predominately female (92%) and never-smokers (75%). The 11 specimens available for full sequencing all demonstrated an 18 bp insertion that resulted in the substitution of a Pro for Leu at residue 747. The mutant EGFR transformed the Ba/F3 cells, which were then sensitive to TKI. Six patients with measurable disease received TKI and 5 had a response on serial CT.
CONCLUSIONS:
EGFR exon 19 insertions are a newly appreciated family of TKI-sensitizing mutations, and patients with tumors harboring these mutations should be treated with EGFR-TKI. While these mutations may be missed through the use of some mutation-specific assays, the addition of fragment length analysis to multi-gene assays allows sensitive detection of both exon 19 insertion and deletion mutations.
Clin Cancer Res. 2011 Dec 21. [Epub ahead of print]
EGFR Exon 19 Insertions: A New Family of Sensitizing EGFR Mutations in Lung Adenocarcinoma.
He M, Capelletti M, Nafa K, Yun CH, Arcila ME, Miller VA, Ginsberg MS, Zhao B, Kris MG, Eck MJ, Janne PA, Ladanyi M, Oxnard GR.
Source
Department of Pathology, Brown University Warren Alpert Medical School.
Abstract
PURPOSE:
EGFR genotyping is now standard in the management of advanced lung adenocarcinoma, as this biomarker predicts marked benefit from treatment with EGFR tyrosine kinase inhibitors (TKIs). EGFR exon 19 insertions are a poorly described family of EGFR mutations, and their association with TKI-sensitivity in lung adenocarcinoma is uncertain.
EXPERIMENTAL DESIGN:
Patients from two institutions with lung cancers harboring EGFR exon 19 insertions were studied. The predicted effects of the insertions on the structure of the EGFR protein were examined, and EGFR exon 19 insertions were introduced into Ba/F3 cells to assess oncogenicity and in vitro sensitivity to TKIs. In patients receiving TKI, response magnitude was assessed with serial CT measurement.
RESULTS:
Twelve cases harboring EGFR exon 19 insertions were identified; patients were predominately female (92%) and never-smokers (75%). The 11 specimens available for full sequencing all demonstrated an 18 bp insertion that resulted in the substitution of a Pro for Leu at residue 747. The mutant EGFR transformed the Ba/F3 cells, which were then sensitive to TKI. Six patients with measurable disease received TKI and 5 had a response on serial CT.
CONCLUSIONS:
EGFR exon 19 insertions are a newly appreciated family of TKI-sensitizing mutations, and patients with tumors harboring these mutations should be treated with EGFR-TKI. While these mutations may be missed through the use of some mutation-specific assays, the addition of fragment length analysis to multi-gene assays allows sensitive detection of both exon 19 insertion and deletion mutations.
From Keith Kerr and colleagues: EGFR and tailoring lung cancer treatment
http://www.ncbi.nlm.nih.gov/pubmed/22039281
J Clin Pathol. 2012 Jan;65(1):1-7. Epub 2011 Oct 29.
The role of the molecular footprint of EGFR in tailoring treatment decisions in NSCLC.
Gately K, O'Flaherty J, Cappuzzo F, Pirker R, Kerr K, O'Byrne K.
Source
Department of Clinical Medicine, Institute of Molecular Medicine, St James's Hospital, Dublin, Ireland.
Abstract
The majority of patients with non-small-cell lung cancer (NSCLC) present with advanced disease, with targeted therapies providing some improvement in clinical outcomes. The epidermal growth factor receptor (EGFR) tyrosine kinase (TK) plays an important role in the pathogenesis of NSCLC. Tyrosine kinase inhibitors (TKIs), which target the EGFR TK domain, have proven to be an effective treatment strategy; however, patient responses to treatment vary considerably. Therefore, the identification of patients most likely to respond to treatment is essential to optimise the benefit of TKIs. Tumour-associated activating mutations in EGFR can identify patients with NSCLC who are likely to have a good response to TKIs. Nonetheless, the majority of patients relapse within a year of starting treatment. Studies of tumours at relapse have demonstrated expression of a T790M mutation in exon 20 of the EGFR TK domain in approximately 50% of cases. Although conferring resistance to reversible TKIs, these patients may remain sensitive to new-generation irreversible/pan-erb inhibitors. A number of techniques have been employed for genotypic assessment of tumour-associated DNA to identify EGFR mutations, each of which has advantages and disadvantages. This review presents an overview of the current methodologies used to identify such molecular markers. Recent developments in technology may make the monitoring of changes in patients' tumour genotypes easier in clinical practice, which may enable patients' treatment regimens to be tailored during the course of their disease, potentially leading to improved patient outcomes.
J Clin Pathol. 2012 Jan;65(1):1-7. Epub 2011 Oct 29.
The role of the molecular footprint of EGFR in tailoring treatment decisions in NSCLC.
Gately K, O'Flaherty J, Cappuzzo F, Pirker R, Kerr K, O'Byrne K.
Source
Department of Clinical Medicine, Institute of Molecular Medicine, St James's Hospital, Dublin, Ireland.
Abstract
The majority of patients with non-small-cell lung cancer (NSCLC) present with advanced disease, with targeted therapies providing some improvement in clinical outcomes. The epidermal growth factor receptor (EGFR) tyrosine kinase (TK) plays an important role in the pathogenesis of NSCLC. Tyrosine kinase inhibitors (TKIs), which target the EGFR TK domain, have proven to be an effective treatment strategy; however, patient responses to treatment vary considerably. Therefore, the identification of patients most likely to respond to treatment is essential to optimise the benefit of TKIs. Tumour-associated activating mutations in EGFR can identify patients with NSCLC who are likely to have a good response to TKIs. Nonetheless, the majority of patients relapse within a year of starting treatment. Studies of tumours at relapse have demonstrated expression of a T790M mutation in exon 20 of the EGFR TK domain in approximately 50% of cases. Although conferring resistance to reversible TKIs, these patients may remain sensitive to new-generation irreversible/pan-erb inhibitors. A number of techniques have been employed for genotypic assessment of tumour-associated DNA to identify EGFR mutations, each of which has advantages and disadvantages. This review presents an overview of the current methodologies used to identify such molecular markers. Recent developments in technology may make the monitoring of changes in patients' tumour genotypes easier in clinical practice, which may enable patients' treatment regimens to be tailored during the course of their disease, potentially leading to improved patient outcomes.
From Neal Lindeman and colleagues: EGFR mutation and lung cancer response to TKIs
http://www.ncbi.nlm.nih.gov/pubmed/20472851
Am J Clin Pathol. 2010 Jun;133(6):922-34.
EGFR mutation is a better predictor of response to tyrosine kinase inhibitors in non-small cell lung carcinoma than FISH, CISH, and immunohistochemistry.
Sholl LM, Xiao Y, Joshi V, Yeap BY, Cioffredi LA, Jackman DM, Lee C, Jänne PA, Lindeman NI.
Source
Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
Abstract
About 10% of patients with non-small cell lung carcinoma (NSCLC) respond to epidermal growth factor receptor (EGFR)-targeted tyrosine kinase inhibitors (TKIs). More than 75% of "responders" have activating mutations in EGFR. However, mutation analysis is not widely available, and proposed alternatives (in situ hybridization and immunohistochemical analysis) have shown inconsistent associations with outcome. Fluorescence in situ hybridization (FISH), chromogenic in situ hybridization (CISH), immunohistochemical analysis, and DNA sequencing were compared in this study of 40 NSCLC samples from TKI-treated patients. Response rates were 12 of 19 in EGFR-mutant vs 1 of 20 EGFR wild-type tumors (P = .0001), 7 of 19 FISH+ vs 4 of 17 FISH- tumors (not significant [NS]), 5 of 16 CISH+ vs 6 of 21 CISH- tumors (NS), and 3 of 9 immunohistochemically positive vs 7 of 22 immunohistochemically negative tumors (NS). EGFR mutation was associated with improved progression-free survival (P = .0004). Increased copy number (FISH or CISH) and protein expression (immunohistochemical) did not independently predict outcome. Thus, EGFR sequence analysis was the only method useful for predicting response and progression-free survival following TKI therapy in NSCLC.
Am J Clin Pathol. 2010 Jun;133(6):922-34.
EGFR mutation is a better predictor of response to tyrosine kinase inhibitors in non-small cell lung carcinoma than FISH, CISH, and immunohistochemistry.
Sholl LM, Xiao Y, Joshi V, Yeap BY, Cioffredi LA, Jackman DM, Lee C, Jänne PA, Lindeman NI.
Source
Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
Abstract
About 10% of patients with non-small cell lung carcinoma (NSCLC) respond to epidermal growth factor receptor (EGFR)-targeted tyrosine kinase inhibitors (TKIs). More than 75% of "responders" have activating mutations in EGFR. However, mutation analysis is not widely available, and proposed alternatives (in situ hybridization and immunohistochemical analysis) have shown inconsistent associations with outcome. Fluorescence in situ hybridization (FISH), chromogenic in situ hybridization (CISH), immunohistochemical analysis, and DNA sequencing were compared in this study of 40 NSCLC samples from TKI-treated patients. Response rates were 12 of 19 in EGFR-mutant vs 1 of 20 EGFR wild-type tumors (P = .0001), 7 of 19 FISH+ vs 4 of 17 FISH- tumors (not significant [NS]), 5 of 16 CISH+ vs 6 of 21 CISH- tumors (NS), and 3 of 9 immunohistochemically positive vs 7 of 22 immunohistochemically negative tumors (NS). EGFR mutation was associated with improved progression-free survival (P = .0004). Increased copy number (FISH or CISH) and protein expression (immunohistochemical) did not independently predict outcome. Thus, EGFR sequence analysis was the only method useful for predicting response and progression-free survival following TKI therapy in NSCLC.
From Sanja Dacic and colleagues: KRAS mutant allele-specific imbalance in lung adenocarcioma
http://www.ncbi.nlm.nih.gov/pubmed/21743433
Mod Pathol. 2011 Dec;24(12):1571-7. doi: 10.1038/modpathol.2011.109. Epub 2011 Jul 8.
KRAS mutant allele-specific imbalance in lung adenocarcinoma.
Chiosea SI, Sherer CK, Jelic T, Dacic S.
Source
Department of Pathology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, USA. chioseasi@upmc.edu
Abstract
The significance of KRAS mutant allele-specific imbalance (MASI) in lung adenocarcinomas is unknown. KRAS MASI was defined as predominance of the mutant allele over the wild-type allele. We assessed the frequency of KRAS MASI by comparing peak heights of mutant and wild-type alleles on sequencing electropherograms and by KRAS fluorescence in situ hybridization (FISH). A review of sequencing electropherograms of 207 KRAS-mutated lung adenocarcinomas demonstrated 23 (11%) cases with the mutant allele peak higher than the wild-type allele peak and 15 (7%) cases with the mutant allele peak equal to the wild-type allele peak. Of 17 cases with the mutant allele peak higher or equal to the wild-type allele peak, 8 (47%) showed KRAS amplification by FISH. KRAS FISH analysis of 36 KRAS-mutated lung adenocarcinomas with the mutant allele peak lower than the wild-type allele peak, 21 KRAS and EGFR wild-type and 16 EGFR-mutated adenocarcinomas showed no KRAS amplification. KRAS MASI was associated with selective amplification of the KRAS mutant allele (P<0.001). Patients with KRAS MASI showed worse overall survival. The cumulative proportion surviving at 17 months for KRAS MASI group was 35% compared with 84.1% for patients with KRAS mutant allele peak lower than wild-type allele peak (P=0.012). The adverse prognostic significance of KRAS MASI was independent of clinical stage and was maintained among stage I patients. The detection of KRAS MASI in lung adenocarcinomas by sequencing electropherograms may identify patients with more aggressive disease.
Mod Pathol. 2011 Dec;24(12):1571-7. doi: 10.1038/modpathol.2011.109. Epub 2011 Jul 8.
KRAS mutant allele-specific imbalance in lung adenocarcinoma.
Chiosea SI, Sherer CK, Jelic T, Dacic S.
Source
Department of Pathology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, USA. chioseasi@upmc.edu
Abstract
The significance of KRAS mutant allele-specific imbalance (MASI) in lung adenocarcinomas is unknown. KRAS MASI was defined as predominance of the mutant allele over the wild-type allele. We assessed the frequency of KRAS MASI by comparing peak heights of mutant and wild-type alleles on sequencing electropherograms and by KRAS fluorescence in situ hybridization (FISH). A review of sequencing electropherograms of 207 KRAS-mutated lung adenocarcinomas demonstrated 23 (11%) cases with the mutant allele peak higher than the wild-type allele peak and 15 (7%) cases with the mutant allele peak equal to the wild-type allele peak. Of 17 cases with the mutant allele peak higher or equal to the wild-type allele peak, 8 (47%) showed KRAS amplification by FISH. KRAS FISH analysis of 36 KRAS-mutated lung adenocarcinomas with the mutant allele peak lower than the wild-type allele peak, 21 KRAS and EGFR wild-type and 16 EGFR-mutated adenocarcinomas showed no KRAS amplification. KRAS MASI was associated with selective amplification of the KRAS mutant allele (P<0.001). Patients with KRAS MASI showed worse overall survival. The cumulative proportion surviving at 17 months for KRAS MASI group was 35% compared with 84.1% for patients with KRAS mutant allele peak lower than wild-type allele peak (P=0.012). The adverse prognostic significance of KRAS MASI was independent of clinical stage and was maintained among stage I patients. The detection of KRAS MASI in lung adenocarcinomas by sequencing electropherograms may identify patients with more aggressive disease.
From Marc Ladanyi and colleagues: Personalized medicine and molecular testing
http://www.ncbi.nlm.nih.gov/pubmed/22203777
J Natl Compr Canc Netw. 2011 Dec;9 Suppl 6:S1-16.
NCCN molecular testing white paper: effectiveness, efficiency, and reimbursement.
Engstrom PF, Bloom MG, Demetri GD, Febbo PG, Goeckeler W, Ladanyi M, Loy B, Murphy K, Nerenberg M, Papagni P, Robson M, Sweetman RW, Tunis S, Demartino J, Larsen JK.
Abstract
Personalized medicine in oncology is maturing and evolving rapidly, and the use of molecular biomarkers in clinical decision-making is growing. This raises important issues regarding the safe, effective, and efficient deployment of molecular tests to guide appropriate care, specifically regarding laboratory-developed tests and companion diagnostics. In May 2011, NCCN assembled a work group composed of thought leaders from NCCN Member Institutions and other organizations to identify challenges and provide guidance regarding molecular testing in oncology and its corresponding utility from clinical, scientific, and coverage policy standpoints. The NCCN Molecular Testing Work Group identified challenges surrounding molecular testing, including health care provider knowledge, determining clinical utility, coding and billing for molecular tests, maintaining clinical and analytic validity of molecular tests, efficient use of specimens, and building clinical evidence.
J Natl Compr Canc Netw. 2011 Dec;9 Suppl 6:S1-16.
NCCN molecular testing white paper: effectiveness, efficiency, and reimbursement.
Engstrom PF, Bloom MG, Demetri GD, Febbo PG, Goeckeler W, Ladanyi M, Loy B, Murphy K, Nerenberg M, Papagni P, Robson M, Sweetman RW, Tunis S, Demartino J, Larsen JK.
Abstract
Personalized medicine in oncology is maturing and evolving rapidly, and the use of molecular biomarkers in clinical decision-making is growing. This raises important issues regarding the safe, effective, and efficient deployment of molecular tests to guide appropriate care, specifically regarding laboratory-developed tests and companion diagnostics. In May 2011, NCCN assembled a work group composed of thought leaders from NCCN Member Institutions and other organizations to identify challenges and provide guidance regarding molecular testing in oncology and its corresponding utility from clinical, scientific, and coverage policy standpoints. The NCCN Molecular Testing Work Group identified challenges surrounding molecular testing, including health care provider knowledge, determining clinical utility, coding and billing for molecular tests, maintaining clinical and analytic validity of molecular tests, efficient use of specimens, and building clinical evidence.
From Lucien Chirieac and colleagues: Clinical practice guidelines for pleural mesothelioma
http://www.ncbi.nlm.nih.gov/pubmed/22223867
J Natl Compr Canc Netw. 2012 Jan 1;10(1):26-41.
Malignant pleural mesothelioma. Clinical practice guidelines in oncology.
Ettinger DS, Akerley W, Borghaei H, Chang A, Cheney RT, Chirieac LR, D'Amico TA, Demmy TL, Ganti AK, Govindan R, Grannis FW, Horn L, Jahan TM, Jahanzeb M, Kessinger A, Komaki R, Kong FM, Kris MG, Krug LM, Lennes IT, Loo BW, Martins R, O'Malley J, Osarogiagbon RU, Otterson GA, Patel JD, Schenck MP, Pisters KM, Reckamp K, Riely GJ, Rohren E, Swanson SJ, Wood DE, Yang SC.
Source
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. Baltimore, MD, USA.
Unfortunately, no abstract.
J Natl Compr Canc Netw. 2012 Jan 1;10(1):26-41.
Malignant pleural mesothelioma. Clinical practice guidelines in oncology.
Ettinger DS, Akerley W, Borghaei H, Chang A, Cheney RT, Chirieac LR, D'Amico TA, Demmy TL, Ganti AK, Govindan R, Grannis FW, Horn L, Jahan TM, Jahanzeb M, Kessinger A, Komaki R, Kong FM, Kris MG, Krug LM, Lennes IT, Loo BW, Martins R, O'Malley J, Osarogiagbon RU, Otterson GA, Patel JD, Schenck MP, Pisters KM, Reckamp K, Riely GJ, Rohren E, Swanson SJ, Wood DE, Yang SC.
Source
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. Baltimore, MD, USA.
Unfortunately, no abstract.
From Alain Borczuk: Pulmonary adenocarcinoma-in-situ
http://www.ncbi.nlm.nih.gov/pubmed/22214965
Mod Pathol. 2012 Jan;25 Suppl 1:S1-10. doi: 10.1038/modpathol.2011.151.
Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma.
Borczuk AC.
Source
Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY 10032, USA. ab748@columbia.edu
Abstract
Classification of adenocarcinoma has undergone recent evaluation to better align histological classification with clinical outcomes. One terminology, in particular, that of bronchioloalveolar carcinoma (BAC), has been debated for many decades. Although initial discussion surrounded the cell-of-origin of this tumor, more recent confusion has been generated from the use of this term both as a pattern of growth within an otherwise invasive adenocarcinoma and as a term for a pre-invasive tumor synonymous with adenocarcinoma in situ. As a result, adenocarcinomas with quite different radiology, gross morphology and metastatic potential have been associated with the BAC term. Focusing on invasion and using an illustrative case, we will explore the current recommendations that incorporate assessment of invasion to clarify the confusion caused by the different uses of the historical term 'BAC'.
Mod Pathol. 2012 Jan;25 Suppl 1:S1-10. doi: 10.1038/modpathol.2011.151.
Assessment of invasion in lung adenocarcinoma classification, including adenocarcinoma in situ and minimally invasive adenocarcinoma.
Borczuk AC.
Source
Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY 10032, USA. ab748@columbia.edu
Abstract
Classification of adenocarcinoma has undergone recent evaluation to better align histological classification with clinical outcomes. One terminology, in particular, that of bronchioloalveolar carcinoma (BAC), has been debated for many decades. Although initial discussion surrounded the cell-of-origin of this tumor, more recent confusion has been generated from the use of this term both as a pattern of growth within an otherwise invasive adenocarcinoma and as a term for a pre-invasive tumor synonymous with adenocarcinoma in situ. As a result, adenocarcinomas with quite different radiology, gross morphology and metastatic potential have been associated with the BAC term. Focusing on invasion and using an illustrative case, we will explore the current recommendations that incorporate assessment of invasion to clarify the confusion caused by the different uses of the historical term 'BAC'.
From Paul Bunn and colleagues: Oncogene status and metastatic lung cancer
http://www.ncbi.nlm.nih.gov/pubmed/22282022
Cancer. 2012 Jan 26. doi: 10.1002/cncr.27409. [Epub ahead of print]
Oncogene status predicts patterns of metastatic spread in treatment-naive nonsmall cell lung cancer.
Doebele RC, Lu X, Sumey C, Maxson DA, Weickhardt AJ, Oton AB, Bunn PA Jr, Barón AE, Franklin WA, Aisner DL, Varella-Garcia M, Camidge DR.
Source
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. robert.doebele@ucdenver.edu.
Abstract
BACKGROUND:
The discovery of distinct subsets of nonsmall cell lung cancer (NSCLC) characterized by activation of driver oncogenes has greatly affected personalized therapy. It is hypothesized that the dominant oncogene in NSCLC would be associated with distinct patterns of metastatic spread in NSCLC at the time of diagnosis.
METHODS:
A total of 209 consecutive patients with stage IV nonsquamous NSCLC with an EGFR (epidermal growth factor receptor) mutation (N = 39), KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog) mutation (N = 49), ALK (anaplastic lymphoma receptor tyrosine kinase) gene rearrangement (N = 41), or wild-type for all 3 (triple negative, N = 80) were included. The percentage of patients with metastatic disease at a given site was compared between each molecular cohort (EGFR, KRAS, or ALK) and the triple negative cohort.
RESULTS:
ALK gene rearrangement was significantly associated with pericardial disease (odds ratio [OR] = 4.61; 95% confidence interval [CI] = 1.30, 16.37; P = .02) and pleural disease (OR = 4.80; 95% CI = 2.10, 10.97; P < .001). Patients with ALK gene rearrangements (OR = 5.50; 95% CI = 1.76, 17.18; P = .003) and patients with EGFR mutations (OR = 5.17; 95% CI = 1.63, 16.43; P = .006) were predisposed to liver metastasis compared to the triple negative cohort. No molecular cohort had a predisposition to pulmonary nodules, or adrenal, bone, or brain metastasis compared to the triple negative cohort. The mean number of metastatic disease sites in patients within the ALK rearranged cohort was significantly greater than that of the triple negative cohort (mean = 3.6 sites vs 2.5 sites, P < .0001).
CONCLUSIONS:
The results support the hypothesis that the dominant molecular oncogenes in NSCLC are associated with different biological behaviors manifesting as distinct patterns of metastatic spread at the time of diagnosis.
Cancer. 2012 Jan 26. doi: 10.1002/cncr.27409. [Epub ahead of print]
Oncogene status predicts patterns of metastatic spread in treatment-naive nonsmall cell lung cancer.
Doebele RC, Lu X, Sumey C, Maxson DA, Weickhardt AJ, Oton AB, Bunn PA Jr, Barón AE, Franklin WA, Aisner DL, Varella-Garcia M, Camidge DR.
Source
Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. robert.doebele@ucdenver.edu.
Abstract
BACKGROUND:
The discovery of distinct subsets of nonsmall cell lung cancer (NSCLC) characterized by activation of driver oncogenes has greatly affected personalized therapy. It is hypothesized that the dominant oncogene in NSCLC would be associated with distinct patterns of metastatic spread in NSCLC at the time of diagnosis.
METHODS:
A total of 209 consecutive patients with stage IV nonsquamous NSCLC with an EGFR (epidermal growth factor receptor) mutation (N = 39), KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog) mutation (N = 49), ALK (anaplastic lymphoma receptor tyrosine kinase) gene rearrangement (N = 41), or wild-type for all 3 (triple negative, N = 80) were included. The percentage of patients with metastatic disease at a given site was compared between each molecular cohort (EGFR, KRAS, or ALK) and the triple negative cohort.
RESULTS:
ALK gene rearrangement was significantly associated with pericardial disease (odds ratio [OR] = 4.61; 95% confidence interval [CI] = 1.30, 16.37; P = .02) and pleural disease (OR = 4.80; 95% CI = 2.10, 10.97; P < .001). Patients with ALK gene rearrangements (OR = 5.50; 95% CI = 1.76, 17.18; P = .003) and patients with EGFR mutations (OR = 5.17; 95% CI = 1.63, 16.43; P = .006) were predisposed to liver metastasis compared to the triple negative cohort. No molecular cohort had a predisposition to pulmonary nodules, or adrenal, bone, or brain metastasis compared to the triple negative cohort. The mean number of metastatic disease sites in patients within the ALK rearranged cohort was significantly greater than that of the triple negative cohort (mean = 3.6 sites vs 2.5 sites, P < .0001).
CONCLUSIONS:
The results support the hypothesis that the dominant molecular oncogenes in NSCLC are associated with different biological behaviors manifesting as distinct patterns of metastatic spread at the time of diagnosis.
Houston Lung Symposium. April 28-29, 2012. Lung and pleura. Targeted molecular therapies. Whole genome analysis. Predictive biomarkers.
http://houstonpathologists.org/images/Brochure.pdf
There have many advances and paradigm shifts in pulmonary pathology and medicine, especially
lung cancer, over the past few years. These include:
(1) New targeted therapies for lung cancer and associated biomarkers, including new lung
cancer biomarker guidelines under development by the College of American Pathologists.,
The International Association for the Study of Lung Cancer and the Association for
Molecular Pathology .
(2) New pathologic classification for adenocarcinoma of the lung proposed by the
International Association for the Study of Lung Cancer, the American Thoracic Society
and the European Respiratory Society.
(3) New staging protocol for lung cancer by the American Joint Committee on Cancer, the
International Union for Cancer Control and the College of American Pathologists.
(4) New guidelines for the diagnosis of diffuse malignant mesothelioma.
(5) New guidelines for the pathologic and clinical diagnosis and management of idiopathic
pulmonary fibrosis by the American Thoracic Society, the European Respiratory Society,
the Japanese Respiratory Society, the Latin American Thoracic Society, the Society of
Thoracic Radiology and the Pulmonary Pathology Society.
(6) Development of new pathology imaging techniques for the in-vivo microscopic-level
diagnosis of pulmonary diseases
Saturday, April 28:
7:45-8:00 am Welcome-Philip Cagle, M.D.
8:00-8:45 am Proposed New Classification of Lung Cancer
Keith Kerr, M.D.
8:45-9:30 am Dilemmas in Lung Cancer Staging
Sanja Dacic, M.D., Ph.D.
9:30-10:15 am Benign Tumors and Tumor-Like Conditions of the Lung
Alain Borczuk, M.D.
10:15-10:45 am Break
10:45-11:30 am Update on Mesothelioma
Lucian Chirieac, M.D.
11:30-12:00 pm Clinical Genotyping of Lung Cancer: Beyond EGFR and EML4-ALK,
Beyond Adenocarcinoma
Marc Ladanyi, M.D.
12:00-12:30 pm Role of Cytopathology in the Molecular Diagnostics and Targeted
Therapy of Lung Cancer
Maureen Zakowski, M.D.
12:30-1:00 pm Lunch
1:30-2:15 pm Separation of Benign versus Malignant Mesothelial Proliferations
Andrew Churg, M.D.
2:15-3:00 pm Update on Idiopathic Interstitial Pnuemonias
Thomas Colby, M.D.
3:00-3:30 pm Break
3:30-4:15 pm Pulmonary Pathology of the Rheumatic Diseases
Kevin Leslie, M.D.
4:15-5:00 pm The Changing Role of Pathology in Managing Patients with Unexplained
Diffuse Lung Disease
Jeffrey Myers, M.D.
5:00-5:30 pm Panel Discussion
5:30 pm Adjournment-Philip T. Cagle, M.D.
Sunday, April 29:
7:45-8:00 am Welcome-Philip Cagle, M.D.
8:00-8::30 am Worldwide Overview of the Current Status of Lung Cancer Diagnosis and
Treatment
Paul Bunn, M.D.
8:30-9:00 am EGFR, ALK and KRAS Molecular Testing in Lung Adenocarcinoma: Why,
When and How
Neal I. Lindeman, M.D.
9:00-9:30 am Treatment of ALK-Positive NSCLC
Yung-Jue Bang, M.D.
9:30-10:00 am Strategies to Overcome Resistance to EGFR Target Therapies
Geoffrey R. Oxnard, M.D.
10:00-10:30 am Break
10:30-11:00 am Cryobiopsy in Pulmonary Diseases
Jurgen Hetzel, M.D.
11:00-11:30 am Advancing Personalized Cancer Medicine in Lung Cancer
Laura MacConaill, M.D.
11:30-12:30 pm Lunch
12:30-1:00 pm Volumetric Optical Frequency Domain Imaging of Lung Pathology:
Improving Biopsy Sampling and Evaluation
Lida P. Hariri, M.D., Ph.D.
1:00-1:30 pm Lung Cancer Differential Diagnosis by Label-Free, Molecular Vibrational
Imaging
Stephen T. C. Wong, Ph.D., P.E.
1:30-2:00 pm Screening for Lung Cancer: Who Should be Screened?
James Jett, M.D.
2:00-2:30 pm Molecular Pathology of Lung Cancer: Changes in Prevention and
Therapy Paradigms
Ignacio Wistuba, M.D.
2:30-3:00 pm Panel Discussion
3:00 pm Adjournment-Philip T. Cagle, M.D.
There have many advances and paradigm shifts in pulmonary pathology and medicine, especially
lung cancer, over the past few years. These include:
(1) New targeted therapies for lung cancer and associated biomarkers, including new lung
cancer biomarker guidelines under development by the College of American Pathologists.,
The International Association for the Study of Lung Cancer and the Association for
Molecular Pathology .
(2) New pathologic classification for adenocarcinoma of the lung proposed by the
International Association for the Study of Lung Cancer, the American Thoracic Society
and the European Respiratory Society.
(3) New staging protocol for lung cancer by the American Joint Committee on Cancer, the
International Union for Cancer Control and the College of American Pathologists.
(4) New guidelines for the diagnosis of diffuse malignant mesothelioma.
(5) New guidelines for the pathologic and clinical diagnosis and management of idiopathic
pulmonary fibrosis by the American Thoracic Society, the European Respiratory Society,
the Japanese Respiratory Society, the Latin American Thoracic Society, the Society of
Thoracic Radiology and the Pulmonary Pathology Society.
(6) Development of new pathology imaging techniques for the in-vivo microscopic-level
diagnosis of pulmonary diseases
Saturday, April 28:
7:45-8:00 am Welcome-Philip Cagle, M.D.
8:00-8:45 am Proposed New Classification of Lung Cancer
Keith Kerr, M.D.
8:45-9:30 am Dilemmas in Lung Cancer Staging
Sanja Dacic, M.D., Ph.D.
9:30-10:15 am Benign Tumors and Tumor-Like Conditions of the Lung
Alain Borczuk, M.D.
10:15-10:45 am Break
10:45-11:30 am Update on Mesothelioma
Lucian Chirieac, M.D.
11:30-12:00 pm Clinical Genotyping of Lung Cancer: Beyond EGFR and EML4-ALK,
Beyond Adenocarcinoma
Marc Ladanyi, M.D.
12:00-12:30 pm Role of Cytopathology in the Molecular Diagnostics and Targeted
Therapy of Lung Cancer
Maureen Zakowski, M.D.
12:30-1:00 pm Lunch
1:30-2:15 pm Separation of Benign versus Malignant Mesothelial Proliferations
Andrew Churg, M.D.
2:15-3:00 pm Update on Idiopathic Interstitial Pnuemonias
Thomas Colby, M.D.
3:00-3:30 pm Break
3:30-4:15 pm Pulmonary Pathology of the Rheumatic Diseases
Kevin Leslie, M.D.
4:15-5:00 pm The Changing Role of Pathology in Managing Patients with Unexplained
Diffuse Lung Disease
Jeffrey Myers, M.D.
5:00-5:30 pm Panel Discussion
5:30 pm Adjournment-Philip T. Cagle, M.D.
Sunday, April 29:
7:45-8:00 am Welcome-Philip Cagle, M.D.
8:00-8::30 am Worldwide Overview of the Current Status of Lung Cancer Diagnosis and
Treatment
Paul Bunn, M.D.
8:30-9:00 am EGFR, ALK and KRAS Molecular Testing in Lung Adenocarcinoma: Why,
When and How
Neal I. Lindeman, M.D.
9:00-9:30 am Treatment of ALK-Positive NSCLC
Yung-Jue Bang, M.D.
9:30-10:00 am Strategies to Overcome Resistance to EGFR Target Therapies
Geoffrey R. Oxnard, M.D.
10:00-10:30 am Break
10:30-11:00 am Cryobiopsy in Pulmonary Diseases
Jurgen Hetzel, M.D.
11:00-11:30 am Advancing Personalized Cancer Medicine in Lung Cancer
Laura MacConaill, M.D.
11:30-12:30 pm Lunch
12:30-1:00 pm Volumetric Optical Frequency Domain Imaging of Lung Pathology:
Improving Biopsy Sampling and Evaluation
Lida P. Hariri, M.D., Ph.D.
1:00-1:30 pm Lung Cancer Differential Diagnosis by Label-Free, Molecular Vibrational
Imaging
Stephen T. C. Wong, Ph.D., P.E.
1:30-2:00 pm Screening for Lung Cancer: Who Should be Screened?
James Jett, M.D.
2:00-2:30 pm Molecular Pathology of Lung Cancer: Changes in Prevention and
Therapy Paradigms
Ignacio Wistuba, M.D.
2:30-3:00 pm Panel Discussion
3:00 pm Adjournment-Philip T. Cagle, M.D.
Thursday, February 23, 2012
Integrating professionalism into the medical student curriculum: AMEE Guide No. 61
http://www.ncbi.nlm.nih.gov/pubmed/22289014
Med Teach. 2012;34(2):e64-77.
Integrating professionalism into the curriculum: AMEE Guide No. 61.
O'Sullivan H, van Mook W, Fewtrell R, Wass V.
Source
The University of Liverpool , UK.
Abstract
Professional values and behaviours are intrinsic to all medical practice, yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism for the twenty-first century raises challenges not only to adapting the course to changing societal values but also for instilling skills of ongoing self-directed continuous development in trainees for future revalidation. This Guide is based on the contemporary available literature and focuses on instilling Professionalism positively into both undergraduate and postgraduate training deliberately avoiding the more negative aspects of Fitness to Practise. The literature on Professionalism is extensive. An evidence-based approach has been taken throughout. We have selected only some of the available publications to offer practical advice. Comprehensive reviews are available elsewhere (van Mook et al. 2009a-g). This Guide takes a structured stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning. Finally, a few well-evaluated case studies for both teaching and assessment have been selected to illustrate our recommendations.
Med Teach. 2012;34(2):e64-77.
Integrating professionalism into the curriculum: AMEE Guide No. 61.
O'Sullivan H, van Mook W, Fewtrell R, Wass V.
Source
The University of Liverpool , UK.
Abstract
Professional values and behaviours are intrinsic to all medical practice, yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism for the twenty-first century raises challenges not only to adapting the course to changing societal values but also for instilling skills of ongoing self-directed continuous development in trainees for future revalidation. This Guide is based on the contemporary available literature and focuses on instilling Professionalism positively into both undergraduate and postgraduate training deliberately avoiding the more negative aspects of Fitness to Practise. The literature on Professionalism is extensive. An evidence-based approach has been taken throughout. We have selected only some of the available publications to offer practical advice. Comprehensive reviews are available elsewhere (van Mook et al. 2009a-g). This Guide takes a structured stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning. Finally, a few well-evaluated case studies for both teaching and assessment have been selected to illustrate our recommendations.
Integrating professionalism into the medical student curriculum
http://www.ncbi.nlm.nih.gov/pubmed/22288994
Med Teach. 2012;34(2):155-7.
Integrating professionalism into the curriculum.
O'Sullivan H, van Mook W, Fewtrell R, Wass V.
Source
The University of Liverpool , UK.
Abstract
Professional values and behaviours are intrinsic to all medical practice yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism in the twenty-first century raises challenges not only for the adaptation of the medical training programme to changing societal values but also for ensuring that trainees gain the skills for self-directed continuous development and future revalidation. This article is an introduction to the AMEE Guide in Medical Education No 61: Integrating Professionalism into the Curriculum ( www.amee.org ), which is based on the extensive contemporary available literature. An evidence-based approach has been taken throughout the Guide as it focuses on instilling professionalism positively into both undergraduate and postgraduate training. It takes a structured, stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning of the trainee. A few well-evaluated case studies for both teaching and assessment have been selected to illustrate the recommendations.
Med Teach. 2012;34(2):155-7.
Integrating professionalism into the curriculum.
O'Sullivan H, van Mook W, Fewtrell R, Wass V.
Source
The University of Liverpool , UK.
Abstract
Professional values and behaviours are intrinsic to all medical practice yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism in the twenty-first century raises challenges not only for the adaptation of the medical training programme to changing societal values but also for ensuring that trainees gain the skills for self-directed continuous development and future revalidation. This article is an introduction to the AMEE Guide in Medical Education No 61: Integrating Professionalism into the Curriculum ( www.amee.org ), which is based on the extensive contemporary available literature. An evidence-based approach has been taken throughout the Guide as it focuses on instilling professionalism positively into both undergraduate and postgraduate training. It takes a structured, stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning of the trainee. A few well-evaluated case studies for both teaching and assessment have been selected to illustrate the recommendations.
A cross-cultural study of students' approaches to professional dilemmas
http://www.ncbi.nlm.nih.gov/pubmed/22324524
Med Educ. 2012 Mar;46(3):245-56. doi: 10.1111/j.1365-2923.2011.04149.x.
A cross-cultural study of students' approaches to professional dilemmas: sticks or ripples.
Ho MJ, Lin CW, Chiu YT, Lingard L, Ginsburg S.
Source
Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan Department of Medicine, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada Department of Medicine, Faculty of Medicine, and Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
Abstract
Medical Education 2012: 46 : 245-256
Context
Medical educators internationally are faced with the challenge of teaching and assessing professionalism in their students. Some studies have drawn attention to contextual factors that influence students' responses to professional dilemmas. Although culture is a significant contextual factor, no research has examined student responses to professional dilemmas across different cultures.
Methods
Semi-structured interviews inquiring into reactions towards, and reasoning about, five video clips depicting students facing professional dilemmas were conducted with 24 final-year medical students in Taiwan. The interviews were transcribed and analysed according to the theoretical framework used in prior Canadian studies using the same videos and interview questions.
Results
The framework from previous Canadian research, including the components of principles, affect and implications, was generally applicable to the decision making of Taiwanese students, with some distinctions. Taiwanese students cited a few more avowed principles. Taiwanese students emphasised an additional unavowed principle that pertained to following the advice of more senior trainees. In addition to implications for patients, team members or themselves, Taiwanese students considered the impact of their responses on multiple relationships, including those with patients' families and alumni residents. Cultural norms were also cited by Taiwanese students.
Conclusions
Medical educators must acknowledge students' reasoning in professionally challenging situations and guide students to balance considerations of principles, implications, affects and cultural norms. The prominence of Confucian relationalism in this study, exhibited by students' considerations of the rippling effects of their behaviours on all their social relationships, calls for further cross-cultural studies on medical professionalism to move the field beyond a Western individualist focus.
Med Educ. 2012 Mar;46(3):245-56. doi: 10.1111/j.1365-2923.2011.04149.x.
A cross-cultural study of students' approaches to professional dilemmas: sticks or ripples.
Ho MJ, Lin CW, Chiu YT, Lingard L, Ginsburg S.
Source
Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan Department of Medicine, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada Department of Medicine, Faculty of Medicine, and Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
Abstract
Medical Education 2012: 46 : 245-256
Context
Medical educators internationally are faced with the challenge of teaching and assessing professionalism in their students. Some studies have drawn attention to contextual factors that influence students' responses to professional dilemmas. Although culture is a significant contextual factor, no research has examined student responses to professional dilemmas across different cultures.
Methods
Semi-structured interviews inquiring into reactions towards, and reasoning about, five video clips depicting students facing professional dilemmas were conducted with 24 final-year medical students in Taiwan. The interviews were transcribed and analysed according to the theoretical framework used in prior Canadian studies using the same videos and interview questions.
Results
The framework from previous Canadian research, including the components of principles, affect and implications, was generally applicable to the decision making of Taiwanese students, with some distinctions. Taiwanese students cited a few more avowed principles. Taiwanese students emphasised an additional unavowed principle that pertained to following the advice of more senior trainees. In addition to implications for patients, team members or themselves, Taiwanese students considered the impact of their responses on multiple relationships, including those with patients' families and alumni residents. Cultural norms were also cited by Taiwanese students.
Conclusions
Medical educators must acknowledge students' reasoning in professionally challenging situations and guide students to balance considerations of principles, implications, affects and cultural norms. The prominence of Confucian relationalism in this study, exhibited by students' considerations of the rippling effects of their behaviours on all their social relationships, calls for further cross-cultural studies on medical professionalism to move the field beyond a Western individualist focus.
The determination of cultural differences in the understanding of professionalism
http://www.ncbi.nlm.nih.gov/pubmed/22324525
Med Educ. 2012 Mar;46(3):257-66. doi: 10.1111/j.1365-2923.2011.04153.x.
Cultural similarities and differences in medical professionalism: a multi-region study.
Chandratilake M, McAleer S, Gibson J.
Source
Center for Medical Education, University of Dundee, Scotland, UK Department of Oral Medicine, Dental School, University of Dundee, Scotland, UK.
Abstract
Medical Education 2012: 46: 257-266
Context
Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understand professionalism' as many researchers realised that professionalism is a social construct and is culture-sensitive. The determination of cultural differences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi-region study, we illustrate the universal and culture-specific aspects of medical professionalism as it is perceived by medical practitioners.
Methods
Forty-six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics.
Results
With acceptable levels of consensus, all regional groups identified 29 attributes as 'essential', thereby indicating the universality of these professional attributes, and six attributes as non-essential. The essentialness of the rest varied by regional group.
Conclusions
This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio-economic factors. Some of the responses appear to be counter-cultural and demonstrate practitioners' keenness to overcome cultural barriers in order to provide better patient care.
Med Educ. 2012 Mar;46(3):257-66. doi: 10.1111/j.1365-2923.2011.04153.x.
Cultural similarities and differences in medical professionalism: a multi-region study.
Chandratilake M, McAleer S, Gibson J.
Source
Center for Medical Education, University of Dundee, Scotland, UK Department of Oral Medicine, Dental School, University of Dundee, Scotland, UK.
Abstract
Medical Education 2012: 46: 257-266
Context
Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understand professionalism' as many researchers realised that professionalism is a social construct and is culture-sensitive. The determination of cultural differences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi-region study, we illustrate the universal and culture-specific aspects of medical professionalism as it is perceived by medical practitioners.
Methods
Forty-six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics.
Results
With acceptable levels of consensus, all regional groups identified 29 attributes as 'essential', thereby indicating the universality of these professional attributes, and six attributes as non-essential. The essentialness of the rest varied by regional group.
Conclusions
This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio-economic factors. Some of the responses appear to be counter-cultural and demonstrate practitioners' keenness to overcome cultural barriers in order to provide better patient care.
From Brigham and Women's Hospital: Operating room war stories
http://www.ncbi.nlm.nih.gov/pubmed/22088266
Am J Surg. 2012 Jan;203(1):63-8. Epub 2011 Nov 16.
War stories: a qualitative analysis of narrative teaching strategies in the operating room.
Hu YY, Peyre SE, Arriaga AF, Roth EM, Corso KA, Greenberg CC.
Source
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND:
"War stories" are commonplace in surgical education, yet little is known about their purpose, construct, or use in the education of trainees.
METHODS:
Ten complex operations were videotaped and audiotaped. Narrative stories were analyzed using grounded theory to identify emergent themes in both the types of stories being told and the teaching objectives they illustrated.
RESULTS:
Twenty-four stories were identified in 9 of the 10 cases (mean, 2.4/case). They were brief (mean, 58 seconds), illustrative of multiple teaching points (mean, 1.5/story), and appeared throughout the operations. Anchored in personal experience, these stories taught both clinical (eg, operative technique, decision making, error identification) and programmatic (eg, resource management, professionalism) topics.
CONCLUSIONS:
Narrative stories are used frequently and intuitively by physicians to emphasize a variety of intraoperative teaching points. They socialize trainees in the culture of surgery and may represent an underrecognized approach to teaching the core competencies. More understanding is needed to maximize their potential.
Am J Surg. 2012 Jan;203(1):63-8. Epub 2011 Nov 16.
War stories: a qualitative analysis of narrative teaching strategies in the operating room.
Hu YY, Peyre SE, Arriaga AF, Roth EM, Corso KA, Greenberg CC.
Source
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND:
"War stories" are commonplace in surgical education, yet little is known about their purpose, construct, or use in the education of trainees.
METHODS:
Ten complex operations were videotaped and audiotaped. Narrative stories were analyzed using grounded theory to identify emergent themes in both the types of stories being told and the teaching objectives they illustrated.
RESULTS:
Twenty-four stories were identified in 9 of the 10 cases (mean, 2.4/case). They were brief (mean, 58 seconds), illustrative of multiple teaching points (mean, 1.5/story), and appeared throughout the operations. Anchored in personal experience, these stories taught both clinical (eg, operative technique, decision making, error identification) and programmatic (eg, resource management, professionalism) topics.
CONCLUSIONS:
Narrative stories are used frequently and intuitively by physicians to emphasize a variety of intraoperative teaching points. They socialize trainees in the culture of surgery and may represent an underrecognized approach to teaching the core competencies. More understanding is needed to maximize their potential.
Physician leaders and "referent power"
http://www.ncbi.nlm.nih.gov/pubmed/22189888
Acad Med. 2012 Feb;87(2):221-5.
Perspective: physician leaders and their bases of power: common and disparate elements.
Gabel S.
Source
Dr. Gabel is medical director, Division of Children and Family Services, New York State Office of Mental Health, Albany, New York.
Abstract
Physicians hold numerous types of leadership positions in academic, executive, and/or clinical environments. To be successful, physician leaders must exert power, or social influence, as power is conceptualized in social psychology. The power of leaders accrues through their positions, expertise, or other factors, such as communication abilities or their ability to influence others to identify with the vision they espouse. This article discusses the types of leadership roles that physicians play and the power types they must apply in these roles. Crossing all leadership roles are a series of necessary personal characteristics and interpersonal competencies that result in what has been called "referent power," a more subtle form of social influence that is crucial for success regardless of position.Leadership training that includes practice in cultivating these personal characteristics and interpersonal competencies should be an essential component of medical and graduate medical education. Studying the types and nature of power also would be a valuable contribution to courses on professionalism in medical practice. Examples are provided of the types and uses of power that may be applied in the various leadership roles that physicians hold.
Acad Med. 2012 Feb;87(2):221-5.
Perspective: physician leaders and their bases of power: common and disparate elements.
Gabel S.
Source
Dr. Gabel is medical director, Division of Children and Family Services, New York State Office of Mental Health, Albany, New York.
Abstract
Physicians hold numerous types of leadership positions in academic, executive, and/or clinical environments. To be successful, physician leaders must exert power, or social influence, as power is conceptualized in social psychology. The power of leaders accrues through their positions, expertise, or other factors, such as communication abilities or their ability to influence others to identify with the vision they espouse. This article discusses the types of leadership roles that physicians play and the power types they must apply in these roles. Crossing all leadership roles are a series of necessary personal characteristics and interpersonal competencies that result in what has been called "referent power," a more subtle form of social influence that is crucial for success regardless of position.Leadership training that includes practice in cultivating these personal characteristics and interpersonal competencies should be an essential component of medical and graduate medical education. Studying the types and nature of power also would be a valuable contribution to courses on professionalism in medical practice. Examples are provided of the types and uses of power that may be applied in the various leadership roles that physicians hold.
American College of Physicians Ethics Manual: Sixth Edition
http://www.ncbi.nlm.nih.gov/pubmed/22213573
Ann Intern Med. 2012 Jan 3;156(1_Part_2):73-104.
American College of Physicians Ethics Manual: Sixth Edition.
Snyder L; for the American College of Physicians Ethics, Professionalism, and Human Rights Committee.
Source
the American College of Physicians, Philadelphia, Pennsylvania.
Abstract
Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.
Ann Intern Med. 2012 Jan 3;156(1_Part_2):73-104.
American College of Physicians Ethics Manual: Sixth Edition.
Snyder L; for the American College of Physicians Ethics, Professionalism, and Human Rights Committee.
Source
the American College of Physicians, Philadelphia, Pennsylvania.
Abstract
Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.
From Newcastle U: Empathy in first-year dental students
http://www.ncbi.nlm.nih.gov/pubmed/22251333
Eur J Dent Educ. 2012 Feb;16(1):e111-6. doi: 10.1111/j.1600-0579.2011.00683.x. Epub 2011 Mar 17.
Does empathy change in first-year dental students?
Beattie A, Durham J, Harvey J, Steele J, McHanwell S.
Source
Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK.
Abstract
INTRODUCTION:
Professionalism is a central tenet of the dental undergraduate curriculum. Dental undergraduate curricula and standards expect the dentist to put the patient's interests first, and in this respect, an important attitude is empathy.
OBJECTIVE:
This study examined the self-reported empathy levels of first-year dental students before and after an early analytical exposure to behavioural sciences and the clinical encounter.
METHOD:
First-year dental undergraduates were given an attitudinal questionnaire to complete before and after the behavioural science course. The questionnaire consisted of the HP version of the Jefferson Scale of Physician Empathy and the Patient-Practitioner Orientation Scale. Paired non-parametric tests and Spearman's Rho correlations, along with simple descriptive statistics, were used to test the statistical significance of observations.
RESULTS:
A total of 66 paired questionnaires were returned, giving a response rate of 75%. There were no correlations between age and total mean score of JSPE or PPOS, and no gender differences. There was a significant increase (P<0.01) in empathy as measured by the JSPE between pre- and post-course scores. The PPOS did not record any significant change in the sharing, caring or total scale scores pre- to post-course.
CONCLUSION:
The modified JSPE has potential utility in assessing the cognitive-affective aspect of dental students' empathy. Using the JSPE, short-term measurable empathy changes can be detected in first-year dental undergraduates after the structured and assessed analytical introduction to the clinical encounter and environment.
Eur J Dent Educ. 2012 Feb;16(1):e111-6. doi: 10.1111/j.1600-0579.2011.00683.x. Epub 2011 Mar 17.
Does empathy change in first-year dental students?
Beattie A, Durham J, Harvey J, Steele J, McHanwell S.
Source
Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK.
Abstract
INTRODUCTION:
Professionalism is a central tenet of the dental undergraduate curriculum. Dental undergraduate curricula and standards expect the dentist to put the patient's interests first, and in this respect, an important attitude is empathy.
OBJECTIVE:
This study examined the self-reported empathy levels of first-year dental students before and after an early analytical exposure to behavioural sciences and the clinical encounter.
METHOD:
First-year dental undergraduates were given an attitudinal questionnaire to complete before and after the behavioural science course. The questionnaire consisted of the HP version of the Jefferson Scale of Physician Empathy and the Patient-Practitioner Orientation Scale. Paired non-parametric tests and Spearman's Rho correlations, along with simple descriptive statistics, were used to test the statistical significance of observations.
RESULTS:
A total of 66 paired questionnaires were returned, giving a response rate of 75%. There were no correlations between age and total mean score of JSPE or PPOS, and no gender differences. There was a significant increase (P<0.01) in empathy as measured by the JSPE between pre- and post-course scores. The PPOS did not record any significant change in the sharing, caring or total scale scores pre- to post-course.
CONCLUSION:
The modified JSPE has potential utility in assessing the cognitive-affective aspect of dental students' empathy. Using the JSPE, short-term measurable empathy changes can be detected in first-year dental undergraduates after the structured and assessed analytical introduction to the clinical encounter and environment.
Physician care
http://www.ncbi.nlm.nih.gov/pubmed/22270800
Med Health Care Philos. 2012 Jan 24. [Epub ahead of print]
The desired moral attitude of the physician: (III) care.
Gelhaus P.
Source
Institute for Ethics, History and Theory of Medicine, University of Muenster, Muenster, Germany, gelhaus@uni-muenster.de.
Abstract
In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude-compassion-has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad-"care"-is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician's ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. 'Empathic compassionate care' does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, 'empathic compassionate care' has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of "empathic compassionate care" and "responsibility" is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.
Med Health Care Philos. 2012 Jan 24. [Epub ahead of print]
The desired moral attitude of the physician: (III) care.
Gelhaus P.
Source
Institute for Ethics, History and Theory of Medicine, University of Muenster, Muenster, Germany, gelhaus@uni-muenster.de.
Abstract
In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude-compassion-has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad-"care"-is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician's ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. 'Empathic compassionate care' does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, 'empathic compassionate care' has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of "empathic compassionate care" and "responsibility" is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.
Physician compassion
http://www.ncbi.nlm.nih.gov/pubmed/22160990
Med Health Care Philos. 2011 Dec 11. [Epub ahead of print]
The desired moral attitude of the physician: (II) compassion.
Gelhaus P.
Source
Institute for Ethics, History and Theory of Medicine, University of Muenster, Muenster, Germany, gelhaus@uni-muenster.de.
Abstract
Professional medical ethics demands of health care professionals in addition to specific duties and rules of conduct that they embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired implied attitude of physicians. In a sequel of three articles, a set of three of these concepts is presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In this article, the emotional and virtuous core of the desired professional attitude-compassion-is elaborated. Compassion is distinguished from sympathy, empathy and pity. Several problems of compassion as a spontaneous, warm emotion for being a professional virtue are discussed: especially questions of over-demand, of justice and of concerns because of a possible threat to the patient's dignity and autonomy. An interpretation of compassion as processed and learned professional attitude, that founds dignity on the general idea of man as a sentient being and on solidarity, not on his independence and capacities, is developed. It is meant to rule out the possible side effects and to make compassion as a professional attitude and as professional virtue attractive, teachable and acquirable. In order to reach the adequate warmth and closeness for the particular physician-patient-relation, professional compassion has to be combined with the capacity of empathy. If appropriate, the combination of both empathy and compassion as "empathic compassion" can demand a much warmer attitude towards the patient than each of the elements alone, or the simple addition of them can provide. The concept of "care" that will be discussed in a forthcoming article of this sequel is a missing necessary part to describe the active potential of the desired moral attitude of the physician more completely. The reconstruction of the desired professional attitude in terms of "empathic compassionate care" is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.
Med Health Care Philos. 2011 Dec 11. [Epub ahead of print]
The desired moral attitude of the physician: (II) compassion.
Gelhaus P.
Source
Institute for Ethics, History and Theory of Medicine, University of Muenster, Muenster, Germany, gelhaus@uni-muenster.de.
Abstract
Professional medical ethics demands of health care professionals in addition to specific duties and rules of conduct that they embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired implied attitude of physicians. In a sequel of three articles, a set of three of these concepts is presented in an interpretation that is meant to characterise the morally emotional part of this attitude: "empathy", "compassion" and "care". In the first article of the series, "empathy" has been developed as a mainly cognitive and morally neutral capacity of understanding. In this article, the emotional and virtuous core of the desired professional attitude-compassion-is elaborated. Compassion is distinguished from sympathy, empathy and pity. Several problems of compassion as a spontaneous, warm emotion for being a professional virtue are discussed: especially questions of over-demand, of justice and of concerns because of a possible threat to the patient's dignity and autonomy. An interpretation of compassion as processed and learned professional attitude, that founds dignity on the general idea of man as a sentient being and on solidarity, not on his independence and capacities, is developed. It is meant to rule out the possible side effects and to make compassion as a professional attitude and as professional virtue attractive, teachable and acquirable. In order to reach the adequate warmth and closeness for the particular physician-patient-relation, professional compassion has to be combined with the capacity of empathy. If appropriate, the combination of both empathy and compassion as "empathic compassion" can demand a much warmer attitude towards the patient than each of the elements alone, or the simple addition of them can provide. The concept of "care" that will be discussed in a forthcoming article of this sequel is a missing necessary part to describe the active potential of the desired moral attitude of the physician more completely. The reconstruction of the desired professional attitude in terms of "empathic compassionate care" is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.
Physician empathy
http://www.ncbi.nlm.nih.gov/pubmed/22167298
Med Health Care Philos. 2011 Dec 14. [Epub ahead of print]
The desired moral attitude of the physician: (I) empathy.
Gelhaus P.
Source
Institute for Ethics, History and Theory of Medicine, University of Muenster, Münster, Germany, gelhaus@uni-muenster.de.
Abstract
In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired underlying attitude of physicians. In this article, one of them-empathy-is presented in an interpretation that is meant to depicture (together with the two additional concepts compassion and care) this attitude. Therefore empathy in the clinical context is defined as the adequate understanding of the inner processes of the patient concerning his health-related problems. Adequacy is scrutinized on behalf of the emotional and subjective involvement of he physician, and on the necessary dependence on medical-moral-goals. In the present interpretation, empathy alone is no guarantee of the right moral attitude, but a necessary instrumental skill in order to perceive and treat a patient as an individual person. The concepts of compassion and care that will be discussed in two forthcoming articles are necessary parts to describe the desired moral attitude of the physician more completely.
Med Health Care Philos. 2011 Dec 14. [Epub ahead of print]
The desired moral attitude of the physician: (I) empathy.
Gelhaus P.
Source
Institute for Ethics, History and Theory of Medicine, University of Muenster, Münster, Germany, gelhaus@uni-muenster.de.
Abstract
In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired underlying attitude of physicians. In this article, one of them-empathy-is presented in an interpretation that is meant to depicture (together with the two additional concepts compassion and care) this attitude. Therefore empathy in the clinical context is defined as the adequate understanding of the inner processes of the patient concerning his health-related problems. Adequacy is scrutinized on behalf of the emotional and subjective involvement of he physician, and on the necessary dependence on medical-moral-goals. In the present interpretation, empathy alone is no guarantee of the right moral attitude, but a necessary instrumental skill in order to perceive and treat a patient as an individual person. The concepts of compassion and care that will be discussed in two forthcoming articles are necessary parts to describe the desired moral attitude of the physician more completely.
From U British Columbia: Restricting resident work hours
http://www.ncbi.nlm.nih.gov/pubmed/22297631
Crit Care Med. 2012 Mar;40(3):960-6.
Restricting resident work hours: The good, the bad, and the ugly.
Peets A, Ayas NT.
Source
From the Division of Critical Care Medicine (AP, NTA), Department of Medicine, University of British Columbia, Vancouver, BC; Sleep Disorders Program (NTA), University of British Columbia Hospital, Vancouver, BC; Division of Critical Care Medicine (AP, NTA), Department of Medicine, Providence Healthcare, Vancouver, BC; Centre for Health Education Scholarship (AP), University of British Columbia, Vancouver, BC.
Abstract
OBJECTIVES:
: Inadequate sleep and long work hours are long-standing traditions in the medical profession, and work schedules are especially intense in resident physicians. However, it has been increasingly recognized that the extreme hours commonly worked by residents may have substantial occupational and patient safety consequences. Largely because of these concerns, new regulations related to resident work hours came into effect July 2011, in the United States. Residents in their first year of training are now restricted to a maximum shift length of 16 hrs, with residents in subsequent years restricted to a maximum of 24 hrs. The purpose of this review is to summarize the literature regarding resident work hours in the intensive care unit, focusing on the potential positive and negative impacts of work hour limits.
DATA SOURCES:
: The authors electronically searched MEDLINE, manually searched reference lists from retrieved articles, and reviewed their own personal databases for articles relevant to resident work hour limits.
METHODS AND MAIN RESULTS:
: To function well, humans, including physicians, require adequate sleep. Resident work hour limits will likely reduce the incidence of fatigue-related medical errors and improve resident safety and quality of life. However, a reduction in work hours may not represent the panacea for patient safety given the potential for increased errors because of discontinuity. Furthermore, there may be other substantial negative impacts, including reduced clinical exposure, erosion of professionalism, and inadequate preparation for independent practice. Costs of implementation are likely to be substantial.
CONCLUSION:
: Currently, there is fairly limited evidence available, and a more in-depth understanding of this complex topic is required to design a residency experience that will provide the next generation of physicians the best compromise between education, experience, and quality patient care. In the end, the primary goal of the postgraduate medical education system must be to ensure the creation of healthy physicians who can provide excellent clinical care in this complex interdisciplinary medical industry and who will have long fulfilling careers providing this outstanding care to their patients.
Crit Care Med. 2012 Mar;40(3):960-6.
Restricting resident work hours: The good, the bad, and the ugly.
Peets A, Ayas NT.
Source
From the Division of Critical Care Medicine (AP, NTA), Department of Medicine, University of British Columbia, Vancouver, BC; Sleep Disorders Program (NTA), University of British Columbia Hospital, Vancouver, BC; Division of Critical Care Medicine (AP, NTA), Department of Medicine, Providence Healthcare, Vancouver, BC; Centre for Health Education Scholarship (AP), University of British Columbia, Vancouver, BC.
Abstract
OBJECTIVES:
: Inadequate sleep and long work hours are long-standing traditions in the medical profession, and work schedules are especially intense in resident physicians. However, it has been increasingly recognized that the extreme hours commonly worked by residents may have substantial occupational and patient safety consequences. Largely because of these concerns, new regulations related to resident work hours came into effect July 2011, in the United States. Residents in their first year of training are now restricted to a maximum shift length of 16 hrs, with residents in subsequent years restricted to a maximum of 24 hrs. The purpose of this review is to summarize the literature regarding resident work hours in the intensive care unit, focusing on the potential positive and negative impacts of work hour limits.
DATA SOURCES:
: The authors electronically searched MEDLINE, manually searched reference lists from retrieved articles, and reviewed their own personal databases for articles relevant to resident work hour limits.
METHODS AND MAIN RESULTS:
: To function well, humans, including physicians, require adequate sleep. Resident work hour limits will likely reduce the incidence of fatigue-related medical errors and improve resident safety and quality of life. However, a reduction in work hours may not represent the panacea for patient safety given the potential for increased errors because of discontinuity. Furthermore, there may be other substantial negative impacts, including reduced clinical exposure, erosion of professionalism, and inadequate preparation for independent practice. Costs of implementation are likely to be substantial.
CONCLUSION:
: Currently, there is fairly limited evidence available, and a more in-depth understanding of this complex topic is required to design a residency experience that will provide the next generation of physicians the best compromise between education, experience, and quality patient care. In the end, the primary goal of the postgraduate medical education system must be to ensure the creation of healthy physicians who can provide excellent clinical care in this complex interdisciplinary medical industry and who will have long fulfilling careers providing this outstanding care to their patients.
From George Washington U: Teaching suffering to medical students?
http://www.ncbi.nlm.nih.gov/pubmed/22313178
Psychol Health Med. 2012 Feb 7. [Epub ahead of print]
Teaching suffering: The testimonial-commentary method.
Katz JD, Haile-Mariam TW, Roth K, Moskovitz P, Niemtzoff M, Fried A.
Source
a Department of Medicine , The George Washington University , Washington , DC , USA.
Abstract
Attempts to define professionalism and humanism suggest that qualities such as compliance to values, patient access, doctor-patient relationship, demeanor, professional management, personal awareness, and motivation are prominent thematic components. In this communication, we present a method for instruction in the values of humanism that may help to overcome the "curricular inertia that plagues medical education." Our approach is structured around a technique of testimonial-commentary as a novel approach to teaching humanism that does not rely upon the traditional role-modeling format. To develop effective medical school curricula for teaching humanism, we cannot rely upon the textbooks of normal and abnormal human anatomy and physiology. We must delve into the "unscientific" realms of human identity ranging from sensuality to brutality: self-preservation to sacrifice. Underneath it all, we must acknowledge that there are the ties that bind us together as people. The Seminar on Human Suffering challenges medical school educators to work with the community at large to insure that physicians will be able to serve those that seek their counsel.
Psychol Health Med. 2012 Feb 7. [Epub ahead of print]
Teaching suffering: The testimonial-commentary method.
Katz JD, Haile-Mariam TW, Roth K, Moskovitz P, Niemtzoff M, Fried A.
Source
a Department of Medicine , The George Washington University , Washington , DC , USA.
Abstract
Attempts to define professionalism and humanism suggest that qualities such as compliance to values, patient access, doctor-patient relationship, demeanor, professional management, personal awareness, and motivation are prominent thematic components. In this communication, we present a method for instruction in the values of humanism that may help to overcome the "curricular inertia that plagues medical education." Our approach is structured around a technique of testimonial-commentary as a novel approach to teaching humanism that does not rely upon the traditional role-modeling format. To develop effective medical school curricula for teaching humanism, we cannot rely upon the textbooks of normal and abnormal human anatomy and physiology. We must delve into the "unscientific" realms of human identity ranging from sensuality to brutality: self-preservation to sacrifice. Underneath it all, we must acknowledge that there are the ties that bind us together as people. The Seminar on Human Suffering challenges medical school educators to work with the community at large to insure that physicians will be able to serve those that seek their counsel.
From U Conn: More on research integrity. Temptations, though, are not "dilemmas"
http://www.ncbi.nlm.nih.gov/pubmed/22330669
Clin Dermatol. 2012 Mar;30(2):231-6.
Ethical dilemmas in journal publication.
Babalola O, Grant-Kels JM, Parish LC.
Source
University of Connecticut School of Medicine, Farmington, CT, USA.
Abstract
Physicians often face tremendous pressures and incentives to publish, sometimes leading to a compromise of ethical standards, either consciously or unconsciously. From the vantage of ethical authorship, we discuss what constitutes authorship; avoidance of ghost authorship; plagiarism, as well as self-plagiarism and duplicate publication; falsification; and fabrication. Editors also face ethical challenges, including how best to manage peer-review bias, to address reviewer tardiness, and to locate reviewers with appropriate expertise and professionalism. Editors need to deal with authors who fragment their work into multiple publications to enhance their curriculum vitae ("salami factor"), as well as to manage the financial benefits of advertising and to avoid conflicts of interest for the journal. Both authors and editors should be straightforward and principled throughout the publication process.
Clin Dermatol. 2012 Mar;30(2):231-6.
Ethical dilemmas in journal publication.
Babalola O, Grant-Kels JM, Parish LC.
Source
University of Connecticut School of Medicine, Farmington, CT, USA.
Abstract
Physicians often face tremendous pressures and incentives to publish, sometimes leading to a compromise of ethical standards, either consciously or unconsciously. From the vantage of ethical authorship, we discuss what constitutes authorship; avoidance of ghost authorship; plagiarism, as well as self-plagiarism and duplicate publication; falsification; and fabrication. Editors also face ethical challenges, including how best to manage peer-review bias, to address reviewer tardiness, and to locate reviewers with appropriate expertise and professionalism. Editors need to deal with authors who fragment their work into multiple publications to enhance their curriculum vitae ("salami factor"), as well as to manage the financial benefits of advertising and to avoid conflicts of interest for the journal. Both authors and editors should be straightforward and principled throughout the publication process.
Physician honesty and openness with patients
http://www.ncbi.nlm.nih.gov/pubmed/22323169
Health Aff (Millwood). 2012 Feb;31(2):383-91.
Survey shows that at least some physicians are not always open or honest with patients.
Iezzoni LI, Rao SR, Desroches CM, Vogeli C, Campbell EG.
Abstract
The Charter on Medical Professionalism, endorsed by more than 100 professional groups worldwide and the US Accreditation Council for Graduate Medical Education, requires openness and honesty in physicians' communication with patients. We present data from a 2009 survey of 1,891 practicing physicians nationwide assessing how widely physicians endorse and follow these principles in communicating with patients. The vast majority of physicians completely agreed that physicians should fully inform patients about the risks and benefits of interventions and should never disclose confidential information to unauthorized persons. Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one-tenth said they had told patients something untrue in the previous year. Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.
Health Aff (Millwood). 2012 Feb;31(2):383-91.
Survey shows that at least some physicians are not always open or honest with patients.
Iezzoni LI, Rao SR, Desroches CM, Vogeli C, Campbell EG.
Abstract
The Charter on Medical Professionalism, endorsed by more than 100 professional groups worldwide and the US Accreditation Council for Graduate Medical Education, requires openness and honesty in physicians' communication with patients. We present data from a 2009 survey of 1,891 practicing physicians nationwide assessing how widely physicians endorse and follow these principles in communicating with patients. The vast majority of physicians completely agreed that physicians should fully inform patients about the risks and benefits of interventions and should never disclose confidential information to unauthorized persons. Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one-tenth said they had told patients something untrue in the previous year. Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.
Wednesday, February 22, 2012
Improving quality of care in substance abuse treatment
http://www.ncbi.nlm.nih.gov/pubmed/22282129
J Behav Health Serv Res. 2012 Jan 27. [Epub ahead of print]
Improving Quality of Care in Substance Abuse Treatment Using Five key Process Improvement Principles.
Hoffman KA, Green CA, Ford Ii JH, Wisdom JP, Gustafson DH, McCarty D.
Source
Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CB 669, Portland, OR, 97239, USA, hoffmaki@ohsu.edu.
Abstract
Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.
J Behav Health Serv Res. 2012 Jan 27. [Epub ahead of print]
Improving Quality of Care in Substance Abuse Treatment Using Five key Process Improvement Principles.
Hoffman KA, Green CA, Ford Ii JH, Wisdom JP, Gustafson DH, McCarty D.
Source
Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CB 669, Portland, OR, 97239, USA, hoffmaki@ohsu.edu.
Abstract
Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.
Concurrent use of alcohol and sedatives by patients prescribed chronic opioid therapy
http://www.ncbi.nlm.nih.gov/pubmed/22285611
J Pain. 2012 Jan 27. [Epub ahead of print]
Concurrent Use of Alcohol and Sedatives Among Persons Prescribed Chronic Opioid Therapy: Prevalence and Risk Factors.
Saunders KW, Von Korff M, Campbell CI, Banta-Green CJ, Sullivan MD, Merrill JO, Weisner C.
Source
Group Health Research Institute, Seattle, Washington.
Abstract
Taking opioids with other central nervous system (CNS) depressants can increase risk of oversedation and respiratory depression. We used telephone survey and electronic health care data to assess the prevalence of, and risk factors for, concurrent use of alcohol and/or sedatives among 1,848 integrated care plan members who were prescribed chronic opioid therapy (COT) for chronic noncancer pain. Concurrent sedative use was defined by receiving sedatives for 45+ days of the 90 days preceding the interview; concurrent alcohol use was defined by consuming 2+ drinks within 2 hours of taking an opioid in the prior 2 weeks. Some analyses were stratified by substance use disorder (SUD) history (alcohol or drug). Among subjects with no SUD history, 29% concurrently used sedatives versus 39% of those with an SUD history. Rates of concurrent alcohol use were similar (12 to 13%) in the 2 substance use disorder strata. Predictors of concurrent sedative use included SUD history, female gender, depression, and taking opioids at higher doses and for more than 1 pain condition. Male gender was the only predictor of concurrent alcohol use. Concurrent use of CNS depressants was common among this sample of COT users regardless of substance use disorder status. PERSPECTIVE: Risks associated with concurrent use of CNS depressants are not restricted to COT users who abuse those substances. And, the increased risk of concurrently using CNS depressants is not restricted to opioid users with a prior SUD history. COT requires close monitoring, regardless of substance use disorder history.
J Pain. 2012 Jan 27. [Epub ahead of print]
Concurrent Use of Alcohol and Sedatives Among Persons Prescribed Chronic Opioid Therapy: Prevalence and Risk Factors.
Saunders KW, Von Korff M, Campbell CI, Banta-Green CJ, Sullivan MD, Merrill JO, Weisner C.
Source
Group Health Research Institute, Seattle, Washington.
Abstract
Taking opioids with other central nervous system (CNS) depressants can increase risk of oversedation and respiratory depression. We used telephone survey and electronic health care data to assess the prevalence of, and risk factors for, concurrent use of alcohol and/or sedatives among 1,848 integrated care plan members who were prescribed chronic opioid therapy (COT) for chronic noncancer pain. Concurrent sedative use was defined by receiving sedatives for 45+ days of the 90 days preceding the interview; concurrent alcohol use was defined by consuming 2+ drinks within 2 hours of taking an opioid in the prior 2 weeks. Some analyses were stratified by substance use disorder (SUD) history (alcohol or drug). Among subjects with no SUD history, 29% concurrently used sedatives versus 39% of those with an SUD history. Rates of concurrent alcohol use were similar (12 to 13%) in the 2 substance use disorder strata. Predictors of concurrent sedative use included SUD history, female gender, depression, and taking opioids at higher doses and for more than 1 pain condition. Male gender was the only predictor of concurrent alcohol use. Concurrent use of CNS depressants was common among this sample of COT users regardless of substance use disorder status. PERSPECTIVE: Risks associated with concurrent use of CNS depressants are not restricted to COT users who abuse those substances. And, the increased risk of concurrently using CNS depressants is not restricted to opioid users with a prior SUD history. COT requires close monitoring, regardless of substance use disorder history.
From West Virginia U: Sigma-1 receptors as potential substance abuse therapeutic targets
http://www.ncbi.nlm.nih.gov/pubmed/22288407
Curr Pharm Des. 2012 Jan 30. [Epub ahead of print]
Sigma-1 receptors: Potential Targets for the Treatment of Substance Abuse.
Robson MJ, Noorbakhsh B, Seminerio MJ, Matsumoto RR.
Source
Department of Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506-9500, USA. rmatsumoto@hsc.wvu.edu.
Abstract
Drug abuse is currently a large economic and societal burden in countries around the globe. Many drugs of abuse currently lack adequate therapies aimed at treating both the addiction and negative complications often associated with their use. Sigma-1 receptors were discovered over 30 years ago and have recently become targets for the development of pharmacotherapies aimed at treating substance abuse and addiction. In vivo preclinical studies have revealed that sigma receptor ligands are able to ameliorate select behavioral effects of many drugs of abuse including cocaine, methamphetamine, ethanol and nicotine. In addition, recent studies have begun to elucidate the mechanisms by which sigma-1 receptors modulate the effects of these drugs on neurotransmission, gene regulation and neuroplasticity. Overall, these recent findings suggest that compounds targeting sigma-1 receptors may represent a potential new class of therapeutics aimed at treating drug abuse. Future studies involving clinical populations will be critical for validating the therapeutic potential of sigma-1 receptor ligands for the treatment of substance abuse.
Curr Pharm Des. 2012 Jan 30. [Epub ahead of print]
Sigma-1 receptors: Potential Targets for the Treatment of Substance Abuse.
Robson MJ, Noorbakhsh B, Seminerio MJ, Matsumoto RR.
Source
Department of Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506-9500, USA. rmatsumoto@hsc.wvu.edu.
Abstract
Drug abuse is currently a large economic and societal burden in countries around the globe. Many drugs of abuse currently lack adequate therapies aimed at treating both the addiction and negative complications often associated with their use. Sigma-1 receptors were discovered over 30 years ago and have recently become targets for the development of pharmacotherapies aimed at treating substance abuse and addiction. In vivo preclinical studies have revealed that sigma receptor ligands are able to ameliorate select behavioral effects of many drugs of abuse including cocaine, methamphetamine, ethanol and nicotine. In addition, recent studies have begun to elucidate the mechanisms by which sigma-1 receptors modulate the effects of these drugs on neurotransmission, gene regulation and neuroplasticity. Overall, these recent findings suggest that compounds targeting sigma-1 receptors may represent a potential new class of therapeutics aimed at treating drug abuse. Future studies involving clinical populations will be critical for validating the therapeutic potential of sigma-1 receptor ligands for the treatment of substance abuse.
Substance abuse and suicide risk among adolescents
http://www.ncbi.nlm.nih.gov/pubmed/22290639
Eur Arch Psychiatry Clin Neurosci. 2012 Jan 31. [Epub ahead of print]
Substance abuse and suicide risk among adolescents.
Pompili M, Serafini G, Innamorati M, Biondi M, Siracusano A, Di Giannantonio M, Giupponi G, Amore M, Lester D, Girardi P, Möller-Leimkühler AM.
Source
Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy, maurizio.pompili@uniroma1.it.
Abstract
The aim of this paper was to review the literature concerning the relationship between suicide and substance abuse behaviours among adolescents, focusing on epidemiology, comorbidity and preventive programmes. We performed a Pubmed/Medline, Scopus, PsycLit and PsycInfo search to identify all papers and book chapters during the period between 1980 and 2011. Adolescents with substance abuse disorder who attempt or complete suicide can be characterized as having mood disorders, stressful life events, interpersonal problems, poor social support, lonely lives and feelings of hopelessness. The research supports the existence of a strong relationship between suicide and substance abuse. Preventive programmes should be based on the detection of risk factors associated with both suicide and substance abuse disorder. Management programmes should combine different therapeutic strategies such as peer-to-peer education, school-based programmes, psychotherapy and pharmacological treatment. Evidence suggests that targeted suicide prevention programmes can be delivered which reduce the burden associated with substance abuse and suicide in youths.
Eur Arch Psychiatry Clin Neurosci. 2012 Jan 31. [Epub ahead of print]
Substance abuse and suicide risk among adolescents.
Pompili M, Serafini G, Innamorati M, Biondi M, Siracusano A, Di Giannantonio M, Giupponi G, Amore M, Lester D, Girardi P, Möller-Leimkühler AM.
Source
Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy, maurizio.pompili@uniroma1.it.
Abstract
The aim of this paper was to review the literature concerning the relationship between suicide and substance abuse behaviours among adolescents, focusing on epidemiology, comorbidity and preventive programmes. We performed a Pubmed/Medline, Scopus, PsycLit and PsycInfo search to identify all papers and book chapters during the period between 1980 and 2011. Adolescents with substance abuse disorder who attempt or complete suicide can be characterized as having mood disorders, stressful life events, interpersonal problems, poor social support, lonely lives and feelings of hopelessness. The research supports the existence of a strong relationship between suicide and substance abuse. Preventive programmes should be based on the detection of risk factors associated with both suicide and substance abuse disorder. Management programmes should combine different therapeutic strategies such as peer-to-peer education, school-based programmes, psychotherapy and pharmacological treatment. Evidence suggests that targeted suicide prevention programmes can be delivered which reduce the burden associated with substance abuse and suicide in youths.
From U Kentucky: Agonist replacement therapy for cocaine dependence
http://www.ncbi.nlm.nih.gov/pubmed/22300101
Future Med Chem. 2012 Feb;4(2):245-65.
Agonist replacement therapy for cocaine dependence: a translational review.
Rush CR, Stoops WW.
Source
Department of Behavioral Science, University of Kentucky, College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA.
Abstract
Cocaine use disorders are prevalent throughout the world. Agonist replacement therapy is among the most effective strategies for managing substance use disorders including nicotine and opioid dependence. This paper reviews the translational literature, including preclinical experiments, human laboratory studies and clinical trials, to determine whether agonist-replacement therapy is a viable strategy for managing cocaine dependence. Discussion is limited to transporter blockers (i.e., methylphenidate) and releasers (i.e., amphetamine analogs) that are available for use in humans in the hope of impacting clinical research and practice more quickly. The translational review suggests that agonist-replacement therapy, especially monoamine releasers, may be effective for managing cocaine dependence. Future directions for medications development are also discussed because the viability of agonist-replacement therapy for cocaine dependence may hinge on identifying novel compounds or formulations that have less abuse and diversion potential.
Future Med Chem. 2012 Feb;4(2):245-65.
Agonist replacement therapy for cocaine dependence: a translational review.
Rush CR, Stoops WW.
Source
Department of Behavioral Science, University of Kentucky, College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA.
Abstract
Cocaine use disorders are prevalent throughout the world. Agonist replacement therapy is among the most effective strategies for managing substance use disorders including nicotine and opioid dependence. This paper reviews the translational literature, including preclinical experiments, human laboratory studies and clinical trials, to determine whether agonist-replacement therapy is a viable strategy for managing cocaine dependence. Discussion is limited to transporter blockers (i.e., methylphenidate) and releasers (i.e., amphetamine analogs) that are available for use in humans in the hope of impacting clinical research and practice more quickly. The translational review suggests that agonist-replacement therapy, especially monoamine releasers, may be effective for managing cocaine dependence. Future directions for medications development are also discussed because the viability of agonist-replacement therapy for cocaine dependence may hinge on identifying novel compounds or formulations that have less abuse and diversion potential.
From Yale: Fathers, post-traumatic stress disorder, substance abuse treatment, and parenting behavior
http://www.ncbi.nlm.nih.gov/pubmed/22305235
J Subst Abuse Treat. 2012 Feb 1. [Epub ahead of print]
Fathers entering substance abuse treatment: An examination of substance abuse, trauma symptoms and parenting behaviors.
Stover CS, Hall C, McMahon TJ, Easton CJ.
Source
Yale University School of Medicine Child Study Center, New Haven, CT 06520.
Abstract
OBJECTIVE:
The relationship between fatherhood and both psychiatric distress and severity of substance abuse (SA) among men entering SA treatment has not been well explored. This study was designed to (a) examine differences in symptoms of men presenting for SA assessment based on fatherhood status and (b) determine how posttraumatic stress disorder (PTSD) symptoms and severity of SA were associated with parenting for men who were fathers.
METHODS:
PTSD symptoms, severity of SA, and parenting data reported on structured questionnaires were collected from 126 men presenting for an SA evaluation at a forensic drug diversion clinic.
RESULTS:
There were no differences in severity of alcohol or drug use between fathers and nonfathers; however, fathers with more PTSD symptoms reported greater severity of alcohol and drug use. Among the fathers, PTSD symptoms correlated significantly and positively with negative parenting behaviors, whereas SA did not. Fathers with more significant PTSD symptoms were more likely to want help with parenting.
CONCLUSIONS:
Further exploration of the impact of trauma-related symptoms on the parenting behaviors of substance-abusing men is warranted.
J Subst Abuse Treat. 2012 Feb 1. [Epub ahead of print]
Fathers entering substance abuse treatment: An examination of substance abuse, trauma symptoms and parenting behaviors.
Stover CS, Hall C, McMahon TJ, Easton CJ.
Source
Yale University School of Medicine Child Study Center, New Haven, CT 06520.
Abstract
OBJECTIVE:
The relationship between fatherhood and both psychiatric distress and severity of substance abuse (SA) among men entering SA treatment has not been well explored. This study was designed to (a) examine differences in symptoms of men presenting for SA assessment based on fatherhood status and (b) determine how posttraumatic stress disorder (PTSD) symptoms and severity of SA were associated with parenting for men who were fathers.
METHODS:
PTSD symptoms, severity of SA, and parenting data reported on structured questionnaires were collected from 126 men presenting for an SA evaluation at a forensic drug diversion clinic.
RESULTS:
There were no differences in severity of alcohol or drug use between fathers and nonfathers; however, fathers with more PTSD symptoms reported greater severity of alcohol and drug use. Among the fathers, PTSD symptoms correlated significantly and positively with negative parenting behaviors, whereas SA did not. Fathers with more significant PTSD symptoms were more likely to want help with parenting.
CONCLUSIONS:
Further exploration of the impact of trauma-related symptoms on the parenting behaviors of substance-abusing men is warranted.
"Alcohol use is often overlooked and more importantly unsuspected in young children 3-11 years of age"
http://www.ncbi.nlm.nih.gov/pubmed/22326714
J Pediatr Nurs. 2012 Feb 9. [Epub ahead of print]
Alcohol Use: From Childhood Through Adolescence.
Lewis TP, Hession C.
Abstract
Alcohol use is often overlooked and more importantly unsuspected in young children 3-11 years of age. Alcohol use in preteens is commonly overlooked when there is growing evidence to suggest that the age at which one begins drinking can be predictive of future problem drinking and other substance abuse. There is a need for health care professionals and elementary school educators to be aware of the real and growing problem of alcohol use from childhood through adolescence. It is sometimes difficult to recognize because many of the effects of alcohol mimic routine presentations seen in children. This article focuses on the significance, contributing factors, effects on the body, comorbidities, and social and psychological effects of alcohol use on children through adolescence. It also examines diagnostic screening for alcohol use in adolescence and the detrimental role of the nurse in assisting with identifying and preventing the problem of alcohol use in childhood through adolescence.
J Pediatr Nurs. 2012 Feb 9. [Epub ahead of print]
Alcohol Use: From Childhood Through Adolescence.
Lewis TP, Hession C.
Abstract
Alcohol use is often overlooked and more importantly unsuspected in young children 3-11 years of age. Alcohol use in preteens is commonly overlooked when there is growing evidence to suggest that the age at which one begins drinking can be predictive of future problem drinking and other substance abuse. There is a need for health care professionals and elementary school educators to be aware of the real and growing problem of alcohol use from childhood through adolescence. It is sometimes difficult to recognize because many of the effects of alcohol mimic routine presentations seen in children. This article focuses on the significance, contributing factors, effects on the body, comorbidities, and social and psychological effects of alcohol use on children through adolescence. It also examines diagnostic screening for alcohol use in adolescence and the detrimental role of the nurse in assisting with identifying and preventing the problem of alcohol use in childhood through adolescence.
From Yale: Psychiatric disease and drug abuse
http://www.ncbi.nlm.nih.gov/pubmed/22327950
Curr Opin Pediatr. 2012 Feb 9. [Epub ahead of print]
Psychiatric disease and drug abuse.
Santucci K.
Source
Yale University School of Medicine, New Haven, Connecticut, USA.
Abstract
PURPOSE OF REVIEW:
The term 'dual diagnosis' most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7-10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this 'dual diagnosis', particularly with the increasing availability of street drugs and increasing accessibility to prescription drugs. The purpose of this review is to identify the magnitude of the problem and strengthen awareness among pediatric healthcare professionals who may provide prevention and/or early intervention.
RECENT FINDINGS:
Causes for the dual diagnosis are unknown, but there are four hypotheses: common factors (risk factors common to both disorders), secondary mental disorder (substance use precipitates mental disorder), secondary substance use ('self-medication hypothesis') and bidirectional (presence of either mental illness or SUD can contribute to the development of the other).
SUMMARY:
Those with the presence of this dual diagnosis are more likely to be nonadherent to treatment and may well have poorer outcomes. Integrated care for the maladies rather than split or isolated care is recommended. Psychosocial therapy holds promise for treating patients with dual diagnosis.
Curr Opin Pediatr. 2012 Feb 9. [Epub ahead of print]
Psychiatric disease and drug abuse.
Santucci K.
Source
Yale University School of Medicine, New Haven, Connecticut, USA.
Abstract
PURPOSE OF REVIEW:
The term 'dual diagnosis' most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7-10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this 'dual diagnosis', particularly with the increasing availability of street drugs and increasing accessibility to prescription drugs. The purpose of this review is to identify the magnitude of the problem and strengthen awareness among pediatric healthcare professionals who may provide prevention and/or early intervention.
RECENT FINDINGS:
Causes for the dual diagnosis are unknown, but there are four hypotheses: common factors (risk factors common to both disorders), secondary mental disorder (substance use precipitates mental disorder), secondary substance use ('self-medication hypothesis') and bidirectional (presence of either mental illness or SUD can contribute to the development of the other).
SUMMARY:
Those with the presence of this dual diagnosis are more likely to be nonadherent to treatment and may well have poorer outcomes. Integrated care for the maladies rather than split or isolated care is recommended. Psychosocial therapy holds promise for treating patients with dual diagnosis.
From Yale: Prevalence of unhealthy substance use by inpatients
http://www.ncbi.nlm.nih.gov/pubmed/22332853
Am J Addict. 2012 Mar;21(2):111-9. doi: 10.1111/j.1521-0391.2011.00207.x. Epub 2012 Feb 7.
Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education.
Holt SR, Ramos J, Harma MA, Cabrera F, Louis-Ashby C, Dinh A, Tetrault JM, Fiellin DA.
Source
Departments of Internal Medicine and Investigative Medicine, Yale University School of Medicine, New Haven, Connecticut.
Abstract
The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p < .01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p < .01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p < .01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.
Am J Addict. 2012 Mar;21(2):111-9. doi: 10.1111/j.1521-0391.2011.00207.x. Epub 2012 Feb 7.
Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education.
Holt SR, Ramos J, Harma MA, Cabrera F, Louis-Ashby C, Dinh A, Tetrault JM, Fiellin DA.
Source
Departments of Internal Medicine and Investigative Medicine, Yale University School of Medicine, New Haven, Connecticut.
Abstract
The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p < .01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p < .01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p < .01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.
From Case Western Reserve: Quality of life among women in substance abuse treatment
http://www.ncbi.nlm.nih.gov/pubmed/22333265
Drug Alcohol Depend. 2012 Feb 12. [Epub ahead of print]
Prospective patterns and correlates of quality of life among women in substance abuse treatment.
Tracy EM, Laudet AB, Min MO, Kim H, Brown S, Jun MK, Singer L.
Source
Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7164, USA.
Abstract
BACKGROUND:
Quality of life (QOL) is increasingly recognized as central to the broad construct of recovery in substance abuse services. QOL measures can supplement more objective symptom measures, identify specific service needs and document changes in functioning that are associated with substance use patterns. To date however, QOL remains an under investigated area in the addictions field, especially in the United States.
METHODS:
This study examines patterns and predictors of QOL at 1 and 6 months post treatment intake among 240 women enrolled in substance abuse treatment in Cleveland, Ohio. The World Health Organization Quality of Life (WHOQOL-BREF) measure was used to assess physical, psychological, social and environmental domains. Hierarchical multiple regressions were conducted to identify correlates of QOL at 6 months post treatment intake.
RESULTS:
All QOL domains across the follow up time points improved significantly. However, QOL scores across domains remained below those of healthy population norms. Trauma symptoms significantly predicted Physical and Psychological QOL. Among treatment process variables, alcohol use was the sole significant factor associated with QOL and only for Environmental QOL. Recovery support and friends support for abstinence were consistently associated with QOL across all four domains. Implications: This study suggests the usefulness of the WHOQOL measure as an indicator of functioning in substance abusing populations. Findings underline the importance of helping women deal with trauma symptoms and develop support for recovery. Further research is needed on the longitudinal relationship between QOL and substance use patterns.
Drug Alcohol Depend. 2012 Feb 12. [Epub ahead of print]
Prospective patterns and correlates of quality of life among women in substance abuse treatment.
Tracy EM, Laudet AB, Min MO, Kim H, Brown S, Jun MK, Singer L.
Source
Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7164, USA.
Abstract
BACKGROUND:
Quality of life (QOL) is increasingly recognized as central to the broad construct of recovery in substance abuse services. QOL measures can supplement more objective symptom measures, identify specific service needs and document changes in functioning that are associated with substance use patterns. To date however, QOL remains an under investigated area in the addictions field, especially in the United States.
METHODS:
This study examines patterns and predictors of QOL at 1 and 6 months post treatment intake among 240 women enrolled in substance abuse treatment in Cleveland, Ohio. The World Health Organization Quality of Life (WHOQOL-BREF) measure was used to assess physical, psychological, social and environmental domains. Hierarchical multiple regressions were conducted to identify correlates of QOL at 6 months post treatment intake.
RESULTS:
All QOL domains across the follow up time points improved significantly. However, QOL scores across domains remained below those of healthy population norms. Trauma symptoms significantly predicted Physical and Psychological QOL. Among treatment process variables, alcohol use was the sole significant factor associated with QOL and only for Environmental QOL. Recovery support and friends support for abstinence were consistently associated with QOL across all four domains. Implications: This study suggests the usefulness of the WHOQOL measure as an indicator of functioning in substance abusing populations. Findings underline the importance of helping women deal with trauma symptoms and develop support for recovery. Further research is needed on the longitudinal relationship between QOL and substance use patterns.
Exercise as drug abuse treatment?
http://www.ncbi.nlm.nih.gov/pubmed/22347866
Front Psychiatry. 2011;2:82. Epub 2012 Jan 12.
Exercise as a potential treatment for drug abuse: evidence from preclinical studies.
Smith MA, Lynch WJ.
Source
Department of Psychology and Program in Neuroscience, Davidson College Davidson, NC, USA.
Abstract
Epidemiological studies reveal that individuals who engage in regular aerobic exercise are less likely to use and abuse illicit drugs. Until recently, very few studies had examined the causal influences that mediate this relationship, and it was not clear whether exercise was effective at reducing substance use and abuse. In the past few years, several preclinical studies have revealed that exercise reduces drug self-administration in laboratory animals. These studies have revealed that exercise produces protective effects in procedures designed to model different transitional phases that occur during the development of, and recover from, a substance use disorder (e.g., acquisition, maintenance, escalation, and relapse/reinstatement of drug use). Moreover, recent studies have revealed several behavioral and neurobiological consequences of exercise that may be responsible for its protective effects in these assays. Collectively, these studies have provided convincing evidence to support the development of exercise-based interventions to reduce compulsive patterns of drug intake in clinical and at-risk populations.
Front Psychiatry. 2011;2:82. Epub 2012 Jan 12.
Exercise as a potential treatment for drug abuse: evidence from preclinical studies.
Smith MA, Lynch WJ.
Source
Department of Psychology and Program in Neuroscience, Davidson College Davidson, NC, USA.
Abstract
Epidemiological studies reveal that individuals who engage in regular aerobic exercise are less likely to use and abuse illicit drugs. Until recently, very few studies had examined the causal influences that mediate this relationship, and it was not clear whether exercise was effective at reducing substance use and abuse. In the past few years, several preclinical studies have revealed that exercise reduces drug self-administration in laboratory animals. These studies have revealed that exercise produces protective effects in procedures designed to model different transitional phases that occur during the development of, and recover from, a substance use disorder (e.g., acquisition, maintenance, escalation, and relapse/reinstatement of drug use). Moreover, recent studies have revealed several behavioral and neurobiological consequences of exercise that may be responsible for its protective effects in these assays. Collectively, these studies have provided convincing evidence to support the development of exercise-based interventions to reduce compulsive patterns of drug intake in clinical and at-risk populations.
Genetic and environmental influences, externalizing behaviors, and drug use in adolescents
http://www.ncbi.nlm.nih.gov/pubmed/22350186
Behav Genet. 2012 Feb 18. [Epub ahead of print]
Genetic and Environmental Influences Underlying Externalizing Behaviors, Cigarette Smoking and Illicit Drug Use Across Adolescence.
Korhonen T, Latvala A, Dick DM, Pulkkinen L, Rose RJ, Kaprio J, Huizink AC.
Source
Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland, tellervo.korhonen@helsinki.fi.
Abstract
We investigated genetic and environmental influences common to adolescent externalizing behavior (at age 12), smoking (at age 14) and initiation of drug use (at age 17) using the FinnTwin12 cohort data. Multivariate Cholesky models were fit to data from 737 monozygotic and 722 dizygotic twin pairs. Heritability of externalizing behavior was 56%, that of smoking initiation/amount 20/32%, and initiation of drug use 27%. In the best-fitting model common environmental influences explained most of the covariance between externalizing behavior and smoking initiation (69%) and amount (77%). Covariance between smoking initiation/amount and drug use was due to additive genetic (42/22%) and common environmental (58/78%) influences. Half of the covariance between externalizing behavior and drug use was due to shared genetic and half due to the environments shared by co-twins. Using a longitudinal, prospective design, our results indicate that early observed externalizing behavior provides significant underlying genetic and environmental influences common to later substance use, here manifested as initiation of drug use in late adolescence.
Behav Genet. 2012 Feb 18. [Epub ahead of print]
Genetic and Environmental Influences Underlying Externalizing Behaviors, Cigarette Smoking and Illicit Drug Use Across Adolescence.
Korhonen T, Latvala A, Dick DM, Pulkkinen L, Rose RJ, Kaprio J, Huizink AC.
Source
Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland, tellervo.korhonen@helsinki.fi.
Abstract
We investigated genetic and environmental influences common to adolescent externalizing behavior (at age 12), smoking (at age 14) and initiation of drug use (at age 17) using the FinnTwin12 cohort data. Multivariate Cholesky models were fit to data from 737 monozygotic and 722 dizygotic twin pairs. Heritability of externalizing behavior was 56%, that of smoking initiation/amount 20/32%, and initiation of drug use 27%. In the best-fitting model common environmental influences explained most of the covariance between externalizing behavior and smoking initiation (69%) and amount (77%). Covariance between smoking initiation/amount and drug use was due to additive genetic (42/22%) and common environmental (58/78%) influences. Half of the covariance between externalizing behavior and drug use was due to shared genetic and half due to the environments shared by co-twins. Using a longitudinal, prospective design, our results indicate that early observed externalizing behavior provides significant underlying genetic and environmental influences common to later substance use, here manifested as initiation of drug use in late adolescence.
From Duke: Understanding severity estimates and risk correlates of marijuana abuse and dependence in adults
http://www.ncbi.nlm.nih.gov/pubmed/22351489
Int J Methods Psychiatr Res. 2012 Feb 20. doi: 10.1002/mpr.1354. [Epub ahead of print]
A dimensional approach to understanding severity estimates and risk correlates of marijuana abuse and dependence in adults.
Wu LT, Woody GE, Yang C, Pan JJ, Reeve BB, Blazer DG.
Source
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA. litzy.wu@duke.edu, litzywu@yahoo.com.
Abstract
While item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender- and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N = 37,897), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicators-multiple causes (MIMIC) approaches. Among 6917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation = 0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than Whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs among African Americans and Hispanics require research to elucidate risk factors and improve assessments of MUDs for different racial/ethnic groups.
Int J Methods Psychiatr Res. 2012 Feb 20. doi: 10.1002/mpr.1354. [Epub ahead of print]
A dimensional approach to understanding severity estimates and risk correlates of marijuana abuse and dependence in adults.
Wu LT, Woody GE, Yang C, Pan JJ, Reeve BB, Blazer DG.
Source
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA. litzy.wu@duke.edu, litzywu@yahoo.com.
Abstract
While item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender- and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N = 37,897), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicators-multiple causes (MIMIC) approaches. Among 6917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation = 0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than Whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs among African Americans and Hispanics require research to elucidate risk factors and improve assessments of MUDs for different racial/ethnic groups.
Meth use during pregnancy doesn't exist in isolation
http://www.ncbi.nlm.nih.gov/pubmed/22260315
Harm Reduct J. 2012 Jan 19;9(1):5. [Epub ahead of print]
Implementation and Evaluation of a Harm-Reduction Model for Clinical Care of Substance Using Pregnant Women.
Wright TE, Schuetter R, Fombonne E, Stephenson J, Haning WF 3rd.
ABSTRACT:
BACKGROUND:
Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program.
METHODS:
Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. For comparison, data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies.
RESULTS:
Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous Abortions, two 28-week intrauterine fetal deaths, and two sets of twins and 4 repeat pregnancies. Over 50% of the women had lost custody of previous children due to substance use. The majority of women who delivered used methamphetamine (86%), either in the year before pregnancy or during pregnancy. Other drugs include marijuana (59.8%), cocaine (33%), opiates (9.6%), and alcohol (15.2%). Of the women served, 85% smoked cigarettes upon enrollment. Of the 97 women delivered during this period, all but 4 (96%) had negative urine toxicology at the time of delivery. Of the 103 infants, 13 (12.6%) were born preterm, equal to the state and national average, despite having many risk factors for prematurity, including poverty, poor diet, smoking and polysubstance use. Overwhelmingly, the women are parenting their children, >90% retained custody at 8 weeks. Long-term follow-up showed that women who maintained custody chose long-acting contraceptive methods; while those who lost custody had a very high (>50%) repeat pregnancy rate at 9 months post delivery.
CONCLUSION:
Methamphetamine use during pregnancy doesn't exist in isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources.
Harm Reduct J. 2012 Jan 19;9(1):5. [Epub ahead of print]
Implementation and Evaluation of a Harm-Reduction Model for Clinical Care of Substance Using Pregnant Women.
Wright TE, Schuetter R, Fombonne E, Stephenson J, Haning WF 3rd.
ABSTRACT:
BACKGROUND:
Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program.
METHODS:
Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. For comparison, data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies.
RESULTS:
Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous Abortions, two 28-week intrauterine fetal deaths, and two sets of twins and 4 repeat pregnancies. Over 50% of the women had lost custody of previous children due to substance use. The majority of women who delivered used methamphetamine (86%), either in the year before pregnancy or during pregnancy. Other drugs include marijuana (59.8%), cocaine (33%), opiates (9.6%), and alcohol (15.2%). Of the women served, 85% smoked cigarettes upon enrollment. Of the 97 women delivered during this period, all but 4 (96%) had negative urine toxicology at the time of delivery. Of the 103 infants, 13 (12.6%) were born preterm, equal to the state and national average, despite having many risk factors for prematurity, including poverty, poor diet, smoking and polysubstance use. Overwhelmingly, the women are parenting their children, >90% retained custody at 8 weeks. Long-term follow-up showed that women who maintained custody chose long-acting contraceptive methods; while those who lost custody had a very high (>50%) repeat pregnancy rate at 9 months post delivery.
CONCLUSION:
Methamphetamine use during pregnancy doesn't exist in isolation. It is often combined with a multitude of other adverse circumstances, including poverty, interpersonal violence, psychiatric comorbidity, polysubstance use, nutritional deficiencies, inadequate health care and stressful life experiences. A comprehensive harm reduction model of perinatal care, which aims to ameliorate some of these difficulties for substance-using women without mandating abstinence, provides exceptional birth outcomes and can be implemented with limited resources.
From U Kentucky: Getting physicians practicing in substance abuse treatment organizations
http://www.ncbi.nlm.nih.gov/pubmed/22301083
J Subst Abuse Treat. 2012 Jan 31. [Epub ahead of print]
Physicians in the substance abuse treatment workforce: Understanding their employment within publicly funded treatment organizations.
Knudsen HK, Oser CB, Abraham AJ, Roman PM.
Source
Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA.
Abstract
The employment of physicians by substance abuse treatment organizations is understudied, despite physicians' importance in implementing pharmacotherapy and integrating treatment into the broader system of medical care. Drawing on data collected from 249 publicly funded treatment organizations, this study examined organizational and environmental factors associated with the employment of physicians in these settings. A negative binomial regression model indicated that greater numbers of physicians were employed when organizations offered detoxification services, were embedded in health care settings, and were larger in size. Funding barriers, including the costs of physicians and inadequate reimbursement by funders, were negatively associated with physician employment. Programs unaware that they could use state contract funding to pay for medical staff employed fewer numbers of physicians than programs aware of this type of state policy. Attempts to increase physician employment in substance abuse treatment may require attention to both organizational and environmental factors rather than simply trying to attract individuals to the field. Increasing physician employment may be challenging in the current economic climate.
J Subst Abuse Treat. 2012 Jan 31. [Epub ahead of print]
Physicians in the substance abuse treatment workforce: Understanding their employment within publicly funded treatment organizations.
Knudsen HK, Oser CB, Abraham AJ, Roman PM.
Source
Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA.
Abstract
The employment of physicians by substance abuse treatment organizations is understudied, despite physicians' importance in implementing pharmacotherapy and integrating treatment into the broader system of medical care. Drawing on data collected from 249 publicly funded treatment organizations, this study examined organizational and environmental factors associated with the employment of physicians in these settings. A negative binomial regression model indicated that greater numbers of physicians were employed when organizations offered detoxification services, were embedded in health care settings, and were larger in size. Funding barriers, including the costs of physicians and inadequate reimbursement by funders, were negatively associated with physician employment. Programs unaware that they could use state contract funding to pay for medical staff employed fewer numbers of physicians than programs aware of this type of state policy. Attempts to increase physician employment in substance abuse treatment may require attention to both organizational and environmental factors rather than simply trying to attract individuals to the field. Increasing physician employment may be challenging in the current economic climate.
From Mayo Clinic: Clarifying the relationships between medical and recreational marijuana use and abuse
http://www.ncbi.nlm.nih.gov/pubmed/22305029
Mayo Clin Proc. 2012 Feb;87(2):172-86.
Blurred boundaries: the therapeutics and politics of medical marijuana.
Bostwick JM.
Source
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Abstract
For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, δ-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse.
Mayo Clin Proc. 2012 Feb;87(2):172-86.
Blurred boundaries: the therapeutics and politics of medical marijuana.
Bostwick JM.
Source
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Abstract
For 5 millennia, Cannabis sativa has been used throughout the world medically, recreationally, and spiritually. From the mid-19th century to the 1930s, American physicians prescribed it for a plethora of indications, until the federal government started imposing restrictions on its use, culminating in 1970 with the US Congress classifying it as a Schedule I substance, illegal, and without medical value. Simultaneous with this prohibition, marijuana became the United States' most widely used illicit recreational drug, a substance generally regarded as pleasurable and relaxing without the addictive dangers of opioids or stimulants. Meanwhile, cannabis never lost its cachet in alternative medicine circles, going mainstream in 1995 when California became the first of 16 states to date to legalize its medical use, despite the federal ban. Little about cannabis is straightforward. Its main active ingredient, δ-9-tetrahydrocannabinol, was not isolated until 1964, and not until the 1990s were the far-reaching modulatory activities of the endocannabinoid system in the human body appreciated. This system's elucidation raises the possibility of many promising pharmaceutical applications, even as draconian federal restrictions that hamstring research show no signs of softening. Recreational use continues unabated, despite growing evidence of marijuana's addictive potential, particularly in the young, and its propensity for inducing and exacerbating psychotic illness in the susceptible. Public approval drives medical marijuana legalization efforts without the scientific data normally required to justify a new medication's introduction. This article explores each of these controversies, with the intent of educating physicians to decide for themselves whether marijuana is panacea, scourge, or both. PubMed searches were conducted using the following keywords: medical marijuana, medical cannabis, endocannabinoid system, CB1 receptors, CB2 receptors, THC, cannabidiol, nabilone, dronabinol, nabiximols, rimonabant, marijuana legislation, marijuana abuse, marijuana dependence, and marijuana and schizophrenia. Bibliographies were hand searched for additional references relevant to clarifying the relationships between medical and recreational marijuana use and abuse.
Wow. Physician heal thyself. >10% of health care students use/have used illegal prescription stimulants
http://www.ncbi.nlm.nih.gov/pubmed/22308929
J Physician Assist Educ. 2011;22(4):15-22.
The use of prescription stimulants to enhance academic performance among college students in health care programs.
Herman L, Shtayermman O, Aksnes B, Anzalone M, Cormerais A, Liodice C.
Source
Department of Physician Assistant Studies, New York Institute of Technology, Old Westbury, NY 11568, USA. lherman@nyit.edu
Abstract
PURPOSE:
Prescription stimulant use as academic performance enhancers is increasingly widespread among college students. The purpose of this study was to evaluate the prevalence of prescription stimulant use among health care students attending a university in the northeastern United States. The study investigated the specific stimulants being used and the frequency of usage. It also examined the rates of nicotine, alcohol, and drug abuse versus dependence.
METHODS:
A web-based survey was administered to medical and health profession students regarding prescription stimulant use for nonprescribed purposes. Tobacco, alcohol, and recreational drug use were also surveyed.
RESULTS:
Approximately 10.4% (32) of students surveyed have either used a stimulant or are currently using prescription stimulants illegally. The most common reason for stimulant use was to focus and concentrate during studying (93.5%). Of the 308 students, 45.2% were female, 83.9% were Caucasian, and amphetamine-dextroamphetamine was the most commonly abused stimulant (71.4%).
CONCLUSIONS:
Results from this study are consistent with previous research of undergraduate students regarding prescription stimulant use for nonprescribed purposes, specifically for academic performance enhancement. Data from the study support that alcohol abuse and dependence among students is a pertinent concern, suggesting that substance abuse in general must be addressed. Substance abuse and awareness programs combined with stress management programs in an overall substance-abuse reduction strategy, including the use of prescription stimulant use beyond the originally intended purpose, may be beneficial. Because of the lack of research focusing on graduate health care students, further investigations should use similar populations.
J Physician Assist Educ. 2011;22(4):15-22.
The use of prescription stimulants to enhance academic performance among college students in health care programs.
Herman L, Shtayermman O, Aksnes B, Anzalone M, Cormerais A, Liodice C.
Source
Department of Physician Assistant Studies, New York Institute of Technology, Old Westbury, NY 11568, USA. lherman@nyit.edu
Abstract
PURPOSE:
Prescription stimulant use as academic performance enhancers is increasingly widespread among college students. The purpose of this study was to evaluate the prevalence of prescription stimulant use among health care students attending a university in the northeastern United States. The study investigated the specific stimulants being used and the frequency of usage. It also examined the rates of nicotine, alcohol, and drug abuse versus dependence.
METHODS:
A web-based survey was administered to medical and health profession students regarding prescription stimulant use for nonprescribed purposes. Tobacco, alcohol, and recreational drug use were also surveyed.
RESULTS:
Approximately 10.4% (32) of students surveyed have either used a stimulant or are currently using prescription stimulants illegally. The most common reason for stimulant use was to focus and concentrate during studying (93.5%). Of the 308 students, 45.2% were female, 83.9% were Caucasian, and amphetamine-dextroamphetamine was the most commonly abused stimulant (71.4%).
CONCLUSIONS:
Results from this study are consistent with previous research of undergraduate students regarding prescription stimulant use for nonprescribed purposes, specifically for academic performance enhancement. Data from the study support that alcohol abuse and dependence among students is a pertinent concern, suggesting that substance abuse in general must be addressed. Substance abuse and awareness programs combined with stress management programs in an overall substance-abuse reduction strategy, including the use of prescription stimulant use beyond the originally intended purpose, may be beneficial. Because of the lack of research focusing on graduate health care students, further investigations should use similar populations.
Identifying people with substance use and other mental disorders
http://www.ncbi.nlm.nih.gov/pubmed/22332851
Am J Addict. 2012 Mar;21(2):97-103. doi: 10.1111/j.1521-0391.2011.00198.x.
Implications of Epidemiological Data for Identifying Persons with Substance Use and Other Mental Disorders.
Rosenthal RN, Nunes EV, Le Fauve CE.
Source
Department of Psychiatry, St. Luke's Roosevelt Hospital Center, New York, New York Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, New York Division on Substance Abuse, New York State Psychiatric Institute, New York, New York Co-Occurring and Homeless Activities Branch, Division of State and Community Assistance, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, Maryland.
Abstract
The authors conducted systematic searches in standard databases using key search terms related to epidemiology, prevalence, and co-occurring substance use and other mental disorders (COD), as well as specific combinations of drug and mental disorders. The authors targeted high-quality, large sample epidemiological surveys so as to utilize studies of high methodological rigor in the construction of recommendations for clinical identification. Further refined searches to identify these studies revealed common themes and related research gaps. Findings suggest that clinicians should have increased expectation that a patient with a substance use disorder (SUD) has a co-occurring mental disorder if the SUD is relatively severe, if the patient began using substances (including tobacco) at an early age, is female, is dependent on nicotine, or has a drug use disorder. Patients identified as having at least one SUD and one co-occurring mental disorder should be assessed to identify other likely CODs, because disorders are not normally distributed and tend to cluster in relatively few individuals.
Am J Addict. 2012 Mar;21(2):97-103. doi: 10.1111/j.1521-0391.2011.00198.x.
Implications of Epidemiological Data for Identifying Persons with Substance Use and Other Mental Disorders.
Rosenthal RN, Nunes EV, Le Fauve CE.
Source
Department of Psychiatry, St. Luke's Roosevelt Hospital Center, New York, New York Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, New York Division on Substance Abuse, New York State Psychiatric Institute, New York, New York Co-Occurring and Homeless Activities Branch, Division of State and Community Assistance, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, Maryland.
Abstract
The authors conducted systematic searches in standard databases using key search terms related to epidemiology, prevalence, and co-occurring substance use and other mental disorders (COD), as well as specific combinations of drug and mental disorders. The authors targeted high-quality, large sample epidemiological surveys so as to utilize studies of high methodological rigor in the construction of recommendations for clinical identification. Further refined searches to identify these studies revealed common themes and related research gaps. Findings suggest that clinicians should have increased expectation that a patient with a substance use disorder (SUD) has a co-occurring mental disorder if the SUD is relatively severe, if the patient began using substances (including tobacco) at an early age, is female, is dependent on nicotine, or has a drug use disorder. Patients identified as having at least one SUD and one co-occurring mental disorder should be assessed to identify other likely CODs, because disorders are not normally distributed and tend to cluster in relatively few individuals.
From Columbia: Increasing attendance in adolescent substance abuse programs
http://www.ncbi.nlm.nih.gov/pubmed/22332855
Am J Addict. 2012 Mar;21(2):126-9. doi: 10.1111/j.1521-0391.2011.00204.x.
A pilot study of low-cost contingency management to increase attendance in an adolescent substance abuse program.
Branson CE, Barbuti AM, Clemmey P, Herman L, Bhutia P.
Source
Department of Psychiatry, St. Luke's-Roosevelt Hospital Center, New York, New York Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, New York.
Abstract
Numerous studies demonstrate the efficacy of contingency management (CM) for improving patient outcomes, yet it is rarely used in treatment settings due to the high cost of implementation. This quasi-experimental study (N = 52) examined the effect of a low-cost "Fishbowl" CM intervention on attendance/retention in an early intervention adolescent substance abuse program. The CM group attended significantly more sessions compared to the control group. Furthermore, the CM intervention costs $3.27 per patient per session. Our findings support the use of low-cost CM to improve adolescent attendance in clinical settings.
Am J Addict. 2012 Mar;21(2):126-9. doi: 10.1111/j.1521-0391.2011.00204.x.
A pilot study of low-cost contingency management to increase attendance in an adolescent substance abuse program.
Branson CE, Barbuti AM, Clemmey P, Herman L, Bhutia P.
Source
Department of Psychiatry, St. Luke's-Roosevelt Hospital Center, New York, New York Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, New York.
Abstract
Numerous studies demonstrate the efficacy of contingency management (CM) for improving patient outcomes, yet it is rarely used in treatment settings due to the high cost of implementation. This quasi-experimental study (N = 52) examined the effect of a low-cost "Fishbowl" CM intervention on attendance/retention in an early intervention adolescent substance abuse program. The CM group attended significantly more sessions compared to the control group. Furthermore, the CM intervention costs $3.27 per patient per session. Our findings support the use of low-cost CM to improve adolescent attendance in clinical settings.
Peer influences on adolescent alcohol and other drug use outcomes
http://www.ncbi.nlm.nih.gov/pubmed/22339982
J Nurs Scholarsh. 2012 Feb 16. doi: 10.1111/j.1547-5069.2011.01437.x. [Epub ahead of print]
Peer Influences on Adolescent Alcohol and Other Drug Use Outcomes.
Ramirez R, Hinman A, Sterling S, Weisner C, Campbell C.
Source
Nu Xi at Large, Director, Family Nurse Practitioner Program, Samuel Merritt University, Oakland, CA Research Associate, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA Senior Research Project Manager, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA Associate Director Health Services Research, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, and Professor, Department of Psychiatry, University of California, San Francisco, CA Research Scientist, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA.
Abstract
Purpose: To examine the role of family environment and peer networks in abstinence outcomes for adolescents 1 year after intake to alcohol and other drug (AOD) treatment. Design: Survey of 419 adolescents 13 to 18 years of age at consecutive intakes to AOD treatment programs at four sites of a large health system, with telephone follow-up survey 1 year after intake. Methods: Examined association of 1-year abstinence with baseline characteristics. Using logistic regression, we examined characteristics predicting 1-year abstinence and predicting having fewer than four substance-using friends at 1 year. Results: We found that family environment scores related to family conflict, limit setting, and positive family experiences, were not related to abstinence outcomes, but peer networks were related. Adolescents with fewer (less than four) AOD-using friends were more likely to be abstinent than those with four or more AOD-using friends (65% vs. 41%, p= .0002). Having fewer than four AOD-using friends at intake predicted abstinence at 1 year (odds ratio [OR]= 2.904, p= .0002) and also predicted having fewer than four AOD-using friends at 1 year (OR= 2.557, p= 0.0007). Conclusions: Although family environment is an important factor in the development of AOD problems in adolescents, it did not play a significant role in treatment success. The quality of adolescent peer networks did independently predict positive outcomes. Clinical Relevance: For physicians, advanced practice registered nurses, and other primary and behavioral care providers who screen and care for adolescents with AOD and other behavioral problems, our finding suggest the importance of focusing on improving the quality of their peer networks.
J Nurs Scholarsh. 2012 Feb 16. doi: 10.1111/j.1547-5069.2011.01437.x. [Epub ahead of print]
Peer Influences on Adolescent Alcohol and Other Drug Use Outcomes.
Ramirez R, Hinman A, Sterling S, Weisner C, Campbell C.
Source
Nu Xi at Large, Director, Family Nurse Practitioner Program, Samuel Merritt University, Oakland, CA Research Associate, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA Senior Research Project Manager, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA Associate Director Health Services Research, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, and Professor, Department of Psychiatry, University of California, San Francisco, CA Research Scientist, Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA.
Abstract
Purpose: To examine the role of family environment and peer networks in abstinence outcomes for adolescents 1 year after intake to alcohol and other drug (AOD) treatment. Design: Survey of 419 adolescents 13 to 18 years of age at consecutive intakes to AOD treatment programs at four sites of a large health system, with telephone follow-up survey 1 year after intake. Methods: Examined association of 1-year abstinence with baseline characteristics. Using logistic regression, we examined characteristics predicting 1-year abstinence and predicting having fewer than four substance-using friends at 1 year. Results: We found that family environment scores related to family conflict, limit setting, and positive family experiences, were not related to abstinence outcomes, but peer networks were related. Adolescents with fewer (less than four) AOD-using friends were more likely to be abstinent than those with four or more AOD-using friends (65% vs. 41%, p= .0002). Having fewer than four AOD-using friends at intake predicted abstinence at 1 year (odds ratio [OR]= 2.904, p= .0002) and also predicted having fewer than four AOD-using friends at 1 year (OR= 2.557, p= 0.0007). Conclusions: Although family environment is an important factor in the development of AOD problems in adolescents, it did not play a significant role in treatment success. The quality of adolescent peer networks did independently predict positive outcomes. Clinical Relevance: For physicians, advanced practice registered nurses, and other primary and behavioral care providers who screen and care for adolescents with AOD and other behavioral problems, our finding suggest the importance of focusing on improving the quality of their peer networks.
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