Sunday, December 29, 2013
In 1973 this story was voted by the Science Fiction Writers of America as one of the finest science fiction novellas ever written
According to Wikipedia, in 1973 this story was voted by the Science Fiction Writers of America as one of the finest science fiction novellas ever written.
From the Lancet: Bryan Liang, Tim Mackey, and colleagues on the priviatization of future uses of .health domains
Lancet. 2013 Oct 26;382(9902):1404. doi: 10.1016/S0140-6736(13)62215-1. Epub 2013 Oct 25.
Ensuring the future of health information online.
Author information
- University of California San Diego, School of Medicine, San Diego, CA 92103-8770, USA; Institute of Health Law Studies, California Western School of Law, San Diego, CA, USA. Electronic address: tmackey@ucsd.edu.
"The future of critical health information on the internet is for sale to private bidders, who have no discernible expertise in public health or medicine. Possibly as early as November, 2013, the rights to a new website suffix dot health (.health), alongside familiar “.com” and “.org” domains, are likely to be awarded to a for-profit company by the Internet Corporation for Assigned Names and Numbers (ICANN), a non-profit organisation that controls all internet naming. This will effectively privatise all future uses of the .health domain and could have a profound effect on health information access and quality for generations to come."
From Tehran U: Perspectives of Iranian medical students about do-not-resuscitate orders
Maedica (Buchar). 2013 Sep;8(3):261-4.
Perspectives of Iranian medical students about do-not-resuscitate orders.
Author information
- 1Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- 2Cancer Research Hospital, Tehran University of Medical Sciences, Tehran, Iran.
ABSTRACT:
Objective: To study the attitudes of Iranian medical students towards the do-not-resuscitate (DNR) decision.Methods: In this cross-sectional study, 220 medical students (110 interns and 110 residents) of Tehran University of medical sciences were selected. They asked to answer to the questionnaire which included two items: first item consisted of demographic questions (age, sex, and level of education); second item included questions about DNR Orders which derived from a previous study conducted by Hosaka et al.
Results: A total of 185 questionnaires returned (Response rate (RR=84%)). Ninety five were residents and ninety were interns. Seventy four percent of residents and 53% of interns felt that DNR order is sporadically necessary. Near 30% of interns and 40% of residents had participated in DNRs in their study period and the most case was the patient with terminal cancer. The most common person who decided DNR orders were physicians.Most participants believed that DNR cards are useful for establishing in clinical settings.
Conclusion: As DNR is definitely a medical decision, it should be clearly discussed with patients and their families. So, it should be provided in standard format in medical situations.
Patterns of funding allocation for tuberculosis control in fragile states
Int J Tuberc Lung Dis. 2014 Jan;18(1):61-6. doi: 10.5588/ijtld.13.0324.
Patterns of funding allocation for tuberculosis control in fragile states.
Author information
- 1Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
- 2Department of War Studies, King's College London, London, UK.
Abstract
OBJECTIVE:
To assess recent (2006-2010) tuberculosis (TB) funding patterns in conflict and non-conflict-affected fragile states to inform global policy.METHODS:
The Creditor Reporting System was analysed for official development assistance funding disbursements towards TB control in 11 conflict-affected states, 17 non-conflict-affected fragile states and 38 comparable non-fragile states. The amounts of funding, funding relative to burden, funding relative to malaria and human immunodeficiency virus (HIV) control, disbursements relative to commitments, sources of funding as well as funding activities were extracted and analysed.RESULTS:
Fragile states received on average more per capita for TB control relative to non-fragile states (US0.159 vs. US0.079). However conflict-affected fragile states received on average less per capita than non-conflict-affected states (US0.144 vs. US0.203), despite worse development indicators. Conflict-affected fragile states also received on average only 70% of TB funds already committed. Analysis by burden revealed the least disparity in funding in highest prevalence settings. Analysis of funding activities suggests increasing importance of TB-HIV integration, multidrug-resistant TB and research in both fragile and non-fragile states. Relative to non-conflict-affected fragile states, conflict-affected fragile states received approximately two thirds the per capita funding for TB.CONCLUSIONS:
This study revealed disparities in TB control funding between fragile and non-fragile as well as between conflict and non-conflict-affected fragile states. Findings suggest possible avenues for improving the allocation of global TB funding."Occasional dullness, in other words, is to be not only expected, but celebrated."
Saving the Lost Art of Conversation
In a fast-paced digital age, an MIT psychologist tries to slow us down.
"Conversations, as they tend to play out in person, are messy—full of pauses and interruptions and topic changes and assorted awkwardness. But the messiness is what allows for true exchange. It gives participants the time—and, just as important, the permission—to think and react and glean insights. “You can’t always tell, in a conversation, when the interesting bit is going to come,” Turkle says. “It’s like dancing: slow, slow, quick-quick, slow. You know? It seems boring, but all of a sudden there’s something, and whoa.”
Occasional dullness, in other words, is to be not only expected, but celebrated. Some of the best parts of conversation are, as Turkle puts it, “the boring bits.” In software terms, they’re features rather than bugs."
mHealth in Sub-Saharan Africa
Int J Telemed Appl. 2013;2013:482324. Epub 2013 Dec 4.
mHealth in Sub-Saharan Africa.
Author information
- 1Ben Gurion University of the Negev, Medical School for International Health, New York, NY 10032, USA.
- 2NYU School of Medicine, Bellevue Hospital Center, New York, NY 10016, USA.
Abstract
Mobile
phone penetration rates have reached 63% in sub-Saharan Africa (SSA)
and are projected to pass 70% by 2013. In SSA, millions of people who
never used traditional landlines now use mobile phones on a regular
basis. Mobile health, or mHealth, is the utilization of short messaging
service (SMS), wireless data transmission, voice calling, and smartphone
applications to transmit health-related information or direct care.
This systematic review analyzes and summarizes key articles from the
current body of peer-reviewed literature on PubMed on the topic of
mHealth in SSA. Studies included in the review demonstrate that mHealth
can improve and reduce the cost of patient monitoring, medication
adherence, and healthcare worker communication, especially in rural
areas. mHealth has also shown initial promise in emergency and disaster
response, helping standardize, store, analyze, and share patient
information. Challenges for mHealth implementation in SSA include
operating costs, knowledge, infrastructure, and policy
among many others. Further studies of the effectiveness of mHealth
interventions are being hindered by similar factors as well as a lack of
standardization in study design. Overall, the current evidence is not
strong enough to warrant large-scale implementation of existing mHealth
interventions in SSA, but rapid progress of both infrastructure and
mHealth-related research in the region could justify scale-up of the
most promising programs in the near future.
Nutritional Value of Meals at Full-service Restaurant Chains
J Nutr Educ Behav. 2014 Jan;46(1):75-81. doi: 10.1016/j.jneb.2013.10.008.
Nutritional Value of Meals at Full-service Restaurant Chains.
Author information
- 1Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA. Electronic address: aha27@drexel.edu.
- 2Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA.
- 3Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA.
- 4Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA.
Abstract
OBJECTIVE:
To assess the nutritional value of meals at full-service national restaurant chains with outlets in the Philadelphia region in 2011.METHODS:
Chains were eligible if nutritional information for all menu items was on company Web pages or printed menus at Philadelphia outlets. Nutrient profiles were analyzed for 2,615 items from 21 eligible chains (out of 29) and compared with United States Department of Agriculture guidelines.RESULTS:
Adult meals (entree, side dish, and one-half appetizer) approximated 1,495 kcal, 28 g saturated fat, 3,512 mg sodium, and 11 g fiber; and rose to 2,020 kcal after including a beverage and one-half dessert. Better calorie and fat profiles were observed for entrees tagged "healthy choice" or aimed at seniors or children; however, sodium far exceeded recommended limits.CONCLUSIONS AND IMPLICATIONS:
Foods served at full-service restaurant chains are high in calories, saturated fat, and sodium. Standard definitions are needed for "healthy choice" tags and for entrees targeted to vulnerable age groups.Understanding the role of welfare state characteristics for health and inequalities
BMC Public Health. 2013 Dec 27;13(1):1234. [Epub ahead of print]
Understanding the role of welfare state characteristics for health and inequalities - an analytical review.
Abstract
BACKGROUND:
The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings.METHODS:
Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria.RESULTS:
Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results.CONCLUSIONS:
Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.From George Washington U: Reducing hospital readmissions among medicaid patients: a review of the literature
Qual Manag Health Care. 2014 Jan-Mar;23(1):20-42. doi: 10.1097/QMH.0000000000000016.
Reducing hospital readmissions among medicaid patients: a review of the literature.
Author information
- Department of Health Policy, George Washington University School of Public Health and Health Services, Washington, District of Columbia (Drs Regenstein and Andres).
Abstract
Reducing
hospital readmissions is a key approach to curbing health care costs
and improving quality and patient experience in the United States.
Despite the proliferation of strategies and tools to reduce readmissions
in the general population and among Medicare beneficiaries, few
resources exist to inform initiatives to reduce readmissions among
Medicaid beneficiaries. Patients covered by Medicaid also experience
readmissions and are likely to experience distinct challenges related to
socioeconomic status. This review aims to identify factors related to
readmissions that are unique to Medicaid populations to inform efforts
to reduce Medicaid readmissions. Our search yielded 254 unique results,
of which 37 satisfied all review criteria. Much of the Medicaid
readmissions literature focuses on patients with mental health or
substance abuse issues, who are often high utilizers of health care
within the Medicaid population. Risk factors such as medication
noncompliance, postdischarge care environments, and substance abuse
comorbidities increase the risk of readmission among Medicaid patients.
New guidelines relax blood pressure goals
BMJ. 2013 Dec 24;347:f7621. doi: 10.1136/bmj.f7621.
New guidelines relax blood pressure goals.
Author information
- Seattle.
In a major revision to treatment goals, an expert panel has concluded that older hypertensive patients, those aged 60 years or older, should be treated to a blood pressure target of less than 150/90 mm Hg, rather than 140/90 mm Hg as recommended in previous guidelines.1
"If addictions, on one hand, are sometimes considered 'bad habits,' then ethics/morality, on the other, can also be understood as virtues or 'good habits.'"
J Forensic Odontostomatol. 2013 Oct 1;31 Suppl 1:13.
An ethical view of addiction and restorative justice.
Author information
- Private Dental Practice, Martinsburg, WV - USA.
Abstract
Addictions
and ethics are complex. As information increases about both additional
sets of ethical decisions are being raised. The underlying ethics of
addictions however is rarely explored. This paper aims to re-present a
brief interactive session offered to the IDEALS Congress in Leuven. If
addictions, on one hand, are sometimes considered "bad habits," then
ethics/morality,
on the other, can also be understood as virtues or "good habits."
Ethics as an actual intervention tool - and not limited simply to ways
of clarifying which of the traditional and newer interventions should be
used under various circumstances - may need, then, more focused
deliberations. The bases for this presentation was first introduced
through a three part series in a regular AGD Impact column - a
newsmagazine for American general dentists.1,2,3 It is my expectation
that introducing this notion to an international audience might confirm
some of Dr. Ozar's and my basic suppositions about treating patients
with addictions and, perhaps, generate new insights into the ethics of
addiction interventions - especially under the theme of restorative
justice. Key to this discussion is a notion that addiction involves
patients who are both fully capable yet, at the same time, also fully
incapable regarding a specific matter at hand. Another notion regards
our understanding of stigma and that addictions are both a personal and a
public health issue. Based on a case presentation, these notions are
further explored within the context of the individual Chairside doctor
patient relationship and demonstrate that to begin addressing this
complex issue, accurate clinical and ethical diagnoses must be
established if the dentist wishes to maintain a professional ethics
relationship with the patient and society.
From the NIH: The Misguided Ethics of Crossover Trials
Contemp Clin Trials. 2013 Dec 20. pii: S1551-7144(13)00200-0. doi: 10.1016/j.cct.2013.12.003. [Epub ahead of print]
The Misguided Ethics of Crossover Trials.
Author information
- 1Medical Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Dr. 10/12N226, Bethesda, MD 20892. Electronic address: vinayak.prasad@nih.gov.
- 2Department of Bioethics, National Institutes of Health, 10 Center Dr. 10/1C118, Bethesda MD 20892. Electronic address: CGrady@cc.nih.gov.
Abstract
Crossover is increasingly favored in trials of cancer therapies; even those that seek to establish the basic efficacy of novel drugs. Crossover is done in part for trial recruitment, but also out of a sense of doing the right thing-offering the investigational agent to more patients. In this paper, we argue that this ethical feeling-that crossover is a preferred trial choice-is misguided. In seeking to sate the desires of participants, we might undermine a trial's ability to answer a meaningful clinical question. When a trial is incapable of answering a question, it becomes unethical. Using a crossover strategy in oncology clinical trials can make trials less ethical, not more.Thursday, December 26, 2013
"Expert witnesses often are the most important aspect of a trial."
J Forensic Odontostomatol. 2013 Oct 1;31 Suppl 1:8.
Are you ready to be an expert witness?
Author information
- American Academy of Forensic Sciences.
Abstract
There
is a distinct possibility that a professional who examines evidence in a
legal action may have to testify in court to explain his or her work,
as well as the conclusions reached and the reasons for doing so. Expert
witnesses often are the most important aspect of a trial. Thus, an
expert needs to be prepared for everything encountered in a courtroom.
Issues with expert testimony: The expertise of the professional in a court of law will be seen in a different light from the work environment when that professional testifies in court. An individual might be one of the most accomplished scientists and /or experts in his or her field, but if that person can not explain his or her conclusions when testifying, the expertise might be ineffective. A well prepared expert witness can greatly assist the legal process.
Conclusion: This presentation will help familiarize the expert to become an asset in the legal system to best present the expert's conclusions. How to prepare for testifying is a crucial skill. If the expert is aware of what lawyers, judges and juries are looking for from the expert, the expert is able to be a successful witness in court.
Issues with expert testimony: The expertise of the professional in a court of law will be seen in a different light from the work environment when that professional testifies in court. An individual might be one of the most accomplished scientists and /or experts in his or her field, but if that person can not explain his or her conclusions when testifying, the expertise might be ineffective. A well prepared expert witness can greatly assist the legal process.
Conclusion: This presentation will help familiarize the expert to become an asset in the legal system to best present the expert's conclusions. How to prepare for testifying is a crucial skill. If the expert is aware of what lawyers, judges and juries are looking for from the expert, the expert is able to be a successful witness in court.
Physician Nonadherence With a Hepatitis C Screening Program ("wide variation in overall adherence")
Qual Manag Health Care. 2014 January/March;23(1):1-9.
Physician Nonadherence With a Hepatitis C Screening Program.
Southern WN, Drainoni ML, Smith BD, Koppelman E, McKee MD, Christiansen CL, Gifford AL, Weinbaum CM, Litwin AH.
Author information
- Department of Medicine (Drs Southern and Litwin), Division of Hospital Medicine (Dr Southern), Division of General Internal Medicine (Dr Litwin), and Department of Family and Social Medicine (Dr McKee), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York; Department of Health Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Drs Drainoni, Christiansen, and Gifford and Ms Koppelman); Department of Medicine (Drs Drainoni and Gifford), Division of General Internal Medicine (Dr Gifford), Section of Infectious Diseases (Dr Drainoni), Boston University School of Medicine, Boston, Massachusetts; Center for Health Quality, Outcomes and Economic Research, ENRM Veterans Administration Hospital, Bedford, Massachusetts (Drs Drainoni, Christiansen, and Gifford and Ms Koppelman); and Division of Viral Hepatitis, National Center for HIV/Viral Hepatitis/STD/TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Smith and Weinbaum).
Abstract
BACKGROUND::
Testing for patients at risk for hepatitis C virus (HCV) infection is recommended, but it is unclear whether providers adhere to testing guidelines. We aimed to measure adherence to an HCV screening protocol during a multifaceted continuous intervention.SUBJECTS AND METHODS::
Prospective cohort design to examine the associations between patient-level, physician-level, and visit-level characteristics and adherence to an HCV screening protocol. Study participants included all patients with a visit to 1 of the 3 study clinics and the physicians who cared for them. Adherence to the HCV screening protocol and patient-level, physician-level, and visit-level predictors of adherence were measured.RESULTS::
A total of 8981 patients and 154 physicians were examined. Overall protocol adherence rate was 36.1%. In multivariate analysis, patient male sex (odds ratio [OR] = 1.18), new patient (OR = 1.23), morning visit (OR = 1.32), and patients' preferred language being non-English (OR = 0.87) were significantly associated with screening adherence. There was a wide variation in overall adherence among physicians (range, 0%-92.4%). Screening adherence continuously declined from 59.1% in week 1 of the study to 13.7% in week 15 (final week). When implementing complex clinical practice guidelines, planners should address physician attitudinal barriers as well as gaps in knowledge to maximize adherence.From U Utah: Totipotency: What it is and what it isn't
Stem Cells Dev. 2013 Dec 24. [Epub ahead of print]
Totipotency: What it is and what it isn't.
Author information
- University of Utah, Neurobiology and Anatomy, 20 North 1900 East, 401 MREB, Salt Lake City, Utah, United States, 84132-3401, 801-585-3482, 801-581-4233, , United States ; mlcondic@neuro.utah.edu.
Abstract
There
is surprising confusion surrounding the concept of biological
totipotency, both within the scientific community and in society at
large. Increasingly, ethical objections to scientific research have both
practical and political
implications. Ethical controversy surrounding an area of research can
have a chilling effect on investors and industry, which in turn slows
the development of novel medical therapies. One author referred to this
phenomenon as, "Ethics' paralyzing grip on commercialization" [1]. In
this context, clarifying precisely what is meant by "totipotency" and
how it is experimentally determined will both avoid unnecessary
controversy and potentially reduce inappropriate barriers to research.
Here, the concept of totipotency is discussed, and the confusions
surrounding this term in the scientific and non-scientific literature
are considered. A new term, "plenipotent," is proposed to resolve this
confusion. The requirement for specific, oocyte-derived cytoplasm as a
component of totipotency is outlined. Finally, the implications of
twinning for our understanding of totipotency are discussed.
Women and hysteria in the history of mental health
Clin Pract Epidemiol Ment Health. 2012;8:110-9. doi: 10.2174/1745017901208010110. Epub 2012 Oct 19.
Women and hysteria in the history of mental health.
Author information
- Dipartimento di Storia, Beni Culturali e Territorio, Università di Cagliari, Italia.
Abstract
Hysteria
is undoubtedly the first mental disorder attributable to women,
accurately described in the second millennium BC, and until Freud
considered an exclusively female disease. Over 4000 years of history,
this disease was considered from two perspectives: scientific and
demonological. It was cured with herbs, sex or sexual abstinence,
punished and purified with fire for its association with sorcery and
finally, clinically studied as a disease and treated with innovative
therapies. However, even at the end of 19(th) century, scientific
innovation had still not reached some places, where the only known
therapies were those proposed by Galen. During the 20(th) century
several studies postulated the decline of hysteria amongst occidental
patients (both women and men) and the escalating of this disorder in
non-Western countries. The concept of hysterical
neurosis is deleted with the 1980 DSM-III. The evolution of these
diseases seems to be a factor linked with social "westernization", and
examining under what conditions the symptoms first became common in
different societies became a priority for recent studies over risk
factor.
"almost speechless": Rampant Canadian pharmacy fraud sign of a broken system ("...dispensed an alternative in exchange for rebates and other discounts from the manufacturer.")
Rampant Canadian pharmacy fraud sign of a broken system, expert says
The Globe and Mail
Published
Monday, Dec. 23 2013"One pharmacist cheated British Columbia taxpayers out of $471,000 in an elaborate methadone billing scheme.
An Ontario regulatory body proclaimed itself “almost speechless” at the extent to which it found another pharmacist had “milked” the provincial drug plan.
And more than a dozen pharmacists in Saskatchewan billed the province for one drug but dispensed an alternative in exchange for rebates and other discounts from the manufacturer."
"Deviations for the active ingredients may go unnoticed by a new user of the generic product, but may entail clinical consequences..."
BMC Pharmacol Toxicol. 2013 Apr 23;14(1):24. [Epub ahead of print]
Pharmaceutical quality of seven generic Levodopa/Benserazide products compared with original Madopar(R) / Prolopa(R).
Abstract
BACKGROUND:
By definition, a generic product is considered interchangeable with the innovator brand product. Controversy exists about interchangeability, and attention is predominantly directed to contaminants. In particular for chronic, degenerative conditions such as in Parkinson's disease (PD) generic substitution remains debated among physicians, patients and pharmacists. The objective of this study was to compare the pharmaceutical quality of seven generic levodopa/benserazide hydrochloride combination products marketed in Germany with the original product (Madopar(R) / Prolopa(R) 125, Roche, Switzerland) in order to evaluate the potential impact of Madopar(R) generics versus branded products for PD patients and clinicians.METHODS:
Madopar(R) / Prolopa(R) 125 tablets and capsules were used as reference material. The generic products tested (all 100 mg/25 mg formulations) included four tablet and three capsule formulations. Colour, appearance of powder (capsules), disintegration and dissolution, mass of tablets and fill mass of capsules, content, identity and amounts of impurities were assessed along with standard physical and chemical laboratory tests developed and routinely practiced at Roche facilities. Results were compared to the original "shelf-life" specifications in use by Roche.RESULTS:
Each of the seven generic products had one or two parameters outside the specifications. Deviations for the active ingredients ranged from +8.4% (benserazide) to -7.6% (levodopa) in two tablet formulations. Degradation products were measured in marked excess (+26.5%) in one capsule formulation. Disintegration time and dissolution for levodopa and benserazide hydrochloride at 30 min were within specifications for all seven generic samples analysed, however with some outliers.CONCLUSIONS:
Deviations for the active ingredients may go unnoticed by a new user of the generic product, but may entail clinical consequences when switching from original to generic during a long-term therapy. Degradation products may pose a safety concern. Our results should prompt caution when prescribing a generic of Madopar(R)/Prolopa(R), and also invite to further investigations in view of a more comprehensive approach, both pharmaceutical and clinical."The reduced acquisition costs of generic products may not necessarily translate into lower overall healthcare costs."
Eur J Hosp Pharm Sci Pract. 2013 Oct;20(5):302-307. Epub 2013 Aug 29.
Equivalence and interchangeability of narrow therapeutic index drugs in organ transplantation.
Abstract
The
calcineurin inhibitors (CNIs), ciclosporin and tacrolimus, are the
mainstay of immunosuppression in solid organ transplantation. Generic formulations of these drugs
are now available. With increasing pressure on healthcare budgets and
the consequent need to match health expectations to available resources,
substitution with a generic product appears an attractive option to reduce costs. Approval of generic products differs from innovator drugs, and narrow therapeutic index drugs
(NTIs; including CNIs) bring their own particular considerations. With
NTIs, small variations in drug exposure could result in reduced
immunosuppression or drug toxicity with potentially adverse effects on
patient outcomes. NTIs are subject to stricter regulatory approval
versus many other generic drugs. However, different generic
formulations may still not necessarily be therapeutically equivalent in
individuals, raising the possibility of significant differences in
exposure between products. Although regional recommendations vary, many
guidelines emphasise the need for NTI drug substitution to be initiated
by the transplant physician, thus ensuring careful therapeutic
monitoring and reduced negative patient impact. The need for therapeutic
monitoring during generic substitution has important implications for the overall costs of generic treatment as these costs have to be factored in to the potential savings made from using generic formulations. The reduced acquisition costs of generic
products may not necessarily translate into lower overall healthcare
costs. This article examines the issue of equivalence and
interchangeability of NTI drugs used in organ transplantation, the implications of the approval process for generic drugs on treatment efficacy and safety, and the effective management of substitutions between products.
Safety and efficacy of generic drugs with respect to brand formulation
J Pharmacol Pharmacother. 2013 Dec;4(Suppl 1):S110-4. doi: 10.4103/0976-500X.120972.
Safety and efficacy of generic drugs with respect to brand formulation.
Author information
- 1Department of Health Science, Regional Center on drug information, Mater Domini University Hospital, Italy and Chair of Pharmacology, School of Medicine, University of Catanzaro, Italy.
- 2Department of General Medicine, ASP Cosenza, Italy.
- 3Department of Pharmacovigilance, ASP Cosenza, Italy.
Abstract
Generic drugs
are equivalent to the brand formulation if they have the same active
substance, the same pharmaceutical form and the same therapeutic
indications and a similar bioequivalence respect to the reference
medicinal product. The use of generic drugs
is indicated from many countries in order to reduce medication price.
However some points, such as bioequivalence and the role of excipients,
may be clarified regarding the clinical efficacy and safety during the switch from brand to generic formulations. In conclusion, the use of generic drugs
could be related with an increased days of disease (time to relapse) or
might lead to a therapeutic failure; on the other hand, a higher drug
concentration might expose patients to an increased risk of
dose-dependent side-effects.
"the position of patient advocate," "voluntary patient representatives," and the "unbiased contact person" Where are the doctors?
HEC Forum. 2013 Dec 25. [Epub ahead of print]
Clinical Ethics and Patient Advocacy : The Power of Communication in Health Care.
Author information
- , Glueckstrasse 10, 91054, Erlangen, Germany, inken.emrich@ethik.med.uni-erlangen.de.
Abstract
In
recent years, the rights of patients have assumed a more pivotal role
in international discussion. Stricter laws on the protection of patients
place greater priority on the perspective and the status of patients.
The purpose of this study is to emphasize ethical
aspects in communication, the role of patient advocates as contacts for
the concerns and suggestions of patients, and how many problems of
ethics disappear when communication is highlighted. We reviewed 680
documented cases of consultation in a 10-year period of patient
advocates' activity at a big German university hospital with 1,300 beds.
On the basis of this extensive material, the article will focus on the
intersection of the advocate's work with the problems of patients in
hospitals. Deficits in the level of communication between health care
professionals and patients were frequently uncovered. Patients primarily
complain about the lack of dialogue and empathy. Middle-aged patients
consulted the patients' advocate disproportionately more often. Measured
against this baseline, the group of 65 and older complained less
frequently. Besides complaints the advocate was asked in more than
one-third of all cases for information about medical matters, hospital
regulations or administrative problems. Patients obviously see the
advocate as a well-connected and ideally unbiased contact person for
uncertainties concerning their malady or a potential stay in hospital.
Those seeking help often set hope in the information given by the
voluntary patient representative. It should be highly recommended for
every German hospital to establish the position of a patient advocate.
Furthermore, patients can profit from regular exchange between the
advocate and the Ethics Committee, also, to help ensure that their
rights are taken into account and implemented in an ethically desirable
context.
Zombie allusions: They just keep on coming: violating city ordinances
'Zombie Tag' in White Park Leads to Summons
Concord Police allege Milford teen violated city ordinance after previous warning.
Posted by
Tony Schinella
(Editor) ,
"A Milford teen will be in court next month to face a city
ordinance charge after allegedly being caught in the park after hours."
Twitter and Public Health
J Public Health Manag Pract. 2013 Dec 18. [Epub ahead of print]
Twitter and Public Health.
Author information
- Northwestern University Feinberg School of Medicine, Program in Public Health, Chicago, Illinois (Ms Bartlett and Dr Wurtz).
Abstract
Twitter
can serve as a powerful communication modality to both "push" and
"pull" public health data; each user is a potential public health sensor
and actor. However, in 2012, only 8% of local health departments had Twitter accounts. We outline how Twitter works, describe how to access public tweets for public health surveillance purposes, review the literature on Twitter's current and potential role supporting public health's essential services, summarize Twitter's limitations, and make recommendations for health department use.
From Johns Hopkins: National and Local Influenza Surveillance through Twitter: An Analysis of the 2012-2013 Influenza Epidemic
PLoS One. 2013 Dec 9;8(12):e83672. doi: 10.1371/journal.pone.0083672.
National and Local Influenza Surveillance through Twitter: An Analysis of the 2012-2013 Influenza Epidemic.
Author information
- 1Department of Engineering Management and Systems Engineering, The George Washington University, Washington, District of Columbia, United States of America ; Center for Advanced Modeling in the Social, Behavioral, and Health Sciences, Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
- 2Department of Computer Science and Center for Language and Speech Processing, Johns Hopkins University, Baltimore, Maryland, United States of America.
- 3Human Language Technology Center of Excellence and Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, United States of America.
Abstract
Social media have been proposed as a data source for influenza surveillance because they have the potential to offer real-time access to millions of short, geographically localized messages containing information regarding personal well-being. However, accuracy of social media surveillance systems declines with media attention because media attention increases "chatter" - messages that are about influenza but that do not pertain to an actual infection - masking signs of true influenza prevalence. This paper summarizes our recently developed influenza infection detection algorithm that automatically distinguishes relevant tweets from other chatter, and we describe our current influenza surveillance system which was actively deployed during the full 2012-2013 influenza season. Our objective was to analyze the performance of this system during the most recent 2012-2013 influenza season and to analyze the performance at multiple levels of geographic granularity, unlike past studies that focused on national or regional surveillance. Our system's influenza prevalence estimates were strongly correlated with surveillance data from the Centers for Disease Control and Prevention for the United States (r = 0.93, p < 0.001) as well as surveillance data from the Department of Health and Mental Hygiene of New York City (r = 0.88, p < 0.001). Our system detected the weekly change in direction (increasing or decreasing) of influenza prevalence with 85% accuracy, a nearly twofold increase over a simpler model, demonstrating the utility of explicitly distinguishing infection tweets from other chatter.
Harnessing pluralism for better health in Bangladesh
Lancet. 2013 Nov 23;382(9906):1746-55. doi: 10.1016/S0140-6736(13)62147-9. Epub 2013 Nov 21.
Harnessing pluralism for better health in Bangladesh.
Author information
- Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh; Centre of Excellence for Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh. Electronic address: ahmed.sm@icddrb.org.
Abstract
How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from official sources, research studies, case studies of specific innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive effects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defines the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world.
From U London: Substandard drugs: a potential crisis for public health
Br J Clin Pharmacol. 2013 Nov 29. doi: 10.1111/bcp.12298. [Epub ahead of print]
Substandard drugs: a potential crisis for public health.
Author information
- Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.
Abstract
Poor quality medicines present a serious public health problem, particularly in emerging economies and developing countries, and may have a significant impact on the national clinical and economic burden. Attention has largely focused on the increasing availability of deliberately falsifieddrugs, but substandard medicines are also reaching patients because of poor manufacturing and quality-control practices in the production of genuine drugs (either branded or generic). Substandard medicines are more wide spread than falsified medications and represent a greater threat to health as they can inadvertently lead to healthcare failures, such as antibiotic resistance and the spread of disease within a community, as well as death or additional illness in individuals. This article will review the different aspects of substandard drug formulation that can occur (for example, pharmacological variability between drug batches or between generic and originator drugs; incorrect drug quantity; and presence of impurities). It will also discuss the possible means of addressing substandard manufacturing practices. A concerted effort is required on the part of governments, drug manufacturers, charities and healthcare providers to ensure that only drugs of acceptable quality reach the patient.
What is the difference between a generic and a biosimilar?
BioSimilars vs. Generic Drugs: What’s In a Word?
"How do biosimilars differ from so-called generic drugs? Generic drugs are essentially “copycat” versions of small molecule drugs – drugs that can be synthesized in the lab by following standardized, pre-defined procedures. Using well-established analytic techniques, the generic version of a small molecule drug can be demonstrated to be chemically and structurally identical to the innovator drug.
Biologic drugs, however, are much more complex than small molecule drugs. These drugs are proteins that must be produced by a living cell – they cannot be chemically synthesized in the lab by following a standard set of procedures. The cell makes these proteins by following a recipe provided by a short sequence of DNA – a gene – that is inserted into the cell. Here’s the catch: even if two different cells are provided the exact same recipe, the final product may be slightly different."
"...generic quality uncertainty leads to competition on brand rather than price."
Health Econ. 2013 Nov 20. doi: 10.1002/hec.3013. [Epub ahead of print]
PHARMACEUTICAL PRICING IN EMERGING MARKETS: EFFECTS OF INCOME, COMPETITION, AND PROCUREMENT.
Author information
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
This paper analyzes determinants of ex-manufacturer prices for originator and generic drugs across countries. We focus on drugs to treat HIV/AIDS, TB, and malaria in middle and low-income countries (MLICs), with robustness checks to other therapeutic categories and the full income range of countries. We examine the effects of per capita income, income dispersion, competition from originator and generic substitutes, and whether the drugs are sold to retail pharmacies versus tendered procurement by non-government organizations. The cross-national income elasticity of prices is 0.27 across the full income range of countries but is 0.0-0.10 between MLICs, implying that drugs are least affordable relative to income in the lowest income countries. Within-country income inequality contributes to relatively high prices in MLICs. Although generics are priced roughly 30% lower than originators on average, the variance is large. Additional generic competitors only weakly affect prices, plausibly because generic quality uncertainty leads to competition on brand rather than price. Tendered procurement that imposes quality standards attracts multinational generic suppliers and significantly reduces prices of originator and generic drugs, compared with their respective prices to retail pharmacies.
From U Zagreb-Croatia: Child protection: legal and ethical obligations in reporting child abuse
J Forensic Odontostomatol. 2013 Oct 1;31 Suppl 1:158-9.
Child protection: legal and ethical obligations in reporting child abuse.
Author information
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Croatia.
Abstract
Child protection is a duty of every single member of the society. Health professionals who work with children, such as members of dental team, are in the unique position to recognize signs of physical, sexual and emotional abuse as well as (dental) neglect. They should report any suspected case where a child is or may be in need of welfare. The professional responsibility is regulated by legal and ethical obligations. Legislation covering child protection can be divided into two main categories: civil law and criminal law.
Method: In this preliminary work the authors investigate the legal and ethical acts, and the similarities vs. differences in obligations regarding reporting child abuse and neglect (CAN) cases in four countries: Croatia, United Kingdom, Italy and Canada.
Results: In all four countries all medical professionals (and officials) have a duty to report their suspicion if a child is in an harmful situation, thus requiring the need of protection and assistance. Additionally, people working closely with children should raise their awareness on possible signs of CAN, and report any suspicious or uncommon behavioral signs. All professionals or officials who fail to report, or even neglect or delay to report a suspicion, are liable on conviction to a pecuniary fine which varies from country to country. Depending on the country, if a professional has reasonable grounds to suspect that a child is or may be in need of protection, must report to: CAS (children's aid society), to CSS (center for social services), to police, to Juvenile Court, or to the ombudsman. The report should be made, immediately or up to 48 hours from the moment of suspicion. In all four countries, dentists are not asked to diagnose 'child maltreatment', but simply report the suspicion with supportive evidence. Ethical obligation comes from medical and dental ethical codes, which is in all four countries regulated by the Chamber or Council of Dentists. In general, ethical obligations cover protection of children, the elderly and the disabled, in particular when the environment, family or the community in which they live is not sufficiently responsive to health care.
Conclusion: All four countries consider children as a vulnerable group which should be protected. Legal and ethical obligations in reporting CAN are similar. Differences are related mostly to fines for non-reporting or a delay in reporting to judicial authorities. Expanded investigation through other European countries and standard operational procedures is needed, in order to harmonize policies and guidelines for reporting CAN and maximize children protection.
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