From @lijjoseph @ALBoothMD @subatomicdoc @DrMisialek and me: “Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience #Patients First #WhyPathologistsMatter

Adam L. Booth, Matthew S. Katz, Michael J. Misialek, Timothy Craig Allen, and Lija Joseph (2018) “Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

“Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience

Adam L. Booth, MD; Matthew S. Katz, MD; Michael J. Misialek, MD; Timothy Craig Allen, MD, JD; Lija Joseph, MD

From the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Booth); the Departments of Pathology and Laboratory Medicine (Dr Joseph) and Radiation Medicine (Dr Katz), Lowell General Hospital, Lowell, Massachusetts; the Department of Pathology, Newton-Wellesley Hospital, Newton, Massachusetts (Dr Misialek); and the Department of Pathology, University of Mississippi Medical School, University of Mississippi Medical Center, Jackson (Dr Allen).

The authors have no relevant financial interest in the products or companies described in this article.

Corresponding author: Lija Joseph, MD, Department of Pathology and Laboratory Medicine, Lowell General Hospital, 295 Varnum Ave, Lowell, MA 01854 (email: Lija.Joseph@lowellgeneral.org).

Context.— Pathologists evaluate human disease and teach medical students, residents, and clinicians. Historically recognized as the “doctor's doctor,” pathologists are well suited to be a direct patient resource of individualized, accurate information.

Objective.— To develop and implement a pathology consultation service whereby patients review their tissue slides directly with the pathologists.

Design.— A pathologist conducted patient consultations, reviewing biopsy or surgery findings on a multiheaded microscope or computer screen. The pathologist evaluated patients' understanding of their disease and invited patients to ask specific questions. We recorded patient demographic data and assessed utilization with a short patient satisfaction survey using 6 questions with a 5-point Likert scale and 2 questions for open response.

Results.— A total of 31 patients came for consultation; 39% (12 of 31) were accompanied by a friend or family member. Patients' median age was 59 years, with a strong female predominance (90%; 28 of 31). The majority of patients had breast cancer (58%; 18 of 31) or hematologic malignancy (19%; 6 of 31). Of the 31 patients, the survey response rate was 58% (18 of 31). Top-box scoring demonstrated program support, with 89% (16 of 18) of respondents strongly recommending the experience to another patient. Additionally, 78% (14 of 18) strongly agreed that they felt more empowered after seeing their disease. Mean scores for Likert-based questions all were higher than 4.0.

Conclusions.— To our knowledge, this study is the first report of direct patient-pathologist consultation. Early data suggest that the program may provide effective patient-specific education. The high response rate and favorable assessment of the program suggest that it may be a valuable resource for some patients.

Michelle Mello and colleagues: Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs. (Bottom line: "...transparency, apology, and proactive compensation can be pursued without adverse financial consequences.")

Health Aff (Millwood). 2018 Nov;37(11):1836-1844. doi: 10.1377/hlthaff.2018.0720.

Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs.

Kachalia A1, Sands K2, Niel MV3, Dodson S4, Roche S5, Novack V6, Yitshak-Sade M7, Folcarelli P8, Benjamin EM9, Woodward AC10, Mello MM11.

Author information

1

Allen Kachalia ( akachalia@bwh.harvard.edu ) is chief quality officer at Brigham Health, in Boston, Massachusetts.

2

Kenneth Sands is chief epidemiologist and chief patient safety officer at HCA Healthcare, in Nashville, Tennessee.

3

Melinda Van Niel is a project manager at Beth Israel Deaconess Medical Center for the Massachusetts Alliance for Communication and Resolution following Medical Injury, in Boston.

4

Suzanne Dodson, now retired, was project manager at Baystate Health, in Springfield, Massachusetts.

5

Stephanie Roche is a health care quality research analyst at Beth Israel Deaconess Medical Center.

6

Victor Novack is head of the Clinical Research Center at Soroka University Medical Center and a professor of medicine at the Faculty of Health Sciences, Ben-Gurion University of the Negev, in Beer Sheva, Israel.

7

Maayan Yitshak-Sade is a postdoctoral research fellow at the Harvard T. H. Chan School of Public Health, in Boston.

8

Patricia Folcarelli is vice president of health care quality at Beth Israel Deaconess Medical Center.

9

Evan M. Benjamin is chief medical officer of Ariadne Labs, Harvard T. H. Chan School of Public Health and Brigham and Women's Hospital.

10

Alan C. Woodward, an emergency medicine physician in Concord, Massachusetts, is past president and former chair of the Committee on Professional Liability of the Massachusetts Medical Society.

11

Michelle M. Mello is a professor of law at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine, in California.

Abstract

To promote communication with patients after medical injuries and improve patient safety, numerous hospitals have implemented communication-and-resolution programs (CRPs). Through these programs, hospitals communicate transparently with patients after adverse events; investigate what happened and offer an explanation; and, when warranted, apologize, take responsibility, and proactively offer compensation. Despite growing consensus that CRPs are the right thing to do, concerns over liability risks remain. We evaluated the liability effects of CRP implementation at four Massachusetts hospitals by examining before-and-after trends in claims volume, cost, and time to resolution and comparing them to trends among nonimplementing peer institutions. CRP implementation was associated with improved trends in the rate of new claims and legal defense costs at some hospitals, but it did not significantly alter trends in other outcomes. None of the hospitals experienced worsening liability trends after CRP implementation, which suggests that transparency, apology, and proactive compensation can be pursued without adverse financial consequences.

What is obesity and what causes it?

A BMI between 25 and 29.9 indicates that a person is carrying excess weight. A BMI of 30 or over suggests that a person may have obesity.

"Although radicalisation is invoked to explain how people become terrorists, there is little empirical evidence."

Nord J Psychiatry. 2018 Nov 1:1-4. doi: 10.1080/08039488.2018.1525640. [Epub ahead of print]

Radicalisation and mental health.

Bhui K1,2.

Author information

1

a Professor of Cultural Psychiatry & Epidemiology, Barts & The London School of Medicine and Dentistry , Wolfson Institute of Preventive Medicine, Queen Mary University of London , London , UK.

2

b Hon. Consultant Psychiatry, East London NHS Foundation Trust , London , UK.

Abstract

BACKGROUND:

Although radicalisation is invoked to explain how people become terrorists, there is little empirical evidence.

AIMS:

To set out the approaches to understand radicalisation, ethical and definitional issues, and how public health approaches may help.

METHODS:

A non-systematic narrative review.

RESULTS:

Radicalisation is proposed to explain how people become terrorists. Factors such as social connections, political engagement, group belonging, mental illnesses and other social and cultural influence show a complex interplay that we are still trying to understand. Common mental illnesses appear to be a risk factor at a population level for developing extremist beliefs, and psychoses and autism are reported as more common amongst some terrorist offenders. The activation of stereotypical and reactive fears and fantasies may distort our understanding of how to prevent radicalisation and terrorism.

CONCLUSIONS:

A public health framework offers a societal, inclusive, and positive approach to preventing radicalisation, alongside criminal justice actions.

"Achieving population-based shifts in health outcomes for low-income communities requires moving far beyond text message reminders..."

Social Determinants Of Health: Holy Grail Or Dead-End Road?

"Achieving population-based shifts in health outcomes for low-income communities requires moving far beyond text message reminders, Uber rides to clinic visits and vouchers for farmer’s markets and food pantries. These shifts demand bold and transformative steps to address poverty by providing education, economic opportunity and a pathway to lifelong economic stability. Congressman Bill Cassidy also said, 'Prosperity is the key to improving health outcomes'. As we develop interventions for the social determinants of health, unless we begin to heed this message, in the years ahead rather than finding the Holy Grail, we will instead certainly find ourselves on the path to a dead-end road."

"It should be easy to award a lifetime achievement award in literature."

No Nobel Prize for Literature? Thank Goodness.

"It should be easy to award a lifetime achievement award in literature. Writers have long working lives, and there is plenty of time for reasonable opinion to coalesce. The vast majority of the great writers of the last century were amply feted well before their deaths. The prize originated in 1901 when Leo Tolstoy was almost universally regarded as the greatest living writer. And so the first Nobel Prize in literature went to Sully Prudhomme, a poet not even the most ardent Francophile knows as anything other than the first writer to win the Nobel. Tolstoy didn’t die until 1910, but the academy never saw its way to giving him the prize before he got pneumonia at the Astapovo rail station. Chekhov, Ibsen, Zola, Hardy, James, and Twain were all alive and acclaimed in the first decade of the 20th century. None won the prize, and the course of the literary Nobel was set."

#Read

THE BOOKISH LIFE

HOW TO READ AND WHYby Joseph EpsteinNovember 2018


What is the true point of a bookish life? Note I write “point,” not “goal.” The bookish life can have no goal: It is all means and no end. The point, I should say, is not to become immensely knowledgeable or clever, and certainly not to become learned. Montaigne, who more than five centuries ago established the modern essay, grasped the point when he wrote, “I may be a man of fairly wide reading, but I retain nothing.” Retention of everything one reads, along with being mentally impossible, would only crowd and ultimately cramp one’s mind. “I would very much love to grasp things with a complete understanding,” Montaigne wrote, “but I cannot bring myself to pay the high cost of doing so. . . . From books all I seek is to give myself pleasure by an honorable pastime; or if I do study, I seek only that branch of learning which deals with knowing myself and which teaches me how to live and die well.” What Montaigne sought in his reading, as does anyone who has thought at all about it, is “to become more wise, not more learned or more eloquent.” As I put it elsewhere some years ago, I read for the pleasures of style and in the hope of “laughter, exaltation, insight, enhanced consciousness,” and, like Montaigne, on lucky days perhaps to pick up a touch of wisdom along the way.

"Mississippi had the highest childhood obesity rate at 26.1%..."

Childhood obesity: America's 'true national crisis' measured state by state

• The US obesity rate for youth, aged 10 to 17, was 15.8% in 2016 to 2017, new report says
• Mississippi had the highest childhood obesity rate at 26.1% for that time
• Utah had the lowest at 8.7%

"New and emerging treatment modalities, including polymer films and nanoparticles, are highlighted as potential future solutions for both prevention and treatment of locally recurrent cancers."

CA Cancer J Clin. 2018 Oct 17. doi: 10.3322/caac.21498. [Epub ahead of print]

Local cancer recurrence: The realities, challenges, and opportunities for new therapies.

Mahvi DA1, Liu R2, Grinstaff MW3, Colson YL4, Raut CP5.

Author information

1

Postdoctoral Research Fellow, Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

2

Instructor in Surgery, Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

3

Michael A. Bell Family Distinguished Chair in Healthcare Innovation and Professor of Translational Research, Biomedical Engineering, Chemistry, Materials Science and Engineering, and Medicine, Department of Chemistry, Boston University, Boston, MA.

4

Professor of Surgery, Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

5

Associate Professor of Surgery, Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Abstract

Locoregional recurrence negatively impacts both long-term survival and quality of life for several malignancies. For appropriate-risk patients with an isolated, resectable, local recurrence, surgery represents the only potentially curative therapy. However, oncologic outcomes remain inferior for patients with locally recurrent disease even after macroscopically complete resection. Unfortunately, these operations are often extensive, with significant perioperative morbidity and mortality. This review highlights selected malignancies (mesothelioma, sarcoma, lung cancer, breast cancer, rectal cancer, and peritoneal surface malignancies) in which surgical resection is a key treatment modality and local recurrence plays a significant role in overall oncologic outcome with regard to survival and quality of life. For each type of cancer, the current, state-of-the-art treatment strategies and their outcomes are assessed. The need for additional therapeutic options is presented given the limitations of the current standard therapies. New and emerging treatment modalities, including polymer films and nanoparticles, are highlighted as potential future solutions for both prevention and treatment of locally recurrent cancers. Finally, the authors identify additional clinical and research opportunities and propose future research strategies based on the various patterns of local recurrence among the different cancers.

"While America remains the wild west of meme culture, the European Parliament recently passed a copyright law that critics say can stifle the free flow of memes across the internet."

A dubious report says memes are to blame for making teens fat

"At the same time, the paper is arguably another example of Europe's increasing hostility toward memes. While America remains the wild west of meme culture, the European Parliament recently passed a copyright law that critics say can stifle the free flow of memes across the internet."

UNT One O'Clock Lab Band Lab 2018: Rich DeRosa's "Birds of a Feather..."

"Sitting in front of infinitely interchangeable and accessible screens, each of us stupidly needs to feel special, and will do what it takes."

The Crisis of Intimacy in the Age of Digital Connectivity

By Stephen Marche

"Or, rather, there is no more and no less intimacy now than there was during the analog era; the intimacy has been transferred to another format. Human beings are intimate creatures. After entering a world of impersonal connection, human beings cannot help but respond by rendering every interaction as personal as possible. Faced with a civilization based on the Uniform Resource Locations, we express ourselves in lust and hunger and violence. Sitting in front of infinitely interchangeable and accessible screens, each of us stupidly needs to feel special, and will do what it takes."

Black moms more likely to die from pregnancy-related ills

"Researchers also found 72% of the pregnancy-related deaths and 93% of violent pregnancy-associated deaths could have been prevented. Obesity contributed to 44% of pregnancy-related deaths in Illinois."

"When the patients made lifestyle changes, it reduced the risk of regaining weight within a few years."

Obesity Is a Weight-Loss Maintenance Problem

Keeping the processes practical and simple carried over into patient care, which permitted for better teaching opportunities and more specific support. When the patients made lifestyle changes, it reduced the risk of regaining weight within a few years.^6-8

One patient remarked, “This was a true mentorship. The honesty, time to educate, optimism, sincerity to help me. I feel better already.”

Another patient shared, “I’m impressed by the intensity of compassion to help me lose weight and understand how to keep it off.”

"Three months in all patients decreased reaction parts of the brain responsible for desire and willpower, to food photos. However, the lowest levels were those who achieved the best success in losing weight..."

SCIENTISTS: OBESITY CAN BE DEFEATED WITH THE POWER OF THOUGHT

Canadian scientists have found that in the human body most responsible for success in weight loss.

"Three months in all patients decreased reaction parts of the brain responsible for desire and willpower, to food photos. However, the lowest levels were those who achieved the best success in losing weight. Data suggest that these patients are serious about the problem and were able to suppress harmful desires. So to beat obesity with the power of thought and will is possible. You only have to wish and undergo cognitive-behavioral therapy, the researchers say."

"By 1937 the Great Terror was in full swing. Anyone with connections to the world outside the Soviet Union was a suspect."

Time After Time

Fritz Houtermans at the beginning—and nearly the end—of the world.

By Jacob Mikanowski

In December 1934, Sergei Kirov, the Communist Party boss of Leningrad, was assassinated by a disgruntled former cadre, setting off a wave of arrests and inquisitions. Meanwhile, the second Five-Year Plan wasn’t going well. There was famine in the countryside (some of it deliberate) and economic malfunction everywhere. Someone had to be at fault. Blame settled on foreign agents and saboteurs.

By 1937 the Great Terror was in full swing. Anyone with connections to the world outside the Soviet Union was a suspect. The atmosphere at the Physico-Technical Institute became unbearably tense. One after another, Fritz’s friends and colleagues were being arrested. Unable to withstand the pressure any longer, one of his scientific collaborators drank acid and threw himself from the institute’s windows. He survived just long enough to be arrested.

"Unhealthy and Unprepared."

Too fat to fight: Pentagon grapples with obesity epidemic

According to the Defense Department, obesity is one of the top reasons why a stunning 71 percent of Americans aged 17-24 do not meet the military's sign-up requirements.

"Given the high percentage of American youth who are too overweight to serve, recruiting challenges will continue unless measures are taken to encourage a healthy lifestyle beginning at a young age," states the study, entitled "Unhealthy and Unprepared."

Donna Summer - On The Radio #DiscoLives

Donna Summer
On The Radio

So many people have had their DNA sequenced that they've put other people's privacy in jeopardy (HT:RG)

So many people have had their DNA sequenced that they've put other people's privacy in jeopardy

"This new reality represents the convergence of two long-standing trends.

One of them is the rise of direct-to-consumer genetic testing. Companies such as Ancestry.com and 23andMe can sequence anyone’s DNA for about $100. All you have to do is provide a sample of saliva and drop it in the mail.

The other essential element is the proliferation of publicly searchable genealogy databases like GEDmatch. Anyone can upload a full genome to these sites and powerful computers will crunch through it, looking for stretches of matching DNA sequences that can be used to build out a family tree."

HT:RG

"Since 1970, there has been at least one hazing-related death on a college campus each year, and the problem is escalating...there have been 40 hazing related deaths since 2009."

Parents who lost sons to fraternity hazing speak to Ole Miss students

"Since 1970, there has been at least one hazing-related death on a college campus each year, and the problem is escalating. As Steve Gruver noted, there have been 40 hazing related deaths since 2009."

"...leader moral humility predicts follower moral efficacy and moral behaviors above and beyond the effects of ethical leadership and leader general humility."

J Appl Psychol. 2018 Oct 8. doi: 10.1037/apl0000353. [Epub ahead of print]

The impact of leader moral humility on follower moral self-efficacy and behavior.

Owens BP1, Yam KC2, Bednar JS1, Mao J3, Hart DW1.

Author information

1

Marriott School of Business.

2

School of Business.

3

School of Business Administration.

Abstract

This study utilizes social-cognitive theory, humble leadership theory, and the behavioral ethics literature to theoretically develop the concept of leader moral humility and its effects on followers. Specifically, we propose a theoretical model wherein leader moral humility and follower implicit theories about morality interact to predict follower moral efficacy, which in turn increases follower prosocial behavior and decreases follower unethical behavior. We furthermore suggest that these effects are strongest when followers hold an incremental implicit theory of morality (i.e., believing that one's morality is malleable). We test and find support for our theoretical model using two multiwave studies with Eastern (Study 1) and Western (Study 2) samples. Furthermore, we demonstrate that leader moral humility predicts follower moral efficacy and moral behaviors above and beyond the effects of ethical leadership and leader general humility. 

Weight hate is wrong — but we must remember it’s bad to be overweight

It is important recognise that if you are more than mildly overweight then there is something wrong with your body

Forgive me, but as a former fat person whose weight still goes up and down, I’m OK with “fat”.

Obesity is useful, too, since it’s a medical term to describe people who are so overweight that their health is at risk.

But “living with obesity” is jargon. And even worse is the ludicrous (I’m tempted to say fatuous) comparison to individuals genuinely living with something they didn’t choose. We don’t choose to be men or women, straight or gay, though that doesn’t mean we’re unhappy about it.

"Some people I talked with thought charm was synonymous with 'cool.' In fact, the two, charm and cool, are all but opposed."

Life’s Little Luxury

Charm makes the world seem a more enticing place—but it is going the way of chivalry, good manners, and unmotivated kindness.

Some people I talked with thought charm was synonymous with “cool.” In fact, the two, charm and cool, are all but opposed. Cool aims for detachment, distance; charm is social, bordering on the intimate. Cool is icy; charm warm. Cool is costive; charm often ebullient. Cool doesn’t require approval; charm hopes to win it. Cool began life in jazz under the great saxophonist Lester Young, who first used the term, but it soon descended to the argot of drugs. Cool gave way to hip and hep. In Dave Frishberg’s song “I’m Hip,” the singer proclaims that he watches “arty French flicks with [his] shades on” and is so hip “I call my girlfriend ‘Man.’ ” Miles Davis was cool, Louis Armstrong charming.

"...this is a rather simple fix to the 'freshman 15'..."

Student: UD's gyms should be open later

While I manage to complete my assignments, I have very little time or motivation to actually exercise. Since both Harrington gym and the Little Bob close at 9 p.m., it is difficult for studious night owls, like me, to attend the gym.

If either of these facilities were open until 12 a.m., I feel as though many more students would be able to find time to exercise after completing our school work. This slight alteration of hours could improve the overall health and well being of students attending UD.

In my opinion, this is a rather simple fix to the “freshman 15,” and an easy way to help address the obesity epidemic that has plagued America. 

"Buried amongst dozens of points in Van Halen’s rider was an odd stipulation that there were to be no brown M&M's candies in the backstage area...For decades this stood as a humiliating act of self-indulgence, a rock band forcing someone to search through candy, removing every last brown one, for no apparent reason. Yet..."

No Brown M&M's: What Van Halen's Insane Contract Clause Teaches Entrepreneurs

"Buried amongst dozens of points in Van Halen’s rider was an odd stipulation that there were to be no brown M&M's candies in the backstage area. If any brown M&M’s were found backstage, the band could cancel the entire concert at the full expense of the promoter. That meant that because of a single candy, a promoter could lose millions.

For decades this stood as a humiliating act of self-indulgence, a rock band forcing someone to search through candy, removing every last brown one, for no apparent reason. Yet when lead singer David Lee Roth finally divulged the real reason for the bizarre clause, an entirely different picture was painted, one that serves as a valuable lesson for business."

U.S. pastor Andrew Brunson convicted of terrorism in Turkey, but is on his way home

"Friday's hearing took place in a prison complex near the western city of Izmir. Brunson arrived in a secured convoy before daybreak. The evangelical pastor was convicted of terror-related charges, but he was also accused of espionage. Prosecutors had been seeking up to a 35-year sentence.  

Brunson, 50, who has lived in Turkey for more than two decades, has always rejected the charges and strongly maintained his innocence. He is one of thousands caught up in a wide-scale government crackdown that followed a failed coup against the Turkish government in July 2016.

Prosecutors accused Brunson of committing crimes on behalf of terror groups, linking him to outlawed Kurdish militants and a network led by a U.S.-based Turkish cleric who is accused of orchestrating the coup attempt. The U.S. maintained that he was being held unjustly and repeatedly called for his release."

Stud Health Technol Inform. 2018;254:53-62.

Selfie Telemedicine - What Are the Legal and Regulatory Issues?

Mars M1, Morris C1, Scott RE1.

Author information

1

Dept. of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.

Abstract

Selfies, self-taken photographs using mobile phones or tablet computers, have become a way of life. People are now sending selfies to health professionals for medical advice or dermatology triage or postoperative wound assessment. These selfies may be unsolicited and sent to clinicians with whom the patient may or may not have a prior doctor-patient relationship or on the instruction of the attending doctor or even to social media groups. They may be sent by email, or by mobile phone and instant messaging applications, or sent to Websites, or telemedicine specific application sites. These photographs and accompanying information are legal documents, should form part of the patient's record, and should be securely transmitted and stored to maintain patient confidentiality and privacy. This paper reviews the legal, ethical and regulatory issues associated with the different forms of selfie telemedicine.

METHOD:

A scoping literature review was undertaken using PubMed, Scopus, Science Direct, Ebsco Host and Google Scholar which were searched for Selfie and any of medicine, telemedicine, telehealth, eHealth, or mHealth. Inclusion criteria were that the paper was in English and described the use of a selfie in relation to healthcare. These were then reviewed for reference to legal, ethical issues and regulatory issues.

RESULTS:

68 papers met the inclusion criteria. Legal and ethical issues identified were consent, confidentiality, privacy, the doctor-patient relationship, data security, responsibility, record keeping, licensure, continuity of care, quality of care, image quality, concordance, phone stewardship and patient satisfaction.

CONCLUSION:

The literature provides little guidance on how legal and ethical issues and shortcomings of selfie telemedicine should be addressed especially the responsibilities of the patient and physician for unsolicited requests. Nor does it provide advice on how records are to be kept, or how images and information stored and sent to and from mobile phones or computers are to be managed. The new issues that arise need to be addressed.

"They had changed the system—and in culture created an entire vast secondary system of their own—and how the system had changed them!"

Ante Up 

The scales of power seen through Norman Podhoretz’s eyes

"They had changed the system—and in culture created an entire vast secondary system of their own—and how the system had changed them! The oceanic efforts of the founders had trickled down into a spoon-deep pool reflecting every pose of the imperial Narcissus. The demon from Vienna, commanding the apocalyptic armies of a whole white continent and poised to flood all earth with genocide, had shriveled into the butcher from Tikrit, clinging to a middling fraction of the Middle East besieged by American sanctions and dissected by American no-fly zones, his slaughters matched or even exceeded by those of any number of American client states. Who could fail to see how Partisan Review’s conflicted martial benediction had swollen, over the course of a long chain of small and not-so-small compromises, into the New Republic’s suavely vehement hurrah for storming Baghdad?"

Obesity Doubles Younger Women's Colon Cancer Odds

"In the study, women aged 20 to 49 who were overweight or obese had up to twice the risk for colon cancer before age 50, compared with normal-weight women.

'Our findings really highlight the importance of maintaining a healthy weight, beginning in early adulthood, for the prevention of early onset colorectal cancer,' said study co-author Yin Cao. She's an assistant professor of surgery at Washington University in St. Louis."

From @pathologistmag - "Communication is everything..."

Tell Me, Doctor…

To keep pace with medicine’s future, pathologists need to develop much better communication skills – with great urgency

"Communication is everything – whether via a pathology report, a test result, a phone call or email to a colleague, a chance meeting with an administrator in the hall, or a conference room discussion. Communication is written words, eye contact, tone of voice, body language, dress and appearance, and much more – and it’s something all physicians should strive to improve. For pathologists – traditionally office-bound, glass slide-reading diagnostic physicians – improved communication is unquestionably the key to our future success in today’s evolving world of molecular medicine, team-focused patient care, and payment for quality."

Childhood Obesity Persists Into Adolescence

"The researchers found that in retrospective analyses, most adolescents with normal weight had always had a normal weight throughout childhood, whereas 53 percent of obese adolescents had been overweight or obese since age 5. The body mass index (BMI) standard-deviation score further increased with age. In prospective analyses, almost 90 percent of the children who were obese at age 3 were overweight or obese in adolescence. The greatest acceleration in annual BMI increments occurred between ages 2 and 6 years. Among children born large for gestational age (43.7 percent), the rate of overweight or obesity in adolescence was 1.55 times higher than among those who had been at an appropriate weight for gestational age (28.4 percent) or small for gestational age (27.2 percent)."

Netflix addiction

Netflix addiction: Nimhans gets its first case, 12 signs you’re addicted to Netflix

"Like many people, who now have fallen victim to the Netflix addiction (a subcategory of screen addiction), have you also thought of watching the entire season of your favourite sitcom once at a stretch? If not, you may count yourself lucky. Whether it's a drama, romance, or something silly, this stunning website (Netflix) has something to match every mood. Perhaps, Netflix has become the new opium of the masses as many people are now obsessed with it. But the consequences of binge-watching shows on video-on-demand platforms and streaming services like Netflix can be deadly, taking a toll on your health, social life, emotions and more. Sitting for long stretches of time is linked to an increased risk of various health issues, including heart disease, diabetes, obesity, cancer, etc."

J Med Ethics. 2018 Sep 28. pii: medethics-2018-104944. doi: 10.1136/medethics-2018-104944. [Epub ahead of print]

Towards a palliative care approach in psychiatry: do we need a new definition?

Lindblad A1, Helgesson G1, Sjöstrand M1.

Author information

1

Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.

Abstract

Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in 'palliative psychiatry', namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based on WHO's widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness. While this is a welcome step in the discussion on palliative care approaches in psychiatry, it also opens up for new questions. One of the most evident is whether psychiatry actually needs its own definition of palliative care or, put differently, whether there is something about mental disorders that differs so radically from other medical conditions that it calls for a separate definition. We acknowledge the need to discuss the goals of psychiatric care in patients with severe persistent psychiatric illness. However, we question whether a separate definition of palliative care exclusive to psychiatry is the right way to go. In this paper, we discuss why.