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April 18, 2014

Cost of Treating Patients May Influence Doctors

(New York Times) – Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care. The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

Preterm Births, Multiples, and Fertility Treatment

(Science Codex) – While it is well known that fertility treatments are the leading cause of increases in multiple gestations and that multiples are at elevated risk of premature birth, these results are not inevitable, concludes an article in Fertility and Sterility. The article identifies six changes in policy and practice that can reduce the odds of multiple births and prematurity, including expanding insurance coverage for in vitro fertilization (IVF) and improving doctor-patient communications about the risks associated with twins.

April 16, 2014

Digital Mirror Reveals What Lies Under Your Skin

(New Scientist) – Maître and his collaborators built the digital mirror to explore philosophical questions about how we relate to our body. But in the future, they say they could imagine doctors using a similar system to help people explore a particular part of their body or prepare for an upcoming operation. Other researchers have already started exploring how augmented reality can help medicine.

PET Scans Offer Clues on Vegetative States

(New York Times) – A new study has found that PET scans may help answer these wrenching questions. It found that a significant number of people labeled vegetative had received an incorrect diagnosis and actually had some degree of consciousness and the potential to improve. Previous studies using electroencephalogram machines and M.R.I. scanners have also found signs of consciousness in supposedly vegetative patients.

Scientists Embark on Unprecedented Effort to Connect Millions of Patient Medical Records

(Washington Post) – Inside an otherwise ordinary office building in lower Manhattan, government-funded scientists have begun collecting and connecting together terabytes of patient medical records in what may be one of the most radical projects in health care ever attempted. The data — from every patient treated at one of New York’s major hospital centers over the past few years — include some of the most intimate details of a life. Vital signs. Diagnoses and conditions. Results of blood tests, X-rays, MRI scans. Surgeries. Insurance claims. And in some cases, links to genetic samples.

New Video Highlights the Need for a Plan When It Comes to Incidental Findings

(Bioethics.gov) – The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has posted its latest video, in which Commission Members discuss their report Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts. In the three minute piece, Members highlight the essential message of the report on the ethical management of incidental findings across contexts: the importance of practitioners—including clinicians, researchers, and direct-to-consumer (DTC) companies—having a plan to anticipate and manage incidental findings.

April 11, 2014

Cost of Drugs Used by Medicare Doctors Can Vary Greatly by Region, Analysis Finds

(Washington Post) – An analysis of government data released Wednesday shows that the cost of drugs administered by doctors accounts for a growing piece of Medicare’s spending and varies widely from region to region in the United States, raising questions about whether some physicians may be misusing the pharmaceuticals. Most of the 4,000 doctors who received at least $1 million from Medicare in 2012 billed mainly for giving patients injections, infusions and other drug treatments, those records show.

A New Edition of Clinical Ethics is Available

Clinical Ethics (Volume 9, No. 1, March 2014) is now available online by subscription only.

Articles include:

  • “Can informed consent apply to information disclosure? Moral and practical implications” by Jacques Tamin
  • “A principlist approach to presumed consent for organ donation” by Hannah Welbourn
  • “Imperfect informed consent for prenatal screening: Lessons from the Quad screen” by ML Constantine, et al.
  • “Informal ethics consultations in academic health care settings: A quantitative description and a qualitative analysis with a focus on patient participation” by Abraham Rudnick, et al.
  • “The impact of an ethics training programme on the success of clinical ethics services” Andrea Dörries, et al.
  • “Staffs’ perceptions of the ethical landscape in psychiatric inpatient care: A qualitative content analysis of ethical diaries” by Veikko Pelto-Piri, Karin Engström, and Ingemar Engström
  • “The medical record as legal document: When can the patient dictate the content? An ethics case from the Department of Neurology” by Robert Accordino, et al.
  • “Longing to a fetal patient” Tutku Ozdogan, et al.

April 10, 2014

The Medicare Data’s Pitfalls

(New York Times) – The release on Wednesday of Medicare payment data is getting mixed reviews from doctors. Many say they favor sharing information but worry that the data presented by Medicare omits important details and may mislead the public and paint an unfairly negative picture of individual doctors.

Ensuring Privacy in the Study of Pathogen Genetics

(The Lancet, by subscription only) – Rapid growth in the genetic sequencing of pathogens in recent years has led to the creation of large sequence databases. This aggregated sequence data can be very useful for tracking and predicting epidemics of infectious diseases. However, the balance between the potential public health benefit and the risk to personal privacy for individuals whose genetic data (personal or pathogen) are included in such work has been difficult to delineate, because neither the true benefit nor the actual risk to participants has been adequately defined.

April 9, 2014

Fearing Punishment for Bad Genes

(New York Times) – About 700,000 Americans have had their DNA sequenced, in full or in part, and the number is rising rapidly as costs plummet — to $1,000 or less for a full genome, down from more than $1 million less than a decade ago. But many people are avoiding the tests because of a major omission in the 2008 federal law that bars employers and health insurers from seeking the results of genetic testing.

April 8, 2014

Cognitive Impairment Common among Community and Nursing-Home Resident Elderly

(Medical Xpress) – More than 70% of elderly Medicare beneficiaries experience cognitive impairment or severe dementia near the end-of-life and may need surrogate decision makers for healthcare decisions. Advance care planning for older adults with dementia may be particularly important for individuals who do not reside in a nursing home or a long-term care facility, according to an article published in the April issue of Health Affairs.

April 4, 2014

Clothes with Hidden Sensors Act as an Always-on Doctor

(New Scientist) – The next generation of wearable technology aims to embed sensors in your clothes, so you only need to get dressed to start monitoring your health.”Wearable electronics are great but the only way they are going to take off is if you stick them on something people have to wear every day,” says Simon McMaster of Footfalls and Heartbeats, a company in New Zealand that is developing smart fibres with sensors knitted straight into the fabrics.

April 3, 2014

Ugandan Clinics Selling Bogus HIV Certificates

(BBC) – Private clinics in Uganda’s capital, Kampala, are selling fake HIV negative certificates to help people get jobs, an undercover investigation by BBC Africa’s Catherine Byaruhanga has revealed. It is the tail-end of the morning rush-hour when I meet Sarah outside a popular supermarket in a suburb of Kampala. She is a young woman in her 20s, with dreadlocks. She is anxious, and can hardly look me in the eye.

April 2, 2014

Mammogram Risks Raise Doubts about Blanket Screening

(New Scientist) – The benefits of mammograms have been overblown and the harms underplayed, concludes a review of studies looking at breast cancer screening since the 1960s. Rather than blanket screening every woman every few years once they reach a certain age, the review recommends only screening those identified as being at high risk.

US Doctors’ Group Says Patients Should Have Option Not to Know Their DNA

(Nature) – The issue of genetic sequencing raises thorny issues of ethics and patient-doctor communication. If a patient chooses to opt out of testing for that recommended list of mutations does she or he really understand what that decision means? Was the physician able to make the significance of the mutations clear in a relatively short appointment? But patients are currently afforded the opportunity to opt out of life-saving procedures, so why should opting out of information about possible genetic mutations be any different? The ACMG board, which put forth this new decision, is implicitly stating that it isn’t.

March 28, 2014

Get Ready to Have Your Biometrics Tracked 24/7

(Wired.UK) – “I’ve been working in biometrics for 20 years, and it’s reaching a tipping point where it’s going to be impossible not to understand where people are and what they are doing. Everything will be monitored. It’s part of the reason why when we put together the definition of biometrics it included biological and behavioural characteristics — it can be anything.”

Medical Experiments Need Consent – Even in Emergency

(New Scientist) – ONE of the most important tenets of biomedical research on humans is informed consent: volunteers must understand what the research is about and what the risks are before agreeing to take part. If they are unable to do so, a family member must consent on their behalf. Sometimes, however, obtaining informed consent is impossible. That often happens in trauma medicine where eligible patients arrive at hospital unconscious and close to death. Under these circumstances the authorities can waive the requirement for informed consent. Under US law, for example, trauma victims can be enrolled in certain medical trials without their knowledge.

March 27, 2014

Leading Surgeons Warn against Media Hype about Tracheal Regeneration

(Medical News Today) – Reports of the two earliest tissue-engineered whole organ transplants using a windpipe, or trachea, created using the patient’s own stem cells, were hailed as a breakthrough for regenerative medicine and widely publicized in the press. However, two leading transplant surgeons in Belgium warn of the dangers of media attention, and urge that tracheal bioengineering be demonstrated as both effective and safe before further transplants take place.

Trouble Falling Asleep? Prescription Sleeping Pills Are Popular, Tempting – and Risky

(Washington Post) – Popular prescription medications for insomnia include the so-called Z-drugs: Ambien (zolpidem), Lunesta (eszopiclone) and Sonata (zaleplon). These drugs have shorter durations of action than older drugs such as the benzodiazepine Dalmane (flurazepam). That means they may help you fall asleep, but their effects don’t last very long. They also are less likely to lead to morning grogginess.

Determining the Fate of Frozen Embryos

(CNN) – The first option we considered with our remaining embryos was to do nothing. Just leave them on ice and make a decision later. They can stay frozen for a long time — in 2005, a child was born from an embryo frozen 13 years earlier — though our clinic recommends waiting no more than seven years. We asked, “What happens if we don’t pay?” The doctor shrugged. “Would you destroy them?” The doctor shook her head. In my experience fertility doctors shrug a lot. There’s a lot of guesswork. Of course they keep billing you.

 

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