Medicine and Health Sciences Commons^™

Alcohol And Environmental Justice: The Density Of Liquor Stores And Bars In Urban Neighborhoods In The United States, John Romley, Deborah Cohen, Jeanne Ringel, Roland Sturm

Roland Sturm

Objective: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. Method: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. Results: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas …

Interprofessional Information Work: Innovations In The Use Of The Chart On Internal Medicine Teams, Lorelei Lingard, Lesley Conn, Ann Russell, Scott Reeves, Karen-Lee Miller, Chris Kenaszchuk, Merrick Zwarenstein

Lorelei Lingard

An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work - the gathering, storage, retrieval and discussion of patient information - may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work - the use of patient charts to foster collaborative decision-making and care enactment - towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work …

The Suitability Of Mindfulness-Based Stress Reduction For Chronic Hepatitis C, Lynn Koerbel, Donna Zucker

Donna M. Zucker

As incidence of chronic hepatitis C (CHC) in the United States increases, management of physical and psychological symptoms over the long term becomes crucial. Research has shown meditation to be a valuable tool in reducing such symptoms for various chronic illnesses. In particular, the Mindfulness-Based Stress Reduction (MBSR) program offers curriculum that has been show to influence both physiology and perception of disease states. Although there has been not direct research to date on the effectiveness of the MBSR program for CHC, several studies have shown significant findings affecting other chronic conditions including heart disease, fibromyalgia and HIV. The purpose …

Delivering Library Services To Distance Learners: A Grass Roots Effort At A Regional Campus., Tammy Guerrero, Kimberly Whalen, Lynda Willer

Kimberly J. Whalen

No abstract provided.

Co-Management In Healthcare: Negotiating Professional Boundaries, Catherine Schryer, Olga Gladkova, Marlee Spafford, Lorelei Lingard

Lorelei Lingard

This article investigates discursive practices associated with the co-management of patients between healthcare providers. Specifically, we focus on two genres (38 referral letters and 37 consultant reports) written by optometrists and ophthalmologists — two groups who are experiencing interprofessional tension over their scopes of practice. In our analysis we foreground four kinds of modality associated with verbs — epistemic, deontic, phatic and subjective. We found that these healthcare providers shared in the epistemic resources used to hedge their sense of clinical certainty, and that ophthalmologists used deontic resources to control future action. However, we also noted that both professions used …

Ethics Of Surgical Training In Developing Countries, Kevin Ramsey, Charles Weijer

Charles Weijer

The practice of surgical trainees operating in developing countries is gaining interest in the medical community. Although there has been little analysis about the ethical impact of these electives, there has been some concerns raised over the possible exploitation of trainees and their patients. An ethical review of this practice shows that care needs to be taken to prevent harm. Inexperienced surgeons learning surgical skills in developing countries engender greater risk of violating basic ethical principles. Advanced surgical trainees who have already achieved surgical competence are best qualified to satisfy these ethical issues. All training programs need to develop a …

Negotiating The Politics Of Identity In An Interdisciplinary Research Team, Lorelei Lingard, Catherine Schryer, Marlee Spafford, Sandra Campbell

Lorelei Lingard

This article explores the politics of identity in an interdisciplinary health research team that has been engaged in a qualitative research program for over five years. We draw on sociological theories of power and knowledge to explore our experiences of identity conflict, team socialization, and knowledge production. Structurally, our article integrates individual and group perspectives through personal narratives and collaborative critique as we explore the complex negotiations required to realize and maintain our team dynamic. These negotiations take place not only with one another as particularly positioned individuals, but also with the ideological and organizational forces that structure our scholarly …

Systematic Review Of Baseline Low-Dose Ct Lung Cancer Screening., Michael Lock

Michael Lock

The purpose of this systematic review was to provide physicians and patients with a synthesis of the available data and an assessment of the operating characteristics associated with baseline LDCT screening for lung cancer. Various databases, meeting abstracts, clinical trials in progress, and major textbooks for relevant data from 1966 to 2006 were searched for relevant studies. The median value of sensitivity, specificity, positive predictive value and negative predictive value were 81%, 81%, 8% and 99%, respectively. Of the studies that compared LDCT with other lung cancer screening maneuvers, it was found that LDCT detected a greater number of cancerous …

Rural Utility Cooperative (Ruc) Final Evaulation Report: Alaska Native Tribal Health Consortium (Anthc), R. Konkel

Steve Konkel

The Rural Utility Cooperative (RUC) Final Evaluation is designed to answer several interrelated

questions:

• Is the RUC working as envisioned?

• Is it making an impact in the RUC Communities?

• Are the RUC Communities better off than the Non-RUC communities?

Qualitative Research In The Rime Community: Critical Reflections And Future Directions, Lorelei Lingard

Lorelei Lingard

No abstract provided.

Evaluating Benefits And Harms In Intensive Care Research, Charles Weijer, Paul Miller

Charles Weijer

No abstract provided.

Implementation Of The Intervention-Based Family Assessment Procedure: A Case Study, Jeanne Jenkins, Audrey Ellenwood

Jeanne E. Jenkins

Chronic illness is a worldwide phenomenon impacting the emotional stability and daily functioning of families across cultures. Families with a chronically ill member are in need of interventions and therapy, yet, time constraints and care-taking demands make it difficult for families to seek traditional family therapy services. The objectives of this article are to (1) overview the Intervention-Based Family Assessment Procedure (IBFA) and (2) present a case vignette demonstrating the implementation of the procedure. The IBFA is an effective diagnostic tool and intervention strategy to help family therapists alter the dysfunctional and rigid structural dynamics of families with a chronically …

Questioning Competence: A Discourse Analysis Of Attending Physicians' Use Of Questions To Assess Trainee Competence, Tara Kennedy, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Attending physicians (APs) must constantly assess trainees' competence to act independently, to promote learning while ensuring quality of care. This study aimed to explore, through discourse analysis of case presentations, the process of competence assessment for case-specific clinical independence.

METHOD: Twenty-six case presentations in emergency medicine were observed and audiorecorded. A discourse analysis was conducted, focusing on APs' use of questioning strategies.

RESULTS: Questioning strategies involved clarifying questions (to ensure APs' understanding of the case), probing questions (to probe trainees' understanding of a case or their underlying knowledge), and challenging questions (to challenge presuppositions). Case-related probing questions and challenging …

Seeing And Listening: A Visual And Social Analysis Of Optometric Record-Keeping Practices, Lara Varpio, Marlee Spafford, Catherine Schryer, Lorelei Lingard

Lorelei Lingard

This article investigates the contribution visual rhetoric and rhetorical genre studies (RGS) can make to health care education and communication genres. Through a visual rhetorical analysis of a patient record used in an optometry teaching clinic, this article illustrates that a genre's visual representations provide significant insights into the social action of that genre. These insights are deepened by an insider analysis of the patient record that highlights how content analyses of visual designs need to be elaborated by contextual considerations. A combined visual rhetoric and RGS analysis shows that clinical novices learn to interpret the record's visual cues to …

Assessment Of Indirect Cost-Of-Illness In A Subsistence Farming Society By Using Different Valuation Methods, Tin Su

Tin Tin Su

Indirect costs or productive labour time lost are the largest share of household economic burden of illness. However, the estimate of household indirect cost can vary depending on the valuation methods used. We therefore estimated household indirect cost in a subsistence farming society in Burkina Faso based on daily production value. These results were validated by using willingness-to-pay method and current wage rate. Among the three methods, the value of a day lost for adults assessed by willingness-to-pay method was considerably higher than other methods. There were no significant differences in indirect costs estimated by daily production value and wage …

Fatigue As A Symptom Of Acute Myocardial Infarction, Ann L. Eckhardt, Michelle Fennessy, Anne Fink, Jessica Jones, Kathryn Szigetvari, Donna Kruse, Laura Tucco, Cathy Ryan, Julie J. Zerwic

Ann L. Eckhardt

Bell's Palsy: Diagnosis And Management, Jeffrey D. Tiemstra, N Khakhate

Jeffrey Tiemstra, MD, FAAFP

Revisiting Equipoise: A Response To Gifford, Paul Miller, Charles Weijer

Charles Weijer

The authors respond to objections Fred Gifford has raised against their paper "Rehabilitating Equipoise." They situate this exchange in the wider context of recent debate over equipoise, highlighting substantial points of agreement between themselves and Gifford. The authors offer a brief restatement of "Rehabilitating Equipoise" in which they amplify some of its core arguments. They then assess Gifford's objections. Finding each to be unfounded, they argue that there is no justification for "pulling the plug" on clinical equipoise.

Evidence For The Regulation Of Contraction-Induced Fatty Acid Oxidation Via Extracellular Signal-Regulated Kinase 1/2 Activation Independent Of Changes In Fatty Acid Uptake, Marcella Raney, Lorraine Turcotte

Marcella Raney

Abstract Data show that extracellular signal-regulated kinase 1/2 (ERK1/2) may be involved in the regulation of fatty acid (FA) uptake during muscle contraction via stimulation of CD36 translocation to the plasma membrane. The perfused hind limb model was used to determine (1) the importance of ERK1/2 signaling on contraction-induced FA uptake and (2) the effect of ERK1/2-mediated FA uptake on contraction-induced FA oxidation. We perfused rat hind limbs with 8 mmol/L glucose, 550 μmol/L palmitate, and no insulin at rest in the absence of inhibitor and during moderate-intensity electrical stimulation and dose-dependent pharmacologic inhibition of ERK1/2 using increasing concentrations of …

Computed Tomographic Screening For Lung Cancer., Michael Lock

Michael Lock

No abstract provided.

Refuting The Net Risks Test: A Response To Wendler And Miller's "Assessing Research Risks Systematically", Charles Weijer, Paul Miller

Charles Weijer

Earlier in the pages of this journal (p 481), Wendler and Miller offered the "net risks test" as an alternative approach to the ethical analysis of benefits and harms in research. They have been vocal critics of the dominant view of benefit-harm analysis in research ethics, which encompasses core concepts of duty of care, clinical equipoise and component analysis. They had been challenged to come up with a viable alternative to component analysis which meets five criteria. The alternative must (1) protect research subjects; (2) allow clinical research to proceed; (3) explain how physicians may offer trial enrolment to their …

Measuring Quality Of Care In Patients With Multiple Clinical Conditions: Summary Of A Conference Conducted By The Society Of General Internal Medicine, Barbara Turner

Barbara Turner

Abstract Performance measurement has been widely advocated as a means to improve health care delivery and, ultimately, clinical outcomes. However, the evidence supporting the value of using the same quality measures designed for patients with a single clinical condition in patients with multiple conditions is weak. If clinically complex patients, defined here as patients with multiple clinical conditions, present greater challenges to achieving quality goals, providers may shun them or ignore important, but unmeasured, clinical issues. This paper summarizes the proceedings of a conference addressing the challenge of measuring quality of care in the patient with multiple clinical conditions with …

Reducing Liver Cancer Disparities - A Community-Based Hepatitis B Prevention Program For The Asian American Communities In Maryland, Chiehwen Ed Hsu

Chiehwen Ed Hsu

Objectives: Several Asian-American groups are at a higher risk of dying of liver diseases attributable to Hepatitis B infection. This culturally diverse community should be well informed of and protected against liver diseases. The present study assesses the knowledge of Hepatitis B before and after a Hepatitis B educational program and determines the infection status of an Asian community. Methods: Nine Asian communities of Montgomery County, Maryland enrolled in the Hepatitis B prevention program between Year 2005 and 2006. They attended culturally-tailored lectures on prevention, completed self administered pre-and-post tests, and received blood screening for the disease. Results: More than …

Should Antipsychotics Be Used In Prodromal Phase Of Psychosis?, Amresh Shrivastava

Amresh Srivastava

No abstract provided.

Silence Is Not Always Golden In Medical Decision-Making, Michael Moreland

Michael P. Moreland

No abstract provided.

Nodal Ratios In Node-Positive Breast Cancer—Long-Term Study To Clarify Discrepancy Of Role Of Supraclavicular And Axillary Regional Radiotherapy, Patricia Tai, Kurian Joseph, Evgeny Sadikov, Shazia Mahmood, Francis Lien, Edward Yu

Edward Yu

Purpose: To study the absolute number of involved nodes/the number of nodes examined or the nodal ratio (NR) in breast cancer. The primary study endpoint was to evaluate the role of supraclavicular and axillary radiotherapy (SART) according to the NR. Methods and materials: From the Saskatchewan provincial registry of 1981-1995, the charts of 5,996 consecutive patients were retrieved to collect detailed prognostic factors. Among these patients, 1,985 were node positive. Because the NRs are more reliable the greater the number of nodes examined, we analyzed 1,255 patients with > or =10 nodes examined. Of these 1,255 patients, 667, 389, and 199 …

Early Psychosis: A Bridge To Future, Amresh Srivastava

Amresh Srivastava

No abstract provided.

Transition-State Variation In Human, Bovine, And Plasmodium Falciparum Adenosine Deaminases, Minkui Lou, Vipender Singh, Erika Taylor, Vern Schramm

Erika A. Taylor, Ph.D.

Adenosine deaminases (ADAs) from human, bovine, and Plasmodium falciparum sources were analyzed by kinetic isotope effects (KIEs) and shown to have distinct but related transition states. Human adenosine deaminase (HsADA) is present in most mammalian cells and is involved in B- and T-cell development. The ADA from Plasmodium falciparum (PfADA) is essential in this purine auxotroph, and its inhibition is expected to have therapeutic effects for malaria. Therefore, ADA is of continuing interest for inhibitor design. Stable structural mimics of ADA transition states are powerful inhibitors. Here we report the transition-state structures of PfADA, HsADA, and bovine ADA (BtADA) solved …

Organisms Associated With Bacterial Vaginosis In Nigerian Women As Determined By Pcr-Dgge And 16s Rrna Gene Sequence, Kingsley Anukam, Gregor Reid

Kingsley C Anukam

Background: Bacterial vaginosis (BV) is a condition with diverse etiology. This condition predisposes women to increased susceptibility to sexually transmitted diseases, including human immunodeficiency virus (HIV) infections and preterm birth. The diagnostic methods currently adopted in the evaluation of patient samples for BV are arguably Amsel criteria, and Nugent score that require microscopy and expert interpretation. These two methods are still subjective. Objective: The objective of this study was to determine the organisms present in the vagina of 34 HIV negative Nigerian women diagnosed as having bacterial vaginosis by using molecular techniques. Methods: The vaginal samples were subjected to DNA …

Screening For Gestational Diabetes At Antenatal Booking In A Malaysian University Hospital: The Role Of Risk Factors And Threshold Value For The 50-G Glucose Challenge Test, Siti Zawiah Omar

Siti Zawiah Omar

Background: The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population. Aims: To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT Method: In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT Women who had GCT >= 7.2 mmol/L underwent the 75-g oral glucose …