Recent Developments in Health Care Law: Culture and Controversy

This article reviews recent developments in health care law, focusing on controversy at the intersection of health care law and culture. The article addresses: emerging issues in federal regulatory oversight of the rapidly developing market in direct-to-consumer genetic testing, including questions about the role of government oversight and professional mediation of consumer choice; continuing controversies surrounding stem cell research and therapies and the implications of these controversies for healthcare institutions; a controversy in India arising at the intersection of abortion law and the rights of the disabled but implicating a broader set of cross-cultural issues; and the education of U.S. health care providers and lawyers in the theory and practice of cultural competency.     

Editorial

The present study was conducted to determine whether older adults can learn and retain information on asthma and play a role as community health workers to teach children about asthma. A total of 36 older adults and 28 students in grades K-6 participated. Pre-tests and post-tests were administered to participants. Improvement in older adult scores after training was significant (p =. 001), and improvement persisted through the conclusion of teaching sessions (p = 0.001). The increase in lower student scores was significant (p = 0.050). Results suggest that older adults can learn and retain asthma information and schoolchildren can learn asthma-related information taught by older adults.     

Postgraduate Medicine

Two unique cases are presented to illustrate that combinations of dislocations among carpal bones are practically limitless. The authors describe a perilunar dislocation in a diabetic patient which was reduced under general anesthesia. However, because the carpal navicular could not be stabilized, arthrodesis of the wrist was carried out. They also review a manipulative reduction performed for dislocation of the distal portion of the radio-ulnar joint with anterior displacement of the distal portion of the ulna.     

Technical Exhibits

Some important but little-emphasized nutritional aspects of gastrointestinal physiology are discussed. Experimental studies which form the basis for present understanding of fluid and electrolyte problems are reviewed briefly. Other topics include harmful and beneficial effects of gastrointestinal bacteria, protein-losing enteropathies, and nutritional problems associated with gastrointestinal resection.     

Association Notes

Neurologic evaluation during the first year of life serves to separate infants into normal and abnormal groups and to identify those who should be carefully watched. The evaluation must reflect physical findings as well as neurologic status, and emphasize the patterned and stereotyped responses characteristic of certain periods of infancy.     

Satisfaction with rehabilitation in relation to self‐perceived quality of life and function among patients with stroke – a 12 month follow‐up

Scand J Caring Sci; 2013; 27; 373–379 Satisfaction with rehabilitation in relation to self‐perceived quality of life and function among patients with stroke – a 12 month follow‐up Background and Purpose: Stroke causes complex disability and function, and perceived quality of life has been shown to correlate with satisfaction with care as well as with life in general among stroke patients. The aim of this study was to study the relation of satisfaction with how rehabilitation was provided with self‐perceived quality of life, self‐perceived function and rehabilitation received, 12 months after the incidence. Method: The subjects were assessed 12 months after the onset of stroke. The Barthel index was used to measure function, and the EuroQol‐5D to measure quality of life. To measure satisfaction with how rehabilitation was provided, a questionnaire from the Swedish Stroke Register was used. Results: Two hundred and eighty‐three patients participated in the follow‐up, 137 women and 146 men, aged between 42 and 95 years (mean age 75.2, SD 11.8). For the majority of patients rehabilitation was initiated at in‐hospital care (directly after onset). One hundred and sixty‐eight patients considered that rehabilitation was well provided for. Sixty‐six regarded that the rehabilitation was only partly provided for and 35 that it was not provided for at all. High value on Barthel Index was associated with satisfaction with how rehabilitation was provided for (OR 2.81). Also, rehabilitation on three or more levels was negatively associated with satisfaction with rehabilitation provision (OR 0.24) and so was being male (OR 0.49). Conclusion: In this study, patients with higher values on Barthel Index were more satisfied with how rehabilitation was provided for. However, male patients and patients who received rehabilitation on three or more levels of care were less satisfied. Given the assumption that patients with more severe dysfunction after stroke are being rehabilitated on more levels, this might imply that it is not the amount of rehabilitation that gives satisfaction but the patients self‐perceived function after rehabilitation.     

New Haven (1974)-Characteristics of a Hospice program of care

Abstract

Under physician leadership, Hospice, Inc., started a home care program for terminally ill cancer patients and their families in March 1974. This paper is based on the 3-year evaluation by the medical director who argues that priority of care should be directed to physical needs, managed in a problem-oriented approach.     

Multiphoton microscopy for pre-clinical evaluation of flow-diverter stents for treating aneurysms

BackgroundConventional histological analyses are the gold standard for the study of aneurysms and vascular pathologies in pre-clinical research. Over the past decade, in vivo and ex vivo imaging using multiphoton microscopy have emerged as powerful pre-clinical tools for detailed tissue analyses that can assess morphology, the extracellular matrix (ECM), cell density and vascularisation. Multiphoton microscopy allows for deeper tissue penetration with minor phototoxicity.ObjectiveThe present study aimed to demonstrate the current status of multimodality imaging, including multiphoton microscopy, for detailed analyses of neo-endothelialisation and ECM evolution after flow-diverter stent (FDS) treatment in an experimental rabbit model of aneurysms.MethodsMultiphoton microscopy tools for assessing autofluorescence and second harmonic generation (SHG) signals from biological tissues were used to evaluate the endovascular treatment of intracranial aneurysms in an animal model of aneurysms (pig, rabbit). Results from multiphoton microscopy were compared to those from standard histology, electronic and bright field microscopy.ConclusionsThe present study describes novel evaluation modes based on multiphoton microscopy for visualising tissue morphology (e.g., collagen, elastin, and cells) to qualify and quantify the extent of neo-intimal formation of covered arteries and device integration into the arterial wall using a rabbit model of intracranial aneurysms treated with FDS.     

Prediction of iron deficiency in chronic inflammatory rheumatic disease anaemia

Summary. We prospectively studied 45 anaemic patients (3 7 women, 8 men) with chronic inflammatory rheumatic diseases. The combination of serum ferritin and CRP (as well as ESR) in its predictive capacity for bone marrow iron stores was examined. The relationship between other iron-related measurements (transferrin, transferrin saturation, soluble transferrin receptor, erythrocyte porphyrins and percentage of hypochromic/microcytic erythrocytes) and bone marrow iron stores was also investigated. Stainable bone marrow iron was taken as the most suitable standard to separate iron-deficient from iron-replete patients. 14 patients (31%) were lacking bone marrow iron. Regression analysis showed a good correlation between ferritin and bone marrow iron (adjusted R ²=0.721, P<00001). The combination of ferritin and CRP (ESR) did not improve the predictive power for bone marrow iron (adjusted R ²=0.715) in this cohort of patients with low systemic inflammatory activity. With respect to the bone marrow iron content the best predictive cut-off value of ferritin was 30μg/l (86% sensitivity, 90% specificity). The other iron-related parameters both individually and when combined were less powerful in predicting bone marrow iron than ferritin alone. Only zinc bound erythrocyte protoporphyrin in combination with ferritin slightly improved prediction (adjusted R ²=0.731). A cut-off point of 11% hypochromic erythrocytes reached a high specificity (90%), but was less sensitive (77%).