Physician-defined patient complexity differs from current diagnosis-based measures |  |
- Physician-defined patient complexity differs from current diagnosis-based measures
- For homeless Delhi kids, winter means more sedatives
- Scientists identify cell death pathway involved in lethal sepsis
- New device could bring optical information processing
| Physician-defined patient complexity differs from current diagnosis-based measures Posted: 23 Dec 2011 05:00 AM PST ( From http://www.rxpgnews.com ) As Americans live longer with multiple medical conditions, managing their care is becoming increasingly challenging. Being able to define and measure patient complexity has important implications for how care is organized, how physicians and health care systems are paid, and how resources are allocated. In an article in the Dec. 20 Annals of Internal Medicine, a team of Massachusetts General Hospital (MGH) researchers report finding that primary care physicians define patient complexity using a broader range of factors – including mental health, social factors and financial issues – than do commonly used approaches based only on diagnoses and prior costs. "Simply counting the number of co-morbid conditions does not really capture whether a patient is complex," explains Richard W. Grant, MD, MPH, the paper's lead author. "All primary care physicians can point to patients of theirs with very complicated medical histories who are relatively straightforward to manage, whereas other patients can be a real challenge despite relatively few medical diagnoses. Our results emphasize the importance of social and behavioral contexts that can create important barriers to delivering high-quality primary care." The study enrolled 40 primary care physicians from 12 MGH-affiliated practices and community health centers. Participating physicians used a web-based tool to review a list of 120 of their own patients and indicated those who, in their view, were complex. For those complex patients, they were asked to indicate which of five domains – medical decision-making, coordinating care, mental health or substance abuse problems, health-related behaviors, and social or economic circumstances – were involved in that determination. The authors found that primary care physicians designated about one-quarter of their patients as complex – with older, more experienced physicians and those working in community health centers reporting higher... http://www.rxpgnews.com    |
| For homeless Delhi kids, winter means more sedatives Posted: 22 Dec 2011 04:02 PM PST ( From http://www.rxpgnews.com ) New Delhi, Dec 22 - The national capital's freezing winters bring an agonising time for the homeless. For many, especially children, the only way to escape the cold is to inhale a variety of sedatives to keep themselves numb in an attempt to fight the chilly weather. About 80 percent of the capital's 50,000 homeless children use diluter fluid, boot polish, 'beedis', rubber tubes and even cough syrups to fight the cold, say activists. 'Homeless kids aged between 6 and 18 widely sniff whiteners, particularly in winter, to get high and escape the cold. A child sniffs around five bottles of whiteners a day on very cold days. It numbs their bodies and they do not feel cold,' Sanjay Gupta, director of Chetna, a city-based NGO working for homeless children, told IANS. A survey by Chetna in 2009 conducted in 13 locations of Delhi found that the diluters used in whiteners are sold in the capital for around Rs.20 every day. 'The whiteners come in a pack with a correction fluid and a diluter. At times certain people only ask for cheap diluters. So, while an entire pack of diluters costs Rs.26, a bottle costs around Rs.11. A bottle of concentrated diluter costs around Rs.20. We make profit by selling diluters alone and there is a good demand for it,' said a retail shop owner, pleading anonymity. A string of shops selling these diluter fluids can be seen near the alleys of Nizamuddin Dargah and railway station in central Delhi. For 11-year-old Shiksha, who lives near Jama Masjid, a thin cardigan and a cotton trouser are not enough to fight the biting cold. When the chilly, windy weather hits the capital, Shiksha is not able to resist diluter fluid and sniffs it so that she can sleep well. 'Once the wind sweeps by, it gets difficult to breathe; my eyes burn and nose waters. After my sister and others insisted on sniffing diluters, I started using them. Now I cannot do without them,' Shiksha confesses. According to data collected by the... http://www.rxpgnews.com   |
| Scientists identify cell death pathway involved in lethal sepsis Posted: 22 Dec 2011 05:00 AM PST ( From http://www.rxpgnews.com ) Sepsis, a form of systemic inflammation, is the leading cause of death in critically ill patients. Sepsis is linked with massive cell death; however, the specific mechanisms involved in the lethality of sepsis are unclear. Now, a new study published by Cell Press in the December 23rd issue of the journal Immunity finds that inhibition of a specific cell death pathway called necroptosis protected mice from lethal inflammation. The research may lead to new therapeutic interventions for fatal inflammatory conditions that are notoriously hard to control. Systemic inflammatory response syndrome (SIRS) is a body-wide inflammatory response that can be caused by an infection, such as in the condition sepsis, or by some sort of physical trauma, such as a severe burn. Sepsis and SIRS are thought to be caused by the cytokine tumor necrosis factor (TNF). However, although research has shown that TNF functions in inflammation, cell death, and survival, the specific mechanisms linking TNF with SIRS are not well understood. Engagement of TNF receptor 1 activates two diametrically opposed pathways: survival/inflammation and cell death, explains senior study author, Dr. Peter Vandenabeele, from Ghent University and Flanders Institute for Biotechnology (VIB) in Belgium. An additional switch decides, depending on the cellular context, between apoptosis and necroptosis, two different cell death pathways. In our study, we explored the involvement of both of these cell death pathways in SIRS. Dr. Vandenabeele and colleagues found that while disruption of molecules required for apoptosis had no impact on lethal SIRS, inhibition or genetic deletion of RIPK molecules, which are required for necroptosis, provided complete protection against SIRS lethality. Basically, inhibition of one type of cell death did not protect mice from lethal inflammation while disruption of a different cell death pathway improved survival. The researchers went on to confirm... http://www.rxpgnews.com   |
| New device could bring optical information processing Posted: 22 Dec 2011 05:00 AM PST ( From http://www.rxpgnews.com ) WEST LAFAYETTE, Ind. - Researchers have created a new type of optical device small enough to fit millions on a computer chip that could lead to faster, more powerful information processing and supercomputers. The passive optical diode is made from two tiny silicon rings measuring 10 microns in diameter, or about one-tenth the width of a human hair. Unlike other optical diodes, it does not require external assistance to transmit signals and can be readily integrated into computer chips. The diode is capable of nonreciprocal transmission, meaning it transmits signals in only one direction, making it capable of information processing, said Minghao Qi (pronounced Chee), an associate professor of electrical and computer engineering at Purdue University. This one-way transmission is the most fundamental part of a logic circuit, so our diodes open the door to optical information processing, said Qi, working with a team also led by Andrew Weiner, Purdue's Scifres Family Distinguished Professor of Electrical and Computer Engineering. The diodes are described in a paper to be published online Thursday (Dec. 22) in the journal Science. The paper was written by graduate students Li Fan, Jian Wang, Leo Varghese, Hao Shen and Ben Niu, research associate Yi Xuan, and Weiner and Qi. Although fiberoptic cables are instrumental in transmitting large quantities of data across oceans and continents, information processing is slowed and the data are susceptible to cyberattack when optical signals must be translated into electronic signals for use in computers, and vice versa. This translation requires expensive equipment, Wang said. What you'd rather be able to do is plug the fiber directly into computers with no translation needed, and then you get a lot of bandwidth and security. Electronic diodes constitute critical junctions in transistors and help enable integrated circuits to switch on and off and to... http://www.rxpgnews.com   |
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