Article Date: 10 Oct 2011 - 0:00 PDT
"A new study from the Centre for Addiction and Mental Health has found evidence that a specific gene is linked to suicidal behaviour, adding to our knowledge of the many complex causes of suicide. This research may help doctors one day target the gene in prevention efforts.
In the past, studies have implicated the gene for brain-derived neurotrophic factor (BDNF) in suicidal behaviour. BDNF is involved in the development of the nervous system.
After pooling results from 11 previous studies and adding their own study data involving people with schizophrenia, CAMH scientists confirmed that among people with a psychiatric diagnosis, those with the methionine ("met") variation of the gene had a higher risk of suicidal behaviour compared to those with the valine variation. . . " Read More
Article Date: 19 Aug 2011 - 1:00 PDT
"Recurring headaches are common during the year following a traumatic brain injury (TBI), regardless of the severity of the TBI, and they tend to occur more often among females and those with a pre-TBI history of headache, according to an article in Journal of Neurotrauma, a peer-reviewed journal published by Mary Ann Liebert, Inc. The article is available free online at the link below.
More than 70% of patients who had suffered a TBI reported having headaches during the first year after their injury. This finding is a result of a multi-center study described by Jeanne Hoffman, PhD, Department of Rehabilitation Medicine, University of Washington, Seattle, and a group of colleagues from University of Washington, Craig Hospital (Denver, CO), Mayo Clinic (Rochester, MN), University of Alabama at Birmingham, University of Texas Southwestern Medical School (Dallas), Virginia Commonwealth University (Richmond), and Moss Rehab (Philadelphia, PA).
Females and persons with a pre-injury history of headache were significantly more likely to report headache, but there was no statistical link between incidence of post-injury headache and the severity of the TBI."
Sources: Mary Ann Liebert, Inc., Publishers, AlphaGalileo Foundation.
One of the keystones of forensic science is DNA testing. DNA (deoxyribonucleic acid) is the genetic material present in every cell. Each individual has a Unique DNA Profile. There are even a few differences between the DNA of identical twins.
A British scientist, Sir Alec Jeffreys, developed DNA profiling in the 1980s. DNA for profiling can be extracted from samples of human cells found at a Crime Scene, including blood, semen, skin, saliva, mucus, perspiration and the roots of hair, and Profiling can even be carried out on old and dried out samples.
The case of Colin Pitchfork was the first murder conviction based on DNA profiling evidence (there was a previous rape conviction based on this type of evidence).
In 1986, another 15-year-old schoolgirl, Dawn Ashworth, was similarly sexually assaulted and strangled in the nearby village of Enderby, and semen samples showed the same blood type.
Richard Buckland, a local 17-year-old with learning disabilities who worked at Carlton Hayes psychiatric hospital, had been spotted near Dawn Ashworth’s murder scene and knew unreleased details about the body. In 1986, he confessed to Dawn Ashworth’s murder but not Lynda Mann’s.
Using Sir Alec Jeffreys’ new technique, scientists compared the semen samples with a blood sample from Richard Buckland. This proved that both girls were murdered by the same man, and also proved that this man was not Richard Buckland – the first person to be exonerated using DNA. . . Read More
Article Date: 05 Aug 2011 - 0:00 PDT
" Fatal overdoses involving prescribed opioids tripled in the United States between 1999 and 2006, climbing to almost 14,000 deaths annually - more than cocaine and heroin overdoses combined. Hospitalizations and emergency room visits related to prescription opioid pain medicines such as oxycodone (brand name Oxycontin) and hydrocodone (Vicodin) also increased dramatically in the same period.
Now a report in the August issue of Health Affairs describes a major initiative at Group Health to make opioid prescribing safer while improving care for patients with chronic pain. Health Affairs is the nation's premier health policy journal, and its August issue focuses on substance abuse.
In the Group Health initiative's first nine months, clinicians at the Seattle-based integrated health system developed and documented care plans for almost 6,000 patients - 85 percent of those receiving long-term opioid therapy for chronic non-cancer pain.
Group Health's initiative was implemented well before the White House Office of Drug Control Policy, the Food and Drug Administration, and the Drug Enforcement Administration announced a national action plan in April 2011 to stem the epidemic of prescription drug abuse. Scientists from Group Health Research Institute are evaluating the initiative's effects on care, hoping Group Health's experience can help guide national efforts.
Use of prescription opioids has increased sharply since the 1980s. Excluding people with cancer and those in end-of-life care, about 4 percent of U.S. adults now use prescription opioids long term. Pharmaceutical industry advocacy and education have fueled increased opioid prescribing for chronic non-cancer pain - despite limited scientific evidence supporting the drugs' long-term effectiveness for chronic non-cancer pain.
In January 2010, Group Health Research Institute Senior Investigator Michael Von Korff, ScD, and colleagues published the first-ever study on overdose risk by dose among patients receiving prescribed opioids for chronic non-cancer pain. That study, published in the Annals of Internal Medicine, linked higher risk of fatal and nonfatal overdose to higher daily dose prescribed. His research also showed that Group Health, like other health systems nationwide, had been prescribing more opioids for chronic non-cancer pain over time - a twofold increase from 1997 to 2005.
Group Health launched a major primary care-based initiative to enhance opioid prescribing safety later in 2010. Led by Group Health Medical Director of Primary Care Claire Trescott, MD, the initiative aims to standardize use of opioids for chronic non-cancer pain, without creating undue restrictions on clinically appropriate opioid prescribing."
Article Date: 31 Jul 2011 - 0:00 PDT
If you suffer traumatic brain injury, your risk of having a stroke within three months may increase tenfold, according to a new study reported in Stroke: Journal of the American Heart Association.
"It's reasonable to assume that cerebrovascular damage in the head caused by a traumatic brain injury can trigger either a hemorrhagic stroke [when a blood vessel bursts inside the brain] or an ischemic stroke [when an artery in the brain is blocked]," said Herng-Ching Lin, Ph.D., senior study author and professor at the School of Health Care Administration, College of Medicine, Taipei Medical University in Taiwan. "However, until now, no research had been done showing a correlation between traumatic brain injury and stroke."
It is the first study that pinpoints traumatic brain injury as a potential risk factor for subsequent stroke.
Traumatic brain injury occurs when an external force such as a bump, blow or jolt to the head disrupts the normal function of the brain. Causes include falls, vehicle accidents, and violence.
In the United States alone, approximately 1 in 53 individuals sustain a traumatic brain injury each year, according to 2004 statistics from the Centers for Disease Control and Prevention.
Worldwide, traumatic brain injuries are a major cause of physical impairment, social disruption and death.
Using records from a nationwide Taiwanese database, researchers investigated the risk of stroke in traumatic brain injury patients during a five-year period. The records included 23,199 adult traumatic brain injury patients who received ambulatory or hospital care between 2001 and 2003. The comparison group comprised 69,597 non-traumatic brain injury patients. The average age of all patients was 42 and 54 percent were male.
During the three months after injury, 2.91 percent of traumatic brain injury patients suffered a stroke compared with only 0.30 percent of those with non-traumatic brain injury - a tenfold difference.
Stroke risk in patients with traumatic brain injury decreased gradually over time, researchers said:
Stroke risk among traumatic brain injury patients with skull bone fractures was more pronounced than in traumatic brain injury patients without fractures, researchers said.
During the first three months, those with skull bone fractures were 20 times more likely to have a stroke than patients without skull bone fractures. The risk decreased over time.
Furthermore, the risk of subarachnoid hemorrhage (bleeding in the area between the brain and the thin tissues that cover the brain) and intracerebral hemorrhage (bleeding in the brain caused by the rupture of a blood vessel) increased significantly in patients with traumatic brain injury versus non-traumatic brain injury patients. . . " Read More
Many adverse events can be prevented, providing what a patient safety expert calls "humongous opportunities for improvement."
By Kevin B. O'Reilly, amednews staff. Posted April 18, 2011.
"One-third of hospital patients experience adverse events and about 7% are harmed permanently or die as a result, according to a study that detected patient safety problems at a far higher rate than other methods.
The study, in April's Health Affairs, echoes two reports issued in November 2010 that showed rates of adverse events hovering near 25% among hospitalized Medicare patients nationwide and at 10 North Carolina hospitals.
The findings draw attention to the safety troubles that have lingered in U.S. hospitals in the 12 years since the Institute of Medicine's headline-grabbing report "To Err is Human." The study cited research estimating that up to 98,000 patients die each year due to preventable medical errors.
"This is one of the best studies that now gives us a sense of how much harm is happening to patients in American hospitals," said Robert Wachter, MD, chief of the medical service at the University of California, San Francisco Medical Center, who was not involved in the research. "There is a tremendous amount of harm befalling patients who are admitted to hospitals and humongous opportunities for improvement."
To judge from a survey released March 31, patients are scared of medical mishaps. Nearly 60% of adults polled by the Consumer Reports National Research Center believe medical errors are common in hospitals, and nearly half said serious harm is common. Nearly 80% of patients said they feared contracting an infection in a hospital, 71% were worried about medication errors and 65% were scared of surgical mistakes. . . " Read More
New Tracking Tool Suggests Medical Errors May Occur in One-Third of Hospital Admissions
By Denise Mann
WebMD Health News
"April 7, 2011 -- Medication errors, infections, and other hospital-related errors may be 10 times more common than previously estimated, according to a study involving a new tracking tool.
Medical errors may actually occur in as many of one-third of hospital admissions, according to a new study in the April issue of Health Affairs.
“It’s a little scary,” admits study author David C. Classen, MD, an associate professor of medicine at the University of Utah in Salt Lake City.
Whether the problem is getting worse or error tracking methods are improving is not known. “We have gotten better tools to detect medical errors which give us a better yardstick to determine if we are improving,” he says.
Researchers used the Institute for Healthcare Improvements’ Global Trigger Tool. With this method, two or three trained nurses or pharmacists review medical charts for certain triggers such as a stop-medication order, an abnormal lab test result, or the use of a known antidote, and then follow up with a physician review of the medical chart to see if these triggers led to any medical mistakes.
Study results show the new tool may be more sensitive than other tracking methods, including voluntary reporting and other measures.
Common hospital errors included medication-related issues, procedure-related mistakes, and hospital-acquired infections. The most severe mistakes were related to a surgery or procedure, the new study showed.
Classen says that asking questions and demanding answers can help reduce the risk of medical errors when you are hospitalized.
If someone tries to give you medication, “stop and say ‘I want to hear all about it before I take it,’” he suggests.
Before surgery, “insist that your surgeon comes and sees you before starting the procedure to review the steps,” Classen says. . . " Read More
By Marisa Taylor and Michael Doyle
In fact, the military had begun second-guessing a decade's worth of tests conducted by its one-time star lab analyst, Phillip Mills.
Investigators discovered that Mills had cut corners and even falsified reports in one case. He found DNA where it didn't exist, and failed to find it where it did. His mistakes may have let the guilty go free while the innocent, such as House, were convicted.
"It cost him his family and it cost him his Navy career," House's attorney, John Wells, said in an interview. "It's certainly outrageous and unconscionable; it's the kind of action that makes you want to scream."
But the problem was bigger than just a lone analyst.
While a McClatchy Newspapers investigation revealed that Mills' mistakes undermined hundreds of criminal cases brought against military personnel, it also found that the U.S. Army Criminal Investigation Laboratory was lax in supervising Mills, slow to re-examine his work and slipshod about informing defendants. Officials appeared intent on containing the scandal that threatened to discredit the military's most important forensics facility, which handles more than 3,000 criminal cases a year.
The military has never publicly acknowledged the extent of Mills' mistakes northe lab's culpability. McClatchy pieced together the untold story by conducting dozens of interviews and reviewing internal investigations, transcripts and other documents. The McClatchy investigation shows: Read More
Bob Probert knew the fierce pounding he dished out and received over 16 seasons as an NHL enforcer was taking its toll as he got older. That's why he wanted his brain to be analyzed once he died. Even though heart failure ultimately ended his life last July at age 45, Probert also was living with a damaged brain. Researchers at Boston University said Thursday that Probert had the degenerative brain disease Chronic Traumatic Encephalopathy. The disease was found through analysis of brain tissue donated by Probert.
He is the second hockey player from the program at the Center for the Study of Traumatic Encephalopathy to be diagnosed with the disease after death. Reggie Fleming, a 1960s enforcer who played before helmets became mandatory, also had CTE.
CSTE is a collaboration between Boston University Medical School and the Sports Legacy Institute that is attempting to address what it calls the "concussion crisis" in sports. The group has been at the forefront of research into head trauma in sports, and has received a $1 million gift from the NFL, which it has pushed for better treatment of concussions.
The family of former Bears safety Dave Duerson agreed to donate his brain to the study after he committed suicide last month at the age of 50.
During his years as one of the most feared players in the NHL, Probert had 3,300 penalty minutes — fifth on the league's career list. He was the toughest and most prolific fighter of his time. Probert, who struggled to overcome drinking problems during his time in the NHL, played for the Detroit Red Wings from 1985-94 and the Chicago Blackhawks from 1995-2002.
"We are only beginning to appreciate the consequences of brain trauma in sports," said Chris Nowinski, the Sports Legacy Institute's co-founder and chief executive officer. "Early evidence indicates that the historical decision not to discourage contact to the head was an enormous mistake, and we hope aggressive changes continue to be made to protect athletes, especially at the youth level." Read More
by Jeffrey I. Kreisberg, PhD
"If you are one of the more than 100 million Americans who visit emergency rooms (ER) at least once a year, you’re not alone.
Americans, insured and not, make ample use of hospital emergency rooms. One out of every five visited an ER at least once in 2007, the latest year for which the National Center for Health Statistics has data. Among the uninsured, 7.4 percent made two or more visits to an ER, but so did 5.1 percent of people with private insurance.
Well if you want to stay safe and receive quality medical care while you’re in the ER, it’s best if you visit the same ER each time.
A report published released recently in the Archives of Internal Medicine and reviewed by Kaiser Health News, showed that nearly one in three Massachusetts adults who made multiple ER trips to separate hospitals — some upwards of five — created a host of dangerous and costly problems because full health information is not always shared between hospitals. The reasons for choosing different facilities varied, sometimes patients moved or changed insurance between visits, while others got transferred between facilities. . . " Read More
"Provocative piece by hospitalist el jefe Bob Wachter. He laments how archaic most electronic records are, and I agree:
You’d think that medicine’s conversion from paper to electronic records would solve many of these problems, but ““ to date ““ all it has done is create new-fangled electronic silos. In most EMRs, including the GE system we’re using at UCSF, the notes are really just electronic incarnations of what previously lived on dead trees ““ no more likely to facilitate collaboration than the paper records they replace."
" In many cases, they spew out template-driven notes that are long on noise and contain very little useful information. Very little power of
"Very little power of the electronic medium is being harnessed."
"On the other hand, Web 2.0 sites, like Facebook, provide intuitive tools that enhance collaboration and social communication:
How great would it be if, through the medical record, I could interact with multiple specialists who have seen my patient ““ in real time, just like my kids are interacting with far-flung friends on Facebook. And if nurses could leave me a note which I could answer online without having to respond to a page. And if the daily plan for a patient ““ developed collaboratively ““ could be shared among all the caregivers, with notes appended when a patient’s clinical ship seemed to be blowing off course.
"One problem is that much of health information technology is staffed and programmed by has-beens. There is very little innovation, with most of forward-thinking ideas confined to sites like Google, Facebook, and MySpace." Read More
by Kevin Pho, MD
"Last fall, a surgeon at Johns Hopkins Hospital was shot by the distraught son of a patient for whom he was caring. The man later killed his mother, then himself. A week earlier, a patient in a Long Island, N.Y., hospital beat his nurse with a leg from a broken chair, causing serious injuries. The following month, a psychiatric technician at a Napa, Calif., state hospital was fatally attacked on the job.
This snapshot of violence against health care workers reflects a disturbing trend. According to a Bureau of Labor Statistics analysis published last year, almost 60% of assaults in the workplace occurred in a health care setting. Nearly three-quarters of these assaults were by patients or residents of a health facility."
No longer havens
"Health care settings have been traditionally thought of as “safe havens,” open to anyone as a place to be protected and cared for. This is a trend worth watching. The Joint Commission, a national accrediting agency, soberly noted last year that “health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide.”Violence is most common in psychiatric facilities and emergency departments, but can also be seen in waiting rooms, long-term care centers and critical care units."
"Nurses are the most frequent targets. According to a 2010 survey from the Emergency Nurses Association, more than half of ER nurses were victims of physical violence and verbal abuse, including being spit on, shoved, or kicked; one in four reported being assaulted more than 20 times over the past three years. The survey noted that the violence seemed to be increasing at the same time the number of alcohol-, drug- and psychiatric-related patients was rising. . . " Read More
Article Date: 05 Mar 2011 - 17:00 PST
"Lack of adequate supervision was a contributing factor in more than 70 per cent of fatal child drownings across Australia, according to a study in the latest Medical Journal of Australia.
Researchers from the University of Ballarat used the National Coroners Information System (NCIS) database to investigate accidental drowning deaths of children aged 0-14 years between July 1, 2000 and June 30, 2009. Of the 339 deaths in that period, supervision was ruled out as a factor in only 29 cases (8.5 per cent), which were the result of events such as cars being swept off the road during flash flooding or boats overturning in rough conditions.
"Supervision was identified as a contributing factor in almost three-quarters (71.7 per cent) of all unintentional cases of child drowning, although the level of explicit identification of supervision varied across age groups," lead researcher Ms Lauren Petrass said.
"Indeed, with deeper interrogation of coroners' findings, absent or inadequate supervision might be associated with as many as 88.8 per cent of child drownings, because in 58 cases (17.1 per cent), inadequate detail was provided in text documents to determine whether supervision was a contributing factor." . . " Read More
Philadelphia, PA, 23 February 2011 - "Understanding the genetics of bipolar disorder could lead to new treatments, but identifying specific genetic variations associated with this disorder has been challenging.
A new study in Biological Psychiatry implicates a brain protein called Piccolo in the risk for inheriting bipolar disorder. In the orchestra of neuronal proteins, Piccolo is a member of a protein family that includes another protein called Bassoon. Piccolo is located at the endings of nerve cells, where it contributes to the ability of nerve cells to release their chemical messengers.
Choi and colleagues conducted a creative study to implicate the gene coding for Piccolo (PCLO) in the heritable risk for bipolar disorder.
They compared gene expression patterns in postmortem cortical tissue from people who were diagnosed with bipolar disorder to tissue from people who did not have psychiatric illnesses prior to their death. This analysis identified 45 genes and genetic variations that had significantly altered mRNA levels, and they used this information to narrow the part of the genome that they explored in their genetics study.
They then tested genetic markers (small DNA sequence variations called single nucleotide polymorphisms or SNPs) that are close to the genes that had altered expression levels in the postmortem tissue. A marker for PCLO, SNP rs13438494, emerged as significant in this analysis, suggesting that variation in PCLO contributes to the risk for bipolar disorder. . . " Read More
by Janice Du Mont, EdD (Research Scientist, Associate Professor)ab, Sheila Macdonald, MN (Provincial Coordinator)c, Nomi Rotbard, MPH (Research Associate, PhD Student)ad, Deidre Bainbridge, BSc (Nurse Practitioner)e, Eriola Asllani, BSc (Data Analyst)a, Norman Smith, PhD (Associate Professor)fg, Marsha M. Cohen, MD (Research Scientist, Professor)ah
"Each consecutive adolescent and adult presenting at a sexual assault treatment centre was screened for drug-facilitated sexual assault (DFSA). Urine was collected and tested for central nervous system active drugs. Oral, vaginal, and/or rectal swabs were tested for male DNA. Unexpected drugs were defined as those not reported as having been voluntarily consumed within the previous 72h. Positive swabs for unexpected DNA were determined by whether the person reported having had consensual intercourse in the previous week.A total of 184 of 882 eligible participants met suspected DFSA criteria. Mean age was 25.8 years (SD=8.5), 96.2% were female and 64.7% White. Urine samples were positive for drugs in 44.9% of cases, alcohol in 12.9%, and both drugs and alcohol in 18.0%."
"The drugs found on toxicological screening were unexpected in 87 of the 135 (64.4%) cases with a positive drug finding and included cannabinoids (40.2%), cocaine (32.2%), amphetamines (13.8%), MDMA (9.2%), ketamine (2.3%), and GHB (1.1%). Male DNA was unexpected in 30 (46.9%) of 64 cases where it was found.Among those persons presenting to a sexual assault treatment centre with a suspicion of DFSA, the presence of unexpected drugs and male DNA was common, lending support for their contention that they had been intentionally drugged and sexually assaulted. Most unexpected drugs found were not those typically described as ‘date rape drugs’."
by Peter Rowan, MSc, FRCP (General Practitioner)a, Michael Hill, PhD, FRCP (Physician)b, G.A. Gresham, Sc.D, FRCPath (Professor)c, Edward Goodall, PhD, NTF (Senior Lecturer)d, Tara Moore, MSc, PhD (Fellow Professor)d
"The results of photographing subjects over 6 months demonstrated that the median time the bruises persisted in both groups was approximately between 18 and 19 days. There was no statistically significant difference between groups of bruises photographed with both the infrared digital camera that had been adapted to capture only infrared light, and with the standard camera which had the same lens fitted to it.The two groups of photographs of bruises imaged at the same time with the two cameras were not significantly different with regard to what skin changes could be detected. The use of the near infrared spectrum, with wavelengths that are longer than the human eye can detect, did not reveal significant evidence of bruising after it had faded from view to both the human eye and to a standard camera."
by David B. Stratton, Esq. of Jordan Coyne & Savits LLP.
"After I helped my wife chop the ice off her van windows this morning at 4:30 am, I made this list of free legal classics."
The Art of Cross-Examination, by Francis Lewis Wellman
The Work of the Advocate, by Elliott and Elliott
Day in Court, or The Subtle Arts of Great Advocates, by Francis Lewis Wellman
A Treatise on Equity Jurisprudence, by Pomeroy
Blackstone's Commentaries on the Laws of England, Bks 1-2
John Marshall Gest, The Lawyer in Literature
Samuel Warren, Famous Cases of Circumstantial Evidence
John Forrest Dillon, John Marshall
Harlan Fiske Stone, Law and its Administration
Livingston Rutherford, John Peter Zenger, his press, his trial
Received 16 May 2010; accepted 20 October 2010.
Certified Forensics Nurse Examiner and Independent Consultant