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All posts; Tags Include "Medical Ethics"

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  • January 13, 2017
  • 02:40 AM
  • 312 views

Acute coronary syndrome on Friday the 13th: a case for re-organising services?

by Rogue Medic in Rogue Medic

"However, patients admitted on five day/number combinations were 20-30% more likely to survive at 13 years. These findings could be explained by subgroup analysis inflation of the type I error, although supernatural causes merit further investigation.[1]"

No. Supernatural causes do not merit further investigation, at least, not based on anything in this paper.

The authors used Friday the 13th as their "normal" date for comparison with every other date, but the outcomes ........ Read more »

Protty, M., Jaafar, M., Hannoodee, S., & Freeman, P. (2016) Acute coronary syndrome on Friday the 13th: a case for re-organising services?. The Medical Journal of Australia, 205(11), 523-525. DOI: 10.5694/mja16.00870  

  • December 16, 2016
  • 05:25 AM
  • 401 views

Patient participation in clinical trials

by Joana Guedes in BHD Research Blog

Clinical trials are crucial to help doctors and scientists understand how to safely treat a particular condition, to evaluate new treatments and to test drug safety and efficacy. They have an important role in every step of managing a condition with different clinical trials helping with prevention, diagnosis, treatments and follow-up support.... Read more »

  • September 15, 2016
  • 09:10 AM
  • 758 views

Paralympic athletes and the rise of the cyborgs

by gdw in FictionalFieldwork

Para and super? The Olympics are over. They’ve brought us some good stories, some nice records, and (self-citation alert!) a humble blog post about the ethics of doping. But the Paralympics, their less mediatized cousin, are in full swing. Paralympians from all over the world gather to wow us with their athletic prowess in the Paralympic […]... Read more »

  • September 8, 2016
  • 09:16 AM
  • 619 views

CRISPR on my plate, and some GMO’s on the side

by gdw in FictionalFieldwork

A CRISPR recipe Less than a month ago, the world’s first official CRISPR/Cas9 meal was served. CRISPR/Cas9 is a fairly new technology to edit genomes, and cut and paste genes at will. Well, it’s not exactly that new. It’s actually been around for a long time. CRISPR, or *humhum* Clustered regularly interspaced short palindromic repeats […]... Read more »

Snell C, Bernheim A, Bergé JB, Kuntz M, Pascal G, Paris A, & Ricroch AE. (2012) Assessment of the health impact of GM plant diets in long-term and multigenerational animal feeding trials: a literature review. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association, 50(3-4), 1134-48. PMID: 22155268  

  • August 17, 2016
  • 01:30 PM
  • 576 views

The PROCAMIO Trial – IV Procainamide vs IV Amiodarone for the Acute Treatment of Stable Wide Complex Tachycardia

by Rogue Medic in Rogue Medic

This is a very interesting trial that may surprise the many outspoken amiodarone advocates, but it should not surprise anyone who pays attention to research.

ALPS showed that we should stop giving amiodarone for unwitnessed shockable cardiac arrest. The lead researcher is still trying to spin amiodarone for witnessed shockable cardiac arrest, even though the results do not show improvement in the one outcome that matters – leaving the hospital with a brain that still works.[1],[2],[3]... Read more »

Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW.... (2016) Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. The New England journal of medicine, 374(18), 1711-22. PMID: 27043165  

Marill KA, deSouza IS, Nishijima DK, Senecal EL, Setnik GS, Stair TO, Ruskin JN, & Ellinor PT. (2010) Amiodarone or procainamide for the termination of sustained stable ventricular tachycardia: an historical multicenter comparison. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(3), 297-306. PMID: 20370763  

Marill KA, deSouza IS, Nishijima DK, Stair TO, Setnik GS, & Ruskin JN. (2006) Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Annals of emergency medicine, 47(3), 217-24. PMID: 16492484  

Kułakowski P, Karczmarewicz S, Karpiński G, Soszyńska M, & Ceremuzyński L. (2000) Effects of intravenous amiodarone on ventricular refractoriness, intraventricular conduction, and ventricular tachycardia induction. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2(3), 207-15. PMID: 11227590  

Bonny A, De Sisti A, Márquez MF, Megbemado R, Hidden-Lucet F, & Fontaine G. (2012) Low doses of intravenous epinephrine for refractory sustained monomorphic ventricular tachycardia. World journal of cardiology, 4(10), 296-301. PMID: 23110246  

Kowey PR. (1988) The calamity of cardioversion of conscious patients. The American journal of cardiology, 61(13), 1106-7. PMID: 3364364  

  • August 11, 2016
  • 08:30 PM
  • 576 views

Acupuncture vs intravenous morphine in the management of acute pain in the ED

by Rogue Medic in Rogue Medic

Should we have people providing "fake" acupuncture in the Emergency Department?

If so, how should we do this?

Since it is not the acupuncture, but the patient's reaction to the "ceremony of the placebo" that appears to be providing the pain relief, how many different ways might we vary the "treatment" to improve the placebo effect?... Read more »

Grissa, M., Baccouche, H., Boubaker, H., Beltaief, K., Bzeouich, N., Fredj, N., Msolli, M., Boukef, R., Bouida, W., & Nouira, S. (2016) Acupuncture vs intravenous morphine in the management of acute pain in the ED. The American Journal of Emergency Medicine. DOI: 10.1016/j.ajem.2016.07.028  

Espay, A., Norris, M., Eliassen, J., Dwivedi, A., Smith, M., Banks, C., Allendorfer, J., Lang, A., Fleck, D., Linke, M.... (2015) Placebo effect of medication cost in Parkinson disease: A randomized double-blind study. Neurology, 84(8), 794-802. DOI: 10.1212/WNL.0000000000001282  

Ee, C., Xue, C., Chondros, P., Myers, S., French, S., Teede, H., & Pirotta, M. (2016) Acupuncture for Menopausal Hot Flashes. Annals of Internal Medicine, 164(3), 146. DOI: 10.7326/M15-1380  

Cherkin, D., Sherman, K., Avins, A., Erro, J., Ichikawa, L., Barlow, W., Delaney, K., Hawkes, R., Hamilton, L., Pressman, A.... (2009) A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Archives of Internal Medicine, 169(9), 858. DOI: 10.1001/archinternmed.2009.65  

Goldman, R., Stason, W., Park, S., Kim, R., Schnyer, R., Davis, R., Legedza, A., & Kaptchuk, T. (2008) Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use. The Clinical Journal of Pain, 24(3), 211-218. DOI: 10.1097/AJP.0b013e31815ec20f  

  • August 3, 2016
  • 09:13 AM
  • 713 views

Do we need a doping Olympics? The ethics of doping in sports

by gdw in FictionalFieldwork

There is only her and the track. The people standing on her left and right do not matter now. She has only one adversary: time. In her head she plays how the future might…will unfold. Forty seven strides. That’s all she needs. All things on the periphery disappear. Her world, her universe becomes a single […]... Read more »

  • May 25, 2016
  • 09:00 AM
  • 967 views

Are our gut bacteria the key to immortality?

by gdw in FictionalFieldwork

The fight against aging Ever since the ancient Sumerians, men has sought eternal life. We still do. Anti-aging science has become quite an industry. As we dive deeper and deeper into our biological foundations, we’re learning more and more about how and why we age. A lot of mysteries remain, but there’s still talk about […]... Read more »

De Winter, G. (2014) Aging as Disease. Medicine, Health Care and Philosophy, 18(2), 237-243. DOI: 10.1007/s11019-014-9600-y  

Biagi E, Franceschi C, Rampelli S, Severgnini M, Ostan R, Turroni S, Consolandi C, Quercia S, Scurti M, Monti D.... (2016) Gut Microbiota and Extreme Longevity. Current biology : CB. PMID: 27185560  

  • May 16, 2016
  • 03:34 PM
  • 808 views

Novel Borrelia Species Causes Lyme Disease with High Spirochetemia

by Pranab Chatterjee in Zoonoticus

In a recent paper in the Lancet Infectious Diseases, Pritt et al  have identified a new genospecies of Borrelia which is attributed to have caused several cases of Lyme disease, marked by a high degree of spirochetemia. In their research article abstract, they state: Methods At the Mayo clinic, from 2003 to 2014, we tested […]... Read more »

  • April 29, 2016
  • 11:02 AM
  • 831 views

Bringing ‘Dirty’ Mice Into Labs Opens A World Of Possibilities

by Rita dos Santos Silva in United Academics

Treating immune disorders might have gotten easier with a new mouse model.... Read more »

  • April 12, 2016
  • 05:00 PM
  • 744 views

Dr. Kudenchuk is Misrepresenting ALPS as 'Significant'

by Rogue Medic in Rogue Medic

This study was very well done, but it was not designed to provide valid information about the effects of amiodarone or lidocaine on witnessed arrests or on EMS Witnessed arrests. Maybe the authors were overconfident.

In resuscitation research, we have abundant evidence that overconfidence is much more common than improvements in outcomes.... Read more »

Kudenchuk, P., Brown, S., Daya, M., Rea, T., Nichol, G., Morrison, L., Leroux, B., Vaillancourt, C., Wittwer, L., Callaway, C.... (2016) Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine. DOI: 10.1056/NEJMoa1514204  

Glover BM, Brown SP, Morrison L, Davis D, Kudenchuk PJ, Van Ottingham L, Vaillancourt C, Cheskes S, Atkins DL, Dorian P.... (2012) Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium. Resuscitation. PMID: 22858552  

  • April 6, 2016
  • 12:02 PM
  • 625 views

World Serology Bank: Key to a Better Understanding of Infectious Disease Dynamics?

by Pranab Chatterjee in Zoonoticus

An article published in The Lancet today has highlighted the possibility of establishing a World Serology Bank to better understand the dynamics of infectious disease dynamics, especially in an era where vaccinations against infectious diseases is becoming more and more prevalent. With rapid advance in diagnostic technologies, there has been impressive progress in what used […]... Read more »

  • April 4, 2016
  • 06:15 PM
  • 686 views

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest

by Rogue Medic in Rogue Medic

I wrote about the start of the ALPS (Amiodarone, Lidocaine, Placebo Study) in 2012[1] and the results are now in.
... Read more »

Kudenchuk, P., Brown, S., Daya, M., Rea, T., Nichol, G., Morrison, L., Leroux, B., Vaillancourt, C., Wittwer, L., Callaway, C.... (2016) Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine. DOI: 10.1056/NEJMoa1514204  

  • March 8, 2016
  • 04:15 PM
  • 805 views

What do you do when a patient wakes up during CPR?

by Rogue Medic in Rogue Medic

The return of consciousness without the return of a pulse is still rare, but may be more common with our increased focus on high quality chest compressions. There is still no evidence that interrupting chest compressions, for anything other than defibrillation, improves outcomes.

Is this due to the consistency of the machine? Maybe. Maybe not. We do not have enough evidence to draw that conclusion.

Is this growing population really growing? Maybe. Maybe not. We do not have enough evidence ........ Read more »

  • February 3, 2016
  • 11:30 AM
  • 734 views

The RAD-57 – Still Unsafe?

by Rogue Medic in Rogue Medic

I decided to look for something I wrote that I have been wrong about. I thought about Masimo and their RAD-57. I had been very critical of Dr. Michael O’Reilly (then Executive Vice President of Masimo Corporation) for being an advocate of bad science, but he has been hired away by Apple.[1] He should be less dangerous with a telephone than he was with the RAD-57. At the time, he wrote –... Read more »

  • December 8, 2015
  • 01:50 PM
  • 685 views

Why is progress so slow in resuscitation research?

by Rogue Medic in Rogue Medic

Why is progress so slow in resuscitation research? A lot of money and time went in to finding out which type of blood-letting ventilation works best – ignoring the absence of valid evidence that ventilation is better than no ventilation. Why not gamble with our patients?

In response to The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR,[1],[2] Kenny commented that –

there are many things in your blog that are not correct.[1]... Read more »

Nichol, G., Leroux, B., Wang, H., Callaway, C., Sopko, G., Weisfeldt, M., Stiell, I., Morrison, L., Aufderheide, T., Cheskes, S.... (2015) Trial of Continuous or Interrupted Chest Compressions during CPR. New England Journal of Medicine, 2147483647. DOI: 10.1056/NEJMoa1509139  

  • November 25, 2015
  • 10:15 AM
  • 884 views

The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR

by Rogue Medic in Rogue Medic

This is not a study that has a valid control group to determine if there is any benefit from ventilation. There is no group that does not receive ventilations, so it is like a study of one type of blood-letting vs. another type of blood-letting with the researchers taking for granted that blood-letting does improve outcomes. That is not a problem if blood-letting actually improves outcomes.

Should we take it for granted that blood-letting improves outcomes and that the only hypothesis worth s........ Read more »

Nichol, G., Leroux, B., Wang, H., Callaway, C., Sopko, G., Weisfeldt, M., Stiell, I., Morrison, L., Aufderheide, T., Cheskes, S.... (2015) Trial of Continuous or Interrupted Chest Compressions during CPR. New England Journal of Medicine, 2147483647. DOI: 10.1056/NEJMoa1509139  

Alldredge BK,, Gelb AM,, Isaacs SM,, Corry MD,, Allen F,, Ulrich S,, Gottwald MD,, O’Neil N,, Neuhaus JM,, Segal MR,.... (2001) A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus. New England Journal of Medicine, 345(25), 1860-1860. DOI: 10.1056/NEJM200112203452521  

  • October 20, 2015
  • 09:45 PM
  • 725 views

How Bad is the Evidence for the New 2015 ACLS Guidelines?

by Rogue Medic in Rogue Medic

The new ACLS guidelines are out. How bad is the evidence?
The short answer – The Advanced Cardiac Life Support guidelines could be worse.
How does the American Heart Association determine that a recommendation is not beneficial?... Read more »

  • July 29, 2015
  • 02:09 PM
  • 1,400 views

The “Invisible Web” Undermines Health Information Privacy

by Jalees Rehman in The Next Regeneration

What do the third parties do with your data? We do not really know because the laws and regulations are rather fuzzy here. We do know that Google, Facebook and Twitter primarily make money by advertising so they could potentially use your info and customize the ads you see. Just because you visited a page on breast cancer does not mean that the "Invisible Web" knows your name and address but they do know that you have some interest in breast cancer. It would make financial sense to sen........ Read more »

  • June 28, 2015
  • 03:05 AM
  • 1,079 views

Who Will Pay for All the New DBS Implants?

by The Neurocritic in The Neurocritic

Recently, Science and Nature had news features on big BRAIN funding for the development of deep brain stimulation technologies. The ultimate aim of this research is to treat and correct malfunctioning neural circuits in psychiatric and neurological disorders. Both pieces raised ethical issues, focused on device manufacturers and potential military applications, respectively.A different ethical concern, not mentioned in either article, is who will have access to these new devices, and who is goin........ Read more »

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