Pacific Medical Center Research Articles

Review: Risk for stroke is high at 2, 30, and 90 days after transient ischemic attack

ACP Journal Club17 June 2008Review: Risk for stroke is high at 2, 30, and 90 days after transient ischemic attackDavid Tong, MDDavid Tong, MDCalifornia Pacific Medical Center, San Francisco, California, USA (D.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-12-200806170-02012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationWu CM, McLaughlin K, Lorenzetti DL, et al. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167:2417-22. https://pubmed.ncbi.nlm.nih.gov/18071162Clinical Impact RatingsGIM/FP/GP: Emergency Med: Hospitalists: Neurology: References1 Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370:1432-42. [PMID: 17928046] Google Scholar2 Lavallée PC, Meseguer E, Abboud H, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6:953-60. [PMID: 17928270] Google Scholar3 Bos MJ, van Rijn MJ, Witteman JC, et al. Incidence and prognosis of transient neurological attacks. JAMA. 2007;298:2877-85. [PMID: 18159057] Google Scholar Author, Article, and Disclosure InformationAffiliations: California Pacific Medical Center, San Francisco, California, USA (D.T.)This article was published at Annals.org on 3 June 2008. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 17 June 2008Volume 148, Issue 12Page: JC4-12KeywordsAntiplatelet therapyCohort studiesIschemic strokeNeurologyStatinsStenosisStrokeSurgerySystematic reviewsTransient ischemic attacks ePublished: 17 June 2008 Issue Published: 17 June 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Hope in Palliative Care: From Narcissism to Self-Transcendence in Amyotrophic Lateral Sclerosis

The concept of hope in palliative care is an important and neglected area of research. Amyotrophic lateral sclerosis (ALS), a progressive degenerative motor neuron disease, offers an excellent opportunity to study this construct as the illness is virtually always fatal. Our research explored the meaning of hope in individuals with ALS. Sixteen patients (13 males and 3 females; mean age, 54) were interviewed during routine clinic visits to the Forbes Norris MDA/ALS Research Center at California Pacific Medical Center, San Francisco. The Forced Vital Capacity (FVC) Scale and the ALS Functional Rating Scale-Revised (ALSFRS-R) and a Hope Scale were administered. Themes of hope were identified and categorized. Hope categories included: (1) hope for a cure, (2) social support, (3) search for information, (4) spiritual beliefs, (5) limiting the impact, (6) adapting to changing capacities, (7) living in the moment, and (8) self-transcendence. The relationship between hope and the FVC value and individual as well as overall ALSFRS-R ratings were examined, and none were significant. Individuals varied in their capacity to cope with their illness unrelated to their physical ability. Themes ranged from a primary focus on the self to one of heightened concern for others, on continuum from narcissism to altruism. Respondents cited using a number of categories of hope (mean=5). Patients draw upon a variety of mechanisms to sustain hope when facing chronic disease, including hope for a cure, support from others, seeking information, spiritual beliefs, limiting the impact, adapting to changing capacities, living in the moment, and transcending the self. The palliative care team can play an important role by promoting discussions regarding hopefulness and its many forms in individuals with ALS.

Interview with a Quality Leader: Barry Straube on the CMS Office of Clinical Standards and Quality

: Barry M. Straube, MD, director of the Office of Clinical Standards and Quality and chief medical officer at the Centers for Medicare & Medicaid Services (CMS), oversees the CMS quality policy portfolio, including national coverage policies and quality standards for Medicare and Medicaid; quality measurement and public reporting; and the Quality Improvement Organization Program. Straube is senior advisor to the administrator on clinical and scientific policy. He received an AB degree from Princeton University and an MD degree from the University of Michigan Medical School. He completed an internal medicine residency at California Pacific Medical Center and served as a renal fellow at Tufts University-New England Medical Center. He is board certified in internal medicine and nephrology.

Evidence of Intrathyroidal B-Lymphocyte Depletion after rituximab Therapy in a Patient with Graves’ Disease

Departments of Endocrinology and Metabolism (D.E.F., L.H.) and Clinical Pathology (O.C.), Odense University Hospital, 5000 Odense, Denmark; Department of Clinical Immunology Section 7631 (C.H.N.), Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; and Division of Ophthalmic Plastic, Reconstructive and Orbital Surgery (R.Z.S.), California Pacific Medical Center, San Francisco, California 94115

Barriers to the integration of new evidence in medicine: The importance of context

In the current issue of Arthritis Care & Research, the study by Pradhan and colleagues (1) suggests that training in the skill of mindfulness (what they and others have defined as “moment-to-moment, non-judgmental awareness” [2]) may benefit patients with rheumatoid arthritis (RA). While the investigators failed to find significant changes in RA disease activity as measured by the Disease Activity Score 28-joint assessment, the 35% reduction in psychological distress at 6-month followup is not insignificant, particularly given the considerable mood disturbance and psychological effects that can accompany pain-related conditions such as arthritis. Although the study was likely underpowered and limited by the lack of an active control condition, the fact that positive changes were observed at 6 months (and were, in fact, more pronounced than those seen at the postintervention assessment) suggests that the intervention, and not merely some nonspecific (placebo/ expectancy) factor, was responsible for the symptom improvements observed. These positive changes in mood and psychological wellbeing are consistent with data from other studies of the potential value of mindfulness-based interventions to reduce stress and help patients cope more effectively with the mental, emotional, and physical challenges that frequently accompany chronic health conditions (3). Pradhan and colleagues’ findings also lend support to the growing evidence base encouraging the use of an array of psychological interventions to improve mood and quality of life in patients with arthritis and other pain-related conditions (4,5). For example, a meta-analysis published in 2002 (4) found that the adjunctive use of psychological interventions (such as multimodal cognitive-behavioral interventions that teach skills for stress management, pain coping, and relaxation) improves clinical outcomes such as pain, function, and quality of life in patients with RA. Similar data exist for osteoarthritis, indicating that psychosocial behaviorally based interventions consistently improve treatment outcomes (6). In spite of such findings and the growing epidemiologic, basic science, and clinical evidence base pointing to the complex interplay of biologic, psychological, and social factors’ influence upon human physiology and health (7– 9), research suggests that psychosocial factors continue to be overlooked or frequently missed in clinical encounters (10,11), and as a rule continue to be underemphasized in medical education (12,13). Studies also suggest that empirically supported behavioral/mind-body interventions for such common health problems as pain and insomnia are used by only a minority of patients with these conditions (14). An example of this apparent disconnect between the evidence base (linking mental-emotional factors and physical health outcomes, including arthritis) and the actual attitude and practice patterns of physicians can be seen in some recent work carried out by a research group of which I am a member. In a national survey of physicians in primary care and several selected primary care specialties, we found that only 20% of physicians and 12% of rheumatologists indicated that the inclusion of psychosocial/ mind-body methods would lead to significant improvements in patients with arthritis (15). Data from a national survey of interns and residents parallel these findings, with only 23% stating that such methods would lead to significant improvement in arthritis treatment (12). In light of such findings, the obvious question arises: why, particularly in an era of so-called evidence-based medicine, is this growing evidence base that points to the clinical utility of behavioral/mind-body therapies and the influence of psychological factors on human health and physiology failing to be integrated into the way medicine is being taught and practiced? It is important to point out that despite the belief that medical practice should be grounded in solid scientific evidence, the generation of such evidence, while often necessary, is frequently insufficient to actually change clinical practice. In an effort to shed light on the possible factors that influence whether or not physicians adopt new knowledge, Cabana et al (16) reviewed 76 studies that examined obstacles to clinical guideline adherence. In their review, factors impacting physicians’ attitudes included a lack of agreement regarding the clinical guideJohn A. Astin, PhD: California Pacific Medical Center, San Francisco. Address correspondence to John A. Astin, PhD, California Pacific Medical Center, 2200 Webster Street, Room 503, San Francisco, CA 94115. E-mail: john@integrativearts.com. Submitted for publication May 14, 2007; accepted in revised form May 28, 2007. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 57, No. 7, October 15, 2007, pp 1116–1118 DOI 10.1002/art.23004 © 2007, American College of Rheumatology

Commercialism in the Clinic: Finding Balance in Medical Professionalism

There is a palpable malaise in American medicine as clinical practice veers off its moorings, swept along by a new commercialism that is displacing medical professionalism and its attendant moral obligations. Although the sociology of this phenomenon is complex and multifactorial, I argue that this move toward medical commercialism was accelerated by the abortive efforts of the Clinton Administration's Health Security Act. Through an analysis of performative speech I show that, although the Clinton plan drew on many strands of speech about healthcare, it favored the discourse of health policy and health economics over that of clinical practice and professionalism. Though the Clinton plan failed, this new vocabulary of health economics has led us to imagine a new descriptive framework, which has commodified healthcare and commercialized the clinic.I am grateful to Drs. William Andereck and Al Jonsen and the California Pacific Medical Center's Program in Medicine and Human Values for the invitation to participate in their deliberations on “Commercialism in Medicine,” my fellow colloquialists for their helpful comments, Dr. Pablo Rodriguez del Pozo for his insights, and Dr. Jonsen, in particular, for his astute editorial advice and guidance.

Inhaled Corticosteroids for Asthma

1. Edward W. Fong, MD* 2. Robert H. Levin, PharmD† 1. *Pediatric Pulmonologist, Children's Hospital and Research Center Oakland, Oakland, Calif., and California Pacific Medical Center, San Francisco, Calif 2. †Professor Emeritus of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, Calif Asthma is an inflammatory disease of the respiratory tract. It is the most common chronic disorder in children and adolescents, with more than 3 million asthma attacks occurring in more than 5% of all children each year. Asthma creates significant morbidity and is the leading cause of school absences. Costs attributed to asthma are in the billions of dollars each year. All levels of persistent asthma require daily anti-inflammatory treatment, and the safest, most effective treatment for patients who have persistent asthma is inhaled corticosteroids (ICSs). Although steroids may be given orally or parenterally, and numerous nonsteroidal medications are available for treating persistent asthma, ICSs are the treatment of choice. Even when ICSs are given daily over a long period of time, they have less toxicity than oral or parenteral steroids administered only occasionally. This article reviews the currently available ICSs, devices and techniques for optimal administration, and potential adverse effects. The data and recommendations are based on the National Asthma Education and Prevention Program (NAEPP) guidelines (1991 and 1997) and Update 2002, which are available at http://www.nhlbi.nih.gov/guidelines/asthma. Asthma is a complex disorder whose pathogenesis is not fully understood. Current thinking is that susceptible individuals develop asthma because of an imbalance between the T-helper (Th)1 and Th2 lymphocytes. Th1 cells produce interleukin-2 (IL-2) and interferon-gamma, which act as a cellular defense mechanism, and Th2 cells produce cytokines (IL-4, IL-5, IL-6, IL-9, and IL-13), which mediate allergic inflammation. According to this current “hygiene hypothesis,” the Th1 cellular defense mechanism is reduced, while Th2 cellular activity increases. This imbalance predisposes the individual to episodes of chronic inflammatory asthma. Whatever triggers the pathogenesis sets up an inflammatory process in which many cellular components participate, including mast cells, T lymphocytes, eosinophils, neutrophils, and epithelial cells. The result is inflammation, hyperresponsiveness (bronchospasm), and in …

Physicians Should Not Always Pursue a Good "Clinical" Outcome

Physicians Should Not Always Pursue a Good "Clinical" Outcome Paul B. Hofmann (bio) and Lawrence J. Schneiderman (bio) Increasingly, hospitals are using so-called futility policies to address medical goals that are centered not just on the prospect of mending the organs, but on whether the outcome will actually benefit the patient. The University of California, San Diego Medical Center, for example, defines a treatment as futile when it "has no realistic chance of providing a benefit that the patient would ever have the capacity to perceive and appreciate, such as merely preserving the physiologic functions of a permanently unconscious patient, or has no realistic chance of achieving the medical goal of returning the patient to a level of health that permits survival outside the acute care setting." The policy goes on to assert that the physician's obligation is to provide optimal comfort care, namely "care whose intent is to relieve suffering and provide for the patient's comfort and dignity. It may include analgesics, narcotics, tranquilizers, local nursing measures, and other treatments including psychological and spiritual counseling. . . .[A]lthough a particular treatment may be futile, palliative or comfort care is never futile." Beginning about fifteen years ago, the topic of medical futility became a matter of stormy contention in medicine. Some critics even argued that the term "medical futility" should be abandoned altogether. But as one critic acknowledged: "The commonsense notion that a time does come for all of us when death or disability exceeds our medical powers cannot be denied. This means that some operative way of making a decision when 'enough is enough' is necessary. . . . [S]ome determination of futility by any other name will become a reality."1 Physicians are trained to achieve good clinical outcomes. Unfortunately, many physicians interpret that to mean good physiologic outcomes in the organ system of their specialty. The cardiologist wants to help the patient maintain a strong cardiac output, a nephrologist wants to make sure the patient's kidney function is adequate, and the pulmonologist concentrates on lung capacity and viability. Patients reasonably assume they, too, have a vested interest in promoting good clinical outcomes. Usually, good clinical and patient outcomes are completely aligned. Indeed, the vast majority of physicians and patients have an accurate mutual understanding of the ultimate objective—to improve the patient's quality of life as soon as possible. Regrettably, though, as medicine becomes ever more complex and specialized, at times a patient's organ, rather than the patient, becomes the focus of attention. A variety of effective interventions can help sustain one organ even as others fail. From a specialist's perspective, prolonging organ function in such a case represents a significant professional challenge. It tests the technical knowledge, skill, and experience of physicians who are energized by the opportunity to demonstrate to themselves, colleagues, patients, and families that the potential benefit of persistent medical and surgical treatment should never be underestimated. To some physicians, then, successfully sustaining a patient who needs constant support and may not even survive hospitalization with a reasonable quality of life is a testament to medical progress. Implicit in this view is that death is necessarily a bad clinical outcome. Some say that Americans view death as optional. Death means failure. But in fact, in many situations, good patient outcomes should be valued more highly than good clinical outcomes. The difference between the two is more than semantics. When medical treatment no longer fulfills a patient's expressed preferences and the patient is terminally ill, a good death should be viewed as an acceptable and appropriate outcome. Under these circumstances, a good death becomes a preferred patient outcome, instead of aggressive treatment to achieve a good clinical outcome as measured by organ function. Death is not necessarily a medical failure; conversely, causing or allowing a bad death is not only a medical failure, but also an ethical breakdown. Paul B. Hofmann Paul B. Hofmann is president of the Hofmann Healthcare Group in Moraga, California, and a former CEO of Emory and Stanford University hospitals. Lawrence J. Schneiderman Lawrence J. Schneiderman is an internist and a visiting scholar at California Pacific Medical Center in San Francisco. Footnotes 1. E. Pellegrino...

2139: Treatment of Anal Carcinoma in HIV-Positive Males: a Single Institution Experience

The standard of care in the treatment of squamous cell carcinoma of the anal canal consists of combined chemotherapy and radiation. Anal carcinoma is more common in HIV-positive patients. We report our experience with anal carcinoma in HIV-positive males at California Pacific Medical Center (CPMC), San Francisco, CA.

Racial Disparity, Location and Stage at Diagnosis of Colorectal Cancer in Patients above and below 50 Years of Age

Purpose: Incidence rates of Colorectal Cancer (CRC) are decreasing in the United States, possibly due to preventive screening. These programs target older populations and may not apply to younger patients. Our aim is to analyze racial disparity, stage at diagnosis, and location of CRC among patients below age 50 years compared to patients above age 50 years. Methods: Patients with CRC were identified retrospectively from tumor registries at St. Joseph's Regional Medical Center, NJ and California Pacific Medical Center, CA., for the period of 1992 to 2004. Statistical analysis was done by Chi-square test. Results: Overall number of patients diagnosed with CRC was 2723 [1963(72.1%) white, 287(10.5%) black, 473(17.4%) others]. We identified 279 (10.2%) less than 50 years of age. We found statistically significant increase in CRC prevalence in blacks compared to white below age 50 years (table 1). Blacks have approximately two (2.12) times greater odds of being diagnosed with CRC than whites below age 50 years (95% Confidence Interval (CI) 1.5–3.03). Regarding location of CRC, patients below 50 years have approximately two (1.75) times greater odds of having their lesion in the rectosigmoid than in the remaining colon (95% CI 1.35–2.27).(table 2) Regarding staging of CRC, patients below age 50 years have almost 2 times (1.85) greater odds of having advanced stage at the diagnosis as compared to above 50 (95% CI 1.43–1.85). (table 2)Table: Racial disparity in the diagnosis of CRC in individuals < 50yrsTable: Distal site distribution and Advanced stage at the diagnosis of CRC in individuals < 50yrsConclusions: In this study there is a significant increase in the diagnoses of CRC in black patients below the age of 50 years. Our study reinforced the new CRC screening recommendation by ACG for blacks to begin screening at the age of 45 years rather than at age 50 years. Also, CRC in younger populations is diagnosed at later stages and is frequently in distal locations.

MAGNETIC COMPRESSION ANASTOMOSIS FOR BILIARY STRICTURE OF HEPATICO-JEJUNOSTOMY AFTER LIVING DONOR LIVER TRANSPLANTATION.

1Hepatobiliary Surgery and Transplantation, University Medical Center, Hamburg, Germany; 2Liver Transplant Program, California Pacific Medical Center, San Francisco, CA; 3Virology, Heinrich Pette Institute, Hamburg, Germany.

Industry Watch

EvoGenix and CSL Partner on Antibodies. Minomic's Business. Japan's Bioventures Today—OMAb Pharma K.K. Immunodiagnostic Systems—Signs Marketing and Sales Agreement with Medical &amp; Biological laboratories. Vical and Anges MG to Collaborate on Allovectin-7. GlaxoSmithKline Strengthens Asian Presence with New S$300M Vaccine Plant. Kalbe Farma Sets up R&amp;D Base in Singapore to Focus on Drug Development of Biopharmaceuticals. MerLion Pharma and ICES Inks R&amp;D Partnership to Boost Singapore's Biotechnology Industry. Philips Inaugurates Asia Pacific's First Medical Learning Center.

Eight-fold Path to Happiness for the Cosmetic Surgery Patient

Division of Ophthalmic Plastic, Reconstructive, and Orbital Surgery, California Pacific Medical Center, San Francisco, California. Accepted for publication October 12, 2005. Presented whole or in part at The Aesthetic Facial Surgery and Rejuvenation Course, Jules Stein Eye Institute, Los Angeles, California, U.S.A., 2004 and 2005, and at The Multi-Specialty Facial Cosmetic Surgery Symposium, Las Vegas, Nevada, 2005. Address correspondence and reprint requests to Dr. Rona Z. Silkiss, 491 30th Street, Suite 103, Oakland, CA 94609. E-mail: [email protected]

Invited Discussion: Use of Wise Pattern for Achieving Symmetry in One Stage in Immediate Reconstructions With Deep Inferior Epigastric Artery Perforator Flap

From the *University of California, San Francisco, CA; and †the California Pacific Medical Center, San Francisco, CA. Received and accepted for publication December 7, 2005. Reprints: Bryant A. Toth, MD, Suite 424, 2100 Webster Street, San Francisco, CA 94115. E-mail: [email protected].

Those Who Will Not Be Healed

\4vian Kleinfelter was a thirty-nine-year-old patient with nineteen Chief Complaints. Her feet tingled. Her ears rang. She saw spots in front of her eyes. Gas pains kept her awake all night. Daily attacks of nausea were accompanied by cramps and rainbow-colored vomitus. It took me an hour and a half, rushing a bit at the end, but I got everything down in twelve scrawled pages: all nineteen Chief Complaints, followed by her Past Medical History, Family History, and Review of Systems. Physical examination took ten minutes-normal head to toe, except for the well-healed scar of a biopsy on her left breast (done three years before, a benign cyst) and a varicose vein on her left calf. To the semi-skilled eyes and hands of a medical student, Vivian seemed the picture of health. Tall and solid, ramrod straight, with curly auburn hair, she had the body and skin tone of a woman ten years younger. Such bright eyes. And such vitality. She talked on and on with the momentum of eager, well-rehearsed speech, her hand flitting about like a hummingbird as she touched the body part that harbored each complaint: eyes, ears, nose, throat, bosom, stomach.... But alas, her visit to the Stanford General Medical Clinic came to naught. Less than naught. Alan Barbour, the clinic director, gave Vivian his best. He examined her body and reviewed every detail in her chart, which included voluminous records from the Cedars-Sinai in Los Angeles and the Pacific Medical Center in San Francisco, then delivered his diagnosis. He spoke with the deepest compassion, but the noble fellow insisted on telling the truth -it was all in Vivian's head, every symptom a hypochondriacal paradigm-and his efforts only enraged her. A disastrous consultation. In the end she stormed out of the clinic. I called her

Biometrics offers alternative to password entry

For clinical pharmacist Cecily Carroll, logging in at a workstation in the pharmacy library at California Pacific Medical Center means gingerly placing her right index finger on a glowing red pad. The single motion by Carroll causes the workstation’s screen to display the security statement from parent Sutter Health. A single-click acknowledgment of the statement takes Carroll to the available applications, including the drug information resources and the clinical information system, which gives her access to medication orders, progress notes about patients, laboratory test results, pathology reports, and discharge notes. But when upstairs in the 21-bed medical–surgical intensive care unit, 10-bed coronary critical care unit, or 3 step-down units where she usually works, Carroll keys in her password rather than using a fingerprint reader. The difference in routine is not so much personal preference as Carroll’s reaction to what she called “a work in progress” at California Pacific Medical Center, which has four hospitals on three campuses in San Francisco.

Nursing time allocation and other considerations for staffing

The purpose of this project was to evaluate how nursing staff on the telemetry unit at Merle West Medical Center, a rural Pacific northwest community medical center in the USA, spend their time on selected nursing tasks, and how they believed staffing and patient acuity levels could best be determined. A self-report survey tool was developed, piloted and administered. Of the tasks that were listed in the survey, registered nurses (RNs) reported spending 39% of their time performing tasks that RNs only can perform. RNs reported spending 12% of their time performing activities that certified nursing assistants (CNAs) could perform alone and 49% of their time was spent on tasks that both RNs and CNAs must perform. Results from the quantitative portion of the survey indicated that RNs may not be used efficiently due to task overlap. Administering a modified survey which includes a balance of direct and indirect patient care tasks, as well as only those tasks that are truly performed frequently, will increase the relevance of the results.

Interactive Guided ImagerySMTherapy with Medical Patients: Predictors of Health Outcomes

To assess whether Interactive Guided Imagery (IGI) is helpful to medical patients and to identify factors that contribute to positive outcomes. A prospective cohort study of 323 medical patients who received 6 IGI sessions on a weekly basis. Patients and practitioners completed questionnaires at the beginning, middle, and end of the 6 IGI sessions. The questionnaires assessed the patients' ability to do IGI, the quality of the practitioner-patient interaction, possible confounding variables, and enabling factors. The hypothesis was that measures of the process of doing IGI and the practitioner-patient relationship would predict outcomes. The subjects were all patients seeking treatment at California Pacific Medical Center in San Francisco, and Marin General Hospital in Greenbrae, CA. Using IGI interactively is a cognitive-behavioral intervention designed to help patients relax by using mental images to discover and cultivate healing intentions, and to reflect on the meaning of these images. The individual measures to assess the patients' ability to do IGI and measures of the practitioner-patient relationship were factor-analyzed to use as predictor variables in a multiple regression. Similarly, the questionnaire items measuring cognitive, emotional, behavioral, and spiritual benefits of IGI were factor-analyzed into factors representing "insight" and "all other" benefits. The multiple regression shows that both process and practitioner-patient interaction factors significantly contributed to a combined 40% of the variance in patients' ratings of insight into the nature of their problem and to becoming aware of an aspect of self, F(4,56) = 9.4, p < 0.005. The same process and interaction factors were less strongly related to the other outcomes, r2 = 0.14, F(4,56) = 2.3, p = 0.06. None of the demographic, confounding, or enabling factors was related to the outcome measures. The process of doing IGI and the relationship with the practitioner were both independently associated with the patients' insight into their health problems.

Bone Density Screening: A New Level of Evidence?

Editorials1 February 2005Bone Density Screening: A New Level of Evidence?Steven R. Cummings, MDSteven R. Cummings, MDFrom San Francisco Coordinating Center; California Pacific Medical Center Research Institute; University of California, San Francisco (Emeritus); San Francisco, CA 94105.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-3-200502010-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Kern and colleagues (1) report that a cohort of older women and men who underwent bone mineral density (BMD) testing of the hip had a lower rate of hip fractures than did those in a cohort who did not get hip BMD testing. If Kern and colleagues' methods are sound, then they provide the first evidence from a trial (albeit not randomized) that screening lowers the risk for fracture.Bone densitometry, invented by dentists in 1897 (2), became compact enough for clinical use during the 1980s (3). As soon as bone densitometry entered clinical practice, debates began ...

Meditation, Prayer and Spiritual Healing: The Evidence

Marilyn Schlitz, PhD, is the Vice President of Research at the Institute of Noetic Sciences and Senior Scientist at the Research Institute of the California Pacific Medical Center. She completed a bachelor of philosophy degree from Monteith College, Wayne State University, a master of arts in social and behavioral studies from the University of Texas, San Antonio, a PhD in social anthropology from the University of Texas in Austin, postdoctoral fellowship in cognitive sciences laboratory, Science Applications International Corporation, and a postdoctoral fellowship in psychology at Stanford University. She has published more than 200 articles in the area of consciousness studies and is the co-editor of Consciousness and Healing, Integral Approaches to MindBody Medicine, by Elsevier. She conducted research at Stanford University, Science Applications Internal Corporation, the Institute of Parapsychology, and the Mind Science Foundation. She has taught at Trinity University, Stanford University, and Harvard Medical School, and has lectured widely, including at the United Nations and at the Smithsonian Institution. She served as a Congressionally appointed advisory member for the National Institutes of Health Center for Complementary and Alternative Medicine and is on the board of trustees for the Esalen Institute and on the board of directors for the Institute of Noetic Sciences. She also serves on the scientific program committee for the Tucson Center for Consciousness Studies.