A study published in the Annals of Emergency Medicine found that the majority of patients who are discharged from emergency rooms leave with little understanding of what happened to them in the ER and what they are supposed to do to take care of themselves after returning home.

Investigators tracked 140 patients discharged from the ERs of two Michigan hospitals to determine whether they understood their diagnosis, treatment, home-care instructions and a list of signs which signified the need for immediate follow-up.

78% of the patients did not understand of at least one of these four areas, and half didn’t understand at least two of them.

The biggest problem was home-care instructions, things like when and how to take medications, activity limitations, wound care and the need for follow-up.

The communication breakdown often caused medication errors and complications necessitating return trips to the ER and even hospital admission.

ERs are a set-up for poor doctor-patient communication. Physicians are busy with multiple patients including some who are quite ill, and patients are distressed by the condition prompting their visit.

Experts suggest two strategies to reduce these errors. The first is a teach-back method in which a patient, ideally while accompanied by a friend or relative, repeats instructions to the physician. The second is a dual-discharge method in which a nurse follows up with patients after physicians discharge them.

In Pune, India this summer a judge relied on evidence from a brain scan to convict a woman, Aditi Sharma, of murder. Sharma insists she is innocent.

The controversial machine is named the Brain Electrical Oscillations Signature test or BEOS. It was developed by Champadi Mukundan, the former Chief of Clinical Psychology at Bangalore’s National Institute of Mental Health.

BEOS is based on preliminary observations by several American scientists including J. Peter Rosenfeld, a psychologist at Northwestern, yet Rosenfeld was quick to denounce the verdict. “Technologies which are neither seriously peer-reviewed nor independently replicated are not…credible,” he said. “The fact that an advanced, sophisticated democratic society…would …convict persons based on unproven technology is…incredible.”

Apparently, BEOS software interprets patterns derived from a conventional electroencephalogram (EEG) recorded while the suspect listens to details of the crime she supposedly committed. Mukundan asserts that certain areas of the brain respond when experiences are relived, and that BEOS can differentiate between memories of witnessed events and memories of deeds they committed.

(more…)

In his 1962 treatise The Structure of Scientific Revolutions, Thomas Kuhn introduced the term “paradigm shift” to describe an abrupt breakthrough in science theory that jump-starts a whole new platform of inquiry, one that could not be envisioned using the older paradigm.

Einstein’s Theory of Relativity was a paradigm shift. So was the discovery in the 19th century that many diseases are caused by bacteria.

Now come whispers of a potential paradigm shift in cancer biology that may speed work towards curing the scourge in its many forms.

The theory is that cancers arise from stem cells.  It hadn’t even been appreciated until recently that all human tissue contained stem cells.

The new theory turns the prevailing model of tumorogenesis upside down. Cancer had been thought to result from mutations in fully differentiated cells such as epithelial cells of the bronchi or neurons in the brain. The new theory means it might possible to develop stem cell targeted treatments which might be more effective and less toxic than those developed under the current paradigm.

The cancer stem cell hypothesis has been the focus of many recent scientific studies. It is the cover story in this week’s Economist.