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Ambika Kilaparthi

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. - 0 views

  • response to placebo was considered a psychological trait related to neurosis and gullibility rather than a physiological phenomenon that could be scrutinized in the lab and manipulated for therapeutic benefit. But then Benedetti came across a study, done years earlier, that suggested the placebo effect had a neurological foundation. US scientists had found that a drug called naloxone blocks the pain-relieving power of placebo treatments. The brain produces its own analgesic compounds called opioids, released under conditions of stress, and naloxone blocks the action of these natural painkillers and their synthetic analogs.
  • Placebo-activated opioids, for example, not only relieve pain; they also modulate heart rate and respiration. The neurotransmitter dopamine, when released by placebo treatment, helps improve motor function in Parkinson's patients. Mechanisms like these can elevate mood, sharpen cognitive ability, alleviate digestive disorders, relieve insomnia, and limit the secretion of stress-related hormones like insulin and cortisol.
  • Alzheimer's patients with impaired cognitive function get less pain relief from analgesic drugs than normal volunteers do. Using advanced methods of EEG analysis, he discovered that the connections between the patients' prefrontal lobes and their opioid systems had been damaged. Healthy volunteers feel the benefit of medication plus a placebo boost. Patients who are unable to formulate ideas about the future because of cortical deficits, however, feel only the effect of the drug itself. The experiment suggests that because Alzheimer's patients don't get the benefits of anticipating the treatment, they require higher doses of painkillers to experience normal levels of relief.
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  • placebo response has limits. It can ease the discomfort of chemotherapy, but it won't stop the growth of tumors. It also works in reverse to produce the placebo's evil twin, the nocebo effect. For example, men taking a commonly prescribed prostate drug who were informed that the medication may cause sexual dysfunction were twice as likely to become impotent.
  • placebo aids recovery is by hacking the mind's ability to predict the future. We are constantly parsing the reactions of those around us—such as the tone a doctor uses to deliver a diagnosis—to generate more-accurate estimations of our fate. One of the most powerful placebogenic triggers is watching someone else experience the benefits of an alleged drug. Researchers call these social aspects of medicine the therapeutic ritual.
  • What turns a dummy pill into a catalyst for relieving pain, anxiety, depression, sexual dysfunction, or the tremors of Parkinson's disease? The brain's own healing mechanisms, unleashed by the belief that a phony medication is the real thing. The most important ingredient in any placebo is the doctor's bedside manner, but according to research, the color of a tablet can boost the effectiveness even of genuine meds—or help convince a patient that a placebo is a potent remedy.
  • Red pills can give you a more stimulating kick
  • green reduces anxiety
  • White tablets—particularly those labeled "antacid"—are superior for soothing ulcers
  • More is better,scientists say. Placebos taken four times a day deliver greater
  • Branding matters. Placebos stamped or packaged with widely recognized trademarks are more effective than "generic"
  • Clever names
  • volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.
  • hybrid treatment strategies that exploit the placebo effect to make real drugs safer and more effective. Cancer patients undergoing rounds of chemotherapy often suffer from debilitating nocebo effects—such as anticipatory nausea—conditioned by their past experiences with the drugs. A team of German researchers has shown that these associations can be unlearned through the administration of placebo, making chemo easier to bear.
  • body's response to certain types of medication is in constant flux, affected by expectations of treatment, conditioning, beliefs, and social cues.
  • Big Pharma have moved aggressively into Africa, India, China, and the former Soviet Union. In these places, however, cultural dynamics can boost the placebo response in other ways. Doctors in these countries are paid to fill up trial rosters quickly, which may motivate them to recruit patients with milder forms of illness that yield more readily to placebo treatment. Furthermore, a patient's hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America
  • The HAM-D was created nearly 50 years ago based on a study of major depressive disorder in patients confined to asylums. Few trial volunteers now suffer from that level of illness. In fact, many experts are starting to wonder if what drug companies now call depression is even the same disease that the HAM-D was designed to diagnose.
  • What all of these disorders have in common, however, is that they engage the higher cortical centers that generate beliefs and expectations, interpret social cues, and anticipate rewards. So do chronic pain, sexual dysfunction, Parkinson's
  • In standard trials, the act of taking a pill or receiving an injection activates the placebo response. In open/hidden trials, drugs and placebos are given to some test subjects in the usual way and to others at random intervals through an IV line controlled by a concealed computer. Drugs that work only when the patient knows they're being administered are placebos themselves.
  • Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine.
anonymous

Perspective: a culture of respect, part 2: - 0 views

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    "Central to an effective response is a code of conduct that establishes unequivocally the expectation that everyone is entitled to be treated with courtesy, honesty, respect, and dignity. The code must be enforced fairly through a clear and explicit process and applied consistently regardless of rank or station.Creating a culture of respect requires action on many fronts: modeling respectful conduct; educating students, physicians, and nonphysicians on appropriate behavior; conducting performance evaluations to identify those in need of help; providing counseling and training when needed; and supporting frontline changes that increase the sense of fairness, transparency, collaboration, and individual responsibility."
anonymous

Medical Professionalism Charter Principles|ABIM Foundation - 0 views

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    "The principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. The three fundamental principles below are a guide to understanding physicians' professional responsibilities to individual patients and society as a whole."
anonymous

Medical education needs to be responsive to changes in professional identity being gene... - 0 views

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    "Medical education needs to be responsive to changes in professional identity being generated from factors within medical student experiences and within contemporary society."
avivajazz  jazzaviva

A Happy Hospitalist | The Medical Village - 0 views

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    A medical village expands on the concept of a patient's medical home to include providers outside of the "home" practice (hospitals, specialists, etc.). The medical village will rely on several important concepts, including collaborative and coordinated care and shared responsibility: PCP-to-specialist, specialist-to-PCP and specialist-to-specialist.
anonymous

e-Learning Resources on Addiction for Undergraduate Medical Education in Canada | Canad... - 1 views

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    "AFMC and the Norlien Foundation have partnered to provide funding and support for the development of a suite of e-learning tools on early brain and biological development and addictions for undergraduate medical education. The suite of resources includes virtual patients, a primer (e-textbook), and podcast series. Topics that are addressed include core concepts of early child development, epigenetics, intervention and treatment strategies, and system responses to addiction."
anonymous

Self-Other Agreement in Multisource Feedback: The Influence of Doctor and Rater Group C... - 0 views

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    "Self-other agreement in MSF ratings is influenced by characteristics of both raters and ratees. Managers, appraisers, and others responsible for interpreting and reviewing feedback results with the doctor need to be aware of these influences."
anonymous

5 Ways to Address Student Resistance in the Flipped Classroom - 1 views

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    "Students forced to take major responsibility for their own learning go through some or all of the steps psychologists associate with trauma and grief: Shock, Denial, Strong emotion, Resistance and withdrawal, Struggle and exploration, Return of confidence, and Integration and success""
anonymous

Can We Bridge the Gap between Theory and Clinical Practice? - 2 views

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    The use of entrustable professional activities (EPAs) and statements of awarded responsibility (STARs) may bridge a potential gap between the theory of competency-based education and clinical practice.
anonymous

5 traits of a bad preceptor | Scrubs - The Leading Lifestyle Nursing Magazine Featuring... - 1 views

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    "Unfortunately, there are some who should not be given the responsibility to teach and guide those who require it. Precepting an inexperienced nurse takes a unique set of traits. The following are five traits that, if you possess, means you might want to rethink being a preceptor:"
anonymous

Flipped learning skepticism: Is flipped learning just self-teaching? - Casting Out Nine... - 1 views

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    "What it provides is space and time for instructors to design learning activities and then carry them out, by relocating the transfer of information to outside the classroom. But then the instructor has the responsibility of using that space and time effectively."
anonymous

The relationship between resilience and personality traits in doctors: implications for... - 1 views

shared by anonymous on 02 May 14 - No Cached
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    "Resilience was associated with a personality trait pattern that is mature, responsible, optimistic, persevering, and cooperative. Findings support the inclusion of resilience as a component of optimal functioning and well being in doctors. Strategies for enhancing resilience should consider the key traits that drive or impair it."
anonymous

Portfolio-based learning and assessment in medical education - 1 views

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    "If you are considering developing this approach with and for colleagues for whom you have educational responsibility, it might help to consider the following 12 questions."
anonymous

About Medical Professionalism | ABIM Foundation - 0 views

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    Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. For many, medical professionalism is the "heart and soul of medicine." More than the adherence to a set of medical ethics, it is the daily expression of what originally attracted them to the field of medicine - a desire to help people and to help society as a whole by providing quality health care. But many physicians today experience profound obstacles to fulfilling the ideals of medical professionalism in practice.
Natalie Lafferty

Internet for Image Searching > START - 1 views

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    An on-line tutorial developed by JISC and Intute on how to find copyright free images on the web for your work. The tutorial includes an overview of legal responsibilities in using images and provides an overview of different licensing models for digital images. It also gives details of some sites which individuals might want to take a look at.
anonymous

Top Ten Tips for Outstanding Interactive Polling Sessions Using Audience Response Techn... - 0 views

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    Clickers are a great way to actively involve students in the class.
anonymous

Electronic Problem based learning - 4 views

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    ePBLMs are actual patient cases in CD format that permits free inquiry. The learner can ask any question of the patient in any sequence and get the patient's response and perform any item of the physical examination in any sequence and learn the result as in the real clinical situation. Any laboratory and diagnostic test can be ordered in any sequence as well. Whatever can be done with the actual patient on history and physical and the ordering of laboratory tests can be done with the ePBLM. A separate "User's Guide" provided with each ePBLM can be used with any of the ePBLMs in the series and provides the key for free inquiry.
anonymous

The CARE Model of Social Accountability: Promoting ... [Acad Med. 2011] - PubMed - NCBI - 1 views

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    "Although a systematic assessment of the CARE model is needed, early evidence shows that the most significant effects can be found in the cultural shift in the college, most notably among students. The CARE model may serve as an important example for other educational institutions in the development of health practitioners and research that is responsive to the needs of their communities."
Peter Kimmich

Historic Deadly Plagues and How They Would Be Treated Today - 0 views

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    In past centuries humans have been at the mercy of all kinds of bacteria, viruses and other icky stuff. Here is a list of famous human pandemics, and how the diseases responsible would be handled today.
anonymous

Toward the Construct Definition of Positive Deviance - 0 views

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    In this article, the authors develop a definition of positive deviance, a foundational construct in positive organizational scholarship. They offer a normative definition of positive deviance: intentional behaviors that depart from the norms of a referent group in honorable ways. The authors contrast this normative perspective on deviance with statistical, supraconformity, and reactive perspectives on deviance. They also develop research propositions that differentiate positive deviance from related prosocial types of behaviors, including organizational citizenship, whistle-blowing, corporate social responsibility, and creativity/innovation. Finally, the authors offer some initial ideas on how to operationalize positive deviance.
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