Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure.

BACKGROUND: Advance care planning (ACP) discussions afford patients and physicians a chance to better understand patients' values and wishes regarding end-of-life care; however, these conversations typically take place late in the course of a disease. The goal of this study was to clarify attitudes of oncologists, cardiologists, and primary care physicians (PCPs) toward ACP and to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system geared at improvement in ACP implementation. METHODS: A 20-question, cross-sectional online survey was created and distributed to cardiologists, oncologists, PCPs, and cardiology and oncology support staff at the NorthShore University HealthSystem (NorthShore) from February to March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool (SurveyMonkey, Inc., Palo Alto, California, USA). RESULTS: Only 15% of cardiologists felt it was their responsibility to conduct ACP discussions with their patients having congestive heart failure (CHF). In contrast, 68% of oncologists accepted this discussion as their responsibility in patients with terminal cancer ( P < .01). These views were mirrored by PCPs, as 68% of PCPs felt personally responsible for ACP discussion with patients having CHF, while only 34% felt the same about patients with cancer. Reported documentation of these discussions in the electronic health record was inconsistent between specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient's family toward these discussions were also significant reported barriers. CONCLUSION: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study tending to feel more personal responsibility for these discussions with patients having cancer than cardiologists with their patients having heart failure. Robust implementation of ACP across the spectrum of medical diagnoses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and the ambulatory settings.

Age as a moderator of the secular trend for grip strength in Canada and the United States.

PURPOSE: To determine whether grip strength changed on average over recent decades at each of two age levels (children and adolescents versus adults) in Canada and the US. METHODS: For each sex, weighted least squares regression analyses were performed on mean grip strength values as reported in studies conducted from the 1960s onwards. RESULTS: Grip strength did not change significantly as a function of year tested in children and adolescents, whereas it declined as a negatively accelerated function of year tested in adults. CONCLUSION: The results are contrary to what might be expected given that body weight has increased in both countries in recent decades and given that grip strength has been found to be positively correlated with body weight. It is suggested that there was a concurrent change in a factor that operated to counteract the effect of increased body weight on grip strength, a prime candidate being a decrease in levels of serum vitamin D. It is also suggested that the secular decline in adult grip strength can be explained by a factor that affects muscular function but which has a long latency period, a prime candidate here being obesity history.

The secular trend for grip strength in Canada and the United States.

Worldwide, body weight has risen dramatically in recent decades, raising the question of whether there were concomitant changes in physical fitness. Past research with children and adolescents has shown that body weight and grip strength are positively correlated. Therefore, it was predicted that grip strength had increased on average in children and adolescents over the past four or five decades. To test this prediction, relevant data were extracted from 18 studies for males (N = 5676 in total) and 17 studies for females (N = 5489 in total). The studies were conducted in Canada and the United States from about 1966 on, with participants' ages ranging from 6 through 19 years. Weighted least squares regression analyses showed that grip strength was significantly predicted by age but not by country. Male grip strength decreased significantly over the period covered, but the change was very small, accounting for far less than 1% of the variance in male grip strength. Discussion focuses on potential explanations for why grip strength did not change over time as predicted.

Simple reaction time: it is not what it used to be.

This article calls attention to the large amount of evidence indicating that simple visual reaction time (RT) has increased. To show that RT has increased, the RTs obtained by young adults in 14 studies published from 1941 on were compared with the RTs obtained by young adults in a study conducted by Galton in the late 1800s. With one exception, the newer studies obtained RTs longer than those obtained by Galton. The possibility that these differences in results are due to faulty timing instruments is considered but deemed unlikely. Of several possible causes for longer RTs, two are regarded as tenable: that RT has been increased by the buildup of neurotoxins in the environment and by the increasing numbers of people in less than robust health who have survived into adulthood. The importance of standardizing tests of RT in order to enable more refined analyses of secular trends in RT is emphasized.

The hunter-gatherer theory of sex differences in spatial abilities: data from 40 countries.

This study used some of the data from the BBC Internet study to assess the universality of sex related spatial competencies, as these are described in the terms of Silverman and Eals' (1992) hunter-gatherer theory of human spatial sex differences. As predicted, men scored significantly higher than women on a test of three-dimensional mental rotations in all seven ethnic groups and 40 countries used. Close to prediction, women scored significantly higher than men on a test of object location memory in all seven ethnic groups and 35 of the 40 countries. The data were discussed in terms of their implications for research approaches in this area and a paradigm for future studies was proposed, based on the interaction of innate and environmental factors in the ontogenetic development of spatial sex differences.

Gender and sexual orientation differences in cognition across adulthood: age is kinder to women than to men regardless of sexual orientation.

Despite some evidence of greater age-related deterioration of the brain in males than in females, gender differences in rates of cognitive aging have proved inconsistent. The present study employed web-based methodology to collect data from people aged 20-65 years (109,612 men; 88,509 women). As expected, men outperformed women on tests of mental rotation and line angle judgment, whereas women outperformed men on tests of category fluency and object location memory. Performance on all tests declined with age but significantly more so for men than for women. Heterosexuals of each gender generally outperformed bisexuals and homosexuals on tests where that gender was superior; however, there were no clear interactions between age and sexual orientation for either gender. At least for these particular tests from young adulthood to retirement, age is kinder to women than to men, but treats heterosexuals, bisexuals, and homosexuals just the same.

The inheritance of cognitive skills: does genomic imprinting play a role?

Genomic imprinting refers to the differential expression of a gene based on parental origin. Animal and clinical studies have suggested that genomic imprinting is influential in brain development, with the maternal genome playing a disproportionate role in the development of the cortex. The present study investigated this phenomenon in a nonclinical human population, using intrafamilial correlations. Broadly consistent with predictions, it was found that abilities mediated by frontal, parietal, and temporal lobes, but not occipital lobes, were more closely correlated between children and mothers versus fathers. The implications of these findings for the prevailing theory of the evolution of genomic imprinting, and for the general study of genetics and behavior, are discussed.

Providing information at the point of care: educational diagnostic reports from a genetic testing service provider.

Strategies to facilitate the provisioning of genetic health-care services by primary care physicians will improve access to these services for the average patient while making the most efficient use of limited human and financial resources within the health-care system. Genetic laboratories have become a major source of information and consultation for clinicians ordering genetic tests. This article describes the development and evaluation of a program to provide physician-directed information from a molecular testing facility to assist physicians in selecting and counseling patients and interpreting genetic test results. Semi-structured telephone interviews were used to gather physicians' opinions about the utility of the program and the way in which the information was used in their practice. Forty-three percent of those interviewed were unfamiliar with some of the information provided, with test methodology and sensitivity/specificity most often identified as novel information. Fifty-two percent of pediatric specialists were unfamiliar with some aspect of the information Sheet, despite being the highest consumers of testing services in this sample. Pediatricians and pediatric specialists also rated the initiative highest in terms of its usefulness in their practice, followed by genetic specialists. Overall, physicians confirmed the utility of the program as an educational tool for themselves, and for other non-patient educational activities in which they are involved.

The relationship between testosterone and route-learning strategies in humans.

The relationships between route-learning strategies and circulating testosterone and estradiol levels were investigated in men and women. Testosterone and estradiol concentrations were measured by salivary assays and route-learning strategies were assessed using a direction-giving paradigm based on a novel map. Testosterone was positively correlated with the use of male-biased route-learning strategies in men, but not in women. These findings suggest sex-specific patterns of relationships between circulating testosterone and spatial processing, which apply to everyday spatial behavior.