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The founders of PubPeer envisioned their website as an online form of a "journal club" that would facilitate post-publication peer review. Recently, PubPeer comments have led to a significant number of research misconduct proceedings - a development that could not have been anticipated when the current federal research misconduct regulations were developed two decades ago. Yet the number, frequency, and velocity of PubPeer comments identifying data integrity concerns, and institutional and government practices that treat all such comments as potential research misconduct allegations, have overwhelmed institutions and threaten to divert attention and resources away from other research integrity initiatives. Recent, high profile research misconduct cases accentuate the increasing public interest in research integrity and make it inevitable that the use of platforms such as PubPeer to challenge research findings will intensify. This article examines the origins of PubPeer and its central role in the modern era of online-based scouring of scientific publications for potential problems and outlines the challenges that institutions must manage in addressing issues identified on PubPeer. In conclusion, we discuss some potential enhancements to the investigatory process specified under federal regulations that could, if implemented, allow institutions to manage some of these challenges more efficiently.
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[This corrects the article DOI: 10.1371/journal.pone.0245257.].
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Despite the increasing personalization of medicine, surprisingly ~37.0°C (98.6°F) continues as the estimate of normal temperature. We investigated between-subject and within-subject thermal variability, whether a significant percentage of individuals have a low mean oral temperature, and whether these differ by sex, age, time of day, ethnicity, body mass index (BMI), or menstrual phase. Oral temperature was measured by Life Brand® Fast-Read Digital Oral Thermometers and sampled 14 times over two weeks, seven morning and seven evening readings. The volunteer sample consisted of 96 adults (42 men, 54 women; 27 couples, 42 singletons), ages 18-67 years. We found sizeable individual differences in body temperature and that the normal temperature of many individuals is considerably lower than 37.0°C (98.6°F). Mean temperatures ranged from 35.2°C (95.4°F) to 37.4°C (99.3°F). The mean temperature across all participants was 36.1°C (97.0°F)-lower than most studies have reported, consistent with recent evidence of temperature declining over decades. 77% had mean temperatures at least 0.55°C (1°F) lower than 37.0°C (98.6°F). Mean temperature did not differ by age, but women had higher temperatures than men, even within a couple with room temperature and warmth of clothing equated. Although oral temperature varied widely across individuals, it showed marked stability within individuals over days. Variability of temperature over days did not differ by sex, but was larger among younger adults. Using 37.0°C (98.6°F) as the assumed normal temperature for everyone can result in healthcare professionals failing to detect a serious fever in individuals with a low normal temperature or obtaining false negatives for those individuals when using temperature to screen for COVID-19, mistaking their elevated temperature as normal. Some have called for lowering the estimate of normal temperature slightly (e.g., 0.2°C [0.36°F]). That still seems an overly high estimate. More important, using any standardized "normal" temperature will lead to errors for many people. Individual differences are simply too great. Personalizing body temperature is needed. Temperature could be measured at yearly doctor visits, as blood pressure is now. That would be simple to implement. Since our results show marked thermal stability within an individual, sampling temperature only once yearly could provide an accurate indication of a person's normal temperature at that time of day. Such records over time would also provide a more accurate understanding of how temperature changes over the lifespan.
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Temperatura Corporal , Adolescente , Adulto , Fatores Etários , Idoso , COVID-19/patologia , COVID-19/virologia , Feminino , Febre/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Fatores Sexuais , Adulto JovemAssuntos
Cloroquina/farmacologia , Infecções por Coronavirus , Aprovação de Drogas/legislação & jurisprudência , Reposicionamento de Medicamentos , Hidroxicloroquina/farmacologia , Pandemias , Pneumonia Viral , Autorização Prévia , Acesso à Informação , Antimaláricos/farmacologia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Reposicionamento de Medicamentos/métodos , Reposicionamento de Medicamentos/normas , Reposicionamento de Medicamentos/tendências , Medicina Baseada em Evidências , Humanos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Autorização Prévia/legislação & jurisprudência , Autorização Prévia/tendências , SARS-CoV-2 , Tratamento Farmacológico da COVID-19RESUMO
Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies.
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Armas de Fogo/legislação & jurisprudência , Violência com Arma de Fogo/prevenção & controle , Papel do Médico , Prática Profissional/ética , Prática Profissional/legislação & jurisprudência , Ferimentos por Arma de Fogo/prevenção & controle , Aconselhamento , Responsabilidade pela Informação , Humanos , Notificação de Abuso , Estados Unidos/epidemiologiaRESUMO
This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: (1) The psychological toll on physicians: "I wonder if I'm broken"; (2) the importance of and need for mass casualty shooting preparedness: "[We need to] recognize this as a public health concern and train physicians to manage it"; (3) massive media attention: "The media onslaught was unbelievable"; and (4) commitment to advocacy for a public health approach to firearm violence: "I want to do whatever I can to prevent some of these terrible events."
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Violência com Arma de Fogo/psicologia , Incidentes com Feridos em Massa/psicologia , Médicos/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Características de Residência , Estados UnidosRESUMO
Background In the United States, patients have the right to access their protected health information. However, to the knowledge of the authors, no study has evaluated the patient request process and the barriers to patient access of their radiology images. Purpose To assess U.S. hospital compliance with federal regulations and patient ease of access to imaging studies. Materials and Methods In this cross-sectional study conducted from June 6 to December 3, 2018, 80 U.S. hospitals were contacted by telephone to determine their patient request process for imaging studies. A scripted interview was used to simulate the patient experience in requesting imaging studies. Hospitals were compared in terms of formats of release (compact disc [CD] via pick up, CD via mail, e-mail, online patient portal, or other online access), departments from which cine files can be requested, fees, and processing times. Results All 80 hospitals stated that they could provide imaging studies on CDs. Only six (8%) hospitals provided imaging studies via e-mail and three (4%) via an online patient portal. Requests for cine files were fulfilled by a department separate from diagnostic radiology in 47 of 80 (59%) hospitals. Patient charges ranged from $0 to $75 for a single CD, no charge to $6 via e-mail, and no charge via an online patient portal. Fifty-nine (74%) hospitals stated that they could release copies within 24 hours, 10 (13%) within 2-5 days, eight (10%) within 5-10 days, and three (4%) within 10-30 days from request date. Imaging studies from outside of the diagnostic radiology department may need to be requested through the departments that performed the study. Conclusion This study demonstrated that although fees and processing times are compliant with federal regulations, patient access to imaging studies is limited primarily to compact disc format. The request process is also complicated for patients because of dispersion of imaging studies across departments. © RSNA, 2019 Online supplemental material is available for this article.
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Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Radiologia/métodos , Estudos Transversais , Diagnóstico por Imagem/economia , Humanos , Acesso dos Pacientes aos Registros/economia , Radiologia/economia , Estados UnidosRESUMO
While federal regulation provides patients the right to access their electronic health records and promotes increased use of health information technology, patient access to electronic health records remains limited. The 21st Century Cures Act, signed into law over a year ago, has important provisions that could significantly improve access and availability of health data. Specifically, the provisions call for partnerships among health information exchange networks, educational and research initiatives, and health information technology certification requirements that encourage interoperability. The article reviews the potential benefits and concerns regarding implementation of these provisions, particularly the difficulty of aligning incentives and requirements for data sharing and the question of whether currently proposed rules and guidance will support the goal of improved patient access and health information exchange. Researchers, clinicians, and patients have the power to advocate for improved patient access and interoperability as policy development and implementation of the 21st Century Cures Act continues.
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Registros Eletrônicos de Saúde/legislação & jurisprudência , Interoperabilidade da Informação em Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Informática Médica/legislação & jurisprudência , Regulamentação Governamental , Troca de Informação em Saúde/legislação & jurisprudência , Humanos , Disseminação de Informação/legislação & jurisprudência , Estados UnidosRESUMO
Importance: Although federal law has long promoted patients' access to their protected health information, this access remains limited. Previous studies have demonstrated some issues in requesting release of medical records, but, to date, there has been no comprehensive review of the challenges that exist in all aspects of the request process. Objective: To evaluate the current state of medical records request processes of US hospitals in terms of compliance with federal and state regulations and ease of patient access. Design, Setting, and Participants: A cross-sectional study of medical records request processes was conducted between August 1 and December 7, 2017, in 83 top-ranked US hospitals with independent medical records request processes and medical records departments reachable by telephone. Hospitals were ranked as the top 20 hospitals for each of the 16 adult specialties in the 2016-2017 US News & World Report Best Hospitals National Rankings. Exposures: Scripted interview with medical records departments in a single-blind, simulated patient experience. Main Outcomes and Measures: Requestable information (entire medical record, laboratory test results, medical history and results of physical examination, discharge summaries, consultation reports, physician orders, and other), formats of release (pick up in person, mail, fax, email, CD, and online patient portal), costs, and request processing times, identified on medical records release authorization forms and through telephone calls with medical records departments. Results: Among the 83 top-ranked US hospitals representing 29 states, there was discordance between information provided on authorization forms and that obtained from the simulated patient telephone calls in terms of requestable information, formats of release, and costs. On the forms, as few as 9 hospitals (11%) provided the option of selecting 1 of the categories of information and only 44 hospitals (53%) provided patients the option to acquire the entire medical record. On telephone calls, all 83 hospitals stated that they were able to release entire medical records to patients. There were discrepancies in information given in telephone calls vs on the forms between the formats hospitals stated that they could use to release information (69 [83%] vs 40 [48%] for pick up in person, 20 [24%] vs 14 [17%] for fax, 39 [47%] vs 27 [33%] for email, 55 [66%] vs 35 [42%] for CD, and 21 [25%] vs 33 [40%] for online patient portals), additionally demonstrating noncompliance with federal regulations in refusing to provide records in the format requested by the patient. There were 48 hospitals that had costs of release (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. At least 6 of the hospitals (7%) were noncompliant with state requirements for processing times. Conclusions and Relevance: The study revealed that there are discrepancies in the information provided to patients regarding the medical records release processes and noncompliance with federal and state regulations and recommendations. Policies focused on improving patient access may require stricter enforcement to ensure more transparent and less burdensome medical records request processes for patients.