Peter Winkelstein

Urinary excretion of pneumococcal cell wall polysaccharide in children

The urinary excretion of the cell wall polysaccharide of Streptococcus pneumoniae was studied in 92 children with the NOW test. Cell wall polysaccharide was detected in 65% of pneumococcal carriers and in 10% of noncarriers. Excretion rates were similar in healthy children and in children with acute otitis media. The high rate of antigen excretion among nonill carriers suggests that colonization is a major source of urinary antigen in children.

New Technique (the NOW Test) for Rapid Detection of Streptococcus pneumoniae in the Nasopharynx

ABSTRACT Although the NOW test was originally introduced as a rapid pneumococcal antigen detection test for use with urine samples, it was successfully adapted to nasopharyngeal samples in the present study. The sensitivity, specificity, positive predictive value, and negative predictive value of the test were 92.2, 97.7, 95.9, and 95.5%, respectively. These results demonstrate that nasopharyngeal colonization with Streptococcus pneumoniae can be documented within 15 min of sample collection.

AMIA's code of professional and ethical conduct

AMIA, as other professional societies, has a long-standing interest in promoting a strong ethical framework for its membership. This white paper presents the latest AMIA Code of Professional and Ethical Conduct. It was approved in November of 2011 by the AMIA Board of Directors. This document constitutes a revision of, and update to, the first code, approved and published in J Am Med Inform Assoc 1 in 2007. In an effort to keep pace with the fields vitality, the code presented here is intended to be a dynamic document, and will continue to evolve as AMIA and the field itself evolve. AMIA will publish on its web site this version of the code as part of a process that seeks ongoing response from, and involvement by, AMIA members. The code is meant to be practical and easily understood, so it is compact and uses general language. Unlike the ethics codes of some professional societies, the AMIA code is not intended to be prescriptive or legislative; it is aspirational, and as such, provides the broad strokes of a set of important ethical principles especially pertinent to the field of biomedical and health informatics. The code is organized around the common roles of AMIA members and the constituents they serve—including patients, students, and others—and with whom they interact. The AMIA Board and the AMIA Ethics Committee encourage members to offer suggestions for improvements and other changes. In this way, the code will continue to progress and best serve AMIA and the larger informatics community. Codes of ethics for professionals present special challenges in conception and execution. The goal of this code is to lay out the core values of this profession in a way that inspires AMIA members to acknowledge and embrace these values. While the crafting of the code involved many …

Ethical and Social Challenges of Electronic Health Information

The development of modern bioethics has been strongly influenced by technology. Important ethical questions surround the use of electronic health records, clinical decision support systems, internet-based consumer health information, outcome measurement, and data mining. Electronic health records are changing the way health information is managed, but implementation is a difficult task in which social and cultural issues must be addressed. Advice produced by decision support systems must be understood and acted upon in the context of the overall goals and values of health care. Empowering health care consumers through readily-available health information is a valuable use of the internet, but the nature of the internet environment raises the spectre of abuse of vulnerable patients. Outcome studies have inherent value judgments that may be hidden. Data mining may impact confidentiality or lead to discrimination by identifying subgroups. All of these issues, and others, require careful examination as more and more health information is captured electronically.

A Code of Professional Ethical Conduct for the American Medical Informatics Association: An AMIA Board of Directors Approved White Paper

The AMIA Board of Directors has decided to periodically publish AMIAs Code of Professional Ethical Conduct for its members in the Journal of the American Medical Informatics Association. The Code also will be available on the AMIA Web site at www.amia.org as it continues to evolve in response to feedback from the AMIA membership. The AMIA Board acknowledges the continuing work and dedication of the AMIA Ethics Committee. AMIA is the copyright holder of this work.

Medicine 2.0: Ethical Challenges of Social Media for the Health Profession

Social media (“web 2.0”) is profoundly changing the way people interact with, and relate to, the internet. The success of Facebook, with over 800 million active users, surely indicates that social media is not a fad. Healthcare will not go untouched by social media. The combination of social media and healthcare (medicine 2.0) will be a powerful one. Social media will impact healthcare in many ways, including reducing information asymmetry, increasing access to, and portability of, personal health information and altering the doctor–patient relationship. Adoption of social media in healthcare will be driven both by patient preferences and by economic forces. The challenge for the health profession is to understand the impacts and drivers of the phenomenon, including the ethical issues raised by this new form of human interaction, and respond appropriately.