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Ronald Epstein

Adam Walczak, Phyllis N Butow, Martin H N Tattersall, Patricia M Davidson, Jane Young, Ronald M Epstein, Daniel S J Costa, Josephine M Clayton
BACKGROUND: Patients are often not given the information needed to understand their prognosis and make informed treatment choices, with many consequently experiencing less than optimal care and quality-of-life at end-of-life. OBJECTIVES: To evaluate the efficacy of a nurse-facilitated communication support program for patients with advanced, incurable cancer to assist them in discussing prognosis and end-of-life care. DESIGN: A parallel-group randomised controlled trial design was used...
October 21, 2016: International Journal of Nursing Studies
Ronald M Epstein, Michael R Privitera
No abstract text is available yet for this article.
November 5, 2016: Lancet
Ronald M Epstein, Paul R Duberstein, Joshua J Fenton, Kevin Fiscella, Michael Hoerger, Daniel J Tancredi, Guibo Xing, Robert Gramling, Supriya Mohile, Peter Franks, Paul Kaesberg, Sandy Plumb, Camille S Cipri, Richard L Street, Cleveland G Shields, Anthony L Back, Phyllis Butow, Adam Walczak, Martin Tattersall, Alison Venuti, Peter Sullivan, Mark Robinson, Beth Hoh, Linda Lewis, Richard L Kravitz
Importance: Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. Objective: To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life...
September 9, 2016: JAMA Oncology
Julia Drylewicz, Ingrid M M Schellens, Rogier Gaiser, Nening M Nanlohy, Esther D Quakkelaar, Henny Otten, Suzanne van Dorp, Ronald Jacobi, Leonie Ran, Sanne Spijkers, Dan Koning, Rob Schuurman, Ellen Meijer, Floortje L Pietersma, Jurgen Kuball, Debbie van Baarle
BACKGROUND: Epstein-Barr virus and Cytomegalovirus reactivations frequently occur after allogeneic stem cell transplantation (SCT). METHODS: Here we investigated the role of immune cell reconstitution in the onset and subsequent severity of EBV- and CMV-reactivation. To this end, 116 patients were prospectively sampled for absolute T cell (CD4 and CD8), B-cell (CD19) and NK-cell (CD16 and CD56) numbers weekly post-SCT during the first 3 months and thereafter monthly until 6 months post-SCT...
2016: Journal of Translational Medicine
Robert Gramling, Kevin Fiscella, Guibo Xing, Michael Hoerger, Paul Duberstein, Sandy Plumb, Supriya Mohile, Joshua J Fenton, Daniel J Tancredi, Richard L Kravitz, Ronald M Epstein
Importance: Patients with advanced cancer often report expectations for survival that differ from their oncologists' expectations. Whether patients know that their survival expectations differ from those of their oncologists remains unknown. This distinction is important because knowingly expressing differences of opinion is important for shared decision making, whereas patients not knowing that their understanding differs from that of their treating physician is a potential marker of inadequate communication...
July 14, 2016: JAMA Oncology
Arvind Kaul, Caroline Gordon, Mary K Crow, Zahi Touma, Murray B Urowitz, Ronald van Vollenhoven, Guillermo Ruiz-Irastorza, Graham Hughes
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many organs, including the skin, joints, the central nervous system and the kidneys. Women of childbearing age and certain racial groups are typically predisposed to developing the condition. Rare, inherited, single-gene complement deficiencies are strongly associated with SLE, but the disease is inherited in a polygenic manner in most patients. Genetic interactions with environmental factors, particularly UV light exposure, Epstein-Barr virus infection and hormonal factors, might initiate the disease, resulting in immune dysregulation at the level of cytokines, T cells, B cells and macrophages...
June 16, 2016: Nature Reviews. Disease Primers
Jennifer K Carroll, Susan A Flocke, Mechelle R Sanders, Lisa Lowenstein, Kevin Fiscella, Ronald M Epstein
BACKGROUND: Physical activity (PA) counselling is challenging in primary care. It is unknown whether clinician training on the 5As (Ask, Advise, Agree, Assist, Arrange) improves PA counselling skills. OBJECTIVE: To evaluate the effect of a clinician training intervention on PA counselling for underserved adults using the 5As framework. METHODS: Pragmatic pilot clinical trial was used in the study. Clinicians (n = 13) were randomly assigned to two groups...
October 2016: Family Practice
Taryn G Aubrecht, Zachary M Weil, Bachir Abi Salloum, Maria Eugenia Ariza, Marshall Williams, Brenda Reader, Ronald Glaser, John Sheridan, Randy J Nelson
Most adult humans have been infected with Epstein-Barr virus (EBV), which is thought to contribute to the development of chronic fatigue syndrome. Stress is known to influence the immune system and can exacerbate the sickness response. Although a role for psychological stress in the sickness response, particularly in combination with EBV-encoded deoxyuridine triphosphate nucleotidohydrolase (dUTPase) has been established, and the role of physical stressors in these interactions remains unspecified. In this study, we seek to determine the interaction of chronic physical (swim) stress and EBV-encoded dUTPase injection...
October 2015: Journal of Behavioral and Brain Science
Jeffrey I Cohen, Lesia Dropulic, Amy P Hsu, Christa S Zerbe, Tammy Krogmann, Kennichi Dowdell, Ronald L Hornung, Jana Lovell, Nancy Hardy, Dennis Hickstein, Edward W Cowen, Katherine R Calvo, Stefania Pittaluga, Steven M Holland
BACKGROUND: Most patients infected with Epstein-Barr virus (EBV) are asymptomatic, have nonspecific symptoms, or have self-limiting infectious mononucleosis. EBV, however, may result in severe primary disease or cancer. METHODS: We report EBV diseases associated with GATA2 deficiency at one institution and describe the hematology, virology, and cytokine findings. RESULTS: Seven patients with GATA2 deficiency developed severe EBV disease. Three presented with EBV infectious mononucleosis requiring hospitalization, 1 had chronic active EBV disease (B-cell type), 1 had EBV-associated hydroa vacciniforme-like lymphoma with hemophagocytic lymphohistiocytosis, and 2 had EBV-positive smooth muscle tumors...
July 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Josef Bartels, Rachel Rodenbach, Katherine Ciesinski, Robert Gramling, Kevin Fiscella, Ronald Epstein
OBJECTIVE: Silences in doctor-patient communication can be "connectional" and communicative, in contrast to silences that indicate awkwardness or distraction. Musical and lexical analyses can identify and characterize connectional silences in consultations between oncologists and patients. METHODS: Two medical students and a professor of voice screened all 1211 silences over 2s in length from 124 oncology office visits. We developed a "strength of connection" taxonomy and examined ten connectional silences for lexical and musical features including pitch, volume, and speaker turn-taking rhythm...
October 2016: Patient Education and Counseling
Ali Nael, Vighnesh Walavalkar, William Wu, Kambiz Nael, Ronald Kim, Sherif Rezk, Xiaohui Zhao
OBJECTIVES: Primary central nervous system lymphomas (PCNSLs) in patients with human immunodeficiency virus (HIV) are predominantly B-cell lymphomas associated with Epstein-Barr virus (EBV) and rarely CD8-positive T-cell PCNSLs. METHODS: Patient history, laboratory results, cerebrospinal fluid (CSF), imaging, and brain biopsy specimens were reviewed and tested for T-cell receptor clonality. RESULTS: A 64-year-old HIV-positive woman sought treatment for lethargy and left-sided weakness...
February 2016: American Journal of Clinical Pathology
Joshua J Fenton, Richard L Kravitz, Anthony Jerant, Debora A Paterniti, Heejung Bang, Donna Williams, Ronald M Epstein, Peter Franks
IMPORTANCE: Low-value diagnostic tests have been included on primary care specialty societies' "Choosing Wisely" Top Five lists. OBJECTIVE: To evaluate the effectiveness of a standardized patient (SP)-based intervention designed to enhance primary care physician (PCP) patient-centeredness and skill in handling patient requests for low-value diagnostic tests. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of 61 general internal medicine or family medicine residents at 2 residency-affiliated primary care clinics at an academic medical center in California...
February 2016: JAMA Internal Medicine
Rachel A Rodenbach, Kyle E Rodenbach, Mohamedtaki A Tejani, Ronald M Epstein
OBJECTIVE: Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them. METHODS: Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality...
March 2016: Patient Education and Counseling
Heather L Shepherd, Alexandra Barratt, Anna Jones, Deborah Bateson, Karen Carey, Lyndal J Trevena, Kevin McGeechan, Chris B Del Mar, Phyllis N Butow, Ronald M Epstein, Vikki Entwistle, Edith Weisberg
OBJECTIVE: To test the feasibility and assess the uptake and acceptability of implementing a consumer questions programme, AskShareKnow, to encourage consumers to use the questions '1. What are my options; 2. What are the possible benefits and harms of those options; 3. How likely are each of those benefits and harms to happen to me?' These three questions have previously shown important effects in improving the quality of information provided during consultations and in facilitating patient involvement...
October 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Ronald M Epstein
Given that presence is ineffable yet real and universal, it is no surprise that it has historically been the domain of mystics. However, presence and its cousins—shared mind, love, and compassion—have now become of intense interest among members of the scientific community under the banners of interpersonal neurobiology and social neuroscience (Decety & Lamm, 2009; Epstein & Street, 2011; Klimecki, Leiberg, Lamm, & Singer, 2013; Zlatev, Racine, Sinha, & Itkonen, 2008). This may seem obvious to readers of Families Systems, and Health, but it is not the basis for medical practice or psychotherapy in general...
September 2015: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Robert Gramling, Elizabeth Gajary-Coots, Susan Stanek, Nathalie Dougoud, Heather Pyke, Marie Thomas, Jenica Cimino, Mechelle Sanders, Stewart C Alexander, Ronald Epstein, Kevin Fiscella, David Gramling, Susan Ladwig, Wendy Anderson, Stephen Pantilat, Sally A Norton
BACKGROUND: Understanding the characteristics of communication that foster patient-centered outcomes amid serious illness are essential for the science of palliative care. However, epidemiological cohort studies that directly observe clinical conversations can be challenging to conduct in the natural setting. We describe the successful enrollment, observation and data collection methods of the ongoing Palliative Care Communication Research Initiative (PCCRI). METHODS: The PCCRI is a multi-site cohort study of naturally occurring inpatient palliative care consultations...
2015: BMC Palliative Care
Robert Epstein, Ronald E Robertson
Internet search rankings have a significant impact on consumer choices, mainly because users trust and choose higher-ranked results more than lower-ranked results. Given the apparent power of search rankings, we asked whether they could be manipulated to alter the preferences of undecided voters in democratic elections. Here we report the results of five relevant double-blind, randomized controlled experiments, using a total of 4,556 undecided voters representing diverse demographic characteristics of the voting populations of the United States and India...
August 18, 2015: Proceedings of the National Academy of Sciences of the United States of America
Franklin Dexter, Henry Rosenberg, Richard H Epstein, Judith Jurin Semo, Ronald S Litman
Recently, we analyzed data from the American Society of Anesthesiologist's (ASA) Anesthesia Quality Institute (AQI) to report the United States (U.S.) anesthesia workload by time of day and day of the week. The AQI data were reported using the Central Time zone. Times for the N = 613 calls to the Malignant Hyperthermia Association of the United States (MHAUS) Malignant Hyperthermia (MH) Hotline from August 1, 2012, through March 7, 2014, were adjusted similarly. The MH Hotline effectively provides at all times to each anesthesia group an additional board-certified anesthesiologist who has expertise in managing, diagnosing, and/or preventing MH crises...
August 1, 2015: A & A Case Reports
Robert Gramling, Mechelle Sanders, Susan Ladwig, Sally A Norton, Ronald Epstein, Stewart C Alexander
CONTEXT: Palliative care (PC) promotes patient-centered outcomes, but the mechanisms underlying these effects remain poorly understood. Identifying, clarifying, and prioritizing patients' goals are conceptually fundamental to the process of patient-centeredness and are the main reasons for PC referral. However, very little is empirically known about the content or process of goal expression in the natural setting of PC. OBJECTIVES: To describe the frequency, types, and determinants of goal expression in PC consultations...
November 2015: Journal of Pain and Symptom Management
Rashmi T Samdani, Jaclyn F Hechtman, Eileen O'Reilly, Ronald DeMatteo, Carlie S Sigel
Lymphoepithelioma-like carcinomas are distinctive epithelial derived malignant neoplasms that have a syncytial growth pattern and lymphoid stroma. The majority of tumors with this appearance are Epstein Barr virus (EBV)-associated. We report a patient with a clinical presentation concerning for lymphoma who was diagnosed with an EBV-associated pancreatic carcinoma with a lymphoepithelioma-like pattern. Targeted sequencing analysis showed a molecular profile distinct from conventional ductal adenocarcinoma of the pancreas...
May 2015: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
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