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Eric Racine

Publications and source records attributed to Eric Racine.

12 recordsLinked to original sources
PubMed2006

Neuroethical responsibilities.

Neuroscience represents a dynamic area of biomedical research where neuroethical responsibilities for researchers are emerging. This paper is the companion piece to the French-language one also published in this issue of the Canadian Journal of Neurological Sciences. It serves as a review of recent advances in neuroethics through the lens of three cases: (1) incidental finding of anomalies in neuroimaging research; (2) creation of neurotechnologies that can lead to cognitive enhancement, and (3) responsible communication of research results. We propose and discuss a multidimensional framework of neuroethical responsibilities to help tackle these issues. The framework reiterates the fundamental role of scientific integrity, puts in the foreground social responsibilities pertaining to the eventual use of neuroscience knowledge, and highlights self-reflection in research and training of researchers.

Cognition↗
PubMed2005

Hyped biomedical science or uncritical reporting? Press coverage of genomics (1992-2001) in Québec.

Genomics integrates the promises and perils of modern biomedical science. Canada and the province of Québec embarked late but aggressively in genomics research based on the 'discourse of promise' in which genomics is embedded. This did not prevent the emergence of a 'discourse of concerns', and debates on the wider meaning of genomics and on the risks related to genomics applications such as gene therapy and gene testing. Given this context, this study aims to understand the evolution of genomics press coverage from the early days up to the publication of the draft sequence of the human genome. Accordingly, we performed a press content analysis on 749 articles reporting genomics research in Québec from 1992 to 2001. We focused on coverage of benefits and ethical issues, tone, and differences in reporting practices between press agencies and journalists. Results show an increasing number of articles, a general decline in the proportion of articles featuring ethical issues, an increased focus on the economy, and greater optimism from 1992 to 2001. In comparison to articles written by journalists, articles signed by press agencies are more optimistic and less often feature ethical issues. Results are discussed following two non-exclusive interpretations: (1) the successes of genomics and its institutionalization in Québec and Canada brought hype and greater social acceptance, and (2) uncritical reporting practices have emerged under pressures for expedient and consumable writing. We are left with two concerns: given worldwide media concentration movements, what are the challenges for the dissemination of diversified and critical information in print media? And, given limited coverage of ethical issues, and concerns about bioethics being too narrowly focused, should public debates on frontier biomedical science be promoted to broaden the scope of biomedical ethics?

Bibliometrics↗
PubMed2005

fMRI in the public eye.

The wide dissemination and expanding applications of functional MRI have not escaped the attention of the media or discussion in the wider public arena. From the bench to the bedside, this technology has introduced substantial ethical challenges. Are the boundaries of what it can and cannot achieve being communicated to the public? Are its limitations understood? And given the complexities that are inherent to neuroscience, are current avenues for communication adequate?

Biotechnology↗
PubMed2005

Imaging or imagining? A neuroethics challenge informed by genetics.

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the difficulty of carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point--even a backbone--for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge.

Behavior↗
PubMed2003

Literacy, readability and cultural barriers: critical factors to consider when educating older African Americans about anticoagulation therapy.

The number of patients on anticoagulation therapy has increased dramatically over the past two decades. Yet, few studies have examined the psychosocial barriers of low literacy, culture and inappropriate patient education materials used to teach older African Americans about their anticoagulation therapy. The aims of this study were to investigate literacy levels among older patients, and evaluate the readability and determine the cultural sensitivity of written information used in an anticoagulation management clinic. A descriptive, correlational design was used. Patients' (n = 62) knowledge levels and the readability and cultural sensitivity of written materials were examined. The Rapid Estimate of Adult Literacy in Medicine (REALM) was used to measure reading skills of patients, while the SMOG formula (a formula for assessing readability) was used to test the readability of written educational materials used in an Anticoagulation Management Clinic. A Knowledge Information Profile, developed for this study by one of the authors (Wilson), was used to measure patient knowledge about warfarin, medication side-effects and food sources of vitamin K. A modified, culturally sensitive and easy-to-read pamphlet was used as an alternative teaching tool in the study. The results of the study revealed the average self-reported for highest grade completed in school was twelfth grade; however, the actual mean reading skills were between seventh and eighth grade. The readability of the written information was three to four grades higher than patients' reading abilities. None of the patient education materials were culturally sensitive. This study underscores the importance of having information that is understandable and culturally relevant to prevent the outcome of internal bleeding. Nurses have a vital role in educating patients and ensuring that teaching materials are appropriate for the target population.

Adult↗
PubMed2003

Nesiritide: a novel approach for acute heart failure.

OBJECTIVE: To review preclinical and clinical information related to nesiritide, a recombinant form of B-type natriuretic peptide approved for treatment of acutely decompensated heart failure. DATA SOURCES: Primary and review articles were identified by MEDLINE search (1966-May 2002) using the key words natriuretic peptide and heart failure, and through secondary sources. Natrecor's document submitted for the Food and Drug Administration (FDA) New Drug Application were obtained from the FDA Web site. STUDY SELECTION/DATA EXTRACTION: Peer-reviewed articles and abstracts of randomized clinical trials in humans were included in this review. DATA SYNTHESIS: Nesiritide has beneficial actions for treatment of heart failure, including arterial and venous dilatation, enhanced sodium and urinary excretion, and suppression of the renin-angiotensin-aldosterone and sympathetic nervous systems. It has been shown to improve hemodynamic parameters, primarily pulmonary capillary wedge pressure, as well as clinical symptoms in patients with acutely decompensated heart failure. Nesiritide produced more rapid hemodynamic improvement and caused significantly fewer adverse effects than intravenous nitroglycerin. The incidence of hypotension, the most common adverse effect, was comparable between nesiritide and nitroglycerin. Additionally, nesiritide is associated with a lower incidence of arrhythmias than dobutamine and has a neutral effect on mortality. CONCLUSIONS: Nesiritide offers an alternative for management of acutely decompensated heart failure. It is considered an option for patients who do not respond to other vasodilators, inotropes, or diuretics and for those at high risk of arrhythmias. Further pharmacoeconomic investigations for nesiritide are warranted.

Half-Life↗
PubMed2002

Role of glycoprotein IIb/IIIa-receptor inhibitors in managing ST-segment-elevation myocardial infarction.

The role of glycoprotein (GP) IIb/IIIa-receptor inhibitors in managing ST-segment-elevation (STE) myocardial infarction (MI) is discussed. Strategies to improve outcomes in patients with STE MI have been directed toward rapidly establishing early reperfusion of the infarct-related artery and the downstream myocardial microvasculature and preventing reocclusion. Because of its superiority to fibrinolytic reperfusion, percutaneous coronary intervention (PCI) has emerged as the treatment of choice in patients with STE MI, including patients who are initially admitted to facilities not equipped to perform PCI. The combination of reduced doses of fibrinolytic agents with the GP IIb/IIIa-receptor inhibitors abciximab and eptifibatide has been explored as a means of improving reperfusion, both without PCI and as a means of facilitating PCI. Two large studies of the combination of abciximab and a reduced dose of a fibrinolytic agent in patients not undergoing PCI found a significant reduction in reinfarction, but mortality rates were unaffected and the risk of bleeding complications and thrombocytopenia was increased compared with the full dose of fibrinolytic agents alone. More encouraging results were seen with abciximab (with and without fibrinolytic therapy) in patients undergoing PCI. Pretreatment with eptifibatide (with and without concomitant fibrinolytic therapy) increased reperfusion prior to PCI, setting the stage for a large ongoing trial of eptifibatide in patients with STE MI undergoing PCI. This trial may help define the new standard of care for patients with STE MI, including the optimal use of GP IIb/IIIa-receptor inhibitors. Recent clinical trials in patients with STE MI show that the use of a GP IIb/IIIa-receptor inhibitor (with or without concomitant therapy with a reduced dose of a fibrinolytic agent) in conjunction with early PCI holds promise for achieving higher reperfusion rates and reducing the frequency of ischemic events.

Abciximab↗
PubMed2002

Justifying high-cost anticoagulant therapy.

The application of pharmacoeconomics for choosing low-molecular-weight heparins (LMWHs) to facilitate better clinical and economic outcomes is examined. Today's pharmacy paradigm challenges pharmacists to weigh budgetary concerns with optimal patient outcomes to ensure medication-use practices represent the interests of both the health care system and the patient. Pharmacy is attempting to apply pharmacoeconomics to daily practice to influence these outcomes. By using pharmacoeconomic principles, methods, and data, pharmacists can project the impact of a new drug, such as LMWHs, on a pharmacy budget or overall hospital expenditures. LMWHs have demonstrated superior clinical outcomes and overall cost-of-care advantages over traditional anticoagulant agents. Although LMWHs are more expensive than unfractionated heparins, the costs are partially offset by reductions of hospital length of stay, rates of heparin-induced thrombocytopenia, and the monitoring of certain laboratory test values. LMWHs also facilitate the use of bridge therapy for patients with venous thromboembolism, atrial fibrillation, or prosthetic-valve replacements, allowing drastic cost savings for health systems that far offset their acquisition costs. LMWHs can also provide health care systems the opportunity to implement targeted dose-reduction and rounding programs and appropriate dosing guidelines. Pharmacoeconomics provides pharmacy professionals a method to document potential cost savings, cost avoidances, and costs offsets as well as a means to justify additional pharmacy staff. Applying pharmacoeconomics when choosing LMWHs for anticoagulant therapy can assist pharmacy practitioners in facilitating better clinical and economic outcomes.

Anticoagulants↗
PubMed2002

Traditional versus modern anticoagulant strategies: summary of the literature.

Traditional and modern anticoagulant therapies for the management, prophylaxis, and treatment of venous thromboembolism (VTE) and acute coronary syndrome (ACS) and key findings of primary studies are summarized. Significant advances have been made during the past decade in the prevention and treatment of VTE and the treatment of ACS. Numerous trials have demonstrated that low-molecular-weight heparins (LMWHs) are at least as effective as and have challenged unfractionated heparins (UFHs) as the standard of care for the treatment of VTE and ACS. For VTE, a number of new antithrombotic agents have been developed and are currently under development, including oral direct thrombin inhibitors and synthetic pentasaccharides, such as fondaparinux, in addition to LMWHs. For ACS, various new treatment modalities, such as the broader use of percutaneous transluminal coronary angioplasty and stents, are available, in addition to new pharmacologic agents, such as glycoprotein IIb/IIIa inhibitors and innovative thrombolytics. Most of these agents and treatment modalities require the use of an anticoagulant as adjuvant therapy. Evidence suggests that LMWHs can be used safely and, in addition to being more practical, have been shown to improve outcomes compared with traditional anticoagulants in certain patient populations. LMWHs demonstrate superior clinical outcomes over traditional anticoagulants for VTE prophylaxis and treatment and ACS treatment. Primary studies of new agents, including oral direct thrombin inhibitors and synthetic pentasaccharides for the treatment of ACS are promising; however, more data are needed on their safety and efficacy.

Anticoagulants↗
PubMed2002

Improved cancer mortality with low-molecular-weight heparin treatment: a review of the evidence.

Work with low-molecular-weight heparins (LMWHs) continues to provide suggestions for survival advantages among patients with cancer diagnoses. Momentum is building in support of this theory through reports, the vast majority of which are derived from secondary analyses of clinical trials on the treatment of thromboembolism. The data retrieved from such studies that compare unfractionated heparin (UFH) with LMWH indicate that LMWH is equally beneficial if not more beneficial to cancer patients in terms of survival. In retrospective analysis, this improved life expectancy is not considered a result of reduced complications from thromboembolism. Thus, theories of antitumor effects of LMWH have developed, supported by evidence that most of the survival benefits are during long-term comparisons. Reports describing the effects of heparin in the setting of cancer have existed for over a half-century, although specific mechanisms for the marginal results seen thus far have yet to surface. Proposals for the most likely targets of the effective heparins include enzyme interaction, cellular growth modifications, and antiangiogenesis.

Heparin↗