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Biomedical subjects

James Giordano

Publications and source records attributed to James Giordano.

At least 19 recordsLinked to original sources
PubMed2007

Confidentiality and autonomy: the challenge(s) of offering research participants a choice of disclosing their identity.

In this article, the authors present one of the key ethical features of research: confidentiality as maintained by nondis-closure of participants' identities. In light of (a) the contingency that certain participants might vest interest in research studies through their identity and (b) the concept of respect for participants' autonomy, the authors consider the possibilities of offering research participants the choice of nonconfidentiality, afforded as an autonomous (negative) right of refusal of nondisclosure of identity. They address the issue that this possibility generates within the context(s) of current codes of ethics related to health research and the manifest responsibilities of the institutional review process. In this way, they attempt to elucidate potential benefits and consequences that arise from confidentiality and nonconfidentiality.

Choice Behavior↗
PubMed2006

Neural and cognitive basis of spiritual experience: biopsychosocial and ethical implications for clinical medicine.

The role of patient spirituality and spiritual/liminal experience(s; SE) in the clinical setting has generated considerable equivocality within the medical community. Spiritual experience(s), characterized by circumstance, manifestation, and interpretation, reflect patients' explanatory models. We seek to demonstrate the importance of SE to clinical medicine by illustrating biological, cognitive, and psychosocial domains of effect. Specifically, we address where in the brain these events are processed and what types of neural events may be occurring. We posit that existing evidence suggests that SE can induce both intermediate level processing (ILP) to generate attentional awareness (ie, "consciousness of") effects and perhaps nonintermediate level processing to generate nonattentive, subliminal (ie, "state of") consciousness effects. Recognition of neural and cognitive mechanisms is important to clinicians' understanding of the biological basis of noetic, salutogenic, and putative physiologic effects. We posit that neurocognitive mechanisms, fortified by anthropologic and social contexts, led to the incorporation of SE-evoked behaviors into health-based ritual(s) and religious practice(s). Thus, these experiences not only exert biological effects but may provide important means for enhancing patients' locus of control. By recognizing these variables, we advocate clinicians to act within an ethical scope of practice as therapeutic and moral agents to afford patients resources to accommodate their specific desire(s) and/or need(s) for spiritual experiences, in acknowledgement of the underlying mechanisms and potential outcomes that may be health promotional.

Attitude of Health Personnel↗
PubMed2006

Moral agency in pain medicine: philosophy, practice and virtue.

Although established as a field of specialization, pain medicine remains somewhat fractionated. Such lack of cohesion creates dissonance on multiple levels, and thus, impedes the provision of effective pain care. This paper asserts that there is a core philosophy of medicine that reflects the intellectual and moral quality of the healing relationship. I argue that pain medicine, in all its constituent disciplines, is bound to this philosophy. The intricate relationship between pain, the pain patient, and the pain physician creates pragmatic and moral dilemmas that may not be well served by the use of prima facie principles. It is argued that an agent-based, virtue ethics best enable the clinician to both apprehend the complexity of this relationship and appreciate other ethical approaches in the discourse arising from issues of care.

Ethics, Medical↗
PubMed2005

Challenges to complementary and alternative medical research: focal issues influencing integration into a cancer care model.

Complementary and alternative therapies are increasingly used by cancer patients for palliative and postcancer preventive and/or wellness care. It is critical that evidence-based models be employed to both provide information for patients' use and informed consent and for physicians to advise patients and assess relative risk:benefit ratios of using specific complementary and alternative medicine (CAM) approaches within the cancer care paradigm. Research models for biomedicine have been somewhat limited when applied to broader, more holistic conceptualizations of health common to many forms of CAM. Thus, while numerous challenges to studying CAM exist, a fundamental question is not just what CAM practices should be studied but how CAM should be studied. The authors propose a model that emphasizes methodologic rigor yet approaches CAM research according to relative levels of evidence, meaning, and context, ranging from experimental, quantitative studies of mechanism to qualitative, observational studies of noetic/salutogenic variables. Responsibility for training researchers prepared to meet such challenges rests on both CAM and mainstream academic institutions, and care must be taken to avoid philosophical and practical pitfalls that might befall a myopic perspective of integration.

Attitude of Health Personnel↗
PubMed2005

The neurobiology of nociceptive and anti-nociceptive systems.

Pain is both a sensory event of the peripheral and central nervous systems and an experience that arises from, and reciprocally can affect processes of higher consciousness. Alterations in peripheral and central neuraxes can lead to sensitization, structural modification and long-term potentiation that can overcome modulatory influence(s) and change the non-linear adaptability of these systems to a progressively linear, pathologic state with a diverse constellation of clinical signs and symptoms. Recent progress in molecular biology, neurochemistry and neuroanatomy has led to significant advancement in understanding the interactive roles of these heterogeneous systems in mediating and modulating various types of pain. This review concisely provides an overview of the structure and function of these substrates. As we reach the midpoint in a decade marked by pain control and research, such knowledge is critical to further both a more comprehensive appreciation of the phenomenon that is pain, and the development of therapeutic interventions that are innovative and effective.

Journal Article↗
PubMed2004

Patterns of serotonin- and 2-methylserotonin-induced pain may reflect 5-HT3 receptor sensitization.

Intraperitoneal injection of serotonin (5-HT; 0.5-4.0 mg/kg) produced dose-dependent nociceptive writhing responses, attenuated at all doses by pre-administration of tropisetron (1.0 mg/kg, i.p.). Administration of 2-methylserotonin (2-methyl-5-HT) alone was ineffective in inducing writhing. The effects of 5-HT (0.5 mg/kg, i.p.) were increased by subsequent injection of 2-methyl-5-HT (0.5-4.0 mg/kg, i.p.). The enhanced nociceptive responses produced by low dose of 5-HT and subsequently administered 2-methyl-5-HT were attenuated by pretreatment with tropisetron. These results suggest that the inflammatory cascade produced by peripheral administration of 5-HT evokes nociception by stimulating visceral 5-HT(3) receptors and that 5-HT-induced mechanisms appear to sensitize the 5-HT(3) receptor to subsequent pharmacologic activation.

Animals↗
PubMed2004

Integrating Chinese traditional medicine into a U.S. public health paradigm.

Chinese traditional medicine (CTM) is a health care system with an extensive history of practical clinical experience. The foundation of CTM, while relatively simple, is substantively different from much of allopathic medicine. Such differences are difficult to explain using a Western medical vocabulary, and extend beyond linguistic foundations. This proves challenging when trying to identify appropriate teaching and research methods that are sensitive to the CTM paradigm and yet relevant to a public health orientation. Given the increased use of CTM, it becomes important to address possibilities that would ensure successful integration of CTM into a public health framework. We propose a model in which both CTM and biomedical clinical services could be offered to provide diverse, yet truly integrative, therapeutic approaches. Within this model, it is critical to enhance reciprocal educational and research-directed opportunities for both CTM practitioners and allopathic clinicians. Considerable responsibility rests upon academic institutions in becoming proactive in developing and implementing educational curricula and research programs that illustrate more effectively the potential bilateral benefit(s), limitations, and, ultimately, roles that CTM and biomedical approaches may assume within an integrative system of care.

Delivery of Health Care, Integrated↗
PubMed2004

Serotonin 5-HT(3) receptor mediation of pain and anti-nociception: implications for clinical therapeutics.

The involvement of the serotonergic system in pain and anti-nociception has long been recognized. Throughout the nervous system, serotonin (5-HT) exerts effects through heterogeneous populations of receptors that have recently been categorized into distinct "families" based upon their molecular properties. Of these, the 5-HT(3) receptor is distinct in that it is inotropic, mediating a sodium current, and thus is exclusively excitatory, irrespective of the tissue(s) in which it is localized. Widely distributed within the brain, spinal cord, peripheral neurons and extraneural tissues, 5-HT(3) receptors have been localized to several anatomical loci within the peripheral and central neuraxes that subtend the afferent transmission and efferent modulation of pain. This review provides an overview of the anatomy and physiology of 5-HT(3) receptors and focuses upon the work of numerous groups, as well as summarizing our previous and ongoing studies, that have investigated the role of 5-HT(3) receptors in pain and anti-nociception. Data from in vitro studies of pharmacologic function and molecular mechanisms, ex vivo bioassays and animal studies are addressed. Of particular interest are those findings relevant to the possible utility of 5-HT(3)-acting agents in treating human pain and the results of clinical trials employing 5-HT(3) selective drugs for applied therapeutics.

Journal Article↗
PubMed2003

Complementary and alternative medicine in mainstream public health: a role for research in fostering integration.

In light of the increased utilization of complementary and alternative medicine (CAM) in recent years, there is an increased possibility that CAM approaches could prove to be important factors in public health, particularly if used within an integrative framework together with mainstream medicine. There exists a defined need for research to explore the integration of conventional health care and CAM approaches, as well as define mechanisms of CAM-based therapies to facilitate such integration. Essential to these goals is the accumulation of a database derived from outcomes-based clinical and basic science investigations. We posit that that CAM clinicians need to be more thoroughly trained as researchers, skilled in developing and recording results of pragmatic studies that could provide credible evidence for the use of CAM in the public sector health care. It is proposed that this may be best achieved through a three-tiered system in which (1) clinician-scientists of both mainstream and alternative disciplines recognize the value of research designed to foster such integration; (2) educational and health care institutions must develop academic and clinical training programs that examine and delineate each disciplines' respective strengths and weaknesses; and (3) such programs are attractive to, and receive continued extramural subsidy. In the broadest sense, such a paradigmatic approach to CAM integration could create a common basis for scientific dialogue, encourage exchanges between medical communities, and establish policies for the development of a true multidisciplinary health care cooperative that is consistent with the current public health model.

Complementary Therapies↗
PubMed2002

Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice.

Complementary and alternative medicine (CAM) is growing in popularity among patients traditionally seen in an allopathic setting. A literature review and information search was conducted to determine the trend in demand for and the availability of CAM in the United States. The results of major surveys show that there is an increase in the use of CAM in the United States. The best predictor of CAM use is higher level of education. In addition, findings reveal that the field of CAM is poorly researched. Many studies in CAM therapies have flaws, such as insufficient statistical power, poor controls, inconsistent treatment, and lack of comparisons. The National Center for Complementary and Alternative Medicine of the National Institutes of Health, has declared their top strategic priority to be investing in research. Currently, more than 70 medical schools offer some type of training in alternative medicine, although there are few guidelines for curriculum and there is considerable heterogeneity in content, format, and requirements among CAM courses. As patients have greater access to information, their needs and values change. They become more involved in their overall health care and are taking a more natural and holistic approach to achieving well-being. Health care practitioners, both allopathic and alternative, must be well informed. There is an imperative to make CAM research a high priority. Valid and reliable empirical data must document the clinical efficacy and safety of CAM practices. In order to integrate CAM into the mainstream, there must be a coordinated effort among all the entities involved. Physicians need to be familiar with proven CAM therapies in order to advise patients about these modalities and the potential benefits and limitations. CAM practitioners should be licensed and regulated in scope of practice to provide a high standard of care, and be sufficiently educated in conventional medical science(s) in order to recognize how, where, and why their respective complementary practice is most effective for integration.

Attitude of Health Personnel↗
PubMed1992

Putative mechanisms of buspirone-induced antinociception in the rat.

Intraperitoneal administration of the serotonin 5-HT1A agonist, buspirone (1-5 mg/kg), produced dose- and time-related core hypothermia that was coincident with analgesia against a thermally noxious stimulus. Surface body temperature was not altered by buspirone. The 5-HT1A antagonist, NAN-190 (2 mg/kg, s.c.), blocked both hypothermic and analgesic effects, while systemic administration of the opioid antagonist, naloxone (1 mg/kg, s.c.), did not change the pattern of buspirone-induced hypothermia or analgesia. The apparent lack of opioid involvement and the documented role of the 5-HT1A receptor system in neuroendocrine substrates of thermoregulation and pain modulation prompted study of adrenal function in these buspirone-induced effects. Buspirone (5 mg/kg, i.p.) produced significant elevations in plasma epinephrine (EPI) and corticosterone (CST). Bilateral adrenalectomy reduced both control and buspirone-elevated EPI and CST levels and attenuated the antinociceptive, but not hypothermic, effects of buspirone (1-5 mg/kg, i.p.). Administration of the phenylethanolamine-N-methyltransferase (PNMT) inhibitor, dichloromethylbenzylamine (DCMB: 25 mg/kg, i.p.) reduced basal and buspirone-elevated plasma EPI, but not CST levels. This treatment did not affect buspirone-induced hypothermia, while significantly reducing buspirone antinociception. Pretreatment with the CST synthesis inhibitor, aminoglutethemide (AG: 2 x 25 mg/kg, i.p.), reduced plasma CST levels while not significantly affecting EPI. AG pretreatment did not alter the hypothermic effects of buspirone, but attenuated antinociception produced by the highest buspirone dose. The AG-induced reductions of buspirone antinociception were less than those effects produced by DCMB treatment. These data suggest that buspirone-induced antinociception may be a non-opioid, adrenally mediated co- and/or epi-phenomenon to core hypothermia evoked by 5-HT1A receptor agonism.

Adrenalectomy↗