Month: January 2014

Many hospitalized older people need decision help

When the time comes for making critical medical decisions while in the hospital, a new study says older people often rely on family members or other surrogates to make those calls.

Researchers found that about half of the older patients they tracked needed help making decisions within two days of being admitted to the hospital.

Considering the aging U.S. population and the mental burden borne by the family and friends making those decisions, the study’s lead author told Reuters Health that hospitals should work to accommodate surrogate decision makers.

“The long-term goal would be to improve hospital processes,” Dr. Alexia Torke, a center scientist at the Indiana University Center for Aging Research in Indianapolis, told Reuters Health.

Previous studies have examined the role of surrogate decision makers in some medical settings, but Torke and her colleagues write in JAMA Internal Medicine that they couldn’t find research showing how often people rely on others to make decisions while in the hospital.

“We set out to describe the scope of the problem as a whole,” Torke said.

For the study, she and her fellow researchers analyzed data on people who were over 65 years old and admitted to either of two hospitals in one Midwestern city between November 2008 and December 2011.

To be included in the study, a person had to have been hospitalized for 48 hours. After that time, a doctor was interviewed about the decision making process for that patient. Other information was taken from the patient’s medical record.

Of 1,598 study participants, the researchers found that 1,083 faced at least one major medical decision that was discussed with the patient or a surrogate.

Of those cases, about 570 patients made all of their decisions alone, 264 made their decisions with the help of a surrogate and surrogates made all of the decisions for 249 patients.

Most patients with surrogates were in the hospitals’ general wards, not the intensive care units.

Surrogate decision makers were most often the patients’ daughters, followed by sons and spouses.

Within the first two days of patients being admitted to the hospital, the researchers found that about 60 percent of surrogates had to make decisions about life-sustaining treatments and about half had to make decisions about operations and where the patients would go after leaving the hospital.

The study participants who required the help of a surrogate were also most likely to have worse outcomes. They were more likely to need a ventilator or a feeding tube, to be sent to a nursing home and to die.

“It’s not so much that having a family member make decisions for you makes things worse,” Torke said. “It’s that people who need decision makers are sicker.”

In a commentary accompanying the new study, Drs. Yael Schenker and Amber Barnato from the University of Pittsburgh write that the frequent use of surrogate decision makers across hospital settings suggests there are ways to broaden how doctors approach these types of decisions.

“I think there are multiple ways that we can support both patient and family involvement in decision making,” Schenker, an assistant professor, told Reuters Health.

For example, she and Barnato write that doctors should ask about people’s preferences when they are admitted to the hospital. That includes asking people who they want involved in the decision making process and how they want that person involved.

Doctors should also be trained in how to facilitate discussions between themselves, the patients and their chosen surrogate, they write. Part of that may include overcoming a tendency to only consider short-term outcomes instead of a patient’s overall illness and goals.

“I think it’s always helpful for patients and families to start conversations about these things,” Schenker said. “I think it’s also important for patients when they’re hospitalized to let doctors know how they want to approach decisions. It’s also unfortunately the case that they won’t always be asked.”

In the study, the researchers found that only about 25 percent of the patients had living wills or some kind of advanced directive to explain their choices. Torke said those documents may help some people but will not cover everything a surrogate may encounter.

“For older adults and their family members, I hope people will have more conversations about the possibilities about going into the hospital and what the older people’s preferences are,” she said.

Source: Chicago tribune

Middle Schoolers Snorting Smarties Candy Lead To Death

A dangerous trend among middle schoolers may soon prompt parents, convenience stores, and pharmacies to hide their Smarties candy stash. Kids have adopted a new extracurricular activity: crushing up and snorting the chalky, round candies to mimic the effects of getting high. Perhaps unsurprisingly, these child snorters are at risk for dangerous side effects such as nasal maggot infestation, nasal scarring, lung irritation or infection, and allergic reactions that can be fatal.

School officials from a school in Scarborough, Maine, have warned parents to watch out for kids snorting Smarties, claiming it is a “widespread phenomenon” that has circulated in videos featured on YouTube. In a document titled “Important Health Information for Parents Regarding the Candy, Smarties,” parents were advised students not only snort, but also smoke Smarties.

“To smoke Smarties, students crush the candies into a fine powder while it is still in its wrapper, tear off an end, pour the powder into their mouths, and blow out the smoke. Some are able to put the powder into their mouths and blow it out their noses,” according to the document. Scarborough school officials remain unclear about the “benefit” for students engaging in this practice.

Although snorting Smarties has recently become a predominant issue in middle schools across the U.S., the dangerous trend is anything but a new phenomenon. YouTube videos traced back to 2007 show kids snorting the Smarties among their peers, resulting in extreme coughing after inhaling the candies.

In 2007, Radio DJs Tyler Kruze and Ryan Walker from Z-104 in Madison, Wisc., attempted to snort the round candies live on air, which was later uploaded to YouTube. The DJs did this taping to warn kids snorting Smarties can have detrimental health effects. “It hurt so bad, dude. It got up there and it was like so much …so fast,” said Kruze. Upon snorting the candy, Walker experienced watery eyes and simply warned kids, “Don’t do it.”

School officials in Portsmouth Middle School in Rhode Island sent a note to parents last Thursday to warn them to watch out for students snorting Smarties. The note, sent via email, elaborated on the methods in which students have been snorting the sugary candy. Also, parents were warned about the possible medical issues that can occur as a result of snorting Smarties.

Portsmouth blogger and parent John McDaid, contacted a former Mayo Clinic doctor on the other possible health dangers of using Smarties as a drug. Dr. Oren Friedman, associate professor of otorhinolaryngology at the University of Pennsylvania, told McDaid on his blog “hard deadlines,” “There’s no way to verify the claims about respiratory arrest, laryngospasm, or leading to drugs.” However, he believes patients with foreign materials in their noses can face a variety of problems, even years after the insult occurs.

Nasal maggot infestation, or nasal myiasis, occurs when flies lay larvae eggs inside the nose as a result of the Smarties rammed up inside the lining, says the Centers for Disease Control and Prevention. Parents can check if their children begin to feel a tickling sensation inside their noses, and also be on the lookout for a foul smell coming from the inside of their nasal passage. Symptoms of nasal maggots include sneezing and a sticky discharge that can lead to coming from the patient’s eyelids, possibly leading to septicemia and other serious infections.

The candies can also lead to death in extreme cases, especially in those who are allergic to sugar or the contents of Smarties. “It is an irritant; it can cause wheezing and maybe chronic cough and asthma and sinus complications. And, ultimately, if someone is allergic to sugar or the contents of Smarties, then they could end up having an anaphylactic reaction and dying,” Dr. Gail Burstein, Erie County health commissioner told The Sun. Last year, 15 students were identified as participating in snorting Smarties at the Frontier Middle School in Erie County.

Smarties candy consists of dextrose, citric acid, calcium stearate, flavoring, and coloring agents but does not provide any high for consumers.

Source: medical daily

China pollution crossing Pacific to U.S.

Pollution from China travels in large quantities across the Pacific Ocean to the United States, a new study has found, making environmental and health problems unexpected side effects of U.S. demand for cheap China-manufactured goods.

On some days, acid rain-inducing sulfate from burning of fossil fuels in China can account for as much as a quarter of sulfate pollution in the western United States, a team of Chinese and American researchers said in the report published by the U.S. National Academy of Sciences, a non-profit society of scholars.

Cities like Los Angeles received at least an extra day of smog a year from nitrogen oxide and carbon monoxide from China’s export-dependent factories, it said.
“We’ve outsourced our manufacturing and much of our pollution, but some of it is blowing back across the Pacific to haunt us,” co-author Steve Davis, a scientist at University of California Irvine, said.

Between 17 and 36 percent of various air pollutants in China in 2006 were related to the production of goods for export, according to the report, and a fifth of that specifically tied to U.S.-China trade.

Beijing’s air pollution at dangerously high levels
China’s December exports slow, imports accelerate
One third of China’s greenhouse gases is now from export-based industries, according to Worldwatch Institute, a U.S.-based environmental research group.

China’s neighbors, such as Japan and South Korea, have regularly suffered noxious clouds from China in the last couple of decades as environmental regulations have been sacrificed for economic and industrial growth.

However, the new report showed that many pollutants, including black carbon, which contributes to climate change and is linked to cancer, emphysema and heart and lung diseases, traveled huge distances on global winds known as “westerlies”.

Trans-boundary pollution has for several years been an issue in international climate change negotiations, where China has argued that developed nations should take responsibility for a share of China’s greenhouse gas emissions, because they originate from production of goods demanded by the West.

The report said its findings showed that trade issues must play a role in global talks to cut pollution.

“International cooperation to reduce transboundary transport of air pollution must confront the question of who is responsible for emissions in one country during production of goods to support consumption in another,” it said.

Air quality is of increasing concern to China’s stability-obsessed leaders, anxious to douse potential unrest as a more affluent urban population turns against a growth-at-all-costs economic model that has poisoned much of the country’s air, water and soil.

Authorities have invested in various projects to fight pollution, but none so far has worked.

Source: cbs news

NHRC asks MCI to introduce ‘Gerontology’ in medical colleges

The National Human Rights Commission on Wednesday asked the Medical Council of India and Union Ministry of Health and Family Welfare to explore the possibility of introducing a new post-graduate level course in ‘Gerontology’ in medical colleges.

The directions were issued keeping in view the problems in old age and the need for providing dedicated facilities to senior citizens as required under Section 20 of the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, according to an NHRC statement released today.

The Commission observed that with the passage of time, the percentage of aged persons in the country is likely to go up considerably and to deal with their problems, it is necessary that the healthcare system in the country should be well equipped.

Accordingly, the Commission in its notice to the Secretaries, Medical Council of India and the Union Ministry of Health and Family Welfare has sought their response within eight weeks.

Source: Zee news

Twins Die in Incubator At Kinamba Health Centre

A couple in Kinamba, Laikipia West is mourning the death of one-week-old twins due to what they termed as negligence by medical practitioners.

The twin boys, who were in an incubator, died on Sunday morning at Kinamba health centre following a power blackout. The father of the twins Alfred Muchangi said they had been in the health facility for a week since they were born.

He said the boys died after medics who were on duty during the 2am incident did not remove the babies from the incubator after a power blackout.

“The boys had been with their mother at the health centre for the last week. On Sunday night, the power went off for hours and the health centre does not have a standby generator. They died,” Muchangi said.

John Githinji, the officer in charge of the facility. said upon examining them he noted that they may have died from a condition known us perspiration pneumonia.

“It is true that the facility does not have a standby generator and power loss could have contributed to the deaths,” he said. He however said the hospital is overstretched due to shortage of clinical officers and nurses.

Githinji said only one staffer was on duty on the fateful night. He said she was attending to outpatient and inpatient at the same time, thus being overwhelmed.

Source: all Africa

Common heart valve problem may be fixed without open-heart surgery

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Researchers are closing in on techniques to fix the most common valve problem in the heart without having to resort to open-heart surgery.

Mitral valve regurgitation, which causes blood to flow backward into the lungs, affects about four million adults in the U.S. For many patients, the condition never causes serious harm. But for others, mitral regurgitation causes extreme fatigue and shortness of breath. In serious cases, patients’ hearts have to pump twice as hard to move the same amount of the blood to the body, leading to heart failure.

To avoid open-heart surgery, doctors are looking to less-invasive ways to implant medical devices that could replace or repair the valve. Some devices are on the market and others are being developed.

When the mitral valve is in need of repair or replacement, open-heart surgery is generally performed. About 50,000 such operations take place in the U.S. a year. But many patients are reluctant or too frail to undergo the surgery. Doctors are also hesitant about recommending the procedure in some older patients with heart disease because surgery hasn’t been shown to prolong life, though doctors believe it improves patients’ quality of life. Permanent heart damage and more heart problems can result if the valve isn’t repaired.

Source: fox news

Sit less, move more to improve health and quality of life

A team of researchers have claimed that people decreasing their sitting time and increasing their physical activity have a lower risk of chronic disease.

The researchers – Sara Rosenkranz and Richard Rosenkranz, both assistant professors of human nutrition from Kansas State University – studied a sample of 194,545 men and women ages 45 to 106.

The data was from the 45 and Up Study, which is a large Australian study of health and aging.

Richard said that not only do people need to be more physically active by walking or doing moderate-to-vigorous physical activity, but they should also be looking at ways to reduce their sitting time.

The twofold approach — sitting less and moving more — is key to improving health, the researchers said.

People often spend the majority of the day being sedentary and might devote 30 to 60 minutes a day to exercise or physical activity, Sara said. Taking breaks to stand up or move around can make a difference during long periods of sitting.

Sitting for prolonged periods of time — with little muscular contraction occurring — shuts off a molecule called lipoprotein lipase, or LPL, Sara said. Lipoprotein lipase helps to take in fat or triglycerides and use it for energy.

For the study, the researchers wanted to take a positive approach and see if increasing physical activity helped to increase health and quality of life. The researchers want to motivate people — especially younger people — to sit less and move more so they can age easier with less chronic disease

The research has been published in the journal BMC Public Health.

Source: dna india

 

Kids get uneven tonsil care, study finds

Getting your tonsils out: It’s a rite of passage for hundreds of thousands of U.S. kids every year.

Yet a study released Monday shows hospitals vary greatly in just how they handle this common procedure. And kids fare differently depending on which hospital they go to. At the best hospitals, just three percent of kids came back for complications like bleeding. But at others, close to 13 percent did.

It is the latest in a series of studies showing that Americans get vastly different care depending on where they live.

It’s not clear why, but the researchers who did the study say it will be worth looking into so that all hospitals can make sure children recover well from the operations. New guidelines issued in 2011 may help get all hospitals and pediatric surgeons on the same page, other experts said.

It’s something in the public eye with the case of 13-year-old Jahi McMath, who died after complications from a complex tonsil operation in December at Children’s Hospital in Oakland, Calif. McMath had her tonsils out, along with her adenoids and parts of her upper throat to try and improve serious sleep apnea.

She started bleeding profusely and went into cardiac arrest shortly after. Doctors said Jahi was brain dead, but the family sued first to keep their daughter on life support, then to remove the body to a facility where her body will be kept on life support.

McMath’s operation was a complicated one. Researchers who did the study published Monday in the journal Pediatrics looked at simpler cases.

Dr. Sanjay Mahant of the University of Toronto and the Hospital for Sick Children in Toronto, and colleagues across the United States, looked at the records of nearly 140,000 children who got simple, uncomplicated tonsillectomies at 36 children’s hospitals between 2004 and 2010. All got same-day operations and were sent home on the day of their procedure.

Over that time, about 8 percent had to go back to the hospital within a month, usually for bleeding.

The researchers also looked at the use of two common drug types — dexamethasone, which can reduce complications such as nausea, and antibiotics.

New guidelines issued in 2011 advise giving dexamethasone to children before the operation, and they recommend against giving any antibiotics.

In the study before the guidelines came out, 76 percent of the children got dexamethasone, and at some hospitals almost none did. And 16 percent of children got antibiotics, although at some hospitals 90 percent of patients did.

“More than 500,000 tonsillectomies are performed each year in children in the United States, most commonly for sleep-disordered breathing and recurrent throat infections,” the researchers wrote. There shouldn’t be such variation from one hospital to another, they said.

It’s one of the reasons the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) issued practice guidelines based on what the studies show – that giving kids dexamethasone before the operation helps, and that giving them antibiotics doesn’t.

“These recommendations are based on evidence gathered from trials over the past two decades, which showed that dexamethasone, administered on the day of surgery, reduces postoperative nausea, vomiting, and pain, whereas perioperative antibiotics do not reduce postoperative bleeding,” Mahant’s team wrote.

Tonsillectomies are mostly done now to help sleep disorders. “There is an increased focus on sleep health in children,” said said Dr. Emily Boss, an assistant professor with the Johns Hopkins University Department of Otolaryngology and a member of the Armstrong Institute for Patient Safety and Quality.

Children can start bleeding as the scab formed after the operation naturally sloughs off, Boss added. “It’s one of the well-known complications,” she said. “It’s hard to predict who will have bleeding and who will not.”

It’s almost certainly nothing the child or parents are doing, Boss added. She said there’s no evidence to support common beliefs about what causes it, such as that eating scratchy food breaks off the clot.

Children do prefer soft, cool foods because their throats are sore, she added. And yes, popsicles or ice cream are not just allowed, but recommended.

“I think this study will force the issue of practicing according to evidence-based guidelines,” Boss said.

There were not any established guidelines before, Boss told NBC News. “People practiced based on their own experiences for a long period of time,” she said.

Other medical organizations are also starting to stress clear practice guidelines. And the Obama administration is also encouraging them, to help make care more consistent and to help lower costs.

A study published by the Dartmouth Atlas project last October found variation in all sorts of treatments. For example, in San Angelo, Texas, 91 percent of heart attack patients filled a prescription for a beta-blocker drug to lower blood pressure in 2008 or 2009, the study found. But in Salem, Ore., just 62.5 percent did. For a statin drug to lower cholesterol, the rates ranged from 91 percent of patients in Ogden, Utah to 44 percent in Abilene, Tex.

Prices vary, also, often with little apparent rhyme or reason. Last week another study found that the hospital charges in California for giving birth can vary from $3,000 to $37,000 – and that’s for a simple, uncomplicated delivery.

In May, the federal government said it would start publishing data on hospital charges. Their first numbers confirmed what health reform advocates complained about for years: The charges vary enormously, and for seemingly unclear reasons.

Source: nbc news

Heavy drinking in middle age may speed men’s mental decline

Middle-aged men who drink heavily show declines in memory, attention and reasoning skills up to six years sooner than those drinking less alcohol, new research suggests.

European scientists found that men drinking 2.5 or more alcoholic beverages daily at midlife were more likely to experience more rapid mental losses over the next decade than light or moderate drinkers.

Heavy drinking’s effects on women could not be accurately assessed because far fewer middle-aged females participated in the research, the study authors said.

“Heavy alcohol consumption is known to be detrimental for health, so the results were not surprising . . . they just add that [it’s] also detrimental for the brain and the effects can be observed as [early] as 55 years old,” said study author Severine Sabia. “There is no need to be an alcoholic to see a detrimental effect of heavy alcohol consumption on cognition [thinking skills].”

Sabia is a research associate in the department of epidemiology and public health at University College London. The study was published online Jan. 15 in the journal Neurology.

Scant research has examined the impact of alcohol consumption on brain aging before old age, according to study documents. The new study, however, included data from more than 5,000 men and 2,000 women at midlife.

Participants’ alcohol consumption was assessed three times in the 10 years before the first of three tests of memory and executive function, which deals with attention and reasoning skills needed in achieving goals. The first test was taken when participants were an average age of 56.

No differences were found in memory and executive function decline between men who didn’t drink alcohol and those who were light or moderate drinkers, consuming up to two servings of beer, wine or liquor each day. Heavy drinkers exhibited mental declines between 1.5 and 6 years faster than those drinking less.

Although the study found an association between heavy drinking in men and earlier decline in mental function, it did not prove a cause-and-effect relationship.

“We have lots of clinical experience to suggest that heavy drinking can have adverse effects on cognition. But what was new about this study, at least in men, was that it didn’t seem that light or moderate drinking” was more harmful than not drinking alcohol at all, said Dr. Marc Gordon, chief of neurology at Zucker Hillside Hospital in Glen Oaks, N.Y., who was not involved in the research.

“A relative strength of this study was that it looked at drinking at much younger ages than waiting until participants were elderly,” added Gordon, also an Alzheimer’s disease researcher at the Feinstein Institute for Medical Research in Manhasset, N.Y. “And nothing in this study [contradicts the idea] that having one drink a day is OK.”

Sabia agreed, saying the results echo previous studies and suggest that moderate alcohol consumption is not likely to harm people’s memory and executive function.

Source: web md

 

FDA approves Mental Disability Blood Test for Infants

The Food and Drug Administration on Friday cleared a first-of-a-kind blood test that can help diagnose mental disabilities in babies by analyzing their genetic code.

The laboratory test from Affymetrix detects variations in patients’ chromosomes that are linked to Down syndrome, DiGeorge syndrome and other developmental disorders. About 2 to 3 percent of U.S. children have some sort of intellectual disability, according to the National Institutes of Health.

The test, known as the CytoScan Dx Assay, is designed to help doctors diagnose children’s disabilities earlier and get them appropriate care and support. It is not intended for prenatal screening or for predicting other genetically acquired diseases and conditions, such as cancer.

While there are already genetic tests used to detect conditions like Down’s syndrome, doctors usually have to order them individually and they can take several days to develop. Pediatricians said Friday that Affymetrix’s test should offer a faster, more comprehensive screening approach. Dr. Annemarie Stroustrup stressed that such tests are generally only used after children exhibit certain physical or behavioral signs that suggest a disorder.

“When there’s something about the child that strikes us as unusual or pointing to a potential genetic disease, that’s when we would use this testing,” said Stroustrup, an assistant professor of pediatrics at Mount Sinai Hospital in New York. “This is not a screening test to be done on all newborns to predict how they are going to do in school when they are 5.”

The technology behind Affymetrix’s test has already been used for several years to screen fetuses for potentially debilitating diseases. Known as microarray analysis, the technique involves a high-powered computer scanning a gene chip of the patient’s DNA for slight chromosome imbalances. Older techniques involve scientists looking at chromosomes under a microscope for major irregularities.

The FDA said it approved the new test based on studies showing it accurately analyzes a patient’s entire genome and can accurately spot variations associated with intellectual disabilities.

Currently hospitals in all 50 states are required to screen newborns for at least 29 disorders that can be detected though laboratory testing, including sickle cell anemia and cystic fibrosis. Generally those tests pickup irregularities in metabolism, not genetic variations. The mandatory screening program, begun a half-century ago, is considered one of the nation’s most successful public health programs.

Affymetrix Inc. is based in Santa Clara, Calif. Shares of the company declined 22 cents to close at $9.26 in trading.

Source: ABC news