Month: May 2014

To Age Well, Walk

To Age Well, Walk

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

The results, published on Tuesday in the journal JAMA, reinforce the necessity of frequent physical activity for our aging parents, grandparents and, of course, ourselves.

While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

“For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people,” said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can’t prove that exercise improves older people’s health, only that healthy older people exercise.

Other small-scale, randomized experiments have persuasively established a causal link between exercise and healthy aging. But the scope of these experiments has generally been narrow, showing, for instance, that older people can improve their muscle strength with weight training or their endurance capacity with walking.

So, for this latest study, the Lifestyle Interventions and Independence for Elders, or LIFE, trial, scientists at eight universities and research centers around the country began recruiting volunteers in 2010, using an unusual set of selection criteria. Unlike many exercise studies, which tend to be filled with people in relatively robust health who can easily exercise, this trial used volunteers who were sedentary and infirm, and on the cusp of frailty.

Ultimately, they recruited 1,635 sedentary men and women aged 70 to 89 who scored below a nine on a 12-point scale of physical functioning often used to assess older people. Almost half scored an eight or lower, but all were able to walk on their own for 400 meters, or a quarter-mile, the researchers’ cutoff point for being physically disabled.

Then the men and women were randomly assigned to either an exercise or an education group.

Those in the education assignment were asked to visit the research center once a month or so to learn about nutrition, health care and other topics related to aging.

The exercise group received information about aging but also started a program of walking and light, lower-body weight training with ankle weights, going to the research center twice a week for supervised group walks on a track, with the walks growing progressively longer. They were also asked to complete three or four more exercise sessions at home, aiming for a total of 150 minutes of walking and about three 10-minute sessions of weight-training exercises each week.

Every six months, researchers checked the physical functioning of all of the volunteers, with particular attention to whether they could still walk 400 meters by themselves.

The experiment continued for an average of 2.6 years, which is far longer than most exercise studies.

By the end of that time, the exercising volunteers were about 18 percent less likely to have experienced any episode of physical disability during the experiment. They were also about 28 percent less likely to have become persistently, possibly permanently disabled, defined as being unable to walk those 400 meters by themselves.

Most of the volunteers “tolerated the exercise program very well,” Dr. Pahor said, but the results did raise some flags. More volunteers in the exercise group wound up hospitalized during the study than did the participants in the education group, possibly because their vital signs were checked far more often, the researchers say. The exercise regimen may also have “unmasked” underlying medical conditions, Dr. Pahor said, although he does not feel that the exercise itself led to hospital stays.

A subtler concern involves the surprisingly small difference, in absolute terms, in the number of people who became disabled in the two groups. About 35 percent of those in the education group had a period of physical disability during the study. But so did 30 percent of those in the exercise group.

“At first glance, those results are underwhelming,” said Dr. Lewis Lipsitz, a professor of medicine at Harvard Medical School and director of the Institute for Aging Research at Hebrew SeniorLife in Boston, who was not involved with the study. “But then you have to look at the control group, which wasn’t really a control group at all.” That’s because in many cases the participants in the education group began to exercise, study data shows, although they were not asked to do so.

“It wouldn’t have been ethical” to keep them from exercise, Dr. Lipsitz continued. But if the scientists in the LIFE study “had been able to use a control group of completely sedentary older people with poor eating habits, the differences between the groups would be much more pronounced,” he said.

Over all, Dr. Lipsitz said, “it’s an important study because it focuses on an important outcome, which is the prevention of physical disability.”

In the coming months, Dr. Pahor and his colleagues plan to mine their database of results for additional followup, including a cost-benefit analysis.

The exercise intervention cost about $1,800 per participant per year, Dr. Pahor said, including reimbursement for travel to the research centers. But that figure is “considerably less” than the cost of full-time nursing care after someone becomes physically disabled, he said. He and his colleagues hope that the study prompts Medicare to begin covering the costs of group exercise programs for older people.

Dr. Pahor cautioned that the LIFE study is not meant to prompt elderly people to begin solo, unsupervised exercise. “Medical supervision is important,” he said. Talk with your doctor and try to find an exercise group, he said, adding, “The social aspect is important.”

Mildred Johnston, 82, a retired office worker in Gainesville who volunteered for the LIFE trial, has kept up weekly walks with two of the other volunteers she met during the study.

“Exercising has changed my whole aspect on what aging means,” she said. “It’s not about how much help you need from other people now. It’s more about what I can do for myself.” Besides, she said, gossiping during her group walks “really keeps you engaged with life.”

Source: new york times

When you need antibiotics – and when you don’t

When you need antibiotics

You’re sick. You’re not sure what it is, but you know you would really love for this achy feeling, stuffed up head, or painful cough to go away. So you go to the doctor — and demand drugs. If recent research is any indication, your physician will likely prescribe you an antibiotic, even if he or she knows it won’t make you better any faster.

“Research has shown that several common infections do not require antibiotics. Yet we continue to unnecessarily take them,” said Amanda Helberg, a physician assistant at Scott & White Lago Vista Clinic in Lago Vista, Texas. “This overuse of antibiotics has led to ‘superbugs,’ and now bacterial resistance is on the rise.”

A letter published this week in the Journal of the American Medical Association shows doctors prescribe antibiotics for acute bronchitis approximately 70% of the time, despite decades of evidence demonstrating that these drugs don’t work against respiratory illness.

“Despite clear evidence, guidelines, quality measures and more than 15 years of educational efforts stating that the antibiotic prescribing rate should be zero … physicians continue to prescribe expensive, broad-spectrum antibiotics,” write Dr. Michael Barnett and Dr. Jeffrey Linder with Brigham and Women’s Hospital in Boston.
Save yourself some money at the doctor’s office by knowing which common ailments require antibiotics, and which ones don’t:

Cold and flu
Upper respiratory infections, better known as the common cold, and influenza are caused by viruses. Antibiotics only kill bacteria.
“Antibiotics are not needed and are of no benefit” for cold and flu, said Dr. John Joseph, a family medicine physician at Scott & White Killeen Clinic in Killeen, Texas.

The best way to prevent the flu is to get vaccinated every year, according to the Centers for Disease Control and Prevention. If you’ve already got it, talk to your doctor about taking an antiviral drug to speed your recovery.

Colds usually last seven to 10 days, Helberg said, and will go away on their own with plenty of rest and fluids. You can take over-the-counter medications to relieve some of the symptoms.

Bronchitis
As the journal letter mentions, “acute bronchitis in otherwise healthy adults does not need to be treated with antibiotics,” Joseph said. But there are exceptions. “Patients with complicating factors such as emphysema or chronic obstructive pulmonary disease (COPD) may receive antibiotics since these patients are more susceptible to developing secondary bacterial infections,” he said.

Ear infections
It’s probably best to let your doctor make the call on ear infections.
Ear infections can be caused by viruses or bacteria, and “the only definitive method for determining the cause of the ear infection is to puncture the eardrum and culture the fluid,” Joseph said. “In the U.S., most physicians treat with antibiotics instead of obtaining the culture.” Some doctors recommend first waiting to see if the infection clears up on its own, according to WebMD, but others worry that letting bacteria go untreated could do more damage.

Pneumonia
Pneumonia can be caused by a variety of things: bacteria, viruses and fungi, according to Mayo Clinic. Antibiotics will work if the doctor has identified the specific type of bacteria causing your infection. Antiviral medications can also be used to treat viral pneumonia.

Sinus Infection
Sinusitis is inflammation of the sinuses, according to the Cleveland Clinic. The infection can be bacterial, viral or fungal, or due to allergies. Most sinus infections are caused by viruses, Joseph said, and do not require antibiotics. Once again, there are exceptions.

Your doctor may prescribe antibiotics if the symptoms are severe and include high fever along with nasal drainage and a productive cough. Antibiotics may also be necessary if you feel better after a few days and then your symptoms return, or if the infection lasts more than a week.

Strep throat
Strep throat is a bacterial infection, and as such, antibiotics are required to fight it, Helberg said. But only a tiny portion of sore throats are actually strep throat, so make sure your doctor makes the right diagnosis based on a physical exam and lab test.

Bottom line
“Consult your doctor or physician assistant when you feel ill,” Helberg said. “Do not take leftover medication for a new infection, do not share antibiotics, and do not take antibiotics for a virus.”

Source: cnn news

Trust your doctor, not Wikipedia, say scientists

Trust your doctor, not Wikipedia,

Wikipedia, the online encyclopaedia, contains errors in nine out of 10 of its health entries, and should be treated with caution, a study has said.

Scientists in the US compared entries about conditions such as heart disease, lung cancer, depression and diabetes with peer-reviewed medical research.

They said most articles in Wikipedia contained “many errors”.

Wikimedia UK, its British arm, said it was “crucial” that people with health concerns spoke to their GP first.

Open-access ‘concerns’
The online encyclopaedia is a charity, and has 30 million articles in 285 languages.

It can be edited by anybody, but many volunteers from the medical profession check the pages for inaccuracies, said Wikimedia UK.

The open-access nature has “raised concern” among doctors about its reliability, as it is the sixth most popular site on the internet, the US authors of the research, published in the Journal of the American Osteopathic Association, said.

Up to 70% of physicians and medical students use the tool, they say.

The 10 researchers across America looked at online articles for 10 of the “most costly” conditions in the US, including osteoarthritis, back problems and asthma.

They printed off the articles on 25 April 2012 to analyse, and discovered that 90% of the entries made statements that contradicted latest medical research.

Lead author Dr Robert Hasty, of the Wallace School of Osteopathic Medicine in North Carolina, said: “While Wikipedia is a convenient tool for conducting research, from a public health standpoint patients should not use it as a primary resource because those articles do not go through the same peer-review process as medical journals.”

Dr Hasty added the “best resource” for people worried about their health was their doctor.

Contact GP ‘first’
Stevie Benton, at Wikimedia UK, said there were a “number of initiatives” in place to help improve the articles, “especially in relation to health and medicine”.

He said the charity had a project to bring together volunteer Wikipedia editors with a medical knowledge to identify articles that need improvement, find credible sources and make entries more “accurate and more readable”.

Mr Benton said Wikipedia was also working with Cancer Research UK to review cancer-related articles by clinical researchers and writers to keep them accurate and up-to-date.

But he added: “However, it is crucial that anybody with concerns over their health contacts their GP as a first point of call. Wikipedia, like any encyclopaedia, should not take the place of a qualified medical practitioner.”

Wikipedia also expressed concern at the small sample size used in the research, as it may not be representative.

The study did not account for Wikipedia leaving out important information.

Source: bbc news

Brain implant allows baby girl, born deaf, to hear for the first time

brain implant

Sitting on her mother’s lap, a 1-year-old baby girl suddenly turns her head to hear the clicking in a black box next to her — the first sounds she’s ever heard. The child’s serious expression reflects a remarkable moment of discovery.

The parents of Elise Bradshaw, who was born profoundly deaf, shared the moments of discovery after Elise received an innovative procedure called an auditory brain stem implant

Elise was diagnosed with Charge syndrome, a rare birth defect that left her profoundly deaf due to missing auditory nerves. “Her world was smaller, things that were happening left and right weren’t necessarily something she was aware of,” her mother Jill Bradshaw of Texas told TODAY.

Without auditory nerves, Elise wasn’t a candidate for a cochlear implant. But doctors at Massachusetts Eye and Ear in Boston, which had recently become part of an FDA-approved trial, thought the new procedure might help the little girl.

A cochlear implant bypasses nonfunctioning “hair cells” of the cochlea and stimulates the auditory nerve. But an ABI bypasses an absent or damaged cochlea and auditory nerve to directly stimulate a portion of the brain involved in hearing called the cochlear nucleus, Dr. Daniel Lee, director of Massachusetts Eye and Ear’s Pediatric Ear, Hearing and Balance Center, told TODAY.

The device is already being used in adults and has been implanted in older children, but Elise is the youngest patient in the United States to participate in the ongoing trial, a collaboration between Mass General and Eye and Ear, a Harvard Medical School teaching affiliate.

“She is neurologically normal, is age appropriate for her developmental milestones, and has incredibly supportive and dedicated parents who are committed to seeing her succeed with the ABI,” Lee said of the decision to include the child in the trial.

In late March, the girl underwent a right-ear craniotomy surgery and placement of auditory brainstem implant (ABI) at the Massachusetts General Hospital. And then on April 15, the audiology team of surgeons activated the implant for the first time, with Elise’s family recording her reactions on video.

A similar implant was given last year to 3-year-old Grayson Clamp, whose father captured the moment the boy heard his father’s voice for the first time in a video that went viral.

Now Elise can hear noises, although doctors are not sure if she’ll eventually be able to understand spoken word.

“As she becomes older, and with appropriate audiology and speech therapy support, we hope that she will be able to understand patterns of sounds and ultimately, speech,” Lee said. “Her ultimate hearing outcome is not known, however, but she is showing good progress thus far.”

Elise’s parents are hopeful.

“Now some of those dreams, careers and so forth, might be an option,” says Jill Bradshaw. The little girl’s parents say she’ll learn sign language as she grows up and she’ll be part of the hearing world and the deaf community.

Source: today

Iodine deficiency common in pregnancy, pediatricians warn

Iodine deficiency common in pregnancy, pediatricians warnMany pregnant and breast-feeding women are deficient in iodine and should take a daily supplement containing iodide, according to a leading group of pediatricians.

Iodine, generally obtained from iodized salt, produces thyroid hormone, an essential component for normal brain development in the developing baby.

But as consumption of processed foods has increased, so has iodine deficiency because the salt in processed foods is not iodized, according to a policy statement from the American Academy of Pediatrics.

“This is the first time that the American Academy of Pediatrics has issued a statement on iodine,” said Dr. Jerome Paulson, medical director for national and global affairs at the Children’s National Health System and chair of the academy’s Council on Environmental Health.

About one-third of pregnant women in the United States are iodine-deficient, according to background information in the article published online May 26 and in the June print issue of the journal Pediatrics.

Currently, only about 15 percent of pregnant and breast-feeding women take supplements containing iodide, the researchers said. Supplemental iodine is usually in the form of potassium iodide or sodium iodide, according to the U.S. National Library of Medicine.

Severe iodine deficiency is associated with stunted physical and mental growth, and even marginal iodine deficiency can decrease brain functioning, the report said.

Pregnant and breast-feeding women should take a supplement that includes at least 150 micrograms of iodide, and use iodized table salt, the academy said. Combined intake from food and supplements should be 290 to 1,100 micrograms a day. Potassium iodide is the preferred form, the doctors said.

Besides boosting brain development, iodine also appears to help protect babies from certain environmental harms.
The policy statement includes a recommendation to shield newborns from well water containing excessive nitrates and from cigarette smoke, both of which can harm the thyroid.

Why so few women take iodide supplements isn’t clear, Paulson said. “It may be that most people don’t appreciate the importance of adequate iodine in the diet for normal fetal development and that the women with marginal levels have no indication of their iodine status,” he said. Iodine deficiency displays no symptoms.

Women thinking of getting pregnant can ask their doctor about iodide supplements, Paulson said. According to the report, a woman who is vegan or doesn’t eat fish or dairy — two food sources of iodine — can ask about having a urine test to check for iodine deficiency.

Warning that supplement labels are misleading, the academy says the U.S. Food and Drug Administration should ensure that makers of prenatal vitamins use only potassium iodide and correct inconsistent labeling so that women understand what they are buying.

Women don’t usually think about iodine deficiency, agreed Erin Corrigan, clinical nutrition manager at Miami Children’s Hospital, who was not involved in the study. “I don’t think it’s on the top of the list for women for nutrients,” she said. “We keep in mind folic, calcium and vitamin D.”

Her patients are told to make sure their prenatal vitamin contains sufficient iodide and to continue taking it while they breast-feed.

Source: news day

Heart disease: treatment using vegetables over drugs

heart

Many doctors treating heart disease tend to prescribe drugs known as statins like Lipitor, but some physicians in Canada are trying a new method: a vegan diet.

Heart disease is the second leading cause of death in Canada. It kills 47,627 Canadians every year.

Dr. Shane Williams is a community cardiologist in Bracebridge, Ont. He’s been a vegan since 2010. Vegans don’t eat meat, fish, poultry, eggs, dairy products, or honey. They do however, eat fruits, vegetables, whole grains, nuts, seeds and legumes.

“People do not know the power of food,” Williams told For the past four years, the cardiologist has been slowly refocusing his patients on lifestyle changes.

“The challenge is that this takes time,” said Williams. Starting in 2011, he started using a plant-based diet for patients who were interested and added group counselling sessions circling on veganism.

Williams says this is making a big difference in patients who are willing to keep an open mind about their diet. “I see it here first hand, and it is simply amazing,” he said.

Liam Cragg, 59, of Bracebridge, Ont. is one case. In 2012, he went to the hospital because he exhibited signs of a heart attack. Cragg followed up with his family doctor a week later who referred him to Williams. After four months on a mostly plant-based regime, Cragg noted a big difference.

“I was at least 30 pounds lighter, my waistline had shrunk by four inches and my knees didn’t ache anymore,” said Cragg. Williams says he commonly spends 60 minutes or more with patients at their initial assessments.

“My experience is that most cardiologists tend to spend 15 to 25 minutes on a first assessment,” explains Williams, who says he’s trying to get “into the mechanics of a particular patient’s motivation for their eating habits.”

The cardiologist would like to see more doctors take an alternative approach in treating patients and specifically, honing in on their behaviour. “What concerns me is that most doctors do not realize the power of food as an alternative to medication,” said Williams.

He is not alone about his theories about veganism and heart disease.

Herbivore vs Carnivore

Dr. William Roberts, a prominent cardiovascular pathologist and the editor of the American Journal of Cardiology, also believes that a vegan diet is the solution to heart disease in the Western world. Roberts contends that the cause of heart disease is elevated cholesterol from not eating vegan. “Human beings are far more like herbivores than carnivores,” he said.

Some experts argue that the structure of our teeth, and the length of our intestinal tract, are indications that humans are more herbivore oriented. While carnivores have sharp teeth, the majority of ours are flat, which is ideal for grinding fruits and vegetables. Carnivores have short intestinal tracts, but ours are very long.

Meat consumption has been linked to higher risks of developing heart disease, cancer and diabetes and there’s a lot of evidence connecting diet and disease.

For example, in plant-based cultures like rural China, central Africa, the Papua highlanders in New Guinea and the Tarahumara Indians of northern Mexico, coronary artery disease is almost nonexistent.

When these people adopt Western, animal-based diets however, they quickly develop heart disease. Roberts argues that the plant-based diet is both cost effective and safe.

“If we put everyone on drugs then thousands of people would suffer side effects, so of course a vegan diet is the least expensive and safest means of achieving the plaque preventing goal,” he said.

Statins can be effective

But, statins, which are cholesterol-lowering drugs, are one of the most commonly used medications in North America and there’s some argument that they’re effective, if used properly.

A study, published in Annals of Family Medicine last week, analyzed 16,712 responses from people aged 30 to 79 years-old. Americans who filled at least two prescriptions for statins were classified as statin users.

According to the authors, many people at high risk for heart disease were not getting the statins they should be. “A lot of people who [might have] benefited aren’t on statins, and we don’t know why that is,” said Dr. Michael Johansen, the study’s lead author.

He said this could be for a number of reasons, including doctors who aren’t prescribing them, patients who don’t have health insurance, or people who aren’t taking medications they’re given.

“As doctors we need to make sure patients understand the benefits, and are being compliant. We need to make sure everyone has access to these drugs from an insurance, and access to care perspective,” said Johansen.

Dr. John McDougall, an American physician and a leading authority on diet and heart disease, says statins should be the last solution.

McDougall thinks that heart disease can be prevented and treated with a diet consisting of starches, vegetables and fruits, but no animal products or added oils.

“Statins should be reserved for very sick people, and a healthy diet is for everyone,” said McDougall.

Back in Bracebridge, Williams and McDougall will be holding what they call an “immersion weekend” sometime in late summer or early fall at the clinic with McDougall participating in a Skype discussion with patients.

Food before drugs

For Williams the focus should be on prevention.

What we’re told by pharmaceutical companies is that only 10 per cent of the cholesterol in our bloodstream is what we consume, and the rest is made by our liver. What they don’t tell us is that the Western diet causes the liver to over produce cholesterol — a pretty significant ‘oops we forgot to tell you’ on the part of pharmaceutical companies,” said Williams.

The plaque that builds up in our arteries is made of cholesterol, but when our cholesterol is low enough there’s nothing for our body to build plaque with.

“The best way to prevent heart disease is to be a vegetarian-fruit eater, a non-flesh eater and a non-saturated fat eater,” said Roberts.

Source: cbc news

Oil Pulling: Is There a Kernel of Truth?

Oil Pulling Is There a Kernel of Truth

In a short time, I’ve gone from wondering ‘what is this crazy new fad of oil pulling?’ to respecting the research going on around the world to improve oral health. As a WebMD medical editor, I read the health news every day and keep up with medical developments. When I heard about the fad of oil pulling I was intrigued. What is this ancient practice from my ancestors’ home in India that’s all over the Internet and social media as a potential cure-all?

Can there really be a medical silver bullet? Of course not. But I do believe most health practices – if they’ve stood the test of time – probably have a kernel of truth. In this case, the test of time has lasted thousands of years. But, as a doctor, I believe even that’s not enough. It also must “do no harm.” Let’s start from the beginning and I’ll share my findings.

What is oil pulling?
Oil pulling refers to swishing a vegetable oil — like sunflower oil, sesame oil, or coconut oil — in your mouth. The way you swish is important. The oil is supposed to half-fill the mouth and then be sucked back and forth through the teeth. The oil and saliva mix as you swish sideways and back and forth for about 10 minutes.

Where did oil pulling come from?
The practice goes back to the Ayurvedic health habits in ancient India, where it was believed to cure many diseases, from headaches to high blood pressure to diabetes and asthma. And, of course, it helped with oral and dental health.

This is where the kernel of truth comes in. I suspect that back in ancient India, the people who had the leisure time to swish valuable oils in their mouths and then spit them out were not struggling for existence. They were the wealthy or the honored of India. These were likely people who did not toil in the fields to bring home a little rice. But rather they took part in all the wonderful Ayurvedic therapies and rituals we now know about and practice — like yoga and meditation.

My point is that this group would have suffered less from illness than those who barely have enough food to feed their families. Was it really the oil pulling that made all the difference in their health?

Why is it in the news now?
So here we are 2014, and oil pulling is in the news, which brings me back to the kernel of truth.

One key to preventing dental cavities and gum disease is regularly getting rid of the plaque buildup on your teeth (just like they say on toothpaste commercials). Apparently, the swishing and “pulling” of the oil for a long period of time in your mouth decreases plaque and gingivitis. The study where I got my information was a small one, but it was logical. It was done at a dental school in India – where this could be an important part of daily oral health.

Today, in India, the cost of swishing cooking oil every day is much less than swishing a mouth rinse. And the poor don’t get 6-month dental checkups. In that light, oil pulling could be an important way to improve oral hygiene and worth further research.

Will I start oil pulling?
So, does oil pulling cure everything from headaches to asthma? That hasn’t been proven and probably won’t ever be. But it does seem to keep your mouth cleaner by cutting plaque. And that could be very useful information for many in today’s world.
For me, I want to learn from the Ayurvedic way of the past. But as long as I have easy access to floss and the electric toothbrush, I’m sticking with that and skipping oil pulling.

Source: web md

Response to Stress Can Fuel Childhood Obesity

child obesty

Emerging research from Penn State and Johns Hopkins universities suggests an overreaction to stress can increase a child’s risk of becoming overweight or obese.

“Our results suggest that some children who are at risk of becoming obese can be identified by their biological response to a stressor,” said Lori Francis, Ph.D., associate professor of biobehavioral health at Penn State.

“Ultimately, the goal is to help children manage stress in ways that promote health and reduce the risks associated with an over- or under-reactive stress response.”

Francis and her colleagues recruited 43 children ages 5- to 9-years-old and their parents to participate in the study.

Researchers evaluated a child’s reactions to stress via the Trier Social Stress Test for Children — a tool that consists of a five-minute anticipation period followed by a 10-minute stress period.

During the stress period, the children were asked to deliver a speech and perform a mathematics task. The team measured the children’s responses to these stressors by comparing the cortisol content of their saliva before and after the procedure.

The researchers also measured the extent to which the children ate after saying they were not hungry using a protocol known as the Free Access Procedure. The team provided the children with lunch, asked them to indicate their hunger level and then gave them free access to generous portions of 10 snack foods, along with a variety of toys and activities.

The children were told they could play or eat while the researchers were out of the room.

The team found that, on average, the children consumed 250 kilocalories of the snack foods during the Free Access Procedure, with some consuming small amounts (20 kilocalories) and others consuming large amounts (700 kilocalories).

“We found that older kids, ages 8 to 11, who exhibited greater cortisol release over the course of the procedure had significantly higher body-mass indices [BMI] and consumed significantly more calories in the absence of hunger than kids whose cortisol levels rose only slightly in response to the stressor,” Francis said.

“We also found that kids whose cortisol levels stayed high — in other words, they had low recovery — had the highest BMIs and consumed the greatest number of calories in the absence of hunger.”

According to Francis, the study suggests that children who have poor responses to stressors already are or are at risk of becoming overweight or obese. Future research will examine whether children who live in chronically stressful environments are more susceptible to eating in the absence of hunger and, thus, becoming overweight or obese.

“It is possible that such factors as living in poverty, in violent environments, or in homes where food is not always available may increase eating in the absence of hunger and, therefore, increase children’s risk of becoming obese,” she said.

The study may be found online in the journal Appetite.

Source: Psych central

VEINROM, a technology to minimize drug administration errors

Dr_Anurag-Tewari

At any healthcare centre, the most common form of intervention recommended for a patient by a physician is drug therapy. Things go awry when medications are wrongly administered for reasons that could be lack of professional practice or other unintentional human errors, incompetent healthcare products and lax procedures and systems. Observational studies all over the world have identified that errors associated with medications are the most frequent cause of adverse medical events.

Erroneous drug administration though, unfortunately, under-reported remains a rampant iatrogenic induced insult to patients. Medical errors are known to be the leading cause of death in the US and probably worldwide. A total of 44,000-98,000 Americans die every year due to this. It’s estimated that each year medical errors injure at least 1.5 million Americans and cost the health system more than 3.5 billion US dollars. Many anaesthesiologists have faced legal prosecution for allegations ranging from malpractice to homicide.

The major consequences of erroneous intravenous drug administration are patient’s morbidity and mortality that could cause a great psychological pain to patients, families, and healthcare providers. Prolonged hospital stay can increase financial burden on patient and healthcare system besides eroding public confidence and trust in healthcare services.

To prevent potential errors during drug administration, a technological innovation by Dr Anurag Tewari, a Fellow of neurosurgical and spine anaesthesiologist at US-based Cleveland Clinic Foundation, could provide a possible solution to minimize medication related errors.

Dr Tewari has designed an innovative drug delivery system called VEINROM, which could totally obliterate the incidence of wrong drug administration in anaesthesiology and other critical care areas. VEINROM (an acronym for Vasopressors, Emergency medicine, Induction agents, Neuromuscular blockers, Reversal drugs, Opioids/painkillers and Miscellaneous drugs) has been proposed by him as a conceivable solution to erroneous intravenous drug administration. The above seven categories of drugs encompass most of the intravenous drugs that are used frequently in anaesthesia.

The envisioned fluid delivery system, VEINROM, will harbour one syringe port for each of the seven drug class categories that are most commonly used drugs in anaesthesiology and critical care. A deterrent to prevent erroneous drug administration, VEINROM is a unique drug delivery manifold and syringe assembly which has incorporated mechanical and electronic mechanisms that will make it very difficult to administer wrong drugs intravenously. Preloaded syringes will further decrease the potential for human error when administering drugs instead of loading-labelling them perioperatively.

The report has been published in the Journal of Anaesthesiology Clinical Pharmacology.

Dr Tewari told India Medical Times, “VEINROM is so far the safest and the only fail-proof intravenous drug delivery assembly of specialized syringes and manifold. It incorporates more than six deterrents that will obliterate the chance of a physician injecting wrong drug into the patient.”

“This is definitely a path breaking innovation in anaesthesiology, critical care and emergency medicine. All three fields are related to service providers working under extreme duress, which predisposes them to inadvertently inject wrong drug into patient’s blood stream. VEINROM intends to ameliorate this potentially lethal outcome and hence circumvent patient harm and also malpractice lawsuits against physicians worldwide,” he added.

Instrumental in designing the technology, Dr Tewari also collaborated with four senior students of the biomedical engineering department of the University of Iowa, US on conceptualizing and designing the prototypes of VEINROM as per the ASTM (American Standards Testing Materials) regulations.

“The four students were Taylor Hines, Brady Palm, Trace Royer, and Eric Alexander. Project VEINROM was adjudged as the best senior research project by the university, besides being awarded prestigious prizes in Francis Elevator Pitch and Huber Storer Entrepreneurial competitions. Right now we are promoting this concept to various manufacturers hoping its introduction into practice will soon lead to enhanced patient safety,” he said.

About his plans to bring the technology to India, Dr Tewari said, “I hope to reach out to the country’s medical fraternity to incorporate this into their practice and help patients and themselves via media. The incidence of erroneous drug administration in India is perhaps equal or more than in the developed nations. Countrymen and physicians stand to benefit immensely from VEINROM.”

Many a times, some of the best people make the worst mistakes and even the best systems sometimes fail to prevent recurring medical errors. Perhaps, it’s the time to bring some changes in the field of anaesthesiology and modification in the safety protocol is essential. Adoption of best practices along with innovative technology could potentially minimize medical errors and improve overall healthcare system and most importantly save lives.
Source: India Medical Times

Woman in Coma Gives Birth to Healthy Baby Boy

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A 39-year-old Santa Cruz woman who has been in a coma for more than 10 weeks gave birth to a healthy baby boy Thursday.

Melissa Carleton, still in a semi-comatose state, gave birth by cesarean section to West Nathaniel Lande at 10:56 a.m. The baby came in at 5 pounds 9 ounces.

“I was just so happy to have a healthy baby, healthy son,” said Brian Lande, Carleton’s husband. “It’s a feeling of immense relief, joy and immense sorrow for Melissa not able to be awake for it.”coma2

The past few months have been filled with anxiety for Lande after Carleton was rushed into emergency surgery to remove a large brain tumor.

“Ten weeks of heartbreak, pain and anxiety not knowing if we get to keep either of our family members,” Lande said.

Lande said he is hopeful Carleton will one day recover to hold their baby. Her prognosis is uncertain.

“I want her to know she did an amazing job, and she loved the baby hard for two months,” he said. “I’m so grateful to her and I miss her. We can now work on getting her to wake up and get back us and be a mom.”

Source: nbc