Harm in hospitals still common for patients
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Despite a decade of efforts to improve patient safety in hospitals—initially inspired by a seminal report on the problem from the U.S. Institute of Medicine in 2000—harmful errors and accidents are still common, new research suggests.
The study, published in the New England Journal of Medicine, showed that between 2002 and 2007, the number of patients experiencing infections acquired in the hospital, medication errors, complications from diagnostic techniques or treatments, and other such “harms” did not change.
Researchers looked at 2,300 patient admission records from 10 randomly selected hospitals in North Carolina. They found 588 incidents of patient harm resulting from medical procedures, medications, or other causes. Two-thirds of these complications were considered preventable by reviewers at the hospitals themselves.
An answer to a longstanding question: How HIV infection kills T cells
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Researchers appear to have an explanation for a longstanding question in HIV biology: how it is that the virus kills so many CD4 T cells, despite the fact that most of them appear to be “bystander” cells that are themselves not productively infected. That loss of CD4 T cells marks the progression from HIV infection to full-blown AIDS, explain the researchers who report their findings in studies of human tonsils and spleens in the November 24th issue of Cell, a Cell Press publication.
“In [infected] primary human tonsils and spleens, there is a profound depletion of CD4 T cells,” said Warner Greene of The Gladstone institute for Virology and Immunology in San Francisco. “In tonsils, only one to five percent of those cells are directly infected, yet 99 percent of them die.”
Lymphoid tissues, including tonsils and spleen, contain the vast majority of the body’s CD4 T cells and represent the major site where HIV reproduces itself. And it now appears that those dying T cells aren’t bystanders exactly.
Researchers say uncover HIV, insulin resistance link
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Researchers at the Washington of Medicine say they have uncovered why so many people with the HIV virus develop a dangerous insulin resistance that leads to diabetes and heart disease.
The culprit lies in the powerful drugs that prevent the development of AIDS and have extended the lives of many HIV patients, the researchers say. They hope the discovery will allow development of safer antiviral drugs.
The research, published this month in the Journal of Biological Chemistry, shows HIV protease inhibitor drugs directly interfere with the way blood sugar levels are controlled in the body.
No family link seen between Parkinson’s, melanoma
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Research has suggested that families affected by melanoma skin cancer may also have a higher-than-average rate of Parkinson’s disease—but a large new study found no evidence of such a link.
This doesn’t mean no genetic link exists, the authors of the new study say. But it does suggest that such a link might not have very important effects.
Melanoma is the least common, but most serious, form of skin cancer. The disease sometimes runs in families, and people with two or more close relatives who have had melanoma are considered to be at higher-than-average risk.
Cholera fighting efforts restart in Haiti’s north
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Aid supplies to combat Haiti’s deadly cholera epidemic are flowing again into the country’s northern regions after protests by Haitians blaming U.N. troops for the outbreak, humanitarian groups said on Sunday.
Vehicles carrying equipment from some aid groups have begun to reach the northern city of Cap-Haitien, where aid efforts were disrupted last week by several days of protests that saw Haitians throw up road barricades and hurl stones at U.N. peacekeepers, said Imogen Wall of the U.N. humanitarian agency, OCHA.
“The security situation there has now stabilized,” Wall said. “We’re going to have to scramble to get back to where we were.”
Moms’ mealtime tactics tied to kids’ eating habits
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School-age children whose mothers tightly control their diets may be prone to overeating, while those with moms who pressure them to eat tend to be fussy about food, a new study finds.
The findings, published in the Journal of the American Dietetic Association, do not necessarily mean that parents’ mealtime strategies cause their children to overeat or become picky eaters.
In fact, the researchers say, it’s likely that parents who pressure or restrict are often reacting to their children’s eating habits.
New tests and interventions may help prevent future health problems
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1. Potassium Citrate May Help Prevent and Treat Osteoporosis Supplement Neutralizes Bone Damage Inflicted by the Western Diet
The Western diet creates an acidic environment in the body that removes calcium from bones and may contribute to the development of osteoporosis. Healthy adults who consume the standard US diet sustain a chronic, low-grade state of acidosis that worsens with age as kidney function declines, limiting urinary acid excretion. Reto Krapf, MD (University of Basel, in Bruderholz/Basel, Switzerland) and colleagues designed a study to see if daily alkali as potassium citrate supplement tablets might neutralize these effects. They enrolled 201 healthy elderly individuals of both genders with normal bone mass in a randomized double-blind, placebo-controlled clinical trial. Participants received either 60 mmol alkali as potassium citrate (a base) or a placebo every day for 2 years. Bone density and high resolution computed tomography scans after 2 years revealed that neutralizing diet-induced acid production with potassium citrate significantly and safely increased subjects’ bone density vs. placebo. “In addition, we discovered that bone architecture improved significantly, suggesting that not only bone mass, but also its quality was improved,” said Dr. Krapf. These results suggest and predict that potassium citrate may be effective for preventing and even treating osteoporosis.
Study co-authors include Sigrid Jehle, MD (University of Basel, in Bruderholz/Basel, Switzerland) and Henry N. Hulter, MD (FibroGen, Inc., San Francisco).
Disclosures: The authors reported no financial disclosures.
UK starts world’s first stroke stem cell trial
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Doctors in Scotland working with British biotech company ReNeuron have injected stem cells into the brain of a man in a pioneering clinical trial to test the safety of a therapy for patients disabled by stroke.
The trial is the first in the world to use neural stem cell therapy in stroke patients, its organisers said on Tuesday, and external experts said it was grounds for “cautious optimism.”
Keith Muir of the University of Glasgow’s Institute of Neuroscience and Psychology, the principal investigator, said the surgery on the first patient, a man in his 60s, had gone well and he had been discharged from hospital.
Sinai Hospital’s Krieger Eye Institute Opens New Retina Center
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The Krieger Eye Institute at Sinai Hospital opened a new center for the treatment of retinal diseases in November. The retina is the layer of tissue at the back of the eye that converts images to electrical impulses. These electrical signals are then perceived by the brain as sight.
The Retina Center treats all retinal diseases including macular degeneration, hypertensive retinopathy, pediatric retinopathy, diabetic retinopathy and sickle cell retinopathy.
“The approach to treating retinal disease has changed drastically in the last few years,” says Donald Abrams, M.D., chief of the Department of Ophthalmology at Sinai Hospital. “This new center allows us to more effectively treat patients suffering from these diseases.”
Mayo Clinic Health Policy Center to Host Health Care Symposium
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With the 2010 election over and new Capitol Hill leadership arriving in 2011, it is important to continue the discussion about patient-centered health care. In a sustained effort to seek consensus-driven policies that would build a high-value health care system, the Mayo Clinic Health Policy Center will host a symposium Dec. 5–7 entitled “Achieving the Vision: Advancing High-Value Health Care.”
WHO: Mayo Clinic Health Policy Center experts and national health care leaders. Among the panelists and speakers are Carolyn Clancy, M.D., director, Agency for Healthcare Research and Quality; Susan Dentzer, editor-in-chief, Health Affairs; Tim Johnson, M.D., senior medical contributor, ABC News; Randall Krakauer, M.D., national medical director for Medicare, Aetna; Pat Mitchell, president and CEO, The Paley Center for Media (welcoming participants on behalf of the Mayo Clinic Board of Trustees during the reception on Dec. 5); and John Noseworthy, M.D., president and CEO, Mayo Clinic.
Lower back and foot pain associated with more severe knee osteoarthritis symptoms
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A new study found that patients with osteoarthritis (OA) of the knee who also have pain in other joints were more likely to experience greater knee pain. Specifically, pain in the lower back as well as foot pain and elbow pain on the same side as the affected knee were associated with more severe knee pain. Full details appear in the December issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.
Knee OA is the leading cause of disability in the U.S., with nearly 4.3 million adults over age 60 having the symptomatic form of the disease according to the Centers for Disease Control and Prevention (CDC). A study by Helmick et al. published in Arthritis & Rheumatism reported 59 million people have low back pain, which is the most common cause of lost work time among individuals less than 45 years of age and the third most common cause among those 45 to 65 years of age.
The current study team led by Pradeep Suri, M.D., from Harvard Medical School, New England Baptist Hospital, and Spaulding Rehabilitation Hospital in Boston, Massachusetts used data provided by individuals from the Osteoarthritis Initiative - a multicenter population-based observational cohort study of knee OA.
Use of omega-3 does not appear to reduce recurrence of atrial fibrillation
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Although some data have suggested that omega-3 fatty acid supplements, such as from fish oil, may improve treatment of atrial fibrillation, a randomized trial with more than 600 patients finds that treatment with high-dose prescription omega-3 did not reduce the recurrence of atrial fibrillation over six months, according to a study that will appear in the December 1 issue of JAMA. The study is being released early online because it will be presented at the American Heart Association’s annual meeting.
“Atrial fibrillation (AF) is a highly prevalent disease that is responsible for reduced quality of life, costly hospitalizations, heart failure, stroke, and death. No current therapy, drug, device, or ablation [removal of tissue or cells] is uniformly effective, and several available therapies have the potential to cause harm. Consequently, useful alternatives are being sought,” the authors write. “Limited data from small trials suggest omega-3 polyunsaturated fatty acids may provide a safe, effective treatment option for AF participants.”
Peter R. Kowey, M.D., of the Lankenau Institute for Medical Research, Wynnewood, Pa., and colleagues conducted a randomized clinical trial to assess the efficacy of a pure prescription formulation of omega-3 fatty acids (prescription omega-3), at a dose considerably higher than what has been tested in previous trials, for preventing recurrent atrial fibrillation. The study included 663 U.S. outpatient participants with confirmed symptomatic paroxysmal (sudden attacks) (n = 542) or persistent (n = 121) AF, with no substantial structural heart disease, who were recruited from November 2006 to July 2009 (final follow-up was January 2010). Participants received prescription omega-3 (8 grams/day) or placebo for the first 7 days; prescription omega-3 (4 grams/day) or placebo thereafter through week 24.
Family ties play big role in atrial fibrillation
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People who have a close family member with atrial fibrillation are 40 percent more likely to develop the heart condition than other people, U.S. researchers said on Saturday.
And the finding was even stronger for people whose relatives developed the heart rhythm problem at a younger age—before they turned 65.
“It was a threefold increased risk,” Dr. Emelia Benjamin of Boston University School of Medicine, who worked on the study to be published in the Journal of the American Medical Association.
Landmark Study Shows Suboptimal Asthma Care
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Researchers assessed asthma burden and treatment practice in the U.S. based on results of the recently completed Asthma Insight and Management telephone survey in a new study presented at the American College of Allergy, Asthma and Immunology annual meeting in Phoenix, Nov. 11-16. The asthma survey, the most comprehensive in the U.S. in the past 10 years, reported 73 percent of patients experienced asthma symptoms or an asthma attack in the past 12 months, 63 percent were affected by asthma throughout the year, and 41 percent believed their asthma was interfering with their life. Authors conclude that “despite the availability of asthma management guidelines and effective asthma treatments, asthma care is inferior, underscoring the need for improved patient education and use of written action plans.”
Title: Patient-Reported Asthma Burden and Treatment Practice in the United States: Results of the Asthma Insight and Management Survey
Lead Author: Eli O. Meltzer, MD, ACAAI Fellow
Cystic Fibrosis Gene Typo Is a Double Whammy
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An imbalance of salt and water in patients with cystic fibrosis makes their lungs clog up with sticky mucus that is prone to infection. The cause of the offending imbalance is a well-known genetic error, one that blocks the molecular expressway for tiny chloride ions to move across the surface of the lungs.
But how does that same gene mutation upset a parallel roadway controlling the flow of the other component of salt, sodium ions? Now, researchers at the University of North Carolina at Chapel Hill School of Medicine have found the answer, demonstrating that the gene mutated in cystic fibrosis not only controls traffic on the chloride highway, but also keeps the sodium highway from being overused.
The finding suggests that the infamous mutation – in a gene called CFTR – is a double whammy, affecting the flow of two different ions that are important to keep the mucus on the surfaces of the airways hydrated. Clarifying this link between the genetic defect and the thick sticky mucus in cystic fibrosis lungs could help researchers develop better therapies.
