Your chances of dying in a hospital because of a medical mistake are much higher than going down in an airplane, according to the World Health Organization.
In a July 21, 2011 news briefing , WHO’s newly appointed envoy for patient safety Liam Donaldson pointed out that the chance of dying in a plane crash is about 1 in 10 million, but 1 in 10 patients encounter medical errors at the hospital. The chances of dying from an error are about 1 in 300, Reuters reports.
Donaldson cited a common comparison of the aviation and health-care industries in an effort to promote the WHO's surgical safety checklist for hospitals, but there are also several ways patients can protect themselves from errors, and in particular, from infection.
Here are a few tips from the Committee to Reduce Infection Deaths:
- Ask hospital workers if they’ve washed their hands, or used an alcohol-based cleaner, before they touch you.
- If the doctor uses a stethoscope, ask him or her to wipe it with alcohol.
- Avoid putting your hands near your mouth.
- If you’re going for surgery, stop smoking in advance — smokers are more likely to get infections and take longer to recover.
-Don’t shave the area where you’ll be having the surgery (bacteria could enter through nicks). And remind the surgeon that you may need an antibiotic before surgery.
The Agency for Healthcare Research and Quality has a list of 20 tips for avoiding errors.
And of course, avoiding hospitals cuts down the risk of contracting a hospital infection. Eating healthily and exercising regularly helps to avoid chronic illnesses that might bring you to the hospital in the first place.
Sunday, July 24, 2011
Monday, July 4, 2011
Copper surfaces reduce risk of hospital infections
A new study presented at the 1st International Conference on Prevention and Infection Control (ICPIC) in Geneva suggests that almost all of the bacteria that cause hospital-acquired infections in ICUs can be killed by utilizing antimicrobial copper surfaces.
Copper, like silver, kills bacteria mechanically. Because of this the microbes cannot develop a resistance to it. The exact mechanism by which copper kills bacteria is still being researched, however, several theories exist and are being studied. They include:
non-disposable metal or plastic surfaces on door knobs, railings and tray tables are often touched by people in hospitals and clinics, becoming sources of infection.
Researchers at the Memorial Sloan Kettering Cancer Centre, New York, the Medical University of South Carolina and the Ralph H. Johnson VA Medical Centre, replaced bed rails, overbed tray tables, nurse call buttons and IV poles with antimicrobial copper versions according to a Sloan Kettering statement. Data presented by trial leader Michael Schmidt, professor of microbiology and immunology at Sloan Kettering, demonstrated a 97 per cent reduction in surface pathogens in rooms with copper surfaces.
Schmidt said: " Bacteria present on ICU room surfaces are probably responsible for 35-80 per cent of patient infections, demonstrating how critical it is to keep hospitals clean."
"The copper objects used in the clinical trial supplemented cleaning protocols, lowered microbial levels, and resulted in a statistically significant reduction in the number of infections contracted by patients treated in those rooms," he said.
Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper kills greater than 99.9% of the VRE, MRSA, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli O157:H7. Antimicrobial Copper surfaces are a supplement to and not a substitute for standard infection control practices and have been shown to reduce microbial contamination, but do not necessarily prevent cross contamination; users must continue to follow all current infection control practices.
Michels et al, Lett Appl Microbiol, 49 (2009) 191-195 demonstrated that Antimicrobial CopperTM outperforms two commercially available silver-containing coatings under typical indoor conditions.
Copper, like silver, kills bacteria mechanically. Because of this the microbes cannot develop a resistance to it. The exact mechanism by which copper kills bacteria is still being researched, however, several theories exist and are being studied. They include:
- a leakage of potassium or glutamate through the outer membrane of bacteria
- a disturbance in osmotic balance
- the ability of copper to bind to proteins that do not require copper
- the oxidative stress caused by generating hydrogen peroxide
non-disposable metal or plastic surfaces on door knobs, railings and tray tables are often touched by people in hospitals and clinics, becoming sources of infection.
Researchers at the Memorial Sloan Kettering Cancer Centre, New York, the Medical University of South Carolina and the Ralph H. Johnson VA Medical Centre, replaced bed rails, overbed tray tables, nurse call buttons and IV poles with antimicrobial copper versions according to a Sloan Kettering statement. Data presented by trial leader Michael Schmidt, professor of microbiology and immunology at Sloan Kettering, demonstrated a 97 per cent reduction in surface pathogens in rooms with copper surfaces.
Schmidt said: " Bacteria present on ICU room surfaces are probably responsible for 35-80 per cent of patient infections, demonstrating how critical it is to keep hospitals clean."
"The copper objects used in the clinical trial supplemented cleaning protocols, lowered microbial levels, and resulted in a statistically significant reduction in the number of infections contracted by patients treated in those rooms," he said.
Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper kills greater than 99.9% of the VRE, MRSA, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli O157:H7. Antimicrobial Copper surfaces are a supplement to and not a substitute for standard infection control practices and have been shown to reduce microbial contamination, but do not necessarily prevent cross contamination; users must continue to follow all current infection control practices.
Michels et al, Lett Appl Microbiol, 49 (2009) 191-195 demonstrated that Antimicrobial CopperTM outperforms two commercially available silver-containing coatings under typical indoor conditions.
Friday, November 5, 2010
Women & Alzheimer's
A new report by the Alzheimer's Foundation shows that women are not only the primary unpaid caregivers and advocates for those with the disease, they are also becoming victims of the disease itself in disproportionate numbers.
According to a recent poll which gathered information from 3,118 adults nationwide, including more than 500 Alzheimer caregivers:
- 60% of Alzheimer's caregivers are women.
- Of those women, 68% report they have emotional stress from care giving.
- Nearly half of these 68% rate their stress as a "5" on a scale of "1" to "5."
- 57% of all caregivers, including 2/3 of the women, admit they fear getting Alzheimer's.
- 4 in 10 caregivers say they had no choice about their new role.
The problem is that many of those caregivers are now being diagnosed with the disease. Women suffer disproportionately from various forms of dementia, including Alzheimer's: by some estimates sixty-five percent of those currently suffering from Alzheimer's are women. Though women are only slightly more likely to develop Alzheimer's than men, its prevalence among women is twice as high simply because women live longer, with a life expectancy of 80 years versus 75 for men. Half of all women over 85 in the U.S. will eventually develop this disease.
New research shows that hormonal differences may increase the risk of Alzheimer's in women. One study, for instance, has found that hormone replacement therapy can increase a person's risk of developing dementia. Another study found that high or low levels of a thyroid hormone called thyrotropin may be associated with an increased risk of Alzheimer's disease in women. Estrogen may also play a role.
Gender also seems to dictate which risk factors matter more in the development of dementia. A French study found that men who had suffered a stroke were three times more likely to develop dementia, while stroke seemed to have no effect at all in women. Yet women prone to depression were twice as likely to suffer from dementia, and women unable to live without assistance due to an inability to perform routine tasks were 3.5 times more likely to develop dementia.
Alzheimer's develops differently in men and women, and they exhibit different symptoms of dementia: men with Alzheimer's disease tend to develop more aggression than women do as the disease progresses. They also tend to wander and perform socially inappropriate actions more frequently than women diagnosed with Alzheimer's. Women on the other hand tend to become more reclusive and emotionally unstable. They hoard items more often than men do, refuse help more often, and exhibit laughter or crying at inappropriate moments. Women also seem more vulnerable to depression and to suffering from delusions.
Because baby boomers are aging and because the population of those over age 85 is reaching record levels in the U.S., the number of people with Alzheimer's is expected to more than triple by 2050. By that time approximately 8 million women will have AD in the USA.
The FDA has only approved two types of medication to improve cognitive symptoms of Alzheimer's disease such as memory loss, according to the Alzheimer's Association. But there is no treatment that stops or reverses its progression. In America about $6 billion of funding is funneled to cancer research, and $4 billion is spent on heart disease research. Only $500 million has been allocated to Alzheimer's research, according to the Alzheimer's Association.
Fortunately there are steps women -and men- can take to protect themselves.
Studies show that getting regular exercise, eating lots of fruits, vegetables and fish, and keeping the mind active can help ward off the disease. So can taking a pass on hormone replacement therapy, which can double the risk of Alzheimer's. If they start showing signs of confusion or memory loss, women can slow Alzheimer's progression by getting diagnosed and taking medication early.
For more information on Alzheimer's disease and dementia, visit alzheimersdisease-info.com .
Wednesday, June 2, 2010
Advances in Gene Therapy: A new generation of Antisense drugs may hold the key to treating our most debilitating diseases.
Gene therapy is the insertion of genes into cells and tissues to treat disease. The gene, which is a stretch of DNA or RNA, is injected into a vector -the delivery vehicle- such an Adenovirus: the virus (with a now modified DNA) is absorbed by a targeted cell, where the cell nucleus alters its proteins using the new gene. Although the technology is still in its infancy, it has shown great promise in treating diseases such as Cancer and HIV/AIDS, as well as deadly viruses.
Pushing modern technology even further, Antisense Therapy utilizes a synthesized strand of nucleic acid which bonds to the mRNA produced by a specific gene and inactivates it, in effect acting like a micro switch which can alter the way specific cells produce proteins or prevent them from reproducing.
Currently there are no available vaccines or therapies for Ebola. Antisense drugs are useful against viral diseases because they are designed to enter cells and eliminate viruses by preventing their replication. The drugs, which act by blocking critical viral genetic sequences, may be more potent than anti-virals such as protease inhibitors that seek to inhibit a protein needed for viral replication. In a new study using Antisense drugs containing called small interfering RNAs (siRNAs), researchers targeted the L protein which is critical for Ebola virus replication. Using a proprietary technology called SNALP, or stable nucleic acid-lipid particles, to deliver the therapeutics to disease sites in animal models infected with the most potent strain of Ebola they were able to effectively inhibit the growth of the virus in 3 out of 4 infected rhesus monkeys.
In cancer studies Antisense drugs have shown the ability to target the proto-oncogenes found in normal cells. These genes, when mutated or expressed at high levels, help turn a normal cell into a tumor cell. Other Antisense drugs can inhibit the protein kinase C-alpha, which signals the cell to divide in other cancers. Scientists have discovered a way to improve the effectiveness of antisense cancer drugs by attaching multiple strands of antisense DNA to the surface of a gold nanoparticle (forming an "antisense nanoparticle"). The DNA then becomes more stable and can bind to the target messenger RNA (mRNA) more effectively.
In HIV/AIDS treatment, researchers have been conducting clinical trials using a HIV lentiviral vector, which has the unique ability to integrate into the genome of non-dividing cells( other Retroviruses can infect only dividing cells). Because "short" antisense -such as ribozymes or RNAi- may be more likely to result in HIV strains that are resistant to the therapy, these new drugs contain a very long antisense that inhibits HIV replication and debilitates HIV's ability to resist the treatment. The antisense lies inactive in a patient’s white blood cells (specifically the CD4+cells), waiting for HIV to enter that cell. When HIV does enter, replication of HIV within that cell activates the vector, which then binds to and destroys the HIV.
Ongoing clinical trials are attempting to determine if patients can go off antiretroviral drugs permanently: while the data from this trial is still not complete, the results are very encouraging.
With the completion of the Human Genome Project draft in 2003, researchers have been given detailed knowledge of the human genome which will provide new avenues for advances in medicine and biotechnology. This information can provide a deeper understanding of the disease processes at the level of molecular biology, and will potentially determine many new therapeutic procedures.
Given the established importance of DNA in molecular biology and its central role in determining the fundamental operation of cellular processes, it is likely that expanded knowledge in this area will facilitate medical advances in numerous areas of clinical interest that may not have been possible without them.
Pushing modern technology even further, Antisense Therapy utilizes a synthesized strand of nucleic acid which bonds to the mRNA produced by a specific gene and inactivates it, in effect acting like a micro switch which can alter the way specific cells produce proteins or prevent them from reproducing.
Currently there are no available vaccines or therapies for Ebola. Antisense drugs are useful against viral diseases because they are designed to enter cells and eliminate viruses by preventing their replication. The drugs, which act by blocking critical viral genetic sequences, may be more potent than anti-virals such as protease inhibitors that seek to inhibit a protein needed for viral replication. In a new study using Antisense drugs containing called small interfering RNAs (siRNAs), researchers targeted the L protein which is critical for Ebola virus replication. Using a proprietary technology called SNALP, or stable nucleic acid-lipid particles, to deliver the therapeutics to disease sites in animal models infected with the most potent strain of Ebola they were able to effectively inhibit the growth of the virus in 3 out of 4 infected rhesus monkeys.
In cancer studies Antisense drugs have shown the ability to target the proto-oncogenes found in normal cells. These genes, when mutated or expressed at high levels, help turn a normal cell into a tumor cell. Other Antisense drugs can inhibit the protein kinase C-alpha, which signals the cell to divide in other cancers. Scientists have discovered a way to improve the effectiveness of antisense cancer drugs by attaching multiple strands of antisense DNA to the surface of a gold nanoparticle (forming an "antisense nanoparticle"). The DNA then becomes more stable and can bind to the target messenger RNA (mRNA) more effectively.
In HIV/AIDS treatment, researchers have been conducting clinical trials using a HIV lentiviral vector, which has the unique ability to integrate into the genome of non-dividing cells( other Retroviruses can infect only dividing cells). Because "short" antisense -such as ribozymes or RNAi- may be more likely to result in HIV strains that are resistant to the therapy, these new drugs contain a very long antisense that inhibits HIV replication and debilitates HIV's ability to resist the treatment. The antisense lies inactive in a patient’s white blood cells (specifically the CD4+cells), waiting for HIV to enter that cell. When HIV does enter, replication of HIV within that cell activates the vector, which then binds to and destroys the HIV.
Ongoing clinical trials are attempting to determine if patients can go off antiretroviral drugs permanently: while the data from this trial is still not complete, the results are very encouraging.
With the completion of the Human Genome Project draft in 2003, researchers have been given detailed knowledge of the human genome which will provide new avenues for advances in medicine and biotechnology. This information can provide a deeper understanding of the disease processes at the level of molecular biology, and will potentially determine many new therapeutic procedures.
Given the established importance of DNA in molecular biology and its central role in determining the fundamental operation of cellular processes, it is likely that expanded knowledge in this area will facilitate medical advances in numerous areas of clinical interest that may not have been possible without them.
Thursday, January 21, 2010
Don’t Have a Seat: New study shows that we spend too much time on our butts and it’s killing us.
How much time do you spend sitting? Think about it: an average American office worker gets out of bed, and then sits in a car on the way to work where they sit down at their desk. Maybe you’ll go out for lunch and sit at a table. Back to work, a commute home, then a few hours sitting in front of the TV before bed.
A new study published in the Journal of the American Heart Association has found that every hour per day spent sitting without physical activity increases a person's risk of dying from heart disease by almost one-fifth, regardless of how physically fit or unfit they are. "Even if someone has a healthy body weight, sitting for long periods of time still has an unhealthy influence on their blood sugar and blood fats," according to Professor David Dunstan, head of the Physical Activity laboratory at Australia’s Baker IDI Heart and Diabetes Institute.
The study measured the intensity of physical activity in 168 subjects over seven days. It found that regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. Higher levels of triglycerides, or blood lipids, have been linked to a heightened risk of heart disease and stroke. High blood glucose levels are linked to the development of diabetes, which itself is a major risk factor for heart disease.
The studies found that the enzymes responsible for breaking down fat are suppressed when a person is sitting instead of standing.
"To hold a body that weighs [77 kilograms] upright takes a fair amount of energy from muscles," he said. "There is a large amount of energy associated with standing every day that can't easily be compensated for by 30 to 60 minutes in the gym."
"To hold a body that weighs [77 kilograms] upright takes a fair amount of energy from muscles," he said. "There is a large amount of energy associated with standing every day that can't easily be compensated for by 30 to 60 minutes in the gym."
His studies found that the enzymes responsible for breaking down fat are suppressed when a person is sitting instead of standing.
But the good news is that pottering about the house or gently walking around the office while on the phone might be enough to keep you fit: regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. In fact, the sheer effort of standing up is enough to double the metabolic rate and the amount of calories burnt.
"If you stand up, you are much more likely to end up pacing or pottering around and that seems to make a crucial difference."
But the good news is that pottering about the house or gently walking around the office while on the phone might be enough to keep you fit: regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. In fact, the sheer effort of standing up is enough to double the metabolic rate and the amount of calories burnt.
"If you stand up, you are much more likely to end up pacing or pottering around and that seems to make a crucial difference."
Wednesday, November 18, 2009
New breast cancer screening guidelines create confusion and controversy.
The U.S. Preventive Services Task Force (USPSTF) has updated their 2002 recommendation statement on screening for breast cancer in the general population, and the new statement has created a loud controversy among physicians, cancer survivors, women's health advocates and, inevitably, politicians. Making its debut in the midst of a hotly debated healthcare reform bill the timing could hardly be worse.
About the USPSTF:
The USPSTF was established in 1984 to "evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care." The USPSTF is an independent, voluntary body, and "...recommendations made by the USPSTF are independent of the U.S. government, and they should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services."
Here is the outline of the new recommendations:
The primary controversy revolves around the statements against routine screening in women through their 40's, and biennial (rather than annual) screening between 50 to 74 as well as the recommendation against teaching breast self-examination.
The position of the Task Force is that the routine annual screening for breast cancer can cause "...psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results." They also note the overdiagnosis of cancer that would not become clinically apparent during a woman's lifetime, and unnecessary early treatment of breast cancer that may become clinically apparent but would not actually shorten a woman's life. Although "...false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups." They also state that there is adequate evidence that teaching breast self examination (BSE) is associated with harms that are "at least small."
However, The American Cancer Society "...continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."
Many physicians and women's health advocates are also either confused or seem to be misinterpreting the recommendations to insinuate that women shouldn't -or won't be allowed to- have a screening at all until they're 40; Dr. John Larrinaga, Medical Director at the Ross Breast Center states: "It doesn't make sense on any level for any person to put their heads in the sand like an ostrich and say we shouldn't be checking ourselves or shouldn't be vigilant about the disease...This is just wrong, this is not scientifically supported." Dr. Ann Marie Shorter, a radiologist with a specialty in breast care says "The statistics are meaningless when it comes to breast cancer deaths if it's your wife, your best friend; these guidelines are a travesty. They don't make sense."
And Rep. Debbie Wasserman Schultz (D-Fla.) "blasted" the report, saying "We can't turn literally 20 years of recommendations ...upside down, and discourage women from becoming familiar with the look and feel of their breasts," and "We can't allow the insurance industry to continue to drive healthcare decisions"
Given the current climate of political diversity on the healthcare bill, the controversy isn't likely to die soon. Meanwhile, breast cancer continues to be the most common form of cancer among women in the US, with about 192,370 new cases of invasive breast cancer expected to be diagnosed in 2009. In our opinion, the best guideline is the old adage: If in doubt, check it out.
_______________________________________________________
Signs and symptoms of breast cancer may include:
When to see a doctor:
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor.
About the USPSTF:
The USPSTF was established in 1984 to "evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care." The USPSTF is an independent, voluntary body, and "...recommendations made by the USPSTF are independent of the U.S. government, and they should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services."
Here is the outline of the new recommendations:
- The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
- The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
- The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
- The USPSTF recommends against teaching breast self-examination (BSE).
- The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
- The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
The primary controversy revolves around the statements against routine screening in women through their 40's, and biennial (rather than annual) screening between 50 to 74 as well as the recommendation against teaching breast self-examination.
The position of the Task Force is that the routine annual screening for breast cancer can cause "...psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results." They also note the overdiagnosis of cancer that would not become clinically apparent during a woman's lifetime, and unnecessary early treatment of breast cancer that may become clinically apparent but would not actually shorten a woman's life. Although "...false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups." They also state that there is adequate evidence that teaching breast self examination (BSE) is associated with harms that are "at least small."
However, The American Cancer Society "...continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."
Many physicians and women's health advocates are also either confused or seem to be misinterpreting the recommendations to insinuate that women shouldn't -or won't be allowed to- have a screening at all until they're 40; Dr. John Larrinaga, Medical Director at the Ross Breast Center states: "It doesn't make sense on any level for any person to put their heads in the sand like an ostrich and say we shouldn't be checking ourselves or shouldn't be vigilant about the disease...This is just wrong, this is not scientifically supported." Dr. Ann Marie Shorter, a radiologist with a specialty in breast care says "The statistics are meaningless when it comes to breast cancer deaths if it's your wife, your best friend; these guidelines are a travesty. They don't make sense."
And Rep. Debbie Wasserman Schultz (D-Fla.) "blasted" the report, saying "We can't turn literally 20 years of recommendations ...upside down, and discourage women from becoming familiar with the look and feel of their breasts," and "We can't allow the insurance industry to continue to drive healthcare decisions"
Given the current climate of political diversity on the healthcare bill, the controversy isn't likely to die soon. Meanwhile, breast cancer continues to be the most common form of cancer among women in the US, with about 192,370 new cases of invasive breast cancer expected to be diagnosed in 2009. In our opinion, the best guideline is the old adage: If in doubt, check it out.
_______________________________________________________
Signs and symptoms of breast cancer may include:
- A breast lump or thickening that feels different from the surrounding tissue
- Bloody discharge from the nipple
- Change in the size or shape of a breast
- Changes to the skin over the breast, such as dimpling
- Inverted nipple
- Peeling or flaking of the nipple skin
- Redness or pitting of the skin over your breast, like the skin of an orange
When to see a doctor:
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor.
Tuesday, November 17, 2009
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