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2014-42/1180/en_head.json.gz/21067 | SearchWomen’s Health Policy Search Results « » The Henry J. Kaiser Family Foundation
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A Report on Women and HIV/AIDS In the U.S.
This report maps the trajectory of the HIV/AIDS epidemic among women in the United States (U.S.), including the following: key historical epidemiological trends and the important role played by women in the response over time; the current impact of HIV among women in the U.S., including a profile of those…
EMPOWERED: A New Campaign From Alicia Keys and Greater Than AIDS to Reach Women on HIV/AIDS
At noon ET on Monday, April 15, the Kaiser Family Foundation hosted a webcast (archived video below) to introduce EMPOWERED, a new campaign from Grammy Award-winning artist and HIV activist Alicia Keys and the Kaiser Family Foundation to reach women about HIV/AIDS. Ms. Keys was joined by White House Senior Advisor…
We Are Empowered: Alicia Keys Wants To Change the Way Women Think About HIV
Fourteen-time Grammy Award-winning artist and HIV advocate Alicia Keys has teamed up with Greater Than AIDS to launch EMPOWERED, a new public information campaign to reach women in the U.S. about HIV/AIDS. Being released in the lead-up to National Women and Girls HIV/AIDS Awareness Day (March 10), the ongoing…
Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges
To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards.
Medicaid’s Role for Women Across the Lifespan: Current Issues and the Impact of the Affordable Care Act
This issue brief, Medicaid’s Role for Women Across the Lifespan: Current Issues and the Impact of the Affordable Care Act, discusses the importance of Medicaid for women and examines how changes under the health reform law will affect the program and women covered by Medicaid. The brief explores Medicaid’s role for women across their lifespans including reproductive health services, care for chronic conditions and disabilities, and long-term care services. And it provides new state-level data on enrollment and coverage policies on services of importance to women.
State Coverage of Preventive Services for Women under Medicaid: Findings from a State-Level Survey
This brief reviews Medicaid’s role in covering preventive care for women, presents findings of importance to women from the survey, and discusses the implications for women on Medicaid following the implementation of health reform.
Assessing the Presidential Candidates’ Positions on Women’s Health Coverage and Reproductive Health Care
Women’s health has been a key issue in the 2012 election with the candidates, President Barack Obama and former Massachusetts Governor Mitt Romney, having different views on women’s health care. This brief discusses two major health care issues that are important to women – health coverage and reproductive health care – and summarizes the presidential candidates’ stated positions on these topics.
The Women, Girls, and Gender Equality Principle of the U.S. Global Health Initiative: How Have USG Programs Responded?
This report examines how countries are responding to and implementing the women, girls, and gender equality principle of the U.S. Global Health Initiative (GHI). This principle, one of seven core principles of the GHI, aims to sharpen the focus on women and girls across U.S. government global health efforts. Based…
Putting Men’s Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level
This report documents the persistence of disparities between white men and men of color — and among different groups within men of color — on 22 indicators of health and well-being, including rates of diseases such as AIDS, cancer, heart disease and diabetes, as well as insurance coverage and health screenings. It also catalogues disparities in factors that influence health and access to care such as income and education, and other social determinants of health. Report
Kaiser Health Tracking Poll — May 2012
The May Health Tracking Poll focuses on the public’s perceptions and reactions to women’s reproductive health reemerging as a heated issue in policy debates and news and its potential impact on the upcoming presidential election. Three in ten women (31 percent) overall believe that there is currently a “wide-scale effort…
Poll Finding | 医学 |
2014-42/1180/en_head.json.gz/21130 | Image by Public Citizen via FlickrFrom The New York Times
Sunday Dialogue: Curing the Health System
A letter on Wednesday urging a single-payer health plan, rather than individual mandates, set off an outpouring of reaction.
The Letter:
To the Editor: In "Will Health Care Reform Survive the Courts?" (State of Play, Sunday Review, Aug. 21), Philip M. Boffey states that "reforms would work far less well without an individual mandate" that requires citizens to buy health insurance or pay a penalty.
I disagree. Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress's power to mandate purchase of private products sold at a profit is disputable, but Congress's power to tax is not. Other industrialized countries have national health plans providing care to more citizens at less cost with better outcomes than our system. And they don't use mandates that allow insurers to charge different prices for different people.
These health care systems have three common properties: public subsidies ensure that everyone has access to care regardless of health, wealth or employment; primary care is encouraged; and publicly accountable, transparent, not-for-profit agencies transfer funds from patient to provider.
There is no need to experiment with mandates. Convert our current health care system into a national health plan. SAMUEL METZ
Portland, Ore., Aug. 21, 2011 The writer, an anesthesiologist, is a founding member of Mad as Hell Doctors, which advocates a single-payer system.
Readers React
Dr. Metz is spot on with his advocacy of a single-payer plan instead of the individual mandate. Sadly, despite the success of Medicare — a single-payer system that politicians tamper with at their peril — the "just say no" climate in Washington, fostered by Republicans who place ideology over country, took that option off the table and left us with an alternative that not only raises legal questions but also fails to address the real threat: the escalating costs of health care.
That said, the health care plan that the politicians have given us, which extends protection to millions of uninsured, is better than no plan at all. After decades of talking about reform, we finally have a plan in place. With luck, a day will come when the political will for a single-payer system exists. Until then, let's do our best to make the plan we have work. JAY N. FELDMAN
Port Washington, N.Y., Aug. 24, 2011
Dr. Metz is right that a single-payer system would be better than an individual mandate. But he does not mention that Medicare, although it is a single-payer, tax-supported system, still cannot control costs and will soon be bankrupt. A national health plan that controls costs needs to reform the way doctors are paid and are organized in practice.
This is how doctors, if they are really "mad as hell," could help. They should join salaried multispecialty, not-for-profit group practices that can accept capitated prepayment for comprehensive care instead of fee for service, and can provide good, cost-effective care that supports primary-care doctors working in close collaboration with specialists.
ARNOLD S. RELMAN
Cambridge, Mass., Aug. 24, 2011 The writer, a physician, is professor emeritus of medicine and of social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.
We need Dr. Metz to keep the flame of national health insurance alive until this country is ready to embrace it as the most cost-effective way to provide coverage. But as Winston Churchill said, "You can always count on Americans to do the right thing — after they've tried everything else."
The battle to pass the Affordable Care Act and the challenge to sustain it should make clear that national health insurance will not be given serious consideration by politicians for some time.
Our approach to health reform has desirable features, like elimination of pre-existing condition exclusions. An individual mandate is required to make health reform work.
Dr. Metz simply prefers another way to require all Americans to have coverage. More power to him. In the meantime, let's try the next best thing.
BRUCE KELLEY
Minneapolis, Aug. 24, 2011 -------------------
I am a young professional who is just starting out on my career path.
I have already been juggled among health care systems because of different schools and different jobs, and the experience was not fun. Recently, I was lucky enough to find employment that offers health insurance, but if I should lose my job, I would lose my health insurance. This doesn't make me feel secure. The individual mandate doesn't make me feel secure either. Health insurance does not equal health care.
I don't want to start paying into health insurance that I may lose because of powers beyond my control. With a single-payer system, you simply get enrolled into a public health insurance system. Through my taxes, I would be making an investment in my health future that would be there whether I lost my job or not. Now that would make me feel secure.
MOLLY TAVELLA
Rancho Cucamonga, Calif., Aug. 24, 2011
The writer is the education and outreach coordinator for Physicians for a National Health Program California.
----------------------- Of course Dr. Metz is correct that a single-payer system — comparable to that used in a number of other countries — would be both beneficial and less expensive than the privately skewed, hodgepodge system we have now. Unfortunately, the lack of political maturity in this country means that arguing that other societies have better ideas than we do is counterproductive, since the myth of American exceptionalism is more important than actually providing better health care while saving money in the process.
ALAN POSNER
East Lansing, Mich., Aug. 24, 2011
-------------------------------- Dr. Metz presents a compelling argument in support of a single-payer plan. He cites the experience of other countries to show that such a system provides better health outcomes at lower cost. Our own experience shows that Medicare requires only about 3 percent for administrative costs, as opposed to 29 percent for private health insurance.
Alas, these arguments are fated to fall on deaf ears. Between 2006 and 2009, the health sector spent $1.7 billion lobbying Congress and federal agencies. No wonder our government can't hear the rest of us!
SHERMAN C. STEIN
Philadelphia, Aug. 24, 2011 The writer is a clinical professor of neurosurgery at the Hospital of the University of Pennsylvania. ---------------------------------- Let me add some data to support Dr. Metz's proposal. The evidence is overwhelming. The cost of health care per person in other industrialized countries is on average less than half of that in the United States. If we spent as much per person as the other countries do, we would save $1.3 trillion every year. One characteristic of those countries' health care is that there is a single entity that runs the system. This ensures uniform and minimal overhead and compliance costs, and provides guidance and regulation for the medical effectiveness of the various procedures.
We can learn much from other countries. The question is whether we are mature enough to do so.
LEONARD S. CHARLAP
Princeton, N.J., Aug. 24, 2011
The Writer Responds
I thank these readers for their thoughtful comments. Dr. Stein notes that private insurance overhead is many times higher than Medicare's. Most economists agree. Including the cost to providers to collect from insurance companies nearly doubles the difference. This administrative excess is more than sufficient to finance comprehensive health care for every American. Nearly 25 state and national studies of single-payer plans corroborate this. Although single payer enables universal care without additional cost, Dr. Relman notes that it will not slow cost increases. He proposes a salaried physician model to replace fee for service. There is much evidence in support.
The salaried physicians in the Department of Veterans Affairs medical system care for America's sickest patients at the lowest cost with the best outcomes and highest patient satisfaction of any system in the country. Clearly, when financial pressures are removed, physicians provide superb care.
Mr. Marlow is only partly correct. In countries with national health plans, patients see their physicians more frequently than we do and spend more days per year in the hospital. Despite this increased access to care, these nations spend half as much as we do, and their populations are healthier. Presumably, unlimited access to inexpensive primary care reduces consumption of more expensive, more complex intensive care. Ms. Tavella makes two important points. First, an insurance policy is no guarantee of health care. Most personal bankruptcies in America are precipitated by medical crises in families with health insurance when the crisis began. Second, when the young, healthy and employed make health care payments in excess of what they consume, this is not a loss. It is an investment in future care when they are old, sick and retired.
Messrs. Feldman, Kelley, Posner and Charlap mourn our inability to achieve single-payer health care despite its obvious financial advantages. But our obstacle is not political, but moral. Many Americans believe that it is immoral to pay for other people's care, even if doing so reduces their own costs. Others believe that it is immoral to pay taxes for health care, even if doing so protects their family from illness and financial catastrophe. We cannot argue morality, but we can present the health and financial consequences of allowing these morals to drive health care policy.
American single-payer systems include the Department of Veterans Affairs system; the Indian Health Service; Tri-Care, the military health plan; Taft-Hartley multiemployer plans; and Medicaid and Medicare. Any of these systems could be improved and expanded to cover all Americans.
Single-payer health care is America's health care solution to America's health problem. SAMUEL METZ
Portland, Ore., Aug. 25, 2011
Single-payer health care, | 医学 |
2014-42/1180/en_head.json.gz/21142 | Search Anticipating Managed Care in the Year of Lindbergh
MANAGED CARE July 1997. © MediMedia USAEthicsAnticipating Managed Care in the Year of LindberghJohn La Puma, M.D.
MANAGED CARE July 1997. ©1997 Stezzi Communications
John La Puma, M.D.
In the Nov. 26, 1927, issue of the Journal of the American Medical Association, M. L. Harris, M.D., wrote a special article called "Medical Economics." It reads, in part:
Contract practice per se is not unethical.... It may be said, however, that a contract is unfair and therefore unethical when the compensation received is inadequate based on the usual fees for the same kind of service and class of people in the same community, or when the compensation is so low as to make it impossible for competent services to be rendered.
How much things change is how much they stay the same. As much as ever, what physicians talk about at night, in the mailroom, or running from office to car to office are unethical business practices.
Ethics in managed care is becoming business ethics, and the medical ethical issues that concern physicians seem to be the same business ethics issues that have concerned physicians for nearly the entire century. Fees. Commercial laboratories. Management of hospitals. Contract practice. Basis of the physician's obligations. In fact, these are the subheadings in Harris' 1927 article.
Business's ethical obligations are integrity and honesty. Medicine's are those, plus altruism, compassion, beneficence, nonmaleficence, respect and fairness. How can physicians and managers make sense of ethics in these days of Redux opportunism for physicians, "duty to die" threats to the elderly, and a booming, independent vitamin and supplement market for all? Can business ethics square with medical ethics?
Medical ethics corporatized
It's not just physicians and managers who worry about whether managed care organizations can make sense of changing values, boundaries and rules. It's the public, too.
The New York Times May 11, 1997, Money & Business section headline — "A Hospital Chain's Brass Knuckles, and the Backlash" — brought Columbia/HCA Healthcare's reply "Patients? Profits? Purpose?" in a full-page ad just a week later. The TV series "Chicago Hope" and "E.R." feature doctors trying to do good despite managed care odds. Internet chat rooms fill with railing plaintiffs.
This spring in Connecticut, home of the medical insurance industry, the most powerful appeals law in the country was approved by both legislative houses. The state insurance commissioner will now hear patient appeals when a managed care plan denies payment for physician-recommended treatment.
The implicit message: Managed care is not out to serve the sick but to make money, and is not to be trusted.
Harris wrote, 70 years ago:
If we recognize that the practice of medicine is a monopoly we must admit that this monopoly entails on the profession a definite and distinct duty which cannot be delegated and this duty is the care of the sick and suffering.... If the medical profession as a body fails to grasp and to fulfill its entire duty in this respect, then will private and public institutions and legislatures step in and take the matter out of the hands of the profession.
True to Harris's prophecy, physicians and managed care are being regulated, and fast. The Connecticut legislature's managed care bill — along with similar laws in Rhode Island, New Jersey, Arkansas and elsewhere — suggest that managed care's immediate future will be one of numerous external constraints.
Are these constraints developing because medicine has not championed the sick and suffering well enough? Or because doctors have too easily substituted a good treatment for the best treatment, eroding our own integrity in the process?
Physicians have enormous discretion in decisions to use medical tests and procedures. Martin Hickey, chief medical officer of Lovelace Health Systems, is fond of saying that a physician's pen is the most powerful tool he or she has. And economic issues are among the most common ethics problems seen by physicians. A study by Julia Connelly, M.D. in the mid-1980s found that ethics problems affected at least 10 percent of all outpatient encounters. There's little reason to believe that percentage has declined in the years since.
Matters of money
Coverage. Access to experimental and marginal treatment. Quality of life near the end of life. Billing, upcoding and referring. Inappropriate underutilization. Disease management. Lifestyle diseases. Incentives and distorted judgment. These issues — the ones in- volving economics — are the dominant ethical issues of 1990s managed care medicine.
It's not that discontinuing dialysis is a snap, or that pulling out a futile feeding tube is something done without feeling. It is instead that, as Steve Miles, M.D., at the University of Minnesota Center for Biomedical Ethics has written, "It's easy to debate values. Money! That's something to fight about."
Teaching how to think about issues is more important than teaching what to think. Clinical economic ethics has surfaced as the discipline about which clinicians and managers need to learn. As Harris' article shows, the same medical economic issues are still on our doorstep, 70 years after he wrote about them.
Ethics between the rocks
The profits and return on investment from managed care should go not only to investors, but to society, which prepared the resources for companies to use. Managed care companies that sponsor rigorous medical research and underwrite medical education, without which there would be no scientific advance, are too few and far between.
Do managed care organizations have moral responsibility for those people who cannot afford to be members? They are, after all, part of the same geographic communities in which towering "We Cover You" billboards shadow homeless people.
Harris closes his essay by writing:
It is because the medical profession has failed to make proper provision for the care of all of the sick, all of the time, that we hear so much agitation about federal and state measures that inevitably tend to state medicine and the loss of the independence of the physician.
Substitute the term "regulation" for "state medicine" in the last line, and the past turns into the future. Problems of autonomy and justice are ones that every generation of physicians and managers has faced and agonized over. If more managed care companies paid more attention to their long-term goals of creating a fair system that puts their communities and mission first, managed care could re-establish its credibility.
John La Puma, M.D., directs the Cooking, Healthy Eating and Fitness program at Alexian Brothers Medical Center in Elk Grove, Ill., and is a Chicago-based internist, speaker and educator. With David Schiedermayer, he is co-author of The McGraw-Hill Pocket Guide to Managed Care: Business, Practice, Law, Ethics (McGraw-Hill, New York, 1996).
Should Medical Ethics Be Part of Public Relations?Want Fairness in Managed Care? Don't Wait for the Market To Do ItEthics of Alternative Medicine: The Unconventional Has Its PlaceUnderstand Guiding Principles When Mixing Business, MedicineHow and How Much Should Physicians Be Paid? Meetings | 医学 |
2014-42/1180/en_head.json.gz/21232 | Clinical trials are a particular kind of clinical research: research involving people. They are considered only when they are shown to be safe and effective through basic science research. The term clinical trial emphasizes that the research is in a testing or trial stage before it can be approved for regular medical care. Clinical trials answer questions that can only be answered in research with people before a discovery can become a part of regular medical care.
Each clinical trial is very carefully planned to protect study participants and test effectiveness. Every trial must meet specific standards and be approved by the researcher's Institutional Review Board (IRB). The approved plan protects people who take part in the trial and describes how everything will happen to make sure the results are accurate and consistent.
In addition to approved plans, clinical trials are conducted in 4 separate steps called "phases." Each phase has specific requirements and each one builds on the next. New drugs, devices and surgeries are required to go through all 4 phases to be approved for general use. Each phase of a clinical trial has a different purpose and helps scientists answer different questions.
In Phase I trials, researchers test an experimental drug or treatment in a small group of healthy people (20-40) to make sure it is safe, to find a safe dose, and learn about any side effects. In some circumstances, such as treatments for a serious condition, people with the condition will participate. A treatment or device can only be offered in Phase 1 trials after a lot of testing has already been done in laboratories and on animals (basic science research). Once the safety of the treatment or device has been confirmed, Phase II trials can begin.
In Phase II trials, studies can begin after the safety of the treatment or device has been confirmed in the Phase I trial. The treatment or device is given to a larger group of people (40-300) who actually have the disease or condition it is meant to treat. Phase II trials test how well a treatment or device works, and further test how safe it is. Once the treatment or device shows that it works and has no serious side effect, it can go to Phase III trials.
In Phase III trials, the treatment or device is given to even larger groups of people (1,000-3,000) to see how well it works and to compare it to treatments or devices already in common use. Researchers continue to monitor any side effects. After successful completion of Phase III trials, all the information is reviewed by the Food and Drug Administration (FDA) and if approved, the treatment or device can be sold for use in the general population.
In Phase IV trials, further studies may begin after the FDA has approved a treatment or device and it is being used in regular medical care. Researchers continue to monitor the treatment or device for things like side effects, complications, and general effectiveness value in new patient populations.
Clinical Trial Categories
There are several categories of clinical trials. Each of these categories contributes different kinds of information about health and disease as seen below:
Treatment trials are done to test a new medicine, device or procedure (like surgery). Sometimes a treatment trial will test a combination of all these things to see how they will work together for the best results.
Prevention trials are designed to find ways to keep a disease from happening in the first place. These studies test things like vitamins, health behaviors, or vaccines to prevent disease. Diagnostic trials figure out which test or combination of tests is best at finding a disease or condition.
Genetic trials look for ties between your DNA and certain diseases or conditions.
Epidemiological trials look at how often diseases happen in different population groups.
Quality of Life trials look at how to improve quality of life for people living with chronic conditions.
Go to the Research Center health topic, where you can:
Last Reviewed: May 15, 2011
Susan Wentz, MD, MS
Director, Area Health Education Center | 医学 |
2014-42/1180/en_head.json.gz/21252 | Shuttle was first stop on employee’s ride to recovery by Leslie Hill | Posted on Thursday, Feb. 6, 2014 — 9:29 AM When Teresa Evans, right, fell ill from the effects of a ruptured brain aneurysm while riding the shuttle bus, Lindsey Besedich, R.N., was one of those who helped her to the Emergency Department. (photo by Joe Howell)
After her normal morning commute turned deadly, Teresa Evans says she is grateful to work at Vanderbilt University Medical Center.
Oct. 7 started like any other Monday. Evans parked in the N shuttle lot and waited for the blue shuttle to Medical Center North, where she works as assistant to Gordon Bernard, M.D. But as she walked to the shuttle stop, a painful headache signaled something was wrong. Fellow riders let her have the first seat on the bus, and she planned to exit and go straight to the Emergency Department.
Lindsey Besedich, R.N., a nurse in cardiac diagnostics, was on the same shuttle and heard screaming as it pulled into the Round Wing drop-off. She jumped up and found Evans splayed awkwardly on the bus steps.
“I thought she had fallen and hurt herself, but I had been a cardiac ICU nurse for seven years, and you can just look at someone and know they are really sick,” Besedich said.
Evans was able to say she had a horrible pain in her head and couldn’t feel her legs. Then three residents arrived on the scene, and Besedich instructed them to find a wheelchair and help her push Evans to the ED.
“She started throwing up, and it wasn’t the normal upset stomach. It was the vomiting when someone is going down. I knew things were really bad,” Besedich recalled.
Evans had a CT scan that showed a subarachnoid hemorrhage, with a large amount of blood filling the area around her brain. She was also developing hydrocephalus (a buildup of cerebrospinal fluid), and emergently had a drain placed to relieve the pressure. While having her CT, Evans’ heart stopped and she had to be resuscitated.
A CT angiogram revealed the source of the bleeding — an 8 mm intracranial aneurysm that had burst. An aneurysm is a bubble or bulge that forms on the wall of blood vessels. Only about two-thirds of patients survive ruptured brain aneurysms, and of those that do, about half have significant disability.
“She came in in the worst condition possible and then coded. With those factors, her prognosis was exceedingly grim,” said J Mocco, M.D., M.S., associate professor of Neurological Surgery. “However, we did our best to get her better and she’s a strong woman, and she made a miraculous recovery. On arrival, the cards were stacked against her, but she has done wonderfully.”
Mocco snaked a catheter from Evans’ groin to her brain in order to fill the aneurysm with small platinum coils. Then she recovered in the Neurological Intensive Care Unit.
“I was mostly out of it during that time. I don’t have much memory, which may be a good thing. I never got scared about death or disability because I never really knew what was happening. My family didn’t know if I would be a vegetable or dead,” Evans said.
Teresa Evans, right, gets a hug from Lindsey Besedich, R.N., at the shuttle drop-off in front of Medical Center North. (photo by Joe Howell)
Evans had therapy through November and December at Stallworth Rehabilitation Hospital and Pi Beta Phi Rehabilitation Institute to work on standing, balancing, walking, speech and mental focus.
She was back to work part-time on Jan. 15, but still has some fatigue, headache and dizziness.
“I’m determined to be back to normal. It may take another year or two. I still have deficits in my memory and ability to focus, but I’m hoping I can compensate for the memory lapses with good notes,” Evans said.
“I’m a private person but thought this needed to be shared, how everyone came together to help me and was so nice and professional. It’s a good reminder of what a great place this is to work. They do this every day — put brains back together and get hearts to beat again.”
Evans’ sister made Christmas ornaments with Besedich’s picture on them, so the whole family could remember “the hero.”
Besedich said she was just in the right place at the right time.
“I’ve been a nurse for 10 years and know she was incredibly lucky that this happened at Vanderbilt. Everyone was meant to be exactly where they were.”
Contact: Leslie Hill, (615) 322-4747 leslie.hill@vanderbilt.edu KLA
AWESOME story! So glad that God put his “Angels” beside her that day :)
Becky Collum
This is Definitely the Work of the Lord !!!!!
Trenia Bigham
God is good.It is a blessing. Go Vanderbilt for the excellent employees that work here, and care.
I too had a brain aneurysm. ..Dr.Shay and Paul Sammons at Vanderbilt hospital performed the same procedure that Teresa received. THAT was seven years ago and I’m doing great..God bless you Teresa
Reporter brain aneurysm, Department of Neurological Surgery, featured-Reporter, j mocco, Reporter Feb 7 2014 | 医学 |
2014-42/1180/en_head.json.gz/21293 | Young Adults with Cancer
Print PDF Bob and Queenie Getting cancer is awful at any age, but it has to be especially difficult for young adults. They're too old for the nurturing and specialized pediatric oncology programs, and too young to fit in with the rest of us with cancer who are middle-aged and older. Do you remember when you were beginning to establish yourself in your career and in your adult relationships? It's a time of transition in which you leave the protective bubble of your parents and begin to forge your own identify. For many of us, this is a time of fun and excitement, but it's also a time in which we don't feel especially grounded. Now imagine throwing cancer into the mix. There are practical worries like finances. You don't have savings and you're likely paying off student loans. You know that the first job or two establishes the foundation for your career path, but you're off sick for several weeks and you're struggling just to stay employed. In a tight economy, you worry that you might be the first to be laid off, and you know that getting a new job will be difficult and complicated. Most twenty five year olds don't need to read the fine print of a company's health insurance policy or worry about what, if anything, they should say about their medical history. Navigating personal relationships is just as tricky. You wonder if you need to redefine yourself in light of your cancer diagnosis and losing your hair due to chemotherapy doesn't help. I recently talked with Leah Shearer of Rochester who was diagnosed with two separate cancers by the age of thirty. She said that dating takes on entirely new dimensions when you've had cancer. "If you're out with someone and he's sweating the small stuff, you wonder how he's going to deal with the really big stuff." Infertility is another concern because it can be a side effect of some cancer treatments. It's a difficult loss on its own, and, as Leah points out, "Because it's one more thing that can be taken away from you." "My number one thing is for the medical community to pay attention to us," Leah told me. "Historically, cancer in our age group hasn't gotten much attention. And there needs to be a safety net to catch young people who fall through the cracks and feel so isolated." Leah's own safety net came in the form on an organization known as "I'm Too Young for This!" Founded by Matt Zachary, the group provides age-targeted information, resources, and connections to the one million young adults, aged 15-39, who have been affected by cancer. When she first came across its website (www.imtooyoungforthis.org), Leah recalled thinking, "Finally, there was something for me." Bob is the Executive Director of the Cancer Resource Center. His articles about living with cancer appear regularly in the Ithaca Journal. He can be reached at bob@crcfl.net Reprinted with Permission of the Ithaca Journal Print PDF News
Apr 24, 2012 - Adolescent and young adult patients with acute lymphoblastic leukemia who are treated with pediatric-inspired regimens exhibit lower all-cause mortality, higher complete remission and event-free survival rates, and lower relapse rates compared with those treated with conventional adult-chemotherapy regimens, according to a study published in the May issue of the American Journal of Hematology.
Women treated for pediatric, young adult cancer face increased risk of breast cancer at young age
Men, young adults, single individuals more likely to use cigarettes along with other tobacco products
Beliefs About Safety May Spark E-Cigarette Use in Young Adults
Marijuana and Tobacco Co-Use Common in Young Adults
Children More Likely to Have SLN Mets Than Young Adults
However, adolescent and young adult survivors of pediatric cancers report less positive health beliefs
Young patient with colon cancer symptoms?
Radiation to treat retinoblastoma in a young child?
Treatment of Young Prostate Cancer Patients?
Prognosis at a young age for prostate cancer?
Giving HPV Vaccine at Young Age?
Screening a Young Child With MEN Mutation?
Adult Hodgkin Lymphoma Treatment
Adult Non-Hodgkin Lymphoma Treatment
Adult Brain Tumors Treatment
Acute Myeloid Leukemia in Adolescents and Young Adults (AYAs): A ...
Role of Radiation Therapy in the Management of Craniopharyngiomas in ...
Low dose involved field radiation (IFRT) or no further treatment ... | 医学 |
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Using Ontario’s Health Equity Impact Assessment (HEIA) Tool in Community Mental Health
Reducing Poverty
January 14, 2013 Poverty affects nearly 1.8 million Ontarians and is both a cause and a consequence of poor mental health. People can experience economic hardship as a result of a variety of difficult life situations, such as divorce, a death in the family, loss of job, etc. The resulting loss of income may lead to poverty in other essential resources, such as housing, education and employment. Evidence indicates that poverty — and the material and social deprivation associated with it — is a primary cause of poor health among Canadians. As a result, one’s quality of life is compromised, which impacts mental health.
Poverty also creates barriers to accessing resources that people with mental illness need for recovery. For people who are predisposed to mental illness, losing stabilizing resources, such as income, employment, and housing, for an extended period of time can increase the risk factors for mental illness or relapse. Experiencing a mental illness can interrupt a person’s education or career path and result in diminished opportunities for employment. A lack of secure employment, in turn, affects one’s ability to earn an adequate income. As a result, people with a mental illness can remain in chronic poverty.
Addressing the relationship between poverty and mental health is the key to promoting mental health and supporting the recovery of people with mental illness.
How CMHA Is Addressing This Issue
CMHA Ontario, along with numerous organizations and provincial networks, has been calling for poverty reduction strategies that increase access to economic and community supports for vulnerable populations. CMHA Ontario is active in supporting people with mental illness to reduce their risk of living in poverty. We do this by advocating for increases in supportive housing, effective employment support programs and raising income support.
Submission: Improving Ontario’s Social Assistance System, August 2011
A joint submission from Canadian Mental Health Association, Ontario and Schizophrenia Society of Ontario, in response to “A Discussion Paper: Issues and Ideas”, which identifies recommendations for improving Ontario’s Social Assistance System for persons with mental health disabilities.
Backgrounder: Poverty and Mental Illness, November 2007
Defines poverty and explains the complex relationship between poverty and mental health.
Strategies for Reducing Poverty in Ontario, June 2008
A CMHA Ontario policy paper calls for social and economic resources that are needed to reduce poverty among people with mental illness.
Backgrounder: Housing and Mental Health, Dec 2012
Explains the importance of affordable housing as an essential resource for good mental health and describes the various types of housing and housing benefits that are available.
Mental Health Promotion in Ontario: A Call to Action, November 2008
A policy paper prepared by CMHA Ontario, together with four other provincial organizations, that identifies access to economic resources as one of the three most significant determinants of mental health.
Money, Fall 2007
An issue of CMHA Ontario’s Network magazine.
What Else Is Happening
In 2007, the Ontario Government formed a new Cabinet Committee to develop poverty indicators and measures to reduce poverty in Ontario. During 2008, the committee undertook a provincial public consultation process to gather information and advice on developing a poverty reduction strategy for Ontario. In December 2008, the Government of Ontario released their plan. Breaking the Cycle: Ontario’s Poverty Reduction Strategy intends to reduce child poverty by 25 percent in five years. The plan combines short, medium and long-term investments and outlines new programs and initiatives. The strategy acknowledges that certain population groups, such as people with disabilities, are at greater risk of poverty and express a long-term vision to address this situation.
In February 2009, the Ontario Government introduced to the legislature Bill 152, the Poverty Reduction Act, 2009. The poverty reduction act was passed on May 2009. It establishes mechanisms for the reduction of poverty in Ontario, including the commitment to reduce child poverty by 25 percent over five years, and to hold public reviews at least every five years in order to sustain a long-term strategy. An annual report to the public shall be made on progress in achieving provincial targets. The first annual report to the public is now available on the Government website atgrowingstronger.ca.
Also in February 2009, the Ontario Government announced three changes to rules for the Ontario Disability Support Program and Ontario Works. The following changes will be implemented on April 1, 2009: earnings exemptions for post-secondary students on OW and ODSP; the existing up-front child care benefit will be extended for recipients who require care to maintain their jobs or are engaged in work related activities; and an extension of the internal review process. These measures, committed to in the government’s poverty reduction strategy, are intended to help recipients pursue educational and employment opportunities. For more information, see Social Assistance Rule Changes To Support Education And Employment, February 25, 2009.
Minimum wage increases are also part of the government’s poverty reduction strategy. Ontario raised the minimum wage to $9.50 on March 31, 2009. This is the sixth increase since 2004, according to a Ministry of Labour news release, March 2, 2009. There is another raise to $10.25 slated for April 2010.
Talking Points: Information to Discuss Breaking the Cycle: Ontario’s Poverty Reduction Strategy is a summary by CMHA Ontario of key actions identified in Ontario’s Poverty Reduction Strategy, and also identifies further actions that are needed.
25-in-5 Network
A Blueprint for Economic Stimulus and Poverty Reduction in Ontario identifies key components for a poverty reduction plan and mobilizes community support for its implementation. February 2009.The 25-in-5 Founding Declaration calls on the government to address three key priorities. April 2007.
Work Isn’t Working for Ontario Families: The Role of Good Jobs in Ontario’s Poverty Reduction Strategy. May 2008.
Summoned to Stewardship: Make Poverty Reduction a Collective Legacy. September 2007.
Ready for Leadership: Canadians’ Perceptions of Poverty. October 2008.
Income Security Advocacy Centre
Make Your Voice Heard on Social Assistancerecommends changes to social assistance that fit within a poverty-reduction framework. May 2008.
Metcalf Foundation
Why Is It So Tough to Get Ahead? discusses how social programs discourages disadvantaged Canadians from achieving self-reliance and makes recommendations for changing social policies. November 2007.
Ontario Association of Food Banks
Our Choice for a Better Ontario: A Plan for Cutting Poverty in Half by 2020. August 2008.
The Cost of Poverty: An Analysis of the Economic Costs of Poverty in Ontario. November 2008.
Ontario Non Profit Housing Association
A Housing Benefit for Ontario: One Housing Solution for a Poverty Reduction Strategy discusses housing benefits that can address the shortage of affordable housing in Ontario. September 2008.
New Asset and Income Policies to Assist Low-Income Adults Under Ontario’s Poverty Reduction Strategy. September 2008.
Wellesley Institute
Poverty is Making Us Sick, a Canadian survey examining the relationship between low income and health. December 2008.
EDs and Board
Essential AccessibilityMinistry of Health and Long-Term Care Copyright and Permissions
Copyright © 2014 Canadian Mental Health Association | 医学 |
2014-42/1180/en_head.json.gz/21365 | Remuneration for Healthy Workers: From Sticks to Carrot Sticks?
In July of this year Clarian Health of Indianapolis announced a new health and wellness program for its employees. Employees failing to meet minimum standards for body-mass index (BMI), blood pressure, tobacco use, glucose and cholesterol levels would have been fined $5 per condition per paycheck. Wednesday, NPR's Morning Edition reported that Clarian has revised its health program. The health care institution will not fine "unhealthy" employees, but will offer incentives to encourage healthier lifestyles. This news, also reported in the Indy Star (1 November 2007), will be welcomed by those who are concerned that personal health data, including genetic information, may someday be used in a discriminatory manner in the workplace. If the public strongly objects to requiring a person's BMI and tobacco use to be considered as conditions of employment, it seems even less likely an employer could successfully use a genetic test indicating, for example, an increased risk for breast cancer. Nevertheless, it is still possible, if not likely, that genetic information could be coupled with health-indicators to assess the health risks of individual employees. These individuals might also be encouraged with "incentives" to adopt healthier lifestyles. Before such practices are implemented, employers should think carefully about how employees will interpret these policies. When "unhealthy" individuals are identified with genetic or other bio-information and required to meet certain health goals to receive incentives, are "health incentives" nothing more than repackaged "disincentives"? Could it be that what was once a "stick", is now a "carrot stick"? - J.O.
health promotion,
Health risk assessments,
incentives,
To Blog or To Jog? Genetic Tests and "Life-Changi...
Barriers to Research and Strategies for Community ...
Engaging the Community in Predictive Health Resear...
Newborn Screening: An Update on Minnesota
Get Your Genetic Test Results Online and Who Needs...
Predictive Health Research: What Isn't It?
Remuneration for Healthy Workers: From Sticks to C... | 医学 |
2014-42/1180/en_head.json.gz/21475 | gmnews.com
2013-04-04 / Bulletin Board
Middlesex County to receive $1 million to support HIV/AIDS care Middlesex County will receive $1,007,693 in federal funding for medical care and support through the Ryan White program for low-income individuals and families living with HIV/AIDS.
“New Jersey has unfortunately ranked highly in the nation for number of reported HIV/AIDS cases, but this funding for the Ryan White Program of Middlesex will provide critical medical care and support services for those living with HIV/AIDS who would otherwise have no means of paying for it,” said Congressman Frank Pallone Jr. (D-NJ), who announced the funding on Feb. 21. “The Ryan White program improves the quality of life for some of our most vulnerable residents, and I will work with my colleagues on the subcommittee on health to ensure the program continues.” The Ryan White program is the single largest federal program designed specifically for people with HIV in the United States. The program works with cities, states and local community-based organizations to provide HIV-related services to more than half a million people with HIV each year.
First enacted in 1990, the program provides care and support services to individuals and families affected by the disease, functioning as the “payer of last resort” by filling the gaps for those who have no other source of coverage or face coverage limits.
Pallone serves as a ranking member of the House Energy and Commerce Subcommittee on Health, which has jurisdiction over the federally funded Ryan White program, which is up for reauthorization in September of this year. Return to top
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2014-42/1180/en_head.json.gz/21589 | Ethel Cesarman Professor of Pathology and Laboratory Medicine
Professor of Pathology and Laboratory Medicine,
Pathology and Laboratory Medicine,
Associate Professor of Pathology and Laboratory Medicine,
Molecular lymphomagenesis and human oncogenic herpesviruses Our laboratory is involved in studying the process of viral oncogenesis in human cancer. We are interested in the molecular characterization of immunodeficiency-associated non-Hodgkin's lymphomas, including those associated with AIDS, as well as those presenting in solid organ transplant recipients, many of which are associated with infection by Epstein-Barr virus (EBV; also called human herpesvirus 4). Much of our research focuses on the characterization of the Kaposi's sarcoma herpesvirus (KSHV), also called human herpesvirus 8 (HHV8), especially as it relates to cellular transformation and oncogenesis. Our laboratory was involved in the recent identification of this infectious agent which is etiologically linked to Kaposi's sarcoma, the most common malignancy in patients with AIDS. We have also identified its consistent presence in a rare subset of non-Hodgkin's lymphomas called primary effusion (or body cavity-based) lymphomas. These lymphomas have been used by us and others to establish cell lines, which are still the only efficient system to grow and produce KSHV in vitro, and represent the most widely used substrate for serologic analysis for assessment of KSHV infection. Characterization of this virus is a developing area still at its early stages and with many aspects to be explored. This virus contains homologs to more than ten cellular genes involved in cellular proliferation, differentiation, inflammation and/or survival, including IL-6, cyclin D, MIP-like chemokines, a chemokine receptor, BCL-2, FLIP, and four IRFs. Our ongoing research involves several aspects of the two oncogenic human herpesviruses, EBV and KSHV, including analysis of virally encoded proteins and their role in subversion of cellular signal transduction pathways, development of & xenograft and transgenic murine models, and searching for inhibitors of oncogenic proteins. Our ultimate goal is to understand the role of EBV and KSHV in the development of cancer, in order to find novel targetted therapies.
Selected publications How do viruses trick B cells into becoming lymphomas?. Current opinion in hematology.
Gammaherpesviruses and lymphoproliferative disorders. Annual review of pathology.
Solar thermal polymerase chain reaction for smartphone-assisted molecular diagnostics. Scientific reports.
The product of Kaposi's sarcoma-associated herpesvirus immediate early gene K4.2 regulates immunoglobulin secretion and calcium homeostasis by interacting with and inhibiting pERP1. Journal of virology.
Pathology of lymphoma in HIV. Current opinion in oncology.
Inherited human OX40 deficiency underlying classic Kaposi sarcoma of childhood. The Journal of experimental medicine. 210:1743-1759.
Multiplexed colorimetric detection of Kaposi's sarcoma associated herpesvirus and Bartonella DNA using gold and silver nanoparticles. Nanoscale. 5:1678-1686.
Pegylated liposomal doxorubicin, rituximab, cyclophosphamide, vincristine, and prednisone in AIDS-related lymphoma: AIDS Malignancy Consortium Study 047. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 31:58-64. | 医学 |
2014-42/1180/en_head.json.gz/21609 | Huntsville Cancer Clinical Trial Creates Astounding Results
Posted 4:16 pm, March 19, 2012, by Elise Morgan, Updated at 04:27pm, March 19, 2012 Share this:FacebookTwitterGooglePinterestLinkedInEmail Patient Tommy Lamb, before (L) and after (R). ×
Patient Tommy Lamb, before (L) and after (R).
Patient Tommy Lamb, before (L) and after (R). Original story aired May 27, 2011
Doctors and researchers at Clearview Cancer Institute in Huntsville saw something Thursday morning they’d never seen in their careers. It’s a clinical trial that went so well, some might say it borders on miraculous.
The trial involved patient Tommy Lamb, who was diagnosed with Chronic Lymphocytic Leukemia, or CLL, in December of 2007. It’s a cancer of the blood and bone marrow. It wasn’t until the last couple of months that the disease started taking a toll, with Lamb experiencing fatigue, night sweats, and enlarged lymph nodes. According to Lamb, “I was ready for treatment, because I was swollen so bad in my neck that it was almost like someone had their hands around my neck all the time.”
Lamb signed up to be part of a clinical trial with a drug known only as GA101. He had no idea that he was the first person in the world to be tested with this drug as a first therapy. He left Wednesday’s therapy feeling emotionally, physically and mentally drained. However, something changed.
“I slept well and got up and felt like an entirely new person,” said Lamb. “I looked in the mirror and I could not believe the difference.”
Lamb was so surprised by the dramatic results he took a picture and emailed it to the doctors and researchers at Clearview Cancer Institute. They couldn’t believe what they were seeing, either. Lamb’s oncologist, Dr. Jeremy Hon told us, “It is an exciting day, because in my career as an oncologist for 26 years in Huntsville, I have not seen this phenomenon.”
Dr. Hon says Lamb’s lymph nodes were 50 percent smaller in less than 24 hours.
Emily Pauli, Ph.D. is the Director of Research at Clearview and was equally surprised by the results.
“This is the reason we do cancer research, for celebrating these moments. We get excited over a 10 percent response, a 15 percent response,” said Dr. Pauli. “This is the first time we have seen a response like this, so quickly, in a patient.”
Dr. Clint Kingsley is the principal investigator for the clinical trial. He says the way this drug works is as a targeted therapy.
“This actually targets some of the receptors or little flags that sit on a cell surface, and it basically marks the cancer cells for the immune system to come in and destroy,” said Dr. Kingsley.
So are we getting too excited, too quickly over one patient’s response? According to the doctors and researchers at Clearview, the answer is no.
“This might be the only person that has this good a response, but when this is the first person in the world who’s had it front line and had a great response, we say the next person probably will too, and we just hope the next person does just as well or even better,” said Dr. Kingsley. “What if he’s the slow guy? This will be great!”
Dr. Hon stressed the importance of this research and clinical trials. He says the support of the community is essential to keep it going, so newer and better drugs will be available down the line.
“As a physician, the joy that brings to us, to see the response and hope and excitement in a patient, it is infectious, it will last for a long time, too,” said Dr. Hon. “This is the type of response that makes us keep doing our hard work, and we don’t see that every day, but know the value of this moment. This moment is hard to describe.”
For Lamb, he says no matter what the result, it’s all about passing it on and making a difference in someone else’s life, even if he never meets them.
“We need to do more of that. We’ve become so self-centered sometimes that we don’t stop to think that we’re here for a much greater purpose, to be a positive influence on others,” said Lamb.
Lamb has five more treatments to go. There will be more clinical trials all over the country before this drug can be approved.
Filed in: News WHNT News 19 Team
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HSA Hosts Meet; Harting Qualifies for Olympic Trials
Second American Ebola patient arrives in U.S.
Jury finds Damien Shipley guilty of capital murder
Local cyclists encouraged to join Ride4Gabe in Huntsville
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Elisa Ferrell wins Huntsville District 3 school board runoff
Huntsville mayor to developer: “We will not succumb to bullies”
Judge denies request for change in ‘Boston bomber’ trial location | 医学 |
2014-42/1180/en_head.json.gz/21640 | Apr 1, 2001 Table of Contents
Practice GuidelinesNIH Consensus Statement on Phenylketonuria
KAREN L. HELLEKSON, PH.D.Am Fam Physician. 2001 Apr 1;63(7):1430-1432.
The National Institutes of Health (NIH) has released a consensus statement on the screening and management of phenylketonuria (PKU). The statement, which was prepared by a nonadvocate group of experts who work in the field, is not an official document of the NIH or the federal government, but rather an independent panel report. The panel met in October 2000 to develop the consensus statement.
This conference was presented by the National Institute of Child Health and Human Development and the NIH Office of Medical Applications of Research. The complete text of the consensus statement may be found on the NIH Web site at
http://consensus.nih.gov.
The panel heard expert presentations and public discussion on the biology and biochemistry of PKU, epidemiology and genetics, screening strategies and treatment regimens. On the basis of this information, the panel drafted a consensus statement that addressed, among others, the following questions:
What are the incidence and prevalence of PKU and other forms of hyperphenylalaninemia?
What newborn screening strategies are available for diagnosis, and how effective are they?
What treatment regimens are used to prevent the adverse consequences of PKU?
What are the recommended strategies for optimal newborn screening and diagnosis, lifelong management and follow-up of PKU?
PKU, a form of hyperphenylalaninemia, is a rare metabolic disorder that is caused by a deficiency of the liver enzyme phenylalanine hydroxylase. This deficiency leads to elevated levels of the amino acid phenylalanine (Phe) in the blood and other tissues. Persons with PKU have a complete absence or profound deficiency of enzyme activity, typically show very high elevations of blood Phe (more than 20 mg per dL [1,210 μmol per L]) and accumulate phenylketones. PKU is usually the result of autosomal recessive disorders caused by mutations in the phenylalanine hydroxylase gene. If untreated, the disorder results in mental retardation, microcephaly, delayed speech, seizures, eczema and behavior abnormalities. Approximately one in every 15,000 infants in the United States is born with PKU.
If PKU is detected early, it can be effectively treated with a special diet. The current treatment for PKU is strict metabolic control with a low-Phe diet that includes specialized foods. Newborn screening programs for PKU, which are administered in every state and have been in place for 40 years, have been extremely successful. When diagnosed as newborns and appropriately treated, infants should have normal health and development and can expect a normal life span. Gene therapy and treatments not related to diet are currently being explored. There are currently no data on the clinical manifestations of PKU as patients grow older; few patients are older than 40 years of age.
Incidence and Prevalence
According to data supplied by the states, the reported incidence of PKU ranges from one per 13,500 to one per 19,000 newborns. For non-PKU hyperphenylalaninemia, the composite estimate is one per 48,000 newborns. There are large variations in the incidence of PKU by ethnic group. A higher incidence is seen in whites and Native Americans, while a lower incidence is seen in blacks, Hispanics and Asians.
PKU, like all other genetic disorders, demonstrates genetic and clinical variability. These mutations also contribute to the biochemical heterogeneity and may be responsible for the biochemical phenotype. Genetic contributions to the phenotype are complex, consisting of documented allelic heterogeneity within the phenylalanine hydroxylase gene. Molecular heterogeneity for PKU results in wide phenotypic heterogeneity, which contributes to biochemical individuality. The existence of discordant phenotypes among siblings who share the same genotype at the phenylalanine hydroxylase locus implies that genetic and environmental factors may influence the clinical phenotype.
Screening Strategies
Screenin | 医学 |
2014-42/1180/en_head.json.gz/21645 | Medical Services » Orthopedic Services » Treatments & Conditions » Joint Replacement
Center for Arthritis and Joint Replacement
Total joint replacement Total joint replacement is usually reserved for patients who have severe arthritic conditions. In the past, most patients who have artificial hip or knee joints were over 55 years of age, but the operation is now being performed in greater numbers on younger patients thanks to new advances in artificial joint technology. Circumstances vary, but generally patients are considered for total joint replacement if: Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living Pain is not relieved by more conservative methods of treatment such as medications, physical therapy, arthroscopy (cleaning the joint), the use of a cane, and/or restricting activities Stiffness in the joint is significant X-rays show advanced arthritis or other problems What is total joint replacement? Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip or knee, are removed and replaced with a plastic or metal device called a prosthesis. The prosthesis is designed to enable the artificial joint to move just like a normal, healthy joint. Joint Components Hip replacement involves replacing the femur (head of the thighbone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal, and the artificial socket is made of polyethylene (a durable, medical grade plastic). In total knee replacement, the artificial joint is composed of metal and polyethylene and, it is used to replace the diseased joint. The prosthesis is anchored into place with bone cement or is covered with an advanced material that allows bone tissue to grow into it. Total joint replacements of the hip, knee and shoulder have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients. While the expected life of conventional joint replacements is difficult to estimate, it is not unlimited. Today’s patients can look forward to potentially benefiting from new advances that may increase the lifetime of prostheses. | 医学 |
2014-42/1180/en_head.json.gz/21773 | Cause of stomach illness difficult to detect
By DAVID PITT Associated Press
In this Aug. 1, 2013, photo, Donna Heller talks about her recent stomach illness in Burleson, Texas. (AP Photo/LM Otero)
WASHINGTON (AP) — Donna Heller thought she had cancer. But multiple visits to the doctor after a month with debilitating nausea and diarrhea didn't yield any answers. Convinced she was dying, she met with her lawyer to get her will in order.Then she saw a television report about an outbreak of cyclospora possibly linked to bagged salad mix. The stomach illness matched all her symptoms and is easily treatable with antibiotics. She told her doctor she suspected that could be the cause, and tests showed she was right."It went so long and nobody was able to give me answers," said Heller, a 54-year-old teacher in Crowley, Texas. "It didn't seem like anybody wanted to take you serious because there are so many stomach problems that resemble each other."A mysterious outbreak of the parasitic illness usually found abroad is growing, with more than 400 confirmed cases in 16 states. FDA officials said Friday they had discovered the source of some of the illnesses, but not all of them. The agency said that the illnesses from Iowa and Nebraska are linked to salad mix from a Mexican farm that was served at Olive Garden and Red Lobster restaurants. Those make up around half of the cases.The rest of the illnesses — many of them in Texas — are still a mystery, state and federal officials say.The source of this outbreak has proved particularly hard to trace. Doctors have to test specifically for cyclospora and many don't because it is relatively rare. So they may not order the correct tests, at least not at first. The parasite is so tiny that it's often difficult to confirm that a person has the illness, according to the Centers for Disease Control and Prevention. Tests often have to be repeated with fresh samples.Heller said initial tests from her doctor showed up as inconclusive, but she later received a call from the CDC telling her she definitely had the illness.Doctors or labs may not notify state health departments as quickly as they would for a more common foodborne illness like salmonella. And there are different rules in different states about whether cyclospora has to be reported to federal health authorities.All those obstacles are making it harder for state and federal officials. It also means there are probably many people who have the disease and don't know it.The illness is rare — roughly 150 cases are reported in the United States annually. Scientists only identified it in the early 1990s.In comparison, there are tens of thousands of lab-confirmed cases of salmonella food poisoning in this country each year, and officials believe there are hundreds of thousands more that are not confirmed.The cyclospora parasite is native to the tropics and tends to come into the United States on imported produce. For example, Guatemalan raspberries were the source of five outbreaks in Canada and the United States in the late 1990s. Two of those outbreaks involved more than 1,000 illnesses each, said Ynes Ortega, a cyclospora expert at the University of Georgia.Officials say part of the problem is that the disease takes a week on average to show up, and diagnosis has often been delayed, making it hard for victims to remember what they ate.CDC spokeswoman María-Belén Moran says the agency also is interviewing people who aren't sick as controls to get more information on eating patterns, as well as lab testing foods that they suspect.For its part, the FDA says it has a 21-person team in its Maryland headquarters and specialists in 10 field offices across the country working to identify the source of the outbreak.Food often goes through several stops — potentially in several countries — before it reaches a grocery cart, and trying to trace it is "labor-intensive and painstaking work, requiring the collection, review and analysis of hundreds and at times thousands of invoices and shipping documents," the FDA said.Heller says she doesn't know what food might have caused her illness, but she said she was eating out a lot near her home 13 miles south of Fort Worth around the time she fell ill in late June.She said she finally went on the correct antibiotics this week and is starting to feel better, though her symptoms aren't gone completely. She said the illness has taken an emotional toll."I literally, through the course of all this, have been brought to tears probably 10 different times, just so defeated," she said.
Sharecare Your Photos | 医学 |
2014-42/1180/en_head.json.gz/21802 | Home iHealth Diseases & Conditions: A-Z Fact Sheets Kidney cancer > Vitamin E
Smaller Larger Vitamin E
| Therapeutic Dosages
| Therapeutic Uses
| What Is the Scientific Evidence for Vitamin E?
| Safety Issues
| Interactions You Should Know About
Vitamin E is an
that fights damaging natural substances known as free radicals. It works in lipids (fats and oils), which makes it complementary to vitamin C, which fights free radicals dissolved in water. As an antioxidant, vitamin E has been widely advocated for preventing heart disease and cancer. However, the results of large, well-designed trials have generally not been encouraging. Many other proposed benefits of vitamin E have also failed to stand up in studies. There are
medicinal uses for vitamin E with solid scientific support.
Vitamin E dosage recommendations are a bit complex because the vitamin exists in many forms.
Newer vitamin E recommendations are in milligrams of alpha-tocopherol. Alpha-tocopherol can come from either natural vitamin E (called, somewhat incorrectly, d-alpha-tocopherol) or synthetic vitamin E (called, also somewhat incorrectly, dl-alpha-tocopherol). However, much of the alpha-tocopherol in synthetic vitamin E is inactive. For this reason, you have to take about twice as much of it to get the same effect.
There are other forms of vitamin E as well, such as beta-, delta-, and gamma-tocopherols, all of which occur in food. These other forms may be important; for example, preliminary evidence hints that gamma-tocopherol may be the most important (or, perhaps, the only) form of vitamin E for preventing prostate cancer.
On this basis, it has been suggested that the best vitamin E supplement would be a mixture of all these.
To make matters even more confusing, vitamin E dosages are commonly listed on labels as international units (IU). Here's how you make the conversion. One IU natural vitamin E equals 0.67 mg alpha-tocopherol; one IU synthetic vitamin E equals 0.45 mg alpha-tocopherol. Therefore, to meet the new dietary recommendations for vitamin E (15 mg per day), you need to get either 22 IU natural vitamin E (22 IU x 0.67 = 15 mg) or 33 IU synthetic vitamin E (33 IU x 0.45 = 15 mg). The official US and Canadian recommendations for daily intake of vitamin E are as follows:
0-6 months: 4 mg7-12 months: 5 mg
1-3 years: 6 mg4-8 years: 7 mg9-13 years: 11 mg
Males and Females
14 years and older: 15 mg
: 15 mg
Nursing Women
The best food sources of vitamin E are polyunsaturated vegetable oils, seeds, and nuts. To get a therapeutic dosage, though, you need to take a supplement. The National Institutes of Health's Office of Dietary Supplements offers this list of foods that are high in vitamin E:
Vitamin E content
(milligrams [mg])
Sunflower seeds, dry roasted
Almonds, dry roasted
Hazelnuts, dry roasted
Tomato, raw
Vitamin E Deficiency
In developed countries, mild dietary deficiency of vitamin E is relatively common.
The optimal therapeutic dosage of vitamin E has not been established. Most studies have used between 50 IU and 800 IU daily, and some have used even higher doses. This would correspond to about 50 mg to 800 mg of synthetic vitamin E (dl-alpha-tocopherol), or 25 mg to 400 mg of natural vitamin E (d-alpha- or mixed tocopherols).
If you wish to purchase natural vitamin E, look for a label that says "mixed tocopherols." However, some manufacturers use this term to mean the synthetic dl-alpha-tocopherol, so you need to read the contents closely. Natural tocopherols come as d-alpha-, d-gamma-, d-delta-, and d-beta-tocopherol.
studies raised hopes that vitamin E supplements could help prevent various forms of
82-84,86,104-107,144,145
However, observational studies are notoriously unreliable for determining the effectiveness of treatments. Only
trials can do that (for information why, see
), and such studies have, on balance, found vitamin E ineffective for preventing heart disease or any common form of cancer other than, possibly, prostate cancer.
75-78,81,96-102,146,155,157-159,180-182,201,225,226,229,230,232-235
. In fact, use of high-dose vitamin E for a long period might slightly
death rate.
Other potential uses of vitamin E have limited supporting evidence.
Intriguing but far from definitive studies suggest that vitamin E might improve
to vaccinations,
control symptoms of
help prevent
deep venous thrombosis (DVTs)
reduce symptoms of
and decrease symptoms of
Vitamin E, combined with
, has also been studied as a way to alleviate premenstrual
(mastalgia
But, more research needs to be done in this area.
While there is weak evidence that vitamin E supplements can reduce discomfort in rheumatoid arthritis,
44,45,147-149
there is strong evidence that it does not prevent it.
Although preliminary studies hinted that use of vitamin E might prevent or slow the progression of
in a 10-year study of almost 40,000 female healthcare professionals, use of natural vitamin E at a dose of 600 mg every other day failed to have any effect on cataract development.
And another large, 8-year trial involving 11,545 physicians aged 50 years and older concluded that vitamins C (500 mg daily) and E (400 IU every other day), alone or in combination, did not lower the risk of developing cataracts.
Evidence regarding whether vitamin E can slow the progression of
is inconsistent.
A very large study failed to find vitamin E helpful for preventing mental decline (resulting from any cause) in women over 65.
Studies of vitamin E in combination with vitamin C for prevention of
(high blood pressure during pregnancy)
have yielded inconsistent results.
Also, a combination of vitamins E and C does not seem to reduce the risk of preterm birth.
Vitamin E has also shown equivocal promise in diabetes. One double-blind trial found benefits for
cardiac autonomic neuropathy
a complication of diabetes. Weaker evidence hints at possible benefits for
However, the best-designed study of all, a long-term trial involving 3,654 people with diabetes, found that use of vitamin E did not protect against diabetes-induced kidney or heart damage.
Similarly, while a few studies performed by one research group suggested that vitamin E might be helpful for improving glucose control in people with diabetes,
subsequent evidence found that the benefits, if they exist at all, are limited to the short-term.
In addition, in an extremely large double-blind study, use of vitamin E at a dose of 600 IU every other day failed to reduce risk of participants developing type 2 diabetes.
Finally, a study unexpectedly found that when people with diabetes took 500 mg of vitamin E daily (either as natural alpha tocopherol or a mixture of alpha and gamma tocopherol), their blood pressure
Similarly, studies on whether vitamin E is helpful for
(hay fever) have produced conflicting results.
A small double-blind study conducted in Iran reported that vitamin E (400 IU daily) was more effective than placebo for treating
However, a larger US study failed to find vitamin E significantly helpful for hot flashes associated with breast cancer treatment.
Vitamin E might help reduce the lung-related side effects caused by the drug amiodarone (used to prevent abnormal heart rhythms).
A trial of 108 patients undergoing chemotherapy cisplatin found that vitamin E supplementation (extended 3 months past chemotherapy) reduced cisplatin-related neurotoxicity (damage to nerves not uncommonly occurring with cisplatin).
Studies have yielded mixed results on whether vitamin E is helpful for controlling seizures in people with
reducing symptoms of
aiding
recovery during heavy exercise
63,64,65,170
and treating
When combined with
, vitamin E may protect against sunburn to a small extent.
The same combination has also shown promise for
acute anterior uveitis
A separate study failed to find vitamin E alone (at the high dose of 1,600 mg daily) helpful for macular edema (swelling of the center of the retina) associated with uveitis.
Vitamin E has been tried for
(Lou Gehrig's disease), but the results in the first reported double-blind study showed questionable benefits if any.
Some vitamin E proponents felt that the dose of vitamin E used in this study might have been too low. Accordingly, they conducted another study using
In one observational study, high intake of vitamin E was linked to decreased risk of progression to AIDS in people with
However, a double-blind study of 49 people with HIV who took combined vitamins C and E or placebo for 3 months did not show any significant effects on the amount of HIV virus detected or the number of opportunistic infections.
It has been suggested that vitamin E may enhance the antiviral effects of AZT, but evidence for this is minimal.
Vitamin E has been suggested for preventing the cardiac toxicity caused by the drug
. However, while it has shown promise in animal studies, when studied in people vitamin E has persistently failed to prove effective for this purpose.
Vitamin E is sometimes recommended for
. However, a 2-year, double-blind, placebo-controlled study of 136 people with osteoarthritis of the knee failed to find any benefit in terms of symptom control or slowing disease progression.
A previous 6-month, double-blind, placebo-controlled trial of 77 individuals with osteoarthritis also failed to find benefit.
A 4-year, double-blind, placebo-controlled trial of 1,193 people with
failed to find vitamin E alone helpful for preventing or treating macular degeneration.
In addition, a review of 3 randomized, placebo-controlled trials, which included 23,099 people, did not find evidence to support the use of vitamin E and beta carotene to delay the onset of this common condition.
Vitamin E has also so far failed to prove helpful for preventing or treating
173asthma
172congestive heart failure
80fibrocystic breast disease
In a very large study involving over 29,000 male smokers, researchers failed to find benefit of alpha-tocopherol (50 IU/day),
(20 mg/day), or the two taken together for the
prevention of type 2 diabetes
over 5-8 year period.
As part of another large study, researchers focused on whether supplementation with vitamin E (in the form of alpha-tocopherol) or beta-carotene could reduce diabetes complications (coronary artery disease) in 1,700 male smokers.
At the 19-year follow-up, neither of the supplements offered any protective benefits.
What Is the Scientific Evidence for Vitamin E?
The results of
trials have been mixed, but on balance, they suggest that high intake of vitamin E and other antioxidants is associated with reduced risk of lung cancer and many other forms of cancer, including bladder, stomach, mouth, throat, laryngeal, liver, and prostate.
83-95,144,145,166,218
Based on these and other results, researchers developed the hypothesis that antioxidants can help
prevent cancer
and set in motion very large, long-term, double-blind, placebo-controlled studies to verify it.
Unfortunately, these studies generally failed to find vitamin E helpful for the prevention of cancer.
14,146,158,159,189-190,225,226,229,230,232-235
An analysis that included 9 carefully designed clinical trials found that antioxidant supplementation (
, and vitamin E) was not effective in reducing the incidence of cancer or cancer deaths.
Another analysis focused on whether vitamin E could reduce the risk of developing colorectal cancer.
The Women’s Antioxidant Cardiovascular Study, a
involving 8,171 women, also did not find evidence to support the use of antioxidants (vitamin C, vitamin E, and beta carotene) to reduce the risk of cancer.
Researchers analyzed 4 trials involving 94,069 people aged 40 and older who were randomized to receive vitamin E or placebo. At the 7-10 year follow-up period, it did not appear that vitamin E had an effect on the incidence of colorectal cancer. And, in an analysis of 20 randomized trials, researchers concluded that antioxidants (beta-carotene, selenium, and vitamins A, C, and E) do not prevent gastrointestinal cancer.
In some studies, the antioxidants appeared to
overall mortality rates.
On the brighter side, a double-blind trial of 29,133 smokers does offer some positive news.
In this study, 50 mg of synthetic vitamin E daily for 5-8 years caused a 32% reduction in the incidence of prostate cancer and a 41% drop in prostate cancer deaths.
Surprisingly, results were seen soon after the beginning of supplementation. This was unexpected because prostate cancer grows very slowly. A cancer that shows up today actually started to develop many years ago. The fact that vitamin E almost immediately lowered the incidence of prostate cancer suggests that it somehow blocks the step at which a hidden prostate cancer makes the leap to being detectable.
Other studies, however, have not been so supportive. For example, researchers reviewed data from the Prostate Cancer Prevention Trial, which included 9,559 men, to find out if certain nutritional supplements had any effect on cancer occurrence.
They concluded that none of the supplements (vitamin E,
omega-3 fatty acids)
reduced the risk of prostate cancer.
Similarly, an analysis of 9 randomized controlled trials involving 165,056 subjects found that the supplements beta-carotene,
, vitamin E, and selenium did not reduce the number of men who developed prostate cancer or who died from the condition.
Along the same line, a trial that included 35,533 men found that neither selenium nor vitamin E (either alone or in combination) prevented prostate cancer.
And, as part of the Physician's Health Study, researchers examined what effect vitamin E (400 IU every other day) and vitamin C (500 mg daily) may have on the development of cancer.
Again, the results showed that neither of these vitamins reduced the risk of cancer (including prostate cancer) in the 14,641 male physicians (aged 50 years and older) who participated in the study.
If vitamin E does have any effect on preventing certain forms of cancer, it has been suggested that gamma-tocopherol rather than alpha-tocopherol might be the most relevant form for this purpose.
Interestingly, use of alpha-tocopherol supplements may deplete both gamma- and delta-tocopherol levels, potentially producing a negative effect.
However, gamma-tocopherol has not yet been tested in meaningful controlled trials, and it is quite possible that were one to be performed, the results would prove as disappointing as those for other forms of vitamin E.
In addition, under certain circumstances, vitamin E may have a pro-oxidant effect—the reverse of what is desired.
Most but not all observational studies have found associations between high intake of vitamin E and reduced risk of cardiovascular disease (
However, as we’ve explained, observational studies by themselves cannot be relied upon to identify useful treatments. Double-blind studies, which provide much more convincing evidence of effectiveness, have generally failed to find vitamin E supplements effective.
The Heart Outcomes Prevention Evaluation (HOPE) trial found that natural vitamin E (d-alpha-tocopherol) at a dose of 400 IU daily did not reduce the number of heart attacks, strokes, or deaths from heart disease any more than placebo.
The trial followed more than 9,000 men and women who had existing heart disease or were at high risk for it.
Negative results were seen in numerous other large trials, as well.
99-102,129,152,153,157,175,194-195,223
When the results of these studies began to come in, some antioxidant proponents suggested that the people enrolled in these trials already had disease too advanced for vitamin E to help. However, a subsequent large trial found vitamin E ineffective for slowing the progression of heart disease in healthy people as well.
Moreover, in an extremely large placebo-controlled trial involving over 14,000 US male physicians at low risk for heart disease, 400 IU of vitamin E every other day failed to lower the risk of major cardiovascular events or mortality over a period of 8 years.
On the contrary, vitamin E was associated with a slightly increased risk of stroke.
Along the same line, a large systematic review that included 9 randomized trials and 118,765 people found that vitamin E may increase the risk of a type of stroke called hemorrhagic
. This stroke occurs when a blood vessel breaks and bleeds into or around the brain. The review also found that vitamin E may reduce the risk of ischemic stroke (when blood flow to the brain is blocked). Since hemorrhagic stroke can lead to more serious complications, the researchers recommended against widespread use of this vitamin.
As with preventing cancer, critics have suggested that the form of vitamin E used in these studies (alpha-tocopherol) was not the best choice, and that gamma-tocopherol might be more helpful.
Gamma-tocopherol is present in the diet much more abundantly than alpha-tocopherol, and it could be that the studies showing benefits with dietary vitamin E actually tracked the influence of gamma-tocopherol. However, an observational study specifically looking to see if gamma-tocopherol levels were associated with risk of heart attack found no relationship between the two.
Nonetheless, intervention trials of gamma-tocopherol are currently underway.
In addition, as noted above, under certain circumstances, vitamin E may have a pro-oxidant effect, and this could explain the negative outcomes.
Interestingly, one study found that vitamin E might help prevent serious cardiovascular events in patients with
who also have a particular genetic marker known as “Hp 2.”
It has been hypothesized that people with the Hp 2 gene have an inadequate endogenous (“built-in”) antioxidant defense system, and for this reason, they might be particularly benefited by taking antioxidant supplements such as vitamin E. However, this concept still remains highly preliminary.
Prevention of Complications During Pregnancy
is a dangerous complication of pregnancy that involves high blood pressure, swelling of the whole body, and improper kidney function. A double-blind, placebo-controlled study of 283 women at increased risk for preeclampsia found that supplementation with vitamin E (400 IU daily of natural vitamin E) and vitamin C (1,000 mg daily) significantly reduced the chances of developing this disease.
While this research is promising, larger studies are necessary to confirm whether vitamins E and C will actually work. The authors of this study point out that studies of similar size found benefits with other treatments, such as aspirin, that later proved to be ineffective when large-scale studies were performed. Furthermore, keep in mind that we don't know whether such high dosages of these vitamins are absolutely safe for pregnant women.
Vitamins E and C have also been studied for their potential benefits in reducing the risk of preterm birth.
In a review of data from a trial involving 9,968 pregnant women, those that took vitamin E (400 IU daily) and vitamin C (1,000 mg daily) from 9-16 weeks gestation to their delivery day did not experience a reduction of preterm births compared to the women in the placebo group.
Between 1987 and 1998, at least five double-blind studies were published that indicated vitamin E was beneficial in treating
(TD).
Although most of these studies were small and lasted only 4 to 12 weeks, one 36-week study enrolled 40 individuals.
Three small double-blind studies reported that vitamin E was not helpful.
Nonetheless, a statistical analysis of the double-blind studies done before 1999 found good evidence that vitamin E was more effective than placebo.
Most studies found that vitamin E worked best for TD of more recent onset.
However, in 1999, the picture on vitamin E changed with the publication of one more study—the largest and longest to date.
This double-blind study included 107 participants from nine different research sites who took 1,600 IU of vitamin E or placebo daily for at least 1 year. In contrast to most of the previous studies, this trial did not find vitamin E effective in decreasing TD symptoms.
Why the discrepancy between this study and the earlier ones? The researchers, some of whom had worked on the earlier, positive studies of vitamin E, were at pains to develop an answer.
They proposed a number of possible explanations. One was that the earlier studies were too small or too short to be accurate, and that vitamin E really didn't help at all. Another was the most complicated: that vitamin E might help only a subgroup of people who have TD—those with milder TD symptoms of more recent onset—and that fewer of these people had participated in the latest study. They also pointed to changes in schizophrenia treatment since the last study was done, including the growing use of antipsychotic medications that do not cause TD.
The effectiveness of vitamin E for a given individual is simply not known. Given the lack of other good treatments for TD and the general safety of the vitamin, it may be worth discussing with your physician.
Seniors often do not respond adequately to vaccinations. One double-blind study suggests that vitamin E may be able to strengthen the immune response to vaccines. In this trial, 88 people over the age of 65 were given either placebo or vitamin E at 60 IU, 200 IU, or 800 IU dl-alpha-tocopherol daily.
The researchers then gave all participants immunizations against hepatitis B, tetanus, diphtheria, and pneumonia, and looked at subjects' immune response to these vaccinations. The researchers also used a skin test that evaluates the overall strength of the immune response.
The results were promising. Vitamin E at 200 mg per day and, to a lesser extent, at 800 mg per day significantly increased the strength of the immune response.
However, it is not clear whether vitamin E has a general
effect. One study in seniors found that use of vitamin E did not help prevent
and other respiratory infections, and, in fact, seemed to slightly increase the severity of infections that did occur.
In a similar-sized double-blind study of long-term care residents, use of vitamin E at 200 IU daily failed to reduce incidence or number of days of respiratory infection or antibiotic use.
The researchers managed to find some evidence of benefit by breaking down the respiratory infections by type, but such after-the-fact analysis is questionable from a statistical perspective. Subsequently, the same researchers repeated the study with a larger group and did find a reduction in frequency of colds.
Another researcher found evidence that vitamin E can have either a harmful or a helpful effect depending on who takes it (the exact differences being as yet undefined).
Evidence is conflicting regarding whether high-dose vitamin E can slow the progression of
In a double-blind, placebo-controlled study, 341 people with Alzheimer's disease received either 2,000 IU daily of vitamin E (dl-alpha-tocopherol), the antioxidant drug selegiline, or placebo. Those given vitamin E took nearly 200 days longer to reach a severe state of the disease than the placebo group. (Selegiline was even more effective.)
In another promising trial, researchers studied the potential cognitive benefits of taking vitamins E and C along with nonsteroidal anti-inflammatory drugs (NSAIDs).
Over a period of 8 years, 3,376 elderly people participated in the trial by filling out mental status questionnaires. Those that took the vitamins and NSAIDs dropped fewer points on their mental status scores compared to the control group during that period. The researchers also found that the people with a particular gene variant that has been linked to Alzheimer’s disease seemed to benefit the most from the treatment, suggesting that the vitamin supplements and the NSAIDs may be especially helpful in slowing the rate of cognitive decline in this group.
Negative results were seen, though, in a study of 769 people at high risk of developing Alzheimer's disease based on early symptoms.
Participants were given either 2,000 IU of vitamin E, the drug donepezil, or placebo for 3 years. Neither treatment reduced the percentage of people who went on to develop Alzheimer's disease.
Such high dosages of vitamin E should not be taken except under a doctor's supervision. (See
In a double-blind, placebo-controlled trial, 100 young women complaining of significant
were given either 500 IU of vitamin E or placebo for 5 days.
Treatment began 2 days before and continued for 3 days after the expected onset of menstruation. While both groups showed significant improvement in pain over the 2 months of the study (presumably due to the power of placebo), pain reduction was greater in the treatment group as compared to the placebo group.
Benefits were also seen in an Iranian, 4-month, double-blind, placebo-controlled study of 278 adolescent girls.
The dose used in this study was 200 IU twice daily.
Mastalgia (Breast Pain)
Eight-five women with premenstrual
were randomized to receive 1 of 4 treatments for 6 months: vitamin E (1,200 IU) and placebo,
(3,000 mg) and placebo, vitamin E and evening primrose, or placebo alone. In this small study, none of the treatment groups experienced better results than the placebo group.
Low Sperm Count/Infertility
In a double-blind, placebo-controlled study of 110 men whose sperm showed subnormal activity, treatment with 100 IU of vitamin E daily resulted in improved sperm activity and higher actual
(measured in pregnancies).
However, a smaller double-blind trial found no benefit.
126 Cardiac Autonomic Neuropathy
sometimes develop irregularities of their heart-beat called
. A 4-month, double-blind, placebo-controlled trial found that vitamin E at a dose of 600 mg daily might improve these symptoms.
The adult safe upper intake level (UL) for vitamin E is set at 1,000 mg daily.
The equivalent amounts are 1,500 IU of natural vitamin E and 1,100 IU of synthetic vitamin E. (For technical reasons, the conversion factor is a bit different than in the daily intake recommendations above.) For pregnant women under 19 years of age, the upper limit is 800 mg.
Blood-thinning Effect
Vitamin E has a blood-thinning effect that could lead to problems in certain situations. In one study of 28,519 men, vitamin E supplementation at the low dose of about 50 IU synthetic vitamin E per day caused an increase in fatal hemorrhagic strokes, the kind of stroke caused by bleeding.
(However, it reduced the risk of a more common type of stroke,
and the two effects essentially canceled out.)
Based on its blood-thinning effects, there are concerns that vitamin E could cause problems if it is combined with medications that also thin the blood, such as warfarin (Coumadin), heparin, clopidogrel (Plavix), ticlopidine (Ticlid), pentoxifylline (Trental), and aspirin. Theoretically, the net result could be to thin the blood
much, causing bleeding problems. A study that evaluated vitamin E plus aspirin did in fact find an additive effect.
In contrast, the results of a study on vitamin E and Coumadin found no evidence of interaction, but it would still not be advisable to combine these treatments except under a physician's supervision.
There is also at least a remote possibility that vitamin E could also interact with supplements that possess a mild blood-thinning effect, such as
. Individuals with bleeding disorders, such as hemophilia, and those about to undergo surgery or labor and delivery should also approach vitamin E with caution.
In addition, vitamin E might at least temporarily enhance the body's sensitivity to its own insulin in individuals with adult-onset diabetes.
This could lead to a risk of blood sugar levels falling too low. In addition, one study found that use of vitamin E can raise blood pressure in people with diabetes.
If you have diabetes, do not take high-dose vitamin E without first consulting your physician.
The results of one large study involving 29,000 males indicate that vitamin E supplementation may increase risk of tuberculosis in heavy smokers. Curiously, however, this was only true in those participants who also consumed high levels of vitamin C (at least 90 mg/d) in their diet. Consuming high levels of vitamin C without supplemental vitamin E actually led to a reduction in tuberculosis risk.
Considerable controversy exists regarding whether it is safe or appropriate to combine vitamin E with standard chemotherapy drugs.
The reasoning behind this concern is that some chemotherapy drugs may work in part by creating free radicals that destroy cancer cells. Antioxidants like vitamin E might interfere with this beneficial effect. However, there is no good evidence that antioxidants actually interfere with chemotherapy drugs, growing evidence that they do not, and some evidence of potential benefit under certain circumstances.
Nonetheless, in view of the high stakes involved, we strongly recommend that you do not take any supplements while undergoing cancer chemotherapy, except on the advice of a physician.
One study appeared to find evidence that use of vitamin E plus
may impair the effectiveness of radiation therapy for head and neck cancers.
Congential Heart Defects
One trial compared 276 mothers with children who were born with congenital heart defects (CHD) with 324 mothers whose children did not have defects.
Based on food frequency questionnaires, mothers who had a high intake of vitamin E were more likely to have children with CHD. However, since studies of this design are notoriously misleading, it is not possible to draw any reliable conclusions about the risk of consuming foods rich in vitamin E during pregnancy.
When all major vitamin E studies are statistically combined through a process called “meta-analysis,” some evidence appears suggesting that long-term usage of vitamin E at high doses might increase overall death rate for reasons that are unclear.
Seek medical advice before taking vitamin E if you are taking blood thinning drugs, such as:
, clopidogrel (Plavix), ticlopidine (Ticlid),
pentoxifylline (Trental)
Vitamin E may help protect you from lung-related side effects if you are taking
Vitamin E may help reduce side effects if you are taking
phenothiazine drugs
Seek medical advice before taking vitamin E if you are taking chemotherapy drugs.
High-dose vitamin E might cause your blood sugar levels to fall too low, requiring an adjustment in medication dosage, if you are taking
oral hypoglycemic medications | 医学 |
2014-42/1180/en_head.json.gz/21879 | VA inspector general begins probe of practices at Buffalo hospital Inquiry set on reuse of insulin pens on patients
Rep. Brian Higgins wants to know why it took two years to discover medical error. Mark Mulville/News file photo
on January 22, 2013 - 1:38 PM
FDA warned hospitals in 2009 not to reuse insulin pens
VA hospital withheld info on possible infections
At-risk family reacts to VA misstep; Collins calls for thorough review
716 patients at VA may have been exposed to HIV
WASHINGTON – The inspector general at the U.S. Department of Veterans Affairs has initiated a review of practices at the Buffalo VA Medical Center that could have exposed more than 700 patients to HIV, hepatitis B or hepatitis C.The inspector general, George Opfer, confirmed the review in letters to Rep. Brian Higgins, D-Buffalo, and Sen. Charles E. Schumer, D-N.Y., the lawmakers said Tuesday.Both lawmakers said they are happy the review is under way.“It is critical that we get to the bottom of this so we can work urgently to correct the flaws in the system that led to this situation and make changes to ensure nothing like this ever happens again,” Higgins said. “We appreciate the inspector general’s serious and swift attention to this matter and await the results of his review.”Catherine Gromek, a spokeswoman for Opfer, said the Inspector General’s Office would not comment on how long the review will take or on anything else about it until it is complete. Schumer, though, called for a “swift and thorough” review.“This astounding failure to follow proper protocols at the VA hospital requires answers in order to help address any and all health concerns for patients, and to avoid … this from ever happening again,” Schumer said.The lawmakers asked for the inspector general to get involved after the hospital acknowledged that it may have been reusing insulin pens on different patients even though the insulin delivery devices are designed to be used on only one patient.Because the hospital was not labeling the insulin pens for use by individual patients, 716 people could have been infected between Oct. 19, 2010, and Nov. 1 of last year, the hospital said.The faulty practice started despite a 2009 Food and Drug Administration warning against reusing insulin pens, and it continued despite a similar January 2012 alert from the Centers for Disease Control and Prevention – warnings that hospital officials said they had not seen.Higgins, Schumer and Rep. Chris Collins, R-Clarence, all have pressed the VA for details about what happened. While the VA discontinued the use of the insulin pens after discovering the error and invited the potentially affected patients in for tests, the lawmakers have said there are still serious questions outstanding.Higgins spelled out those questions in a letter to Eric Shinseki, the secretary of veterans affairs.“Please explain why it took two years to discover this error and what new checks and balances are being implemented to prevent future medical errors hospital-wide,” Higgins said in that letter. “Also detail why affected patients weren’t notified immediately.”In addition to the inspector general’s review, the House Committee on Veterans Affairs is planning to hold a hearing on the problem at the Buffalo VA hospital at Collins’ request.“It is my hope that this review, along with the upcoming House hearing on this matter that I have requested, will shine a spotlight on why this dangerous situation happened, how it went undetected for over two years, and what the Buffalo VA is doing to make sure it is following ‘best practices’ in the delivery of health care of our veterans,” Collins said.email: jzremski@buffnews.com | 医学 |
2014-42/1180/en_head.json.gz/21902 | Become a Supporter We Get Support From: Become a Supporter Dramatically Different Medicare Bills Set Hospitals Thinking
By Annie Feidt |
APRNThursday, May 23, 2013
For the first time, the federal government has publicly shared what hospitals bill Medicare for the 100 most common diagnoses and treatments.
The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things.
Hospital veteran Rick Davis, the CEO of Central Peninsula General Hospital in Soldotna, was eager to review the massive Excel spreadsheet on hospital charges as soon as it was out.
"It's going to create ripples across the nation, really, on pricing," he says. "It does show some pretty big disparities between hospitals."
For example, Alaska Regional, in Anchorage, charges Medicare $46,252 for a patient with heart failure and a major complication. Alaska Native Medical Center, also in Anchorage, charges $20,839.
In both cases, Medicare doesn't pay anywhere close to the full charge. The government reimburses Regional $13,950 and Alaska Native, $12,935. Private insurance usually pays more than Medicare, but negotiates the amount.
The system doesn't make much sense, but Davis says more transparency will help:
"For there to be pressure on pricing on the consumer side, the consumer has to understand what it's going to cost them. And so, I think this is a good report. I think it's going to force hospitals to address their pricing."
Davis says the data show the prices at his own hospital, Central Peninsula, are fair. And he doesn't expect to make any adjustments.
But Bruce Lamoureux, CEO of the Providence health system in Anchorage, says his hospital will consider changing some prices, down or even up, based on the report:
"There are some instances where our charges for a particular procedure are, in one case, half of a different provider's, and in a different case, twice a different provider."
Lamoureux thinks the information actually gives consumers some negotiating power when it comes to health care costs, something they've never had before. He says the system of hospital pricing and reimbursement is badly broken and this step toward more transparency is long overdue.
But a hospital bill is only one part of the overall health care cost picture.
"That's kind of like a rack rate in the hotel room," says Karen Perdue, president of the Alaska State Hospital & Nursing Home Association. "Most people aren't paying that one rate in the hotel. Different payers are demanding different deals at the hospital, so I think what consumers need is not only a more accurate way to determine what their costs are going to be, but also what the full cost will be, not just the hospital cost."
Like the charges from doctors and anesthesiologists, which aren't included on a hospital bill. Perdue says her board is looking at ways to make hospital cost data easily available to consumers. But health care is a complicated industry and it's not an easy task.
"Transparency, for us, feels like the future and where we should be going, and where we should be putting our effort," she says. "How we should do that in a way that is meaningful to the consumer is the challenge ahead of us."
This story is part of a collaboration with NPR, Alaska Public Radio Network and Kaiser Health News. Copyright 2014 Alaska Public Radio Network. To see more, visit http://www.aprn.org/. | 医学 |
2014-42/1180/en_head.json.gz/21941 | Q&A: Am I stuck in my job's costly health plan? by
Calvin Woodward Associated Press
March 21, 2014 08:00 AM | 330 views | 0 | 1 | | This March 1, 2014, file photo shows part of the website for HealthCare.gov as photographed in Washington. The new health care law helps some people, hurts others and confuses almost everyone. (AP Photo/Jon Elswick, File)
Editor's Note: First in a three-part series addressing real-life questions about personal impact of health care law. WASHINGTON (AP) — The new health care law helps some people, hurts others and confuses almost everyone. Hoping to simplify things a bit, The Associated Press asked its Twitter, Facebook and Google Plus followers for their real-life questions about the program and the problems they're running into as the March 31 deadline approaches to sign up for coverage in new insurance markets. Two of their questions and our answers: Can they fine me? Q: "I'm currently unemployed and without health insurance. How does this affect me at this time? ... I'll be fined because I can't afford coverage?" — Cat Moncure, Harrisonburg, Va. A: As long as you don't have income, the government doesn't require you to get health coverage and won't fine you. Specifically, if you don't make enough money so that you have to file a federal tax form, you're in the clear from the law's insurance mandate. The tax-filing threshold is $10,000 for an individual, $20,000 for a family. But let's say you get a job this year and earn enough so that you have to file a 2014 tax form. Then you'll have to do some math to see whether you have come under the requirement to get health insurance. If the cheapest policy you can get costs more than 8 percent of your income, you still don't need health insurance. In that case, you'll get an exemption from the coverage requirement when you file your taxes. If you make more than that, then you will need coverage or face an IRS penalty. Of course, none of this helps you get health care if you need to see a doctor while you are jobless. In some states, Medicaid is the answer because they've expanded the program to low-income adults without children, not just families, children or certain disabled or elderly adults. But Virginia did not expand its program. The new Virginia governor, Terry McAuliffe, has made Medicaid expansion a priority. But there's no telling how long that might take or whether he'll succeed. It's probably worthwhile to go to HealthCare.gov, click on "see plans before I apply" and follow the steps to find out what plans are available in your area, what they cost and what kind of subsidy you might get if you purchase one in that marketplace. You don't lose anything by window shopping. Whatever you do, know that if you get a job during 2014, your new income may require you to get insurance at that time. You'll want to keep an eye on that, so you don't find yourself facing a penalty when you file 2014 taxes. ___ Trapped in workplace plan? Q: "My insurance went up. Now, I have no $$ left to actually afford the copays or the much needed eyeglasses for my daughter. I think I'm what Obamacare considers the working poor. I work, therefore I don't get free health care. Like everything else offered to help struggling people, I make less than $200 over the minimum, so I get zilch." — Laura Carter, suburbs of Savannah, Ga. Her story: Carter supports an 18-year-old daughter and herself with a $27,000 salary from her job as a mitigation specialist and collector in Savannah, 45 minutes from her home. When her company changed insurers in October, her premiums for family coverage soared by about $150 a month, to $285. A: People like Carter, who feels stuck in a workplace plan she can't afford, may qualify for subsidized coverage in the new insurance markets, called exchanges, under certain conditions. The exchanges are mostly for people who do not get insurance at work. But they are also open to those who get work-based insurance that costs too much. The rule is this: If you are paying more than 9.5 percent of your income for your employer's insurance, you should be able to switch to a plan in the exchange, and if your income is low enough, you should qualify for subsidized premiums in that plan. It gets a bit more complicated when your work coverage extends to a family member, like Carter's daughter. In Carter's case, she has to ask her employer how much insurance would cost her if only she were covered. If it's more than 9.5 percent of her income, she meets the test. Then she and her daughter should be able to move to a plan in the exchange. Based on her income, she should be able to find considerably cheaper coverage there. In a family with adult children under 26, it may also be worth seeing how much separate policies would cost for parent and child, and whether the child might qualify for Medicaid coverage. These options are much more promising when the child is no longer a dependent on the parent's taxes. Also, Medicaid might only be an option in states that expanded the program. Georgia, for one, didn't. Under the law, children up to 26 can stay on their family's coverage, so there's no need to split it up if it doesn't save money. ___ Associated Press writer Ricardo Alonso-Zaldivar contributed to this report. ___ Do you have your own questions about how the U.S. health care law affects you? Ask AP using the #APHealthCare hashtag on Twitter or by commenting under our Facebook or Google Plus posts on the topic: Facebook: http://apne.ws/1eq5yMo Google Plus: http://apne.ws/1geM3bI Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Cherokee commission chair candidates share insights
Wal-Mart cuts health benefits for some part-timers
Anne D’Innocenzio, AP Retail Writer
Crew arrives to clean quarantined Texas apartment
David Warren, Associated Press and Jamie Stengle, Associated Press
Commissioners adopt $195.6M budget for 2015 | 医学 |
2014-42/1180/en_head.json.gz/21966 | Children's cold, allergy medicine recalledBy the CNN Wire Staff A child receives drops of Children's Tylenol after getting a vaccination. STORY HIGHLIGHTS Children's Motrin, Tylenol among drugs being recalled for failing to meet quality standards Recall not based on adverse health effects, company says Drugs were made in United States, distributed to other countries RELATED TOPICS
(CNN) -- A voluntary recall has been issued for more than 40 over-the-counter drugs for children, including Tylenol and Motrin, because they don't meet quality standards. "This recall is not being undertaken on the basis of adverse medical events," McNeil Consumer Healthcare said in a statement Friday. "However, as a precautionary measure, parents and caregivers should not administer these products to their children." FDA commissioner Margaret Hamburg gave a similar recommendation in a statement Saturday, saying, "we want to be certain that consumers discontinue using these products," though she called the chance for serious health problems "remote." "Some products in the recall may have a higher concentration of active ingredient than specified while others may have inactive ingredients that don't meet testing requirements, the company said. The company said it issued the recall after consulting with the Food and Drug Administration. The affected brands include: Tylenol Infants' Drops, Children's Tylenol Suspensions, Children's Tylenol Plus Suspensions, Motrin Infant Drops, Children's Motrin Suspensions, Children's Zyrtec Liquids in Bottles and Children's Benadryl Allergy Liquids in Bottles. The drugs were made in the United States and distributed to Canada, the Dominican Republic, Dubai, Fiji, Guam, Guatemala, Jamaica, Puerto Rico, Panama, Trinidad & Tobago and Kuwait. "There are a number of other products on the market, including generic versions of the recalled products, which are intended for use in infants and children and are not affected by the recall," the FDA said Saturday in issuing guidance to parents. More details are available by calling 1-888-222-6036 or visiting McNeil's website.
When it's more than 'winter blues'
Why you keep playing the lottery Tobacco companies ordered to publicly admit deception on smoking dangers | 医学 |
2014-42/1180/en_head.json.gz/22054 | Print this Page Email to a Friend Font Size LifeBridge Health > About The Sandra and Malcolm Berman Brain & Spine Institute > Our Healthcare Providers > Our Providers > Michael A. Williams, M.D. Michael A. Williams, M.D.
Michel Mirowski, MD, Office Building
5051 Greenspring Avenue
Specialty: Neurology
Michael A. Williams, M.D., is the Medical Director of The Sandra and Malcolm Berman Brain & Spine Institute. He is a board-certified neurologist and a leading authority on adult hydrocephalus, having conducted and published extensive research on the subject. He serves on the Medical Advisory Board of the Hydrocephalus Association, the largest patient advocacy group for hydrocephalus in the U.S.
Dr. Williams is a graduate of the Indiana University School of Medicine. Following an internship at Methodist Hospital of Indianapolis, he completed a neurology residency at Indiana University Medical Center. His postdoctoral education continued with a two-year fellowship in neurosciences critical care at Johns Hopkins Hospital, where he ultimately served as an attending physician in the Neurosciences Critical Care Unit for 11 years. He was also founder and past medical director of the hospital's Adult Hydrocephalus Program. He is a widely sought lecturer and educator on the topics of hydrocephalus and ethics.
Dr. Williams is certified by the American Board of Psychiatry and Neurology. He served as chair of the Ethics, Law and Humanities Committee of the American Academy of Neurology from 2003 to 2009. In addition, he is a member of the American Neurological Association and a Delegate to the American Medical Association House of Delegates. Dr. Williams is active on numerous advisory committees and panels with a focus on ethics, organ donation and end-of-life care. Some of Dr. Williams' most recent articles and presentations relate to interdisciplinary training for end-of-life care, understanding the syndrome of hydrocephalus in young and middle-aged adults, and demonstrating that diagnosing and treating hydrocephalus in the elderly results in significant reductions of Medicare health care expenditures.
Dr. Williams discusses hydrocephalus
In this WBAL-AM "Know Your Health" radio clip, Dr. Williams discusses early diagnosis of dementia and other brain disorders. | 医学 |
2014-42/1180/en_head.json.gz/22089 | Category: Gynecology | Neurology | Nutrition | News Back to Health News
Trans Fats May Raise Stroke Risk in Older Women
Last Updated: March 01, 2012.
Study found those who ate the most had 39% greater chance of trouble, though aspirin use helped
Study found those who ate the most had 39% greater chance of trouble, though aspirin use helped.By Ellin HolohanHealthDay Reporter
THURSDAY, March 1 (HealthDay News) - Here's one more reason to avoid trans fats in your diet, especially if you are an older woman: A new study found a 39 percent increased risk of stroke among postmenopausal women who ate the highest amount of this common ingredient in baked goods, fast food and packaged products.
The research, done at the University of North Carolina in Chapel Hill, did find that women who took aspirin regularly had a significantly reduced stroke risk.
But the study author stressed that the second discovery does not mitigate the first.
"The findings don't mean that you can eat trans fats and just take an aspirin," said Dr. Ka He, who added that the study showed an association and not a cause-and-effect relationship between aspirin use and lower incidence of strokes. He compared it to thinking that a smoker "could just exercise" to cancel the effect of cigarettes.
Men, who were not included in the study, are less likely to benefit from aspirin due to a gender influence that is not yet fully understood, He said.
"We recommend a reduced intake of trans fats" to avoid heart disease and stroke, added He, an associate professor of nutrition and epidemiology at UNC's Gillings School of Global Public Health. Strokes are the fourth leading cause of death and the leading cause of disability among adults in the United States, according to the American Heart Association.
Strokes occur when an artery carrying blood to the brain is either blocked or bursts, cutting off the flow of blood and oxygen. As a result, brain cells start to die. Strokes can affect speech, motor skills or cognitive functions, depending on which part of the brain is damaged.
Risk factors for strokes include obesity, smoking, hypertension and lack of exercise. Drinking too much alcohol, or none at all, is also associated with strokes.
In the UNC study, which was published online March 1 in the Annals of Neurology, researchers analyzed data from the national project known as the Women's Health Initiative. They looked at the trans-fat intake of more than 87,000 women aged 50 to 79 using a dietary database developed at the University of Minnesota and questionnaires that measured trans-fat consumption.
Participants were asked how much of 122 foods they ate in the three months before the study, with follow-up surveys taken three years later. Medical histories were updated annually between 1998 and 2005, and 1,049 strokes were documented during that time. No association was found between eating other types of fat and ischemic stroke, by far the most common type of stroke in the United States, He said.
Trans fats contribute to cardiovascular disease -- one of the risk factors for stroke -- by raising bad cholesterol and lowering good cholesterol, and may have the worst impact on health of all fats, He said.
Trans fats are rare in nature, but "can commonly occur in foods as a result of food processing when a liquid vegetable oil is turned into a solid fat," explained Nancy Copperman, director of public health initiatives at the North Shore-Long Island Jewish Health System in Great Neck, N.Y.
"It is interesting to note that the women who consumed the most trans fat also had other unhealthy lifestyle behaviors such as decreased physical activity, increased energy intake and smoking," said Copperman, adding that they also had a higher incidence of diabetes.
Encouraging women to eat a balanced diet and maintain a healthy lifestyle can be "a major step in preventing stroke and other lifestyle-related diseases," she said.
Public-policy legislation limiting trans fats in food has reduced their availability, she added. Some metropolitan areas, including New York City, have banned trans fats in foods served in restaurants.
Another expert noted that the study "is really telling us the power of fat in the diet."
"Trans fats are not really a part of a healthy diet," said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City. She called trans fats "toxic," adding that "this is one ingredient in food we should not be eating at all." She also urged consumers to read food labels because trans fats sometimes can be included in reduced-fat foods.
"Just because it says 'reduced fat' doesn't mean it's healthy," Steinbaum noted.
To learn more about dietary fats, visit the U.S. National Library of Medicine.
SOURCES: Ka He, M.D., Sc.D., M.P.H., associate professor, nutrition and epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, N.C.; Suzanne Steinbaum, M.D., director, women and heart disease, Lenox Hill Hospital, New York City; Nancy Copperman, M.S., R.D., C.D.N., director, Public Health Initiatives, Office of Community Health, North Shore-LIJ Health System, Great Neck, N.Y.; March 1, 2012, Annals of Neurology, online
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2014-42/1180/en_head.json.gz/22090 | Category: Gastroenterology | Rheumatology | Nutrition | News Back to Health News
Mouse Study Suggests Certain Fats Could Trigger Crohn’s, Colitis
Last Updated: June 13, 2012.
Concentrated milk fat increased inflammation, but polyunsaturated fat did not
Concentrated milk fat increased inflammation, but polyunsaturated fat did not.
WEDNESDAY, June 13 (HealthDay News) -- Certain types of saturated fats common in today's Western diet may change gut bacteria and trigger inflammatory bowel disease in people genetically predisposed to the disorder, according to a new study that looked at this relationship in mice.
Inflammatory bowel disease includes ulcerative colitis and Crohn's disease.
The University of Chicago researchers said their findings help explain why once rare immune-system-related disorders such as inflammatory bowel disease have become more common in the United States and other Westernized nations in the last half-century.
The researchers said their study may shed some light on why many people who are genetically prone to the condition still don't develop it and how certain environmental factors can cause inflammation in those at risk.
Scientists note, however, that research with animals often fails to provide similar results in humans.
Working with mice with characteristics of human inflammatory bowel disease, the researchers found that concentrated milk fats alter the composition of bacteria in the intestines. These changes can alter the fragile truce between the immune system and the complex but largely beneficial mix of bacteria in the intestines.
Harmful bacteria can trigger an unregulated tissue-damaging immune-system response that can be difficult to turn off, according to the study published online June 13 in the journal Nature.
Concentrated milk fats are used widely in processed and confectionary foods, the researchers noted.
The same response was not seen with polyunsaturated fats, which are found in plant-based foods and oils.
"This is the first plausible mechanism showing step by step how Western-style diets contribute to the rapid and ongoing increase in the incidence of inflammatory bowel disease," study author Dr. Eugene Chang, a professor of medicine at the University of Chicago, said in a university news release.
"We know how certain genetic differences can increase the risk for these diseases, but moving from elevated risk to the development of disease seems to require a second event that may be encountered because of our changing lifestyle," he said.
Not much can be done to correct genes that increase a person's risk for inflammatory bowel disease, and getting people to change their diets is often difficult and seldom effective, Chang said.
"However, the balance between host and microbes can be altered back to a healthy state to prevent or treat these diseases," he added. "In essence, the gut microbiome can be 'reshaped' in ... ways that restore a healthy relationship between host and microbes, without significantly affecting the lifestyles of individuals who are genetically prone to these diseases. We are testing that right now."
The Crohn's and Colitis Foundation of America has more about inflammatory bowel disease.
SOURCE: University of Chicago Medical Center, news release, June 12, 2012
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2014-42/1180/en_head.json.gz/22152 | ZOLL Medical Corporation Named to Globe 100 Again Jun 7, 2011
June 1, 2011 -- CHELMSFORD, MASS. -- ZOLL Medical Corporation (Nasdaq GS: ZOLL), a manufacturer of resuscitation devices and related software solutions, today announced that The Boston Globe has named the Company to the Globe 100 list of top performing public companies in Massachusetts. Based on a composite score derived from financial data for the four quarters ending December 31, 2010, ZOLL was ranked 39 among Massachusetts-based companies whose stock is publicly traded, moving up from number 67 a year earlier. It is one of eight medical device companies to have been included in the Globe 100, which is now in its 23rd year. This year, only 90 Massachusetts companies were named to the Globe 100 list, serving as a lingering reminder of the challenging economic climate. "The Massachusetts economy is recovering and the companies on the Globe 100 are leading the way," said Shirley Leung, Boston Globe Business Editor. To qualify for this year's Globe 100, a company must have been public for the entire 2010 calendar year and have reported a positive net income for both 2009 and 2010. Companies are ranked on four criteria: return on average equity, one-year percentage change in revenue, one-year percentage change in profit margin, and 2010 revenue. "We are extremely pleased to be named again this year and rank as number 39 in the company of Massachusetts' strongest business organizations from various sectors," said Richard A. Packer, Chief Executive Officer of ZOLL. "We are also delighted that based on our performance we continue to rise in the rankings despite some of the challenges in health care spending over the last year." About ZOLL Medical CorporationZOLL Medical Corporation develops and markets medical devices and software solutions that help advance emergency care and save lives, while increasing clinical and operational efficiencies. With products for defibrillation and monitoring, circulation and CPR feedback, data management, fluid resuscitation, and therapeutic temperature management, ZOLL provides a comprehensive set of technologies that help clinicians, EMS and fire professionals, and lay rescuers treat victims needing resuscitation and critical care. A NASDAQ Global Select company and a Forbes 100 Most Trustworthy Company in 2007, 2008, and 2009, ZOLL develops and manufactures its products in the United States, in California, Colorado, Illinois, Massachusetts, Pennsylvania, and Rhode Island. More than 400 direct sales and service representatives, 1,100 business partners, and 200 independent representatives serve our customers in over 140 countries around the globe. For more information, visit www.zoll.com.
ZOLL Medical Corporation Named to Globe 100 Again Cardiac
ZOLL Medical Corporation Education/Training
Cloud-Based Service Provides Lifesaving Information to First Responders During Chemical Emergencies Loading | 医学 |
2014-42/1180/en_head.json.gz/22156 | Some of my: Inventions | Magazine interviews | Sheds | Favorite ER memories
Home | Bio | Questions & Answers: of the site | Contact | My books | www.ERbook.net | My other sites | My blog
Information for people contemplating
a career in emergency medicine and
other medical specialties
By Kevin Pezzi, MD
About Kevin Pezzi, MD Kevin Pezzi, MD
After graduating in the top 1% of his class from Wayne State University School of Medicine, Dr. Pezzi practiced emergency medicine for 11 years. He was one of the few people in the country to be elected to Alpha Omega Alpha after the second year of medical school. He wrote several books and developed numerous web sites, such as ones that give Internet users free ways to combat spam, track information they want to follow, create keyword lists by dragging and dropping, and balance braces, parentheses, brackets, and tags in their computer code. Dr. Pezzi has thousands of inventions to date, including a handful of big ideas that will change the world, helping people in myriad ways and enriching his investors. He is currently developing a device that will make you wonder if you've been teleported a century into the future. You're probably jaded by other gizmos that were lavished with “it will change the world” hype before they were released, only to be met with “That's it?” yawns after they were unveiled. Just wait. As M. C. Escher said, "Only those who attempt the absurd will achieve the impossible."
Be notified when The Next Big Thing is releasedTrack this topic using the free track-this.info service created by Dr. Pezzi
Dr. Pezzi developed a new technique of fractional multiplication, in spite of his lifelong aversion to math. He beat Bill Gates on a test of mathematical ability and logic. Dr. Pezzi is also the innovator of several medical procedures. His brother has called him "the absent-minded Professor," a characterization that is not without merit. For example, while a college student at Michigan State University, he once went into the wrong room to take a final exam. Even though he was not enrolled in the class, he scored 147 out of 150, easily the highest score achieved by any of the hundreds of students taking the test. As a sophomore in college, he decided that his future was in the CIA, not medicine, so he skipped most of organic chemistry. Three days before the final, he changed his mind, crammed, and received a 4.0 for the course. In spite of seriously misjudging the optimal strategy for taking the Medical College Admission Test (MCAT), he scored astronomically. A government official once claimed that Dr. Pezzi achieved the highest score ever attained on an IQ test administered nationwide, although Pezzi dismisses this as disingenuous pandering.
Dr. Pezzi has been interviewed numerous times on television and radio, and also in various newspapers, web sites, and magazines, including Men's Health, AARP The Magazine (the world's largest circulation magazine), AMNews (a publication of the American Medical Association), Entertainment Weekly, Good Housekeeping, Cosmopolitan, Cooking Light, Pool & Spa News (I kid you not! :-), and others.
He enjoys inventing, thinking, programming computers, baking, dating, bicycling, traveling, working in his shop, moving dirt with his tractor and bulldozer, building microhomes and giving them to homeless people, being kind to animals, being outdoors, reading, and of course writing. And did I mention inventing? Despite living in a culture that often ridicules new ideas, there is nothing better than thinking of new ideas to help people.
“The great pleasure in life is doing what people say you cannot do.”
— Walter Bagehot
“The thing about smart people is that they seem like crazy people to dumb people.”
“If people aren't calling you crazy, you aren't thinking big enough.”
— Richard Branson
“Crazy ideas sometimes work, and the technological society that we have is built on a foundation of those crazy ideas that work.”
— Nathan Myhrvold
“You know, I've got a plan that could rescue Apple. I can't say any more than that it's the perfect product and the perfect strategy for Apple. But nobody there will listen to me.”
— Steve Jobs, 1995
“A man with a new idea is a crank—until the idea succeeds.”
“Invention requires a long-term willingness to be misunderstood.”
— Jeff Bezos, Amazon CEO
“In heaven all the interesting people are missing.”
— Friedrich Nietzsche
“The great artists of the world are never Puritans, and seldom even ordinarily respectable. No virtuous man—that is, virtuous in the YMCA sense—has ever painted a picture worth looking at, or written a symphony worth hearing, or a book worth reading.”
— H. L. Mencken
(some interesting science suggests why that is true)
Contact Dr. Pezzi
Dr. Pezzi's web sites How to get any
book of mine free
Search my ER sites:
Stop Burglars CD | My web innovations:
MySpamSponge | Track-this.info | ContactMeFree | MyProfileWriter | Keyword list tool | Balance braces
ER-doctor.com:
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Copyright © 2007 - 2014 Kevin Pezzi, MD | Terms and Conditions of Use | Model/Image © & More Notice | Original design by Andreas Viklund. | 医学 |
2014-42/1180/en_head.json.gz/22168 | PUBLIC RELEASE DATE: 20-Aug-2014
Contact: Keri Stedman
keri.stedman@childrens.harvard.edu
www.twitter.com/BostonChildrens
'Deep sequencing' picks up hidden causes of brain disorders
New approach complements whole-genome and whole-exome sequencing
Not every cell in the body is the same genetically, and disease-causing mutations don't necessarily affect every cell�making these mutations easy to miss even with next-generation genomic sequencing. A study from Boston Children's Hospital used a "deep sequencing" technique and was able to identify subtle somatic mutations�those affecting just a percentage of cells�in patients with brain disorders. The approach, described in the August 21st issue of The New England Journal of Medicine, opens up new possibilities for finding genetic causes for previously mysterious neurologic and psychiatric conditions.
"There are two kinds of somatic mutations that get missed," explains Christopher Walsh, MD, PhD, chief of Genetics and Genomics at Boston Children's Hospital and principal investigator on Boston Children's portion of the Undiagnosed Disease Network. "One is mutations that are limited to specific tissues: If we do a blood test, but the mutation is only in the brain, we won't find it. Other somatic mutations may be in all tissues, but occur in only a fraction of the cells�a mosaic pattern. These could be detectable through a blood test in the clinic but aren't common enough to be easily detectable."
Walsh and postdoctoral fellow Saumya Jamuar, MD, now a clinical geneticist at the KK Women's and Children's Hospital in Singapore, used a technique called "targeted high-coverage sequencing" to search for mutations in 158 patients with brain malformations of unknown genetic cause, who had symptoms such as seizures, intellectual disability and speech and language impairments.
Rather than analyzing the whole genome or exome (protein-coding regions of genes), the investigators focused on a panel of known or suspected genes, but drilled deeper than the traditional genomic sequencing technique. Whole genome or exome sequencing typically breaks the DNA into little fragments, each of which is read multiple times�typically 30�to find the disease-causing mutation. But 30 reads aren't enough to reliably catch mutations that only occur in 15 to 20 percent of our cells�especially given that mutations may affect just one of our two copies of a gene. So Walsh, Jamuar and colleagues scaled up the number of reads, sequencing each candidate gene not 30 times but 200 times or more. This enabled them to find mutations in 27 of the 158 patients (17 percent). Of these, eight mutations (30 percent) occurred in only a proportion of the blood cells (so-called mosaic mutations). Five of the eight were missed by traditional Sanger genomic sequencing. One of the eight had also undergone prior whole-exome sequencing that missed the diagnosis. "Our findings suggest that serious neuropsychiatric disorders can result from mutations that are detectable in as few as 10 percent of patients' blood cells," says Walsh. "By limiting ourselves to selected genes, but covering them more deeply, we may be able to find more answers for families and better understand these disorders."
Walsh, who is part of Boston Children's Brain Development and Genetics Clinic, which sees patients with brain malformations, thinks the results may possibly help explain other brain-based disorders such as autism, intellectual disability and epilepsy that don't have an inherited cause but occur as a result of de novo mutations�those occurring spontaneously and sometimes, as in these cases, after conception.
"Traditionally, our genes are considered to be the same across all cells of our body, and disease-causing mutations are either inherited from one or both parents or occur in the parent's sperm or egg before conception," Jamuar explains. "Our study creates a paradigm shift, providing evidence that a significant proportion of mutations causing brain disorders occur after conception and would be missed by routine testing. Finding the mutation ends the patient's diagnostic odyssey and allows us to provide more accurate genetic counseling to the family." "The range of possibilities caused by somatic mutations is vast," says Timothy Yu, MD, PhD, a co-author on the study and a researcher in the Division of Genetics and Genomics at Boston Children's. "The challenge remains in developing technologies to study these mutations in other conditions."
The NEJM study was funded by the National Institute of Neurological Disorders and Stroke (R01NS079277, R01NS035129, K23NS069784), the National Institute of Mental Health (1RC2MH089952), the University of Washington Centers for Mendelian Genomics (HG006493), the Manton Center for Orphan Disease Research, the National Institute of General Medical Sciences (T32GM07753), the Allen Foundation and the Howard Hughes Medical Institute.
Boston Children's Hospital is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including seven members of the National Academy of Sciences, 14 members of the Institute of Medicine and 14 members of the Howard Hughes Medical Institute comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's today is a 395-bed comprehensive center for pediatric and adolescent health care. Boston Children's is also the primary pediatric teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Boston Children's, visit: http://vectorblog.org.
Join the social discussion and tweet us @BostonChildrens @BCH_Innovation.
Follow Boston Children's on Facebook: http://on.bchil.org/1mJ9fxf. Follow Boston Children's on YouTube: http://on.bchil.org/1oJib5B. [ | 医学 |
2014-42/1180/en_head.json.gz/22221 | County Home > Public Health > About Us > Director's Message
The Forsyth County Department of Public Health is continuing to work with the staff at Oak Forest Health and Rehabilitation and with state health officials to investigate an outbreak of Legionnaires’ disease among residents of the facility. Six cases of Legionella infection have been identified to date. All affected residents are improving or have fully recovered.
As part of this investigation, environmental samples were taken from various locations within the Oak Forest facility. Testing of these samples identified low levels of Legionella bacteria. In response to this outbreak and in consultation with the Forsyth County Department of Public Health and the North Carolina Division of Public Health, Oak Forest Health and Rehabilitation has complied with all recommended control measures to protect residents, visitors, and staff. No new Legionella infections have occurred in facility patients since control measures were instituted.
Oak Forest Health and Rehabilitation has hired an environmental engineering firm to assist in remediation of their water system and to help eradicate Legionella bacteria from the facility. Remediation has included superheating, flushing, and hyperchlorination of the facility’s water system. To ensure the continued safety of residents, visitors, and staff, water restrictions will remain in place until Legionella bacteria are no longer identified at the facility through follow-up environmental testing. The staff and administrators of Oak Forest Health and Rehabilitation are to be commended for their ongoing cooperation with public health officials and their commitment to the health of their residents, visitors, and staff. For more information about Legionella bacteria please visit: http://www.cdc.gov/legionella/fastfacts.html.
Marlon B. Hunter | 医学 |
2014-42/1180/en_head.json.gz/22251 | GENERATIONS of Compassion - Healing - Innovation
St Joseph's @StJosephsHealth
GrowingNeeds
Buildinga Future
GreenDesign
OurNeighborhood
Howto Help
St. Joseph's Hospital Health Center has developed this plan for expansion with a responsibility for meeting the needs of our patients and community at top of mind. But as we begin construction, we recognize our responsibilities with regard to the environment as well. That's why we're making our project one of the largest green healthcare construction projects in New York state.
The plan includes a green roof, green data center, solar panels, daylighting views, energy conserving systems, greenway park, site drainage, and underground water and storm water infrastructure. All of these features are aimed at maximizing the sustainability of the new St. Joseph's Hospital Health Center and ensuring that every impact we have on future generations is a positive one.
Green Attributes
From the earliest stages of design, St. Joseph's has worked to ensure that the expansion will help make our facilities as green as possible. With this mindset, the plan features a number of green attributes aimed at energy savings, waste reduction and a smaller carbon footprint.
Energy-conserving systems
Greenway park
Underground water and storm water infrastructure
These features will help reduce energy consumption by 3,040,905 kilowatt hours per year, and 18,000 btu per year, and reduce water consumption by 786,500 gallons per year. Additionally, St. Joseph's Hospital Health Center will reduce its carbon output by an estimated 2,187 metric tons per year.
St. Joseph's In the News!
The "green" aspects of St. Joseph's expansion project were recently featured in Green CNY magazine, published by the Syracuse Post-Standard. Click here for the full story. Donate Now
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2014-42/1180/en_head.json.gz/22260 | SUPPORT GIFFORD
AwardsHospital Report CardCommunity ReportsEmploymentPhoto GalleryNewsEventsHistory CHOOSE A PROVIDER
About Us Thank you for your interest in Gifford. We are a non-profit community medical center, a Critical Access Hospital and Federally Qualified Health Center with more than 110 years of experience in providing high-quality, accessible health care to the people of the White River Valley and central Vermont regions. Started by Dr. John Gifford in 1903, Gifford has retained much from its modest beginnings and also changed significantly.
Just like Dr. Gifford, today’s medical providers place patient care first. Our providers and staff, many of whom have been with us for decades, are committed to compassionately caring for patients, improving lives and bettering overall community health.
But the Gifford of today has also grown and changed. We have added substantial technology, square footage and personnel since the early days. Gifford now has more than 600 employees and 11 locations. We offer advanced diagnostic technologies, accessible primary care through Gifford Health Care, diverse specialty and surgical care, high-quality emergency and inpatient care, a renowned Birthing Center and an award-winning nursing home that will soon be part of a senior living community. We’re extremely proud of all aspects of our medical center – from the cleanliness of our facilities to the quality of our food to the compassion of our staff.
We also take pride in our record of energy efficiency, financial stability and community commitment. We purchase locally grown produce for our patient and staff meals, we offer annual grants and scholarships, staff members donate countless hours to organizations and schools, and we invest in the local economy.
We are an organization truly committed to you and are thankful for the privilege of serving as your medical home. We hope you enjoy exploring our website and learning more about Gifford. As always, we welcome your feedback and your visit. To be part of the conversation, consider “liking” us on Facebook to receive notices on hospital happenings, such as free educational talks and new providers to our area. You can also share your thoughts and ideas with a member of our team or volunteer board. A listing of our board members follows.
Sincerely, Joe Joseph Woodin, Administrator
“As a community health center and medical home, Gifford’s mission is to improve and manage the health of the people we serve by providing and assuring access to affordable, high-quality health care, and by promoting the health and well-being of everyone in our service area.”
Board members Gus Meyer, chair
Gus Meyer has been calling Vermont home since the age of 9 and has lived in the same house in Randolph for more than three decades. He’s a private practice psychologist working primarily in central Vermont schools providing evaluations for special education eligibility.
Gus is a Middlebury College graduate and earned both his master’s degree and Ph.D. at Washington State University in clinical psychology. He previously worked at the Clara Martin Center and has made giving back to his community a priority. He served a term on the selectboard, has worked for decades with the local Boys and Girls Club and helped start the Orange County Diversion Board. He joined the Gifford board in 2006 and calls the volunteer position an honor.
Peter Nowlan, vice chair
Born and raised in West Windsor, Peter Nowlan studied history at the University of Vermont before being drafted in 1968. He entered officer candidate school, serving for five years as an infantry captain in the U.S. Army in Vietnam.
When he returned to Vermont, Peter read a Rutland Herald article about the Vermont Law School being established. He was a member of the charter class of 1973, graduating in 1976. He spent a couple of years as an assistant attorney general before opening his own practice in Randolph in 1981. He still operates that practice today.
A Randolph resident, Peter has served the community as a past village trustee and then a selectman, school board member, Town Meeting monitor and joined the Gifford board in 2012.
Lincoln Clark, treasurer
A New York City native and Middlebury College graduate, Lincoln Clark spent his career in the publishing and marketing, communications and research industries in New York City. He moved to Vermont full-time in 1984, first working for a New York-based company and then running his own business.
He retired more than a decade ago, joined Gifford’s board in the late 1990s and then again in 2010. A Royalton resident, he is also his town’s trustee of public funds and helps review requests to the revolving loan fund. He’s a past member of the Royalton Planning Commission, has been active with the South Royalton School and was on the Vermont Institute of Natural Science board. He was also an alumni interviewer for Middlebury College for 25 years.
Bob Wright, secretary
Bob Wright worked his way up from the foundry floor to manager at Vermont Castings in Randolph. Born at Gifford and raised in Randolph, Bob attended local schools and then college for a couple of years before starting at Vermont Castings. He was promoted to foundry manager in 1986 – a position he has held since, working out of the same office for nearly three decades.
A Brookfield resident, Bob is active in the business community, as a member and past board member of the local chamber of commerce, the Randolph Rotary club and Gifford. Bob has served as a past vice chair and chair of the Gifford board. He participates because of his enjoyment of community service and his admiration for Gifford’s success.
Joseph Woodin, Administrator
Joseph Woodin studied industrial engineering and operations research at the University of Massachusetts and earned a master’s in administration from St. Michael’s College. Before launching a decades-long career in health care leadership, Joe was an industrial engineer in manufacturing for the Belden Wire and Cable Co. He spent seven years at Central Vermont Medical Center as a senior executive and five years at what is now Fletcher Allen Health Care in its management services department.
Joe joined Gifford in 1999 as first chief operating officer but was quickly promoted in 2000 to chief executive officer and president. Under his leadership, Gifford since has operated “in the black,” meeting both its state-approved budget and operating margin. Joe lives in Randolph.
William Baumann Jr.
Bill Baumann missed being a true Vermonter by a matter of months. His family moved from Long Island to Alburg when Bill was 6 months old. What he lacks by birthright, he has made up for in endeavor. In a 47-year engineering career, Bill has contributed significantly to the local landscape and downtown, including serving as project engineer for the design phase of the Vermont Veterans’ Memorial Cemetery in Randolph Center.
Bill attended Norwich University and worked for the Vermont Agency of Transportation, the the U.S. Army Ordnance Corps and a New York-based firm before joining DuBois & King in Randolph in 1969. He rose through the ranks to president and majority owner until organizing an employee buyout to keep the company local.
Today Bill of Randolph is retired – mostly. He joined the Gifford board in 2009 to help support such a vital local institution.
Carol Bushey
Carol Bushey grew up in Tunbridge, moving to Randolph Center as a teen and soon heading off to the Thompson School of Practical Nursing. She went on to work as a nurse, including at Gifford, until transitioning to a long career in real estate and then insurance. In 2001, she bought and still operates The Frankenburg Agency in Randolph.
Carol now lives in Brookfield and invests significant time and effort in bettering her community. She spent more than a decade helping to coordinate a golf tournament for Make-a-Wish Vermont, serves on the board of the Randolph Area Food Shelf and joined the Gifford board last year, quickly getting involved in charity events like Gifford’s Last Mile Ride as a participant and as a business sponsor.
Linda Chugkowski
Linda Chugkowski was born and raised in Northfield and, other than a few years spent in New York, has lived there since. Even Linda’s employer – Northfield Savings Bank – bears the Northfield name.
Linda has worked in banking for more than four decades. She joined Northfield Savings Bank in 1979 and has spent the last nearly two decades as a mortgage originator.
She joined Gifford’s board in 2007 and has taken a special interest in the Last Mile Ride, in which she participates and is a top fundraiser each year. Matt Considine
Matt Considine grew up in Waltham, Mass. He attended Wesleyan University in Connecticut studying finance and then earned his master’s in business administration from The Wharton School at the University of Pennsylvania in Philadelphia. A distinguished career working in analyst, portfolio management and vice president positions at investment management companies followed.
He had visited Vermont for years and finally in 2008, he and wife, Melanie, moved to Vermont in search of some elbow room. He worked as a programmer until being named to a new position, director of investments for the state of Vermont in 2011. He continues in that role and joined the Gifford board in 2014 to contribute to his community hospital. In his free time, he enjoys the outdoors and astronomy.
Randy Garner
An Oregon native, Randy Garner always thought he’d work in funeral service, but an unexpected 24-year career as a paramedic came first. Randy was an EMT even before graduating from high school. He did paramedic training while in college studying accounting. While still in school at age 20, the privately-owned ambulance company where he worked was going on the market. Randy bought it and ran it until 1998 when he moved to Vermont.
Randy had been visiting for Vermont for several years, spending a month working at Day’s Funeral Home in Randolph while the owner went away. When he moved to Vermont full-time he joined Day’s as first an employee and then part-owner. A Randolph resident, he also got involved in his community as part of the Randolph Rotary, Bethany Church, Chandler and Gifford. A past chair, he is in his 12th year on the Gifford board.
Sheila Jacobs
Sheila Jacobs had an early start with Gifford. She was born at Gifford and her first job was staffing the switchboard in the evenings.
In 1984, she started what would be decades-long career in banking, climbing through the ranks and leading to her current role as assistant vice president and branch manager for Mascoma Savings Bank’s historic Bethel location. Her move to the Bethel branch meant an opportunity to return to the community she loves and, after 22 years spent living in White River Junction, Sheila moved back to her native Randolph in 2000.
Since then, she has gotten involved her community. She is a member of the Randolph Area Hospice, is on the board of the White River Valley Chamber of Commerce, is a member of the Randolph Rotary Club, a justice of the peace and joined the Gifford board in 2013.
Linda Morse
Despite 30 years living across the country in California, Linda Morse is more familiar with Gifford than some. She was born at Gifford, she grew up in Randolph and her father, Leslie Morse, served as Gifford administrator from 1957-1968.
Linda is a retired environmental planner by trade. She received her undergraduate degree in math from Middlebury College and attended graduate school at the University of California – Berkeley, studying landscape architecture.
She moved back to Vermont full-time in 2005 and became involved in Chandler, serves on the Braintree Conservation Commission and joined the Gifford board in 2013 to support the health and well-being of the Randolph and greater communities.
Fred Newhall
A seventh generation Vermonter, Fred Newhall grew up in Berlin and attended Norwich University as part of the Corps of Cadets, achieving the rank of Captain Chief of Investigations for the Headquarters Company as part of the Air Force ROTC.
When it came time for graduation, Fred opted for civilian life and put his accounting degree to work as an accountant, controller or chief financial officer at a host of primarily Vermont manufacturing companies. He is currently controller at Maponics in White River Junction.
Now a Randolph resident, Fred joined the board in 2012 as an opportunity to serve the community.
A Bethel native who now lives in Randolph, Jody Richards is a managing partner at Farrow Financial, a financial planning and money management firm in Randolph Center.
She has degrees from Vermont Technical College in veterinary technology, Strayer University in Virginia in economics and Boston University in investment management. She is also certified as a financial planner, a funds specialist and a charted financial analyst.
Jody first joined Gifford’s investment subcommittee in 2011, then its finance committee in 2013 and finally its Board in 2014.
In her free time, Jody is a mom, avid equestrian and has a small farm that raises natural, grass-fed pork and beef, including miniature belted Galloways – a rarer breed Jody sells around the country.
Barbara Rochat
Barbara Rochat moved to Chelsea in 1980 to escape the “suburbia” of New Jersey. The property Barb and her family bought was an old farm, but Barb had no plans of farming. That is until her husband bought her a couple of sheep one year for her birthday. In the decades since, the Rochats have seen their herd grow to more than 50 sheep, started selling meat, added chickens, and bought Rutland-based Vermont Quality Meats, which ships a variety of Vermont food products to primarily New York and Boston markets.
Barb is also a past EMT in Chelsea and in 2008 joined the Gifford board. Like sheep farming, volunteering in health care came with a learning curve, but Barb is happy to be affiliated with such a “shining star in the field.”
Dr. Ellamarie Russo-DeMara, Medical Staff president
Dr. Ellamarie Russo-DeMara is a gynecology, and specially certified menopause practitioner at Gifford’s Bethel and White River health centers. Dr. Russo-DeMara attended Wagner College in Staten Island, N.Y., and the New York College of Osteopathic Medicine, also in New York. Her residency was at SUNY Downstate Medical Center and Lutheran Medical Center in Brooklyn.
A gynecologist for more than 20 years, she joined Gifford in 2005, served as chairwoman of Gifford Ob/Gyn and Midwifery until 2010 and currently serves as president of Gifford’s Medical Staff. In addition, she is a member of the State Board of Health, a position appointed by the governor. She lives in Sharon.
Sue Sherman
Sue Sherman was born in Providence, R.I., and grew up on the coast in Connecticut, before moving to Vermont. A graduate of the School for Bank Administration, she has spent her adult years in banking, first as a teller in Connecticut and then for the last 35 years working her way through the ranks at Randolph National Bank. Currently she is a mortgage originator (loan officer) and vice president for Lake Sunapee Bank, which purchased Randolph National Bank.
In addition to her volunteerism with Gifford, Sue serves on the Randolph Area Community Development Corp. board as secretary. She lives in Rochester.
Missing: Paul Kendall
Chelsea open house
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2014-42/1180/en_head.json.gz/22386 | Leading and Bleeding-Edge Things That Have the Potential to Change The World
Finding Zen in a Patch of Nature
Targeting solar geoengineering to minimize risk and inequality
Probiotics Are Found to Be a Secret Weapon for Fighting Symptoms of the Common Cold in College Students
“Probiotic microorganisms may soften your immune system’s reaction by reducing your body’s inflammatory response.”
College students are notoriously sleep-deprived, live in close quarters and lead stress-filled lives, making them especially susceptible for contracting colds and upper-respiratory infections. For these reasons, a team lead by researchers at the University of Medicine and Dentistry of New Jersey–School of Health Related Professions (UMDNJ–SHRP) selected this population to study the effects of probiotic supplementation on health-related quality of life (HRQL) during the common cold.
The study, led by Registered Dietitian Tracey J. Smith, an adjunct professor at UMDNJ–SHRP, randomized 198 college students aged 18 to 25 and living on-campus in residence halls at Framingham State University in Massachusetts. Groups received either a placebo (97 students) or a powder blend containing Chr. Hansen’s probiotic strains BB-12® and LGG® (101 students) for 12 weeks. Each day, students completed a survey to assess the effect of the probiotic supplementation.
Although there have been previous studies on the effect of probiotics on the duration of colds and severity of symptoms, this is the first study to investigate the effect of probiotic strains on HRQL during upper-respiratory infections, taking into account duration, symptom severity and functional impairment—all important factors of HRQL. “HRQL is subjectively assessed by the patient and most simply defined as ‘the component of overall quality of life that is determined primarily by the person’s health and that can be influenced by clinical interventions,’” Smith says.
An article detailing the results of the study, “Effect of Lactobacillus rhamnosus GG (LGG®) and Bifidobacterium animalis ssp lactis (BB-12®) on health-related quality of life in college students with upper respiratory infections,” was published in the October 2012 issue of the British Journal of Nutrition. “We know that certain probiotic strains support immune health and may improve health-related quality of life during upper-respiratory infections,” says Smith. “This double-blind study assessed how probiotic supplementation affects the duration and severity of symptoms, and the impact of symptoms on the daily life of infected students.”
The study found that while all students caught colds at roughly the same rate, the students who took the probiotic supplementation experienced:
• A duration of colds that was two days shorter (four days vs. six days)
• Symptoms that were 34% less severe and
• A higher quality of life that resulted in fewer missed school days (15 vs. 34 missed by students taking the placebo).
What makes probiotics so effective in treating symptoms of upper-respiratory infections? “Cold symptoms like a stuffy nose and sore throat are the body’s inflammatory response toward a virus, not a direct action of the virus itself,” explains Smith. “Probiotic microorganisms may soften your immune system’s reaction by reducing your body’s inflammatory response.”
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2014-42/1180/en_head.json.gz/22451 | Another Whooping Cough Case in Bryan Schools
Updated: Tue 7:08 PM, Jan 18, 2005
/ Article It's a drill Bryan school officials know all too well. Notifying parents that one of their kid's classmates has contracted a case of pertussis, more commonly known as whooping cough. For the fifth time in eight months, the district went through the routine again Tuesday sending letters home with students who attend Jane Long Middle School, the campus where the latest case surfaced.
It was less than two weeks ago that a Sam Rayburn Middle School student and a sibling attending Bonham Elementary both came down with whooping cough. Prior to that, SFA Middle School had a case last November and Rayburn reported a whooping cough dismissal in May. In a statement, school spokeswoman Sandy Farris said, "Though not an unusually high number of cases given the large student population, district officials are hoping the parent letters will alleviate any concerns, as well as provide facts regarding the disease. "Pertussis (whooping cough) is caused by germs that live in the mouth, nose, and throat and can be sprayed into the air when a person with the disease sneezes, coughs or talks. Other people nearby can then inhale the germs. Touching a used tissue or sharing a cup used by someone with pertussis can also spread the disease. "Pertussis symptoms appear five to twenty-one days after infection. Usually, only close contacts with people with pertussis result in another becoming infected. Pertussis begins with cold-like symptoms (sneezing and a runny nose) and a cough that gradually becomes worse. After one to two weeks, the cough usually occurs in strong “coughing fits.” In young children, this is often followed by a whooping noise as they try to catch their breath. After coughing, a person may have difficulty catching their breath, vomit, or become blue in the face from lack of air. Between coughing spells, the person may appear well. There is generally no fever. The cough is often worse at night and cough medicines usually do not help reduce the coughing. Coughing fits can last six weeks or longer. Adults, teens, and vaccinated children often have milder symptoms similar to bronchitis or asthma.
"Although pertussis vaccine is available, it cannot be given after seven years of age. Older children and adults with mild illness can transmit the infection and are often the source of illness in infants. Therefore, early recognition and treatment of pertussis in contacts of young infants and preventive treatment of their household members is especially important. Symptomatic children may return to school after completing the first five days of appropriately prescribed antibiotics."
The school district urges parents to watch if a child comes down with cold symptoms that include a cough, or if your child has had an unexplained cough, talk to your child’s doctor. For more information about pertussis contact the Brazos County Health Department or your family physician. | 医学 |
2014-42/1180/en_head.json.gz/22536 | For more information, please call us at
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Search Medical Staff Awards & AccoladesAmerica's Best Hospitals 2014-15U.S. News and World ReportRead more Stay in TouchThere are many ways you can keep up on the latest health tips, news and events from Lenox Hill Hospital.Watch our videosConnect with usFollow UsRead our E-MagazineReceive our E-Newsletters Lenox Hill Hospital is First and Only Hospital in Manhattan to Install New System for Breast Cancer ScreeningMay 9, 2003Lenox Hill Hospital is the first and only hospital in Manhattan to acquire the new ImageChecker Computer Aided Detection (CAD) system for use in breast cancer screening to assist radiologists in minimizing false negative readings during mammograms.The ImageChecker is the first FDA-approved computer-aided system for use in breast cancer screening. Clinical studies show use of this system could result in earlier detection of up to 23.4 percent of the cancers currently detected with screening mammography in those women who had a mammogram nine to 24 months earlier."Early diagnosis is the key to surviving breast cancer, and mammography screenings with the benefit of this CAD system could prevent thousands of breast cancer deaths each year," said Evan Morton, MD, Section Chief of Women's Imaging at Lenox Hill Hospital. "Regular screening mammograms are still the best way to detect breast cancer early, which is also when it is easiest to treat. With this new system in place at Lenox Hill Hospital, we will be able to significantly increase our detection rate of early cancers."The system is currently used in conjunction with film-based mammography. After digitizing a film mammogram, the system's specialized processing software analyzes the image and draws the radiologist's attention to features that may be indicative of cancer. Typically, the radiologist first reviews the entire mammogram and then activates the system's monitor to see if any areas have been highlighted for additional review. If an image is highlighted, the radiologist goes back to the original mammogram to review this area of the image in more detail.According to the National Institutes of Health, if breast cancer is identified early, when it is confined to the duct or local area of the breast, the patient's chances for survival are dramatically higher. The five-year survival rate for breast cancer patients decreases from approximately 95 percent for cancers detected and treated at an early stage, to 36 percent for later stage cancers (where the cancer has spread to surrounding tissue) to just 7 percent for late stage cancers that have spread to distant organs.Members of the press seeking information about Lenox Hill Hospital should call the Public Relations Department at (212) 434-2400.
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2014-42/1180/en_head.json.gz/22644 | Cardinal Health launches in-pharmacy ad network
Ben Comer
Cardinal Health launched the Pharmacy Health Network in early August, serving up digital prescription and OTC advertising in 3,000 independent retail and franchised pharmacies nationwide.In addition to video advertising, the in-store digital program will provide educational content via flat-panel LCD screens to patients at the point-of-purchase —as they wait for prescriptions to be filled. Independent pharmacies such as Leader and Medicine Shoppe will participate. According to Tara Schumacher, director of media relations at Cardinal Health, the network will reach an estimated 22 million consumers each month.Advertising capabilities include customized video, brochure racks and other take-away items such as samples, coupons and business reply cards, according to a statement. Additional content from the NBC Digital Health Network and AccuWeather.com will also be featured on the network. Real Digital Media is providing media players.Dallas, Texas-based Respario Digital Advertising Group will manage the network, and handle the technology and content. Schumacher said the program is designed to be “as turn-key as possible” from a pharmacy owner's perspective. “All that's necessary is an internet connection…the pharmacy doesn't have to pay for the technology or installation,” she said. Schumacher said a list of pharmaceutical companies interested in advertising on the network had been circulating internally, but was unable to divulge specific company names.The network launch was announced during Cardinal Health's Retail Business Conference (RBC) in Washington DC (July 29-August 1). Cardinal Health's revenues were up by 5% in 2008 to $91 billion. Operating earnings increased by 54% over the same period to $2.1 billion, according to an annual report.
From the September 2009 Issue of MMM »
Headliner: Mike Kaufmann, Cardinal Health
Cardinal Health agrees to stop buying on secondary market
Healthline launches online ad network
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Private View: New ways to engage with customers
These healthcare social media campaigns successfully use emotion, altruism and the human desire to "brand" oneself to get customers engaged. | 医学 |
2014-42/1180/en_head.json.gz/22689 | | | Schizophrenia Survey: Acknowledgements
We would like to thank the many individuals living with schizophrenia and caregivers who participated in the schizophrenia survey. Their willingness to share their stories and experiences has been inspiring and insightful.
Our gratitude extends to the members of the Advisory Committee who contributed countless hours developing the scope of the survey and helping to integrate the findings to an insightful outcome. Their expertise was informative and their commitment to the report invaluable.
The survey was designed, administered, and results evaluated by the professional team at Harris Interactive. We thank them for contributing their expertise to the initiative.
Along with NAMI staff who served on the Advisory Committee, additional NAMI staff who contributed to the initiative include Charles Harmon, Director of External Relations; Ronald Honberg, J.D., Director of Policy and Legal Affairs; Angela Kimball, Director of State Policy; Don Lamm, Director of Web Services; Dan Waggoner, NAMI Intern.
NAMI Advisory Committee members:
Loren Booda has lived with schizoaffective disorder for 30 years. He works as a NAMI HelpLine information specialist and has volunteered as a NAMI support group facilitator. Mr. Booda has also been recognized for volunteerism in his regional park system and for his volunteer activities on behalf of a local nursing home. He has an M.S. in Physics from George Mason University. Ken Duckworth, M.D., is a clinical and research psychiatrist and assistant professor at Harvard University Medical School, and serves as Medical Director for NAMI. Dr. Duckworth has extensive experience serving as the acting commissioner and medical director of Massachusetts Department of Mental Health. Elizabeth R. Edgar, M.S.S.W., is a Senior Policy Analyst at NAMI. Ms. Edgar has worked in the mental health field since 1975 as a community mental health agency service provider and manager, state department of mental health community services and housing administrator, and national technical assistance project director. Further understanding of treatment needs and the family perspective comes from her relationship with her 33 year-old daughter who is recovering from a severe mental illness.
Michael Fitzpatrick, M.S.W., is Executive Director of NAMI. He has nearly 35 years of experience in the public mental health sector and served as the House Chair of the Health and Human Services Committee in the Maine State Legislature from 1994-1996. Mr. Fitzpatrick has served on numerous community, government and non-profit boards and expert panels. He presently serves as the Chair of the Campaign for Mental Health Reform and serves on the Board of REACH (Resource for Advancing Children's Health) Institute. Mr. Fitzpatrick has a master's degree in social work from Boston College.
Katrina Gay is Director of Communications for NAMI, where she oversees the organization's strategic and operational communications initiatives. Her career has encompassed a variety of communications and public relations specialties. Ms. Gay serves on the advisory board of Esperanza magazine. She was educated at Texas A&M University and the University of Houston, where she studied economics.
Stephen M. Goldfinger, M.D., is a community psychiatrist whose career has focused on the treatment and rehabilitation of the most seriously disabled psychiatric patients. He is currently a Professor and Chair of Psychiatry and Behavioral Sciences at the State University of New York, Downstate Medical Center, Brooklyn. Dr. Goldfinger trained at Harvard College, Yale Medical School, and completed his psychiatric residency at the University of California, San Francisco/Mt. Zion Hospital.
Anand Pandya, M.D., is the Director of Inpatient Psychiatry at Cedars-Sinai Medical Center. He is a nationally recognized expert in disaster psychiatry, having co-founded the non-profit Disaster Psychiatry Outreach. He received the Kenneth Johnson Memorial Book Award for Disaster Psychiatry: Intervening when Nightmares Come True. He serves as President of NAMI. He is also active in the American Psychiatric Association where he has served on the Scientific Program Committee for many years.
Charles Schulz, M.D., is the Hastings Endowed Chair and Head of the Department of Psychiatry at the University of Minnesota. He received his medical degree and psychiatric residency training from the University of California, Los Angeles. He became a clinical associate in the Neuropsychopharmacology Section of the National Institute of Mental Health (NIMH) following his residency. At the University of Minnesota, Dr. Schulz has continued his work in brain imaging studies of both people with schizophrenia and borderline personality disorder as well as in treatment studies. Carol Tamminga, M.D., is the Communities Foundation of Texas Chair in Psychiatry at the University of Texas Southwest (UTSW), the Vice Chair for Research and the Chief of the Department of Psychiatry at UTSW Medical School. In her research role, Dr. Tamminga's efforts strive to examine and understand the mechanisms underlying schizophrenia, especially its most prominent symptoms, psychosis and memory dysfunction, in order to build rational treatments for the illness.
Analysis and Recommendations Authors:
In addition to the writing contributions of Katrina Gay and Ken Duckworth, M.D., we acknowledge:
Laudan Aron (Laudy), who is the Director of Senior Policy Research for NAMI where she oversees all of NAMI's research activities, including the bi-annual report to the nation on public mental health service systems, Grading the States. Prior to joining NAMI in November 2007, Ms. Aron was a Senior Research Associate with the Urban Institute in Washington, D.C., and has also conducted national program evaluations, survey designs, data analyses, and reviews of the literature for many federal agencies and foundations.
Bob Carolla, J.D., the editor of this report, who is the Director of Media Relations for NAMI. A graduate of Boston University Law School, where he was topics editor of the American Journal of Law and Medicine, Mr. Carolla served ten years as a senior legislative assistant in the U.S. Senate. He is on the editorial board of Bp Magazine, which serves people with bipolar disorder and their families.
Christine Lehman, who is a research analyst and science writer with 15 years of experience in the analysis and communication of health research, with a focus on public and mental health. This project was made possible with support from AstraZeneca, Solvay, and Wyeth.
Cover design ~ Landforddesign | Report design ~ Cindy Stone Design Copyediting ~ Sara Kruger, Jeny Beausoliel | Printing ~ TK Solutions, Nashville, Tennessee | 医学 |
2014-42/1180/en_head.json.gz/22690 | | | Congressional Briefing On Mental Health Courts
(Action Needed To Increase Participation)
For Immediate Release, 27 Sep 99
Contact: Chris Marshall
On September 29, a bipartisan coalition of members of Congress will convene a seminar on Capitol Hill on the success of Mental Health Courts in reversing the disturbing trend of "criminalization" of mental illness. This briefing is intended to educate members of Congress and their staffs on how Mental Health Courts are effective in 1) diverting children and adults with severe mental illness from jails and prisons where treatment services do not exist and 2) delivering treatment services to people with serious brain disorders who are currently serving long sentences in state and local jails. NAMI is supporting this briefing as an important step forward in helping members of Congress better understand how the criminal justice system has become the "dumping ground" in communities where underfunded public mental health programs have failed to deliver adequate services and supports for people with serious brain disorders. ACTION REQUESTED
NAMI is grateful to the sponsors of this briefing - U.S. Representatives Marcy Kaptur (D-OH), Ted Strickland (D-OH) and Nancy Johnson (R-CT). In order to ensure that as many members of Congress and their staffs attend this important briefing, NAMI advocates are urged to contact members of their state's congressional delegation and ask that they support this event by sending a member of their staff. Tell your member of Congress how Mental Health Courts could work (or are already working) in your community.
This briefing will be held Wednesday, September 29 at 2:00 p.m. in Room 2105 of the Rayburn House Office Building. Speakers include: Judge Ginger Lerner-Wren, Broward County Florida (a presenter at the 1999 NAMI convention), Dr. Andrea Weisman, DC Central Detention Facility, Professor Brenda Smith, American University Law School, Dave Norman, Esquire, DC Public Defenders Office and Sally Peck, Murder Victims Families.
All members of Congress can be reached by calling the Capitol Switchboard at 202-224-3121 or by going to the NAMI website at www.nami.org/policy.htm and click on "Write to Congress."
In 1992, NAMI and the Public Citizen's Health Research Group released "Criminalizing the Seriously Mentally Ill," a report authored by E. Fuller Torrey, M.D. This report disclosed in shocking detail how jails have become the "mental institutions" of the 1990s. In many parts of the country, states have begun programs that are leading to a reduction in the number of persons with serious mental illnesses who are inappropriately jailed after not receiving the services they need from local mental health systems. By creating a court to handle misdemeanor cases involving individuals with these brain disorders, the county hopes to quickly resolve such cases and to divert these individuals into appropriate treatment programs instead of the criminal justice system.
One of the first and most successful of these local programs is the "mental health court" in Broward County, Florida. Begun in 1997, the program is loosely modeled after so-called "drug courts," established in many parts of the country to hear misdemeanor cases involving offenders with substance abuse disorders. Despite the belief of many that drug courts represent an effective way to divert minor drug offenders into treatment, they have not until now served as a model for people with severe mental illnesses. The Broward County mental health court is believed to be the first of its kind in the United States.
According to Judge Ginger Lerner-Wren, all misdemeanor cases involving individuals identified as severely mentally ill are heard on an expedited basis, either on the same day as or the day after the initial arrest. Depending on the circumstances of specific cases, the court has the authority to divert individuals into inpatient or outpatient treatment, or to release them. The court also has the power to institute conditional release or civil commitment orders when individuals meet the legal criteria for these mechanisms. Finally, the court is vested with the power to revoke conditional discharges when individuals do not comply with treatment plans. As one observer of Broward County's program has noted, the court has been effective in diverting misdemeanants with severe mental illnesses away from jails and into appropriate treatment. "Mentally ill people who commit misdemeanors shouldn't be in jail . .. . it's not humane, it's not right, it's not cost-effective." | 医学 |
2014-42/1180/en_head.json.gz/22775 | Home > Departments and Services > Surgery > Vascular Surgery > Patient Story
Arnold's Story: Balloon Cryoplasty
After three failed angioplasties, Arnold Levy was told his only choice was major bypass surgery to correct the artery blockages in his leg. At 64 years old and the sales manager of a busy car dealership, he was hoping to avoid surgery and the four to six-week recovery time. Because his blood vessels had become clogged by fatty deposits known as plaque, Arnold was not getting good blood flow to his feet. He was experiencing severe leg pain and stiffness and having trouble walking. Arnold was hoping for another option … he found one at Newton-Wellesley Hospital. “I had heard about Newton-Wellesley Hospital’s outstanding vascular surgery program so I thought I would schedule an appointment and see what procedures they might be offering.” A long tradition of excellence in critical care, innovation, education and research is central to the vascular surgery collaboration between Newton-Wellesley and Massachusetts General Hospital. Under the direction of Christopher J. Kwolek, MD, Chief of Vascular Surgery at Newton-Wellesley Hospital and Vascular Surgeon at Massachusetts General Hospital, the Hospital provides access to highly regarded vascular surgeons and state-of-the-art surgical facilities to offer world-class vascular surgery.
“When I met with Dr. Kwolek, he immediately gave me hope that there were other options besides major surgery,” says Arnold. “He gave me peace of mind and said there were a number of treatments he could try before surgery.” As an alternative to surgery, Dr. Kwolek was able to use balloon cryoplasty, a new minimally invasive treatment proven to be successful in opening clogged vessels. By working through a small catheter inserted into the groin, a small balloon is inserted into the blocked blood vessel. The balloon is then filled with nitrous oxide, which turns into a gas that freezes the plaque in the artery, opening the blockage. Minimally invasive surgical techniques, like cryoplasty, benefits patients by resulting in less trauma, lessened hospital stays and, in many cases, outpatient day surgery. After this procedure, Dr. Kwolek was able to once again prolong bypass by using stents to create almost 100 percent blood flow in Arnold’s leg.
“While Mr. Levy may eventually require an open bypass procedure, these endovascular techniques may postpone this for several years without losing the option for an open procedure in the future,” says Dr. Kwolek.
Given the intricacies of the vascular system, vascular surgery requires highly specialized training and skills. The human vascular system is made up of arteries and a multitude of blood vessels that supply blood, oxygen and nutrients to every part of the body. A variety of conditions can result in vascular blood flow becoming insufficient to meet the body's needs. This collaboration is staffed by surgeons who are recognized authorities in their field and offer the most extensive surgical experience of hospitals nationwide. “The field of vascular disease management is changing,” says Dr. Kwolek. “The prime benefit to our patients is the ongoing effort to discover, learn and utilize new procedures to treat vascular disease. By using new technology and techniques, we can shorten recovery time and offer patients options that do not involve major surgery. This minimally invasive procedure allowed Mr. Levy to maintain his lifestyle and continue working and providing for his family.” After his procedures at Newton-Wellesley Hospital, Arnold is back on his feet.
“I work at a busy car dealership and am constantly on the go. Before I met with Dr. Kwolek, the pain was really affecting my day-to-day activities. Now, I no longer have stiffness and pain. I have been able to return to work… nothing can slow me down.” | 医学 |
2014-42/1180/en_head.json.gz/22813 | Chlorine in Tap Water Linked to Increase in Number of People Developing Food Allergies
By Nick Mcdermott Daily Mail, December 3, 2012 Straight to the Source For related articles and more information, please visit OCA's Health Issues page and our Coming Clean Campaign page.
Chlorine in tap water has been linked to the rising number of people developing food allergies, a study has revealed.
The chemical, which is used to treat drinking water and is also present in commonly-available pesticides and household items, may weaken food tolerance in some individuals.
Researchers found adults with high levels of dichlorophenol - a chemical by-product of chlorine - in their urine, were up to 80 per cent more likely to have a food allergy.
Britain has seen a rise in food allergies in recent years, with up to ten million adults claiming to be unable to eat a variety of foods from milk to mustard - although scientists believe the figure may be exaggerated by the 'worried well'.
Studies also estimate that four per cent of children have a food allergy. A rising number are diagnosed with gut allergies linked to common foods such as cow's milk, wheat, soya, eggs, celery, kiwi fruit and other fruit and vegetables.
Food allergy can take the form of a sudden life-threatening reaction known as anaphylaxis, as well as eczema or an itchy rash. Much of the water supply in Britain is chlorinated to kill germs, although experts say it is at much lower levels than in the US.
They point out that, for British households at least, certain common household products are more likely to be sources of dichlorophenol than tap water.
Professor Jeni Colbourne, the chief inspector of drinking water, said strict regulations in the UK meant dichlorophenol is unlikely to be found in household taps.
She said its likeliest source for British consumers were household products impregnated with triclosan, commonly used in lipsticks, face washes, toothpaste and kitchen utensils. An anti-bacterial, it can break down to form dichlorophenol.
>>> Read the Full Article For more information on this topic or related issues you can search the | 医学 |
2014-42/1180/en_head.json.gz/22916 | New CAT Scan Machine Unveiled at Elmhurst Hospital
Daniel Bush
Dec 10, 2008 | 2848 views | 0 | 45 | | Play |
Elmhurst Hospital unveiled its new state-of-the-art CAT Scan machine at a Dec. 4 ribbon cutting ceremony attended by Councilwoman Helen Sears (D- Jackson Heights), who funded the acquisition through her capital budget.The $1.6 Million GE 64-slice Scanner significantly increases the speed, efficiency, and information-gathering capability of the CAT Scan procedure, which is used to screen patients for cancer, among other diseases, and to examine everything from vital organs to bone structure and blood vessels. “Its one of the latest technologies as far as Cat Scans are concerned,” said Emil Sudlow, the Radiology Department’s Cat Scan supervisor. “It’s a pretty big step. It’s a lot more sensitive to things you would probably miss or that would require a more invasive procedure.”The new machine, which will not replace the hospital’s two 16-slice scanners, produces four times as many high-resolution images, or slices, said Sudlow, in less time and using a smaller dose of radiation. “It’s like cutting through a loaf of bread,” Sudlow explained. “The thinner your slices are the easier it is to see what’s between those slices.”After the slices are captured they are computerized at a nearby workstation and transformed into 3-D images that have impressed hospital radiologists with their accuracy and detail. “It’s a very good scanner,” said Dr. Joel Mollin, an attending radiologist. “I’m very impressed with the way it’s working.”Dr. Mazullah Kamran, the hospital’s associate chief of Cardiology, said one of the machine’s main purposes would be to take cardiac images in order to identify and diagnose anomalies in core arteries around the heart. To capture images of the heart using the older machines, patients have to hold their breath while lying flat on their backs for as long as half a minute, said Kamran. The new machines have cut that time by as much as half, in some cases, a crucial difference for Queens patients who are undergoing the procedure with greater frequency in recent years.“Since 2004 we’ve doubled our number of CAT scan studies,” said George Leconte, the hospital’s administrator for Ancillary Services. Leconte, who worked closely with Sears to obtain the new machine, praised the councilwoman’s dedication to health care improvement. “Helen Sears has been a fantastic supporter of Elmhurst Hospital,” said Leconte. The 64-slice scanner has been in operation in the hospital’s ground floor radiology department for the past two months. The average patient cost to be screened by the new machine in hospitals around the country ranges from $600 to $1,000, said Dr. Kamran. Its is not yet known how expensive the average scan at Elmhurst will be, Kamran said.The official unveiling of the 64-slice scanner on Thursday was the culmination of a two-year drive by Sears, who first applied to the city to include the item in the capital budget in 2006.“Health care changes all the time, technology changes all the time, and it’s important that hospitals keep that up,” said Sears after the ribbon cutting. Elmhurst Hospital patients “need state of the art equipment,” Sears said. “The people who come here, from all walks of life, deserve the highest quality care.” Copyright 2014 Queens Ledger. All rights reserved.
Raining cats and dogs at Borough Hall pet adoption event
CATHEDRAL PREP SEMINARY | 医学 |
2014-42/1180/en_head.json.gz/23001 | Home > Life Sciences > Microbiology > News Articles 26 Genes Linked To Lung Cancer Identified
By News Staff | October 22nd 2008 01:00 AM | Print | E-mail | Track Comments Tweet
Researchers say they have assembled the most complete catalog to date of the genetic changes underlying the most common form of lung cancer. They identified 26 genes that are frequently mutated in a type of cancer called lung adenocarcinoma, a finding that more than doubles the number of genes already known to be linked to the deadly disease. More than 1 million people worldwide die of lung cancer each year, including more than 160,000 in the United States. About 40 percent of them are adenocarcinoma, a type of non-small cell lung cancer and one that is exceedingly difficult to treat. Only about 15 percent of patients are still alive five years after diagnosis.They also found that some of the same genes associated with lung tumors are also defective in other cancers, that smokers and non-smokers with lung cancer have distinct genetic defects and that several molecular pathways underlie most of the mutations.
"This genomic approach has given us a completely different view of lung cancer," says Richard K. Wilson, Ph.D., director of Washington University's Genome Sequencing Center and one of the study's lead authors. "This broad view will allow scientists to more accurately categorize tumors, which should speed efforts to develop more targeted therapies to fight the disease."
The study published in Nature was conducted as part of the Tumor Sequencing Project, a collaborative effort to assemble a genome-wide catalog of the genetic mutations in lung adenocarcinoma. Like most cancers, lung adenocarcinoma arises from changes that accumulate in people's DNA over the course of their lives. However, little is known about the precise nature of these genetic alterations, how they occur and how they disrupt biological pathways to cause cancer's unfettered cell growth.
"By harnessing the power of genomic research, this pioneering work has painted the clearest and most complete portrait yet of lung cancer's molecular complexities," says Alan E. Guttmacher, M.D., acting director of the National Human Genome Research Institute, the agency that funded the research.
Working with lung cancer samples donated by 188 patients from across the United States, the group sequenced 623 suspect genes and compared them to the same genes in healthy tissues from the same patients. Initially, they found more than 1,000 mutations across the samples. Looking more closely, the researchers identified 26 genes mutated in a significant number of samples. Most of the genes had not previously been associated with lung cancer but are found in other tumors.
The new genes fingered in lung adenocarcinoma include:
Neurofibromastosis 1: Mutations in this gene cause a rare inherited neurological disorder that increases the risk of tumors that form on nerve tissues, including the brain, spinal cord and individual nerves;
Ataxia telangiectasia mutated (ATM): Mutations of this gene have been found in a rare inherited neurological disorder and in various types of leukemia and lymphoma;
Retinoblastoma 1: Mutations in this gene have linked to a rare childhood cancer that begins in the retina;
Adenomatosis polyposis coli (APC): Mutations of this gene are common in colon cancer.
The team also examined the effects of the genetic mutations on biological pathways and determined which of the pathways is most crucial to lung adenocarcinoma. This line of discovery is essential to efforts to develop new and better treatments for cancer.
For example, the researchers discovered that more than 70 percent of the 188 tumors had at least one mutation affecting the mitogen-activated protein kinase (MAPK) pathway, indicating it plays a pivotal role in lung cancer. Based on those findings, the researchers suggested new treatment strategies for some subtypes of lung adenocarcinoma might include compounds that affect this pathway. One such group of compounds, the MEK inhibitors, has produced promising results in mouse models of lung cancer.
"Looking at the pathways helps simplify the picture," Wilson explains. "Generally, we found that each mutation only occurs in a small percentage of the tumor samples, but when we looked at all the mutations that intersect a particular signaling pathway, we were surprised to find a lot of overlap in only a handful of pathways. This gives us a much better idea of what goes wrong in cells when they become cancerous."
Additionally, the finding that more than 30 percent of tumors had mutations affecting the rapamycin (mTOR) pathway raises the possibility that the drug rapamycin might be tested in lung adenocarcinoma. The drug, which inhibits mTOR, is approved for use in organ transplants and renal cancer.
The researchers also analyzed the patterns of genetic changes in both smokers and non-smokers with lung cancer. About 90 percent of lung cancer is linked to smoking, but 10 percent of patients diagnosed with the disease have never smoked. They found that the number of mutations detected in tumor samples from smokers was significantly higher than in tumors from never-smokers. Smokers' tumors contained as many as 49 mutations, while none of the never-smokers' tumors had more than five.
More work is needed to determine the clinical significance of these differences. However, doctors do know that in some other types of cancer, high mutation levels may cause a tumor to spread rapidly or be resistant to treatment.
The study also confirmed previous observations that indicated lung cancer in never-smokers may be triggered by different genetic mutations than those in smokers. For example, mutations in the epidermal growth factor (EGFR) gene were prevalent in tumors from non-smokers, while mutations in the KRAS and Src tyrosine kinase 11 genes were common in tumors from smokers.
"Our findings underscore the value of systematic, large-scale genome studies for exploring cancer. We now must move forward to apply this approach to even larger groups of samples and a wider range of cancers," Wilson says.
Related Articles on Science 2.0Is Tumor Metastasis Prevention On The Horizon?Advertising Against Lung CancerJunk Science And The Hypocrisy Of Medical MarijuanaMarried Couples Who Smoke Pot Have Fewer Domestic Violence IncidentsCurious George Will Give You Lung Cancer | 医学 |
2014-42/1180/en_head.json.gz/23033 | Get Rid of Bumpers, Stuffed Animals in Baby's Crib
Soft items can suffocate sleeping infants, pediatricians warn
TUESDAY, Nov. 22 (HealthDay News) -- A comfortable and safe sleep environment is crucial for infants and could mean the different between life and death, pediatricians say.
Sudden infant death syndrome remains the leading cause of death for children younger than one year, according to the U.S. Centers for Disease Control and Prevention. There's been a significant decline in the number of SIDS-related deaths since the American Academy of Pediatrics recommended that all babies be placed on their backs.
But sleep-related deaths caused by entrapment, suffocation and asphyxia have increased, leading the AAP to expand its sleep safety guidelines.
"These new guidelines will help enlighten parents about what items and behaviors can lead to infant sleep-related deaths," Dr. Lisa Martin, a pediatrician at Loyola University Health System and an associate professor of pediatrics at Loyola University Chicago Stritch School of Medicine, said in a Loyola news release.
"Infants, especially young infants, are completely dependent on their caregivers to provide a safe sleep environment, since they don't have the ability to roll away from objects that are restricting their breathing," she noted.
As well as always placing infants on their backs to sleep, the AAP says babies should be placed on a firm sleep surface and the crib should be free of objects such as loose bedding, bumper pads, pillows and stuffed animals.
"There are numerous products out there that are not necessary and could even become death traps for a baby. Items like bumper pads and sleep positioners have not been shown to prevent injuries, and the concern is that an infant can get trapped and suffocate," Martin said.
"Babies don't care if they have a boring crib; they do care if it's safe. The more objects in a sleeping space, the more dangerous it is for a baby," she added.
A good rule of thumb for keeping babies warm is to dress them in one additional layer of clothing above what a parent is wearing, Martin advised. For example, if a parent is wearing two layers, a baby will need three.
Another AAP recommendation is to offer infants a pacifier at nap and bedtime.
"Pacifiers have been shown to protect against SIDS, but if a mother is planning on breast-feeding, wait to offer it until the baby is three or four weeks old and make sure breast-feeding habits have been established," Martin said.
Here's where you can find the complete list of AAP recommendations for reducing the risk of SIDS. Robert Preidt SOURCE: Loyola University Health System, news release, Nov. 16, 2011
Health Tip: Breast-feeding With Diabetes October 22, 2014 Tall, Heavy 1-Year-Olds May Be at Risk for Obesity Later, Study Finds October 21, 2014 Learn More About Sharp | 医学 |
2014-42/1180/en_head.json.gz/23051 | Newsletters > 2007 > February > 28 > Myostatin Blockers: The Potential Benefits and Risks of These Forthcoming 'Super-Muscle' Drugs
Myostatin Blockers: The Potential Benefits and Risks of These Forthcoming 'Super-Muscle' Drugsby www.SixWise.comIn 2000, a boy was born in Charite Hospital in Berlin, Germany. Unlike the other babies, his muscles were not soft and undefined. They were bulging from his arms and legs. As the child grew, he developed muscles twice the size of his peers, while maintaining half the body fat, and before the age of 4 he was able to hold seven-pound weights with his arms extended.
A boy born in Germany in 2000 is the first known human to have a mutation in the myostatin protein, which results in enhanced muscle growth (he is 7 months old in this picture).
This little Hercules, who is now a healthy 7-year-old, is the first human with a proven mutation in myostatin, a protein that limits muscle growth. By blocking this protein, for instance, researchers have grown muscular mice they call "mighty mice," and cattle breeders have developed the Belgian Blue breed -- the so-called "double muscle" cattle that are especially meaty and very lean.
The discovery of the myostatin mutation in a human, however, has sparked significant interest in myostatin-blocking drugs, which are surrounded by a growing sea of debate.
Myostatin Blockers for Muscular Dystrophy and Diabetes?
Myostatin-blocking drugs could theoretically help people with Duchenne muscular dystrophy and similar diseases that destroy muscle, such as cancer, AIDS, and even normal aging. Astronauts, who lose muscle mass after being in zero-gravity for prolonged periods, could also potentially benefit from such drugs.
Pharmaceutical company Wyeth has already gained the rights to develop a human myostatin blocker, and has begun testing a version with antibodies that block the protein in adults. Results are expected as early as March of this year.
"Just decreasing this protein by 20, 30, 50 percent can have a profound effect on muscle bulk," said Dr. Lou Kunkel, director of the genomics program at Boston Children's Hospital and professor of pediatrics and genetics at Harvard Medical School (and also a doctor participating in the Wyeth's research).
Further, according to Dr. Se-Jin Lee, a Johns Hopkins professor who helped create the "mighty mice" (and who, along with Johns Hopkins, would receive royalties for Wyeth's drug), a myostatin blocker may also be able to suppress fat accumulation and help stop the development of diabetes.
Potential Problems Down the Road?
While proponents say the drugs hold promise, others express concern at potential side effects of blocking the myostatin protein, which are completely unknown at this time. While myostatin blockers hold promise for those with serious diseases like muscular dystrophy, they could also be abused by bodybuilders and athletes looking to gain a competitive edge.
One possible concern, according to Dr. Markus Schuelke, the pediatric neurologist at Charite University Medical Center in Berlin who discovered the myostatin mutation in the baby, is that blocking myostatin could interfere with satellite cells that help replace injured or dead muscle cells. It's thought that myostatin helps keep the satellite cells at rest until they're needed, and it's possible that without myostatin the satellite cells could become depleted.
Meanwhile, some say myostatin blockers may be too targeted to boost muscle growth, as there are a variety of proteins similar to myostatin that also limit muscle growth. Another drug company, Acceleron Pharma, is planning to test a drug on humans that reportedly blocks not just myostatin but also many of the other similar proteins.
Myostatin-Blockers Could Become the New "Steroids"
Other companies looking to gain a piece of the myostatin fortune include food producers, who are looking to alter animals such as chickens so they contain more meat, and supplement companies, which are already promoting myostatin-blocking alternatives made from sea algae to body builders and other athletes.
"Myostatin blockade," said Dr. Elizabeth McNally of the University of Chicago, "will probably work its way into professional and amateur athletics, as well as into the ever-growing business of physical enhancement."
Experts say the knock-off supplements currently on the market don't work and could carry unknown health risks, as could the real myostatin-blockers that may one day be available not only to those with serious illnesses but also to those looking to simply "beef up" their physique.
Modafinil & Company: The Promises & Perils of Mind-Altering, World-Changing Drugs Like Modafinil
Drugs with Potentially Psychotic Side Effects: Which Ones are They (& Who Deserves to Know)?
Forbes.com February 26, 2007 | 医学 |
2014-42/1180/en_head.json.gz/23054 | More changes at SJ Hospital
Jul 16, 2014 | 2441 views | 0 | 33 | | The San Juan Health Service District has experienced significant changes in the past six months.In the past week, Dr. Curtis Black completed his obligation and moved his family to a new opportunity in Oregon. In addition, Lyman Duncan was relieved of duties as financial officer of the district.Since December, 2013, the district has seen the loss of three physicians – Drs Black, Paul Reay and Bryce Peterson - and the administrative team of Phil Lowe and Duncan.At the same time, the district has experienced a financial crisis caused, in part, by challenges related to a new electronic medical records program. The district said that despite the financial and employee challenges, the hospital and clinics have full medical coverage.“We have doctors and mid-level full providers in our hospital and clinics every day,” said District CEO Laurie Schafer.Dr. Kelly Jeppesen is currently the only permanent physician in the district, along with two physician’s assistants and a nurse practitioner. Dr. Welker is working Monday through Thursday for the next 3.5 months. Schafer said Dr. Lance Allan and Dr. Peterson provide ER coverage. Other “locum tenens” doctors fill any gaps in coverage.Schafer reports that family practice physician Dr. Catherine Harrington has signed a contract and will begin practicing in San Juan County in November. Dr. Harrington is coming from Texas with a husband and five children. Schafer said Dr. Harrington looks forward to beginning a new practice in San Juan County. Schafer adds that the recruitment of additional physicians is ongoing. The goal is to have two additional family practice physicians, in addition to the administrative team.
SJR Newspaper Rock race is Saturday
Record time, perfect conditions at Newspaper Rock 26K, 10K | 医学 |
2014-42/1180/en_head.json.gz/23123 | Medicine and Science News2013 Archive2012 Archive2011 Archive
Related Topics Michael A. Dyer, PhDMedicine & Science News St. Jude scientist named Howard Hughes Medical Institute investigatorMichael Dyer, Ph.D., of St. Jude Children's Research Hospital, has been recognized as one of the nation’s leading biomedical researchers by the Howard Hughes Medical Institute
Memphis, Tennessee, May 9, 2013
Michael Dyer, Ph.D., a scientist at St. Jude Children's Research Hospital, has been selected as a Howard Hughes Medical Institute (HHMI) investigator. Dyer is one of 27 scientists nationwide chosen for the recognition from among 1,155 applicants. There are approximately 330 HHMI investigators in the United States, and Dyer will become the third of these investigators currently working at St. Jude.
Investigators selected for the program by HHMI are some of the country’s top biomedical researchers, demonstrating creativity, innovative and excellence in their areas of study. Dyer is an expert in the fields of developmental neurobiology, cell cycle regulation, stem cell biology, developmental therapeutics and cancer genetics.
“Dr. Dyer’s research has repeatedly overturned long-held beliefs in science, earning him great respect as a world-class scientist and as an innovator,” said Dr. William E. Evans, St. Jude director and CEO. “Being selected as an HHMI investigator is a great honor for any scientist, and the additional funding it provides will accelerate Dr. Dyer’s research and the impact he is having on the treatment of childhood cancers.”
Dyer’s contributions include a 2007 study that showed brain cells called neurons could still divide. The finding countered a century-old scientific belief that differentiated, or mature, nerve cells could not multiply and make new cells. In 2012, Dyer and his colleagues demonstrated that an unexpected mechanism was responsible for the rapid growth of an eye tumor called retinoblastoma.
Dyer is a member of the St. Jude Developmental Neurobiology department and co-leader of the Developmental Therapeutics for Solid Malignancies Program. He is also an investigator with the St. Jude Children’s Research Hospital-Washington University Pediatric Cancer Genome Project, an effort to decode the genomes of childhood cancer patients and identify the genetic missteps that lead to disease.
Through the HHMI Investigator Program, scientists are provided salary, benefits and a research budget during their initial five-year appointment. The initiative represents an investment in basic biomedical research of approximately $150 million. This year’s groups of investigators hail from 19 institutions and represent a variety of scientific disciplines.
Dyer joined the St. Jude faculty in 2002 and quickly emerged as a leader in the study of retinoblastoma. He has received numerous honors and awards, including the 2008 Cogan Award from the Association for Research in Vision and Ophthalmology, a Career Development Award from Research to Prevent Blindness, as well as that organization’s Lew R. Wasserman Merit Award. Dyer was also selected as a Pew Scholar in the Biomedical Sciences and was named an HHMI Early Career Scientist. He received his doctoral degree in molecular and cellular biology from Harvard University and completed his postdoctoral training at Harvard Medical School.
Dyer joins St. Jude researchers Charles Sherr, M.D., Ph.D., and Brenda Schulman, Ph.D., in holding HHMI investigator designations. The new HHMI investigators begin their appointments in September 2013.
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2014-42/1180/en_head.json.gz/23270 | download the newsletter At least one-third of people with drinking problems and about half of all people with drug addictions also battle mental illness. The realization that so many individuals experience co-occurring disorders — referred to as a dual diagnosis — has led to numerous studies illuminating the most effective approaches to treatment.
The UCLA Dual Diagnosis Program specializes in treating people with addiction who have also been diagnosed with a mental illness, which may include a depressive disorder, anxiety disorder, bipolar disorder, post-traumatic stress disorder, or attention deficit hyperactivity disorder. The intensive outpatient program offers evidence-based, comprehensive treatment that can significantly improve the prospects for successful recovery from alcoholism or drug addiction.
Research supports addressing both disorders simultaneously
The treatment of underlying mental-health problems among people with substance-use disorders is now considered critical to recovery. Conventional treatment programs, such as those based on a 12-step philosophy, have typically focused only on the addiction. This approach stems in part from the lack of involvement of medical professionals in such programs and the belief — now outdated — that mental-health issues should be addressed only after a substance-use problem has been brought under control.
That paradigm has changed. Research has demonstrated that untreated mental-health conditions can adversely impact the outcome of addiction treatment. Studies show that people with mental illness who have achieved short-term sobriety may be more likely to relapse if they continue to experience the dysphoric symptoms associated with depression or anxiety. These findings support the inclusion of medical doctors in the treatment of addiction and co-occurring disorders.
Intensive outpatient treatment
At UCLA’s Dual Diagnosis Program, individuals receive an initial 70-minute diagnostic assessment with a board-certified psychiatrist. This careful diagnostic assessment may be particularly useful to primary care physicians who have questions regarding the role of substance abuse in a patient’s particular medical condition.
Individuals enrolled in the Dual Diagnosis Program receive eight weeks of outpatient care that addresses both conditions. The services include:
Life Skills Course group therapy from 6 pm to 8 pm, Monday through Friday
Weekly individual therapy sessions
Weekly Q&A sessions for patients and family members or friends
Twice-monthly sessions with a psychiatrist
With conveniently scheduled evening sessions, most patients are able to continue meeting their work, school and family obligations. The eight-week program can be repeated in accordance with the patient’s wishes and professional recommendations. Most insurance plans provide some level of coverage.
Expert management of medications
Treatment consists of both individual and group counseling as well as medication prescribed by physicians with expertise in addiction medicine. The physicians at UCLA’s Dual Diagnosis Program have professional training in prescribing psychotropic medications in a safe and effective manner. Group therapy sessions combine patients who share common characteristics, such as drug addiction and an anxiety disorder or alcoholism and depression.
Individuals who complete treatment in the Dual Diagnosis Program emerge with an improved understanding of the roots of the substance-use disorder and better tools to manage the vulnerabilities that could lead to relapse. Treatment of the underlying mental-health disorder enhances the patient’s return to a healthy and productive life.
Helping to understand interrelated conditions
Separating a substance-use disorder from another psychiatric disorder can be challenging, says Jason E. Schiffman, MD, director of the Dual Diagnosis Program.
“One of the main services we’re providing is to help primary care physicians who wonder whether a patient’s substance use is contributing to whatever pathology they’re treating,” he says. “They can refer the patient to us, and we’ll have a psychiatrist do a thorough assessment to try to tease apart what is actually going on.”
The presence of an underlying mental-health disorder may be the cause of failed attempts at sobriety. Simultaneous treatment of both conditions can increase the chances for long-term recovery, he says.
“Given that mental-health conditions are so prevalent among people with substance-use disorders, there really is a need for trained and qualified physicians to be able to assess patients and provide appropriate treatments for these mental health conditions — treatments that are not going to interfere with the addiction treatment,” says Dr. Schiffman.
Participating Physicians
Jason E. Schiffman, MD, MBAAssociate PhysicianDirector, UCLA Dual Diagnosis Program
Dana Harris, MDAssociate Physician
Margaret Haglund, MDAssociate Physician
For appointments: (310) 983-35981640 S. Sepulveda Blvd., Suite 120Los Angeles, CA. 90025www.semel.ucla.edu/dual-diagnosis-program
Next: UCLA Offers Eating Disorders Program for Adults | 医学 |
2014-42/1180/en_head.json.gz/23388 | Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak - Update 13
China joins WHO collaborative network
Disease Outbreak Reported 28 March 2003
At a press briefing held today in Beijing, the head of the WHO investigative team in China, John MacKenzie of Australia, announced several steps forward in the government’s commitment to join international efforts to contain a newly emerging infectious disease. (see Severe Acute Respiratory Syndrome - Press briefing, Beijing, China)
The WHO team of five experts arrived in Beijing last Sunday to investigate an outbreak of atypical pneumonia that began in Guangdong Province on 16 November 2002.
Experts have strongly suspected a link between the southern China outbreak and current cases of severe acute respiratory syndrome (SARS) that first surfaced in mid-February in Asia. The disease has since spread to 13 countries on three continents.
The WHO investigation is being conducted in collaboration with the Chinese Ministry of Health, the Chinese Centers for Disease Control, and officials from Guangdong Province.
In the initial stage of the investigation, the WHO team compared case definitions used in China with those used by WHO to identify SARS and concluded that most cases of atypical pneumonia reported in China from mid-November until 28 February were “indeed cases of SARS.”
As reported by the WHO team, Chinese authorities have now agreed to join the WHO collaborative effort to contain the SARS outbreak and prevent its further international spread. Chinese institutes will be selected within days to participate in three global electronic networks set up by WHO to facilitate rapid international collaboration on SARS-related scientific and medical problems. Networks of experts are working to further identify and characterize the SARS virus, develop better tools for diagnosis and management, and understand how the disease is transmitted and what works best to prevent its spread.
WHO authorities have also been given access to meticulous records kept on Chinese SARS cases. As China, according to statistics released earlier this week, has experienced the largest number of SARS cases of any country in the world, these data are expected to take understanding of the new disease, and particularly its origins, a major step forward.
One of the greatest challenges in containing new diseases is the lack of understanding of their behaviour as they emerge. The Chinese data, which also cover the longest time frame, are further expected to improve understanding of how the disease spreads from person to person and why some outbreaks appear to have much milder cases than others.
Progress in identifying the causative agent, now being reported by members in a WHO global network of collaborating laboratories, indicates that the causative agent is a new virus in humans that may have jumped the species barrier from its animal host or mutated in ways that have given it more lethal properties. Chinese data may help solve the riddle of how the new virus first began to cause disease in humans.
China released new figures on the Guangdong outbreak on Wednesday, significantly increasing the global cumulative total. On Thursday, officials issued the first reports of cases and deaths in ongoing outbreaks in Beijing province and in the northern province of Shanxi.
China has further agreed today to begin providing up-to-date electronic reports of SARS cases throughout China. These reports will be submitted electronically as official reports to WHO from the Ministry of Health.
According to members of the WHO team in China, the government may need a few days to get the new nationwide system of daily electronic reports in operation.
Update on cases and countries As of today, a cumulative total of 1485 cases and 53 deaths have been reported from 13 countries. This represents an increase of 77 cases. No new deaths have occurred.
No reports were received from China today due to the decision to introduce a new system of nationwide daily electronic reporting to WHO.
With 58 new cases, Hong Kong Special Administrative Region of China remains the most severely affected area. Other countries reporting new cases include Canada (1), China, Taiwan (4), Singapore (8), and the United States of America (6).
Viet Nam reported no new cases and no new deaths for the fifth day in a row. WHO experts believe that rapid detection of the outbreak and immediate introduction of stringent infection control procedures may have held further transmission at bay.
Some patients recovering To date, 19 SARS patients have been discharged from hospitals in Hong Kong, 17 from Viet Nam, and 25 from Singapore. | 医学 |
2014-42/1180/en_head.json.gz/23461 | Mood-Altering Medications Not Overused in Teens 12/03/2012 01:01 PM
Mood-Altering Medications Not Overused in Teens By Associated Press
Mood-Altering Medications Not Overused in Teens WebMD Health News By Brenda Goodman, MA Reviewed by Louise Chang, MD More from WebMD Concussions: Teen’s Tragedy Spurs Policy Change Group Calls for...
Mood-Altering Medications Not Overused in TeensWebMD Health News
Brenda Goodman, MA
Concussions: Teen’s Tragedy Spurs Policy ChangeGroup Calls for Tanning Salon Ban for TeensSexual Harassment a Hurdle for Teen GirlsSurvey: Teens Driving Distracted, FastDec. 3, 2012 -- Most teens with mental illnesses don’t take medications for their conditions, a new survey finds.The study contradicts reports of widespread and indiscriminate pill-popping in high schoolers. If anything, researchers say, many kids may not be getting enough help for real problems that are affecting their lives.“The one thing that we heard over and over when we started this study was that parents are getting their kids prescriptions for stimulants so they can do better on the SATs,” says researcher Kathleen Merikangas, PhD, chief of the genetic epidemiology branch in the intramural research program at the National Institute of Mental Health in Bethesda, Md.But researchers, who questioned teens for the study, say they found no evidence of that trend.“I was surprised that the rates were as low as they were. I thought the frequency of medication use was lower than we would have expected," Merikangas says.She points out that not treating mental health problems in teens can often lead to serious problems. They include failing grades, disruptive or criminal behavior, substance abuse, and suicide.“As a society, we need to think about access to care before all of these bad outcomes occur,” Merikangas says.Psychiatric Medications in TeensPrevious studies have relied on insurance claims to estimate rates of medication use in children and teens. Those studies have found sharp rises with psychiatrists prescribing to kids, especially poor children.One 2006 study found that prescriptions of psychotropic drugs written to teens had shot up 250% between 1994 and 2001. It’s not always clear from claims data why the drugs are prescribed or even if they’re taken.The new study, published in the Archives of Pediatric and Adolescent Medicine, took a different approach.Researchers surveyed more than 10,000 teens in the U.S. who were between the ages of 13 and 18. The teens were carefully selected to reflect the makeup of the general population.Researchers interviewed the teens at home and asked about any symptoms of mental problems in the past year that had been severe enough to affect their day-to-day functioning. When they reported taking medications, researchers had them produce the pill bottle so they could write down the drug name.About half the teens in the study met the criteria for a mental disorder, and 22% were classified as being severely affected by their problems.Despite that, only 14.1% of kids had taken any kind of psychotropic drug. The highest rates of medication use were in kids who met the criteria for attention deficit hyperactivity disorder (ADHD). Nearly 1 in 3 kids with ADHD reported taking a psychotropic medication. About 1 in 5 had been prescribed stimulants to help manage their condition.In contrast, teens who were anxious, depressed, or bipolar were less likely to be prescribed a drug that could help. About 11% of teens diagnosed with an anxiety disorder were prescribed medications. About 20% of kids with depression or bipolar disorder were taking a mood-altering medication.The study also found that the majority of kids who had been prescribed a psychotropic drug had a mental disorder severe enough to disrupt their day-to-day lives.Many Kids Need Better Mental Health Care“Not only were they not overprescribed, one could say that this group was inadequately treated,” says Victor Fornari, MD, director of the division of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y.Fornari, who wasn’t involved in the research, praised the study for its careful methods. He says it reflects attitudes he often sees in his own practice.“There’s enormous resistance. Many families, maybe 50%, refuse treatment, even when they are told their child has a psychiatric disorder,” Fornari tells WebMD.Health coverage may be another factor behind the lower-than-expected rates of medication use seen in teens.In an editorial on the study, David Rubin, MD, a pediatrician at the Children’s Hospital of Philadelphia, points out that many middle-class families simply can’t afford mental health care. These teens are often covered on their parents’ private insurance plans, which rarely cover mental health visits.“The take-home message is that as a country it should bother us that many children do not have access to the appropriate services they need, and that rates of medication use (whether high or low) are really a symptom of a mental health system that does not meet the standard of what any parent -- whether rich or poor -- would hope for their children if they were in crisis,” Rubin says.SOURCES:Merikangas, K. Archives of Pediatric and Adolescent Medicine, Dec. 4, 2012.Rubin, D. Archives of Pediatric and Adolescent Medicine, Dec. 4, 2012.Kathleen Merikangas, PhD, chief, Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Md.Victor Fornari, MD, Director, Division of Child/Adolescent Psychiatry, North Shore-LIJ Health System, New Hyde Park, N.Y.David Rubin, MD, associate professor, pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Penn.© 2012 WebMD, LLC. All rights reserved. | 医学 |
2014-42/1180/en_head.json.gz/23472 | HEALTHDAY - ALLERGY RESPIRATORY Jan 28, 2014 5:00 PM by Randy Dotinga
Premature Birth Linked to Asthma, Wheezing in Childhood
TUESDAY, Jan. 28, 2014 (HealthDay News) -- A new analysis of existing research suggests that premature babies face a higher risk of developing asthma and wheezing disorders when they're older. Researchers from Harvard Medical School, the Maastricht University Medical Center in the Netherlands and the University of Edinburgh in Scotland examined 30 studies that included about 1.5 million children. They found that premature children (born before 37 weeks of gestation) were 46 percent more likely to develop asthma or wheezing problems than kids who weren't born prematurely. Full-term birth is generally considered about 40 weeks' gestation. Very premature children (those born before 32 weeks' gestation) faced an even higher estimated risk -- almost three times that of children born at full term, said Jasper Been, from Maastricht University, and his colleagues. About 11 percent of children are born prematurely, the study authors said in the report, which was published in the Jan. 28 online edition of the journal PLoS Medicine. "The current findings do not support prior suggestions that the association between preterm birth and wheezing disorders becomes less prominent with increasing age," the researchers wrote in the report. "Instead, the strength of the association was similar across age groups [up to 18 years]," which suggests that the effects of preterm birth on the lungs tend to have life-long consequences. Although the study found an association between premature birth and respiratory problems such as asthma later in life, it did not prove a cause-and-effect relationship. More information For more about premature birth, visit the U.S. National Library of Medicine. »Comments Top Videos | 医学 |
2014-42/1180/en_head.json.gz/23488 | Pharmacists on 'Front Line' To Promote Medication Adherence
Posted on 2011-12-07 by Mary Wimberley (205) 726-2922 As many as 3 out of 4 Americans may not always take their medications as directed, say leaders of Script Your Future, a nationwide campaign to address the problem.
Alabama Governor Robert Bentley joined a chorus of health care and community leaders Tuesday, Dec. 6, at the Birmingham launch of the initiative to encourage better medication adherence, especially for patients with chronic conditions such as diabetes, respiratory illness and cardio vascular disease.
According to a study, not taking medication as directed causes nearly 125,000 deaths in the United States each year.
“I want to see Alabama healthy,” said Bentley, a physician who practiced medicine for 35 years before being elected governor in 2010. “We need to make sure that patients take their medication, and take it properly.”
Samford University’s McWhorter School of Pharmacy is one of 25 Alabama-based health care stakeholders, including the State Department of Senior Services, who seek to help patients better adhere to their medication and to help health care workers better communicate with patients.
In addition to doctors, nurses and other health care providers, pharmacists are an important part of the team that can help patients understand the value of proper medication adherence, say campaign leaders.
Community pharmacist Kenny Sanders, treasurer of the Alabama Board of Pharmacy and a member of the Samford pharmacy school's advisory board, said that the financial cost for non-adherence can be high. Estimates range from $100 to $300 billion nationally each year for additional medicines, emergency room visits and hospital admissions that result from poor medication adherence, he said.
“This is a heavy burden for Alabama, and the nation,” said Sanders, adding that pharmacists are uniquely prepared to help patients take medications properly. “We are trained in school to do this, we are committed to it, and we preach it,” said Sanders, an adjunct pharmacy professor at Samford. He is also a preceptor for pharmacy students from Samford and Auburn University.
Pharmacists are on the front line of health care, he said. “We talk to patients every day. Our patients know us, and I hope we know them.”
He said he is pleased that students are already active in advancing Script Your Future initiatives, noting that Samford and Auburn students took part in a recent SYF challenge to develop and implement the most effective adherence interventions in their local communities.
Birmingham is part of a nation-wide Script Your Future effort launched earlier this year in Washington, D.C., and is one of only six cities in which the pilot program is being installed. The Birmingham launch event was held at Homewood Pharmacy, where 1998 Samford Pharm.D. graduate Robert Mills is the owner, and 2009 Samford Pharm.D. graduate Alex Sproule is manager.
Script Your Future tools include free text message reminders, sample questions for patients to ask health care practitioners, and other helpful information. The materials can be found on the campaign website: www.ScriptYourFuture.org. | 医学 |
2014-42/1180/en_head.json.gz/23537 | Question: How much does a Licensed Practical Nurse make in Buffalo, NY make per year? Answer: The average salary for licensed practical nurse jobs in New York, NY is $41000.
Licensed practical nurse (LPN) is the term used in much of the United States and most Canadian provinces to refer to a nurse who, according to the Occupational Outlook Handbook of the U.S. Department of Labor, cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians." The term licensed vocational nurse (LVN) is used in the U.S. states of California and Texas.Equivalent professions outside the United States are "registered practical nurse" (RPNs) in the Canadian province of Ontario, "enrolled nurses" (ENs) or "Division 2 nurses" in Australia and New Zealand, and "state enrolled nurses" (SENs) in the United Kingdom.A nurse's postnominal (listed after the name) credentials usually follow his or her name in this order:Generally credentials are listed from most to least permanent. A degree, once earned, cannot, in normal circumstances, be taken away. State licensure is only revoked for serious professional misconduct. Certifications generally must be periodically renewed by examination or the completion of a prescribed number of continuing education units (CEUs). Health The geography of New York State varies widely. While the state is best known for New York City's urban atmosphere, especially Manhattan's skyscrapers, most of the state is dominated by farms, forests, rivers, mountains, and lakes. New York's Adirondack Park is larger than any U.S. National Park in the contiguous United States. Niagara Falls, on the Niagara River as it flows from Lake Erie to Lake Ontario, is a popular attraction. The Hudson River begins with Lake Tear of the Clouds and flows south through the eastern part of the state without draining lakes George or Champlain. Lake George empties at its north end into Lake Champlain, whose northern end extends into Canada, where it drains into the Richelieu River and then the St. Lawrence. Four of New York City's five boroughs are on the three islands at the mouth of the Hudson River: Manhattan Island, Staten Island, and Brooklyn and Queens on Long Island."Upstate" is a common term for New York counties north of suburban Westchester, Rockland and Dutchess counties. Upstate New York typically includes Lake George and Oneida Lake in the northeast; and rivers such as the Delaware, Genesee, Mohawk, and Susquehanna. The highest elevation in New York is Mount Marcy in the Adirondacks.New York is a state in the Northeastern region of the United States. New York is the 27th-most extensive, the third-most populous, and the seventh-most densely populated of the 50 United States. New York is bordered by New Jersey and Pennsylvania to the south and by Connecticut, Massachusetts and Vermont to the east. The state has a maritime border with Rhode Island east of Long Island, as well as an international border with the Canadian provinces of Ontario to the west and north, and Quebec to the north. The state of New York is often referred to as New York State, so as to distinguish it from New York City.New York City, with a Census-estimated population of over 8.3 million in 2012, is the most populous city in the United States. Alone, it makes up over 40 percent of the population of New York State. It is known for its status as a center for finance and culture and for its status as the largest gateway for immigration to the United States. New York City attracts considerably more foreign visitors than any other US city. Both the state and city were named for the 17th century Duke of York, future King James II of England. Nursing Buffalo /ˈbʌfəloʊ/ is the second most populous city in the state of New York, after New York City. Located in Western New York on the eastern shores of Lake Erie and at the head of the Niagara River across from Fort Erie, Ontario, Canada, Buffalo is the seat of Erie County and the principal city of the Buffalo-Niagara Falls metropolitan area, the largest in Upstate New York. Buffalo itself has a population of 261,310 (2010 Census) and the Buffalo–Niagara–Cattaraugus Combined Statistical Area is home to 1,215,826 residents.Originating around 1789 as a small trading community near the eponymous Buffalo Creek, Buffalo grew quickly after the opening of the Erie Canal in 1825, with the city as its western terminus. By 1900, Buffalo was the 8th largest city in the United States, and went on to become a major railroad hub, and the largest grain-milling center in the country. The latter part of the 20th century saw a reversal of fortunes: Great Lakes shipping was rerouted by the opening of the St. Lawrence Seaway, and steel mills and other heavy industry relocated to places such as China. With the start of Amtrak in the 1970s, Buffalo Central Terminal was also abandoned, and trains were rerouted to nearby Depew, New York (Buffalo-Depew) and Exchange Street Station. By 1990 the city had fallen back below its 1900 population levels.Travel nursing is a nursing assignment concept that developed in response to the nursing shortage. This industry supplies nurses who travel to work in temporary nursing positions, mostly in hospitals. While travel nursing traditionally refers specifically to the nursing profession, it can also be used as a blanket term to refer to a variety of travel healthcare positions, including physical therapy, occupational therapy, speech-language pathology, and even doctors and dentists.Reasons cited for pursuing travel nursing opportunities include higher pay, professional growth and development, and personal adventure. Travelers typically select from one or more recruitment agencies to act as intermediaries between the traveler and hospitals or other potential employers, but may also work as an Independent Contractor (IC). Agencies may submit applications for numerous positions concurrently on behalf of a traveler. No single agency has access to all travel opportunities.Nurses in the United States can practice nursing in a wide variety of specialties.Registered nurses generally receive their basic preparation through one of five basic avenues: Business Finance USD Buffalo News:
Nurse concerns not a worry, says union"If somebody's acutely ill the licensed practical nurse will come to the registered nurse, who then will make the decisions," said O'Shea. "She does the assessment, and then she makes the critical decisions." But the union representing LPNs takes offence ...
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A guide to paying for care for the elderlyWorking out how much you might have to pay ... if it concludes that continuing care does apply, and the NHS makes that assessment. This is why it is important that the patient awaiting discharge has an advocate to make sure that appropriate care is ...
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NY bill would mandate hospital nurse staffing"What am I to do other than do the best of my ability to work with what we have?" he said. "It's a lot of prioritization. We pretty much get patient and family ... staff including nursing aides and licensed practical nurses, the group said, calling the ...
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Become a Buffalo LPN – LPN Programs, Schools, Salary in ...Buffalo’s LPNs make up 27% of nurses in the city. ... Buffalo LPNs earn an average of $36,420 per year. ... Licensed Practical Nurse.
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2014-42/1180/en_head.json.gz/23683 | Mercy - Des Moines names new president
Mercy Medical Center - Des Moines announced this afternoon that its board of directors has selected Robert P. "Bob" Ritz as the organization's new president.
Ritz, who will begin his duties in early July, currently serves as division president of Hospital Sisters Health System in Springfield, Ill., and as president and CEO of St. John's Hospital in Springfield. He brings 25 years of health care leadership experience and a long list of accomplishments to Central Iowa.
Mercy - Des Moines, an 802-bed acute-care not-for-profit Catholic hospital, is situated on three campuses with a staff of more than 6,600 employees and a medical staff of more than 950 physicians and health professionals. Mercy is part of Catholic Health Initiatives, a national nonprofit health system based in Englewood, Colo.
"I am very pleased to have the opportunity to join the highly respected team of people at Mercy," Ritz said in a release. "Mercy Medical Center - Des Moines is an organization with a great reputation, strong values, and a history and tradition focused on the healing ministry of the Sisters of Mercy." Ritz said he is deeply committed to creating the best possible patient experience as he works with others on the team to improve health care delivery. Ritz will succeed Dave Vellinga as president of Mercy - Des Moines, and will report to Vellinga, who is president and CEO of Mercy Health Network and a member of the Mercy board of directors. Ritz's appointment will allow Vellinga to concentrate his energies on the activities and relationships of Mercy Health Network across Iowa and with national organizations, officials said in a release.
Click here for a related Business Record story about Dave Vellinga.
During the past five years at Hospital Sisters Health System, Ritz helped develop strategic alignments with area hospitals and physician practices, oversaw a $180 million first-phase project to rebuild the hospital's main campus, and helped St. John's navigate through a variety of financial and competitive challenges.
"We are extremely pleased to have a leader with Bob's experience join Mercy," said Mercy board chairman Steve Chapman. "He has demonstrated the ability to continually improve care in a constantly changing environment. He is an exceptional communicator and understands the importance of teamwork in achieving excellence. Most importantly, he clearly has demonstrated throughout his career that his personal values and mission are completely aligned with those of Mercy." | 医学 |
2014-42/1180/en_head.json.gz/23704 | Home » Richard Zoumalan, MD
Richard Zoumalan, MD
Richard A. Zoumalan, MD is a member of the Sinus Center at Cedars-Sinai. He is a facial plastic and reconstructive surgeon, board certified in otolaryngology-head and neck surgery.Dr. Zoumalan’s clinical focus is on rhinoplasty, revision rhinoplasty, aging face surgery and facial reconstruction after trauma and cancer. He has expertise in nasal procedures, which can help people breathe better.Dr. Zoumalan has done extensive research in the field of facial plastic and reconstructive surgery. He has published over 40 research articles and book chapters and he has spoken at dozens of scientific medical conferences including otolaryngology meetings.After earning his bachelor's degree in physiological sciences with honors from the University of California, Los Angeles, Dr. Zoumalan earned his medical degree at Northwestern University School of Medicine. He then completed a general surgery internship at New York University and an otolaryngology-head and neck surgery residency at New York University. He followed this with a fellowship in facial plastic and reconstructive surgery at the University of Washington, sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.
FmRsZGRtZHgHbHgBZGJtZngGZmNheBNkY2RtZGE= | 医学 |
2014-42/1180/en_head.json.gz/23766 | Tablet/Capsule ID Tool Label: OXYCODONE AND ACETAMINOPHEN- oxycodone and acetaminophen tablet Label RSS
NDC Code(s): 35356-817-01,
35356-817-20,
Packager: Lake Erie Medical DBA Quality Care Products LLC
This is a repackaged label.
Source NDC Code(s): 53746-203
DEA Schedule: CII
Rx Only Close
Each tablet for oral administration contains: Oxycodone Hydrochloride, USP……………. 5 mg* Acetaminophen, USP………………………325 mg *5 mg oxycodone HCl is equivalent to 4.4815 mg of oxycodone. Oxycodone and Acetaminophen Tablets, USP also contain the following inactive ingredients: colloidal silicon dioxide, crospovidone, magnesium stearate, microcrystalline cellulose, povidone, pregelatinized starch and stearic acid. Oxycodone, 14-hydroxydihydrocodeinone, is a semisynthetic opioid analgesic which occurs as a white, odorless, crystalline powder having a saline, bitter taste. The molecular formula for oxycodone hydrochloride is C18H21NO4•HCl and the molecular weight 351.82. It is derived from the opium alkaloid thebaine, and may be represented by the following structural formula: Acetaminophen, 4’-hydroxyacetanilide, is a non-opiate, non-salicylate analgesic and antipyretic which occurs as a white, odorless, crystalline powder, possessing a slightly bitter taste. The molecular formula for acetaminophen is C8H9NO2 and the molecular weight is 151.16. It may be represented by the following structural formula: Close
Central Nervous System Oxycodone is a semisynthetic pure opioid agonist whose principal therapeutic action is analgesia. Other pharmacological effects of oxycodone include anxiolysis, euphoria and feelings of relaxation. These effects are mediated by receptors (notably μ and k) in the central nervous system for endogenous opioid-like compounds such as endorphins and enkephalins. Oxycodone produces respiratory depression through direct activity at respiratory centers in the brain stem and depresses the cough reflex by direct effect on the center of the medulla. Acetaminophen is a non-opiate, non-salicylate analgesic and antipyretic. The site and mechanism for the analgesic effect of acetaminophen has not been determined. The antipyretic effect of acetaminophen is accomplished through the inhibition of endogenous pyrogen action on the hypothalamic heat-regulating centers. Gastrointestinal Tract and Other Smooth Muscle Oxycodone reduces motility by increasing smooth muscle tone in the stomach and duodenum. In the small intestine, digestion of food is delayed by decreases in propulsive contractions. Other opioid effects include contraction of biliary tract smooth muscle, spasm of the Sphincter of Oddi, increased ureteral and bladder sphincter tone, and a reduction in uterine tone. Cardiovascular System Oxycodone may produce a release of histamine and may be associated with orthostatic hypotension, and other symptoms, such as pruritus, flushing, red eyes, and sweating. Pharmacokinetics Absorption and Distribution The mean absolute oral bioavailability of oxycodone in cancer patients was reported to be about 87%. Oxycodone has been shown to be 45% bound to human plasma proteins in vitro. The volume of distribution after intravenous administration is 211.9 ±186.6 L. Absorption of acetaminophen is rapid and almost complete from the GI tract after oral administration. With overdosage, absorption is complete in 4 hours. Acetaminophen is relatively uniformly distributed throughout most body fluids. Binding of the drug to plasma proteins is variable; only 20% to 50% may be bound at the concentrations encountered during acute intoxication. Metabolism and Elimination A high portion of oxycodone is N-dealkylated to noroxycodone during first-pass metabolism. Oxymorphone, is formed by the O-demethylation of oxycodone. The metabolism of oxycodone to oxymorphone is catalyzed by CYP2D6. Free and conjugated noroxycodone, free and conjugated oxycodone, and oxymorphone are excreted in human urine following a single oral dose of oxycodone. Approximately 8% to 14% of the dose is excreted as free oxycodone over 24 hours after administration. Following a single, oral dose of oxycodone, the mean ± SD elimination half-life is 3.51 ± 1.43 hours. Acetaminophen is metabolized in the liver via cytochrome P450 microsomal enzyme. About 80-85% of the acetaminophen in the body is conjugated principally with glucuronic acid and to a lesser extent with sulfuric acid and cysteine. After hepatic conjugation, 90 to 100% of the drug is recovered in the urine with in the first day. About 4% of acetaminophen is metabolized via cytochrome P450 oxidase to a toxic metabolite which is further detoxified by conjugation with glutathione, present in a fixed amount. It is believed that the toxic metabolite NAPQI (N acetyl-p-benzoquinoneimine, N-acetylimidoquinone) is responsible for liver necrosis. High doses of acetaminophen may deplete the glutathione stores so that inactivation of the toxic metabolite is decreased. At high doses, the capacity of metabolic pathways for conjugation with glucuronic acid and sulfuric acid may be exceeded, resulting in increased metabolism of acetaminophen by alternate pathways. Close
Oxycodone and Acetaminophen Tablets, USP are indicated for the relief of moderate to moderately severe pain. Close
Oxycodone and acetaminophen tablets should not be administered to patients with known hypersensitivity to oxycodone, acetaminophen, or any other component of this product. Oxycodone is contraindicated in any situation where opioids are contraindicated including patients with significant respiratory depression (in unmonitored settings or the absence of resuscitative equipment) and patients with acute or severe bronchial asthma or hypercarbia. Oxycodone is contraindicated in the setting of suspected or known paralytic ileus. Close
Misuse, Abuse and Diversion of Opioids Oxycodone is an opioid agonist of the morphine-type. Such drugs are sought by drug abusers and people with addiction disorders and are subject to criminal diversion. Oxycodone can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing oxycodone and acetaminophen tablets in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion. Concerns about misuse, addiction, and diversion should not prevent the proper management of pain. Healthcare professionals should contact their State Professional Licensing Board or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product. Administration of oxycodone and acetaminophen tablets should be closely monitored for the following potentially serious adverse reactions and complications: Respiratory Depression Respiratory depression is a hazard with the use of oxycodone, one of the active ingredients in oxycodone and acetaminophen tablets, as with all opioid agonists. Elderly and debilitated patients are at particular risk for respiratory depression as are non-tolerant patients given large initial doses of oxycodone or when oxycodone is given in conjunction with other agents that depress respiration. Oxycodone should be used with extreme caution in patients with acute asthma, chronic obstructive pulmonary disorder (COPD), cor pulmonale, or pre-existing respiratory impairment. In such patients, even usual therapeutic doses of oxycodone may decrease respiratory drive to the point of apnea. In these patients alternative non-opioid analgesics should be considered, and opioids should be employed only under careful medical supervision at the lowest effective dose. In case of respiratory depression, a reversal agent such as naloxone hydrochloride may be utilized (see OVERDOSAGE). Head Injury and Increased Intracranial Pressure The respiratory depressant effects of opioids include carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure, and may be markedly exaggerated in the presence of head injury, other intracranial lesions or a pre-existing increase in intracranial pressure. Oxycodone produces effects on pupillary response and consciousness which may obscure neurologic signs of worsening in patients with head injuries. Hypotensive Effect Oxycodone may cause severe hypotension particularly in individuals whose ability to maintain blood pressure has been compromised by a depleted blood volume, or after concurrent administration with drugs which compromise vasomotor tone such as phenothiazines. Oxycodone, like all opioid analgesics of the morphine-type, should be administered with caution to patients in circulatory shock, since vasodilation produced by the drug may further reduce cardiac output and blood pressure. Oxycodone may produce orthostatic hypotension in ambulatory patients. Hepatotoxicity Precaution should be taken in patients with liver disease. Hepatotoxicity and severe hepatic failure occurred in chronic alcoholics following therapeutic doses. Close
General Opioid analgesics should be used with caution when combined with CNS depressant drugs, and should be reserved for cases where the benefits of opioid analgesia outweigh the known risks of respiratory depression, altered mental state, and postural hypotension. Acute Abdominal Conditions The administration of oxycodone and acetaminophen tablets or other opioids may obscure the diagnosis or clinical course in patients with acute abdominal conditions. Oxycodone and acetaminophen tablets should be given with caution to patients with CNS depression, elderly or debilitated patients, patients with severe impairment of hepatic, pulmonary, or renal function, hypothyroidism, Addison’s disease, prostatic hypertrophy, urethral stricture, acute alcoholism, delirium tremens, kyphoscoliosis with respiratory depression, myxedema, and toxic psychosis. Oxycodone and acetaminophen tablets may obscure the diagnosis or clinical course in patients with acute abdominal conditions. Oxycodone may aggravate convulsions in patients with convulsive disorders, and all opioids may induce or aggravate seizures in some clinical settings. Following administration of oxycodone and acetaminophen tablets, anaphylactic reactions have been reported in patients with a known hypersensitivity to codeine, a compound with a structure similar to morphine and oxycodone. The frequency of this possible cross-sensitivity is unknown. Interactions with Other CNS Depressants Patients receiving other opioid analgesics, general anesthetics, phenothiazines, other tranquilizers, centrally-acting anti-emetics, sedative-hypnotics or other CNS depressants (including alcohol) concomitantly with oxycodone and acetaminophen tablets may exhibit an additive CNS depression. When such combined therapy is contemplated, the dose of one or both agents should be reduced. Interactions with Mixed Agonist/Antagonist Opioid Analgesics Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, and butorphanol) should be administered with caution to a patient who has received or is receiving a course of therapy with a pure opioid agonist analgesic such as oxycodone. In this situation, mixed agonist/antagonist analgesics may reduce the analgesic effect of oxycodone and/or may precipitate withdrawal symptoms in these patients. Ambulatory Surgery and Postoperative Use Oxycodone and other morphine-like opioids have been shown to decrease bowel motility. Ileus is a common postoperative complication, especially after intra-abdominal surgery with use of opioid analgesia. Caution should be taken to monitor for decreased bowel motility in postoperative patients receiving opioids. Standard supportive therapy should be implemented. Use in Pancreatic/Biliary Tract Disease Oxycodone may cause spasm of the Sphincter of Oddi and should be used with caution in patients with biliary tract disease, including acute pancreatitis. Opioids like oxycodone may cause increases in the serum amylase level. Tolerance and Physical Dependence Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is manifested by withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and tolerance are not unusual during chronic opioid therapy. The opioid abstinence or withdrawal syndrome is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other symptoms also may develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate. In general, opioids should not be abruptly discontinued (see DOSAGE AND ADMINISTRATION: Cessation of Therapy). Information for Patients/Caregivers The following information should be provided to patients receiving oxycodone and acetaminophen tablets by their physician, nurse, pharmacist, or caregiver: 1. Patients should be aware that oxycodone and acetaminophen tablets contain oxycodone, which is a morphine-like substance. 2. Patients should be instructed to keep oxycodone and acetaminophen tablets in a secure place out of the reach of children. In the case of accidental ingestions, emergency medical care should be sought immediately. 3. When oxycodone and acetaminophen tablets are no longer needed, the unused tablets should be destroyed by flushing down the toilet. 4. Patients should be advised not to adjust the medication dose themselves. Instead, they must consult with their prescribing physician. 5. Patients should be advised that oxycodone and acetaminophen tablets may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating heavy machinery). 6. Patients should not combine oxycodone and acetaminophen tablets with alcohol, opioid analgesics, tranquilizers, sedatives, or other CNS depressants unless under the recommendation and guidance of a physician. When co-administered with another CNS depressant, oxycodone and acetaminophen tablets can cause dangerous additive central nervous system or respiratory depression, which can result in serious injury or death. 7. The safe use of oxycodone and acetaminophen tablets during pregnancy has not been established; thus, women who are planning to become pregnant or are pregnant should consult with their physician before taking oxycodone and acetaminophen tablets. 8. Nursing mothers should consult with their physicians about whether to discontinue nursing or discontinue oxycodone and acetaminophen tablets because of the potential for serious adverse reactions to nursing infants. 9. Patients who are treated with oxycodone and acetaminophen tablets for more than a few weeks should be advised not to abruptly discontinue the medication. Patients should consult with their physician for a gradual discontinuation dose schedule to taper off the medication. 10. Patients should be advised that oxycodone and acetaminophen tablets are a potential drug of abuse. They should protect it from theft, and it should never be given to anyone other than the individual for whom it was prescribed. Laboratory Tests Although oxycodone may cross-react with some drug urine tests, no available studies were found which determined the duration of detectability of oxycodone in urine drug screens. However, based on pharmacokinetic data, the approximate duration of detectability for a single dose of oxycodone is roughly estimated to be one to two days following drug exposure. Urine testing for opiates may be performed to determine illicit drug use and for medical reasons such as evaluation of patients with altered states of consciousness or monitoring efficacy of drug rehabilitation efforts. The preliminary identification of opiates in urine involves the use of an immunoassay screening and thin-layer chromatography (TLC). Gas chromatography/mass spectrometry (GC/MS) may be utilized as a third-stage identification step in the medical investigational sequence for opiate testing after immunoassay and TLC. The identities of 6-keto opiates (e.g., oxycodone) can further be differentiated by the analysis of their methoximetrimethylsilyl (MO-TMS) derivative. Drug/Drug Interactions with Oxycodone Opioid analgesics may enhance the neuromuscular-blocking action of skeletal muscle relaxants and produce an increase in the degree of respiratory depression. Patients receiving CNS depressants such as other opioid analgesics, general anesthetics, phenothiazines, other tranquilizers, centrally-acting anti-emetics, sedative-hypnotics or other CNS depressants (including alcohol) concomitantly with oxycodone and acetaminophen tablets may exhibit an additive CNS depression. When such combined therapy is contemplated, the dose of one or both agents should be reduced. The concurrent use of anticholinergics with opioids may produce paralytic ileus. Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, naltrexone, and butorphanol) should be administered with caution to a patient who has received or is receiving a pure opioid agonist such as oxycodone. These agonist/antagonist analgesics may reduce the analgesic effect of oxycodone or may precipitate withdrawal symptoms. Drug/Drug Interactions with Acetaminophen Alcohol, ethyl: Hepatotoxicity has occurred in chronic alcoholics following various dose levels (moderate to excessive) of acetaminophen. Anticholinergics: The onset of acetaminophen effect may be delayed or decreased slightly, but the ultimate pharmacological effect is not significantly affected by anticholinergics. Oral Contraceptives: Increase in glucuronidation resulting in increased plasma clearance and a decreased half-life of acetaminophen. Charcoal (activated): Reduces acetaminophen absorption when administered as soon as possible after overdose. Beta Blockers (Propanolol): Propranolol appears to inhibit the enzyme systems responsible for the glucuronidation and oxidation of acetaminophen. Therefore, the pharmacologic effects of acetaminophen may be increased. Loop diuretics: The effects of the loop diuretic may be decreased because acetaminophen may decrease renal prostaglandin excretion and decrease plasma renin activity. Lamotrigine: Serum lamotrigine concentrations may be reduced, producing a decrease in therapeutic effects. Probenecid: Probenecid may increase the therapeutic effectiveness of acetaminophen slightly. Zidovudine: The pharmacologic effects of zidovudine may be decreased because of enhanced nonhepatic or renal clearance of zidovudine. Drug/Laboratory Test Interactions Depending on the sensitivity/specificity and the test methodology, the individual components of oxycodone and acetaminophen tablets may cross-react with assays used in the preliminary detection of cocaine (primary urinary metabolite, benzoylecgonine) or marijuana (cannabinoids) in human urine. A more specific alternate chemical method must be used in order to obtain a confirmed analytical result. The preferred confirmatory method is gas chromatography/mass spectrometry (GC/MS). Moreover, clinical considerations and professional judgment should be applied to any drug-of-abuse test result, particularly when preliminary positive results are used. Acetaminophen may interfere with home blood glucose measurement systems; decreases of > 20% in mean glucose values may be noted. This effect appears to be drug, concentration and system dependent. Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis: Animal studies to evaluate the carcinogenic potential of oxycodone and acetaminophen have not been performed. Mutagenesis: The combination of oxycodone and acetaminophen has not been evaluated for mutagenicity. Oxycodone alone was negative in a bacterial reverse mutation assay (Ames), an in vitro chromosome aberration assay with human lymphocytes without metabolic activation and an in vivo mouse micronucleus assay. Oxycodone was clastogenic in the human lymphocyte chromosomal assay in the presence of metabolic activation and in the mouse lymphoma assay with or without metabolic activation. Fertility: Animal studies to evaluate the effects of oxycodone on fertility have not been performed. Pregnancy Teratogenic Effects Pregnancy Category C: Animal reproductive studies have not been conducted with oxycodone and acetaminophen. It is also not known whether oxycodone and acetaminophen can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Oxycodone and acetaminophen should not be given to a pregnant woman unless in the judgment of the physician, the potential benefits outweigh the possible hazards. Nonteratogenic Effects: Opioids can cross the placental barrier and have the potential to cause neonatal respiratory depression. Opioid use during pregnancy may result in a physically drug-dependent fetus. After birth, the neonate may suffer severe withdrawal symptoms. Labor and Delivery Oxycodone and acetaminophen tablets are not recommended for use in women during and immediately prior to labor and delivery due to its potential effects on respiratory function in the newborn. Nursing Mothers Ordinarily, nursing should not be undertaken while a patient is receiving oxycodone and acetaminophen tablets because of the possibility of sedation and/or respiratory depression in the infant. Oxycodone is excreted in breast milk in low concentrations, and there have been rare reports of somnolence and lethargy in babies of nursing mothers taking an oxycodone/acetaminophen product. Acetaminophen is also excreted in breast milk in low concentrations. Pediatric Use Safety and effectiveness in pediatric patients have not been established. Geriatric Use Special precaution should be given when determining the dosing amount and frequency of oxycodone and acetaminophen tablets for geriatric patients, since clearance of oxycodone may be slightly reduced in this patient population when compared to younger patients. Hepatic Impairment In a pharmacokinetic study of oxycodone in patients with end-stage liver disease, oxycodone plasma clearance decreased and the elimination half-life increased. Care should be exercised when oxycodone is used in patients with hepatic impairment. Renal Impairment In a study of patients with end stage renal impairment, mean elimination half-life was prolonged in uremic patients due to increased volume of distribution and reduced clearance. Oxycodone should be used with caution in patients with renal impairment. Close
Serious adverse reactions that may be associated with oxycodone and acetaminophen tablet use include respiratory depression, apnea, respiratory arrest, circulatory depression, hypotension, and shock (see OVERDOSAGE). The most frequently observed non-serious adverse reactions include lightheadedness, dizziness, drowsiness or sedation, nausea, and vomiting. These effects seem to be more prominent in ambulatory than in nonambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down. Other adverse reactions include euphoria, dysphoria, constipation, and pruritus. Hypersensitivity reactions may include: Skin eruptions, urticarial, erythematous skin reactions. Hematologic reactions may include: Thrombocytopenia, neutropenia, pancytopenia, hemolytic anemia. Rare cases of agranulocytosis has likewise been associated with acetaminophen use. In high doses, the most serious adverse effect is a dose-dependent, potentially fatal hepatic necrosis. Renal tubular necrosis and hypoglycemic coma also may occur. Other adverse reactions obtained from postmarketing experiences with oxycodone and acetaminophen tablets are listed by organ system and in decreasing order of severity and/or frequency as follows: Body as a Whole: Anaphylactoid reaction, allergic reaction, malaise, asthenia, fatigue, chest pain, fever, hypothermia, thirst, headache, increased sweating, accidental overdose, nonaccidental overdose Cardiovascular: Hypotension, hypertension, tachycardia, orthostatic hypotension, bradycardia, palpitations, dysrhythmias Central and Peripheral Nervous System: Stupor, tremor, paraesthesia, hypoaesthesia, lethargy, seizures, anxiety, mental impairment, agitation, cerebral edema, confusion, dizziness Fluid and Electrolyte: Dehydration, hyperkalemia, metabolic acidosis, respiratory alkalosis Gastrointestinal: Dyspepsia, taste disturbances, abdominal pain, abdominal distention, sweating increased, diarrhea, dry mouth, flatulence, gastro-intestinal disorder, nausea, vomiting, pancreatitis, intestinal obstruction, ileus Hepatic: Transient elevations of hepatic enzymes, increase in bilirubin, hepatitis, hepatic failure, jaundice, hepatotoxicity, hepatic disorder Hearing and Vestibular: Hearing loss, tinnitus Hematologic: Thrombocytopenia Hypersensitivity: Acute anaphylaxis, angioedema, asthma, bronchospasm, laryngeal edema, urticaria, anaphylactoid reaction Metabolic and Nutritional: Hypoglycemia, hyperglycemia, acidosis, alkalosis Musculoskeletal: Myalgia, rhabdomyolysis Ocular: Miosis, visual disturbances, red eye Psychiatric: Drug dependence, drug abuse, insomnia, confusion, anxiety, agitation, depressed level of consciousness, nervousness, hallucination, somnolence, depression, suicide Respiratory System: Bronchospasm, dyspnea, hyperpnea, pulmonary edema, tachypnea, aspiration, hypoventilation, laryngeal edema Skin and Appendages: Erythema, urticaria, rash, flushing Urogenital: Interstitial nephritis, papillary necrosis, proteinuria, renal insufficiency and failure, urinary retention Close
Oxycodone and acetaminophen tablets are a Schedule II controlled substance. Oxycodone is a mu-agonist opioid with an abuse liability similar to morphine. Oxycodone, like morphine and other opioids used in analgesia, can be abused and is subject to criminal diversion. Drug addiction is defined as an abnormal, compulsive use, use for non-medical purposes of a substance despite physical, psychological, occupational or interpersonal difficulties resulting from such use, and continued use despite harm or risk of harm. Drug addiction is a treatable disease, utilizing a multi-disciplinary approach, but relapse is common. Opioid addiction is relatively rare in patients with chronic pain but may be more common in individuals who have a past history of alcohol or substance abuse or dependence. Pseudoaddiction refers to pain relief seeking behavior of patients whose pain is poorly managed. It is considered an iatrogenic effect of ineffective pain management. The health care provider must assess continuously the psychological and clinical condition of a pain patient in order to distinguish addiction from pseudoaddiction and thus, be able to treat the pain adequately. Physical dependence on a prescribed medication does not signify addiction. Physical dependence involves the occurrence of a withdrawal syndrome when there is sudden reduction or cessation in drug use or if an opiate antagonist is administered. Physical dependence can be detected after a few days of opioid therapy. However, clinically significant physical dependence is only seen after several weeks of relatively high dosage therapy. In this case, abrupt discontinuation of the opioid may result in a withdrawal syndrome. If the discontinuation of opioids is therapeutically indicated, gradual tapering of the drug over a 2-week period will prevent withdrawal symptoms. The severity of the withdrawal syndrome depends primarily on the daily dosage of the opioid, the duration of therapy and medical status of the individual. The withdrawal syndrome of oxycodone is similar to that of morphine. This syndrome is characterized by yawning, anxiety, increased heart rate and blood pressure, restlessness, nervousness, muscle aches, tremor, irritability, chills alternating with hot flashes, salivation, anorexia, severe sneezing, lacrimation, rhinorrhea, dilated pupils, diaphoresis, piloerection, nausea, vomiting, abdominal cramps, diarrhea and insomnia, and pronounced weakness and depression. “Drug-seeking” behavior is very common in addicts and drug abusers. Drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing or referral, repeated “loss” of prescriptions, tampering with prescriptions and reluctance to provide prior medical records or contact information for other treating physician(s). “Doctor Shopping” to obtain additional prescriptions is common among drug abusers and people suffering from untreated infection. Abuse and addiction are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of true addiction and is characterized by misuse for non-medical purposes, often in combination with other psychoactive substances. Oxycodone, like other opioids, has been diverted for non-medical use. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised. Proper assessment of the patient, proper prescribing practices, periodic re-evaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs. Like other opioid medications, oxycodone and acetaminophen tablets are subject to the Federal Controlled Substances Act. After chronic use, oxycodone and acetaminophen tablets should not be discontinued abruptly when it is thought that the patient has become physically dependent on oxycodone. Interactions with Alcohol and Drugs of Abuse Oxycodone may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression. Close
Signs and Symptoms Serious overdose with oxycodone and acetaminophen tablets is characterized by signs and symptoms of opioid and acetaminophen overdose. Oxycodone overdosage can be manifested by respiratory depression (a decrease in respiratory rate and/or tidal volume, Cheyne-Stokes respiration, cyanosis), extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, pupillary constriction (pupils may be dilated in the setting of hypoxia), and sometimes bradycardia and hypotension. In severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur. In acute acetaminophen overdosage, dose-dependent, potentially fatal hepatic necrosis is the most serious adverse effect. Renal tubular necrosis, hypoglycemic coma and thrombocytopenia may also occur. In adults, hepatic toxicity has rarely been reported with acute overdoses of less than 10 grams and fatalities with less than 15 grams. Plasma acetaminophen levels > 300 mcg/ml at 4 hours postingestion were associated with hepatic damage in 90% of patients; minimal hepatic damage is anticipated if plasma levels at 4 hours are < 120 mcg/ml or < 30 mcg/ml at 12 hours after ingestion. Importantly, young children seem to be more resistant than adults to the hepatotoxic effect of an acetaminophen overdose. Despite this, the measures outlined below should be initiated in any adult or child suspected of having ingested an acetaminophen overdose. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48 to 72 hours post-ingestion. Treatment Primary attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and the institution of assisted or controlled ventilation. Supportive measures (including oxygen, intravenous fluids, and vasopressors) should be employed in the management of circulatory shock and pulmonary edema accompanying overdose as indicated. Cardiac arrest or arrhythmias may require cardiac massage or defibrillation. The opioid antagonist naloxone hydrochloride is a specific antidote against respiratory depression which may result from overdosage or unusual sensitivity to opioids including oxycodone. Therefore, an appropriate dose of naloxone hydrochloride should be administered (usual initial adult dose 0.4 mg-2 mg) preferably by the intravenous route, simultaneously with efforts at respiratory resuscitation. Since the duration of action of oxycodone may exceed that of the antagonist, the patient should be kept under continued surveillance and repeated doses of the antagonist should be administered as needed to maintain adequate respiration. Opioid antagonists should not be administered in the absence of clinically significant respiratory of circulatory depression secondary to oxycodone overdose. In patients who are physically dependent on any opioid agonist including oxycodone, an abrupt or complete reversal of opioid effects may precipitate an acute abstinence syndrome. The severity of the withdrawal syndrome produced will depend on the degree of physical dependence and the dose of the antagonist administered. Please see the prescribing information for the specific opioid antagonist for details of their proper use. Gastric emptying and/or lavage may be useful in removing unabsorbed drug. This procedure is recommended as soon as possible after ingestion, even if the patient has vomited spontaneously. After lavage and/or emesis, administration of activated charcoal, as a slurry, is beneficial, if less than three hours have passed since ingestion. Charcoal adsorption should not be employed prior to lavage and emesis. If an acetaminophen overdose is suspected, the stomach should be promptly emptied by lavage. A serum acetaminophen assay should be obtained as soon as possible, but no sooner than 4 hours following ingestion. Liver function studies should be obtained initially and repeated at 24-hour intervals. The antidote N-acetylcysteine (NAC) should be administered as early as possible, preferably within 16 hours of the overdose ingestion, but in any case within 24 hours. As a guide to treatment of acute ingestion, the acetaminophen level can be plotted against time since ingestion on a nomogram (Rumack-Matthew). The upper toxic line on the nomogram is equivalent to 200 mcg/ml at 4 hours while the lower line is equivalent to 50 mcg/ml at 12 hours. If serum level is above the lower line, and entire course of N-acetylcysteine treatment should be instituted. NAC therapy should be withheld if the acetaminophen level is below the lower line. The toxicity of oxycodone and acetaminophen in combination is unknown. Close
Dosage should be adjusted according to the severity of the pain and the response of the patient. It may occasionally be necessary to exceed the usual dosage recommended below in cases of more severe pain or in those patients who have become tolerant to the analgesic effect of opioids. If pain is constant, the opioid analgesic should be given at regular intervals on an around-the-clock schedule. Oxycodone and acetaminophen tablets are given orally. The usual adult dosage is one tablet every 6 hours as needed for pain. The total daily dose of acetaminophen should not exceed 4 grams. Strength Maximal Daily Dose Oxycodone and Acetaminophen Tablets 5 mg / 325 mg 12 Tablets Cessation of Therapy In patients treated with oxycodone and acetaminophen tablets for more than a few weeks who no longer require therapy, doses should be tapered gradually to prevent signs and symptoms of withdrawal in the physically dependent patient. Close
Oxycodone and Acetaminophen Tablets USP, 5 mg / 325 mg are supplied as white to off-white, round, flat-faced, beveled edged tablets, debossed “IP203” on obverse and bisect on reverse. They are available as follows: Bottles of 20 NDC: 35356-817-20 Bottles of 30 NDC: 35356-817-30 Bottles of 40 NDC: 35356-817-40 Bottles of 60 NDC: 35356-817-60 Bottles of 90 NDC: 35356-817-90 Bottles of 120 NDC: 35356-817-01 Store at 20° to 25°C (68° to 77°F). [see USP Controlled Room Temperature.] Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure. DEA Order Form Required Close
Manufactured by: Amneal Pharmaceuticals of NY Hauppauge, NY 11788 Distributed by: Amneal Pharmaceuticals Glasgow, KY 42141 Rev. 08-2008 Close
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OXYCODONE AND ACETAMINOPHEN oxycodone and acetaminophen tablet Product Information Product Type
NDC:35356-817(NDC:53746-203) Route of Administration
CII Active Ingredient/Active Moiety Ingredient Name
Strength OXYCODONE (OXYCODONE)
5 mg ACETAMINOPHEN (ACETAMINOPHEN)
WHITE (OFF-WHITE)
11mm Flavor
IP;203 Contains
20 in 1 BOTTLE
120 in 1 BOTTLE
Labeler - Lake Erie Medical DBA Quality Care Products LLC (831276758) Establishment Name
Business Operations Lake Erie Medical DBA Quality Care Products LLC
repack(35356-817) Close
OXYCODONE AND ACETAMINOPHEN- oxycodone and acetaminophen tablet Number of versions: 1
OXYCODONE AND ACETAMINOPHEN- oxycodone and acetaminophen tablet RxCUI RxNorm NAME
1049221 Acetaminophen 325 MG / Oxycodone Hydrochloride 5 MG Oral Tablet
1049221 APAP 325 MG / oxycodone hydrochloride 5 MG Oral Tablet
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2014-42/1180/en_head.json.gz/23778 | Dementia Symptoms
Symptoms of Dementia
What is Dementia with Lewy Bodies?
Dementia with Lewy bodies (DLB) is a loss of cognitive abilities in the elderly whose nerve cells contain abnormal aggregates of protein. These same protein aggregates are also found in patients with Alzheimer’s disease and Parkinson’s disease. In post mortem brain biopsies, the neurons of individuals with DLB reveal clumps of alpha-synuclein and ubiquitin protein under the microscope. It’s been estimated that DLB is responsible for 10 to 15 percent of all dementia in the elderly. As many as 1.3 million people may suffer from DLB in the U.S.
Dementia with Lewy Bodies is also called Lewy body dementia, diffuse Lewy body disease, cortical Lewy body disease, and senile dementia of Lewy type.
What Are Lewy Bodies?
Lewy bodies are abnormal aggregates of alpha-synuclein, ubiquitin and other proteins that develop inside nervous tissue. They were first detected by the German neurologist Frederick Lewy in 1912. Dr. Lewy was a colleague of Alois Alzheimer, the German neuropathologist who gave his name to the senile dementia characterized by short term memory loss and other behavioral changes.
Lewy bodies were first identified in post mortem brain studies of Parkinson’s disease patients. They are also found in the brains of sufferers from multiple system atrophy (MSA), and Alzheimer’s disease. In these three types of dementia, Lewy bodies are restricted to particular parts of the brain whereas in Lewy body dementia, Lewy bodies are more widely distributed throughout the brain.
What Causes Lewy Body Dementia?
The precise causes ofDLB are unknown. While scientists do not suspect a strong genetic connection, there is some evidence that the disease is associated with the PARK11 gene, also linked to Parkinson’s disease.
What Are the Signs and Symptoms of Lewy Body Dementia?
There’s a great deal of variation in how DLB manifests from individual to individual. Nonetheless, most patients with this disorder show disturbances related to memory, language abilities, cognitive reasoning and the ability both to judge simple distances and to carry out simple commands. Parkinson’s-like motor dysfunction is also characteristic of the disease including shuffling gait, a greatly reduced range of facial expressions, stiff movements and a characteristic palsy known as “cogwheeling.” Occasionally, fluctuations in autonomic processes such as changes in heart rate and blood pressure can occur.
One of the most disturbing aspects of Lewy body dementia is that individuals afflicted with it actively hallucinate, seeing people and things who aren’t there such as people in chairs and pets on beds.
Symptoms are characterized by exacerbations and remissions that can fluctuate over very short time intervals. Over the years this has led to the suspicion on the part of many caregivers that people with DLB
How a Diagnosis of Lewy Body Dementia Is Made
Since the definitive diagnosis of DLB can only be made after a patient’s death when the abnormal brain proteins are identified, diagnosis relies upon deductive criteria.
A pattern of falls and vasovegal episodes (syncope), delusions and hallucinations and extreme sensitivity to antipsychotic medications are all strongly suggestive of the Lewy body dementia diagnosis.
Lewy Body Dementia Treatment
As of yet there is no medical treatment specifically targeted at the underlying causes of Lewy body dementia. Management, therefore, is based on alleviating symptoms associated with the disease.
Cholinesterase inhibitors are sometimes prescribed to minimize the Parkinson’s-like motor ability dysfunctions, but these frequently have the effect of worsening the hallucinations and delusions associated with the disease. Similarly, the neuroleptic drugs prescribed for managing psychiatric symptoms may worsen motor symptoms although low doses of atypical antipsychotics, such as quetiapine, have been found to be helpful in managing these patients.
Lewy body dementia is progressive; over time, patients become incapable of caring for themselves. Good care giving depends on customizing the patient’s schedule, activities and home environment to accommodate to his or her diminishing motor abilities and psychiatric hygiene. The burden on caregivers can be immense. Changes in routine can often trigger behavioral changes.
Six Things To Know About Lewy Body Dementia
The disease is characterized by the presence of abnormal proteins called Lewy bodies inside the brain.
Lewy body disease is difficult to distinguish from Parkinson’s disease and Alzheimer’s disease.
The symptoms of Lewy body dementia include hallucinations, motor dysfunction, delusions, cognitive impairments, disturbances in autonomic processes, depression and anxiety.
Lewy body dementia is most in males over 65. Patients may live as long as eight years after the onset of symptoms.
There is no cure for Lewy body dementia. Treatment of the disease is geared towards managing the symptoms.
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Hospital-acquired Infections and Social Media The authors explore whether real-time reporting will reduce the spread of infection
By Helen C. "Kate" Liebelt and D'vorah Graeser Posted on:
A young girl's life-threatening infection by the dangerous bacterial strain C.difficile, contracted in the one environment where her health should have been safe - a hospital - a made front page news in USA Today in August. Multi-page coverage of hospital-acquired infections reminded readers across the country that the U.S. healthcare system is a far cry away from managing deadly bacteria that accounts for 30,000 deaths each year in the U.S. alone, not to mention the half-million Americans who suffer from infection by such dangerous bacteria as C.difficile. The USA Today article featured the faces of 16 victims of highly publicized hospital-acquired infections, demonstrating that the reporting and management of hospital-acquired infections is still a challenge that many healthcare institutions continue to wrestle with despite the efforts of many private and public health and patient advocacy organizations. Reporting Requirements
Over 30 states have established hospital-acquired infection public reporting requirements. For example, since 2005, the State of New York has required hospitals to report select hospital-acquired infections to the New York State Department of Public Health and compares this data against national reporting rates. And the State of California's Department of Public Health has created an interactive infection heat map based on data from medical lab and patient records. However, there are significant doubts as to whether hospitals are reporting the most dangerous types of infections. Real-time Reporting and Social Media
As public health analysis and reporting becomes more sophisticated, hospitals will have to adopt a more transparent, real-time approach to reporting. Social media provides an interesting new perspective into the dissemination of information about hospital infections. Over the last year, terms such as "hospital-acquired infection," "MRSA," and "superbug" have trended upward on social media channels. It's likely the frequency of those terms will increase at a faster rate, based on new, strict infection reporting requirements enacted at national and state levels. Public health organizations such as the Centers for Disease Control and Prevention, and patient advocacy organizations such as Campaign Zero (an organization founded to eliminate deaths from hospital-acquired infections) have started using social media to communicate important alerts. Increasing Visibility in the Digital World
iMedSocial, a startup social media consultancy focused on the healthcare industry, performed an analysis of this trend over a six month period (Feb. 1, 2012 - Aug. 1, 2012). The findings demonstrate that hospital-related infections continue to garner more visibility in the digital world. During this period, terms associated with hospital-acquired infections received 17,640 online mentions at an average of 96.4 mentions per day. Mentions peaked on May 17 at 207 and troughed on June 9 at 41. Closer examination of the results revealed a negative sentiment associated with key search terms at a rate of 17% versus a positive sentiment rating of 11%, and the remaining results were found to be neutral. Message boards and forums constituted 24% of mentions of hospital infection-related terms: blogs for 17.91% of results; microblogs, 4.80%; social networks, 10.46%; other media types, 42.63%. If we isolate our search to microblogs alone, we find 846 hits over this time period with an average of 4.6 mentions per day, with a peak of 35 on May 4 and a trough of no mentions on Feb. 1. A closer examination of relevant hits from a geographical standpoint revealed California had the largest number at 157, Missouri with 95, Texas with 78 and New York with 53. This indicates that stories related to hospital-acquired infections most frequently make references to California, Missouri, Texas and New York. Subject Hits
To better understand the context of the use of these key words with regard to the subject of hospital-acquired infections, we compared hits on this subject, including words associated with handwashing and hygiene, with hits on this subject that included a colloquial or scientific reference to infection ("MRSA," "superbug," "bacterial"). On average, we identified a ratio of roughly 5:1, or 5 references to infection for every reference to hand washing on a given day. Regardless of the platform, peak references to hospital-acquired infections were never matched by peak references to handwashing, and in fact hand washing was barely discussed in this context at all, even though handwashing by hospital personnel has been shown to be one of the most effective ways to combat such infections.
In an age of information where the capability to report hospital-acquired infections in real time via Facebook, Twitter or internal employee portals is not just a possibility, it is a reality, hospitals should consider social media policies that can help an organization respond to reports of hospital-acquired infections and enable an organization to demonstrate the ways in which they are reducing hospital-acquired infections. The USA Today article referenced 5 healthcare organizations that have been commended for their efforts to reduce hospital-acquired infections. This is positive press that every hospital or healthcare system can aspired to receive with the help of a strong social media strategy. Helen C. "Kate" Liebelt is a seasoned healthcare consultant with experience in strategy, operations and compliance consulting for hospitals, healthcare systems, as well as pharmaceutical and medical devices companies and not for profit organizations. She has held management positions at major healthcare companies including Baxter Healthcare Corp., TAP Pharmaceuticals Inc. and Takeda Global Research & Development Inc. as well as global public relations firm Fleishman-Hillard, Inc. and major consulting firms. Email Helen at KL@iMedSocial.com. Follow her on Twitter at @KLiMedSocial. D'vorah Graeser, PhD, is the co-founder of iMedSocial, which provides social media analysis, support and guidance for those who are passionate about healthcare, innovation and technology. She is also the founder and chief executive officer of Graeser Associates International (GAI), an international health care intellectual property firm. Dr. Graeser has been a U.S. patent agent for over 15 years and has extensive experience in the biomedical and computer fields. Contact Dr. Graeser at info@imedsocial.com or follow her on twitter @DGiMedSocial.
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2014-42/1180/en_head.json.gz/23990 | In Memoriam: Dr. Michael Sloan
September 14, 2011 · 4:45 pm Michael Sloan, MD, professor of neurology at USF Health who directed the Comprehensive Stroke Center at Tampa General Hospital, died Sept. 9, 2011. He was 57.
Dr. Sloan was a major authority in stroke who made substantial contributions to the advances in the field over the past 20 years. The stroke program he led as a USF Health faculty member at TGH since 2007 consistently earned the Gold Seal of Approval™ for health care quality – a disease-specific certification bestowed by the Joint Commission, the nation’s largest health care accreditation organization.
“Dr. Sloan was held in the highest regard, not only by all of us here at USF and at TGH, but also by all of his national and international peers. His decision to join USF Neurology unquestionably brought a new level of recognition to both the Stroke Division and the Department,” said Clifton Gooch, MD, professor and chair of neurology at USF Health.
“Thousands of patients and families were touched by him, and he saved many lives and rescued many more from what would have otherwise been crushing and permanent disability,” Dr. Gooch said. “Sentiments of support and sympathy continue to pour in to us from around the world as news of his passing spreads. He is, and always will be, deeply missed.”
Dr. Sloan earned his medical degree from Wayne State University in Detroit, MI. He completed an internal medicine residency at Bershire Medical Center, a neurology residency at Tufts University/New England Medical Center, and a fellowship in vascular neurology at the University of Virginia.
Named of one the Best Doctors in America each year for the past decade, Dr. Sloan was internationally renowned as an academic stroke specialist. He served as chair of the National Stroke Study Group for the American Heart Association, and chair of the Stroke Registry for the state of Florida, among many other national and international leadership positions. He was honored by colleagues with many of the highest awards in his field.
Dr. Sloan was a fellow of the American Academy of Neurology, the American College of Cardiology and the American Heart Association’s Stroke Council.
Dr. Sloan is survived by his wife, Cheryl; mother, Jody Sloan; daughters, Jessica and Brittany; brothers, David and Daniel; sister-in-law, Millie; niece, Marissa; and nephew, Adam. He was preceded in death by his father, Eugene Sloan.
Services were held Sept. 14 at Toale Brothers Funeral Homes, Colonial Chapel, 40 N. Orange Ave., Sarasota, FL 34236, with burial following in Temple Beth Shalom Cemetery, Sarasota. | 医学 |
2014-42/1180/en_head.json.gz/23997 | Home > Programs and Services > Education > Allergy and Immunology Fellowship > Mission Statement
Allergy and Immunology Fellowship
Mission StatementTraining ProgramProgram OutlineFacultyResearchCurrent FellowsResourcesApplicationContact
The goal of the Allergy and Immunology Fellowship Program at the Icahn School of Medicine is to train interested and highly motivated internists and pediatricians in the specialty of allergy and clinical immunology. The educational mission is to provide a stimulating and comprehensive training experience that will lead to both an understanding and application of the principles of basic immunology to allergic disorders, congenital and acquired immunodeficiency diseases, organ and bone marrow transplantation, and autoimmune diseases. This includes developing an understanding of the clinical and laboratory assessment of allergic and immune system disorders, having a firsthand opportunity to conduct research projects, and attending and presenting original data at national meetings in allergy and immunology. The ultimate goal is to produce physicians/physician scientists who will take an active role in the expansion of allergy and clinical immunology as a growing specialty by developing careers in academic medicine, biotechnology, and patient care. | 医学 |
2014-42/1180/en_head.json.gz/23998 | Home > Departments & Institutes > Department of Preventive Medicine > About Us > Message from the Chair
Department of Preventive Medicine
About UsMeet the ChairMessage from the ChairNewsEventsDivisionsPrograms and ServicesFaculty and Staff
Welcome to Mount Sinai’s Department of Preventive Medicine.
Our department was established in 1967 and reflects Mount Sinai’s deep and abiding commitment to the community and to prevention. Our mission is to prevent disease, protect the environment, and promote health globally, regionally, and locally, including our neighboring community of East Harlem.
We accomplish this by being one of the largest medical school departments of preventive medicine in the United States. We have 57 full-time faculty, 137 adjunct and voluntary faculty, and 265 staff. Our portfolio of peer-reviewed extramural grants and contracts from the National Institutes of Health, the National Institute for Occupational Safety and Health, and private foundations in 2009 totaled $50.7 million.
The Department of Preventive Medicine is committed to protecting children worldwide from environmental threats to health by working closely with the World Health Organization. In addition, the department leads the National Children’s Study — the largest study of children’s health ever undertaken in the United States. Content manager – please link National Children’s Study to http://www.nationalchildrensstudy.gov. The study will follow 10,000 children from conception to age 21 to discover the preventable environmental causes of disease.
The department also hosts several World Trade Center medical programs, providing diagnostic and treatment services to over 20,000 of the men and women who served in New York City in the days, weeks, and months after the terrorist attacks on September 11, 2001.
Philip J. Landrigan, MD, MSc
Professor and Chair, Department of Preventive Medicine
Professor, Pediatrics | 医学 |
2014-42/1180/en_head.json.gz/24152 | CVD in Asian Americans: Are There Disparities and Are They Important?
Updated:Jun 3,2014
Cardiovascular Disease in Asian Americans: Are There Disparities and Are They Important?Disclosure: J. David Curb has received National Institutes of Health grants.Pub Date: Monday, August 23, 2010Author: J. David Curb, MD, FAHACitationPalaniappan LP, Araneta MRG, Assimes TL, et al; on behalf of the American Heart Association Council on Epidemiology and Prevention Council on Peripheral Vascular Disease Council on Nutrition Physical Activity and Metabolism and Council on Clinical Cardiology. Call to action: cardiovascular disease in Asian Americans: a science advisory from the American Heart Association. Circulation 2010; published online before print August 23, 2010, 10.1161/CIR.0b013e3181f22af4.Article TextIn the National Heart, Lung, and Blood Institute (NHLBI) description of the topic of "Novel Methods of Monitoring Health Disparities" to be supported under the 2009 Request for Applications (RFA) for Grand Opportunities proposals, the following statement is made: "Population disparities in health and mortality have increased in the United States since the 1980s, with increases in mortality and poor health being most pronounced among the most disadvantaged many of whom are members of nonwhite minority subpopulations."[1] Asian Americans, as a group, however, have been considered to be a "model minority" to whom this generalization did not apply.[2] In general, studies of Asian Americans have treated them as a large, homogeneous group. Although the genetic admixture of most Asian American subgroups with whites is currently much more limited than in blacks and Hispanics, as pointed out in the manuscript by Palaniappan et al., within the Asian American population there is substantially more geographic, ethnic, cultural, and genetic diversity than is commonly recognized. The data on the health of the various components of this population are even more limited than that for Hispanics and African Americans.[3] Among Asian American populations, there appear to be striking, not fully understood disparities in the risk of cardiovascular disease (CVD). Abnormalities in some risk factors, such as glucose metabolism and type 2 diabetes, appear to be much more markedly influenced by the adoption of a "western" lifestyle in nonwhite immigrants than the effects of this lifestyle in whites.[4]Overall, the causes of ethnic disparities in CVDs and their trends over time are poorly understood. Disparities may be due to differences in the prevalence of traditional risk factors such as diabetes, smoking, hypertension, and obesity, as well as dietary factors. Most involve the interaction between genetic and environmental contributors. Limited access to health care, socioeconomics, and culture may also enhance some differences. Nevertheless, as pointed out in the Palaniappan et al. manuscript, the Asian American differences can not be wholly attributed to differences in economic status or obesity.[3] However, the stresses of the current economic crisis may worsen some health disparities. Thus, variations in the potential for health care reform and the question of which areas such reforms would be most effective, are raised.One factor that receives notably insufficient attention in most reports on health in Asian Americans is acculturation, partially because it is difficult to measure adequately. In truth, variation in stages of acculturation is so important that it may render many reported comparisons between Asian subgroups, as well as comparisons with other U.S. populations, difficult to decipher.Although outlined in detail by Palaniappan et al.,[3] there have been two major waves of Asian American immigration into the United States. There was a large inflow of Asian American immigrants into the United States, the majority of which were Chinese and Japanese, beginning in the early 1800s and ending in the early 1900s. These individuals were largely poor and were brought in to perform hard labor in agriculture and construction. Many families of these original immigrants have done well economically and are well-established members of the middle and upper middle class in this country. Since the 1950s, a more economically varied group of Asians, from a wider array of Asian countries and socioeconomic backgrounds, have immigrated to the United States. Many came from countries in southern Asia. Some other groups, such as those from the Philippines, followed slightly different immigration patterns. Asian subgroups have had variable acculturation into an American lifestyle, as well as variations in ages, times, and generations of immigration. Thus, there are wide variations in current acculturation patterns among those from different subgroups and Asian countries. Palaniappan et al. give a number of examples of changes in risk and health associated with acculturation.[3]There is evidence that, at least for some groups, later generations of fully acculturated Asian Americans may have very different health experiences than the first generation immigrants. This was well documented in the Honolulu Heart Program (HHP), a longitudinal follow-up of >8,000 Japanese American men.[5,6] For example, these first and second generation Japanese American men in Hawaii appeared to be healthier, have higher levels of function, and a longer life expectancy [7] and lower CVD rates [6] than other Americans in the mid-twentieth century. This documented relative good health contributed to the difficulty the HHP investigators experienced in obtaining funding to follow subsequent generations of Japanese Americans, so far less is known about the third and fourth generation Japanese American immigrant's health. Studies of several small groups of HHP Japanese American offspring, some with Japanese comparison groups in Japan, have been carried out. These have confirmed cardiovascular risk factors in the third generation Japanese American immigrants are becoming more similar to those in whites.[8,9] One such study of subclinical atherosclerosis indicates that 40 to 49 year old third generation Japanese offspring of the HHP cohort have as much or more severe atherosclerosis, as measured by Electron Beam Computed Tomography (EBCT), than a similarly aged white comparison group in Pittsburgh.[9] In addition, they have three times the rate of significant coronary calcification than does a Japanese comparison group in Japan.[10] This is despite a 50% smoking rate in the genetically very similar comparison group in Japan. The Japanese Americans were more obese and had much higher rates of diabetes, while both the Japanese in Japan and Japanese Americans, in contrast to their low cholesterol fathers, had similar serum cholesterol levels to whites. Despite extensive analysis of many traditional and nontraditional risk factors, no definitive explanation of these differences in atherosclerosis has yet been found. Understanding the causes of this difference could lead to factors that could be used to further reduce the incidence of CVD worldwide.The combination or very different patterns of immigration among Asian subgroups, differences in culture, lifestyle, and genetic background, as well as profound changes in cardiovascular risk with increasing acculturation, means that most past and many present studies that aggregate all Asians, recent and established immigrants, as well as all acculturation levels, in analysis groups, are virtually uninterruptible as comparison groups. Their only utility is to characterize the health of the specific individuals in the particular location and study and the results cannot be generalized outside that study group to others of the same ethnicity.Available data indicate there is a significant potential for an epidemic of diabetes and CVD and thus an acceleration of disparities in Asian American populations, as well as in these same groups, in their countries of origin.[11,12] If social and political policies slow immigration of the young into the United States, as is proposed by many, as the whole United States population continues to age and second and third generation immigrants become fully Americanized, there are likely to be significant effects on our economy. As the population inevitably rapidly ages, the average chronic disease burden will significantly increase and the workforce supporting that burden will become proportionately smaller in comparison to the current population age structure.The current rapidly changing Asian American environment offers the possibility for studying a unique natural experiment that may be lost if we delay starting studies to examine it. Because the same health conditions are now being studied by governments in many Asian countries, extension of the area of study to the countries of origin through innovative collaborative studies, as has been done with the HHP offspring, at little cost to the United States taxpayer, offers a novel method for extending our observations into areas of the risk factor and disease distribution not easily studied in United States populations alone. For the large portion of the U.S. population that is Asian, there is no adequate, broad-based study in place to monitor health trends closely. Developing and using a network of scientists with expertise in the study of the Asian populations, as well as identifying existing data resources that can be pooled and analyzed to understand more about atherosclerotic diseases in this important population, is critical. Such a network can more rapidly provide a greatly increased understanding of social, biological, genetic, demographic, and economic influences on cardiovascular health. High-quality research generated by such a network working closely with the American Heart Association, National Institutes of Health, and other private and government entities could play a critical role in informing and evaluating public policy and clinical practice, both for Asian Americans and for the entire United States population, as well as in developed and developing countries in Asia and the rest of the world.The availability of high-quality ethnic specific population data derived from carefully designed epidemiological and socioeconomic examinations and analyses will be essential for efforts to design changes in the U.S. health care system and in public health interventions that will reduce health disparities. A systematic strategy for monitoring key risk factors and the effects of health-related policies and reforms are urgently needed. The monitoring should be defined not only by geography but also by socioeconomic or sociocultural characteristics.Referenceshttp://www.nhlbi.nih.gov/recovery/funding/grand-opp-grants.htmEsperat MC, Inouye J, Gonzalez EW, et al. Health disparities among Asian Americans and Pacific Islanders. Annu Rev Nurs Res 2004;22:135-59.Palaniappan et al. Cardiovascular Disease in Asian Americans: Call for Action.Maskarinec G, Grandinetti A, Matsuura G, et al. Diabetes prevalence and body mass index differ by ethnicity: the Multiethnic Cohort. Ethn Dis 2009;19(1):49-55.Kagan A, Harris BR, Winkelstein W Jr, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: demographic, physical, dietary, and biochemical characteristics. J Chronic Dis 1974;27:345-64.Yano K, Reed DM, McGee DL. Ten-year incidence of coronary heart disease in the Honolulu Heart Program: Relationship to biologic and lifestyle characteristics. Am J Epidemiol 1984;119:653-666.Curb JD, Reed DM, Miller FD, et al. Health status and life style in elderly Japanese men with a long life expectancy. J Gerontology 1990;45(5):S206-211.Ueshima H, Okayama A, Saitoh S, et al. Differences in cardiovascular disease risk factors between Japanese in Japan and Japanese-Americans in Hawaii: the INTERLIPID study. J Hum Hypertens 2003;17:631-639.Sekikawa A, Curb JD, Ueshima H, et al. Marine-derived n-3 fatty acids and atherosclerosis in Japanese, Japanese Americans, and white men: a cross-sectional study. J Am Coll Cardiol 2008;52(6):417-24.Abbott RD, Ueshima H, Rodriguez BL, et al. Coronary artery calcification in Japanese men in Japan and Hawaii. Am J Epidemiol 2007;166(11):1280-7. Aug 28, 2007 [Epub ahead of print]Mensah GA, Mokdad AH, Ford E, et al. Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular implications. Cardiol Clin 2004;22(4):485-504. Review.Spalding A, Kernan J, Lockette W. The metabolic syndrome: a modern plague spread by modern technology. J Clin Hypertens (Greenwich). 2009;11(12):755-60.-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association -- AHA Scientific Journals
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2014-42/1180/en_head.json.gz/24158 | | | Through Rain, Sleet and Snow, NAMI Walks On
By Brendan McLean, NAMI Communications Coordinator
Each time the participants of the NAMI Seneca, Sandusky and Wyandot (SSW) walk made their way around Conner Park in Fremont, Ohio, the weather seemed to get worse. On the first lap the soft rain turned into a downpour. On the second, the rain turned to sleet. By the third, it had turned to snow.
But through the harsh weather, the ebullient walkers marched on. More than 350, well-bundled, walkers�100 more participants than the previous year�came together on April 28, to make the seventh annual walk a record breaking walk for the NAMI Affiliate.
“A lot of people came out to support NAMI even with the bad weather” said Melanie White, who will become executive director of NAMI SSW on June 1. “It was really important and powerful for members of the community to help raise awareness for mental illness.”
Nearly 65 of the walkers were fourth and fifth grade students from nearby Green Springs Elementary School. Students in the school’s anti-bullying group, Students Taking a Right Stand, along with parents and other staff members, braved the cold to walk to support NAMI.
While there were no reports of members of the Ministry of Silly Walks making an appearance, it appears the Ministry of Silly Hats had a strong showing. Covering the heads of many of these shivering young walkers weren’t wool knit caps or ear muffs, but rather oversized furry orange hats�that resembled shag rugs piled on their heads, hats in the shape of frogs, hats made out of balloons, at least one Teenage Mutant Ninja Turtle and a handful of rainbow colored wigs and various other oddities covered the heads of the young students (and the principle).
The group had met and decided to do something to show their team spirit at the walk. Out of their high-spirited discussion came the idea to where silly hats and design t-shirts. Unfortunately the weather prevented the students from showcasing their individually designed shirts.
“Despite the weather, we had such a huge response. Nearly all of the students came. I could not believe the number fourth and fifth graders who gave up a Saturday to come and walk,” said Randy Stockmaster, the principle at Green Springs. Stockmaster is a member of the Leadership Sandusky County group, a yearlong non-profit leadership class that seeks to provide members of the community with successful leadership skills. After looking at all of the organizations in the Sandusky area, he and his team members in the class selected NAMI as their nonprofit organization to assist during the year. Working closely with Josie Setzler, the current executive director of NAMI SSW who will be retiring on June 1 and Melanie White, it was decided the best way he and his fellow team members could help would be by participating and helping publicize the annual walk.
White is looking forward to the opportunity to become executive director and continuing Setzler’s outstanding efforts in garnering community support. “Without local support, NAMI wouldn’t be successful. Having [the children from the elementary school] out there this year walking and raising awareness was terrific,” said White. With a young, vibrant support group, the future for NAMI Seneca, Sandusky and Wyandot Counties looks bright. | 医学 |
2014-42/1180/en_head.json.gz/24234 | Online Nursing Degree Guide
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Become a Certified Registered Nursing Anesthesiest (CRNA) A nurse anesthetist, also known as a certified registered nurse anesthetist (CRNA), work closely with other health care professionals such as surgeons, dentists, podiatrists and other anesthesiologists to provide the same anesthesia services as an anesthesiologist. Over 28,000 CRNAs currently work to provide for a patient’s needs before, during and after surgery. CRNAs are licensed professional nurses who administer approximately sixty-five percent of the twenty-six million anesthetics given to patients in the U.S. each year, according to the AANA (American Association of Nurse Anesthetists).
The CRNA assumes a responsible role for the patient during surgery, as this nurse performs pre- and post-operative procedures such as physical assessments, education for the patient and family members, anesthetic preparation managements, the actual administering of the anesthesia, recovery from the anesthesia and detailed postoperative management. The nurse anesthetist is with a patient during the entire surgical procedure to monitor every important body function for patient safety.
Prerequisites for Becoming a CRNA
Individual programs may required various work and educational experience, but in most cases the nurse who seeks a CRNA license must have a BSN or other appropriate undergraduate degree. The applicant also must be a registered nurse (RN) and have up to five years of experience in acute nursing care, preferably adult intensive care or emergency nursing.
How to become a CRNA
If the applicant is accepted for a CRNA course, he or she can expect to study a curriculum that emphasizes anatomy, physiology, pathophysiology, biochemistry, chemistry, physics and pharmacology. Most nurse anesthetist programs are found within nursing schools. The first year is spent in the classroom and the second year in the field, where the nurse is assigned to a hospital for hands-on experience with administration of general and regional anesthesia and to learn about acute and chronic pain managements.
A typical CRNA program is a graduate program that will lead to a master’s degree (MSN). Therefore, a typical CRNA program generally will take two to three years to complete, depending upon whether the course is completed on a full- or part-time basis. After completing extensive education and training, CRNAs become nationally certified to practice in all 50 states.
Careers Available After Becoming a CRNA
CRNAs may have one of the most flexible, well-paying and exciting careers of any nursing occupation. These nurses can practice in a variety of settings alone, in groups and collaboratively. You can find CRNAs in hospital operating rooms, obstetrical delivery rooms, ambulatory surgery centers, pain clinics and doctors’ offices. CRNAs work in the public sector, in private situations, in the military and as independent contractors. Additionally, these nurses witness every kind of surgery imaginable, from total hip to neonatal open heart procedures.
Since CRNAs remain with their patients for the entire surgical process to administer anesthesia and to monitor pain management, the level of responsibility that CRNAs assume is reflected in their salaries. According to the AANA, the reported average annual CRNA salary in 2005 was approximately $160,000. This high salary also reflects the severe shortage and high demand for CRNAs, especially in the public sector.
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2014-42/1943/en_head.json.gz/18915 | MedicineWorld.Org
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Heart Watch Blog May 19, 2011, 8:43 AM CT
Nanopatch for the heart
Engineers at Brown University have created a nanopatch for the heart that tests show restores areas that have been damaged, such as from a heart attack.Credit: Frank Mullin, Brown University
When you suffer a heart attack, a part of your heart dies. Nerve cells in the heart's wall and a special class of cells that spontaneously expand and contract � keeping the heart beating in perfect synchronicity � are lost forever. Surgeons can't repair the affected area. It's as if when confronted with a road riddled with potholes, you abandon what's there and build a new road instead.Needless to say, this is a grossly inefficient way to treat arguably the single most important organ in the human body. The best approach would be to figure out how to resuscitate the deadened area, and in this quest, a group of researchers at Brown University and in India may have an answer.The scientists turned to nanotechnology. In a lab, they built a scaffold-looking structure consisting of carbon nanofibers and a government-approved polymer. Tests showed the synthetic nanopatch regenerated natural heart tissue cells �� called cardiomyocytes � as well as neurons. In short, the tests showed that a dead region of the heart can be brought back to life."This whole idea is to put something where dead tissue is to help regenerate it, so that you eventually have a healthy heart," said David Stout, a graduate student in the School of Engineering at Brown and the lead author of the paper published in Acta Biomaterialia........
Posted by: Daniel Read more Source
April 3, 2011, 9:31 AM CT
Antidepressants linked to thicker arteries
Antidepressant use has been associated with thicker arteries, possibly contributing to the risk of heart disease and stroke, in a study of twin veterans. The data is being presented Tuesday, April 5 at the American College of Cardiology meeting in New Orleans.Depression can heighten the risk for heart disease, but the effect of antidepressant use revealed by the study is separate and independent from depression itself, says first author Amit Shah, MD, a cardiology fellow at Emory University School of Medicine. The data suggest that antidepressants may combine with depression for a negative effect on blood vessels, he says. Shah is a researcher working with Viola Vaccarino, MD, PhD, chair of the Department of Epidemiology at Emory's Rollins School of Public Health.The study included 513 middle-aged male twins who both served in the U.S. military during the Vietnam War. Twins are genetically the same but appears to be different when it comes to other risk factors such as diet, smoking and exercise, so studying them is a good way to distill out the effects of genetics, Shah says.Scientists measured carotid intima-media thickness � the thickness of the lining of the main arteries in the neck -- by ultrasound. Among the 59 pairs of twins where only one brother took antidepressants, the one taking the drugs tended to have higher carotid intima-media thickness (IMT), even when standard heart disease risk factors were taken into account. The effect was seen both in twins with or without a prior heart attack or stroke. A higher level of depressive symptoms was linked to higher IMT only in those taking antidepressants.........
Posted by: JoAnn Read more Source
March 31, 2011, 6:55 AM CT
Migraine headaches and a common heart defect
Cincinnati, OH, March 31, 2011 -- Roughly 15% of children suffer from migraines, and approximately one-third of these affected children have migraines with aura, a collection of symptoms that can include weakness, blind spots, and even hallucinations. Eventhough the causes of migraines are unclear, a newly released study soon to be published in The Journal of Pediatrics suggests a correlation between migraine headaches in children and a heart defect called patent foramen ovale, which affects 25% of people in the U.S.Dr. Rachel McCandless and his colleagues from the Primary Children's Medical Center and the University of Utah studied children 6-18 years old who were diagnosed with migraines between 2008 and 2009. The 109 children enrolled in the study were treated at the Primary Children's Medical Center, which serves kids from Utah, Idaho, Montana, Nevada, Colorado, and parts of Wyoming.The scientists took two-dimensional echocardiograms of each child's heart, looking for a patent foramen ovale (PFO), a common defect in the wall between the two upper chambers of the heart. Eventhough a PFO is not necessarily dangerous, it can allow unfiltered blood to bypass the lungs and circulate throughout the body. As Dr. McCandless explains, "Some adult studies have suggested a link between having a PFO and migraine headaches".........
Walnuts are top nut for heart-healthy antioxidants
A new scientific study positions walnuts in the No. 1 slot among a family of foods that lay claim to being among Mother Nature's most nearly perfect packaged foods: Tree and ground nuts. In a report here today at the 241st National Meeting & Exposition of the American Chemical Society, researchers presented an analysis showing that walnuts have a combination of more healthful antioxidants and higher quality antioxidants than any other nut."Walnuts rank above peanuts, almonds, pecans, pistachios and other nuts," said Joe Vinson, Ph.D., who did the analysis. "A handful of walnuts contains almost twice as much antioxidants as an equivalent amount of any other usually consumed nut. But unfortunately, people don't eat a lot of them. This study suggests that consumers should eat more walnuts as part of a healthy diet".Vinson noted that nuts in general have an unusual combination of nutritional benefits � in addition those antioxidants � wrapped into a convenient and inexpensive package. Nuts, for instance, contain plenty of high-quality protein that can substitute for meat; vitamins and minerals; dietary fiber; and are dairy- and gluten-free. Years of research by researchers around the world link regular consumption of small amounts of nuts or peanut butter with decreased risk of heart disease, certain kinds of cancer, gallstones, Type 2 diabetes, and other health problems.........
March 22, 2011, 10:31 PM CT
Load Up on Fiber Now
A newly released study from Northwestern Medicine shows a high-fiber diet could be a critical heart-healthy lifestyle change young and middle-aged adults can make. The study found adults between 20 and 59 years old with the highest fiber intake had a significantly lower estimated lifetime risk for cardiovascular disease in comparison to those with the lowest fiber intake.The study will be presented March 23 at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011 in Atlanta, Ga. This is the first known study to show the influence of fiber consumption on the lifetime risk for cardiovascular disease."It's long been known that high-fiber diets can help people lose weight, lower cholesterol and improve hypertension," said Donald M. Lloyd-Jones, M.D., corresponding author of the study and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine and a heart specialist at Northwestern Memorial Hospital. "The results of this study make a lot of sense because weight, cholesterol and high blood pressure are major determinants of your long-term risk for cardiovascular disease".A high-fiber diet falls into the American Heart Association's recommendation of 25 grams of dietary fiber or more a day. Lloyd-Jones said you should strive to get this daily fiber intake from whole foods, not processed fiber bars, supplements and drinks.........
March 7, 2011, 7:06 AM CT
13 new genes to heart disease
Insight into the complex biological mechanisms that cause heart disease has taken a major step forward with the discovery of 13 new genes that increase the risk of coronary artery disease (CAD). The influence of the majority of the new genes is independent of other established risk factors, suggesting new, unsuspected causes of CAD. The discovery more than doubles the number of genes known to affect the progression of heart disease.The research also verified th | 医学 |
2014-42/1943/en_head.json.gz/18949 | Safe Haven gets more support from commission
Greenberg, Schoen leaning toward privatization of senior care By KATHERINE WUTZExpress Staff Writer
This photo shows a typical studio apartment in Safe Haven Health Care�s facility in Kuna, Idaho. CEO Scott Burpee said that the Kuna facility is very similar to the one he plans to build in Bellevue, with both assisted living and skilled nursing components. On Thursday, that facility got support from two of the three commissioners, who said the facility offers the greatest benefit to the county for the least cost.
Courtesy photo TanaBell Health Services faced opposition from elected officials and members of the public during a special meeting called to discuss senior care Thursday morning, despite advocates’ saying the company’s proposal could maintain local control while relieving the county of a long-term funding burden. Troy Bell, CEO of the Pocatello-based company, clarified his proposal for taking over the Blaine Manor skilled nursing facility in Hailey. By asking for a voter-approved $4 million levy, Bell said, his company intends to remodel the Blaine Manor facility and cover construction and operating shortfalls in the short term. The remodel would include the addition of between 20 and 25 assisted living units, which would be more profitable for the company and help cover the shortfall from the existing 25 skilled nursing beds. Bell also said the existing Blaine Manor board could remain as an advisory board for the facility. Blaine Manor board member Linda Haavik said the board would be open to allowing Croy Canyon Ranch Foundation a number of years to raise funds to build a tiered-care facility west of Hailey. She said that if the facility is ready, the licenses, patients and certifications from Blaine Manor could be transferred, and it could be managed by TanaBell. One benefit, Bell said, is that he would be fully committed to retaining skilled nursing in the state, provided that Medicare and Medicaid continue to be funded by the state and federal government. “As long as the state provides licenses and funding, you’ll have long-term skilled nursing care in the community,” he said. Commissioner Angenie McCleary, who has been an outspoken supporter of the plan, reiterated during the meeting today that she believes that TanaBell and Blaine Manor would be most likely to provide a high level of care for the seniors of Blaine County. “I have received numerous calls and emails from people [about Safe Haven],” she said. “They have raised concerns in a number of areas.” Pocatello-based Safe Haven Health Care and Safe Haven CEO Scott Burpee presented for the second time last week a proposal that included building a campus-type facility with several “pods” of units that could be switched from assisted living to skilled nursing and vice-versa according to market demands. The proposal does not involve a levy, and the company would take over operations and shortfalls at Blaine Manor starting in October until completion of its planned Bell Mountain facility in Bellevue. McCleary said she heard from community members who decided not to put relatives in Safe Haven homes after visiting the facilities, from a former employee of Safe Haven who had a negative experience and from members of the Blaine Manor board who expressed concern. “They could have endorsed Safe Haven, but they didn’t,” she said. “That is a measure of their opinion of [Safe Haven’s] quality of care.” She also stated concern about three lawsuits against Burpee that involved his previous company, Valley Vista Care Corp.
Blaine Manor board member Steve Pauley asked the commissioners to take those lawsuits seriously, citing a March 2012 article in the Idaho Mountain Express that quoted Commissioner Larry Schoen and McCleary expressing concern about the suits.“This operator has that history to live with,” Pauley said. “I hope you have the same feeling about these allegations that you did back then.” Commissioner Jacob Greenberg said he understood the “moral obligation” to ensure a certain level of care, but added that he did not think Safe Haven would not provide good care—and its business model makes more sense. Greenberg stated during a meeting last week that he had concerns about giving TanaBell $4 million in taxpayer funds to renovate a facility that the company would later buy. He added this week that he felt TanaBell would gain a renovated facility and pay “far below market value” for it at the end of its lease. “Right now, my leaning is toward Safe Haven,” he said.Greenberg joins Schoen in that leaning. Schoen stated last week that he felt TanaBell and Safe Haven would provide very similar services, but Safe Haven would do so at a much lower cost to the county.Members of the public, including Bellevue residents and City Council members, said they agreed with Greenberg. Councilman Dave Hattula said privatizing skilled nursing the way hospital care was privatized in 2001 would be the best solution.“I don’t really hear anyone complaining about St. Luke’s,” he said. “So are we going to burden the taxpayers more?” Hattula added that he had not heard any negative comments about Safe Haven’s existing facility in Bellevue. Bellevue Councilwoman Janet Duffy said she agreed with Hattula that the county taxpayers should not be burdened further with levies for senior care, and Bellevue Councilwoman Barb Patterson said the county should keep in mind taxpayers’ budgets, not just the county budget. “I love Blaine Manor,” she said. “You couldn’t ask for a better facility. But everyone is looking at budgets, and families have budgets, too.” Still, some members of the public said they remained open to options that would require a levy or even a bond. Croy Canyon Ranch Foundation board member Janet Wygle said the county owes it to long-term residents to ensure that they had somewhere to go at the end of their lives. “This is a loving, caring community,” Wygle said. “We take care of our kids, we take care of our criminals—there was a privatized option for a jail, we could have handed it over, but we didn’t, because we even care about our criminals. The county owes a lot more to our seniors than shuffling them off to a private entity.” The county will continue its discussion on senior care on Tuesday, Feb. 12, the date Schoen had previously set as a deadline for a final decision. The commissioners will be out of town at a conference next week.
Kate Wutz: kwutz@mtexpress.com | 医学 |
2014-42/1943/en_head.json.gz/18962 | | | Military and Veterans Mental Health
State Budget Crises Hurt DoD and VA Need for Partnerships, Warns NAMI Convention
Washington, D.C.-- American troops returning from Iraq and Afghanistan and other veterans cannot depend solely on the Departments of Defense (DoD) and Veterans Affairs (VA) for mental health care—even though the civilian mental health care system is in crisis, according to the annual convention of the National Alliance on Mental Illness (NAMI) held this past week.
"The VA and DoD can't do it alone. We need to rely on community providers," declared Jon Towers, senior policy advisor on the U.S. Senate Committee on Veterans Affairs at a symposium broadcast live on C-SPAN.
In the opening speech at the 2010 NAMI Convention, U.S. Representative Patrick Kennedy warned, "Every day in America, our military veterans are being held behind enemy lines" because of the nation's "Byzantine mental health system."
"By changing the mental health system for veterans, we will change it for all of us," Kennedy said.
"We're only going to see great progress when the civilian community starts paying attention," said Tom Tarantino, legislative associate for Iraq and Afghanistan Veterans of America (IAVA) in the July 2 symposium.
"This shouldn't be a DoD-VA dialogue, but a national dialogue," said the Army Surgeon General's special assistant for mental health, Col. Elspeth Cameron Ritchie, M.D., who called for a "needs assessment" in local communities to identify duplications and gaps in efforts.
The 2010 NAMI Convention symposium followed a speech by Pamela Hyde, administrator of the U.S. Department of Health & Human Services (HHS) Substance Abuse & Mental Health Services Administration (SAMHSA), who said as many soldiers in the Army are dying from suicide as have died in Iraq.
However, state and local mental health services face massive state budget cuts and long-term lack of investment. In Grading the States, a NAMI report published in 2009 that assessed state mental healthy care systems based on 65 specific criteria, the average grade was only a D.
The 2010 NAMI Convention symposium included Ira Katz, M.D., the VA's deputy chief patient care services officer and Joy Ilem, deputy national legislative director for Disabled American Veterans.
In a PowerPoint presentation available on the NAMI Web site, Ritchie listed long-term challenges including education, integration of services and increasing the number of providers.
"The mental health of service members depends on the mental health of family members," Towers said.
"More than two million American children have had parents deployed to Iraq or Afghanistan," Hyde said. "A growing number of families are military-connected. The numbers are huge."
NAMI has worked with the VA to provide its Family-to-Family Education Program to families of veterans and also maintains an on-line Veterans Resource Center.
NAMI is the nation's largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness. | 医学 |
2014-42/1943/en_head.json.gz/19006 | Controversy over DSM-5: new mental health guide 24 August, 2013
“Doctors in dispute: What exactly is normal human behaviour?”, wrote The Independent, while The Observer said: “Psychiatrists under fire in mental health battle.”
These headlines focused on a new version of a major guide to mental health that was published in May 2013 amid a storm of controversy and bitter criticism.Fourteen years in the writing (and according to one psychiatrist, “thick enough to stop a bullet”) the fifth edition of the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) has been dubbed “The Psychiatrist’s Bible”.DSM-5 is an attempt to provide doctors with a much-needed definitive list of all recognised mental health conditions, including their symptoms. But with so many gaps in our understanding of mental health, even attempting to do so is hugely controversial.There are two main interrelated criticisms of DSM-5:an unhealthy influence of the pharmaceutical industry on the revision process an increasing tendency to “medicalise” patterns of behaviour and mood that are not considered to be particularly extremeA brief history of the DSMThe DSM was created to enable mental health professionals to communicate using a common diagnostic language. Its forerunner was published in 1917, primarily for gathering statistics across mental hospitals. It had the politically incorrect title Statistical Manual for the Use of Institutions for the Insane and included just 22 diagnoses.The DSM was first published in 1952 when the US armed forces wanted a guide on the diagnosis of servicemen. There was also an increasing push against the idea of treating people in institutions.The first version had many concepts and suggestions that would be shocking to today’s mental health professional. Infamously, homosexuality was listed as a “sociopathic personality disorder” and remained so until 1973. Autistic spectrum disorders were also thought to be a type of childhood schizophrenia.Because our understanding of mental health is evolving, the DSM is periodically updated. In each revision, mental health conditions that are no longer considered valid are removed, while newly defined conditions are added. Pharmaceutical influence on mental health diagnosesHealthcare in the US is big business. A 2011 report estimated that the total US spending on health during that year was $2.7 trillion. This represents 17.9% of the country gross domestic product (GDP). In contrast, NHS spending represents just 8.2% of the UK’s GDP. However, treating mental health conditions (including dementia) is the highest area of spending within the NHS.Links and potential conflict of interests between the pharmaceutical industry and the DSM-5 taskforce (the group that revised the manual) are a matter of record. | 医学 |
2014-42/1943/en_head.json.gz/19090 | IRIDEX Announces Proprietary MicroPulse™ Technology For Treatment Of Eye Diseases Caused By Diabetes And Age-Related Macular Degeneration Featured On 'American Health Front' Program
Innovative, Tissue-Sparing, Cost-Effective Therapy
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MOUNTAIN VIEW, Calif., April 22, 2014 /PRNewswire/ -- IRIDEX Corporation (Nasdaq: IRIX) today announced that an educational story based on its innovative MicroPulse™ technology for the treatment of diabetic macular edema (DME) and age-related macular degeneration (AMD), was recently featured on the Washington, D.C. edition of "American Health Front," a health news program focused on advances in medical techniques and technologies. Neal Adams, M.D., a board-certified ophthalmologist and principal at DC Retina in Silver Spring, MD, presented an overview of the MicroPulse technology, a promising, tissue-sparing laser therapy that allows the tissue to cool between laser pulses, minimizing or preventing tissue damage.
Dr. Adams noted that certain key treatment risks are reduced or eliminated with the use of MicroPulse, and patient comfort is increased compared to conventional, continuous-wave laser treatment.
"Patient care is about caring for the patient and individualizing treatment, which is why I offer MicroPulse for my AMD and diabetic patients," Dr. Adams said. "It doesn't burn or damage the retina and the results are often excellent…It's really impressive technology."
"Numerous recent studies have shown the effectiveness and durability of the MicroPulse technology in treating DME, meaning it should be considered a cost-effective alternative to the regimen of drug treatments via eye injections currently in use," noted William M. Moore, CEO of IRIDEX.
"Drugs injected directly into the eye have a role in treating retinal diseases, but there are serious issues in terms of costs and logistics due to the need for continuous injections for the rest of one's life. This is just not a sustainable model in today's value-based medicine world," Moore said. "MicroPulse offers powerful advantages, in terms of durability, economics and logistics for payors and patients." To see the entire program, click on the following link: https://www.dropbox.com/s/tnbasgtsdvhpxgs/Dr%20Adams%2C%20American%20Health%20Front%202014.mp4 The program can also be seen on YouTube at the following link:https://www.youtube.com/watch?v=6B59WmxzvXY About MicroPulse Technology
MicroPulse is a tissue-sparing laser therapy that works by electronically "chopping" the laser emission into trains of microsecond pulses. This enhances the physician's ability to more precisely control the laser effects on target tissues, offering the potential for ocular treatment with less collateral effects than conventional laser treatments.
About IRIDEX IRIDEX Corporation was founded in 1989 and is a worldwide leader in developing, manufacturing, and marketing innovative and versatile laser-based medical systems, delivery devices and consumable instrumentation for the ophthalmology market. We maintain a deep commitment to the success of our customers, with comprehensive technical, clinical, and service support programs. IRIDEX is dedicated to a standard of excellence, offering superior technology for superior results. IRIDEX products are sold in the United States through a direct sales force and internationally through a combination of a direct sales force and a network of approximately 70 independent distributors into over 100 countries. For further information, visit the IRIDEX website at http://www.iridex.com/.
This announcement contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Act of 1934, as amended, relating to the Company's products and the markets for the Company's products. These statements are not guarantees of future performance and actual results may differ materially from those described in these forward-looking statements as a result of a number of factors. Please see a detailed description of these and other risks contained in our Annual Report on Form 10-K for the fiscal year ended December 28, 2013, and our Quarterly Reports on Form 10-Q for the fiscal quarters ended March 30, 2013, June 29, 2013, and September 28, 2013, each of which was filed with the Securities and Exchange Commission. Forward-looking statements contained in this announcement are made as of this date and will not be updated.
Video - http://www.youtube.com/watch?v=6B59WmxzvXY SOURCE IRIDEX Corporation RELATED LINKS
http://www.iridex.com
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IRIDEX to Host MicroPulse® Worldwide 3-Day Forum at the American Academy of Ophthalmology
IRIDEX Expands Retinal Portfolio
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See more news releases in Entertainment Television Health Care & Hospitals Medical Equipment New Products & Services 2014 | 医学 |
2014-42/1943/en_head.json.gz/19130 | We don't just have a voice in healthcare. At Riverside, we help direct it. riversideonline.com Home » Riverside Foundation » Stories Riverside Foundation
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Racecars, Pink Ribbons and a Mission
Breast Cancer Survivor and Son Raise Funds for Tree of Life
Patients may not know that our mission is to care for others as we would care for those we love, but they can feel it. Jenny Crittenden of Deltaville is living proof of the Riverside Care Difference. After her diagnosis with breast cancer late last year, Riverside became part of her journey: from her first mammogram at Riverside Walter Reed Hospital, to the personal guidance of her oncologist, to the extraordinary compassion of her surgeon as she faced a double mastectomy at age 44.
Crittenden had never heard of the Riverside Care Difference, or our promise to keep our patients safe and be kind to them as we help them heal, but "I felt that," she said. "I felt that from people who took care of me."
Crittenden is grateful that her cancer was caught early, and now she's giving back. With the help of her son, Vaughan, Jenny is spearheading a fundraiser — the Langley Speedway Pink Project — to help other local patients facing cancer.
“I wanted to help the community and help the people who helped my mom.”
- Vaughan Crittenden
The family chose Riverside because the funds stay in our local communities. Each dollar raised goes directly to a cancer patient who needs help, and the health system takes care of overhead and administrative costs for managing the Tree of Life through the Riverside Foundation.
“We wanted to be able to impact patients in the community: to make sure 100% of the proceeds go to patients, whether it's education and prevention or treatment and procedures.”
- Jenny Crittenden
The Langley Speedway Pink Project will benefit the Tree of Life, a fund that supports cancer patients with immediate needs, such as electric bills, transportation to doctor appointments, rent or medication. Recently, the fund enabled an Eastern Shore man to pay his health insurance premiums until he was well enough to work again. Patient navigators at Riverside, including Yvonne Pike, connect those in need to the Tree of Life Cancer Fund when other resources have been exhausted.
“It's beyond amazing," Pike said. "It can make a difference between a patient being able to stay in treatment or not being able to stay in treatment."
Inability to work through their illness is a problem for many with cancer. Those with jobs that are physically demanding typically have to take a leave of absence, potentially losing their positions and their health insurance.
"People actually drop out of treatment because they can't work," Pike said. "Sadly, we still see times when patients have to choose between a roof over their head and treatment for cancer."
Jenny Crittenden doesn't want anyone to have to make such a difficult choice. She knows that cancer doesn't discriminate — it can hit anyone, at any time. Her brother is recovering from colon cancer, and two other relatives and a number of friends have been diagnosed with breast cancer. Through the Langley Speedway Pink Project, she's hoped to cast a wide net so that patients facing the illness realized they were not alone.
For her son, a 22-year-old student at James Madison University, the project was also about empowering people who want to help. From the moment his mother confirmed her cancer diagnosis, Vaughan couldn't shake the feeling that he needed to take action. The next night, he decorated his winged champ kart with pink tape for his last race of the season at Langley Speedway, where he's been competing since he was 12. He noticed other drivers also had pink on display in more subtle ways. "But everybody was doing it on their own," he said. "All of these people want to do something."
Arranging a fund-raiser at the track, where Vaughan is currently completing an internship, felt like a natural fit. Langley Speedway is a hometown track, with racing levels from amateur to semi-pro, and thanks to the generous spirit of its hometown racing fans — and the hard work of Jenny and Vaughn — the event was a great success. Over 6,000 patients, friends, community members and Riverside staff came to show their support at the track where stars like Richard Petty, Jimmy Johnson, Adam Petty and Denny Hamlin have raced.
“It was such a privilege to participate in this event. I cannot thank Jenny, Vaughn and all the volunteers enough for all their hard work and dedication to the cancer care fund. My patients amaze me every day. Their strength of spirit and their ability to think of others even in the face of the emotional, mental and physical strain that comes with their cancer diagnosis is truly inspiring.”
– Dr. Magi Khalil, Riverside oncologist
Jenny and Vaughn Crittenden truly embody the spirit of Riverside Care. They emerged from trying times with hearts full of compassion, kindness and a drive to care for others as they would care for those they love. The Pink Project has ensured that many others facing cancer will receive the same remarkable care and support that inspired Jenny to give back through Riverside. We are honored to be a continuing part of her journey as she helps others in such a meaningful, reaching way.
100% OF THE PROCEEDS from the Langley Speedway Pink Project went to help those battling cancer through the Tree of Life Cancer Fund.
Riverside Foundation
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(757) 234-8740(757) 369-1862 Fax | 医学 |
2014-42/1943/en_head.json.gz/19306 | Firefighters Burn Institute Regional Burn Center
Health System > Burn Center > Newsroom
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Palmieri inducted as president of American Burn Association FFBI Regional Burn Center
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Tina Palmieri, professor and director of the Firefighters Burn Institute Regional Burn Center at UC Davis Medical Center, was inducted as president of the American Burn Association (ABA) at the association's annual meeting in Seattle this week.
"Being president of the ABA is an honor and privilege," said Palmieri. "I am representing some of the most dedicated medical professionals and have the opportunity to shape the future of burn care, including clinical practice, prevention, research and teaching."
Serving the burn community both locally and nationally, Palmieri led the presentation, "Anatomy of the National Burn Repository," at the annual ABA meeting. She has held leadership roles in the ABA for many years. She chaired the Program, Education and Research Committees and was on the Steering Committee for the ABA Multicenter Trials Group, which unites burn researchers to perform meaningful outcomes research.
Palmieri organized, obtained funding for and published findings of the Burn State of the Science Consensus Conference, which set the research priorities for burns over the next decade. Her work has helped garner millions of dollars in funding for burn outcomes research.
"The main goal of my research is to improve the quality of life of people who have sustained burn injury," said Palmieri. "Survival alone shouldn't be our goal anymore. It should be to give people the best possible quality of life after a burn injury."
Palmieri has expertise in treating both pediatric and adult burn injuries. In addition to her position at UC Davis, she is Assistant Chief of Burns at Shriners Hospitals for Children - Northern California.
The ABA is dedicated to improving the lives of everyone affected by burn injury through patient care, education, research and advocacy. ABA membership includes burn care physicians, nurses, physical and occupational therapists, social workers, psychologists, rehabilitation experts, researchers, firefighters, burn survivors and others with interest in the field of burn care.
UC Davis Medical Center is a comprehensive academic medical center where clinical practice, teaching and research converge to advance human health. Centers of excellence include the National Cancer Institute-designated UC Davis Comprehensive Cancer Center; the region's only level 1 pediatric and adult trauma centers; the UC Davis MIND Institute, devoted to finding treatments and cures for neurodevelopmental disorders; and the UC Davis Children's Hospital. The medical center serves a 33-county, 65,000-square-mile area that stretches north to the Oregon border and east to Nevada. It further extends its reach through the award-winning telemedicine program, which gives remote, medically underserved communities throughout California unprecedented access to specialty and subspecialty care. For more information, visit medicalcenter.ucdavis.edu.
Firefighters Burn Institute Regional Burn Center | 2315 Stockton Blvd. | Sacramento, CA 95817 | UCDMC Adult outpatient referral: (916) 734-3636 | Shriners Children new patient referral: (916) 453-2180 | 医学 |
2014-42/1943/en_head.json.gz/19308 | 2014 PDF (PDF)
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Faith & Hope for Robert Pritchard
Former UCF DE suffered a massive stroke in July.
Robert Pritchard is aiming to return to UCF next fall to complete his graduate studies.
By Brian Ormiston UCFAthletics.com
Robert's Recovery Photo Gallery
ORLANDO, Fla. (UCFAthletics.com) - On July 9, former UCF defensive end Robert Pritchard's life changed forever. The Georgia native began suffering from uncontrollable seizures and it would later be confirmed that he had a rare and massive stroke. His road to recovery has been long, and it still has a long way to go.
Pritchard, who competed for the Knights from 2008-11, is aiming to return to UCF next fall to complete his graduate studies.
Robert Pritchard Story
Courtesy of the Pritchard family
July 9, 2012: Robert Pritchard, an otherwise healthy 22-year old, began suffering from uncontrollable seizures and was rushed by ambulance to Atlanta's Emory University Hospital Midtown. Upon arrival, it was not clear what was causing the seizures, but his symptoms then evolved to include paralysis. He was given anti-seizure medications, but the seizures continued. The physicians were concerned because the paralysis seemed to be long lasting, so they decided to start a battery of CT's/MRI's. Unfortunately, Roberts's condition was far worse than anyone of us could imagine. He was barely able to complete the first round of testing due to the increased seizure activity. The attending neurologist requested that he be sent immediately to the Neurological ICU for further monitoring.
July 10, 2012: The test results from the scans showed impressive swelling and a "spot" in the right hemisphere of his brain. Brain lesion, stroke, cancer, tumor were all thrown on the table. The physician began leaning toward stroke, but wanted proper evidence to call it so. If it was a stroke the only way to confirm was to wait until the next day to see if the "spot" would grow. Meanwhile, medications were started for infection, dehydration and anti-coagulation (blood thinners); pain medication was withheld due to its sedative properties. They wanted him to stay awake, despite the increasing pain, to monitor his consciousness. With the swelling, his consciousness would be the only bedside clue if his illness was progressing. By midday it was obvious that the pain was causing blood pressure to increase, so the physician made a decision to intubate, sedate and mechanically ventilate (using a breathing tube and a ventilator) Robert to protect his airway, in case he does lose consciousness.
July 11, 2012: The speculation was confirmed, he did have a stroke. He not only had a blood clot, he also had a bleed, compounded by swelling. Besides, the medications that Robert was receiving were not at "therapeutic levels," because he was too healthy for the dosages. This illness should not happen to a healthy 22-year old. To add fuel to the fire, because he was so young with a big, young brain, the physician was extremely worried that there was not enough room for much swelling if it couldn't control. They would take him out of sedation every four hours to ensure he could still follow commands.
July 12, 2012: Robert was still in very critical condition and his physicians made it clear that although the stroke is the primary reason why he was there the secondary reason, the swelling was a far more pressing issue. This particular night the RN that Robert had, she was his only patient due to the severity of his situation, was extremely vigilant and eager to make sure his condition did not worsen. She began to lift him out of sedation every two hours. By her doing this she was able to catch his change in mental status, even though he was sedated. She checked him at 12:00 and he was able to follow commands, raising his thumb, wigging his toes, but by 2:00 a.m. nothing. This brilliant young nurse did something that we later found out saved his life. She was able to contact the radiology department to stop all testing, have the on-call radiologist waiting for Robert have a "STAT" brain scan. The physicians were able to see the swelling had increased just enough to impede the functions of the well side of his brain. There was no more room for swelling. The physicians made a bold move to have half of his skull removed to make room for his brain, which was in jeopardy of dying off because unfortunately with the increase in swelling there is a decrease in blood flow. Also, having surgery was an even bigger deal due to the levels of blood thinners he was on. They would have to stop the therapy in order for them to cut him in any way shape or form. This means increasing the likelihood of another blood clot forming. But the risk from the swelling out-weighed the risk for the future blood clots or them not being able to stop him from bleeding on the operating table.
Robert had the surgery, it was successful, but now we had to wait. There was a debate between his attending neurologist and the neurosurgeons as to the time frame for restarting the anti-clotting medications again. The attending wanted to start as soon as possible, but the surgeons wanted to wait up to six hours. They decided the only way to get passed the issue to monitor his brain activity even more closely. He needed to be transferred to the sister location, a larger facility with more physicians. To be exact, he would now have access to all 16 neurologists at Emory, who were all familiar with his case. He was, for a week of his stay, the most critical neurology patient they had. We agreed for him to be transferred just hours after his major surgery and Robert handled it like a champ. Once he arrived at this location, they decided that the blood clot issue out-weighed the possible bleed out and they began his blood thinning treatments again. They also decided to insert an instrument called "The Bolt" which would give them constant access to his fluctuating cranial pressures.
July 31, 2012: After weeks of intense monitoring and recovery, Robert was cleared for rehabilitation. And just his luck, one of the best rehab facilities, The Shepherd Center, was right under his nose. He was the perfect candidate. The form of aggressive rehab is just was Robert needed. And we firmly believe that he was definitely up to the challenge with his extensive years of athletic training.
September 13, 2012: Although he had made great strides in his recovery, Robert is still wheelchair-bound and was scheduled for weeks more of outpatient services from Shepherd. Renovations had to be made to his mother's home including: the addition of ramps, widening of doors, adding of a sit-down shower and rails, etc. The first sets of medical bills have started to roll in from Emory. They alone totaled nearly $300,000.00. This does not include any prescriptions or other unforeseen expenses associated with his medical care. UCF Football HOME
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2014-42/1943/en_head.json.gz/19354 | HomeUW TodayArchiveNew class of biomolecules triggered in response to respiratory virus infection
New class of biomolecules triggered in response to respiratory virus infection
Leila Gray UW Health Sciences/UW Medicine
Dr. Michael Katze, UW professor of microbiology and head, Center for Systems and Translational Research on Infectious Disease, directed a study that found a new class of biomolecules are triggered inside mammalian cells in response to respiratory virus infection. Dr. Xinxia Peng, computational research scientist, UW Department of Microbiology, was the first author of an mBio paper that showed long, non-protein coding RNAs may help regulate innate immunity For the first time, scientists have discovered that a poorly understood class of RNA produced in a mammal’s cells during a respiratory virus attack may affect the outcome of the infection. Their findings are reported today in mBio, a journal of the American Society for Microbiology.
RNA (ribonucleic acid) contains information transcribed from the cell’s instruction manual, its DNA. The best known of these RNAs translate sections of DNA code into building blocks for proteins.
Most studies of how animals’ cells respond to virus infection typically look at protein-coding genes, which produce germ-fighting or inflammation-producing substances. However, mammalian cells also transcribe thousands of other RNAs that don’t code for proteins.
“The role of most of these non-protein-coding RNAs remains an enigma,” noted lead author of the study Dr. Xinxia Peng. computational research scientist, UW Department of Microbiology. Dr. Michael Katze, professor of microbiology at the University of Washington (UW) in Seattle, directed the project. Katze heads the Center for Systems and Translational Research on Infectious Disease (STRIDE). “Some attention,” Katze said, “has been given to small RNAs, like microRNAs, in host-virus interactions, but now it’s becoming apparent that many long -non-protein coding RNAs — bigger than 200 nucleotides — are also biologically important.”
Researchers are learning that long non-protein-coding RNAs have a wide variety of functions. A few examples are modifying chromosomes, regulating genes, influencing cell structure, and serving as precursors for small RNAs and microRNAs, which are involved in virus-host interactions.
The library of RNA transcripts inside of a cell is called its transcriptome, and is a reflection of gene activity. Many different RNAs can be read from a single gene. That is why a transcriptome contains much more complex instructions than seems possible from the DNA code. Unlike the genome, the transcriptome varies in different types of cells in the body and in accordance with ever-changing conditions inside and outside the cell.
Peng recalled, “There were intensive discussions about what value the new whole-transcriptome analysis would add to our understanding of viral pathogenesis. After several exploratory analyses, we realized that many long non-protein coding RNAs also responded to SARS virus infection. We were so excited. The response had just been overlooked by people. ”
“People have not seriously looked at these long-non-protein coding RNAs during viral infection,” Peng noted, “because so little is known about these RNAs in general and this type of RNA can’t be monitored easily with typical technologies.” Katze and his research team were able to use highly advanced technologies, namely next generation sequencing, to perform a whole-transcriptome analysis of the host response to severe acute respiratory syndrome coronavirus (SARS-CoV) infection. The study was conducted in four strains of mice, some more susceptible to this virus or to the flu virus than others.
Through a comprehensive computational analysis of the data, the researchers observed that virus infection triggered about 500 long non-protein coding RNAs transcribed from known locations on the genome and about 1,000 from previously unspecified genomic regions.
“Using this approach,” Katze noted, “we demonstrated that virus infection alters the expression of numerous long non-protein coding RNAs. These findings suggest that these RNAs may be a new class of regulatory molecules that play a role in determining the outcome of infection.”
The long non-protein coding RNAs may be helping to manage the infected animal’s response to the virus, including the basic, first-line defense against infection — the animal’s innate, or inborn, immunity.
Another important finding was that the strains of more susceptible mice had a common profile showing distinct rates of genetic activity. This profile contained unique “signatures” of non-protein coding RNA activity. These signatures were associated with lethal infection. Test-tube studies show that more that 40 percent of the long non-coding RNAs and genomic regions activated in a SARS infection were also activated in response to both influenza virus infection and interferon treatment.
This finding further pointed to a signature profile associated with pathogenicity — the power of a virus-host interaction to cause disease.
“The relevance of long-non-protein coding RNAs to viral infections has not been systematically studied,” said Dr. Paulene Quigley, program manager of the STRIDE center. “But now, with our ability to do whole-transcriptome analysis using next generation sequencing, we can systematically catalog and compare these long non-protein coding RNA in response to infection. What we are finding is very promising for infectious disease research.”
These results, to the best of the scientists’ knowledge, are the first to clearly demonstrate the widespread production and activation of long non-coding RNAs in response to virus infection. Their success opens new avenues for investigating the roles of long-non-protein coding RNAs in innate immunity to infection.
Exactly how the long-non-protein coding RNAs perform these functions is not yet known. It’s possible that they might interact with protein complexes that modify gene expression during a viral infection. They might also modulate the host’s response by regulating neighboring protein-coding genes.
“The functions of non-protein coding RNAs remain largely unexplored, but we now have the tools to study them,” Katze said. “Such studies are critical, because non-protein coding RNAs may represent a whole new class of innate immunity signaling molecules, interferon-dependent regulators, or modulators of the host response during viral infection. They could also be a new class of biomarkers for infectious disease and for diagnostics development. Identifying similar profiles in response to lethal respiratory infections may even provide clues into the ‘high-path’ viral infection, one of the holy grails of virology. That’s a big deal any way you slice it.”
Highly pathogenic viruses causing life-threatening illnesses, like SARS or West Nile or pandemic flu, continue to emerge. Looking forward, a detailed knowledge of non-protein coding RNA regulation and function likely will be necessary for a full understanding of how viruses cause disease and how the body defends against or succumbs to viruses.
In addition to Peng and Katze, other researchers on the study are Lisa Gralinski, Department of Epidemiology, University of North Carolina, Chapel Hill; Christopher S. Armour, Matthew C. Biery, and Christopher K. Raymond, all of NuGEN Technologies; Martin T. Ferris, Department of Genetics, University of North Carolina, Chapel Hill; Matthew J. Thomas, Sean Proll, Birgit G. Bradel-Tretheway, Marcus J. Korth, all of the UW Department of Microbiology; John C. Castle, Institute for Translational Oncology and Immunology, Mainz, Germany; Heather K. Bouzek, UW Department of Microbiology, David. R. Haynor, UW Department of Radiology; Matthew B. Frieman, Department of Microbiology and Immunology, University of Maryland, Baltimore; Mark Heise, Department of Genetics, University of North Carolina, Chapel Hill; and Ralph S. Baric, Department of Epidemiology and Department of Microbiology and Immunology, University of North Carolina, Chapel Hill.
The work was supported by the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Human Services, through grant U54 AI081680 (Pacific Northwest Regional Centers of Excellence) and contract no. HHSN272200800060C, a Systems Biology Approach for Infectious Disease Research. | 医学 |
2014-42/1943/en_head.json.gz/19439 | Health Dec 13, 2012 3:59 PM by Eric Ross
FDA review of tobacco products grinds to a halt
RICHMOND, Va. (AP) - Talk about a smoke break. Tobacco companies have introduced almost no new cigarettes or smokeless tobacco products in the U.S. in more than 18 months because the federal government has prevented them from doing so, an Associated Press review has found. It's an unprecedented pause for an industry that historically has introduced dozens of new products annually, and reflects its increasingly uneasy relationship with the Food and Drug Administration, which in 2009 began regulating tobacco. Officials at the FDA say the reviews of applications for new products have taken so long because of "significant deficiencies" and because the agency is taking extra care in reviewing products that pose public health risks. Industry executives say cigarettes haven't changed in any meaningful way and the delays don't make sense. They say the changes are as simple as a brand name change, cigarette filters or, in some cases, different packaging. Since June 2009, when the law allowing the agency to regulate tobacco went into effect, the tobacco industry has submitted nearly 3,500 product applications, according to data obtained by the AP under a Freedom of Information Act request. While none have been ruled upon, the vast majority of these products are already being sold. A grandfather clause in the law allows products introduced between February 2007 and March 2011 that are similar to those previously on the market to be sold while under review. They can be removed from store shelves if they don't pass muster with the agency. But 400 products submitted for review since March 2011 are being kept off the market. The reviews, which the industry expected to take 90 days, have dragged on for years in some cases. About 90 percent of applications have lingered for more than a year. The FDA does not have to disclose what the products are, and the companies won't say, citing competitive reasons. Part of the problem is that the tobacco industry is still learning how to deal with being regulated. "They have the burden of demonstrating that new products and product changes won't increase youth tobacco use, won't increase toxicity and won't wrongly deter people from quitting," said Matt Myers, president of the Campaign for Tobacco-Free Kids. The group has raised concerns about new products that it says were illegally introduced without review by Richmond, Va.-based Altria Group Inc., parent company of Philip Morris USA, the nation's largest tobacco company, and No. 2 tobacco maker Reynolds American Inc. Philip Morris USA's Marlboro Black NXT - a cigarette that can be switched to menthol by crushing a capsule in the filter - and two new styles of Reynolds' Pall Mall menthol cigarettes shouldn't be allowed to be sold without FDA approval, the Campaign for Tobacco-Free Kids argues. The companies, however, believe they are complying with federal law. The FDA says it is investigating. It's essential that the FDA move "strongly and decisively to make public either why these product should be allowed to be marketed or to get them pulled off the market immediately," Myers said. The share of Americans who smoke has fallen dramatically since 1970, from nearly 40 percent to about 19 percent. But the rate has stalled since about 2004, with about 45 million adults in the U.S. smoking cigarettes. Tax hikes, smoking bans, health concerns and social stigma are all making the cigarette business tougher. The industry's revenue growth has been modest, staying steady only because the companies have raised prices as fewer cigarettes are smoked and others have focused on the small-but-growing smokeless tobacco market. Tobacco companies need new products to keep their brands growing and steal smokers from competitors. And though they say they only market to smokers, if cigarette makers can't lure new ones, their business will die. They also can't look for growth overseas. All of the companies sell cigarettes only in the U.S. Their brands are sold in other countries by different companies. "You try to introduce new products to keep some excitement and freshness out there," tobacco analyst Jack Russo of Edward Jones said. "There are just so many hurdles and regulations and battles to get new products approved. ... It's kind of like you have a new sheriff in town, and you're trying to figure out what the new rules are." In an interview with the AP, Dr. Lawrence Deyton, director of FDA's Center for Tobacco Products, said the agency is working with companies to get more information about products and hopes the industry will be more transparent about its reasoning that product changes don't affect public health. Small changes in ingredients or additives can make a cigarette more addictive or harmful, Deyton said. "Though cigarettes seem like a very simple product - chopped-up tobacco rolled in paper ... we know that cigarettes are highly engineered. They're technologically incredibly sophisticated," said Deyton. The center has an annual budget of more than $450 million, funded by the industry, and more than 365 employees, about 115 of whom work on the application reviews. "This is new for them ... and this is new for FDA as well. ... We're not playing gotcha," Deyton said. The FDA isn't exercising common sense, Murray Kessler, CEO of Newport cigarette maker Lorillard Inc., said in an interview. "These are cigarettes. They haven't changed in 50 years. They've had the most minor changes," Kessler said. "I don't think the spirit of the law ever envisioned this type of cumbersome scrutiny." For example, Kessler said that under the FDA's guidelines, if the nation's third-biggest tobacco company wanted to take a Kent brand cigarette and rename it "Newport," it would be subject to review even though "it's not substantially equivalent - it's exactly equivalent." Lorillard petitioned the agency in June seeking to speed the reviews. The FDA has until around the end of the year to respond. The slowdown has caused a split in the industry as well. Smaller companies like Lorillard say larger companies like Philip Morris USA were able to put more products in test markets before the FDA deadline. That let them stay on the market while being reviewed by the FDA. At a mid-November analyst conference in New York, Kessler reiterated his frustration with the process but said the FDA is communicating with Lorillard on two of its applications for new products and its petition. Lars-Erik Rutqvist, senior vice president of scientific affairs at smokeless tobacco maker Swedish Match, said the frustration lies in "the fact that it takes so long and there's no explanation why." "I think there's suspicion within industry that this is how it's going to be in the future and this is more or less a way of punishing the industry," Rutqvist said. Other industry observers like Richard A. Daynard, professor of law at Northeastern University and chairman of the Tobacco Products Liability Project, say the process wasn't "intended to be a black hole." "There's certainly a tension in having the FDA regulate a deadly product that has no compensating benefits, but that's their job under this thing and they need to get with it," he said. Despite the tug-of-war, government processes taking longer than expected isn't new ground, said Ira Loss, an analyst with Washington Analysis who has covered the FDA for three decades. "This would not be the only division at FDA that has trouble meeting deadlines for review," he said, citing a backlog of applications for generic drugs. "(The industry has) a right to gripe. ... There probably should be (an avenue for recourse), but there isn't. What are you going to do, put people in jail?" »Comments Most Popular | 医学 |
2014-42/1943/en_head.json.gz/19637 | Toward universal coverage : Turkey's green card program for the poor (English)
This case study unravels Turkey's path to universal coverage. It outlines both the transformation of the health system and the performance of the 'Yesil Kart', the Green Card, program, a noncontributory health insurance scheme for the poor. ... See More +
Initially launched in 1992, the Green Card program has seen a rapid expansion in the number of beneficiaries and program benefits since the implementation of the Health Transformation Program, or HTP in 2003, with the number of beneficiaries more than tripling, from 2.5 million beneficiaries in 2003 to 9.1 million beneficiaries in 2011. In addition, both the coverage and targeting of the program improved substantially. While the Green Card program initially began as a separate targeted scheme for the poor, in January 2012 it became part of the UHI scheme managed by Social Security Institution, or SSI. As this study will show, gradual steps were taken over the years to expand coverage, improve targeting, and expand benefits of the Green Card program to align it with the UHI. This, combined with the improvements in service delivery within a comprehensive reform of the health sector, makes Turkey a unique example of universal coverage for quality health services. The study is organized as follows. Section two briefly outlines Turkey's health reform and how health care is currently organized and delivered. Section three describes the Green Card Program, it evolution, and its performance. The final section discusses the pending agenda. See Less -
Document Type: Working Paper (Numbered Series)
Document Date: JAN 01, 2013 Author: Menon, Rekha; Postolovska, Iryna; Mollahaliloglu, Salih
Health workforce policy in Turkey : recent reforms and issues for the future (English)
The health status of the Turkish population has improved significantly over the past few decades, accompanying improvements in the scale and functioning of the health-care system. ... See More +
Impressive progress has been made in expanding financial protection to the population through expansions in the breadth and depth of health insurance coverage combined with service delivery reforms to improve equity in access to health services. This note summarizes the main developments in the area of health workforce policy and how these have affected key health workforce performance outcomes. Specifically, the main objectives are to: (i) summarize trends in key health workforce outcomes; (ii) compare health workforce outcomes in Turkey to Organization for Economic Co-operation and Development (OECD) and other countries; (iii) discuss the impact of recent reforms in the health sector on health workforce outcomes; and (iv) highlight key health workforce policy issues for the future. See Less -
Document Date: JUL 01, 2009 Author: Sparkes, Susan; Vujicic, Marko; Mollahaliloglu, Salih
75012 Working Paper (Numbered Series) | 医学 |
2014-42/1943/en_head.json.gz/19716 | GEN Exclusives
Study Finds a Friend at NIH but Will Congress Share the Love?
Paper in NEJM tries to make case for boosting federal research funding amid House leaders’ pursuit of spending cuts.
Alex Philippidis
Corbis - Fotolia.com
A paper published in The New England Journal of Medicine (NEJM) engaged in some timely agenda-setting recently when it presented a study quantifying the number of FDA-approved drugs discovered through research at federally funded organizations. It stated that federally backed research resulted in the sanction of 153 drugs, vaccines, and new indications for existing therapies in the U.S. between 1970 and 2009.
Authors of “The Role of Public-Sector Research in the Discovery of Drugs and Vaccines” left no doubt they wanted to weigh in on the ongoing debate over federal funding of basic research, declaring among their conclusions: “Public-sector research has had a more immediate effect on improving public health than was previously realized.”
The paper’s lead author, Ashley J. Stevens, D.Phil., told GEN, “The message that I wanted people to take away from this was that the government puts a lot of funding into research at these various places, and it is primarily to advance the nation’s knowledge base, not to create commercial spinoffs.
“I wanted people to realize that in the course of doing this, you did get these important health benefits to the public and economic development benefits to the companies that take these inventions and develop them,” added Dr. Stevens, special assistant to the vp for research technology development and senior research associate at Boston University’s Institute of Technology Entrepreneurship and Commercialization and a lecturer at the BU School of Medicine.
That message, fair to say, has found a friend at the NIH. Its director, Francis S. Collins, M.D., Ph.D., cited the NEJM study on February 14 from the podium of the press briefing on the budget for his agency and the other agencies that comprise the U.S. Department of Health and Human Services.
Not surprisingly, Dr. Collins defended President Obama’s plan to increase NIH’s budget about 2.4%, or $745 million, for the fiscal year starting October 1. This would take the money available to the institute from $31.24 billion, which was the last-approved budget in 2010, to almost $31.98 billion. Congress has yet to approve a budget for the rest of the 2011 fiscal year; a continuing resolution ends March 4.
Newly empowered House Republicans acted quickly earlier this month to propose a leaner NIH, with the House Appropriations Committee introducing a bill cutting the agency’s budget by 5%, or $1.63 billion. The bill went beyond the billion-dollar reduction proposed by committee chairman Hal Rogers (R-KY) let alone the no-cut, no-growth NIH budget initially offered by the committee until House GOP backbenchers pressed for further reduction. After all, Republicans won control of the chamber based on promises to rein in spending.
Cutting Gov’t Spending
The paper published in NEJM looked at so-called public-sector research institutes (PSRIs). It defines PSRIs to include even privately run universities and private nonprofit research institutes. Both types of organizations, and even many public ones, also raise private funds toward research, whether in the form of new labs and other facilities or endowed chairs for top researchers.
Labeling both public and private institutions “public” for using federal research funding plays into the hands of NIH would-be budget-cutters, who equate growth in federal research spending with an unconstitutionally “big government.”
The Constitutional argument resonates with fiscal conservatives in this year’s majority, among them Tea Party supporters. They note that the constitution framers in 1787 rejected adding to the duties of Congress “encourage, by proper premiums and provisions, the advancement of useful knowledge, and discoveries.”—a proposal introduced by James Madison himself.
But the Bayh-Dole Act of 1980 combined with the rise of biotech in the 1970s, married Washington and the life science industry as partners in commercializing basic research. Indeed between 1991 and 2009, government funded between 60 and 70% of the cost of basic research.
Industry’s share of financing such activities rose until 1999, then declined until 2006 when it resumed its climb again, noted Dr. Stevens, citing research from the Association of University Technology Managers, of which he is president. The remaining funding sources include colleges and universities, nonprofit research institutions, state governments, venture capital funds, foundations, and other philanthropic and charitable organizations.
Public Sector’s Role in Translational Studies
The 153 drugs cited in the NEJM study consist of 102 new molecular entities including eight in vivo diagnostic materials and an over-the-counter product; 36 biologic drugs; and 15 vaccines. With Democrats vowing to resist any cuts, a veteran lobbyist for greater federal research spending says the report will help his cause.
“I think that study really helps justify sustained federal support for NIH,” Jon Retzlaff, managing director of science policy and government affairs for the American Association for Cancer Research, said to GEN. “The NIH and the public sector is continually being asked by Congress and the general public to do more in the translation of those basic discoveries to clinical advances. And I think that report shows there’s been success with NIH in making these discoveries that are being used in the clinical world now.”
The study reported in NEJM also examined NDA approvals between 1990 and 2007. A total of 1,541 NDAs were sanctioned, and 143 of them were generated by PSRIs. Among the total 1,541 NDAs, 348 were given fast-track status and eventual go-ahead under priority review.
Of these priority applications, 66 originated at PSRIs. This represents almost 19% of the total fast-track NDAs that got approved and just over 46% of the total PSRI-generated NDAs. Comparatively, 20% of NDAs stemming from purely private research were approved under priority review. Points like these are likely to be lost on many Congressional critics of federal research funding.
PSRIs Gaining Influence
NIH is the most prolific among the 75 discoverers or co-discoverers of those 153 drugs, with 22 products. Next highest with 11 drugs is another public institution, the University of California system. That raises another question: How efficient is it for NIH to maintain the current system of distributing grants to researchers at other institutions rather than consolidate them and their research in-house at its 27 institutes?
The answer would depend on an endeavor that admittedly would take much more time and effort than the NEJM paper but would be even more valuable. Of importance would be an examination of the cost of developing each of the 153 drugs; which drugs cost the most and least to produce; research costs at public versus private research institutes; and whether the institutions that spent the most produce the most new drugs as a result.
Dr. Stevens pointed out that such an examination would be a tall order. Pharma and biotech companies, he noted, are often uncomfortable pinpointing the research costs of specific drugs. But additional study might offer some answers to why the cost of bringing new drugs to market has ballooned from $318 million in 1987, to $800 million in 2001, to $1.3 billion today, according to the Tufts Center for the Study of Drug Development. Much of that escalation reflects rising clinical costs.
“It feels the discovery part of this is going to be costing somewhere in the range of $500,000 to the $3–4 million range,” Dr. Stevens said. “What you can’t get is the development cost,” he added, cautioning his calculations are estimates at best. “Ballpark, you see numbers of $100 million to $500 million. I think the private investment is going to be 100 times the public investment in this.”
That’s certainly a driver in so many companies cutting R&D costs, as is the parade of drugs set to lose patent protection. Both factors will bring additional research to the PSRIs. And as that happens, PSRIs can be expected to step in and claim more of the spoils such as patents, licensing fees, and royalties.
Where Is the Money Going?
Another issue worthy of additional study is why some drugs are more likely than others to be developed with public money. Half of the 153 drugs identified in NEJM were in just two therapeutic areas: hematology or oncology (40) and infectious disease (36). The authors posit a theory: The top-four categories of discovered drugs correspond to the four NIH institutes with the biggest budgets—National Cancer Institute; National Institute of Allergy and Infectious Diseases; National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases.
“One possible interpretation of this observation is simply that there was more funding available for research involving these disease categories, which resulted in more useful intellectual property,” according to the study. That interpretation was borne out just four days after publication of the NEJM study.
On February 14, NIH published a detailed breakdown of how much the agency awarded in research funding into each of 229 research and disease areas. Compare the funding received by the top four therapeutic areas with the top four therapeutic areas revealed in the NEJM paper: $10.17 billion for hematology and oncology, $4.458 billion for infectious diseases, $2.542 billion for cardiology, and $1.35 billion for metabolic diseases.
All four disease categories have seen projected year-to-year decreases for FY 2011 and FY ’12, reflecting the end of funds available through the $814 billion American Recovery and Reinvestment Act. But when FY ’10 nonstimulus funds are compared evenly with the ’11 and ’12 budgets, funding for the top four stays flat or increases slightly.
Maintaining that trajectory, Retzlaff said, will be priority one for him and should be priority one for the nation. But while President Obama is seeking more NIH money, he has also positioned himself as a cost-cutter in the face of $1 trillion plus deficits.
Alex Philippidis is senior news editor at Mary Ann Liebert, Inc., and Genetic Engineering & Biotechnology News.
KEYWORDS: Grants
Policy/Legislation
U.S. Budget
Obama Budget: More NIH Grants, Higher FDA User Fees
Chilly Budget Climate All but Freezes Proposed FY ’12 Spending for NIH and CDC | 医学 |
2014-42/1943/en_head.json.gz/19733 | Radiation for Breast Cancer May Raise Heart Risks: Study
MONDAY, Oct. 28 (HealthDay News) -- Radiation therapy for early stage breast cancer carries a small, but real, risk of heart disease, new research finds.
The lifetime risk ranges from 0.05 percent to 3.5 percent, depending on how the radiation was delivered and a woman's overall risk for heart disease, the researchers report.
Women at greatest risk are the ones receiving radiation on their left breast while lying on their back and who also are at risk for heart disease.
Radiation of the left breast ups the risk since that also exposes the heart to radiation, the study authors explained.
The lowest risk is among women receiving radiation for their right breast while lying face down. When radiation is given on the right side, the heart is totally out of the field of radiation, they noted.
"Our findings confirm that the radiation exposure associated with left-breast cancer radiotherapy is associated with a generally small, increased risk of heart disease later in life," said lead researcher David Brenner, a professor of radiation biophysics at Columbia University Medical Center, in New York City.
"Of course, that side effect needs to be balanced against the fact that lumpectomy plus radiation is of well-proven efficacy for treating early stage breast cancer," he said. "All cancer therapies involve balancing benefits and risks."
In addition, the doses of radiation used today are much lower than they were 20 years ago, so the heart receives less exposure than it once did. "The risk of radiation-associated heart disease is lower for patients treated now than it was in the past," Brenner added.
For women who need radiation for their left breast, the risk of developing heart disease can be lessened by lying face down during treatment, the researchers found.
In addition, since women most at risk of developing heart disease are those who are already at risk for it, Brenner suggests they can reduce their risk by not smoking and keeping blood pressure and cholesterol under control.
The report was published in a research letter online Oct. 28 in the journal JAMA Internal Medicine.
Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said it is known that radiation to treat breast cancer increases the risk for heart disease.
When doctors do the planning for the therapy, they try to limit the amount of radiation that reaches the heart, she said. "You try to exclude the vital organs, but you can't exclude them 100 percent on the left side."
However, the risk of heart disease later on in life should not deter women from getting radiation therapy, Bernik said.
"If you are doing breast conservation, radiation is part of the plan," she said. "The recurrence rate is much too high without the radiation." Heart disease related to radiation treatment for breast cancer, however, can take anywhere from five to 20 years to develop, according to a recent study published in the New England Journal of Medicine.
"There are a lot of women who do not want to have breast conservation because of the radiation risk -- they are concerned about the heart risk," said Dr. Laura Kruper, co-director of the Breast Oncology Program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.
Kruper said there are newer radiation therapy methods that reduce the risk. "We are really tailoring patients' treatments," she said. "We have a lot of tools now where we can offer women breast conservation and minimize their [heart] risk." For the study, Brenner and his colleagues examined the radiation treatment plans for 4 | 医学 |
2014-42/1943/en_head.json.gz/19745 | A network provides healthcare to the uninsured Holdco hospitals to offer a safety net by
Al SullivanReporter senior staff writer Hudson Reporter
Apr 10, 2013 | 4280 views | 0 | 8 | | A HELPING HAND – Holdco-owned hospitals, such as Bayonne Medical Center, are helping to expand services to uninsured patients. Patients can call (201) 418-2128 to schedule an appointment at one of the free clinics.
Nearly one out of every four people living in Hudson County does not have health insurance, according to a recent Robert Wood Johnson Foundation/University of Wisconsin County Health Ranking and Roadmap.This means many of these people seek out the services of emergency rooms, statewide Charity Care, or do not seek medical assistance until their conditions are far worse than they might have been if they saw a doctor regularly.While this 23 percent of uninsured in the county may see some relief with expanded Medicaid and other new federal programs, three Hudson County Hospitals – Bayonne Medical Center, Christ Hospital, and Hoboken University Medical Center – are taking matters into their own hands.The network, Holdco, which bought all three entities in the last five years, is in the process of developing a healthcare system in Hudson County that will not have to rely on institutions beyond its boundaries.They also have been operating free clinics for patients with no insurance. The patients receive free medical services and evaluations by physicians and nurse practitioners, as well as laboratory studies, imaging studies, and medications.“While doing shifts in the Emergency Department, it was evident that many of the same patients would have repeated ER visits as well as readmissions,” said Dr. Mark Spektor, an ER physician and president and CEO of Bayonne Medical Center. “We felt that these patients were at risk due to their economic and insurance status. The current Medicaid expansion will not provide illegal immigrants with coverage, and this program will be essential for those individuals to gain access to healthcare. If given access to longitudinal, rather than episodic care, we felt these patients would maintain their health better, be more productive, and would require emergency care and acute hospitalizations at a lower rate.” The clinics, which have been operating for several months, see more than 650 patients per month, and the volume of visits is growing. According to Dr. Spektor, preliminary data shows a 30-percent reduction in avoidable admissions and ER visits.Dr. Virginia Witt is medical director of Christ Hospital Family Health Center. “The Family Health Center is a much-needed resource for the members of our community who cannot afford to pay for their healthcare needs,” she said.The hospitals plan to expand the program to other locations. “We are serious about making this significant investment in population health management,” said Dr. Spektor. “We feel strongly that a healthier Hudson County will benefit everyone.” Many patients swear by the free clinics. Luzmila Navarro has been living in Jersey City for 15 years and had never heard of a free clinic. “We have been to the clinic at least three times,” she said. “The staff is amazing and very courteous. The doctors are caring and take the time to listen to us. I have been telling all my neighbors who cannot afford to pay for their care to come visit this wonderful clinic.” Audre Gaskin added, “The clinic has really been a blessing to me, and the staff was unbelievable.” Rogelio Bulanadi echoed that assessment, noting that the clinic had done an outstanding job of caring for his father. Gregory Hampton sang the praises of the nurse practitioner at the clinic, while Daniel Canales was grateful that the clinic was close to his home. “I have been to so-called free clinics before that were not free,” said Alicia Toribio. “This clinic has been a blessing for me, and my diabetes is managed very well.” Patients can call (201) 418-2128 to schedule an appointment at one of the free clinics.Future may have even more to offerNow profitable for the first time under private ownership, these hospitals have played hardball with insurance companies to get reimbursement rates they can live with. Although the network has made some progress with a few insurance companies, its future plans include establishing its own insurance company.Right now, the hospitals are not in network with several major insurers.Paul Walker, executive director of Hoboken University Medical Center, said that since the network facilities are for-profit hospitals, they will rely less on public money and more on their ability to provide service. “There are a lot of for-profit hospitals, but in an urban area, this has been unheard of,” Walker said. The old model, he said, doesn’t work. When insurance companies were paying so little, and hospitals were desperate for cash to pay ongoing bills, no one was looking to the future.The hospitals are also grooming their own network of doctors—medical-school graduates who will be part of long-term plans.“In three to five years, we might be known as an insurance company that happens to own hospitals,” said Peter Kelly, executive director of Christ Hospital in Jersey City.Al Sullivan may be reached at asullivan@hudsonreporter.com
Hospital Runs Ad for $1,995 Colonoscopies in Sunday Newspaper
JONATHAN M. METSCH, DR.P.H., LLC
” A much-touted benefit of the Affordable Care Act, the out-of-pocket limit doesn't exactly live up ...
Ebola: Local medical professional releases paper on what to do | 医学 |
2014-42/1943/en_head.json.gz/20006 | Do Mammograms Save Lives? ‘Hardly,’ a New Study Finds
Dan Kedmey
Samuel Ashfield / Getty Images
In fact, they may contribute to "overdiagnosis"
A study of mammograms spanning 25 years and thousands of patients has come to a startling conclusion: mammograms appear to be useless, at best.
The New York Times reports that the study, published on Tuesday in the British Medical Journal, has shaken the medical community in part because it’s one of the most thorough studies of the procedure to date.
Researchers tracked more than 89,835 Canadian women, half of whom were randomly assigned to mammogram screenings. The other half had no mammograms and performed breast exams on themselves.
Twenty-five years later, the researchers found an identical rate of breast-cancer deaths in both groups. The mammograms’ only discernible impact was to elevate the diagnosis rate by 22%, or “overdiagnose” patients who were suffering from nonlethal forms of cancer and therefore could have avoided surgeries, chemotherapy and radiation treatments.
It’s not the first study to highlight the elusive impact of mammograms, nor is it the final word in this notoriously hard-to-measure field, but the New York Times reports that the American Cancer Society will include it, along with every other study on mammography, in an official review of its guidelines this year. Whether it can nudge the advice of medical experts depends on how much weight they put on the polarizing new findings. For now, the consensus across every country’s medical guidelines, save Switzerland’s, is to keep screening.
[NYT] | 医学 |
2014-42/1943/en_head.json.gz/20115 | BSE ('Mad Cow Disease') and vCJD?Mad Cow Disease? actually refers to bovine spongiform encephalopathy (BSE), a disease first described in 1996 in cattle, which is related to a disease in humans called variant Creutzfeldt-Jakob disease (vCJD). Both disorders are universally fatal brain diseases caused by a prion--a protein particle that lacks nucleic acid (DNA) and is believed to be the cause of various infectious diseases of the nervous system. The link between the agent that causes human deaths from vCJD and outbreaks of BSE in cattle appears to be dietary consumption of infected cattle products, including beef.Nonvariant forms of Creutzfeldt-Jakob disease (CJD), which was described before 1996, still exist and may have one of three causes: unknown (sporadic form); genetic mutation; or contaminants introduced during a medical procedure (conventional sterilization methods may not remove the prion that transmits the infection). According to the World Health Organization, less than 5 percent of nonvariant CJD cases are introduced through medical procedures. Nonvariant CJD is also universally fatal.What is bovine spongiform encephalopathy (Mad Cow Disease)?BSE is a progressive, fatal neurological disorder of cattle resulting from infection by a prion. A total of 217 patients with vCJD have been identified since 1996. The majority are from the United Kingdom (170) and other countries in Europe (41). Three have been reported in the U.S., but all three are thought to have acquired the disease overseas.In addition to the cases of BSE reported in the United Kingdom (78 percent of all cases were reported there) and the U.S., cases have also been reported in other countries, including France, Spain, Netherlands, Portugal, Ireland, Italy, Japan, Saudi Arabia, and Canada. Public health control measures have been implemented in many of the countries to prevent potentially BSE-infected tissues from entering the human food chain. These preventative measures appear to have been effective. For instance, Canada believes its prevention measures will eradicate the disease from its cattle population by 2017.What is variant Creutzfeldt-Jakob Disease (vCJD)?Creutzfeldt-Jakob Disease (CJD) is a rare, fatal brain disorder that causes a rapid, progressive dementia (deterioration of mental functions), as well as associated neuromuscular disturbances. The disease, which in some ways resembles BSE, traditionally has affected men and women between the ages of 50 and 75. The variant form, however, affects younger people (the median age of onset is 28) and has atypical clinical features as compared with CJD.What is the current risk of acquiring vCJD from eating beef and beef products produced from cattle in Europe?Currently this risk appears to be very small, perhaps fewer than one case per 10 billion servings--if the risk exists at all. Travelers to Europe who are concerned about reducing any risk of exposure can avoid beef and beef products altogether, or can select beef or beef products, such as solid pieces of muscle meat, as opposed to ground beef and sausages. The solid pieces of beef have a reduced opportunity for contamination with tissues that may harbor the BSE agent. Milk and milk products are not believed to transmit the BSE agent. You cannot acquire vCJD or CJD by direct contact with a person who has the disease. Three cases acquired during transfusion of blood from an infected donor have been reported in the United Kingdom. Consult your�doctor for more information. | 医学 |
2014-42/1943/en_head.json.gz/20118 | Online Pressroom
Contact: Samantha Schmidt
sschmidt@arrs.org
For Release: October 1, 2008
CT Scans Change Treatment Plans in More Than a Quarter of ER Patients with Suspected Appendicitis
CT scans change the initial treatment plans of emergency physicians in over ¼ of patients with suspected appendicitis, according to a study performed at the University of Washington Harborview Medical Center in Seattle, WA. During the study 100 adult patients admitted to the ER for symptoms of appendicitis were evaluated. The treatment plans of these patients were assessed before and after CT and compared. Results showed that “treatment plans changed in 29% of patients as a result of CT. In many instances, CT ruled out appendicitis when the treatment plan prior to the scan was surgical consultation, eliminating the potential for unnecessary surgery on patients with a normal appendix,” according to Robert O. Nathan, MD, lead author of the study. “The data suggest that CT can be withheld in patients in whom emergency clinicians rate the likelihood of appendicitis as unlikely but that CT findings are often of benefit when appendicitis is judged to be very likely,” said Dr. Nathan.
“Patients can be assured that CT scanning of the appendix adds value to therapeutic decision making, thereby improving their care,” said Dr. Nathan. This study appears in the October issue of the American Journal of Roentgenology. For a copy of the full study, please contact Heather Curry via email at hcurry@arrs.org.
Click here for the abstract
About ARRS
The American Roentgen Ray Society (ARRS) was founded in 1900 and is the oldest radiology society in the United States. Its monthly journal, the American Journal of Roentgenology, began publication in 1906. Radiologists from all over the world attend the ARRS annual meeting to participate in instructional courses, scientific paper presentations and scientific and commercial exhibits related to the field of radiology. The Society is named after the first Nobel Laureate in Physics, Wilhelm Röentgen, who discovered the x-ray in 1895.
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CONTACT ARRS | ABOUT ARRS | PRESSROOM | ADVERTISING | PRIVACY POLICY | TERMS OF USE Copyright © 2013, American Roentgen Ray Society, ARRS, All Rights Reserved. | 医学 |
2014-42/1943/en_head.json.gz/20147 | HealthDay Articles & Information
| HealthDay Articles & Information
Search Health Information Quick Survey May Pick Up Ovarian Cancer Warnings: Study
In the absence of reliable screening tool, questionnaire might aid early detection
FRIDAY, Sept. 28 (HealthDay News) -- A simple three-question survey might identify women who have symptoms that may indicate ovarian cancer, according to a new study.
The two-minute paper-and-pencil questionnaire can be given in a doctor's office and checks for six warning signs that may improve early detection of ovarian cancer, according to researchers at the Fred Hutchinson Cancer Research Center in Seattle.
The survey asks women if they are experiencing one or more of the following symptoms: abdominal and/or pelvic pain; feeling full quickly and/or unable to eat normally; abdominal bloating and/or increased abdomen size. It also asks about the frequency and duration of these symptoms.
The study included 1,200 women, ages 40 to 87, who completed the questionnaire. Five percent had a positive symptom score that indicated the need for further tests. Of this group of about 60 women, one was diagnosed with ovarian cancer. Of the 95 percent of women who had a negative symptom score, none developed ovarian cancer during one year of follow-up.
The study was published online in the September issue of the Open Journal of Obstetrics and Gynecology.
Early detection of ovarian cancer greatly increases the likelihood of survival. Cure rates for women diagnosed when the disease is confined to the ovary are 70 percent to 90 percent. However, more than 70 percent of women with ovarian cancer are diagnosed with advanced-stage disease, when the survival rate is only 20 percent to 30 percent according to a Hutchinson news release.
"Women with symptoms that are frequent, continual and new to them in the past year should talk to their doctor, as they may be candidates for further evaluation with ultrasound and blood tests that measure markers of ovarian cancer such as CA-125," study lead author M. Robyn Andersen said in the release.
"Recent research indicates that approximately one in 140 women with symptoms may have ovarian cancer. Aggressive follow-up of these symptoms can lead to diagnosis when ovarian cancer can be caught earlier and more effectively treated," she noted.
The authors said that until better biological screening tools are developed, collecting information about symptoms appears to have promise.
This year, the U.S. National Cancer Institute estimates that more than 22,000 women will receive an ovarian cancer diagnosis and that roughly 15,500 women will die of the disease.
The American Cancer Society has more about early diagnosis of ovarian cancer.
SOURCE: Fred Hutchinson Cancer Research Center, news release, Sept. 21, 2012 | 医学 |
2014-42/1943/en_head.json.gz/20163 | Common Food Preservative May Slow, Even Stop Tumor Growth, University of Michigan School of Dentistry Study 10/31/2012 7:29:01 AM
Nisin, a common food preservative, may slow or stop squamous cell head and neck cancers, a University of Michigan study found. What makes this particularly good news is that the Food and Drug Administration and the World Health Organization approved nisin as safe for human consumption decades ago, says Yvonne Kapila, the study’s principal investigator and professor at the University of Michigan School of Dentistry.
Folic Acid Doesn't Cut Risk of Colon Polyps, Brigham and Women's Hospital Study Women With Lupus Have a Higher Risk for Preeclampsia, Harvard School of Public Health Study Mice With "Humanized" Livers Improve Early Drug Testing, Stanford University School of Medicine Scientists Show National Institutes of Health (NIH) Researchers Identify Novel Genes That May Drive Rare, Aggressive Form of Uterine Cancer Massachusetts Institute of Technology (MIT) Neuroscientists Identify a Brain Region That Can Switch Between New and Old Habits Drug Shows Promise in Animal Model of Alzheimer's and Parkinson's With Dementia, Mount Sinai School of Medicine Study New Developments Reveal a Molecule With a Promising Function in Terms of Cancer Treatment, Research Institute at Strasbourg School of Biotechnology Study Omega-3s Boost Memory in Bright, Young Minds, University of Pittsburgh Study Stay-At-Home Transcription Factor Prevents Neurodegeneration, University of Wuerzburg Study University of Manchester Scientists Unravel Resistance to Breast Cancer Treatment • ScienceDaily
• News Release | 医学 |
2014-42/1943/en_head.json.gz/20164 | More Space for Science & Jobs for Michigan: University of Michigan Health System's North Campus Research Complex Continues to Grow 11/16/2012 7:42:26 AM
$17.5M medical lab project approved; nearly 300 jobs created since 2009ANN ARBOR, Mich., Nov. 16, 2012 /PRNewswire-USNewswire/ -- The University of Michigan will invest $17.5 million to further expand research space at its North Campus Research Complex, even as a new analysis shows that nearly 300 new jobs have already been created at the site in the three and a half years since it opened.Late yesterday, the U-M Board of Regents approved a project to renovate and open 68,000-square feet of biomedical research space on the site, including space for shared research tools that can be used by many scientists.Nearly 1,700 people already work in the array of laboratories and offices at NCRC, and hundreds more are preparing to move there to take part in carefully planned research clusters. U-M bought the sprawling former pharmaceutical research complex, including 27 buildings, in June 2009 and moved the first employees there in March 2010."This new project will continue U-M's commitment to make NCRC a hub for research that translates new discoveries from the laboratory to the marketplace and clinic," says NCRC executive director David Canter. "We have made good progress in creating a place where U-M scientists and partners from the private and public sectors can work together, and fuel growth that aids the Michigan economy." The mix of people now working at NCRC includes faculty, staff and students from 10 colleges and schools within U-M, as well as researchers from the Veterans Affairs Ann Arbor Healthcare System, and the staff of two established private scientific companies and 19 U-M startup companies.A crucial part of realizing NCRC's potential is the availability of advanced research equipment that would be too expensive for any one laboratory or small company to buy or maintain on its own. The newly approved renovation project, in a building called 20E, will create a new home for sophisticated cell analysis machines and microscopes, and other such 'core' facilities. The rest of the building will be used for biomedical research labs.A new report at http://ar.umncrc.org details key developments at NCRC, including: Careful planning for use of NCRC research space has brought together more than 150 scientists who do research in cancer, cardiovascular disease, biointerfaces, health care services, transportation, bioinformatics and emergency medicine. This clustering of researchers, and their teams, along themes increases collaboration. Shared scientific services on the site now include flow cytometry, microscopy and image analysis, DNA sequencing, molecular imaging, physiology phenotyping, and bioinformatics analysis. The 19 U-M startup companies in the Venture Accelerator at NCRC lease lab and office space, and receive support from U-M's Venture Center. More than 17,000 people have attended events in NCRC's large conference and meeting space in the last year. The development of a "community" feel at NCRC is growing, with library services, food service provided by Opus One of Detroit, child care, art exhibits, exercise facilities and regular gatherings for scientists and staff, as well as transportation and technology that eases connections with the rest of U-M. The large kitchen on the site was used for the past year by the U-M Hospitals & Health Centers to prepare meals for inpatients in the three U-M hospitals, and local homebound residents who receive Meals on Wheels deliveries, saving money and time while the hospital kitchens were renovated and enlarged.An animation showing the progress in filling the 27 existing buildings at NCRC over the last three and a half years is available at http://youtu.be/WBDM_KQAO_MFor more information, visit www.umncrc.org.SOURCE University of Michigan Health System | 医学 |
2014-42/1943/en_head.json.gz/20166 | Clinical Trials Going Active for Cellceutix (CTIX) Anti-Cancer Drug Kevetrin 10/8/2012 8:56:34 AM
BEVERLY, MA--(Marketwire - October 08, 2012) - Cellceutix Corporation (OTCBB: CTIX) (the "Company"), a clinical stage biopharmaceutical company focused on discovering small molecule drugs to treat unmet medical conditions, including drug-resistant cancers and autoimmune diseases, reports today that it has been advised that the clinical trials for the Company's novel anti-cancer drug candidate, Kevetrin™, will be going active this week at Harvard Cancer Center's Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center.
Upon the new designation, the trial information on www.clinicaltrials.gov will be updated to "recruiting" status. The clinical trial titled, "A Phase 1, Open-Label, Dose-Escalation, Safety, Pharmacokinetic and Pharmacodynamic Study of Kevetrin (Thioureidobutyronitrile) Administered Intravenously, in Patients With Advanced Solid Tumors," is available at: http://clinicaltrials.gov/ct2/show/NCT01664000?term=cellceutix&rank=1 The Company has been informed that Dana-Farber and Beth Israel Deaconess are ready to begin the recruiting, enrollment and dosing processes as previously reported. Cellceutix has been advised to expect the first dosing of Kevetrin to be administered within approximately one week of activating the trial.
In a separate matter, the Company wishes to update shareholders that Dr. Reddy's Laboratories has already started on the project of manufacturing Prurisol, Cellceutix's new drug candidate for the treatment of psoriasis. As previously disclosed, the Company is advancing Prurisol directly into Phase II clinical trials under guidance from the U.S. Food and Drug Administration. The clinical trials are planned to commence upon the manufacturing of the drug candidate in oral form by Dr. Reddy's Laboratories.
About Kevetrin™
As a completely new class of chemistry in medicine, Kevetrin™ has significant potential to be a major breakthrough in the treatment of solid tumors. Mechanism of action studies showed Kevetrin's unique ability to affect both wild and mutant types of p53 (often referred to as the "Guardian Angel Gene" or the "Guardian Angel of the Human Genome") and that Kevetrin strongly induced apoptosis (cell death), characterized by activation of Caspase 3 and cleavage of PARP. Activation of p53 also induced apoptosis by inducing the expression of p53 target gene PUMA. p53 is an important tumor suppressor that acts to restrict proliferation by inducing cell cycle checkpoints, apoptosis, or cellular senescence.
In more than 50 percent of all human carcinomas, p53 is limited in its anti-tumor activities by mutations in the protein itself. Currently, there are greater than 10 million people with tumors that contain inactivated p53, while a similar number have tumors in which the p53 pathway is partially abrogated by inactivation of other signaling components. This has left cancer researchers with the grand challenge of searching for therapies that could restore the protein's protective function, which Kevetrin appears to be doing the majority of the time.
About Cellceutix
Headquartered in Beverly, Massachusetts, Cellceutix is a publicly traded company under the symbol "CTIX". It is an emerging bio-pharmaceutical company focused on the development of its pipeline of compounds targeting areas of unmet medical need. Our flagship compound, Kevetrin™, is an anti-cancer drug which has demonstrated the ability in pre-clinical studies to regulate the p53 pathway and attack cancers which have proven resistant to today's cancer therapies (drug-resistant cancers). Cellceutix also owns the rights to seven other drug compounds, including KM-133, which is in development for psoriasis, and KM-391 for the treatment of the core symptoms of autism. More information is available on the Cellceutix web site at www.cellceutix.com.
Safe Harbor Forward-Looking Statements
To the extent that statements in this press release are not strictly historical, including statements as to revenue projections, business strategy, outlook, objectives, future milestones, plans, intentions, goals, future financial conditions, future collaboration agreements, the success of the Company's development, events conditioned on stockholder or other approval, or otherwise as to future events, such statements are forward-looking, and are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. The forward-looking statements contained in this release are subject to certain risks and uncertainties that could cause actual results to differ materially from the statements made. Factors that may impact Cellceutix's success are more fully disclosed in Cellceutix's most recent public filings with the U.S. Securities and Exchange Commission.
Cellceutix Corp.Leo Ehrlich(978) 236-8717 //--> | 医学 |
2014-42/1943/en_head.json.gz/20241 | Find a Doctor Hospitals & Locations Medical Services Classes & Events Billing & Records Contact Us Patient Login Western New York Living
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Western New York Living
Buffalo is the second largest city in New York State with a population of approximately 1.3 million people in the surrounding metropolitan area.
Residents of Western New York can enjoy the cosmopolitan lifestyle of cities such as Buffalo and Niagara Falls, combined with the small town character of quaint communities nestled into the surrounding countryside. And just across the Peace Bridge from downtown Buffalo, Canada brings an international flair to the area, including the excitement of Toronto, a mere 90 minutes away.
Watch the 6-minute video below, produced by the Buffalo Niagara Convention & Visitors Bureau, to learn more about our city: See also: Buffalo: America's Best Designed City
Buffalo enjoys a mixed and thriving economy with a moderate cost of living. Housing costs in Western New York are among the lowest in the Northeast with a broad selection of affordable houses, apartments and condominiums. Click here to compare the cost of living in your current city with that of Buffalo-Niagara.
Quality Education
Western New York is home to a variety of educational institutions for students of all levels.
Residents of Western New York enjoy cultural resources such as museums, art galleries, theaters and more. For information about Buffalo's attractions, visit the websites below:
Buffalo Convention and Visitors Bureau
BuffaloRising.com
For sports fans, Western New York offers the National Football League's Buffalo Bills and the National Hockey League's Buffalo Sabres. The Sabres play in a state-of-the-art sports complex in downtown Buffalo. An Ideal Climate
Contrary to its snow-bound reputation, Buffalo has some of the most pleasant weather in the Northeast. Lake Erie moderates the temperature, cooling in the summer and warming in the winter. The lake is responsible for the famous snowstorms equated with Buffalo, which fall mostly in the hills south of the city.
Buffalo and Western New York have some of the best summer weather in the country, with plenty of sunshine and warm breezes to complement outdoor activities.
Washington Post, July 2014 - In Buffalo, N.Y., a new vitality is giving the once-gritty city wings
Toronto Star, April 2014 - Shocked and awed by the rebirth of Buffalo
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2014-42/1943/en_head.json.gz/20263 | Doctors in Missouri warn against eating raw crawfish Wednesday, May 26, 2010 | 8:06 p.m. CDT;
updated 8:22 p.m. CDT, Wednesday, May 26, 2010
JIM SALTER/The Associated Press
ST. LOUIS — When Adam Brewer tagged along with a friend's family for a float trip down the Jack's Fork River in southern Missouri last June, he also decided to join in one of their family traditions — eating raw crawfish.
Big mistake.
"Uncles and older cousins on the float trip had been doing it for years, to make the little kids laugh," said Brewer, a 19-year-old college student from Florissant. "So I just kind of joined in."
It wasn't until September that Brewer got sick. First he thought he had the flu. Then his lungs filled with fluid. Over the next several months, doctors checked him for pneumonia, blood diseases and cancer.
Finally, in March, physicians from Washington University came up with the diagnosis: A rare but severe parasitic infection caused by the raw crawfish Brewer had eaten nine months earlier.
Crawfish — also known as crayfish or crawdads — are common in Missouri and many other states. They look like small crabs and live under rocks in rivers, streams, creeks and ponds. They're fine to eat, as long as they're cooked.
Raw crawfish are no delicacy — Brewer can attest to the fact they don't taste good — so eating them fresh from the river may seem like an odd choice.
Still, the practice is common enough that last year, the Missouri Department of Health and Senior Services put out a warning urging people not to do it. Posters have been placed at some state parks.
"They're mostly intoxicated when they do it," said Dr. Gary Weil, professor of medicine and molecular microbiology at Washington University. "Sometimes they're just showing off, but it is a nutty thing to do. And they pinch."
Washington University physicians have treated six people with illnesses caused by eating raw crawfish in the past three years — all from rivers and streams in Missouri. Three of the cases, including Brewer's, have occurred since September. Before the six Missouri cases, only seven other cases of the infection, paragonimiasis, had been reported in North America.
Another Washington University physician, Michael Lane, said there are probably many other cases that have not been diagnosed.
"I think we're potentially seeing the tip of the iceberg from people going out on the river, having a good time, having too much to drink and enjoying some 'Missouri sushi,'" Lane said.
The parasitic worm that causes the infection is the size of the tip of a pen when ingested but can grow to the size of a grape once inside the human lung, Weil said. They usually travel from the intestine to the lungs and sometimes to the brain, where they can cause severe headaches and vision problems. Washington University physicians treated one man who went partially blind from the parasites. He recovered his eyesight after treatment.
Symptoms include fever, difficult or labored breathing, chronic cough, coughing up blood and chest and abdominal pain.
The illness is curable but rare enough that physicians often overlook it. Symptoms, if left untreated, can persist for years, even decades.
The infection is treated with an oral drug, praziquantel. Within a week to 10 days, experts say, symptoms are generally gone.
After months of illness and undergoing agonizing tests over and over again, Brewer said he recovered almost immediately once his ailment was diagnosed. He said he learned a lesson the hard way.
"Don't eat anything raw out of the river," Brewer said. "I'd never do it again." | 医学 |
2014-42/1943/en_head.json.gz/20343 | Exercise May Blunt Heavy Drinking's Effect on BrainBy Randy DotingaHealthDay ReporterWEDNESDAY, April 17 (HealthDay News) -- New research raises the possibility that exercise may protect the brains of heavy drinkers from the damage of alcohol.
The research is preliminary, however, and has limitations. The number of heavy drinkers in the study was small, at just nine. Also, it's not possible to know which came first: brain damage from alcohol use or protection to the brain from exercise.
Still, "aerobic exercise could be a beneficial recommendation for individuals with a history of heavy alcohol use," said study author Hollis Karoly, a graduate student at the University of Colorado at Boulder. "This study represents an interesting first step in this line of research. Overall, we hope that this study inspires future research into the relationship between alcohol, exercise and the brain."
Scientists are intrigued by how both alcohol and exercise affect the workings of the brain. Alcohol "can remodel brain chemistry and brain structure. It can lead to neuron cell death, and alcoholism can lead to dementia," said Dr. J.C. Garbutt, a psychiatry professor who studies alcohol use at the University of North Carolina at Chapel Hill. "Exercise has been shown to lead to enhancement of connections in the brain and may help by lowering blood pressure and changing body metabolic factors such as high fats and high blood sugar, which can negatively affect the brain."
In the new study, the Colorado researchers studied brain scans of 37 men and 23 women, aged 21 to 55, from the Albuquerque, N.M., area who answered questions about alcohol use, smoking and exercise. Thirty-nine were white.
Nine appeared to be what the study defined as problem drinkers.
Those who drank but didn't exercise had lower levels of so-called "white matter" in the brain. However, Karoly said, "we found that among high exercisers, the relationship between alcohol use and white matter damage was not significant."
White matter is important for relaying messages across the brain, Karoly said, "so damage to white matter could have a whole host of negative implications as far as cognitive processes such as memory, attention and self-regulation." The subjects didn't take tests to assess any of those mental abilities, however.
The people in the study who appeared to exercise the most reported that they got two or more hours of exercise per week. But it's not clear what kind of exercise they got or how accurate their recollections about exercise were.
Oddly, the participants in the study who exercised the most also drank the most -- nearly 1.75 drinks a day, on average. Those who exercised the least drank an average of less than 1.4 drinks a day.
Although the study showed an association between exercise and brain health, it did not prove a cause-and-effect link.
Garbutt said it's difficult to find definitive conclusions in the research. "I would view this as a very early, preliminary study that may highlight some areas for future research but doesn't provide much in the way of a solid finding to communicate to the public," he said.
Garbutt cautioned that anyone who drinks heavily or suffers from alcoholism "should get a good medical evaluation before undertaking aerobic exercise. Alcohol can affect heart rhythms, bone strength and the liver and pancreas, and one shouldn't start major exercise without knowing if there are risks such as heart problems."
But if a physician says it's OK, "exercise is good and might even help the brain," he said.
The study was published online April 16 and will appear in the September issue of the journal Alcoholism: Clinical & Experimental Research.
For more about alcoholism, try the U.S. National Library of Medicine.Health News Copyright © 2013 HealthDay. All rights reserved. | 医学 |
2014-42/1943/en_head.json.gz/20382 | 15-Year Anniversary
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Further information in support of a selective smallpox vaccination policy Applicants sought for fellowships in intervention epidemiology in Europe (the EPIET programme) Calls published for the Marie Curie scheme under FP6 to improve mobility of researchers within the European Research Area Home
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Citation style for this article: Applicants sought for fellowships in intervention epidemiology in Europe (the EPIET programme). Euro Surveill. 2003;7(1):pii=1995. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1995
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Applicants sought for fellowships in intervention epidemiology in Europe (the EPIET programme)
The European Programme for Intervention Epidemiology Training (EPIET) started in 1995. The programme is funded by the European Commission and by various European Union (EU) member states as well as Norway and the World Health Organization (WHO). Subject to agreement for another round of funding, the ninth cohort of fellows will start in October 2003. The programme invites applications for 10 fellowships for this 24 month training programme in communicable disease field epidemiology.
Applicants for the 2003 cohort must be nationals of an EU member country or Norway and should have experience in public health, a keen interest in field work and be pursuing a career involving public health infectious disease epidemiology. They should have a good knowledge of English and of at least one other EU language and be prepared to live abroad for a period of 24 months. The professional with appropriate experience is likely to be below 40 years of age.
Aim of the training
The aim of the training is to enable the fellow to assume service responsibilities in communicable disease epidemiology. The in service training will focus on outbreak investigations, disease surveillance, applied research, and communications with decision makers, the media, the public and the scientific community. Fellows will attend a three week intensive introductory course and then be based at a host institute in one of the 15 participating European countries, Norway and WHO. Further training modules are organised during the two year programme, normally in one of the participating national institutes with responsibility for communicable disease surveillance. Detailed information can be obtained from the EPIET programme office at the address below. Letters of application accompanied by a curriculum vitae should be submitted by 28 February 2003 to:
EPIET Programme Office
Swedish Institute for Infectious Disease Control (SMI) / EPI
SE-171 82 Solna, Sweden
Tel: +46 8 457 23 70
Fax: +46 8 30 06 26
mailto: carole.desmoulins@smi.ki.se www.EPIET.org
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2014-42/1943/en_head.json.gz/20398 | FDA Lawyers Blog Published by FDA Attorneys Frommer Lawrence & Haug LLP Home
Recently in Guidance Category
Early-Stage Alzheimer's Disease Drug Development Draft Guidance Issued by FDA
On February 5, 2013, FDA announced the availability of Draft Guidance relating to the development of drugs for the treatment of early stage Alzheimer's disease. The Draft Guidance, titled, "Alzheimer's Disease: Developing Drugs for the Treatment of Early Stage Disease" addresses: (1) diagnostic criteria for early stage Alzheimer's disease; (2) appropriate clinical outcome measures; and (3) ways to demonstrate disease modification. Addressing these issues in early stage Alzheimer's disease poses unique difficulties, because patients may have little to no impairment of global functioning. FDA is seeking public comment on the Draft Guidance within sixty days.
The Draft Guidance provides FDA's current thinking on useful diagnostic criteria for early Alzheimer's disease. FDA cited useful research in developing diagnostic criteria, such as the research criteria for prodromal Alzheimer's disease and preclinical Alzheimer's disease. Specifically, FDA also cited as useful efforts by the research community to incorporate biomarkers into the diagnostic criteria. FDA concluded that, "we support the concept of enriching trial populations with patients most likely to progress to more overt dementia, using both clinical biomarker-based criteria." FDA also indicated, however, that FDA could not formally endorse any specific diagnostic framework, because more work was necessary to assess the specificity and sensitivity of these criteria, as well as the validation of these methodologies. Written by Andrew S. WassonOther Posts By This Author
The Draft Guidance also provides FDA's current thinking on ways to establish clinical efficacy in trials involving patients suffering from early stage Alzheimer's disease. While FDA requires a co-primary outcome measure to demonstrate efficacy on both cognitive and functional levels for clinical trials on the dementia stage of Alzheimer's disease, in the draft guidance, FDA acknowledged that these endpoints may be impractical for patients suffering from early stage disease. Therefore, FDA indicated that for early stage disease "clear evidence of an effect on delaying cognitive impairment may provide sufficient evidence of effectiveness." Continue reading "Early-Stage Alzheimer's Disease Drug Development Draft Guidance Issued by FDA" » Posted by Frommer Lawrence & Haug | Permalink | Printable Version | Email This Post
, Guidance
, Human Drugs
Combination Product Final Rule and Guidance Issued to Streamline CGMP and Supplements
Yesterday, FDA issued two new items to help clarify combination products: 1) a Final Rule published in the Federal Register entitled, "Current Good Manufacturing Practice Requirements for Combination Products" and 2) a Draft Guidance entitled, "Guidance for Industry and FDA Staff:
Submissions for Postapproval Modifications to a Combination Product Approved Under a BLA, NDA, or PMA", also announced in the Federal Register.
The Final Rule is intended to clarify which good manufacturing practice ("CGMP") requirements apply when drugs, devices, and biological products are combined to create combination products. The Rule also provides a mechanism that FDA describes as "transparent and streamlined regulatory framework" for companies to use when demonstrating compliance with CGMP requirements for "single-entity" and "co-packaged" combination products. "Single-entity" combination products are two or more regulated components, e.g., drug/device, biologic/device, drug/biologic/device, which are physically, chemically, or otherwise combined or mixed and produced as a single-entity. Two or more separate products packaged together in a single package or as a unit and comprised of two or more regulated products is a "co-packaged" combination product. The Final Rules started as a Draft Guidance announced on October 4, 2004 (69 FR 59239), entitled "Current Good Manufacturing Practices for Combination Products." Based on comments and FDA's own internal review, FDA decided that "rulemaking was warranted" and issued Proposed Rules on September 23, 2009 (74 FR 48423).
Written by Brian J. MalkinOther Posts By This Author
The concept behind the CGMP Rule is simple for parts that are separately manufactured and marketed: each of the constituent parts of a combination product are subject only to the CGMP regulations applicable to that part, e.g., drug, biologic, or device. The two categories of combination products mentioned above, however, "single-entity" and "co-packaged" are slightly different due to the possibility for overlapping CGMP requirements for the different regulated components. Companies have two basic options for these types of products: 1) demonstrate compliance with the specifics of all CGMPs to each of the parts, or 2) demonstrate compliance with the specifics of either the drug CGMPs at 21 C.F.R. Parts 210 and 211 or the quality system ("QS") regulation at 21 C.F.R. Part 820 rather than both, for drug/devices under certain conditions. For combination products including biologics, the specific regulations are 21 C.F.R. parts 600 through 680, and for product including any human cell, tissue, and cellular tissue-based products, the regulations are 21 C.F.R. Part 1271.
Continue reading "Combination Product Final Rule and Guidance Issued to Streamline CGMP and Supplements" » Posted by Frommer Lawrence & Haug | Permalink | Printable Version | Email This Post
Animal Drugs
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Safety Reporting Requirements Explained -- More Targeted Reporting Emphasized
Towards the end of last year, FDA added two new final guidances related to the safety reporting requirements for investigational new drug exemptions ("INDs") and bioavailability and bioequivalence ("BA/BE") studies entitled: Guidance for Industry and Investigators: Safety Reporting Requirements for INDs and BA/BE Studies and Guidance for Industry and Investigators: Safety Reporting Requirements for INDs and BA/BE Studies-Small Entity Compliance Guide. These guidances are intended to explain final rules published on September 29, 2010 that amended the IND safety reporting requirements under 21 C.F.R. Part 312 and added safety reporting requirements for individuals conducting BA/BE studies under 21 C.F.R. Part 320. We blogged on that development then.
A key focus of the new regulations was to add clarifying definitions to certain terms, "adverse event", "suspected adverse reaction", "unexpected" adverse event or reaction, "serious" adverse event or reaction, and "life-threatening", as well as further define reporting requirements. According to the main Guidance (not the one for small entities), sponsors frequently took a broad reading of the phrase "associated with the use of the drug" in the context of the former 21 C.F.R. § 312.32(a), which stated, "there is a reasonable possibility that the experience may have been caused by the drug." With this broad reading, the Guidance continues, "sponsors frequently reported, as individual cases, serious adverse experiences for which there was little reason to believe that the drug caused the event." The Guidance includes three examples of overzealous reporting, including reporting adverse experiences that were manifestations of the underlying disease, common occurrences in the study population independent of drug exposure, or study endpoints. FDA described these types of reporting as a drain on agency resources and "uninformative when reported as single events (i.e., without a comparison of the incidence of the event in treated and untreated subjects), they do not contribute meaningfully to the developing safety profile of an investigational drug or to human subject protection."
Interestingly, this appears to be somewhat of a departure from how FDA had enforced its reporting regulations on clinical investigators. Shortly after I first joined FDA in the 1990s, I was involved in a clinical investigator disqualification proceeding that resulted in a clinical investor being disqualified from further clinical studies because, among other things, he had not timely or accurately reported certain adverse events. While the Presiding Officer took into account that many of the patients had underlying conditions prior to the experimental therapy, the Center for Drug Evaluation and Research ("CDER's") approach appeared to focus on the need for the investigator to report all adverse event associated with the therapy. In this case, the therapy had to do with infusing a drug with a catheter to help dissolve gall bladder and common bile duct stones, which the CDER described as a drug/device. The investigator admitted that he had not immediately reported certain events that occurred as a result of the catheter insertion (most likely not due to the drug) or the patient's underlying conditions, because in his opinion, they were not associated with the drug therapy. At that time, CDER took the approach that the investigator's opinion was irrelevant, because the adverse events were at least temporally associated with the drug/device and therefore had to be timely reported.
Continue reading "Safety Reporting Requirements Explained -- More Targeted Reporting Emphasized" » Posted by Frommer Lawrence & Haug | Permalink | Printable Version | Email This Post
, Clinical Trials
Electronic Clinical Source Data Draft Guidance Published by FDA
On November 19, 2012, FDA issued a draft Guidance entitled, "Electronic Source Data in Clinical Investigations." The Guidance recommends various procedures relating to the electronic capture of source data in clinical investigations in an effort to reduce errors, to provide real-time data access, and to maintain accurate records for inspection by study investigators and FDA. | 医学 |
2014-42/1943/en_head.json.gz/20483 | Home > Health News > Antibiotic Lowers Death Risk for Elderly Patients With Pneumonia: Study
But azithromycin boosted chances of heart attack slightly in this vulnerable population.
TUESDAY, June 3, 2014 (HealthDay News) -- The antibiotic Zithromax (azithromycin) significantly lowers older pneumonia patients' risk of death but slightly increases their risk of heart attack, a new study indicates.
Researchers analyzed data from more than 65,000 patients aged 65 and older who were treated for pneumonia at Veterans Administration hospitals between 2002 and 2012. About half of them received azithromycin and half did not.
Ninety days after hospital admission, death rates were just over 17 percent for patients in the azithromycin group and about 22 percent in the other group. The patients who received azithromycin had a slightly higher risk of heart attack (5.1 percent versus 4.4 percent), but nearly the same risk for any cardiac event (about 43 percent), heart rhythm disorders (about 26 percent) and heart failure (26 percent), the investigators found.
For every 21 patients treated with azithromycin, one death was prevented within 90 days, while for every 144 patients treated with the antibiotic, there was one heart attack, said Dr. Eric Mortensen, of the VA North Texas Health Care System and University of Texas Southwestern Medical Center at Dallas, and colleagues.
This means that the use of azithromycin prevents about seven deaths for every heart attack it causes, according to the authors of the study published in the June 4 issue of the Journal of the American Medical Association.
Guidelines for patients hospitalized with pneumonia recommend combination therapy with a class of antibiotics called macrolides, including azithromycin, as first-line treatment. However, recent research has suggested that azithromycin may increase the risk of cardiovascular events, according to background information in the study.
Pneumonia and influenza together are the eighth most common cause of death and the leading cause of infectious death in the United States.
The U.S. National Library of Medicine has more about pneumonia.
SOURCE: Journal of the American Medical Association, news release, June 3, 2014 | 医学 |
2014-42/1943/en_head.json.gz/20525 | Potential Treatment For Snakebites Leads To A Paralyzing Test
Many people who die of venomous snakebites never make it to a hospital. A San Francisco doctor came up with what he thinks may be a workaround to save those lives. But he had to test it first.
The bite of a cobra can paralyze its victims and, if enough venom is released, fatally stop their breathing. It's estimated that more than 75 percent of patients in India who die from a snake's bite never make it to the hospital. STRDEL Each year, as many as 125,000 people around the world die from venomous snakebites, often because they live in remote, rural areas and didn't get to a hospital in time to get treatment. Toxins in the venom of snakes like cobras and kraits slowly paralyze their victims, who ultimately die of suffocation.A San Francisco emergency room physician says he may have the beginnings of a workaround that could fend off paralysis and save many of those lives.Already, hospitals sometimes use an intravenous version of the drug neostigmine to buy time if they don't have the right antivenom. But it's a scary treatment for laypeople to have to use in the field. "In the IV form, neostigmine is a very tricky drug," says Matt Lewin, the San Francisco physician. "An overdose will stop the heart."Lewin is medical adviser to international research expeditions for the California Academy of Sciences, so he has to worry about things like cobra bites. He kept noodling about how neostigmine might be used safely outside a hospital.On a camping trip in Mongolia, Lewin was talking the problem over with longtime pal and mentor Philip Bickler, an anesthesiology professor at the University of California, San Francisco, when they suddenly realized that a neostigmine intranasal spray might work. It's been used to treat some paralytic symptoms of myasthenia gravis, they realized, and might be a safer way to reverse the paralysis of snakebite, too.But to test their theory, they would need to partially paralyze someone — temporarily, and under controlled conditions. So they found a volunteer, "a healthy, 45-year-old male." (Lewin wouldn't divulge the volunteer's identity to Shots, but says, "You could say he's someone whose perspective I'm very familiar with.")With emergency rescue treatments at the ready, a team of anesthesiologists at UCSF began by infusing the very much awake and alert volunteer with a steady drip of mivacurium, a curare-like drug similar to cobra venom.Over the course of 90 minutes, the doctors watched as the volunteer's eyelids and cheeks began to droop — the same initial symptoms seen after a cobra's bite. His vision blurred. Then he began to have difficulty swallowing. By 115 minutes after the infusion started, he was having trouble lifting his head.At that point — and before breathing got too difficult, Lewin rushes to say — the doctors gave the volunteer a carefully measured spritz of neostigmine through the nose.It worked. The drug safely reversed the paralysis within minutes.The experiment was "very safe" and approved beforehand by UCSF's safety committee on human research, Lewin says. The volunteer was "intensively monitored at all times by two anesthesiologists immediately before, during and for five hours after the study," he says. A third doctor collected data.They published their study online this week in the journal Clinical Case Reports.The next step, in addition to followup testing with actual venom in animals, will be to test other drugs to see if they work better, Lewin says. Many snake venoms are complicated mixtures with a variety of effects, and nasal neostigmine may not be the best solution ultimately. "We were just hoping with this to start the conversation," he says. "Can you think of another catastrophic condition like this for which there is no out-of-hospital treatment at all?"Snakebite victims should still get to a trauma center as soon as possible after a bite. "The idea here isn't to replace antivenom," Lewin says. Nasal sprays with drugs like neostigmine would do only part of the job. But they could buy people the crucial time they need to get life-saving care. Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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2014-42/1943/en_head.json.gz/20566 | Joslin Diabetes Center News » News Archives » 2008 Press Releases » Joslin Study Identifies Key Factor that Links Metabolic Syndrome
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Joslin Study Identifies Key Factor that Links Metabolic Syndrome
Finding May Help Millions at High Risk of Cardiovascular Disease
BOSTON – Feb. 5, 2008 -- A new study led by researchers at Joslin Diabetes Center has identified insulin resistance in the liver as a key factor in the cause of metabolic syndrome and its associated atherosclerosis, disorders that put tens of millions of Americans at high risk of cardiovascular disease.
The findings, published in the February issue of Cell Metabolism, provide not only an understanding of how metabolic syndrome occurs, but also pinpoint a target for treatment of the condition. This represents the work of Sudha Biddinger, M.D., Ph.D., and a team led by C. Ronald Kahn, M.D., Head of the Joslin Research Section on Obesity and Hormone Action and the Mary K. Iacocca Professor of Medicine at Harvard Medical School. “This is one of the first true insights into the role of the liver in the metabolic syndrome and provides guidance for future therapies,’’ said senior investigator Dr. Kahn, an internationally recognized researcher in diabetes and metabolism. “Showing this connection between atherosclerosis and insulin resistance is one of the most dramatic findings I’ve seen in 35 years.’’ Metabolic syndrome is a collection of medical problems related to insulin resistance, including obesity, glucose intolerance, hypertension, lowered HDL (“good”) cholesterol and elevated triglycerides. Together these are associated with an increased risk of atherosclerosis, the buildup of plaque in the coronary arteries that leads to heart attack and stroke.
The findings indicate that many of the most important features of the metabolic syndrome do have a common cause, thus challenging a joint position statement issued by the American Diabetes Association and the European Association for the Study of Diabetes that questioned the very existence of the metabolic syndrome (Diabetes Care. 2005;8:2289–2304). “This study clearly indicates that metabolic syndrome is not merely a collection of abnormalities that should be considered and treated independently, as some experts have advocated,’’ said Kahn and Biddinger. “Rather, it appears that metabolic syndrome is truly a group of closely linked disturbances in glucose and cholesterol metabolism that stem from a defect in insulin signaling in the liver.”
Dr. Biddinger said the study sought to understand whether insulin resistance – a condition where the pancreas makes insulin but the body doesn’t respond to it – could increase the risk of atherosclerosis. “The fact that one-fourth of American adults have the metabolic syndrome is alarming. The fact that large numbers of children are now being diagnosed with the metabolic syndrome is even more alarming,” said Biddinger. “These kids are at risk for having heart attacks in their 30s. We really need to understand the connection between the metabolic syndrome and atherosclerosis.”
To try and find out, the researchers engineered mice by “knocking out” -- i.e. genetically eliminating -- insulin receptors in the liver. From this one site of insulin resistance alone, these mice developed many of the lipid abnormalities associated with metabolic syndrome. Furthermore, when fed a high-fat diet, the mice developed extremely high cholesterol, more than four times the levels found in normal mice fed the same diet. More importantly, all of the “knockout” mice developed atherosclerosis, while none of the normal mice did.
These findings “focus attention on the liver, since resistance in the liver is enough to cause these abnormalities,” said Kahn. “By pinpointing the liver, it gives researchers a target for developing potential clinical treatments, such as finding a way to overcome insulin resistance in the liver or to change the way the liver responds to insulin resistance.”
The research was funded in part by grants from the National Institutes of Health and The Iacocca Foundation. In addition to Drs. Biddinger and Kahn, other researchers participating in the study included: Antonio Hernandez-Ono, Christian Rask-Madsen, Joel T. Haas, José O. Alemán, Ryo Suzuki, Erez F. Scapa, Chhavi Agarwal, Martin C. Carey, Gregory Stephanopoulos, David E. Cohen, George L. King and Henry Ginsberg from the Joslin, Columbia University School of Medicine, Massachusetts Institute of Technology, and the Beth Israel Deaconess Medical Center. HomeAffilate ResourcesMedia RelationsSitemapPrivacyTerms of UseWebmaster | 医学 |
2014-42/1943/en_head.json.gz/20611 | U.S. Hospitals Deporting Unconscious Immigrants: Over 600 in Five Years
By Erik Derr (staff@latinospost.com) | First Posted: Apr 23, 2013 06:20 PM EDT (Photo : Creative Commons) 0
Subscribe to the latinospost newsletter! Hundreds of undocumented immigrants have been deported from United States hospitals while they were unconscious, after health care providers decided it would cost too much to let them stay.
Two cases in point: Jacinto Cruz and Jose Rodriguez Saldana, who were recovering in Iowa Methodist Medical Center in Des Moines after both were seriously hurt in a car accident.Like Us on Facebook Before either of the men awoke, hospital staffers had them flown back to their native Mexico, because it wasn't certain the insurance coverage Cruz and Saldana had received from the pork manufacturing company where they worked covered the type of long-term care they would need.
The hospital indicated the families of the two men gave permission for the transfers, but the families themselves deny it.
Neither Cruz nor Saldana was in the U.S. legally.
When they awoke, the men were 1,800 miles and a border crossing away from the first hospital in Des Moines.
There are hundreds of cases like those of Cruz and Saldana, where undocumented hospital patients have been deported while unconscious, law professor Lori Nessel, director of the Center for Social Justice at Seton Hall Law School, was reported saying in a report by the Associated Press.
The federal government claims it's not involved in the hospital deportations, that it has been the decisions of the health care providers exclusively to send patients back to their home countries without their know --- all in the name of curbing medical expenses.
Called "medical repatriation," the patients are placed on chartered international flights paid for by the hospitals.
At least 600 immigrants, if not more, were deported over a five year period, Nessel said.
"The problem is, it's all taking place in this unregulated sort of a black hole," without any way of monitoring the practice, she said.
There's growing concern hospitals will expand the deportations after federal health care reforms kick in.
"It really is a Catch-22 for us," said Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System. "This is the area that the federal government, the state, everybody says we're not paying for the undocumented."
All hospitals are required to care for patients no matter if they are citizens or not, or if they have the ability to pay or not.
Those care requirements, however, change once a patient is stabilized.
Immigrant advocates say the practice violates U.S. and international law, unfairly targeting a defenseless population.
"They don't have advocates, and they don't have people who will speak on their behalf," asserted Miami attorney John De Leon.
Many hospitals say they in fact try contact immigration authorities when they have patients who don't have proper documentation, but most of those calls are ignored, leaving the car providers no other alternative other than resolving the problems themselves.
Meanwhile, the American Medical Association's Council on Ethical and Judicial Affairs back in 2009 told doctors not to let "hospital administrators to use their significant power and the lack of regulations to send patients to other countries."
But, when it's one against an entire hospital administration, and there aren't any legal protections in place, what's a doctor to do? | 医学 |
2014-42/1943/en_head.json.gz/20639 | Osteoarthritis Cholesterol
50+ Wellness
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Study finds high rates of off-label prescribing Published April 19, 2012
Birth defects more common in IVF babies: study
Cancer pain relief lacking, especially for minorities
NEW YORK (Reuters Health) - More than 10 percent of prescriptions in one Canadian province were for drugs not approved to treat the patient's condition, a new study finds. And many times, there was little evidence the drugs would work.A medication is being used "off label" if a doctor prescribes it to treat a condition other than the one(s) Health Canada, the U.S. Food and Drug Administration or similar national regulatory agencies approved it for based on tests of safety and efficacy.Dr. Tewodros Eguale, who led the new study, said doctors typically prescribe medications off-label when their patients fail to respond to other popular approved drugs or when they have a rare condition with few available treatments. Eguale, from McGill University in Montreal, and his colleagues used data on every prescription written by Quebec physicians participating in an electronic health record network. The network is unusual in that it requires a doctor to state what the prescribed drug is intended to treat.Between 2005 and 2010, 113 primary care doctors wrote more than 250,000 prescriptions for just over 50,000 patients. Eleven percent of those prescriptions were considered off-label by the standards of the Health Canada drug database.The researchers didn't have information on how well those drugs ended up working for the patients who took them. But they determined that four out of five off-label prescriptions didn't have strong evidence suggesting they were likely to be effective."Strong evidence" in this case included at least one controlled clinical trial -- considered the "gold standard" of medical research - showing the drug could help the patient's disorder.Drugs meant to treat central nervous system conditions, like chronic pain, as well as infections and ear, nose and throat problems were most likely to be prescribed off-label.The researchers also found that drugs approved by the Canadian government prior to 1981 were much more likely to be prescribed off-label than modern drugs.Eguale told Reuters Health that not being approved for a specific condition doesn't mean a medication won't work, or that it's not safe.Just as with newly-approved drugs, he said, "one has to be cautious. If you're giving it for off-label indications, you have to be careful about safety."In an editorial accompanying the new study, published in the Archives of Internal Medicine, Dr. Patrick O'Malley wrote that unless pharmaceutical companies believe they can make a profit, they probably won't try to get new approvals for a drug even if its (off-label) use is widely accepted.Getting a drug approved for specific conditions can be onerous and require lots of financial risk, according to O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.The current U.S. research infrastructure would not be able to test whether every drug is appropriate for every known condition, according to O'Malley. So there's no way to know whether the 11 percent of drugs used off-label in the new study is too much or too little, he said -- but there are things doctors can do to make sure they're using such drugs appropriately."Doctors should first be very clear about what evidence is available for that treatment, and they should be informing patients," he told Reuters Health.Eguale and his colleagues found that physicians who said they practiced evidenced-based medicine were less likely to prescribe medication off-label.And, Eguale said, making sure drugs are properly prescribed goes beyond just the physician."I think we need an informed physician, but we need an informed patient as well," he said.The study did have certain limitations, the researchers note, including that the definition of "off-label" may have differed depending on how much of a drug was prescribed. And some apparently off-label use could have been explained by other conditions not included in a patient's electronic record.The study also only looked at one province in Canada, which means the results may not be true for other areas of the country or in other countries.But O'Malley said he suspects the results would not be that different in the U.S.SOURCE: http://bit.ly/iz1fsj and http://bit.ly/irzmct Archives of Internal Medicine, online April 16, 2012. | 医学 |
2014-42/1943/en_head.json.gz/20661 | In The News Maimonides In The NewsIn The NewsContact Us
Cancer HomeWhy Choose UsMaimonides In The NewsIn The NewsUS News & World Report Names Maimonides The Top Hospital in Brooklyn
US News & World Report Names Maimonides The Top Hospital in Brooklyn
US News & World Report has rated Maimonides Medical Center the highest ranked hospital in Brooklyn. The report designates Maimonides as “high performing” in six specialty areas: cancer care, geriatrics, gynecology, neurology & neurosurgery, pulmonology and urology.
“We’ve promised Brooklyn the best in medicine, and it’s a promise we’re proud to fulfill year after year,” says Pamela Brier, President and CEO of Maimonides Medical Center. “This latest accolade reflects on the dedication and expertise of our doctors and nurses, and is wonderful news for the patients and families we serve.”
The methodology for the US News & World Report rankings includes scoring in multiple categories, such as: Mortality Index, Nurse Staffing, Key Technologies, Patient Services, Volume, Patient Safety and Reputation.
Achieving this level of excellence requires adherence to the highest standards of care throughout the Medical Center, and involves health professionals across multiple disciplines. A number of key technologies are required to support that care, and Maimonides continues to provide the most advanced diagnostic tools available.
Here is a quick snapshot of the six specialty areas cited by US News & World Report:
The Maimonides Cancer Center is Brooklyn’s only free-standing cancer center and is fully accredited by the American College of Surgeons’ Commission on Cancer. The Maimonides Breast Cancer Center recently scored 100% on its accreditation review by the National Accreditation Program for Breast Centers.
The Geriatrics Program at Maimonides delivers multi-disciplinary care to patients aged 75 and older. Geriatrics has its own Acute Care for Elders (ACE) Unit, with every staff member specially-trained in the care of these patients and their families. The Geriatrics physicians see patients in a stunning new office on 49th Street, across the street from the Maimonides main campus.
Women’s Health has always been a priority at Maimonides, and its Gynecology Services reflect that philosophy. A Regional Perinatal Center, Maimonides delivers more babies than any other hospital in the state. Other subspecialty services include: gynecologic oncology, urogynecology, reproductive endocrinology & fertility, and robotic gynecologic surgery.
Our Neuroscience Team provides the full array of subspecialties, including: Stroke Medicine, Interventional Neuroradiology and Neurosurgery, as well as Neurology specialists in Headaches, Multiple Sclerosis, Parkinson’s & Movement Disorders.
According to the federal government, Maimonides is a “Top 10” hospital nationally for patient outcomes in the treatment of pneumonia. Our Pulmonologists and Thoracic Surgeons are noted for consistently delivering the highest level of care to patients with lung and breathing disorders, including: asthma, COPD, lung cancer, tuberculosis, and sleep apnea.
The Maimonides Division of Urology is growing in size and reputation. Brooklyn’s most experienced practitioners of robotic urologic surgery, the Urology team includes specialists in Urologic Oncology, erectile dysfunction, urinary stone disease and incontinence.
To learn more about these and the many Centers of Excellence at Maimonides Medical Center, visit the website at www.maimonidesmed.org. | 医学 |
2014-42/1943/en_head.json.gz/20666 | States Expand Newborn Screening for Life-Threatening Disorders
New March of Dimes Report Finds State-By-State Gaps Nearly Eliminated WHITE PLAINS, N.Y., FEB. 18, 2009 - Regardless of where they are born in the United States, nearly all newborns now receive mandated screening for many life-threatening disorders, a remarkable public health advance of the last four years, according to a new report issued today by the March of Dimes.
All 50 states and the District of Columbia now require that every baby be screened for 21 or more of the 29 serious genetic or functional disorders on the uniform panel recommended by the American College of Medical Genetics (ACMG) and endorsed by the March of Dimes. If diagnosed early, these disorders can be successfully managed or treated to prevent death, disability, or other severe consequences such as mental retardation.
Although all states now have laws or rules that require the screening, as of December 31, 2008, Pennsylvania and West Virginia still must implement their expanded programs, according to the March of Dimes report card. "Today we announce that expanded screening is required by the states for nearly 100 percent of the more than 4 million babies born each year in the U.S. The clear beneficiaries are babies and their families," said Jennifer L. Howse, PhD, president of the March of Dimes. "With the help of volunteers, parents and our partners, we have nearly erased the cruel injustice that sentenced babies to an undetected but treatable metabolic or functional condition based on their birth state. This is a success story."
"This is a sweeping advance for public health," said R. Rodney Howell, MD, chairman of the federal Health & Human Services Secretary's Advisory Committee on Heritable Disorders in Newborns and Children, (ACHDNC). "The March of Dimes and its chapters nationwide can be proud of their leadership role to essentially eliminate the geographic gaps in the state newborn screening safety net. Now, whether babies are screened and can get the immediate treatment they need to lead a healthy life no longer depends on the state in which they are born."
March of Dimes will maintain its watchdog role on newborn screening, said Dr. Howse, and will continue to promote consistent guidelines nationwide, and to advocate for funding for the Newborn Screening Saves Lives Act (P.L. 110-204). The intent of this legislation is to help improve state newborn screening programs by providing education for families and provide additional funding for follow-up and treatment for infants who test positive for disorders identified through screening.
The recent advent of tandem mass spectrometry provided the means to identify many conditions from one blood spot. In 2000, the March of Dimes recommended criteria for adding screens in an editorial published in Pediatrics and launched its advocacy efforts to require comprehensive newborn screening in every state at a time when most states screened for only four conditions. In 2005, the ACMG issued a report recommending that 29 screens be mandated for every newborn. In 2005, the first year that the March of Dimes report card measured state-by-state requirements on expanded newborn screening, only 38 percent of infants were born in states that required screening for 21 or more of 29 core conditions. Today, as a result of years of intensive bi-partisan volunteer advocacy efforts led by March of Dimes chapters, nearly all babies born in the U.S. live in states that require screening for 21 or more of these treatable disorders. Twenty-four states and the District of Columbia require screening for all 29 disorders, with more states expected to join them this year. In fact, 46 states and the District of Columbia screen for 26 or more of these conditions.
"Newborn screening saved Giana's life," said David Swift, of California, whose daughter was diagnosed with 3MCC (3-methylcrotonyl-CoA carboxylase deficiency) because of newborn screening. "It was only thanks to March of Dimes advocacy efforts that the hospital Giana was born in was part of a pilot program to expand newborn screening in California."
3MCC is a serious disorder that leaves newborns unable to metabolize leucine - an essential amino acid found in many forms of protein. But because Giana, now age six, was diagnosed early, she was put on a special diet and is living a relatively normal life.
Newborn screening is done by testing a few drops of blood, usually from a newborn's heel, before hospital discharge. A positive result does not always mean the infant has a disorder. If a screening result is positive, the infant is referred for additional testing, and if the diagnosis is confirmed, and given treatment as soon as possible.
Parents can find information about the recommended newborn screening tests at the March of Dimes Web site: marchofdimes.org/nbs. The March of Dimes Newborn Screening Report Card details state-by-state newborn screening requirements. The March of Dimes contracts with the National Newborn Screening and Genetics Resource Center to collect the data. The ACMG recommendation to screen for 29 conditions has been endorsed by clinicians and researchers alike, including the American Academy of Pediatrics (AAP) and the ACHDNC. Both the March of Dimes and the AAP have called for national newborn screening guidelines as well as federal funding to help states improve their programs and help affected families receive needed services.
A list of which screening tests are provided by each state can be found on the March of Dimes Web site at http://marchofdimes.org/peristats, which is updated regularly, or at the National Newborn Screening and Genetics Resource Center Web site at http://genes-r-us.uthscsa.edu. The March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit marchofdimes.org or nacersano.org. And for detailed national, state and local perinatal statistics, visit PeriStats at marchofdimes.org/PeriStats. | 医学 |
2014-42/1943/en_head.json.gz/20677 | Faculty Specks, Ulrich M.D.
Dr. Specks is the principal investigator (PI) of laboratory-based research studies designed to characterize the role of the neutrophil serine proteases, proteinase 3 (PR3) and elastase in the pathogenesis of Wegener's granulomatosis, vasculitis and lung fibrosis. Specific aims of these studies are to identify epitopes on the PR3 molecule which are preferentially recognized by PR3-ANCA (autoantibodies from patients with Wegener's granulomatosis), to characterize the effect of such epitope-specific PR3-ANCA on biological functions of PR3, and to determine whether the functional effects of PR3-ANCA have a bearing on specific clinical disease manifestations. Furthermore, the laboratory investigates structure-function relationships of PR3 and elastase and their significance in the pathogenesis of lung fibrosis. These studies have been supported by grants from the American Heart Association, the NIH and the Robert N. Brewer Foundation.
Dr. Specks is also involved in clinical research studies aimed at the identification of novel, more efficacious and safer treatment modalities for patients with Wegener's granulomatosis, ANCA- associated vasculitis, and pulmonary fibrosis. In particular, Dr. Specks is the co-principal investigator (together with Dr. John H. Stone, Johns Hopkins University, Baltimore) for the multicenter trial "Rituximab Therapy for the Indcuction of Remission and Tolerance in ANCA-associated Vasculitis (RAVE)" which is sponsored by NIAID and the Immune Tolerance Network. This trial compares the efficacy and safety of rituximab to that of cyclophosphamide for patients with severe Wegener's granulomatosis and microscopic polyangiitis. Dr. Specks also serves as the principal investigator for the Mayo site of the NIH sponsored Vasculitis Clinical Research Consortium (VCRC), which conducts a variety of clinical research studies in different forms of vasculitis under the leadership of (PI, Dr. Peter A. Merkel ,Boston University)
In addition, Dr. Specks is involved in several other clinical studies designed to enhance our understanding of the clinical manifestations, course and prognosis of Wegener's granulomatosis and other ANCA-associated vasculitides.
Primary AppointmentPulmonary and Critical Care Medicine
Academic RankProfessor of Medicine
EducationFellow - Connective Tissue Research Max-Planck-Institut für BiochemieFellow - Pulmonary Medicine Mayo Graduate School of Medicine, Mayo Clinic College of MedicineResident - Internal Medicine Mayo Graduate School of Medicine, Mayo Clinic College of MedicineResident - Pathology UniversitätsklinikumDoktor der Medizin - Thesis: ""Hypoglycemia in Low Birth Weight Neonates"" Medizinische Fakultät, University of BonnMD Rheinische Friedrich-Wilhelms-Universitat BonnBaccalaureate Studies European School, Brussels, Belgium
Division of Pulmonary and Critical Care Medicine
Center for Immunology and Immune Therapies
Clinical Immunology and Immunotherapeutics Program | 医学 |
2014-42/1943/en_head.json.gz/20684 | Home > Make a Gift > Contact Us > Mcancernews > Winter 2013 New drug cuts risk of deadly transplant side effect in half
A new class of drugs reduced the risk of patients contracting a serious and often deadly side effect of lifesaving bone marrow transplant treatments, according to a study from researchers at the University of Michigan Comprehensive Cancer Center.The study, the first to test this treatment in people, combined the drug vorinostat with standard medications given after transplant, resulting in 21% of patients developing graft-vs.-host disease compared to 42% of patients who typically develop this condition with standard medications alone.Photo by Duncan Smith/Photodisc/ThinkstockResults of the study were presented Dec. 9 at the 54th Annual Meeting of the American Society of Hematology."Graft-vs.-host disease is the most serious complication from transplant that limits our ability to offer it more broadly. Current prevention strategies have remained mostly unchanged over the past 20 years. This study has us cautiously excited that there may be a potential new way to prevent this condition," says lead study author Sung Choi, M.D., assistant professor of pediatrics at the U-M Medical School.Vorinostat is currently approved by the U.S. Food and Drug Administration to treat certain types of cancer. But U-M researchers, led by senior study author Pavan Reddy, M.D., found in laboratory studies that the drug had anti-inflammatory effects as well -- which they hypothesized could be useful in preventing graft-vs.-host disease, a condition in which the new donor cells begin attacking other cells in the patient's body.Choi presented data on the first 47 patients enrolled on the study at the University of Michigan Comprehensive Cancer Center and Washington University. Participants were older adults who were undergoing a reduced-intensity bone marrow transplant with cells donated from a relative. Patients received standard medication used after a transplant to prevent graft-vs.-host disease. They also received vorinostat, which is given as a pill taken orally.The researchers found vorinostat was safe and tolerable to give to this vulnerable population, with manageable side effects. In addition, rates of patient death and cancer relapse among the study participants were similar to historical averages.The results mirror those found in the laboratory using mice. Reddy, an associate professor of internal medicine at the U-M Medical School, has been studying this approach in the lab for eight years."This is an entirely new approach to preventing graft-vs.-host disease," Choi says. Specifically, vorinostat targets histone deacetylases, which are different from the usual molecules targeted by traditional treatments."Vorinostat has a dual effect as an anti-cancer and an anti-inflammatory agent. That's what's potentially great about using it to prevent graft-vs.-host, because it may also help prevent the leukemia from returning," Choi says.The study is continuing to enroll participants. The researchers hope next to test vorinostat in patients receiving a transplant from an unrelated donor, which carries an even greater risk of graft-vs.-host disease. This approach is not currently available outside of this clinical trial.Patients seeking more information about the current clinical trial or about other treatment options at the University of Michigan Comprehensive Cancer Center, are urged to call the U-M Cancer AnswerLine™ at 800-865-1125 or visit our clinical trials website. back to top
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Subscribe to MCancerNewsKeep up with the latest news by receiving the most recent issue directly to your email. Get the latest articles and interviews about cancer research, treatment and coping with cancer by visiting our blog, mCancerTalk. | 医学 |
2014-42/1943/en_head.json.gz/20713 | Feds Target Reliance on Antipsychotics in Nursing Homes
02/04/2013 Nursing homes around the country are under pressure from the Federal government to reduce their use of anti-psychotics. This powerful class of prescription drug is meant for mental illnesses such as schizophrenia. But they are also being used on people with Alzheimer's Disease at startling rates. New Hampshire Public Radio's Todd Bookman has this look at the efforts inside one New Hampshire nursing home trying to end the use of so-called chemical restraints. Todd Bookman of New Hampshire Public Radio reports.
Feds Target Reliance on Antipsychotics in Nursing Duration:5:5
Photo cutline: Dr. Sandeep Sobti is working to lower the reliance on antipsychotic medications in New Hampshire nursing homes.
For Alan Lancaster, the early signs of Alzheimer's disease emerged about a decade ago. He kept forgetting his ATM card in the machine. He started having trouble using the telephone. The disease quickly progressed, eventually stealing his ability to speak.
Then last winter, his wife Constance says, he started having outbursts.
"They began at home," she says. "They were one of the signs to us that something was wrong, because he had always been very mild mannered. Occasionally he would lose his temper and he would break something. Might be a pencil, might be his glasses. Or he might kick the wall. That was frustration - speaking."
Worn down from stress, Constance and her two grown children decided to place Alan in a nursing home in Vermont. That lasted all of three days. The staff said he was too combative, potentially violent. They transferred him to an emergency room, and eventually Alan landed in a hospital psych ward. He received a jumble of medications, including Seroquel, an antipsychotic.
"There were times when he was completely unresponsive. Not even an eyelid flutter," Constance says. "A day that my daughter and her children and I visited, we spent four hours there, waiting for him to respond, and he never woke up."
Alan lost the ability to walk. He came down with pneumonia. After what Constance calls a brutal month, he was transferred to Maplewood Nursing Home, a county-run facility on the banks of the Connecticut River in Westmoreland.
There, Dr. Sandeep Sobti (left), a geriatric psychiatrist, immediately started to wean Alan off the medications. Sobti says the use of powerful antipsychotics on Alzheimer's patients is the equivalent of handcuffing people to wheelchairs.
"That used to be a method that was relied on, the same way we are relying on medications right now to control the behaviors," Sobti says. "It was inhumane and I'm very glad it is in the past. And I hope someday this chemical restraint business will be in the past."
The federal government feels the same way. Last summer, it began publishing the rate of antipsychotic use at each nursing home in the country. Inside Maplewood, about 25 percent of all residents receive an antipsychotic drug. That's on par with the state average, though a wide range exists. Some facilities in New Hampshire approach 80 percent, others less than 5 percent.
Alice Bonner, with the Centers for Medicare and Medicaid Services, says publishing the data is one way to help drive down rates. But she cautions that a facility shouldn't be judged on this single statistic.
"Just seeing a high rate of antipsychotic use in a nursing home, by itself, doesn't mean that there is a problem in that nursing home. Because, for example, maybe they are not using those medications in people with dementia - maybe they have other types of mental health patients in that facility who really benefit from those drugs," Bonner says. "But it allows the family at least to say, 'Wait a minute, this is something that I want to ask about before I place my mother here.'"
Along with the ethical questions of simply sedating Alzheimer's patients, Bonner says the drugs pose a serious health risk: They increase a senior's chance of falling, of stroke, and risk of death.
At Maplewood, Dr. Sobti has pushed for alternatives to antipsychotics. He urges more patience among staff - more focus on what is causing poor behaviors, not just what medicine can be used to calm someone down.
It sounds simple, but he says caregivers don't get the needed training for behavioral issues. "It cannot be overstated. That issue cannot be overstated," Sobti says. "We need that and we need that a lot. Without that, any attempt at making a meaningful decrease of medications will not work as well as it would with that education."
Along with that better training, Dr. Sobti strongly encourages family to play an active role in treatment. He says they should ask questions, and question the need for each medication.
But figuring out how to better manage behaviors takes time, and that can be frustrating for loved ones. Kathyrn Kindopp is the chief administrator at Maplewood. She says people don't want to see a parent or spouse in distress.
"There is so much pressure to fix something now. And I think society has been pre-programmed, that for every ailment, there is a pill. And it is a quick fix," Kindopp says. "And sometimes we need everyone to be patient as we work through what are the alternatives that can occur."
For Alan Lancaster, it took a few months at Maplewood to get his other medications and care in order. His wife Constance says he had to relearn how to walk, how to eat solid foods.
"I don't fault them. They probably thought it's really important to get him to a point where he never raises a fist at anybody or ever acts out. But he's a human being, and if he is feeling that, it is going to happen," she says. "And it is better, in my assessment, for him to have real emotions and get past it. They wanted him to be perfectly behaved."
Constance says perfect isn't possible with Alzheimer's disease. In the fall, her husband was good enough, healthy enough, to leave Maplewood and move back home. Photo by Todd Bookman.
This story is provided by the New England News Network Exchange. | 医学 |
2014-42/1943/en_head.json.gz/20757 | Sign up for our newsletter: Yom Hashoah - Holocaust Memorial Program About Yom Hashoah
Each year the JCC gathers local educators and Holocaust survivors to come together and create a program and memorial service that will educate the public about the horror of the Nazi regime and to teach the importance of tolerance. Holocaust survivors take a leading role in planning the Yom Hashoah Memorial Program and providing living testimony about their own experiences in an effort to ensure that such crimes are never repeated.
Some History...
During World War II, the Germans, specifically the Nazis exterminated 11 million individuals, including over 1.5 million children. Of these 11 million, many were political dissidents, Jehovah’s Witnesses, Roma Gypsies, non-heterosexuals, and anyone who was mentally or physically handicapped. They were considered inferior and in the Nazi’s minds did not meet their criteria of an acceptable human being. Of this 11 million, 6 million Jews were exterminated, 1.5 million of them children, because the Nazis’ believed that Jews and their religion made them inferior.
In March 2007, the United Nations designated January 27 as a worldwide day of commemorance for the victims of the Holocaust, citing that the world must know and remember what happened. In addition, the Jewish community instituted a Jewish holy day to remember the Holocaust, the Hebrew day of the 27th of Nissan. This day was chosen because it represented a time period right after the Passover, when the Israelites became a people after they were freed in Egypt, and the time period in which the Warsaw Ghetto had its uprising. It usually occurs in late April or early May.
This Day – Yom Hashoah – which literally means “Day of the Catastrophe” is considered a Day of Remembrance, where local Survivors and the Jewish community come together to remember loved ones lost, honor the Survivors, and pay tribute to individuals who keep the memory of the atrocities foremost in people’s minds to ensure such atrocities will never happen again. Special memorial prayers (Yizkor) are recited.
For more information contact Liba Kornfeld, Director of Jewish Family Life, at 504.897.0143 - liba@nojcc.org
Jewish Holidays Jewish New Orleans History Synagogues New Orleans Links & Resources Community Events Adloyadah - Purim Carnival Chanukah Celebration Yom Hashoah - Holocaust Memorial Program Yom Ha'atzmaut - Israel Independence Day Israel Coffeehouse Series Morris Bart, Sr. Lecture Series at the J JCC Book Club Florence Melton School of Adult Education Class Schedule Meet the Faculty Employee Login | 医学 |
2014-42/1943/en_head.json.gz/20932 | Toe Deformities Should Be Treated Early: Experts
Delaying treatment can lead to other problems, such as skin infections, doctor says
MONDAY, Aug. 8 (HealthDay News) -- Hammer toes, curly toes, crossover toes and bunions are not only painful, they can be a red flag for other health problems, a new report warns.
According to a review published in the August issue of the Journal of the American Academy of Orthopaedic Surgeons, deformities of the lesser toes, which includes all the toes except for the big toe, should be treated as early as possible by an orthopaedic surgeon to avoid other complications.
"Toe pain can limit a person's quality of life," said the review's lead author, Dr. Khalid Shirzad, an orthopaedic surgeon at Northwest Orthopaedic Specialists, P.S., in Spokane, Wash., in a news release. "When it hurts to walk, that person will start decreasing time spent on activities they enjoy. If the initial problem is not treated, it may lead to further issues such as skin infections, deformities, and muscular problems."
Most often, the review authors pointed out, deformities of the lesser toes are the result of shoes that don't fit, or hurt. Other causes of these conditions include: injury; inflammatory arthritis; neuromuscular and metabolic diseases, such as cerebral palsy, multiple sclerosis or rheumatoid arthritis; and genetics.
Although diabetes doesn't directly cause toe deformities, it can cause people to lose sensation in their feet, and as a result, they may not notice when they have a painful toe injury or deformity, Shirzad explained.
These foot conditions -- in which the toes are bent, misaligned or curled -- cause redness, swelling, sores or calluses where the affected toes meet the inside of a shoe, the experts noted. There are, however, several effective nonsurgical treatments for these conditions, including: Pads or gel sleeves to reduce pressure on the toe joint.
Wraps, tape or shoe inserts, which help align the toes.
Surgical options are also available for patients with persistent toe deformities, but surgery may involve reconstruction of the soft tissues, bones or both, the authors pointed out in the news release.
"The most important thing the public should take from this is to be conscious of your footwear," said Shirzad. "Well-fitted shoes that do not pinch the foot or constrict the toes can prevent many toe deformities."
The U.S. National Library of Medicine provides more information on foot pain. Mary Elizabeth Dallas SOURCE: American Academy of Orthopaedic Surgeons, news release, Aug. 1, 2011
Doctors Often Unaware Their Patients Have Catheters October 23, 2014 Health Tip: Coping With Chronic Pain October 23, 2014 Learn More About Sharp | 医学 |
2014-42/1943/en_head.json.gz/20933 | Study Links Pot Use With Poor Sleep
WEDNESDAY, June 4, 2014 (HealthDay News) -- People who use marijuana may have trouble falling and staying asleep and feel drowsy during the day, new research suggests.And adults who started using the drug before they were 15 seem to be twice as likely as nonusers to have problems falling asleep, not feeling rested after sleep and feeling tired during the day, the University of Pennsylvania researchers said.It's possible that people who already suffer from insomnia turn to marijuana as a way to help them sleep, said study lead researcher Michael Grandner, an instructor in psychiatry at the university. "The type of person who reports marijuana use in the U.S. is more likely to also be the type of person who has sleep problems," he said. "It doesn't mean that one is causing the other." It's more likely that people with sleep problems and stress may turn to marijuana as a way to self-medicate, Grandner said. "But there is little evidence, outside of anecdotes, to suggest that this will really help fix the problem in the long term," he said.Rather than turning to marijuana to beat insomnia, Grandner suggests trying treatments that really work."For example, the most well-studied treatment for insomnia actually does not involve medications and works well -- it's called cognitive behavioral therapy for insomnia and essentially works by reprogramming your brain to sleep," he said. Since the study found that those who started using marijuana earlier in life were more likely to have sleep problems, it may be important to help teenagers find healthier and more effective ways to cope with stress, Grandner suggested.The study didn't prove that marijuana leads to sleep problems, just that there's an association between the two. It was scheduled to be presented Wednesday at the Associated Professional Sleep Societies' annual meeting in Minneapolis.For the study, Grandner's team collected data on approximately 1,800 U.S. adults who took part in the 2007-2008 National Health and Nutrition Examination Survey. The participants reported how often they had used marijuana in the past month and at what age they began using it. They also reported whether they had any trouble sleeping. The researchers defined severe sleep problems as trouble sleeping at least 15 days a month.The strongest link between marijuana use and sleep problems was found in adults who started using the drug before age 15. They were about twice as likely to have severe problems falling asleep, the study authors said.The debate about marijuana has been heating up as it has been legalized in two states and approved for medical use in others.Study lead author Jilesh Chheda, a research assistant at the University of Pennsylvania's division of mood and anxiety disorders, said in the Sleep Societies' news release: "Marijuana use is common, with about half of adults having reported using it at some point in their life. As it becomes legal in many states, it will be important to understand the impact of marijuana use on public health, as its impact on sleep in the 'real world' is not well known."The federal government lists marijuana as a "schedule 1 substance" that has no medicinal uses and is a high risk for abuse, according to the U.S. National Institute on Drug Abuse. Two states, Colorado and Washington, have legalized marijuana for adult recreational use, and 21 states allow its use for certain medical conditions, such as cancer and glaucoma.Paul Armentano, deputy director of NORML, a group that lobbies for the legalization of marijuana, said the "association reported in this paper of a history of cannabis [marijuana] use and severe difficulty falling asleep is relatively minor and it is questionable whether it holds any real world relevance. "The ongoing criminalization of cannabis and those who consume the plant is a disproportionate response to what is, at worst, a public health concern -- not a criminal justice matter," he added.Health concerns about marijuana, particularly its potential use or abuse by young people, are best handled by regulation, public education and age restrictions, "not by criminalization and stigmatization," Armentano said. More informationFor more on marijuana, visit the U.S. National Library of Medicine.SOURCES: Michael Grandner, Ph.D., instructor in psychiatry, University of Pennsylvania, Philadelphia; Paul Armentano, deputy director, NORML, Washington, D.C.; June 4, 2014, presentation, Associated Professional Sleep Societies meeting, Minneapolis Related Articles | 医学 |
2014-42/1943/en_head.json.gz/20982 | Medicine and Science News2013 Archive2012 Archive2011 Archive
Related Topics Wing H. Leung, MD, PhDMedicine & Science NewsChing-Hon Pui, MD Bone marrow transplant survival more than doubles for young high-risk leukemia patientsMemphis, Tennessee, July 14, 2011
St. Jude Children’s Research Hospital investigators reported markedly improved survival of pediatric patients transplanted for high-risk leukemia regardless of donor; cite treatment advances and better donor selection
Bone marrow transplant survival more than doubled in recent years for young, high-risk leukemia patients treated at St. Jude Children’s Research Hospital, with patients who lacked genetically matched donors recording the most significant gains. The results are believed to be the best ever reported for leukemia patients who underwent bone marrow transplantation.
The findings are expected to make transplantation a treatment option for more children and adolescents with high-risk forms of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) who lack genetically matched donors, either related or unrelated. The research appears in the July 14 edition of the scientific journal Blood.
“This study shows that transplantation offers real hope of survival to patients with high-risk leukemia that is not curable with intensive chemotherapy,” said Wing Leung, M.D., Ph.D., the study’s principal investigator and director of Bone Marrow Transplantation and Cellular Therapy at St. Jude. Leung linked the gains to advances in cancer treatment as well as improved infection control and more sophisticated donor selection.
Five years after transplantation, survival was 65 percent for the 37 St. Jude patients with high-risk ALL treated at the hospital between 2000 and 2007, compared to 28 percent for the 57 St. Jude ALL patients who underwent treatment between 1991 and 1999. ALL is the most common childhood cancer.
AML survival after transplantation rose from 34 percent for the 50 St. Jude patients treated between 1997 and 2002 to 74 percent for the 46 AML patients treated between 2002 and 2008.
During the same periods, there was an eight-fold reduction in infections, a four-fold drop in treatment-related toxicity and a 2.5-fold decrease in leukemia-related deaths. The overall survival gains coincided with an end to irradiation therapy for St. Jude leukemia patients, a treatment that is associated with a range of immediate and long-term side effects.
“We can now identify donors for virtually all pediatric patients who need transplant to cure their leukemia. Importantly, our transplanted patients not only have high cure rates but also excellent quality of life, resulting largely from advances in chemotherapy, donor selection and supportive care,” said Ching-Hon Pui, M.D., St. Jude Department of Oncology chair and the paper’s senior author.
Bone marrow transplantation involves destroying the patients’ own diseased blood-producing bone marrow and replacing it with hematopoietic cells from healthy donors. This study included three types of donors: genetically matched related donors; genetically matched unrelated donors; and partially genetically matched donors. Parents generally make up the third group, who are known as haploidentical donors.
The largest survival gains involved patients whose blood and immune systems were rebuilt with cells from haploidentical donors. Survival for these patients increased from 12 percent in earlier ALL and AML treatment eras to 88 percent in the most recent treatment era.
Historically, transplant patients fared best and suffered fewer complications when the donors were relatives who carried the same six proteins on their white blood cells. Known as HLA proteins, they serve as markers to help the immune system distinguish between an individual’s healthy tissue and diseased cells that should be eliminated.
St. Jude investigators pioneered the use of haploidentical transplants, demonstrating that careful matching of patients and donors and proper processing of the hematopoietic donor cells enhances the anti-cancer effect of transplantation without significantly increasing side effects. The process involves careful testing and HLA screening of potential donors to identify the one whose immune system is likely to mount the most aggressive attack against remaining leukemia cells using specialized immune cells known as natural killer cells. The odds of finding a good haploidentical donor are 70 to 80 percent, compared to about a 25 percent chance of having a matched sibling donor, Leung said. The likelihood of finding a genetically identical, unrelated donor ranges from about 60 to 90 percent depending on the patient’s race or ethnicity.
Other authors are Dario Campana, Jie Yang, Deqing Pei, Elaine Coustan-Smith, Kwan Gan, Jeffrey Rubnitz, John Sandlund, Raul Ribeiro, Ashok Srinivasan, Christine Hartford, Brandon Triplett, Mari Dallas, Asha Pillai and Joseph Laver, all of St. Jude; and Rupert Handgretinger, formerly of St. Jude and now of University Children’s Hospital, Tubingen, Germany.
The research was supported in part by the National Institutes of Health, a Center of Excellence Grant from the state of Tennessee, Assisi Foundation of Memphis and ALSAC.
St. Jude Children’s Research Hospital is internationally recognized for its pioneering research and treatment of children with cancer and other catastrophic diseases. Ranked one of the best pediatric cancer hospitals in the country, St. Jude is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. St. Jude has treated children from all 50 states and from around the world, serving as a trusted resource for physicians and researchers. St. Jude has developed research protocols that helped push overall survival rates for childhood cancer from less than 20 percent when the hospital opened to almost 80 percent today. St. Jude is the national coordinating center for the Pediatric Brain Tumor Consortium and the Childhood Cancer Survivor Study. In addition to pediatric cancer research, St. Jude is also a leader in sickle cell disease research and is a globally prominent research center for influenza.
Founded in 1962 by the late entertainer Danny Thomas, St. Jude freely shares its discoveries with scientific and medical communities around the world, publishing more research articles than any other pediatric cancer research center in the United States. St. Jude treats more than 5,700 patients each year and is the only pediatric cancer research center where families never pay for treatment not covered by insurance. St. Jude is financially supported by thousands of individual donors, organizations and corporations without which the hospital’s work would not be possible.
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