During my freshman year in high school, my science teacher assigned us to interview people in the community about how they use science in their careers. Although I don’t remember most of the people I spoke with, I can tell you that I spent meaningful time with a local community pharmacist who changed my life.
What I saw was a man who loved his career and truly cared for his patients. In an instant, I knew that I wanted to become a pharmacist, and I never wavered from that goal throughout high school.
Knowing what you want to be when you grow up at age 14 is unusual, but it is very liberating. I simply had to work backwards to figure out how to achieve my goal of becoming a pharmacist.
After high school, I chose to attend Ohio Northern University (ONU) because it had a unique pharmacy program. Rather than attending college for 2 years and then applying to the pharmacy program, ONU students were admitted to the College of Pharmacy from day one.
Although it was expensive, being in pharmacy school from day one and avoiding the risk of rejection made it worthwhile for me.
In college, I spent a lot of time in the library. Although the classwork was difficult, I did well with one exception: organic chemistry.
I did fail organic chemistry—a notorious “weed out” course—but I successfully retook the class over the summer and graduated on time with the rest of my classmates. Failing a course is a difficult stumbling block, but I stood strong and persevered.
Today, I’m thankful for the wonderful pharmacy profession for so many reasons.
First, I’m thankful that community pharmacists are the health care professionals most accessible to the public. If my local pharmacist wasn’t accessible to me, then I likely would have taken a different career path.
Second, I’m proud of the work we pharmacists do, the diversity of our career options, and the relationships we share with our patients and fellow health care providers.
Pharmacy is a profession that makes a real difference in people’s lives. It certainly has made all the difference in mine.
Bệnh nhiệt miệng khiến việc ăn uống và nói chuyện trở nên cực kỳ vất vả. (Ảnh: Internet)
Các vết lở miệng, nhiệt miệng sẽ dịu đi ngay lập tức nếu các bạn áp dụng một trong các mẹo sau đây!
Bị lở miệng, nhiệt miệng là một trong những vấn đề thường gặp, nhất là khi chúng ta căng thẳng, thay đổi nội tiết tố, hệ miễn dịch suy yếu hay tiếp xúc quá nhiều với ánh nắng. Mặc dù không gây nguy hiểm nhưng chúng thường khiến chúng ta cảm thấy đau đớn, khó chịu. Đặc biệt, nếu không biết cách chăm sóc đúng cách, các vết lở có thể chuyển sang dạng viêm cấp, gây tấy đỏ và rất đau, thậm chí c̣n có thể gây sốt cao, nổi hạch góc hàm khiến cho việc ăn uống sẽ cực ḱ vất vả.
V́ vậy, để chữa trị bệnh lở miệng, nhiệt miệng một cách nhanh chóng, chúng ta hăy cùng khám phá 5 mẹo cực hay dưới đây. Đảm bảo, chỉ với những nguyên liệu từ thiên nhiên, các bạn sẽ cảm thấy vết lở dịu đi nhanh chóng chỉ trong ṿng một đêm.
1. Sữa chua
Sữa chua có nhiều men vi sinh giúp cân bằng vi khuẩn trong miệng và cơ thể. Ăn nhiều sữa chua sẽ giúp liền vết loét miệng và pḥng tránh vết nhiệt miệng mới. Ngoài ra, khi thoa sữa chua lên vùng rộp, vết lở sẽ dịu lại nhanh chóng.
Sữa chua không chỉ ngon mà c̣n rất tốt cho sức khỏe. (Ảnh: Internet)
2. Sữa tươi
Sữa tươi giàu canxi và dưỡng chất tốt kháng lại virus gây bệnh. Đặc biệt, chất béo trong sữa sẽ làm chậm quá tŕnh phát triển của mầm bệnh. Khi thoa một chút sữa tươi lên vùng da bị viêm, giữ khoảng 15 phút, sau đó rửa sạch, áp dụng ngày 4,5 lần, các bạn sẽ thấy hiệu quả rơ rệt.
Chất béo trong sữa sẽ làm chậm quá tŕnh phát triển của mầm bệnh. (Ảnh: Internet)
3. Nha đam
Theo nhiều nghiên cứu, chất nhựa trong nha đam có khả năng gây tê, tính sát khuẩn cao, có tác dụng sát trùng và thanh nhiệt. V́ vậy, sử dụng nha đam có thể giúp làm dịu, điều trị và chữa lành vùng da bị lở. Đồng thời, nó cũng thúc đẩy việc quá tŕnh làm lành diễn ra nhanh hơn, từ đó giảm viêm sưng do mụn nước.
Chất nhựa trong nha đam có khả năng gây tê, tính sát khuẩn cao, có tác dụng sát trùng và thanh nhiệt. (Ảnh: Internet)
Để trị nhiệt, bạn có thể cắt một đoạn nha đam lấy phần nhựa bôi vào vết bị lở loét ở vùng miệng. Việc sử dụng nước thảo mộc chiết xuất từ lô hội, súc miệng hàng ngày cũng làm giảm nguy cơ mắc phải bệnh nhiệt miệng hơn.
4. Túi trà lọc
Không chỉ mang lại một li trà nóng thơm ngon, những túi trà lọc c̣n có tác dụng nhiều hơn vậy. Nhờ thành phần giàu chất ô xi hóa và acid tannic có đặc tính kháng khuẩn, túi trà lọc được dùng rất nhiều để chăm sóc sức khoẻ và sắc đẹp.
Túi trà lọc có rất nhiều tác dụng trong việc chăm sóc sức khỏe và sắc đẹp.
Đối với chứng nhiệt miệng, sau khi pha xong túi trà, các bạn chỉ cần chườm lên vùng miệng bị lở, giữ một lúc rồi hẳn rửa sạch. Các chất có lợi trong trà sẽ giúp làm lành vết thương, vết lở loét trong miệng.
5. Tỏi
Tỏi có chứa 3 thành phần chính là Allicin, Liallyl sulfide và Ajoene. Trong đó, Allicin là một trong những chất rất quan trọng, có khả năng diệt khuẩn, sát trùng rất tốt. Do đó, khi ép vài tép tỏi và đặt lên các mụn nhiệt hoặc vết lở trong miệng, khoảng 15 phút, các Allicin trong tỏi sẽ phát huy tác dụng, diệt bỏ những loại vi khuẩn, vi rút gây nên các vết lở, vết nhiệt miệng.
Các Allicin trong tỏi sẽ phát huy tác dụng, diệt bỏ những loại vi khuẩn, vi rút gây nên các vết lở, vết nhiệt miệng. (Ảnh: Internet)
Ngoài ra, chúng ta cũng có thể đem tầm 3 – 4 nhánh tỏi, giă nát, lấy nước cốt. Sau đó, ngậm trong miệng khoảng 10 – 15 phút th́ nhổ ra và vệ sinh lại bằng nước muối loăng. Thực hiện liên tục cách này khoảng 3 – 5 ngày sẽ giúp vết nhiệt miệng không c̣n đau nữa và nhanh lành hơn hẳn.
Coi Thức Ăn Là Thuốc, Bác Sĩ Việt Tại Mỹ Chỉ Cách Ăn Uống Ngừa Ung Thư
BS Wynn Huynh Tran
Thức ăn được coi là thuốc, đă là thuốc sẽ có tác dụng phụ. Đồ ăn ngon th́ thường có hại. 35% ung thư do ăn uống.
Ung thư đang có xu hướng tăng trên toàn thế giới chứ không riêng tại Việt Nam. Năm 2000, số ca mắc mới ung thư tại Việt Nam là 69.000. Hiện tại, con số này tăng lên 126.000, trong đó có khoảng 94.000 trường hợp tử vong, gấp 9 lần tai nạn giao thông và dự kiến sẽ tăng lên 190.000 ca mắc mỗi mỗi năm vào năm 2020.
Tỉ lệ mắc ung thư ở cả 2 giới là 140/100.000 dân, đứng thứ 78/172 quốc gia và vùng lănh thổ.
Đáng tiếc, hầu hết các bệnh nhân ung thư ở Việt Nam thường phát hiện bệnh khi đă ở giai đoạn muộn (giai đoạn 3-4), phổ biến từ 70-90%, đặc biệt ung thư phổi (84,3%), ung thư gan (87,8%)...
Theo nhiều nghiên cứu, 80% ung thư do yếu tố môi trường, trong đó chế độ ăn uống không hợp lư và ô nhiễm thực phẩm chiếm tới 35%.
Theo BS Wynn Huynh Tran, đang làm việc tại Mỹ, là người sáng lập tổ chức y khoa VietMD, sở dĩ ăn uống làm tăng nguy cơ ung thư do thức ăn chính là thuốc, tác dụng chính là cung cấp năng lượng cho cơ thể nhưng tác dụng phụ có thể làm tăng đường huyết, tăng mỡ máu... nếu ăn không đúng cách.
“Thức ăn là thuốc, ảnh hưởng trực tiếp đến sức khoẻ hàng ngày nên ăn cái ǵ hôm nay sẽ ảnh hưởng đến ngày mai. Đồ ăn ngon th́ thường có hại”, BS Tran nhấn mạnh.
BS Tran cho biết, ung thư chỉ phát sinh từ 1 tế bào. B́nh thường mỗi ngày tế bào sinh ra và chết đi nhưng nếu 1 tế bào ác tính sinh ra, chúng sẽ không mất đi mà nhân lên không kiểm soát được, phát triển thành khối u, gọi đó là ung thư.
“Các loại ung thư khác nhau là khác nhau nên khẳng định đến thời điểm này chưa có loại thuốc nào chữa được tất cả các loại ung thư. Chưa kể cơ địa mỗi người là khác nhau nên việc chữa ung thư khó khăn là v́ vậy”, BS Tran chia sẻ.
Ông cũng nhấn mạnh, ung thư không phải 1 bệnh mà là nhiều bệnh tổng hợp lại. Không ai chết v́ ung thư nhưng chết v́ nhiều bệnh liên quan tới ung thư.
“Khối u không giết chúng ta nhưng khối u khiến ta bị đau, khối u cũng di căn tới gan khiến gan bị hư, di căn đến phổi, di căn đến xương... Bệnh nhân chết v́ di căn ung thư chứ không phải v́ ung thư”, BS Tran giải thích.
Trái với suy nghĩ của nhiều người, BS Tran cho biết, ung thư phát triển chậm. Ung thư chỉ được phát hiện khi tế bào ác tính nhân lên gấp 1 tỷ lần, tương đương với kích cỡ hạt đậu.
“Chính v́ ung thư phát triển chậm nên những ǵ ăn hôm nay có thể giúp ngăn ngừa được bệnh”, BS Tran nói.
Để ngừa ung thư, BS Tran khuyên mọi người dân nên áp dụng 6 nguyên tắc ăn uống đơn giản sau:
6 nguyên tắc ăn uống ngừa ung thư, tổng hợp từ nhiều nghiên cứu khác nhau. Làm đúng 6 điều này bác sĩ thất nghiệp phân nửa.
1. Uống nhiều nước
Uống ít nhất 2 lít nước/ngày, uống nhiều lần trong ngày, không đợi khát mới nước, uống kèm nước với trái cây, rau củ. Nếu không uống nước cũng giống như chúng ta chạy xe không đổ dầu.
Chúng ta có thể nhịn ăn 30 ngày nhưng nếu không uống nước 2 ngày th́ có thể nguy hiểm tới tính mạng nên mới có chuyện tuyệt thực nhưng không ai tuyệt đối không uống nước.
2 lít nước chỉ tính riêng nước lọc, nước canh, không tính các loại nước có đường, có ga như Cocacola, Starbucks, 7Up, Pepsi, thậm chí cả trà.
2. Ăn nhiều rau quả
Hầu hết rau quả tươi đều có chất chống ung thư do đó bữa cơm càng ăn nhiều các loại rau càng tốt như cà rốt, su hào, rau dền, cải tím...
Bữa ăn nên ăn nhiều loại rau củ
Gia đ́nh nào có tiền có thể dùng rau quả hữu cơ, không có tiền th́ ăn rau quả tươi thường. Tuy nhiên đừng bao giờ ăn đồ hộp do rau củ trong đồ hộp có chất bảo quản.
3. Bớt ăn thịt đỏ
Trong thịt đỏ (ḅ, heo...) chứa chất kích viêm, những chất này theo thời gian khiến tế bào dễ bị ác tính. Thịt đỏ được chế biến sẵn càng nguy hiểm.
Nếu thịt đỏ chế biến với dầu ăn, tạo ra các phản ứng sinh ra Acrylamide, một hoá chất có thể gây ung thư.
4. Ăn uống đa dạng
Ăn uống thiếu đa dạng là một sai lầm. Nên ăn nhiều loại thực phẩm khác nhau để có nhiều chất kháng ung thư khác nhau trong đó ăn nhiều rau, trái cây, củ, hạt đậu, gạo lứt, mè, ngũ cốc... và ăn thức ăn từ nhiều nền văn hoá khác như Trung Đông, Địa Trung Hải, Thái Lan, Ấn Độ... để tế bào ung thư ít có khả năng phát triển.
5. Giảm chiên xào, áp chảo
Thức ăn chế biến nhiệt độ cao với dầu tăng rủi ro ung thư (nghiên cứu từ Nhật Bản và Hàn Quốc về ung thư dạ dày và tiêu hoá).
Nhật Bản, Hàn Quốc là 2 nước có tỉ lệ ung thư dạ dày rất cao do ăn nhiều thịt chiên, xào.
6. Ăn cho ngon, không ăn cho no
Ăn vừa đủ sẽ giúp hệ tiêu hoá, dạ dày khoẻ mạnh.
Ngoài ra BS Tran lưu ư cần phải chăm sóc bữa ăn tinh thần như nghe nhạc, đi chùa, xem phim... thậm chí đi ngắm cảnh để nghe tiếng nước chảy, chim hót. Người Việt ít để ư đến việc này.
Hiện nay có một số bệnh nhân ung thư dùng thêm thực phẩm chức năng, tuy nhiên BS Tran lưu ư, người bệnh cần tham khảo kĩ ư kiến của bác sĩ do thực phẩm chức năng cũng có một số tác dụng phụ, như fucoidan thường gây xuất huyết.
Và cuối cùng, để ngừa và điều trị ung thư hiệu quả, mọi bác sĩ đều nhấn mạnh đến việc tầm soát, ḍ t́m ung thư trước khi có triệu chứng như người trên 50 tuổi khuyên nội soi đại tràng, nữ trên 40 tuổi chụp nhũ ảnh hàng năm.
Hiện nay cũng bắt đầu có công nghệ phân tích gene để phát hiện những tế bào có nguy cơ phát triển thành tế bào ác tính để có thể can thiệp sớm.
Early-life challenges affect how children focus, face the day
University of Washington
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Adversity early in life tends to affect a child's executive function skills -- their ability to focus, for example, or organize tasks.
Experiences such as poverty, residential instability, or parental divorce or substance abuse, also can lead to changes in a child's brain chemistry, muting the effects of stress hormones. These hormones rise to help us face challenges, stress or to simply "get up and go."
Together, these impacts to executive function and stress hormones create a snowball effect, adding to social and emotional challenges that can continue through childhood. A new University of Washington study examines how adversity can change the ways children develop.
"This study shows how adversity is affecting multiple systems inside a child," said the study's lead author, Liliana Lengua, a UW professor of psychology and director of the Center for Child and Family Well-Being. "The disruption of multiple systems of self-control, both intentional planning efforts and automatic stress-hormone responses, sets off a cascade of neurobiological effects that starts early and continues through childhood."
The study, published May 10 in Development and Psychopathology, evaluated 306 children at intervals over more than two years, starting when participants were around 3 years old, up to age 5 ½. Children were from a range of racial, ethnic and socioeconomic backgrounds, with 57% considered lower income or near poverty.
Income was a key marker for adversity. In addition, the children's mothers were surveyed about other risk factors that have been linked to poor health and behavior outcomes in children, including family transitions, residential instability, and negative life events such as abuse or the incarceration of a parent.
Against these data, Lengua's team tested children's executive function skills with a series of activities, and, through saliva samples, a stress-response hormone called diurnal cortisol.
The hormone that "helps us rise to a challenge," Lengua said, cortisol tends to follow a daily, or diurnal, pattern: It increases early in the morning, helping us to wake up. It is highest in the morning -- think of it as the energy to face the day -- and then starts to fall throughout the day. But the pattern is different among children and adults who face constant stress, Lengua said.
"What we see in individuals experiencing chronic adversity is that their morning levels are quite low and flat through the day, every day. When someone is faced with high levels of stress all the time, the cortisol response becomes immune, and the system stops responding. That means they're not having the cortisol levels they need to be alert and awake and emotionally ready to meet the challenges of the day," she said.
To assess executive function, researchers chose preschool-friendly activities that measured each child's ability to follow directions, pay attention and take actions contrary to impulse. For instance, in a game called "Head-Toes-Knees-Shoulders," children are told to do the opposite of what a researcher tells them to do -- if the researcher says, "touch your head," the child is supposed to touch their toes. In another activity, children interact with two puppets -- a monkey and a dragon -- but are supposed to follow only the instructions given by the monkey.
When children are better at following instructions in these and similar activities, they tend to have better social skills and manage their emotions when stressed. Children who did well on these tasks also tended to have more typical patterns of diurnal cortisol.
But children who were in families that had lower income and higher adversity tended to have both lower executive function and an atypical diurnal cortisol pattern. Each of those contributed to more behavior problems and lower social-emotional competence in children when they were about to start kindergarten.
The study shows that not only do low income and adversity affect children's adjustment, but they also impact these self-regulation systems that then add to children's adjustment problems. "Taken all together, it's like a snowball effect, with adverse effects adding together," Lengua said.
While past research has pointed to the effects of adversity on executive function, and to the specific relationship between cortisol and executive function, this new study shows the additive effects over time, Lengua said.
"Executive function is an indicator that shows the functioning of cognitive regulation. Cortisol is the neuroendocrine response, an automatic response, and the two consistently emerge as being related to each other and impacting behavior in children," she said.
The research could be used to inform parenting programs, early childhood and school-based interventions, Lengua said. Safe, stable environments and communities, and positive, nurturing parenting practices support child development, while a focus on relationships and healthy behaviors in preschool settings can support children of all backgrounds -- those with high as well as low adversity.
Early-life challenges affect how children focus, face the day
University of Washington
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Print E-Mail
Adversity early in life tends to affect a child's executive function skills -- their ability to focus, for example, or organize tasks.
Experiences such as poverty, residential instability, or parental divorce or substance abuse, also can lead to changes in a child's brain chemistry, muting the effects of stress hormones. These hormones rise to help us face challenges, stress or to simply "get up and go."
Together, these impacts to executive function and stress hormones create a snowball effect, adding to social and emotional challenges that can continue through childhood. A new University of Washington study examines how adversity can change the ways children develop.
"This study shows how adversity is affecting multiple systems inside a child," said the study's lead author, Liliana Lengua, a UW professor of psychology and director of the Center for Child and Family Well-Being. "The disruption of multiple systems of self-control, both intentional planning efforts and automatic stress-hormone responses, sets off a cascade of neurobiological effects that starts early and continues through childhood."
The study, published May 10 in Development and Psychopathology, evaluated 306 children at intervals over more than two years, starting when participants were around 3 years old, up to age 5 ½. Children were from a range of racial, ethnic and socioeconomic backgrounds, with 57% considered lower income or near poverty.
Income was a key marker for adversity. In addition, the children's mothers were surveyed about other risk factors that have been linked to poor health and behavior outcomes in children, including family transitions, residential instability, and negative life events such as abuse or the incarceration of a parent.
Against these data, Lengua's team tested children's executive function skills with a series of activities, and, through saliva samples, a stress-response hormone called diurnal cortisol.
The hormone that "helps us rise to a challenge," Lengua said, cortisol tends to follow a daily, or diurnal, pattern: It increases early in the morning, helping us to wake up. It is highest in the morning -- think of it as the energy to face the day -- and then starts to fall throughout the day. But the pattern is different among children and adults who face constant stress, Lengua said.
"What we see in individuals experiencing chronic adversity is that their morning levels are quite low and flat through the day, every day. When someone is faced with high levels of stress all the time, the cortisol response becomes immune, and the system stops responding. That means they're not having the cortisol levels they need to be alert and awake and emotionally ready to meet the challenges of the day," she said.
To assess executive function, researchers chose preschool-friendly activities that measured each child's ability to follow directions, pay attention and take actions contrary to impulse. For instance, in a game called "Head-Toes-Knees-Shoulders," children are told to do the opposite of what a researcher tells them to do -- if the researcher says, "touch your head," the child is supposed to touch their toes. In another activity, children interact with two puppets -- a monkey and a dragon -- but are supposed to follow only the instructions given by the monkey.
When children are better at following instructions in these and similar activities, they tend to have better social skills and manage their emotions when stressed. Children who did well on these tasks also tended to have more typical patterns of diurnal cortisol.
But children who were in families that had lower income and higher adversity tended to have both lower executive function and an atypical diurnal cortisol pattern. Each of those contributed to more behavior problems and lower social-emotional competence in children when they were about to start kindergarten.
The study shows that not only do low income and adversity affect children's adjustment, but they also impact these self-regulation systems that then add to children's adjustment problems. "Taken all together, it's like a snowball effect, with adverse effects adding together," Lengua said.
While past research has pointed to the effects of adversity on executive function, and to the specific relationship between cortisol and executive function, this new study shows the additive effects over time, Lengua said.
"Executive function is an indicator that shows the functioning of cognitive regulation. Cortisol is the neuroendocrine response, an automatic response, and the two consistently emerge as being related to each other and impacting behavior in children," she said.
The research could be used to inform parenting programs, early childhood and school-based interventions, Lengua said. Safe, stable environments and communities, and positive, nurturing parenting practices support child development, while a focus on relationships and healthy behaviors in preschool settings can support children of all backgrounds -- those with high as well as low adversity.
Female cannabis users underrepresented in health research, study reveals
University of York
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Research at the University of York has shown that women are underrepresented in research into links between cannabis and psychosis, which could limit understanding of the impact of the drug.
In a review of scientific literature over a number of years, Ian Hamilton from the University of York's Department of Health Sciences, found that the majority of research reflects the experience of male cannabis users, with very limited information on how women react to the drug.
They also found that there was little research on cannabis psychosis in countries where cannabis use is high.
Research tends to be focused in America, Europe and Australia, missing the impact of the drug in Africa, Asian and the Middle East, where very little is known about the number of people that develop cannabis psychosis.
Ian Hamilton said: "Across the world governments are opening up access to cannabis for health or recreation. This means that it is important that people have access to information about the risks as well as benefits of using cannabis.
"Cannabis psychosis is one risk which can have a devastating effect on an individual and their family. Building on previous research from the University of York, we reviewed the evidence linking cannabis to psychosis, and identified two significant problems.
"One such problem relates to gender bias. The research we looked at predominantly includes men and not women; this could link to a wider problem with the lack of female scientists in addiction research also.
"The other issue relates to geographical spread of addiction research; we are missing a large population size in not focusing study in areas outside of America, Europe and Australia.
"We could gain much more knowledge on the risk of cannabis psychosis by including other countries and cultures."
The study suggests that more attention needs to be on who is at risk of cannabis psychosis as well as the health implications of taking the drug. This research has to include more women and countries across Asia, Africa and the Middle East, the researchers argue.
Ian Hamilton added: "We need to accept that cannabis psychosis is about more than genetics or biology but is effected by social factors such as where and how young people grow up and the problems they experience as they develop."
Walking speed points to future clinical outcomes for older patients with blood cancers
Slower pace linked to lower survival and increased likelihood of hospitalization; measuring gait speed offers useful tool to better tailor care
Dana-Farber Cancer Institute
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Researchers at Dana-Farber Cancer Institute and the VA Boston Healthcare System have uncovered a new vital sign for gauging survival and likelihood of having an unplanned hospitalization in older patients with blood cancers: the speed at which they can walk.
In a study published today in the journal Blood, the researchers report that for every 0.1 meter per second decrease in how fast patients walk four meters (about 13 feet), the risk of dying, unexpectedly going to the hospital, or using the emergency room increased by 22 percent, 33 percent, and 34 percent, respectively. The association was strongest in patients with non-Hodgkin lymphoma.
"The slower someone walks, the higher their risk of problems," said the study's senior author, Jane A. Driver, MD, MPH, co-director of the Older Adult Hematologic Malignancy (OHM) Program at Dana-Farber and associate director of the Geriatric Research Education and Clinical Center at VA Boston Healthcare System.
Measuring gait speed not only helps identify individuals who are frail and may have worse long-term outcomes, but it also can indicate those who are in better-than-expected shape based on their age. Researchers say the study results support efforts to integrate gait speed as a routine part of medical assessments for older patients with blood cancer, and that it should be measured over time to guide treatment plans.
"There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes. This test can be done in less than a minute and takes no longer than measuring blood pressure or other vital signs," said Driver. "Based on our findings, it is as good as other commonly used methods which take considerably more time and resources and may not be practical for many oncology clinics."
The new study enrolled 448 adults ages 75 years and older who had hematologic cancers. Participants were 79.7 years old on average and completed several screenings for cognition, frailty, gait, and grip strength. Gait speed was measured using the National Institutes of Health 4-meter gait speed test. Patients were asked to walk at a normal pace for 4 meters and their speed was recorded in meters per second using a stopwatch.
The association between slower walking speed and poorer outcomes persisted even after adjusting for cancer type and aggressiveness, patient age and other demographic factors, as well as traditional measures of frailty and functional status. Gait speed remained an independent predictor of death even after accounting for standard measures of physical health.
Patients whose performance status - their general well-being and quality of life - was rated as very good or excellent by their physician were stratified into three groups by gait speed - those at risk or frail, pre-frail, or robust. Of the 314 patients in this group, nearly 20 percent had an unplanned hospital stay unrelated to elective or scheduled treatments, and 16.8 percent visited the emergency department.
"Our study reveals that the current standard of care for functional assessment in oncology--performance status--is not sufficient for elders with blood cancers. Gait speed appears to be much better at differentiating those patients at highest risk for poor outcomes," explained Gregory A. Abel, MD, MPH, director of the OHM clinic.
So much a part of everyday life that it's easily taken for granted, walking is a complex activity that involves multiple bodily systems, including the musculoskeletal, cardiovascular, and nervous systems, all of which must function properly together. Gait speed has been widely used as an assessment in rehabilitative and geriatric medicine. Measuring it doesn't require special equipment, is reasonably efficient, and has value even for patients who use a cane or a walker, Driver noted.
New clinical guide helps physicians identify risk, talk with patients about firearm safety and injury
University of California - Davis Health
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New clinical guide helps physicians identify risk, talk with patients about firearm safety and injuries. Clinicians often feel that they have a role in preventing firearm injury. But few talk with patients about the risk of firearms and safe firearm practices during office visits.
Physicians and researchers at the UC Davis Violence Prevention Research Program (VPRP), Brown University, the University of Colorado and Stanford University are looking to change that. They've developed a clinical guide to help providers get more comfortable recognizing a patient's risk of firearm injury or death. It also helps them talk with patients about firearm safety and teaches them how to intervene in emergency situations.
Their guide, published June 4 in the Annals of Internal Medicine's "In the Clinic" series, is based on existing research and on expert opinion.
"Clinicians are uniquely positioned to identify at-risk patients and discuss safe firearm practices, and patients are overwhelmingly open to having these conversations, especially when they happen directly in the context of the patient's health or the health of someone else in the home," said Rocco Pallin, first author and director of VPRP's What You Can Do initiative.
"This article presents background and practical tools to help clinicians recognize risk and start having these conversations when they feel firearms are clinically relevant," she said.
The guide shares findings from existing studies on firearm-related harm and violence prevention. It recommends strategies for screening, counseling and potential interventions when needed. It also provides a toolkit with information for patients and clinicians on firearm injury and firearm safety.
Researchers believe that a better understanding of gun ownership and more evidence on the factors that increase the risk of violence and injury can help physicians increase patient safety. The authors suggest a conversational and collaborative approach to discussions about firearm safety.
Facts on gun violence, gun ownership and risk factors for clinicians:
Homicides: Highest among teens and young adults, especially African Americans. Highest in the south. Highest in urban areas.
Suicides: Highest among middle-aged and older white men. Highest in Montana, Idaho and western states. Highest in rural areas.
U.S. gun owners: Most are male, white, middle-aged or older and residents of non-urban areas.
Reasons Americans own guns: protection from other people (63%), for hunting (40%) and other sporting uses (28%).
Gun safety: Approximately 20% of homes with children have guns stored in the least safe manner.
Mental illness and guns: Contrary to common belief, only 4% to 5% of person-on-person violence is primarily attributable to diagnosed mental illness.
Risk factors: Patients with abusive partners, alcohol and other substance misuse, history of violent behavior, dementia, impaired cognition, poorly controlled mental illness, prior convictions for violent crimes.
Laws: It is legal for physicians to have discussions about gun ownership with their patients. A survey of gun owners found 70% were somewhat comfortable talking about owning guns if their physicians asked.
Garen Wintemute, VPRP's director, emphasizes that "preventing firearm violence is absolutely 'in our lane' for physicians and other health professionals. We hope this new guide and other materials at the What You Can Do website will give them the knowledge and tools they need to help protect the health and safety of their patients and communities."
New clinical guide helps physicians identify risk, talk with patients about firearm safety and injury
University of California - Davis Health
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New clinical guide helps physicians identify risk, talk with patients about firearm safety and injuries. Clinicians often feel that they have a role in preventing firearm injury. But few talk with patients about the risk of firearms and safe firearm practices during office visits.
Physicians and researchers at the UC Davis Violence Prevention Research Program (VPRP), Brown University, the University of Colorado and Stanford University are looking to change that. They've developed a clinical guide to help providers get more comfortable recognizing a patient's risk of firearm injury or death. It also helps them talk with patients about firearm safety and teaches them how to intervene in emergency situations.
Their guide, published June 4 in the Annals of Internal Medicine's "In the Clinic" series, is based on existing research and on expert opinion.
"Clinicians are uniquely positioned to identify at-risk patients and discuss safe firearm practices, and patients are overwhelmingly open to having these conversations, especially when they happen directly in the context of the patient's health or the health of someone else in the home," said Rocco Pallin, first author and director of VPRP's What You Can Do initiative.
"This article presents background and practical tools to help clinicians recognize risk and start having these conversations when they feel firearms are clinically relevant," she said.
The guide shares findings from existing studies on firearm-related harm and violence prevention. It recommends strategies for screening, counseling and potential interventions when needed. It also provides a toolkit with information for patients and clinicians on firearm injury and firearm safety.
Researchers believe that a better understanding of gun ownership and more evidence on the factors that increase the risk of violence and injury can help physicians increase patient safety. The authors suggest a conversational and collaborative approach to discussions about firearm safety.
Facts on gun violence, gun ownership and risk factors for clinicians:
Homicides: Highest among teens and young adults, especially African Americans. Highest in the south. Highest in urban areas.
Suicides: Highest among middle-aged and older white men. Highest in Montana, Idaho and western states. Highest in rural areas.
U.S. gun owners: Most are male, white, middle-aged or older and residents of non-urban areas.
Reasons Americans own guns: protection from other people (63%), for hunting (40%) and other sporting uses (28%).
Gun safety: Approximately 20% of homes with children have guns stored in the least safe manner.
Mental illness and guns: Contrary to common belief, only 4% to 5% of person-on-person violence is primarily attributable to diagnosed mental illness.
Risk factors: Patients with abusive partners, alcohol and other substance misuse, history of violent behavior, dementia, impaired cognition, poorly controlled mental illness, prior convictions for violent crimes.
Laws: It is legal for physicians to have discussions about gun ownership with their patients. A survey of gun owners found 70% were somewhat comfortable talking about owning guns if their physicians asked.
Garen Wintemute, VPRP's director, emphasizes that "preventing firearm violence is absolutely 'in our lane' for physicians and other health professionals. We hope this new guide and other materials at the What You Can Do website will give them the knowledge and tools they need to help protect the health and safety of their patients and communities."
Research reveals a natural pregnancy hormone could relax a locked-up joint
Researchers at Boston University and Beth Israel Deaconess Medical Center discover surprising step toward melting away 'frozen shoulder'
Boston University
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More than nine million Americans know the scary feeling: sudden, severe shoulder pain and the sensation that their arm feels stuck, unable to move. "Frozen shoulder" is a common condition that happens when the connective tissues around the shoulder joint become thickened and stiff, often a result of trauma, extended use, immobilization, surgical procedures, or inflammation.
It affects more women than men, and typically strikes people between the ages of 40 and 60. Steroid shots or pain medications can sometimes manage symptoms of frozen shoulder, but there's no easy cure. As a last resort, invasive surgery can sometimes restore range of motion and relieve pain.
Researchers from Boston University and Beth Israel Deaconess Medical Center (BIDMC) found that giving relaxin in the form of several injections directly to the shoulder joint, could restore full range of motion. The results of their study were published in the Proceedings of the National Academies of Sciences.
When Beth Israel Deaconess Medical Center orthopedic surgeon Edward Rodriguez had a startling realization--some of his patients experienced lasting relief from their frozen shoulders after becoming pregnant--he hoped it could lead to a better noninvasive therapy and turned for help to Boston University scientist Mark Grinstaff, a College of Engineering Distinguished Professor of Translational Research, and his research group. The Grinstaff Group, a lab bridging BU's College of Engineering and College of Arts & Sciences, is doing research at the intersection of biomedical engineering, chemistry, and materials science engineering.
Guided by Rodriguez's hunch that biochemical changes related to pregnancy could be responsible for melting away a frozen shoulder, the team of researchers, including Boston University graduate student Will Blessing from Grinstaff's team, dove headfirst into reading everything known about pregnancy hormones.
The team's interest was piqued by a natural hormone called "relaxin," which pretty much does what its name indicates. It helps tissues stretch, an important capability for a woman's body to adjust to pregnancy and prepare for childbirth. Relaxin is present in all men and women at a low baseline level, but when a woman becomes pregnant, her body begins producing relaxin to a much higher degree.
"In everyone, relaxin helps maintain the structure of tissue so that it can function properly and not be absolutely rigid," says Blessing, who is earning a PhD in chemistry at BU. "Pregnancy kicks it into overdrive because it helps prime the uterus for childbirth and loosens up and dilates blood vessels to account for carrying blood for an extra person, without increasing the burden on the mother's heart."
Blessing, Grinstaff, and research collaborators at BIDMC, led by Ara Nazarian, tested the effects of administering relaxin to rats with stiff shoulder joints.
"It's an especially cool finding because the answer was in front of our eyes the whole time--relaxin is found in all of us naturally," Blessing says.
He credits Rodriguez for noticing a link between pregnancy and improved frozen shoulder over the course of routine checkups with his patients. Instead of just chalking it up to being a fluke, Blessing says, Rodriguez realized it could be a clinically significant observation.
For the millions of people currently coping with frozen shoulder, or any other frozen joint, the discovery brings hope that a cure is within sight. Known medically as arthrofibrosis, frozen joints affect more than five percent of the general population. For a good sense of just how common the condition is, just look to people who have undergone ACL reconstruction surgery. A third of them will go on to develop arthrofibrosis in their affected knee.
Depending on joint location and how stiff it becomes, people with a frozen joint can experience reduced quality of life and be limited in performing even the most basic activities of daily living and self-care. It can also impact their ability to work and to drive a car. If a patient doesn't respond to currently available steroid and pain management treatments, their disability can be considered permanent.
"While more research is needed, repurposing this pregnancy hormone as a treatment for arthrofibrosis could provide an unprecedented opportunity," said Nazarian, one of the study's co-corresponding authors, in a BIDMC press release.
Although their research is preliminary, Blessing is hopeful they can advance their findings so that it can help people with frozen joints go about their everyday routines more easily, no longer restricted by an elbow or shoulder that won't move as they need it to. "Someday, this might actually reverse the disease," he says.
Rice University bioengineers mix injectable scaffolds at room temperature to grow new tissue
Rice University
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IMAGE: Rice University graduate student Jason Guo fills a mold with bioactive hydrogel. Injectable hydrogels can be enhanced with biomolecules and mixed at room temperature to help heal a variety of... view more
Credit: Jeff Fitlow/Rice University
Like fishermen, Rice University bioengineers are angling for their daily catch. But their bait, biomolecules in a hydrogel scaffold, lures microscopic stem cells instead of fish.
These, they say, will seed the growth of new tissue to heal wounds.
The team led by Brown School of Engineering bioengineer Antonios Mikos and graduate student Jason Guo have developed modular, injectable hydrogels enhanced by bioactive molecules anchored in the chemical crosslinkers that give the gels structure.
Hydrogels for healing have until now been biologically inert and require growth factors and other biocompatible molecules to be added to the mix. The new process makes these essential molecules part of the hydrogel itself, specifically the crosslinkers that allow the material to keep its structure when swollen with water.
Their work, reported in Science Advances, is intended to help repair bone, cartilage and other tissues able to regenerate themselves.
Best of all, the Rice lab's customized, active hydrogels can be mixed at room temperature for immediate application, Mikos said.
"This is important not only for the ease of preparation and synthesis, but also because these molecules may lose their biological activity when they're heated," he said. "This is the biggest problem with the development of biomaterials that rely on high temperatures or the use of organic solvents."
Experiments with cartilage and bone biomolecules showed how crosslinkers made of a soluble polymer can bond small peptides or large molecules, like tissue-specific extracellular matrix components, simply by mixing them together in water with a catalyst. As the injected gel swells to fill the space left by a tissue defect, the embedded molecules can interact with the body's mesenchymal stem cells, drawing them in to seed new growth. As native tissue populates the area, the hydrogel can degrade and eventually disappear.
"With our previous hydrogels, we typically needed to have a secondary system to deliver the biomolecules to effectively produce tissue repair," Guo said. "In this case, our big advantage is that we directly incorporate those biomolecules for the specific tissue right into the crosslinker itself. Then once we inject the hydrogel, the biomolecules are right where they need to be."
To make the reaction work, the researchers depended on a variant of click chemistry, which facilitates the assembly of molecular modules. Click chemistry catalysts don't usually work in water. But with the helpful guidance of Rice chemist and co-author Paul Engel, they settled on a biocompatible and soluble ruthenium-based catalyst.
"There's one specific ruthenium-based catalyst we can use," Guo said. "Others are often cytotoxic, or they're inactive under aqueous conditions, or they might not work with the specific kind of alkyne on the polymer.
"This particular catalyst works under all those conditions - namely, conditions that are very mild, aqueous and favorable to biomolecules," he said. "But it had not been used for biomolecules yet."
Study: New drug regimens improve outcomes for kidney transplant patients
UC researchers present BEST trial findings at American Transplant Congress
University of Cincinnati
CINCINNATI (June 5, 2019) -- Preliminary results from a $5.2 million clinical trial led by University of Cincinnati researchers show that the immunosuppressive drug belatacept can help safely and effectively treat kidney transplant patients without the negative long-term side effects of traditional immunosuppressive regimens, the study's leaders announced this week.
The UC-led Belatacept Early Steroid Withdrawal Trial (BEST) represents a significant step forward in the science of how not only to save lives through kidney transplantation, but also how to prolong the lives and improve the quality of life for those patients for decades after surgery.
"In the BEST trial, we tried to achieve something that hadn't been done in transplantation: to eliminate the use of corticosteroids very early after surgery and at the same time avoid the toxicities associated with the cornerstone immunosuppressive medications that had been used for four decades," said principal investigator E. Steve Woodle, MD, William A. Altemeier Professor in Research Surgery at the UC College of Medicine and director of Solid Organ Transplantation for UC Health.
"We wanted to reduce the side effects and toxicities of these medications and make it easier for patients to tolerate their anti-rejection drugs, while achieving rejection rates that are reasonable," Woodle said. "This work solved a vexing 40-year-old problem and represents a major step forward in the field of transplantation."
The study's two-year findings were presented by BEST investigators in several scientific sessions of the annual American Transplant Congress, held June 1-5 in Boston.
Additional findings related to the study were presented by study authors, including Rita Alloway, PharmD, research professor of nephrology at the UC College of Medicine and director of Transplant Clinical Research at UC Health. The two belatacept-based regimens evaluated in the study did not employ long-term use of prednisone (a corticosteroid) or tacrolimus (a calcineurin inhibitor).
"The primary problem that has prevented elimination of corticosteroids and calcineurin inhibitors to date has been excessive rejection rates," Alloway said. "The BEST Trial demonstrates that rejection risk with the new belatacept-based regimens was increased somewhat, and the reduced side effects and long-term cardiovascular risk reduction are major potential advantages of these regimens for the future."
For the 16,000 people who receive a kidney transplant in the U.S. each year, the standard of care involves a post-surgery regimen that includes corticosteroid and calcineurin inhibitor (CNI) immunosuppressants--drugs that for decades have helped organ transplant patients live, but can also come with long-term effects such as kidney toxicity or cardiovascular damage.
In 2011, the U.S. Food and Drug Administration approved the use of belatacept to prevent rejection in kidney transplant patients. Belatacept is a modified version of the drug abatacept, which is used to treat rheumatoid arthritis.
The BEST study is the first large, multicenter trial to remove both corticosteroids and CNIs from a patient's drug regimen after kidney transplantation. Both drugs place patients at an increased risk of cardiovascular disease, high blood pressure, high cholesterol and diabetes. CNIs have also shown toxicity to transplanted kidneys.
UC Medical Center was the coordinating center for the trial, and many of the patients were treated there.
Beginning in September 2012, the BEST Trial enrolled more than 300 adult kidney transplant patients at eight transplant centers across the U.S. In the randomized trial, the patients received one of two belatacept-based immunosuppressive regimens, or the typical corticosteroid-based immunosuppressive regimen as a control.
After two years, the data shows that patients in the belatacept-based groups showed slightly higher rates of rejection, but lower rates of GI toxicity, neurotoxicity, electrolyte imbalance and other adverse effects associated with steroid-based regimens.
"This CNI- and steroid-free [immunosuppressive] protocol is a promising step forward in minimizing toxicities and improving renal allograft function," the study authors wrote. "Longer-term observations will need to be continued."
One unique feature of the BEST Trial was the involvement of patient-reported outcomes collected via patient surveys--uncommon in a clinical trial but critical to the success of the study, Alloway said. Those findings were shared for the first time at the American Transplant Congress meeting.
"The patients tell you how much better they feel and function with this new drug combination than they do with the standard combination," Alloway said. "And so we're able to show what specific side effects are reported in less than 5%, less than 10%, less than 15% of patients--and how that's different than what you see in the standard of care."
Mosquito control program reduces dengue, costs in Sri Lanka
Intervention focused on removing mosquito breeding sites found to be both effective and cost-saving
New York University
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A public health, police, and military partnership to reduce the mosquito population in Sri Lanka resulted in a more than 50-percent reduction in dengue, as well as cost savings, finds a study from an international team of researchers led by NYU College of Global Public Health. The findings are published in The Lancet Planetary Health.
Dengue is a viral illness transmitted by mosquitoes and can cause fever, pain, rash, and other flu-like symptoms. Severe cases require hospitalization, placing an economic burden on areas where dengue is found. While a new dengue vaccine raised hope about reducing the impact of the disease, the vaccine's risks have limited its use, maintaining the focus on controlling mosquito populations to halt the spread of the disease.
Dengue is particularly prevalent in countries in south Asia and has become a major public health problem in Sri Lanka, which has seen a dramatic increase in the disease in recent years. In response, in 2014, Sri Lanka's Ministry of Health started a proactive mosquito control program in partnership with its military and police forces.
The program aimed to reduce mosquitos in high-risk communities by conducting door-to-door inspections on a large scale. Teams made up of a combination of public health authorities, police, and military personnel inspected at least 50 locations daily in order to identify and remove mosquito breeding sites, such as containers of stagnant water around homes. The program augmented the routine mosquito control interventions with larvicides and insecticides.
This study evaluated the impact of the mosquito control intervention from June 2014 to December 2016 in an urban region in western Sri Lanka highly affected by dengue. The researchers analyzed the rates of dengue in symptomatic patients in the presence and absence of the intervention, adjusting for climate variables, including rainfall and temperature, to measure the program's impact. The researchers also assessed the cost and cost-effectiveness of the program.
"Evaluating the effectiveness and cost-effectiveness of population-level interventions is essential for guiding public health planning and empowering policy makers to deploy the most effective and efficient interventions, particularly in resource-limited settings," said Yesim Tozan, assistant professor of global health at NYU College of Global Public Health and the study's senior author.
The mosquito control program had a significant effect on larval mosquito populations in the region as well as on dengue, with researchers measuring a 57-percent reduction in dengue incidence. They estimate that 2,192 cases of dengue were averted during the 31-month intervention.
The program cost $271,615, the majority (89 percent) of which went to personnel, given the human resource-intensive nature of the intervention involving door-to-door inspections and removal of mosquito breeding places. To analyze its cost-effectiveness, the researchers calculated costs using three scenarios of the proportion of dengue cases treated in hospitals: moderate hospitalization (50 percent), low hospitalization (25 percent), and high hospitalization (75 percent).
The researchers found that the cost savings from treating fewer dengue cases in medical settings thanks to the intervention were $291,990 in the moderate hospitalization scenario, offsetting the mosquito control program costs and yielding a savings of $20,247. The program was estimated to avert 176 disability-adjusted life-years over the study period, or $98 in savings per disability-adjusted life-year. The scenario with high hospitalization levels was also cost saving, while the scenario with low hospitalization was cost-effective based on certain calculations but not others.
"Our study suggests that communities affected by dengue can benefit from investments in mosquito control if interventions are implemented rigorously and coordinated across sectors. By doing so, it is possible to reduce the disease and economic burden of dengue," said Prasad Liyanage of the Sri Lanka Ministry of Health and Umeå University in Sweden and the study's lead author.
"Even if a safe dengue vaccine becomes available in the future, mosquito control is likely to remain a key complementary strategy to curtail the continued spread and intensification of dengue," said Tozan.
Safe consumption spaces would be welcomed by high-risk opioid users
Three-city study finds strong support for harm-reduction strategy
Johns Hopkins University Bloomberg School of Public Health
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A large majority of people who use heroin and fentanyl would be willing to use safe consumption spaces where they could obtain sterile syringes and have medical support in case of overdose, suggests a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
In the study, published June 5 in the Journal of Urban Health, the researchers surveyed 326 users of heroin, fentanyl and illicit opioid pills in Baltimore, Boston and Providence, cities hard-hit by America's ongoing opioid overdose epidemic. About 77 percent of participants reported a willingness to use safe consumption spaces--sanctioned locations which have been set up and evaluated in other countries such as Canada and Australia but not yet in the U.S. Willingness to use safe consumption spaces was even higher, at 84 percent, among people who relied on public spaces such as streets, parks and abandoned buildings to use drugs.
The results indicated that 84 percent of the Boston participants, 78 percent of the Baltimore participants and 68 percent of the Providence participants were willing to use a safe consumption space--the overall rate coming in at 77 percent.
"On the whole, we found a strong willingness to use safe consumption spaces. This is important because often the voices of people who use drugs are not always included in policy debates or in the implementation of public health interventions," says study lead author Ju Nyeong Park, PhD, MHS, an assistant scientist in the Department of Health, Behavior and Society at the Bloomberg School.
Safe consumption spaces, also called safe injection facilities and overdose prevention sites, represent a "harm-reduction" approach to the public health and social problems stemming from drug addiction.
They have been in use abroad since the mid-1980s and now number more than 100 facilities in 12 countries. Studies indicate that the public health benefits are many, as they greatly reduce overdose deaths, greatly reduce transmission of HIV and Hepatitis B and C viruses via needle-sharing, help keep users out of parks and other public places and offer good opportunities for steering users to treatment.
There are currently no legal safe consumption spaces in the U.S., however, due to a federal law--known as the "crack house statute"--that creates a serious criminal liability for anyone knowingly connected with a property purposed for illegal drug use. Concerns about safe consumption spaces encouraging illegal drug use and potentially blighting the neighborhoods where they are situated also have led to local opposition in some cases. But the severity of the current opioid-use epidemic in the U.S. --opioids were involved in most of the 70,000-plus drug overdose deaths in 2017--is such that safe consumption spaces are now discussed as viable options among policymakers in some state and local governments. Public health researchers also have been weighing in with studies.
"The study documents that people who use drugs are motivated to be safe and take precautions to reduce their exposure to harm," says Susan Sherman, PhD, professor in the Bloomberg School's Department of Health, Behavior and Society and the study's senior investigator. "We can use this evidence to holistically address the opioid epidemic."
Park, Sherman and their colleagues, working through street recruitment and local syringe service programs, contacted and obtained survey data from a diverse sample of 326 people in Baltimore, Boston and Providence who said they had used opioids non-medically in the previous 30 days. Most reported using injected drugs--mostly heroin. Almost 70 percent were homeless, and 60 percent reported habitually using drugs in public or semi-public places. More than a third of participants reported having experienced an overdose in the past six months. About 73 percent reported recent use of a drug they suspected had contained fentanyl, a synthetic opioid that is much more potent--and thus has higher overdose potential--than heroin.
The participants most likely to say they were willing to use a safe consumption space were those who preferred drugs containing fentanyl and those who primarily used drugs in public spaces. Among those who primarily used drugs publicly, 84 percent said they were willing to use a safe consumption space.
When participants were asked about things that could make it harder for them to use a safe consumption space, the factors they cited most frequently were fear of arrest (38 percent) and privacy concerns (36 percent).
All in all, participants' broad willingness to use safe consumption spaces suggests that such facilities, if available, would provide a viable alternative to using drugs on the streets. "It's encouraging because even though these are people engaging in very high-risk behaviors in very different contexts within these three cities, they were willing to use this harm-reduction intervention," Park says.
Study suggests new computer analytics may solve the hospital readmission puzzle
Machine learning score predicts hospital returns better than standard methods
University of Maryland Medical Center
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BALTIMORE, Md, June 5, 2019 -A University of Maryland School of Medicine study suggests that a novel machine learning model developed at the University of Maryland Medical System (UMMS), called the Baltimore score (B score), may help hospitals better predict which discharged patients are likely to be readmitted.
The research was led by Daniel Morgan, MD, MS, Associate Professor of Epidemiology and Public Health at the University of Maryland School of Medicine (UMSOM). Dr. Morgan analyzed data on more than 14,000 patients from three UMMS hospitals using this special predictive score to determine the likelihood these patients would be readmitted.
The research, published in the journal JAMA Network Open, could help set the stage toward improving patient care and avoiding returns to the hospital.
"A significant proportion of readmissions may be preventable with better planning and follow-up for how the patient would transition back into the community," said Dr. Morgan.
Readmissions occur for almost 20 percent of patients hospitalized in the United States and are associated with patient harm and expenses. Furthermore, rates of unplanned readmission within 30 days after discharge are used to benchmark a hospital's performance and quality of patient care. Nevertheless, studies have shown that clinicians are poorly equipped to identify patients who will be readmitted, and many readmissions are thought to be preventable.
"If hospitals can better target time and money in planning for discharge to home, then patients may not have to come back to the hospital, with the harm sometimes associated with hospitals, including risks for infection, falls, delirium and other adverse events," said Dr. Morgan.
Using Health Data and An Algorithm
Machine learning is widely used to make predictions about the future, based on a set of computer algorithms that analyze massive amounts of data. The algorithms form what is known as a neural network, modeled loosely after the human brain, to recognize and learn from patterns. In the realm of hospital patient care, the increased adoption of electronic health records makes it possible to apply machine learning techniques to health care data.
Existing readmission risk-assessment tools, including the LACE index, the HOSPITAL score and the Maxim/RightCare score, look at a limited set of variables for each patient, such as length of stay in a hospital, type and severity of admission, types and amounts of medications, other chronic conditions a patient may have, and previous hospital admissions.
One of the study's co-authors, William Bame, a Senior Data Scientist at UMMS, designed a neural network to mine thousands of health data variables in real time. The system then calculated a score to predict a patient's chance of returning after hospital discharge.
This experimental B score algorithm was individualized for each of three University of Maryland Medical System hospitals in different settings, after initially evaluating more than 8,000 possible data variables from September 1, 2014 through August 31, 2016. The final machine learning model drew from 382 variables, including demographics; lab test results; whether the patient required breathing assistance; body mass index; affiliation with a specific church; marital status; employment; medication usage and substance abuse.
Morgan and colleagues compared the B score readmission risk ranking to actual readmissions at the three hospitals, and to the predictions scored by the other programs. Across the three hospitals, despite the different settings, the B score overall was better able to identify patients at risk of readmission than other scores. It was most accurate among patients at highest risk. Patients scoring in the top 10 percent of B score risk at discharge had a 37.5 percent chance of 30-day unplanned readmission. Likewise, a patient in the top five percent B score at discharge had a 43.1 percent change of readmission.
"The widespread use of electronic health records has enhanced information flow from all clinicians involved in a patient's treatment," said UMSOM Dean E. Albert Reece, MD, PhD, MBA, University Executive Vice President for Medical Affairs and the John Z. and Akiko K. Bowers Distinguished Professor. "This study underscores how patient data may also help solve the readmission puzzle and, ultimately, improve the quality of patient care."
Freshwater stingray venom varies according to sex and age
A study by the FAPESP-funded Research, Innovation and Dissemination Center shows that toxins produced by young female stingrays cause more pain, whereas toxins produced by adult stingrays cause tissue necrosis
Fundaçăo de Amparo à Pesquisa do Estado de Săo Paulo
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IMAGE: Toxins produced by young female stingrays cause more pain, whereas toxins produced by adult stingrays cause tissue necrosis. view more
Credit: Carla Lima
There is no antidote or specific treatment for freshwater stingray venom, although accidents involving these animals are frequent on rivers in the Amazon and other regions.
A groundbreaking study conducted at the Butantan Institute in Săo Paulo, Brazil, analyzed freshwater stingray toxins to elucidate their mechanism of action and highlighted methods of treatment. One of the key findings was that the composition and effects of the venom produced by members of the family Potamotrygonidae vary even among individuals of the same species.
A sting by a young ray is extremely painful and is used help to frighten off predators, whereas the toxins injected by adult rays cause necrosis and are therefore effective weapons in the hunt for small fish, shrimp and other crustaceans.
"Environmental pressure leads to a modification in the venom's composition and its toxicological effect. When the environment changes, the type of food also changes, and all this causes evolutionary pressure that can lead to a change in toxin composition," said Carla Lima, Vice Director of Butantan Institute's Special Applied Toxicology Laboratory (LETA).
The study was conducted by Lima and Mônica Lopes-Ferreira, the director of LETA, under the aegis of the Center on Toxins, Immune Response and Cell Signaling (CeTICS). The results were published in the journal Toxicon. Lopes-Ferreira is head of dissemination at CeTICS, a Research, Innovation and Dissemination Center (RIDC) funded by Săo Paulo Research Foundation - FAPESP and hosted by the Butantan Institute.
"Several studies have been performed with freshwater stingrays to compare the toxicity of venom from their stinger and mucus. However, studies demonstrating the influence of sex and maturation stage on the composition of stingray venom and its toxic effects are still scarce," Lopes-Ferreira said.
"We set out to discover whether the stage of development and gender of Potamotrygon rex, a freshwater stingray found in rivers throughout South America, influences the composition of its venom and its capacity to trigger an acute inflammatory response using mice as a model. Our results suggest that nociception is induced mainly by the toxins produced by young females," Lima said.
Nociception is the reception, conduction, modulation, central processing and perception of sensory information elicited by tissue injury that is transmitted to the central nervous system by nociceptors, which are peripheral sensory neurons that respond to damaging stimuli in skin and tissue. The brain interprets the signals received by nociceptors as pain.
"In contrast, adult ray venom is more effective in producing protein exudation," Lima added.
Exudation is the discharge of organic liquids via cell walls and membranes in response to injury or inflammation.
"Our findings showed that the composition of the venom of P. rex is influenced by the animal's development to maturity. The production of peptides and proteins capable of influencing the leukocyte-endothelium interaction and favoring neutrophil infiltration into damaged tissue is modulated according to the stage of development," Lopes-Ferreira said.
Potamotrygon rex
The researchers collaborated with colleagues at the Federal University of Tocantins - UFT (also in Brazil), who coauthored the article, to collect venom samples from stingrays captured in the Tocantins River.
All the stingrays belonged to the species P. rex, which is endemic to South America and common in the middle and upper Tocantins, although it was only first scientifically described in 2016.
"To verify toxicity, venom from young and adult rays was applied directly to the skin of anesthetized mice and the resulting alterations to tissue were analyzed under the microscope," Lopes-Ferreira said.
According to the researchers, venom from rays up to two years old, especially females, was found to be more potent and capable of causing acute pain due to the presence of neuroactive peptides.
"Schools of young rays spend a great deal of time hiding in the mud in the riverbed, feeding on microcrustaceans and leaving only rarely. Their sting causes a painful wound and probably serves to ward off predators," Lima said.
Two-year-old rays are sexually mature. They leave their siblings and hiding places in the riverbed to live as lone predators in the water column, which is more or less turbid.
"Toxin composition changes at this point," Lima said. "Pain-causing peptides give way to proteins that cause inflammatory wounds and tissue necrosis."
According to the study, sexual maturity is required for this alteration in the venom composition to occur. Rapid changes in the river water and the natural environment may delay an animal's development and the transformation of its toxins.
This can be observed, for example, in the fish that inhabit the rivers affected by the January 2019 dam burst and the mine tailings spill in Brumadinho, in the Brazilian state of Minas Gerais.
"A sudden change in pH or the transformation of crystal-clear water into turbid water can impair the maturation of stingrays and their arsenal of toxins. Massive contamination will also destroy much of their food and force a change in diet," Lopes-Ferreira said.
Venom composition is known to change in snakes depending on the life stage and sex. According to the authors, this is the first time the same phenomenon has been observed in river or marine stingrays.
Accidents becoming more frequent
"The number of accidents involving stingrays in the Amazon Basin is substantial and continuously rising. To date, there are no antidotes for freshwater stingray venom; therefore, it must be treated with medication to control pain and tissue necrosis. For this reason, it is important to study toxin compositions and to discover how toxins vary between young and adult stingrays or between males and females," Lopes-Ferreira said.
One of the reasons for the increasing number of accidents may be the growing demand for rays in the global ornamental fish trade. According to a report produced by Brazil's Environment Ministry as part of its commitments under the Convention on International Trade in Endangered Species (CITES), Brazil legally exported 68,600 specimens belonging to six freshwater stingray species between 2003 and 2016. The highest price was fetched by P. leopoldi, the polka-dot river stingray, which accounted for approximately 40% of the total (27,700).
Freshwater stingrays are captured at a young age, when their disks are approximately 6 cm in diameter. In an aquarium, they can grow to approximately 20-30 cm. They may then be considered too large, in which case they may be released into a river, lake or dam reservoir. This is why there are now many of these stingrays in rivers in southern and southeastern Brazil, which may be another reason for the increasing frequency of accidents.
"Now that we know the venom changes depending on age and sex, we'll be able to provide more suitable treatments for victims when they come to the emergency room. If they report an encounter with a small ray, for example, the attending or nurse can opt for antivenom serum therapy with peptides. However, if the individual has been stung by an adult ray, medical staff should consider a protein antivenom," Lopes-Ferreira said.
Freshwater stingrays are found only in South America. They evolved from a marine ancestor that took up residence inland after part of the continent was flooded by rising sea levels during the Eocene Epoch, approximately 50 million years ago, and possibly in the Miocene, approximately 20 million years ago.
When the sea retreated from what is now Amazonia, saltwater species had to adapt to freshwater environments or they would disappear. Some species succeeded, including the Amazon river dolphin (Inia geoffrensis) and manatee (Trichechus spp.), as well as the stingrays.
There are four genera with a total of 34 species. Potamotrygon alone comprises 27 species; 21 are found in Brazil, and 11 are endemic to Brazilian rivers.
Planning On Taking A Life The Same Day You’re Giving Birth To One
Bad Behavior, Canada, Hospital, Non-Dialogue, Nurses, Ontario | | Healthy | June 6, 2019
I’m past due with my second child by a week when I wake up around 4:00 am and find fresh blood in the toilet after urinating. I wake my husband, get the toddler ready, and grab the bags, and we get to the hospital a little before 7:00 am. At this point, I am beginning to feel contractions coming on. The intake takes several minutes before I’m placed in a pre-check room — essentially a small department of eight beds, divided by curtains, where they do cervix checks, blood pressure, and first-step inductions. I’m placed in the last bed on the far side and hooked up to a fetus monitor while a new nurse checks all my vitals. I come to hate this woman immediately.
She tells us first that my toddler can’t be in the room with us, to which my husband and I both say we are trying to contact nearby family but no one’s answering yet, plus we have yet to be moved to a birthing suite and I cannot carry all those bags myself at this time. The nurse relents after two more tellings, but says snippily that the toddler can’t be there for the birth. We both know and inform her that we have no intention of having my toddler in the room at that time. She leaves and my husband goes back to calling family repeatedly.
A second nurse comes in, checks everything and suggests maybe I go home, stating that it’s probably too early for anything to happen. I tell her I don’t want to — that the contractions are starting to hurt badly — so she takes me into the birthing wing and sets me up in the jacuzzi. I’m there for twenty minutes. The first half, I’m starting to feel better, but then the contractions double. I count through the pain that I’m in a contraction for about a minute every two minutes.
Cue the b**** nurse. She comes in at 8:00 am and says I shouldn’t be in the tub — yet doesn’t help me climb out — and that my contractions can’t possibly be coming that fast, and has me walk back to the intake wing. Everything hurts! I’m trying not to cry and to do the breathing exercises, etc., all while the nurse hooks me back up to the fetus monitor, berates my husband for still having our toddler here, and then leaves. She only returns once, to snap at me, saying, “You need to keep it down! You can’t be screaming or crying; you’re upsetting other patients here!”
For context, I was induced in my first pregnancy due to the possibility of preeclampsia, stayed four days in the hospital, and was so completely loopy between lack of sleep and the epidural that come the birth, I did it half-dazed. I have never experienced the pain before this, but I’m trying to soldier on and muffle any screaming and tears due to my toddler being in the room. I finally convince the nurse to check my cervix next time she’s in, which she does, only to say I’m not even dilated. That’s a lie, because I was nearly two centimeters dilated when I saw my OB three days ago. I ask for the doctor and she says he’s not there and leaves. My husband leaves at this time to pass our toddler on to family. Out of desperation, I call out for a nurse until another one comes a few minutes later. I immediately ask to see the doctor and she goes to fetch him. He comes in at 9:00 am with the b**** nurse, who’s talking to him, “She’s not dilated… Didn’t do labour classes… Not breathing right…”
I want to punch her.
The doctor takes off the fetus monitor devices and checks my cervix. He goes, “She’s four centimeters dilated! Get her to the birthing suite now.” Then he vacates the room.
The nurse looks at me. “Okay, let’s go.”
A second nurse asks if she should grab the wheelchair, to which b**** nurse says we don’t need it and proceeds to have me walk out of the intake wing and into the labour side. That’s a distance of seven hospital beds and past three birthing rooms.
I’m leaning against the wall, trying to walk through crippling contractions, while she’s telling me I need to hurry up and I shouldn’t take so long. I hiss at my husband that if she doesn’t stop talking at me, once I get closer I’m going to rip her throat out. Unfortunately, she says nothing by the time I shuffle to the door and disappears.
No thanks to her, I can’t receive any pain medication because I am too far dilated by this point, and I deliver my healthy baby a few minutes after 10:00 am.
Under This Care, You Won’t Live To Be 26, Let Alone 102
England, Hospital, Ignoring & Inattentive, London, Non-Dialogue, Nurses, UK | | Healthy | June 5, 2019
After being rushed to hospital via ambulance, I was put in a bed on the ward around two in the morning.
Each bay had four beds in it, and each bed was labelled one through four. The patients’ names were above the beds, and the charts were located at the bottom of the beds.
I hadn’t been asleep for long when I was suddenly thrown upright by someone fiddling with my bed and adjusting the top so I was sitting. Another nurse grabbed my arm before I had fully woken up, so there was one on each side. One was taking my blood pressure and the other was about to insert a needle into my cannula.
Neither had said a word to me.
Tired, cranky, and having only just gotten to sleep after being transferred up from A&E, I asked them what they were doing.
“Just giving you your medicine, Catherine,” one of the nurses replied.
My name is not Catherine.
I asked them to check my chart and to get the needles away from me. They did, grumbling as if I was being dramatic, only to both go wide-eyed. I was in bed two and apparently, they needed the woman in bed one.
I thought nothing of it. I was only happy that they hadn’t injected me with a random drug as I was pregnant, and who knows what could have happened.
It wasn’t until the next morning that I found out that Catherine in the bed across from me was 102 years old and suffering from dementia.
I was twenty-five and heavily pregnant at the time.
I don’t know how they managed to mix us up, but it did not give me much confidence in the nurses during that hospital stay.
Sleep Until Noon And Then TV Show – Yeah, They Really Need Therapy
Crazy Requests, Germany, Medical Office, Time | | Healthy | June 4, 2019
(As an occupational therapist, it’s my responsibility to coordinate appointments with my patients, both in the office or in their home. Sometimes I have to shuffle them around to fit them all in, minding their work schedules and such. I’m trying to find an appointment with a patient
Patient: “You can’t come before 11:00 am; I like to sleep late. But 1:00 pm on Wednesday would be fine.”
Me: “I’m afraid that’s not possible, as I have already scheduled another patient at that time. How about Thursday, 2:00 pm?”
Patient: “I don’t know. [TV Show] is running at that time. Can you come later on Wednesday?”
Me: “Not really. The whole Wednesday is full; I have patients coming in from 8:00 am to 6:00 pm. I’m not even sure I will get to take a break in between. So, Wednesday isn’t going to work.”
Patient: “Well, I don’t mind you coming in after 6:00 pm. In fact, that would be perfect. But don’t come after 7:00 pm, because it would be too late.”
(I love my job. But I’m not going to work that much overtime, after a ten-hour day, to accommodate your naps and TV shows!)
Doctor/Physician, Extra Stupid, Medical Office, USA | |
Healthy | June 2, 2019
(This happens when I get sick during middle school. My mother brings me to urgent care to get me checked out.)
Doctor: “Looks like she’s managed to catch this year’s flu.” *gives usual instructions for dealing with it* “After her temperature has been normal for a full day she can go back to school.”
Mom: “Just one day?”
Doctor: “Yes, that should be long enough.”
(My mother tells me on the car ride home that she found this odd. Before, when my brother or I have gotten sick like this, our regular doctor has instructed her to keep us home until our temperature was normal for two full days. But, he’s the doctor, right? He must know what he’s talking about. So, once my fever has been down for a day, I go back to school. The day starts out fine, but on the bus ride home I start to feel really cruddy. I tell my mom how I’m feeling, and we end up going into urgent care again. A nurse comes in to talk to us first, and my mom tells her about my last visit there.)
Nurse: “He said to send her back after only one day of feeling better? Seriously?!”
(She was pretty incredulous that such instructions had been given. The checkup proceeded, and it turns out I’d caught pneumonia. That most likely happened because I’d gone back to school before my immune system was able to fully bounce back.)
Doesn’t Understand The Weight That Comes With Being A Doctor
Doctor/Physician, Extra Stupid, Jerk, Medical Office, USA, Virginia | | Healthy | June 1, 2019
(I go to a doctor’s office where you have a regularly-prescribed doctor but if they are out, you get another that works in that specific building. I have been suffering from extreme menstrual pains ever since I started and have been to the doctor many times to find a solution, getting dumb answers — such as when I tell them I’ve lost about 50 pounds over six months and they tell me that I’m not watching my weight — but this one takes the cake.)
Newer Doctor: “I see you’ve been here for this problem before. What did [Regular Doctor] say?”
Me: “The last time I was here, he suggested [pain reliever] and to stop eating dairy completely, and if that didn’t work, he was going to prescribe me [birth control].”
Newer Doctor: “Oh, no, no, no. We are not going to put you on a pill to mess with all your hormones. You should go on a diet and you’ll start to feel better.”
Me: “But I’m already on the Keto diet. Do you want me to start eating ice?”
Newer Doctor: “I don’t believe that! I’ve seen your records of weight, and you’ve lost a lot, but you need to lose much more!”
Me: “Isn’t the suggested weight 180 pounds? I’m 195. At this rate, I’ll be 140 before summer!”
Newer Doctor: “That’s good! A doctor should always tell you to lose weight! I hate when I go to the doctor and they just try to change everything about my body.”
Me: *thinking* “Isn’t that exactly what you’re doing?!”
(I took her advice with a grain of salt and went back when my regular doctor got back. I started taking the pill and it has helped significantly!)
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