Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Berard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital revealed. Prof. Berard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies. ‘The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role,’ she explained. ‘Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.’
Berard and her colleagues worked with data from the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten. In addition to information about the mother’s use of antidepressants and the child’s eventual diagnosis of autism, the data included a wealth of details that enabled the team to tease out the specific impact of the antidepressant drugs. For example, some people are genetically predisposed to autism (i.e., a family history of it.) Maternal age, and depression are known to be associated with the development of autism, as are certain socio-economic factors such as being exposed to poverty, and the team was able to take all of these into consideration.
‘We defined exposure to antidepressants as the mother having had one or more prescription for antidepressants filled during the second or third trimester of the pregnancy. This period was chosen as the infant’s critical brain development occurs during this time,’ Prof. Berard said. ‘Amongst all the children in the study, we then identified which children had been diagnosed with a form of autism by looking at hospital records indicating diagnosed childhood autism, atypical autism, Asperger’s syndrome, or a pervasive developmental disorder.
Finally, we looked for a statistical association between the two groups, and found a very significant one: an 87% increased risk.’ The results remained unchanged when only considering children who had been diagnosed by specialists such as psychiatrists and neurologists.
The findings are hugely important as six to ten percent of pregnant women are currently being treated for depression with antidepressants.

University of Montreal http://tinyurl.com/zgflp3h

Tiny microbubbles are being used to more effectively identify liver tumours, according to a study. Patients with hepatocellular carcinoma, the third leading cause of cancer deaths worldwide, were found to benefit from contrast-enhanced ultrasound (CEUS) imaging when MRI imaging was inconclusive, according to Dr. Stephanie Wilson, a professor of medicine at the University of Calgary in Canada and Co-President of the International Contrast Ultrasound Society. She said that inconclusive MRIs occur frequently.
‘This is an exciting option because hepatocellular carcinoma is the most common form of liver cancer, and standard imaging with MRI is often an insufficient option for characterizing the tumour,’ Dr .Wilson said.
CEUS uses liquid suspensions of tiny gas microbubbles to improve the clarity and reliability of an ultrasound image without exposing patients to ionizing radiation. The microbubbles are smaller than red blood cells and, when they are injected into a patient’s arm vein, they improve the accuracy of diagnostic ultrasound exams. The microbubbles are expelled from the body within minutes.
David Cosgrove, Emeritus Professor at Imperial and Kings Colleges London, said the findings demonstrate the vast potential benefits of using microbubble ultrasound contrast agents as a safe, convenient and effective diagnostic imaging tool that improves patient care without exposing individuals to ionizing radiation. ‘CEUS is an excellent modality that can help differentiate benign from malignant tumours,’ he added.

International Contrast Ultrasound Society http://tinyurl.com/zms76su

Researchers from the Harvard affiliated Hebrew SeniorLife Institute for Aging Research (IFAR), have published a recent article i which gives evidence that sub-sensory vibrations delivered to the foot sole of older adults significantly augmented the physiologic complexity of postural control and led to improvement in a given mobility assessment. Researchers came to this conclusion by applying vibrating soles to the feet of 12 healthy adults at various sensory thresholds over the course of three visits. After the vibrations were delivered, researchers tested postural sway complexity during eyes open and eyes closed standing assessments. They then evaluated mobility using the timed up and go (TUG) assessment. Findings of the study show that foot sole vibrations at 70 and 85% of sensory threshold increased postural sway complexity. Moreover, these increases correlated with improved TUG times for participants.

When standing, the feet are the only points of contact with the external environment. Therefore, standing postural control is dependent upon the nervous system to detect characteristics of the ground below the foot and deliver that information back to the central nervous system. Vibratory noise increases the sensory input from the foot soles to the postural control system, which leads to greater postural control and improved mobility.

Institute for Aging Researchwww.instituteforagingresearch.org/resources/news

Patient safety before, during, and after surgery requires an appropriately educated, committed and empowered health care team, according to recommendations being presented today at the inaugural National Surgical Patient Safety Summit (NSPSS). The two-day event, which includes more than 100 representatives from medical professional associations, insurers, health care systems, payers and government agencies, is sponsored by the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Surgeons (ACS), with the goals of developing surgical care and surgical education curricula standards, and prioritizing safety research efforts.

Workgroups, including surgeons, anaesthesiologists and nurses, convened prior to the summit to prepare draft recommendations for all surgical team members, surgical institutions, medical and nursing schools, surgical residency and fellowship programs, and surgical credentialing organizations. The recommendations include the creation and adoption of standardized:

Surgical safety education programs with assessment of competence for surgeons, residents, medical students, perioperative team members, and surgical institutions on effective communication, resilience, leadership and teamwork.
Safety training modules (simulation-based) for the entire surgical team-doctors, nurses, anesthesiologists, surgical technicians and physician assistants.
Training on teamwork, and other essential non-technical skills, beginning during undergraduate medical education, and continuing through surgical residency and postgraduate training, as a requirement of ongoing Maintenance of Certification (MOC).
‘Shared-decision making’ practices and procedures to ensure an informed and prepared surgical patient.
Patient-centred, timely and accurate surgical consent processes.
Communication tools and procedures to improve the accuracy and efficiency of transferring patient information before, during and following surgical care.
Surgical site marking and identification policies (with local modifications as appropriate) for all surgical procedures and surgical facilities, and utilizing a pre-surgical team ‘Brief,’ a pre-surgical team ‘Time-out’ and a postsurgical team ‘De-Brief.’
A common data collection system to measure and improve patient safety outcomes. The system should include uniform definitions, a consistent reporting structure, and accessibility and usability by all stakeholders-hospitals, care providers and medical society databases.
These recommendations will be used to finalize National Surgical Patient Safety Standards, develop surgical safety education curriculum proposals, and to identify surgical safety knowledge gaps and research priorities.

American Academy of Orthopaedic Surgeons http://newsroom.aaos.org/media-resources/news/surgical-safety-patients.htm

An outcomes study led by Alexi Wright, MD, MPH, a researcher and a gynecological oncologist in the Susan F. Smith Center for Women’s Cancers at Dana-Farber, surveyed families of older patients who had died of advanced lung and colorectal cancer, asking what factors were associated with ‘excellent’ end-of-life care for their loved ones.
The families were more likely to assess care as excellent – by relatively large margins – when:

• the patient had hospice care for more than three days, compared with fewer than three days or none;
• the individual wasn’t admitted to an intensive care unit (ICU) in the last 30 days of life;
• the patient died at home or some other location outside the hospital, such as a hospice facility.

‘Our study findings are a powerful argument for the importance of advance care planning,’ Wright said. ‘The more information patients have, the more likely they are to receive the kind of medical care they want near death. And patients’ deaths influence family members’ perceptions of their quality of care.’
Wright reported that end-of-life care could be of higher quality if there are efforts to enroll patients in hospice earlier – not when death is imminent – and to avoid intensive care unit admissions in the final weeks.
Terminally ill patients should have the legal option to choose physician-assisted death, even if – as is often the case in USA States where it is legal- they don’t use it, wrote Susan Block, MD, founding chair, Department of Psychosocial Oncology and Palliative Care at Dana-Farber and two other authors of a ‘Viewpoint’ opinion piece.
Patients nearing the end of life want control over their bodies and their lives as ‘a small measure of self-preservation,’ they noted. Such individuals can gain peace of mind when they have a ‘back-up’ plan, they added.
‘When physicians are willing to explore and work with a patient requesting physician-assisted death, patients can experience substantial benefits that are more apparently under an open legal process,’ said the authors.

Dana-Farber Cancer Institute http://tinyurl.com/jx6wwxz