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Steam inhalation is not effective for chronic sinus congestion

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Steam inhalation is not effective in relieving symptoms of chronic sinus congestion, research from the University of Southampton has shown.

The study also showed that advice to use nasal irrigation, which is when the nasal cavity is washed to flush out mucus, did help relieve symptoms but had less impact than previous studies have shown.

Millions of people a year suffer from chronic rhinosinusitis or sinus infections. To alleviate symptoms and as an alternative to the common treatment of antibiotics, which are often not effective and contribute to antibiotic resistance, steam inhalation and nasal irrigation are widely suggested.

The research team, led by Paul Little, Professor of Primary Care Research at the University of Southampton, conducted a randomised controlled trial on the effectiveness of advice from primary care physicians to use nasal irrigation and steam inhalation for chronic sinusitis.

The study involved 871 patients from 72 primary care practices in England who were randomised to groups to receive steam inhalation, saline nasal irrigation supported by an advice video, use both treatments techniques or to receive usual physician care.

Professor Little comments: ‘The threat of global antibiotics resistance is very real and we need to find alternative ways of educating and treating people who do not need to have antibiotics. We have found that even a very brief intervention of a video showing patients how to use saline nasal irrigation can improve symptoms, help people feel they do not need to see the doctor to manage the problem and reduce the amount of over the counter medication the get.’

Patients who were instructed to use nasal irrigation showed improvement at three and six months as measured by the Rhinosinusitis Disabilty Index. Steam inhalation did not appear to alleviate sinusitis symptoms apart from reducing headaches.

Given that the impact was less than in previous studies, which had used more intensive coaching in the use of nasal irrigation, the study suggest that further research is needed to understand how much coaching of patients is required.

Southampton University www.southampton.ac.uk/news/2016/07/steam-inhalation.page

Simple measures cut sepsis deaths nearly in half

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Sepsis, commonly called blood poisoning, is a common affliction that can affect people of all ages. A series of simple measures tested at a Norwegian hospital can make a difference in successfully treating sepsis.
Researchers were able to cut the number of patients who died from sepsis, or infections that spread to the bloodstream, by 40percent (from 12.5percent to 7.1percent) after the introduction of relatively simple steps at the wards at Levanger Hospital in Nord-Trondelag, Norway.
The steps, which included increased training and a special observation chart, were introduced as part of a research project carried out by Nord University, Levanger Hospital, and the Mid-Norway Centre for Sepsis Research at NTNU and St. Olavs Hospital in Trondheim, Norway.
‘This study suggests that ward nurses have a key function in increasing the survival for patients with serious infection. The use of cost-effective and clear tools for the identification of sepsis and the scoring of severity in patients as well as a standardized treatment course can achieve this,’ says Erik Solligard, the senior author of the study and head of the Mid-Norway Centre for Sepsis Research. ‘These simple steps should be implemented in all Norwegian hospitals.’
According to the Global Sepsis Alliance, a worldwide alliance of healthcare providers working to increase knowledge about the problem, the majority of sepsis cases are caused by common infections. Pneumonia, urinary tract infections, skin infections like cellulitis and infections in the abdomen (such as appendicitis) can cause sepsis, as well as invasive medical procedures like the insertion of a catheter into a blood vessel. The Alliance says sepsis is the primary cause of death from infection, despite advances in modern medicine like vaccines, antibiotics, and intensive care.
‘Sepsis is a very common and serious condition that many people die from,’ Solligard says. ‘Patients with lifestyle diseases such as diabetes or cancer are particularly at risk. However, sepsis doesn’t attract nearly as much attention.’
Solligard said rates of sepsis are expected to increase in the future, fuelled by the double problem of increasing incidences of lifestyle diseases and antibiotic-resistant bacteria. For that reason, hospitals should have a standardized observation regime so sepsis can be diagnosed early in its progression, and should create clear treatment plans for addressing sepsis, he said.
‘We need much more research on sepsis, especially on how the illness can be prevented,’ he said.
In their study, the researchers created a flow-chart for the identification of sepsis and an observation chart with a severity score that nurses at Levanger Hospital could use at the ward (for triage). Doctors who worked in the ward were given written information, whereas nurses and nursing students were given a 4-hour training course, and the treatment course was standardized with clear guidelines for doctors and nurses.
In addition to increasing survival, the use of these measures reduced the development of serious sepsis during hospital stays by 30percent and the number of days in intensive care was reduced by an average of 3.7 days per patient, thus making the methods not only life-saving, but simple and cost effective.

Gemini http://tinyurl.com/hh3dtvt

Brain-machine interface triggers recovery for people with paraplegia

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During the 2014 FIFA World Cup opening ceremony, a young Brazilian man, paralyzed from the chest down, delivered the opening kick-off. He used a brain-machine interface, allowing him to control the movements of a lower-limb robotic exoskeleton.

This unprecedented scientific demonstration was the work of the Walk Again Project, a non-profit, international research consortium that includes Alan Rudolph, vice president for research at Colorado State University, who is also an adjunct faculty member at Duke University’s Center for Neuroengineering.

Barely two years after the demonstration, the WAP has released its first clinical report. They report that a group of patients who trained throughout 2014 with the WAP’s brain-controlled system, including a motorized exoskeleton, have regained the ability to voluntarily move their leg muscles and to feel touch and pain in their paralyzed limbs. This, despite being originally diagnosed as having a clinically complete spinal cord injury – in some cases more than a decade earlier.

The patients also regained degrees of bladder and bowel control, and improved cardiovascular function, which in one case resulted in a reduction in hypertension.

This is the first study to report that long-term brain-machine interface use could lead to significant recovery of neurological function in patients suffering from severe spinal cord injuries.

The WAP researchers theorize that the long-term training regimen likely promoted brain reorganization and activated dormant nerves that may have survived the original spinal injury from 3-14 years earlier.

The researchers are led by neuroscientist Miguel Nicolelis, director of the Duke University Center for Neuroengineering and president of the Alberto Santos Dumont Association for Research Support. They say they do not yet know the limits of this clinical recovery, since patients have continued to improve since the World Cup demo. However, they believe their initial findings could influence future clinical practices for patients with paraplegia by upgrading brain-machine interfaces from a simple assistive technology to a potential new therapy for spinal cord injury rehabilitation.

Colorado State University source.colostate.edu/brain-machine-interface-triggers-recovery-for-paraplegic-patients/

KIMES 2016: foreign visitor surge reflects growing interest in Korean medical market

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The 32nd Korea International Medical & Hospital Equipment Show held in Seoul from 17 to 20 March showcased Korea’s important medical equipment industry.

Over the years, KIMES has grown into one of the major trade shows in Asia. This year, the event gathered more than 73,000 visitors over 38,808 square meters of exhibition space. One of its main advantages is that it acts as a showcase for Korea’s particularly strong medical equipment industry. Indeed, out of the 1,152 companies from 37 countries who were exhibiting this year, 548 were Korean manufacturers and the show provided an ideal setting for highlighting the increasingly important role played by leading Korean companies such as Samsung, Listem, JW Medical, DK Medical, BIT Computer and Alpinion to name but a few.
As a platform enabling Korea’s medical device industry to show its latest equipment and technology alongside leading global players like GE, Fuji, Shimadzu and Hitachi, KIMES has succeeded in attracting numerous contingents of foreign visitors especially from the Asia region who have a strong purchasing power, including officials in medical institutions and hospitals, radiologists, medical laboratory specialists, pharmacists and emergency medical personnel. The number of foreign visitors has increased significantly this year, reaching 3563 medical professionals from 86 countries, a growth of 17.2% versus 2015. Over the last 5 years, the total of foreign visitors has grown by 184% compared with 19% for domestic visitors. Unsurprisingly, China is top of the list accounting for more than 30% of the total of foreign visitors, followed by South East Asia with nearly 20% and Japan.
A post show survey of exhibitors conducted by the organizers showed a majority of them satisfied with the results of their participation and over 70% committing to exhibit again in 2017.

www.kimes.kr

Sony Europe Ltd. acquires eSATURNUS NV

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Sony Europe Ltd. (‘Sony’) recently announced the acquisition of
eSATURNUS NV (‘eSATURNUS’), a Belgium-based company that provides leading clinical Video over IP solutions in the medical field. Sony expects this acquisition to help further materialize Sony’s vision and strategy of providing new services and end-to-end clinical image workflow solutions for hospitals. eSATURNUS’s deep know-how of hospital operating room workflows, as well as IP-based video integration software, enables processing, control and distribution of multiple image sources combined with medical information. Coupled with Sony’s leading imaging and AV/IT technologies in this field, the combined company expects to further develop a wide variety of smart clinical Video over IP solutions for inside and outside operating rooms.
Sony’s acquisition of eSATURNUS includes all of eSATURNUS’s assets, covering intellectual property rights, as well as its technologies and software solution capabilities. Sony intends to expand the business first in Europe, with further international deployment to follow in the future.
Adam Fry, Vice President, Sony Professional, Sony Europe, commented, ‘Over the past few years, we’ve seen the requirements within hospitals significantly change. There is a constant need to maximize the investment hospitals make in clinical equipment but with the advent of new technology and workflow solutions, it has never been more important to them to be able to invest in future proofed’ installations, with a holistic and long-range view. This means hospitals are looking for end-to-end and state-of-the-art workflows that perform efficiently but that can also evolve over time. Together with eSATURNUS, Sony will aim to further develop smart, scalable and leading-edge clinical Video over IP workflow solutions in digitally-integrated operating room systems.’
Thomas Koninckx, CEO & Co-Founder, eSATURNUS NV, added, ‘The integration of eSATURNUS within Sony will make us part of an incredible organization, and provide access to Sony’s leading technology platform. The aligned vision of eSATURNUS and Sony means that existing and prospective customers can expect even faster technological evolution in the future, and excellent global service. We are pleased to be able to deliver new smart solutions in digitally integrated operating rooms.

www.pro.sony.eu www.esaturnus.com

Higher staffing levels linked to reduced risk of inpatient death

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A study led by King’s College London and the University of Southampton has shown that a higher registered nurse to patient ratio is linked to a reduced risk of inpatient death.
The study of staffing levels in NHS hospitals found that in trusts where registered nurses had six or fewer patients to care for, the death rate for patients with medical conditions was 20 per cent lower than in those where they had more than 10. Hospitals with more doctors per bed also had lower death rates but hospitals with more unregistered nursing support workers may have had higher death rates.
The study, by researchers from King’s College London, the University of Southampton, Karolinska Institutet, Stockholm and the New York School of Medicine, analysed two measures over two years (2009-11): the number of beds per registered nurse, doctor, and healthcare support worker in 137 acute care trusts; and the number of patients per ward nurse, drawn from a survey of just under 3000 registered nurses in a nationally representative sample of 31 of these trusts (46 hospitals and 401 wards).
They also calculated the predicted number of deaths for medical and surgical inpatients, taking account of influential factors, such as age, other underlying conditions, and number of emergency admissions during the previous 12 months.
Among patients admitted to medical, wards, higher death rates were associated with higher numbers of occupied beds for each registered nurse and for each doctor employed by the trust. By contrast, higher numbers of healthcare support workers were associated with higher rates of inpatient death.
When all staff groups were included in the statistical analysis of all 137 trusts, the associations remained significant only for doctors and healthcare support workers.
But analysis focussing on nurses actually working on wards of the subsidiary group of 31 trusts showed that the death rate was 20 per cent lower in those where each registered nurse cared for an average of six or fewer medical inpatients than in trusts were each registered nurse cared for 10 or more. These associations remained significant after further statistical analysis.
The results on surgical wards were similar, with higher registered nurse to patient ratios associated with a 17 per cent lower inpatient death rate.
The registered nurse headcount varied by as much as a factor of four between those at the top and bottom of the staffing scale. Even after taking account of all nursing staff, this variation only dropped to a threefold difference between those with the highest and lowest nurse headcounts.

Kings College London http://tinyurl.com/hujb9hc

Psychiatry on closed and open wards: the suicide risk remains the same

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In psychiatric clinics with an exclusively open-door policy, the risk of patients committing suicide or absconding from treatment is no higher than in clinics with locked wards. This has been demonstrated in a large study by the University of Basel and the University Psychiatric Clinics of Basel (UPK), in which around 350,000 cases were analysed over a period of 15 years.

Self-endangering behaviour by patients, suicidality and absconding from treatment represent great challenges for all medical institutions. In many psychiatric clinics, therefore, high-risk patients are accommodated in locked wards. This is done on the grounds that patients can only receive adequate protection and appropriate therapy if they are prevented from attempting suicide or absconding, but there is no evidence that locked wards actually prevent self-endangering behaviour. It is, however, known that such wards create a treatment climate that is not conducive to successful therapy and tends to increase motivation to escape.

In their naturalistic observational study, PD Dr. Christian Huber and Prof. Dr. Undine Lang of the UPK and the University of Basel, together with colleagues, studied 349,574 cases in 21 German clinics over the period from 1998 to 2012. Some of these clinics practiced an open door policy, making do without any locked wards. Sixteen clinics also maintained intermittently or permanently locked wards in addition to open wards. All of the clinics were legally obliged to admit all individuals from a certain area, regardless of the severity of their illness or of self-endangering behaviour on the part of the patient.

One of the study’s findings is that the rate of suicide attempts and suicides is no lower in clinics with locked departments. Furthermore, institutions with open doors did not record a higher rate of absconding. ‘The effect of locked doors in clinics is overestimated,’ says first author Christian Huber. ‘According to our study, being locked in does not improve patient safety and, in some cases, actually hinders the prevention of suicide and absconding. An atmosphere of control, restricted personal freedoms and sanctions is more likely to be a risk factor impeding successful therapy.’

University of Basel www.unibas.ch/en/News-Events/News/Uni-Research/Psychiatry-on-Closed-and-Open-Wards-The-Suicide-Risk-Remains-the-Same.html

Dehydration in older people could be accurately identified

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Older people are particularly at risk of water-loss dehydration – which is caused by not drinking enough fluid. It can lead to poor health outcomes such as disability and even death.
The best test for diagnosing dehydration, known as a serum osmolality test, is expensive and not currently viable for wide-scale NHS screening.
But new research published recently reveals how routine blood tests for sodium, potassium, urea and glucose could be used to screen for dehydration.
By putting the results of these tests through an osmolarity equation’, health professionals can tell whether an older person is drinking enough fluid.
Lead researcher Dr Lee Hooper from UEA’s Norwich Medical School said: ‘Around 20 per cent of older people living in residential care are dehydrated, and that figure rises to around 40 per cent among those admitted to hospital.
‘Older people often drink less than younger people for a variety of reasons. Loss of routine and fewer social contacts can reduce drinking. In some cases older people choose to drink less as getting to the toilet can be more difficult and take longer. It can be physically difficult to make, carry and drink a cup of tea when you get older – especially if you need a zimmer frame to walk about. And older people tend not to feel thirsty when they drink too little so their bodies don’t warn them to start drinking.
‘On top of all that – as our kidneys get older we are less able to concentrate our urine to preserve fluid, so the body’s ability to regulate its fluid balance slowly reduces.
‘Dehydration often goes unnoticed by carers, but it can lead to increased risk of hospital admission, urinary tract infections, disability and even death.
‘A serum osmolality test measures the freezing point of blood serum to show how concentrated a sample of blood is. People’s blood becomes more concentrated as they become dehydrated.
‘But it is an expensive and time consuming procedure – and clinical laboratories would not be able to handle routine screening. Simpler tests such as urine measurements, which appear to work well in children and young adults, do not work in older adults.
‘When our blood becomes more concentrated, as we become dehydrated, concentrations of serum sodium, potassium, urea and glucose rise. Many blood tests routinely measured in older people already check for all of these, and assess them independently.
‘We wanted to test whether results from routine tests for sodium, potassium, urea and glucose could be used together to accurately screen for dehydration by using a simple mathematical equation.
‘There are a number of different equations already being used, but they vary considerably from each other, and it wasn’t known which were most useful for elderly people. We wanted to find a universal equation which would be accurate for a broad range of elderly people including people with conditions such as diabetes.’
The research team studied 595 people over age 65 – including those who were healthy and lived independently, frail people living in residential care, and those in hospital. The group also spanned several European countries and took into account those with poor renal function and diabetes.
They assessed the diagnostic accuracy of 39 different equations, and compared the results to directly measured serum osmolality.
They found that an osmolarity equation described by Khajuria and Krahn had greatest universal accuracy – across healthy and frail older people, those in and out of hospital, with and without diabetes, with and without poor renal function, at all levels of dehydration and in men and women.
Dr Hooper said: ‘We propose that clinical laboratories use this equation to report on hydration status of older people when reporting blood test results that include sodium, potassium, urea and glucose. We hope our findings will lead to pragmatic screening in older people to allow early identification of dehydration. This would help doctors, nurses and carers support older people to increase their fluid intake.’

University of East Angliahttp://tinyurl.com/hmefojk

Rising opioid prescriptions following low-risk surgeries

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Physicians are prescribing more opioid painkillers than ever before to patients undergoing common surgeries, according to new research from the department of Anesthesiology and Critical Care at the Perelman School of Medicine at the University of Pennsylvania. Their work is published online simultaneously with a major new guideline from the Centers for Disease Control and Prevention (CDC) that calls on physicians to avoid over-prescription of opioids for surgical patients and other patients with painful conditions.
Opioid abuse and addiction is a growing concern in the U.S. with the National Institute on Drug Abuse estimating that approximately 2.1 million Americans suffer from substance use disorders related to prescription opioid pain relievers and an estimated 467,000 Americans are addicted to heroin, with increasing recognition of the strong relationship between opioid use and heroin abuse.
The new study, which included researchers from the University of Toronto, analysed insurance claims from 2004 through 2012 for 155,297 adults undergoing four common outpatient surgeries-carpal tunnel repair, laparoscopic gall bladder removal, some minimally invasive knee surgeries, and hernia repair. In an analysis of patients who had not received an opioid prescription in the six months preceding surgery, the researchers observed that four out of every five patients in the study filled a prescription for an opioid pain medication within the seven days after surgery. The percentage of patients who got those drugs increased over for the period studied all four surgical procedures.

Most notably, the amount of opioid medication dispensed to patients after surgery also increased markedly between 2004 and 2012 for all procedures studied. Among patients undergoing knee arthroscopy, for example, the investigators estimated a greater than 18 percent increase in the average total amount of opioid dispensed, driven by a change in the average daily dose.
‘These data show us a concerning trend,’ said the study’s senior author, Mark Neuman, MD, MSc, an assistant professor of Anesthesiology and Critical Care and director of the Penn Center for Perioperative Outcomes Research and Transformation (Penn CPORT). ‘The growth we observe over time in opioid prescribing after surgery occurs against the backdrop of a major public health crisis of prescription opioid abuse. Additional work is needed to understand how postoperative opioid prescribing patterns might play into this epidemic, and to define better strategies for treating postoperative pain safely and effectively in the future.’
The CDC’s guidelines address pain management outside of active cancer treatment, palliative care, and end-of-life care, recommending nonopioid therapy for the treatment of chronic pain, stating that opioids should be reserved for situations where the benefits for pain and function are expected to outweigh the risks. The guidelines also recommend that clinicians establish treatment goals before prescribing opioids and address how opioids can be discontinued if benefits do not outweigh risks. In addition, the CDC recommends that clinicians prescribe the lowest effective dosage, carefully reassessing benefits and risks when considering increasing dosage and evaluate the benefits and harms of continued opioid therapy with patients every three months or more frequently for high-risk combinations or dosages.

Penn Medicine http://tinyurl.com/gt5cjqw

Transfusion with stored blood safe in heart surgery

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A large registry study led from Sweden’s Karolinska Institutet sheds new light on the much debated issue of transfusions with stored blood. The study shows that the use of stored blood units does not influence patient outcomes after heart surgery.
In Sweden and most other western countries, blood units can be stored for as long as 6 weeks before being transfused. However, a high-profile publication in 2008, which claimed that storage for a mere 14 days or more was unsafe for heart surgery, has caused confusion and anxiety at hospital clinics worldwide.
‘There have literally been hundreds of studies conducted on this topic the past five or six years, none of which have been able to provide a definitive answer’, says senior author Gustaf Edgren , MD, Associate Professor at the Department of Medical Epidemiology and Biostatistics .
To tackle the problem at its roots, Dr. Gustaf Edgren and his research team performed a large-scale study of almost 50,000 patients in Sweden over a 16-year period. The study was made possible by linking a number of high-quality health registries, which allowed researchers to include all heart surgery patients in Sweden during the study period, with complete information about all blood transfusions administered together with clinical details about the patients. The cohort included patients receiving transfusions with blood that had been stored between 14 and 42 days.
‘This study is by far the largest investigation focusing on the issue of blood storage in this very sensitive patient group, and we find absolutely no hint of negative health effects associated with stored blood’, says lead study-author Ulrik Sartipy, a cardiac surgeon and associate professor at the Department of Molecular Medicine and Surgery .
‘Thanks to these unique health registers we have been able to provide very firm reassurance that the current blood storage practices are safe,’ says Gustaf Edgren.

Karolinska Institutet http://tinyurl.com/zudvdfb

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