A drug that blocks neurotransmitters could reduce nausea and vomiting caused by chemotherapy, research co-authored by a Sanford Health physician and published in the New England Journal of Medicine finds.
Sanford oncologist and cancer researcher Steven Powell, M.D., was among a team of researchers who discovered that the drug olanzapine, which is FDA approved for use as an antipsychotic agent, significantly improved nausea prevention in patients who were receiving chemotherapy for cancer treatment. The drug blocks neurotransmitters involved with nausea and vomiting.

‘We’ve long known the nausea and vomiting that come along with chemotherapy are a major problem and affect the quality of life of our patients,’ said Powell. ‘The findings of this study, fortunately, provide physicians with a tool to better address the needs of those they are treating for cancer.’
Researchers noted that within the first day after treatment, 74 percent of study participants experienced no nausea or vomiting when their chemotherapy was paired with olanzapine. When a placebo was used instead of olanzapine, that figure dropped to 45 percent. This benefit continued for five days after chemotherapy treatment for many patients.

Sanford Health www.sanfordresearch.org/newsevents/news/NewsDetail25278.cfm?Id=0,1887

Pediatric researchers at UT Southwestern Medical Center have identified a key component of the pathogenesis of bronchopulmonary dysplasia (BPD), a devastating and sometimes fatal lung disease that affects premature infants. Their findings clarify what prompts the inflammatory response that results in BPD, which previously had been unclear.
The study determined how the NLRP3 inflammasome activates the protein Interleukin 1 beta, which in turn triggers inflammation and development of BPD.
In an animal model of BPD, researchers also tested two FDA-approved drugs that either block the effect of or decrease the production of Interleukin 1 beta and found that these treatments allowed more normal lung development.
Bronchopulmonary dysplasia, a common chronic lung disease in premature infants, develops as a result of the ventilation and oxygen necessary for these infants to survive. Infants born before 30 weeks gestation have immature lungs that lack surfactant, a substance comprised of phospholipids and proteins that is needed for lungs to properly function. This causes premature infants to develop respiratory distress syndrome, requiring the aid of mechanical ventilation. The infants’ exposure to elevated oxygen levels during ventilation activates the process of inflammation that leads to BPD.
‘The same ventilation that ultimately saves their lives, damages their lungs,’ said Dr. Rashmin Savani, Professor and Chief of Neonatal-Perinatal Medicine. ‘Our findings suggest that if we target premature infants born at less than 28 weeks gestation from three to 10 days after birth with this therapy, we might be able to drastically reduce or even eliminate the development of BPD.’ Dr. Savani also holds the William Buchanan Chair in Pediatrics.
Next steps include testing the therapeutic intervention strategies outlined in this study in larger animal models, potentially followed by a Phase 1 clinical trial.

UT Southwestern Medical Center http://tinyurl.com/j2yjrtz

‘OB Nest’: Just the name may bring warm feelings to parents and prospective parents. However, at Mayo Clinic, it’s much more than a name. It’s a new way that Mayo Clinic is providing prenatal care. And, families say they are thrilled with the process.
Current prenatal care for a pregnancy consists of 12-14 visits with an obstetrician. However, often these visits are just brief check-ins to make sure a pregnancy is progressing well. Previous research has looked at ways to give providers more time for high-risk patients, and save time and office visits for women with low-risk pregnancies. While these studies have shown that fewer visits are safe, patients reported less satisfaction overall.
Seeking to identify ways to improve patient experience and perceived value, Mayo Clinic researchers decided to test a new way of providing prenatal care, dubbed ‘OB Nest.’
With the changes to the care experience provided within OB Nest, the researchers found that not only did patient satisfaction improve, but also this improved satisfaction came with fewer office visits.
‘Traditionally, pregnancy is treated as a sickness,’ says Yvonne Butler Tobah, M.D., a Mayo Clinic obstetrician and lead author of this study. ‘We wanted our care to reflect the normal, life-bringing event that it is, and [we] looked for a way to transform prenatal care into a wellness, patient-oriented experience.’
The Department of Obstetrics and Gynecology, in collaboration with the Center for Innovation, worked with patients and staff to collect and prioritize ideas to improve the way pregnant women and their families experience prenatal care. Along with the department, the Care Experience Program, which is part of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, took this information and these ideas and designed evidence-based practice improvements for prenatal care.
OB Nest study participants – all of whom were experiencing low-risk pregnancies – entered the programme with a specific nurse identified as their lead contact. They received eight scheduled office visits (More were optional.) and home monitoring equipment for fetal heart rate and maternal blood pressure. In addition, they could take part in an online care community with other OB Nest participants and nurses from the OB Nest care team.
‘My schedule is very hectic,’ says Seri Carney, M.D., a mom who participated in the OB Nest study during pregnancy with her second child. ‘It was really nice to only have to go in for my appointments every other month. My husband and I didn’t have to worry as often about arranging our work schedules for the appointments.’
‘We could listen to the heartbeat whenever we wanted,’ says Dr. Carney. ‘Our daughter was 4 at the time, and doing it at home meant that she could get involved, too. That was really fun. It also felt like it made me more aware of the movements and heartbeat of my baby.’
In her third trimester, when Dr. Carney noticed her baby’s heartbeat was a little low, she was able to email her care team. They reacted right away and got Carney in for a stress test. All was fine, and within a few weeks, she and her family welcomed baby Luisa Jane.
The OB Nest research project is part of Mayo Clinic’s healthcare delivery research efforts, and aligns with the Institute for Healthcare Improvement Triple Aim.
‘This fulfills the holy grail of what patients expect today,’ says Abimbola Famuyide, M.B.B.S., chair of the Department of Obstetrics and Gynecology, and study principal investigator. ‘How can we continue to improve patient experience and clinical outcomes, while, at the same time, keep costs down?’
‘Improving the patient experience, in the case of OB Nest, includes empowering expectant women to truly engage in, and take control of, their care,’ says Dr. Famuyide. He and his team learned that having one nurse as the centre point for each woman’s care and concerns provided them the comfort of easy connection. Concurrently, fewer office visits saved healthcare provider resources, while reducing patient burden.
This practice transforming research is leading to permanent changes in the way women receive prenatal care across Mayo Clinic. It is part of the goal of the Mayo Model of Community Care, to deliver wellness-focused, high-value healthcare – improving access, convenience and patient satisfaction, while lowering costs.

Mayo Clinichttp://tinyurl.com/jsjgz2t

A team of researchers have discovered a new way for early detection of a potentially deadly fungal infection in patients with suppressed immune systems such as those being treated for leukemia or who have had an organ transplant.
A multidisciplinary research group led by Allan Brasier of The University of Texas Medical Branch at Galveston.
Patients receiving leukemia chemotherapy treatments, bone marrow stem cell transplants or lung transplants are some of those at risk for serious infection by the disease-causing Aspergillus fungus, a common mould in the environment that easily becomes airborne. When inhaled, the mould colonizes the respiratory tract. In patients with immune suppression from their chemotherapy treatment, the mould invades into the bloodstream where it spreads and infects several organs including the liver, lungs and brain. People with normal immune systems are able to destroy the inhaled mould without becoming infected.
Despite close monitoring for infection and aggressive anti-fungal therapy in vulnerable people, the fatality rates are as high as 50 to 90 percent depending on a patient’s underlying disease and site of infection. While early diagnosis can improve the patient’s outcome, timely detection of the infection is difficult.
Currently, the infection is diagnosed with X-rays and tests that measure levels of fungal molecules that produce an immune reaction in a patient’s blood. These tests are not very accurate and often can lead to a wrong diagnosis.
The study describes how the team studied patients undergoing chemotherapy for leukemia, bone marrow transplants and lung transplants from several of the collaborating institutions and identified, confirmed and evaluated a new method of detecting the infectious mould in patients with leukemia. Similar people with no health conditions participated in the study as a comparison group.
The test results for the mould were different for each group of patients, so future commercial diagnostic tests using this technology should be tailored for different medical conditions commonly linked with this infection.
Brasier, director of UTMB’s Institute for Translational Sciences, said the breakthrough was ‘an example of successful collaboration that brought together experts in several different scientific fields to approach a difficult problem.’ The team’s discovery could translate to refined diagnostics, earlier treatment and improved survival for patients affected by this infection. More studies will be needed to confirm and validate this panel as a diagnostic test in independent patients.

The University of Texas Medical Branch at Galveston http://tinyurl.com/hezj57l