For patients in intensive care, knowing how much glucose, lactate and other substances are in the blood is a question of life or death. EPFL has developed a miniaturized microfluidic device that will allow medical staff to monitor these levels in real time and react more quickly.
No larger than a pack of chewing gum, the prototype developed by EPFL
Investigators at The Feinstein Institute for Medical Research have discovered that brain scans can be used to predict patients
RA is the commonest autoimmune arthritis affecting 1% of the population. Despite its main articular manifestations, RA can involve extra-articular organs including the auditory system.
Environmental factors for instance smoking, alcohol and noise can deteriorate the condition. Passive smokers are also at risk of HI. Long-term exposure to alcohol affects hearing in RA, causing harmful effects on the cochlear function.
Results of pure tone audiometry revealed that RA patients have high prevalence of HI for all frequencies.Transiently Evoked Otoacoustic Emissions (TEOAEs) test has been used widely to evaluate cochlear function, and is capable of detecting various amounts of decreases in RA patients at an early stage of the disease.
Treatment of HI in RA is empirical. Oral steroids and intensifying Disease-Modifying Antirheumatic Drugs might be an option. Anti-oxidants (eg. vitamin E) may play a protective role for the inner ear. Regular audiometric test and TEOAEs should be performed. Patients will also benefit from the cessation of smoking and alcohol. Like other causes of HI in healthy individuals, HI in RA can also be managed by use of different types of hearing aids and implantable devices.
EurekAlert www.eurekalert.org/pub_releases/2016-04/bsp-iic042216.php
High-grade glioma is the most aggressive form of brain cancer. Despite improvements in surgical procedures, chemotherapy, and radiotherapy, this type of brain tumour is still notoriously hard to treat: less than 10% of patients survive beyond five years. Researchers from KU Leuven have now shown that next-generation cell-based immunotherapy may offer new hope in the fight against brain cancer.
Cell-based immunotherapy involves the injection of a therapeutic anticancer vaccine that stimulates the patient
Idiopathic pancreatitis is often caused by small gallstones that are difficult to observe prior to surgery, shows a study from the University of Eastern Finland. Small gallstones were found in surgery from two out of three idiopathic pancreatitis patients. The study also showed that acute pancreatitis was more common in statin users than non-users.
The main causes of acute pancreatitis in Finland are alcohol and cholelithiasis. In up to 10-20 per cent of cases, the underlying cause remains unclear. These cases may be explained by small gallstones that are not found during regular examination. A gallstone can get stuck in the junction of the common bile duct and the pancreatic duct, thus causing pancreatitis.
In a multi-centre gastrointestinal surgery study, first-time idiopathic pancreatitis patients were randomized into a surgery group and a control group. 39 patients underwent gallbladder removal surgery, and 46 were controls. During an average follow-up of three years, pancreatitis recurred in 14 persons in the control group and in four persons in the surgery group, so recurrence was clearly more likely in controls. Similarly, there were 23 pancreatitis cases in controls and only eight in the surgery group. Small gallstones were found in surgery from two out of three patients, although not observed in repeated abdominal ultrasound prior to surgery.
This finding is important when charting the causes of idiopathic pancreatitis and courses of treatment. For instance, alcohol use may too often be suspected as the cause. The recurrence of idiopathic pancreatitis can in many cases be prevented by laparoscopic gallbladder removal surgery.
The study also analysed the association of pancreatitis with the use of cholesterol-lowering drugs, statins, as gallstones often contain crystallised cholesterol. Animal studies have shown statins to dissolve gallstones. The majority of gallstones are found in the elderly, often asymptomatic. Researchers assumed that statins may also reduce the size of gallstones in humans, enabling gallstones to travel from the gallbladder to the junction of the common bile duct and the pancreatic duct, and then manifest as pancreatitis.
In a retrospective study carried out in Kuopio University Hospital, idiopathic pancreatitis was found to be more common in statin users than in non-users. On the other hand, statin users
The microbiome of patients admitted to the intensive care unit (ICU) at a hospital differs dramatically from that of healthy patients, according to a new study. Researchers analysing microbial taxa in ICU patients’ guts, mouth and skin reported finding dysbiosis, or a bacterial imbalance, that worsened during a patient’s stay in the hospital. Compared to healthy people, ICU patients had depleted populations of commensal, health-promoting microbes and higher counts of bacterial taxa with pathogenic strains – leaving patients vulnerable to hospital-acquired infections that may lead to sepsis, organ failure and potentially death.
What makes a gut microbiome healthy or not remains poorly defined in the field. Nonetheless, researchers suspect that critical illness requiring a stay in the ICU is associated with the loss of bacteria that help keep a person healthy. The new study, which prospectively monitored and tracked changes in bacterial makeup, delivers evidence for that hypothesis.
‘The results were what we feared them to be,’ says study leader Paul Wischmeyer, an anesthesiologist at the University of Colorado School of Medicine. ‘We saw a massive depletion of normal, health-promoting species.’
Wischmeyer notes that treatments used in the ICU – including courses of powerful antibiotics, medicines to sustain blood pressure, and lack of nutrition – can reduce the population of known healthy bacteria. An understanding of how those changes affect patient outcomes could guide the development of targeted interventions to restore bacterial balance, which in turn could reduce the risk of infection by dangerous pathogens.
Previous studies have tracked microbiome changes in individual or small numbers of critically ill patients, but Wischmeyer and his collaborators analysed skin, stool, and oral samples from 115 ICU patients across four hospitals in the United States and Canada. They analysed bacterial populations in the samples twice – once 48 hours after admission, and again after 10 days in the ICU (or when the patient was discharged). They also recorded what the patients ate, what treatments patients received, and what infections patients incurred.
The researchers compared their data to data collected from a healthy subset of people who participated in the American Gut project dataset. (American Gut is a crowd-sourced project aimed at characterizing the human microbiome by the Rob Knight Lab at the University of California San Diego.) They reported that samples from ICU patients showed lower levels of Firmicutes and Bacteroidetes bacteria, two of the largest groups of microbes in the gut, and higher abundances of Proteobacteria, which include many pathogens.
Wischmeyer was surprised by how quickly the microbiome changed in the patients. ‘We saw the rapid rise of organisms clearly associated with disease,’ he says. ‘In some cases, those organisms became 95 percent of the entire gut flora – all made up of one pathogenic taxa – within days of admission to the ICU. That was really striking.’ Notably, the researchers reported that some of the patient microbiomes, even at the time of admission, resembled the microbiomes of corpses. ‘That happened in more people than we would like to have seen,’ he says.
American Society of Microbiology http://tinyurl.com/hz98ug9
A simple phone checklist can help detect tell-tale changes in the health status of people receiving nonmedical home care, according to the findings of a pilot study led by investigators at Harvard Medical School.
Results of the research are based on a program that requires home-care aides to record changes in status during a telephone clockout at the end of each shift.
The research was conducted in collaboration with Right at Home, a senior home care provider, and ClearCare, a company that provides a software platform for homecare agencies.
Analysis of the data captured over a six-month period across 22 Right at Home agencies reveals that changes in clinical status are relatively common — occurring in 2 percent of all caregiver shifts and affecting, on average, 2 percent of recipients. The majority of changes were in behaviour (17 percent) and skin condition (16 percent), followed by changes in eating or drinking behaviour (14 percent) and ability to stand or walk (9 percent).
The results, researchers said, underscore the potential of real-time monitoring systems to spot problems and avert complications before they escalate enough to require hospitalization. Indeed, over the course of the six-month trial, 14 percent of the home-care recipients were hospitalized.
Recipients of non-medical home care often have chronic health conditions that lead to hospitalizations, some of which may be preventable.
The research team cautioned that whether the real-time monitoring system could, in fact, prevent hospitalizations and reduce cost of care remains unknown. That, they said, is the subject of an ongoing randomized trial across 400 home-care locations in the United States. However, the research team said, the fact that a basic phone questionnaire could capture important indicators in clinical status points to the value of harnessing simple technologies to monitor those receiving care at home.
‘Millions of elderly Americans receive supportive home-care services each year, and many of them require frequent hospitalizations, so we set out to determine whether a simple real-time checklist could help improve outcomes and lower health care spending,’ said study leaderDavid Grabowski, Ph.D., professor of health care policy at Harvard Medical School. ‘Our results are a first step to answering that question.’
Under the pilot program, home caregivers were required to do a phone clock out at the end of their shifts. Caregivers receive an automated phone message prompting them to report any changes in health status. The message included a list of questions pertaining to changes in mental, neurologic, gastrointestinal, urinary and other indicators. Any changes reported via the automated system were immediately dispatched to a manager at the home-care agency office for further assessment and triage. The care manager determined whether the condition required closer monitoring, a change in care, a call into the doctor’s office or all of the above. The idea, researchers said, is to prevent complications before they become grave enough to require hospitalization.
Patients who may benefit the most include those with chronic conditions such as diabetes, neurologic disorders or cardiovascular disease, in whom even seemingly innocuous changes could spell bigger trouble. That theme, researchers said, emerged clearly in a series of interviews with home-care workers. For example, one manager relayed the story of a person with diabetes whose caregiver reported a foot ulcer through the phone-based checklist. Normally, that injury would not have been reported until the end of the week, but because of the prompt alert, the care manager reached out to the patient’s nurse, who initiated treatment immediately. One week later, the wound had healed. Sores, wounds and injuries are particularly dangerous in people with diabetes and can lead to rapid decay of tissue and, in some cases, limb amputations.
EurekAlert www.eurekalert.org/pub_releases/2016-08/hms-pcc081116.php
A novel measure for assessing the body’s response to surgery may allow for better anesthesia management in the O.R., less pain when regaining consciousness from anesthesia and better postoperative outcomes, according to a study. The measure, called the nociception (pain) level index, allowed physicians to more accurately evaluate responses to painful stimulation in patients under general anesthesia, compared to traditional measures.
‘There’s currently no standardized, objective method for physicians to monitor the effectiveness of pain-relieving drugs being administered during surgery,’ said Ruth Edry, M.D., lead study author and senior physician anesthesiologist at Rambam Medical Centre in Haifa, Israel. ‘Not effectively monitoring bodily responses to painful stimulation can lead to insufficient amounts of pain medication being administered, which can result in the patient having severe pain upon regaining consciousness from anesthesia, while too much medication may cause other side effects such as nausea and vomiting or respiratory complications.’
Under general anesthesia, patients are unconscious, but their body still shows reflex responses to the surgical procedure, including changes in heart rate, blood pressure, eyes tearing or sweating. These unwanted reflexes can in some cases be dangerous, and anesthesiologists adjust the amount of anesthesia and pain medication when they occur. The nociception (pain) level index, which uses an algorithmic combination to process multiple hormonal and neurological reactions, aims to provide a better, earlier measure of the body’s reflex response to painful stimulation during surgery, compared to the traditional monitoring of individual factors such as changes in heart rate or blood pressure.
In the study, 58 patients who had general anesthesia for a variety of different surgical procedures were examined. Routine anesthesia monitoring was supplemented with a pain monitoring device (PMD-100; Medasense Biometrics; Ramat-Gan, Israel), which generated the nociception (pain) index. The patients’ index was compared to individual, more traditional measures, including heart rate and blood pressure. This index was assessed at several stages including intubation and skin incision, which were designated ‘noxious’ stimuli that would be painful in the conscious person, and where then compared to other non-painful periods.
Compared to other accepted monitors for measuring the body’s response to painful stimulation during surgery, the nociception (pain) index better discriminated presumed pain-causing stimuli from non-pain-causing stimuli. The index also accurately quantified the body’s response to increasingly more painful stimulation, with high sensitivity and specificity, as well as showed a decrease when pain medication was administered.
‘Our results demonstrate the superiority of combining multiple physiologic measures over any individual parameter in the evaluation of the body’s response to pain during surgery,’ said Dr. Edry. ‘The article presents an effective index for trending the body’s response to painful stimulation in the anesthetized patient. Once in clinical practice, we can conduct large-scale studies to better assess the influence of this monitor on patient outcomes.’
The American Society of Anesthesiologisthttp://tinyurl.com/johadqm
Ultrasound technology is taking to the skies with the Essex & Herts Air Ambulance Trust, a charity that provides a free, life-saving Helicopter Emergency Medical Service for the critically ill and injured of Essex, Hertfordshire and the surrounding areas. Stuart Elms, Clinical Director of the Trust, explained: ‘We operate two helicopters crewed by full-time pre-hospital care doctors and critical care paramedics who can be rushed to the scene of an incident with highly specialized and advanced life-saving equipment and pharmacy. As part of our practice, we are moving towards using ultrasound for management of cardiac arrest and advanced life support. Working with expert sites such as the Essex Cardiothoracic Centre at Basildon, Harefield Hospital and SonoSite, our aim is to train our critical care paramedics to use point-of-care ultrasound, allowing us to tailor our cardiac care even more accurately.’ ‘SonoSite is a world leader in point-of-care ultrasound, and its hand-carried iViz instrument lends itself perfectly to pre-hospital use, both in the aircraft and at the scene. The system is small and portable with a good screen that gives a brilliant view, and can be used one handed. The preset views allow rapid set-up and scanning, and are supported by a training mode that allows comparison of normal and abnormal pathology. Ultimately, we also hope to take advantage of the system’s mobile computing capacity to automatically upload data to electronic patient report forms prior to arrival at the hospital. Our aim is to make as much use of ultrasound as we currently do of stethoscopes – whether they are cardiac, medical or trauma patients – helping to improve outcomes.’
www.sonosite.comWhile researchers and physicians have been using the approach for years to diagnose balance issues, it has never been used for stroke.
Studies show that $1 billion is wasted each year on unnecessary tests and hospital admissions for people with dizziness who are suspected of having a stroke but who actually have benign inner ear problems. On the other hand, about 40,000 to 70,000 patients have strokes each year that are initially missed when they come to the emergency room presenting dizziness.
To differentiate stroke from other conditions that cause dizziness, neurologist David Newman-Toker devised a technique that looks for minute differences in eye movements.
A 2009 study showed that the test can outperform more standard clinical tests for stroke, including an MRI or CT scan, but they come with a drawback. ‘Learning to administer these tests correctly requires months to years of mentorship and can be extremely difficult, even for specialists,’ he says.
To automate the process, Newman-Toker turned to video-oculography. While researchers and physicians have been using the approach for years to diagnose balance issues, it has never been used for stroke.
He is now testing the capability of a pair of computerized eye goggles to administer this exam. The technology resembles a pair of swim goggles and uses a video camera connected to a computer to examine eye movements. In patients with severe dizziness, if the goggles find the eyes stay stable when the head is rotated, eye jerking changes direction or either eye is higher, the patient has a stroke; otherwise, it is a benign postviral ear condition known as vestibular neuritis.
Newman-Toker is working to demonstrate the device’s accuracy and utility in emergency room clinical practice and says the technology could be in use in about five years.
John Hopkins Hospital http://tinyurl.com/pgftpgj
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