Health specialists at the University of York have found than acupuncture treatment can boost the effectiveness of standard medical care, lessening the severity of chronic pain and depression.
The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.
In a report, the researchers showed that there is significant evidence to demonstrate that acupuncture provides more than a placebo effect.
Professor of Acupuncture Research, Hugh MacPherson, working with a team of scientists from the UK and US, brought together the results of 29 high quality clinical trials focused on patients treated with acupuncture and standard medical care.
In the majority of these trials, patients with chronic pain treated with acupuncture and standard medical care were tested against those who were provided with standard medical care alone, such as anti-inflammatory drugs and physiotherapy. The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.
The report shows that the addition of acupuncture compared to standard medical care alone significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain. It also showed that acupuncture reduced the pain and disability of osteoarthritis, which led to patients being less reliant on anti-inflammatory tablets to control pain.

Hull University http://tinyurl.com/y8j5grso

New evidence suggests low-cost drug should become frontline response for major blood loss after childbirth.

An inexpensive and widely available drug could save the lives of one in three mothers who would otherwise bleed to death after childbirth, according to a major study.

The global trial of 20,000 women found that death due to bleeding was reduced by 31percent if the treatment was given within three hours.

The drug, called tranexamic acid (TXA), works by stopping blood clots from breaking down. The findings also show it reduced the need for urgent surgery to control bleeding (laparotomy) by more than a third (36percent).

Severe bleeding after childbirth (known as post-partum haemorrhage or PPH) is the leading cause of maternal death worldwide. More than 100,000 women globally die each year from the condition, but this clot-stabilising drug has the potential to reduce the number substantially.

The WOMAN (World Maternal Antifibrinolytic) Trial recruited mothers from 193 hospitals in 21 countries, mainly in Africa and Asia, but also in the UK and elsewhere. The London School of Hygiene & Tropical Medicine coordinated the trial. It was funded by The Wellcome Trust and UK Department of Health through the Health Innovation Challenge Fund, and the Bill & Melinda Gates Foundation.

The results show that of the women given tranexamic acid within three hours, 89 died from bleeding compared with 127 given placebo (in addition to standard care). The researchers found no side effects from the drug for either mothers or babies. These findings provide the first comprehensive evidence on using tranexamic acid for post-partum haemorrhage and suggest it should be used as a frontline treatment.

Haleema Shakur, Associate Professor of Clinical Trials at the London School of Hygiene & Tropical Medicine and Project Director on the WOMAN Trial, said: ‘We now have important evidence that the early use of tranexamic acid can save women’s lives and ensure more children grow up with a mother. It’s safe, affordable and easy to administer, and we hope that doctors will use it as early as possible following the onset of severe bleeding after childbirth.’

Tranexamic acid was invented in the 1960s by a Japanese husband and wife research team, Shosuke and Utako Okamoto.

London School of Hygiene & Tropical Medicinewww.lshtm.ac.uk/newsevents/news/2017/woman_trial_results.html

Hospitalization in an intensive care unit (ICU) can be a frightening and sometimes traumatizing experience for patients. Although engaging the patient and improving communication among the clinical team can positively impact care and the patient experience, the ICU environment can be a challenging place to engage patients. In new research, led by Brigham and Women’s Hospital, researchers tested a structured and technology-centred program that was focused on team communication and patient engagement. They found that this approach was associated with a lower rate of adverse events and improved patient satisfaction. Results of this project, named PROSPECT (Promoting Respect and Ongoing Safety through Patient Engagement Communication and Technology), have recently been published.
“Our goal was to shift our clinical thinking from ‘What is the matter?’ to discovering ‘What matters to you?’” said Patricia Dykes, PhD, RN, a senior nurse scientist in the Center for Patient Safety, Research and Practice at BWH and lead author of the paper. “If we can effectively collaborate with our patients and their care partners and engage them in their care, then we have the potential to enhance the care, improve adherence to care plans, positively impact satisfaction rates and reduce healthcare costs.”
Researchers developed an intervention to support integrated, multidisciplinary patient-centred communication characterized by shared checklists, health information, and goals of care articulated by both clinicians and patients. The aim of the intervention, which was tested in two medical ICUs at BWH and included 1,075 patients and their care partners, was to reduce adverse events defined as falls, pressure ulcers, catheter-associated urinary tract infections and ventilator-associated events. Secondarily, the team also sought to improve patient and care partners’ satisfaction rates, agreement on care plans between patient and providers, and healthcare utilization.
The specific interventions were systems-based and included a 60-min training session for all clinicians involved in the study. The training introduced a standard model for care meant to enhance clinicians’ responsiveness to the needs, concerns and expectations of the patients and their care partners as well as training on a web-based toolkit to facilitate team communication and patient engagement. The web-based toolkit included an ICU safety checklist that populated with real-time data from the patient’s electronic health record (EHR). The toolkit also included shared care planning and messaging tools accessed by clinicians through the EHR and by patients and care partners through a bedside portal on an iPad. Eighteen percent of patients and care partners used the portal to document their goals of care, their preferences, and to directly communicate.
When compared to a similar group of ICU patients, researchers found that the intervention was associated with a 29 percent reduction in adverse events. The reduction was determined by the drop in adverse events per 1,000 patient days. Patient days are the total number of days for all patients who were admitted for an episode of care, for example, 20 patients in a hospital for 1 day would represent 20 patient days. The rate fell from 59 per 1,000 patient days in the baseline period to 41.9 per 1,000 patient days in the intervention period, driven by a drop in the number of catheter-associated urinary tract infections and pressure ulcers. While researchers are unable to determine which specific component of the intervention drove this reduction, they suspect it is due largely to implementation of the electronic check list, as only a small percentage of patients or care partners participated through the portal.
“We took the paper checklist that is widely used in ICUs across the country and enhanced it with technology. This allowed more patient-specific information to be available to the multidisciplinary group of clinicians that were making daily decisions about a patient’s care while they executed the checklist,” said Dykes. “For example, if you’re deciding whether or not to remove a catheter or a central line, it is extremely helpful to know the type of catheter and when it was put in. When using a paper check list, that information is not available, but if you transition that checklist to a web-based tool that pulls data from a patient’s electronic health record, then you can make a much more informed decision.”
Researchers also found an improvement in patient satisfaction scores, which were captured through a survey of a subsample of patients and care partners. Ninety-three percent of patients in the intervention who responded to the survey assigned a top score to their overall hospital rating score compared to 71.8 percent of patients in the baseline group. Care partner satisfaction also improved, from 84.3 to 90 percent. Changes in concordance of the care plan between the care team and patients was not observed and resource utilization did not significantly change between the intervention and baseline groups.

Brigham and Women’s Hospital
www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/PressRelease.aspx?sub=0&PageID=2782

Michigan researchers will look at the ability of high intensity ultraviolet light delivered by Xenex Germ-Zapping Robots to protect patients from deadly superbugs, such as Clostridium difficile, found on surfaces.
Patients are vulnerable to hospital-acquired infections – infections they can get while staying at a medical facility. Significant progress has been made in preventing some infection types, but they continue to be a major threat nationwide.
At the end of two years, researchers will report on rates of hospital-acquired infections in units where pulsed xenon UV light (PX-UV) was added to cleaning routines compared to units where a sham UV disinfection system was added to standard cleaning.
They’ll measure if cleaning plus PX-UV reduced the number of infections from drug-resistant organisms including C.difficile, vancomycin-resistant enterococci (VRE), Klebsiella pneumonia, Escherichiae coli producing extended-spectrum betalactamases (ESBLs), methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii.
Hospital cleanliness is recognized as a critically important process to help prevent hospital-acquired infections. It involves extensive cleaning and disinfection after a patient has been discharged and before the next patient has been admitted to the room.
PX-UV lamps in the robot produce a flash of germicidal light in millisecond pulses, damaging the cell structure and stopping the DNA repair mechanisms for most pathogens.
The unique design of the study, which is double-blinded and sham-controlled, makes it the first to examine the clinical impact of adding PX-UV to hospital cleaning routines.

Michigan Medicine http://tinyurl.com/yblkwdge

Having a stroke damages immune cells as well as affecting the brain, research has found. The findings help explain why patients have a greater risk of catching life-threatening infections, such as pneumonia, after having a stroke.

Therapies that boost survival of the affected immune cells or compensate for their damage could help improve the recovery of stroke patients, the researchers say.

The study found that patients have reduced levels of protective antibodies in their blood after having a stroke, which might explain why they are more susceptible to infections. Tests with mice revealed those which experienced a stroke had fewer numbers of specialised immune cells called marginal zone B cells, which produce antibodies. Affected mice were more susceptible to bacterial lung infections, the researchers found. Loss of the B cells was caused by a chemical called noradrenaline produced by nerves activated during stroke.

Researchers, led by the University of Edinburgh’s Roslin Institute, found they could protect the mice from infections using a therapy to block the effects of noradrenaline.

We now plan to build on our findings by developing and testing new treatments that can block or bypass these immune deficits with B cells a particular target.

Noradrenaline is part of the body’s fight or flight response. It helps to prepare the body for action and has a range of effects, such as raising heart rate, boosting blood supply and triggering the release of energy from stores.

Blocking noradrenaline would probably be too dangerous in stroke patients, the researchers caution.

They say development of other therapies that block or bypass the damage to the immune system could offer new approaches to help cut the risk of infection after stroke.

University of Edinburgh www.ed.ac.uk/news/2017/immune-discovery-points-to-stroke-therapy