A study conducted at the Department of Global Public Health and Primary Care (IGS), University of Bergen (UiB), concluded that Norwegian family doctors show little cultural competency when dealing with patients from an immigrant background.
“We need a new strategy on immigrant health, which should include an obligatory component in medical training in cultural competency,” says Associate Professor Esperanza Diaz, at IGS. She is co-author on the study.
The researchers studied a group of general practitioners that were either training to become specialists or were already specialists. The study participants were asked questions about what kind of strategies they used in meetings with patients from immigrant backgrounds.
The doctors responded that they treated these patients similarly to patients without immigrant backgrounds. In follow-up discussions, the participating doctors recognised that they had experienced cultural differences between the different patient groups.
“We discovered that the Norwegian doctors engage in relatively little reflection about cultural differences and the potential impact of such differences. It is as though they think they, themselves, represent the normal zero point, and this concerns us,” Diaz says.
Diaz underlines that cultural competency should be a  part of the medical education curriculum.
“Today, cultural competency depends on medical students taking personal initiatives, such as by joining special courses or engaging in voluntary activities. Cultural competency should be part of the ordinary medical education curriculum,” says Esperanza Diaz.
University of Bergen
www.uib.no/en/med/111669/doctors-need-cultural-training

Patients who survive acute respiratory distress syndrome (ARDS) often leave a hospital intensive care unit with debilitating mental, physical, or cognitive problems that may limit their quality of life.
Now, a new study of 645 ARDS survivors by researchers at Intermountain Medical Center, Johns Hopkins University, and the University of Utah, has identified subgroups of ARDS survivors who suffer what’s been called post-intensive care syndrome, a collection of symptoms that can linger for years.
“A lot of work has been done around post-intensive care syndrome. We’re realizing the people who are surviving are often terribly wounded, and they have emotional and psychological distress as severe as combat veterans returning from war,” said Samuel M. Brown, MD, lead author of the study and director of the Center for Humanizing Critical Care at Intermountain Medical Center. “They may have profound weakness or shortness of breath or other important limitations to their quality of life after they survive.”
ARDS is a potentially life-threatening injury to the lungs that occurs most often in an intensive care unit among critically-ill patients with pneumonia or other infections, although it can have other causes.
For many ARDS patients, the primary symptom is shortness of breath so severe they require lung life-support therapies in order to breathe. ARDS can kill, and older patients are especially vulnerable.
Many ARDS survivors leave the hospital with an array of challenges that form post-intensive care syndrome. The survivors may live with long-term effects, including permanent lung damage and different degrees of physical, cognitive, and mental health problems.
During the last quarter-century, the symptoms of post-intensive care syndrome have been increasingly recognized and understood. Critical care specialists say between half and two-thirds of ARDS survivors struggle with it after they’re released from the hospital, Dr. Brown said.
“Patients are struggling and we’re trying to understand how to guide them through the process of the recovery and develop tailored rehabilitation programs to help them,” he said.
To that end, researchers at Intermountain Medical Center and Johns Hopkins University have been seeking common threads among survivors, focusing on combinations of impairments, including physical health, mental health, and brain function. The study builds on previous research by the team.
In the study of ARDS survivors six months out of intensive care, the researchers found four different patient subgroups:
 

• those with mildly impaired physical and mental health (22% of patients)
• those with moderately impaired physical and mental health (39%)
• those with severely impaired physical health and moderately impaired mental health (15%)
• those with severe physical and mental health impairments (24%).

 
According to the research, physical and psychological injuries tend to go hand in hand. Cognitive impairment is independent of those two, however.
The study found people who have worse physical problems have worse symptoms of anxiety, depression, or post-traumatic stress disorder. The one exception was a small but distinct group (15% of all survivors) who had severe physical limitations, but only moderately severe mental health problems.
Researchers speculate that could mean those individuals already had some chronic physical challenges before developing ARDS and were more accustomed to living with physical limitations.
“It’s also possible that group might have more resilience, so they’re better able to respond to the new physical disability, which is consistent with other recent studies suggesting that improving resilience may help ARDS survivors,” Dr. Brown said.
The study noted that six months after leaving intensive care, about half of the subjects in the study still weren’t living independently, even though 91 percent of them had done so prior to contracting ARDS. Instead, they lived in nursing homes or with relatives.

Intermountain Healthcare
intermountainhealthcare.org/news/2017/08/icu-patients-who-survive-respiratory-condition-may-have-post-intensive-care-syndrome/

Shimadzu Corporation was recognized for their global strategies and product launch efforts for diagnostic X-ray imaging systems and received the 2017 Global General Radiography Product Line Strategy Leadership Award from Frost & Sullivan, a major global market research and consulting company based in the U.S. The RADspeed Pro EDGE package general radiography system, the MobileDaRt Evolution MX7 version mobile X-ray system and the SONIALVISION G4 multi-functional universal R/F system, were the systems that determined the merit for this award.
The Global General Radiography Product Line Strategy Leadership Award was newly created in 2017 by Frost & Sullivan, a company that employs more than 1,800 consultants and industry analysts in offices located in more than 40 countries around the world. The award is presented to the company that introduces products and services that demonstrate the highest leadership in the global market for diagnostic X-ray imaging systems in 2016 and employs the best strategies for success.
Shimadzu, while continually designing systems and software to reduce X-ray exposure to patient and caregiver alike and while also improving the quality of images for diagnostic X-rays, was selected to be the first recipient of this award for the year 2016. Additionally, Shimadzu continues developing leading-edge applications supporting numerous types of examinations and diagnostic procedures. These measures and the company’s ability to penetrate the global market with high-performance diagnostic X-ray imaging systems that meet all types of customer demands and combine versatility and functionality were highly praised, resulting in the winning of this prestigious award. www.shimadzu.com

Results of a small clinical trial show promise for treating a rare neurodegenerative condition that typically kills those afflicted before they reach age 20. The disease, called Niemann-Pick type C (NPC), causes cholesterol to build up in neurons, leading to a gradual loss of brain function. In the drug trial, researchers have shown that treatment with a type of sugar molecule called cyclodextrin slows progression of the disease.
The study, led by researchers at Washington University School of Medicine in St. Louis and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH).
“We were surprised to see evidence that this therapy could slow progression of the disease and, in some cases, get back some function — speech in particular,” said first author Daniel S. Ory, MD, the Alan A. and Edith L. Wolff Professor of Cardiology at Washington University School of Medicine in St. Louis. “In a neurodegenerative disease, therapies can’t recover neurons that have died. But if some brain cells are dysfunctional rather than dead, it seems this drug can recover some of that function.”
The findings are a result of efforts by the National Center for Advancing Translational Sciences of the NIH to find new treatments for rare and neglected diseases. NPC affects about one in 100,000 births, though Ory noted the disease is under-diagnosed and genetic studies suggest a true incidence of closer to one in 40,000 births.
The cholesterol buildup characteristic of NPC can affect organs other than the brain, such as the liver and spleen, but neurological symptoms often first suggest something is amiss. Age of onset varies considerably, but learning delays and clumsiness may emerge in early childhood, followed by progressive loss of brain function, including loss of motor control, hearing, speech and cognition. Most patients with the condition die 10 to 15 years after the onset of symptoms.
In the combined phase one/two clinical trial, 14 NPC patients who were ages 4 to 23 years and showing neurological symptoms were given cyclodextrin, administered into the spinal column once per month for 12 to 18 months. Another three patients were given cyclodextrin in the spinal column every two weeks for 18 months. Since cyclodextrin does not cross into the brain from the bloodstream, the drug must be injected into the spinal column by lumbar puncture, an outpatient procedure often referred to as a spinal tap. The study did not have a control group that received a placebo, so researchers compared the patients’ progression with historical data collected from past NPC patients.
Doctors used a specialized scoring system to measure disease progression. Called the NPC Neurological Severity Score, it helps assess eye movement, gait, speech, swallowing, fine motor skills, cognition, hearing, memory, and presence and severity of seizures. In each category, patients can score zero to five points, with zero indicating normal function and five indicating severe disability or loss of that category of function.
The historical data from past NPC patients showed that patients’ scores increased — meaning the disease worsened — an average of 2.9 points per year. In contrast, the scores of patients in the trial increased an average of 1.2 points per year, a difference that is statistically significant. The improvements compared with the historical data were seen most in gait, cognition and speech.
“Some of the patients began this trial without the ability to speak, and now they speak,” Ory said. “There is a slowing of the decline, but we were surprised to see trends toward improvement in a few categories. Compared with the historical data, half of the patients in this study saw an improvement or no worsening in the neurological severity score.”
However, hearing loss, a symptom of NPC, was also a major adverse effect of the drug.

Washington University School of Medicine
medicine.wustl.edu/news/drug-trial-shows-promise-rare-deadly-neurological-disorder/
 

Microfluidic platforms have revolutionized medical diagnostics in recent years. Instead of sending blood or urine samples off to a laboratory for analysis, doctors can test a single drop of a patient’s blood or urine for various diseases at point-of-care without the need for expensive instruments. Before the sample can be tested however, doctors need to insert specific disease-detecting biomolecules into the microfluidic platform. While doing so, it has to be ensured that these biomolecules are well-bound to the inside of the device to protect them from being flushed out by the incoming sample. As this preparatory step can be time-consuming, it would be advantageous if microfluidic platforms could come pre-prepared with specific biomolecules sealed inside. However, this sealing process requires exposure of the device components to high energy or ‘ionized’ gas and whether biomolecules can survive this harsh process is unknown.
To answer this question, researchers at the Okinawa Institute of Science and Technology Graduate University (OIST) have created a novel sensor that detects biomolecules more accurately than ever before. This sensor was used to demonstrate that biomolecules can be successfully sealed within microfluidic devices. The results have profound implications for healthcare diagnostics and open up opportunities for producing pre-packaged microfluidic platform blood or urine testing devices.
The microfluidic platform device, in which disease-detecting biomolecules can be bound for ready-to-use test kits, is not much bigger than a thumbtack.
Traditionally, metal oxide semiconductor (MOS) sensors are used to detect the binding of biomolecules to a surface by measuring changes in charge. Comprised of a silicon semiconductor layer, a glass insulator layer and a gold metal layer, these sensors are incorporated in an electric circuit with the biomolecule sitting in an electrolyte-filled plastic well on top of the sensor. If you then apply a voltage and measure current, you can work out the charge from the capacitance reading given off. Biomolecules with different charges will give you different capacitance readings, enabling you to quantify the presence of biomolecules.
The novel sensor created by researchers in OIST’s Micro/Bio/Nanofluidics Unit, measures charge using the same technique as conventional sensors but has the additional function of measuring mass. Instead of having a solid gold metal layer, the so-called nano-metal-insulator semiconductor (nMIS) sensor has a layer of tiny gold metal islands. If you shine light on these nanostructures, the surface electrons start oscillating at a specific frequency. When biomolecules are added to these nanoislands, the frequency of these oscillations change proportional to the mass of the biomolecule. Based on this change, you can use this technique to measure the mass of the biomolecule, and confirm whether it survives exposure to ionized gas during encapsulation within the microfluidic platform.   
 “We made a simple sensor that can answer very complex surface chemistry questions,” says Dr. Nikhil Bhalla who worked on the creation of the nMIS sensor.
Measuring two fundamental properties of surface chemical reactions on the same device means that researchers can be far more confident that biomolecules have been successfully encapsulated within the microfluidic platform. A measurement of charge or mass alone could be misleading, making it look like biomolecules have bound to a surface when in fact they have not. Having more than one technique in the same device means that you can switch from one mode to the other to see if you have the same result.
“Scientists have to validate one reaction with multiple techniques to confirm that an observation is authentic. If you’ve got a sensor that enables the detection of two parameters on a single platform, then it is really beneficial for the sensing community,” says Dr. Bhalla.
“By combining these two simple measurement techniques into one compact platform, it opens doors to create portable and reliable sensing technologies in the future”, adds PhD student Shivani Sathish.

Okinawa Institute of Science and Technology Graduate Universityhttp://tinyurl.com/ycy35a79