Common beliefs and misconceptions in the community about dementia are still proving obstacles to treatment despite a rise in public awareness campaigns,
Researchers from Flinders University in South Australia pooled the results of 32 dementia surveys from around the world published between 2012 and 2017 and found that public awareness of the causes of dementia has not changed.
Almost half of the total 36,519 respondents had the common misconception that dementia was a normal part of ageing and was not preventable. The importance of formal educational attainment and management of cardiovascular were acknowledged by less than half of respondents even though regular exercise has been proven as the single most powerful influencer of brain health.
The public also tended to endorse poorly supported risk reduction strategies such as taking vitamin supplements, ahead of more effective but time consuming and energetic strategies, such as exercise regimes.
“We were surprised to find that dementia literacy is still so poor, given how much effort has been put into improving understanding,” said lead researcher Monica Cations.
“The view that dementia is a normal part of ageing with few treatment options is a demonstrated barrier to both preventive health behaviours and to help-seeking and diagnosis in the event that symptoms emerge.”
The 32 surveys were sourced from Europe(12), the United States (11), Asia (7) and Australia (2).
The findings and associated problems are outlined in the paper, What does the general public understand about prevention and treatment of dementia? A systematic review of population-based surveys, which has been published by PlosOne.
There are about 47 million people living with dementia worldwide.
While research has not yet discovered a cure, there is accumulating evidence about the potential to prevent approximately one third of cases of dementia with management of risk factors such as poor educational attainment, hypertension, and depression.
The recently adopted World Health Organization (WHO) Global Action Plan on Dementia urges all countries to implement campaigns to raise awareness about dementia. The plan includes a global target that all member countries will have at least one public awareness campaign on dementia by 2025.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196085http://theleadsouthaustralia.com.au/category/industries/health/

In the last few decades, dozens of new breast cancer drugs — from chemotherapies to targeted compounds — have become available for clinical use, and mammogram technology has gone from film to digital. But are the changes making a difference in how many women die of breast cancer?
The answer to that question is a resounding yes, according to a multi-institutional network of researchers who have modelled the effect of breast cancer screening and treatment on mortality rates.
The researchers’ models showed that screening and treatment reduced breast cancer mortality by 49 percent in 2012, compared with 37 percent in 2000.
“These numbers represent very positive news for breast cancer patients,” said Sylvia Plevritis, PhD, professor of radiology and of biomedical data science at the Stanford University School of Medicine and lead author of the paper. “Advances in screening and treatment are saving patients’ lives, and this paper quantifies just how much of a difference these advances are making.”
In 2005, Plevritis and her colleagues in the Cancer Intervention and Surveillance Modeling Network used data from 1975 through 2000 to reveal the relative contributions of screening and treatment to reductions in breast cancer mortality rates. Using knowledge of how breast cancer advances, they developed models representing how many women would die of the cancer with no screening and no treatments, then simulated the effect of screening and treatment on those mortality numbers.  
The decrease in mortality from the modelled baseline, they found, was about 50 percent due to screening and 50 percent due to treatment.
“Now, over 10 years later, a lot has happened in the field,” said Plevritis, who heads the Stanford Center for Cancer Systems Biology. “We’ve moved from film-based mammography to digital; there are new molecularly targeted treatments and new types of chemotherapy regimens. We wondered whether these advances had changed the relative contributions of treatment and screening on breast cancer mortality.”
Advances in screening and treatment are saving patients’ lives, and this paper quantifies just how much of a difference these advances are making.
So researchers in the network updated their models to reflect molecular subtypes of breast cancer. Six independent teams — including researchers from Stanford, the Dana-Farber Cancer Institute, Erasmus Medical Center, Georgetown University Medical Center, Albert Einstein College of Medicine, the University of Wisconsin, Harvard Medical School and MD Anderson Comprehensive Cancer Center — put together models representing the effect of current treatment and screening.
The group added new data — spanning 2000 to 2012 — to the existing data and compared the conclusions of each model, calculating average effects on mortality of screening and of treatments, including chemotherapy, hormone therapy and the drug trastuzumab, which targets an epidermal growth factor receptor, ERBB2, overexpressed in some tumours. By comparing six models, the researchers were able to replicate the analysis, making the team more confident in results that were seen in all the models. Not only did they look at the effects on breast cancer as a whole, but on molecular subtypes of breast cancer, such as those that are ER positive, meaning that they grow in response to the hormone ostrogen.
“This time around, it was important to look at molecular subtypes because more women are being treated based on the molecular subtype of their tumour,” Plevritis said.
The researchers found that in 2012, screening and treatment together reduced breast cancer mortality by 49 percent. For all breast cancers together, 37 percent of that reduction was due to screening, and 63 percent was due to treatment.
However, when they looked at some molecular subtypes of cancer, the numbers varied. For ER-positive/ERBB2-positive cancer, the most common type and the type for which the greatest number of new targeted treatments are available, only 31 percent of the mortality decline was associated with screening, with 69 percent associated with treatment. For ER-negative/ERBB2-negative cancer, which has fewer treatment options, 48 percent of the mortality decline was associated with screening and 52 percent with treatment, similar to results from 2000.
“Newer drugs, particularly ones that are molecularly targeted, are associated with a greater reduction in breast cancer mortality than screening,” said Jeanne Mandelblatt, MD, MPH, professor of oncology and of medicine at Georgetown University and a senior author of the paper. “However, screening is still having a significant effect in reducing breast cancer deaths.”
In particular, the researchers pointed out, screening can lead to cancer detected at earlier stages and therefore less-intense treatments. Aside from reducing mortality rates, this can translate into fewer side effects and patient co-morbidities.

Stanford Medicinehttps://tinyurl.com/y87wczhd

Scientists have created an artificial intelligence system that could help treat patients with sepsis.
The technology, developed by researchers from Imperial College London, was found to predict the best treatment strategy for patients.
The system ‘learnt’ the best treatment strategy for a patient by analysing the records of about 100,000 hospital patients in intensive care units and every single doctor’s decisions affecting them.
The findings showed the AI system made more reliable treatment decisions than human doctors. The team behind the technology say the tool could be used alongside medical professionals, to help doctors decide the best treatment strategy for patients.
Sepsis, also known as blood poisoning, is a potentially fatal complication of an infection, and kills around 44,000 every year in the UK.
In the study, researchers looked back at US patient records from 130 intensive care units over a 15 year period to explore whether the AI system’s recommendations might have been able to improve patient outcomes, compared with standard care. The researchers now hope to trial the system, called AI Clinician, in intensive care units in the UK.
Dr Aldo Faisal, senior author from the Department of Bioengineering and the Department of Computing at Imperial, said: “Sepsis is one of the biggest killers in the UK – and claims six million lives worldwide – so we desperately need new tools at our disposal to help patients. At Imperial, we believe that AI for Healthcare is the solution. Our new AI system was able to analyse a patient’s data – such as blood pressure and heart rate – and decide the best treatment strategy. We found that when the doctor’s treatment decision matched what the AI system recommended, they had a better chance of survival.”
The team used the AI system to assess which particular treatment approach to sepsis was most successful.
Sepsis can cause a drastic drop in blood pressure which can leave organs deprived of blood flow and oxygen, and can ultimately lead to multiple organ failure and death.
To raise blood pressure and keep the heart pumping, doctors give extra fluids, usually in the form of a salt solution, as well as medication that tightens blood vessels and raises blood pressure, called vasopressors.
Professor Anthony Gordon, senior author from the Department of Surgery & Cancer at Imperial explained: “We know that most patients with sepsis need fluid drips and in more severe cases also need vasopressors to maintain blood pressure and blood flow. There is still much debate amongst clinicians about how much fluid to give and when to start vasopressors. There are clinical guidelines but they provide general advice. The AI Clinician is able to learn what is the best option for each individual patient at that moment in time.”
We’re already making steps to improve diagnosis with our new sepsis tool, but we must also embrace any new technology solutions that can improve patient care and save lives.”
To help doctors decide which approach would boost a patient’s chance of survival, the research team created an AI system that would assess a patient’s vital signs and recommend the best treatment approach.
The system analysed the medical records of 96,000 US patients with sepsis in intensive care units. Using a process called reinforcement learning – where robots learn how to make decisions and solve a problem – the AI Clinician went through each patient’s case and worked out the best strategy of keeping a patient alive. The system calculated 48 variables including age, vital signs and pre-existing conditions.
The system then predicted the best treatment strategy for each patient with sepsis. The results revealed that 98 per cent of the time, the AI system matched or was better than the human doctors’ decision.
The study also found that mortality was lowest in patients where the human doctor’s doses of fluids and vasopressor matched the AI system’s suggestion. However, when the doctor’s decision differed from the AI system, a patient had a reduced chance of survival.
The team say the findings show the AI Clinician could help doctors decide the best treatment strategy for patients.

Imperial College Londonhttps://tinyurl.com/y7bubfbc

Turning down the lights and reducing noise levels as part of a stimulation reduction initiative can decrease assaults and the amount of time patients must spend in restraint at psychiatric intensive care units, according to new research from the University of Alabama at Birmingham. Findings showed that simple techniques to reduce sensory overstimulation played a major role in creating a safer environment for both patients and staff.
“The time period roughly between 4-7 p.m. often sees an environment of commotion and disquietude on high acuity psychiatric units resulting in a higher incidence of assaults and/or need to place patients in restraints to control aggressive behaviour” said Rachel E. Fargason, M.D., professor in the UAB Department of Psychiatry and senior author of the study. “On many psychiatric units, this three-hour period between the end of structured activities and the dinner meal is the most problematic of the day.”
Fargason says the combination of bright lights, talkative staff, anxious evening visitors, clattering housekeeping carts and physician traffic can create a highly overstimulating environment.
“Sensory overstimulation is irritating to healthy individuals, but can be intolerable to individuals with neuro-psychiatric disorders,” said Badari Birur, M.D., assistant professor of psychiatry at UAB and a study co-author. “Healthy individuals regularly engage in centering activities such as stroking their hair or tapping a foot. However, neuro-psychiatrically challenged individuals are often unable to self-identify their sensory needs or execute these adaptive behaviours.”
Fargason and her team began a structured change in sensory stimulation on the 20-bed, locked psychiatric intensive care unit at UAB Hospital in October 2015 by dimming lights in the common spaces of the units at 4 p.m. This was followed by sound reduction and the introduction of music in November. Between December and February 2016, the team added tactile and visual art activities, movement, stretching, and aromatherapy.
“Both assaults and use of restraints dropped dramatically as we implemented these sensory adaptations,” Fargason said. “Rates for both fell to close to zero, well below industry benchmarks and regulatory requirements.”
The need for restraints fell by 72 percent, to just over half of 1 percent of total patient hours requiring restraint usage. Assault rates fell 83 percent to a rate of 0.06 percent.
Since the completion of the study, the psychiatric ICU has continued to utilize the stimulation reduction techniques and continues to see positive results on a regular basis.
“Once the project was fully implemented, the evident calming effects on the patients became reinforcing,” Birur said. “Altering the sensory milieu on a busy psychiatry unit requires multidisciplinary efforts by leaders and frontline team champions to influence this kind of beneficial culture change.”
The team, which included nurses, occupational and physical therapists, patient care technicians, and physicians, reports that the quieter auditory and low-light culture became the new normal on that unit.
“While initially implementing the process changes, assistant nurse manager Barbara Aguilar had to remind patients, visitors and even staff to leave overhead lights off and to speak in quiet voices,” said Melissa Bearden, OT/L, occupational therapy manager for the Center for Psychiatric Medicine. “Eventually the culture shifted, and patients and staff now remind each other or self-correct.”
Fargason says the findings could have impact on other hospital units, particularly where patients are behaviourally challenged due to dementia, delirium or medication.

University of Alabama at Birminghamhttps://tinyurl.com/ydd949rw

Researchers at the University of Louisville, Kentucky, have demonstrated that a new radiotracer, 2-18F-fluorodeoxysorbitol (18F-FDS), can identify and track bacterial infection in lungs better than current imaging methods and is able to differentiate bacterial infection from inflammation.
“Currently, bacterial infections can be diagnosed only after they have become systemic or have caused significant anatomical tissue damage, a stage at which they are challenging to treat owing to the high bacterial burden,” explains Chin K. Ng, PhD, at the University of Louisville School of Medicine, Louisville, Kentucky.
He points out, “18F-FDG PET, a widely commercially available imaging agent, is capable of imaging infection, but it cannot distinguish infections from other pathologies such as cancer and inflammation. Therefore, there is a great need to develop imaging agents with high specificity and sensitivity. There are still no specific imaging agents that can differentiate bacterial infection from sterile inflammation at an early stage.”
For this study, mice were inoculated with either live Klebsiella pneumoniae bacteria to induce lung infection, or the dead form of the bacteria to induce inflammation. Half of the mice with the live bacteria were imaged with PET/CT using either 18F-FDS or 18F-FDG on days 0, 1, 2 and 3 to monitor disease progression post infection. The other half were screened by bioluminescent imaging, and mice with visible infection were selected for follow-up PET/CT scans with 18F-FDS. For the inflammation group, half the mice were imaged with PET/CT using 18F-FDS and half using 18F-FDG from day 1 to day 4 post-inoculation.
While both 18F-FDS and 18F-FDG effectively tracked the degree of bacterial infection measured by bioluminescent optical imaging, only 18F-FDS was able to differentiate lung infection from lung inflammation.
Ng notes, “Bacterial infection represents a threat to human health, including hospital-acquired, implant-related, and multidrug-resistant infections. 18F-FDS whole-body PET/CT imaging in mice has shown to be a unique imaging technique that could differentiate infection from inflammation. This same technique could potentially be used in patients to identify infection sites and determine the bacterial infection class, so that patients could avoid taking antibiotics that are known to have no effect against specific bacteria.”
He adds, “The interpretation of CT appearances of lung disorders can be complex if a differential diagnosis needs to distinguish between inflammation and infection. Thus 18F-FDS PET/CT could be initially used as a follow up after an inconclusive CT diagnosis for suspected bacterial lung infection. As proven clinical data accumulate over time, 18F-FDS PET/CT could become a new clinical standard for confirming bacterial infection in the lungs or other sites.”
Looking ahead to making 18F-FDS clinically available, Ng states, “Since 18F-FDS can be made from 18F-FDG with one extra, simple conversion step, and sorbitol has already been approved for use in humans by the U.S. Food and Drug Administration, the approval pathway for 18F-FDS should be straightforward. 18F-FDS would be inexpensive and readily available once approved.”
He also observes, “This and other new PET imaging agents demonstrate that molecular imaging and nuclear medicine can offer unique technologies for patient care and will continue to play a key influential role in healthcare.”

Society of Nuclear Medicine and Molecular Imaginghttps://tinyurl.com/y9n45qso