A study conducted at Scripps Health has found that a novel new heart monitoring device helped emergency room patients avoid unnecessary follow-up care. Scripps Health electrophysiologist Steven Higgins, MD, presented findings of the study, titled ‘Prevalence of Arrhythmias in Emergency Department Patients Discharged Using a Novel Ambulatory Cardiac Monitor,’ at the Heart Rhythm Society
Patients who have had metal-on-metal hip replacements are no more likely to develop cancer in the first seven years after surgery than the general population, although a longer-term study is required, a study led by the University of Bristol claims.
A recent BMJ and BBC Newsnight investigation looked into the potentially high level of toxic metals from failing hip implants which may, in future, affect thousands of people around the world. The investigation also looked at why these hip replacements were allowed despite the risks being known and documented for decades. The BMJ has a large collection of articles about the safety of medical devices which can be found here.
This study, commissioned by the National joint Registry of England and Wales and carried out by authors from the Universities of Bristol and Exeter, looks at whether these concerns are valid. The registry contains records of over one million procedures from at least 97 per cent of orthopaedic units. Every year registry data and hospital episode statistics are linked up to check how patients who have had joint replacements are faring.
Ashley Blom, Professor of Orthopaedic Surgery in the School of Clinical Sciences at the University of Bristol, who led the team that undertook the study, said: ‘This research shows that there is no increased risk of cancer with metal-on-metal hip replacements in the first seven years after surgery. Although this is very reassuring, we do not know what are the long-term risks and thus further studies will be necessary in the future.’
In this study cancer rates in patients with metal-on-metal hip replacements were compared with both a group of patients who had other hip bearing surfaces implanted and the general population. Overall, 14 per cent (40,576) of registered patients had some type of metal-on-metal bearing surface: seven per cent (21,264) had a stemmed metal-on-metal prosthesis and seven per cent (19,312) had a resurfacing procedure. The researchers compared patients’ outcomes using mathematical modelling. The models included the age and sex of the patient as well as three measures of general health at the time of hip surgery (the American Society of Anaesthesiologists grade that scores the patient’s other serious illnesses, the number of distinct diagnostic codes recorded at time of surgery, and the number of NHS funded admissions to hospital in the previous five years). The authors do say, however, that comparison with the general population is not straightforward as hip replacement patients ‘tend to be healthier than others of the same gender and age group’.
Results show that the chance of a 60-year-old man with moderate health and a metal-on-metal stemmed hip replacement being diagnosed with cancer in the five years following surgery is 6.2 per cent, compared to 6.7 per cent chance with hip replacement using other bearing surfaces. For women, these figures were 4.0 per cent for metal-on-metal stemmed hip replacement and 4.4 per cent for other bearing surfaces. Further results show that the incidence of cancer diagnosis is low after hip replacement and lower than that predicted for the age and sex matched general population.
The authors hope that this study will help clinicians reassure patients that the ‘risk of cancer for hip replacement patients is relatively low’ with no evidence of an increase in cancer associated with metal-on-metal hips. They add though that this only shows results for up to seven years following surgery and the analysis of long-term data is required over the next few decades as some cancers take many years to develop.
University of Bristol
Teenagers could be given full protection against Meningitis B, a new vaccine trial suggests. The study, conducted in Chile, is the first large-scale trial of 4CMenB amongst adolescents.
Tests showed that two doses of pharmaceutical company Novartis
Heart cells bio-engineered at University of Michigan Center for Arrhythmia Research display activity similar to most people’s resting heart rate
A cutting-edge method developed at the University of Michigan Center for Arrhythmia Research successfully uses stem cells to create heart cells capable of mimicking the heart
Neither aspirin nor Warfarin is superior for preventing a combined risk of death, stroke, and cerebral haemorrhage in heart failure patients with normal heart rhythm, according to a landmark clinical trial.
The 10-year Warfarin and Aspirin for Reduced Cardiac Ejection Fraction (WARCEF) trial is the largest double-blind comparison of these medications for heart failure, following 2,305 patients at 168 study sites in 11 countries on three continents. The research was led by clinical principal investigator Shunichi Homma, MD, of Columbia University Medical Center/NewYork-Presbyterian Hospital, and statistical principal investigator John L.P. (Seamus) Thompson, PhD, of Columbia University
Primary care physicians are faced with treating a large proportion of chronic pain patients, but many do not often have specific training in the assessment and management of chronic pain, including the use of opioid medications for chronic pain management. Recognising the significant role prescribers can play in reducing the risk of addiction, unintentional overdose, and death from the misuse and abuse of opioids, the U.S. Food and Drug Administration (FDA) has made prescriber education a central part of its Risk Evaluation and Mitigation Strategy (REMS) requirements for manufacturers of long-acting and extended-release (LA/ER) opioids.
With this in mind, Inflexxion
An increasing number of abdominal gunshot and stab wounds are being treated without the need for unnecessary operations.
Researchers from The Johns Hopkins School of Medicine, USA, and the Aga Khan University in Pakistan reviewed nearly 26,000 patients with penetrating abdominal gunshot or stab injuries from the American College of Surgeons’ National Trauma Data Bank.
They focused on patients aged 16 years plus who survived long enough to be admitted to one of the 378 level one or two trauma centres for at least 24 hours. Just over half of the 25,737 patients (51%) had stab wounds and the remainder had gunshot wounds.
The study found that just over 22% of the gunshot wounds were treated using selective non-operative management (SNOM), together with just under 34% of stab wounds. The remainder of the surviving patients received laparotomy surgery.
‘SNOM rates for stab wounds increased by 50% between 2002 and 2008 and rates for gunshot injuries increased by 28%’ says co-author Dr Adil H Haider, associate professor of surgery and co-director of the Center for Surgery, Trials and Outcomes Research at Johns Hopkins. ‘This correlated with a decrease in the number of non-therapeutic laparotomies (NTL).
‘In most instances, failed SNOM was associated with increased death rates, underlining the importance of careful patient selection and protocols to reduce failure rates. However, it is important to point out that failure rates fell for both injuries during the seven-year study period and that successful SNOM was associated with shorter hospital stays.’
Key findings of the study included:
Gunshot wounds
Getting a shot at the doctor
A research team from East Anglia, awarded a grant from children
Though pacemakers require only small amounts of energy (about 1 millionth of a Watt), their batteries have to be replaced periodically, which means multiple surgeries for patients. Researchers have searched for ways to prolong battery life — trying to generate energy to power a pacemaker using blood sugar, or the motion of the hands and legs — but these methods either interfere with metabolism or require a more drastic surgery, such as passing a wire from the limbs to the chest area.
Aerospace engineers M. Amin Karami and Daniel J. Inman, from the University of Michigan in Ann Arbor, have developed a prototype device that could power a pacemaker using a source that is surprisingly close to the heart of the matter: vibrations in the chest cavity that are due mainly to heartbeats.
In their method, vibrations in the chest cavity deform a layer of piezoelectric material, which is able to convert mechanical stress into electrical current. Tests indicate that the device could perform at heart rates from 7 to 700 beats per minute (well below and above the normal range), and that it could deliver eight times the energy required for a pacemaker. Furthermore, the authors write, the amount of energy generated is always larger than the amount required to run a pacemaker, regardless of heart rate.
Though the team has yet to develop a prototype that is biocompatible, they say that the potential to package this energy harvester with pacemakers gives it an advantage over competing methods.
U-M Department of Aerospace Engineering
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