A more precise method for determining bone marrow involvement in patients with diffuse large B-cell lymphoma (DLBCL)
Although as many as 25 percent of patients undergoing surgery suffer from sleep apnea, few hospitals have policies to help manage the risks of this condition during surgery, and there is little evidence to help guide anesthesiologists and surgeons caring for these patients. In a new editorial in the New England Journal of Medicine, Stavros Memtsoudis, M.D., Ph.D., director of Critical Care Services at Hospital for Special Surgery, New York City, calls for a new research initiative to identify the safest and most effective ways to manage patients with sleep apnea.
Sleep apnea, a disorder in which a person frequently stops breathing for short periods during sleep, not only makes for a restless night but also puts the person at increased risk of high blood pressure, diabetes, heart attack and stroke. But although the condition is more common than diabetes, and poses particular hazards during surgery, relatively little research has been done to help guide clinicians.
‘Patients with sleep apnea may be at risk for many complications during surgery, including airway blockage and intubation problems,’ said Dr. Memtsoudis. ‘But that’s not all: we know that apnea affects many other organ systems as well. The American Society of Anesthesiologists published guidelines in 2006 to help us take better care of patients with sleep apnea, but there was
Pre-term infants appear to mature better if they are shielded from most wavelengths of visible light, from violet to orange. But it has been a challenge to develop a controllable light filter for pre-term incubators that can switch between blocking out all light–for sleeping–and all but red light to allows medical staff and parents to check up on the kids when they’re awake. Now researchers describe a proof-of-concept mirror that switches between reflective and red-transparent states when a small voltage is applied.
The research team had previously identified a magnesium-iridium reflective thin film that transforms into a red-transparent state when it incorporates protons. Providing those protons in a way that is practical for pre-term incubators, however, was the challenge. The typical method–using dilute hydrogen gas–is unacceptable in a hospital setting. So the team created a stack of thin films that includes both an ion storage layer and the magnesium-iridium layer: a voltage drives protons from the ion storage layer to the magnesium-iridium layer, transforming it into its red-transparent state. Reversing the voltage transforms it back into a reflective mirror.
The researchers report that the device still allows some undesirable light wavelengths through, but a force of just 5 V changes the device’s state in as little as 10 seconds. The researchers are now looking at other materials to improve colour filtering and switching speed.
EurekAlert
Nurses have been warned about wearing nail extensions and using nail polish after a poll suggested infection control was being put at risk by fashion-conscious NHS staff.
Guidance states that fingernails should be short and free of varnish. But an online poll of nearly 500 student nurses found lapses were commonplace with 60% reporting nail extensions and polish being used.
The Royal College of Nursing said the findings were ‘worrying’.
The survey was carried out by Cardiff University and London’s City University. Overall each of the 488 students who took part reported seeing at least one breach in infection control rules by health staff once other problems, such as a failure to wash hands as well as breaches of nail care were taken into account.
The researchers said the survey showed lapses were widespread.
Tom Sandford, of the RCN, added: ‘Fingernails should be short and free of nail varnish. False nails should not be worn. Nail varnish and extensions harbour bacteria and prevent good hand hygiene. Health organisations should uphold clear local policies on uniforms and work-wear and their implications for infection control and health and safety.’
BBC
The introduction of CT pulmonary angiography has been associated with an 80% rise in the detection of pulmonary emboli in the US, but with little change in death rates.
Professor Renda Soylemez Wiener and colleagues argue this is evidence of over-diagnosis. They say some patients are helped, but many are harmed by the adverse effects of unnecessary treatment.
This article is the first of a series looking at the risks and harms of over-diagnosis in a range of common conditions. The series, together with the Preventing Overdiagnosis conference in September, are part of the BMJ’s Too Much Medicine campaign to help tackle the threat to health and the waste of money caused by unnecessary care.
Pulmonary embolism has been described as one of the most commonly missed deadly diagnoses. Until recently, ventilation-perfusion (VQ) scanning was the first line test, but a new technology introduced in 1998
Stroke patients at risk of blood clots and death could be helped by a compression device that wraps around the legs. Researchers have shown for the first time that by gently squeezing the legs, the risk of dying after stroke is reduced.
It is thought that the compression reduces the risk of clots in the veins of the legs by increasing blood flow.
The results of the trial reveal that thigh-length intermittent pneumatic compression (IPC) reduces the risk of deep vein thrombosis (DVT), which commonly affects stroke patients. Until now, no treatment has been available that safely reduces the risk of the blood clots in the legs and the risk of dying.
More than 2800 stroke patients across the UK were involved in the randomised trial, which took place between 2008 and 2012. Hundreds of researchers from more than 100 hospitals took part.
The IPC sleeves, which cost the NHS as little as
The small size and abnormal anatomy of children born with heart defects often force doctors to place lifesaving defibrillators entirely outside the heart, rather than partly inside
For patients with advanced gastric cancer, treatment with chemotherapy after surgery can reduce the risk of cancer related death by 34% over five years compared to surgery alone.
Prof Sung Hoon Noh, a gastric surgeon from Yonsei University College of Medicine, Korea, presented 5-year follow-up from the phase III CLASSIC trial, which added combination chemotherapy to a standard surgical procedure called D2 gastrectomy. The chemotherapy regimen studied in the trial is called XELOX, which is a combination of the drugs capecitabine and oxaliplatin.
CLASSIC was a multinational open-label randomised phase III trial performed in South Korea, China and Taiwan. Patients with stage II
Nearly 20 percent of kidneys that are recovered from deceased donors in the U.S. are refused for transplant due to factors ranging from scarring in small blood vessels of the kidney
A new study of electronic intensive care units (eICUs) shows them to be an effective way to provide 24-hour intensive care to patients in remote locations.
An eICU uses telecommunications technology to diagnose and treat patients in the ICU remotely. Using two-way cameras, video monitors, microphones, and alarms to provide round-the-clock care for patients in ICUs, eICUs can provide care to patients in multiple hospitals, using the skills of intensive care physicians, called intensivists, and intensive care nurses.
Researchers at Northside Medical Center in Ohio studied results of interactions with 2,537 patients admitted to ICUs over a period of 2 years. Of these interactions, 1,310 patients were without eICU monitoring and 1,227 were monitored with eICU in addition to in-house monitoring of medical staff.
The eICU used intensivists and other healthcare providers to give continuous monitoring and management from a remote location in two adult ICUs of a 375-bed community teaching hospital in the United States. Results were taken on the rate of falls, incidences of code blues, (a hospital code used to indicate a patient requiring immediate resuscitation), mortalities, and length of stays between the two periods before and aft er implementation of the eICU.
Specific outcomes encountered by patients with normal vs eICU monitoring showed code blues 54 vs 39, falls 1 vs 0, and overall mortality 90 vs 77. The median length of stay was 3.1 days without eICU monitoring and 3 days with eICU monitoring.
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