Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, according to a systematic review led by King
Upstate Medical University researchers joined diabetes researchers across the country in reporting that an investigational MiniMed integrated insulin pump system with automatic insulin suspension safely reduced night-time hypoglycemia for people with diabetes without increasing average blood glucose.
Hypoglycemia, or low blood sugar, can be life threatening for people with type 1 diabetes, especially at night when they are likely to be unaware of any symptoms while they sleep. The condition can result in confusion, unresponsiveness and
Type 1 diabetes is a lifelong condition caused when the pancreas stops producing the insulin needed to control blood sugar levels. Patients must carry out frequent finger-prick tests and inject insulin to keep their blood sugar within safe limits. Left untreated, Type 1 diabetes is fatal; even suboptimal control increases the risk of heart disease, stroke, kidney failure, nerve damage and blindness.
Patients under the age of five are a particularly vulnerable group. Too young to recognise the shaking and dizziness that warn of a drop in their blood sugar, they are at high risk of developing overnight hypoglycaemia.
Now, a clinical trial with this age group is testing an
New mortality estimates from WHO show that annual measles deaths have reached historic lows, dropping 78% from more than 562 000 in 2000 to 122 000 in 2012. During this time period, an estimated 13.8 million deaths have been prevented by measles vaccination and surveillance data showed that reported cases declined 77% from 853 480 to 226 722.
These gains are a result of global routine measles immunisation coverage holding steady at 84%1 and 145 countries having introduced a routine second dose of measles vaccine to ensure immunity and prevent outbreaks. In addition to routine immunisation, countries vaccinated 145 million children during mass campaigns against measles in 2012 and reached more than 1 billion since 2000, with the support of the Measles & Rubella Initiative.
Despite the impressive gains made, progress towards measles elimination2 remains uneven with some populations still unprotected. Measles continues to be a global threat, with five of six WHO regions still experiencing large outbreaks and with the Region of the Americas responding to many importations of measles cases. The African, Eastern Mediterranean and European regions are not likely to meet their measles elimination targets on time. The Region of the Americas has achieved measles elimination and continues to maintain this status while the Western Pacific region is approaching its target.
Routine measles vaccination coverage is an important progress indicator towards meeting Millennium Development Goal Four3 because of its potential to reduce child mortality and widely recognised as a marker of access to children
Simple measures of the severity of an older kidney failure patient’s illness when starting dialysis
There are good bacteria and there are bad bacteria
Massachusetts General Hospital (MGH) researchers have used vascular precursor cells derived from human induced pluripotent stem cells (iPSCs) to generate, in an animal model, functional blood vessels that lasted as long as nine months. In their report the investigators describe using iPSCs
A patient in a seemingly vegetative state, unable to move or speak, showed signs of attentive awareness that had not been detected before, a new study reveals. This patient was able to focus on words signalled by the experimenters as auditory targets as successfully as healthy individuals. If this ability can be developed consistently in certain patients who are vegetative, it could open the door to specialized devices in the future and enable them to interact with the outside world.
For the study, the researchers used electroencephalography (EEG), which non-invasively measures the electrical activity over the scalp, to test 21 patients diagnosed as vegetative or minimally conscious, and eight healthy volunteers. Participants heard a series of different words – one word a second over 90 seconds at a time – while asked to alternatingly attend to either the word
Use of a minimally invasive endoscopic procedure to remove superficial, early stage oesophageal cancer is as effective as surgery that takes out and rebuilds the esophagus, according to a study by researchers at Mayo Clinic in Florida. The research examined national outcomes from endoscopic treatment compared to esophagectomy, surgical removal of the oesophagus.
It found that endoscopic therapy offered long-term survival rates similar to those for oesophagectomy, says lead author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic in Florida.
‘Endoscopic resection in the oesophagus is similar to how we remove polyps in the colon, although it is much more technically complex. Oesophagectomy is a major surgical procedure that cuts out the entire oesophagus, and pulls the stomach into the neck to create a new food tube,’ Dr. Wallace says.
‘Our study on national outcomes, as well as our own experience with the procedure at Mayo Clinic in Florida, suggests that both offer the similar chances for cure and long-term survival,’ he says. ‘Patients now have the option to preserve their oesophagus when only early stage cancer is present.’
The research looked at national outcomes from the two procedures in patients with oesophageal adenocarcinoma, the most common type of oesophageal cancer in the United States. The research team examined data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database.
They identified 1,619 patients with superficial, early stage oesophageal adenocarcinoma who had endoscopic therapy (19 percent) or surgery (81 percent) from 1998 through 2009. Many of these patients were treated for cancers that arose from Barrett’s oesophagus, a condition in which the cells in the lower part of the oesophagus morph into a pre-cancerous state.
The researchers collected survival data through the end of 2009, and found that endoscopy therapy increased progressively
Andrea Morelli, M.D., of the University of Rome, Italy, and colleagues conducted a study to investigate the effect of the short-acting beta-blocker esmolol on the heart rate of patients with severe septic shock and high risk of death.
Septic shock is associated with adverse effects on cardiac function. Beta-blocker therapy controls heart rate and may improve cardiovascular performance, but concerns remain that this therapy may lead to cardiovascular decompensation (inability of the heart to maintain adequate circulation), according to background information in the article.
The randomised phase 2 study was conducted in a university hospital intensive care unit (ICU) between November 2010 and July 2012. It recruited patients in septic shock with a heart rate of 95/min or higher requiring high-dose norepinephrine to maintain an average arterial pressure of 65 mm Hg or higher. The researchers randomly assigned 77 patients to receive a continuous infusion of esmolol to maintain heart rate between 80 beats per minute (BPM) and 94 BPM for the duration of their ICU stay and 77 patients to standard treatment. The primary outcome was a reduction in heart rate below the predefined threshold of 95 BPM and maintain a heart rate between 80 and 94 BPM over a 96-hour period.
The researchers found that the target range for heart rate was achieved in all patients in the esmolol group, which was significantly lower throughout the intervention period than what was achieved in the control group. In addition, the esmolol group had a 28-day mortality rate of 49.4 percent vs. 80.5 percent in the control group. Overall survival was higher in the esmolol group.
There was no clinically relevant differences between groups in other investigated cardiopulmonary variables nor in rescue therapy requirements.
‘Further investigation of the effects of esmolol on clinical outcomes is warranted,’ the authors write.
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