Forced body cooling known as therapeutic hypothermia has reduced in-hospital deaths among sudden cardiac arrest patients nearly 12 percent between 2001 and 2009, according to a Mayo Clinic study being presented at the upcoming American Academy of Neurology 2012 Annual Meeting in New Orleans. The research is among several Mayo abstracts that will be discussed at the conference.

The goal of therapeutic cooling is slowing the body’s metabolism and preventing brain damage or death. It is believed that mild therapeutic hypothermia suppresses harmful chemical reactions in the brain and preserves cells. Two key studies published in 2002 found therapeutic hypothermia more effective for sudden cardiac arrest patients than traditional therapies. Mayo researchers analysed a database covering more than 1 million patients and found mortality rates among in-hospital sudden cardiac arrest patients dropped from 69.6 percent in 2001 — the year before the studies appeared — to 57.8 percent in 2009, the most recent data available.

‘Because we reviewed such a large number of cases, we are confident that the reduction in mortality among in-hospital sudden cardiac arrest patients is significant and sustained,’ says co-author Alejandro Rabinstein, M.D., a Mayo Clinic neurologist. ‘We continue to seek answers to the questions: Why did this trend develop, and how can we accelerate it,’ says co-author Jennifer Fugate, D.O.

These measures are important because disease accumulates in the cortex over time, and inflammation in the cortex is a sign the disease has progressed.

The use of a dedicated pediatric imaging department (with dedicated pediatric computed tomography (CT) technologists) for pediatric CT scans significantly reduces the radiation dose delivered to the patient, according to a study.
When performed and monitored properly, the benefits of CT scans outweigh the potential long-term risk of radiation. To minimise the potential adverse effects of radiation exposure to pediatric patients, it is necessary to reduce the dose of radiation delivered to these patients while preserving the diagnostic quality of the images produced.
‘There are many strategies for reducing radiation dose. The use of protocols with adjusted exposure parameters for pediatric patients on the basis of child size, organ system scanned and the size of the region scanned is most notable. However, compliance with these protocols can be challenging for technologists, particularly when scanning a combination of adult and pediatric patients,’ said Heather L. Borders, MD, lead author of the study.
A retrospective review of abdominal and pelvic CT console dose and exposure parameter data on 495 patients from a combined pediatric and adult radiology department and subsequently 244 patients from a dedicated pediatric radiology department was performed. Patients were divided into 1 of 8 weight categories for analysis.
A statistically significant decrease in the estimated effective dose for abdominal and pelvic CT studies was observed in all but one of the weight categories at the pediatric radiology department compared with the pediatric and adult radiology department.
‘Imaging pediatric patients in a dedicated pediatric imaging department with dedicated pediatric CT technologists may result in greater compliance with pediatric protocols and significantly reduced patient dose,’ said Borders.
‘Conversely, greater scrutiny of compliance with pediatric dose-adjusted CT protocols may be necessary for departments that scan both children and adults,’ she said. EurekAlert

Migraine pain sits at the upper end of the typical pain scale

To improve the quality of life in gay men and minorities treated for prostate cancer, a greater awareness of ethnic and sexual preference-related factors is needed to help men choose a more-suitable treatment plan, researchers from Thomas Jefferson University Hospital conclude in a literature review.
Some of the factors to consider, for example, include increased risk of urinary and bowel function decline in African Americans regardless of treatment received and differing sexual expectations and social support in gay men.
‘Different communities of men view the effects of prostate cancer treatments very differently,’ said co-author Edouard J. Trabulsi, M.D., of the Department of Urology and Kimmel Cancer Center at Thomas Jefferson University Hospital, noting the poorer quality of life among certain sub-populations.
‘It’s in the patient’s best interest for caregivers to acknowledge perceptions and expectations during the treatment decision process,’ he said. ‘They should take specific demographics, socio-economic status, and sexual preference into consideration, and tailor an approach based on a patient’s specific concerns about the implications of various treatments.’
Today, many of these confounding factors are poorly documented and poorly addressed by medical practitioners when discussing treatment, be it radical prostatectomy, radiation or androgen deprivation therapy. There is also scant research about prostate-cancer-related quality of life effects in men who have sex with men (MSM).
In this literature review, the authors use several studies to illustrate differences in treatment outcomes, sexual function and coping mechanisms among subpopulations, including African Americans, Latin Americans, Asians and MSM.
According to the analysis, African Americans, who have higher prostate cancer incidence and mortality rates than whites, are less likely to initiate and complete treatment and less likely to trust a physician. They are also at an increased risk of urinary, bowel and general physical function decline, regardless of treatment.
Treatment preferences and sexual outcomes also differ. According to the review, in a study of 665 military men who had the same access to care, white men were three times more likely to choose a radical prostatectomy as their treatment options for low and intermediate risk prostate cancer, whereas African Americans tended to prefer non-surgical treatments, such as external beam radiation therapy.
A multi-centre longitudinal cohort study set up to monitor urinary and sexual function in over 1,200 men who underwent radical prostatectomy for clinically localised prostate cancer showed that African Americans were more likely to retain sexual function.
As with African Americans, Latin American men who underwent radiation therapy or a radical prostatectomy demonstrated greater levels of severe sleep dysfunction than whites. They were also are less likely to enter hospice.
MSM with prostate cancer have additional social and sexual challenges often overlooked. MSM are typically diagnosed later in life and may be reluctant to divulge their sexual preference to their caregiver. This may preclude them from discussing their quality of life expectations and sexual practices.
One reason for poorer quality of life may also be attributed to a lack of social support group, the researchers discovered in their analysis. As MSM men are less likely to have long-term partners, they might not have the same level of support at home and might look for support in other places.
However, the number of support groups specifically tailored for MSM with prostate cancer is limited.
‘In the United States, MSM-specific support groups are available in just six cities. MSM living outside these cities might rely more on Internet-based support groups and are at increased risk of becoming socially isolated,’ the authors write.
MSM are also less likely to invite their partners into the examiner room when discussing treatment options and related adverse effects. Study findings also suggest that treatment with androgen deprivation therapy for prostate cancer could have a greater negative impact on quality of life for gay men compared to heterosexual men.
‘There are potential barriers for accurately assessing and measuring quality of life in MSM. Here, we focus attention on these poorly studied aspects to help overcome such concerns,’ said Dr. Trabulsi, who is also the Director of the Multidisciplinary Genitourinary Cancer Center at Jefferson’s Kimmel Cancer Center. ‘It’s everything from discussion about sexual preference to toxicity-related effects to their ability to maintain a relationship with a partner.’ EurekAlert

Siemens awarded large-scale service contract in Australia covering 6,000 items of medical technology equipment

In a 1.3 billion Australian Dollar partnership between the Western Australian Department of Health and the services company Serco, Siemens has been subcontracted by Serco to provide a Managed Equipment Service (MES) for the new Fiona Stanley Hospital in Perth, Australia. Consequently, Siemens will be providing services that will manage procurement, installation, maintenance, and regular system replacements of diagnostic and treatment equipment for the next 15 years.

The agreement involves capital investment of 100 Million Australian Dollars (app. 78 million euros) and includes around 6,000 items from CT scanners to monitoring equipment. This is the largest deal that Siemens Healthcare has ever won in Australia.

Fiona Stanley Hospital in Perth, currently under construction, is a two-billion-dollar venture and one of the largest healthcare new build projects in Australia. The Western Australian Department of Health has contracted the international services company Serco as the overall facilities manager of the hospital. Serco in turn has selected Siemens to provide support in the form of a Managed Equipment Service (MES). This is a comprehensive service agreement that manages not only initial procurement, but also replacement, ongoing management, maintenance and disposal of medical equipment, as well as coordination of user trainings.

Siemens will be managing and supporting around 6,000 pieces of medical equipment for almost all departments in the hospital, ranging from diagnostic imaging, laboratory diagnostics, anesthetics, audiology and intensive care. Under the vendor-independent agreement, Siemens will manage differing equipment suppliers, with the aim of integrating them into the hospital workflow to optimize the quality of care and to ensure best technologies are available to the patients. The contract runs for a period of 15 years and includes management of planned replacement of the equipment with updated technology.

In December 2011, Siemens commenced with the first phase of the 100 million AUD capital investment program which will see the first major items being procured. These include advanced computed tomography scanners, magnetic resonance systems, and other imaging equipment.

The Fiona Stanley Hospital is scheduled to open in April 2014 and will be Western Australia