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Current ratings for: Study Shows That PTSD And Depression Together Make It Harder For Children To Recover Following Natural Disasters
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As Hurricane Isaac nears the Gulf Coast, one may wonder what the impact of natural disasters are on children. Who is most at risk for persistent stress reactions? How can such youth be identified and assisted in the aftermath of a destructive storm?
Dr. Annette M. La Greca, a professor of psychology and pediatrics at the University of Miami, and her colleagues, have been studying children's disaster reactions following Hurricanes Andrew (1992), Charley (2004) and Ike (2008). Recent findings from Hurricane Ike shed light on these questions about children's functioning.
The new findings suggest that it is important to evaluate children's symptoms of post-traumatic stress and depression, in order to identify those who may be the most adversely affected. Findings also suggest that helping children cope with stressors that occur during or after the disaster may improve children's psychological functioning. "Children may have to move or change schools. Their neighborhood may not be safe for outdoor play and they may not be able to spend time with their friends. Children need help coping with these and other post-disaster stressors," La Greca says.
In collaboration with Scott and Elaine Sevin, Dr. La Greca developed a workbook for parents to help their children cope with the many stressors that occur after disasters. The book gives parents tips for helping children stay healthy and fit, maintain normal routines, and cope with stressors and with emotions, such as fears and worries. The After the Storm workbook is available at no cost at http://www.7-dippity.com.
A paper to be published in the Journal of Affective Disorders indicates that, eight months after the disaster, children with signs of both post-traumatic stress and depression represent a high-risk group for longer-term adverse reactions. Such children are less likely to recover by 15 months post-disaster than other youth. They also report more severe levels of psychological symptoms and experience more post-disaster stressors than other youth. The authors on this paper are Drs. Betty Lai and Annette La Greca from the University of Miami, Dr. Beth Auslander from the University of Texas Medical Branch, and Dr. Mary Short from the University of Houston-Clear Lake.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our aid / disasters section for the latest news on this subject.
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n.p. "Study Shows That PTSD And Depression Together Make It Harder For Children To Recover Following Natural Disasters."Medical News Today. MediLexicon, Intl., 30 Aug. 2012. Web. 30 Aug. 2012. <http://www.medicalnewstoday.com/releases/249635.php>
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n.p. (2012, August 30). "Study Shows That PTSD And Depression Together Make It Harder For Children To Recover Following Natural Disasters."Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/249635.php.
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Current ratings for: Cortisone Injections Can Lead To Necrosis
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Injections of corticoid preparations can have severe side effects. In this issue of Deutsches Arzteblatt International, Christian Holland and coauthors contribute to physicians' awareness of problems of this type with a report on the relevant findings of medicolegal expert committees in Germany (Dtsch Arztebl Int 2012; 109[24]: 425-30.
One patient, for example, received multiple intramuscular injections of dexamethasone and diclofenac for the treatment of back pain. Six weeks after the last injection, 500 g of necrotic tissue had to be surgically removed from the site of the injections; a subsequent wound infection led to multiple further hospitalizations. The authors describe both aseptic and septic complications, including abscesses and purulent joint infections. When they affect the spine, such complications can cause weakness of varying degrees of severity, ranging all the way to para- or tetraplegia. Fatal sepsis can also occur.
From 2005 to 2009, the German medicolegal expert committees and arbitration panels dealt with 278 cases of complications after corticoid injections. Medical errors were found to have been committed in 40% of cases. Typical errors were faulty asepsis, treatment without indication, and injections that were too closely spaced in time or in excessive doses. Furthermore, whenever it is determined that a patient has not given legally valid informed consent for an injection, the physician is liable for any and all adverse consequences of the injection for the patient's health. By giving physician readers the appropriate knowledge base, the article is intended to help them avoid such difficult medicolegal situations.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our back pain section for the latest news on this subject.
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Deutsches Aerzteblatt International. "Cortisone Injections Can Lead To Necrosis."Medical News Today. MediLexicon, Intl., 2 Jul. 2012. Web. 27 Aug. 2012. <http://www.medicalnewstoday.com/releases/247297.php>
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Current ratings for: Yoga Could Be A Cost-effective Treatment For Back Pain
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4.5 (2 votes)
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4.5 (2 votes)
According to research published in Spine, the yoga intervention program called 'Yoga for Healthy Lower Backs' is most likely going to be cost effective for not only the UK National Health Service (NHS), but for the wider society as well.
The specially-developed 12-week group yoga intervention program was observed and compared to conventional general practitioner (GP) care alone.
In order to decide if this was an appropriate use of NHS resources, the cost of the program needed to be checked out. There are currently no available yoga classes through the NHS which is why the team wanted to find the likely cost of a program.
After much examination, the experts, from the University of York's Department of Health Sciences and the Centre for Health Economics, and the Hull York Medical School, concluded that there was a high chance (around 70%) of the yoga intervention being cost effective if the cost remained below £300 per patient (for a cycle of 12 classes).
Results also showed that participants in the control group had more days off work than those in the yoga program. After reporting back pain, a control group participant took an average of 12 days off. The cost associated with this control group participant's time off was £1,202, as opposed to £374 for a yoga group member.
Professor David Torgerson, lead author and Director of York Trials Unit, in the University of York's Department of Health Sciences, said: "Back pain represents a significant burden to the NHS in the UK and to society as a whole. As well as the associated health care costs, it is also a major cause of work absenteeism which leads to a productivity loss to society."
He continued to explain how there has been little research on yoga's cost effectiveness, even though evidence has shown the benefits for people with chronic and low back pain. "In our study we evaluated a specially-designed yoga class package by using individual-level data from a multi-centred randomized controlled trial. On the basis of the 12-month trial, we conclude that 12 weekly group classes of specialised yoga are likely to provide a cost-effective intervention for the treatment of patients with chronic or recurrent low back pain."
Back pain is one of the most common medical conditions treated in primary care in the U.K., costing the NHS about £1.37 billion and the health care sector £2.10 billion a year. Each year, an estimated 2.6 million people suffer with back problems and turn to their GP for advice.
Professor Alan Silman, Medical Director of Arthritis Research UK, said:
"We welcome the fact that not only has yoga been found to help people manage their back pain, but that it is also cost effective, and results in fewer sick days. It is another option for people who are struggling to manage their condition, and one that encourages the move to self-management. Yoga is an intervention that has been proven to make their everyday lives easier and their pain more manageable.
"We'd hope that on the back of this, more people with back pain are encouraged to take up the yoga program."
Participants who had either chronic or recurrent back pain were examined in the trial, who were split up into one group of 156 people offered yoga classes designed to improve their back, and a second control group of 157 who received GP care alone.
Each group had regular GP care, either involving medication to relieve pain or a referral to pain clinics and physiotherapists.
The program was designed to last for 12-weeks by Alison Trewhela, an Iyengar Yoga teacher and Senior Practitioner in Yoga on the British Register of Complementary Practitioners, with yoga teacher Anna Semlyen, a Back Care Advisor to the British Wheel of Yoga. Twelve professional yoga teachers delivered the work out.
Alison Trewhela concluded:
"GPs and commissioners are showing great interest in this yoga program. Many consider it could be the primary treatment option because it offers long-term positive outcomes, as well as a multi-disciplinary combination of taught skills that suits the bio-psycho-social nature of the condition of chronic low back pain.
Within its confidence-boosting, gradually-progressing environment, the gentle 'Yoga for Healthy Lower Backs' course addresses joint mobility, muscle-strengthening, emphasis on the breath, mental attitude to pain and perspective on life lessons, postural awareness and low back education, relaxation techniques, and advice about other potentially health-giving techniques and benefits."
Written by Sarah Glynn Copyright: Medical News Today Not to be reproduced without permission of Medical News Today
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Current ratings for: American Headache Society Scientific Conference Focuses On Traumatic Brain Injury
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The impact of traumatic injuries to the brain - whether sustained in combat or on the playing fields of America's schools - is a major topic for international migraine specialists the week of June 18 as they gather in Los Angeles for the 54th Annual Scientific Sessions of the American Headache Society. This is among many timely issues concerning headache, migraine, and brain injuries on the four-day agenda here which runs through Sunday morning, June 24.
"As migraine specialists, we cannot ignore the fact that traumatic brain injury (TBI) is an increasingly common medical problem today and that those who experience severe and untreated blows to the brain may end up with serious neurological damage and long-lasting medical and psychological problems," said Elizabeth Loder, MD, MPH, president of the American Headache Society (AHS) and Chief of the Division of Headache and Pain in the Department of Neurology at the Brigham and Women's Hospital in Boston. "We owe it to our nation's military as well as to our children in contact sports to raise awareness of TBI and make this issue a national health priority."
Dr. Loder cited a 60% increase in emergency room visits by adolescents for sports-related brain injuries over the last decade, as reported by the Centers for Disease Control late last year.
"The rising incidence of these injuries, which may have serious long-term consequences for many young people, is a public health problem of epidemic proportion," she said. "High school and collegiate athletic departments are developing programs to minimize the risks but much more is needed to prevent and recognize severe concussions related to high-impact contact sports. These injuries may result in brain damage that can cause persistent severe headache, emotional problems such as depression and anxiety, sleep disturbances, memory and learning impairment, and even degenerative brain diseases later." The symposium, on June 23, will cover "School Issues with Concussion" and "Post-Concussion Headaches" and include world-renown experts on the subject.
In earlier wars, many TBIs would have been fatal
Modern warfare and high-tech explosives have ushered in a new era of traumatic brain injury among American combat soldiers. The Defense and Veterans Brain Injury Centers (DVBIC) estimates there have been more than 178,000 traumatic brain injuries sustained by soldiers in the wars of the last 10 years.
"In earlier wars, such injuries would have been fatal, but now with improvements in protective gear our soldiers are surviving, but often crippled with excruciating headache, depression, and post-traumatic stress disorder," said Alan Finkel, MD, who has written widely on the subject. "Today we have bombs that exert 'overpressure' -- waves that come off an explosion at twice the speed of sound and compress everything in their wake without breaching either a soldier's bone or tissue. But the damage they do to the brain is enormous and unprecedented."
Dr. Finkel will chair the AHS session that includes discussion of "Military Traumatic Brain Injuries: Mild, Common, and Unique," "Epidemiology of Military Headache," and "Treating Military Post-Traumatic Headache."
Some 500 of the world's most eminent migraine and headache specialists are expected to attend. This year's theme, "Planting the Seed for Future Headache Research" will spotlight other areas of current basic and clinical research such as the role of the cortex in migraine, the role of imaging in patients with headache, the latest breaking science emerging from the nation's leading scientific laboratories in migraine research, and controversial issues in the diagnosis and management of complex headache disorders.
Migraine is one of the most ancient and mysterious of diseases with many myths and folklores attached to its diagnosis and treatment. Over the last 5,000 years, migraine sufferers subjected themselves to an array of extreme and bizarre treatments to find relief, Dr. Loder, MD, noted. These have included drilling a hole in the skull to let out the "bad humours," bloodletting, sorcery, binding a clay crocodile to the head, and inserting the bones of a vulture into the nose.
Some 36 million Americans suffer from migraine, more than have asthma and diabetes combined. An additional 6 million suffer from chronic migraine, where patients experience at least 15 headache days per month along with other disabling neurological symptoms. Migraine can be extremely disabling and costly - accounting for more than $20 billion each year in the United States. Costs are attributed to direct medical expenses (e.g. doctor visits, medications) and indirect expenses (e.g. missed work, lost productivity).
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our headache / migraine section for the latest news on this subject.
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Tartaglia Communications. "American Headache Society Scientific Conference Focuses On Traumatic Brain Injury."Medical News Today. MediLexicon, Intl., 21 Jun. 2012. Web. 27 Aug. 2012. <http://www.medicalnewstoday.com/releases/246818.php>
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Tartaglia Communications. (2012, June 21). "American Headache Society Scientific Conference Focuses On Traumatic Brain Injury."Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/246818.php.
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Current ratings for: Exercise Can Help Cancer Patients, But Few Oncologists Suggest It
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Numerous studies have shown the powerful effect that exercise can have on cancer care and recovery. For patients who have gone through breast or colon cancer treatment, regular exercise has been found to reduce recurrence of the disease by up to 50 percent. But many cancer patients are reluctant to exercise, and few discuss it with their oncologists, according to a Mayo Clinic study published in the Journal of Pain and Symptom Management.
"As doctors, we often tell patients that exercise is important, but to this point, nobody had studied what patients know about exercise, how they feel about it and what tends to get in the way," says lead author Andrea Cheville, M.D., of Mayo Clinic's Department of Physical Medicine and Rehabilitation.
The study is part of a series of investigations looking at exercise habits among cancer patients. Researchers found that patients who exercised regularly before their diagnosis were more likely to exercise than those who had not. Many patients considered daily activities, such as gardening, sufficient exercise.
"There was a real sense of 'What I do every day, that's my exercise,'" says Dr. Cheville, noting that most patients didn't realize daily activities tend to require minimal effort. "Most were not aware that inactivity can contribute to weakening of the body and greater vulnerability to problems, including symptoms of cancer."
In addition, researchers found that patients took exercise advice most seriously when it came directly from their oncologists, but none of those studied had discussed it with them.
"Generally, patients are not being given concrete advice about exercise to help them maintain functionality and to improve their outcomes," Dr. Cheville says.
Exercise can improve patients' mobility, enable them to enjoy activities and keep them from becoming isolated in their homes. It can contribute to overall feelings of strength and physical safety, ease cancer-related fatigue and improve sleep. The researchers plan to investigate how to make the message about exercise meaningful to patients to optimize symptom relief and enhance recovery.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our cancer / oncology section for the latest news on this subject.
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n.p. "Exercise Can Help Cancer Patients, But Few Oncologists Suggest It."Medical News Today. MediLexicon, Intl., 31 Aug. 2012. Web. 31 Aug. 2012. <http://www.medicalnewstoday.com/releases/249636.php>
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Current ratings for: Mystery Surrounding The Death Of Two Sisters Nearly 50 Years Ago Solved By Researchers
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5 (1 votes)
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Researchers at Mount Sinai School of Medicine have identified the genetic cause of a rare and fatal bone disease by studying frozen skin cells that were taken from a child with the condition almost fifty years ago. Their study, which details how the MT1-MMP gene leads to the disease known as Winchester syndrome, appears in the online edition of The American Journal of Human Genetics.
In 1969, Patricia Winchester, MD, a pediatric radiologist in New York City, was asked to diagnose two young sisters who were losing bone in their hands and feet, developing severe arthritis in their fingers and losing movement of their shoulders, elbows, hips and knees because of osteoporosis. The frozen skin cells that were recently studied by principal investigator, John Martignetti, MD, PhD, and his team of researchers in the Department of Genetics and Genomic Sciences at Mount Sinai, had been taken from one of the sisters. Ultimately, the disease rendered the girls incapable of moving without assistance, and proved fatal.
The cause of the disease has remained unknown until now, when the study's lead authors, post-doctoral students, Rebecca Mosig, PhD and Brad Evans, PhD, zeroed in on the MT1-MMP gene.
"This gene encodes an enzyme that needs to be specifically positioned on the membranes of cells to function correctly," explains Dr. Martignetti. "What we discovered is that these girls had a gene mutation which resulted in incorrect shuttling of the protein. Instead of being directed to the cell surface where it could interact with the outside environment, the mutant protein never reached its final, correct destination and remained trapped in the cell's cytoplasm. Mislocalized, it lost its ability to function and the children developed severe arthritis and bone The enzyme lost its ability to interact with another disease-casuing protein, MMP-2. Dr. Martignetti's team had previously identifed mutations in the MMP-2 gene as the cause of a similar group of bone disorders in children.
The researchers says this recent discovery should provide diagnostic clarity and insight into possible treatments for children with Winchester syndrome, and other bone disorders, and for people in the general population who have osteoporosis and arthritis.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our bones / orthopedics section for the latest news on this subject.
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n.p. "Mystery Surrounding The Death Of Two Sisters Nearly 50 Years Ago Solved By Researchers."Medical News Today. MediLexicon, Intl., 31 Aug. 2012. Web. 31 Aug. 2012. <http://www.medicalnewstoday.com/releases/249666.php>
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'Mystery Surrounding The Death Of Two Sisters Nearly 50 Years Ago Solved By Researchers'
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Current ratings for: Helping Seniors With Pain: New GSA Resources
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5 (1 votes)
The pain suffered by older adults is the shared focus of the two newest entries in The Gerontological Society of America's (GSA) From Publication to Practice* series. Together they address both pain management and new labeling changes for one of the most popular pain medications, acetaminophen. Both issues aim to provide readers with information on how new advances in pain prevention, treatment, and management may improve care and quality of life for older adults. The From Publication to Practice series was launched last year to promote the translation of research into meaningful health outcomes.
"Taken together, these two new resources will enable the gerontological community to identify opportunities to improve pain management services," said Cathy Alessi, MD, the 2011 chair of GSA's Health Sciences Section. "Research indicates that severe pain in older adults leads to a decreased quality of life, including both satisfaction with life and health-related quality of life."
One of the installments, "An Interdisciplinary Look at Advancing Pain Care, Education, and Research: Responding to the IOM's Call to Action To Improve Pain Management," was supported by an educational grant from Purdue Pharma, L.P. While addressing shortfalls in assessment and treatment for older adults with pain, this publication aims to inform health care providers, researchers, policy makers, educators, caregivers, and patients about a recent Institute of Medicine (IOM) report, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research."
While pain affects approximately one-third of Americans - and exacts a huge toll from society in terms of morbidity, mortality, disability, demands on the health care system, and economic burden - it remains widely undertreated. GSA's new publication also provides an overview of needs for care, education, and research, and lays out a blueprint for transforming pain care.
The other new issue, "An Interdisciplinary Look at Labeling Changes for Acetaminophen and the Implications for Patient Care," was supported by McNeil Consumer Healthcare. It was produced in response to the U.S. Food and Drug Administration's recent modifications to the recommended daily dosage of acetaminophen. The purpose of these changes is to make patients aware of the presence and amount of acetaminophen in single-ingredient and combination products - with the goal of preventing overdoses that can cause acute liver failure.
Acetaminophen is present in more than 600 over-the-counter and prescription products used by more than 50 million Americans each week. This commonly used medication is taken to treat conditions such as pain, fever, and the aches and pains associated with cold and flu. Acetaminophen - over-the-counter or prescription - is the most frequently prescribed agent for pain relief. This installment of From Publication to Practice provides essential information on the new labeling changes and describes the resulting implications for patient care, especially for older patients. It also presents important steps that clinicians and aging network professionals can take when educating patients.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our pain / anesthetics section for the latest news on this subject.
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The Gerontological Society of America. "Helping Seniors With Pain: New GSA Resources."Medical News Today. MediLexicon, Intl., 2 Feb. 2012. Web. 29 Aug. 2012. <http://www.medicalnewstoday.com/releases/241030.php>
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Current ratings for: Diagnosis Often Missed For Hispanic Children With Developmental Delay
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Broader outreach on developmental milestones needed
Hispanic children often have undiagnosed developmental delays and large numbers of both Hispanic and non-Hispanic children who first were thought to have developmental delay actually had autism, researchers affiliated with the UC Davis MIND Institute have found.
The study, one of the largest to date to compare development in Hispanic and non-Hispanic children, is published in the journal Autism. The results lead the study authors to recommend increased public health efforts to improve awareness, especially among Hispanics, about the indicators of developmental delay and autism.
"Our study raises concerns about access to accurate, culturally relevant information regarding developmental milestones and the importance of early detection and treatment," said Virginia Chaidez, the lead author and a postdoctoral researcher in the UC Davis Department of Public Health Sciences when the study was conducted. "Autism and developmental delay tend to go undiagnosed when parents are not aware of the signs to look for, and the conditions are often misdiagnosed when parents don't have access to adequate developmental surveillance and screening."
Developmental delay is diagnosed in children who lag behind others in reaching important mental or physical milestones, while autism is characterized by deficits in social interactions and communication behaviors. The symptoms of both disorders can be improved with targeted interventions, with the greatest improvements seen when interventions begin early in life.
In conducting the study, the researchers used data from the Childhood Autism Risk from Genetics and the Environment (CHARGE) Study, a population-based study of factors that increase risk for autism or developmental delay. The current study included 1,061 children living in California who were between 24 and 60 months of age. They were divided into three groups: children with autism, children with developmental delay but not autism, and children with typical development. All diagnoses were confirmed or changed based on evaluations by MIND Institute clinicians.
The evaluations of Hispanic children were conducted by bicultural and bilingual clinicians in Spanish or English, depending on the primary language used at home. The results for children with at least one Hispanic parent of any race were compared to the results for children of non-Hispanic white parents.
"Our goal was to use the CHARGE Study to help fill the gaps in research on autism for Hispanics so we can better understand what autism is like for this growing U.S. population," said Irva Hertz-Picciotto, professor of public health sciences, researcher with the UC Davis MIND Institute and principal investigator of CHARGE. "No other study of autism has included such a large proportion of Hispanic children."
When the outcomes for Hispanic children were compared to non-Hispanic children, the results revealed more similarities than differences in terms of autism profiles, including diagnostic scores, language function, whether or not children lost acquired skills and overall intellectual, social and physical functioning.
A striking outcome, however, was that 6.3 percent of Hispanic children enrolled in the study who were selected randomly out of the general population met criteria for developmental delay, compared with only 2.4 percent of non-Hispanic participants, which is the expected percentage. This raised concerns among the researchers that many Hispanic children with developmental delays may not be getting the services they need.
For both Hispanic and non-Hispanic children, there was a high percentage (about 19 percent overall) of Hispanic and non-Hispanic children recruited for the study with developmental delay who actually met criteria for autism, raising concerns about adequate access to accurate developmental assessment.
When the analysis was restricted to bilingual children, a significant relationship also emerged between secondary language exposure (when a child was spoken to 25 to 50 percent of the time in a language other than English) and lower scores on standardized tests of receptive and expressive language. This resulted in lower overall cognitive scores for this group.
"Our results emphasize the importance of considering cultural and other family factors such as multiple language exposure that can affect development when interpreting clinical tests, even when they are conducted in the child's preferred language," said Robin Hansen, chief of developmental-behavioral pediatrics at UC Davis, director of clinical programs with the MIND Institute and a study co-author.
Hansen, the MIND Institute clinical team and the Center for Excellence in Developmental Disabilities at the MIND Institute have worked hard to provide accurate, current and evidence-based information about developmental disabilities to parents, educators, therapists and health-care specialists through an annual conference, website resources and community outreach.
"That so many children are slipping through the cracks is disheartening," Hansen said. "The differences between developmental disabilities can be subtle but important and involve distinct treatment pathways. We need to make sure that all children are getting routine developmental screening, early diagnosis and intervention so they can achieve their fullest potential."
For information on developmental milestones, visit the Centers for Disease Control and Prevention "Learn the Signs" website , which is available in English and Spanish at. Parents with concerns about their child's development should work with their health-care provider, school district and California Department of Developmental Services regional center to identify appropriate services.
The research was funded by the National Institute of Environmental Health Sciences (grants R01-ES015359 and P01-ES11269), the U.S. Environmental Protection Agency's STAR program (grants R-829388 and R-833292) and the UC Davis MIND Institute.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our autism section for the latest news on this subject.
“Autism spectrum disorders in Hispanics and non-Hispanics”, Virginia Chaidez et al. Autism March 7, 2012, doi: 10.1177/1362361311434787
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Current ratings for: Bigger Health System Changes Needed For Productivity Gains From Health IT
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Productivity gains that can be achieved by widely adopting health information technology are likely to come from the reengineering of health care and may require new measurement tools to accurately gauge their impact, according to a new analysis from RAND Corporation researchers.
While debate remains about whether electronic health records and other health IT investments will deliver promised improvements, RAND researchers suggest that existing administrative data used to measure productivity gains may be unable to detect the effects of health IT. Their analysis is outlined in a commentary published in the New England Journal of Medicine.
"As seen previously in manufacturing and other industries, the benefits of computerization in health care may only become evident over time as the delivery of health care is reengineered," said Spencer Jones, the paper's lead author and an information scientist at RAND, a nonprofit research organization. "Health IT has the power to change the way health care is delivered and we need to develop tools that can accurately measure the impact of those changes."
One recent study found that less than 2 percent of ambulatory performance metrics were suitable for measuring the effects of computerization, with other performance measures unable to capture improvements that can be made through health IT, according to researchers.
For example, health providers who use telephone calls or email in lieu of some office visits will appear to be less productive based on existing health care productivity measures, even if they deliver care in a more-convenient and effective fashion than other providers, according to the RAND Health analysis.
The U.S. government is investing $27 billion to encourage adoption of health information technology under the Health Information Technology for Economic and Clinical Health Act of 2009.
Proponents expect health IT to transform health care delivery from a fragmented enterprise plagued by poor quality and high costs to a highly organized, integrated system that delivers high-quality care efficiently. Skeptics suggest the productivity benefits of health IT have been overstated, arguing it may create safety problems and even increase costs.
In their analysis, RAND researchers discuss a productivity paradox that became apparent during the computerization of many other U.S. industries during the 1970s and 1980s. Despite a vast increase in computing capacity, the growth of productivity fell dramatically during the period. The relationship became known as the "IT productivity paradox" and economists debated whether the investments in IT were worthwhile.
Further study showed that once these industries reengineered their processes to fully harness the benefits of IT, the anticipated productivity gains were realized. But it took time for this to happen.
For health IT to produce similar gains, the health care professions need to do more than just digitize paper-based workflows, according to the RAND analysis. Health IT should lead to new processes that support teamwork, care coordination and innovative approaches such as interactive patient portals. Such approaches have the potential to yield greater convenience, access and quality while dramatically lowering costs - the definition of greater productivity.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source. Visit our it / internet / e-mail section for the latest news on this subject.
Other authors of the analysis are Paul S. Heaton and Robert S. Rudin of RAND, and Dr. Eric C. Schneider of RAND, Brigham and Women's Hospital, the Harvard Medical School and the Harvard School of Public Health. RAND Corporation
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Current ratings for: Sudden Cardiac Death Less Likely If You're Exercising
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There is a smaller chance of dying from sudden cardiac arrest if it is exercise-related, than cardiac arrests for other reasons, researchers from The Netherlands reported at the European Society for Cardiology 2012 Congress, in Munich, Germany. Dr Arend Mosterd, and team from the Academic Medical Center, University of Amsterdam, presented their findings from ARREST (the Amsterdam Resuscitation Study). The study has been published in Circulation.
Dr Mosterd reported, "although physical activity is the best way to promote cardiovascular health, exercise can also trigger an acute cardiac event leading to death. These dramatic and often high profile events, for example in soccer players, invariably lead to concerns and cast a shadow over the overwhelmingly positive effects of regular exercise."
ARREST is a database of all resuscitation attempts that have been performed in the metropolitan area of Amsterdam, which covers a population of approximately 2.4 million people. In the Netherlands, people dial 112 for medical emergency services, where an operator puts the caller in contact with a regional ambulance dispatch hub. If the dispatch center suspects it is a case of cardiac arrest, two ambulances of a single tier are sent out.
An AED (automated external defibrillator) used in CPR training
A standard ambulance includes a team which carries a manual defibrillator. The dispatcher makes sure a first responder is sent out, possibly police officers or firefighters, who carry an AED (automated external defibrillator). Many areas in the Netherlands where large numbers of people gather, such as sports venues, office buildings, airports, supermarkets, and large bus stations have an automated external defibrillator on site. Lay rescuers, who have had special training, can use the onsite AED before the emergency team arrives.
The research team gathered data from ARREST to find out how frequent exercise-related cardiac arrests were in the Amsterdam metropolitan area from 2006 to 2009. They also wanted to determine what the outcomes were for people with sports-related cardiac arrests.
They found that there were 48 out-of-hospital sports related cardiac arrests each year, equivalent to 5.8% of the total number of cardiac arrests that occur out-of-hospital.
From 2006 to 2009, in the Amsterdam metropolitan area:
According to the data gathered, 45% of people who suffered a cardiac arrest whilst exercising survived.
145 out of a total of 2,517 OHCAs (out-of-hospital cardiac arrests) were experienced by people who had been doing some kind of exercise during the cardiac arrest, or up to 60 minutes before it occured.
- 49 had been cycling - 22 had been playing tennis - 16 had been at the gym - 13 had been swimming
Of the 145 cases, ten were female
7 (inc. 1 female) of the 145 cases were aged no more than 35 years
65 of the 145 cases survived the event
People with an exercise-related OHCA were found to have a 45% chance of surviving the event
People with a non-exercise OHCA had a 15% chance of surviving the event
Dr Mosterd said:
"Patients persons suffering an exercise related OHCA are three times more likely to survive the event than persons whose arrest is not exercise related. None of the survivors of exercise related OHCA suffered serious neurologic damage, which was not the case for those surviving a non exercise related OHCA."
Exercise-related OHCAs occur in more younger people than non-exercise related ones, the researchers added.
99.3% of exercise-related OHCAs occurred in public places, compared to 24.3% of non-exercise related ones. This also makes it much more likely that the sports-related ones are seen and acted upon by bystanders. 86.2% of sports-related cases received bystander CPR (cardiopulmonary resuscitation), compared to 64.4% of non-sports related ones, while 35% of sports-related cases were administered shocks using automated external defibrillators, compared to 22.2% in non-sports related ones.
Dr Mosterd said:
"The remarkably good survival of victims of exercise related out-of-hospital cardiac arrest can partially be ascribed to the fact that they are younger and more likely to suffer the arrest in a public location, leading to bystander cardiopulmonary resuscitation, often with the use of an automated external defibrillator. Taking these factors into account exercise per se also contributes to a better outcome."
There is only one other study that has compared exercise-related OHCAs with those in the general population, the team explained; it was carried out in France.
Dr Mosterd said:
"The survival rate to hospital discharge of exercise related OHCA victims was three times higher in our study group than was observed in the French study (45% vs 16%). As most exercise related events are bystander witnessed (89% in the Netherlands vs 93% in France) the most likely explanation for the remarkably better survival in the Netherlands relates to the high rate of initiation of bystander CPR (86%) compared to 31% in France. It is of note that the highest survival rates (around 50%) in France are found in two regions where bystanders initiated CPR in 90% of cases (compared to 86% in our population).
More research is needed to determine why, after taking into account favourable factors such as age, location of the event and initiation of CPR, persons who exercise during or shortly before having a cardiac arrest still have a better prognosis than people who have a cardiac arrest that is unrelated to exercise. The number of exercise related out-of-hospital cardiac arrests in the general population is low, particularly in women and in those aged 35 years or younger. We demonstrated for the first time that cardiac arrests occurring during or shortly after exercise carry a markedly better prognosis (45% survival) than cardiac arrests that are not exercise related (15% survival)."
Dr Mosterd added that timely bystander CPR efforts with AED usage are probably crucial for improving survival rates in people with non-hospital cardiac arrests. He believes their findings should have "direct implications for public health programs aimed at preventing exercise related sudden death."
What is sudden cardiac arrest?
Sudden cardiac arrest, also known as circulatory arrest or cardiopulmonary arrest, occurs when the heart stops working, the patient stops breathing and loses consciousness. It usually happens when something goes wrong with the electrical signals in the heart that undermines its pumping action, resulting in the loss of blood flow. In most cases, the heart simply stops.
Cardiac arrest is a medical emergency.
Cardiac arrest is not the same as a heart attack:
A heart attack or myocardial infarction occurs when one of the arteries that supplies blood to the heart muscle, the coronary artery, has a sudden blockage that stops the blood supply to a portion of the heart muscle - that part of the heart muscle dies. Put simply, a heart attack is the death of a portion of the heart muscle.
A cardiac arrest is caused by a sudden heartbeat irregularity (arrhythmia), called ventricular fibrillation. The electrical signals within the heart degenerate to total chaos, and it stops beating. Put simply, a cardiac arrest is when the heart stops because of an electrical fault. Without emergency medical help the patient nearly always dies.
A heart attack can sometimes bring on electrical disturbances which may eventually result in cardiac arrest. Administering CPR (cardiopulmonary resuscitation), or just providing rapid compressions to the chest, may keep the patient alive a little longer until emergency personnel arrive, which may save his/her life.
The only treatment that can get the heart moving again is to deliver a large electrical shock to the heart with a defibrillator - the shocks "reboot" the heart, so that normal heart rhythm may be restored.
Written by Christian Nordqvist Copyright: Medical News Today Not to be reproduced without permission of Medical News Today
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Marijon E, Tafflet M, Celermajer DS, Dumas F, Perier MC, Mustafic H, Toussaint JF, Desnos M, Rieu M, Benameur N, Le Heuzey JY, Empana JP, Jouven X. ”Sports-related sudden death in the general population” Circulation. 2011; 124(6):672-681. doi: 10.1161/CIRCULATIONAHA.110.008979
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