Category Archives: Blogging

What to know about cataract surgery

You have chosen to share the following article:

How elderberries can help you fight the flu

To proceed, simply complete the form below, and a link to the article will be sent by email on your behalf.
Note: Please don’t include any URLs in your comments, as they will be removed upon submission.

We do not store details you enter into this form. Please see our privacy policy for more information.

Message sent successfully

The details of this article have been emailed on your behalf.

Click here to return to the Medical News Today home page.

Original RSS Content

Source

Bridge of nose pain: Causes and how to treat it

You have chosen to share the following article:

How elderberries can help you fight the flu

To proceed, simply complete the form below, and a link to the article will be sent by email on your behalf.
Note: Please don’t include any URLs in your comments, as they will be removed upon submission.

We do not store details you enter into this form. Please see our privacy policy for more information.

Message sent successfully

The details of this article have been emailed on your behalf.

Click here to return to the Medical News Today home page.

Original RSS Content

Source

What to know about dissolvable stitches

You have chosen to share the following article:

How elderberries can help you fight the flu

To proceed, simply complete the form below, and a link to the article will be sent by email on your behalf.
Note: Please don’t include any URLs in your comments, as they will be removed upon submission.

We do not store details you enter into this form. Please see our privacy policy for more information.

Message sent successfully

The details of this article have been emailed on your behalf.

Click here to return to the Medical News Today home page.

Original RSS Content

Source

Foods to eat and avoid with the flu

You have chosen to share the following article:

How elderberries can help you fight the flu

To proceed, simply complete the form below, and a link to the article will be sent by email on your behalf.
Note: Please don’t include any URLs in your comments, as they will be removed upon submission.

We do not store details you enter into this form. Please see our privacy policy for more information.

Message sent successfully

The details of this article have been emailed on your behalf.

Click here to return to the Medical News Today home page.

Original RSS Content

Source

Supratherapeutic Psychotropic Drug Levels in the Emergency Department and Their Association with Delirium Duration: A Preliminary Study


Objectives

Polypharmacy is associated with delirium, but the mechanisms for this connection are unclear. Our goal was to determine the frequency of supratherapeutic psychotropic drug levels (SPDLs) in older hospitalized patients and if it is associated with the duration of emergency department (ED) delirium.

Design

Secondary analysis of a prospective cohort study.

Setting

Tertiary care academic medical center.

Participants

ED patients 65 years or older who were admitted to the hospital.

Measurements

Delirium was assessed in the ED and during the first 7 days of hospitalization using the modified Brief Confusion Assessment Method. Drug concentrations were determined in serum samples collected at enrollment via a novel platform based on liquid chromatography–tandem mass spectrometry capable of identifying and quantitating 78 clinically approved medications including opioids, benzodiazepines, antidepressants, antipsychotics, and amphetamines. Patients with serum psychotropic drug concentrations above established reference ranges were considered supratherapeutic and have a SPDL. We performed proportional odds logistic regression to determine if SPDLs were associated with ED delirium duration adjusted for confounders. Medical record review was performed to determine if the doses of medications associated with SPDLs were adjusted at hospital discharge.

Results

A total of 158 patients were enrolled; of these, 66 were delirious in the ED. SPDLs were present in 11 (17%) of the delirious and 4 (4%) of the non‐delirious ED patients. SPDLs were significantly associated with longer ED delirium duration (adjusted proportional odds ratio = 6.0; 95% confidence interval = 2.1‐17.3) after adjusting for confounders. Of the 15 medications associated with SPDLs, 9 (60%) were prescribed at the same or higher doses at the time of hospital discharge.

Conclusion

SPDLs significantly increased the odds of prolonged ED delirium episodes. Approximately half of the medications associated with SPDLs were continued after hospital discharge at the same or higher doses.

Source

World first: Doctors use ‘reprogrammed’ stem cells to repair cornea

Scientists in Japan have, for the first time, treated a damaged cornea using induced pluripotent stem cells. According to the surgeon, the person’s vision has improved since the procedure.
Close up brown eye
The cornea covers the front section of the eye, including the iris and pupil.

Scientists create induced pluripotent stem (iPS) cells by reprogramming adult cells.

This process converts the cells into embryonic-like cells, which means that they can develop into any other type of human cell, including nerve, pancreatic, liver, and corneal cells.

Although iPS cells have great potential to treat a range of conditions, they have been slow to make it from the laboratory to the clinic.

In carrying out a new groundbreaking procedure, ophthalmologist Kohji Nishida from Osaka University in Japan has taken the next step.

Corneal repair

The cornea is the transparent front section of the eye, which covers the iris and pupil. Stem cells in the cornea ensure that it becomes refreshed and repaired when necessary, keeping it clear so that light can enter.

However, if these stem cells sustain damage due to disease or injury, maintenance of the cornea is no longer possible, and this can lead to corneal blindness.

Individuals with damaged corneas must wait for donor tissue to become available, and — as with any organ transplant — this can be a lengthy process.

The person who underwent the recent surgery has a genetic condition that affects the stem cells of the cornea. Her vision was blurry, and she would eventually have lost her sight.

The researchers implanted thin sheets of iPS cells into the patient’s eye, hoping that they would take root and fill in the gaps that her missing corneal stem cells had left.

The importance of iPS cells

Japan are the front-runners in iPS technology. In 2006, Shinya Yamanaka first presented his research on these experimental cells.

Although stem cells had caused excitement in medical circles, iPS cells appeared to promise more. Scientists could not unshackle stem cells from the ethical concerns of using fetal tissue, but they derive iPS cells from adult skin cells, sidestepping this issue entirely.

Additionally, because scientists derive iPS cells from the patient’s own tissue, there should be no issue with transplant rejection. Preventing the rejection of embryonic stem cells has proven to be a significant challenge.

In 2012, Yamanaka shared the Nobel Prize in Physiology or Medicine for his part in the discovery and advancement of iPS cells.

In Japan, researchers have already tested iPS cells against a number of conditions in clinical trials, including spinal cord injuries and Parkinson’s disease. In October 2018, a neurosurgeon implanted 2.4 million cells into the brain of a patient with Parkinson’s disease.

More procedures to come

Following successful research in an animal model, the Japanese health ministry gave Nishida permission to carry out the corneal repair procedure in four people.

So far, the first treatment appears to be a success. According to Nishida, the person’s cornea is still clear, and their vision has improved in the month since the operation.

Nishida plans to carry out the second procedure later this year, and he is hopeful that the surgery will be available to more people within 5 years.

The authors of a recent global survey of corneal transplantation concluded that there is “only one cornea available for 70 needed.” Hopefully, this groundbreaking technology will, eventually, go some way toward closing that gap.

Original RSS Content

Source

Flu shot may lower death risk in people with hypertension

New research suggests that flu vaccines can help keep heart attacks and strokes at bay in people with hypertension.
close up of doctor administering flu shot
Flu vaccinations may save the lives of those who are at high cardiovascular risk.

Although the flu is a common illness, the burden of this condition in the United States is considerable.

According to the Centers for Disease Control and Prevention (CDC), influenza results in up to 960,000 hospitalizations and up to 79,000 deaths every year.

In the case of people with hypertension who are already at risk of cardiovascular events, the flu can strain the immune system and raise the risk of heart attacks and strokes.

Experts agree that “the single best way to protect against the flu” is to get a vaccine early each year. The flu shot triggers the formation of antibodies approximately 2 weeks after the vaccination, which protects against infection with the virus contained in the vaccine.

Now, a team of researchers led by Daniel Modin, a research associate of the University of Copenhagen, Denmark, wondered whether putting an end to the flu infection with the aid of vaccination would protect against cardiovascular problems.

Modin and colleagues presented their findings at the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology conference, which this year takes place in Paris, France.

18% lower risk of death from any cause

The team analyzed data on 608,452 people who were 18–100 years old and had hypertension. The scientists followed the participants during nine flu seasons, from 2007 through to 2016, comparing those who had a flu shot with those who had not.

Throughout the follow-up period, Modin and team looked at death from any cause, cardiovascular death, and death from a heart attack or stroke.

The researchers also examined the link between getting a flu shot before the flu season and death risk during the flu season. They accounted for potential confounders, such as age, other medical conditions, medications, and socioeconomic status.

The research revealed an association between vaccination in the flu season and an 18% reduction in relative risk of dying from all causes, 16% less relative risk of dying from a cardiovascular event, and 10% lower relative risk of dying from a heart attack and stroke.

“We show that influenza vaccination may improve cardiovascular outcomes in patients with hypertension,” comments the study’s first author.

“During the nine flu seasons we studied, vaccine coverage ranged from 26% to 36%, meaning that many patients with high blood pressure were not vaccinated. If you have high blood pressure, it would be worth discussing vaccination with your doctor.”

Given these results, it is my belief that all patients with high blood pressure should have an annual flu vaccination.”

Daniel Modin

He adds, “Vaccination is safe, cheap, readily available, and decreases influenza infection. On top of that, our study suggests that it could also protect against fatal heart attacks and strokes and deaths from other causes.”

The researcher also explains the common link between flu and cardiovascular events, saying that the immune reaction and ensuing inflammation during the flu may shake up a person’s cardiovascular health.

Modin says, “Heart attacks and strokes are caused by the rupture of atherosclerotic plaques in the arteries leading to the heart or the brain. After a rupture, a blood clot forms and cuts off the blood supply.”

“It is thought that the high levels of acute inflammation induced by influenza infection reduce the stability of plaques and make them more likely to rupture.”

Original RSS Content

Source

How Do Frail Medicare Beneficiaries Fare Under Bundled Payments?


BACKGROUND/OBJECTIVES

Bundled payments are an alternative payment model in which a hospital takes accountability for the costs of a 90‐day episode of care. Such models are meant to improve care through better coordination across care settings, but could have adverse consequences for frail adults if they lead to inappropriate cuts in necessary post‐acute care.

DESIGN

Retrospective claims‐based analysis of hospitals’ first year of participation in Medicare’s Bundled Payments for Care Improvement (BPCI) program.

SETTING

US hospitals.

PARTICIPANTS

A total of 641 146 Medicare beneficiaries admitted to 688 BPCI programs and 1276 matched control hospitals for myocardial infarction, heart failure, pneumonia, sepsis, chronic obstructive pulmonary disease, or major joint replacement of the lower extremity in 2012 to 2016.

INTERVENTION

Participation in BPCI.

MEASUREMENTS

Proportion of patients in each quartile of a validated claims‐based frailty index, total and setting‐specific standardized Medicare payments per episode, days at home, 90‐day readmissions, and 90‐day mortality.

RESULTS

Higher levels of frailty were associated with higher Medicare payments and worse clinical outcomes (for the medical composite, costs per episode were $11 921, $17 348, $22 828, and $29 157 across frailty quartiles; days at home were 70.1, 60.4, 54.3, and 51.5; 90‐day readmission rates were 16.0%, 27.0%, 38.2%, and 50.9%; and 90‐day mortality rates were 15.4%, 22.5%, 25.1%, 21.3%); patterns were similar for joint replacement. Under the BPCI program, there was no differential change in the proportion of highly frail patients at BPCI vs control hospitals. There were also no differential deleterious changes in payments or clinical outcomes for frail relative to nonfrail patients at BPCI vs non‐BPCI hospitals.

CONCLUSION

While frail patients had higher costs and worse outcomes in general, there was no evidence of changes in access or worsening clinical outcomes in BPCI hospitals for frail patients relative to the nonfrail in hospitals’ first year of participation in the program. These findings may be reassuring for policy makers and clinical leaders.

Source