Monday, December 11, 2017

Holiday treats, hectic schedules may increase risk of heart attack

Holiday treats, hectic schedules may increase risk of heart attack

Between the ubiquitous goody trays, unending to-do lists and stressful travel itineraries, it can be tough to stay on track when it comes to health during the holiday season, whether it's sticking to a diet or maintaining an exercise regimen.
11 dec 2017--Such holiday-fueled pressures may also contribute to the fact that the holidays are also the most dangerous time of year for heart attacks.

Research shows deaths from heart attacks peak during December and January, possibly due to changes in diet and alcohol consumption, stress from family interactions, strained finances, travel and entertaining, and respiratory problems from burning wood.
"We tend to exercise less and eat more during the holidays," said John Osborne, M.D., Ph.D., a Dallas-area preventive cardiologist. "It's a very stressful time. There's a lot of emotion attached to the holidays and that can be another factor to why we have more cardiovascular events."
As the holidays upend routines, taking medications as prescribed can also get lost in the shuffle, Osborne said.
"I can't tell you how often I get calls from patients who have traveled somewhere and forgot their medications," he said, adding that he worries more about the patients who don't contact him. "Some people figure they'll be fine to be off them for a week or so, but if you start missing medications, that can have a big impact on causing your blood pressure to be out of control."
For those who have already had a heart attack, the heightened risk during the holidays is particularly dangerous. That's because about one in five heart attack survivors age 45 and older will have another heart attack within five years.
Being with family during the holidays is a good time for patients to talk about their health history—not just heart attacks, but also high blood pressure and high cholesterol, experts say.
"We can dramatically lower the risk of cardiovascular events with lifestyle changes, but don't ignore your family history," Osborne said. "Genetics can catch up to you, even if you're doing all the right stuff."
Heart disease can be prevented in many cases through lifestyle factors, such as maintaining a healthy weight, exercising regularly, controlling cholesterol and blood pressure and not smoking, but "making lifestyle changes can be difficult," Osborne said.
"I admit to my patients that I don't love to exercise, but I really feel great having exercised," he said. "Getting that motivation can be painful, but it's fantastic when you get to the other side."
Osborne said tools such as mobile apps can provide education and electronic reminders to help people stay focused on heart health.
"I have a very brief period with patients," he said. "Tools like apps can encourage good health behaviors, being that gentle in-your-face technology."

More information: D. P. Phillips. Cardiac Mortality Is Higher Around Christmas and New Year's Than at Any Other Time: The Holidays as a Risk Factor for Death, Circulation (2004). DOI: 10.1161/01.CIR.0000151424.02045.F7


Provided by American Heart Association

Sunday, December 10, 2017

How to talk to your doctor about information you find online


How to talk to your doctor about information you find online
More and more people are going online to search for information about their health. Though it can be a minefield, where unverified sources abound, searching the internet can help people to understand different health problems, and give them access to emotional and social support.

10 dec 2017--For many in the UK, getting to actually see a GP remains difficult, and constraints around appointment times mean that some discussions are often cut short. But by using the internet, patients can prepare for appointments, or follow up on issues that were raised in the consulting room but left them with unanswered questions.
But not everyone is so keen on patients using the internet in this way. Some GPs and other heath professionals have doubts about the quality and usefulness of the information available. There are also suggestions that "cyberchrondria" may be fuelling a surge in unnecessary tests and appointments.
Similarly, though so many people are using online resources to fill in gaps in their knowledge, or to help them ask the right questions, they may not be comfortable bringing it up in the consulting room.
For our latest research project, we wanted to find out just why it can be so difficult to discuss online information with doctors. We found that in addition to people being embarrassed in case they have misunderstood the information, or can't remember it accurately, they also fear a negative reaction from the GP who may think they are difficult or challenging.

How to make it work

So how can you as a patient bring up online information with your doctor? First, it sounds obvious but you need a good, open relationship with your GP. Tell them you have been looking online, but ask for their feedback on the information, and for any useful sites they know of. We found that patients with a good doctor relationship felt able to discuss information and ideas from websites and online forums in a considered and critical manner.
Importantly, it is not about the patient trying to be the doctor. Ideally, patients should bring along their information, use it to help explain their key concerns, or detail the options they've explored, but also make clear that they still want and value their GP's input on their findings.
Some of the patients we spoke to told us that they are acutely aware of their doctor's negative feelings towards the internet. In these situations, people are sometimes tempted to disguise the source of their information. Rather than openly discussing their findings from the internet, they may pretend they got the information elsewhere when mentioning it to their doctor or be very careful not to reveal its origin at all.
For some people we spoke to, the process of trying to integrate the results of their web searches into their communications with the GP was frustrating to say the least. They felt uncomfortable, embarrassed, and sometimes held back key information. This made for unproductive meetings which were felt to be a waste of time.
This process can definitely be improved. As more appointments are going to be conducted over smartphone rather than face to face, and some GPs have admitted using Wikipedia to diagnose patients, the rest of the process needs to catch up with technology.
There needs to be a new and more productive way to integrate online information into doctor-patient discussions. First of all, there should be better ways for patients to collect and organise accurate information online so that they can organise their thoughts and prepare for a visit.
In the consulting room itself, GPs should use the research as an opportunity to have more productive discussions, and use it as a way to teach patients more about their own health issues. They need to question the information source, message and credibility, but GPs could also use it as an opportunity to nudge patients to think about their health options and consider what's important to them.
Just as a GP is not solely responsible for the health of a patient, neither is the patient themselves. Internet research can no longer be dismissed. Even if inaccurate, it can help build a better relationship between patient and doctor, and give them both a better understanding of managing health in the modern world.

This article was originally published on The Conversation. Read the original article.The Conversation

Provided by The Conversation

Saturday, December 09, 2017

Is prescribing drugs 'off label' bad medicine?

Is prescribing drugs 'off label' bad medicine?

A woman, let's call her Sarah, is a young actor looking to make her debut at a major theatre. She is fit and healthy, but gets nervous on opening nights and can't sleep. She's tried zopiclone, but it didn't work, so her GP prescribes a course of quetiapine. Quetiapine is usually used to treat bipolar disorder, but the doctor explains to Sarah that he is prescribing it "off label". In other words, for a condition the drug wasn't licensed to treat.

09 dec 2017--There are legitimate reason for prescribing off label – although, there are also legitimate criticisms of the practice.
In the UK, doctors, dentists, optometrists and other prescribers are discouraged from prescribing drugs off-label when a licensed alternative is available. But off-label prescribing is done, with caution, for several reasons.
First, each prescription drug has a product licence, that is, the company that makes it had to submit a mountain of evidence to the regulator proving not only that the drug is effective, but it is safe.
Second, the prescriber and the dispensing pharmacist are legally liable when things go wrong, so the patient can sue.
Finally, sometimes there are no alternative drugs for a given health problem. For example, in Sarah's case, quetiapine is not licensed to treat insomnia. However, she has tried all available drugs licensed to treat insomnia, and none of them have worked.

The right to say 'no thanks'

Drugs are prescribed off label based on limited evidence. Sometimes, doctors have to build the evidence as they use each medicine off label and learn from their experience – what works for a given condition and what doesn't. Published case studies can also provide clues about what other uses a drug might be useful for. Case studies, though, are at the bottom of the hierarchy of medical evidence.
GPs and other prescribers have to make decisions based on the available evidence, which may not be very much. Sometimes it's based on little more than an educated guess.
In Sarah's case, the doctor feels that quetiapine might help. If the drug doesn't work for her, she'll have to come back to see him, and perhaps try a different drug – also off label.
This highlights another problem, though. Some patients – especially the elderly – take their doctor's advice as gospel and follow it regardless of how a drug makes them feel. As a result, they can end up taking pills that aren't effective and may even have unpleasant side effects.
In this example, Sarah should go back to her GP if she is concerned and she has the right not to take medicine that she doesn't want to.

This article was originally published on The Conversation. Read the original article.The Conversation

Provided by The Conversation

Friday, December 08, 2017

New clinician resource available explains biological impact of aging on immunity

The American College of Physicians (ACP), the American Pharmacists Association (APhA), and The Gerontological Society of America (GSA), representing 220,000 clinicians, today released "Aging and Immunity: The Important Role of Vaccines", a new resource highlighting the biological impact of aging on immunity.

08 dec 2017--Developed with support by GSK, the guidebook is designed to help health care professionals understand the biological impact of aging on immunity and reinforce the importance of adult immunization, especially for vaccine-preventable diseases such as shingles, pneumonia, and influenza. The guidebook also offers practical tips and strategies for supporting aging patients' health and overcoming barriers to vaccination.

Age-related decline in immunity

"As we age, our immune system declines, making older adults more susceptible to serious conditions," said Jack Ende, MD, MACP, President, ACP. "Understanding the aging immune system is becoming increasingly important for clinicians because vaccination is an effective solution to overcoming some of this age-related decline in immunity."
Research has shown that one of the most important things health care professionals can do to support aging patients is to provide a strong recommendation for them to be vaccinated.
"At every opportunity, clinicians should recommend vaccination according to the schedule from the Advisory Committee on Immunization Practices, have a program that supports vaccine administration, or refer patients to a health care professional who administers vaccines, and document administration of vaccines," said Kelly Goode, PharmD, BCPS, FAPhA, Board of Trustees Member and Immediate Past President, APhA.

As individuals age, the chances of getting shingles increases

"Aging and Immunity" details how cell-mediated immunity deteriorates as a person ages. For instance, in people who had chickenpox as children, deteriorating cell-mediated immunity is considered a factor for why latent varicella zoster virus commonly becomes reactivated in older adults, causing shingles. About one million cases of shingles are diagnosed in the United States every year. Shingles occurs in one in every three people in the United States, mostly adults over the age of 50. For those who live to age 85, one in every two people will contract shingles. The painful condition occurs in people who are healthy as well as people with chronic diseases or immunosuppression. Vaccination is an important way of reducing risk of getting shingles and its complications, like postherpetic neuralgia (PHN) and necessity of prescribing pain relievers.
"Shingles is an example of a disease that afflicts one million adults every year and costs the economy $1 billion in health care expenses. It especially impacts older adults as a direct result of age-related decline in immunity," said James Appleby, BSPharm, MPH, Executive Director and CEO, GSA. "Shingles can affect anyone who carries the varicella zoster virus, and virtually all adults do, whether they had chickenpox during their childhood or not."

Addressing barriers to vaccination

"Aging and Immunity" explains barriers to vaccination at the patient and practice levels and offers recommendations about how clinicians can overcome them. Strategies to improve vaccination rates include using standing orders, collaborating with other health care team members, identifying a staff vaccine champion in the practice, adding reminders to charts, and counseling patients about recommended vaccines.
"We recognize the critical role health care professionals play in educating patients about vaccine-preventable diseases," said Barbara Howe, M.D., Vice President and Director, North American Vaccine Development, GSK. "Our collaboration with ACP, APhA, and GSA reinforces our commitment to educating health care professionals and patients about the importance of vaccination throughout an individual's life.
"
More information: www.acponline.org/system/files … d_immunity_guide.pdf


Provided by American College of Physicians

Wednesday, December 06, 2017

New easy-to-use tool can help determine Alzheimer's risk, similar to pediatric growth curves

A simple new tool that tracks cognitive performance in adults aims to help physicians identify people who may be on the path to Alzheimer disease or another form of dementia. The tool, called the QuoCo (cognitive quotient), is published in CMAJ (Canadian Medical Association Journal).

06 dec 2017--"Similar to 'growth charts' used in pediatrics, the QuoCo cognitive charts allow physicians to plot cognitive performance of any patient based on age, education and score on the Mini-Mental State Examination, and track cognitive change over time," says Dr. Robert Laforce Jr., Université Laval and CHU de Québec-Université Laval. "This would allow physicians to intervene and potentially treat an older adult who 'fell off' the curve."
Dementia is a growing problem world-wide with many undiagnosed cases. Although there are no cures, potential treatments are being tested and some risk factors, such as diet and exercise, can be addressed to delay onset.
The authors hope that the QuoCo tool will be used by health care professionals, especially family physicians, to monitor cognitive decline in patients before irreversible damage occurs.
"Dementing illnesses have reached pandemic levels," write the authors. "Early detection of cognitive impairment remains our best approach to disease management before irreversible brain damage occurs. Family physicians are in a key position to contribute to this approach; however, they are ill-equipped."
The authors note that the Mini-Mental State Examination is an imperfect screening measure and has its own limitations, although it is used internationally clinically and in research on dementia and cognitive decline.
In a related commentary, Dr. Andrew Costa, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, writes "the widespread benefits derived from cognitive charts for any screening examination rests on the assumption that at-risk patients are being screened systematically over time and that cognitive test results are communicated, or can be readily referenced by, physicians. We seem to be some distance away from that reality."
He notes that the success of any innovation rests upon training health care professionals to use these tools in clinical practice properly.

More information: Canadian Medical Association 
Journal (2017). www.cmaj.ca/lookup/doi/10.1503/cmaj.160792


Provided by Canadian Medical Association Journal

Sunday, December 03, 2017

Lack of communication puts older adults at risk of clashes between their medicines

Lack of communication puts older adults at risk of clashes between their medicines
Key results from the National Poll on Healthy Aging. 
Most older Americans take multiple medicines every day. But a new poll suggests they don't get - or seek - enough help to make sure those medicines actually mix safely.
That lack of communication could be putting older adults at risk of health problems from interactions between their drugs, and between their prescription drugs and other substances such as over-the-counter medicines, supplements, food and alcohol.

03 dec 2017--The new results, from the National Poll on Healthy Aging, show that only about one in three older Americans who take at least one prescription drug have talked to anyone about possible drug interactions in the past two years.
Even among those taking six or more different medicines, only 44 percent had talked to someone about possible drug interactions.
The results come from a nationally representative sample of 1,690 Americans between the ages of 50 and 80. The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Disjointed sources of care

Part of the reason for lack of communication about drug interactions may lie in how older Americans get their health care and their medicines. One in five poll respondents said they have used more than one pharmacy in the past two years, including both retail and mail-order pharmacies. Three in five see multiple doctors for their care.
And even though 63 percent said their doctor and pharmacist are equally responsible for spotting and talking about possible drug interactions, only 36 percent said their pharmacist definitely knew about all the medications they're taking when they fill a prescription.
"Interactions between drugs, and other substances, can put older people at a real risk of everything from low blood sugar to kidney damage and accidents caused by sleepiness," says Preeti Malani, M.D., the director of the poll and a professor of internal medicine at the U-M Medical School.
"At the very least, a drug interaction could keep their medicine from absorbing properly," she adds. "It's important for anyone who takes medications to talk with a health care professional about these possibilities."
Malani notes that although 90 percent of poll respondents said they were confident that they knew how to avoid drug interactions, only 21 percent were very confident.
Given the wide range of prescription and over-the-counter drugs on the market, and the number of drugs that interact with supplements, alcohol and certain foods, Malani says it's hard for even medical professionals to catch all potential interactions.
Newer medical computer systems that flag patients' records for potential interactions automatically, based on the names of their drugs, are helping, Malani says.
Also helpful is Medicare coverage for prescription drug reviews, called Medication Therapy Management, for people who take medicines for multiple chronic conditions. But not all medical computer systems talk to one another, and an MTM must be approved by the patient's Medicare prescription drug benefit provider.
"Even with trackers and systems in place, patients need to be open with their providers and tell them all the medications and supplements they're taking, including herbal remedies," says Alison Bryant, Ph.D., senior vice president of research for AARP. "It's especially important for older adults to be vigilant about this because they tend to take multiple medications."
AARP has put together a free online drug interaction tracker that can identify potential risks. It's available at http://healthtools.aarp.org/drug-interactions, but should be used in conjunction with a patient's conversations with their health care providers and pharmacists.

Recommendations for patients and providers

Malani and her colleagues say that it is up to patients, pharmacists and doctors alike to reduce drug interaction risks.
Patents should write down the names and dosages of their prescription medicines, and of any supplements and over-the-counter drugs they take, and bring it all to their doctors' appointments or pharmacies, she says. It is also important to be truthful about alcohol consumption when asked, since alcohol use can affect many medications. And patients shouldn't just stop taking a medicine if they think they're experiencing a side effect - they should also call their doctor's office or speak with a pharmacist first.
Meanwhile, health care providers should ask patients more about what medicines and supplements they take, and counsel patients at risk of side effects using language they can understand.
The poll results are based on answers from those who said they took at least one prescription drug, among a nationally representative sample of about 2,000 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.


Provided by University of Michigan

Saturday, December 02, 2017

Dual virtual reality/treadmill exercises promote brain plasticity in Parkinson's patients

Dual virtual reality/treadmill exercises promote brain plasticity in Parkinson's patients
A new Tel Aviv University study suggests that a therapy that combines Virtual Reality and treadmill exercise dramatically lowers the incidence of falling among Parkinson's patients by changing the brain's behavior and promoting beneficial brain plasticity, even in patients with neurodegenerative disease.

02 dec 2017--Patients with Parkinson's disease experience gradual neuronal loss, leading to cognitive and motor impairments that damage their ability to walk and cause debilitating, often fatal, falls. The new study shows that fall rates are reduced in response to treadmill with Virtual Reality. The number of neurons activated in the pre-frontal cortex is also reduced in response to the same combination. This reduction likely reflects enhancements in motor control and greater automaticity of cognitively demanding tasks.
The research underlines the importance of combining cognitive rehabilitation with the motor rehabilitation of Parkinson's disease patients.
The study was conducted by Prof. Jeff Hausdorff of TAU's Sackler School of Medicine and Tel Aviv Medical Center along with colleagues Dr. Inbal Maidan of Tel Aviv Medical Center and Dr. Anat Mirelman and Prof. Nir Giladi, both of TAU's Sackler School of Medicine and Tel Aviv Medical Center. The findings were recently published in the journal Neurology.
"In previous research, we showed that patients with Parkinson's disease use cognitive function, which is reflected in activation of the pre-frontal cortex of the brain, to compensate for impaired motor function," Prof. Hausdorff says. "We also showed that a specific form of exercise targeting the cognitive control of gait—combined treadmill training with a Virtual Reality representation of obstacles in a path—leads to a significantly lower fall rate in Parkinson's patients.
"The Virtual Reality gait program, in which patients must avoid obstacles, enhances the patient's cognitive performance and thus reduces the requirement for prefrontal brain activity," Prof. Hausdorff continues.
Seventeen subjects in two groups, one which combined treadmill training with Virtual Reality and one which used treadmill training alone, underwent a six-week intervention, exercising three times a week for about an hour each time. The Virtual Reality group played a "game" in which they viewed their feet walking in a city or park environment. Through the game, they implicitly learned how to deal with obstacles in the virtual environment, how to plan ahead and how to do two things at once—that is, address cognitive challenges related to safe ambulation.
The other group just walked on a treadmill without the VR components or cognitive challenges. Before and after the subjects participated in the exercise programs, the researchers used functional MRI imagery to evaluate the patients' brain activation patterns.
"The study's findings reinforce the hypothesis that training improves motor and cognitive performance through improved neuroplasticity—more so than that seen with treadmill training alone," Prof. Hausdorff explains. "Interestingly, the benefits of treadmill training with VR were specifically seen during walking conditions that require cognitive input (i.e., obstacle negotiation and dual tasking), conditions associated with falls in everyday environments. In these conditions, fewer neurons were needed after training with VR, while no change was seen in the group that trained by walking on a treadmill without VR."
Previous research conducted on mouse models of Parkinson's disease suggested the importance of task-specific exercises on the brain. However, the new TAU study is the first to show such findings in people with Parkinson's disease.
"Exercise that focuses on motor components promotes plasticity in brain areas associated with sensory-motor integration and coordination," Prof. Hausdorff says. "But exercise incorporating cognitive components also stimulates changes in brain regions related to cognition. It may therefore have a greater impact on compensatory brain function and the cognitive functions related to safe ambulation (i.e., walking without falling)."
"The takeaway here is that even relatively late in the disease, when 60-80 percent of dopaminergic neurons have died, there is still an opportunity to promote plasticity in the brain," Prof. Hausdorff concludes. "Moreover, to induce specific brain changes, exercise should be personalized and targeted to a specific clinical problem."


Provided by Tel Aviv University

Thursday, November 30, 2017

How to reduce medications in older generations

New research published today in the Journal of Gerontology has developed new ways to characterise older people who take multiple medicines and those who are open to "deprescribing", a process where medicines are reviewed in order to reduce or stop less effective medicines.

30 nov 2017--Lead researcher from the University of Sydney's School of Public Health, Kristie Weir, says; "Polypharmacy (multiple medications) in the older population is increasing and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing), but a collaborative approach between patient and doctor is required."
"Deprescribing isn't new, but there has been a recent explosion of research in this area showing how it can be done safely and in collaboration with patients. We provide a novel approach to describe these differences between older people who are happy to take multiple medicines, and those who are open to deprescribing.
"Ultimately, considering these variations in attitudes towards medicines and openness to deprescribing could improve communication between clinicians and their patients.
"We categorized three distinct types of people which could help guide the type of advice given by clinicians to older patients when discussing the issues around taking multiple medicines," she says. "Recognising these three types of patients can help clinicians tailor their communication approaches," she says.

Type one:

People who are resistant to deprescribing and are very attached to their medications as they are perceived as highly important to their wellbeing. This group like to be informed but ultimately preferred to leave decisions about medicines to their doctor.

Type two:

These people indicated they were open to deprescribing and preferred an active role in decision making to share responsibility with their doctor. They would consider deprescribing and said they didn't like the idea of completely relying on medications to stay healthy. This group have mixed attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

Type three:

People who were less engaged in decision making, most deferred decisions about medicines to their doctor or companion. The people in this group had chronic health conditions and as such were taking a large number of medicines. They often didn't give much thought to medicines and are commonly unaware deprescribing is an option but were open to deprescribing if their doctor recommended it.
"This research shows that doctors should tailor communication to individual older people who are taking multiple medicines in order to provide the best level of care," says Ms Weir.
"For some patients it might be that you need to help them think a bit more about their medicines and educate them more. Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate.
"We need to develop ways to support clinicians and patients to have these important but challenging conversations," she says.


Provided by University of Sydney

Tuesday, November 28, 2017

Benzodiazepines increase mortality in persons with Alzheimer's disease

Benzodiazepine and related drug use is associated with a 40 percent increase in mortality among persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. The findings were published in the International Journal of Geriatric Psychiatry.

28 nov 2017--The study found that the risk of death was increased right from the initiation of benzodiazepine and related drug use. The increased risk of death may result from the adverse events of these drugs, including fall-related injuries, such as hip fractures, as well as pneumonia and stroke.
The study was based on the register-based MEDALZ (Medication Use and Alzheimer's Disease) cohort, which includes all persons diagnosed with Alzheimer's disease in Finland during 2005-2011. Persons who had used benzodiazepines and related drugs previously were excluded from this study, and therefore, the study population consisted of 10,380 new users of these drugs. They were compared with 20,760 persons who did not use these drugs.
Although several treatment guidelines state that non-pharmacological options are the first-line treatment of anxiety, agitation and insomnia in persons with dementia, benzodiazepines and related drugs are frequently used in the treatment of these symptoms. If benzodiazepine and related drug use is necessary, these drugs are recommended for short-term use only. These new results encourage more consideration for benzodiazepine and related drug use in persons with dementia.

More information: Laura Saarelainen et al. Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study, International Journal of Geriatric Psychiatry (2017). DOI: 10.1002/gps.4821


Provided by University of Eastern Finland

Sunday, November 26, 2017

Prototype ear plug sensor could improve monitoring of vital signs

Prototype ear plug sensor could improve monitoring of vital signs

Scientists have developed a sensor that fits in the ear, with the aim of monitoring the heart, brain and lungs functions for health and fitness.
In previous pilot studies that involved trialling the device with 24 people, the researchers from Imperial College London have demonstrated the prototype's potential for monitoring brain, heart and breathing activity.

26 nov 2017--Now, the latest study from Professor Danilo Mandic's team from Imperial has shown that their 'Hearable' technology also has potential as a heart monitor. In the preliminary study, the new in-ear heart monitoring device was found to accurately capture heart data in six people.
The device detected heart pulse by sensing the dilation and constriction of tiny blood vessels in the ear canal, using the 'mechanical' part of the electro-mechanical sensor. The electrode part of the sensor is used to detect a full and clinically valid electrocardiogram, which records the electrical activity of the heart.
The new research was published in the journal Royal Society Open Science.
Based on these results and previous preliminary findings, the researchers suggest Hearable may in the future go on to identify and manage heart conditions such as heart attack or irregular heart beat, and also serve to observe the general health state of body.
They suggest the device for heart monitoring may also be easier and more convenient for patients and clinicians to use. Traditional electrocardiogram (ECG) testing involves wearing a chest belt for 24 hours. However, the in-ear device fits discreetly in the ear, meaning it can be worn for longer, providing a longer-term picture of the patient's heart activity.
Hearable is made of foam and moulds to the shape of the ear like a conventional ear plug. As well as mechanical sensors, it uses electrical sensors to detect brain activity.
Prototype ear plug sensor could improve monitoring of vital signs
Credit: Imperial College London
Professor Mandic, lead author of the study from the Department of Electrical and Electronic Engineering, said: "This is the latest piece of research on what we think could be a versatile new piece of wearable technology. We've now completed a number of tests on our sensor that focused on detecting vital signs within the body. Our early results are proving interesting and, although we are still a way off from seeing it used outside of experiments, we have many exciting avenues to explore."

Future applications

The technology is still in its early development, but the researchers say the device also has other potential applications such as in sleep science and monitoring fatigue, epilepsy, drug delivery, and person authentication. By monitoring the brain, the device could be used as a new method for cyber security, where brain signals, much like the fingerprint lock on a smart phone, are used to activate a device. Unlike a fingerprint, brain waves are impossible to forge.
It may also be useful in other settings such as in the health and fitness industry. By monitoring the heart and lungs, the researchers believe that the sensor could perform similar functions to wrist-worn fitness trackers.
However, unlike wrist-worn trackers, which monitor from the arm at the body's extremity, the ear-worn sensor, despite a relatively weaker signal, may get more stable results because the position of the ear relative to the internal organs is nearly always the same.
During previous pilot trials in humans, the researchers showed that the prototype can be used to monitor a combination of vital signs and brain function, which could be used to screen for and monitor stress, anxiety, sleep disorders, and heart disease.
Ultimately, the researchers are aiming for the device to wirelessly transmit the data to clinicians in real-time to provide immediate results and analysis. This could open up new possibilities in patient care.
For example, patients who are monitored overnight in sleep clinics are usually asked to wear lung, heart, and brain monitors, all of which provide an unnatural sleeping environment. The earpiece would mean patients could be monitored for a number of days and sleep in their own beds, while transmitting data in real time, to improve monitoring.
Professor Mandic said: "This is a very exciting piece of technology but its evidence in humans is limited. We will now work to put these preliminary results into practice and could eventually use this in real life situations."

More information: Wilhelm von Rosenberg et al. Hearables: feasibility of recording cardiac rhythms from head and in-ear locations, Royal Society Open Science (2017). DOI: 10.1098/rsos.171214


Provided by Imperial College London

Saturday, November 25, 2017

Resistance training improves quality of life and psychological functioning for older adults

Resistance training can promote environmental quality of life and sense of coherence in older adults. This was observed in a study carried out at the University of Jyväskylä, Faculty of Sport and Health Sciences, Finland, in co-operation with the Gerontology Research Center and the Neuromuscular Research Center.

25 nov 2017--"The importance of resistance training for the muscular strength and physical functioning in older adults is well known, but the links to psychological functioning have been studied less," says doctoral student Tiia Kekäläinen from the University of Jyväskylä.
The study included 104 healthy older adults aged 65 to 75 who did not meet the physical activity recommendations for aerobic exercise at baseline and did not have a previous strength training experience.
Participants were randomized to three training groups and a control group. The training groups participated in supervised resistance training for nine months. For the first three months, all training groups trained twice a week to become familiar with resistance training methods, and for the next six months they participated in progressive resistance training with different frequencies: once, twice or three times a week. Psychological functioning was assessed through physical, psychological, social and environmental quality of life, sense of coherence, and depressive symptoms.
Environmental quality of life improved after three months of resistance training. After nine months training, also sense of coherence increased, but only among those older adults who trained the whole nine months with twice a week frequency.
"The results suggest that older adults´ ability to manage their environment and life could be improved by resistance training. In the future, it would be interesting to investigate the stability of these changes over a longer period than nine months. There is also a need for further research on the frequency of training, as this study does not allow us to say whether the differences between training groups were due to training frequency or continuity," Kekäläinen says.
This study supports the findings of previous studies that resistance training has positive effects on the psychological functioning of older people. Consequently, regular resistance training could be recommended to older adults not only for physical benefits, but also for the promotion of psychological functioning.

More information: Tiia Kekäläinen et al. Effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults: randomized controlled trial, Quality of Life Research (2017). DOI: 10.1007/s11136-017-1733-z


Provided by University of Jyväskylä

Thursday, November 23, 2017

Thanksgiving traditions that can boost health and wellness

Thanksgiving

USC Leonard Davis School of Gerontology experts Carin Kreutzer and Leah Buturain Schneider shared Thanksgiving tips that benefit both the mind and body.

Mind: Give thanks

23 nov 2017--Gratitude is good for you. Research shows it can lower blood pressure, decrease depression and improve quality of life.
"Gratitude works," said Buturain Schneider, a gerontologist, theologian and mindful aging expert at USC.
But gratitude is not a feeling, it is a behavior we can practice every day of the year, she said.
"You can strengthen an awareness of gratitude by sharing what you are thankful for or letting people know you appreciate them. Expressing this helps build bridges, connects us to the sacrifices of others and allows us to see abundance rather than what we lack."

Serve up strong relationships

Social isolation has recently been cited as possibly being more harmful to health than smoking or obesity. Despite the headaches of travel and stress that family dynamics can bring, Thanksgiving helps build community by encouraging shared experiences with family and friends, or even welcoming strangers.
"Until age 80, most people say they want to be healthy. After 80, people say what matters most is relationships," Buturain Schneider said. "The Thanksgiving holiday is a powerful reminder of how coming together to share a meal can provide a sense of fellowship and belonging that many people, particularly older adults, are missing in their lives."

Extend a helping hand

Many homeless shelters and retirement communities are inundated with individuals who sign up to serve meals on Thanksgiving. And like gratitude, research shows that helping others can bring health benefits to the giver.
"We feel most alive when using our gifts and helping other people," Buturain Schneider said. "The challenge is to make time in our lives to do this year-round so the recipients can express their own gratitude and get support on more than just one holiday."

Body: Make lunch your largest meal

Research Increasingly shows that it is not just what we eat, but when we eat that matters. Many families eat their Thanksgiving meal in the afternoon, not in the evening, and that is a step in the right direction for all days, said dietitian Kreutzer, director of the Master of Science in Nutrition, Healthspan, and Longevity program at the USC Leonard Davis School.
"Our bodies are more efficient at burning calories during the day when we are active versus storing excess calories as fat at night while we sleep. Front-loading calories gives you time to digest all those calories well before bedtime, which can have benefits for weight loss and overall health, including controlling weight and managing and preventing diabetes and obesity."

Move after meals

From local Turkey trots to family flag football games, Thanksgiving offers annual opportunities to exercise. Along with maintaining a healthy diet, moderate daily activity is a proven intervention that can reduce risk for a variety of diseases, including heart disease, cancer, diabetes and Alzheimer's.
"Thanksgiving is the perfect time to begin to incorporate movement into your day. A daily walk or other form of movement is good for your body and your brain."

Leave some leftovers

Some people actually prefer Friday's turkey sandwich to Thursday's main meal. Whatever your choice, it's important to spread the bounty. Practicing portion control at every meal helps ensure we don't eat too much in one sitting.
"When it comes to protein, three to four ounces is enough for most people," Kreutzer said. "Saving food for the next few days allows you to enjoy the meal multiple times and spares you from taking in too many calories at once."


Provided by University of Southern California

'Lesser of two evils' argument used to defend antipsychotic overuse for dementia

Lesser of two evils argument used to defend antipsychotic overuse for dementia

The increasing use of antipsychotic drugs to manage dementia in care homes has been explained by some practitioners as "the lesser of two evils", despite clear risks for patients.

23 nov 2017--New research published today in The Gerontologist explored attitudes of professionals who work with people living with dementia in care homes and found that interviewees used the explanation to defend the use of potentially harmful drugs to manage patient behaviour, and saw their use as less harmful or unpleasant compared to when the same patients aren't medicated.
Dr Parastou Donyai, Associate Professor of Social and Cognitive Pharmacy at the University of Reading who led the research said:
"What we saw was that using 'the lesser of two evils' argument to justify the overprescribing of antipsychotics comes with assumptions about what is best for patients and carers, often without a good understanding of what risks are associated with using the medication or alternative ways to manage behaviour. Dementia is one of the most prevalent diseases affecting the world with more than 45 million people experiencing it in some form or another, so it's really important that we understand the best ways of caring for our loved ones and stop the uncritical over-prescription of drugs that may not be suitable for patients."
Care home workers also shared the attitude of "medicines not Smarties", seeing antipsychotics as drugs prescribed far too often and often as an "easy option".
Among the ways in which professionals cited the idea of the drugs being doled out like sweets, one said that they knew that "staff are lowly paid, poorly motivated" and "very overworked". This attitude is critical of the overuse of antipsychotics, although people who work in dementia care used this language to protect themselves from being associated with any overprescribing.
Dr Donyai continued:
"What we see is that people providing dementia care can built up a way to rationalise the over-prescription of antipsychotics while protecting themselves when discussing the issue. We do know that similar attitudes are adopted with other medication, and we need to look further at how to correct the unquestioned assumptions that lie behind what was expressed in interviews."

More information: Dilbagh Gill et al. "The Lesser of Two Evils" Versus "Medicines not Smarties": Constructing Antipsychotics in Dementia, The Gerontologist (2017). DOI: 10.1093/geront/gnx178


Provided by University of Reading

Tuesday, November 21, 2017

Study: For older women, every movement matters

aging

Folding your laundry or doing the dishes might not be the most enjoyable parts of your day. But simple activities like these may help prolong your life, according to the findings of a new study in older women led by the University at Buffalo.

In the U.S. study of more than 6,000 white, African-American and Hispanic women ages 63 to 99, researchers reported significantly lower risk of death in those who were active at levels only slightly higher than what defines being sedentary.
Women who engaged in 30 minutes per day of light physical activity—as measured by an accelerometer instead of a questionnaire—had a 12 percent lower risk of death. Women who were able to do a half-hour each day of moderate to vigorous activity had a 39 percent lower mortality risk, according to the study, published online ahead of print today in the Journal of the American Geriatrics Society.
For the age group in this study, light physical activities include regular chores such as folding clothes, sweeping the floor or washing the windows. Activities like these account for more than 55 percent of how older people spend their daily activity. Moderate to vigorous activities would be brisk walking or bicycling at a leisurely pace.
The bottom line? "Doing something is better than nothing, even when at lower-than-guideline recommended levels of physical activity," said the study's lead author, Michael LaMonte, research associate professor of epidemiology and environmental health in UB's School of Public Health and Health Professions. "To the best of our knowledge, this is the first study to show this."
Even when researchers simultaneously accounted for the amount of each type of activity (light and moderate-to-vigorous) a woman did, they still observed significantly lower mortality associated with each time, independently of the other.
"This is remarkable because current public health guidelines require that physical activity be of at least moderate or higher intensity to confer health benefits," LaMonte, PhD, said. "Our study shows, for the first time in older women, that health is benefited even at physical activity levels below the guideline recommendations."
"The mortality benefit of light intensity activity extended to all subgroups that we examined," added study principal investigator Andrea LaCroix, professor and chief of epidemiology at the University of California, San Diego.
The mortality benefit was similar for women younger than 80 compared to women over the age of 80. It was similar across racial/ethnic backgrounds, and among obese and non-obese women. "Perhaps most importantly for this population, the mortality benefit was similar among women with high and low functional ability," LaCroix, PhD, said.
While the study focused on older women, researchers say their findings send a powerful message to younger women and men - that it's important to develop healthy habits around physical activity while you are young so that you are more likely to maintain them when you get older.
Cross off that 'to do' list, study shows all daily activity can prolong life
A recent study at UC San Diego School of Medicine reports that light physical lowers mortality risks for women age 65 and older. 
Novel approach using motion sensing devices

The study incorporated a novel approach. Unlike the majority of previous studies on this issue in which physical activity was measured using questionnaires, researchers measured physical activity using accelerometers.
These motion-sensing devices electronically document and store daily movement patterns and intensity on a 24-hour clock for as many days as the device is worn. Women in this study wore the devices for between four and seven days. Researchers then downloaded the information and analyzed it.
To make their analysis of physical activity even more specific to older women, they also conducted a laboratory study in a subset of study participants during which they aligned the accelerometer information with completion of activity tasks germane to older women's usual daily activity habits.
"No other study as large as ours and specifically on older women has included this step to enhance interpretation of accelerometer data in a context relevant to the study participants," LaMonte said.

Aging well in an aging society

The findings could have implications for national public health guidelines for physical activity for older U.S. women, especially when considering the projected growth of this particular population over the next several decades.
The researchers' findings are being considered by the U.S. Department of Health and Human Services' 2018 Physical Activity Guidelines Advisory Committee. The guidelines were first introduced in 2008 under then-HHS Secretary Michael O. Leavitt.
By 2050, the population group aged 65 and older will have doubled since 2000, reaching nearly 77 million, according to LaMonte, adding that women in this age group will outnumber men 2-to-1 at the current expected growth pattern. "Our results suggest that the health benefits of lighter activity could reach a large swath of women in an aging society," LaMonte said.
"These findings are especially relevant to aging well in an aging society," he added. "Some people, because of age or illness or deconditioning, are not able to do more strenuous activity. Current guidelines do not specifically encourage light activity because the evidence base to support such a recommendation has been lacking."

More information: Michael J. LaMonte et al, Accelerometer-Measured Physical Activity and Mortality in Women Aged 63 to 99, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15201


Provided by University at Buffalo

Sunday, November 19, 2017

Primary care physicians cautious about new guidelines for high blood pressure

Primary care physicians cautious about new guidelines for high blood pressure
The lower threshold recommended by the American College of Cardiology and the American Heart Association classifies 46 percent of U.S. adults as having high blood pressure, compared with 32 percent under the previous definition.
Primary care faculty at UMass Medical School will continue counseling patients about lifestyle modifications as well as medication to manage blood pressure and reduce cardiovascular disease risk rather than striving to achieve a set point for all, despite stringent new guidelines from the American College of Cardiology and the American Heart Association.

19 nov 2017--Formerly called "prehypertensive," systolic blood pressure between 121 and 129 over diastolic pressure of between 80 and 89 is now defined as "elevated blood pressure." This lowered threshold classifies 46 percent of U.S. adults as having high blood pressure, compared with 32 percent under the previous definition.
"Cardiovascular disease is a public health problem and we should address it as such, recommending healthy lifestyles for everyone," said Ronald Adler, MD, associate professor of family medicine & community health. "Pushing to reach the same aggressive blood pressure target for all our patients will inevitably lead to the unintended consequences of medication adverse effects plus complications such as dizziness and falls from blood pressure that is too low."
The guidelines also call for providers to assess a patient's 10-year-risk for cardiovascular disease using the ASCVD Risk Calculator—also a source of debate—to guide doctor–patient conversations and shared decision making about how to manage elevated blood pressure.
"While I have many concerns about the calculator's ability to predict future disease, it does open up the opportunity for providers and patients to discuss risk modification when discussing blood pressure," said Frank Domino, MD, professor of family medicine & community health. "To that end, I tell patients if they do not want to take a blood pressure pill, they only need to get 20 minutes of aerobic exercise five days a week."
Other American and international health organizations define high blood pressure as more than 150/90 for those older than 60 years and more than 140/90 for everyone else, including diabetics, regardless of age.
"I worry that the new guideline doesn't account for the potential harms of overdiagnosis and overtreatment, especially in the elderly," said Dr. Adler. "Our medical care should focus on controlling those with more significantly elevated blood pressure and cardiovascular risk to ensure that we reach targets about which there is widespread consensus more reliably."
The new guidelines were announced Nov. 13 and published in the journal Hypertension.

More information: Paul K. Whelton et al. 2017

ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, Hypertension (2017). DOI: 10.1161/HYP.0000000000000065


Provided by University of Massachusetts Medical School

High blood pressure is redefined as 130, not 140: US guidelines (Update)

Half of US adults have high blood pressure in new guidelines
In this June 6, 2013, file photo, a patient has her blood pressure checked by a registered nurse in Plainfield, Vt. New medical guidelines announced Monday, Nov. 13, 2017, lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition. 
High blood pressure was redefined Monday by the American Heart Association, which said the disease should be treated sooner, when it reaches 130/80 mm Hg, not the previous limit of 140/90.
Doctors now recognize that complications "can occur at those lower numbers," said the first update to comprehensive US guidelines on blood pressure detection and treatment since 2003.

19 nov 2017--A diagnosis of the new high blood pressure does not necessarily mean a person needs to take medication, but that "it's a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches," said Paul Whelton, lead author of the guidelines published in the American Heart Association journal, Hypertension, and the Journal of the American College of Cardiology.
Healthy lifestyle changes include losing weight, exercising more, eating healthier, avoiding alcohol and salt, quitting smoking and avoiding stress.
The new standard means that nearly half (46 percent) of the US population will be defined as having high blood pressure.
Previously, one in three (32 percent) had the condition, which is the second leading cause of preventable heart disease and stroke, after cigarette smoking.
The normal limit for blood pressure is considered 120 for systolic, or how much pressure the blood places on the artery walls when the heart beats, and 80 for diastolic, which is measured between beats.
Once a person reaches 130/80, "you've already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure," said Whelton.
"We want to be straight with people—if you already have a doubling of risk, you need to know about it."

People in 40s most affected

Once considered mainly a disorder among people 50 and older, the new guidelines are expected to lead to a surge of people in their 40s with high blood pressure.
"The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45," according to the report.
Damage to the blood vessels is already beginning once blood pressure reaches 130/80, said the guidelines, which were based in part on a major US-government funded study of more than 9,000 people nationwide.
The category of prehypertension, which used to refer to people with systolic pressure of 120-139, no longer exists, according to the new guidelines.
"People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89)."
Medication is only recommended for people with Stage I hypertension "if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk."
The proper technique must be used to measure blood pressure, and levels "should be based on an average of two to three readings on at least two different occasions," said the report.
"I absolutely agree with the change in what is considered high blood pressure because it allows for early lifestyle changes to be addressed," said Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York.
"It is important, however, to realize that the change in the definition does not give course to increase prescription of medications, rather that it brings to light the need to make lifestyle changes," Bhusri said in an email to AFP.
The new guidelines were announced at the American Heart Association's 2017 Scientific Sessions conference in Anaheim, California.

More information: Abstract/Full Text (subscription or payment may be required)
Guidelines Report

No cardiovascular disease reduction with intensive blood pressure lowering treatment

Blood pressure lowering treatment does not reduce death or cardiovascular disease in healthy individuals with a systolic blood pressure below 140. This is shown in a systematic review and meta-analysis from Umeå University. The results, published in JAMA Internal Medicine, support current guidelines and contradict the findings from the Systolic Blood Pressure Intervention Trial (SPRINT).

19 nov 2017--Blood pressure treatment goals have been intensively debated since the publication of the SPRINT study in 2015. While current guidelines recommend a systolic blood pressure goal < 140 mm Hg, SPRINT found additional mortality and cardiovascular diseasereduction with a goal < 120 mm Hg.
A systematic review and meta-analysis from Umeå University, published today in JAMA Internal Medicine, contradicts these findings. The Umeå study shows that treatment does not affect mortality or cardiovascular events if systolic blood pressure is < 140 mm Hg. The beneficial effect of treatment at low blood pressure levels is limited to trials in people with coronary heart disease.
"Our findings are of great importance to the debate concerning blood pressure treatment goals," says Dr Mattias Brunström, researcher at the Department of Public Health and Clinical Medicine, Umeå University and lead author.
The study is a meta-analysis, combining data from 74 randomized clinical trials, including more than 300 000 patients. The researchers separated primary preventive studies from studies in people with coronary heart disease or previous stroke. The analysis found that the treatment effect was dependent on how high blood pressure was in previously healthy individuals. If systolic blood pressure was above 140 mm Hg, treatment reduced the risk of death and cardiovascular disease. Below 140 mm Hg, treatment did not affect mortality or the risk of first-ever cardiovascular events.
"Several previous meta-analyses have found that blood pressure lowering treatment is beneficial down to levels below 130 mm Hg. We show that the beneficial effect of treatment at low blood pressure levels is limited to trials in people with coronary heart disease. In primary preventive trials, treatment effect was neutral," says Mattias Brunström.

More information: JAMA Internal Medicine (2017). DOI: 10.1001/jamainternmed.2017.6015


Provided by Umea University

Extreme swings in blood pressure are just as deadly as having consistently high blood pressure

Extreme swings in blood pressure are just as deadly as having consistently high blood pressure
Extreme ups and downs in systolic blood pressure may be just as deadly as having consistently high blood pressure, according to a new study from the Intermountain Medical Center Heart Institute in Salt Lake City.
Extreme ups and downs in systolic blood pressure may be just as deadly as having consistently high blood pressure, according to a new study from the Intermountain Medical Center Heart Institute in Salt Lake City.

19 nov 2017--Following a review of electronic medical records, researchers from the Intermountain Medical Center Heart Institute discovered that patients with systolic blood pressure numbers that varied by as much as 30 or 40 between doctor visits over an extended period of time were more likely to die than those with less extreme variances in their blood pressure.
The systolic blood pressure reading (the upper number) indicates how much pressure blood is exerting against the artery walls when the heart beats. According to the American Heart Association, a normal systolic blood pressure is less than 120. High blood pressure is categorized as above 140.
"Blood pressure is one of those numbers we encourage people to keep track of, as it's one indicator of your health heart," said Brian Clements, DO, an internal medicine specialist with the Intermountain Medical Center Heart Institute, and lead invesigator of the study. "The takeaway from the study is, if you allow your blood pressure to be uncontrolled for any period of time, or notice big changes in your blood pressure between doctor visits, you increase your risk of stroke, heart attack, kidney or heart failure, or even death."
Results of the study of nearly 11,000 patients will be reported at the 2017 American Heart Association Scientific Sessions in Anaheim, CA, on Monday, November 13.
Researchers at the Intermountain Medical Center Heart Institute modeled their study after an analysis of the largest hypertension clinical trial ever conducted - the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
They examined visit-to-visit variability of systolic blood pressure in 10,903 patient records from Intermountain Healthcare facilities. The patients were required to have had seven blood pressure measurements between 2007 and 2011. After the date of their seventh recorded systolic blood pressure measurement, the patients were followed for five years, with researchers looking at all causes of mortality.
"The call to action for patients as a result of this study is to do everything they can to control their blood pressure on a regular basis," said Dr. Clements. "Eat healthy foods, exercise regularly, and if your doctor has prescribed you medications for your blood pressure, be sure and take them consistently. Because any time your blood pressure is out of control, you're at higher risk of injury or death."
In most people, systolic blood pressure rises steadily with age due to increased stiffness of large arteries, long-term build-up of plaque, and increased incidence of cardiac and vascular disease, according to the the American Heart Association.
Dr. Clements also recommends that people control their environment when measuring their blood pressure to help reduce additional variables from influencing the measurement.
  • Sit or lay down for 15 minutes prior to taking your blood pressure. Don't do things that will cause you stress, as that may raise your blood pressure.
  • Use a blood pressure cuff that fits. Make sure it's not too tight or too large.
"After the ALLHAT study, we were in a unique position because Intermountain Healthcare has such a rich database of records that are perfect for identifying trends and outcomes," said Dr. Clements. "In this case, we're working to identify the cause of the variances in systolic blood pressure and learn if it's an independent predictor of mortality, thus helping clinicians work with their patients to better manage their heart health."


Provided by Intermountain Medical Center

Saturday, November 18, 2017

Virtual reality training may be as effective as regular therapy after stroke

stroke
A blood clot forming in the carotid artery. 
Using virtual reality therapy to improve arm and hand movement after a stroke is equally as effective as regular therapy, according to a study published in the November 15, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology.

18 nov 2017--"Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke," said study author Iris Brunner, PhD, of Aarhus University, Hammel Neurocenter in Denmark. "Future studies could also look at whether people could use virtual reality therapy remotely from their homes, which could lessen the burden and cost of traveling to a medical center for standard therapy."
The study involved 120 people with an average age of 62 who had suffered a stroke on average about a month before the study started. All of the participants had mild to severe muscle weakness or impairment in their wrists, hands or upper arms. The participants had four to five hour-long training sessions per week for four weeks. The participants' arm and hand functioning was tested at the beginning of the study, after the training ended and again three months after the start of the study.
Half of the participants had standard physical and occupational therapy. The other half had virtual reality training that was designed for rehabilitation and could be adapted to the person's abilities. The participants used a screen and gloves with sensors to play several games that incorporated arm, hand and finger movements.
"Both groups had substantial improvement in their functioning, but there was no difference between the two groups in the results," Brunner said. "These results suggest that either type of training could be used, depending on what the patient prefers."
Brunner noted that the virtual reality system was not an immersive experience. "We can only speculate whether using virtual reality goggles or other techniques to create a more immersive experience would increase the effect of the training," she said.


Provided by American Academy of Neurology

Friday, November 17, 2017

Memory complaints and cognitive decline: Data from the GuidAge study

A memory complaint, also called Subjective Cognitive Decline (SCD), is a subjective disorder that appears to be relatively common, especially in elderly persons.

17 nov 2017--The reports of its prevalence in various populations range from approximately 10% to as high as 88%, although it is generally thought that the prevalence of everyday memory problems lie within the range of 25% to 50%. It has been suggested that SCD may be an indication of cognitive decline at a very early stage of a neurodegenerative disease (i.e. preclinical stage of Alzheimer's disease) that is undetectable by standard testing instruments. SCD may represent the first symptomatic manifestation of Alzheimer's disease in individuals with unimpaired performance on cognitive tests.
The McNair and Kahn Scale or Cognitive Difficulties Scale was employed to define and characterize cognitive complaints in the GuidAge study, involving a population of more than 2800 individuals aged 70 years or older having voluntarily complained of memory problems to their general practitioner (GPs). It contains items that are related to difficulties in attention, concentration, orientation, memory, praxis, domestic activities and errands, facial recognition, task efficiency, and name finding.
The results of the GuidAge study suggest that the assessment of cognitive complaint voluntarily reported to primary-care physicians, by the McNair and Kahn scale can predict a decline in cognitive performance, as 5 items out of 20 were statistically significant.

These 5 items are:
  • item 1, "I hardly remember usual phone numbers",
  • item 5, "I forget appointment, dates, where I store things",
  • item 6, "I forget to call people back when they called me",
  • item 10, "I forget the day of the week",
  • item 13, "I need to have people repeat instructions several times".
Thanks to this short scale GPs, in clinical practice, can identify which patients with memory complaints should be referred to a memory center to assess cognitive functions.


Provided by IOS Press

Thursday, November 16, 2017

Landmark study may impact standard stroke treatment guidelines

stroke
A blood clot forming in the carotid artery. 
Standard guidelines for stroke treatment currently recommend clot removal only within six hours of stroke onset. But a milestone study with results published today in the New England Journal of Medicine shows that clot removal up to 24 hours after stroke led to significantly reduced disability for properly selected patients.

16 nov 2017--The international multi-center clinical study, known as the DAWN trial, randomly assigned 206 stroke victims who arrived at the hospital within six to 24 hours to either endovascular clot removal therapy, known as thrombectomy, or to standard medical therapy.
Thrombectomy involves a catheter placed in the femoral artery and snaked up the aorta and into the cerebral arteries where the clot that is blocking the artery, and causing the neurological symptoms, is retrieved.
Almost half of the patients (48.6 percent) who had clot removal showed a considerable decrease in disability, meaning they were independent in activities of daily living 90 days after treatment. Only 13.1 percent of the medication group had a similar decrease. There was no difference in mortality or other safety end-points between the two groups.
"These findings could impact countless stroke patients all over the world who often arrive at the hospital after the current six-hour treatment window has closed," says co-principal investigator Raul Nogueira, MD, professor of neurology, neurosurgery and radiology at Emory University School of Medicine and director of neuroendovascular service at the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital.
"When the irreversibly damaged brain area affected by the stroke is small, we see that clot removal can make a significant positive difference, even if performed outside the six-hour window," says co-principal investigator Tudor Jovin, MD, director of the University of Pittsburgh Medical Center Stroke Institute. "However, this does not diminish urgency with which patients must be rushed to the ER in the event of a stroke. The mantra 'time is brain' still holds true."
To select patients for the trial, the researchers used a new approach which used brain imaging and clinical criteria as opposed to just time alone.
"Looking at the physiological state of the brain and evaluating the extent of tissue damage and other clinical factors seems to be a better way to decide if thrombectomy will benefit patients as opposed to adhering to a rigid time window," says Nogueira.
The researchers planned to enroll a maximum of 500 patients over the course of the study period. However, a pre-planned interim review of the treatment effectiveness after 200 patients were enrolled in the trial led the independent Data Safety Monitoring Board overseeing the study to recommend early termination of the trial, based on pre-defined criteria demonstrating that clot removal provided significant clinical benefit in the studied patients.
"Our research and clinical teams are immensely proud of these breakthrough findings, which are so profound they will likely result in a paradigm shift that will not be seen again for many years in the field of stroke therapeutics," says Michael Frankel, MD, professor of neurology, Emory University School of Medicine, chief of neurology and director of the Marcus Stroke and Neuroscience Center for the Grady Health System.
According to Frankel, the Emory neuroscience team was a major contributor to the DAWN trial, working at Grady Memorial Hospital, the second leading site of the trial's enrollment.
The DAWN trial included trial locations in the United States, Spain, France, Australia and Canada. The trial was sponsored by Stryker Corporation, a medical technology company that manufactures the clot removal devices used in the study.
The DAWN trial results were presented at the European Stroke Organization Conference in May.


Provided by Emory University

Wednesday, November 15, 2017

US regulators approve first digital pill to track patients

US regulators approve first digital pill to track patients

FDA approved the first drug in the United States with a digital ingestion tracking system, in an unprecedented move to ensure that patients with mental illness take the medicine prescribed for them. The drug Abilify MyCite was developed by Otsuka Pharmaceutical
15 nov 2017--U.S. regulators have approved the first drug with a sensor that alerts doctors when the medication has been taken, offering a new way of monitoring patients but also raising privacy concerns.
The digital pill approved Monday combines two existing products: the former blockbuster psychiatric medication Abilify—long used to treat schizophrenia and bipolar disorder—with a sensor tracking system first approved in 2012.
The technology is intended to help prevent dangerous emergencies that can occur when patients skip their medication, such as manic episodes experienced by those suffering from bipolar disorder.
But developers Otsuka Pharmaceutical Co. and Proteus Digital Health are likely to face hurdles. The pill has not yet been shown to actually improve patients' medication compliance, a feature insurers are likely to insist on before paying for the pill. Additionally, patients must be willing to allow their doctors and caregivers to access the digital information.
These privacy issues are likely to crop up more often as drugmakers and medical device companies combine their products with technologies developed by Silicon Valley.
Experts say the technology could be a useful tool, but it will also change how doctors relate to their patients as they're able to see whether they are following instructions.
"It's truth serum time," said Arthur Caplan, a medical ethicist at NYU's Langone Medical Center. "Is the doctor going to start yelling at me? Am I going to get a big accusatory speech? How will that interaction be handled?"
The technology carries risks for patient privacy too if there are breaches of medical data or unauthorized use as a surveillance tool, said James Giordano, a professor of neurology at Georgetown University Medical Center.
"Could this type of device be used for real-time surveillance? The answer is of course it could," said Giordano.
The new pill, Abilify MyCite, is embedded with a digital sensor that is activated by stomach fluids, sending a signal to a patch worn by the patient and notifying a digital smartphone app that the medication has been taken.
The FDA stressed however that there are limitations to monitoring patients.
"Abilify MyCite should not be used to track drug ingestion in 'real-time' or during an emergency," the statement said, "because detection may be delayed or may not occur."
Patients can track their dosage on their smartphone and allow their doctors, family or caregivers to access the information through a website.
In a statement issued last May at the time the FDA accepted submission of the product for review, the companies said "with the patient's consent, this information could be shared with their health care professional team and selected family and friends, with the goal of allowing physicians to be more informed in making treatment decisions that are specific to the patient's needs."
While it's the first time the FDA has approved such a pill, various specialty pharmacies and hospitals in the U.S. have previously "packaged" various drugs and sensors. But the federal endorsement increases the likelihood that insurers will eventually pay for the technology.
Drugmakers frequently reformulate their drugs to extend their patent life and to justify raising prices. For instance, Otsuka already sells a long-acting injectable version of Abilify intended to last for one month. The patent on the original Abilify pill expired in 2015.
The Japanese drugmaker has not said how it will price the digital pill. Proteus Digital Health, based in Redwood City California, makes the sensor.

Tuesday, November 14, 2017

Doctors and patients make more decisions together

doctor

In a shift away from the more patriarchal/matriarchal relationship between doctor and patient, patients report an increased partnership with their physicians in making medical decisions, reports a new study from Northwestern Medicine and Harvard University.

14 nov 2017--Shared decision-making between patients and their clinicians increased 14 percent from 2002 to 2014, the study reports. According to the study, patients generally felt their physicians more commonly:
  • Asked them to help make medical decisions
  • Listened carefully to them
  • Explained things in a way that was easy to understand
  • Showed respect for what they had to say
  • Spent enough time with them
The paper will be published Monday in the Annals of Family Medicine.
"There has been increased attention among clinicians and health systems to involve patients in decision-making," said co-lead author Dr. Jeffrey Linder, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine internist. "Patients who have engaged in shared decision-making understand their condition and options better. They feel less uncertain about a chosen course of action."
Shared decision-making generally results in better-informed patients, who then decide not to use treatments or interventions that have marginal or no benefit, Linder said.
"Finally clinicians are realizing that just because we say, 'You should do that,' a patient will not necessarily comply with our recommendation," said co-lead author Dr. David Levine, an instructor in medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital in Boston. "Moving the conversation to a space where it is a shared decision likely improves adherence."
Although there was a significant increase in shared decision-making, there is still much room for improvement, the authors said. More than 30 percent of Americans felt their clinician did not always listen to them, and more than 40 percent felt their clinician did not always spend enough time with them.
The study also highlighted a few areas where shared decision-making is lacking. Shared decision-making scores were lower for patients in poor health and for patients who were of a different race/ethnicity than their clinician. Focusing on patients with poor health or of a different race/ethnicity than the doctor or clinician could increase shared decision-making in these groups.
The study was an analysis of a nationally representative survey of Americans. It involved about 10,000 people per year from 2002 to 2014.


Provided by Northwestern University

Monday, November 13, 2017

Research shows low chance of sudden cardiac arrest after sex

sex

A small percentage of sudden cardiac arrest events are related to sexual activity, but survival rates in those cases remain low, according to a research letter published today in the Journal of the American College of Cardiology and presented at the American Heart Association's Scientific Sessions 2017. Despite these sexual activity related SCA events being witnessed by a partner, bystander CPR was performed in only one-third of cases.

13 nov 2017--Sudden cardiac arrest (SCA) is when the heart suddenly stops beating; it usually occurs without warning. If not treated immediately it can lead to sudden cardiac death, which results in around 350,000 deaths annually in the United States. It is known that sexual activity may trigger non-fatal cardiac events such as myocardial infarction, but researchers in this study sought to determine if sexual activity is a potential trigger for SCA in the general population.
The researchers looked at the community-based Oregon Sudden Unexpected Death Study (Oregon SUDS) database from 2002 to 2015 to discover the frequency to which SCA occurred during or within one hour after sexual activity for all persons over the age of 18. All reported cases of SCA were based on emergency medical service reports containing detailed information regarding cause of the cardiac arrest event.
In total, the researchers identified 4,557 SCAs in Portland during the 13-year study period. Of these, 34 (0.7 percent) of SCAs were linked to sexual activity. On average, these patients were more likely to be male, middle-aged, African-American and have a history of cardiovascular disease, with a majority taking cardiovascular medication. Patients who experienced SCA related to sexual activity also had a higher rate of ventricular fibrillation/tachycardia than those who did not.
Only one-third of these SCA cases received bystander CPR. The researchers determined that the low bystander CPR rate accounted for the less than 20 percent of patients who survived to hospital discharge.
"Even though SCA during sexual activity was witnessed by a partner, bystander CPR was performed in only one-third of the cases," said Sumeet Chugh, MD, senior study author and associate director of the Cedars-Sinai Heart Institute. "These findings highlight the importance of continued efforts to educate the public on the importance of bystander CPR for SCA, irrespective of the circumstance."
Limitations to the study included unknown information surrounding the frequency of sexual activity, so researchers could not determine relative risk compared to rest and physical activity.
Overall, the study authors said they found a relatively low burden of SCA in relation to sexual activity. The majority of cases were men with a previous history of cardiovascular disease. The researchers also noted that some cases of SCA after sexual activity may also involve medications, stimulants and alcohol use.

More information: Aapo L. Aro et al, Sexual Activity as a Trigger for Sudden Cardiac Arrest, Journal of the American College of Cardiology (2017). DOI: 10.1016/j.jacc.2017.09.025 , dx.doi.org/10.1016/j.jacc.2017.09.025


Provided by American College of Cardiology