Month: January 2014

As Schools Boost Access to EpiPens, Do Teachers Know How to Use Them?

Dr. Dave Stukus, a pediatric allergist at Nationwide Children’s Hospital says anyone with severe allergies knows that an epinephrine auto-injector can be the difference between life and death. With approximately two and a half million epinephrine auto-injectors (such as EpiPens and Auvi-Qs) in circulation, my colleagues and I at Nationwide Children’s Hospital want to ensure that people know how to administer them appropriately — you could save a life.

A new law signed by President Barack Obama on Nov. 13 last year provides states with financial incentives to pass laws that allow schools to stock epinephrine, and to treat children who do not have a prescription for the drug. As a result, more people will be administering auto-injectors for the first time.

It is not hard to use one, you just need to take action quickly. In fact, the most common reason associated with death from severe allergies is waiting too long to administer epinephrine.

The good news is that instructions are written and pictured on each auto-injector. One type of auto-injector even gives verbal instructions.

Here’s what you will need to know to correctly use an auto-injector:

1. Prepare the device

Pull off the safety cap. Make a fist around the syringe so the tip is pointing down. But there’s a warning: DO NOT PUT YOUR THUMB ON THE ORANGE TIP. The needle comes out of the orange tip.

2. Inject the medicine

While you do not need to apply excessive force, you will swing your arm a bit to inject the contents of an auto-injector (you need to provide enough force that the needle deploys from the auto-injector tip and delivers its contents directly into thigh muscle). First, hold the orange tip near the patient’s outer thigh to position the device at a 90-degree angle (needle-tip straight down), then swing the auto-injector against the patient’s outer thigh and press firmly against it until you hear a click. Hold the auto-injector against the thigh for 10 seconds. Then, remove the auto-injector from the thigh and massage the injection site for 10 seconds. You can leave the patient’s pants on if necessary; the device will work right through them.? [8 Strange Signs You’re Having an Allergic Reaction ]

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3. Get emergency medical help

Always call 9-1-1 after using epinephrine. The medicine may start to wear off or the reaction may come back. You can repeat the dose in 5 minutes if the child is not improving. Give the used epinephrine injector to a health care provider and ask for a refill right away if needed.

A few other things to note: Inhalers, such as albuterol and antihistamines (such as Benadryl), are not enough to treat severe allergic reactions. They can be given after epinephrine is used, if available. When in doubt, give epinephrine!

Do not store an auto-injector in a refrigerator or a hot car. It should be kept at room temperature. The liquid medicine in the pen should be clear. If it is discolored or has floating specks, get a new pen.

Source: live science

Meyer Lemon and Ginger for sore throat

There is a lot going on in this lovely infusion, with the tart lemon and pungent ginger. Turmeric contributes beautiful color, along with its nutritional benefits – it has been shown to have powerful anti-inflammatory and antioxidant attributes — and the tiny pinch of cayenne packs a small punch. If you feel a sore throat coming on I highly recommend this tea

4 slices Meyer lemon

1 tablespoon minced ginger

2 cloves

1/8 teaspoon turmeric

2 1/2 cups boiling water

2 to 3 teaspoons honey (to taste)

Pinch of cayenne

Place the lemon slices, ginger, cloves, and turmeric in a large measuring cup or teapot and pour on the boiling water. Stir in the honey, cover and let steep for 30 minutes. Strain and reheat if desired but do not boil. Just before serving add a tiny pinch of cayenne.

Yield: Serves 2

Advance preparation: You can keep this in the refrigerator for a day. Reheat but do not boil.

Nutritional information per serving (Note: Nutritional values refer only to the honey used in the infusion as the amount of nutrients absorbed from the other ingredients is difficult to measure): 21 calories; 0 grams fat; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 6 grams carbohydrates; 0 grams dietary fiber; 1 milligram sodium; 0 grams protein

Source: New york times

Teen fitness is linked to reduced risk of myocardial infarction

If teenage boys were asked to choose between exercising and playing computer games, the majority would choose computer games. But new research suggests adolescent boys should be more physically active, as low fitness levels may increase their risk of having a heart attack later in life.

This is according to a study published in the European Heart Journal.

A research team from Sweden, led by Prof. Peter Nordström, of Umeå University, analyzed data of 743,498 men. All men were a part of the Swedish armed forces between 1969 and 1984, and underwent a medical examination when they were 18-years-old.

The medical examination involved measuring the participants’ blood pressure, weight, height and muscle strength.

It also measured their aerobic fitness through a cycle test. Cycling resistance was increased by 25 watts a minute until the participants’ were too exhausted to carry on. Their maximum wattage was used for the study.

The research team divided the participants’ results into five groups, ranging from the lowest levels of aerobic fitness to the highest.

All men were followed for an average of 34 years until either the date of death, the date of their first heart attack, or until January 1 2011.

During the follow-up period, there were 7,575 incidences of myocardial infarctions – the equivalent to approximately 1,222 heart attacks per 100,000 men.

High aerobic fitness linked to lower heart attack risk
On comparing aerobic fitness with the participants’ risk of heart attack, the researchers found that men in the lowest aerobic fitness group were 2.1 times more likely to suffer a heart attack later in life compared with men in the highest aerobic fitness group.

The results also revealed that for every 15% increase in aerobic fitness, the men were 18% less likely to have a heart attack. This was after taking factors such as body mass index (BMI) and socioeconomic background into consideration.

Furthermore, the investigators found that men who carried out regular cardiovascular training in late adolescence reduced their risk of heart attack later in life by 35%.

Results dependent on BMI
To analyze how BMI and aerobic fitness combined had an impact on the participants’ risk of heart attack, the researchers separated the men into four groups in line with the World Health Organization’s definitions of BMI.

These were:

Underweight/lean (BMI less than 18.5kg/m2)
Normal weight (BMI between 18.5-25kg/m2)
Overweight (BMI between 25-30kg/m2)
Obese (BMI over 30kg/m2)
Results revealed that the fittest obese men had almost double the risk of heart attack compared with men who were lean but the most unfit. Furthermore, the fittest obese men had almost four times the risk of heart attack compared with the fittest lean men.

Commenting on their findings, Prof. Nordström says:

“Our findings suggest that high aerobic fitness in late adolescence may reduce the risk of heart attack later in life.

However, being very fit does not appear to fully compensate for being overweight or obese in respect to this risk. Our study suggests that it’s more important not to be overweight or obese than to be fit, but that it’s even better to be both fit and a normal weight.”

He notes that further research is needed to determine how these findings are clinically relevant, “but given the strong association that we have found,” he adds, “the low cost and easy accessibility of cardiovascular training, and the role of heart disease as a major cause of illness and death worldwide, these results are important with respect to public health.”

Source: Medical news today

Mediterranean diet linked to lower risk of Type 2 diabetes

Even without weight loss, adhering to a diet rich in fresh produce, chicken, fish and olive oil is 40% more effective in heading off the development of Type 2 diabetes than following a low-fat diet, a new study has found.

The research suggests that for the nation’s 78 million obese adults, a diet that minimizes red meat and sweets but incorporates plant-based fats may be a sustainable way to improve health — even if permanent weight reduction proves elusive.

The findings add to mounting research that suggests a traditional Mediterranean diet may be easier to adhere to and more likely to improve health than more restrictive regimens.
Compared with those on a low-fat diet, trial participants whose Mediterranean-style diet was supplemented with a daily dose of tree nuts — almonds, walnuts and hazelnuts — were 18% less likely to develop Type 2 diabetes. The researchers called that a positive trend but acknowledged that the difference fell short of demonstrating beyond doubt the superiority of such a diet over a standard low-fat diet.

Published Monday in the Annals of Internal Medicine, the latest entry in the diet fray followed for more than four years a group of 3,541 older Spaniards who were at high risk of developing cardiovascular disease. They were a subgroup of a larger clinical trial that demonstrated the effectiveness of the Mediterranean diet in reducing the risk of heart attacks and strokes.

Source: latimes

Anti-smoking efforts have saved 8 million American lives

Anti-tobacco efforts have saved 8 million lives in the 50 years since the publication of a landmark Surgeon General report, “Smoking and Health,” a new analysis shows.

The 1964 report, which concluded that tobacco causes lung cancer, led to a sea change in American attitudes toward smoking. Smoking rates have plunged 59% since then, falling from 42% of adults in 1964 to 18% in 2012, according to the Centers for Disease Control and Prevention.

By avoiding tobacco or quitting the habit, people have gained nearly two decades of life, according to the analysis, published Tuesday in the Journal of the American Medical Association.

An American man’s life expectancy at age 40 has increased by an average of nearly eight years, and a woman’s by nearly 5½ years, since 1964. About one-third of those gains come from decreased tobacco use, the analysis says.

“Tobacco control has been described, accurately, as one of the great public health successes of the 20th century,” CDC director Thomas Frieden writes in an accompanying editorial.

Twenty-six states and Washington, D.C., now ban smoking in indoor public places. As smoking rates have declined, so have the incidence rates of many cancers. About 40% of the decline in men’s overall cancer death rates, in fact, is due to the drop in tobacco use, according to the American Cancer Society.

Tobacco damages virtually every part of the body, Frieden says, causing one-third of heart attacks. Smoking increases the risk of 14 kinds of cancer, including acute myeloid leukemia and tumors of the mouth, esophagus, stomach and pancreas, according to the American Cancer Society. About 443,000 Americans die from smoking-related illnesses every year.

Nearly 18 million Americans have died from tobacco just since the Surgeon General report was published, according to the new analysis, led by Theodore Holford of the Yale University School of Public Health.

Tobacco killed 100 million people worldwide in the 20th century, according to the Campaign for Tobacco-Free Kids. If current trends continue, tobacco will kill an additional 1 billion in the 21st century, the group estimates.

Frieden notes that smoking remains a major health challenge. Nearly one-third of non-smokers are still exposed to secondhand smoke, either at home or at work. Images of smoking are still common on TV and in movies. Tobacco taxes are too low in many parts of the country, making cigarettes affordable for both adults and kids. And although most smokers say they want to quit, few of them receive proven treatment, such as counseling and medication, which together can double their odds of kicking the habit, he writes.

A spokesman for R.J. Reynolds Tobacco Company declined to comment.

David Sylvia, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says his company’s goal today is simply to make current smokers aware of its brands, and it has no interest in attracting new smokers.

“Adults should have the ability to choose to purchase a legal product,” Sylvia says. “We want to make sure that when adult, current smokers are choosing their brand, they think about our brand.”

Source: USA Today

Hookah smoking’s dangers lead to bans

Do you smoke cigarettes? What about marijuana? Many doctors, including myself, routinely ask patients these questions. Over the years, fewer and fewer people say yes. But if you — like me — thought Canada was winning the war on smoking, look again.

New data suggests young Canadians are turning to waterpipes, also called shisha or hookah — and the fumes they’re inhaling may be even more toxic than cigarettes.

Traditionally, hookah smokers use harsh flavourless tobacco, but flavours like fruit, chocolate and even bubble gum are now popular.

Almost 10 per cent of Ontario students between Grades 7 and 12 smoked a hookah in the last year, according to the 2013 Ontario Drug Use and Health Survey performed by the Centre for Addiction and Mental Health (CAMH). That’s one and a half per cent more than reported cigarette use in this age group.

A similar trend is occurring across the country. According to a study published in Preventing Chronic Disease in May, researchers from the University of Waterloo found that the number of Grade 9 to 12 students in Canada reporting ever using a hookah increased from 9.5 per cent in 2006 to 10.1 per cent in 2010, while cigarette use declined during that time.

Hookah bars in Canada aren’t required to have age restrictions because they serve tobacco-free herbal hookah — which for the most part, isn’t prohibited by anti-tobacco smoking laws. But hookah smoke can be just as dangerous as cigarette smoke because the charcoal used to heat tobacco in waterpipes emits high levels of carbon monoxide, metals, and cancer-causing chemicals. And that’s now prompting lawmakers across Canada to look at ways to curb the practice.

Alberta passed a law in November that bans hookah smoking in public places altogether. Many Ontario towns and cities like Barrie, Peterborough, Brantford, and Orillia have put similar bylaws in place, despite no province-wide action. Toronto alone has more than 80 hookah bars.

Hookah originated in the Middle East and India in the 16th century. Waterpipes burn charcoal to heat tobacco or herbs, producing smoke. The pipe then bubbles the smoke through water to cool it before inhalation.

Traditionally, hookah smokers use harsh flavourless tobacco. But mixing tobacco with flavours like fruit, chocolate and even bubble gum is now popular. Since smoking tobacco indoors is not allowed in most places in Canada — bars serve herbal hookah instead. “Herbal” tobacco-free hookah uses a mixture of flavours and herbs.

Hookah poses health hazards to smokers and those exposed to second hand smoke, says Roberta Ferrence. (CBC)

Appealing flavours are pulling in users far beyond Arab communities. In fact, the latest Canadian Youth Smoking Survey funded by Health Canada showed that young people of African, Latin American and Asian descent were the most likely to use the pipes.

Because hookah smokers share a pipe, “it’s a great way to spend time with friends,” says Anton Volov, a first-year undergraduate student at York University – adding that “my friends have told me it’s healthier than cigarettes.”Volov smokes hookah at bars twice a week and enjoys trying new flavours each time.

Hookah poses serious potential health hazards to smokers and those exposed to second hand smoke — just like cigarettes, says Dr. Roberta Ferrence, the senior scientific advisor to the Ontario Tobacco Research Unit, a lead research agency funded by the Ontario government. Hookah smokers are at increased risk for heart and lung disease and cancer, she adds.

Herbal hookah’s hazards

The United States Centers for Disease Control and Prevention explains that hookah users may absorb higher concentrations of toxins than cigarette users — because they puff more often, inhale more deeply and smoke for longer periods of time in each session. A typical 1-hour hookah session involves 200 puffs, while an average cigarette is 20 puffs.

Thus far, Alberta is the only province to take action and ban hookah smoking. “The evidence for the hazardous effects of hookah, even herbal hookah, is clear. We have to protect our youth,” says Fred Horne, Alberta’s Minister of Health.

Now, the Ontario Campaign for Action on Tobacco wants the Government of Ontario to bring “tobacco-like” products under existing Smoke-Free legislation, which would make it illegal to serve even herbal hookah in public areas.

Ontario is committed to ensuring tobacco-containing hookah is not smoked in public areas, as already prohibited by law, says David Jensen, spokesperson for the Ontario Ministry of Health and Long Term Care. But Ontario is not planning to outright ban hookah use in public areas — because research showing the harmful effects of herbal hookah is limited and smoking hookah “is a social or cultural activity for some people,” Jensen says.

Michael Perley, the director of the Ontario Campaign for Action on Tobacco, disagrees. “This is clearly not a cultural activity anymore,” he says. The hazardous health effects of herbal hookah are well known, he adds.

In a study published in Tobacco Control in September, researchers in Alberta found that smoke from herbal hookah contained levels of toxic substances equal to or in excess of cigarette smoke. Ferrence performed a similar study published in Tobacco Control in September that examined the air quality of 12 hookah bars in Toronto — where only herbal hookah was allowed. The air contained much higher levels of cancer-causing particulate matter and carbon monoxide than those found in smoking rooms of bars.

They also found high air nicotine levels in most of these hookah bars, suggesting hookah with tobacco was still being served. Many bars claim they serve herbal hookah to get around tobacco-free legislation — but we know this isn’t true, Perley says. But it doesn’t matter whether hookah contains tobacco or is herbal — the health risks are still there, Ferrence says.

Donald Martin, a consultant lobbyist with Safe Shisha — a group that promotes safe and responsible hookah use on behalf of bar owners in Alberta — argues against banning hookah. Instead, he wants hookah bar regulations like age restrictions, special licenses, and ventilation standards. “Anybody can just set up shop, why not introduce some regulations to ensure hookah is smoked safely,” Martin says. “How is this different than licensing alcohol?” he asks.

Simply regulating hookah bars would leave Canada behind Lebanon, Turkey, and parts of Saudi Arabia and India — where governments have banned the indoor smoking of hookah, Perley says. “Even countries where hookah is traditionally used are banning it,” he says.

People need to know how harmful hookah can be, Ferrence says. In Beijing, people are told to stay in their homes when particulate matter levels in the air due to smog exceed 500 micrograms per cubic meter. “We consistently measured levels of 1500 in hookah bars, that’s three times the amount,” she says. “In one bar, levels were as high as 17,000,” she adds.

Source: CBC news

Ear Acupuncture May Hold Promise for Weight Loss

Placing five acupuncture needles in the outer ear may help people lose that spare tire, researchers report.

Ear acupuncture therapy is based on the theory that the outer ear represents all parts of the body. One type uses one needle inserted into the area that is linked to hunger and appetite, while the other involves inserting five needles at different key points in the ear.

“If the trend we found is supported by other studies, the hunger acupuncture point is a good choice in terms of convenience. However, for patients suffering from central obesity, continuous stimulation of five acupuncture points should be used,” said lead researcher Sabina Lim, from the department of meridian and acupuncture in the Graduate College of Basic Korean Medical Science at Kyung Hee University in Seoul, South Korea.

According to Lim, the effectiveness of acupuncture on obese patients is closely related to metabolic function. “Increased metabolic function promotes the consumption of body fat, overall, resulting in weight loss,” she said.

The report was published online Dec. 16 in the journal Acupuncture in Medicine.

Dr. David Katz, director of the Yale University Prevention Research Center, said, “We must avoid rushing to judge that a treatment is ineffective just because we don’t understand the mechanism. Rather, if a treatment is genuinely effective, it invites us to figure out the mechanism.”

But this study does not prove the effectiveness of acupuncture, he said. “Placebo effects are strong, particularly when they involve needles. The evidence here falls short of proof,” Katz said.

According to the U.S. National Center for Complementary and Alternative Medicine, results from the few studies on acupuncture and weight loss have been mixed.

In one study, researchers examined the effect of ear acupuncture with sham acupuncture on obese women. “Researchers found no statistical difference in body weight, body-mass index and waist circumference between the acupuncture group and placebo,” said Katy Danielson, a spokeswoman for the center.

For this latest study, Lim and her colleagues compared acupuncture of five points on the outer ear with one-point acupuncture. They randomly assigned 91 overweight people to five-point acupuncture, one-point acupuncture (hunger) or sham (placebo) treatment.

During the eight weeks of the study, participants were told to follow a restrictive diet, but not a weight-loss diet. They were not supposed to increase their exercise.

Those who received five-point acupuncture had needles placed 2 millimeters deep in one outer ear taped in place and kept there for a week. Then the same treatment was applied to the other ear. The process was repeated over eight weeks.

Other patients received similar treatment with one needle or with sham acupuncture where the needles were removed immediately after insertion.

source: webmd

Reduction in hospital medical errors with improved handoff communication

A new study from Boston Children’s Hospital’s division of general paediatrics — published by the Journal of the American Medical Association (JAMA) — indicates that improving verbal and written communication during patient handoffs can reduce medical errors substantially without burdening existing workflows.

Medical errors are a leading cause of death and injury in the US, with an estimated 80 per cent of serious medical errors involving some form of miscommunication, particularly when care is transferred in a hospital setting from one provider to the next.

“By introducing more standardized communication during patient handoffs for this study, Boston Children’s saw a substantial drop in the overall number of medical errors,” says the study’s principal investigator Dr Christopher Landrigan.

“We believe if other medical centres adopted similar protocols it could have a positive and significant impact on patient safety.”

Error types included those with little or no potential for harm, intercepted potential adverse events, non-intercepted potential adverse events and preventable adverse events. Preventable adverse events decreased from 3.3 per 100 admissions to 1.5 per 100 admissions following intervention.

With the goal of improving provider-to-provider communication, Dr Landrigan and Dr Amy Starmer, lead author of the study, designed a multi-faceted, bundled handoff system consisting of three key components: standardized communication and handoff training, a verbal mnemonic and a new team handoff structure.

“Traditionally, doctors are trained in medical school to interview a patient and write daily summaries of the care plan, but though vital to patient care, rarely receive communication or handoff training,” says Dr Starmer. “We sought to rectify that omission with this study.”

The researchers examined 1,255 patient admissions that occurred during the implementation of the handoff bundle to measure how it impacted patient care and clinician workflow across two separate inpatient units at Boston Children’s.

Implementation of the new system began with an interactive workshop for all participating clinicians, during which they practiced giving and receiving handoffs under different clinical and real-world scenarios. The workshop was based on best practices for handoffs using elements of the TeamSTEPPS communication programme, developed by the military and the US Agency for Healthcare Research and Quality.

Secondly, participants adopted an easy-to-remember mnemonic to ensure all relevant information was verbally communicated during the handoff. Face-to-face handoffs were also restructured to involve all team members and minimize interruptions and distractions.

Finally, in conjunction with Boston Children’s informatics team, the researchers created a structured handoff tool within the electronic medical record (EMR) to standardize the documentation of patient information that is transmitted at change of shift. The electronic handoff tool self-populates with standard patient information. This replaced the previous method of information exchange that required clinicians to manually enter and re-enter information in a word processing document, increasing the potential for human error.

After implementation of the communication bundle there were fewer omissions or miscommunications about important data during handoffs, which led to positive results. Of the 1,255 patient admissions studied, medical errors decreased 45.8 per cent. In addition, following the intervention, providers spent more time communicating face-to-face in quiet areas conducive to conversation, and spent more time at the bedside with patients.

“We believed these systems would lead to a reduction in medical errors, but did not expect to see a change of this magnitude,” Dr Starmer says. “And even more surprising was that the systems were introduced so easily. Participants embraced the new systems, became more productive, and could then focus more energy to the job at hand.”

Based on the results of this study, Dr Landrigan and team developed I-PASS, a handoff bundle rolling out to 10 teaching hospitals across North America.

“Our ultimate goal,” says Dr Landrigan, “is to develop a robust handoff programme that can be broadly disseminated across hospitals and specialties to reduce medical errors and optimize patient safety.”

Source: India Medical Times

Medical student finds real illness in actor faking symptoms

Diagnosing medical conditions can be a tricky business at the best of times, but University of Virginia medical student Ryan Jones recently made the perfect call during a training exercise.

During the simulation last March, medical actor Jim Malloy’s job was to accurately and convincingly portray a patient with the symptoms of abdominal aortic aneurysm, a condition in which a small section of the lower aorta begins to balloon.

The university medical facility says the condition is common in men between 65 and 75 years old, adding that such aneurysms can easily go undetected and possibly be fatal if they burst.

Even though it was just a simulation, Jones said he detected the symptoms of a real aneurysm. He felt a mass in Malloy’s abdomen.

“I figured [the university] must have found a man with an aneurysm who was willing to volunteer,” Jones said.

“I thought it was all prearranged,” he said, adding that Malloy even kept in character when he informed him what he had found.

Jones informed an attending physician, who advised Malloy to consult a cardiologist.

A subsequent ultrasound revealed Malloy had a 5.9-centimetre-long aneurysm.

Last August, he underwent stent placement surgery at the university medical centre, and is now doing fine.

Since making that very real diagnosis, Jones has graduated from medical school and is currently applying for residency.

Click the audio at left to hear the interview from As It Happens with Jones and Malloy.

Source: CBC news

Hepatitis E Outbreak in Uganda

Health Minister Christine Ondoa has expressed concern over the rising prevalence of Hepatitis B in eastern Uganda, despite efforts to contain the deadly disease.

“Ministry and district health officers are working tirelessly to see that we solve this problem; we call upon all people to embrace preventive measures because it is better than cure,” Ondoa said in Soroti last week,

Like HIV, Hepatitis B spreads through sex, mother-to-child transmission, sharing of sharp objects and blood transfusion. But it is 15 times more infectious than HIV/Aids.

The disease is incurable and difficult to detect, and causes liver cancer and chronic liver failure.

“The government has already introduced medicine for children below one year,” Ondoa said, as the government launched a programme to distribute 21 million nets. “This is the vaccine they get below the left thigh when they are six weeks; parents immunize your children against Hepatitis B.”

Hepatitis B virus infection is highly endemic in Uganda, with transmission occurring in childhood and adulthood. Some 1.4 million adults are chronically infected and some communities disproportionately affected.

Source: All Africa