March 24, 2010, 12:13 AM CT
Advance care planning improves end of life care
Advance care planning improves end of life care and reduces stress, anxiety and depression in surviving relatives, as per new research published on bmj.com today.
Advance care planning has the potential to improve end of life care by enabling patients to discuss and document their future health wishes, and appoint a substitute decision maker (surrogate), thus increasing the likelihood of patient wishes being known and respected at the end of life.
But no randomised controlled trials have investigated whether advance care planning improves end of life care.
So scientists based in Australia set out to test the theory that coordinated advance care planning would improve end of life care, the perceptions of the quality of care, and levels of stress, anxiety, and depression in surviving relatives.
Their study involved 309 competent patients aged 80 or more who were admitted to a large university hospital in Melbourne between August 2007 and March 2008.
A total of 155 patients received usual care (control group) and 154 received usual care plus advance care planning from trained non-medical facilitators (intervention group). Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical therapy preferences; to appoint a surrogate; and to document their wishes.........
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March 24, 2010, 12:12 AM CT
New guidance to improve trial reports
New guidance to improve the reporting of trial findings is published simultaneously today (24 March 2010) by the BMJ
and eight other leading journals around the world.
Full and transparent reporting of trials is crucial to ensure that decisions about health care are based on the best available evidence.
The guidance, known as the Consolidated Standards of Reporting Trials (CONSORT) statement, was first published in 1996 and revised in 2001. It includes a checklist to help authors write reports of randomised controlled trials so that others can judge the reliability and validity of the results.
More than 400 journals and three leading editorial groups across the world have now given their official support to CONSORT.
The latest version, CONSORT 2010, improves the specificity and clarity of the prior checklist. Several new items will also make it easier for decision makers to judge the soundness of trial results. A separate explanatory paper, also published by the BMJ today, provides published examples of transparent reporting.
Speaking on behalf of co-authors, Douglas Altman and David Moher, and for the CONSORT Group, Kenneth Schulz, Distinguished Scientist and Vice President of Family Health International in the US emphasises that CONSORT 2010 represents an evolving guideline. He says: "In the future we will further revise the CONSORT material considering comments, criticisms, experiences, and accumulating new evidence. We invite readers to submit recommendations via the CONSORT website (www.consort-statement.org)."........
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March 24, 2010, 12:10 AM CT
Chemotherapy plus synthetic compound for pancreatic cancers
Human pancreas cancer cells dramatically regress when treated with chemotherapy in combination with a synthetic compound that mimics the action of a naturally occurring "death-promoting" protein found in cells, scientists at UT Southwestern Medical Center have found.
The research, conducted in mice, appears in today's issue of Cancer Research
and could lead to more effective therapies for pancreatic and possibly other cancers, the scientists said.
"This compound enhanced the efficacy of chemotherapy and improved survival in multiple animal models of pancreas cancer," said Dr. Rolf Brekken, associate professor of surgery and pharmacology and the study's senior author. "We now have multiple lines of evidence in animals showing that this combination is having a potent effect on pancreas cancer, which is a devastating disease".
In this study, Dr. Brekken and his team transplanted human pancreatic tumors into mice, then allowed the tumors to grow to a significant size. They then administered a synthetic compound called JP1201 in combination with gemcitabine, a chemotherapeutic drug that is considered the standard of care for patients with pancreas cancer. They observed that the drug combination caused regression of the tumors.
"There was a 50 percent regression in tumor size during a two-week therapy of the mice," Dr. Brekken said. "We also looked at survival groups of the animals, which is often depressing in human therapeutic studies for pancreas cancer because virtually nothing works. We found not only significant decrease in tumor size, but meaningful prolongation of life with the drug combination".........
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March 22, 2010, 7:50 PM CT
Seaweed against obesity
Seaweed could hold the key to tackling obesity after it was found it reduces fat uptake by more than 75 per cent, new research has shown.
Now the team at Newcastle University are adding seaweed fibre to bread to see if they can develop foods that help you lose weight while you eat them.
A team of researchers led by Dr Iain Brownlee and Prof Jeff Pearson have observed that dietary fibre in one of the world's largest commercially-used seaweed could reduce the amount of fat absorbed by the body by around 75 per cent.
The Newcastle University team observed that Alginate a natural fibre found in sea kelp stops the body from absorbing fat better than most anti-obesity therapys currently available over the counter.
Using an artificial gut, they tested the effectiveness of more than 60 different natural fibres by measuring the amount of fat that was digested and absorbed with each therapy.
Presenting their findings today at the American Chemical Society Spring meeting in San Francisco, Dr Brownlee said the next step was to recruit volunteers and study whether the effects they have modelled in the lab can be reproduced in real people, and whether such foods are truly acceptable in a normal diet.
"The aim of this study was to put these products to the test and our initial findings are that alginates significantly reduce fat digestion," explains Dr Brownlee.........
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March 22, 2010, 7:45 PM CT
Gene linked to lung cancer in never-smokers
A five-center collaborative study that scanned the genomes of thousands of "never smokers" diagnosed with lung cancer as well as healthy never smokers has found a gene they say could be responsible for a significant number of those cancers.
In the March 22 on line issue of Lancet Oncology
, the scientists reported that about 30 percent of patients who never smoked and who developed lung cancer had the same uncommon variant, or allele, residing in a gene known as GPC5. The research was co-led by researchers at the Mayo Clinic campus in Minnesota, Harvard University, University of California at Los Angeles (UCLA), and MD Anderson Cancer Center. Scientists found in laboratory studies that this allele leads to greatly reduced GPC5 expression, in comparison to normal lung tissue. The finding suggests that the gene has an important tumor suppressor-like function and that insufficient function can promote lung cancer development.
"This is the first gene that has been observed that is specifically linked to lung cancer in people who have never smoked," says the study's lead investigator, Ping Yang, M.D., Ph.D., Mayo Clinic genetic epidemiologist.
"What's more, our findings suggest GPC5 appears to be a critical gene in lung cancer development and genetic variations of this gene may significantly contribute to increased risk of lung cancer," she says. "This is very exciting".........
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March 19, 2010, 10:44 AM CT
Ultrasound to Treat Chronic Pain
An osteoarthritic knee has damaged joint surfaces, inflamation and swelling. This creates a stagnant environment. Just like a saturated sponge will not accept more water, the osteoarthritic joint is slow to soak up nutrients. However, ultrasound delivered at a low volume for a long time through a newly designed compact transducer agitates remaining cartilage and tissues. The ultrasound penetrates the joint and tissues. It stimulates the joint thermally and mechanically and improves permeability, creating a dynamic environment conducive to healing. Similar to a sponge that has been wrung out, the treated knee is now able to absorb nutrients. The waste is removed and swelling subsides.
Credit: Zina Deretsky, National Science Foundation
Imagine that after long day tending to patients, a middle-aged nurse feels a burning pain in her knees so intense she can barely walk. For millions of people who suffer from arthritis or other chronic joint pain, this is a familiar story. Right now there are few day-to-day therapies available for these patients, and a number of involve strong medications that can be harmful over time.
If George K. Lewis, a biomedical engineering graduate student at Cornell University has his way, there may soon be another option. Lewis and colleagues have created a miniaturized ultrasound device that would allow patients to apply ultrasound treatment to inflamed joints at home, work, or even while going about their day.
Most of us are familiar with the amazing powers of diagnostic ultrasound technologies in modern medicine, which allow doctors to tell us the gender of a child previous to birth or the condition of our internal organs without exploratory surgery. Doctors have also used ultrasound therapeutically to effectively treat joint pain from arthritis and other ailments without the use of drugs. The drawback to these current therapys, however, is that they can only be administered in a doctor's office or clinic, since the ultrasound devices available are bulky and expensive.........
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March 19, 2010, 7:40 AM CT
Failed college dreams don't spell depression
High school seniors, take note: A wise person once said, "It is better to shoot for the stars and miss than aim at the gutter and hit it".
That's right on, says Florida State University Sociology Professor John R. Reynolds, who just completed a study to determine whether unrealized educational expectations are linked to depression among adults. Reynolds also is the director of the Pepper Institute on Aging and Public Policy at Florida State.
He and co-author Chardie L. Baird, an assistant professor of sociology at Kansas State University, found no long-term emotional costs of aiming high and falling short when it comes to educational aspirations, despite several social psychological theories that would seem to suggest otherwise. The researchers' conclusion: Society should not discourage unpromising students who have dreams of earning a college degree.
"We should not be in a hurry to dissuade these students from planning to go to college," Reynolds said. "In fact, the only way to guarantee negative mental health outcomes is not trying. Aiming high and failing is not consequential for mental health, while trying may lead to higher achievements and the mental and material benefits that go along with those achievements".
"Is There a Downside to Shooting for the Stars? Unrealized Educational Expectations and Symptoms of Depression," which was reported in the American Sociological Review
(http://asr.sagepub.com/cgi/content/full/75/1/151), is the first large, national study to look at the mental health consequences of failing to meet educational expectations.........
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March 19, 2010, 7:32 AM CT
Acne Drug Prevents Hiv Breakout
Janice E. Clements, Ph.D.
Johns Hopkins researchers have observed that a safe and inexpensive antibiotic in use since the 1970s for treating acne effectively targets infected immune cells in which HIV, the virus that causes AIDS, lies dormant and prevents them from reactivating and replicating.
The drug, minocycline, likely will improve on the current therapy regimens of HIV-infected patients if used in combination with a standard drug cocktail known as HAART (Highly Active Antiretroviral Therapy), as per research published now online and appearing in print April 15 in The Journal of Infectious Diseases. "The powerful advantage to using minocycline is that the virus appears less able to develop drug resistance because minocycline targets cellular pathways not viral proteins," says Janice Clements, Ph.D., Mary Wallace Stanton Professor of Faculty Affairs, vice dean for faculty, and professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine.
"The big challenge clinicians deal with now in this country when treating HIV patients is keeping the virus locked in a dormant state," Clements adds. "While HAART is really effective in keeping down active replication, minocycline is another arm of defense against the virus".
Unlike the drugs used in HAART which target the virus, minocycline homes in on, and adjusts T cells, major immune system agents and targets of HIV infection. As per Clements, minocycline reduces the ability of T cells to activate and proliferate, both steps crucial to HIV production and progression toward full blown AIDS.........
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March 17, 2010, 8:19 PM CT
Feeling lonely adds to rate of blood pressure increase
Chronic feelings of loneliness take a toll on blood pressure over time, causing a marked increase after four years, as per a newly released study at the University of Chicago.
A newly released study shows, for the first time, a direct relation between loneliness and larger increases in blood pressure four years latera link that is independent of age and other factors that could cause blood pressure to rise, including body-mass index, smoking, alcohol use and demographic differences such as race and income.
The scientists also looked at the possibility that depression and stress might account for the increase but observed that those factors did not fully explain the increase in blood pressure among lonely people 50 years and older.
"Loneliness behaved as though it is a unique health-risk factor in its own right," wrote researcher Louise Hawkley in an article, "Loneliness Predicts Increased Blood Pressure," reported in the current issue of the journal Psychology and Aging
Hawkley, Senior Research Scientist with the Center for Cognitive and Social Neuroscience, is part of a University of Chicago research team that has been doing pioneering work on the impact of loneliness on health and quality of life issues. It includes Ronald Thisted, Chairman of Health Studies; Christopher Masi, Assistant Professor in Medicine; and John Cacioppo, the Tiffany & Margaret Blake Distinguished Service Professor in Psychology.........
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March 17, 2010, 8:00 PM CT
Video Game for Improving Hand Function
Credit: Rutgers Tele-Rehabilitation Institute
System combined a Sony PlayStation 3 console and a commercial gaming glove with custom-developed software and games to provide exercise routines aimed at improving hand speed and range of finger motion.
Engineers at Rutgers University have modified a popular home video game system to help teenagers with cerebral palsy improve hand functions. In a pilot trial with three participants, the system improved the teens' abilities to perform a range of daily personal and household activities.
The modified system combined a Sony PlayStation 3 console and a commercial gaming glove with custom-developed software and games to provide exercise routines aimed at improving hand speed and range of finger motion.
The Rutgers engineers, who are members of the university's Tele-Rehabilitation Institute, worked with clinicians at the Indiana University School of Medicine to deploy systems in participants' homes for up to 10 months. A description of the modified system and its use in the pilot trial appeared this week in the journal, IEEE Transactions on Information Technology in Biomedicine.
"Based on early experience, the system engages the interest of teens with cerebral palsy and makes it convenient for them to perform the exercises they need to achieve results," said Grigore Burdea, professor of electrical and computer engineering and director of the Rutgers Tele-Rehabilitation Institute.
Each system communicated via the Internet to allow the Indiana and Rutgers scientists to oversee participants' exercise routines and evaluate the effectiveness of the systems. The system is an example of both virtual rehabilitation, where patients interact with computer-generated visual environments to perform exercises, and tele-rehabilitation, where patients perform exercises under remote supervision by physical or occupational therapists.........
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