Compression Stockings Don’t Prevent Postthrombotic Syndrome .


Background:
Postthrombotic syndrome (or PTS, sometimes referred to as postphlebitic syndrome) is a condition that can occur in up to 20% of patients who experience a DVT. It involves pain and swelling of the affected leg. In some cases the symptoms can progress, leading to reduced mobility and reduced quality of life. The main strategy to reduce the risk of developing PTS has been the use of special compression stockings, which reduced edema. Previous studies have demonstrated benefit with use of compression stockings; however, as they were not blinded, they were not very conclusive.

The Study:
Investigators conducted the aptly named SOX trial (cute, right?!). The study was a double blinded, placebo-controlled, randomized trial. The intervention was the use of elastic compression stockings exerting 30 to 40 mm Hg at the ankle vs placebo stockings, which exerted only 5 mm Hg at the ankles.

The investigators found no significant difference in the incidence of PTS between the two groups.

Conclusion:
The results of this well-done analysis contradict findings of previous studies that suggested compression stockings may reduce the incidence of PTS. This study casts doubt on routine use of compression stockings to prevent PTS. While there may yet be a role for compression stockings, we will have to wait for further studies to elucidate which group of patients may have the greatest benefit from them.

FDA approves many drugs that predictably increase heart and stroke risk


The agency charged to protect patients from dangerous drug side effects needs to be far more vigilant when it comes to medications that affect blood pressure.

Robert P. Blankfield, MD, MS, a clinical professor of family medicine, issues this call to the U.S. Food and Drug Administration (FDA) in an editorial published recently in an online edition of the Journal of Cardiovascular Pharmacology and Therapeutics; the print version of the article is expected to appear this autumn.

The editorial notes that several medications survived FDA scrutiny, only to be pulled from the market after reports of increased heart attacks and strokes related to use of the drugs. These include rofecoxib (Vioxx), valdecoxib (Bextra), and sibutramine (Meridia). What these drugs have in common is that they raise blood pressure. Other medications approved by the FDA, including some antidepressant medications as well as medications used to treat attention deficit hyperactivity disorder, also raise blood pressure but remain on the market despite inadequate safety data.

At issue is the apparent disconnect between what patients and doctors might consider “clinically significant” risk and the standards that some FDA reviewers apply when evaluating the safety of new therapeutics. When it comes to medications that affect blood pressure, a few FDA reviewers only classify “clinically significant” blood pressure spikes as those that raise systolic blood pressure by 20 mm Hg (milliliters of mercury) or diastolic blood pressure by 10 to 15 mm Hg.

Increases in systolic blood pressure of more than 2 mm Hg or increases in diastolic blood pressure of more than 1 mm Hg raise the risk for heart attack by 10 percent and stroke by 7 percent in middle-aged adults, according to an epidemiological study published in Lancet in 2002. Younger individuals have less risk. For example, studies published in 2011 in the New England Journal of Medicine and the Journal of the American Medical Association indicate that attention deficit hyperactivity disorder medications are safe when used by young adults. While different populations differ in terms of cardiovascular risk, Blankfield believes one point should draw broad agreement: unless one is a healthy, young adult, clinicians and patients should have adequate cardiovascular safety data before they make prescription decisions.

“It is unwise to allow medications that predictably increase risk to be marketed without adequate safety data,” said Blankfield, also a family physician at University Hospitals Berea Health Center. “Risk should be quantified, and the product label should accurately communicate the risk.”

Blankfield, who has published other editorials recommending that the FDA require safety data for drugs that raise blood pressure, advocates a three-step solution. First, the FDA needs to establish specific guidelines regarding what degree of blood pressure elevation constitutes a risk for different populations (i.e. young adults, middle aged adults, older adults, diabetics, hypertensives, etc.). Then the agency should require pharmaceutical companies to provide cardiovascular safety data on medications that increase blood pressure. Finally, the agency should require pharmaceutical companies to post relevant data and/or warnings on medication labels.

“This would allow physicians and patients to make informed decisions about medications,” he said. “Physicians and the general public may assume that if a drug is approved by the FDA, it is safe. Yet even modest elevations in blood pressure increase the risk of heart attacks and strokes.”

Blankfield was moved to write this editorial now because of the public health importance of the issue.

The Science of Dreams and Why We Have Nightmares.


The agency charged to protect patients from dangerous drug side effects needs to be far more vigilant when it comes to medications that affect blood pressure.

Robert P. Blankfield, MD, MS, a clinical professor of family medicine, issues this call to the U.S. Food and Drug Administration (FDA) in an editorial published recently in an online edition of the Journal of Cardiovascular Pharmacology and Therapeutics; the print version of the article is expected to appear this autumn.

The editorial notes that several medications survived FDA scrutiny, only to be pulled from the market after reports of increased heart attacks and strokes related to use of the drugs. These include rofecoxib (Vioxx), valdecoxib (Bextra), and sibutramine (Meridia). What these drugs have in common is that they raise blood pressure. Other medications approved by the FDA, including some antidepressant medications as well as medications used to treat attention deficit hyperactivity disorder, also raise blood pressure but remain on the market despite inadequate safety data.

At issue is the apparent disconnect between what patients and doctors might consider “clinically significant” risk and the standards that some FDA reviewers apply when evaluating the safety of new therapeutics. When it comes to medications that affect blood pressure, a few FDA reviewers only classify “clinically significant” blood pressure spikes as those that raise systolic blood pressure by 20 mm Hg (milliliters of mercury) or diastolic blood pressure by 10 to 15 mm Hg.

Increases in systolic blood pressure of more than 2 mm Hg or increases in diastolic blood pressure of more than 1 mm Hg raise the risk for heart attack by 10 percent and stroke by 7 percent in middle-aged adults, according to an epidemiological study published in Lancet in 2002. Younger individuals have less risk. For example, studies published in 2011 in the New England Journal of Medicine and the Journal of the American Medical Association indicate that attention deficit hyperactivity disorder medications are safe when used by young adults. While different populations differ in terms of cardiovascular risk, Blankfield believes one point should draw broad agreement: unless one is a healthy, young adult, clinicians and patients should have adequate cardiovascular safety data before they make prescription decisions.

“It is unwise to allow medications that predictably increase risk to be marketed without adequate safety data,” said Blankfield, also a family physician at University Hospitals Berea Health Center. “Risk should be quantified, and the product label should accurately communicate the risk.”

Blankfield, who has published other editorials recommending that the FDA require safety data for drugs that raise blood pressure, advocates a three-step solution. First, the FDA needs to establish specific guidelines regarding what degree of blood pressure elevation constitutes a risk for different populations (i.e. young adults, middle aged adults, older adults, diabetics, hypertensives, etc.). Then the agency should require pharmaceutical companies to provide cardiovascular safety data on medications that increase blood pressure. Finally, the agency should require pharmaceutical companies to post relevant data and/or warnings on medication labels.

“This would allow physicians and patients to make informed decisions about medications,” he said. “Physicians and the general public may assume that if a drug is approved by the FDA, it is safe. Yet even modest elevations in blood pressure increase the risk of heart attacks and strokes.”

Blankfield was moved to write this editorial now because of the public health importance of the issue.

When Best Friends Can Visit.


she seemed to take a turn for the better.”

Harry Grandis received a visit from his pet Yorkie, Minnie, while he was a patient at Virginia Commonwealth University Medical Center, which has a pet visitation policy.

Courtesy of Ann Grandis

“I love that dog. I love her so much,” said Mrs. London, now 74.

It was a one-time deal: after a hurried meeting, hospital staff members decided they wouldn’t allow Delilah to come again, nor would they let other family members bring family pets to see other patients, Mr. London said.

That’s the policy at most hospitals across the country.

But a few medical institutions have taken a different approach and thrown open their doors to patients’ own dogs and cats, letting them visit along with spouses, children and friends. (Lots of hospitals have pet therapy programs using trained dogs, but that’s a different matter.)

The University of Maryland Medical Center in Baltimore lets family pets visit their owners, so long as certain requirements are met, as does the University of Iowa Hospital and Clinics in Iowa City; Virginia Commonwealth University Medical Center in Richmond; Rush University Medical Center in Chicago; two hospitals associated with the Mayo Clinic in Rochester, Minn.; and more than a dozen other medical centers.

On Long Island, North Shore University Hospital allows personal pets to stay with patients around the clock in its 10-bed palliative care unit, as does Hospice Inn, a freestanding 18-bed hospice facility that’s part of North Shore-LIJ Health System.

Policies vary at the institutions that allow visits by patients’ pets, but many share some of the same requirements. A doctor’s order allowing the family pet to visit is typically necessary, as is an attestation from a veterinarian that the animal is healthy and up to date on all its shots. Most institutions require that dogs — the most common visitors, by far — be groomed within a day or so of a visit and on a leash when they walk through hospital corridors. Cats must be taken in and out of the institution in a carrier.

If a dog or cat wants to get up on a patient’s bed, a covering is laid down first. If an animal seems agitated or distressed when it comes into the hospital, staff members who meet the family and escort them to the patient’s room have the right to turn it away. If the patient shares a room with someone, that person must agree before a pet may visit.

“We have not had any problems,” said the Rev. Susan Roy, director of pastoral care services at the University of Maryland Medical Center, whose “your pet can visit” policy has been in place since 2008. If anything, she said, the visits can be hard on dogs, who often respond viscerally to an owner’s illness and may take a day or two to recover from a visit.

Rush University Medical Center spent three years studying the issue before its new pet visitation policy went into effect in February. Diane Gallagher, the hospital’s associate vice president of nursing operations, described some of the questions: Would animals transmit infections to patients, or vice versa? What were the liability issues? Could allowing pets to visit interfere with patient care — if, for instance, a family dog became alarmed and protective of the sick person when a doctor, a nurse or a technician came into the room?

In the end, officials decided that the benefits — comfort and reduced stress for patients — were more substantial than the risks.

Although research has shown that hospital therapy dogs can pick up germs and potentially transmit bacteria that can cause dangerous infections, those animals typically wander from room to room, while people’s own pets are expected to stay with the patient they are visiting. If someone has an open wound or an active infection, a visit from a family pet is discouraged, according to most hospital policies.

Research on the value of personal pets visiting patients in the hospital hasn’t been done. One small 2010 study of 10 healthy dog owners by researchers at Virginia Commonwealth’s Center for Human-Animal Interaction found that both unfamiliar and familiar dogs provoked similar reactions: a relaxation response and reduction in blood pressure and levels of cortisol, a stress-related hormone, according to Dr. Sandra Barker, director of the center and a professor of psychiatry.

But personal anecdotes abound. Anne Mahler, 57, a clinical nurse specialist at Hebrew SeniorLife, the largest provider of elder care services in the Boston area, remembers how depressed her elderly father was after breaking a hip and trying to recover in a rehabilitation facility. That institution wouldn’t allow his beloved dog Molly, a springer spaniel, to come to his room, but a visit was arranged in a back room off the lobby.

“My dad sat there sobbing,” Ms. Mahler said. Afterwards, the older man began eating more regularly, his attitude lightened, and he seemed determined to do everything possible to return home to join Molly.

More than 400 seniors live on the long-term care unit at Hebrew SeniorLife’s Roslindale campus, and staff members strongly encourage pet visits, Ms. Mahler said.

Harry Grandis fought off bladder cancer for seven years before finally succumbing to the illness last October at the age of 91. The final year of his life he was hospitalized five times at Virginia Commonwealth University Medical Center, and during two of those stays had regular visits from Minnie, his beloved Yorkshire Terrier.

“Minnie would come into Harry’s room and his eyes would light up,” said Ann Grandis, his widow. “It was like bringing home to him. It just made such a difference.”

Harry returned home to die, and on the last day of his life Minnie lay in bed at his side until close to the end. Now it’s Ann who relies on Minnie and would want her there if anything untoward were to happen. “I would be lost without her,” Ms. Grandi, 70, said. “She’s family.”

3D printers help surgeons hone their skills on replica body parts.


On the table sits the trachea of a 12-month-old child. Mitch Finlayson lifts it between two fingers, and smiles.

The plastic model, an accurate re-creation of a windpipe and bronchial tree, was created with a 3D printer using scans from a patient at the Royal Children’s Hospital in Melbourne. It will be used to train paediatric surgeons in bronchoscopy, a procedure in which a tiny camera is guided through the bronchial tubes into the lungs.
“It’s basically a fibre-optic arm with a camera at the end of it,” Mr Finlayson said of the procedure.

“It’s actually quite difficult to manoeuvre. The movements are unique and difficult to practise – creating a bronchial tree enables clinicians to practise before the actual procedure.”
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Mr Finlayson, who works in a lab providing training simulations for RCH surgeons, said the technique could drastically increase the breadth of surgeons’ experience, and the number of surgeons prepared to operate in rare scenarios.

“The beauty of 3D printing is that we can create abnormal anatomy that we typically wouldn’t see at high frequency,” he said.

Robert Stunden, a paediatric surgeon and chairman of the Victorian state committee of the Royal Australasian College of Surgeons, said the technology could revolutionise training. “Previously, you had to be present at the operation with a rare anatomy to be able to appreciate it.”

Mr Stunden said the next stage would include materials that behave like body parts.

Sepsis, Albumin, and the Therapeutic Potential of Improving Oncotic Pressure


In physiology, as in all other sciences, no discovery is useless … we may be certain that every advance achieved in the quest of pure knowledge will sooner or later play its part in the service of man. —    Dr Ernest Henry Starling, The Linacre Lecture on the Law of the Heart (1915) .

Modern sepsis treatment owes a conceptual debt to British physiologist Dr. Ernest Starling. Starling’s experiments suggested that increasing ventricular end-diastolic volume can increase cardiac output, and this is one of the goals in mind when septic patients are given intravenous crystalloid. In a separate line of work, Starling also described the hydrostatic and oncotic forces that ultimately cause much of this intravenous crystalloid to leak into the interstitium, resulting in pulmonary and peripheral edema that can seriously complicate a septic patient’s ICU course. In this week’s NEJM, Dr. Pietro Caironi (Universita degli Studi di Milano, Italy) and colleagues report on the therapeutic potential of improving intravascular oncotic pressure in septic patients.

The multicenter, open-label ALBIOS trial randomized 1,818 adult patients with severe sepsis to an albumin group or to a control group. Both groups received intravenous crystalloid whenever clinically indicated. The albumin group additionally received daily infusions of intravenous 20% albumin from randomization until ICU discharge or day 28 (whichever came first). Did daily albumin infusions improve outcomes? Unfortunately not. The 28-day mortality was about 32% in both groups (p = 0.94). There was also no difference on secondary outcomes such as mortality at 90 days, severity of organ dysfunction, or ICU length of stay. “Sepsis carries a high mortality,” says cardiologist and NEJM Executive Editor Dr. Gregory D Curfman,

“Rigorously conducted trials allow clinicians to confidently determine which interventions are effective in a particular patient group and which offer little to no benefit.” Although albumin infusions didn’t confer any survival advantage to ALBIOS study subjects, some hope remains that they might be beneficial in a more select group of patients. Participants in the albumin group had higher mean arterial pressures and lower net fluid balances during the first 7 days, and a post-hoc analysis suggested daily albumin infusions might improve 90-day mortality in the subset of patients with shock. Will albumin play a part in the service of the septic patient? Perhaps the next trial will tell.

A quantum accelerometer is being built for navy submarines – physicsworld.com


Physicists in the UK are developing an accelerometer for the Royal Navy, based on the quantum interference of ultracold atoms. The device will allow submarines to pinpoint their position underwater to within 1 m after travelling one day, without having to surface to use GPS. This is much better than is possible with current accelerometers, which are accurate to within 1 km after a day’s travel. With further development, the device could be used for oil exploration or even to do “gravity scans” of concealed objects.

Since the 1990s, physicists have been able to do interferometry experiments with ultracold atoms. Pioneered by Stanford University’s Mark Kasevich, the classic version of the experiment involves allowing an atom to fall under the influence of the Earth’s gravity. A laser pulse is fired at the atom that puts it in a superposition of two quantum states, which follow different trajectories much like photons travelling through an optical interferometer. A second pulse recombines the states and the resulting interference gives a precise measure of gravity – and can even reveal subtle effects of the general theory of relativity.
Extremely sensitive

Such a device can also be used as an extremely sensitive vertical accelerometer. Now, Ed Hinds and colleagues at Imperial College London have taken this experiment and rotated it by 90° to make an accelerometer that works in the horizontal direction. The device uses about one million rubidium atoms, which are trapped on an integrated chip using a magnetic field and laser light.

An important feature of the chip is that a single beam of laser light is used to trap the atoms. This beam is fired at a surface grating to create several beams of diffracted light, which together with a magnetic field are then used to trap the atoms.

The atoms have two quantum ground states, which the researchers denote as |1〉 and |2〉. The system is prepared so that all of the atoms are in |1〉 and then a light pulse puts the atoms into a superposition of |1〉 and |2〉. This action plays the role of the first beamsplitter in an optical Sagnac interferometer. State |1〉 has no recoil, while state |2〉 recoils along the direction defined by the light beams. Then, a second light pulse is fired at the atoms and this swaps the states so that |1〉 (with no recoil) becomes |2〉 (with recoil) and vice versa. This is analogous to the two mirrors of an optical interferometer, which direct the two diverging light beams towards a second beamsplitter, where they are recombined. Finally, a third light pulse plays the same role as the second beamsplitter of an optical interferometer.
Taking different paths

A measurement is then made to determine how many of the atoms are in state |1〉 – or, alternatively, how many are in |2〉. Either measurement can be used to compute the interferometer phase, which is related to the effective path difference taken by the two states. This path difference is proportional to the acceleration of the atoms along the direction of the light beams.

The simple design and operation of the accelerometer means that, in principle, it could be miniaturized for use on submarines. Indeed, the chamber in which the atoms are held has already been miniaturized on a chip. However, the associated electronic and optical components are still mounted in racks and on an optical table. Another challenge is to make the chip impervious to helium gas, which can leak through the walls and eventually contaminate the vacuum in which the atoms must be held.
Gravity scanners

The team is now working on shrinking the optical and electronic components of the accelerometer so that it can fit into about 1 m3. While this would make it suitable for naval use, the device would have to be further miniaturized – to the size of a beer can, for instance – before it could be sent down an exploratory bore hole to search for oil or other mineral deposits. Other possible applications that could emerge in a 5–10-year timeframe include “gravity scanners” that can peer into sealed containers and create density maps of their contents.

Hinds told physicsworld.com that it is likely that similar devices are being created for the navies of other nations. Indeed, Kasevich and colleagues have unveiled an atomic-interferometry-based “quantum gyroscope”, which is essentially an accelerometer that can be used for navigation. At the time, Kasevich said that the technology was going to be commercialized by AOsense, a company that he co-founded (see “Falling atoms measure the Earth’s rotation”).

The chip used by Hinds to trap the rubidium atoms is described in Nature Nanotechnology.
General relativity put to the test

In another recent development in the field, physicists in Germany and the US have used atomic interferometry to measure the effects of gravity on two different atoms: rubidium and potassium. The experiment found that the acceleration due to gravity experienced by both types of atoms is the same to one part in 10 million. This is the latest verification of the universality of free fall, which is a cornerstone of Einstein’s general theory of relativity. The rubidium atoms are more than twice as massive as their potassium counterparts. If they were seen to respond differently to gravity, it could point physicists towards a quantum-mechanical theory of gravity.

Clinical trial reaffirms diet beverages play positive role in weight loss .


Summary:
A new study confirms that drinking diet beverages can help people lose weight. “This study clearly demonstrates that diet beverages can in fact help people lose weight, directly countering myths in recent years that suggest the opposite effect — weight gain,” said a study co-author.

New research finds that drinking diet beverages can help people lose weight.

A new study published today in Obesity, the journal of The Obesity Society, confirms that drinking diet beverages can help people lose weight.

“This study clearly demonstrates that diet beverages can in fact help people lose weight, directly countering myths in recent years that suggest the opposite effect — weight gain,” said James O. Hill, Ph.D., executive director of the University of Colorado Anschutz Health and Wellness Center and a co-author of the study. “In fact, those who drank diet beverages lost more weight and reported feeling significantly less hungry than those who drank water alone. This reinforces that if you’re trying to shed pounds, you can enjoy diet beverages.”

The 12-week clinical study of 303 participants is the first prospective, randomized clinical trial to directly compare the effects of water and diet beverages on weight loss within a behavioral weight loss program. Conducted simultaneously by researchers at the University of Colorado Anschutz Center for Health and Wellness in Aurora and Temple University’s Center for Obesity Research and Education in Philadelphia, the study shows that subjects who consumed diet beverages lost an average of 13 pounds — 44 percent more than the control group, which lost an average of 9 pounds. More than half of the participants in the diet beverage group — 64 percent — lost at least five percent of their body weight, compared with only 43 percent of the control group. Losing just five percent of body weight has been shown to significantly improve health, including lowering the risk of heart disease, high blood pressure and type 2 diabetes. The study was supported by an unrestricted educational grant from the American Beverage Association.

“There’s so much misinformation about diet beverages that isn’t based on studies designed to test cause and effect, especially on the Internet,” said John C. Peters, co-author of the study and the chief strategy officer of the CU Anschutz Health and Wellness Center. “This research allows dieters to feel confident that low- and no-calorie sweetened beverages can play an important and helpful role as part of an effective and comprehensive weight loss strategy.”

Study participants were randomly assigned to one of two groups: those who were allowed to drink diet beverages, such as diet sodas, teas and flavored waters, or those who were in a control group that drank water only. With the exception of beverage options, both groups followed an identical diet and exercise program for the duration of the study.

In addition to losing 44 percent more weight than the control group, the diet beverage group also:
Reported feeling significantly less hungry;
Showed significantly greater improvements in serum levels of total cholesterol and low-density lipoprotein (LDL) — the so-called “bad” cholesterol; and
Saw a significant reduction in serum triglycerides.

Both diet soda and water groups saw reductions in waist circumference, and blood pressure.

This latest study adds to the body of research demonstrating that diet beverages do not hinder, but in fact help, with weight loss. In particular, two studies published in the American Journal of Clinical Nutrition by researchers from the University of North Carolina in 2012 and 2013 randomly assigned non-dieting participants to drink either water or diet beverages. While both groups cut their food intake significantly, after six months the diet beverage group had a greater likelihood of reaching a meaningful (5 percent) amount of weight loss compared to the control group. The diet beverage group also experienced a greater reduction in dessert consumption than the water group. Overall, the findings suggest that diet beverages do not fuel a preference for sweet foods and drinks.

Additional research published in 2009 on weight loss maintenance, drawn from the National Weight Control Registry, found that successful weight loss maintainers drank three times more diet beverages than those who had never lost weight.

The study was supported by the American Beverage Association (ABA), a trade association in Washington, DC.It was peer-reviewed and posted on http://www.clinicaltrials.gov. Neither ABA, nor any of its members, was involved in any part of the study, its analysis or the writing of this paper.

Story Source:

The above story is based on materials provided by University of Colorado, Anschutz Medical Campus. The original article was written by Marcia Neville. Note: Materials may be edited for content and length.

Journal Reference:
John C. Peters, Holly R. Wyatt, Gary D. Foster, Zhaoxing Pan, Alexis C. Wojtanowski, Stephanie S. Vander Veur, Sharon J. Herring, Carrie Brill, James O. Hill. The effects of water and non-nutritive sweetened beverages on weight loss during a 12-week weight loss treatment program. Obesity, 2014; 22 (6): 1415 DOI: 10.1002/oby.20737

Suspended animation trial begins on gunshot and knife victims – SmartPlanet


http://www.smartplanet.com/blog/bulletin/critical-injury-suspended-animation-trials-begin-on-humans/

From the desk of Zedie.

NY police to carry heroin antidote


NY police to carry heroin antidote http://www.bbc.co.uk/news/world-us-canada-27593522

From the desk of Zedie.