New treatment option for pancreatic cancer

Pancreatic cancer is considered a largely incurable disease with the one year survival rate at 20% and the five year survival rate at only 4%.  These numbers reflect the challenge of treating pancreatic cancer and the need for new innovative drugs.  Recent research reported this week by Healthday News on a new drug, AMG 479, shows promise for treatment of this deadly cancer.  Because insulin-like growth factor is known to play a role in cancer growth, AMG 479 is subsequently designed to interfere with the activity of insulin-like growth factors, specifically IGF-1 and IGF-2.  This is the first drug found to interfere with these factors without cross reacting with the closely related insulin receptor.  Researchers reported an 80% inhibition rate of tumor growth.  Consequently AMG 479 appears to be an excellent candidate to be used alone or in combination with Gemcitabine, the only current available treatment for pancreatic cancer which has not yet shown to increase survival rates.  Future research on this promising treatment for pancreatic cancer is certainly needed.

Valproate study

A  recent study reported in this week’s edition of the New England Journal of Medicine examined the neurological effects of valproate on children exposed to the medication during fetal development.  The study included 309 children from 25 epilepsy centers in the United Kingdom and United States.  Periodical assessment of the children up to age six was planned and these published results were noted after three years of evaluations.  It was found that IQ scores were significantly lower in those children who were exposed to valproate when compared to other epilepsy drugs including carbamazapine, lamotrigine, and phenytoin.  It was also found the neurological effects were dose dependent with higher doses being associated with decreased IQ scores. Consequently, after examining the results, the authors stressed the importance of utilizing other anti-seizure drugs as first line therapy especially in women of child bearing age.

Multivitamins No Cancer, Heart Help, Study Says

Associated Press 2009. http://www.msnbc.msn.com/id/29106052/

The largest study on multivitamin use showed that heart health and cancer risk is not reduced. An eight year study on postmenopausal women was completed by Marian Neuhouser, a researcher for the Fred Hutchinson Cancer Research Center in Seattle. The study included over 160,000 women over the age of 50, 42% of which were regular vitamin users. The results of the study showed that fairly equal numbers of vitamin users and nonusers developed various cancers, heart attacks, and other cardiovascular problems. Furthermore, almost 10,000 deaths occurred in both users and nonusers.

It is recommended that people maintain a healthy diet, both rich in fruits and vegetables and low in red meat. These habits are known to not only decrease cancer risk, but also reduce cardiovascular risk.

Living Wills and pre-hospital lifesaving care

Mirarchi, F.L., Kalantzis, S., Hunter, D., McCracken, E., and Kisiel, T. (2009).
Triad II: Do living wills have an impact on pre-hospital lifesaving care?
The Journal of Emergency Medicine 36 (2), 105-115.

This is posted on behalf of Bobbie Fiore:

There is confusion regarding the interpretation of living wills and DNR especially
in the pre-hospital setting. A three part study done at Hamot Hospital, Erie, Pa
addressed this issue. The Realistic Interpretation of Advanced Directives I or
TRAID I study included EMS, doctors, and nurses who reviewed a living will and then were asked the code status. The results indicated that 89% of EMS, 79% of nurses, and 64% of doctors were incorrect in stating the code status as DNR.
.
TRIAD II used only paramedics and EMS participants. They were given clinical
information and a living will and then told the patient’s condition had changed.
They were given options for intubation, no intubation, defib, no defib or
call for medical direction. Many surveyed chose to delay their responses
feeling that the living will meant DNR.

It is being recommended that an out-of-the-hospital DNR be obtained from
a health care provider. It was also interesting to note that there have
been recommendations to consider the elimination of living wills.

Blood Pressure Drug May Not Ease Irregular Heartbeat

SOURCES: Aldo P. Maggioni, M.D., director, ANMCO Research Center, Florence, Italy; Anne M. Gillis, professor, medicine, and director, arrhythmia program, University of Calgary, Alberta, Canada; April 16, 2009, New England Journal of Medicine) Retrieved April 15, 2009 from, http://www.healthfinder.gov/news/newsstory.aspx?docid=626049

Early research showed some promise that Valsartan would reduce the number of atrial fibrillation episodes in patients. "But in the patients we randomized in this study, it was not useful in preventing recurrence," said study author Dr. Aldo P. Maggioni, director of the ANMCO Research Center in Florence. His team published the findings in the April 16 issue of the New England Journal of Medicine. The study included 1,442 patients, half given Valsartan and half given a placebo. These patients were followed over a one year period and were found to have almost equal numbers of AFIB episodes (51.4% in those taking Valsartan and 52.1% in those taking the placebo). The overall evidence does not support use of Valsartan in preventing recurrent episodes of AFIB.

Policy decision- Radiation devices not banned, April 15, 2008

The U.S. Nuclear Regulatory Commission today announced it will not ban the use of cesium-137 chloride (CsCl) radiation devices, such as those used by hospitals to irradiate blood, before a replacement technology is available. Banning or phasing-out cesium chloride radiation sources at before a replacement form or other technology is available would be counterproductive, because society would lose the many benefits these sources provide in medicine, industry and research,said NRC Chairman Dale Klein. The AHA had urged the commission not to ban or require replacement of the devices for similar reasons.
AHA News Now, April 15, 2009 (www.aha.org)

Background information obtained from position letter from AHA to U.S. NRC, dated October 14, 2008: A recent National Academy of Sciences study recommends the replacement or elimination of CsCl due to its potential risk to individuals, society and the environment if improperly handled or used in a malicious act. While we understand the NRC’s concerns, the AHA urges the Commission to proceed cautiously as it considers these complex issues, particularly the medical use and research applications of CsCl, so as not to adversely impact patient care and advances in biomedical research. Blood irradiation is medically necessary for some patients to prevent transfusion-associated graft versus host disease. CsCl blood irradiators are the most reliable, efficient and low-maintenance tools available. Hospitals that have blood donation centers or treat significant numbers of immuno-compromised patients often own such irradiators. CsCl irradiators also play an important role in medical research related to understanding and treating cancer and other serious illnesses. They also are used to develop countermeasures for radiologic terrorism.
Letter can be retieved at: http://www.aha.org/aha/letter/2008/081014-cl-pollack-nrc.pdf

Hand Hygiene!

This is an interesting and important, but different kind of blog...

We learned at the beginning of our academic journeys in nursing that handwashing is the single most effective method to prevent infection, right? Then why do some places struggle to meet hand hygiene compliance rates? Isn't this something we want for every patient, every nurse, every health care worker?

The Joint Commission yesterday, April 13, 2009, released a guide to help health care practitioners assess compliance with hand hygiene guidelines. The Joint Commission's National Patient Safety Goals require accredited organizations to follow recognized hand hygiene guidelines. The monograph reviews the strengths and weaknesses of commonly used approaches to measuring compliance, and includes examples of assessment tools submitted through the Consensus Measurement in Hand Hygiene project, a collaboration with infection prevention and control organizations. The monograph can help health care organizations more effectively measure compliance and strengthen improvement activities that save lives and money.

The fact that this monograph needed to be put inplace sends a message that we are not all doing our part and/or we all can not agree on how comliance is measured. You can visit the monograph at: http://www.jointcommission.org/NR/rdonlyres/68B9CB2F-789F-49DB-9E3F-2FB387666BCC/0/hh_monograph.pdf

Myocardial Infarction in Women: Promoting Symptom Recognition, Early Diagnosis, and Risk Assessment

Zbierajewski-Eischeid, Samantha J. RN, MS; Loeb, Susan J. PhD, RN, Dimensions of Critical Care Nursing, Issue:Volume 28(1), January/February 2009, pp 1-6.

Even with national campaigns to help increase awareness, most people do not realize that heart disease is now the leading cause of death for women. Women experiencing an acute cardiac event often do not recognize the symptoms or are misdiagnosed by healthcare providers because of atypical symptom presentation. This can lead to a significant delay in treatment and a less desirable recovery outcome. To help promote early identification of cardiac risk and cardiac events, this article highlights the range of symptom presentation in women with myocardial infarction and focuses on how advanced clinical nurses can increase nurses' and the public's understanding of this disease in women.

I liked this article, because it is a systematic review that reveals the the importance of stressing the atypical symptoms of female MI patients and that ther is often a delay in treatment due to these symptoms (fatigue, mild heartburn, etc). It also stresses the importance of communicating not only the with the licensed health care professionals, but also nursing students that women admitted to acute care hospitals for non-MI diagnosis must be evaluated for occurence of MIs during the hospital stay.

Summary- Heart disease is the leading cause of death for women in the US, but many women are still unaware of this fact despite significant attempts to heighten awareness. Also, healthcare providers often do not possess sufficient knowledge of differences in symptoms, diagnosis, risk, treatments and outcomes between men and women with heart disease.Advanced clinical nurses are the ideal healthcare providers to address this knowledge gap through educating their nursing colleagues, nursing students, and their female patients, as well as advocating with physicians. Through heart health promotion initiatives, delays in seeking care, misdiagnosis, and less aggressive treatment of women can be effectively addressed. In summary, education is key to reducing the mortality rate for women. Therefore, encouraging patients and providers to take advantage of the numerous educational opportunities provided by campaigns promoting women's awareness of heart disease is essential. Achieving the goal of educating women to recognize symptoms, assess risk, and seek early diagnosis for MI will contribute to improved treatment outcomes, elimination of gender disparities, and reversal of current trends regarding cardiovascular disease-related deaths in women.

Injury Prevention in Youth Sports

Veigel, Jake D.1; Pleacher, Michael D.2 Current Sports Medicine Reports, Volume 7(6), November/December 2008, pp 348-352.

Thought this was an interesting article as my daughter just injured her arm and ended up with a cast this week... tis the spring season! Enjoy~ Kris

Sport is the principal cause of injury in children and adolescents. Youth participation in organized athletics is estimated to be 45million in the United States alone. These injuries influence health and fitness and have socioeconomic impact. Many injuries can be prevented. This article outlines the efficacy of current injury prevention strategies in youth sports through the use of educational programs, rule changes in baseball and hockey, safety equipment, and conditioning programs.

With an estimated 45 million children and adolescents involved in organized athletics in the United States, it is not surprising that sport is the primary cause of injury in young people. The majority of injuries are mild strains, sprains, and contusions, with few severe enough to require hospitalization. Despite the relatively low severity of these injuries, they can have a significant impact. Injuries may lead to reduced participation in sport and fitness activities, thus contributing to the childhood obesity epidemic. Injury also may disrupt potential benefits of sport, including increased self-esteem, community involvement, and increased fitness. Injury has direct costs from evaluation, treatment, and rehabilitation, and indirect costs of parental sick leave and lost productivity if parents miss work to tend to an injured child.

Many youth sport-related injuries can be prevented. Prevention strategies include educational programs (rules and safe play/injury prevention programs), rule changes (no checking/limited checking in hockey); , safety equipment (increased use of helmets and headgears in sports, eye protection in squash, leg braces for volleyball) , and preseason and in-season conditioning programs (specific sport exercises, warm-up and cool-down exercises).

Based upon the recent available data, there are numerous strategies that can be implemented in youth sports to effectively prevent injuries. Enhancing the safety of athletes may lead to greater enjoyment of and longer participation in sports. Given the recent pediatric obesity epidemic, it stands to reason that medical professionals should promote safe and enjoyable physical activities for our youth. Strong evidence exists that supports the implementation of altered rules, use of safety equipment, and participation in specific conditioning programs. Enforcement of rules designed to protect athletes should be uniform. Education of parents and coaches must continue regarding evolving injury prevention methods. Sports medicine providers who care for young athletes are in a unique position to stay abreast of new literature on injury prevention and to educate athletes, parents, and coaches of new ways to protect our young athletes.

Collection and Use of Cancer Family History in Primary Care

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services

Prepared by:
McMaster University Evidence-based Practice Center, Hamilton, ON
Task Order Leaders:
Nadeem Qureshi, M.B.B.S., D.M.
Brenda Wilson, M.B., Ch.B., M.Sc, M.R.C.P.(U.K.), F.F.P.H.

Authors:
Nadeem Qureshi, M.B.B.S., D.M.
Brenda Wilson, M.B., Ch.B., M.Sc., M.R.C.P.(U.K.), F.F.P.H.
Pasqualina Santaguida, B.Sc..P.T., Ph.D.
June Carroll, M.D., C.C.F.P., F.C.F.P.
Judith Allanson, M.B., Ch.B., F.R.C.P., F.R.C.P.(C.), F.C.C.M.G., D.A.B.M.G.
Carolina Ruiz Culebro, M.D.
Melissa Brouwers, Ph.D.
Parminder Raina, Ph.D.
AHRQ Publication No. 08-E001
October 2007

Suggested Citation:
Qureshi N, Wilson B, Santaguida P, Carroll J, Allanson J, Ruiz Culebro C, Brouwers M, Raina P. Collection and Use of Cancer Family History in Primary Care. Evidence Report/Technology Assessment No. 159 (prepared by the McMaster University Evidence-based Practice Center, under Contract No. 290-02-0020). AHRQ Publication No. 08-E001. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.

This article/book was a systematic review of 56 English-only studies evaluating primary care practitioners' (PCP's) collection of family histories of breast, colorectal, ovarian, or prostate cancers in adults.

The review addressed three research questions: 1.) What is the evidence that patients know their family history of the four types of cancer cited above and report it accurately? 2.) How well do family history collection tools improve the acquisition of such information by PCP's? and 3.) What tools exist to help PCP's adequately evaluate and act upon family history-based risk factors and how well do any such tools perform?

This review was a thorough exploration of the above questions and developed numerous results and conclusions. These included the fact that respondents are more likely to accurately report relatives who are free of cancer (indicating specificity) than to report relatives who have had cancer (indicating sensitivity). Also, family history reporting may be more accurate for first degree relatives than second. In addition, accuracy could be influenced by the type of cancer involved and by the type of information collection method.

In the discussion of the recommendations of the authors, several points were noted. Among these were that a consensus should be reached regarding the extent of family history necessary for given clinical situations, the value of patient-completed tools in history collection and risk assessment, and that further research is necessary into the specifics of tool design, update interval, and the role of family history tools and risk assessment tools in the primary care setting.

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1b.chapter.93702

In conclusion, this article is a useful examination of the strengths and weaknesses of family cancer history collection and data assessment tools and methods of interpretation in the primary care setting.

Blog #2: Health Promotion

This article was about a study that was done in regards to one women’s belief about the long-term effects of taking multivitamin supplements daily. The woman in the article is in her 70s and has been taking a multivitamin supplement for the past thirty years of her life with the hope of decreasing her risk of developing heart disease and certain types of cancers. Her parents both had passed away from cancer when they were around her current age.

However, the article describes a recent study published in February of 2009, which mainly focused on the diet and health practices of postmenopausal women. The study discovered that taking multivitamin supplements do not help to decrease ones risk of developing heart disease or certain types of cancers. The study further suggested that a person who eats fruits and vegetables has a lower risk of developing these diseases versus someone who takes multivitamin supplements. The article does suggest that if a person’s goal is to maintain a general well being or to fill in any deficiencies a person may have, such as anemia, taking a multivitamin is sensible.

Study: Multivitamins don't lower older women's cancer risk

Abedin, Shahreen. (2009). Study: Multivitamins don't lower older women's
cancer risk. Retrieved on April 13, 2009 from http://www.cnn.com/
2009/HEALTH/02/10/multivitamins.cancer/index.html?iref=newssearch.

Blog #1: Health Promotion

Anna Emery:  Health Promotion Blog #1

The article below was taken from Health Magazine 2009.  The article is very interesting as it focuses on a special kind of adipose tissue referred to as brown fat.   With the help of ongoing research, there have been studies that have discovered that some adults may also have brown fat which, when the particular individual is in a colder environment, is triggered to burn off calories in an attempt to raise the temperature of the individual at any given time.  Each time the individual is exposed to cold temperatures, more brown fat is released and the individual loses weight by burning calories.  This article focuses on the different studies that have proven brown fat no longer only exist in newborns and animals but now brown fat also exists in adults.  Additionally, the article mentions that there may be a drug on the market that may help to trigger brown fat to be released to burn more calories and as a result lose weight, without enduring cold temperature.  However, realistically the article does not say that being cold is the best way to lose weight, but rather brown fat along with diet and exercise may do the trick! 

I current work in Labor and Delivery at Magee-Womens Hospital where I interact with babies and pregnant mothers.  One of the first basic rules of newborns is that most babies will lose weight before he or she gains any weight.  The main for this is due to the high levels of adipose tissue or brown fat that the baby has stored.  So, in the first few hours to days of birth if the baby has trouble maintaining his or her temperature, the brown fat that is stored in the body is triggered to burn calories and, as a result, can the newborn to lose weight.  For this reason, I found this article so very interesting because to learn that now adults and infants alike have an adipose tissue capable of producing phenomenal results is remarkable.

"Brown fat" burns calories -- may lead to new obesity treatments   

Harding, Amber.  (2009). "Brown fat" burns calories -- may lead to new obesity treatments.  Retrieved on April 12th, 2009 from http://www.cnn.com/2009/HEALTH/04/10/brown.fat.obesity/index.html

 

How Much Fish to Eat While Pregnant?

Pallarito, Karen. (2009). How Much Fish to Eat While Pregnant?: Experts debate pros, cons of consumption and mercury exposure. HealthDay News. Retrieved on April 13, 2009 from http://www.healthfinder.gov/news/newsstory.aspx?docid=62260.


This article is self explanatory if you take a glance at the title... don't think I need to clue you in to the main idea:) However, the main points are as follows as outlined in the article:

• Pregnant women should include fish in their diet for optimal maternal health and fetal growth and development, but not so much as to expose babies to dangerous levels of mercury.
  
• U.S. FDA recommends no more than 12 oz/week, but scientists in nutrition & medicine state this is minimum amount needed.
• Both the FDA as well as the American College of Obstetricians and Gynecologists agree fish consumption should be of a low-mercury content. I.e. mothers are urged to avoid certain types of fish such as shark, swordfish, king mackerel and tilefish, which are higher in mercury. Some mothers were reading into the warnings and avoiding fish altogether. However, eliminating fish entirely is not a good thing.
  
• Fish contains lg amts of omega-3 fatty acids which are important for neural development; thus, limiting it can be detrimental to a child's development
• Several studies were highlighted that proved that when babies born to mothers who ate numerous servings of fish per week, their intelligence and motor skills test scores were higher than those who did not.

Brittney Kopas

"Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis"

Tobian, Aaron A.R., Serwadda, David, Quinn, Thomas C., Kigozi, Godfrey, Gravitt, Patti E., Laeyendecker, Oliver, Charvat, Blake, Ssempijja, Victor, Riedesel, Melissa, Oliver, Amy E., Nowak, Rebecca G., Moulton, Lawrence H., Chen, Michael Z., Reynolds, Steven J., Wawer, Maria J., Gray, Ronald H.Male Circumcision for the Prevention of HSV-2 and HPV Infections and SyphilisN Engl J Med 2009 360: 1298-1309

Prior clinical trials have shown that male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men. This study evaluated the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2), human papillomavirus (HPV) infections, and syphilis in HIV-negative men.

5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 were enrolled. 3393 were HSV-2 negative at enrollment. Of these subjects, 1684 were randomly assigned to have an immediate circumcision (intervention group) and 1709 to have circumcision after 24 months (control group). Subjects were tested for HSV-2, HIV infection, HPV, and syphilis at the beginning and at the end of the sutdy (24 months). In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months.

The study's results showed that male circumcision significantly reduced the incidence of HIV and HSV-2 infection and the prevalence of HPV infection. Therefore, male circumcision can have significant public health benefit.

Young Vegetarians may Have Eating Disorders

http://latimesblogs.latimes.com/booster_shots/2009/04/young-vegetarians-may-have-eating-disorders.html

The study analyzed data from surveys, questionnaires and observations taken at 31 Minnesota schools in 1998. The 2,516 adolescents and young adults in the study ranged in age from 15 to 23. The students were categorized as current vegetarians, former vegetarians or never vegetarian. A vegetarian diet can mean eating only plant sources or consuming some dairy and eggs or even some chicken and fish.

The study found that 19.6% of the current vegetarians and 20.9% of former vegetarians used some form of extreme, unhealthy weight-control behaviors (such as using a diet pill or laxatives or inducing vomiting), and 21.2% and 16%, respectively, said they had binged on food with a loss of control. In comparison, 9.4% of the never-vegetarian group had used extreme, unhealthy weight-control behaviors and only 4.4% said they had lost control while eating and binged.

The study was published in the Journal of the American Dietetic Assoc. and commented that physicians should screen their patients for eating habits and behaviors. Young adults are believed to result in such behaviors for adherence to social expectations. Also, binge eating disorders associated with a loss of control were caused by a lack of protein and fat in the diets of reported vegetarians.