October 19, 2007, 5:08 AM CT

Effectiveness of most PTSD therapies is uncertain

A number of people, including significant proportions of active duty military personnel and veterans, suffer from post-traumatic stress disorder (PTSD), often in conjunction with other injuries or illnesses. While several drugs and psychotherapies are used to treat PTSD, a number of of the studies concerning their effectiveness have problems; as a result, they do not provide a clear picture of what works and what doesn't, says a new report from the Institute of Medicine.

Given the growing number of veterans with PTSD, the U.S. Department of Veterans Affairs (VA), Congress, and the research community urgently need to take steps to overcome the problems that often plague studies of psychiatric therapies for PTSD, and to ensure the right studies are undertaken to yield data that would help clinicians treat PTSD sufferers, said the committee that wrote the report.

The committee evaluated 53 studies of pharmaceuticals and 37 studies of psychotherapies used in PTSD therapy and concluded that because of shortcomings in a number of of the studies, there is not enough reliable evidence to draw conclusions about the effectiveness of most therapys. There are sufficient data to conclude that exposure therapies -- such as exposing individuals to a real or surrogate threat in a safe environment to help them overcome their fears -- are effective in treating people with PTSD. But the committee emphasized that its findings should not be misread to suggest that any PTSD therapy ought to be discontinued or that only exposure therapies should be used to treat PTSD......... Posted by: Emily      Read more         Source

October 19, 2007, 4:53 AM CT

Genome data solves case of the lethal genes

It is better to be looked over than overlooked, Mae West supposedly said. These are words of wisdom for genome data-miners of today. Data that goes unnoticed, despite its widespread availability, can reveal extraordinary insights to the discerning eye. Such is the case of a systematic analysis by the U.S. Department of Energy Joint Genome Institute (DOE JGI) of the massive backlog of microbial genome sequences from the public databases. The survey identified genes that kill the bacteria employed in the sequencing process and throw a microbial wrench in the works. It also offers a possible strategy for the discovery of new antibiotics. These findings appear in the Oct. 19 edition of the journal Science.

In nature, promiscuous microbes share genetic information so readily that using genes to infer their species position on the evolutionary tree of life was believed to be futile. Now, scientists at DOE JGI have characterized barriers to this gene transfer by identifying genes that kill the recipient bacterium upon transfer, regardless of the type of bacterial donor. These lethal genes also provide better reference points for building phylogenic treesthe means to verify evolutionary relationships between organisms.

At DOE JGI, we are responsible for producing and making publicly available genomes from hundreds of different microbes, most of which are relevant to advancing the frontiers of bioenergy, carbon cycling, and bioremediation, said Eddy Rubin, DOE JGI Director. We realized that sequencing a genome is like conducting a massive experiment in gene transfer. By checking which genes could not be sequenced, we discovered barriers to transfer......... Posted by: Emily      Read more         Source

Fri, 19 Oct 2007 01:58:22 GMT

Abusing the NHS

A few weeks ago, I wrote an article for Hospital Doctor about the difficulties surrounding flu immunisations. Last year, we received lots of complaints because there was not enough vaccine to go round. That was because we stole half the NHS allocation of vaccine and re-sold it to the private sector making a huge personal profit. It is hard to get by on £250,000 a year particularly when, with our two day week, we have so much leisure time. Or that is what the government would have the public belief. Forget the rumours that Patricia Hewitt (remember her?) had miscalculated the amount of vaccine required.

The second commonest complaint we had last year was from people who had had to queue, some for as long as twenty minutes. We did our best. All the partners and practice nurses came in on three separate and well advertised Saturday mornings and immunised all comers. Despite our best efforts, the queue went out into the car-park, and the weather was not good.

Others said, "Why can't you do the immunisations during the week?" They found it "inconvenient" to come at the weekend. I would prefer to do that but the weekdays are too busy to fit in a massive immunisation campaign.

It is easy to forget that most patients with genuine illness are either old or very young, and none of them work. They prefer to come during normal working hours. It is only the pretentious, middle-class, focus-group attending, Rolex wearing, alfresco dining, BMW driving, foreign-holiday booking ("Do you know how much the safari is costing? Why should I have to pay for those Malarone tablets?"), BUPA subscribing, well-off "worried well" who demand the "right" to see a doctor in the evenings and at weekends. Sebastian is 27 and wants to "pop in" on Saturday afternoon to discuss the merits of regular PSA monitoring. His partner, Harriet, is with him and wants to know if intestinal yeast is a possible cause of her Irritable Bowel Syndrome.

Sebastian and Harriet are destroying the NHS with their inappropriate demands and attract no sympathy from us. We are, however, sympathetic to our elderly patients, for whom queuing is onerous. So this year we decided to have an appointment system for the immunisations. Five minute slots for each patient, bookable in advance.

Last year the complaints came in after the immunisation sessions. This year, they started to come in before the sessions. "Why do we have to book in advance? Why can't we just turn up on the day, as we always did? That's a much better system, isn't it doctor? As long as we don't have to wait too long like last year."

We did the first session last weekend. The doctors, nurses and this year, reception staff, all attended. We immunised 789 patients. And although the session took much longer than last year, there were no queues out into the car park. An anecdotal straw poll of those who came suggested that they preferred the new system.

There was one problem.

83 patients with booked appointments did not turn up. EIGHTY THREE. That is over ten percent of those who had booked. One or two of them telephoned on Monday to apologise. Most did not.

And that epitomises the problem we have with the NHS. If there were a charge of, say, £20 payable in advance but refundable to those with genuine financial hardship (provided always they turned up) the problem would be solved.

As would many problems if a similar system could be adopted across the NHS for all health care. Posted by: Dr John Crippen      Read more     Source

October 17, 2007, 9:37 PM CT

New model predicts more virulent microbes

Microbes and humans interact in myriad ways, sharing a long history. A number of of the most successful microbes are those that inhabit but do not kill their host. Cheaters lose. Tuberculosis settles into the lungs. Helicobacter pylori, the microbe causing ulcers, burrows into the stomach where it thrives on acids. And Salmonella typhi takes up residence in the gallbladder. All of these organisms can persist in our bodies for decades. What explains their success".

A new mathematical model, devised by a microbiologist renowned for his study of H. pylori and a mathematician, provides the framework for understanding how persistent microbes obtain equilibrium with their human hosts. The multi-scale model, reported in the October 18, 2007, issue of the journal Nature, is based on the idea that certain microbes and humans evolved together and along the way established complex strategies that enabled them to co-exist. These strategies are contingent in part on human population size.

The model helps explain the rules that govern the transmission of microbes and how they have operated in human history, says Martin J. Blaser, M.D., the Frederick King Professor and Chair of the Department of Medicine, and Professor of Microbiology at New York University School of Medicine. He and Denise Kirschner of the University of Michigan Medical School, Ann Arbor, are authors of the study. The model uses game theory, developed by Nobel prize-winning mathematician John Nash, the subject of the book and movie A Beautiful Mind, to describe a particular type of equilibrium......... Posted by: Emily      Read more         Source

October 17, 2007, 9:28 PM CT

Malaria vaccine candidate has promising safety

The first study to test GlaxoSmithKline's (GSK) investigational RTS,S/AS02 malaria vaccine in African infants serves as the first proof of concept in this population that the vaccine has a promising safety and tolerability profile and reduces malaria parasite infection and clinical illness due to malaria, as per a paper published recently online in The Lancet.

The study reports that vaccine efficacy against new infections was 65 percent over a three-month follow-up period after the infants received all three doses of the vaccine. The results also showed that the vaccine reduced episodes of clinical malaria by 35 percent over a six-month follow-up period starting after the first dose.

This efficacy data is consistent with the estimate of 45 percent reduction in new infections reported in a 2004 trial in Mozambique among children one to four years old. However, the clinical malaria results from this study should be viewed in the context that the primary endpoint was safety. The secondary endpoints are efficacy against infection and against clinical malaria. Efficacy against severe disease was not included due to the smaller size of the safety study. Eventhough a large-scale Phase III study will be mandatory to definitively determine the efficacy of the vaccine, the data from this trial are encouraging......... Posted by: Emily      Read more         Source

October 17, 2007, 4:40 AM CT

Team to study psychosocial stress

Scientists from Carnegie Mellon University and the University of Pittsburgh, led by Pitt Psychology Professor Thomas Kamarck, are studying the effectiveness of a wrist-mounted instrument for measuring psychosocial stress exposure during the course of daily life.

Kamarck and colleagues have received a $426,000 grant from the National Institutes of Health (NIH) for the first year of their four-year project, which is part of a larger NIH initiative to study environmental factors that people encounter every day that may increase their risk of certain diseases.

The study will make use of the eWatch, a multisensor package about the size of a large wristwatch that has been developed by Daniel Siewiorek, director of the Human-Computer Interaction Institute in Carnegie Mellons School of Computer Science, and Asim Smailagic, research professor in Carnegie Mellons College of Engineering. Both are co-researchers in the new study.

Prior studies have determined that people who report highly stressful lifestyles may develop higher rates of a variety of illnesses, ranging from viral infection to heart disease, but measuring exposure to stress is problematic.

However, Kamarck says traditional methods of measuring life stress dont quantify the duration or intensity of exposure effectively. For example, a husband and wife may react to the death of the same relative very differently, he said. Furthermore, stress is an ongoing fluctuating process. At what point does a stressor begin or end?........ Posted by: Emily      Read more         Source

October 16, 2007, 7:39 PM CT

Genetic journey of HIV from birth to death

University of Florida researchers have discovered how HIV evolves over the course of a persons lifetime into a more deadly form that heralds the onset of full-blown AIDS. The findings could pave the way for new therapeutic agents that target the virus earlier in the disease process, before it takes a lethal turn, scientists say.

We were very interested in understanding how the virus mutates from the beginning of the infection until the end, said Marco Salemi, an assistant professor of pathology, immunology and laboratory medicine in the UF College of Medicine and lead author on the study, which appeared in an online issue of the journal PLoS ONE in September. Previously, the only thing known was that somehow the HIV population mutates. And as soon as that happens, patients start developing AIDS. But no one knew how and where the population evolved over time.

To find out, UF scientists began tracking four children born with HIV, studying blood samples taken at birth, throughout life and just after death, when tissues samples were also taken. Using a high-resolution computational technique, they monitored mutations in a protein that helps HIV attach to human cells and then categorized the virus into two groups, R5 and X4. The R5 population is commonly present in high numbers during the early stages of infection. But the X4 population enters the scene later, just before HIV gives way to full-blown AIDS. The scientists tracked the viruses in each patient to find out when and where the telltale X4 population first appeared......... Posted by: Emily      Read more         Source

Wed, 17 Oct 2007 00:56:04 GMT

Clostridium Difficile : more diarrhoea

Rose Gibb

Bloodied gowns left on trolleys, clinical waste bags dumped in corridors and blood stains are not what you want in a hospital. (Undercover reporter working as cleaner)

The official Healthcare Commission on Maidstone and Kent NHS Hospital trust does not not provide happier reading.

Shambolic mis-management or, to be more precise, lack of management of infection in a Kent NHS Trust. A depressing catalogue of incompetence. Lack of leadership from the top - and by that I mean from Consultant Microbiologists, doctors with specialist training in infection and bacteriology - was the main problem. Add to that government pressure on non-medically qualified managers to increase hospital turnover with inadequate nursing resources and you have a receipe for disaster.

A few words on Clostridium Difficile.

It has been around for years. It is rare. Contrary to what the media would have you believe, it is not caused by poor hygiene. Just as MRSA lives happily up your nose without causing problems, so C.Difficle lives happily in your colon until the bacteriological environment of the colon is changed. And it is usually changed by an inexperienced junior hospital doctor prescribing a long and inappropriate course of broad spectrum antibiotics. Elderly women frequently get urinary tract infections. Mostly, they can be cured by six tablets of trimethoprim, one twice a day for three days. Cheap, cheerful, narrow spectrum and harmless. But give an inappropriate dose of what inexperienced doctors and nurses tend to view as a "stronger" antibiotic and the balance of the gut flora is disturbed and C.Difficle takes over. (A simple guide to C. Difficile here)

Once a patient becomes symptomatically infected with C.Difficile scrupulous barrier nursing is required. They had neither the facilities nor the skills to provide such nursing in Kent.
Patients and their families who contacted us were unhappy about much of the care received. They told us that when patients rang the call bell because they were in pain or needed to go to the toilet, their call often wasn't answered, or not in time. Particularly distressing, nurses had told patients to "go in the bed", presumably because this was less time consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores. (Healthcare Commission)
The chief executive of the Trust, Rose Gibb, has been instructed to fall on her sword and to do so without pay if the Secretary of State has his way. She, and many of her staff, may yet face criminal prosecution for manslaughter. I feel sorry for her. Far too reminiscent of John Byng. I feel sorry for them all. They were cutting corners to meet government targets.

As they are in a hospital near you. Posted by: Dr John Crippen      Read more     Source

October 15, 2007, 6:29 PM CT

Mortality rates 71 percent lower at top-rated hospitals

Patients have on average a 71 percent lower chance of dying at the nations top-rated hospitals compared with the lowest-rated hospitals across 18 procedures and conditions analyzed in the tenth annual HealthGrades Hospital Quality in America Study, issued today by HealthGrades, the healthcare ratings company. The study, which documents a wide variation in the quality of care between the highest-performing hospitals and all others, also observed that if all hospitals performed at the level of hospitals rated with five stars by HealthGrades, 266,604 Medicare lives could potentially have been saved over the three years studied.

The HealthGrades study of patient outcomes at the nations approximately 5,000 hospitals, the most comprehensive annual study of its kind, covers more than 41 million Medicare hospitalization records over the years 2004 to 2006. The study examines procedures and conditions ranging from heart attack to pneumonia to valve-replacement surgery. Based on the study, HealthGrades today made available its 2008 quality ratings for virtually every hospital in the country at www.healthgrades.com, a Web site designed to help individuals research and compare local healthcare providers.

As per the study, mortality rates at Americas hospitals have improved 11.8 percent from 2004 to 2006, with the nations top-rated hospitals improving at a faster rate (12.8 percent) than the lowest rated hospitals (11.4 percent). Of the 18 procedures and conditions studied, those that saw the most improvement in mortality rates were pancreatitis (19.2 percent), pulmonary embolism (17.4 percent) and diabetic acidosis and coma (16.6 percent). Those with the smallest improvement were resection/replacement of the abdominal aorta (0.4 percent), coronary interventional procedures such as angioplasties and stents (0.8 percent) and therapy of heart attack (8.9 percent)......... Posted by: Emily      Read more         Source

October 15, 2007, 6:26 PM CT

Once-a-day epilepsy drug is effective for partial seizures

The epilepsy drug lamotrigine is effective in controlling partial seizures when taken once a day as an added treatment, as per a research studyreported in the October 16, 2007, issue of Neurology, the medical journal of the American Academy of Neurology.

These results are important because maintaining stable blood levels of epilepsy drugs and good control of seizures depends on people taking their medications reliably and consistently, said study author Dean Naritoku, MD, of Southern Illinois University in Springfield and member of the American Academy of Neurology. The more often people have to remember to take their medicine each day, the more likely they are to miss a dose. Once-a-day dosing is more convenient for patients.

The study involved 239 people from the United States and several other countries. Participants were age 13 and older with partial seizures not fully controlled by medication. Some of the participants also had secondary generalized seizures. The participants were already taking one to two epilepsy medications; lamotrigine was added to their treatment. They received either lamotrigine in an extended-release formula or placebo for 19 weeks.

Those taking lamotrigine as an added treatment had 46 percent fewer partial seizures during the study, in comparison to 24 percent fewer for those taking a placebo. In addition, 42 percent of those taking lamotrigine as an added treatment reduced their seizure frequently by at least half by the end of the study, in comparison to 24 percent of those taking a placebo......... Posted by: Emily      Read more         Source