Physical activity not only lowers body weight, it cuts cardiovascular risk and blood pressure, improves lipid profiles, has positive effects on the immune system and can reduce the risk of certain cancers. It strengthens the heart, helps the lungs function better, enables the blood to carry more oxygen, makes muscles stronger and improves motion in the joints.
There is some evidence that exercise can enhance mood and even counter mild to moderate depression. Active people have a lower risk of stroke. [15]
Starting an exercise program at any point in life boosts health. Activity helps older people remain active longer. Walking three to four hours a week reduces death by any cause by 54 percent even among people who have diabetes. [16]
All these benefits vanish quickly once people stop exercising.
The Centers for Disease Control and Prevention and the American College of Sports Medicine set the standard for physical activity in 1995, recommending at least 30 minutes a day of moderate exercise on most or all days of the week, in increments as short as 10 minutes. [17]
" From the 1970s up to the 1990s, 'exercise' was geared to improving fitness and was based on the model of an athletic male college student," says Harvard's I-Min Lee, M.D. "Today, the new model is health, not athletic training."
One new study tested various combinations of high and moderate exercise intensity and duration, combined with a 30 percent reduction in calories consumed. The level of intensity produced no significant differences in weight loss. What did make a difference, the researchers say, was time.
Women who exercised 150 minutes a week lost 4.7 percent of their starting weight, while those who spent 200 minutes or more exercising lost 13.6 percent. [18]
Cheap, high-calorie foods and too much time in front of the TV or computer combine to fatten America's children, say many experts. Nearly half of American youths age 12 to 21 get no regular vigorous exercise, says a U.S. Surgeon General's report.[19]
Meanwhile, older people want to exercise to improve their health and appearance, maintain their independence and remain active with their families. But they are discouraged by poor health conditions that interfere with ease of exercise, lack of time and the toll of aging. [20]
Almost any form of physical activity can improve overall health and the cardiovascular system: walking, gardening, pushing a stroller, swimming laps, jumping rope, riding a bike. A "start low and go slow" approach is a good way to begin a personal exercise plan, experts say.
"The point is, at least do something," Lee says. "Something is better than
nothing."
To read the whole article please go to this web page at the Center for the Advancement of Health
вторник, 7 июня 2011 г.
понедельник, 6 июня 2011 г.
Continued Damage From Banned Obesity Drug Revealed By Study
Fenfluramine, the appetite suppressant drug banned in the US in 1997 due to fears over its links to heart conditions, has been shown to have serious long-term effects. In a report published in the open access journal BMC Medicine, researchers have shown that people who stopped using fenfluramine eleven years ago had damaged heart valves up to seven years later.
Fenfluramine (and the closely related dexfenfluramine) were widely prescribed as half of a so-called 'fen/phen' drug combination used to combat obesity. Since its withdrawal, there have been reports that tens of thousands of lawsuits have been filed against the drug's manufacturers over damage caused. In this study, Charles Dahl from the Central Utah Clinic led a team of researchers who studied the heart condition of 5743 former fenfluramine users. He said, "Valve problems were common in individuals exposed to fenfluramines, more frequent in females and associated with duration of drug use in all valves assessed".
Heart valves, such as the aortic, mitral and tricuspid valves, ensure that blood flows in the correct direction around the heart. When they fail, blood back-flows (termed regurgitation). If the regurgitation is severe enough, congestive heart failure and/or the need for heart valve surgery may occur. Dahl said, "We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation".
This is the largest study to examine duration of exposure to the drug and the first to estimate the incidence of valvular surgery among prior users. The authors found that 0.44% of former fenfluramine users in this group had valve surgery as a result of the use of fenfluramines. This risk for valve surgery was increased approximately seven fold. They write, "This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer".
Notes:
1. Valvular Regurgitation and Surgery Associated with Fenfluramine Use: An Analysis of 5743 Individuals
Charles F Dahl, Marvin R Allen, Paul M Urie and Paul N Hopkins
BMC Medicine (in press)
Article available at the journal website: biomedcentral/bmcmed/
All articles are available free of charge, according to BioMed Central's open access policy.
2. BMC Medicine publishes original research articles, technical advances and study protocols in any area of medical science or clinical practice. To be appropriate for BMC Medicine, articles need to be of special importance and broad interest. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, Scopus, EMBASE, Thomson Reuters (ISI) and Google Scholar.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
Fenfluramine (and the closely related dexfenfluramine) were widely prescribed as half of a so-called 'fen/phen' drug combination used to combat obesity. Since its withdrawal, there have been reports that tens of thousands of lawsuits have been filed against the drug's manufacturers over damage caused. In this study, Charles Dahl from the Central Utah Clinic led a team of researchers who studied the heart condition of 5743 former fenfluramine users. He said, "Valve problems were common in individuals exposed to fenfluramines, more frequent in females and associated with duration of drug use in all valves assessed".
Heart valves, such as the aortic, mitral and tricuspid valves, ensure that blood flows in the correct direction around the heart. When they fail, blood back-flows (termed regurgitation). If the regurgitation is severe enough, congestive heart failure and/or the need for heart valve surgery may occur. Dahl said, "We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation".
This is the largest study to examine duration of exposure to the drug and the first to estimate the incidence of valvular surgery among prior users. The authors found that 0.44% of former fenfluramine users in this group had valve surgery as a result of the use of fenfluramines. This risk for valve surgery was increased approximately seven fold. They write, "This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer".
Notes:
1. Valvular Regurgitation and Surgery Associated with Fenfluramine Use: An Analysis of 5743 Individuals
Charles F Dahl, Marvin R Allen, Paul M Urie and Paul N Hopkins
BMC Medicine (in press)
Article available at the journal website: biomedcentral/bmcmed/
All articles are available free of charge, according to BioMed Central's open access policy.
2. BMC Medicine publishes original research articles, technical advances and study protocols in any area of medical science or clinical practice. To be appropriate for BMC Medicine, articles need to be of special importance and broad interest. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, Scopus, EMBASE, Thomson Reuters (ISI) and Google Scholar.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
воскресенье, 5 июня 2011 г.
Chronic Sleep Loss Affects The Body Differently To Acute Sleep Loss, Researchers Show
We've all experienced that occasional all-too-short night of sleep -- staying out too late at a party on a weeknight, studying into the wee hours for a morning exam or being kept up during the night with a sick child. Our bodies try to catch up by making us sleep more and/or more deeply the following night.
It is well established that following an acute period of sleep loss, the body responds this way in order to maintain a homeostatic balance between sleep and wakefulness. Very little is known, however, about the health consequences of chronic partial sleep loss -- losing a little bit of sleep over a period of days, months or even years.
Now sleep researchers at Northwestern University have discovered that when animals are partially sleep deprived over consecutive days they no longer attempt to catch up on sleep, despite an accumulating sleep deficit. Their study is the first to show that repeated partial sleep loss negatively affects an animal's ability to compensate for lost sleep. The body responds differently to chronic sleep loss than it does to acute sleep loss.
The results, which shed light on a problem prevalent in industrialized nations with 24/7 societies such as the United States, where Americans get nearly an hour less sleep a night than they did 40 years ago, were published online recently by the Proceedings of the National Academy of Sciences (PNAS).
"We now know that chronic lack of sleep has an effect on how an animal sleeps," said Fred W. Turek, professor of neurobiology and physiology and director of Northwestern's Center for Sleep and Circadian Biology and an author of the paper. "The animals are getting by on less sleep but they do not try and catch up. The ability to compensate for lost sleep is itself lost, which is damaging both physically and mentally."
In the study, the researchers kept animals awake for 20 hours per day followed by a four-hour sleep opportunity, over five consecutive days. The team monitored brain wave and muscle activity patterns in order to precisely quantify sleep-wake patterns.
After the first day of sleep loss, animals compensated by increasing their intensity, or depth, of sleep, which is indicative of a homeostatic response. However, on the subsequent days of sleep loss, the animals failed to generate this compensatory response and did not sleep any more deeply or any longer than they did under non-sleep deprived conditions (baseline measurements). At the end of the study, the animals were given three full days to sleep as much as they wanted. Amazingly, they recovered virtually none of the sleep that was lost during the five-day sleep deprivation period.
The findings support what other scientists have discovered in recent experimental studies in humans. Chronic partial sleep loss of even two to three hours per night was found to have detrimental effects on the body, leading to impairments in cognitive performance, as well as cardiovascular, immune and endocrine functions. Sleep-restricted people also reported not feeling sleepy even though their performance on tasks declined.
The Northwestern team's results suggest that animals may undergo a change in their need for sleep, or in their sleep homeostat, in situations where normal sleep time is prohibited or where sleep could be detrimental for survival. An extreme but realistic example of this, says Turek, would be how animals respond to catastrophic environmental conditions, such as Hurricane Katrina. No matter how sleep deprived an animal or human may be, it would not be adaptive for the sleep homeostat to kick in and to make the animal fall sleep when it is in the midst of a flood or forest fire. Therefore, the body undergoes some change that allows it to counter its homeostatic need for sleep and to stay awake to avoid danger.
Turek and his team propose that this change in the sleep regulatory system is reflective of an allostatic response. In the short term, allostatic responses are adaptive, but when sustained on a chronic basis, such as in their study, an allostatic load will develop and lead to negative health outcomes. The allostatic load resulting from the accumulating sleep debt loops back to the sleep regulatory system itself and alters it.
"Even though animals and humans may be able to adapt their sleep system to deal with repeated sleep restriction conditions, there could be negative consequences when this pattern is maintained over a long period of time," said Turek. "This brings us back to the idea that repeated partial sleep restriction in humans has been linked to metabolic dysfunction and cardiovascular disease."
"Our lab is very interested in the interactions between sleep loss and metabolic function," said Aaron D. Laposky, research assistant professor at the Center for Sleep and Circadian Biology and an author of the paper. "As Americans have been getting less sleep per night, there has been a parallel trend for body mass index to significantly increase. We believe that when partial sleep loss occurs repeatedly over a long period of time, individuals are predisposed to alterations in the function of many physiological systems."
In addition to Laposky and Turek, other authors of the PNAS paper, titled "Repeated sleep restriction in rats leads to homeostatic and allostatic responses during recovery sleep," are graduate student Youngsoo Kim (lead author) and visiting scholar Bernard M. Bergmann, both from Northwestern.
It is well established that following an acute period of sleep loss, the body responds this way in order to maintain a homeostatic balance between sleep and wakefulness. Very little is known, however, about the health consequences of chronic partial sleep loss -- losing a little bit of sleep over a period of days, months or even years.
Now sleep researchers at Northwestern University have discovered that when animals are partially sleep deprived over consecutive days they no longer attempt to catch up on sleep, despite an accumulating sleep deficit. Their study is the first to show that repeated partial sleep loss negatively affects an animal's ability to compensate for lost sleep. The body responds differently to chronic sleep loss than it does to acute sleep loss.
The results, which shed light on a problem prevalent in industrialized nations with 24/7 societies such as the United States, where Americans get nearly an hour less sleep a night than they did 40 years ago, were published online recently by the Proceedings of the National Academy of Sciences (PNAS).
"We now know that chronic lack of sleep has an effect on how an animal sleeps," said Fred W. Turek, professor of neurobiology and physiology and director of Northwestern's Center for Sleep and Circadian Biology and an author of the paper. "The animals are getting by on less sleep but they do not try and catch up. The ability to compensate for lost sleep is itself lost, which is damaging both physically and mentally."
In the study, the researchers kept animals awake for 20 hours per day followed by a four-hour sleep opportunity, over five consecutive days. The team monitored brain wave and muscle activity patterns in order to precisely quantify sleep-wake patterns.
After the first day of sleep loss, animals compensated by increasing their intensity, or depth, of sleep, which is indicative of a homeostatic response. However, on the subsequent days of sleep loss, the animals failed to generate this compensatory response and did not sleep any more deeply or any longer than they did under non-sleep deprived conditions (baseline measurements). At the end of the study, the animals were given three full days to sleep as much as they wanted. Amazingly, they recovered virtually none of the sleep that was lost during the five-day sleep deprivation period.
The findings support what other scientists have discovered in recent experimental studies in humans. Chronic partial sleep loss of even two to three hours per night was found to have detrimental effects on the body, leading to impairments in cognitive performance, as well as cardiovascular, immune and endocrine functions. Sleep-restricted people also reported not feeling sleepy even though their performance on tasks declined.
The Northwestern team's results suggest that animals may undergo a change in their need for sleep, or in their sleep homeostat, in situations where normal sleep time is prohibited or where sleep could be detrimental for survival. An extreme but realistic example of this, says Turek, would be how animals respond to catastrophic environmental conditions, such as Hurricane Katrina. No matter how sleep deprived an animal or human may be, it would not be adaptive for the sleep homeostat to kick in and to make the animal fall sleep when it is in the midst of a flood or forest fire. Therefore, the body undergoes some change that allows it to counter its homeostatic need for sleep and to stay awake to avoid danger.
Turek and his team propose that this change in the sleep regulatory system is reflective of an allostatic response. In the short term, allostatic responses are adaptive, but when sustained on a chronic basis, such as in their study, an allostatic load will develop and lead to negative health outcomes. The allostatic load resulting from the accumulating sleep debt loops back to the sleep regulatory system itself and alters it.
"Even though animals and humans may be able to adapt their sleep system to deal with repeated sleep restriction conditions, there could be negative consequences when this pattern is maintained over a long period of time," said Turek. "This brings us back to the idea that repeated partial sleep restriction in humans has been linked to metabolic dysfunction and cardiovascular disease."
"Our lab is very interested in the interactions between sleep loss and metabolic function," said Aaron D. Laposky, research assistant professor at the Center for Sleep and Circadian Biology and an author of the paper. "As Americans have been getting less sleep per night, there has been a parallel trend for body mass index to significantly increase. We believe that when partial sleep loss occurs repeatedly over a long period of time, individuals are predisposed to alterations in the function of many physiological systems."
In addition to Laposky and Turek, other authors of the PNAS paper, titled "Repeated sleep restriction in rats leads to homeostatic and allostatic responses during recovery sleep," are graduate student Youngsoo Kim (lead author) and visiting scholar Bernard M. Bergmann, both from Northwestern.
суббота, 4 июня 2011 г.
Study On CPR During Ambulance Transport Of Cardiac Arrest Patients Named "Best EMS Professional Research Presentation" At NAEMSP Conference
ZOLL Medical Corporation (NasdaqGS: ZOLL) announced that a study entitled, "Increased CPR Variability During Ground Ambulance Transport of Patients in Cardiac Arrest" presented by Ben Bobrow, M.D., Medical Director for the Arizona Department of Health Services, Bureau of Emergency Medical Services & Trauma System and the Maricopa Medical Center Resuscitation Science Center, was named the "Best EMS Professional Research Presentation" at the National Association of EMS Physicians (NAEMSP®) 2010 Conference in Phoenix, Arizona. With data supplied from ZOLL E Series® devices, the study concluded that healthcare providers are able to perform more consistent compressions when treating cardiac arrest patients at the scene as opposed to in the back of a moving ambulance.
This study was conducted with Guardian Medical Transport in Flagstaff, Arizona, and the Mesa Fire Department in Mesa, Arizona, as part of a larger Resuscitation Quality Improvement Program. The aim was to quantify and compare the quality of chest compressions at the scene of a resuscitation attempt and during transport. The research was undertaken in response to questions that had been raised about the safety and efficacy of performing manual chest compressions during the ambulance transport of patients in cardiac arrest.
Dr. Bobrow stated, "We found an increase in the variability of chest compression quality for the rate and depth of compressions in our two EMS agencies during the ground transport of cardiac arrest patients. Further investigation is needed to determine the causes of the increased variability along with the optimal timing and method of delivering manual chest compressions."
The EMS agencies participating in the project utilized ZOLL E Series monitor-defibrillators with an accelerometer to continuously record chest compression quality during resuscitation both at the scene and during ambulance transport. The device's built-in Real CPR Help®, which provides real-time audiovisual feedback on the correct rate and depth of chest compressions, was inactivated. ZOLL's Code Review software was used to collect data on chest compression quality during the time a patient was treated at the scene and in transport. The time during which the patient had spontaneous circulation was excluded from analysis as CPR would not have been required during those minutes. Variability was defined as the average of minute-by-minute standard deviations in depth or rate.
A total of 90 adult cardiac arrest events were electronically recorded, of which 45 included chest compressions both at the scene and in the ambulance. Variability in chest compression rate and chest compression depth was significantly greater during transport compared with at the scene. Absolute chest compression depth and chest compression rate tended to be lower during transport. Although not reaching statistical significance, the percentage of chest compressions in compliance with AHA 2005 guidelines for depth (1.5-2 in) and rate (100?±10 compressions/minute) was nearly double at the scene compared with during transport.
"We are pleased that ZOLL technology was used in this study," said Jonathan A. Rennert, President of ZOLL. "We are very committed to helping agencies conduct research that may ultimately result in improving outcomes from cardiac arrest."
About Sudden Cardiac Arrest
SCA, an abrupt disruption of the heart's function, which causes a lack of blood flow to vital organs, claims more than 1 million lives each year. It is the leading cause of unexpected death in the world and strikes without warning. Currently, only about 5 percent of victims survive; 95 percent will die from SCA.
Source
ZOLL Medical Corporation
This study was conducted with Guardian Medical Transport in Flagstaff, Arizona, and the Mesa Fire Department in Mesa, Arizona, as part of a larger Resuscitation Quality Improvement Program. The aim was to quantify and compare the quality of chest compressions at the scene of a resuscitation attempt and during transport. The research was undertaken in response to questions that had been raised about the safety and efficacy of performing manual chest compressions during the ambulance transport of patients in cardiac arrest.
Dr. Bobrow stated, "We found an increase in the variability of chest compression quality for the rate and depth of compressions in our two EMS agencies during the ground transport of cardiac arrest patients. Further investigation is needed to determine the causes of the increased variability along with the optimal timing and method of delivering manual chest compressions."
The EMS agencies participating in the project utilized ZOLL E Series monitor-defibrillators with an accelerometer to continuously record chest compression quality during resuscitation both at the scene and during ambulance transport. The device's built-in Real CPR Help®, which provides real-time audiovisual feedback on the correct rate and depth of chest compressions, was inactivated. ZOLL's Code Review software was used to collect data on chest compression quality during the time a patient was treated at the scene and in transport. The time during which the patient had spontaneous circulation was excluded from analysis as CPR would not have been required during those minutes. Variability was defined as the average of minute-by-minute standard deviations in depth or rate.
A total of 90 adult cardiac arrest events were electronically recorded, of which 45 included chest compressions both at the scene and in the ambulance. Variability in chest compression rate and chest compression depth was significantly greater during transport compared with at the scene. Absolute chest compression depth and chest compression rate tended to be lower during transport. Although not reaching statistical significance, the percentage of chest compressions in compliance with AHA 2005 guidelines for depth (1.5-2 in) and rate (100?±10 compressions/minute) was nearly double at the scene compared with during transport.
"We are pleased that ZOLL technology was used in this study," said Jonathan A. Rennert, President of ZOLL. "We are very committed to helping agencies conduct research that may ultimately result in improving outcomes from cardiac arrest."
About Sudden Cardiac Arrest
SCA, an abrupt disruption of the heart's function, which causes a lack of blood flow to vital organs, claims more than 1 million lives each year. It is the leading cause of unexpected death in the world and strikes without warning. Currently, only about 5 percent of victims survive; 95 percent will die from SCA.
Source
ZOLL Medical Corporation
пятница, 3 июня 2011 г.
Shands At The University Of Florida Expands Cardiac And Neuro Diagnostic Capabilities Through Utilization Of Toshiba's Aquilion One
Shands at the University of Florida, the primary teaching hospital for the UF College of Medicine and one of the Southeast's premier health centers, has expanded its diagnostic imaging capabilities for both cardiac and neurological diseases through the utilization of two Toshiba America Medical Systems, Inc. AquilionTM ONE CT systems. The systems' ability to capture the entire heart or brain in one rotation has enabled UF physicians at Shands to improve diagnostic accuracy and workflow for patients presenting with stroke and heart attack symptoms, while making imaging safer for patients by limiting radiation doses. Toshiba will be showcasing the Aquilion ONE's advanced cardiac capabilities at this year's American College of Cardiology (ACC) annual meeting in New Orleans, April 2 - 5, 2011 (Booth # 2847).
UF radiologists are using Toshiba's Aquilion ONE CT system for advanced cardiac applications for patients presenting with chest pain in the emergency department, evaluation of coronary artery disease and definitive non-invasive evaluation of congenital heart disease with low radiation dose. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements and can image the entire heart in less than a single heartbeat.
"Having a system with the ability to capture the entire heart and great vessels with a single gantry rotation allows for imaging with very low dose and can often provide all of the information required for operative planning in the setting of complex congenital heart disease," said Dr. Roger Shifrin, UF College of Medicine radiology clinical assistant professor. "This capability is extremely important for this patient set, as they will likely undergo multiple exams with radiation over the course of their lifetime."
In addition to successfully evaluating cardiac patients, UF physicians at Shands have been able to further develop and elevate the hospital's stroke imaging. Prior to the Aquilion ONE, diagnostic accuracy for stroke with CT was limited, because many strokes were occurring outside of the detector row imaging area. With the Aquilion ONE's ability to cover up to 16 cm of anatomy, the entire brain can be imaged in a single rotation, dramatically improving the identification of stroke. It can show the organ's dynamic blood flow and real-time function, allowing visualization of dynamic function. These capabilities enable the clinicians at Shands at UF to identify stroke in minutes and are critical in developing the best treatment path and improving the life of the patient, as every second counts in stroke diagnosis.
"Whole-brain perfusion imaging on the Aquilion ONE has improved our ability to accurately and efficiently diagnose stroke," said Dr. Keith Peters, UF College of Medicine associate professor of radiology and neurological surgery. "Additionally, having the ability to conduct dynamic CT angiography over a one-minute sequence allows for the detection of a range of neurological diseases such as brain tumors, carotid-cavernous fistulas, patients with trauma or an altered mental state and other subtle abnormalities, such as rapid blood flow."
"Working with the team at Shands at the University of Florida is a clear example of Toshiba's commitment to developing industry-leading technology that helps hospitals improve their patient care," said Joseph Cooper, director, CT Business Unit, Toshiba. "The Aquilion ONE has allowed Shands at UF to enhance both its cardiac and neurology departments' capabilities through the expansion of diagnostic offerings and implementation of training programs, resulting in improved workflow and better patient outcomes."
About Shands at the University of Florida
Shands HealthCare is private, not-for-profit and affiliated with the University of Florida. Located in Gainesville, Fla., the 618-bed Shands at UF medical center specializes in tertiary and quaternary care for critically ill patients and is one of the Southeast's leading referral medical centers. Approximately 800 UF faculty physicians practice in about 100 areas of specialty care. Shands at UF's areas of excellence are cancer, cardiovascular, neurosurgical and transplant services; and pediatric services at Shands Children's Hospital at UF. Shands at UF operates a State-designated Level I Trauma Center, a Level III Neonatal Intensive Care Unit and one of four regional burn centers. Shands at UF also offers a Neuro ICU with highly specialized physician care expertise in neurosurgery, endovascular neurosurgery, vascular, neurology, critical care medicine, epileptology and neuroradiology. Shands at UF continually receives recognition as one of the nation's top hospitals by U.S. News & World Report because of the dedication to patient care, education and research provided by UF and Shands clinical and support teams.
About Toshiba's Aquilion CT Product Line Recognition
The Aquilion CT product line has received numerous accolades including the number one ranking in CT from MD Buyline since 2002 (eight consecutive years). The Aquilion 64 line has also been named Best in KLAS in 2006 and 2007 in CT; Best in KLAS in 2008, 2009 and 2010 for 64-detector row and above; and Frost & Sullivan's "Healthcare Innovation Award in Cardiovascular Imaging" in 2008. Most recently, Toshiba's service was ranked number one in 26 out of 40 attributes in the IMV, Ltd. ServiceTrakTM Imaging 2010 report on CT system service.
UF radiologists are using Toshiba's Aquilion ONE CT system for advanced cardiac applications for patients presenting with chest pain in the emergency department, evaluation of coronary artery disease and definitive non-invasive evaluation of congenital heart disease with low radiation dose. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements and can image the entire heart in less than a single heartbeat.
"Having a system with the ability to capture the entire heart and great vessels with a single gantry rotation allows for imaging with very low dose and can often provide all of the information required for operative planning in the setting of complex congenital heart disease," said Dr. Roger Shifrin, UF College of Medicine radiology clinical assistant professor. "This capability is extremely important for this patient set, as they will likely undergo multiple exams with radiation over the course of their lifetime."
In addition to successfully evaluating cardiac patients, UF physicians at Shands have been able to further develop and elevate the hospital's stroke imaging. Prior to the Aquilion ONE, diagnostic accuracy for stroke with CT was limited, because many strokes were occurring outside of the detector row imaging area. With the Aquilion ONE's ability to cover up to 16 cm of anatomy, the entire brain can be imaged in a single rotation, dramatically improving the identification of stroke. It can show the organ's dynamic blood flow and real-time function, allowing visualization of dynamic function. These capabilities enable the clinicians at Shands at UF to identify stroke in minutes and are critical in developing the best treatment path and improving the life of the patient, as every second counts in stroke diagnosis.
"Whole-brain perfusion imaging on the Aquilion ONE has improved our ability to accurately and efficiently diagnose stroke," said Dr. Keith Peters, UF College of Medicine associate professor of radiology and neurological surgery. "Additionally, having the ability to conduct dynamic CT angiography over a one-minute sequence allows for the detection of a range of neurological diseases such as brain tumors, carotid-cavernous fistulas, patients with trauma or an altered mental state and other subtle abnormalities, such as rapid blood flow."
"Working with the team at Shands at the University of Florida is a clear example of Toshiba's commitment to developing industry-leading technology that helps hospitals improve their patient care," said Joseph Cooper, director, CT Business Unit, Toshiba. "The Aquilion ONE has allowed Shands at UF to enhance both its cardiac and neurology departments' capabilities through the expansion of diagnostic offerings and implementation of training programs, resulting in improved workflow and better patient outcomes."
About Shands at the University of Florida
Shands HealthCare is private, not-for-profit and affiliated with the University of Florida. Located in Gainesville, Fla., the 618-bed Shands at UF medical center specializes in tertiary and quaternary care for critically ill patients and is one of the Southeast's leading referral medical centers. Approximately 800 UF faculty physicians practice in about 100 areas of specialty care. Shands at UF's areas of excellence are cancer, cardiovascular, neurosurgical and transplant services; and pediatric services at Shands Children's Hospital at UF. Shands at UF operates a State-designated Level I Trauma Center, a Level III Neonatal Intensive Care Unit and one of four regional burn centers. Shands at UF also offers a Neuro ICU with highly specialized physician care expertise in neurosurgery, endovascular neurosurgery, vascular, neurology, critical care medicine, epileptology and neuroradiology. Shands at UF continually receives recognition as one of the nation's top hospitals by U.S. News & World Report because of the dedication to patient care, education and research provided by UF and Shands clinical and support teams.
About Toshiba's Aquilion CT Product Line Recognition
The Aquilion CT product line has received numerous accolades including the number one ranking in CT from MD Buyline since 2002 (eight consecutive years). The Aquilion 64 line has also been named Best in KLAS in 2006 and 2007 in CT; Best in KLAS in 2008, 2009 and 2010 for 64-detector row and above; and Frost & Sullivan's "Healthcare Innovation Award in Cardiovascular Imaging" in 2008. Most recently, Toshiba's service was ranked number one in 26 out of 40 attributes in the IMV, Ltd. ServiceTrakTM Imaging 2010 report on CT system service.
четверг, 2 июня 2011 г.
Institute Of Medicine Makes Recommendations On Producing Trustworthy Guidelines
Few issues are more important to the American College of Cardiology and the American Heart Association than translating scientific evidence into guidelines and performance measures for healthcare providers, a process we have been engaged in for several decades. The use of these evidence-based guidelines has been proven to improve the quality of care and actual outcomes for patients. We applaud the IOM for its new report and share its position that it is critical that no commercial or any other bias can be allowed to influence the development of clinical practice guidelines.
The new Institutes of Medicine report, "Clinical Guidelines Practices We Can Trust," published March 23, 2011, cites the American College of Cardiology and American Heart Association's standards for guideline development as being almost perfectly aligned with their recommendations.
Both the AHA and ACC also appreciate the focus on the issue in the Archives of Internal Medicine article by Mendelson et al, which analyzes the disclosure of relationships with industry in joint guidelines developed by the American College of Cardiology and American Heart Association between 2004 and 2008.
Both the American College of Cardiology and the American Heart Association have long had strict policies for preventing any undue influence of industry. In 2004-2008, these policies relating to practice guidelines included the requirements that:
- All writing panel members must verbally disclose all relevant relationships with industry at every meeting and conference call.
- Individual panelists with a relationship with industry were held responsible to recuse themselves from any matter relevant to their relationship.
- All disclosures would be published as an appendix to each guideline.
- Multiple tiers of reviewers assured the lack of bias of each guideline document.
As the Archives article states, the American College of Cardiology and the American Heart Association refined their policies in 2010 to require even more stringent management of relationships with industry, to align with the Council of Medical Specialty Societies (CMSS). Thus the data within and the conclusions drawn by the article do not reflect the reality of the guidelines development process today.
Updated practices include these additions:
- The Chair of the guidelines writing panel may not have any relevant relationships with industry.
- In addition to the Chair, a majority (at least 50 percent) of guidelines writing committee members must not have any relevant relationships with industry.
- A writing committee member may not draft a recommendation nor any text nor vote on any recommendation that is relevant to any of their industry relationships.
- Members of the final approving bodies of ACC and AHA, Science Advisory Coordinating Committee and the Board of Trust respectively, also must recuse themselves from voting if they have a relevant relationship with industry.
For determining eligibility to serve on a writing committee, a person is considered to have a relevant relationship IF:
- The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or
- The company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or
- The person or a member of the person's household has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.
The American College of Cardiology and the American Heart Association remain fully committed to transparency in the development of all our guidelines. We will continue to look closely at our policies regarding relationships with industry and welcome public dialogue that may help us continue to enhance our practices in the future.
The new Institutes of Medicine report, "Clinical Guidelines Practices We Can Trust," published March 23, 2011, cites the American College of Cardiology and American Heart Association's standards for guideline development as being almost perfectly aligned with their recommendations.
Both the AHA and ACC also appreciate the focus on the issue in the Archives of Internal Medicine article by Mendelson et al, which analyzes the disclosure of relationships with industry in joint guidelines developed by the American College of Cardiology and American Heart Association between 2004 and 2008.
Both the American College of Cardiology and the American Heart Association have long had strict policies for preventing any undue influence of industry. In 2004-2008, these policies relating to practice guidelines included the requirements that:
- All writing panel members must verbally disclose all relevant relationships with industry at every meeting and conference call.
- Individual panelists with a relationship with industry were held responsible to recuse themselves from any matter relevant to their relationship.
- All disclosures would be published as an appendix to each guideline.
- Multiple tiers of reviewers assured the lack of bias of each guideline document.
As the Archives article states, the American College of Cardiology and the American Heart Association refined their policies in 2010 to require even more stringent management of relationships with industry, to align with the Council of Medical Specialty Societies (CMSS). Thus the data within and the conclusions drawn by the article do not reflect the reality of the guidelines development process today.
Updated practices include these additions:
- The Chair of the guidelines writing panel may not have any relevant relationships with industry.
- In addition to the Chair, a majority (at least 50 percent) of guidelines writing committee members must not have any relevant relationships with industry.
- A writing committee member may not draft a recommendation nor any text nor vote on any recommendation that is relevant to any of their industry relationships.
- Members of the final approving bodies of ACC and AHA, Science Advisory Coordinating Committee and the Board of Trust respectively, also must recuse themselves from voting if they have a relevant relationship with industry.
For determining eligibility to serve on a writing committee, a person is considered to have a relevant relationship IF:
- The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or
- The company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or
- The person or a member of the person's household has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.
The American College of Cardiology and the American Heart Association remain fully committed to transparency in the development of all our guidelines. We will continue to look closely at our policies regarding relationships with industry and welcome public dialogue that may help us continue to enhance our practices in the future.
среда, 1 июня 2011 г.
Adhering To Guidelines For Acute Coronary Syndromes Benefits Even Very Elderly Patients
Some say age 90 is the new age 70. If so, there's never been a better time for elderly patients to discuss with family and physicians just how aggressive medical care should be in case of a threatened or definite heart attack.
According to a study published in the May 1, 2007 issue of the Journal of the American College of Cardiology (JACC), patients age 90 and older who came to the emergency room with acute coronary syndromes were less likely than younger patients to receive recommended treatments - but for those who did, survival was much better.
"Having an acute coronary syndrome, even over the age of 90, is not as dire as it once was," said David J. Cohen, M.D., M.Sc., F.A.C.C., director of cardiovascular research at Saint Luke's Mid America Heart Institute, Kansas City, MO. "With optimal medical therapy and invasive care, the outcomes were nearly as good as in a somewhat younger group of patients."
Acute coronary syndrome is an umbrella diagnosis that encompasses both a type of heart attack known as non ST-segment elevation myocardial infarction (NSTEMI) and unstable angina, or chest pain. It is usually caused by a blood clot that temporarily or partially blocks the coronary artery.
Therapies recommended by American College of Cardiology/American Heart Association guidelines include: aspirin, which prevents blood clotting by interfering with platelets; heparin, a "blood thinner" that interferes at a different point in the blood clotting cascade; and beta blockers, which slow the heart rate, reduce the force of the heart's contraction and prevent rhythm abnormalities.
In addition, the guidelines recommend that, within 48 hours, high-risk patients have cardiac catheterization, a procedure that allows cardiologists to see inside the coronary arteries using x-rays, catheters and high-contrast dye, and helps to determine the need for angioplasty, stenting or surgery. These patients should also be treated with glycoprotein IIb/IIIa inhibitors, which interfere with blood platelets and, therefore, prevent clotting inside the artery during or after the invasive procedure.
Each of these therapies has been shown to improve clinical outcomes in patients with acute coronary syndromes, but the studies proving their value have generally been conducted in younger patients. Their effectiveness in the extreme elderly - one of the most rapidly growing segments of the U.S. population - has not been tested.
"The elderly have different responses to medications and treatments than younger patients," said Dr. Cohen. "One of the major goals of our study was to find out whether proven therapies for acute coronary syndromes would work in the extreme elderly."
To do that, Dr. Cohen and his colleagues analyzed data from the CRUSADE National Quality Improvement Initiative, which recruited nearly 52,000 patients age 75 and older with acute coronary syndromes. Of these, more than 5,500 were at least 90 years old, and 112 were at least 100 years old. On January 1, 2007, the CRUSADE registry was replaced by the American College of Cardiology's NCDR-ACTION Registry - (Acute Coronary Treatment & Intervention Outcomes Network). The ACC's NCDR- Registry - now collects myocardial infarction data from hundreds of hospitals across the country into one unified platform with standardized clinical data elements to facilitate benchmark outcomes, and analyze treatment regimens.
Researchers found that extremely elderly patients were often considered unsuitable for recommended therapies. For example, doctors noted that cardiac catheterization was inadvisable in nearly 60 percent of patients age 90 and above, as compared to 27 percent of patients age 75 to 89. The reason most often cited was age itself. Even when there was no apparent reason to consider therapy inadvisable, extreme elderly patients were significantly less likely to receive recommended treatments.
Doctors may have acted out of caution, rather than age bias. CRUSADE researchers found that anticlotting medications and cardiac catheterization were more likely to cause bleeding complications in extremely elderly patients. In fact, as the number of therapies increased from one to five, the risk of major bleeding complications climbed from 3.5 percent to 17.3 percent. Nonetheless, survival was also better with increasing adherence to recommended therapies, particularly aspirin, beta blockers and cardiac catheterization.
"The data are telling us that that the balance favors survival, and we have to be willing to tolerate some increased bleeding," Dr. Cohen said. "We shouldn't simply, on the basis of age, say a person is too high-risk. We should discuss these therapies with patients and their families."
Robert J. Applegate, M.D., F.A.C.C., a professor of cardiology at Wake Forest University School of Medicine, Winston-Salem, NC, said the results of the CRUSADE analysis were encouraging but not definitive. "These results indicate that use of treatments recommended for younger patients with threatened or definite heart attacks was also effective in older patients, but at a cost of more bleeding. Although these findings are encouraging, it is not clear whether the better outcomes simply reflected treatment of healthier patients," he said. "Treatment of threatened or definite heart attacks in very elderly patients should still be made on a case-by-case basis until further studies confirm these results."
In the meantime, bleeding risk may be minimized by adjusting the dosage of anticlotting medications, based on a more careful assessment of kidney function, Dr. Cohen noted. In extremely elderly patients, a normal blood creatinine may give false assurance that kidney function is normal. Calculating creatinine clearance, which takes into account age, gender, and body size, often paints a more accurate picture.
"One of the things we've learned over the last several years from the CRUSADE registry is the importance of checking kidney function and adjusting medication dosage," Dr. Cohen said. "Neglecting to do that really does seem to be associated with worse outcomes."
Dr. Cohen reports receiving research grants from Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly, all companies that manufacture anticlotting medications.
Also in this issue of JACC
Researchers from Israel, India and Germany evaluated a special hourglass-shaped stent that reduces blood flow in the coronary sinus, the main vein that drains blood from the heart. In patients with severe coronary artery disease, reduced drainage from - and, therefore, increased pressure in - the coronary sinus has the potential to redirect blood to new vessels the body naturally develops in oxygen-starved, or ischemic, areas of the heart.
In this study, the first of its kind in humans, researchers experienced no procedural complications with the Coronary Sinus Reducer (Neovasc Medical, Inc.). During follow-up, patients reported improvement in the severity of angina, or chest pain, and in the quality of life. In addition, at six months, the shortfall in blood flow to the heart was at least partially reversed.
According to investigators: "These findings, along with the clinical improvement observed, support further evaluation of the Coronary Sinus Reducer in a randomized placebo-controlled trial, as an alternative tool for treating patients with refractory angina who are not candidates for or are at high risk for revascularization."
Contact: Amy Murphy
American College of Cardiology
According to a study published in the May 1, 2007 issue of the Journal of the American College of Cardiology (JACC), patients age 90 and older who came to the emergency room with acute coronary syndromes were less likely than younger patients to receive recommended treatments - but for those who did, survival was much better.
"Having an acute coronary syndrome, even over the age of 90, is not as dire as it once was," said David J. Cohen, M.D., M.Sc., F.A.C.C., director of cardiovascular research at Saint Luke's Mid America Heart Institute, Kansas City, MO. "With optimal medical therapy and invasive care, the outcomes were nearly as good as in a somewhat younger group of patients."
Acute coronary syndrome is an umbrella diagnosis that encompasses both a type of heart attack known as non ST-segment elevation myocardial infarction (NSTEMI) and unstable angina, or chest pain. It is usually caused by a blood clot that temporarily or partially blocks the coronary artery.
Therapies recommended by American College of Cardiology/American Heart Association guidelines include: aspirin, which prevents blood clotting by interfering with platelets; heparin, a "blood thinner" that interferes at a different point in the blood clotting cascade; and beta blockers, which slow the heart rate, reduce the force of the heart's contraction and prevent rhythm abnormalities.
In addition, the guidelines recommend that, within 48 hours, high-risk patients have cardiac catheterization, a procedure that allows cardiologists to see inside the coronary arteries using x-rays, catheters and high-contrast dye, and helps to determine the need for angioplasty, stenting or surgery. These patients should also be treated with glycoprotein IIb/IIIa inhibitors, which interfere with blood platelets and, therefore, prevent clotting inside the artery during or after the invasive procedure.
Each of these therapies has been shown to improve clinical outcomes in patients with acute coronary syndromes, but the studies proving their value have generally been conducted in younger patients. Their effectiveness in the extreme elderly - one of the most rapidly growing segments of the U.S. population - has not been tested.
"The elderly have different responses to medications and treatments than younger patients," said Dr. Cohen. "One of the major goals of our study was to find out whether proven therapies for acute coronary syndromes would work in the extreme elderly."
To do that, Dr. Cohen and his colleagues analyzed data from the CRUSADE National Quality Improvement Initiative, which recruited nearly 52,000 patients age 75 and older with acute coronary syndromes. Of these, more than 5,500 were at least 90 years old, and 112 were at least 100 years old. On January 1, 2007, the CRUSADE registry was replaced by the American College of Cardiology's NCDR-ACTION Registry - (Acute Coronary Treatment & Intervention Outcomes Network). The ACC's NCDR- Registry - now collects myocardial infarction data from hundreds of hospitals across the country into one unified platform with standardized clinical data elements to facilitate benchmark outcomes, and analyze treatment regimens.
Researchers found that extremely elderly patients were often considered unsuitable for recommended therapies. For example, doctors noted that cardiac catheterization was inadvisable in nearly 60 percent of patients age 90 and above, as compared to 27 percent of patients age 75 to 89. The reason most often cited was age itself. Even when there was no apparent reason to consider therapy inadvisable, extreme elderly patients were significantly less likely to receive recommended treatments.
Doctors may have acted out of caution, rather than age bias. CRUSADE researchers found that anticlotting medications and cardiac catheterization were more likely to cause bleeding complications in extremely elderly patients. In fact, as the number of therapies increased from one to five, the risk of major bleeding complications climbed from 3.5 percent to 17.3 percent. Nonetheless, survival was also better with increasing adherence to recommended therapies, particularly aspirin, beta blockers and cardiac catheterization.
"The data are telling us that that the balance favors survival, and we have to be willing to tolerate some increased bleeding," Dr. Cohen said. "We shouldn't simply, on the basis of age, say a person is too high-risk. We should discuss these therapies with patients and their families."
Robert J. Applegate, M.D., F.A.C.C., a professor of cardiology at Wake Forest University School of Medicine, Winston-Salem, NC, said the results of the CRUSADE analysis were encouraging but not definitive. "These results indicate that use of treatments recommended for younger patients with threatened or definite heart attacks was also effective in older patients, but at a cost of more bleeding. Although these findings are encouraging, it is not clear whether the better outcomes simply reflected treatment of healthier patients," he said. "Treatment of threatened or definite heart attacks in very elderly patients should still be made on a case-by-case basis until further studies confirm these results."
In the meantime, bleeding risk may be minimized by adjusting the dosage of anticlotting medications, based on a more careful assessment of kidney function, Dr. Cohen noted. In extremely elderly patients, a normal blood creatinine may give false assurance that kidney function is normal. Calculating creatinine clearance, which takes into account age, gender, and body size, often paints a more accurate picture.
"One of the things we've learned over the last several years from the CRUSADE registry is the importance of checking kidney function and adjusting medication dosage," Dr. Cohen said. "Neglecting to do that really does seem to be associated with worse outcomes."
Dr. Cohen reports receiving research grants from Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly, all companies that manufacture anticlotting medications.
Also in this issue of JACC
Researchers from Israel, India and Germany evaluated a special hourglass-shaped stent that reduces blood flow in the coronary sinus, the main vein that drains blood from the heart. In patients with severe coronary artery disease, reduced drainage from - and, therefore, increased pressure in - the coronary sinus has the potential to redirect blood to new vessels the body naturally develops in oxygen-starved, or ischemic, areas of the heart.
In this study, the first of its kind in humans, researchers experienced no procedural complications with the Coronary Sinus Reducer (Neovasc Medical, Inc.). During follow-up, patients reported improvement in the severity of angina, or chest pain, and in the quality of life. In addition, at six months, the shortfall in blood flow to the heart was at least partially reversed.
According to investigators: "These findings, along with the clinical improvement observed, support further evaluation of the Coronary Sinus Reducer in a randomized placebo-controlled trial, as an alternative tool for treating patients with refractory angina who are not candidates for or are at high risk for revascularization."
Contact: Amy Murphy
American College of Cardiology
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