Thursday, May 26, 2011
THOUGHT FOR THE DAY ....
Some of the happiest people in the world are not happy because they have everything but because they make the best of what they do have.
FUN FACTS
* The game of volleyball was invented in 1895 by William G. Morgan. *
* On average women say 7,000 words per day. Men manage just over 2000. *
* 11% of people are left handed. *
* The average speed of a skydiver is 200kph (124mph) *
* Never hold your nose and cover your mouth when sneezing, as it can blow out your eyeballs. *
* On average women say 7,000 words per day. Men manage just over 2000. *
* 11% of people are left handed. *
* The average speed of a skydiver is 200kph (124mph) *
* Never hold your nose and cover your mouth when sneezing, as it can blow out your eyeballs. *
Asthma often elicits unneeded antibiotics for kids
NEW YORK (Reuters Health) - One out of six kids with asthma receives an antibiotic they don't need, according to new study findings.
The researchers found that doctors prescribe roughly 1 million unnecessary antibiotics to U.S. kids with asthma each year, potentially encouraging the spread of "superbug" infections that are resistant to even the most powerful drugs.
Another study published in the same issue of the journal Pediatrics shows the U.S. is not the only country to over-prescribe antibiotics in kids with asthma - researchers in Belgium found that kids who receive drugs for asthma were nearly twice as likely as other kids to also get an antibiotic.
"You must have a good reason to prescribe both an asthma drug and an antibiotic," study author Dr. Kris De Boeck of the University Hospital of Leuven told Reuters Health.
This "overuse" and "incorrect use" of antibiotics will "put pressure on bacteria and drive them to develop survival strategies," thereby increasing the likelihood they will become resistant to the drugs, added De Boeck.
Babies and young children commonly develop wheezing when they have a respiratory infection, so doctors may prescribe an antibiotic. But for some children, that wheezing is an early indication of asthma.
And for children already diagnosed with asthma, official guidelines stipulate that doctors should not include antibiotics as part of treatment, except in children who also have infections.
To investigate whether doctors are following that advice, Dr. Ian M. Paul at Penn State College of Medicine and his colleagues reviewed information collected as part of national surveys about U.S. doctors' visits. They reviewed more than 60 million visits involving children with asthma and no declared symptoms suggesting they had an infection that could be treated by an antibiotic. Regardless, during 1 in 6 of those visits, the children received a prescription for an antibiotic.
Meanwhile, De Boeck and her team reviewed a database from the insurer that covers more than 40 percent of the Belgian population, and found that kids receiving asthma drugs were 90 percent more likely to also get an antibiotic during the same year. Specifically, nearly 75 percent of kids who received asthma drugs also got an antibiotic, which occurred in less than 40 percent of kids who were not given any drugs to treat asthma.
Many doctors likely offer antibiotics to asthmatic kids "out of fear, out of habit," De Boeck said in an email. "Some physicians state that parents do not want to leave the consultation room before they get a medicine."
There may also be some confusion over when kids need antibiotics, and hopefully "teaching" and "awareness" will help give doctors a better understanding, said De Boeck. For instance, kids with fever, wheeze, and "diffuse disease" may have asthma triggered by a viral infection, which will not respond to an antibiotic.
"It is common knowledge that antibiotic overuse leads to increased bacterial resistance in the community," write Dr. Rita Mangione-Smith of the University of Washington and Paul Krogstad of the University of California, Los Angeles, in an accompanying editorial. "As we continue to overuse antibiotics, our armamentarium to fight resistant infections continues to shrink."
SOURCE: http://bit.ly/lKao3F and http://bit.ly/m6oGDC Pediatrics, online May 23, 2011.
The researchers found that doctors prescribe roughly 1 million unnecessary antibiotics to U.S. kids with asthma each year, potentially encouraging the spread of "superbug" infections that are resistant to even the most powerful drugs.
Another study published in the same issue of the journal Pediatrics shows the U.S. is not the only country to over-prescribe antibiotics in kids with asthma - researchers in Belgium found that kids who receive drugs for asthma were nearly twice as likely as other kids to also get an antibiotic.
"You must have a good reason to prescribe both an asthma drug and an antibiotic," study author Dr. Kris De Boeck of the University Hospital of Leuven told Reuters Health.
This "overuse" and "incorrect use" of antibiotics will "put pressure on bacteria and drive them to develop survival strategies," thereby increasing the likelihood they will become resistant to the drugs, added De Boeck.
Babies and young children commonly develop wheezing when they have a respiratory infection, so doctors may prescribe an antibiotic. But for some children, that wheezing is an early indication of asthma.
And for children already diagnosed with asthma, official guidelines stipulate that doctors should not include antibiotics as part of treatment, except in children who also have infections.
To investigate whether doctors are following that advice, Dr. Ian M. Paul at Penn State College of Medicine and his colleagues reviewed information collected as part of national surveys about U.S. doctors' visits. They reviewed more than 60 million visits involving children with asthma and no declared symptoms suggesting they had an infection that could be treated by an antibiotic. Regardless, during 1 in 6 of those visits, the children received a prescription for an antibiotic.
Meanwhile, De Boeck and her team reviewed a database from the insurer that covers more than 40 percent of the Belgian population, and found that kids receiving asthma drugs were 90 percent more likely to also get an antibiotic during the same year. Specifically, nearly 75 percent of kids who received asthma drugs also got an antibiotic, which occurred in less than 40 percent of kids who were not given any drugs to treat asthma.
Many doctors likely offer antibiotics to asthmatic kids "out of fear, out of habit," De Boeck said in an email. "Some physicians state that parents do not want to leave the consultation room before they get a medicine."
There may also be some confusion over when kids need antibiotics, and hopefully "teaching" and "awareness" will help give doctors a better understanding, said De Boeck. For instance, kids with fever, wheeze, and "diffuse disease" may have asthma triggered by a viral infection, which will not respond to an antibiotic.
"It is common knowledge that antibiotic overuse leads to increased bacterial resistance in the community," write Dr. Rita Mangione-Smith of the University of Washington and Paul Krogstad of the University of California, Los Angeles, in an accompanying editorial. "As we continue to overuse antibiotics, our armamentarium to fight resistant infections continues to shrink."
SOURCE: http://bit.ly/lKao3F and http://bit.ly/m6oGDC Pediatrics, online May 23, 2011.
Beyond Guide Dogs: New Animal-Assisted Therapy
You know about guide dogs for the blind, but that’s just one of the ways service animals are helping people with health conditions and special needs. Dogs and other four-legged friends can detect disease, aid people with limited mobility and comfort war vets and hospital patients. Read on to learn about the new boom in animal-assisted therapy…
CAT scans and biopsies are useful for detecting cancer, and blood tests can confirm diabetes. But researchers have found a highly accurate, simple and more adorable tool for sniffing out diseases: dogs.
Yes, woman’s best friend has learned to detect colorectal, skin, bladder, lung, breast and ovarian cancers by smell, according to scientific studies conducted over the past decade. In many cases, they’re more accurate, deliver faster results and are cheaper than lab tests.
Service dog training now includes skills such as alerting diabetics to dangerous drops in blood sugar levels. They can help autistic kids socialize and veterans cope with post-traumatic stress disorder (PTSD). They can also notify a deaf mom when her baby is crying.
“Dogs are pack animals, programmed to please,” says Rebecca Johnson, Ph.D., R.N., associate professor at the University of Missouri’s College of Veterinary Medicine and director of the Research Center for Human-Animal Interaction. “They’re trained to do extraordinary things.”
Canines aren’t the only service animals. Miniature horses guide the blind, and our simian relatives do more than just monkey around: They’re improving life for those with limited mobility.
Here are the top health conditions for which animals are used, and how they get their jobs done.
Animal-Assisted Therapy #1: Cancer detection
Dogs, with their extraordinary sense of smell – about a million times better than a human’s – can identify chemicals diluted to a few parts per trillion. Their potential to “diagnose” cancer was first recognized in 1989, when a pet dog alerted its owner to a melanoma (skin cancer) by repeatedly sniffing a skin sore.
Since 2001, as reported in numerous respected medical journals, dogs have been trained to detect a variety of cancers.
Lung and breast cancer: In 2006, research dogs detected these with an astonishing 88%-97% accuracy, according to a study led by the Pine Street Foundation, a cancer research and education group in San Anselmo, Calif., and the Polish Academy of Sciences.
The dogs sniffed the breath of participants who had recently been diagnosed with cancer through a biopsy, mammogram or CAT scan. They also smelled cancer-free control patients. Amazingly, they were able to identify those with lung and breast cancer, both in early and late stages of the disease.
Colorectal and prostate cancer: Marine, a specially trained black Labrador retriever, detected colorectal cancer 91% of the time when sniffing human breath and stool samples, according to a study published in the British journal Gut in January 2011.
The uncanny canine also clocked a 90% detection rate for prostate cancer when smelling urine samples, another study found.
Bladder cancer: Drawing on dogs’ instinctual sniffing of urine, a British team of researchers in 2004 trained six dogs to identify the urine of patients with bladder cancer, according to a report in the journal Nature. The cancer cells apparently release molecules with a special odor.
When the dogs were trained to discriminate between cancer patients and those with benign bladder conditions, their accuracy rate was about 40%.
Studies continue, but canine cancer detection isn’t yet available to the public. And don’t try it with Fido at home. Dogs need special training for this work, experts say.
Animal-Assisted Therapy #2: Diabetes intervention
Imagine you’re watching TV and your blood-sugar level plunges well below 70 mg/dL (80-100 mg is ideal). You feel nervous, fuzzy-headed and weak – but don’t realize that hypoglycemia, or low blood sugar, has set in. Left untreated, the condition can lead to a seizure or coma.
Suddenly, your yellow Lab nudges you repeatedly, urging you to pay attention. What’s up?
“I know my blood sugar’s low and I need something with sugar fast,” says Pebbles Miller, 45, a diabetic and paramedical examiner. She both volunteers for and uses the services of Dogs4Diabetics, a nonprofit organization in San Anselmo, which provides service dog training for people with insulin-dependent diabetes.
“My dog, Fairmont, is right about my hypoglycemia 90% of the time,” Miller says. “I’m sure he’s saved my life several times.”
In 2008, researchers from Queen’s University in Belfast surveyed 212 dog owners with type 1 diabetes. About 65% of them said their dogs had reacted to at least one hypoglycemic episode. A third said their dogs had reacted to more than 10 events.
“In almost every training class, we have a dog that alerts a visitor who doesn’t know they’re diabetic,” says Dogs4Diabetics executive director Susan Millhollon. “It usually turns out they are.”
Animal-Assisted Therapy #3: Epilepsy notification
Researchers believe some dogs are able to sense when someone is about to have an epileptic seizure – either through electromagnetic changes, the scent of certain body chemicals or subtle neuromuscular cues, says the University of Missouri’s Johnson.
Johnson witnessed such a canine alert at a dog-training session. One of the dogs, which had been taught to detect low blood sugar, suddenly became agitated and nudged the hand of a nearby woman, trying to get her attention. Seconds later, the woman had an epileptic seizure, Johnson says.
A pre-seizure warning could give someone with epilepsy enough time to take medication or to get into a safe position, Johnson says.
Some physicians are skeptical of a dog’s ability to warn of seizures, but at the very least, service dog training can teach them to stay beside an epileptic person during an event or press a button on a phone programmed to dial 911.
Animal-Assisted Therapy #4: Autism ambassadors
Twenty-four years ago, during a dog demonstration for profoundly disabled kids, veteran Illinois teacher Nancy Lind had an epiphany: The students, she realized, understood that the dog and its leash were connected. Maybe dogs could motivate children to accomplish goals experts deemed unattainable. Was she right!
She created a nonprofit organization, Rainbow Animal Assisted Therapy, and has made major breakthroughs with autistic and severely disabled children with trained dogs. The kids have learned to put on hats and gloves after dogs pulled them off, and mastered the use of spoons and forks to make applesauce sandwiches that they “served” to the dogs.
“We’re very goal-oriented with physical, behavioral and cognitive skills,” Lind says.
That includes playing games (soccer, fly ball and bowling with dogs), giving them commands and learning to shed their fear of animals.
Lind’s organization, founded in 1987, has 250 dogs working in 150 programs in the greater Chicago area.
Animal-Assisted Therapy #5: Assistance for disabled people
A paralyzed woman’s cell phone tumbles from her lap to the ground, the parts scattering like a broken dish. Her 8-pound Capuchin monkey, trained to help her, gathers up the batteries and other pieces. Responding to verbal commands, such as “flip,” “turn” and “push,” the monkey reassembles the phone, replacing it on her owner’s lap.
“These monkeys can flip pages of a book, load DVDs and turn on computers,” explains Megan Talbert, executive director of Helping Hands: Monkey Helpers for the Disabled, a nonprofit organization that provides trained monkeys to adults with spinal cord injuries.
“They know their names, words and commands,” she says. Plus, “they’re intelligent, cuddly and affectionate, and make great companions.”
The monkeys, which weigh only about 10 pounds, can sit on the shoulders and laps of their owners, providing warm contact and affection.
“Amy [the monkey] rides on my shoulder and grooms my hair,” says M.K., a Wisconsin Helping Hands client who only has sensation above her torso. (She wished to remain anonymous).
“I can actually feel her fur and body warmth on my face – and that means more to me than I can even say,” she says.
It costs about $38,000 to raise a monkey from birth through its training as a service animal. Helping Hands pays all monkey-related expenses for their lifetime – up to 35 years – including vet expenses and food.
Animal-Assisted Therapy #6: PTSD partners
Up to 30% of the more than 2 million U.S. soldiers deployed to combat zones in the last two years or so experienced post-traumatic stress disorder (PTSD), according to the University of Maryland Veterans and Shelter Dogs Initiative.
They often face many hurdles as they re-enter family and work life. Vets with PTSD re-experience intrusive memories, are hyper-vigilant and avoid relationships.
That’s where animal-assisted therapy is making a difference.
In a 2-year, 3-phase study that began in March 2010 at the University of Missouri’s Research Center for Human Animal Interaction, 50 veterans were paired with shelter dogs in a dog-walking and obedience-training program. Some of the vets mentor new participants, and some are chosen to help with service dog training.
At each stage, the canine contact is easing PTSD symptoms, says UM’s Johnson.
The dogs are trained for such tasks as entering a dark room (an anxiety-producing experience for some veterans with PTSD) and flipping on a light switch. They’re also taught to walk around the corner of a store aisle ahead of their owners, signaling the OK to proceed when they’re sure the person won’t bump into strangers unexpectedly.
As the study proceeds, “we expect to see improvements in PTSD levels, physical activity and family functioning in the veterans,” Johnson says.
Animal-Assisted Therapy #7: Help with visual and hearing impairment, heart disease, hypertension and other conditions
Anyone who’s had a pet knows that spending time with Fido is an excellent tonic for short-term or chronic health conditions.
That’s why a number of organizations, including Delta Society and American Humane Association, offer animal-assisted therapy for the blind, deaf and hospitalized patients, among others.
Dogs, cats, rabbits and birds are among animals taken to hospitals and long-term care facilities to interact with patients. Several studies have shown a decrease in some subjects’ heart and respiratory rates, blood pressure and other stress levels while petting animals.
And while guide dogs have long assisted the blind, horses are now getting service animal training to help them get around, as well as for recreational riding and companionship. They have three advantages over canines: Horses live longer, are non-allergenic, and can assist people who have trouble getting up out of a chair.
Miniature horses employed by the Guide Horse Foundation are taught with the same techniques as service dog training. They’re allowed in stores and businesses, and can even fly on commercial aircraft.
“Horses are natural guide animals and have been guiding humans for centuries,” the foundation notes. And unlike with many guide dogs, people immediately recognize a horse as a working service animal.
Best of all, they create social interaction for their clients. Who could resist something so warm and cuddly?
CAT scans and biopsies are useful for detecting cancer, and blood tests can confirm diabetes. But researchers have found a highly accurate, simple and more adorable tool for sniffing out diseases: dogs.
Yes, woman’s best friend has learned to detect colorectal, skin, bladder, lung, breast and ovarian cancers by smell, according to scientific studies conducted over the past decade. In many cases, they’re more accurate, deliver faster results and are cheaper than lab tests.
Service dog training now includes skills such as alerting diabetics to dangerous drops in blood sugar levels. They can help autistic kids socialize and veterans cope with post-traumatic stress disorder (PTSD). They can also notify a deaf mom when her baby is crying.
“Dogs are pack animals, programmed to please,” says Rebecca Johnson, Ph.D., R.N., associate professor at the University of Missouri’s College of Veterinary Medicine and director of the Research Center for Human-Animal Interaction. “They’re trained to do extraordinary things.”
Canines aren’t the only service animals. Miniature horses guide the blind, and our simian relatives do more than just monkey around: They’re improving life for those with limited mobility.
Here are the top health conditions for which animals are used, and how they get their jobs done.
Animal-Assisted Therapy #1: Cancer detection
Dogs, with their extraordinary sense of smell – about a million times better than a human’s – can identify chemicals diluted to a few parts per trillion. Their potential to “diagnose” cancer was first recognized in 1989, when a pet dog alerted its owner to a melanoma (skin cancer) by repeatedly sniffing a skin sore.
Since 2001, as reported in numerous respected medical journals, dogs have been trained to detect a variety of cancers.
Lung and breast cancer: In 2006, research dogs detected these with an astonishing 88%-97% accuracy, according to a study led by the Pine Street Foundation, a cancer research and education group in San Anselmo, Calif., and the Polish Academy of Sciences.
The dogs sniffed the breath of participants who had recently been diagnosed with cancer through a biopsy, mammogram or CAT scan. They also smelled cancer-free control patients. Amazingly, they were able to identify those with lung and breast cancer, both in early and late stages of the disease.
Colorectal and prostate cancer: Marine, a specially trained black Labrador retriever, detected colorectal cancer 91% of the time when sniffing human breath and stool samples, according to a study published in the British journal Gut in January 2011.
The uncanny canine also clocked a 90% detection rate for prostate cancer when smelling urine samples, another study found.
Bladder cancer: Drawing on dogs’ instinctual sniffing of urine, a British team of researchers in 2004 trained six dogs to identify the urine of patients with bladder cancer, according to a report in the journal Nature. The cancer cells apparently release molecules with a special odor.
When the dogs were trained to discriminate between cancer patients and those with benign bladder conditions, their accuracy rate was about 40%.
Studies continue, but canine cancer detection isn’t yet available to the public. And don’t try it with Fido at home. Dogs need special training for this work, experts say.
Animal-Assisted Therapy #2: Diabetes intervention
Imagine you’re watching TV and your blood-sugar level plunges well below 70 mg/dL (80-100 mg is ideal). You feel nervous, fuzzy-headed and weak – but don’t realize that hypoglycemia, or low blood sugar, has set in. Left untreated, the condition can lead to a seizure or coma.
Suddenly, your yellow Lab nudges you repeatedly, urging you to pay attention. What’s up?
“I know my blood sugar’s low and I need something with sugar fast,” says Pebbles Miller, 45, a diabetic and paramedical examiner. She both volunteers for and uses the services of Dogs4Diabetics, a nonprofit organization in San Anselmo, which provides service dog training for people with insulin-dependent diabetes.
“My dog, Fairmont, is right about my hypoglycemia 90% of the time,” Miller says. “I’m sure he’s saved my life several times.”
In 2008, researchers from Queen’s University in Belfast surveyed 212 dog owners with type 1 diabetes. About 65% of them said their dogs had reacted to at least one hypoglycemic episode. A third said their dogs had reacted to more than 10 events.
“In almost every training class, we have a dog that alerts a visitor who doesn’t know they’re diabetic,” says Dogs4Diabetics executive director Susan Millhollon. “It usually turns out they are.”
Animal-Assisted Therapy #3: Epilepsy notification
Researchers believe some dogs are able to sense when someone is about to have an epileptic seizure – either through electromagnetic changes, the scent of certain body chemicals or subtle neuromuscular cues, says the University of Missouri’s Johnson.
Johnson witnessed such a canine alert at a dog-training session. One of the dogs, which had been taught to detect low blood sugar, suddenly became agitated and nudged the hand of a nearby woman, trying to get her attention. Seconds later, the woman had an epileptic seizure, Johnson says.
A pre-seizure warning could give someone with epilepsy enough time to take medication or to get into a safe position, Johnson says.
Some physicians are skeptical of a dog’s ability to warn of seizures, but at the very least, service dog training can teach them to stay beside an epileptic person during an event or press a button on a phone programmed to dial 911.
Animal-Assisted Therapy #4: Autism ambassadors
Twenty-four years ago, during a dog demonstration for profoundly disabled kids, veteran Illinois teacher Nancy Lind had an epiphany: The students, she realized, understood that the dog and its leash were connected. Maybe dogs could motivate children to accomplish goals experts deemed unattainable. Was she right!
She created a nonprofit organization, Rainbow Animal Assisted Therapy, and has made major breakthroughs with autistic and severely disabled children with trained dogs. The kids have learned to put on hats and gloves after dogs pulled them off, and mastered the use of spoons and forks to make applesauce sandwiches that they “served” to the dogs.
“We’re very goal-oriented with physical, behavioral and cognitive skills,” Lind says.
That includes playing games (soccer, fly ball and bowling with dogs), giving them commands and learning to shed their fear of animals.
Lind’s organization, founded in 1987, has 250 dogs working in 150 programs in the greater Chicago area.
Animal-Assisted Therapy #5: Assistance for disabled people
A paralyzed woman’s cell phone tumbles from her lap to the ground, the parts scattering like a broken dish. Her 8-pound Capuchin monkey, trained to help her, gathers up the batteries and other pieces. Responding to verbal commands, such as “flip,” “turn” and “push,” the monkey reassembles the phone, replacing it on her owner’s lap.
“These monkeys can flip pages of a book, load DVDs and turn on computers,” explains Megan Talbert, executive director of Helping Hands: Monkey Helpers for the Disabled, a nonprofit organization that provides trained monkeys to adults with spinal cord injuries.
“They know their names, words and commands,” she says. Plus, “they’re intelligent, cuddly and affectionate, and make great companions.”
The monkeys, which weigh only about 10 pounds, can sit on the shoulders and laps of their owners, providing warm contact and affection.
“Amy [the monkey] rides on my shoulder and grooms my hair,” says M.K., a Wisconsin Helping Hands client who only has sensation above her torso. (She wished to remain anonymous).
“I can actually feel her fur and body warmth on my face – and that means more to me than I can even say,” she says.
It costs about $38,000 to raise a monkey from birth through its training as a service animal. Helping Hands pays all monkey-related expenses for their lifetime – up to 35 years – including vet expenses and food.
Animal-Assisted Therapy #6: PTSD partners
Up to 30% of the more than 2 million U.S. soldiers deployed to combat zones in the last two years or so experienced post-traumatic stress disorder (PTSD), according to the University of Maryland Veterans and Shelter Dogs Initiative.
They often face many hurdles as they re-enter family and work life. Vets with PTSD re-experience intrusive memories, are hyper-vigilant and avoid relationships.
That’s where animal-assisted therapy is making a difference.
In a 2-year, 3-phase study that began in March 2010 at the University of Missouri’s Research Center for Human Animal Interaction, 50 veterans were paired with shelter dogs in a dog-walking and obedience-training program. Some of the vets mentor new participants, and some are chosen to help with service dog training.
At each stage, the canine contact is easing PTSD symptoms, says UM’s Johnson.
The dogs are trained for such tasks as entering a dark room (an anxiety-producing experience for some veterans with PTSD) and flipping on a light switch. They’re also taught to walk around the corner of a store aisle ahead of their owners, signaling the OK to proceed when they’re sure the person won’t bump into strangers unexpectedly.
As the study proceeds, “we expect to see improvements in PTSD levels, physical activity and family functioning in the veterans,” Johnson says.
Animal-Assisted Therapy #7: Help with visual and hearing impairment, heart disease, hypertension and other conditions
Anyone who’s had a pet knows that spending time with Fido is an excellent tonic for short-term or chronic health conditions.
That’s why a number of organizations, including Delta Society and American Humane Association, offer animal-assisted therapy for the blind, deaf and hospitalized patients, among others.
Dogs, cats, rabbits and birds are among animals taken to hospitals and long-term care facilities to interact with patients. Several studies have shown a decrease in some subjects’ heart and respiratory rates, blood pressure and other stress levels while petting animals.
And while guide dogs have long assisted the blind, horses are now getting service animal training to help them get around, as well as for recreational riding and companionship. They have three advantages over canines: Horses live longer, are non-allergenic, and can assist people who have trouble getting up out of a chair.
Miniature horses employed by the Guide Horse Foundation are taught with the same techniques as service dog training. They’re allowed in stores and businesses, and can even fly on commercial aircraft.
“Horses are natural guide animals and have been guiding humans for centuries,” the foundation notes. And unlike with many guide dogs, people immediately recognize a horse as a working service animal.
Best of all, they create social interaction for their clients. Who could resist something so warm and cuddly?
Doctors prescribe fewer tests for better care
NEW YORK (Reuters Health) - Ordering fewer tests and prescribing fewer antibiotics will not only curb healthcare spending but also improve the quality of primary care, a large group of U.S. doctors said Monday.
After soliciting input from more than 250 members, the National Physicians Alliance (NPA) came up with 15 recommendations it believes will help doctors practice medicine more efficiently.
The group's report, published in the Archives of Internal Medicine, follows concerns over the growing use of new technologies, such as CT scans, that in many cases don't have a clear medical value.
The report lists five evidence-based recommendations in three areas: family medicine, internal medicine and pediatrics.
The gist of the advice? Leave well enough alone.
For instance, the group discourages the use of blood and urine tests in healthy people, because they will probably yield few results and end up costing a lot. (See Reuters Health story of May 16, 2011).
It also cautions against heart tests such as ECGs or CT scans in symptom-free, low-risk individuals, because there is scant evidence that spotting cholesterol buildups provides any benefit in these people.
In fact, people may end up with side effect from the expensive tests, including kidney problems, anxiety and a slightly increased cancer risk.
The NPA also recommends against imaging tests for lower back pain in the first six months, noting that such tests do not lead to better results.
For kids, the group urges doctors to hold off on antibiotics for a sore throat, unless the strep test comes back positive.
Most sore throats are caused by viruses, which don't respond to antibiotics, and using the drugs unnecessarily may fuel the spread of drug-resistant bacteria and expose patients to side effects.
And according to the NPA, kids should not use over-the-counter cough or cold medicines, because there is little evidence that they work. Despite this, more than 10 percent of kids use these drugs.
The NPA plans to distribute its recommendations to its 22,000 members across the U.S. and hopes to gain support from consumer and patient safety groups.
According to the report, "Having such endorsements will help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."
SOURCE: http://bit.ly/m79pZ1 Archives of Internal Medicine, online May 23, 2011.
After soliciting input from more than 250 members, the National Physicians Alliance (NPA) came up with 15 recommendations it believes will help doctors practice medicine more efficiently.
The group's report, published in the Archives of Internal Medicine, follows concerns over the growing use of new technologies, such as CT scans, that in many cases don't have a clear medical value.
The report lists five evidence-based recommendations in three areas: family medicine, internal medicine and pediatrics.
The gist of the advice? Leave well enough alone.
For instance, the group discourages the use of blood and urine tests in healthy people, because they will probably yield few results and end up costing a lot. (See Reuters Health story of May 16, 2011).
It also cautions against heart tests such as ECGs or CT scans in symptom-free, low-risk individuals, because there is scant evidence that spotting cholesterol buildups provides any benefit in these people.
In fact, people may end up with side effect from the expensive tests, including kidney problems, anxiety and a slightly increased cancer risk.
The NPA also recommends against imaging tests for lower back pain in the first six months, noting that such tests do not lead to better results.
For kids, the group urges doctors to hold off on antibiotics for a sore throat, unless the strep test comes back positive.
Most sore throats are caused by viruses, which don't respond to antibiotics, and using the drugs unnecessarily may fuel the spread of drug-resistant bacteria and expose patients to side effects.
And according to the NPA, kids should not use over-the-counter cough or cold medicines, because there is little evidence that they work. Despite this, more than 10 percent of kids use these drugs.
The NPA plans to distribute its recommendations to its 22,000 members across the U.S. and hopes to gain support from consumer and patient safety groups.
According to the report, "Having such endorsements will help dispel the misconception that these clinical recommendations represent rationing and support the idea that often less is truly more."
SOURCE: http://bit.ly/m79pZ1 Archives of Internal Medicine, online May 23, 2011.
Can Improved Nutrition Help Fight MS?
Question: I just read your article on neuropathy in my latest NewsMax Health e-mail newsletter. I noticed you said that treating multiple sclerosis does not reverse the neuropathy, because the myelin sheath that causes a "short-circuit" in the minute electrical impulses conducted by the nerve fibers is destroyed. But can the "symptoms" of MS be removed by nutrition?
Dr. Hibberd's Response:
I know a nurse who had MS. Once she started on food supplements, her symptoms reversed, but if she did not keep up the regime her symptoms returned. So, it did not cure the MS, but kept it under control. Have you had any similar experiences?
Multiple Sclerosis affects 350,000 people in the United States. 90 percent of cases are diagnosed under the age of 55, with a 2-3 times greater incidence in women. There is an increased incidence in those who live their first 15 years in northern areas (1 in 2,000) versus those in tropical climates (1 in 10,000). There is also an increased incidence in cigarette smokers.
Genetic studies confirm a genetic lead in less than 50 percent of cases, but gene disorders in the region of chromosome 6 and recently discovered (July 29 2007) gene variants of chromosome 5 associated with altered function of Interleukin-7 receptor alpha: IL-7R, are now associated with increased risk for this disorder.
There have been major advances in treatment over the past 10 years. With MS, the insulation (called a myelin sheath) of the nerves is destroyed, allowing a short circuit of electrical signals, and disarray of a previously well-functioning nervous system. To date, evidence seems to support an immunologic attack preceded by some stimulus, presumed to be viral and/or environmental.
Once the damage occurs, we have little effective medication for healing. We recommend a good diet with appropriate supplementation along with effective treatment to arrest the immunologic attack on the myelin sheath.
We are still studying ways to enhance the body's ability to heal and even regenerate nervous tissue, but I have no doubt that our diet has a very important role in this, as well as with all other healing processes in our bodies.
MS is a disease subject to remissions and exacerbations that may progress rapidly over months or slowly over decades. I do believe that a well-rounded diet, and judicious exercise associated with medical control of underlying medical conditions bode well for success in its treatment.
Dr. Hibberd's Response:
I know a nurse who had MS. Once she started on food supplements, her symptoms reversed, but if she did not keep up the regime her symptoms returned. So, it did not cure the MS, but kept it under control. Have you had any similar experiences?
Multiple Sclerosis affects 350,000 people in the United States. 90 percent of cases are diagnosed under the age of 55, with a 2-3 times greater incidence in women. There is an increased incidence in those who live their first 15 years in northern areas (1 in 2,000) versus those in tropical climates (1 in 10,000). There is also an increased incidence in cigarette smokers.
Genetic studies confirm a genetic lead in less than 50 percent of cases, but gene disorders in the region of chromosome 6 and recently discovered (July 29 2007) gene variants of chromosome 5 associated with altered function of Interleukin-7 receptor alpha: IL-7R, are now associated with increased risk for this disorder.
There have been major advances in treatment over the past 10 years. With MS, the insulation (called a myelin sheath) of the nerves is destroyed, allowing a short circuit of electrical signals, and disarray of a previously well-functioning nervous system. To date, evidence seems to support an immunologic attack preceded by some stimulus, presumed to be viral and/or environmental.
Once the damage occurs, we have little effective medication for healing. We recommend a good diet with appropriate supplementation along with effective treatment to arrest the immunologic attack on the myelin sheath.
We are still studying ways to enhance the body's ability to heal and even regenerate nervous tissue, but I have no doubt that our diet has a very important role in this, as well as with all other healing processes in our bodies.
MS is a disease subject to remissions and exacerbations that may progress rapidly over months or slowly over decades. I do believe that a well-rounded diet, and judicious exercise associated with medical control of underlying medical conditions bode well for success in its treatment.
Beware the Blood Clot
Question: What causes the ankles and legs below the knees to swell and feel very uncomfortable and tight to the touch?
Dr. Hibberd's Answer:
Edema in the legs with tightness is very suggestive of obstructed venous or lymphatic return. If not caused by a blood clot itself, the very existence of this swelling places you at high risk for blood clot formation. Often, blood clots affect one leg or the other, but up to 20 percent of patients may have clots in both legs without knowing it.
If both your legs are involved, it also may be related to poor venous return to the heart due to various causes, or even from other conditions associated with trauma, infection, drugs, heart failure, advanced lung disease, or thyroid/liver/protein disorders.
Blood clots in the deep veins of our legs occasionally break free and land in the lung causing a blockage known as a pulmonary embolus, a life-threatening condition. Superficial vein clots are not usually life threatening.
See your doctor immediately for a professional evaluation. If necessary, he or she will order an immediate painless ultrasound study to confirm the diagnosis. This rapid intervention may save your life if you have a clot. Once your doctor has correctly diagnosed this, your next step is to follow advice on timely treatment and prevention. Remember that this kind of swelling, if not from a clot now, definitely predisposes you to later clot formation, and aggressive management to correct this is usually advisable.
Dr. Hibberd's Answer:
Edema in the legs with tightness is very suggestive of obstructed venous or lymphatic return. If not caused by a blood clot itself, the very existence of this swelling places you at high risk for blood clot formation. Often, blood clots affect one leg or the other, but up to 20 percent of patients may have clots in both legs without knowing it.
If both your legs are involved, it also may be related to poor venous return to the heart due to various causes, or even from other conditions associated with trauma, infection, drugs, heart failure, advanced lung disease, or thyroid/liver/protein disorders.
Blood clots in the deep veins of our legs occasionally break free and land in the lung causing a blockage known as a pulmonary embolus, a life-threatening condition. Superficial vein clots are not usually life threatening.
See your doctor immediately for a professional evaluation. If necessary, he or she will order an immediate painless ultrasound study to confirm the diagnosis. This rapid intervention may save your life if you have a clot. Once your doctor has correctly diagnosed this, your next step is to follow advice on timely treatment and prevention. Remember that this kind of swelling, if not from a clot now, definitely predisposes you to later clot formation, and aggressive management to correct this is usually advisable.
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