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Ear, Nose & Throat Associates |
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May 2007 News Archives
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May 2: Poorer Kids Have Poorer Sleep: Study, Forbes
WEDNESDAY, May 2 (HealthDay News) – Compared to middle–class children, youngsters in low–income families are more likely to have sleep problems, which can affect their health and performance at school, a U.S. study finds.
The study compared the sleeping habits of 64 healthy inner–city Hispanic and black children, ages 4 to 10, to those of middle–class white children.
Parents provided information about their children’s amount of sleep, sleep anxiety, night awakenings, night terrors, bedwetting, sleepwalking, sleep–disordered breathing, daytime sleepiness, bedtime resistance, and the time it took to fall asleep.
The incidence of sleep problems was 25 percent higher among low–income children than among middle–class children.
The study was expected to be presented this week at the American Academy of Neurology’s annual meeting, in Boston.
"While these results aren’t surprising, they need to be followed up with a study involving a larger number of children, since sleeping problems can have a negative impact on a child’s health and may hinder a child’s performance at school," study author Anuj Chawla, of Tulane University’s School of Medicine in New Orleans, said in a prepared statement.
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May 2: Secondhand Smoke Doubles Risk for Dementia, WebMD
By Charlene Laino
If your spouse still smokes, here’s a new reason to urge him or her to quit.
A new study suggests that people who live with a smoker for more than 30 years are about 30 percent more likely to develop dementia than those who have never lived with a smoker.
The situation is even worse for people who are already at increased risk for dementia due to clogged arteries leading to the brain, says researcher Tad Haight, MA, senior statistician at the University of California at Berkeley.
For such people, living with a smoker for more than 30 years appears to raise dementia risk more than twofold compared with people who never lived with a smoker and don’t have blocked brain arteries, he tells WebMD.
The study, presented at the American Academy of Neurology’s annual meeting, included 985 people aged 65 and older who had never smoked.
None had dementia or had suffered a heart attack or stroke or had blocked leg arteries at the start of the study.
Of the total, 495 lived with a smoker for an average of 28 years.
Over the next seven years, 10 percent of the 985 people suffered a heart attack or stroke or developed blockages or clots in their leg arteries. Fifteen percent were diagnosed with dementia.
No Extra Dementia Screening Warranted
Ronald C. Petersen, MD, director of theAlzheimer’s Disease Center at the Mayo Clinic in Rochester, Minn., says that while the study showed a link between passive smoke and dementia, it doesn’t prove that it actually caused the memory disorder.
Petersen tells WebMD that people who have lived with a smoker shouldn’t rush to their doctor to get tested for dementia.
"From a practical point of view, the thing to do is remove yourself from the situation and follow a healthy lifestyle – things we recommend in any case," Petersen says.
But there’s no reason still not use it as ammunition to convince your spouse to kick the habit.
This article was reviewed by Louise Chang, MD.
SOURCES: AmericanAcademy of Neurology 59th Annual Meeting, Boston, April 29–May 5, 2007. Tad Haight, MA, senior statistician, University of California, Berkeley. Ronald C. Petersen, MD, director of the Alzheimer’s Disease Center, Mayo Clinic, Rochester, Minn.
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May 1: Exercise science principles strengthen swallowing rehabilitation, Huliq.com
Just thinking about swallowing rehabilitation makes it harder to do.
Head and neck cancer, a stroke, brain tumor, brain injury or even a tracheostomy tube and mechanical ventilation needed to sustain life can make it impossible.
Dysphagia, or swallowing problems, can also result from aging and accompanying loss of muscle strength.
"We swallow a thousand times or more per day, just our own saliva, without even thinking about it," says Dr. Lori Burkhead, speech–language pathologist and clinical research scientist at the Medical College of Georgia Department of Otolaryngology – Head and Neck Surgery. "We swallow in our sleep. Babies do it in utero. It is something we do without giving it much thought, but it’s actually a very complex act that involves an intricate coordination between the brain, muscles and respiratory system."
An estimated 18 million Americans have difficulty with this routine function that, at worst, can lead to aspiration pneumonia, malnutrition, dehydration and death.
Evidence suggests that the same exercise science principles that strengthen bodies can help restore this fundamental function using mouth and throat muscles. Because swallowing muscles are not easy to access, applying the usual principles of exercise is more difficult. "Physical therapists can put a weight in someone’s hand and exercise them or they can give patients external assistance and get them to complete a movement," says Dr. Burkhead. "I can’t put weights on throat muscles for strengthening and I can’t get at those muscles to help patients finish the movements they cannot do on their own."
Theories about the amount of resistance needed to strengthen a muscle, the number of repetitions and specificity of exercise along with technology such as biofeedback may help speech–language pathologists put more science and success into helping patients regain the ability to swallow, according to a review article authored by Dr. Burkhead available online in the scientific journal Dysphagia at http://dx.doi.org/10.1007/s00455-006-9074-z.
"At present, there remain more questions than answers regarding how to most effectively and efficiently approach dysphagia rehabilitation," Dr. Burkhead and her co–authors write. Historically, research has focused on compensatory maneuvers such as changing body position or modifying the amount or consistency of food and liquid. Compensation is important, but the problem still remains unless it is addressed through rehabilitation efforts, they say.
Although exercise principles used in physical rehabilitation and sports training have been gaining attention in dysphagia rehabilitation, Dr. Burkhead proposes more emphasis on these theories and more studies to learn to optimize these principles.
Dr. Burkhead asserts that many of the treatment techniques used in physical rehabilitation or athletic training are applicable and beneficial in dysphagia rehabilitation. "Physical therapists won’t just tell a stroke patient to get up and walk; they first work on strengthening muscles of interest and discrete movements until patients can stand and take a few steps. They start with the components of a movement and then ultimately train the movement of interest, which in this case would be walking. The same thing goes for swallowing therapy. We can start with tongue movement or lip closure, but then we must be very conscious of moving toward task–specific exercise and working our patients at more challenging levels of intensity, which is something that our field is now starting to pay more attention to," says Dr. Burkhead.
There also is heightened interest in using tools such as neuromuscular electrical stimulation and biofeedback to boost the effects of exercise. She already routinely incorporates biofeedback. "It provides concrete information for the therapist as well as the patient and empowers them to take a more active role in their recovery. We frequently ask patients to swallow with greater emphasis or to swallow in unusual ways as part of their exercise regimen. Biofeedback helps them know if they are doing it correctly and with the right amount of intensity."
Computer–aided biofeedback provides patients a graphic representation on a computer screen of what their muscles are doing. The therapist can challenge patients to reach for higher and higher goals, which challenges the muscles more and more. "This helps the patient understand what they are doing right and to do more of it," she says. "This empowers patients and helps them not only judge but then modify their own performance."
Dr Burkhead also is developing a strengthening technique that incorporates a creative way to access hard–to–reach muscles. Her technique incorporates the use of the Therabite® device, developed by Atos Medical in Sweden, to improve mouth opening. The device holds the jaw in position while the patient places his tongue at the roof of the mouth and swallows. The rationale is based on exercise principles known to work in other parts of the body. Her studies in healthy patients have shown that swallowing in this unusual position significantly increases activation of the swallowing muscles.
Despite advances in this field, many questions remain about how to best help patients resume safe swallowing. "We use the evidence available to us along with what we know about how the body works to design treatment plans that target the problems as best we can. Many patients have improved with traditional therapy techniques, but I think that more research will lead to better therapy and greater outcomes in a shorter amount of time." –Medical College of Georgia
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May 7: Sinus drug linked to liver damage, skin peeling, Vancouver Sun
Health Canada reviewing Ketek after 105 reported reactions
Sharon Kirkey, Vancouver Sun
Somewhere near Quebec City lives a young mother who spent four weeks in a burn unit last year after a suspected drug reaction covered her body with burn–like red blisters and peeled off her skin from head to thigh.
The woman had been prescribed the antibiotic Ketek for a simple sinus infection.
But the 26–year–old developed toxic epidermal necrolysis, an extremely rare drug reaction where people essentially shed the outer protective layer of their skin.
The woman was found semi–conscious with swollen lips and face. Water blisters developed on her thorax, face and back and her skin was peeling all over – more than 50 per cent of her body was affected, according to the most recent issue of Health Canada's adverse drug reaction newsletter.
Toxic epidermal necrolysis occurs in as few as one in a million people and Ketek is only suspected in the woman’s case. She also had a history of allergic reactions to penicillin as well as to the drug class to which Ketek belongs.
But drug maker Sanofi Aventis is discussing with Health Canada whether to strengthen the existing warning about allergic reactions to include the potential for "skin events."
It would be the latest in a series of safety warnings for a drug that has been linked with severe and sometimes fatal liver damage. Some experts say it should never have been approved in the first place.
"I’ve run into one infectious disease physician after another who keeps saying, why do we need this drug? What exactly is the hole that it’s filling," said Dr. David Ross, clinical assistant professor at George Washington University School of Medicine and Health Sciences in Washington, D.C.
Prescribed more than 390,000 times in Canada since its approval in 2003, Ketek is suspected of contributing to one death, as well as side effects such as face and joint swelling, blackouts, shortness of breath and increased pulse rate.
Health Canada has received 105 suspected adverse drug reaction reports involving Ketek, including a 55–year–old woman who died in 2004 from a heart attack and coronary artery disorder after taking 800 mg daily of Ketek for 10 days, according to the documents.
The reports are based on suspicions only, and could be due to an underlying illness. The woman had been taking antihistamines, decongestants and hormones as well.
The drug company declined to discuss the case, which it reported to Health Canada. Sanofi Aventis spokesman Sylvain Clermont said a U.S. Food and Drug Administration advisory committee recommended as recently as December that Ketek remain on the market, although the panel voted to restrict its use.
"This process was very rigorous . . . and the conclusion was to leave the product on the market, to make sure [that] when needed, Ketek is available," Clermont said.
But a Canadian pharmaceutical expert said the drug should be shelved. "It’s not needed and it can be fatal in some people," said Dr. Jim Wright, a professor in the department of anesthesiology, pharmacology and therapeutics at the University of British Columbia and director of the Therapeutics Initiative project.
Ketek has been implicated in 53 U.S. cases of toxic liver damage, four of them fatal. Recently American drug regulators issued new warnings after the advisory committee ruled that the benefits of using Ketek for sinusitis and bronchitis don’t outweigh the risks.
For now, the drug remains approved in Canada for sinusitis and bronchitis, as well as for respiratory tract infections and pneumonia.
But Ketek’s future is uncertain. Health Canada is reviewing the drug and is considering new information from manufacturer Sanofi Aventis. Health Canada warned last year that acute liver failure, including hepatic necrosis – where the cells in the liver die – leading to liver transplant or death has occurred during or immediately after treatment with Ketek.
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May 8: Approval for cancer patient drug, BBC News
A drug which could help prolong the lives of some cancer patients can now be prescribed by Scottish doctors.
Taxotere, which will be used to treat sufferers of head, neck, breast and lung cancers, was recommended for use by the Scottish Medicines Consortium.
In trials, patients taking Taxotere had a 30% lower mortality rate than those receiving the standard treatment alone.
In 2005, the SMC turned the drug down for prostate cancer treatment as its cost effectiveness had not been proven.
However, this is the first time it has been used for the treatment of head and neck cancer, for which it is believed to be most effective.
About 100 patients are initially expected to receive the drug in Scotland, costing the NHS about £3,000 per patient each year.
Taxotere, which is described as being a chemotherapy drug, was approved for use by the NHS in England and Wales last year.
The SMC decided not to recommend the treatment to the NHS two years ago on the basis that it did not demonstrate value for money at £7,000 for each course.
At the time, the decision was criticised by health professionals and cancer charities, who said a price should not be put on prolonging and improving the lives of cancer patients.
Dr Elizabeth Junor, a consultant clinical oncologist at Edinburgh’s Western General Hospital, said Taxotere could prove particularly important for patients with head or neck tumours, for which there are very few treatments compared with other types of cancer.
She said: "This SMC recommendation will mean that more patients can now get this new treatment combination, which is another significant step forward for us in the management of head and neck cancer.
"We hope it will result in many more lives being saved across Scotland."
Squamous cell carcinoma of the head and neck (SCCHN) is the generic term given to 90% of all head and neck cancers.
Survival time
About 760 people in the UK are diagnosed with the disease each year. It can affect the mouth, tongue and throat.
Ex–Beatle George Harrison and journalist John Diamond, husband of Nigella Lawson, were both victims of the cancer.
Only about 40% of those diagnosed with the condition survive for more than five years.
Taxotere, which was originally developed to treat breast cancer, has been shown to extend the survival time for men with prostate cancer by 25% over the standard treatment.
It is used when prostate cancer patients are no longer responding to hormone treatment, and reduces pain and weight loss.
Prostate cancer is the UK’s most common form of male cancer. It affects one in 15 men in Scotland and kills 10,000 every year across the UK.
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May 9: Human Papilloma Virus Linked to Throat Cancer, MedPage Today
BALTIMORE, – Human papilloma virus (HPV), known to cause a range of anogenital cancers, has also been associated with a dramatically increased risk of some throat cancers, according to researchers here.
Action Points
- Explain to interested patients that oropharyngeal squamous–cell carcinoma is usually associated with heavy drinking and smoking.
- Note that this study find that infection with the human papilloma virus – known to cause a range of anogenital cancers – is an independent risk factor for this form of throat cancer.
In a case–control study of newly diagnosed oropharyngeal squamous–cell carcinoma, infection with virus type 16 was associated with nearly a 15–fold increase in risk, according to Maura Gillison, M.D., Ph.D., of Johns Hopkins.
And seropositivity for the type 16 virus – regarded as a measure of lifetime exposure to the virus – was associated with a 32–fold increase in risk, Dr. Gillison and colleagues reported in the May 10 issue of the New England Journal of Medicine.
Oral sex is probably the main way the virus is transmitted, the researchers said, although mouth–to–mouth transmission – as in kissing – can’t be ruled out.
"It is important for health care providers to know that people without the traditional risk factors of tobacco and alcohol use can nevertheless be at risk for oropharyngeal cancer," said Gypsyamber D’Souza, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, a study co–author.
The HPV link has been suspected for some time, Dr. Gillison and colleagues said, mainly because molecular evidence shows that 26% of all squamous–cell carcinomas of the head and neck have signs of oncogenic HPV and the proportion is higher for oropharyngeal cancer.
To attack the epidemiological side of the issue, the researchers enrolled 100 patients with oropharyngeal squamous–cell carcinoma and matched each of them with two healthy controls of the same sex and within five years of age.
The researchers sampled participants’ blood and saliva, collected information – using an anonymous questionnaire – on sex practices, tobacco and alcohol exposure, family history, and oral hygiene.
The study found that genetic material from HPV 16 was present in 72% of the tumors. Also:
- Oropharyngeal cancer was associated with active oral HPV–16 infection, with an odds ratio of 14.6 and a 95% confidence interval from 6.3 to 36.6.
- Cancer was also associated with oral infection with any of 37 types of HPV, with an odds ratio of 12.3 and a 95% confidence interval from 5.4 to 26.4.
- Cancer was associated with seropositivity for the HPV-16 L1 capsid protein, with an odds ratio of 32.2 and 95% confidence interval from 14.6 to 71.3.
The analysis also found that a high lifetime number of vaginal–sex partners – defined as 26 or more – was associated with cancer. The odds ratio was 3.1, with a 95% confidence interval from 1.5 to 6.5.
The same was true for a high lifetime number of oral–sex partners (defined as six or more), where the odds ratio was 3.4 with a 95% confidence interval from 1.3 to 8.8.
The researchers found that the link became stronger as the numbers of vaginal–sex and oral–sex partners increased – the P–values for the trends were 0.002 and 0.009, respectively.
Interestingly, although tobacco and alcohol use are traditionally considered the key risk factors for oropharyngeal squamous–cell carcinoma, the study showed no added risk for tobacco and alcohol users.
"It’s the virus that drives the cancer," Dr. Gillison said. "Since HPV has already disrupted the cell enough to steer its change to cancer, then tobacco and alcohol use may have no further impact."
The study raises some important clinical questions "now that the association between some cases of oropharyngeal cancer and HPV infection appears to be firmly established," said Stina Syrjänen, D.D.S., Ph.D., of the University of Turku in Finland, in an accompanying editorial.
Those questions, Dr. Syrjänen said, include:
- If there’s a need to screen high–risk groups, such as smokers and drinkers, for persistent oral or oropharyngeal HPV infection.
- Whether HPV–associated cancers should be treated in the same way as those that are HPV–negative, but linked to heavy smoking and drinking.
- Whether some oral, oropharyngeal, and laryngeal cancers might be prevented by HPV vaccination.
The study was supported by the Damon Runyon Cancer Research Foundation, the State of Maryland Cigarette Restitution Fund, the National Institute of Dental and Craniofacial Research, and the National Institutes of Health. The authors reported no potential financial conflicts.
Dr. Syrjänen reports receiving consulting fees from Merck.
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May 9: Too many babies don't get second tests for hearing, USA Today
By Rita Rubin, USA TODAY
A third of newborns who fail their hearing screening test don’t get a follow–up evaluation, leaving them susceptible to delays in language development that they might never overcome, a report says today.
The proportion of newborns screened for hearing loss has climbed steadily in recent years, hitting 95% by mid–2006, says author Karl White, director of the National Center for Hearing Assessment and Management at Utah State University.
About 3.8 million newborns are screened for hearing loss each year, according to the Centers for Disease Control and Prevention. The screening takes about nine minutes and should be done before 1 month of age, preferably before the baby leaves the hospital, according to the CDC.
About 2%, or 76,000 babies, don’t pass and are referred for a diagnostic assessment of their hearing. Additional testing is needed to determine whether they are among the one to three babies per 1,000 who actually have hearing loss, the CDC says.
Until recently, only about half of babies who failed the screening were reported as having the additional testing, but that proportion rose to two–thirds in the past year, White found. "One year doesn’t make a trend," cautions White, whose study was paid for by the Maternal and Child Health Bureau of the Department of Health and Human Services. "We think we’re getting better, but there’s still a huge problem here."
One problem is a shortage of audiologists who do diagnostic tests on babies, White says. Reimbursement rates are the same whether the patient is an adult or an infant, he says, even though adults are easier to test.
Among other contributing factors, White says, are "parent expectations and parent lack of understanding." As far as most parents are concerned, he says, hearing is a dichotomy: "You either have it or you don’t." But babies who startle at loud noises, such as pots slamming, might not be able to hear lower–decibel sounds, White says.
Newborn hearing screening programs have lowered the average age of diagnosis to 3 to 4 months, he says. But if babies who fail screening don’t receive follow–up testing, White says, they won’t be diagnosed until they’re around 2 or 3 years old. By then, language and social skills are lagging, he says, and they might never catch up: "There are deaf people who are identified at 6 years of age who turn out to be incredibly successful, but, on average, that doesn’t happen."
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May 10: AAO-HNS Announces Endorsement of Healthcare Truth and Transparency Act of 2007
Newswise – As part of a continuing effort to ensure the American public has the most accurate and truthful information available when making critical healthcare decisions, the American Academy of Otolaryngology – Head and Neck Surgery (AAO–HNS) strongly supports H.R. 2260, the Healthcare Truth and Transparency Act of 2007.
The bipartisan bill, sponsored by Rep. Jim McDermott, MD (D–WA) and Rep. John Sullivan (R–OK), was introduced in the United States House of Representatives on Thursday, May 10, 2007. The bill represents a major step forward in prohibiting misleading and deceptive advertising or representation in healthcare services, and will require certain healthcare providers to clearly state their qualifications. The bill also authorizes the nation’s highest consumer protection body, the Federal Trade Commission (FTC), to take action against deceptive conduct.
"In this day and age, Americans are overwhelmed with information regarding their healthcare options, whether through the media, or the Internet, or even word–of–mouth," said AAO–HNS Executive Vice President and Chief Executive Officer, David R. Nielsen, MD, FACS. "We want to make sure that patients and the general public are not being misled when they seek care. This means protecting those patients from individuals who are not being clear about the exact nature of their medical qualifications."
"We applaud Representatives McDermott and Sullivan for taking the necessary steps to ensure that patients nationwide are receiving the highest quality of healthcare," Dr. Nielsen added. "We will do our best as the premier advocacy organization of ear, nose, and throat physicians and head and neck surgeons to assist in the education of other Members of Congress so they may understand why this legislation is so critical to our nation’s healthcare system."
Joining the AAO–HNS in supporting the Healthcare Truth and Transparency Act are leading professional associations representing diverse physician specialties, including the American Psychiatric Association, the Academy of Ophthalmology, the American Academy of Orthopaedic Surgeons, the American College of Surgeons, the American Medical Association, the American Osteopathic Association, the American Society of Anesthesiologists, and the American Society of Plastic Surgeons.
About the AAO–HNS
The American Academy of Otolaryngology – Head and Neck Surgery (http://www.entnet.org), one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission: "Working for the Best Ear, Nose, and Throat Care."
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May 16: Cancer: The good news, The Independent
Survival rates soar as cancer treatments improve
By Jeremy Laurance, Health Editor
Cancer is no longer the death sentence that it once was. Our most feared disease is turning into a condition that people live with, rather than die from, figures published yesterday show.
In the past 30 years, overall survival rates from cancer have doubled, thanks to better treatments, earlier diagnosis and greater public awareness of the warning symptoms.
Almost half of patients (46.2 per cent) diagnosed in 2000–01 were expected to live 10 years, compared with a quarter (23.6 per cent) of those diagnosed in 1971, according to the charity Cancer Research UK.
Ten–year survival is a benchmark of success in cancer treatment and is regarded as close to a cure.
The breakneck progress, that has accelerated in the past decade, is set to continue, experts predicted. Among 10 goals announced yesterday, Cancer Research UK set a target of 66 per cent overall five–year survival by 2020, up from 50 per cent in 2001.
However, Britain still trails Europe in terms of cancer survival, despite the recent improvement. The last European survey of cancer , Eurocare–3, published in 2003 showed British patients died sooner than in most other European countries.
Professor Michel Coleman, a cancer epidemiologist at the London School of Hygiene and Tropical Medicine, who calculated the latest figures, said cancer was still a "major public health problem" that would affect one in three people during their lifetimes.
"Survival rates for many cancers have been lower in the UK than in many comparable countries. The differences may be less when Eurocare–4 is published later this year – I am hopeful we may have caught up," he said.
Professor Mike Richards, the Government’s national cancer director, said: "I await Eurocare–4 with interest. I am optimistic we will see a narrowing of the gap [in survival rates]. We have seen an acceleration in survival in the 90s [in the UK] and I have every hope that will be continued."
A key reason for Britain’s past poor performance has been delays in diagnosing patients – hence their cancers were more advanced when treatment started – compared with other countries. But extra investment in the NHS since 2000 has boosted the number of cancer specialists and shortened waits for treatment. About 250,000 patients are treated for cancer in Britain each year and more than 99 per cent are now treated within the Government target of two months.
Professor Richards admitted that uptake of new cancer drugs was slower in Britain than in other countries, as highlighted in a report by the Karolinska Institute, Stockholm, last week. Most of the drugs had been approved for use by the National Institute for Clinical Excellence (Nice) and efforts had been made to speed its assessment process. But he added: "Drugs are only one part of the answer."
Early detection of cancer, greater use of specialist surgery, screening programmes to detect cancer at an earlier stage and advances in chemotherapy and radiotherapy have all helped to increase survival rates.
Cancer is not one disease but many and the chances of survival vary widely with the type of illness. A patient who has pancreatic cancer, the most lethal form of disease, has a 2.5 per cent chance of living five years, compared with testicular cancer which has a 95 per cent survival rate.
There have been big gains in survival rates for some cancers while almost no progress has been made against others. Five–year survival rates for breast cancer have increased from just over 50 per cent to almost 80 per cent over the period. But pancreatic cancer and lung cancer have seen zero improvement with survival rates remaining below 5 per cent.
Harpal Kumar, who was appointed chief executive of Cancer Research UK last month, said there was "a lot to celebrate" in the survival figures but also "a lot further to go".
"Cancer scientists agree we are at the dawn of a new era in cancer research," he said. "New diagnostics and new treatments are on the way and there will be a pay–off in terms of improved survival. Great strides are being made thanks to the basic research done in the past."
Dr Kumar set out 10 goals to be achieved by 2020 against which progress could be measured. They include reducing the number of adult smokers by four million (from 12 to 8 million), reducing the incidence of cancer in under–75s by a quarter, doubling the use of better targeted treatments with fewer side effects and increasing the proportion of patients who are diagnosed at an early stage from the present 45 per cent to 66 per cent.
He said: "Our goals are as broad as they are ambitious. They recognise the importance of furthering our fundamental biological understanding of cancer while, at the same time, taking that knowledge out of the lab and turning it into new treatments."
Jo–Anne Tedd, accounts officer: ‘I feel like I have got a new lease of life’
It was a fortnight before her wedding when Jo–Anne Tedd was diagnosed with bowel cancer in 2002. She had consulted her GP for haemorrhoids and he referred her to the local hospital in Warwickshire where she lives.
"It was a shock – it is not what you expect. I got an appointment pretty quickly and the consultant reassured me it could be treated."
Two days after her wedding, Ms Tedd, 44, was in hospital having her bowel removed in a procedure known as an ileostomy. The honeymoon had to wait.
"I had always feared having a colostomy bag. However, since my surgery I have done things I never thought I would." She had suffered for years from ulcerative colitis, a disorder in which the lining of the bowel becomes inflamed. Although unrelated to cancer it had made her feel unwell and restricted what she could do. Removal of her bowel solved that problem overnight.
"I am fitter, stronger, and in better health than before. I do more now than ever. If you have a positive outlook it makes it easier – you deal with it. But you still have your moments," she said.
She has bought a 600cc Suzuki Bandit motorbike to join her husband, Peter, an engineer and keen motorcyclist, on outings to the Cotswolds. She has also learned how to snowboard and does fun runs.
Ms Tedd works as an accounts officer for a large organisation and the couple have four grown–up children from previous marriages. She said: "I was devastated to find out I had cancer. However, I feel like I have got a new lease of life. Of course not everyone is as fortunate as me."
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May 17: Some Children Are Born With "Temporary Deafness", Medical News Today
Clinical research conducted in the Department of Communication Disorders at the University of Haifa revealed that some children who are born deaf "recover" from their deafness and do not require surgical intervention. To date, most babies who are born deaf are referred for a cochlear implant. "Many parents will say to me: ‘My child hears; if I call him, he responds’. Nobody listens to them because diagnostic medical equipment did not register any hearing. It seems that these parents are smarter than our equipment," said Prof. Joseph Attias, a neurophysiologist and audiologist in the Department of Communication Disorders at the University of Haifa, who made the discovery.
There are two causes of congenital deafness among children. One is the lack of hair cells, receptors in the inner ear that convert sounds into pulse signals that activate the auditory nerve. The second cause is a malfunction of the nerves. A child may be born with what appears to be a normal inner ear, but the hair cells do not "communicate" with the auditory nerves and the child cannot hear. To date, doctors have recommended the same treatment for all children born deaf. Once a child has been diagnosed as deaf, doctors recommend a cochlear implant, a surgically– implanted electronic device that bypasses the hair cells and directly stimulates the auditory nerve. Prof. Attias stresses that a cochlear implant is an excellent treatment for children with congenital deafness whose hearing does not improve over time. However, it appears that some children are born with "temporary deafness" a condition previously unidentified.
This discovery, like other revolutionary discoveries, was made by chance. A child who was born with malfunctioning hair cells and was scheduled for a cochlear implant was referred to Prof. Attias for a pre–surgical evaluation. The evaluation found that the child’s brain and auditory nerves exhibited beginning responses to sound stimuli. The surgery was postponed. Follow–up visits showed increasing function of the hair cells and eventually the child reached a state of normal hearing. Prof. Attias, who is part of a cochlear implant team at Schneider Children's Medical Center, looked in the department archives and found other, similar cases. "Because these children go through a series of tests and evaluations by different doctors, a process that often takes months, there are cases of children who were initially referred for the procedure who didn't have it done. Sometimes parents decide not to do the surgery; sometimes they do it elsewhere. I called parents and found another seven cases of children who were diagnosed as deaf, did not have the procedure done, and began to hear," said Prof. Attias.
Prof. Attias then found another five children who had been referred to him for pre–operative testing who had begun to hear. At the end of his clinical research, he identified a "window of opportunity" of 17 months during which deaf children may begin to hear. "A child whose deafness is caused by a malfunctioning connection between hair cells and the auditory nerve should not have a cochlear implant in the first 17 months of life. Research results show the possibility that at least some of these children undergo the procedure for nothing," explained Prof. Attias.
He added that some of the children only develop partial hearing, which can be augmented with external hearing aids. Prof. Attias is now researching "temporary deafness" among young children, looking to find a way to identify those who will recover and those who will not.
University of Haifa
Mount Carmel
Haifa 31905
Israel
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May 17: Sleep disorder linked to form of dementia, United Press International
ROCHESTER, Minn., May 17 (UPI) – A U.S.–led international research team has discovered a correlation between an extreme form of sleep disorder and eventual onset of dementia.
Scientists discovered patients with a violent rapid eye movement sleep behavior disorder, or RBD, have a high probability of developing Lewy body dementia, Parkinson’s disease or multiple system atrophy. Lewy bodies are abnormal aggregates of protein that develop inside nerve cells.
"Our data suggest many patients with idiopathic RBD may be exhibiting early signs of an evolving neurodegenerative disease, which in most cases appear to be caused by some mishap of the synuclein protein," said Mayo Clinic Dr. Bradley Boeve, the lead author of the study.
Just what happens in the protein following gene expression isn’t clear, said Boeve. But he said the result is quite clear: patients " usually older males " strike out violently, often yelling, when they enter the rapid eye movement stage of sleep. Many such patients develop symptoms of dementia and postmortems show they all develop Lewy bodies.
The study, which included researchers from Harvard Medical School, the University of Minnesota, and Germany’s Goethe University, is detailed in the journal Brain.
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May 20: Sleep Apnea Boosts Car Crash Risk, Forbes
(HealthDay News) – People with sleep apnea – a nighttime breathing disorder that disrupts sleep – are at double the risk of being in a serious car crash, a Canadian study finds.
"We were surprised not only about how many of the sleep apnea patients’ crashes involved personal injury, but that some patients had fairly mild sleep apnea and were still having serious crashes," study author Dr. Alan Mulgrew, of the University of British Columbia Sleep Disorders Program, said in a prepared statement.
Researchers studied 800 people with sleep apnea and 800 people without the condition.
They found that those with sleep apnea were twice as likely to be in a car crash, and three to five times more likely to be in a serious crash involving personal injury.
Over three years, the people with sleep apnea had a total of 250 crashes, compared with 123 crashes among those without sleep apnea. Previous studies have identified a link between sleep apnea and increased risk for crashes, but this is the first study to examine the severity of such crashes.
The sleep apnea patients’ self–reported feelings of sleepiness were not linked with an increased risk of crashes, which suggests that the patients weren’t aware of the potential driving hazards caused by sleep apnea.
In the general population, men have more vehicle crashes than women. Among the sleep apnea patients in this study, men and women had similar crash rates.
The study was expected to be presented Sunday at the American Thoracic Society’s international conference in San Francisco.
More information
The American Sleep Association has more about sleep apnea.
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May 21: Sleep Apnea Increases Risk of Heart Attack or Death, Ivanhoe Newswire
If you have sleep apnea, getting it treated could save your life.
A new study from Yale University finds the condition increases the risk of having a heart attack or dying by 30 percent over a period of four to five years.
1,123 patients referred for sleep apnea evaluation had an overnight sleep study to determine if they had the condition. Over the next four to five years they were monitored to see how many of them had any heart disease events – heart attack, coronary angiography, or bypass surgery – or died. Results show the more severe the sleep apnea was at the beginning of the study the greater the risk of developing heart disease or dying.
The authors recommend patients with sleep apnea symptoms – excessive daytime sleepiness, snoring along with breathing pauses – see a doctor. They believe when sleep apnea is appropriately treated, the risk of heart disease can be lowered.
Sleep apnea causes the upper airway to narrow or collapse during sleep. The most effective treatment is the nasal CPAP. It delivers air through a mask while you sleep, keeping the airway open. It can help patients get a good night’s sleep, prevent daytime accidents due to sleepiness, and improve quality of life.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e–mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/.
SOURCE: The American Thoracic Society 2007 International Conference in San Francisco, May 18–23, 2007
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May 22: Sleep Apnea Could Raise Obstetric Risks, The Washington Post
TUESDAY, May 22 (HealthDay News) – Sleep apnea greatly increases the risk of diabetes and high blood pressure during pregnancy, according to a U.S. study that looked at nationwide data on millions of pregnancies in 2003.
Sleep apnea is a nighttime breathing disorder that disrupts sleep, causing multiple awakenings. Obesity is a major risk factor for sleep apnea.
Out of almost 4 million deliveries, 452 women had sleep apnea. Of the almost 168,000 women with gestational diabetes, 67 had sleep apnea. Of the almost 201,000 women with pregnancy–induced high blood pressure, 166 had sleep apnea.
The researchers concluded that sleep apnea was associated with a twofold increase in the risk of gestational diabetes and a fourfold increase in the risk of pregnancy–induced high blood pressure.
The findings were to be presented Tuesday at the American Thoracic Society’s international conference in San Francisco.
"The repetitive decrease in oxygen that occurs during the night in someone with sleep apnea heightens the body’s ‘fight or flight’ state, which can raise blood pressure," researcher Hatim Youssef of the Robert Wood Johnson Medical School at the University of Medicine & Dentistry of New Jersey, said in a prepared statement.
"The body also secretes more hormones such as cortisol and epinephrine, and the body responds by producing more glucose coupled with a decreased sensitivity to insulin, which can lead to diabetes," Youssef explained.
He noted that pregnancy can worsen sleep apnea, particularly during the third trimester when weight gain is the greatest.
"When a mother’s oxygen level drops at night, it may also affect the oxygen level of the fetus, and we don’t know what the long–term effects are," Youssef said. "That’s why it’s important for a pregnant woman with sleep apnea to be treated with CPAP (continuous positive airway pressure) during her pregnancy."
CPAP delivers air through a mask while a person sleeps.
More information
The U.S. National Heart, Lung, and Blood Institute has more about sleep apnea.
SOURCE: American Thoracic Society, news release, May 22, 2007
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May 22: At the Dentist’s: Vicious Cycle of Gum Disease, Bone Loss and Cancer, The New York Times
By NICHOLAS BAKALAR
The bone loss caused by gum disease is associated with an increased risk for tongue cancer, and the more the bone loss, the greater the risk, researchers report.
Chronic Periodontitis and the Risk of Tongue Cancer (The Archives of Otolaryngology: Head & Neck Surgery) Scientists evaluated bone loss around the teeth in 51 men with newly diagnosed tongue cancer and in 54 men without the diagnosis. X’rays were taken of the men’s jaws, and a radiologist who did not know the cancer status of the men measured the amount of bone loss. The study took place from 1999 to 2005.
After adjusting for smoking status, sex, race and ethnicity, number of cavities, crowns, fillings and missing teeth, the researchers calculated that for every one millimeter of bone loss, the risk of tongue cancer increases more than fivefold.
Chronic infection, the authors write in the May issue of The Archives of Otolaryngology: Head & Neck Surgery, can play a role in cancer, either directly by the effect of the toxic products of micro–organisms, or indirectly by inflammation that stimulates the formation of tumors.
"I was surprised by the magnitude of the effect," said Frank A. Scannapieco, the senior author and a professor of oral biology at the School of Dental Medicine at the State University of New York at Buffalo. But, he added, "There have to be more population–based studies to support these conclusions."
Although chronic gum disease was the only oral variable significantly associated with oral cancer, the authors acknowledged that the number of people in the study was small and that the diagnoses of periodontal disease were made from X–rays rather than direct measurement.
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May 30: Patients, Families Take Up The Cause of Hospital Safety, The Wall Street Journal
Grass’Roots Movement Offers Support, Information to People Affected by Medical Errors
When her 18–month–old daughter Josie died after a series of medical mistakes at Johns Hopkins Children’s Center in Baltimore six years ago, Sorrel King was consumed by grief and anger, wanting to destroy the hospital and even end her own life. But with three other children to live for, she and her husband Tony decided they had to help fix a broken system.
"We had to do something good that would prevent this from ever happening to a child again," Ms. King says. When the hospital offered a financial settlement, Ms. King, a former fashion designer who had become a stay–at–home mom, asked Johns Hopkins to take some of the money back to start a children’s safety program. She also created the Josie King Foundation to fund safety initiatives at other hospitals.
Now, to take the message to a broader audience of both consumers and medical professionals, she is launching a new Web site, josieking.org, with her own blog on patient safety; an online community where families can post their medical–error experiences and provide emotional support; advice from medical and legal experts on how to avoid error and deal with it when occurs; and resources for hospitals seeking to improve safety.
Ms. King is one of the leading forces in a grass–roots patient–safety movement led by patients and family members who have experienced a devastating medical error – in many cases teaming up with the very providers responsible for the harm. Often working in tandem, they are becoming an increasingly powerful and vocal force world–wide, working with hospitals, governments and nonprofit groups to help formulate safety policies and lobbying for legislation in the U.S. and other countries to protect patients.
They are using the Web to spread the message, creating online communities to share strategies for preventing medical errors and provide support and advice to consumers who have experienced harm.
One group, Consumers Advancing Patient Safety, which launched its own online community two months ago, was tapped by the World Health Organization to help build a global network of consumer patient–safety champions, conducting patient–safety workshops around the world.
According to the Geneva–based organization, part of the United Nations, an average of one in 10 patients world–wide admitted to a hospital suffers some form of preventable harm that can result in severe disability or death. The additional hospitalization, litigation claims, hospital–acquired infections, lost income, disability and medical expenses cost some countries between $6 billion and $29 billion a year, the group says.
Sue Sheridan, a CAPS board member now working with the WHO Patients for Patient Safety project, experienced two tragic adverse medical events: Her son Cal’s neonatal jaundice went untreated, leading to a kind of severe brain damage called kernicterus, and her husband Pat died after a cancer diagnosis wasn’t communicated, resulting in a six–month delay in treating his condition.
Ms. Sheridan says one of the last things her husband told her before his death was, "Never give up on patient safety." The message, she says, "was seared in my soul."
Others doing work in this vein include Jennifer Dingman, who co–founded Persons United Limiting Substandards and Errors in Health Care (pulseamerica.org) after losing her mother to a series of preventable medical errors; a related group, Pulse of New York, was started by Ilene Corina after her 3–year–old son bled to death following a tonsillectomy. Cathy Lake started the surgicalfire.org Web site to alert consumers to the risk of fires from electrical equipment used during surgery after her mother was severely burned and subsequently died after a series of complications and treatment errors.
And caregivers are joining, too. After a routine surgery led to complications that nearly killed her, Linda Kenney joined with the anesthesiologist who had been involved, Rick Van Pelt, to form Medically Induced Trauma Support Services (MITSS.org), which provides support and other resources for both families and medical professionals.
"These people are the real heroes of patient safety, putting themselves at risk by going back into the same burning building and reliving their experiences to help someone else," says Charles Denham, a physician and hospital–safety expert who is chairman of a number of patient–safety programs. Dr. Denham’s nonprofit Texas Medical Institute of Technology funded a video in which Ms. King describes the medical errors that led to Josie’s death; it is now used as a training tool by hospitals.
Ms. King, who had another child after Josie’s death – she now has two daughters and two sons – says one of her chief aims is to convey the importance of the family as the patient’s advocate in a hospital. And she says it is critical for caregivers to listen to families’ concerns. Rushed to the hospital with severe burns suffered when she accidentally stepped into a scalding tub at home, Josie was responding well to treatment in the intensive–care unit. But after she was moved to an intermediate–care unit, she began to exhibit unusual symptoms, such as furiously sucking on a washcloth and crying for every drink she saw.
Despite her mother’s warnings and expressions of concern, hospital staff overlooked or misinterpreted mounting signs of severe dehydration, and gave her a narcotic despite verbal orders that she receive no further medication. She died two days before she was scheduled to go home.
"The day Josie died, it hit me so hard it was like being struck by lightning," Ms. King recalls. "For months and years I kept searching for a reason, and gradually I began to see that there was one." As she began traveling the country to speak at health–care conferences, "I realized I could make a little bit of difference," she says. "They all know there is a problem, and they want desperately to solve it."
Rick Kidwell, the Johns Hopkins attorney who handled the case, was the first person Ms. King called about using some settlement funds to start a patient–safety program. He is now one of several experts who offer commentary and advice about patient safety on the new Web site, including Peter Pronovost, medical director of the Johns Hopkins Hospital’s Center for Innovation in Patient Care.
Mr. Kidwell is also now director of risk management at the University of Pittsburgh Medical Center, where the Josie King Foundation has been sponsoring a pilot program called Condition Help. It’s a hot line families can call to summon a "rapid response" team of specialists inside the hospital if they feel that a patient is in danger and isn’t receiving the necessary attention.
Beth Kuzminsky, a nurse and associate at UPMC’s Center of Quality Improvement and Innovation, says at first the program was unsettling to doctors and nurses, who worried that it would scare patients, and would reflect badly on them if a family used the call line. But staffers were convinced that the system wouldn’t be abused by patients.
Since July 2005, a Condition H has been called 62 times, she notes. And the data suggest that 69% of the incidents would have led to potentially harmful patient situations if Condition H hadn’t been called. The program will be expanded in January to all of UPMC’s 14 acute–care hospitals.
Ms. King advises families to record important medical information while in the hospital, including when and by whom medical procedures were performed and the names of the doctors and nurses on duty each day. Her foundation has created a "Care Journal" with space for jotting down the information. Ms. King says she is in talks with UPMC, Johns Hopkins and Duke University Medical Center about providing the journals to patients and families.
Ms. King says it is equally important to help medical staff who have been involved in errors or adverse events, because there is often no formal help with the emotional fallout of being involved in patient harm.
And nurses and doctors may be told to keep quiet and avoid contact with the patient or family in case of a lawsuit. One of her foundation’s programs, "Care for the Caregivers," includes a course to teach intensive–care nurses how to write about stressful situations at work, to help sort out their emotions.
"It isn’t just the family and patient who suffer when there is a medical error," says Ms. King. "It’s also devastating to the caregiver, and there is not much of a support system."
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