Going to the ER

Almost everyone who lives with pain has been to the emergency room at some time.
You may have gone because your pain was out of control and you could not reach your own health care team.  You may have gone because you feared that your pain was a sign of a new medical problem.   You may have gone because you have no insurance. Or your own doctor may have sent you there.
A randomized survey conducted by the ACPA and the American College of Emergency Medicine Physicians found these reason and more among the 500 people with recurring or chronic pain who visited the emergency department (ED) once or more in the last two years. To see the full survey results, click here.
While most of the people surveyed were satisfied with their treatment in the ED, there were important gaps between what people expected from their visit and what they experienced.  This site can help you know what to expect in case you need to go to the ED in the future. When you are prepared, you are likely to have a more positive experience.

Clostridium difficile infection rate has risen among hospitalized children since late 1990s

Child/Adolescent Health

Clostridium difficile infection rate has risen among hospitalized children since late 1990s The number of cases of Clostridium difficile infection (CDI) among hospitalized children in the United States more than doubled over a 10-year period, according to a new study. A bacterium that can colonize the gastrointestinal tract, C. difficile can cause symptoms ranging from nothing to severe diarrhea, inflammation of the colon, bowel perforation, and even death. The researchers found that the incidence of CDI in hospitalized children increased from 3,565 cases in 1997 to 7,779 cases in 2006. Children with CDI had a 20 percent greater risk of death and a 36 percent higher risk of requiring surgery to remove part of or the entire colon. In addition, children diagnosed with CDI were four times more likely to have an extended hospital stay and twice as likely to have higher hospital costs than hospitalized children not infected by C. difficile. The researchers found no trend in the severity of CDI over time, despite the disease's increased incidence. However, patients with inflammatory bowel disease were 11.4 times as likely to have CDI compared with childlren without this condition. Solid-organ transplants, HIV infection, and transplantation of blood-forming stem cells—all requiring or resulting in immune suppression—increased the odds of CDI 3.3- to 4.5-fold in adjusted multivariable analysis. The researchers used data from the AHRQ-funded Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP-KID) for 1997, 2000, 2003, and 2006. HCUP-KID is a stratified random sample of 5.8 million inpatient discharges for children from 22 to 38 States (depending on the year). For 2006, it represented an estimated 89 percent of all pediatric hospital discharges in the United States. The study was funded in part by the Agency for Healthcare Research and Quality (HS016957). More details are in "Clostridium difficile infection in hospitalized children in the United States," by Cade M. Nylund, M.D., Anthony Goudie, Ph.D., Jose M. Garza, M.D., and others in the May 2011 Archives of Pediatrics and Adolescent Medicine 165(5), pp. 451-457.

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery

Patient Safety and Quality

No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery During coronary artery bypass surgery, a vein is taken from the leg to replace blocked arteries in the heart. Today, the majority of vein harvesting is done endoscopically rather than using an open surgical procedure. By using this minimally invasive approach, the surgeon can reduce pain and infection. Recently, some experts have questioned whether this approach to leg vein harvesting may expose patients to the risk of vein-graft failure, death, heart attack, and repeated blockages after surgery. A new study that compared the two techniques over a 4-year period found no increase in harm to patients who underwent endoscopic vein harvesting. Between 2001 and 2004, 8,542 patients underwent coronary artery bypass grafting procedures in northern New England. More than half (52.5 percent) had endoscopic vein harvesting. Over the study period, endoscopic vein harvesting grew in popularity, from 34 percent in 2001 to 75 percent in 2004. Patients receiving endoscopic vein harvesting were more likely to be male, have vascular disease, and have two-vessel disease. They were less likely to have a history of a heart attack or congestive heart failure. In terms of hospital outcomes, open surgical harvesting was associated with an increase in postoperative leg wound infections. On the other hand, endoscopic harvesting resulted in an increase in patients being returned to the operating room to correct postoperative bleeding. With respect to long-term outcomes, there was a significant reduction in long-term mortality with endoscopic harvesting. The relatively small increased risk of repeat revascularization over four years with endoscopic harvesting was non-significant. The study was supported in part by the Agency for Healthcare Research and Quality (HS15663). See "Long-term outcomes of endoscopic vein harvesting after coronary artery bypass grafting," by Lawrence J. Dacey, M.D., John H., Braxton, Jr., M.D., Robert S. Kramer, M.D., and others in the January 18, 2011, Circulation 123(2), pp. 147-153.

Lung Diseases and Conditions

Many steps are involved in breathing. If injury, disease, or other factors affect any of the steps, you may have trouble breathing.
For example, the fine hairs (cilia) that line your upper airways may not trap all of the germs you breathe in. These germs can cause an infection in your bronchial tubes (bronchitis) or deep in your lungs (pneumonia). These infections cause a buildup of mucus and/or fluid that narrows the airways and limits airflow in and out of your lungs.
If you have asthma, breathing in certain substances that you're sensitive to can trigger your airways to narrow. This makes it hard for air to flow in and out of your lungs.
Over a long period, breathing in cigarette smoke or air pollutants can damage the airways and the air sacs. This can lead to a condition called COPD (chronic obstructive pulmonary disease). COPD prevents proper airflow in and out of your lungs and can hinder gas exchange in the air sacs.
An important step to breathing is the movement of your diaphragm and other muscles in your chest, neck, and abdomen. This movement lets you inhale and exhale. Nerves that run from your brain to these muscles control their movement. Damage to these nerves in your upper spinal cord can cause breathing to stop, unless a machine is used to help you breathe. (This machine is called a ventilator or a respirator.)
A steady flow of blood in the small blood vessels that surround your air sacs is vital for gas exchange. Long periods of inactivity or surgery can cause a blood clot called a pulmonary embolism (PE) to block a lung artery. A PE can reduce or block the flow of blood in the small blood vessels and hinder gas exchange.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.
Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to your disease or condition, talk with your doctor.

Antidepressants Might Raise Fall Risk in Nursing Homes

Residents with dementia taking so-called SSRIs seem to be at higher risk of injury, study suggests.

By Robert Preidt

Wednesday, January 18, 2012

WEDNESDAY, Jan. 18 (HealthDay News) -- Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of falls in nursing home residents with dementia, a new study finds.
Researchers in the Netherlands analyzed data about daily prescription medicine use and falls among 248 nursing home residents with dementia. The dataset collected between Jan. 1, 2006 and Jan. 1, 2008 included 85,074 person-days.
Antidepressants were used on 13,729 days (16 percent), with SSRIs used on 11,105 of these days, the investigators found.
A total of 683 falls were experienced by 152 (61.5 percent) of the 248 nursing home residents, which works out to fall incidence of 2.9 falls per person-year. Thirty-eight residents had one fall but 114 had frequent falls.
Injury or death resulted from 220 of the falls: 10 were hip fractures, 11 were other types of fractures, and 198 were injuries such as sprains, bruises, swelling and open wounds. One person died after falling, according to the results.
The researchers found that the risk of having an injury-causing fall was three times higher for residents taking SSRIs than for those who didn't take the antidepressants. For example, the absolute daily risk of a fall was 0.28 percent for an 80-year-old woman taking a daily dose of an SSRI, compared with 0.09 percent for a woman the same age who didn't take an SSRI.
Similar increases in risk were found for both women and men of different ages, according to the study published Jan. 19 in the British Journal of Clinical Pharmacology.
"Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills," lead author Carolyn Shanty Sterke, who works in the section of geriatric medicine at Erasmus University Medical Center in Rotterdam, said in a journal news release.
Falls are a major issue for nursing home residents with dementia, and one-third of falls among nursing home residents result in an injury, the study authors noted.
"Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," Sterke said in the news release.
While the study uncovered an association between injury-causing falls and SSRI use, it did not prove a cause-and-effect relationship.

SOURCE: British Journal of Clinical Pharmacology, news release, Jan. 18, 2012

Male Heart Disease May Be Linked to Mom's Lifetime Nutrition Risk associated, in part, with mother's body size, placenta size and shape at birth, researchers say

Male Heart Disease May Be Linked to Mom's Lifetime Nutrition Risk associated, in part, with mother's body size, placenta size and shape at birth, researchers say By Alan Mozes THURSDAY, June 2 (HealthDay News) -- A man's heart disease risk after the age of 40 may be linked, at least in part, to his mother's body size and placenta size when he was born, a new study suggests. "Chronic disease is the product of a mother's lifetime nutrition and the early growth of her child," study lead author Dr. David Barker, a professor of clinical epidemiology at the University of Southampton in the United Kingdom, said in a news release from the European Society of Cardiology. "It is not simply a consequence of poor lifestyles in later life. Rather, it is a result of variations in the normal processes of human development." The finding is reported online June 1 in the European Heart Journal by Barker, who is also a professor in cardiovascular medicine at Oregon Health and Science University, and colleagues. Indications of the maternal influence on the heart disease risk of male offspring stem from an analysis involving nearly 7,000 Finnish men who were born in Helsinki between 1934 and 1944. At that time, birth records included notations on the baby's size, the placental surface size, and other information on the mother's weight, height and age, and previous pregnancies. (The placenta -- a temporary organ that lines the uterus and feeds the baby in the womb -- is expelled at birth.) The investigators found that male heart disease risk in late adulthood appeared to rise among: Men whose mothers were short, pregnant for the first time and had relatively oval placentas (indicating that the placental development had been disrupted). Men whose mothers were tall and heavy and had relatively small placentas (which might have restricted the infants' growth mid-gestation). Men whose mothers were tall with a lower-than-normal body mass index and whose placentas were heavy relative to birth weight (the mothers' BMIs suggest that their nutrition was poor during pregnancy, Barker explained). Regardless of which combination was in play, those men with the greatest likelihood for developing heart disease as adults had tended to be relatively thin at birth. This fact, the authors suggested, was an indication that malnourishment was a factor at the time of birth. "We have been able to show for the first time that a combination of the mother's body size and the shape and size of the placental surface predicts later heart disease," Barker said. Going forward, the research team intends to study abnormal development of the heart by examining pregnant women's nutritional habits and body characteristics alongside prenatal growth patterns and placenta sizes at birth.