Hospital code blue deadlier at night
Wed, 20 Feb 2008 04:09:12 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - Many hospitals call it "code blue," a signal given over the intercom when a patient's heart has stopped. When code blue works well, a team speeds to the bedside and revives the patient. The graveyard shift is the worst time to call code blue, a new study finds. Patients who go into cardiac arrest while in the hospital are more likely to die if it happens after 11 p.m., when staffing may be lower or patients watched less closely.
"Our findings should be a pretty big wakeup call to urge hospitals to critically evaluate how they are performing resuscitation," said the study's lead author, Dr. Mary Ann Peberdy of the Virginia Commonwealth University Health System in Richmond. "It may well be possible that there is a less effective and less efficient response at night."
The study, appearing in Wednesday's Journal of the American Medical Association, didn't examine why days and overnights differed. But researchers found among the late night cases a higher portion of instances where patients were discovered with no heart electrical activity, that is, too late to deliver a lifesaving shock.
Staff who are fatigued, less experienced or too few in number could be to blame, researchers speculated. Weekends had lower survival rates than weekdays, but the difference wasn't as pronounced as between late night and daytime hours.
Only in the emergency room was there no night-or-day difference in survival.
The study was based on an analysis of more than 86,000 cardiac arrests in more than 500 hospitals over seven years.
There were 58,593 cardiac arrests during the day or evening. Of those, 11,604, almost 20 percent, survived to leave the hospital. There were 28,155 cardiac arrests during the shift that began at 11 p.m. Of those, 4,139, fewer than 15 percent, survived for discharge.
After taking into account other factors associated with survival, the researchers still found the chances of surviving until discharge 18 percent lower if the cardiac arrest was during the period from 11 p.m. to 6:59 a.m.
"Everyone who works in a hospital is going to look at this and say, 'Are we doing everything we should be?'" said Dr. Charles Porter, a cardiologist at the University of Kansas Hospital in Kansas City, Kansas. There, automated external defibrillators, or AEDs, are readily available and any staff member, even a custodian, can summon a rapid response team if a patient doesn't look good.
A study last month found that being in the hospital was no guarantee of getting prompt treatment for cardiac arrest. In that study, published in the New England Journal of Medicine, researchers found that one-third of patients don't get a potentially live-saving shock within the recommended two minutes.
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On the Net:
JAMA: http://jama.ama-assn.org
Getting off meds has consequences
Wed, 20 Feb 2008 03:01:22 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - Psychiatrists say it's a common scenario — troubled patients stop taking their medicine, because of cost, side effects, the stigma, or delusions that they don't need it. The consequences can be tragic, though rarely as horrific as the Valentine's Day suicide-slaughter at Northern Illinois University.
No one knows what triggered Steven Kazmierczak's campus rampage, yet one of the clues to an emerging psychiatric profile is this: His girlfriend says he recently stopped taking Prozac.
Prozac is a drug generally prescribed for major depression. It and similar antidepressants carry warning labels about risks for suicidal behavior in patients younger than Kazmierczak, who was 27.
Still, stopping these drugs can also lead to suicidal thoughts and behavior. And taking them may increase the risk for other violence if they're mistakenly prescribed as the only treatment for patients in a depressive phase of bipolar disorder, psychiatrists say. In that case, the drugs may trigger a manic phase that could include aggressive behavior toward others.
In court cases, attorneys have sometimes tried to blame violent behavior on Prozac. However, scientific evidence to support that is lacking, and psychiatrists and the drug's maker, Eli Lilly and Co., say the underlying mental illness is the most likely culprit.
"There is much information that is still unknown about his life and medical history and therefore it may never be known as to why ultimately chose to take the lives of others as well as himself," Lilly spokesman Charlie McAtee said in a statement.
Kazmierczak, a graduate student in social work at the University of Illinois, was a worrier with obsessive-compulsive tendencies, his girlfriend told CNN, but it is not known if he'd been diagnosed with depression or bipolar disorder. She said he'd stopped taking Prozac three weeks before last week's tragedy.
Two days before the Feb. 14 shootings, a New York man who'd been treated for psychiatric problems and who had also stopped taking medication is accused of fatally stabbing a therapist.
"Can stopping medications be an important contributory factor to deterioration of behavior ... where violence ends up being committed? Yes, absolutely," said Dr. Paul Ragan, an associate professor of psychiatry at Vanderbilt University.
Ragan said he has had patients attempt suicide after stopping antidepressants because their insurance ran out, although violence against others is rare in depression.
"Suspending a patient's use of antidepressants is very rarely linked to violence toward others," McAtee said.
On or off medication, the vast majority of people with schizophrenia, depression and bipolar disorder "do not engage in violent behavior," said Dr. David Fassler, a University of Vermont psychiatry professor.
Still, compliance with medication is a significant problem, he said.
"Research demonstrates that about 25 percent of patients stop taking antidepressant medication within three months. By six months, some studies suggest that the overall compliance rate is less than 50 percent," Fassler said.
For about one-third of patients, side effects are the main reason they stop taking psychiatric drugs, Fassler said.
Dr. Lynne Tan, a psychiatrist at Montefiore Medical Center in New York, said many patients complain that antidepressants cause restlessness, agitation and racing thoughts. Sweating, sexual dysfunction and headaches are other common side effects. Sometimes they subside over time, and if not, patients can be switched to other medications, she said.
Elizabeth, a 26-year-old graduate student in social work at the University of Chicago who asked that her last name not be used to protect her privacy, said she stopped and restarted antidepressants many times since being diagnosed with depression at age 16.
"Stigma does play a big part of it," she said. "That's why I was so eager to consider myself well and to go off of it."
When she left college and was no longer covered by her parents' insurance, cost also became an issue — $60 to $70 a month for a generic antidepressant. She declined to identify the drug.
But each time she stopped, debilitating depression including suicidal thoughts would return, she said.
"If I've learned anything from this journey, it's that medication really works for me," she said.
Greg Coughlin, 53, a health department employee for DuPage County west of Chicago, said several years ago he repeatedly stopped taking drugs for a type of schizophrenia because he was "in denial" about suffering from mental illness.
Coughlin said the last time he stopped, in the 1990s, he became extremely obnoxious and agitated, and ended up in a mental hospital.
Now he's on three mood stabilizers that zap his energy and cause weight gain, but make him feel "more solid, more relaxed, more satisfied in life."
Coughlin, a board member of the Illinois chapter of the National Alliance on Mental Illness, said he finally accepts that to function, he'll need to be on drugs for life.
Elizabeth said she can live with the side effects — extreme sweating and a hand tremor — and credits psychotherapy, a support group and exercise with helping her cope.
While accounts from friends and professors suggest that at least on the surface, Kazmierczak was coping well, there were also signs of trouble.
He had a history of cutting himself, which is often a symptom of inner anger and a sense of feeling powerless, said psychologist Wendy Lader, who runs a suburban Chicago treatment center for self-cutters.
Self-cutting is thought to be more common among women, but women are also more likely than men to seek treatment for it, Lader said.
Kazmierczak also wore macabre shock-value tattoos covering both forearms — an unusual and disturbing choice for someone pursuing a career in social work, Lader said.
Dr. Louis Kraus, a forensic psychologist with Rush University Medical Center in Chicago, said with no known criminal background or history of violence or anti-social behavior before the killings, Kazmierczak presents a bewildering psychiatric image.
"Obviously something very tragic is missing from this puzzle that we don't fully understand yet," Kraus said.
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On the Net;
National Institute of Mental Health: http://www.nimh.nih.gov
National Alliance on Mental Illness: http://www.nami.org
Depression and Bipolar Support Alliance: http://www.dbsalliance.org
Study Gel fails to stop HIV infection
Tue, 19 Feb 2008 22:20:19 GMTBy MARILYNN MARCHIONE, AP Medical Writer
The first anti-AIDS vaginal gel to make it through late-stage testing failed to stop HIV infection in a study of 6,000 South African women, disappointed researchers announced Monday.
The study was marred by low use of the gel, which could have undermined results, they said. Women used it less than half the number of times they had sex, and only 10 percent said they used it every time as directed.
Scientists are still analyzing the results to see if this made a difference. They also plan more tests on a revamped gel containing an AIDS drug that they hope will work better.
The gel used in the current study did prove safe, however, and researchers called that a watershed event.
But for now, the effort is the latest disappointment in two decades of trying to develop a microbicide — a cream or gel women could use to lower their risk of getting HIV through sex. A female-controlled method is especially needed in poor countries where women often can't persuade men to use condoms.
A year ago, scientists stopped two late-stage tests of a different gel after early results suggested it might raise the risk of HIV infection instead of lowering it.
The new study tested Carraguard, a microbicide developed by the nonprofit, New York-based Population Council. It contains carrageenan, which comes from seaweed and is widely used in the food and cosmetics industries as a gel, stabilizer and thickening agent. Lab, animal and early human tests suggested it might prevent HIV and other sexually spread infections.
The latest study was done from March 2004 through March 2007 in Gugulethu, Isipingo and Soshanguve, all in South Africa.
More than 9,000 women, average age 31, volunteered for the study. About 27 percent tested positive for HIV and were disqualified. In all, 6,202 women were randomly given either Carraguard or a placebo gel. Neither the women nor the study staff knew who received what. All received safe-sex counseling and condoms.
Women participated from nine months to two years, with 4,244 completing the study. About 18 percent dropped out, often because they became pregnant and the gel is not known to be safe for use in pregnancy. Another 13 percent could not be found for follow up information.
At the end of the study, there were 134 new HIV infections in the Carraguard group and 151 in the fake gel group — a rate of 3.3 infections per 100 women each year in the microbicide group and 3.7 for the placebo group.
"The results are comparable," with no statistically significant difference, said Khatija Ahmed, a microbiologist who headed the study's Setshaba Research Centre site near Pretoria.
However, women in the study used the gels only 44 percent of the time, and some used it hardly at all. Researchers are still analyzing the numbers to see what that means. If nonuse was far greater in the microbicide group than the placebo group, "it could have had an impact on our final study results," said Barbara Friedland, the study's behavioral coordinator.
A plus: reported condom use doubled, from 33 percent at the start of the study to 64 percent during it. Other sexually spread infections declined.
The study was paid for by the Bill & Melinda Gates Foundation and the U.S. Agency for International Development, or USAID.
Jeff Spieler, an official at USAID, called the trial "groundbreaking work" in a statement. "We have always known that the path to developing a successful microbicide would be a long one."
The Population Council hopes to start tests this year of a revamped Carraguard containing an experimental AIDS drug, MIV-150. The group also has studies under way of a contraceptive version of the gel, Carraguard plus hormones.
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Population Council: http://www.popcouncil.org/microbicides
Microbicides: http://www.microbicide.org
Global Campaign for Microbicides: http://www.global-campaign.org
Health Tip Zinc in Your Diet
Wed, 20 Feb 2008 04:46:23 GMT- Zinc is a mineral that the body needs to help the immune system, in wound healing, and in the breakdown of carbohydrates. Second only to iron in its concentration in the body, zinc is found in protein-rich foods such as meat, peanuts and peanut butter, and legumes.
If you're not getting enough zinc, here's a list of possible warning signs, courtesy of the U.S. National Library of Medicine:
- Slow growth rate.
- No appetite.
- Slow-healing wounds, lesions on the skin, and persistent infections.
- Hair loss.
- Abnormalities in your ability to taste and smell.
- Difficulty seeing in the dark.
- Insufficient hormone production in men.
