Study Big hospitals better for preemies
Thu, 24 May 2007 03:09:24 GMT
By MIKE STOBBE, AP Medical Writer
Thousands of sickly newborns could be saved each year if officials closed some of the nation's smaller neonatal intensive care units, according to a new study that suggests larger hospitals are better able to treat the infants.
Extremely premature babies were up to twice as likely to survive when treated at a busy, advanced-care center instead of one of the many community hospitals that have opened NICUs in recent years.
Even among the most advanced centers, those that handled the most babies had the best survival records, said Ciaran Phibbs, lead author of the study appearing in Thursday's
http://www.hospitalcompare.hhs.gov and http://www.calhospitalcompare.org may help.
Debby Rogers, vice president of quality and emergency services for the California Hospital Association, said closing NICUs carries some risk.
Residents of some rural areas have limited access to advanced medical services, and it's better for them to have limited NICU care than no such care at all, she said.
Phibbs said his team considered that argument, and found 92 percent of the births in 2000 occurred in urban areas with more than 100 such deliveries each year.
___
On the Net:
New England Journal: http://www.nejm.org
Woman upbeat after internal decapitation
Wed, 23 May 2007 21:36:11 GMT
LINCOLN, Neb. - Most days are good, some not for a woman who is recovering from what has been called "internal decapitation." Shannon Malloy suffered "atlantooccipital dislocation" — that's what doctors call it. The force of her head hitting a car dashboard separated her skull from her spine.
Though rare, it's more common in children and is usually found during autopsies.
Speaking from her mother's home in Denver, Malloy, 30, said she remembers no pain from the crash near Tecumseh in southeast Nebraska on Jan. 25.
"I remember being slumped over and not being able to respond," she said.
She was a passenger in the car. She would not provide details of the accident, she said, because she's suing an insurer.
"Stay alive," Malloy said she told herself while still in the car. "I can't die."
She said she heard her boyfriend, Graham Neary, say to her: "Please stay with me."
"Then I don't remember much until the paramedics pulled me out of the car," Malloy said.
She recalls parts of her next three weeks at a Lincoln hospital, on a ventilator, unable to talk.
"At some point in the ICU, I remember writing a note , asking if I was paralyzed.
"She said, 'No.'"
Surviving the catastrophic injury has become more common because of faster protection of the airway and better spinal isolation at accident scenes.
Malloy also suffered a broken pelvis and ankle.
Yet she remains mostly upbeat.
"My family keeps joking that I must be brain-damaged because I'm so positive," she said.
After three weeks in intensive care and two weeks of rehabilitation, she walked out to begin her new life with daunting physical challenges.
Her eyes remain crossed, awaiting surgery.
She can turn her head only an inch side to side, but the restrictive halo apparatus she was wearing came off April 13.
She can't swallow yet.
"My esophagus muscle is so tight that even water won't pass through," she said. "I can't even swallow my own spit."
No surgeries have been scheduled to address her vision or inability to swallow.
Money remains a problem, as has the paperwork required to get help from Medicaid.
Sometimes, Malloy said, "I feel like I'm on the outside looking in. At other times, I wish I was on the outside looking in."
"I'm not a religious person, but there's a reason for me to be here," she said. "And I've got to find out what that reason is and fulfill it."
___
Information from: Lincoln Journal Star, http://www.journalstar.com
Hospitals to study child seizures
Wed, 23 May 2007 21:40:43 GMT
WASHINGTON - When children suffer life-threatening seizures, doctors have minutes to decide which of two drugs to use to try to save them — with no good research on which works better.
Eleven hospitals around the country are beginning a special study to finally answer that question: A computer will randomly assign patients to get either Valium or Ativan within five minutes of arriving in the emergency room.
Because of the time crunch, doctors won't seek parents' permission first. Children brought to those emergency rooms with the unrelenting seizures known as "status epilepticus" will be enrolled in the study automatically.
The
http://www.nichd.nih.gov/news/releases/study_pediatric_seizure_QA_052207.cfm
Ban kept for gay men donating blood
Wed, 23 May 2007 22:05:43 GMT
WASHINGTON - Gay men remain banned for life from donating blood, the government said Wednesday, leaving in place — for now — a 1983 prohibition meant to prevent the spread of
http://www.fda.gov/cber/faq/msmdonor.htm
Cultural bigotry rises as India sees social change
Wed, 23 May 2007 10:41:20 GMT
By Krittivas Mukherjee
MUMBAI - A barrage of kisses on Shilpa Shetty's
cheeks, paintings of naked Hindu gods, Valentine's Day, Fashion
TV and sex education -- all are unacceptable according to
India's increasingly sensitive moral police.
Small but growing and ever more vocal groups of cultural
vigilantes are attacking anything that does not conform to
their notion of purity and morality, from paintings, books and
films to modern dress, Western attitudes and even beauty
salons.
It is an assault some ascribe to the dislocation caused by
a booming economy, and the gap between an affluent, urban youth
embracing Western values and the more traditional rest of
society, whether older or poorer.
&;Lopsided economic growth has created a dispossessed
population which cannot relate to Western cultural values and
norms,&; said S. Parasuraman, head of the Tata Institute of
Social Sciences. &;The political class exploits this.&;
More often than not, the religious card gets played.
As the Hindu nationalist Bharatiya Janata Party tries to
reach out to the moderate centre of Indian politics and
redefine itself after its national election defeat in 2004, its
radical fringe is looking for issues to reinvigorate itself.
With a profusion of 24-hour television news channels, these
groups get disproportionate air time and publicity which media
analysts say only emboldens them further.
Earlier this month, an art student was beaten up and his
exhibition destroyed for portraying Hindu deities in the nude.
The student, Chandramohan, was himself arrested on charges of
offending religious sentiments, but later freed on bail.
No charges have been laid against the vandals, who were
surely encouraged by the success of like-minded radicals in
forcing one of India's top painters, M.F. Husain, into exile
about a year ago for a similar offence.
In April, effigies of Hollywood star Richard Gere and
Bollywood actress and &;Celebrity Big Brother&; winner Shilpa
Shetty were burnt after they kissed at a public event. An
Indian court even ordered Gere's arrest to face charges of
obscenity.
Meanwhile, anything from Valentine's Day to sex education
in schools is denounced as an alien Western import. Lovers are
beaten up for kissing or even holding hands in public.
&;Western countries are fighting psychological warfare to
influence Indian youth,&; said Abhimanyu Gulati, a BJP leader.
&;We are saving the country from cultural anarchy and they
call us the Indian Taliban.&;
UNEQUAL LIBERALISM?
But Hindu radicals are not the only ones trying to reshape
society through direct action.
In
Kashmir, an 18-year-old insurgency against Indian rule
has radicalized a section of the Muslim population -- with the
encouragement of neighboring Pakistan.
Muslim women activists have raided and shut down beauty
salons and even attacked women who don't wear the burqa.
Many Indians see the radicals as a national embarrassment.
But politicians, police and the courts have often turned a
blind or conniving eye.
The book and film &;The Da Vinci Code&; was banned in several
states after protests by Christian groups. Dance bars were
banned in 2005 in the western state of Maharashtra because they
were said to corrupt young minds and breed prostitution.
And in New Delhi, the central government occasionally bans
channels like Fashion TV or AXN for showing too much female
flesh or too many raunchy advertisements.
Part of the problem, according to commentators like Vir
Sanghvi and Pratap Bhanu Mehta, is that India has failed to
engage in serious debate about the balance between art and
religion, and between freedom of expression and the defense of
religious sentiments.
&;There is a perception, right or wrong, that when Hindu
gods or goddesses are lampooned, free speech is mobilized as an
argument; but a lampooning of Islamic symbols is seen as an
anti-minority move,&; Mehta wrote in the Indian Express.
For Mehta, the right of free expression should apply
equally.
&;I find it the height of impropriety and hubris that we
humans are in the business of protecting our gods rather than
the other way round.&;
Liberals in India fail to apply the same standards to all
religions, agrees Sanghvi, and have never engaged in any
serious debate about what should be allowed to be shown in
public.
&;Our problem in India is that we have no standards, no
barriers and no sense of what is acceptable and what is not,&;
he wrote.
&;Each time the issue erupts we engage in the same
finger-pointing debates, and call each other names.&;
China virus outbreak kills third child
Thu, 24 May 2007 13:42:01 GMT
BEIJING - A viral disease that has broken out in
eastern China's Shandong province has killed a third child,
Xinhua said on Thursday, raising doubts over earlier claims
that the epidemic may have been contained.
The news agency said that an 11-month-old boy had developed
a fever and blisters before dying on Tuesday in a hospital in
Linyi city, where 1,263 cases of &;hand, foot, and mouth
disease&; have been reported since April.
The virus, which typically causes painful blisters around
the mouth and throat and hands and feet, had already claimed
the lives of a 14-month-old boy earlier this month and a
two-year-old girl on April 29.
Xinhua cited the provincial health bureau as saying that
the outbreak of the virus, which is highly contagious among
children but not normally fatal, was &;slowing down.&; The
government earlier said it had been contained.
The local government has launched a campaign to remind
parents to take preventive measures such as frequent
handwashing.
Chinese bloggers in Shandong said in early May that 26
children had died in the outbreak. Local media said authorities
in Linyi had denied that figure.
Diabetes complications frequently afflict elderly
Thu, 24 May 2007 18:24:44 GMT
NEW YORK - People who develop diabetes
late in life often suffer from a range of diabetes-related
complications, and their life expectancy is shorter than that
of nondiabetic individuals of the same age, a new study shows.
The investigators, Dr. Frank A. Sloan, of Duke University
in Durham, North Carolina, and colleagues point out in the
Archives of Internal Medicine that &;little is known about the
impact of diabetes mellitus in elderly populations.&;
The researchers examined illness and mortality rates in
33,772 Medicare beneficiaries with diabetes and in 25,563
similar people without diabetes over a 14 year
period.
The death rate was over 9 percentage points higher among
the people with diabetes than the control patients. Being newly
diagnosed as diabetic translated into a loss of life expectancy
of just over 2 years.
Overall, 92 percent of the diabetes group experienced an
adverse health event compared with 72 percent of the control
group.
Disorders affecting the legs and complications associated
with surgery were higher among patients with diabetes.
Furthermore, 58 percent of those with diabetes were diagnosed
with heart failure, compared with 34 percent of the control
group. While kidney disease and retinal eye disorders were less
common, both increased markedly in the diabetic group.
&;Although the present data provide no insight into the
cause of these patterns, the burden of diabetes mellitus
complications on the individual and on the health care system
is enormous,&; the researchers conclude.
SOURCE: Archives of Internal Medicine, May 14, 20077.
Lumpectomy safe for younger breast cancer patients
Thu, 24 May 2007 18:23:13 GMT
By Will Boggs, MD
NEW YORK - Breast cancer tends to be more
aggressive when it occurs in younger women, and doctors often
advise radical surgery. Now, however, a study shows that
breast-conserving treatment, commonly known as lumpectomy, is
safe for women younger than 40.
Acceptable outcomes, &;almost comparable to the rates
observed among patients older than 40 years, can be obtained if
high-quality surgery and radiotherapy are combined with
chemotherapy,&; Dr. Adri C. Voogd from Maastricht University in
the Netherlands told Reuters Health.
Voogd and colleagues evaluated the outcomes of 758 women 40
years of age or younger who underwent this course of treatment
between 1988 and 2002.
Ninety-five women developed a local recurrence of breast
cancer during follow-up, the researchers report in the medical
journal Cancer, and an additional 17 women had recurrences
diagnosed after the cancer was found to have spread to other
sites in the body.
&;Of the local recurrences that were identified in our
study, the large majority occurred at or near the site of the
primary tumor, and only 7% developed elsewhere in the breast,&;
the researchers explain. &;This suggests that, at least in young
women, most local recurrences are not new primary tumors, but
are more likely to be true recurrences, originating from
residual tumor tissue.&;
The team calculates that local recurrence rates were 9% at
5 years and 18% after 10 years.
&;With our findings, we hope to have taken away some of the
fears and make breast conservation a more acceptable treatment
option for young women with breast cancer,&; Voogd said.
SOURCE: Cancer, May 15, 2007.
