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.
(Past studies have found that, overall, 80 to 85 percent of patients who suffer a cardiac arrest in the hospital die in the hospital.)
"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.
___
On the Net:
JAMA: http://jama.ama-assn.org
Tuesday, February 19, 2008
Wednesday, February 13, 2008
Fast-food binge harms liver, but boosts good cholesterol: study
PARIS (AFP) - A month-long diet of fast food and no exercise led to dangerously high levels of enzymes linked to liver damage, in an unusual experiment inspired by the docu-movie "Supersize Me."
But investigators, reporting their findings on Thursday, were also stunned to find that a relentless regimen of burgers, fries and soda also boosted so-called good cholesterol, seen as a key measure of cardiovascular health.
Researchers in Sweden asked 12 men and six women in their twenties, all slim and in good health, to eat two meals per day at McDonalds, Burger King or other fast-food restaurants over four weeks.
The volunteers were also told to refrain from exercising. The goal was to increase body weight by 10 to 15 percent to measure the impact of an abrupt surge in calorie intake.
Blood samples were taken before, during and after the experiment to monitor levels of an enzyme called alanine aminotransferase, or ALT, a potential marker for liver damage often seen among heavy drinkers and patients with hepatitis C.
Levels of ALT increased sharply after only one week, and quadrupled on average over the entire period, said lead researcher Frederik Nystrom, a doctor at the University Hospital of Linkoping.
"The results scared me," he told AFP. "One of the subjects had to be withdrawn from the study because he had 10 times the normal ALT levels."
For 11 of the 18 subjects, ALT rose to levels that would normally reflect liver damage, even among individuals who did not drink any alcohol, although no such damage occurred, he said.
Two of the individuals had liver steatosis, or fatty liver, in which fat cells build up dangerously in the liver, he said. Steatosis is associated with the risk of developing Type 2 diabetes, which has taken on epidemic proportions, especially in industrialised countries.
Published in the British Medical Association's journal Gut, the study "proves that high ALT levels can be caused by food alone," said Nystrom.
That signs of liver damage were linked to carbohydrates was another key finding, he said.
"It was not the fat in the hamburgers, it was rather the sugar in the coke," he said.
But the most startling result implies that an intensive fast food diet might have some health benefits too, apparently from fat.
"We found that healthy HDL cholesterol actually increased over the four-week period -- this was very counter-intuitive," Nystrom said.
HDL, sometimes called "good cholesterol," seems to clean the walls of blood vessels, removing excess "bad cholesterol" that can cause coronary artery disease and transporting it to the liver for processing.
Nystrom has yet to publish the cholesterol findings, but said they were consistent with the so-called "French Paradox."
For nearly two decades, scientists have wrestled to explain how the French can consume a diet rich in fats -- from abundant butter, cream, cheese and meat -- yet have generally low levels of heart disease and hypertension.
"The study showed that the increase in saturated fat correlated with the increase in healthy cholesterol," he said.
The young Swedish guinea pigs ate at least two fast-food meals a day, and terminated the study once they had gained a maximum of 15 percent in weight.
On average, they tipped the scales 6.5 kilos (14.3 pounds) more, but one ballooned by 12 kilos (26.4 pounds).
Nystrom got the idea for his study from the 2004 Oscar-nominated documentary "Supersize Me," in which filmmaker Morgan Spurlock asked doctors to monitor him over a 30-day period in which he ate at McDonalds morning, noon and night.
Doctors were so alarmed by changes in his blood chemistry -- including skyrocketing levels of ALT -- that they begged him to halt his experiment.
"I wasn't just inspired by the movie, I copied it to the best of my ability," said Nystrom.
The movie helped spur a change of tack by fast-food corporations to include healthier options on their menus.
On their websites, McDonald's and Burger King highlight salads and low-fat products -- alongside the classic burgers and colas -- and offer guidance on balanced diets and a healthy lifestyle.
But investigators, reporting their findings on Thursday, were also stunned to find that a relentless regimen of burgers, fries and soda also boosted so-called good cholesterol, seen as a key measure of cardiovascular health.
Researchers in Sweden asked 12 men and six women in their twenties, all slim and in good health, to eat two meals per day at McDonalds, Burger King or other fast-food restaurants over four weeks.
The volunteers were also told to refrain from exercising. The goal was to increase body weight by 10 to 15 percent to measure the impact of an abrupt surge in calorie intake.
Blood samples were taken before, during and after the experiment to monitor levels of an enzyme called alanine aminotransferase, or ALT, a potential marker for liver damage often seen among heavy drinkers and patients with hepatitis C.
Levels of ALT increased sharply after only one week, and quadrupled on average over the entire period, said lead researcher Frederik Nystrom, a doctor at the University Hospital of Linkoping.
"The results scared me," he told AFP. "One of the subjects had to be withdrawn from the study because he had 10 times the normal ALT levels."
For 11 of the 18 subjects, ALT rose to levels that would normally reflect liver damage, even among individuals who did not drink any alcohol, although no such damage occurred, he said.
Two of the individuals had liver steatosis, or fatty liver, in which fat cells build up dangerously in the liver, he said. Steatosis is associated with the risk of developing Type 2 diabetes, which has taken on epidemic proportions, especially in industrialised countries.
Published in the British Medical Association's journal Gut, the study "proves that high ALT levels can be caused by food alone," said Nystrom.
That signs of liver damage were linked to carbohydrates was another key finding, he said.
"It was not the fat in the hamburgers, it was rather the sugar in the coke," he said.
But the most startling result implies that an intensive fast food diet might have some health benefits too, apparently from fat.
"We found that healthy HDL cholesterol actually increased over the four-week period -- this was very counter-intuitive," Nystrom said.
HDL, sometimes called "good cholesterol," seems to clean the walls of blood vessels, removing excess "bad cholesterol" that can cause coronary artery disease and transporting it to the liver for processing.
Nystrom has yet to publish the cholesterol findings, but said they were consistent with the so-called "French Paradox."
For nearly two decades, scientists have wrestled to explain how the French can consume a diet rich in fats -- from abundant butter, cream, cheese and meat -- yet have generally low levels of heart disease and hypertension.
"The study showed that the increase in saturated fat correlated with the increase in healthy cholesterol," he said.
The young Swedish guinea pigs ate at least two fast-food meals a day, and terminated the study once they had gained a maximum of 15 percent in weight.
On average, they tipped the scales 6.5 kilos (14.3 pounds) more, but one ballooned by 12 kilos (26.4 pounds).
Nystrom got the idea for his study from the 2004 Oscar-nominated documentary "Supersize Me," in which filmmaker Morgan Spurlock asked doctors to monitor him over a 30-day period in which he ate at McDonalds morning, noon and night.
Doctors were so alarmed by changes in his blood chemistry -- including skyrocketing levels of ALT -- that they begged him to halt his experiment.
"I wasn't just inspired by the movie, I copied it to the best of my ability," said Nystrom.
The movie helped spur a change of tack by fast-food corporations to include healthier options on their menus.
On their websites, McDonald's and Burger King highlight salads and low-fat products -- alongside the classic burgers and colas -- and offer guidance on balanced diets and a healthy lifestyle.
Tuesday, February 5, 2008
Key vitamin deficiency linked to tripled risk of dementia: study
PARIS (AFP) - Lack of folate, also called vitamin B-9, may triple the risk of developing dementia in old age, according to a study published Tuesday.
Researchers in South Korea measured naturally occurring folate levels in 518 elderly persons, none of whom showed any signs of dementia, and then tracked their development over 2.4 years.
At the end of the period, 45 of the patients had developed dementia, including 34 diagnosed with Alzheimer's disease, said the study, published by the British Medical Association's Journal of Neurology, Neurosurgery and Psychiatry.
When the researchers, led by Jin-Sang Yoon of Chonnam National University in Kwangju, South Korea, remeasured folate levels, they uncovered a strong link with the dementia.
Even after other factors were taken into account -- including age, disability, alcohol consumption, weight change -- "the onset of dementia was significantly associated with an exaggerated decline in folate," the researchers concluded.
Folate and folic acid, another form of the compound, are essential for the creation of new cells in the body.
The compound occurs naturally in leafy vegetables such as spinach, turnip greens, lettuces, dried beans and peas and in certain fruits.
An study published last year in The Lancet showed an improvement in short-term memory, mental agility and verbal fluency among persons over 50 who took a daily dose of 800 micrograms (mcg) of folic acid. The US recommended daily dose is 400 mcg.
Taking folic acid before conception and throughout the first trimester helps a mother ensure that her child will not develop certain brain and spinal cord defects, including spina bifida, according to previous research.
Researchers in South Korea measured naturally occurring folate levels in 518 elderly persons, none of whom showed any signs of dementia, and then tracked their development over 2.4 years.
At the end of the period, 45 of the patients had developed dementia, including 34 diagnosed with Alzheimer's disease, said the study, published by the British Medical Association's Journal of Neurology, Neurosurgery and Psychiatry.
When the researchers, led by Jin-Sang Yoon of Chonnam National University in Kwangju, South Korea, remeasured folate levels, they uncovered a strong link with the dementia.
Even after other factors were taken into account -- including age, disability, alcohol consumption, weight change -- "the onset of dementia was significantly associated with an exaggerated decline in folate," the researchers concluded.
Folate and folic acid, another form of the compound, are essential for the creation of new cells in the body.
The compound occurs naturally in leafy vegetables such as spinach, turnip greens, lettuces, dried beans and peas and in certain fruits.
An study published last year in The Lancet showed an improvement in short-term memory, mental agility and verbal fluency among persons over 50 who took a daily dose of 800 micrograms (mcg) of folic acid. The US recommended daily dose is 400 mcg.
Taking folic acid before conception and throughout the first trimester helps a mother ensure that her child will not develop certain brain and spinal cord defects, including spina bifida, according to previous research.
Sunday, February 3, 2008
Dogs Could Be a Diabetic's Best Friend
SUNDAY, Feb. 3 (HealthDay News) -- Irish researchers hope to prove that a dog's keen sense of smell gives it the ability to watch over the blood sugar levels of diabetics.
Canines have already shown themselves capable of leading the blind, alerting the deaf, and helping the physically disabled with daily tasks.
But researchers at Queen's University in Belfast, Northern Ireland, are taking the "helpful companion" idea one step further by gathering scientific evidence that could verify dogs can reliably detect dangerous blood sugar level drops in diabetics.
"Anecdotal reports suggest that some dogs can perform early warning of hypoglycemia by using their sense of smell to 'sniff out' if their owner's blood sugar levels are dropping," said lead researcher and psychology professor Deborah Wells.
More than 20 million U.S. children and adults have diabetes, according to the American Diabetes Association. Those with the disease do not produce enough insulin, a hormone the body needs to convert sugars, starches and other food into energy.
Diabetics must test their blood glucose level regularly, even sometimes in the middle of the night to avoid the peaks and valleys that can cause organ failure, say experts.
Wells hopes to find out what cues dogs pick up on so they can officially be recognized and trained as early-warning systems for diabetics.
At least two organizations in the United States already train dogs to detect low glucose levels. But exactly what the canines notice when a person experiences a blood sugar low is still a mystery, said Mark Ruefenacht, founder of Dogs for Diabetics, in Concord, Calif.
The organization is working with a forensic laboratory to identify a possible odor.
"We just haven't come up with the right answers," he said. "Every time we think we have the answer, we find that we don't."
Ruefenacht, a diabetic, started the organization three years ago, inspired after a puppy he was raising for Guide Dogs for the Blind woke him one night. Ruefenacht forgot to check his blood sugar before going to sleep, and he thinks he had a seizure that alarmed the pup.
Since then, the all-volunteer group has placed 30 trained canines in the homes of Northern California residents with type 1 diabetes.
Demand for the dogs is high; more than 100 people are on the waiting list.
Dogs for Diabetics uses Labrador retrievers that don't graduate from guide dog school. These dogs usually flunk for reasons such as refusing to walk in the rain or step onto an escalator -- all skills important for being a working dog, but not a general assistance one.
Ruefenacht said his dogs undergo three to four months of training similar to what is used to prepare dog to detect narcotics or explosives. The 2-year-old canines are first taught to detect scent samples of low blood sugar. Then they learn to find that scent on people, and alert others by holding in their mouth a soft tube that hangs from around their neck.
Dogs that successfully complete training are 90 percent accurate, Ruefenacht said.
These clever canines aren't the only ones that must learn new tricks.
Mary Simon has battled diabetes for more than three decades, and she now drives four hours each week from her home in Fresno to attend the required class.
"I need this dog desperately," said Simon, a diabetic who is also medical director for the Diabetic Youth Foundation in Concord, Calif.
Medication she takes hampers her ability to feel nighttime lows, she said, and the special glucose sensor she wears doesn't always work.
When Simon first learned of the hypoglycemic detection dogs a few years ago, she didn't think their talent was needed because glucose sensors were about to hit the market. Since then, she's changed her mind.
"My own personal experience is we need [the dogs] right now," she said.
Not everyone is so quick to put their trust in the canines' ability.
Larry Myers, a veterinarian and professor at Auburn University in Alabama, has trained dogs to detect everything from drugs to agricultural pests for 25 years. He said the jury is still out on whether dogs can truly detect low blood sugar levels, but he believes it's a possibility worth exploring.
Even though dogs have amazing olfactory abilities, he said they are not universally sensitive to all chemicals.
"Do hypoglycemic individuals, in fact, emit an odor that is characteristic? I don't know, and I don't think anybody does know right now," he said.
A possibility other than scent is the dogs are picking up on visual cues, which is thought to be the case with seizure detection dogs. Such dogs allegedly can pick up on extremely subtle physiological changes in their human companion that may begin five to 45 minutes before an actual attack. The dogs then warn the humans so they can find a safe environment or take precautionary measures.
"It turns out what the dogs are really sensitive to is subtle changes in behavior of the individuals just prior to seizing," Myers said. "It's more of a fact that dogs are very, very, very observant of human behavior."
More information
To learn more about diabetes, visit the American Diabetes Association.
Canines have already shown themselves capable of leading the blind, alerting the deaf, and helping the physically disabled with daily tasks.
But researchers at Queen's University in Belfast, Northern Ireland, are taking the "helpful companion" idea one step further by gathering scientific evidence that could verify dogs can reliably detect dangerous blood sugar level drops in diabetics.
"Anecdotal reports suggest that some dogs can perform early warning of hypoglycemia by using their sense of smell to 'sniff out' if their owner's blood sugar levels are dropping," said lead researcher and psychology professor Deborah Wells.
More than 20 million U.S. children and adults have diabetes, according to the American Diabetes Association. Those with the disease do not produce enough insulin, a hormone the body needs to convert sugars, starches and other food into energy.
Diabetics must test their blood glucose level regularly, even sometimes in the middle of the night to avoid the peaks and valleys that can cause organ failure, say experts.
Wells hopes to find out what cues dogs pick up on so they can officially be recognized and trained as early-warning systems for diabetics.
At least two organizations in the United States already train dogs to detect low glucose levels. But exactly what the canines notice when a person experiences a blood sugar low is still a mystery, said Mark Ruefenacht, founder of Dogs for Diabetics, in Concord, Calif.
The organization is working with a forensic laboratory to identify a possible odor.
"We just haven't come up with the right answers," he said. "Every time we think we have the answer, we find that we don't."
Ruefenacht, a diabetic, started the organization three years ago, inspired after a puppy he was raising for Guide Dogs for the Blind woke him one night. Ruefenacht forgot to check his blood sugar before going to sleep, and he thinks he had a seizure that alarmed the pup.
Since then, the all-volunteer group has placed 30 trained canines in the homes of Northern California residents with type 1 diabetes.
Demand for the dogs is high; more than 100 people are on the waiting list.
Dogs for Diabetics uses Labrador retrievers that don't graduate from guide dog school. These dogs usually flunk for reasons such as refusing to walk in the rain or step onto an escalator -- all skills important for being a working dog, but not a general assistance one.
Ruefenacht said his dogs undergo three to four months of training similar to what is used to prepare dog to detect narcotics or explosives. The 2-year-old canines are first taught to detect scent samples of low blood sugar. Then they learn to find that scent on people, and alert others by holding in their mouth a soft tube that hangs from around their neck.
Dogs that successfully complete training are 90 percent accurate, Ruefenacht said.
These clever canines aren't the only ones that must learn new tricks.
Mary Simon has battled diabetes for more than three decades, and she now drives four hours each week from her home in Fresno to attend the required class.
"I need this dog desperately," said Simon, a diabetic who is also medical director for the Diabetic Youth Foundation in Concord, Calif.
Medication she takes hampers her ability to feel nighttime lows, she said, and the special glucose sensor she wears doesn't always work.
When Simon first learned of the hypoglycemic detection dogs a few years ago, she didn't think their talent was needed because glucose sensors were about to hit the market. Since then, she's changed her mind.
"My own personal experience is we need [the dogs] right now," she said.
Not everyone is so quick to put their trust in the canines' ability.
Larry Myers, a veterinarian and professor at Auburn University in Alabama, has trained dogs to detect everything from drugs to agricultural pests for 25 years. He said the jury is still out on whether dogs can truly detect low blood sugar levels, but he believes it's a possibility worth exploring.
Even though dogs have amazing olfactory abilities, he said they are not universally sensitive to all chemicals.
"Do hypoglycemic individuals, in fact, emit an odor that is characteristic? I don't know, and I don't think anybody does know right now," he said.
A possibility other than scent is the dogs are picking up on visual cues, which is thought to be the case with seizure detection dogs. Such dogs allegedly can pick up on extremely subtle physiological changes in their human companion that may begin five to 45 minutes before an actual attack. The dogs then warn the humans so they can find a safe environment or take precautionary measures.
"It turns out what the dogs are really sensitive to is subtle changes in behavior of the individuals just prior to seizing," Myers said. "It's more of a fact that dogs are very, very, very observant of human behavior."
More information
To learn more about diabetes, visit the American Diabetes Association.
Friday, February 1, 2008
Beware the bowl: Double dipping spreads bacteria
COLUMBIA, South Carolina (AP) -- Keep an eye on the salsa this Super Bowl Sunday: A researcher inspired by a famous "Seinfeld" episode has concluded that double dipping is just plain gross.
Double dipping "is like putting your whole mouth right in the dip," a Clemson University researcher says.
"That's like putting your whole mouth right in the dip!" George Costanza was admonished on the show after he dipped a chip twice at a wake. That's not too far off, said Clemson University professor Paul L. Dawson.
Last year the food microbiologist's undergraduate students examined the effects of double dipping using volunteers, wheat crackers and several sample dips. They found that three to six double dips transferred about 10,000 bacteria from an eater's mouth to the remaining dip sample.
"I was very surprised by the results," Dawson said in a telephone interview Thursday. "I thought there would be very minimal transfer. I didn't think we would be able to detect it."
Don't Miss
Big game may be hazardous to your heart
The professor said the students' research didn't get into the risk behind such a bacteria transfer, but they got the idea.
"I like to say it's like kissing everybody at the party -- if you're double dipping, you're putting some of your bacteria in that dip," Dawson said.
The results of the research are scheduled to be published in the journal Food Safety within the next six months, he said. E-mail to a friend
Double dipping "is like putting your whole mouth right in the dip," a Clemson University researcher says.
"That's like putting your whole mouth right in the dip!" George Costanza was admonished on the show after he dipped a chip twice at a wake. That's not too far off, said Clemson University professor Paul L. Dawson.
Last year the food microbiologist's undergraduate students examined the effects of double dipping using volunteers, wheat crackers and several sample dips. They found that three to six double dips transferred about 10,000 bacteria from an eater's mouth to the remaining dip sample.
"I was very surprised by the results," Dawson said in a telephone interview Thursday. "I thought there would be very minimal transfer. I didn't think we would be able to detect it."
Don't Miss
Big game may be hazardous to your heart
The professor said the students' research didn't get into the risk behind such a bacteria transfer, but they got the idea.
"I like to say it's like kissing everybody at the party -- if you're double dipping, you're putting some of your bacteria in that dip," Dawson said.
The results of the research are scheduled to be published in the journal Food Safety within the next six months, he said. E-mail to a friend
Subscribe to:
Posts (Atom)