BOSTON - A new approach could identify autism in babies as young as one month of age.
Early detection ensures that both the children and their families get behavioral support services that can Excellerate outcomes.
Duke University researchers studied the medical records of more than 45,000 children and identified patterns in health care that could predict as early as the first month of life which children would later be diagnosed with autism.
For example, these infants were more likely to have seen an ophthalmologist or a neurologist, have GI problems or receive physical therapy compared to neurotypical children. Using this algorithm, they found that almost half of children with autism could be identified at 30 days of life.
They say their findings will need to be confirmed but could allow pediatricians and parents to recognize red flags in the youngest of babies and begin therapy promptly.
A new study by Western Sydney University researchers has found that a short 15–20 minute discussion between a local endocrinologist and general practitioner (GP) in Sydney's south west is improving the care of people with complex type 2 diabetes.
Published in the International Journal of Integrated Care, the three-year study is the first evaluation of "patient-free" diabetes case conferencing—a model where, with the patient's consent, an endocrinologist visits a GP practice, alongside a practice nurse or diabetes educator, to collaborate on the care of patients to develop a joint management plan for the patient.
The study found blood glucose (HbA1c), blood pressure, weight, as well as other cardiovascular risk factors all improved following the three-year trial involving more than 600 patients with type 2 diabetes from 40 general practices across south western Sydney.
Blood glucose results substantially improved between 2017 and 2020, with more than a third (37%) of patients within the target range compared with just one in five (20%) before the program.
In addition, more than three quarters (77%) of patients were recording systolic blood pressure within the target range on follow-up, compared with less than half of patients (47%) in 2017.
Co-author Professor David Simmons, Head of Endocrinology at Campbelltown Hospital and from the University's School of Medicine said the study found the model made a significant contribution to diabetes management in primary care settings.
"Diabetes is a significant health issue in south western Sydney and it is critical we work together to find more effective, integrated and streamlined ways to manage patients and Excellerate outcomes," said Professor Simmons.
"The findings from this study show how a collaborative discussion between a GP and endocrinologist where the patient is not present, can be one of the most effective integrated diabetes care interventions.
"This can allow the GP to continue to care for the patient in the practice, avoiding the need to see an endocrinologist in person. The collaboration also helps build the GP's expertise in managing their other complex patients and the endocrinologist learns more about the patient from the GP which facilitates truly patient-centered care."
The findings add to the evidence suggesting that case conferencing programs can help close the gaps in service provision such as barriers between different settings, Excellerate the patient experience by accommodating more complex cases in primary care and reduce duplication of care.
Co-author Ms. Reetu Zarora, a Ph.D. student at Western Sydney University, highlighted how the model of care doesn't just save time and resources in primary care settings but also has a positive impact more broadly on the health system.
"This is a real win-win-win for patients, GPs and the health system: patients get specialist input into their care without any extra time or cost, GPs can continue to manage their patients using their extra knowledge, and the health system has less demand on hospital clinics, potentially reducing and preventing hospitalizations in people with complex diabetes compared with usual care. This should reduce diabetes-related health issues," said Ms. Zarora.
"In addition, the case conferencing model through the study was shown to be suitable in both urban and rural settings where a number of participating practices support large multi-ethnic populations with varying socioeconomic status.
"This points to the potential for broader applications of the model of care including in regions with resource restraints and diverse populations."
More information: Reetu Zarora et al, Effectiveness of Diabetes Case Conferencing Program on Diabetes Management, International Journal of Integrated Care (2023). DOI: 10.5334/ijic.6545
Citation: New approach to diabetes management helps Excellerate patient outcomes (2023, February 17) retrieved 19 February 2023 from https://medicalxpress.com/news/2023-02-approach-diabetes-patient-outcomes.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
(WNDU) - Coronary bypass surgery is the most common heart surgery in the United States, with over 200,000 procedures performed every year.
The surgery itself improved blood flow to the heart by bypassing arteries clogged with plaque.
Now, surgeons are performing this procedure in a specialized way, and for many patients, that means the heart keeps beating during the entire procedure.
For New York artist Yvelisse Boucher, putting brush to paper last year was cathartic and very personal. Boucher began painting safari-themed pictures after hearing wonderful news from her son and his fiancee.
“They were expecting a baby,” Boucher recalled.
It also compelled the 61 year old to make a life-altering decision.
“I have some work to do,” Boucher said. “I gotta be able to run around and chase this little guy.”
Boucher was facing some serious health issues, she had type two diabetes, a previously undetected stroke left her weak on one side, she had heart disease, and learned she needed a triple bypass.
“I was terrified,” Boucher said. “I was truly, truly terrified.”
Cardiac expert John Puskas recommended a highly-specialized surgery using arteries instead of veins and unlike other bypass procedures, surgeons didn’t stop the heart.
“So, the no-aortic touch all arterial bypass operation does not use the heart-lung machine at all,” said Dr. John Puskas, MD, a cardiovascular surgeon at Mount Sinai Morningside. “Instead of attaching arteries of veins to the aorta, we actually leave them with their own normal.”
Dr. Puskas removed an artery from Boucher’s wrist to perform the bypass. Surgeons also surgically repositioned two internal arteries to Excellerate blood flow. Dr. Puskas says the arterial graft and off-pump surgery leads to shorter recovery, and better outcomes.
Boucher says she kept thinking about meeting her grandson, which kept her going during recovery.
Finally, the moment Boucher had been waiting for arrived.
“I did a little peek-a-boo thing with him and he gave me my first smile and my heart just burst,” Boucher joked.
Just a figure of speech, Boucher is recovering well, spending time with little Ezra, and feeling better than ever.
Studies show there is a 2% stroke risk during traditional bypass surgery. With the arterial graft no-touch technique, surgeons reduce the stroke risk to one-quarter of 1%.
Copyright 2023 WNDU. All rights reserved.
Feb. 17—Dr. Daniel J. D'Arco, who has been providing orthopedic care in Schuylkill County for over 25 years, has relocated to the Simon Kramer Cancer Institute, New Philadelphia.
D'Arco has served on medical boards of various regional hospitals, including as chief of orthopedics, chairman of the department of orthopedics and director of the Orthopedic Institute at the former Pottsville Hospital and at the Good Samaritan hospital.
He graduated as chief resident of orthopedics at Penn State Hershey Medical Center in 1995.
D'Arco is board-certified in orthopedic medicine and surgery and highlights his "conservative and integrative care to area patients who do not require surgery or wish to avoid it, with a kind approach often difficult to find in this underserved region."
Despite his relocation from Pottsville to the institute, where there is ample free parking, D'Arco said he will continue "to diagnose and Excellerate the physical well-being of people with chronic conditions or other injuries."
He treats back and neck problems; knee, hip, shoulder and hand conditions; and sprains, fractures, carpal tunnel and more.
"Sometimes patients miss opportunities to extend non-operative care as well as missed overlapping syndromes such as spinal maladies often neglected in the modern arena of high volume/short appointments," D'Arco said.
He cites "gentle injections, expert opinions and proven bracing applications" in helping to restore lifestyle goals.
"For instance, back and knee braces are important tools for qualified patients with knee instability often associated with advancing osteoarthritis or chronic low back pain, when fit properly," D'Arco said. "However, they can be less effective and even trigger negative consequences when simply handed out based on 'diagnostic codes' or when improperly applied."
While it is true that orthopedic surgery can make a positive impact when broken bones need repair or if reconstruction is required, D'Arco said, "it is often best reserved as a last resort; many people benefit from alternatives to these aggressive interventions."
D'Arco's office can be reached at 570-628-6858 or www.PaMBJ.com.
Pediatric patients with limited English proficiency (LEP) may face additional challenges when they present to an emergency room. However, researchers from Children's Hospital of Philadelphia (CHOP) found that a multidisciplinary approach helped implement the services of interpreters earlier and significantly improved the identification of these patients to help them receive the care they need. The findings were published online by the journal Pediatrics.
Patients with LEP face a number of challenges, including an increased risk of adverse events due to potential medication error, as well prolonged or repeat visits to the emergency department. When treating children, the language needs of both the patient and the caregiver must be met, adding further challenges to delivering the best care possible.
Medical interpreters are vital to making sure patients with LEP receive proper treatment; however, many caregivers are unaware that this service is available to them. A review found only about 2.5% of patient encounters in the emergency department utilized an interpreter, but census data suggests that in CHOP's region, roughly 10% of patients have at least one parent with LEP.
The data we had prior to this study suggested there was underrecognition of the language needs in our emergency department. We wanted to Excellerate early identification of patients and caregivers who could benefit from an interpreter and make sure those services were properly tracked in health records so we could continue to meet their language needs."
Katherine M. Gupta, MD, first study author, attending physician in the emergency department at CHOP
The research team identified areas that could help Excellerate the emergency department workflow for patients with LEP and introduced a series of interventions to increase the identification of language needs and offer interpreters as needed. These processes included a screening question during nursing triage, an icon on the emergency department track board that helps communicate language needs to the emergency department staff and alerts for electronic health records.
After implementing these measures for six months, the team observed several noticeable improvements in identifying language needs in the emergency department. Identification rates for patients with LEP during the nursing triage increased from 60% to 77%, interpreter utilization increased from 77% to 86%, and proper documentation of interpreter use increased from 38% to 73%.
"By implementing the methods used in this study, we have an opportunity to obtain more reliable metrics on patients with LEP and investigate the true extent of language-based disparities in care," said senior study author Joseph Zorc, MD, an attending physician in the Emergency Department and Director of Emergency Information Systems at CHOP. "Our staff has become keenly aware of the language needs during emergency department visits and there is growing interest in addressing LEP issues and investigating the feasibility of dedicated in-person interpreters specifically assigned to emergency department cases."
Gupta, K.M., et al. (2023) Improving Identification of Interpreter Need in the Pediatric Emergency Department. Pediatrics. doi.org/10.1542/peds.2022-057330.
ST. LOUIS – SSM Health Saint Louis University Hospital offers a team approach to care for patients diagnosed with amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease.
ALS is a progressive neuromuscular disease that attacks nerve cells, the brain, and the spinal cord. While it does not usually affect a person’s mind or senses, it does affect their ability to use muscles, restricting movement of the limbs and body, including the muscles required for swallowing and breathing.
SLU Hospital offers the only ALS Association-certified clinic in St. Louis. This multi-disciplinary clinic brings together the total team of physician specialists and nurses to coordinate multiple services to treat patients with ALS, while also conducting research and clinical trials in an effort to find a cure.
“These clinics should be an essential part of the ALS patient’s care because studies have shown (that patients in) multidisciplinary clinics lived longer,” said Dr. Ghazala Hayat, a SLUCare neurologist and director of the ALS Center at SSM Health Saint Louis University Hospital.
Hayat notes that the reason a multidisciplinary clinic extends the life of the patient is because of the coordinated care. There is no cure for ALS, but there is a team of specialists who can support and treat the patient.
“Now, we have three medications which are FDA approved for patients who have ALS,” Hayat said
The ALS clinic brings together all the medical experts and specialists to address a patient’s needs in a coordinated effort. It reduces the number of appointments for the patient and creates a more efficient way to treat the individual’s needs, inclusive of respiratory, neurology, pulmonology, psychology, physical therapy, and more.
“Some patients have a slow progression. about three to five years is the survival. So multidisciplinary care actually adds to their, they say improved survival and also their quality of life.,” Ghazala said. “At the end of the day, all of the specialists have sat around the table to supply the best care. The patients are always very happy and satisfied.”
Following the visit, the patient has complete recommendations on treatment and is in continuous communication with the ALS nurse or coordinator regarding their needs.
To learn more about the ALS Clinic, click here.
The SSM Health Medical Minute airs Wednesdays on News 11 at 7 p.m. and FOX 2 News at 9 p.m.
By Michael Hutchins, Herald Democrat
Wilson N. Jones Regional Medical Center will soon offer a more natural approach to birth and delivery from within the hospital environment. The hospital will begin offering certified nurse midwife services to expectant mother and their families starting in March in addition to its OBGYN care.
For centuries, midwives have played an important role in the birthing process and have assisted countless mothers while they are giving birth. WNJ Director of Women’s Services Jamie Rankin said the term midwife can have many meanings ranging from lay midwives in the community who follow traditional practices to the certified nurse midwives that bring a background and experience with medical care to the practice.
“Midwives have been around forever, but a certified nurse midwife is actually a registered nurse that gone through advanced practice and they are able to deliver babies,” Rankin said.
The move by WNJ comes as a part of an expansion of its delivery and labor department. Through the new service, officials said the hospital hopes to offer the options of a more natural labor and delivery while still maintaining the care that comes with a hospital environment.
“A certified nurse midwife is a registered nurse who has gone through advanced practice and is able to take care of women during their entire pregnancy,” Rankin said. “They’re able to deliver them and they are also able to provide gynecologic services, well women exams and things like that.”
“Traditional care for a pregnant patient is the see an OBGYN throughout their pregnancy and then they’re delivered by an OBGYN. We are kind of transitioning to supply the midwife option and so we have hired a certified nurse midwife, and her name is Kim Parks,” Rankin continued.
Parks brings with her more than 30 years of profession experience including tenures at Parkland Memorial Hospital and Hunt Regional Medical Center. In 2009, Parks received her masters degree and has been working as a certified nurse midwife since then. In her career, Parks has attended more than 2,000 births and has assisted in more than 300 cesarean sections.
Parks has been with the hospital for about three months and has been going through orientation with Dr. Anthony Abrantes, who serves as an OBGYN at the hospital. With the addition of Parks, Rankin said Abrantes will be able to focus on the specialized cases and deliveries.
“He will be able to see the more sick patients, the ones with different issues like hypertension in pregnancy, diabetes in pregnancy and multiple gestations … and she will be able to take care of the more routine and normal pregnancies,” Rankin said, adding the a CNM can also handle these deliveries.
While the hospital is expected to begin these services next month, several of the rooms on the third floor have been set up for the new programs. The department, which maintains level II maternal and level I nursery designations, will include four labor/delivery/recovery and post-partum suites, six dedicated post-partum suites and a 15 bed well baby nursery, among other women’s services.
The rooms a large, with wooden floor and accents aimed at bringing out a more home-style feel and atmosphere. Each of the suites comes equipped with a queen-sized Murphy bed that folds into the wall.
“Once they deliver, we help mom get up and shower, clean up, and while we’re doing that, we clean the room and kind of get all of the medical things out and we pull down our murphy bed and then we have a queen-size bed here in the room,” Rankin said. “It’s a very home-like environment, and we try to make it feel less like a hospital and more like home.”
The move to include CNM services comes amid a shift and higher demand for midwife services in exact years as expectant mothers look for alternatives to traditional healthcare when it comes to labor and delivery.
“Traditional healthcare has gotten to where women are in a labor bed. They are hooked up to monitors and they don’t really get out and move around and things anymore,” Rankin said. “We’re kind of stepping back and saying to women, you have options and that if you want to get up and move, you can and we’re still going to monitor you as we need to. If everything is looking good with your baby, we can do lower intervention and that’s really the benefit of it.”
The comes as the country is experiencing a shortage of OBGYNs and healthcare providers are looking for alternative care options.
“It really allows for these advanced practice registered nurses to come in and help fill in the gap, They have all of the specialized training that they need to do that, and so they work in collaboration with the OBGYN to provide care to those patients,” Rankin said. “The women are still getting the same high quality care, it is just more accessible and they have more time to individualize the care to the patient’s preferences.”
Current plans call for the department to be expanded over time to include four CNMs and four OBGYNs. The hospital has already hired its second CNM, who is working as a registered nurse in the department at this time.
In conjunction with the expansion of the department, WNJ is running a living legacies contest and is searching for the oldest person who was delivered at the hospital. For some families, WNJ is where multiple generations took their firth breaths a nd the hospital is looking to tell those stories, Rankin said.
“This is a great legacy in the community, and so what we are wanting to do is see who is the oldest person alive that was delivered here, because its just so great to see and hear their stories. That’s what we really want to do,” she said.
The protein STAT5 has long been an appealing target against cancer, but after decades of research it was consigned to the "undruggable" category. Now, University of Michigan Rogel Cancer Center researchers have found success with a new approach.
By tapping into a cellular garbage disposal function, researchers found they could eliminate STAT5 from cell cultures and mice, setting the stage for potential development as a cancer treatment.
STAT5 plays a key role in how some blood cancers develop and progress. But efforts to identify a small molecule inhibitor to block STAT5 have been stymied. Previous research efforts have found it challenging to design a drug to bind to STAT5 with a high-affinity, a measure of how well they fit together. Even when a compound was found to bind with the protein, it may not make its way into cell and tissue. It's also difficult to find a compound that inhibits STAT5 only without affecting any of the other STAT proteins.
Shaomeng Wang, Ph.D., Warner-Lambert/Parke-Davis Professor in Medicine and professor of medicine, pharmacology and medicinal chemistry at the University of Michigan, had another idea.
His lab has been working on a new drug development approach targeting protein degradation. This is a naturally occurring function within cells to get rid of unwanted protein. Think of it as the garbage disposal: When a protein is no longer needed to keep a body healthy, this mechanism removes the unwanted or damaged protein from the cell.
Using this approach, Wang's lab identified a protein degrader, AK-2292, that targets and removes STAT5. The compound was highly specific to STAT5 with no effect on other STAT proteins. It was effectively taken up by both cell lines and mouse models and was found to stop cell growth in cell lines of human chronic myeloid leukemia (CML) and to induce tumor regression in mouse models of CML. Results are published in Nature Chemical Biology.
The protein degrader works by eliminating STAT5 proteins from tumor cells and tissues, unlike a small molecule inhibitor that would traditionally be designed to bind with the protein and interfere with its function.
"We've overcome some of the major issues that were barriers for scientists to target STAT5," Wang said. "People have worked in this field for the last 20 years, and there are no small molecules targeting STAT5 going into clinical development. This study shows us STAT5 can be targeted through a protein degradation approach. It's a new, exciting direction for developing a potential drug molecule targeting STAT5 for the treatment of cancers in which this protein plays a major role."
"This compound gives us a very solid foundation to do further optimization to identify a compound that we eventually can advance into clinical development," Wang added.
Wang's lab has been investigating protein degraders for several years and has a number of degraders in advanced preclinical development studies, which they hope will lead to clinical trials for the treatment of cancer in people.
More information: Atsunori Kaneshige et al, A selective small-molecule STAT5 PROTAC degrader capable of achieving tumor regression in vivo, Nature Chemical Biology (2023). DOI: 10.1038/s41589-022-01248-4
Citation: Researchers use a new approach to hit an 'undruggable' target (2023, February 15) retrieved 19 February 2023 from https://medicalxpress.com/news/2023-02-approach-undruggable.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
New Haven, Conn. (WTNH) – High cholesterol, high blood pressure, and heart disease are all serious medical conditions that often result in one common symptom, Erectile Dysfunction.
In this Health Update segment, our guest talks about an issue many men face. It can be a sensitive topic, but there are certainly solutions out there.
CT Style Host Natasha Lubczenko spokewith Katie Harward from Hidden Creek Medical Clinic, who discussed their solution to treating E.D., and the risky conditions that may be the source of the problem.
Katie said, “When you deal with these complications, you have plaque buildup and the narrowing of blood vessels. So over time, the blood vessels just kind of shrivel up. And then when you have these diseases, it kind of comes closer to narrowing faster.”
“What we do at Hidden Creek Medical Clinic, is that we have a breakthrough treatment called Acoustic Wave Therapy. It’s no pain, no injections, and no downtime. But what it does, is it re-opens those blood vessels for you. So, we are treating the root cause of the E.D.”
After an assessment and exam from a doctor, you undergo a series of these non-invasive treatments, which may help repair existing blood vessels to treat E.D. at the root of the cause.
Watch this interview to learn more about this innovative procedure, as Katie answers the following questions:
Hidden Creek Medical Center is offering a special promotion for our CT Style viewers. Call today to get a free assessment, free exam and a free blood flow ultrasound. They also have a special gift for you and your significant other! A $650 value FREE.
Call (959)221-7000 Visit: https://www.hiddencreekmedicalclinic.com/