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Killexams : Medical Specialist study - BingNews https://killexams.com/pass4sure/exam-detail/FNS Search results Killexams : Medical Specialist study - BingNews https://killexams.com/pass4sure/exam-detail/FNS https://killexams.com/exam_list/Medical Killexams : Half the World Has a Clitoris. Why Don’t Doctors Study It? No result found, try new keyword!The organ is “completely ignored by pretty much everyone,” medical experts say, and that omission can be devastating to women’s sexual health. Mon, 17 Oct 2022 00:49:00 -0500 text/html https://www.nytimes.com/2022/10/17/health/clitoris-sex-doctors-surgery.html Killexams : How to Become a Fertility Specialist No result found, try new keyword!Below is an education guide for anyone who plans to become a fertility specialist doctor. An aspiring reproductive medicine physician needs to obtain bachelor's and medical degrees. There are two ... Thu, 13 Oct 2022 06:52:00 -0500 text/html https://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/how-to-become-a-fertility-specialist Killexams : The hardest word: Study finds doctors, families avoid saying 'death'

ROCHESTER, Minn. — A new study has found that conversations between families and physicians who treat critically ill infants avoided direct language in 92% of all references to death and dying, but that the two parties did so through different linguistic evasions.

The study, conducted by Duke University researchers between September 2018 and 2020, analyzed 68 recorded conversations between physicians and 24 participating families of infants hospitalized for neurologic conditions in an intensive care unit.

It was published in the journal JAMA Network Open.

"This study was really inspired by a recognition that it can be hard to talk clearly and directly about challenging, high-stakes topics," said Dr. Monica Lemmon, an associate professor of pediatrics and population health sciences at Duke and lead author of the paper. "We aimed primarily to characterize the way death is discussed."

While it is commonplace to use softer language for death and dying in day-to-day conversations, in order to minimize confusion, consensus guidelines within medicine the paper noted "emphasize the importance of clear communication, including avoiding euphemism use."

In the new study, researchers found 33 out of 68, or 45% of all family meetings, involved a discussion of death. There were 406 recorded references to death within those meetings — 275 made by clinicians, and 131 made by family members. Of those, the words "die," "death," "dying" and "stillborn" were used just 15% of the time by family members, and 5% of the time by physicians.

"What was most striking was the direct use of the words themselves ... were used quite rarely," Lemmon said. She said that "families often used colloquialisms or common phrases to reference death," while "clinicians instead most often used medical jargon, which may be less clear to people who aren't medically trained."

Physicians used medical jargon 43% of the time when discussing death during the study, which included as examples terms for death such as "event," "code," "episode," "arrest," or "irretrievable drop" in heart rate.

Families preferred colloquialisms 34% of the time, the paper found. These included phrases such as "pass away," and "not make it." The paper identified two other forms of euphemisms: expressions referring to survival — like "don't live," or "not survive" — and the use of pronouns in place of death, such as "it," "this," "that" or "something."

In an accompanying commentary, a trio of pediatricians from the University of Minnesota Medical School placed the findings within a larger problem described as "jargon oblivion" in medicine. For lead author Dr. Michael Pitt, the new study provides physicians with a framework to better understand what that looks like in practice.

"I think what this study adds is real proof to what we expected," he said. "Which is that we tend to avoid these difficult words — death, dying — at the bedside during important conversations with families. They elegantly quantified that in a study where they recorded and transcribed these transcripts, and showed that providers rarely used these terms."

The harm, Pitt says, is that families may need to hear the word death to understand that death is what is being discussed.

"They hear 'we did everything we could' (and) they might want to reply, 'OK, get somebody else to do something, then.'"

Pitt recalls that when his father recently died, "the nurse called my mom and said, 'He's no longer with us,'" he said.

"She initially thought that meant that he'd been transferred, or gotten lost ... you're having the most serious conversation of a family's life, yet they may not understand what you're saying unless you use clearer language."

Dr. Brenda Schiltz is a pediatric critical care specialist at Mayo Clinic who has had numerous conversations with families in which she was required to discuss the real or possible death of a child. "I think it's a good paper," she says of the Duke study.

"It wasn't surprising at all, to be honest," she adds. "We teach trainees all the time about when we're breaking bad news ... to be very concrete, to use the word 'death.' But even when do all those teachings, it's a hard thing to tell somebody. It's a very hard thing to tell somebody."

Schiltz says that while clear communication about death is critical, it often is a shift in thinking for physicians.

"Not only is it hard," she said, "as a physician and everybody that's on the medical team, we're trying to save these babies. No one wants to feel as if we lost that battle. We're always fighting. We're always trying to keep hope alive, and try one more thing ... It's tough to admit when, despite our best efforts, we can't save somebody."

The study did not look at whether the families studied preferred direct language about death, Lemmon notes, or whether the euphemisms identified produced any confusion in the conversations.

"Some euphemisms might be quite clear to all the parties involved," she said. "Especially when they're used by a family member and mutually understood by the clinical team. That said, it's important there's a shared understanding of what we're all talking about, and for this particular study, the outcome of death is something critically important for everyone to be on the same page around."

October 14, 2022 10:58 AM

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Fri, 14 Oct 2022 22:00:00 -0500 en text/html https://www.grandforksherald.com/newsmd/death-doctors-and-families-both-avoid-using-clear-language-about-it
Killexams : Multi-center study sheds light on understudied breast cancer type

A multi-center analysis of patients with invasive lobular carcinoma, or ILC—the second most common histological subtype of invasive breast cancer in the U.S.—showed that, despite its prevalence, ILC is detected later and has worse outcomes than the predominant subtype of invasive breast cancer, known as invasive ductal carcinoma (IDC), or no special type.

Published today in the Journal of the National Cancer Institute, the study of more than 33,000 from three large centers—UPMC Hillman Cancer Center, Cleveland Clinic Cancer Center and The Ohio State University Comprehensive Cancer Center—Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC—James)—shows that ILC and IDC are biologically distinct, highlighting important differences between the two diseases and the need for specific detection and treatment options for the lobular subtype.

"Lobular cancer makes up about 10% to 15% of breast cancer cases, but it has historically been neglected by the , so we really don't know that much about it," said co-lead author Steffi Oesterreich, Ph.D., co-leader of the Cancer Biology Program at UPMC Hillman and professor at the University of Pittsburgh School of Medicine's Department of Pharmacology & Chemical Biology. "There has been increasing awareness that ILC and IDC are distinct, but this large multi-center study provides compelling evidence that these are two different diseases that require different management."

Co-senior authors Megan Kruse, M.D., a breast medical oncology specialist at Cleveland Clinic, and Nicole Williams, M.D., a breast medical oncologist at OSUCCC—James, worked with Oesterreich to analyze records from patients treated at the three cancer centers for ILC or IDC between 1990 and 2017.

"These findings likely indicate that detection of lobular breast cancer is delayed," said Kruse. "When these tumors are finally detected, they're larger and they've already moved to the lymph nodes, indicating the cancer is spreading. We need to put more effort into improving early detection of ILC by developing new imaging technologies or other methodologies."

The idea for the study was sparked one evening as Oesterreich was washing dishes and listening to a recording of a Lobular Breast Cancer Alliance conference call that she'd missed. When Susan MacDonald, a lobular breast cancer advocate from Cleveland, mentioned that Cleveland Clinic researchers were beginning a project to analyze the center's breast cancer registry, Oesterreich's ears pricked up.

"I thought, 'Wow, we have been doing the very same thing at UPMC. It would make sense to collaborate and work together,'" said Oesterreich.

ILC's key feature is loss of a gene called E-cadherin that helps cells stick together. As a result, lobular cancer cells grow in lines, producing tumors that look more like than the familiar round lumps of IDC, explained Oesterreich. These web-like tendrils make ILC difficult to spot on mammograms until the cancer has grown and often advanced.

The analysis found that ILC cells were lower grade than IDC, meaning that they looked more similar to normal cells. However, ILC tumors were diagnosed twice as often at stage III or IV— advanced stages in which cancer cells have spread beyond breast tissue to the lymph nodes or metastasized to other parts of the body. Lobular tumors were also larger in size than their ductal counterparts.

The researchers restricted the next part of their analysis to patients with tumors bearing estrogen receptors and lacking the HER2 receptor. They found that patients with lobular cancer had worse disease-free survival and overall survival. ILC patients also had more than those with IDC, and recurrences tended to occur later.

"In other words, more tumors are coming back, and they're coming back later for patients with ILC," explained Oesterreich, who also holds the Shear Family Endowed Chair in Breast Cancer Research and is co-director of the Women's Cancer Research Center, a partnership between UPMC Hillman and Magee-Womens Research Institute. "This suggests that tumor cells hibernate somewhere in the body until they are reawakened. We need to find where these cells hang out and why they reawaken."

A commercially available advanced genomic test called Oncotype DX was used to predict risk of recurrence and response to chemotherapy for patients with early-stage estrogen-receptor-positive, HER2-negative breast cancer.

The analysis found that there was a significant association between the Oncotype DX score and cancer recurrence for patients with IDC. Very few ILC cases were classified as high-risk, despite more late recurrences, highlighting the need for specific molecular tests that Improve predictions for lobular breast cancer.

"Lobular breast cancer and ductal breast cancer are two distinct diseases. Our study shows that lobular breast cancers are diagnosed at a more advanced stage and have increased chance of recurrence. However, invasive lobular cancer was less likely to be classified as high-risk by a commonly used genomic test," said Williams. "Despite their differences, these cancers are often treated the same. We hope these findings will spark research aimed at developing new diagnostic tools and drugs to Improve outcomes for patients with lobular breast cancer."

Other researchers who contributed to the study were co-first authors Azadeh Nasrazadani, M.D., Ph.D., and Jian Zou, M.S., both of Pitt or UPMC; Neil Carleton, B.S., Yujia Li, B.S., Kathryn Demanelis, Ph.D., George Tseng, Ph.D., Adrian V. Lee, Ph.D., all of Pitt or UPMC; Tiffany Onger, M.D., and Matthew D. Wright, M.D., both of Cleveland Clinic; and Bhuvaneswari Ramaswamy, M.D., of The Ohio State University Wexner Medical Center.



More information: Clinicopathological features and outcomes comparing patients with invasive ductal and lobular breast cancer, Journal of the National Cancer Institute (2022).

Citation: Multi-center study sheds light on understudied breast cancer type (2022, October 14) retrieved 17 October 2022 from https://medicalxpress.com/news/2022-10-multi-center-understudied-breast-cancer.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.

Fri, 14 Oct 2022 03:00:00 -0500 en text/html https://medicalxpress.com/news/2022-10-multi-center-understudied-breast-cancer.html
Killexams : Hearing specialist weighs in as over-the-counter hearing aids hit store shelves

The FDA recently approved over-the-counter hearing aids, which are now available in stores.

About 80% of people with hearing loss haven’t yet tried to Improve it and the introduction of these hearing aids aims to change that statistic.

“We have been anticipating the release of these regulations for probably six years, maybe a little bit longer,” said Dr. Sarah Sydlowski, audiologist for Cleveland Clinic and president of the American Academy for Audiology. “It’s something that came on to the radar of legislators and regulators quite a long time ago, and the focus has been on improving accessibility and affordability of hearing care.”

RELATED: Over-the-counter hearing aids have arrived: What you need to know

She said the new over-the-counter hearing aids are designed for individuals 18 and older with perceived mild or moderate hearing issues.

Those interested will not be required to have a medical test or prescription before buying them.

However, Sydlowski still recommends seeing an audiologist for a hearing test so you can learn more about what kind of hearing difficulties you may have, as well as the various treatment options available.

“I think over-the-counter devices are going to be a wonderful option for people who aren’t ready to take that big step to fully understand their hearing loss or to see an audiologist in order to have a prescription device programmed,” she said. “So, this will be a great way for people to maybe have an entry point and then when they’re having more difficulty or the device isn’t providing the benefit they need, they can come see an audiologist.”

Sydlowski notes that while this is an exciting development, she still thinks more needs to be done to raise awareness about hearing loss.

Although it’s one of the top three most common health conditions, a accurate study showed only about 10% of older adults between the ages of 50 and 80 were able to properly identify what’s considered a “normal” range of hearing.

A related study also found many primary care providers don’t know that hearing loss can be both prevented and successfully improved.

Copyright 2022 by Cleveland Clinic News Service. All rights reserved.

Mon, 17 Oct 2022 02:00:00 -0500 en text/html https://www.news4jax.com/health/2022/10/17/hearing-specialist-weighs-in-as-over-the-counter-hearing-aids-hit-store-shelves/
Killexams : New study finds that monkeypox virus can spread widely within specialist hospital isolation rooms

Monkeypox virus can be shed into the surrounding environment by people who are infected, particularly in shed skin particles and in debris from monkeypox skin lesions and scabs. The virus is relatively hardy and under appropriate conditions can remain infectious on surfaces for weeks, creating a potential infection risk to others.

The UK Health Security Agency (UKHSA) recommends that patients with monkeypox who have requiring hospital admission are cared for in isolation rooms, with infection prevention and control (IPC) precautions that aim to contain potentially infectious virus within the room and protect staff who enter. However, to date it has been unclear whether these measures are proportionate to the potential virus exposure risks.

To investigate this, researchers from the Liverpool School of Tropical Medicine, the University of Oxford's Nuffield Department of Medicine and the UKHSA conducted a study which collected samples from the rooms of patients hospitalized with monkeypox. The findings have been published in The Lancet Microbe.

The research team assessed the extent of virus shedding onto surfaces in specialist isolation rooms containing patients admitted to hospital for the management of severe monkeypox. They also investigated whether the virus was detectable in air samples from the rooms.

The researchers found that viral DNA shed by the patients could be found on multiple surfaces throughout the isolation rooms (56 (93%) positive by PCR out of 60 samples). Monkeypox virus DNA was also found on (PPE) worn by caring for these patients, and in the anterooms where they remove their PPE. Monkeypox virus DNA was also detected in five out of twenty air samples taken within these isolation rooms.

Changing bed linen was an activity particularly associated with detection of DNA in air samples in the room. This suggests that viral particles, probably in shed skin particles, can become suspended in the air when bed sheets are changed. Monkeypox virus capable of replicating in cells under laboratory conditions (an indicator that the virus could infect other people) was identified in two of four PCR-positive samples selected for virus isolation. This includes air samples collected during the bed linen change.

Lead author, Dr. Susan Gould, from the Liverpool School of Tropical Medicine, says, "Our results found that changing a patient's bedding appears to be particularly associated with an increased ability to detect monkeypox virus in air samples. In 2018, a UK healthcare worker was thought to have developed monkeypox after being exposed to the virus while changing a patient's bedding, before monkeypox had been considered and diagnosed. Our results suggest that changing bed linen used by hospitalized patients with monkeypox does indeed increase the risk of exposure to virus, by disturbing virus on bed linen and allowing it to be suspended in the air."

In addition to detecting virus DNA, the researchers were able to isolate replication-competent virus in some surface and air samples. The results show, for the first time, that monkeypox virus in some air samples taken around patients hospitalized with monkeypox is capable of replicating in cells and is not just 'dead' virus. Dr. Gould says that "these results suggest that monkeypox virus shed into a hospitalized patient's environment poses an infection risk that needs to be managed."

Senior author on the paper, Dr. Jake Dunning, of the University of Oxford's Nuffield Department of Medicine and the Royal Free London NHS Foundation Trust, says that "it is important to note that detection of virus, even when demonstrated to be infectious, does not necessarily mean that exposure to the virus in real life would result in infection of the exposed person. However, it does reveal a potential transmission risk and one that is reasonable to control in hospital settings. Our results confirm that the strict IPC measures we follow in specialist infectious diseases centers are necessary and appropriate."

This investigation specifically evaluated exposure risks when caring for patients admitted to specialist facilities in hospitals. The results and recommendations may therefore not apply to other settings, such as outpatient clinics where patients attend for a short time, interactions differ, and the virus is unlikely to accumulate to such an extent. There is no suggestion that transmission of monkeypox virus via aerosols is a common way for the infection to spread from one person to another.

Dr. Gould added that "in the context of ward-based care, our results support infection prevention and control measures designed to protect against exposure to infectious virus on surfaces and in the air, such as appropriate PPE, as well as applying measures designed to contain shed virus within hospitalized patients' isolation rooms, including the use of negative pressure rooms and doffing areas."

The study was led by scientists from the Liverpool School of Tropical Medicine and the University of Oxford, as part of the National Institute for Health and Care Research Health Protection Unit in Emerging and Zoonotic Infections, which includes the University of Liverpool as a partner.

The HPRU in Emerging and Zoonotic Infections and UKHSA identified a need for environmental sampling in hospitals managing inpatients with monkeypox and rapidly began investigations. Prior to publication the team shared its results with those caring for patients with monkeypox admitted to hospitals in the UK, and with international partners, infectious diseases specialist networks, and public health organizations.

Dr. Dunning says that "this work demonstrates the ability of HPRUs to conduct rapid, reactive studies to obtain data from novel outbreaks, focussing on research that informs public health guidance and policies, as well as improving patient care."



More information: Susan Gould et al, Air and surface sampling for monkeypox virus in a UK hospital: an observational study, The Lancet Microbe (2022). DOI: 10.1016/S2666-5247(22)00257-9

Citation: New study finds that monkeypox virus can spread widely within specialist hospital isolation rooms (2022, October 13) retrieved 17 October 2022 from https://medicalxpress.com/news/2022-10-monkeypox-virus-widely-specialist-hospital.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.

Thu, 13 Oct 2022 05:10:00 -0500 en text/html https://medicalxpress.com/news/2022-10-monkeypox-virus-widely-specialist-hospital.html
Killexams : Study: Limiting contact in practice best way to reduce head injuries in youth football

Mark Jonas, a member of the Wisconsin Football Coaches Association Hall of Fame, knows what it takes to make kids into champions on the football field. He just took over the team at the Southern Door High School in rural Wisconsin and changed practice this summer to try to keep his players healthy.Video above: This Wearable Detects Concussion-Level Trauma the Moment It HappensLast year, the players did full-on tackling and blocking in practice, and some got head injuries, he said.This year, Jonas has them doing form tackling, no-contact drills that teach tackling technique. When they block, they push against a sled rather than each other.The changes seem to be working: No kids have showed signs of head injuries in practice or in games."I hate to be cliche, but I always think, 'what would you do if that was your kid?' You want your kid to be as healthy as possible and as safe as possible and enjoy the experience," Jonas said. "You don't enjoy the experience when you have a bad concussion. Our practices are for learning, not for beating the crap out of each other."Practices in which kids don't pummel each other are exactly what the authors of a new study say it may take to reduce the number of chronic brain problems in high school football players without getting rid of the sport altogether.Football is the most popular sport with high school boys; more than 1.46 million play. Over the years, participation has declined slightly as more parents and children have grown concerned about head injuries and the long-term effects of smashing into each other or the ground.All 50 states have adopted some sort of concussion rules for schools, and districts have put rules in place to limit head injuries and make football safer. But it's not just concussions that are a problem. There's a growing body of evidence showing that chronic sports-related exposure to head impacts, not just in football, can cause microstructural damage and alter or impair some brain activity.The authors of the study, published Thursday in the journal Pediatrics, suggest that a change in the way high schoolers practice may have an even bigger effect than previous approaches meant to restrict head injuries.The researchers, from Indiana University, studied games and practices for three high school teams in the Midwest in the 2021 season. They observed practice and studied videos of the teams. Additionally, the players wore mouthguards with sensors in them. They also surveyed the players and parents.They found that there were 7,312 head impacts among the 74 players: about 66.5 hits per student. Linemen caught the brunt of the head hits. There were the fewest head hits when the kids practiced "air" training, meaning drills without contact.With 5,144 minutes of "air" drills, there were about 310 head impacts overall. In comparison, in 6,901 minutes of "thud" drills, in which players train at high speeds and restrict contact to above the waist, there were 3,360 head impacts."The limitation of impact-prone practice drills may reduce overall head-impact exposure," the study says. "This data are significant because athletes who are diagnosed with a concussion have shown to be exposed to frequent head impacts before the concussive event. This makes a strong case that minimizing head-impact exposure, especially before games, can be done by incorporating less impact-prone drills."Dr. Elizabeth Matzkin, Mass General Brigham Orthopaedic Surgeon and Sports Medicine specialist in Boston, works with several high school and Division 1 college football teams. She thinks the suggestion of limited-contact practice is a good one."Unfortunately, concussion is a problem, and anything that we can do to limit I think not just concussion -- but what part of this article gets to is just head impact, you know, kids falling down, hitting their heads on the ground. Everything adds up," said Matzkin, who did not work on the study. "How we can modify practices to limit head impacts in our high school football players, it's a really good place to start."Dr. Jeffrey Kutcher, medical director of the Henry Ford Kutcher Clinic for Concussion and Sports Neurology, said this study adds important and specific evidence to back up previous understanding of the sport."While this isn't a new idea or new concept, it definitely provides data that allows us to have stronger conventions about how we design football practice," said Kutcher, who was not involved in the new research.The study authors suggest that the data can be effective only if coaches adopt a policy that emphasizes less time spent on "thud" and "live" drills and more time in lower-exposure drills. Whether coaches would be willing to change practice is something they would like to study more.Jon Millett, athletic director at Cony High School in Augusta, Maine, said his football coach holds practices for the team that are a mix of no-contact and contact."You have to practice what you're going to do. There's no way to get around that," he said.In practices, they use Guardian Caps, spongy lightweight devices that go on top of helmets and are designed to reduce the force of impact to the head. He says he isn't aware of any concussions on the football team this year."Even if it saved one kid from a injury down the road, it's worth it," Millett said. "Obviously, the objective is to keep everybody healthy and functioning so that they can be part of the team."Jonas' players in Wisconsin also use Guardian Caps, even without full contact in practice. He said he grew up with a very different kind of practice, but "when you hit and hit every day," he thinks it puts kids at unnecessary risk of injury.Working on hand and shoulder placement, doing drills, is enough. He said his kids know what they're doing on Friday nights."This is one of the hardest-hitting groups I've ever had in 26 years of being a head coach," Jonas said.And it's paid off. Jonas' team is 8-0 in his first year coaching at the school. They're ranked fifth in the state."We just can't afford to have our kids hurt," he said. "Keeping full contact out of practice has worked great for us. Ultimately, the muscle memory is in the tackling for what you bring to that form, and this group of kids brings a lot, so we're really lucky."

Mark Jonas, a member of the Wisconsin Football Coaches Association Hall of Fame, knows what it takes to make kids into champions on the football field. He just took over the team at the Southern Door High School in rural Wisconsin and changed practice this summer to try to keep his players healthy.

Video above: This Wearable Detects Concussion-Level Trauma the Moment It Happens

Last year, the players did full-on tackling and blocking in practice, and some got head injuries, he said.

This year, Jonas has them doing form tackling, no-contact drills that teach tackling technique. When they block, they push against a sled rather than each other.

The changes seem to be working: No kids have showed signs of head injuries in practice or in games.

"I hate to be cliche, but I always think, 'what would you do if that was your kid?' You want your kid to be as healthy as possible and as safe as possible and enjoy the experience," Jonas said. "You don't enjoy the experience when you have a bad concussion. Our practices are for learning, not for beating the crap out of each other."

Practices in which kids don't pummel each other are exactly what the authors of a new study say it may take to reduce the number of chronic brain problems in high school football players without getting rid of the sport altogether.

Football is the most popular sport with high school boys; more than 1.46 million play. Over the years, participation has declined slightly as more parents and children have grown concerned about head injuries and the long-term effects of smashing into each other or the ground.

All 50 states have adopted some sort of concussion rules for schools, and districts have put rules in place to limit head injuries and make football safer. But it's not just concussions that are a problem. There's a growing body of evidence showing that chronic sports-related exposure to head impacts, not just in football, can cause microstructural damage and alter or impair some brain activity.

The authors of the study, published Thursday in the journal Pediatrics, suggest that a change in the way high schoolers practice may have an even bigger effect than previous approaches meant to restrict head injuries.

The researchers, from Indiana University, studied games and practices for three high school teams in the Midwest in the 2021 season. They observed practice and studied videos of the teams. Additionally, the players wore mouthguards with sensors in them. They also surveyed the players and parents.

They found that there were 7,312 head impacts among the 74 players: about 66.5 hits per student. Linemen caught the brunt of the head hits. There were the fewest head hits when the kids practiced "air" training, meaning drills without contact.

With 5,144 minutes of "air" drills, there were about 310 head impacts overall. In comparison, in 6,901 minutes of "thud" drills, in which players train at high speeds and restrict contact to above the waist, there were 3,360 head impacts.

"The limitation of impact-prone practice drills may reduce overall head-impact exposure," the study says. "This data are significant because athletes who are diagnosed with a concussion have shown to be exposed to frequent head impacts before the concussive event. This makes a strong case that minimizing head-impact exposure, especially before games, can be done by incorporating less impact-prone drills."

Dr. Elizabeth Matzkin, Mass General Brigham Orthopaedic Surgeon and Sports Medicine specialist in Boston, works with several high school and Division 1 college football teams. She thinks the suggestion of limited-contact practice is a good one.

"Unfortunately, concussion is a problem, and anything that we can do to limit I think not just concussion -- but what part of this article gets to is just head impact, you know, kids falling down, hitting their heads on the ground. Everything adds up," said Matzkin, who did not work on the study. "How we can modify practices to limit head impacts in our high school football players, it's a really good place to start."

Dr. Jeffrey Kutcher, medical director of the Henry Ford Kutcher Clinic for Concussion and Sports Neurology, said this study adds important and specific evidence to back up previous understanding of the sport.

"While this isn't a new idea or new concept, it definitely provides data that allows us to have stronger conventions about how we design football practice," said Kutcher, who was not involved in the new research.

The study authors suggest that the data can be effective only if coaches adopt a policy that emphasizes less time spent on "thud" and "live" drills and more time in lower-exposure drills. Whether coaches would be willing to change practice is something they would like to study more.

Jon Millett, athletic director at Cony High School in Augusta, Maine, said his football coach holds practices for the team that are a mix of no-contact and contact.

"You have to practice what you're going to do. There's no way to get around that," he said.

In practices, they use Guardian Caps, spongy lightweight devices that go on top of helmets and are designed to reduce the force of impact to the head. He says he isn't aware of any concussions on the football team this year.

"Even if it saved one kid from a [brain] injury down the road, it's worth it," Millett said. "Obviously, the objective is to keep everybody healthy and functioning so that they can be part of the team."

Jonas' players in Wisconsin also use Guardian Caps, even without full contact in practice. He said he grew up with a very different kind of practice, but "when you hit and hit every day," he thinks it puts kids at unnecessary risk of injury.

Working on hand and shoulder placement, doing drills, is enough. He said his kids know what they're doing on Friday nights.

"This is one of the hardest-hitting groups I've ever had in 26 years of being a head coach," Jonas said.

And it's paid off. Jonas' team is 8-0 in his first year coaching at the school. They're ranked fifth in the state.

"We just can't afford to have our kids hurt," he said. "Keeping full contact out of practice has worked great for us. Ultimately, the muscle memory is in the tackling for what you bring to that form, and this group of kids brings a lot, so we're really lucky."

Sat, 15 Oct 2022 01:39:00 -0500 en text/html https://www.wcvb.com/article/reducing-head-injuries-in-youth-football/41630546
Killexams : Past Dell Medical School dean 'disrupting' primary care with new Harbor Health

Clay Johnston, the first dean of the University of Texas Dell Medical School, could have retired or gone to work at another university. Instead, he's helping to launch a different model of primary medical care with Harbor Health.

Johnston stepped down from Dell Medical School in September 2021, after leading the school since January 2014. The school just named its second dean, Dr. Claudia F. Lucchinetti from the Mayo Clinic in Rochester, Minnesota. She will start Dec. 1.

Harbor Health, which has both pediatric and adult primary care physicians, has opened two locations, one in Round Rock and one in Central Austin. It has more planned for Kyle and other Austin neighborhoods as well as mobile clinics with one or two test rooms each.

Improving care:Bass family gift $2.26 million to fund Dell Medical School study of UT Health Austin care model

The concept of Harbor Health is really an extension of what Johnston was working on at the medical school to Improve patient care while improving the cost of care, he said. "How can we better align with society's interests; how can we create a whole system of keeping people healthy?" he said.

Dell Medical School has been working in its specialty care clinics at UT Health Austin to get insurance companies to pay one price per patient for their care.

If a patient was seeing a specialist about a knee replacement, UT Health Austin wanted insurance companies to pay one fee to cover all the care the doctors and therapists working with that patient would provide throughout the whole process rather than billing for each event. It was very similar to the way insurance and the patient might pay an obstetrician one fee for the whole pregnancy, instead of doing a co-pay and insurance charge for every visit and every billable event.

Dell Medical School was working on "reducing waste in the system, and there's a ton of waste," Johnston said. "We were able to show we could do it. ... That should have been a huge experience."

The insurance companies, though, didn't buy in, Johnston said. "We wanted them to pay us for results," he said, instead of per-item fees. "They just wouldn't do it. ... We just kept running into walls."

Improving specialty care:UT Health Austin opens first clinics in $99 million project

Dell Medical School also looked at expanding care into primary care in this way, not just specialty, he said, but that's typically not where medical schools spend their energy, and a consultant strongly encouraged the school to not go that route, Johnston said.

Johnston said he realized about three years ago that this changing of the way health specialty care is billed and paid for by insurance wasn't catching on at the medical school, and Dell Medical School didn't have a way to scale it up, he said.

What he did have is one insurance company that was really interested in what Dell Medical School was trying to do. That was Bind Insurance from Indiana, and its founder, Tony Miller. Bind was rating the care doctors provided and charging patients more if they saw a doctor with not as good outcomes than if they saw a doctor with better outcomes.

Miller has since sold that insurance company and founded Harbor Health as its CEO with Johnston as its chief medical officer.

Like what Dell Medical School has tried to do with specialty care, Harbor Health wants to change the way insurance companies pay for primary care as well as change the primary care experience.

"We're in it to disrupt the system," Johnston said. "The health system has gone off the rails."

Changing insurance models:Health insurance with no co-pay or deductible? Curative is trying it in Central Texas

Harbor Health is working with insurance companies to get them to pay Harbor Health what they typically pay for care for each person a year. Harbor Health will then take that money and provide as much care as a patient needs as well as connecting patients with certified who are either part of Harbor Health or in outside practice groups, but are recommended by Harbor Health based on their known outcomes.

"I don't play golf or drink Scotch, but if I did, I still wouldn't be choosing these doctors based on this," Johnston said. "We're getting a commitment from them to practice in a certain way."

Patients will have as much access to their care team as they want, including through text messages, calls, extended hours and Saturday hours.

Johnston likens the experience trying to get a pediatrician on the phone to talk about a child's stomach pain. Not being able to, a family might end up in the emergency room, paying for imaging and for emergency room and doctor fees for what is constipation.

"Getting access to a pediatrician should be simple," he said. That should include texting the doctor a question and getting an answer, he said.

A Harbor Health care team includes a primary doctor, a health guide to help patients navigate their health care, and a nurse. That primary care team will consult with certified and bring them into the team, which might not require a separate visit by the patient to that specialist, if the primary care team can manage based on the specialist's recommendations.

"We're trying to do this differently," Johnston said. "We're trying to be responsive and cost-effective."

That means focusing on preventative care and taking time with patients. Johnston said, Harbor Health doctors might spend an hour working with a patient instead of the 15 or 20 minutes most primary care doctors allot.

Harbor Health is a for-profit company. It intends to make money by receiving the same fee for each patient each year and saving the patient unnecessary hospital visits and other medical expenses by focusing on early and preventative care to Improve their health.

Harbor Health is starting in Austin first, but Johnston wants to be able to grow across Texas and then the country.

"For me, I want to see the job done," he said. "I'm in it until we've gotten to the point where it's making a difference across the country."

Medical school critics:Central Health to Dell Medical School: Where does our $35 million go?

This article originally appeared on Austin American-Statesman: Past Dell Medical School dean 'disrupting' primary care with new Harbor Health

Thu, 13 Oct 2022 07:49:37 -0500 en-US text/html https://www.msn.com/en-us/health/medical/past-dell-medical-school-dean-disrupting-primary-care-with-new-harbor-health/ar-AA12VaCx
Killexams : Study could help recommend the best treatment for women with early-stage mucinous ovarian cancer

A global study into mucinous ovarian cancer could help oncologists recommend the best treatment for women who are diagnosed early with the condition.

By looking down a microscope for two different 'patterns of invasion' – the way that cancer cells invade ovarian tissue – oncologists can better predict which patients may have better or worse prognoses and can target treatment accordingly. The finding was reported in a paper published today in Clinical Cancer Research, a journal of the American Association for Cancer Research.

"Mucinous ovarian cancer is a rare type of ovarian cancer. It actually has more in common with gastrointestinal cancers, and can be hard to diagnose and hard to treat once it has spread beyond the ovaries," says lead author Nicki Meagher, who has just completed her PhD in the Molecular Oncology group, UNSW School of Clinical Medicine.

She says that observing which of the two types of invasion patterns that the cancer cells form could help certified decide on treatment strategies.

We've shown for the first time that women who have early-stage disease – meaning they have tumors that haven't spread beyond the ovary – have much poorer survival chances in the first two years from diagnosis if they have what we call an infiltrative pattern of invasion.

Knowing this in the early stage of the disease means we can identify patients who could benefit from additional chemotherapy following surgery to remove their ovaries."

Nicki Meagher, Lead Author

The two patterns of invasion are defined by the way the cancer cells organize themselves when viewed under a microscope. The infiltrative pattern of invasion associated with poorer health outcomes shows cancer cells spreading in an uneven, haphazard way through the ovarian tissue. The other pattern is known as expansile, where cells expand through tissue in a more orderly manner, and is associated with better prognoses.

Up until now, other studies had suggested that the infiltrative pattern of invasion was associated with poorer patient outcomes, but no study had large enough numbers of patients with early-stage cancer to reach statistical significance.

But the current study, that involved more than 100 researchers in Australia, UK, Canada, Asia, Europe and the US, was able to test this hypothesis in much larger numbers by examining the tissue of 604 patients. The researchers also looked for the expression of 19 genes including THBS2 and TAGLN in addition to the patterns of invasion.

Professor Susan Ramus who oversaw the global study and heads the Ovarian Tumour Tissue Analysis consortium says that guidelines on how to treat women with early-stage mucinous ovarian cancer have differed around the world due to limited data on infiltrative patterns of invasion associated with survival rates.

"For example, in some parts of the world, an infiltrative pattern was acknowledged as an important feature and determined what treatment those women receive," Professor Ramus says.

"Whereas in others, all patients are recommended for the same pathway of treatment. We hope that after this large study treatment guidelines can be aligned and that we can target treatment for women who may have these more serious indicators, even if they are diagnosed in early stages."

The researchers also noted that women with higher expression of two genes, THBS2 and TAGLN in their tumors, had poorer overall survival.

"We're hoping that this may be able to help explain some of the biology potentially down the track," says Ms Meagher.

"Another avenue could be that knowledge of expression of these genes could assist in developing targeted drugs."

The researchers are part of a wide network of experts who plan to carry out a validation study to further investigate these genomic markers as the basis for a targeted treatment strategy.

Source:

Journal reference:

Meagher, N.S., et al. (2022) Gene expression profiling of mucinous ovarian tumors and comparison with upper and lower gastrointestinal tumors identifies markers associated with adverse outcomes. Clinical Cancer Research. doi.org/10.1158/1078-0432.CCR-22-1206.

Tue, 11 Oct 2022 12:00:00 -0500 en text/html https://www.news-medical.net/news/20221012/Study-could-help-recommend-the-best-treatment-for-women-with-early-stage-mucinous-ovarian-cancer.aspx
Killexams : Toddlers who engage more in physical activity and less screen time have better executive function, study finds

USA: A accurate study reported in The Journal of Pediatrics found that 2-year-old children who spent less time looking at screens and engaged more in daily physical activities have better executive function compared to those who did not.

The study explored whether adherence to American Academy of Pediatrics guidelines for diet and physical activity had any relationship with toddlers' ability to remember, plan, pay attention, shift between tasks, and regulate their own thoughts and behavior, a suite of skills known as executive function.

The study found that 24-month-old children who spent less than 60 minutes looking at screens each day and those who engaged in daily physical activity had better executive function than those who didn't meet the guidelines.

"Executive function underlies your ability to engage in goal-directed behaviors," said University of Illinois Urbana-Champaign kinesiology and community health professorNaiman Khan, who led the study with graduate student Arden McMath andfood science and human nutrition professor Sharon Donovan. "It includes abilities such as inhibitory control, which allows you to regulate your thoughts, emotions and behavior; working memory, by which you are able to hold information in mind long enough to accomplish a task; and cognitive flexibility, the adeptness with which you switch your attention between tasks or competing demands."

"We wanted to test the hypothesis that healthy weight status and adherence to the AAP guidelines for diet and physical activity would extend to greater executive function in 24-month-old children," McMath said.

Through its Bright Futures initiative, the AAP recommends that children spend less than 60 minutes looking at screens each day, engage in at least 60 minutes of physical activity, consume five or more servings of fruits and vegetables and minimize or eliminate the consumption of sugar-sweetened beverages.

Previous studies have linked adherence to guidelines for physical activity levels, screen time and diet quality with executive function in school-aged or adolescent children, McMath said.

"We focused on an earlier period in child development to see whether and how early in life these relationships begin," she said.

The families of the 356 toddlers in the new research are participants in the STRONG KIDS 2 cohort study at the U. of I., a long-term look at the interdependent factors that predict dietary habits and weight trajectories of children who are followed from birth to 5 years old. The study uses parental surveys and data on the children collected at eight time points over the five years, including when the children are 24 months old.

"The surveys asked parents to report on several aspects of their child's daily habits, including how much time they looked at screens, how physically active they were, whether they had at least five servings of fruits and vegetables and whether they refrained from drinking sugar-sweetened beverages," McMath said.

The parents also responded to a standard survey designed to measure executive function in toddlers. These questions asked them to evaluate their child's ability to plan and organize their thoughts, regulate their emotional responses, inhibit impulses, remember information and shift attention between tasks.

The team used a structural equation modeling technique to assess the direct and indirect relationships between adherence to the AAP guidelines and executive function in the toddlers.

"We found that toddlers who engaged in less than 60 minutes of screen time per day had significantly greater ability to actively control their own cognition than those who spent more time staring at phones, tablets, televisions and computers," McMath said. "They had greater inhibitory control, working memory and overall executive function."

Toddlers who got daily physical activity also did significantly better on tests of working memory than those who didn't, the researchers found.

While the study found no significant relationship between the children's weight status and executive function, it suggested that "associations between health behaviors and executive function may precede observed relationships between executive function and weight status" in older children, the authors wrote.

"The influence of engaging in healthy behaviors on cognitive abilities appears to be evident in early childhood, particularly for behaviors surrounding physical activity and sedentary time," Khan said.

The STRONG KIDS 2 cohort study is funded in part by the National Dairy Council, the National Institutes of Health, the Gerber Foundation, the U.S. Department of Agriculture and the Christopher Family Foundation.

Reference:

Arden L. McMath, Samantha Iwinski, Sa Shen, Kelly F. Bost, Sharon M. Donovan, Naiman A. Khan, Published:August 23, 2022 DOI: https://doi.org/10.1016/j.jpeds.2022.08.026

Wed, 12 Oct 2022 02:00:00 -0500 en text/html https://medicaldialogues.in/pediatrics-neonatology/guidelines/toddlers-who-engage-more-in-physical-activity-and-less-screen-time-have-better-executive-function-study-finds-100531
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