UroToday – The Institute of Medicine has drawn professional and public attention to the safety of patients in our health care system through two prominent publications. The Joint Commission has responded by developing a series of National Patient Safety Goals that must be followed to achieve accreditation.

For patients undergoing surgery and procedures, the JCAHO developed the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person SurgeryTM which outlines a number of essential practices designed to ensure patient safety, including the designation of “minimal risk” and “more than minimal risk” procedures.

As a result, without data to show the contrary, many institutions and practices may judge the 2 most commonly performed office procedures, cystoscopy and transrectal ultrasound guided biopsies (TRUS-BX), to represent more than minimal risk procedures, and thus be subjected to the same requirements as a major surgical procedure.

The authors performed a prospective quality assurance study to evaluate the true risk associated with these 2 commonly performed procedures in order to address the concern that these would be considered as more than minimal risk.

Surena F. Matin, MD as part of Beyond the Abstract on UroToday

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2009 – UroToday

To subdue the steaming heat of hurricanes or to thaw out during a blizzard, gasoline-powered, portable generators are a lifeline during weather emergencies when homes are cut off without electricity. But these generators emit poisonous carbon monoxide – a single generator can produce a hundred times more of the colorless, odorless gas than a modern car’s exhaust. New research from the National Institute of Standards and Technology (NIST) shows that to prevent potentially dangerous levels of carbon monoxide, users may need to keep generators farther from the house than previously believed – perhaps as much as 25 feet.

Up to half of the incidents of non-fatal carbon monoxide (CO) poisoning reported in the 2004 and 2005 hurricane seasons involved generators run within 7 feet of the home, according to the U.S. Centers for Disease Control and Prevention (CDC).

Carbon monoxide can enter a house through a number of airflow paths, such as a door or window left open to accommodate the extension cord that brings power from the generator into the house. While some guidance recommends 10 feet from open windows as a safe operating distance, NIST researcher Steven Emmerich says the “safe” operating distance depends on the house, the weather conditions and the unit. A generator’s carbon monoxide output is usually higher than an automobile’s, he says, because most generators do not have the sophisticated emission controls that cars do.

“People need to be aware that generators are potentially deadly and they need to educate themselves on proper use,” Emmerich says. With funding from CDC, NIST researchers are gathering reliable data to support future CDC guidance.

NIST building researchers simulated multiple scenarios of a portable generator operating outside of a one-story house, using both a test structure and two different computer models – the NIST-developed CONTAM indoor air quality model and a computational fluid dynamics model.

The simulations included factors that could be controlled by humans, such as generator location, exhaust direction and window-opening size, and environmental factors such as wind, temperature and house dimensions. In the simulations the generator was placed at various distances from the house and tested under different weather conditions.

“We found that for the house modeled in this study,” researcher Leon Wang says, “a generator position 15 feet away from open windows was not far enough to prevent carbon monoxide entry into the house.”

Winds perpendicular to the open window resulted in more carbon monoxide entry than winds at an angle, and lower wind speeds generally allowed more carbon monoxide in the house. “Slow, stagnant wind seems to be the worst case because it leads to the carbon monoxide lingering by the windows,” Wang explains. Researchers determined that placing the generator outside of the airflow recirculation regions near the open windows reduced carbon monoxide entry.

In the next phase of the study NIST will model a two-story house that researchers believe will interact with the wind differently. NIST researchers also have worked with the Consumer Product Safety Commission on related work. (See: “NIST to Study Hazards of Portable Gasoline-Powered Generators,” NIST Tech Beat, March 5, 2008.)

The generator study can be downloaded at fire.nist/bfrlpubs/build09/PDF/b09009.pdf.

* L. Wang and S.J. Emmerich. Modeling the Effects of Outdoor Gasoline Powered Generator Use on Indoor Carbon Monoxide Exposures. (NIST Technical Note 1637,) 2009.

Source:
Evelyn Brown

National Institute of Standards and Technology (NIST)

Fruits and vegetables that provide the highest levels of vitamins and minerals to the human diet globally depend heavily on bees and other pollinating animals, according to a new study published in the international online journal PLoS ONE.

The new study was carried out by an interdisciplinary research team, comprised of pollination ecologists and a nutrition expert, based at the Leuphana University of LГјneburg, the University of Berlin in Germany, and the University of California at Berkeley and San Francisco. The research team showed that globally “animal-pollinated crops contain the majority of the available dietary lipid, vitamin A, C and E, and a large portion of the minerals calcium, fluoride, and iron worldwide. The yield increase attributable to animal-dependent pollination of these crops is significant and could have a potentially drastic effect on human nutrition if jeopardized.”

More specifically, the team showed that in the global crop supply, several key vitamins and other nutrients related to lower risk for cancer and heart disease are present predominantly in crops propagated by pollinators. These include the carotenoids lycopene and Гџ-cryptoxanthin, which are found in brightly colored red, orange and yellow fruits and vegetables. Other important antioxidants, including several forms of vitamin E and more than 90% of the available vitamin C, are provided by crops that are pollinated by bees and other animals.

Key minerals for the development of bones and teeth, including more than 50% of calcium and fluoride available in the global food supply, are present in crops produced with pollinators. Plant sources of calcium, such as sesame seed, almond or spinach, are particularly important in regions of the world where dairy production is often not culturally, environmentally or financially feasible.

The animal-pollinated crops included in this study vary in the extent of their dependence on animal pollinators, with many able to propagate via alternative mechanisms, such as wind or self pollination. Despite this, the researchers estimate that up to 40% of some essential nutrients provided by fruits and vegetables could be lost without pollinators.

Bees and other animal pollinators are experiencing declines in many parts of the globe. Many farmers around the world depend on the European honey bee, importing them seasonally to pollinate their fields. However, the European honey bee has suffered massive overwintering losses, proposed causes of which include disease, pesticides and lack of nutritional (floral) resources. Wild pollinators that provide pollination services “for free” are also declining rapidly as habitat is destroyed by intensive farming practices such as agrochemical-based monoculture. The results of this study demonstrate the potential impact of this pollinator decline on human health.

Source:
Alexandra-Maria Klein

Pensoft Publishers

New research suggests that old age may not play a role in why older people become forgetful. According to a study published in the September 15, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology, the same brain lesions that are associated with dementia are responsible for mild memory loss in old age.

“It appears these brain lesions have a much greater impact on memory function in old age than we previously thought,” said study author Robert S. Wilson, PhD, with Rush University Medical Center in Chicago. “Our results challenge the concept of normal memory aging and hint at the possibility that these lesions play a role in virtually all late-life memory loss.”

For the study, 350 Catholic nuns, priests and brothers were given memory tests annually for up to 13 years. Tests included word list recall, naming, verbal, number and reading assessments. After death, the participant’s brains were studied for lesions.

The study found that memory decline tended to be gradual until speeding up in the last four to five years of life. Tangles, Lewy bodies, and stroke were all related to gradual memory decline. Almost no gradual decline was seen in the absence of tangles. Both Lewy bodies and stroke approximately doubled the rate of gradual memory decline. Tangles and Lewy bodies were also related to rapid memory decline but explained only about one third of the effect.

“Understanding how and when these brain lesions affect memory as we age will likely be critical to efforts to develop treatments that delay memory loss in old age,” said Wilson.

The study was supported by the National Institute on Aging.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

Source: American Academy of Neurology (AAN)

Indiana University School of Medicine scientists have begun a unique clinical trial using stem cell injections as a treatment that could offer hope to tens of thousands of people who face sores, ulcers and even amputations due to severe peripheral artery disease.

An estimated 10 million Americans are affected by the poor blood circulation — generally in the legs — of peripheral artery disease (PAD). It is caused by atherosclerosis, the clogging and hardening of arteries that can lead to heart attacks. Although about half of those with PAD have no symptoms, others report varying levels of pain and other symptoms including numbness and sores on the legs and feet.

Early treatment is similar to actions to prevent heart disease, such as a better diet, stopping smoking cessation, weight loss and if appropriate, cholesterol-lowering drugs. If the disease progresses, patients may receive an artery bypass graft or an angioplasty procedure that widens the blood vessel.

But as many as 12 percent of PAD patients cannot undergo such surgical procedures, and 30,000 to 50,000 people in the United States receive amputations annually due to PAD, said Michael Murphy, M.D. assistant professor of surgery and an investigator at the Indiana Center for Vascular Biology and Medicine at the medical school, who is leading the stem cell trial. For many of these severely affected patients, their quality of life is similar to patients battling terminal cancer, he said.

The cells used in the IU trial include adult stem cells, which are “parent” cells that can create new specialized cells when needed by the body. In the IU trial, researchers are using stem cells — and slightly more specialized descendants called progenitor cells — that can create the cells that make up the lining of blood vessels.

In the clinical trial at IU School of Medicine, Dr. Murphy and his colleagues extract bone marrow from the patient’s hip while the patient is under a general anesthetic. The adult stem cells and progenitor cells are separated from the bone marrow in a laboratory procedure while the patient recovers from the anesthesia. The cells then are injected into the patient’s leg.

Patients will receive one injection and then will be evaluated on several occasions for 12 weeks. IU doctors expect to treat 10 patients in the trial, and seven have already undergone the procedure. (Two of the patients were treated at Duke University where Dr. Murphy was previously on faculty.) Although the researchers will be looking at such indicators as blood vessel growth and wound healing, the current trial is a initial, or phase 1, test meant primarily to demonstrate that the procedure is safe.

However, said Dr. Murphy, “We think this is a very promising treatment that could help patients with severe peripheral artery disease for whom there is now no effective therapy.”

Previous studies in animals and other laboratory tests have indicated that injections of the stem and progenitor cells into tissues resulted in development of new blood vessels.

In addition, research has shown that people with heart disease, or who are at increased risk of heart disease, tended to have fewer of the blood vessel stem and progenitor cells circulating in their blood.

“Our hypothesis is that people run out of these cells, or they have inadequate supplies — perhaps because of genetic factors. As a result, they can’t repair or replace damaged blood vessel cells, and heart disease ensues,” said Keith March, M.D., Ph.D., director of the vascular biology and medicine center and professor of medicine and of cellular and integrative physiology.

The IU scientists hope to counteract the shortage of those critical cells by introducing the stem cells and progenitor cells taken from the patients’ bone marrow. In turn, it’s hoped, they will promote blood vessel repair and the growth of new blood vessels by stimulating the production of special protein growth factors.

By introducing the stem and progenitor cells taken from the patient’s bone marrow, the IU scientists hope that they will be able to jump-start those repair and replacement processes. They expect that would occur when the bone-marrow derived cells stimulate the production of special protein growth factors that would stimulate the development of new blood vessels.

If the current trial shows that the procedure is safe, the next step would be to test the procedure in a larger number of patients next year, Dr. Murphy said. In that test, the cells would be delivered intravenously in hopes that it would have a broader impact on circulation than a local injection. In addition, he and his colleagues hope to conduct trials using cells taken from fat tissue and from umbilical cord blood to avoid the surgery necessary for bone marrow extraction. Research also is underway to determine whether the cells could be modified in ways to encourage them to produce more growth enhancing proteins before they are given to the patients, Dr. Murphy said.

Eric Schoch
eschochiupui.edu
Indiana University
newsinfo.iu.edu

The NSW Liberal/National Government’s announcement today of its support for plain packaging of tobacco products shows the Government is committed to reducing cancer deaths and continues a long tradition of bipartisan support for tobacco control in Australia, Cancer Council Australia said today.

CEO, Professor Ian Olver said the announcement from Health Minister Jillian Skinner that the NSW Government would support the Commonwealth’s plan to mandate plain packaging of tobacco products showed good health policy in Australia could cut across jurisdictional and party political boundaries.

“Minister Skinner should be commended for speaking in favour of plain packaging for tobacco products, particularly at this early stage in her tenure as Minister for Health in Australia’s most populous state,” Professor Olver said.

“We have always been optimistic that the bill to mandate plain packaging of tobacco products would receive bipartisan support.

“While federal Liberal and National Party parliamentarians are yet to vote on the bill, the strong position taken by their NSW colleagues continues a tradition in Australia of bipartisan support for policies that put population health before tobacco industry interests.”

Professor Olver said the look and feel of tobacco packaging was a powerful marketing tool, particularly for attracting new smokers, which was why the tobacco industry was so emphatic in opposing the plain packaging bill.

“Mandating plain packaging of tobacco products has enormous potential for reducing tobacco consumption in Australia, by far the largest cause of preventable cancer death in this country,” he said.

“The NSW Government should be commended for taking a strong leadership position with great potential to assist in reducing the death and disease burden of cancer in the state, particularly if it translates to a bipartisan vote in favour of the plain packaging bill in Federal Parliament.”

Source:

Cancer Council Australia

Latest figures from the Health Protection Agency (HPA) indicate that flu activity in the UK is continuing to decline. The predominant strain in circulation is now influenza B which has overtaken influenza A H1N1 2009 ‘swine flu’. This drop in activity is consistent across all the surveillance systems that are used to look at levels of flu.

In the past week, the number of number of GP consultations in England has fallen to 40.7 per 100,000, down from 66.5 per 100,000 the previous week. The baseline level is 30 per 100,000 and the peak level was 124.4 per 100,000 in the flu report dated 30 December.

The total number of people who are reported to have died from flu in the UK since the season began in October has reached 338. The vast majority of the new deaths reported today (84) did not occur in the past week – a substantial number will have occurred over the past six weeks, but due the verification process they have only been confirmed this week.

Of the 306 cases with information on age, ten have been aged less than five years; 14 were aged between 5-14; 217 aged between 15-64 and 65 were older than 64 years of age.

Where information is available on the fatal cases, 184 out of 252 (73 per cent) were in a clinical ‘at risk’ group for vaccination. Where information on vaccine status was available for this season’s trivalent vaccine, 82 out of 108 (76 per cent) had not received their jab this season.

Professor John Watson, head of the respiratory diseases department at the HPA, said: “Our latest flu report suggests levels of flu are continuing to decline across the UK and we appear to be over the peak of activity.

“However flu is still circulating and it is important that people remember to practice good cough and hand hygiene such as covering your nose and mouth with a tissue when you cough and sneeze, and then disposing of these as soon as possible to stop it spreading in the community.”

Notes

1. Throughout the flu season the HPA published weekly figures on flu and flu-like illness on a Thursday afternoon via its weekly flu report. To view the latest report, visit the HPA website.

2. The Department of Health now publishes its Winterwatch report which reports on how well the NHS is coping with winter pressures and has practical advice. This can be found at the following link.

3. The flu H1N1 (2009) virus, formerly known as ‘swine flu’, is now one of the group of seasonal flu viruses circulating around the world. Following a pandemic, it is often the case that the pandemic strain becomes the most common seasonal strain of influenza the next flu season, so it is not surprising to see H1N1 (2009) circulating this winter.

4. This year’s seasonal flu vaccine includes a H1N1 (2009) component so that people who are vulnerable are protected against all the circulating strains. For the first time the seasonal vaccine is being offered to pregnant women as they were disproportionally affected by the H1N1 (2009) strain during the pandemic and are more at risk of serious complications.

5. The seasonal flu vaccine is recommended for those aged 65 or over and those with the following conditions, regardless of age: chronic respiratory disease, heart disease, renal disease and chronic liver disease, diabetes requiring insulin or oral hypoglycaemic drugs, immunosuppression. Vaccination is also recommended for pregnant women, those living in long-stay residential care homes, health care workers and carers.

6. Symptoms of seasonal flu include sudden onset of fever, cough as well as sore throat, aching muscles and joints. The Department of Health has recently confirmed guidance on the use of antiviral drugs for the management of people who are displaying flu symptoms, this includes previously healthy people as well as those in ‘at risk’ groups.

7. Antivirals are drugs given to high risk patients who become ill with seasonal influenza. They are most effective if taken within 48 hours of onset and may help limit the impact of some symptoms and reduce the potential for serious complications. They are also used in some situations where it is important to help prevent people from getting influenza.

8. If you are suffering from flu you can use NHS Direct colds and flu symptom checker available here.

Source:

Health Protection Agency

Vanda Pharmaceuticals
Inc. (Nasdaq: VNDA), a biopharmaceutical company focused on the development
and commercialization of clinical-stage product candidates for central
nervous system disorders, today announced positive top-line results from
the company’s Phase III clinical trial evaluating VEC-162, a balanced
melatonin receptor agonist, in transient insomnia. VEC-162 demonstrated
statistically significant improvements at all three tested doses compared
to placebo (p

UroToday – A group of European investigators reported in the online edition of the Journal of Urology that Annexin A3 (ANXA3) combined with PSA improves the detection of prostate cancer (CaP). ANXA3 is a calcium and phospholipid binding protein involved in cell migration, differentiation, immunomodulation and bone metabolism. ANXA3 is implicated in CaP tumorigenesis. The researchers hypothesized that measurement of ANXA3 and PSA would outperform PSA alone in the detection of CaP.

The study cohort included 591 patients at 4 European urology clinics. ANXA3 was measured in urine collected after 20 seconds of digital prostate massage by Western blotting. Serum PSA and it derivatives were also measured. A mathematical function combining ANXA3/total PSA (ANXA3/tPSA) was developed. A training set derived from 243 patients in whom biopsy and initial PSA results were known was analyzed using logistic regression and optimized for 3 subpopulations; patients in the PSA ranges 2-6ng/ml, 4-10ng/ml and the entire training population. The optimized parameters from the training data were evaluated in a second validation set of 264 men.

CaP was detected by 10-core prostate biopsy in 368 of 591 men, and 223 men were found not to have CaP. The model was then run for the 3 subpopulations using the following variables; initial tPSA, density normalized ANXA3 (s.anx.d), combinations of s.anx.d and PSA related variables, and results of the entire dataset with nonlinear combinations of variables. In men with a tPSA 2-6ng/ml, ANXA3 readout had an area under the ROC curve (AUROC) of 0.725 compared to 0.679 or less for all PSA-related readouts. A combined variable of s.anx.d/tPSA was superior to all others with an AUROC of 0.812. The best AUROC obtained was 0.832 attained by a nonlinear combination of s.anx.d and percent fPSA in 280 men with a tPSA between 4-10ng/ml. Correlation analysis of tPSA and ANXA3 values revealed that the 2 markers are independent. These data suggest that ANXA3 complements PSA in the detection of CaP.

Schostak M, Schwall GP, Poznanovic? S, Groebe K, MГјller M, Messinger D, Miller K, Krause H, Pelzer A, Horninger W, Klocker H, Hennenlotter J, Feyerabend S, Stenzl A, Schrattenholz A
J Urol. 2009 Jan;181(1):343-53
doi:10.1016/j.juro.2008.08.119

UroToday Contributing Editor Christopher P. Evans, MD, FACS

UroToday – the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to:
www.urotoday

Copyright © 2008 – UroToday

Research suggests pathogenic strains of Group B Streptococcus (GBS) are an under-recognised cause of urinary tract infections.

The bacteria are better known as a cause of infection in pregnant women with subsequent risks of preterm delivery and transmission to newborn infants often with devastating consequences.

Microbiologist Dr Glen Ulett, from the Griffith Institute for Health and Medical Research, said pathogenic strains of GBS have been shown to bind to the surface of human bladder cells as the initial step in the development of urinary tract infections.

“Affected cells appear to change their morphology and secrete significant amounts of interleukin, an inflammatory cytokine which activates the body’s immune system.”

He said the interleukin levels associated with GBS infection were significantly higher than those associated with Escherichia coli, the cause of 90 per cent of urinary tract infections. The findings have appeared in the Journal of Infectious Diseases.

“The fact that GBS causes more inflammation than E. coli was the exact opposite to what we expected and supports the notion that GBS urinary tract infection is unique and may cause disease at a lower bacterial count than is typical,” Dr Ulett said.

He said because GBS is part of the normal microbial flora of the genital tract in about 40 per cent of healthy women, isolation of the bacteria in urine samples was often attributed to contamination of the sample rather than an possible indicator of disease.

“Because there are no clearly defined risk factors for GBS infection, the high prevalence of the bacteria, and the difficulties of diagnosis, we are probably often overlooking this organism as a cause of urinary tract infections.”

Dr Ulett said a clinical study of over 34,000 patients published last year in collaboration with Westmead Hospital, University of Queensland and the University of Alabama, showed that non-typeable GBS serotypes were not associated with urinary tract infections as was previously thought.

“Importantly, we showed that GBS serotype III was the only serotype more commonly associated with urinary tract infections compared with other serotypes. This gives us a better understanding of the potential targets for vaccine development.”

He said while a vaccine to protect women against GBS urinary tract infections may not be a priority on its own, it may be a spin-off benefit from the need to protect newborn infants against fulminating GBS infection through maternal vaccination.

Source:
Mardi Chapman
Research Australia