Carbon Chemist

Tag: Bleeding

  • How Hologic is Shaping the Future of Women’s Healthcare

    How Hologic is Shaping the Future of Women’s Healthcare

    [ad_1]

    In celebration of International Women’s Day 2024, we’re honored to host Tim Simpson and Sarah Smith from Hologic, a forefront leader in women’s health. As we dive into this year’s theme, “Invest in Women: Accelerate Progress” and “#InspireInclusion,” let’s explore how Hologic’s pioneering work and dedication align with these powerful calls to action.

    Join us as we discuss the crucial role of investment in women’s healthcare and the innovative strides Hologic is making toward inclusive and progressive healthcare solutions.

    Firstly, please introduce yourself and Hologic. More specifically, how does Hologic’s mission align with the 2024 International Women’s Day theme of “Invest in Women: Accelerate Progress” and ”#Inspireinclusion”?

    Tim: I’m Tim Simpson, General Manager UK & Ireland at Hologic. Hologic is a global champion of women’s health, providing innovations designed to detect, diagnose, and treat women’s health conditions. We see it as our mission to advance women’s health, and for this to happen in the UK, targeted investments in research and technology are crucial.

    Sarah: I’m Sarah Smith, Senior Marketing Manager, Surgical Gynaecology, EMEA. Improvement in women’s healthcare only begins when there is investment in empowering women to feel confident to know when to talk to a healthcare professional (HCP) about their health concerns. By the same token, we also need to invest in educating HCPs so that when a woman speaks to their GP, they leave feeling heard and understood.

    Learn more about Hologic

    From your perspective, why is putting women at the heart of decision-making critical in advancing women’s healthcare?

    Sarah: Putting women at the heart of all decisions is the cornerstone of patient-centered care. Shared decision-making is needed to ensure that the patient and clinician work together to make the best healthcare decision for the individual.

    In women’s health, it is particularly important to champion shared decision-making. High rates of misdiagnosis, myths, and misperceptions about conditions1,2, as well as barriers to dialogue due to the sensitive nature of some conditions, can often leave women in the dark when it comes to decisions about their health and treatment.2

    Providing women with better education via initiatives, such as our Wear White Again awareness campaign for women suffering from Heavy Menstrual Bleeding, is vital in empowering them to seek help.

    Improved education and knowledge can make a considerable difference, especially in situations where dialogue barriers may prevent women from clearly communicating their condition’s impact on their lives. Equally, providing clinicians with relevant and up-to-date information is crucial so that when women present symptoms, the conversations between them and their clinicians are productive and satisfactory for both parties.

    In the context of reducing health inequalities, what are some of the barriers to accessing quality healthcare for women, and how is Hologic working to overcome these challenges?

    Tim: We know from our annual Hologic Global Women’s Health Index that cancer testing amongst women has improved. However, our supplementary research found that women from ethnic minorities (non-white women) reported lower attendance for breast cancer screening (11% vs. 25%), compared with white women.”3,4 It is concerning to see these discrepancies, as we know cancer can affect anyone.

    One of the main barriers to attending screenings is being time-poor, with another being not having access to the correct health information. We know it’s vital that health information is accessible for all and translated into multiple languages.

    To tackle these inequalities, we must work in partnership with different organizations, for example, charities that hold vital insights into women’s experiences, to better understand how we make breast cancer screening accessible for all.

    In 2021, we partnered with Manchester-based charity, Prevent Breast Cancer for our global Project Health Equality Campaign, which engaged with hundreds of women to raise awareness of breast cancer and the importance of attending their screening.

    Both breast and cervical cancer remain a significant concern worldwide. Could you discuss the efficiencies Hologic is implementing to help reduce the incidence of these common cancers?

    Tim: We believe diagnostic innovation is key to helping detect cancers early, therefore improving the chances of a better outcome. Both cervical and breast cancer screening are well suited for digital technologies and the application of artificial intelligence (AI), given both require highly trained medical professionals to identify rare, subtle changes visually. This process can be labor-intensive and time-consuming. AI and computer vision are technologies that could help to improve this significantly.

    AI and increased screening units and mammographers can potentially increase breast cancer screening capacity by removing the need for review by two radiologists5.

    When AI-guided imaging is used as part of a screening program, it could effectively and efficiently highlight the areas that are of particular interest to the reader, in the case of breast screening or cytotechnologists, when considering cervical screening.

    Additionally, AI can be used for risk stratification, meaning it could help identify women who are particularly at risk and push them further up the queue for regular screening.

    For example, women with dense breast tissue have a greater risk factor than having two immediate family members who have suffered from breast cancer. What is more, dense breasts make it more difficult to identify cancerous cells in standard mammograms6. This means that in some cases, cancers may be missed, and in others, women will be unnecessarily recalled for further investigation. 

    Could you discuss the advancements in diagnosing and treating heavy menstrual bleeding and how these impact women’s lives?

    Sarah: Our research conducted in 2022 found that only a quarter of those who reported symptoms of heavy menstrual bleeding (HMB) (24%) have received a formal diagnosis. Perhaps even more concerning is that nearly half of the women who experience symptoms of the condition (42%) have not spoken to their GP about them, demonstrating a potential belief that it is something to be endured rather than managed7.

    GPs cannot be experts in every area, and as they continue to do more with limited resources, it is vital to ensure that primary care is supported to understand HMB better. This is a point echoed by the Women’s Health Strategy, which has the ambition of healthcare professionals in primary care to be well-informed and trained in menstrual and gynecological health8.

    Alongside this research, Hologic has launched a report entitled, ‘The right patients, the right setting, the right clinicians’ to set out its vision on tackling HMB. The report recommends launching Women’s Health Hubs and the development of a specific Office for Health Improvement and Disparities communication campaign to support clinicians with building a greater knowledge of menstrual conditions, so GPs can effectively recognise and diagnose HMB.

    How does Hologic’s approach to women’s health care exemplify innovation in addressing long-standing health issues like endometriosis and menstrual health?

    Sarah: Part of our approach at Hologic when championing women’s healthcare is to make sure we connect with key stakeholders along the patient pathway, as we know we need to work collaboratively to change the status quo. This attitude is reflected in our everyday lives – I spend much of my time speaking to clinicians and patients to understand better the challenges they face and the solutions we can collectively create.

    This was the approach we took when conducting the heavy menstrual bleeding roundtable. We made sure we had a diverse set of menstrual health experts who could speak to different parts of the patient pathway. We were also honored to be joined by Dame Lesley Regan, the first Women’s Health Ambassador for England.

    As mentioned, we produced the report following the inspiring roundtable discussion. It is available on our Hologic UK website.  

    Image Credit: fizkes/Shutterstock.comImage Credit: fizkes/Shutterstock.com

    How does Hologic UK & Ireland measure the impact of its initiatives on women’s health, and what benchmarks do you use to evaluate success in contributing to the broader goals of healthcare equity and access?

    Tim: At Hologic, we believe you cannot improve what you don’t measure, so we must continue to collect vital data to help us pinpoint how we best support women across the country.

    In 2021, we launched the Hologic Global Women’s Health Index (HGWHI)*, a globally comparative study in partnership with Gallup, to measure and monitor the behaviors and attitudes influencing women’s access to quality healthcare. It provides us with a unique insight into the experiences of women across the globe, including the UK. HGWHI runs annually; we’re launching the UK data in May.

    Our ambition is that the HGWHI results, in partnership with research from key organizations, will help to form a quality data set that can be used as a benchmark for how UK women perceive their health in the years to come.

    ​As leaders in the healthcare industry, how do you foresee the role of technology evolving to further support women’s health initiatives in the next decade?

    Tim: We know that preventing disease saves lives9. Therefore, as a business leader, I believe technology should lie at the heart of prevention, detection, and diagnosis. Technology for breast cancer screening is an area where investment is crucial to meet women’s health needs in preventative health.

    Currently, many screening programs use traditional 2D mammography technology, which makes identifying cancer lesions more difficult in dense breasts. Therefore, investing in technology such as tomosynthesis (3D Mammography) for breast cancer screening would help provide the reassurance that women deserve. Tomosynthesis detects up to 65% more invasive breast cancers when compared to traditional 2D Mammography alone10.**

    The second method of improving breast and cervical cancer screening programs is using artificial intelligence (AI) to support reading images. Therefore, investing in digital infrastructure is crucial to improving the accuracy and efficiency of diagnosis, as it will ultimately lead to earlier treatment and, thus, better patient outcomes.

    Endometriosis Month coincides with International Women’s Day. How is Hologic raising awareness and advancing treatment options for this often-overlooked condition?

    Sarah: This year’s Endometriosis Month theme is, ‘Could it be endometriosis?’ which makes me think about all the undiagnosed women and girls living in pain. At Hologic, we prioritize fostering relationships with stakeholders and policymakers to raise awareness of what is needed to improve women’s health and the importance of treating gynecological health.  

    As previously mentioned, the HMB roundtable with Dame Lesley Regan, the first Women’s Health Ambassador for England, and other influential leaders from across the continuum of menstrual health care to discuss how we can improve patient pathways for heavy menstrual bleeding was a recent example.

    Additionally, we recognize the importance of data to understand women’s conditions and care and, therefore, conducted research in 2022. This data collected provided the below insights on pain 4:

    • Nearly a quarter of women in the UK experience pain daily, and a fifth of those have had to stop working because of their pain.
    • Among these respondents, the top causes were joint pain, backache, and headache. Women also reported pain due to periods, menopause, heavy menstrual bleeding, and endometriosis.
    • It takes women, on average, 4.29 visits with a healthcare professional before being diagnosed with the cause of their pain, with just more than a quarter of women still not having a diagnosis.

    At Hologic, we believe that to achieve improvement in the treatment of women’s pain is two-fold. We need to continue to educate healthcare professionals (HCPs), so they are provided with the most up-to-date information to diagnose menstrual conditions effectively.

    We also need to ensure that HCPs know that diagnosis and treatment can be overwhelming for the patient and allow time to support patients through the process, setting clear expectations to avoid disappointment post-treatment.

    Can you share a success story or case study where Hologic’s initiatives directly impact women’s healthcare outcomes?

    Tim: We’ve seen first-hand the positive impact AI-guided imaging can directly have on women’s healthcare outcomes. An example of this would be the UK’s first pilot of digital cytology in cervical cancer screening at University Hospital Monklands.

    The technology rapidly reviews test slides, providing the screener with the most diagnostically relevant cells. The initial results are promising, with the hospital reporting increased capacity in slide assessment and improved analysis turnaround times.

    Allan Wilson, Consultant Biomedical Scientist at NHS Lanarkshire, who led the pilot project, commented on the possibilities of the technology in allowing screeners to dedicate more time to training on the latest technologies and dealing with difficult-to-diagnose cases.

    He also noted that with advanced technology, giving women their results quicker increases their confidence in cervical cancer screening while reducing the likelihood of a false negative so any pre-cancerous changes can be picked up and treated earlier before they become cancerous.​​​​​​

    How does Hologic ensure that women’s voices and experiences are incorporated into the development and improvement of gynaecological surgical solutions?

    Sarah: At Hologic, we work extremely closely with patient groups and women’s charities to better understand the patient’s voice. They hold key knowledge and insights about the patient’s experience.

    At the Heavy Menstrual Bleeding Roundtable that I referenced earlier, we brought together experts from different parts of the patient pathway to ensure that women’s experiences were an integral part of the discussion. This meant that their views shaped the resulting report. helped ensure that we were able to understand a woman’s experience. This, in turn, helps us to improve our services and solutions.

    Looking towards the future, what are the main areas of women’s health that Hologic is focusing on for research and development?

    Tim: Hologic is passionate about delivering solutions that are based on data-driven insights that improve women’s well-being. As we look ahead to the future, we will continue to invest in developing our solutions and services that enable healthcare professionals to provide better healthcare to women.

    We also remain committed to raising awareness of the need to address the inequities in women’s health and educating women so they can better advocate for themselves.

    Where can readers find more information?

    About Tim Simpson

    Tim Simpson General Manager at Hologic, UK and Ireland. Tim joined Hologic in 2019 as UK Country Business Manager, before becoming Hologic UK and Ireland’s General Manager in February 2022.

    About Sarah Smith

    Sarah Smith, Senior Marketing Manager, Gynaecology Surgical EMEA. Sarah has worked at Hologic for over twenty years, beginning her role as Senior Marketing Manager EMEA in 2023.​

     

    Sources:

    1. Better for Women. Royal College of Obstetricians and Gynaecologists. 2019. Available from: https://www.rcog.org.uk/about-us/campaigning-and-opinions/better-for-women/ [Accessed 15 February 2024]
    2. Thompson J and Blake D. Women’s Experiences of Medical Miss-Diagnosis: How Does Gender Matter in Healthcare Settings?”. Women’s Studies Journal 2020; 34:28.
    3. Hologic. Hologic Global Women’s Health Index. 2021
    4. OnePoll. Women’s Health Index. 2022
    5. American Cancer Society [Internet]. Breast Cancer Facts & Figures 2019-2020 Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf [Accessed 15 February 2024]
    6. National Cancer Institute. Dense Breast: Answers to Commonly Asked Questions. Available from: https://www.cancer.gov/types/breast/breast-changes/dense breasts#:~:text=Dense%20breasts%20can%20make%20a,tissue%20appears%20as%20dark%20areas [Accessed 15 February 2024]
    7. Hologic data on file MISC-08708-GBR-EN . Survey of 2,000 Women aged 18-55 plus top up 1,000 UK women who have heavy menstrual bleeding during October 20th – 27th 2022.
    8. Department of Health and Social Care. Women’s Health Strategy for England. Available from https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england [Accessed 15 February 2024]​​​​​​
    9. Department of Health & Social Care. [Internet] Prevention is better than cure. 2018. [Accessed 14 February 2024] Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/753688/Prevention_is_better_than_cure_5-11.pdf
    10. Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA, 2014 Jun 25;311(24):2499-507.

    *The Hologic Global Women’s Health Index is one of the most comprehensive initiatives measuring the state of health for 97% of the world’s women and girls aged 15 and older.

    **Results from Friedewald, SM, et al. “Breast cancer screening using tomosynthesis in combination with digital mammography.” JAMA 311.24 (2014): 2499-2507; a multi-site (13), non-randomized, historical control study of 454,000 screening mammograms investigating the initial impact the introduction of the Hologic Selenia® Dimensions ® on screening outcomes. Individual results may vary. The study found an average 41% (95% CI: 20-65%) increase and that 1.2 (95% CI: 0.8-1.6) additional invasive breast cancers per 1000 screening exams were found in women receiving combined 2D FFDM and 3D™ mammograms acquired with the Hologic 3D Mammography™ System versus women receiving 2D FFDM mammograms only.

    [ad_2]

    Source link

  • Reevaluating the role of direct oral anticoagulants in cardiovascular treatment

    Reevaluating the role of direct oral anticoagulants in cardiovascular treatment

    [ad_1]

    Direct oral anticoagulants (DOACs) are a common treatment for patients with a wide variety of cardiovascular conditions. DOACs are the preferred treatment over vitamin K antagonists (VKAs) for many patients with atrial fibrillation or venous thromboembolism, since the latter would have a higher risk of intracranial bleeding and more complex dosing routine. However, new research suggests that DOACs should not be the first line of treatment for every patient who need to treat or prevent blood clots.

    A systematic overview from researchers at Brigham and Women’s Hospital, a founding member of Mass General Brigham, discusses the efficacy of DOACs compared to other treatment methods. This review utilized data from randomized controlled trials to compare DOACs with other treatment methods for various cardiovascular conditions. Although there is merit to using DOACs in many common conditions, the manuscript provides a robust summary of clinical trials indicating that DOACs fare worse in patients with mechanical heart valves, thrombotic antiphospholipid syndrome, atrial fibrillation associated with rheumatic heart disease, and patients with embolic stroke of unclear source. The authors also highlight clinical scenarios in which there is uncertainty, with a look toward future for better evidence generation.

    The results we reviewed here have significant implications for optimizing anticoagulation therapy and improving patient outcomes in clinical practice. There is a critical need for further research regarding why DOACs are less efficacious or safe than the standard of care in certain scenarios.”


    Behnood Bikdeli, MD, MS, of the Brigham’s Heart and Vascular Center

    Source:

    Brigham and Women’s Hospital

    Journal reference:

    Bejjani, A., et al. (2024). When Direct Oral Anticoagulants Should Not Be Standard Treatment. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2023.10.038.

    [ad_2]

    Source link

  • Researchers develop bilayer adhesive hemostat using proteins derived from mussels and silkworms

    Researchers develop bilayer adhesive hemostat using proteins derived from mussels and silkworms

    [ad_1]

    In recent news, there has been a case where a patient experienced pain due to a surgical procedure involving sutures, resulting in the unintended presence of gauze within the patient’s body. Gauze is typically employed to control bleeding during medical interventions, aiding in hemostasis. However, when inadvertently left in the body, it can lead to inflammation and infection. Addressing this issue, recent research has been published by researchers focusing on a hemostatic agent derived from mussels and silkworm cocoons. This hemostatic agent has garnered attention in the academic community due to its efficacy in clotting blood and its safety within the body.

    A collaborative team, led by Professor Hyung Joon Cha (Department of Chemical Engineering and the School of Convergence Science and Technology) and Dr. Jaeyun Lee (Department of Chemical Engineering) at Pohang University of Science and Technology (POSTECH), Professor Kye Il Joo (Department of Chemical Engineering and Materials Science) at Ewha Womans University, and Dr. Jong Won Rhie (Department of Plastic and Reconstructive Surgery) at Seoul St. Mary’s Hospital of the College of Medicine at the Catholic University of Korea, has developed a bilayer nanofiber membrane hemostat using natural proteins derived from mussels and silkworm cocoons. The findings of this research have been recently published online in the latest issue of Small, an international journal specializing in nanoengineering.

    Conventional hemostatic agents such as gauze or medical bands are limited to application on the surface of the skin. Although there are certain materials that naturally degrade within the body like fibrin glue and collagen sponges, they necessitate proteins sourced from humans or animals, making them considerably expensive. Moreover, existing hemostatic materials lack consistent adherence to bleeding sites and are prone to infection from external contaminants.

    In response, the researchers developed a bilayer adhesive hemostat utilizing mussel adhesive proteins that exhibit strong tissue adhesion underwater and silk fibroin extracted from silkworm cocoons. In the research, mussel adhesive proteins demonstrated excellent hemostatic effects including platelet activation. The researchers employed methanol vapor to modify the secondary structure of silkworm silk proteins, resulting in a nanofiber membrane with a hydrophobic outer surface.

    In light of this, the team engineered a hemostatic agent featuring an inner layer with mussel adhesion proteins for wound adhesion and an outer protective layer entirely composed of silkworm silk proteins. Through animal experiments, the hemostatic agent demonstrated rapid acceleration of tissue adhesion and hemostasis in bleeding wounds, effectively preventing the infiltration of water containing infectious agents such as bacteria. Using two proteins that are both highly biocompatible and biodegradable, the researchers have introduced a novel hemostatic agent capable of clotting blood and providing defense against infection.

    Professor Hyung Joon Cha of the POSTECH who led the study remarked, “We have validated the exceptional hemostatic performance of a multifunctional topical adhesive hemostatic agent that is derived from nature and is based on degradable proteins in the human body.” He added, “We will continue further research to assess its applicability in real-world patient care or surgical settings.”

    The research was conducted with support from the Marine BioMaterials Research Center Program of the Ministry of Oceans and Fisheries and the Mid-Career Research Program of the National Research Foundation of Korea.

    Source:

    Pohang University of Science & Technology (POSTECH)

    Journal reference:

    Lee, J., et al. (2024). Protective Topical Dual‐Sided Nanofibrous Hemostatic Dressing Using Mussel and Silk Proteins with Multifunctionality of Hemostasis and Anti‐Bacterial Infiltration. Small. doi.org/10.1002/smll.202308833

    [ad_2]

    Source link

  • Pregnancy care was always lacking in jails. It could get worse.

    Pregnancy care was always lacking in jails. It could get worse.

    [ad_1]

    Standing in front of the concrete steps of her home in Midway, Texas, Collier, initially barefoot and wearing a baggy gray T-shirt, told officers she planned to see a doctor in the morning because she had been bleeding.

    Police body camera footage obtained by KFF Health News through an open records request shows that the officers then told Collier — who was 29 at the time and enrolled in online classes to study psychology — to turn around.

    Instead of taking her to get medical care, they handcuffed and arrested her because she had outstanding warrants in a neighboring county for failing to appear in court to face misdemeanor drug charges three weeks earlier. She had missed that court date, medical records show, because she was at a hospital receiving treatment for pregnancy complications.

    Despite her symptoms and being about 13 weeks pregnant, Collier spent the next day and a half in the Walker County Jail, about 80 miles north of Houston. She said her bleeding worsened there and she begged repeatedly for medical attention that she didn’t receive, according to a formal complaint she filed with the Texas Commission on Jail Standards.

    “There wasn’t anything I could do,” she said, but “just lay there and be scared and not know what was going to happen.”

    Welfare Check Turns Into Arrest for Pregnant Texan

    Collier’s experience highlights the limited oversight and absence of federal standards for reproductive care for pregnant women in the criminal justice system. Incarcerated people have a constitutional right to health care, yet only a half-dozen states have passed laws guaranteeing access to prenatal or postpartum medical care for people in custody, according to a review of reproductive health care legislation for incarcerated people by a research group at Johns Hopkins School of Medicine. And now abortion restrictions might be putting care further out of reach.

    Collier’s arrest was “shocking and disturbing” because officers “blithely” took her to jail despite her miscarriage concerns, said Wanda Bertram, a spokesperson for the Prison Policy Initiative, a nonprofit organization that studies incarceration. Bertram reviewed the body cam footage and Collier’s complaint.

    “Police arrest people who are in medical emergencies all the time,” she said. “And they do that regardless of the fact that the jail is often not equipped to care for those people in the way an emergency room might be.”

    After a decline during the first year of the pandemic, the number of women in U.S. jails is once again rising, hitting nearly 93,000 in June 2022, a 33% increase over 2020, according to the Department of Justice. Tens of thousands of pregnant women enter U.S. jails each year, according to estimates by Carolyn Sufrin, an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine, who researches pregnancy care in jails and prisons.

    The health care needs of incarcerated women have “always been an afterthought,” said Dana Sussman, deputy executive director at Pregnancy Justice, an organization that defends women who have been charged with crimes related to their pregnancy, such as substance use. For example, about half of states don’t provide free menstrual products in jails and prisons. “And then the needs of pregnant women are an afterthought beyond that,” Sussman said.

    Researchers and advocates worry that confusion over recent abortion restrictions may further complicate the situation. A nurse cited Texas’ abortion laws as one reason Collier didn’t need care, according to her statement to the standards commission.

    Texas law allows treatment of miscarriage and ectopic pregnancies, a life-threatening condition in which a fertilized egg implants outside the uterus. However, different interpretations of the law can create confusion.

    A nurse told Collier that “hospitals no longer did dilation and curettage,” Collier told the commission. “Since I wasn’t hemorrhaging to the point of completely soaking my pants, there wasn’t anything that could be done for me,” she said.

    Collier testified that she saw a nurse only once during her stay in jail, even after she repeatedly asked jail staffers for help. The nurse checked her temperature and blood pressure and told her to put in a formal request for Tylenol. Collier said she completed her miscarriage shortly after being released.

    Collier’s case is a “canary in a coal mine” for what is happening in jails; abortion restrictions are “going to have a huge ripple effect on a system already unequipped to handle obstetric emergencies,” Sufrin said.

    ‘There are no consequences’

    Jail and prison health policies vary widely around the country and often fall far short of the American College of Obstetricians and Gynecologists’ guidelines for reproductive health care for incarcerated people. ACOG and other groups recommend that incarcerated women have access to unscheduled or emergency obstetric visits on a 24-hour basis and that on-site health care providers should be better trained to recognize pregnancy problems.

    In Alabama, where women have been jailed for substance use during pregnancy, the state offers pregnancy tests in jail. But it doesn’t guarantee a minimum standard of prenatal care, such as access to extra food and medical visits, according to Johns Hopkins’ review.

    Policies for pregnant women at federal facilities also don’t align with national standards for nutrition, safe housing, and access to medical care, according to a 2021 report from the Government Accountability Office.

    Even when laws exist to ensure that incarcerated pregnant women have access to care, the language is often vague, leaving discretion to jail personnel.

    Since 2020, Tennessee law has required that jails and prisons provide pregnant women “regular prenatal and postpartum care, as necessary.” But last August a woman gave birth in a jail cell after seeking medical attention for more than an hour, according to the Montgomery County Sheriff’s Office.

    Pregnancy complications can quickly escalate into life-threatening situations, requiring more timely and specialized care than jails can often provide, said Sufrin. And when jails fail to comply with laws on the books, little oversight or enforcement may exist.

    In Louisiana, many jails didn’t consistently follow laws that aimed to improve access to reproductive health care, such as providing free menstrual items, according to a May 2023 report commissioned by state lawmakers. The report also said jails weren’t transparent about whether they followed other laws, such as prohibiting the use of solitary confinement for pregnant women.

    Krishnaveni Gundu, as co-founder of the Texas Jail Project, which advocates for people held in county jails, has lobbied for more than a decade to strengthen state protections for pregnant incarcerated people.

    In 2019, Texas became one of the few states to require that jails’ health policies include obstetrical and gynecological care. The law requires jails to promptly transport a pregnant person in labor to a hospital, and additional regulations mandate access to medical and mental health care for miscarriages and other pregnancy complications.

    But Gundu said lack of oversight and meaningful enforcement mechanisms, along with “apathy” among jail employees, have undermined regulatory protections.

    “All those reforms feel futile,” said Gundu, who helped Collier prepare for her testimony. “There are no consequences.”

    Before her arrest, Collier had been to the hospital twice that month experiencing pregnancy complications, including a bladder infection, her medical records show. Yet the commission found that Walker County Jail didn’t violate minimum standards. The commission did not consider the police body cam footage or Collier’s personal medical records, which support her assertions of pregnancy complications, according to investigation documents obtained by KFF Health News via an open records request.

    In making its determination, the commission relied mainly on the jail’s medical records, which note that Collier asked for medical attention for a miscarriage once, in the morning on the day she was released, and refused Tylenol.

    “Your complaint of no medical care is unfounded,” the commission concluded, “and no further action will be taken.”

    Collier’s miscarriage had ended before she entered the jail, argued Lt. Keith DeHart, jail lieutenant for the Walker County Sheriff’s Office. “I believe there was some misunderstanding,” he said.

    Brandon Wood, executive director of the commission, wouldn’t comment on Collier’s case but defends the group’s investigation as thorough. Jails “have a duty to ensure that those records are accurate and truthful,” he said. And most Texas jails are complying with heightened standards, he said.

    Bertram disagrees, saying the fact that care was denied to someone who was begging for it speaks volumes. “That should tell you something about what these standards are worth,” she said.

    Last year, Chiree Harley spent six weeks in a Comal County, Texas, jail shortly after discovering she was pregnant and before she could get prenatal care, she said.

    I was “thinking that I was going to be well taken care of,” said Harley, 37, who also struggled with substance use.

    Jail officials put her in the infirmary, Harley said, but she saw only a jail doctor and never visited an OB-GYN, even though she had previous pregnancy complications including losing multiple pregnancies at around 21 weeks. This time she had no idea how far along she was.

    She said that she started leaking amniotic fluid and having contractions on Nov. 1, but that jail officials waited nearly two days to take her to a hospital. Harley said officers forced her to sign papers releasing her from jail custody while she was having contractions in the hospital. Harley delivered at 23 weeks; the baby boy died less than a day later in her arms.

    The whole experience was “very scary,” Harley said. “Afterwards we were all very, very devastated.”

    Comal County declined to send Harley’s medical and other records in response to an open records request. Michael Shaunessy, a partner at McGinnis Lochridge who represents Comal County, said in a statement that, “at all times, the Comal County Jail provided Chiree Harley with all appropriate and necessary medical treatment for her and her unborn child.” He did not respond to questions about whether Harley was provided specialized obstetric care.

    ‘I trusted those people’

    In states like Idaho, Mississippi, and Louisiana that installed near-total abortion bans after the Supreme Court eliminated the constitutional right to abortion in 2022, some patients might have to wait until no fetal cardiac activity is detected before they can get care, said Kari White, the executive and scientific director of Resound Research for Reproductive Health.

    White co-authored a recent study that documented 50 cases in which pregnancy care deviated from the standard because of abortion restrictions even outside of jails and prisons. Health care providers who worry about running afoul of strict laws might tell patients to go home and wait until their situations worsen.

    “Obviously, it’s much trickier for people who are in jail or in prison, because they are not going to necessarily be able to leave again,” she said.

    Advocates argue that boosting oversight and standards is a start, but that states need to find other ways to manage pregnant women who get caught in the justice system.

    For many pregnant people, even a short stay in jail can cause lasting trauma and interrupt crucial prenatal care.

    Collier remembers being in “disbelief” when she was first arrested but said she was not “distraught.”

    “I figured I would be taken care of, that nothing bad was gonna happen to me,” she said. As it became clear that she wouldn’t get care, she grew distressed.

    After her miscarriage, Collier saw a mental health specialist and started medication to treat depression. She hasn’t returned to her studies, she said.

    “I trusted those people,” Collier said about the jail staff. “The whole experience really messed my head up.”




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

    [ad_2]

    Source link

  • Blocking artery plus surgery offers hope for reducing reoperations in brain hematoma patients

    Blocking artery plus surgery offers hope for reducing reoperations in brain hematoma patients

    [ad_1]

    Injection of a substance to block an artery feeding the dura (protective sack around the brain) along with surgery to remove pooled blood reduced the risk that patients will require repeat surgery compared to surgical drainage alone, according to preliminary late-breaking science presented today at the American Stroke Association’s International Stroke Conference 2024. The meeting, held in person in Phoenix Feb. 7 – 9, 2024, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    A subdural hematoma occurs when there is a tear in one of the thin blood vessels that stretch between the surface of the brain and the overlying membranes that protect the brain. A subdural hematoma can occur because of physical trauma such as a car accident, however, it may also develop slowly in the days or weeks after the injury. This study explored treatment for subacute or chronic subdural hematoma. Subacute subdural hematoma occurs following less severe trauma, such as a concussion – with symptoms such as weakness, numbness, tingling, seizure, headache, confusion or dizziness that develops over hours or days after the event. Chronic subdural hematoma can result from slow bleeding after minimal trauma that the patient may not even remember – symptoms may be subtle and/or may take weeks to be noticeable enough to seek treatment.

    Chronic subdural hematoma is one of the most common neurosurgical conditions and is likely to increase in the future since we have a sizeable aging population, with many taking blood thinners to manage various medical conditions. These hematomas often form in the elderly because as we age, the brain shrinks and pulls away from the inside of the skull, stretching the veins that form a bridge between the dura and the brain, which makes them more likely to tear after a small trauma and leak blood into the protective space between the brain and skull, the dura.”


    Jason Davies, M.D., Ph.D., study co-author, associate professor in the departments of neurosurgery and biomedical informatics at the State University of New York, Buffalo

    Treatment for subacute or chronic subdural hematoma may involve a surgical procedure to drain pooled blood from the area or closely monitoring symptoms to determine if and when intervention may be necessary. The challenge is that even with surgery, repeat surgery may be needed in up to 20% of cases of subdural hematomas.

    The EMBOLISE clinical trial tested whether a subacute or chronic subdural hematoma is less likely to require additional surgery if, in addition to surgical drainage, a substance is injected to block, or embolize, one of the arteries supplying blood to the dura. The OnyxTM liquid embolic system, tested in this trial, is already used prior to surgery to reduce bleeding in people having an operation to correct an abnormal connection between arteries and veins in the brain.

    Between December 2020 and August 2023, researchers enrolled 400 adults (average age of 72; 27% women) at 39 centers (including both community and academic hospitals). All were about to undergo surgery for subacute or chronic subdural hematoma and were considered able to care for themselves and likely to survive at least one year. Patients were randomly assigned to receive either surgery alone or surgery plus embolization using the liquid embolic system to help reduce the progression or recurrence of subdural hematoma.

    The primary outcome was how frequently there was reaccumulation of blood (a recurrence) that required surgical drainage within 90 days.

    The analysis found:

    • Subsequent subdural hematoma within 90 days and need for surgical drainage occurred in 4.1% of patients who had surgery plus embolization and 11.3% of those who had surgery alone.

    • At 90 days after surgery, increasing disability and neurological dysfunction was found to be comparable (statistically the same) in both groups, with 11.9% of patients who had surgery plus embolization and 9.8% of patients who had surgery alone.

    • Serious adverse events attributed to embolization occurred in 2% of patients who received it.

    “The EMBOLISE trial showed that there was a nearly 3-fold reduction in re-operation for patients that were treated with surgery plus embolization,” Davies said. “Fewer trips to the operating room mean less potential for pain, complications, recovery and expense for the patient. Furthermore, we see that the complications related to the embolization procedure were low and that there was no increase in neurological problems.” 

    Study details and background:

    • The EMBOLISE (Embolization of the Middle Meningeal Artery With OnyxTM Liquid Embolic System in the Treatment of Subacute and Chronic Subdural Hematoma) study was conducted at multiple hospitals and health centers in the United States.

    • The liquid embolic system treatment starts as an injectable soft solid, flows as a liquid when force is applied, and then returns to a soft solid state to stop the leaking blood vessel.

    • Other arms of the EMBOLISE study, which included patients not undergoing surgery and randomized to either receive the liquid embolic system or not, are ongoing and not being presented at ISC 2024.

    • Additional measures to gauge success of the liquid embolic system treatment included the number of hospital readmissions; change in hematoma (pooling of blood) volume or thickness; and change in midline shift (when a hematoma pushes brain tissue out of alignment), all assessed at 90 days after treatment.

    • Safety endpoints included the incidence of neurological death or serious adverse events occurring within 30, 90 and 180 days after treatment.

    The main limitation was a relatively high loss to follow up. “One of the challenges of conducting this trial was dealing with a frail elderly population, especially in the middle of the pandemic. Tracking patients down for follow up is always a challenge, and these were compounded by the various COVID-era restrictions that many of our sites faced,” Davies said.

    Source:

    American Heart Association

    [ad_2]

    Source link

  • Combining clot busters and blood thinners shows no advantage for people with ischemic strokes

    Combining clot busters and blood thinners shows no advantage for people with ischemic strokes

    [ad_1]

    Giving blood thinners in addition to clot-busting medications to people with ischemic strokes (clot-caused strokes) did not improve their outcomes 90 days later, according to preliminary late-breaking science presented today at the American Stroke Association’s International Stroke Conference 2024. The meeting, held in person in Phoenix, Feb. 7 – 9, 2024, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    These results are from the MOST (Multi-Arm Optimization of Stroke Thrombolysis) trial. MOST is a 57-center U.S. trial that was halted after an independent data and safety board analyzed results on the first 500 patients out of a planned 1,200 participants and determined it highly unlikely that a benefit would be found if the research was completed. The study was looking for improvement in functional outcomes at 90 days.

    When we began the trial, we believed the medications would improve outcomes, so we were surprised with the negative results. However, we designed the trial to allow us to efficiently answer the question for two blood-thinning medications in one trial. We have definitely done that and are pleased with the ability to answer this question.”

    Opeolu M. Adeoye, M.D., M.S., lead author of the study and BJC HealthCare Distinguished Professor of Emergency Medicine and chair of the department of emergency medicine at Washington University School of Medicine in St. Louis, Missouri

    “A lot of our approaches in stroke treatment were learned from how we treat heart attacks. In previous trials, we first tested to make sure these medications were safe for use in stroke and then launched MOST to confirm their safety and test whether they would work to improve functional outcomes and reduce disability after stroke,” Adeoye said.

    The MOST trial enrolled adults with ischemic stroke severe enough that rehabilitation would likely be needed. All participants received a standard clot-busting medication to dissolve the clot (thrombolysis) within three hours of stroke onset. Participants were then randomized to one of three groups for additional treatment: one group received the blood thinner argatroban within 75 minutes of the clot-busting medication, followed by a 12-hour infusion of argatroban. A second group received an initial dose of the blood thinner eptifibatide within 75 minutes of the clot-busting medication, followed by a 2-hour infusion of eptifibatide and a 10-hour infusion of saline placebo. The control group received a clot buster and a placebo treatment (a 12-hour infusion of intravenous saline solution containing neither of the blood-thinning medications).

    The primary outcome was the study participant’s level of physical function at 90 days after ischemic stroke. Physical function levels were assessed using the modified Rankin score, or mRS, a 6-point disability scale. The videotaped assessment was judged by an independent neurologist reviewer who was not aware of which treatment patients had received. The mRS score was translated into a utility-weighted mRS, using validated ratings of functional outcomes by patients and physicians, resulting in a 0 to 10-point scale in which a higher score means a greater benefit from the treatment. The interim analysis was planned at the start of the study and scheduled to take place after 500 patients were enrolled. In addition, a data safety and monitoring board (DSMB) reviewed safety data after every 30 patients enrolled, looking particularly for occurrences of bleeding in the brain.

    In the 514 patients enrolled prior to the trial being halted by the DSMB in July 2023, the analysis found:

    • The two blood thinners used did not significantly increase the risk of bleeding into the brain.
    • However, neither of the two blood thinners improved outcomes in the stroke survivors. On the 0 to 10 utility-weighted mRS scale, patients receiving placebo averaged 6.8, those receiving argatroban averaged 5.2, and those receiving eptifibatide averaged 6.3. (Types of disability will vary, however, people with a utility-weighted mRS scale of 6 are expected to have difficulty performing activities of daily living without assistance or support.)

    Study details and background:

    • The three-arm study was conducted at 57 hospitals in the United States between October 2019 and July 2023.
    • Participants all had ischemic (clot-caused) stroke that rated a 6 or higher on the National Institutes of Health Stroke Severity Scale and considered a moderately severe stroke.
    • 514 adults were enrolled in the trial before it was halted; participants were an average age of 68; about 50% were women; and about 25% identified as Black adults.
    • Participants were treated within three hours after the onset of stroke symptoms (or the last time seen well) using the standard-of-care approach of thrombolysis (delivering clot-busting medications to dissolve the clot).
    • In addition, 44% of the patients across all three groups were treated with interventional removal of their clots called thrombectomy.
    • At the time of enrollment, participants were randomized to receive a blood thinner or placebo within 75 minutes of thrombolysis: 59 received argatroban; 228 received eptifibatide; and 227 received placebo.
    • The primary safety measure was the occurrence of bleeding in the brain (symptomatic intracranial hemorrhage) within 36 hours of receiving one of the two blood thinners. Safety measures were analyzed by the study’s DSMB after every 30 patients were enrolled.

    Medical professionals providing care were aware of whether a blood thinner or placebo were given to each patient. However, neither the patients nor the professionals rating patient outcomes were aware of which patients in any group had received a blood thinner or placebo.

    “In addition, we were not able to address the possible benefit of giving these or similar blood thinners directly into an artery in the area of the stroke, rather than giving the medications systemically through a vein, as done in this trial,” Adeoye said.

    For patients undergoing thrombectomy (mechanical removal of a stroke-causing clot), studies are underway to determine whether delivering blood thinners into the affected artery may improve outcomes.

    The study was conducted at National Institutes of Health StrokeNet sites. StrokeNet was created to conduct small and large clinical trials and research studies to advance acute stroke treatment, stroke prevention and recovery and rehabilitation after a stroke across the lifespan. Other principal investigators were Andrew D. Barreto, M.D., M.S.; Joseph P. Broderick, M.D.; Colin P. Derdeyn, M.D.; Jordan Elm, Ph.D.; and James C. Grotta, M.D. The full list of authors and their disclosures are listed in the abstract.

    All study authors reported funding from the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health.

    Source:

    American Heart Association

    [ad_2]

    Source link

  • Most stroke survivors can safely take two types of common antidepressants

    Most stroke survivors can safely take two types of common antidepressants

    [ad_1]

    Most stroke survivors were able to safely take two types of common antidepressants, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    Among people with ischemic (clot-caused) stroke, those who began taking an antidepressant known as an SSRI (selective serotonin reuptake inhibitor) and/or an SNRI (serotonin and norepinephrine reuptake inhibitor) for the common conditions of post-stroke depression and anxiety, did not have an increased risk of hemorrhagic (bleeds) stroke or other serious bleeding. This included people taking anticoagulation medications. There was, however, an increased risk of hemorrhagic stroke among stroke patients taking two anti-platelet medications, also called dual anti-platelet therapy or DAPT.

    Mental health conditions, such as depression and anxiety, are very common yet treatable conditions that may develop after a stroke. Our results should reassure clinicians that for most stroke survivors, it is safe to prescribe SSRI and/or SNRI antidepressants early after stroke to treat post-stroke depression and anxiety, which may help optimize their patients’ recovery. However, caution is needed when considering the risk-benefit profile for stroke patients receiving dual anti-platelet therapy because we did find an increased risk of bleeding among this group.”


    Kent P. Simmonds, D.O., Ph.D., study lead author, third-year physical medicine and rehabilitation resident, University of Texas Southwestern Medical Center in Dallas

    According to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update, when considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death, behind diseases of the heart, cancer, COVID-19 and unintentional injuries/accidents. Approximately one-third of stroke survivors develop poststroke depression. If left untreated, depression may affect quality of life and reduce the chances for optimal poststroke recovery such as returning to their usual daily living activities without assistance.

    The most common classes of antidepressants are SSRIs or SNRIs, and they are widely used and effective for treating anxiety and depression. However, they may not be prescribed at all or early enough after a stroke, when the risk of depression or anxiety is particularly high, due to concerns that they may increase the risk of a hemorrhagic stroke or other serious types of bleeding.

    Researchers looked at the frequency of serious bleeding among hundreds of thousands of stroke survivors who took different types of SSRI and/or SNRI antidepressants (such as sertraline, fluoxetine, citalopram, venlalfaxine). Serious bleeding was defined as bleeding in the brain, digestive tract; and shock, which occurs when bleeding prevents blood from reaching the body’s tissues.

    Researchers also investigated serious bleeding among stroke survivors who took antidepressants combined with different types of blood-thinning medications that are used to prevent future blood clots. These blood-thinning medications may include either anticoagulants or antiplatelet medications. Anticoagulants are prescribed as a single medication and include medications such as warfarin, apixaban and rivaroxaban. Antiplatelet medications may be prescribed as either a single medication (commonly aspirin) or two types of antiplatelet medications can be used in dual antiplatelet therapy. DAPT includes aspirin plus another antiplatelet medication called a P2Y12 inhibitor (such as clopidogrel, prasugrel or ticagrelor).

    The study found:

    • SSRI and SNRIs were generally safe to start during the important early stages of recovery as patients taking these medications were not more likely to develop serious bleeding compared to stroke survivors who did not take an antidepressant. This included ischemic stroke patients who are also taking anti-coagulation therapy.

    • An increased risk of serious bleeding occurred when SSRIs or SNRIs were taken in combination with DAPT treatments (aspirin and blood thinners). However, the overall risk remained low as serious bleeding events were rare.

    • Among ischemic stroke patients on antidepressant medications, there was a 15% increase in the risk of serious bleeding when taking medications from classes such as mirtazapine, bupropion and tricyclics compared to SSRI/SNRIs.

    “Maximizing rehabilitation early after a stroke is essential because recovery is somewhat time-dependent, and most functional gains occur during the first few months after a stroke,” Simmonds said. “Fortunately, dual antiplatelet therapy is often administered for 14, 30 or 90 days, so, when indicated, clinicians may not need to withhold antidepressant medications for prolonged periods of time. Future research should investigate the risk of bleeding associated with the use of anti-depressant and anxiety medications among patients with hemorrhagic or bleeding stroke.”

    According to a 2022 American Heart Association scientific statement, social isolation and loneliness are associated with about a 30% increased risk of heart attack or stroke, or death from either. “Depression may lead to social isolation, and social isolation may increase the likelihood of experiencing depression. The current study helps answer safety issues around the use of antidepressants for treatment of mental health issues that may develop after a stroke,” said Crystal Wiley Cené, M.D., M.P.H., FAHA, chair of the writing group for the Association’s scientific statement, and a professor of clinical medicine and chief administrative officer for health equity, diversity and inclusion at the University of California San Diego Health. Dr. Cené was not involved in this study.

    Study details and design:

    • The retrospective study included electronic medical records data from 666,150 ischemic stroke patients from over 70 large health care centers in the United States: 35,631 were taking SSRI/SNRI antidepressant medication, and 23,241 were taking other antidepressants; however, most (607,278) were not taking any antidepressant.

    • Patients were treated at 70 health care centers over 20 years.

    • Patients were identified from electronic medical records for 2003 through 2023.

    The study had some limitations. Researchers used statistical methods to adjust for differences among the groups that may not have accounted for all the important differences among the groups. The study also did not account for the dosage, duration, or number of antidepressants taken by participants, which may have affected the results.

    Source:

    American Heart Association

    [ad_2]

    Source link

  • Newer clot-buster may offer a safe, effective way to treat ischemic stroke in mobile stroke units

    Newer clot-buster may offer a safe, effective way to treat ischemic stroke in mobile stroke units

    [ad_1]

    Compared with the standard clot-busting medication alteplase, the newer clot-buster tenecteplase may offer a safe, effective and simpler way to treat ischemic (clot-caused) stroke in mobile stroke units, according to real-world experiences detailed in a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    Both tenecteplase and alteplase are clot-busting medications. However, tenecteplase is given in a single injection into the bloodstream, while alteplase requires an hour-long infusion after an initial injection. Alteplase is currently the only FDA-approved clot-buster for treating ischemic stroke. Tenecteplase is FDA-approved for the treatment of clots blocking coronary arteries and is used off-label to treat ischemic stroke.

    One of the most important parts of treating stroke patients is getting them the medication they need as quickly and as safely as possible. We know from a recent, large, randomized study that tenecteplase is superior for stroke treatment when given on an ambulance with imaging capability, however, these findings had not been confirmed outside of a trial. Our study looked at real-world implementation of tenecteplase, and we found that we were able to administer it without delay and provide our stroke patients with safe care as quickly as possible on our mobile stroke unit.”


    J. Tyler Haller, Pharm. D., lead author of the study and clinical pharmacy specialist in neurocritical care at St. Joseph’s Hospital and Medical Center in Phoenix

    The Barrow Neurological Institute in Phoenix has the only mobile stroke treatment unit in Arizona – a specially equipped and staffed mobile emergency room. It is deployed when fire department dispatchers determine that a 911 call indicates a possible stroke patient. The mobile stroke unit is staffed by stroke-certified personnel and includes a CT scanner, portable lab and clot-dissolving medications to help quickly diagnose and treat stroke.

    For this study, the researchers analyzed the electronic medical records of people who received clot-busting medication in the mobile stroke unit between February 2021 and April 2023. The study looked at the medical records of people who received treatment both before and after the mobile stroke unit switched from alteplase to tenecteplase in May 2022. During the study period, 40 participants received alteplase, and 32 participants received tenecteplase. The participants’ median age was 66 years, and their median score on the National Institute of Health Stroke Scale was 9, indicating a moderately severe stroke.

    The study found:

    • There was no significant difference in the time span between a patient’s entry to the mobile stroke unit and the administration of either clot-busting medication.

    • There was no difference in time from: entry to imaging results; dispatch of the unit to the administration of medications; or the clinician’s decision about treatment to the time medications were administered.

    • As an indicator of safety, the researchers compared how often patients developed bleeding in the brain within 24 hours of receiving a clot-busting medication: No patient receiving either medication developed this complication.

    “While there was no significant difference in time to administration across the two medications, health care staff feedback confirmed that the calculation and administration of tenecteplase was easier to administer in comparison to alteplase,” said Tiffany O. Sheehan, Ph.D., R.N., FAHA, senior author of the study and manager, Stroke Center Development, Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix. “Administering a single infusion of tenecteplase is more straightforward and allows health care staff extra time to stabilize patients since they do not have to monitor an hour-long infusion of alteplase. This makes the transfer of patients as they are taken to a hospital less complicated.”

    “Apart from being less expensive, our results confirm tenecteplase is safe and as effective as alteplase. We will continue to collect safety and outcome data on our practice; however, we anticipate that other mobile stroke units across the country will begin to utilize tenecteplase if they are not already,” Haller said.

    “Mobile Stroke Units have been a very exciting development because they reduce the time to treatment, and we know that after a stroke, time is brain. Most cities in the U.S. don’t have this kind of treatment available, though, because of cost. So anything that can be done to reduce costs and other challenges of operating a Mobile Stroke Unit has potential to be impactful. Tenecteplase is increasingly being used because of its ease of use, the lower cost and its comparable safety and effectiveness, compared to tPA,” said Mitchell S. V. Elkind, M.D., M.S., FAHA, chief clinical science officer of the American Heart Association, a past president of the American Heart Association, past chair of the Advisory Committee of the American Stroke Association -; a division of the American Heart Association, and a tenured professor of neurology and epidemiology at Columbia University in New York. Dr. Elkind was not involved in this study.

    The study is limited because it is a retrospective analysis of electronic medical records from a single mobile stroke unit. The researchers studied the time before and after the mobile stroke unit began using tenecteplase and was unable to control for other changes in practice that may have occurred during that time.

    Source:

    American Heart Association

    [ad_2]

    Source link

  • Dementia risk can be the highest in the first year after stroke

    Dementia risk can be the highest in the first year after stroke

    [ad_1]

    Having a stroke may significantly increase the risk of developing dementia. The risk of dementia was the highest in the first year after a stroke and remained elevated over a period of twenty years, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    Our findings show that stroke survivors are uniquely susceptible to dementia, and the risk can be up to 3 times higher in the first year after a stroke. While the risk decreases over time, it remains elevated over the long-term.”


    Raed Joundi, M.D., D.Phil., lead study author, assistant professor at McMaster University in Hamilton, Ontario, Canada, and investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences

    To evaluate dementia risk after stroke, the researchers used databases at the Institute for Clinical Evaluative Sciences (University of Toronto, Canada), which includes more than 15 million people in the Canadian province of Ontario. They identified 180,940 people who had suffered a recent stroke -; either an ischemic stroke (clot-caused) or intracerebral hemorrhage (bleeding within the brain) -; and matched those stroke survivors to two control groups -; people in the general population (who had not had a heart attack or stroke) and those who had had a heart attack and not a stroke. Researchers evaluated the rate of new cases of dementia starting at 90 days after stroke over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after the stroke and over time, up to 20 years.

    The study found:

    • The risk of dementia was highest in the first year after stroke, with a nearly 3-fold increased risk, then decreasing to a 1.5-fold increased risk by the 5-year mark and remaining elevated 20 years later.

    • Dementia occurred in nearly 19% of stroke survivors over an average follow-up of 5.5 years.

    • The risk of dementia was 80% higher in stroke survivors than in the matched group from the general population. The risk of dementia was also nearly 80% higher in stroke survivors than in the matched control group who had experienced a heart attack.

    • The risk of dementia in people who had an intracerebral hemorrhage (bleeding in the brain) was nearly 150% higher than those in the general population.

    “We found that the rate of post-stroke dementia was higher than the rate of recurrent stroke over the same time period,” Joundi said. “Stroke injures the brain including areas critical for cognitive function, which can impact day-to-day functioning. Some people go on to have a recurrent stroke, which increases the risk of dementia even further, and others may experience a progressive cognitive decline similar to a neurodegenerative condition.”

    Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. According to the CDC, of those at least 65 years of age, there is an estimated 7 million adults with dementia in 2014 and projected to be nearly 14 million by 2060.

    “Our study shows there is a large burden of dementia after acute stroke in Canada and identifies it is a common problem that needs to be addressed. Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said. “More research is needed to clarify why some people who have a stroke develop dementia and others do not.”

    A 2023 American Heart Association scientific statement, Cognitive Impairment After Ischemic and Hemorrhagic Stroke suggests post-stroke screenings and comprehensive interdisciplinary care to support stroke survivors with cognitive impairment.

    A limitation of the study is that administrative data, hospital records and medication dispensary data were used for the analysis. Researchers were not able to perform cognitive assessments or neuroimaging (noninvasive images of the brain) on stroke survivors, therefore, there is no way to confirm the dementia diagnosis or type of dementia. However, the dementia definition was previously validated and shown to be accurate when compared to medical charts.

    Study background and details:

    • The study examined data from 2002 to 2022 on a total population of 15 million adults in Ontario, Canada.

    • Data was mined from all hospital admissions, pharmacies prescribing medications for dementia and emergency departments across the province of Ontario.

    • The analysis included 180,940 stroke survivors (mean age of 69, and 45% women) who had either an ischemic stroke or intracerebral hemorrhage and survived without dementia for at least 90 days.

    • The study population was matched 1 to 1 on age, sex, rural residence, neighborhood marginalization, hypertension, diabetes (including Type 1 and Type 2 together), high cholesterol, atrial fibrillation, heart failure and peripheral artery disease -; factors known to increase the risk of dementia.

    Source:

    American Heart Association

    [ad_2]

    Source link

  • Early whole blood transfusion boosts survival in trauma patients

    Early whole blood transfusion boosts survival in trauma patients

    [ad_1]

    Significant bleeding due to traumatic injury is the number one cause of preventable deaths in the U.S., with the majority of deaths occurring within six hours. Emerging evidence suggests that the transfusion of whole blood (blood that is not separated into parts) is associated with a survival benefit compared to the traditional use of blood component transfusion (red blood cells, plasma, and platelets) in these patients.

    A new study from researchers from Boston University Chobanian & Avedisian School of Medicine demonstrates that the earlier one receives whole blood transfusion for severe traumatic bleeding, the greater chance of survival. However, if this transfusion was delayed by as little as 14 minutes after arriving at the hospital, the survival benefit was significantly reduced.

    These findings may lead to clinicians and hospital systems to consider whole blood as a standard emergency transfusion product incorporated into the massive transfusion protocol. There may be a similar benefit for using whole blood transfusion at the scene of injury or during transport.”


    Crisanto Torres, MD, MPH, corresponding author, assistant professor of surgery, Boston University Chobanian & Avedisian School of Medicine

    The researchers analyzed 1,394 patients nationwide who presented to the emergency department with severe traumatic hemorrhage requiring massive transfusions, including whole blood, due to their traumatic injuries. They evaluated if the receipt of early whole blood transfusions was associated with improved survival at 24 hours and 30 days compared to delayed whole blood transfusions in severely bleeding trauma patients receiving component-based therapy massive blood transfusions. Those patients who received whole blood transfusion earlier upon their arrival to the emergency department had improved survival rates.

    “Our study indicates a targeted time goal for whole blood administration within 14 minutes of hospital arrival. There is a decrease in survival probability for each minute delay in whole blood transfusion, but the most pronounced reduction in the probability of survival was seen after 14 minutes,” added Torres who also is a trauma surgeon at Boston Medical Center.

    These findings appear online in JAMA Surgery.

    Source:

    Boston University School of Medicine

    Journal reference:

    Torres, C. M., et al. (2024). Timing to First Whole Blood Transfusion and Survival Following Severe Hemorrhage in Trauma Patients. JAMA Surgery. doi.org/10.1001/jamasurg.2023.7178.

    [ad_2]

    Source link