Physician, Heal Thyself!

An unwavering work ethic is a hallmark of many health professionals. But a new survey finds that when a doctor is sick, such dedication to duty can have serious consequences.

A poll of 150 attendees of an American College of Physicians meeting in 2010 revealed that more than half of resident physicians had worked with flu-like symptoms at least once in the last year and one in six reported working sick on three or more occasions during that time.

The survey conducted by researchers at the University of Chicago Medicine and Massachusetts General Hospital also asked the doctors whether they believed they’d ever directly transmitted an illness to a patient.  Shockingly, nearly 10 percent of respondents answered yes, and more than 20 percent believed other residents had passed on an illness to a patient. So much for the Hippocratic Oath and the promise to do no harm!

The results published in the Archives of Internal Medicine are further evidence of a culture of self-sacrifice long prevalent in medicine. Researchers say a physician’s sense of loyalty to already-overwhelmed peers, along with a commitment to patient care, often conflicts with an ethical stance against exposing patients and staff to an illness or compromised performance.

Resisting the pressure to work when ill can be particularly difficult for young doctors,” said study author Anupam B. Jena, MD, PhD,. “A work-first, self-second attitude is often seen as ideal among peers, superiors and even patients.”

In the first known account of the reasons for presenteeism among doctors-in-training, more than half of respondents cited obligation to colleagues who’d be forced to cover their duties or an obligation to patient care as the top reasons for not taking a sick day.

Far fewer, a mere 12%, indicated they’d worked when ill due to concerns their colleagues would think they were “weak” and 8% came to work sick because they felt pressured to repay colleagues for coverage.

Seniority appeared to be a factor in the results. Second-year residents were more likely than first-years to select responsibility to patient care as a reason for presenteeism. Gender differences were also brought to light with female residents more likely to work sick and cite patient care as the reason. Female residents were also more likely to report fear of being perceived as weak as a motive for not taking time off.

While time away from the office carries a similar stigma in other high-pressure professions, a business  executive showing up sick to the boardroom is significantly less worrisome than a doctor with flu treating patients. An otherwise healthy doctor can often recover quickly, but an infected patient with an already-compromised immune system may not.

Clearly it’s time for doctors to stop playing superheroes.  Presenteeism needs to be addressed and eliminated. Given the intellect of most doctors it shouldn’t be too difficult for them to understand that refraining from work while ill is the most professional way to ensure responsible and safe care for patients.

A word to my doctors – if  what you’ve got is contagious or makes you so sick that your judgment is clouded – STAY HOME!

The Tangled Webs We Weave

Growing fresh blood vessels is a much fantasized goal of biomedical engineers. It’s probably also a fantasy of dialysis patients, hemophiliacs and others with medical conditions that necessitate regular venipuncture and whose veins are a mess from being breached several times a week.

To date, most approaches for growing blood vessels have involved coaxing human cells, either from donors or the patient themselves to manufacture connective tissue. One of the biggest challenges however has been to make the tissues develop into vein shaped vessels.  Some researchers have started with flat sheets of this tissue which they then roll into tubes. Others have used tubular molds. Typically, however, the scaffolding is eventually destroyed by the body’s immune system.

Now one company –  Cytograft Tissue Engineering, is trying a technique that made us look twice. They’re weaving the vessels from human thread that’s been created by spinning thin strips of cultured connective tissue.

The hope is that these woven structures could be easier to mass-produce than the tubes made with other techniques.

A long time ago we decided we were going to make strong tissues without any scaffolding,” says Nicolas L’Heureux, Cytograft’s cofounder and chief scientific officer. “Once you get it in the body, your body doesn’t see it as foreign.”

The company developed the “human textile” idea from earlier work using sheets of biological material to reconstruct blood vessels. Researchers grow the human skin cells in a flask under conditions that encourage the cells to lay down a sheet of extracellular matrix – a structural material that makes up connective tissue. They then harvest the sheets from the culture flasks and then slice the sheets into thin ribbons that can be spooled into threads which can be used by automated weaving and braiding machines to create three-dimensional structures that do not require fusing.

Weaving 48 strands of human connective tissue into a tube

Creating textiles is an ancient and powerful technique, and combining it with biomaterials is exciting because it has so much more versatility than the sheet method,” says Christopher Breuer, a surgeon, scientist, and tissue engineer at the Yale School of Medicine. “The notion of making blood vessels or more complex shapes like heart valves, or patches for the heart, is much easier to do with fibers. There is no limit to the size or shapes that you can make.”

In other words, the biological strands could be used to weave blood vessels, patches and grafts that a patient’s body would readily accept for almost any kind of wound repair or reconstruction.

Cytograft has not yet tested its woven blood vessels in humans, but preclinical dog work has shown that the grafts are resistant to puncture damage and that very little blood leaks from the weave.

Furthermore, the implants remain intact after months. That’s partly because Cytograft’s implants contain no cells. Though the company’s earlier implants were made of extracellular matrix produced from a patient’s own cells, they now harvest the material from cells unrelated to the person receiving the graft and remove the “donor” cells completely. Without any foreign cells to trigger an  immune response blood vessels can be produced ahead of time for use in any patient.

The company is also working on a technique in which the cell-produced sheets are processed into particles instead of threads. Molding the particles together could eventually produce a liver, pancreas, or kidney.

Health or horror? Let us know what you think.

The King Provides Clues to Human Emotion

Last year, while waiting to catch a plane from Washington DC to San Antonio TX, I was joined by a young gentleman, around 24 or 25 years of age and his super-glamorous mom. Initially I was somewhat surprised that they had chosen to sit right next to me, given that the departure area was otherwise empty.

Within seconds he had struck up a conversation, within minutes I was practically his new BFF and before the flight was called he was holding my hand, whispering in my ear and grinning like a teenager.

Before you start thinking “wedding bells” or “cougar time”, what I learned from his mom, was that he had Williams syndrome. What I learned later, after googling the condition, was that people with Williams syndrome have an unusually gregarious personality. They view everyone as their friend, and it’s not unusual for them to rush up to total strangers and strike up conversations as though they are old acquaintances.

Those with the disorder look at the world through a unique lens. Despite their desire to befriend people they have high levels of generalized anxiety poor social judgment, disturbed peer relationships and altered responses to fearful and happy faces.  Their average IQ is 60, they experience severe spatial-visual problems, and suffer from cardiovascular and other health issues. They also have an affinity for music.

This week, I learned that the latter trait is helping scientists shed light on the mystery of emotion and human interaction. Social and emotional responses are so fundamental to human behavior that they are often taken for granted. However, the genetic and neurobiological bases of social behavior are largely unknown, as are the mechanisms for disruptions in social behavior and emotional regulation that appear throughout the lifespan as features of mental illnesses.

In a study led by Julie R. Korenberg, Ph.D., M.D. one of the world’s leading experts in genetics, brain, and behavior of Williams syndrome, people with and without Williams syndrome listened to music while researchers  gauged emotional response by measuring the release of oxytocin and arginine vasopressin – two hormones associated with emotion.

The study, published in PLoS One, signals a paradigm shift both for understanding human emotional and behavioral systems and expediting the treatments of illnesses such as Williams syndrome, post-traumatic stress disorder, anxiety, and possibly even autism.

The study is also the first to reveal new genes that control emotional responses and to show that arginine vasopressin is involved in the response to music.

The trial involved  21 participants – 13 with Williams syndrome and a control group of 8 without the disorder. Before the music was played, participants’ blood was drawn to determine a baseline level for oxytocin. Those with Williams syndrome had three times as much of the hormone as those without the syndrome.

Blood also was drawn at regular intervals while the music played and was analyzed afterward to check for real-time changes.

While other studies have examined how oxytocin affects emotion when artificially introduced into people through nasal sprays, this is the one of the first significant studies to measure naturally occurring changes in oxytocin levels in rapid, real-time as people undergo an emotional response.

Researchers asked the first participant to listen to the 1950’s Elvis Presley classic, “Love Me Tender.” The woman showed no outward response to the song. So, to elicit a greater response from the remaining study participants, the researchers invited them to bring along their favorite music.  Many of them chose heavy metal, but again, there was little outward response to the music.

However, when the blood samples were analyzed, they showed that oxytocin levels, and to a lesser degree arginine vasopressin (AVP), had not only increased but begun to bounce among the William syndrome group. In contrast, both oxytocin and AVP levels remained largely unchanged as those without Williams syndrome listened to music.

Interestingly, the oxytocin level in the woman who’d listened to “Love Me Tender” skyrocketed compared to the levels of participants who listened to different music.

Korenberg believes the blood analyses strongly indicate that oxytocin and AVP are not regulated correctly in people with Williams syndrome, and that the behavioral characteristics unique to people with the condition are related to this problem.

To ensure accuracy of results, study participants were also asked to place their hands in 60° Fahrenheit water to test for negative stress. The same results were produced as when they listened to music. Those with Williams syndrome experienced an increase in oxytocin and AVP, while those without the syndrome did not.

In addition, study participants took three standard social behavior tests that evaluated willingness to approach and speak to strangers, emotional states, and various areas of adaptive and problem behavior. Those test results suggest that increased levels of oxytocin are linked to both increased desire to seek social interaction and decreased ability to process social cues.

The association between abnormal levels of oxytocin and AVP and altered social behaviors found in people with Williams Syndrome points to surprising, entirely unsuspected deleted genes involved in regulation of these hormones and human sociability,” Korenberg said. “It also suggests that the simple characterization of oxytocin as ‘the love hormone’ may be an overreach. The data paint a far more complicated picture.”

However, the results of the study offer great hope. By regulating levels of oxytocin and vasopressin it should be possible to relieve suffering and improve the lives of those with Williams syndrome.

In the meantime, this study certainly brings new meaning to the phrase “mood music.”

The biggest-selling drug in 2018 will be…

EvaluatePharma, a UK based company specializing in pharma and biotech analysis has been gazing long and hard into its crystal ball.

Having scrutinized the world’s leading 3,500 pharmaceutical and biotech companies they have come up with a list of what, they believe, will be the top 10 selling drugs in 2018.

  1. Januvia       (diabetes) – $9.7 billion
  2. Humira        (arthritis) – $8.2 billion
  3. Avastin        (cancer) – $7.5 billion
  4. Enbrel          (arthritis)  – $7.2 billon
  5. Revlimid     (myelodysplastic syndrome) – $6.75 billion
  6. Prevnar 13  (pneumococcal vaccine) – $6.72 billion
  7. Rituxan         (cancer) – $6.3 billion
  8. Lantus           (diabetes) – $5.9 billion
  9. Remicade     (arthritis) – $5.8 billion
  10. Advair            (COPD)  – $5.7 billion

Surprised?  No conventional molecules, no cholesterol lowering agents, no blood pressure meds and not a single new drug among the top ten.  However, they predict the #11 best seller will be GS-7977 – the much anticipated oral hepatitis C drug from Gilead Sciences .

Not so surprising, given the obesity epidemic sweeping the western world that 2 of the front runners are diabetes drugs. Likewise, given the globally aging population – 3 are for arthritis.

#5 may be a surprise to many. Few people had ever heard of myelodysplastic syndrome before ABC news anchor Robin Roberts announced last week that she has the disease.  Still, it’s predicted number 5 status doesn’t mean that an epidemic is expected – it’s still relatively rare with only 10,000 or so new cases detected each year. Its lofty status on the list is more to do with the price. It costs a staggering $10,000 or so for a 28 day supply of the pills.

Other predictions from the EvaluatePharma World Preview 2018 report:

  • Worldwide prescription drug sales are forecast to total $885bn in 2018 an increase of 3.1% from 2011
  • Over $290bn of pharmaceutical sales are at risk from patent expirations between now and 2018
  • Pfizer was the top company for prescription drug sales in 2011, but  Novartis will top the list by 2018
  • Global pharmaceutical R&D spend forecast will grow by 1.5% per year to $149bn in 2018
  • Anti-coagulants (blood thinners) are set to record highest growth of major therapy categories to 2018

Interesting stuff. But the problem with such long term predictive models is that they are but a snapshot  trying to project out six years.

In reality, life is a movie, with a frequently changing plot. For example if J&J’s canagliflozin can reduce obesity and improve blood sugar levels better than Januvia then the projected No. 1 ranking is suspect, at best.

Sexy Treatment for Traumatic Brain Injury?

Traumatic Brain Injury (TBI) is a serious public health problem that affects more than 1.7 million Americans each year.  It is the leading cause of death and disability in children and young adults worldwide and is responsible for more than 52,000 deaths, 275,000 hospitalizations, and 80,000 cases of long-term disability in the US alone.

Caused by a bump, blow or jolt to the head or a penetrating head injury, a TBI disrupts the normal function of the brain. The severity of a TBI may range from “mild” – a brief change in mental status or consciousness to “severe” – an extended period of unconsciousness or amnesia after the injury.  Contrary to most media portrayals, the leading cause of TBI is not injuries sustained during war or football, but road traffic accidents.

Despite significant efforts over the past 20 years, there is still no approved treatment to reverse the damage caused by TBI. However, there is a growing body of research to suggest that the sex hormone progesterone may be a powerful neurosteroid that can protect against the effects of TBI.

Discovery of progesterone’s neuroprotective properties began with the observation of a gender difference in response to experimentally induced traumatic brain injury (TBI). After noting anecdotal reports that female rats recover better than male rats following TBI, researchers conducted studies which showed that the hormone might account for this discrepancy in outcomes.

And while progesterone initially may seem like an unusual choice as a neuroprotective therapeutic agent, there is abundant evidence suggesting that this is a normal role of this steroid hormone. In addition to its well-known effects on the reproductive system, progesterone is a potent neurosteroid.  Progesterone receptors are abundant and widely distributed in the central nervous system. Moreover, unlike other sex steroids, progesterone is not only synthesized in the gonads and adrenal glands, but also produced by glial cells in the brain and by Schwann cells in the peripheral nervous system.

BHR Pharma, based in Herndon VA, has developed BHR-100, a novel intravenous formulation of progesterone for treating TBI.   The company’s Phase III multi-center SyNAPSe clinical trial is currently underway and has enrolled 500 of the 1,180 patients suffering from severe TBI needed.

BHR Pharma, is also studying BHR-310 (intranasal progesterone powder) a ready-for-use, nasal spray TBI treatment.  The compound is being developed so that it may be administered to wounded warriors at the site of injury, without the help of medically trained personnel. Studies of progesterone for TBI show that the earlier progesterone is given the better the chance to prevent further damage and improve recovery. A simple nasal spray device would therefore allow the progesterone to begin working before patients are admitted to a hospital.

The FDA has granted Orphan Drug designation to BHR-100 and the drug is on a Fast Track status designed to accelerate its potential approval.  SRxA’s Word on Health will continue to follow these developments and bring you news as it breaks.

What’s Your Skin Saying?

Aside from being the largest organ in our body, our skin protects us against invasive bacteria, regulates our body temperature, and picks up information from the stimulation of touch, pressure, pain, heat, and cold. Little wonder, then, that when there’s something wrong with your health that your skin is often the first to know.

Here’s the skinny on several dermatologic oddities worth watching out for:

Orange palms and soles

What it means: The cartoonish skin hues can be the unfunny result of an underactive thyroid gland. Hypothyroidism causes increased levels of beta-carotene in the blood. When there’s a thyroid problem, the gland doesn’t metabolize the vitamins as quickly, so beta-carotene accumulates. Orange skin can also occur due beta-carotene as a result of a diet heavy in carrots, carrot juice, sweet potatoes, and squash.

More clues: The skin of someone with hypothyroidism also tends to be dry and cold, and sometimes more pale than yellowed. Feeling tired, sluggish, weak, or achy are the main symptoms, along with possible unexplained weight gain. Women over 50 most often develop hypothyroidism.

What to do: Carotenemia caused by a skewed diet isn’t serious and resolves itself when a broader range of foods is consumed. Hypothyroidism, however, is a medical condition that can lead to complications such as heart problems, and warrants attention from a doctor.

Breaking out in hives in the sun

What it means: Being truly allergic to the sun is pretty rare. A more likely explanation is having taken a photosensitizing drug that increases the person’s sensitivity to light. One of the most common culprits is thiazide diuretics prescribed for hypertension. Other meds that can produce this effect include antihistamines, tetracycline, and tricyclic antidepressants.

More clues: The rash is limited to sun-exposed areas, including the forearms, the neck, and, less commonly, the face. It can feel worse and last longer than a sunburn.

What to do: Check the labels of your prescription medications. Look for phrases such as “May cause chemical photosensitivity.”

Long dark lines in the palm

What it means: A palm-reading mystic might have her own interpretation, but to a physician, a deepening of the pigment in the creases of the palms or soles is a symptom of adrenal insufficiency – Addison’s disease.

More clues: Hyperpigmentation may also be visible around other skin folds, scars, lips, and pressure points

What to do: It’s important to see a doctor, as skin changes may be the first symptoms seen before an acute attack. Lab tests to measure cortisol will provide a diagnosis.

Large, dusky blue leg veins

What it means: If you’ve got ropy, blue-to-purple lines snaking up your legs this could be a sign that some of your veins are not working properly.

More clues: Varicose veins are sometimes mistaken for spider veins, a weblike network of smaller blue or red veins closer to the skin’s surface. Varicose veins tend to be larger, darker, and sometimes raised, with a twisted appearance.

What to do: Exercise, compression stockings, and avoiding constricting postures (like crossing your legs when seated) can help ease discomfort, but they won’t make varicose veins disappear. While not all faulty veins cause problems, severe venous insufficiency can lead to blood clots and need to be treated.

Brownish spots on the shins

What it means: The fronts of the legs tend to bang and bump into things a lot. For someone with diabetes, the damage to the capillaries and small blood vessels that are characteristic of the disease will cause them to leak when traumatized, leading to brown discoloration known as diabetic dermopathy.

More clues: The brownish patches may also be rough, almost scaly and tend to form ovals or circles.

What to do: There’s no health danger from diabetic dermopathy, and no need for treatment.

Persistent rash that you want to scratch raw

What it means: Clusters of small, ferociously itchy blisters that show up repeatedly in the forearms near the elbows, the knees, the buttocks, the back, or the face or scalp are a hallmark of celiac disease, or an allergy to gluten.

More clues: The rash appears on both sides of the body. Itching and burning are so intense you can hardly quit scratching.

What to do: Report the rashes to your doctor or a dermatologist to evaluate and rule out other causes. A gluten-free diet for life is usually advised to keep symptoms at bay.

Purple stains or splotches

What it means: What looks a bit like a bruise, is often mistaken for a bruise, but tends to hang around longer because it’s not exactly a bruise, may be purpura.   It has several possible causes, ranging from a bleeding disorder (thrombocytopenia) to vitamin C deficiency to excessive intake of aspirin, NSAIDs, vitamin E, ginkgo biloba, coumadin, or alcohol.

More clues: A classic bruise tends to turn black and blue following an injury. With purpura, there doesn’t need to be any trauma, the discoloration persists longer than a bruise and the purple color doesn’t blanch when you press it. Purpura are most common on the forearms, legs, and backs of the hands.

What to do: Report the condition to your doctor who can help to identify the cause and recommend the appropriate treatment.

Intense itchiness without rash

What it means: Feeling itchy can have many causes, but when there’s no accompanying visible skin change, it may be  one of the first symptoms of Hodgkin’s disease or non-Hodgkin’s lymphoma.

More clues: The itchiness is more intense than that caused by ordinary dry skin. It occurs most commonly, in the lower legs. Less often, the skin looks reddish and inflamed.

What to do: Report persistent, intense itching to your doctor.

What happened to the Sun(shine)?

Two years ago, the Physician Payments Sunshine Provision was introduced in response to concerns that undisclosed financial relationships between Pharma and  physicians could unduly influence medical practice and patient care.

As part of the provision, all pharmaceutical companies are required to post payments to physicians of anything more than $10 on their web sites.

This law was based on the premise that transparency in these transactions is of public importance and that disclosure acts as a deterrent against quid pro quo exchanges. It was hoped that physicians would be more reluctant to accept large payments if they were publicly disclosed.  Ultimately it was hoped that such disclosure would bring transparency into the prescribing process.

So has this little ray of federal sunshine changed things?

In an attempt to gain insight, if not a definitive answer, a group of researchers examined a large database for prescription drug claims for statins and antidepressants that were written between July 2003 to March 2009 in a half dozen states, including Maine and West Virginia, which have their own sunshine laws.

In both states, brand-name and generic prescriptions were compared with two other states that do not have sunshine laws in order to determine the extent to which prescribing may reflect disclosure requirements. The analysis examined the change in prescribing, before and after their disclosure laws, and compared those results with the change in prescribing in comparison states over the same period.

The researchers postulated that a difference in prescribing in the disclosure state relative to comparison states would potentially reflect the impact of the disclosure law.

So what did they find?

Although there were some statistically significant differences between brand-name and generic prescribing for one or both types of drugs, overall, the effects were small to negligible.

In other words, there was minimal switching from brand-names to generics among two wildly popular therapeutic categories that were heavily promoted during the time period examined.

Why? The authors speculate that disclosure requirements did not capture all promotional spending by pharmaceutical companies and, while industry payments to physicians may have been disclosed to state agencies, the data may not have been disseminated sufficiently to the public to have an impact.

If the policymakers who passed these measures were hoping for a deterrent effect they may be disappointed,” said the study’s lead author, Genevieve Pham-Kanter, Ph.D., assistant professor in the Department of Health Systems, Management and Policy at the Colorado School of Public Health and research fellow at Harvard University and Massachusetts General Hospital.

Whether these results can or should be used by Pharma as an argument for scrapping the Sunshine Act remains to be seen.

Still, what the study demonstrates is that Congress and the Centers for Medicare and Medicaid Services (CMS) along with hundreds of pharmaceutical companies, will be paying hundreds of millions of dollars each year to implement a law that may not actually have its intended effect.

While transparency is an important goal, the administrative and financial burden have unintended knock-on consequences for Industry-funded research, education, and other scientific activities. , call into question.  America is currently facing a job crisis and has still not recovered from the economic decline.  The pharmaceutical industry provides a significant portion of new jobs and taxes that may help America out of these troubled times.

In light of this study, and the tremendous burdens the Sunshine Act imposes on the numerous stakeholders, Congress should perhaps reconsider the need for a federal sunshine law or come up with cheaper, less onerous alternatives.

Whoa, whoa, whoa, whoa – Washing at the Handwash!

A few years ago the Centers for Disease Control and Prevention (CDC) estimated that about 1.7 million patients get a hospital acquired infection each year. Of these, 99,000 die. More recently they estimated that infections develop in about 1 to 3 out of every 100 patients who have surgery.

Separately, a new study just presented at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC) found that preventing further complications in patients who develop infections after hip or knee replacement surgery could save the U.S. health-care system as much as $65 million a year.

Hardly surprising then, that the pressure is mounting to reduce hospital-acquired infections. Some of this is being driven by Medicare who has started reducing  payments for hospital readmissions.

Infection-prevention specialists are now focusing on new practices and products to minimize patient exposure from the environment as well as from medical procedures and surgical instruments.

For example, Baycrest Geriatric Healthcare System in Ontario, were able to reduce the rate of transmission for the staph infection MRSA by 82% over a 33-month period by bathing patients daily with germ-killing cloths.   The cloths are presoaked with a powerful antimicrobial agent – chlorhexidine gluconate, which reduces organisms on a patient’s skin and leaves a residue that lasts up to six hours.  Baycrest, also screens all patients on admission to determine if they are colonized with MRSA on the skin, indicating the organism is present on the body but not yet causing an infection.

Many other innovative  infection-prevention ideas were suggested at the APIC “film festival”, which featured short videos including music, drama, dance, humor and animation to promote adherence to best practices.

SRxA’s Word on Health particularly liked the winning video “Scrub-A-Dub Dub”, which features Jerry Herman a former patient from the All Children’s Hospital in St. Petersburg, FL, along with his twin brother, Josie.

The 10-year-old, who spent several months in the ICU, almost totally paralyzed by Guillain-Barré Syndrome, reinforces proper hand-washing technique among staff, patients and families.

Can a hip-hop song improve health?  We think maybe it can.

Let’s NOT Go Surfing Now

When the Beachboys sang ‘Everybody’s Gone Surfin’ I’m fairly sure they were thinking about waxed boards, shaggy blond hair and ocean waves.

50 years later surfing is a term also associated with browsing the web and more recently with the increasingly popular teen past-time of clinging to the exterior of a speeding car.

The “sport” of car surfing is alarming health experts. National statistics have shown a steady rise in car surfing fatalities. According to the Centers for Disease Control and Prevention (CDC), since 1990, at least 99 people have died or sustained serious injuries as a result of car surfing.

Broken bones and road rash – severe skin abrasions caused by impact from a fall – are minor injuries from car-surfing,” said Thomas Esposito, MD, chief of the Division of Trauma, Surgical Critical Care and Burns in the Department of Surgery at Loyola University Medical Center. “Head injuries are very prevalent and the effects are devastating.” Young people believe they are invincible but several seconds of thoughtless, risky behavior can lead to a lifetime of permanent disability or even death.”

The national rise in car surfing fatalities corresponds with the introduction of media depictions of the activity in movies, video games and in social media “For those desiring their five minutes of fame, social media such as YouTube and Facebook offer perceived fame and instant gratification,” said Esposito. “Replicating a dangerous stunt and capturing it with a cellphone may seem like a cool idea but can have serious long-term consequences.”

According to the CDC, males are more likely to car surf than females and the average age of persons injured as a result of car surfing is 17.6 years. A larger than average proportion of injuries occur among teen males ages 15 to 19. Injuries have been reported in 31 states, with 39% of these coming from the Midwest and 35% from the South.

Esposito notes that one of the key risks is sudden, unanticipated car maneuvers such as accelerating, swerving or braking, that can force a car surfer off of the vehicle. “People who fall off a moving vehicle may suffer brain contusions, broken bones, fractured skulls, loss of consciousness, internal bleeding, paralysis and death.”

Parents take note! If your teenage son asks to borrow the car to go surfing, just check he’s got his board and is headed off to the beach.  Car surfing is a dangerous game with stakes that are too high if they lose.

The Ultimate Life Test?

Imagine a simple blood test that could tell you if you’re going to die. Would that be super cool or super scary?  Well, imagine no more, it turns out there is such a test.

Researchers at McMaster University have found a test that can identify people who are at high risk of dying in the month after surgery.  Apparently elevated levels of troponin T (a protein marker of heart injury) correlate with an increased risk of death.

Currently, troponin levels are not commonly measured after most types of surgery.

The results from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study, the largest international prospective study evaluating complications after surgery, have just been published in the Journal of the American Medical Association (JAMA).

VISION enrolled 15,133 adult patients in North and South America, Asia, Australia, and Europe.  Troponin T was measured daily during the first three days after surgery. Patients were followed while in the hospital and at 30 days after surgery.

VISION demonstrated that a simple blood test strongly identifies which non-cardiac surgery patients are at high risk of dying in the next 30 days,” said Dr. P.J. Devereaux, VISION principal investigator.

According to Devereaux the results also demonstrated that most patients did not die until an average of six or more days after their troponin T blood test was identified as elevated. “This holds out great hope that there is time to intervene.”

Knowing who is at risk through the test can help physicians target patients who need enhanced observation or interventions.

Surgery activates pathways of inflammation, stress, and clotting that predispose the heart to injury. As a result, many patients suffer heart attacks after surgery. The majority of these patients, however, will not experience chest pain. Evidence from this study supports experts who have advocated the use of troponin blood tests after surgery.

The VISION study suggests that myocardial injury detected through elevated troponin T may explain 42% of deaths that occur after surgery.

This study has substantial potential to change how patients are monitored after surgery,” said Dr. Jean Rouleau, scientific director of the Institute for Circulatory and Respiratory Health of the Canadian Institutes of Health Research. “These results hold substantial promise that through measuring troponin blood tests after surgery, physicians can identify which patients are at high-risk of dying and this can allow them to consider enhanced monitoring and interventions in an attempt to improve outcomes. This is a good example of how a carefully conducted clinical study can impact  patient care.”

SRxA’s Word on Health would like to know if you would take the test.