It's the mother of all hackathons — a group of MIT researchers are bringing together engineers, designers, health experts and parents with the goal of building a better breast pump. "We really want to bring the breast pump out of the lactation closet," said Alexis Hope, a research assistant at the MIT Media Lab. "If you talk to moms about something that makes the first part of having a baby miserable, they always say the breast pump. They're loud, they have a million parts, they're impossible to clean, heavy. They're completely impractical for the realities of your life."
In May, a small group from the lab came together to brainstorm, and a blog post about their efforts drew so much interest the organizers — who include four moms — decided to expand. They expect up to 80 people to join forces Sept. 20 and 21 and work all weekend "to make the breast pump not suck." Participants will split into five-person teams and then pitch their prototypes to the group at the end. Hope said it's "just a starting point," but ideally some of the innovations will catch the eye of pump manufacturers.
Half of all new moms in the United States now breastfeed for the six months recommended by pediatricians. Many of them use pumps to produce milk for when they return to work or are away from the baby. Studies have shown breast milk and nursing has health benefits for both the infant and the mother.
For three young siblings, eating is a life or death proposition, thanks to a rare white blood cell disease, reported KSL.
The Frisk children— Jaxen, age 9; Tieler, age 7; Boston, age 4— have spent weeks in the hospital and are allergic to pets, pollens and multiple foods. The siblings all have eosinophilic gastrointestinal disorder (EGID), an abnormal build-up of eosinophil white blood cells in their GI tracts that can cause inflammation and tissue damage in response to foods and allergens. While the disease is relatively rare, it has increased in prevalence over the past decade affecting one in 2,000 people, according to the American Partnership for Eosinophilic Disorders.
"You need food to survive. But it is also what can kill you in our house," their mother, Jenny Frisk, told KSL.
When they’re exposed to their triggers, the children could have an anaphylactic reaction— potentially fatal allergic symptoms throughout the body.
"Tieler had one sip of milk when she was 1-year-old, and instantly started projectile vomiting and got hives all over her body," her father, Gary, told KSL. "It's a life and death situation at birthday parties, or religious events, or anywhere we go, because food is such a big part of our culture."
Between the three children, they’ve endured 11 surgeries and eight extended hospital stays, with more expected in the future.
On top of the children’s health issues, Gary battled cancer two years ago and Jenny had to have several surgeries due to serious adrenal insufficiencies that were unrelated to EGID.
The family has been bankrupted twice by medical bills. While they make too much income to qualify for help, they don’t make enough to pay for their children’s medical needs. Friends and family have started a GoFundMe account to raise money to pay for genetic testing and treatment.
"When we're looking at an illness that is not curable, and the treatment isn't covered (by insurance), the light at the end of the tunnel is really far away," Jenny said.
By David McNamee
Recently, Medical News Today reported on a breakthrough in xenotransplantation - the science of transplanting functional organs from one species to another. Scientists from the Cardiothoracic Surgery Research Program of the National Heart, Lung and Blood Institute (NHLBI) demonstrated success in keeping genetically engineered piglet hearts alive in the abdomens of baboons for more than a year.
While that is a sentence that might sound absurd, or even nightmarish to some, xenotransplantation is a credible science involving the work of leading scientists and respected organizations like the NHLBI and the Mayo Clinic, as well as large private pharmaceutical firms such as United Therapeutics and Novartis.
What is more, xenotransplantation is not a new science, with experiments in cross-species blood transfusion dating as far back as the 17th century.
Why transplant the organs of animals into living humans?
The reason why xenotransplantation is a burning issue is very simple: because of a crippling shortage of available organs for patients who require transplants, many people are left to die.
US Government information on transplantation reports that an average of 79 people receive organ transplants every day, but that 18 people die each day because of a shortage of organs.
The number of people requiring an organ donation in the US has witnessed a more than five-fold increase in the past 2 decades - from 23,198 in 1991 to 121,272 in 2013. Over the same period, the number of people willing to donate has only doubled - 6,953 donors in 1991, compared with 14,257 donors in 2013.
Although some researchers are attempting to solve this shortage by developing mechanical components that could assist failing organs, these devices are considered to increase the risk of infection, blood clots and bleeding in the patient.
Stem cell research is also actively pursuing the goal of growing replacement organs, but despite regular news of breakthroughs, the reality of a functional lab-grown human organ fit for transplant is a long way off.
As the NHLBI's Dr. Muhammad M. Mohiuddin, who led the team responsible for the baboon trial, explained:
"Until we learn to grow organs via tissue engineering, which is unlikely in the near future, xenotransplantation seems to be a valid approach to supplement human organ availability. Despite many setbacks over the years, recent genetic and immunologic advancements have helped revitalized progress in the xenotransplantation field.
Xenotransplantation could help to compensate for the shortage of human organs available for transplant."
Xenotransplantation's eccentric history
The earliest known example of using animal body parts to replace diseased or faulty components of human bodies dates back to the 17th century, when Jean Baptiste Denis initiated the clinical practice of animal-to-human blood transfusion.
Perhaps predictably, the results were not successful and xenotransfusion was banned in Denis' native France.
Fast forward to the 19th century and a fairly unusual trend for skin xenotransplantation had emerged. Animals as varied as sheep, rabbits, dogs, cats, rats, chickens and pigeons were called upon to donate their skin, but the grafting process was not for the squeamish.
Medical records show that, in order for the xenosurgeons of the time to be satisfied that the donor skin had vascularized (developed capillaries), the living donor animal would usually have to be strapped to the patient for several days. However, the most popular skin donor - the frog - was typically skinned alive and then immediately grafted onto the patient.
Despite several reputed successes, modern physicians are skeptical that these skin grafts could have been in any way beneficial to the patient.
The first corneal xenotransplantation - where the cornea from a pig was implanted in a human patient - took place as early as 1838. However, scientists would not look seriously again at the potential for xenotransplantation until the 20th century and the first successes in human-to-human organ transplantation.
In 1907, the Nobel prize-winning surgeon Alexis Carrel - whose work on blood vessels made organ transplantation viable for the first time - wrote:
"The ideal method would be to transplant in man organs of animals easy to secure and operate on, such as hogs, for instance. But it would in all probability be necessary to immunize organs of the hog against the human serum. The future of transplantation of organs for therapeutic purposes depends on the feasibility of hetero [xeno] transplantation."
These words have been described as "prophetic" because Carrel is describing the exact line of research adopted by xenotransplantation scientists a century later.
A few years later, another leading scientist, Serge Voronoff, would also predict modern science's interest in using the pancreatic islets of pigs to treat severe type 1 diabetes in human patients. However, other xeno experiments by Voronoff have not endured critical reappraisal quite so well.
Voronoff's main scientific interest was in restoring the "zest for life" of elderly men. His attempt to reverse this element of the aging process was to transplant slices of chimpanzee or baboon testicle into the testicles of his elderly patients.
Incredibly, this surgery proved quite popular, with several hundred operations taking place during the 1920s in both the US and Europe.
By the 1960s, despite limited availability, the transplantation of kidneys from deceased to living humans had been established by French and American surgeons.
Dialysis was not yet in practice and given that, in the absence of an available donor kidney, his renal failure patients were facing certain death, the Louisiana surgeon Keith Reemtsma took the unprecedented step of transplanting animal kidneys. He chose chimpanzees as the donor animals, due to their close evolutionary relationship with humans.
Although 12 of his 13 chimpanzee-to-human transplants resulted in either organ rejection or infectious complications within 2 months, one patient of Reemtsma continued to live and work in good health for 9 months, before dying suddenly from acute electrolyte disturbance. Autopsy showed that the chimpanzee kidneys had not been rejected and were working normally.
Experiments in the xenotransplantation of essential organs continued in living patients until the 1980s - without lasting success. However, the procedures attracted widespread publicity, with some attributing a subsequent rise in organ donation to the failed attempt to transplant a baboon heart into a baby girl in 1983.
Where does research currently stand?
Despite the more obvious similarities between humans and other primates, pigs are now considered to be the most viable donor animal for xenotransplantation.
Despite diverging from humans on the evolutionary scale about 80 million years ago, whole genome sequencing of the pig has shown that humans and pigs share similar DNA, while the pig's organs - in size and function - are anatomically comparable to humans.
However, perhaps the main advantage of the pig as donor is in its availability - potentially providing an "unlimited supply" of donor organs. If transplantation is viable, pig donors would provide an immediate solution for the organ shortage problem.
Xenotransplantation optimists also believe that the process can improve on the existing success rate of transplantation of human organs. By keeping the pigs healthy, regularly monitored for infection, and alive right until the point when the required organs are excised under anesthesia, the adverse effects associated with transplantation from deceased donors - such as non-function of organs or transmission of pathogens - would be much less likely, this group argues.
However, there are still significant scientific barriers to the successful implementation of xenotransplantation.
The company United Therapeutics - who moved into xenotransplantation research after the daughter of CEO Martine Rothblatt was diagnosed with pulmonary hypertension, a condition with a 90% shortage rate of available lung donors - claim to be making progress with eliminating these barriers.
MedIcal News Today spoke to Rothblatt, who once claimed that the company will have successfully transplanted a pig lung into a human patient "before the end of the decade."
"For a first clinical trial, which was my goal, I think we are on track," she told us. "I said our goal by end of decade is to transplant a xeno lung into a patient with end-stage lung disease and bring them safely back to health."
As well as pioneering lung xenotransplants, the company has ambitions of making pig kidneys, livers, hearts and corneas available for human transplant.
"All are years away, but lung may well be most difficult," admits Rothblatt. "We call it the canary in the coal mine."
In order to make pig lungs compatible with humans, Rothblatt has estimated that 12 modifications need to be made to the pig genome that will prevent rejection. She claims United Therapeutics have now succeeded in making six of these genome modifications.
Also, it was United Therapeutics' genetically modified piglets that provided the world record-beating pig hearts for the NHLBI study in baboons.
Opposition to xenotransplantation
However, science is not the only obstacle to xenotransplantation. Despite clearing all steps of the research with ethics committees at every step, Rothblatt - who has a doctorate in medical ethics - admits there will be unforeseeable regulatory dilemmas and ethics conversations before xenotransplantation can be accepted into clinical practice.
In 2004, the UK's Policy Studies Institute conducted the first major survey of public attitudes towards potential solutions for the organ shortage crisis. The public perception of xenotransplantation was shown to be overwhelmingly negative.
Indeed, response to animal-to-human transplantation was so hostile that some respondents demanded that it be removed as an option on the survey. Although many respondents considered xenotransplantation unethical, the major concern was that animal viruses could infect humans and spread into the population.
Following the survey, an intriguing debate over the ethics of xenotransplantation took place in the pages of Philosophy Now. Making the case against xenotransplantation, Laura Purdy - professor emerita of philosophy at Wells College in Aurora, NY - commented that "the xeno debate proceeds as if saving lives is our top moral priority." She argues that, from this perspective, it suggests that the lives lost down the line as a result of perfecting xenotransplantation do not count.
"What about the 11 million babies and children who die every year from diarrhea, malaria, measles, pneumonia, AIDS and malnutrition?" she questioned. "What about the half-million women who die every year during pregnancy and childbirth when simple measures could save most of them?"
We asked Prof. Purdy why the fact that people die from matters unrelated to transplantation issues would morally preclude science from attempting to also solve the issue of organ donor shortages.
"I agree that, other things being equal, saying that people are dying from other causes doesn't show why we should not also tackle this cause," she replied.
"But once one has taken on board the larger risks to society, both from the research as well as the deployment of the technology, as well as the probability that this is merely a bridge technology that, hopefully will be made obsolete by future developments (such as partial or whole artificial hearts) or advances in public health (making headway against diabetes) and the probability that both research and implementation will be very expensive, that seriously erodes the case for proceeding.
Resources for health are far from infinite. There is a great deal that we could be doing now to advance human health that does not have these downsides - why not focus more there?"
Whether public attitudes toward xenotransplantation have mellowed in the decade since the Policy Studies Institute's survey is not currently known.
However, as the technology advances and the likelihood of implementation draws closer, so too must the public conversation over the perceived rights and wrongs of animal organ transplantation advance in order to hold the science accountable.
Do you have a view on this issue? If so, use our comments box to join the debate.
By Maureen Salamon
Pediatricians prescribe antibiotics about twice as often as they're actually needed for children with ear and throat infections, a new study indicates.
More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but supports the dangerous evolution of bacteria toward antibiotic resistance.
"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.
"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."
The study was published online on Sept. 15 in the journal Pediatrics.
Antibiotics, drugs that kill bacteria or stop them from reproducing, are effective only for bacterial infections, not viruses. But because doctors have few ways of distinguishing between viral or bacterial infections, antibiotics are often a default treatment.
To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.
Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.
But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.
"I thought it was really a clever study, actually, to get a sense of the burden of bacterial disease and what the antibiotic usage is," said Dr. Jason Newland, medical director of patient safety and system reliability, and associate professor of pediatrics at University of Missouri-Kansas City School of Medicine.
Newland, former director of the Antimicrobial Stewardship Program at Children's Mercy Hospital and Clinics in Kansas City, cited the 2013 "threat report" by the U.S. Centers for Disease Control and Prevention that indicated 23,000 Americans die each year due to antibiotic-resistant infections.
"We all know when we use antibiotics that we increase the chance of resistance because bacteria evolve," he said. "We need to use them well and not in such excess doses. We have to do way better."
A rapid strep test is currently available to distinguish between bacterial or viral throat infections. But other than that test, physicians have no other clinical tools to tell the cause of most upper respiratory infections, according to background information in the study. Kronman said he hopes the new research will not only help encourage the development of more such tools, but also spur clinicians to think more critically about prescribing antibiotics unless clearly needed.
Kronman added that prior research indicates that parents -- who often pressure pediatricians into prescribing antibiotics -- respond to alternate suggestions to alleviate their children's upper respiratory symptoms, such as using acetaminophen and humidifiers, instead of doctors simply saying they won't prescribe antibiotics.
"We have to take this [problem] on as a society," Newland said. "The reality is that the excess, unnecessary use of antibiotics is really putting us at great risk of not having these antibiotics [work] in the future."
By Debra Wood
Modern Healthcare readers selected four nurses in leadership roles to be ranked on this year’s 100 Most Influential People in Healthcare list, based on their effect on the industry.
“It’s great for nursing, because we do this together,” said Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, who made the magazine’s annual list for the first time, ranking 45th.
“I’m honored to be recognized,” she continued, “but I realize this is not about me. It’s about the hundreds and thousands of nurses working together to make the American Nurses Association a powerful force, to make nursing a powerful force, and to help our colleagues in health care and the general public understand the impact of nursing practice. I am the lucky person to be in the CEO role, but there are a lot of people making this happen.”
Other nurses in leadership who made the list included Marilyn Tavenner, agency administrator with the Centers for Medicare & Medicaid Services (CMS), listed fifth; Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association in Washington, D.C., 34th; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI) in Cambridge, Mass., 50th.
“The four nurses on Modern Healthcare’s 100 Most Influential People list this year are transformative and visionary leaders, and some of the brightest lights in the nursing world,” said Susan B. Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. “They are role models.”
Weston was one of 19 new people to join the list, which is dominated by elected and appointed government officials, top executives of health care industry corporations and physicians. Anyone can nominate a candidate. The magazine received 15,000 submissions for 2014. The top 300 nominees, including 10 nurses, were presented to Modern Healthcare readers for voting. Half of the candidates are selected through the reader votes and the other half by the magazine’s editors.
While not a nurse, RoseAnn DeMoro, executive director of National Nurses United (NNU), with 185,000 members, made the list again, at 41st.
“With the disproportionate economic influence of the hospital and insurance giants in particular, it is especially gratifying to see the name of RoseAnn and NNU on this list,” said NNU Co-president Deborah Burger, RN.
With the relatively small showing for nursing on this year’s list, opportunity exists for more nurses to move up to positions of leadership and influence.
“Nurses spend the most direct time with patients and, therefore, offer a vitally important perspective,” Keehan said. “As a nurse myself who moved into leadership, I encourage nurses to lend their voice to management decisions and consider leadership roles in their units or hospitals. It may not feel natural for some nurses to assert themselves, but the future of health care requires that we listen to their ideas and concerns. I hope to see many more nurses bring their passion for patient care and support of staff to the work of making health care better for everyone.”
Weston pointed out that nurses practice throughout the health care system, not only in hospitals but in home health, public health, primary care and long-term care. They observe when the system works and when it doesn’t for patients.
“That gives nurses the capacity to help make the system work for patents and communities and to redesign the system to transform and improve care,” Weston said. “Nurses are stepping forward to be leaders, and people are understanding nurses are not just functional doers of things, but thoughtful strategists.”
Weston expects more nurses will make the list in the years ahead. She encourages nurses to talk more about the work they do and the effect it has on people.
“The more we highlight the impact we are making, the more people will understand the great strategists and decision makers that nurses are,” Weston said. “There are a lots of pockets of innovation being led by nurses that are improving the quality of care, reducing the cost of health care and improving the access. We need to support each other in taking those pockets of innovation and spreading them.”
Weston has forged partnerships with other disciplines when delivering clinical care and when transforming the health care system.
“Health care is a team sport,” Weston said. “The degree we can work together catalyzes the work getting done.”
Increasing the number of nurses in leadership positions is one of the key recommendations of the Institute of Medicine’s groundbreaking Future of Nursing report and a central goal of the Campaign for Action.
“As the largest group of health professionals, and as those who spend the most time with patients, nurses have unique insight into health care,” Hassmiller said. “We need that insight at the highest levels of our health care system--on the boards of health care systems and hospitals; leading federal, state and local agencies; and more.”
Two members of the Campaign for Action’s strategic advisory committee made the 2014 Most Influential People in Healthcare list: Leah Binder, president and CEO of The Leapfrog Group, and Alan Morgan, CEO of the National Rural Health Association. Additionally, several members of organizations on the Champion Nursing Council and Champion Nursing Coalition were recognized.
“Health care transformation is underway in our country,” Hassmiller concluded. “Nurses possess the skills to ensure that the perspectives of people, families and communities remain front and center in any health decisions that get made.”
Meet the ‘Most Influential’ Nurses¹
5. Marilyn Tavenner, agency administrator with the Centers for Medicare and Medicaid Services, began her career as a nurse at Johnson-Willis Hospital in Richmond, Va., and spent 25 years working in various positions for HCA Inc., culminating as group president for outpatient services. Tavenner was one of several people in government to make Modern Healthcare’s annual list of the 100 Most Influential People in Healthcare.
34. Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association, started out as a nurse and served in the 1980s as Providence Hospital's vice president for nursing, ambulatory care, and education and training. She joined the Catholic Health Association in 2005. She told NurseZone that she hopes many more nurses will bring their passion for patient care to make health care better for everyone.
45. Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, has held a variety of nursing roles, including direct patient care in intensive care and medical-surgical units, nurse educator, clinical nurse specialist, director of patient care support and nurse executive. She has served as executive director of the Arizona Nurses Association and deputy chief officer of the Veteran’s Affairs Workforce Management Office. Weston reported that she has had great role models and mentors in her nursing career.
50. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, began as a staff nurse in 1973 at Quincy City Hospital, moved up and became chief operating officer in 1986, before joining IHI. Bisognano is one of many quality improvement leaders on this year’s Most Influential list.
Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.
Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.
Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.
Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip
Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.
Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.
With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!
By Dr. Chethan Sathya
Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.
This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case.
Such a device isn't far from reality.
Researchers in Canada are working on a surgical tracking box -- like the ones placed in airplanes -- that records surgeons' movements and identifies errors during an operation.
By pinpointing mistakes and telling surgeons when they're veering "off course," a black box could prevent future slip-ups, says Dr. Teodor Grantcharov, a minimally invasive surgeon at St. Michael's Hospital in Toronto. Unlike the so-called black boxes in aviation, which are used after disasters occur, the surgical black box Grantcharov is creating will be used proactively to prevent major patient complications.
A number of hospitals have already expressed interest in using the device, Grantcharov says.
But the litigious medical environment may make its implementation problematic. If the recordings were used in court, they could open the floodgates to a new wave of malpractice concerns, which would be counterproductive to surgeons and patients, Grantcharov says.
"We have to ensure the black box is used as an educational tool to help surgeons evaluate their performance and improve," he says.
A work in progress
Grantcharov's black box is a multifaceted system. In addition to the actual box, it includes operating room microphones and cameras that record the surgery, the surgeon's movements and details about team dynamics.
It will allow surgeons to hone in on exactly what went wrong and why.
The black box will eventually assess everything from how surgeons stitch to how delicately they handle organs and communicate with nurses during high-stress situations. Error-analysis software within the black box will help surgeons identify when they are "deviating" from the norm or using techniques linked to higher rates of complications.
So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.
"At this initial stage, we are analyzing surgeries to determine how many errors occur and which ones actually lead to bad results for patients," Grantcharov says. Not every error will result in a patient complication.
Grantcharov's initial research has shown that surgeons recognize few of their mistakes, and, on average, make about 20 errors per surgery -- regardless of experience level. Once Grantcharov's team determines which errors affect patient safety, it hopes to be able to provide this information to surgeons in real time. The team has also developed software that can synthesize the recorded data into user-friendly and interpretable information for surgeons.
The concept of using a black box in surgery isn't new. But until now, the technology never made it out of the laboratory because it lacked comprehensiveness, Grantcharov says. Earlier surgical black boxes didn't record all the important elements of the operating room, he says, leaving pieces of the puzzle missing.
"To truly understand what causes an error, you need to know all the factors that may come into play."
Grantcharov was inspired to develop the surgical black box after years of witnessing how patient complications affected surgeons.
"The feeling of not knowing what causes a complication, whether it's surgical technique, communication in the operating room or the patient's condition itself, is tormenting," Grantcharov says.
Many surgeons, however, may be uncomfortable with using a black box in the operating room, says Dr. Teodoro Forcht Dagi with the American College of Surgeons Perioperative Care Committee.
"If there was a legal requirement to record every operation, then many surgeons would be resistant," Forcht Dagi says. He says he believes doing so would create a sense of nervousness that would paralyze a surgeon's ability to operate and end up ultimately harming patients.
"The black box needs to be used solely by surgeons for their own education, in which case I think it's a great idea," Forcht Dagi says.
Errors during surgery have generally been dealt with after the fact, and only once a complication during the patient's recovery occurs. Weeks after surgery, cases with complications are presented to a panel of experts, who weigh in on what may have gone wrong during the operation.
Yet in many cases nothing is recorded apart from an audio transcript of the operation, making it tough to identify what caused each complication. The black box would add much needed context.
"I would rush (a black box) into service immediately," says Richard Epstein, professor of law at New York University's School of Law. Since most medical lawsuits end up being "he said, she said" arguments, not knowing exactly what happened in the operating room just adds to the level of distrust, Epstein says.
In the United States, the Healthcare Quality Improvement Act prevents courts from using data that doctors and hospitals use for peer review, a self-regulation process in which experts or "peers" evaluate one another. The law allows doctors to assess each other openly and identify areas for improvement without fear of litigation.
But there are exceptions to this rule, says William McMurry, president of the American Board of Professional Liability Attorneys. For instance, cases where surgeries are recorded but don't receive any peer review can be used in court.
While McMurry says that "keeping patients in the dark about the details of their surgery is never OK," he points out that litigation concerns should not derail use of the black box. It will be an asset to the health care system regardless of whether it can be used in court, he says.
"We care about better health care, and the black box will provide surgeons with the information they need to avoid mistakes," McMurry says. "It's a win-win situation."
The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America in the next few months. Talks are also under way with a number of American hospitals.
If doctors accept it, implementation in U.S. hospitals could happen quickly since the surgical black box isn't considered a medical device and doesn't require approval from the U.S. Food and Drug Administration.
Bottom line, Grantcharov says, is that even after years of practicing medicine, the black box "made me a safer surgeon and a better teacher."
"People tend to think that happiness in schizophrenia is an oxymoron," says senior author Dr. Dilip V. Jeste, distinguished professor of Psychiatry and Neurosciences at the University of California, San Diego School of Medicine.
"Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients," he adds. "This means we can help make these individuals' lives happier."
Dr. Jeste's team surveyed 72 schizophrenia outpatients in the San Diego area - all but nine of whom were taking at least one anti-psychotic medication. Just over half of the respondents were residents in assisted-living facilities.
A comparison group was comprised of 64 healthy men and women who did not currently use alcohol or illegal drugs and who had not been diagnosed with dementia or other neurological illnesses.
The mean age for both groups was 50 years.
In the survey, the respondents answered questions on their happiness over the previous week. They were asked to rate statements such as "I was happy" and "I enjoyed life" on a scale from "never or rarely" to "all or most of the time."
The results reveal that about 37% of the schizophrenia patients were happy most or all of the time, compared with about 83% of respondents in the comparison group.
However, about 15% of people in the schizophrenia group reported being rarely or never happy, but no one in the comparison group reported such a low level of happiness.
'Patients' happiness was unrelated to the severity or duration of their illness'
The researchers compared the self-reported happiness of the respondents with other factors including age, gender, education, living situation, medication status, mental health, physical health, cognitive function, stress, attitude toward aging, spirituality, optimism, resilience and personal mastery.
The study - which is published in the journal Schizophrenia Research - suggests that the patients' levels of happiness were unrelated to the severity or duration of their illness, cognitive or physical function, age or education. This is clinically significant because, among healthy adults, all of these factors are associated with a greater sense of well-being.
Lead author Barton W. Palmer, PhD, professor in the UC San Diego Department of Psychiatry summarizes the study's findings:
"People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising.
What is impressive is that almost 40% of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced."
By JANE E. BRODY
The teenage years can be tough enough under the best of circumstances. But when cancer invades an adolescent’s life, the challenges grow exponentially.
When the prospects for treatment are uncertain, there’s the fear of dying at so young an age. Even with an excellent chance of being cured, teenagers with cancer face myriad emotional, educational and social concerns, especially missing out on activities and losing friends who can’t cope with cancer in a contemporary.
Added to that are the challenges of trying to keep up with schoolwork even as cancer treatment steals time and energy, and may cause long-lasting physical, cognitive or psychological side effects.
Sophie, who asked that her last name be withheld, was told at 15 that she had osteosarcoma, bone cancer. After a bout of how-can-this-be-happening-to-me, she forged ahead, determined to stay at her prestigious New York high school and graduate with her class.
Although most of her sophomore year was spent in the hospital having surgery and exhausting chemotherapy, she went to school on crutches whenever possible. She managed to stay on track, get good grades — and SAT scores high enough to get into Cornell University.
Now 20, Sophie is about to start her junior year and is majoring in biology and genetics with a minor in computer science. She plans to go to medical school, so this summer she has been studying for the MCATs and volunteering at a hospital.
Her main concern now is that people meet and get to know her as a whole, normal person, not someone who has had cancer, which is why she asked that I not identify her further.
“I’m pretty healthy, and I don’t want people to think I’m weak and need special care,” she said in an interview.
“Having cancer puts other issues into perspective,” she added. “I feel like I have to do as much as I can. I’ve gotten involved in so much. I try to enjoy myself more. And I don’t regret for a minute how I’ve been spending my time.”
Sophie’s determination to do the most she can and her desire for normalcy are hardly unusual, said Aura Kuperberg, who directs an extraordinary program for teenagers with cancer and their families at Children’s Hospital Los Angeles. Dr. Kuperberg, who has a doctorate in social work, started the program, called Teen Impact, in 1988. It operates with the support of donations and grants and deserves to be replicated at hospitals elsewhere.
“The greatest challenge teens with cancer face is social isolation,” she said in an interview. “Many of their peers are uncomfortable with illness, and many teens with cancer may withdraw from their friends because they feel they are so different and don’t fit in.”
In the popular young adult novel “The Fault in Our Stars,” a teenager with advanced cancer says, “That was the worst part of having cancer, sometimes: The physical evidence of disease separates you from other people.”
Within the family, too, teenagers can feel isolated, Dr. Kuperberg said. “Patients and parents want to protect one another. They keep up a facade that everything will be O.K., and feelings of depression and anxiety go unexpressed.”
Teen Impact holds group therapy sessions for young patients, parents and siblings so they “don’t feel alone and realize that their feelings are normal,” Dr. Kuperberg said. The goal of the program, which also sponsors social activities, is to help young cancer patients — some still in treatment, others finished — live as normally as possible.
“For many, cancer is a chronic illness, with echoes that last long after treatment ends,” Dr. Kuperberg said. “There are emotional side effects — a sense of vulnerability, a fear of relapse and death, and an uncertainty about the future that can get in the way of pursuing their hopes and dreams. And there can be physical and cognitive side effects when treatment leaves behind physical limitations and learning difficulties.”
But, she added, there is often “post-traumatic growth that motivates teens in a very positive way.”
“There’s a lot of altruism,” she said, “a desire to give back, and empathy, a sensitivity to what others are going through and a desire to help them.”
Sophie, for example, took notes for a classmate with hearing loss caused by chemotherapy. She recalled her gratitude for the friend “who was there for me the whole time I was in treatment, who would come over after school and sit on the couch and do puzzles while I slept.”
One frequent side effect of cancer treatment now receiving more attention is the threat to a young patient’s future reproductive potential.
In an opinion issued this month, The American College of Obstetricians and Gynecologists urged doctors to address the effects of cancer treatment on puberty, ovarian function, menstrual bleeding, sexuality, contraceptive choice, breast and cervical cancer screening, and fertility.
“With survival rates pretty high now for childhood cancers, we should do what we can to preserve future fertility,” said Dr. Julie Strickland, the chairwoman of the college’s committee on adolescent health care. “We’re seeing more and more cooperation between oncologists and gynecologists to preplan for fertility preservation before starting cancer treatment.”
The committee suggested that, when appropriate, young cancer patients be referred to a reproductive endocrinologist, who can explore the “full range of reproductive options,” including the freezing of eggs and embryos.
For boys who have been through puberty, it has long been possible to freeze sperm before cancer treatment.
Although some female patients may be unwilling to delay treatment, even for a month, to facilitate fertility preservation, at the very least they should be offered the option, Dr. Strickland said in an interview.
She described experimental but promising possibilities, like freezing part or all of an ovary and then implanting it after cancer treatment ends. It is already possible to move ovaries out of harm’s way for girls who need pelvic radiation.
By Jason Lee
Surgeons in Beijing, China, have successfully implanted an artificial, 3D-printed vertebra replacement in a young boy with bone cancer. They say it is the first time such a procedure has ever been done.
During a five-hour operation, the doctors first removed the tumor located in the second vertebra of 12-year-old Minghao's neck and replaced it with the 3D-printed implant between the first and third vertebrae, CCTV.com reported earlier this month.
"This is the first use of a 3D-printed vertebra as an implant for orthopedic spine surgery in the world," said Dr. Liu Zhongjun, the director of orthopedics at No. 3 Hospital, Peking University, who performed the surgery.
The boy was playing football when he headed the ball and injured his neck, and it was later confirmed that he had a tumor, Minghao's mother said.
Prior to the surgery, the patient had been lying in the orthopedics ward for more than two months, and he could occasionally stand up, but only for a few minutes.
Normally, a diseased axis would be replaced by a standardized, hollow titanium tube, Liu told Reuters.
"Using existing technology, the patient's head needs to be framed with pins after surgery," as his head cannot touch the bed when he is resting for at least three months, he explained. "But with 3D printing technology, we can simulate the shape of the vertebra, which is much stronger and more convenient than traditional methods."
Five days after the surgery, Minghao still could not speak and had to use a writing board to communicate. However, doctors said at the time that he was in a good physical condition and they expected him to make a strong recovery.