DiversityNursing Blog

By Hannah Poturalski

A research effort underway at an area nursing home is testing out telehealth robots and other technology to enhance a patient’s ability to remain independent longer.

Students and faculty from the University of Cincinnati’s College of Nursing, as well as students from the colleges of medicine, engineering and allied health sciences, have partnered with Maple Knoll Village to develop innovative models using technology to help older adults stay independent and in their homes longer, said Tim McGowan, vice president of operations at Maple Knoll.

“The quicker we can develop the technology necessary to safely monitor them at home, the lower the cost of care will be and the quality of life for the patient returning home will improve,” McGowan said.

Every month more than a quarter-million Americans turn age 65. By 2015, for the first time in U.S. history, people age 65 and older will outnumber children under age five, according to the Council on Aging of Southwestern Ohio.

The partnership has opened a “smart house” on the Maple Knoll campus, formally called the Innovation Collaboratory House, inside an independent living unit for the UC students to conduct research and pilot new technologies.

Debi Sampsel, chief officer of innovation and entrepreneurship at UC, said the partnership developed in October 2012, and the smart house opened last spring for senior capstone classes in nursing and engineering.

Now hundreds of students are using the facility for education, research and translational practice.

“The house is about preparing them to come out into the community and hone in on their skills and techniques they’ll need in real positions,” Sampsel said. “We can start mirroring real life because they have to start thinking on their feet.”

A number of student-led projects are underway at the house, including the ability to control the temperature and lighting from a remote location, and motion detectors used to track patterns of activity in daily living to detect when an unexpected change in habit has occurred, said Megan Gresham, spokeswoman for Maple Knoll.

“Staff or family can be alerted if say they’re not getting out of bed at a certain time,” Gresham said.

Sampsel said students are also training on human simulators — with speech and movements controlled by a teacher in the next room — to learn the proper ways to take an IV, bathe a patient, take blood pressure and listen to the heart and lungs.

“This fits into our strategic plan to creatively leverage technology to change health care,” said Greer Glazer, dean of UC’s College of nursing.

After a public open house June 26, the UC students will start working with physicians on geriatric rounds at Maple Knoll. A large telehealth robot, called “Flo Bot,” will go along on the rounds and nurse practitioner students and college of medicine fellows will access the data remotely from UC.

A smaller telehealth system coined “Little Bot” will be used by students making rounds inside the independent living units of resident who have volunteered.

“I’m most appreciative for the resident support at Maple Knoll,” Sampsel said. “It really brings home what their (the students’) health care profession is going to be all about.”

Sampsel said the two entities are developing a formal agreement to be reached this summer.

Source: journal-news.com 

BY ROSE RUSSELL

Kevin Cischke left a music career after 25 years to pursue a new one in nursing, and it won’t bother him that he’ll be a man in a profession largely dominated by women.

As the face of the nursing profession slowly changes, Mr. Cischke, 45, is among the growing number of men signing up for the job. According to the U.S. Census Bureau, slightly less than 10 percent of the 3.5 million nurses in 2011 were men. That’s up from 1970, when only 2.7 percent of nurses were males.

For Mr. Cischke – who will receive a bachelor’s in nursing next year from Mercy College — nursing is in line with his interests. When introduced to nursing, the former organist and choir master for the Archdiocese of Detroit fell in love with it.

“A couple of my close friends who are nurses said I should look into this profession to see if it would interest me,” he said, during a break from his externship in the emergency room at Mercy St. Vincent Medical Center. “It was a whirlwind love affair that has not ended, and I don’t suspect that it will.”

Craig Albers, chief nursing officer and vice president of patient care services at Mercy St. Charles Hospital, said men in nursing offer an important component in the delivery of public health care.

“In the past, nursing was more of a pink collar profession and more of a career for women. A lot of times it’s seen as a profession for Caucasian women. Now, with large numbers of baby boomers retiring and seeking health care, we need a diverse workforce able to work with a diverse population,” said Mr. Albers.

A nurse himself since 1998, he began his college studies pharmacy. When he decided he needed more patient interaction, a professor suggested he look into nursing.

“I job shadowed an ICU nurse and the role really appealed to me. That’s what led me to the profession,” he said.

It was the patients who also attracted Mr. Cischke.

"I enjoy the patient-care side of things. I wanted hands-on patient care. That's what drives me, and the fact that I can continue to learn and grow fits my personality perfectly," he said.

He also liked contributing to the profession and addressing concerns of his male peers. In fact, when they discovered something missing in their nursing school experience, he led the way to establishing a local chapter of the American Assembly of Men in Nursing. The organization addresses issues that affect men in nursing. About 20 men and five women are members of the group.

"I continued to explore what the assembly had to offer, promote, and to accomplish and I realized that their goals aligned with what we needed to have at Mercy to support our male students," said Mr. Cishke, one of 116 male students in the nursing program.

The organization will also help groom male nurses for retiring baby boomers who increasingly use health care. Health professionals who deliver care to boomers must be on their toes.

"Our baby boomer population will be very informed and knowledgeable and Internet and computer savvy, and people going into the nursing profession will have to be extremely knowledgeable and confident and able to communicate with their patients because the patients are very knowledgeable," said Mr. Albers.

While male nurses' physical strength is also a plus for patient care, Mr. Albers said more men joining the field may pursue advanced fields in nursing, such as management, administration, business, and anesthetics. Those advanced career possibilities attracted Daniel Koehler to the profession.

He received a bachelor's in nursing from Lourdes University in December. Eight years ago, he obtained a bachelor's in human biology from Michigan State University. He then worked in the restaurant and fitness businesses before going to nursing school.

He wasn't intimidated by the predominantly female profession, and in fact received positive responses from others.

"Most guys don't grow up thinking they want to be nurses," as many girls do, said Mr. Koehler, whose mother was a nurse in Germany. "With the guys I've met in the profession, I think less of that stigma now days."

Though slightly less than 10 percent of ProMedica's nurses are men and slightly more than 8 percent of the nurses in the Mercy health system are men, the idea that nursing is a woman's job stopped Roberta Pratte's father and grandfather, both medics in the military, from continuing in the profession. As a teenager, Ms. Pratte — a Mercy nursing professor — recalls hearing her grandfather speak fondly about nursing.

"Back then it wasn't something that men talked about or thought about. I sensed that they regretted that they were not allowed to follow their dream," said Ms. Pratte, an instructor at Mercy College. She has been a nurse for 33 years, and her mother was also a nurse.

Large numbers of nurses are expected to retire soon, adding to the already critical nursing shortage. That's why the profession is pushing to attract men and women into nursing. As a matter of fact, the American Assembly for Men in Nursing is campaigning to increase the number of male nurses by 20 percent by the year 2020, said Ms. Pratte. She also said the Institute of Medicine and the Centers for Disease Control and Prevention are reviewing how to fill nursing positions to ensure that the public gets proper care.

Source: toledoblade.com

By Stacey Burling

The nurses' emotional response to George's impending loss was a sign of the emotional power of narrative, which the National League for Nursing is harnessing to improve education about late-life medical problems. The group also is embracing a multimedia approach that includes the written word, audio recordings of the "patients" voiced by actors, simulations that include mannequins and live actors, and the latest addition: virtual animations of the patients and nurse avatars who make treatment decisions.

"Traditional-based teaching is really over for most of us," Elaine Tagliareni, the league's chief program officer, told the crowd of about 175 who had gathered for her group's Advancing Care Excellence for Seniors conference. The Independence Blue Cross Foundation is a sponsor. Using technology to improve care was a theme this year.

The nursing group wants to reach a new generation of students who are already accustomed to multimedia learning, may be taking classes online, and will work in a world where technology increasingly connects patients, doctors, and nurses who are not in the same room.

Medical and nursing schools have long used standardized patients: actors who portray certain medical conditions. Increasingly sophisticated mannequins have been playing a bigger role in medical education in recent years.

Drexel University's College of Nursing and Health Professions began using a virtual-patient program produced by Shadow Health last year. It is meant to reinforce classroom training. The University of Pennsylvania School of Nursing also is using a Shadow Health program to teach nurses how to take a health history and perform a physical exam.

Gregg Lipschik, director of life-support training and undergraduate curriculum at the Penn Medicine Clinical Simulation Center, said Penn sometimes uses a virtual program to review resuscitation techniques. It pairs computer simulation and mannequins to teach procedures such as bronchoscopies.

Lipschik said use of simulation had been growing since 1999, when an Institute of Medicine report recommended it to reduce medical errors and improve teamwork. "It's really boomed in the last few years," he said.

The nursing league began its Advancing Care program in 2009, Tagliareni said, because "care of older adults is not well integrated into nursing programs" even though 75 percent of the care nurses give is to people over 65. It's adding the new dementia cases to expand education on another neglected topic.

The patient profiles are purposely complicated - like real people - and they unfold over time in unpredictable ways. The death of George Palo's golden retriever is a calamity not only because George's grief adds to his thinking problems but because walking Max was a key way the man exercised and interacted with the outside world. The profiles are accompanied by teacher information.

Tagliareni said that the dementia patients may not end up in the virtual world but that other fictitious elderly characters like Millie Larsen and Red Yoder may be available this fall in the gamelike "vSim for Nursing" program developed by Wolters Kluwer Health of Philadelphia and Laerdal Medical.

An audience member said her students easily identified with the league's patients. "That's my Pop-Pop," one of them told her.

The group at the meeting saw a younger virtual patient named Stan and his virtual nurse, Dan. Stan had gone to the emergency room with stomach pain from a bowel obstruction. The student, who had access to test information and doctor's orders, had to use a menu of options to decide what Dan should say and do. The animation was primitive, but the decisions were complex. At the end of their 30-minute encounter, the student received a number score and a report on what had been done and should have been done.

Barbara McLaughlin, head of nursing at Community College of Philadelphia, did a pilot test of vSim, which costs $100 per student for two years of access, with her students last year. "They liked them [the scenarios] a lot because it gave them the opportunity to do the same experience over and over and correct their mistakes," she said.

Source: philly.com

Wolters Kluwer Health

Concerted effort is needed to reverse the ongoing rise in pertussis cases and deaths, especially among children and young people, according to the article in the Journal of Christian Nursing by Emily Peake, APRN, MSN, FNP-C, CLC, and Lisa K. McGuire, MSN, MBA-HCM, RN. "This effort begins with nurses and nurse practitioners and other primary care providers who educate patients and the public," they write. "The battle of pertussis is winnable through education, awareness, and vaccination."

Caused by infection with Bordetella pertussis  bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.

Why is pertussis on the rise? "Ambivalence toward precautionary childhood vaccinations" is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, "Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases."

Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there's evidence that even non-religious parents are using these exemptions to avoid vaccinating their children.

Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.

"Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines," Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.

The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. Closer to home, partnerships should be formed with service organizations, food banks, churches, hospitals and schools. "These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations," the authors write. "Faith community nurses are in an ideal role to create and lead these partnerships."

Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, "By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime."

Source: infectioncontroltoday.com

By Jeffrey S. Solochek

TRINITY, Fla. (AP) — Evan Wolin sat patiently in his slightly oversized cap and knee-length black gown, waiting his turn.

One by one, the teacher called his classmates to the stage. Then, finally, she read his name.

Evan burst from his seat, sped to the front and grabbed his diploma, a huge smile eclipsing his face. He thrust the paper into the air with an extra arm pump, as his mom, Jessica, tried not to cry while she captured it all on her phone.

He was so ready for kindergarten.

____

Nearly three years ago, when Evan first entered Longleaf Elementary's preschool program for children with developmental delays, few predicted that this day would come.

At 2 1/2 years old, he had barely begun walking, hadn't started talking and coped daily with many medical problems stemming from being born a micropreemie.

"On paper, his medical diagnosis had us thinking, 'Oh, my,' " recalled school speech pathologist Janice Whittaker.

Since he still sometimes used a feeding tube, some of the staff at Longleaf thought Evan might be better suited for a program at Cotee River Elementary, which had dedicated nurses on staff. But his mom, a special-education teacher, and dad, a school administrator, did not want their son in a medical unit.

"I knew developmentally I wanted him in the area school. I knew that he had more in him," Jessica Wolin said. "Although he wasn't speaking, although he wasn't eating, I knew he was very bright. . I always wanted him to be challenged."

Teacher Heather Goldstein, also a neighbor of the Wolins who remembered seeing Evan come home as an infant "with every tube connected to him," committed to making her classroom work for his needs.

"As soon as they told me, I went right online to research everything," she said. "I thought, if he is coming I want to make sure I have everything in place."

Before he arrived, Goldstein reorganized the furniture in her book- and toy-filled classroom to make it easier for Evan to navigate. She continued to learn about his medical demands and prepare for his academic requirements, communicating with his family to keep them informed on daily activities.

Jessica Wolin praised Goldstein's dedication, saying the teacher went above and beyond to make Evan feel at home in school and to help ensure his success. District special-education prekindergarten coordinator Kelli Boles never doubted it.

Goldstein, Boles said, exemplifies what the school district wants from its teachers in the program, which is federally funded and guaranteed to all eligible children with special needs ages 3 to 5. When other educators need training or classroom ideas, Boles sends them to Goldstein.

"She knows where the kids are, what they need to work on," Boles said. "She's the model of what I would like to see for all classrooms."

Goldstein's overriding philosophy is simple: Treat all kids like typical kids, set high expectations and then help them get there. She's taught her special-needs preschoolers to read and write that way, not to mention how to speak and socialize.

____

During a recent class day, Goldstein had Evan working with pattern blocks, where he would match colored plastic shapes to a design on a paper. She had him count yellow hexagons to figure out how many he needed to complete the pattern. Then she turned to another set of pieces.

"What do we call the blue?" she asked. "We used to call them diamonds, but now that you're going to kindergarten we have to call them ..."

"Rom," Evan said, looking up at Goldstein for affirmation.

"Rhombus," she said, completing the word.

"I love rhombus," Evan said cheerfully, placing them on the pattern and then sweeping them all away to start again. "I did it!"

"What do you get to do now?" Goldstein asked.

"Build a tower!" Evan shouted. He started to stack pieces, knock them down and repeat.

____

Goldstein refuses to take full credit for Evan's progress. Parents must participate actively, she said, and the child must be determined, too, in order for them all to find success.

That collaboration shone through for Evan, she said. "He amazes me every year."

His mom feels much the same.

When he was born at 24 weeks weighing 1.5 pounds, some people wondered whether he would even survive. She kept the faith through illnesses and surgeries for short-bowel syndrome, months in the hospital, feeding tubes, therapists.

Would he walk? Would he talk? Would he eat?

Now he races around at breakneck speed, bouncing from his pet hamster to his stash of toy cars, climbing on furniture and jabbering nonstop. He loves bacon and pancakes (and syrup and eggs), and though he's still small for his age, he loves to play with as much abandon as any 5-year-old.

In April, he was named Longleaf's pre-K student of the month.

Program coordinator Boles had nothing but good to say about Evan's progress, which includes his move to a traditional kindergarten class in the fall.

"He is like the poster child of why we do this, because early intervention works," she said, expressing hope that more families would enroll their eligible children in the classes.

Jessica Wolin, meanwhile, looks forward to Evan's next adventure. Sure, she's nervous about kindergarten, just like she was about so many other steps in her son's life.

But "he's done all those things. I want to be surprised by him. I want to see the next surprise."

Source: ksl.com

By MICHELLE ANDREWS

School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student's seizure or asthma attack, among many other things.

And though school nurses see many students regularly, they don't always have the most up-to-date information about the students' health. School nurses must get permission from parents to communicate with a child's doctor. Once the doctor gives them a care plan for the child, they generally rely on the doctor and/or parents for updates and changes.

"When things change, we don't always get told in a timely manner," says Nina Fekaris, a school nurse in the Beaverton, Ore., school district. "It works, but it takes a lot of coordination."

At the same time, school-based health care is unfamiliar territory to many medical professionals, who operate in a health care universe largely separate from school clinics and other community-based medical services.

In Delaware, "lots of nurses expressed that they had difficulty communicating with providers" at Nemours Health System, which serves children around the state, according to Claudia Kane, program manager of the Student Health Collaboration at Nemours.

In 2011, Nemours got together with the Delaware School Nurses Association and the state Department of Education to develop a program that, with parental approval, gives school nurses read-only access to the electronic health records of more than 1,500 students who have complex medical conditions or special needs. That includes conditions such as diabetes, asthma, attention deficit hyperactivity disorder, seizure disorders or gastrointestinal problems.

Beth Mattey, a school nurse in Wilmington, says that now that she has access to the Nemours system, she can check the recent lab test results of a student who has diabetes. "It's helpful for me to monitor his [blood sugar levels] and work with him to make sure he's in better control," says Mattey, who is president-elect of the National Association of School Nurses.

When a student put a staple through his finger, Mattey was able to check to make sure he went to the doctor and got treatment. "Checking with him directly involves calling him out of class," she says.

Eventually, school nurses will be able to put information into the Nemours electronic records system as well, says Kane.

In the meantime, Nemours doctors, some of whom were initially skeptical about allowing school nurses access to health system medical records, are warming up to the arrangement. Kane says it encourages communication between physicians and school nurses, and eases the burden of routine tasks because Nemours doctors no longer have to fax over care plans or instructions to the school nurse every few months for students who are part of the program.

The Nemours Student Health Collaboration project is operating in all Delaware public school districts as well as half of charter schools and about one-third of private schools. Kane says Nemours plans to extend the program to school-based health centers next.

Source: npr.org

Do you think they should have access to medical records?

By Alexandra Sifferlin

After six years of trying, scientists have discovered a way to genetically modify mosquitoes so they produce sperm that will only conceive male offspring.

Female mosquitoes are the ones who bite people and pass along malaria, so scientists think if they can significantly lower the number of female mosquitoes the rate of malaria will also go down. In their researchpublished in the journal Nature Communications, the researchers created a modified strain of mosquitoes that produced 95% male offspring.

When they introduced the strain to a five caged wild mosquito populations, the modified pests eradicated entire mosquito populations in four of them. There were too few females for the populations to survive. The researchers hope that this same scenario could happen in the wild, and malaria-carrying mosquitoes could die off.

Their findings are important because the scientists are the first to interfere in the sex ratios of mosquitoes, and their strategy could be successful in eliminating malaria, which remains a fatal disease in some sub-Saharan regions in Africa. Malaria prevention methods worldwide have brought down malaria mortality rates by 42%, but scientists are concerned over insecticide-resistant mosquitoes that pass along drug resistant malaria.

“The research is still in its early days, but I am really hopeful that this new approach could ultimately lead to a cheap and effective way to eliminate malaria from entire regions. Our goal is to enable people to live freely without the threat of this deadly disease,” said study author Roberto Galizi from the Department of Life Sciences at Imperial College London in a statement.

Source: time.com

By Karen Weintraub

The parents of children with autism often have to cut back on or quit work, and once they reach adulthood, people on the autism spectrum have limited earning potential.

Those income losses, plus the price of services make autism one of the costliest disabilities – adding $2.4 million across the lifespan if the person has intellectual disabilities and $1.4 million if they don't, according to a new study published in the journal JAMA Pediatrics.

"We've known for a long time autism is expensive, but we've really never had data like this to show us the full magnitude of the issue," said Michael Rosanoff, associate director of public health research for the advocacy group Autism Speaks, which funded the research. "These are on top of the costs to care for a typically developing individual."

Jackie Marks knows the problem firsthand. The Staten Island, N.Y., mom has 13-year-old triplets, all on the spectrum and all with intellectual deficits.

Everything about their care costs more money, she says, from the diapers and wipes she still has to buy to the specially trained babysitters she has to hire every time she wants to go out. For karate classes, she has to pay for one-on-one lessons; the therapist helping with social skills costs $150 an hour per child.

"I enjoy my children immensely," Marks said. "I have a wonderful husband. That, at the end of the day makes it all worth it. But is it like a typical experience? No."

Marks quit her job with the state as a bank auditor to care for Tyler, Dylan, and Jacob. Her husband's job not only has to cover day-to-day needs, but he has to put away enough money to pay for both her and the boys after he retires. She hopes the boys will be able to work someday, but they'll never have the kind of earnings that will sustain them, she said, and will probably receive modest Social Security benefits once they turn 18.

Four things need to change to bring down the cost of autism for families and society, according to David Mandell, director of research for the Center for Mental Health Policy and Services at the University of Pennsylvania.

Adults on the spectrum need more job opportunities. There are many small success stories of individuals or small groups of people with autism who are employed, but "we need to be more creative about thinking about employment on a large scale," Mandell said.

Adult care must be improved so only people who really need expensive residential care get it, and everyone else can find support in their own community, he said. "I think in too many cases, these residential settings represent a failure of our society to provide community-based, cheaper options," he said. "More flexible, cheaper options would be a way to bring these costs down."

Families with autism need more opportunities to stay in the workplace. "Issues that face autism ultimately face all families," Mandell said. "If we had more family-friendly workplace policies, we might see substantial change in the way families were able to manage the work-life balance when they had children with (all kinds of) disabilities."

Society needs to take the long view, he said. Spending money diagnosing and helping young children on the spectrum will probably save money when they are older, by reducing disability and improving employability. "We often talk about the cost of care, and we don't spend much time talking about the cost of not caring," he said.

NUMBERS:

•Cost of supporting someone with an autism spectrum disorder plus intellectual disability: $2.4 million in the USA and 1.5 million pounds in the United Kingdom ($2.2 million in U.S. dollars)

•Cost of supporting someone with an autism spectrum disorder but no intellectual disability: $1.4 million in the USA and .92 million pounds in the United Kingdom ($1.4 million)

Source: usatoday.com

By KAREN KAPLAN

Another influenza season is in the books, and overall it caused less sickness and death than flu seasons in the recent past, according to a new report from the Centers for Disease Control and Prevention.

Between Sept. 29, 2013, and May 17, 2014, a total of 53,471 specimens sent to U.S. labs tested positive for a flu virus. Among them, 87% were influenza A viruses, and the most common of these were versions of the H1N1 virus that prompted the swine flu epidemic in 2009. The other 13% of the confirmed specimens were influenza B viruses.

The CDC findings, which were published Thursday in the Morbidity and Mortality Weekly Report, did not estimate a total number of flu deaths for the 2013-14 flu season. But based on records kept by doctors and hospitals, researchers concluded that flu activity in the last year resulted in “lower levels of outpatient illness and mortality” compared with years when the predominant strains were versions of the H3N2 virus.

At least 96 children died of the flu in the last year, laboratory tests confirmed. Those deaths were reported in 30 states, New York City and Chicago. In about half of these cases, the patients had at least one preexisting condition, such as a neurologic disorder or a pulmonary disease, that may have made them more vulnerable to the flu.

The most striking statistic in the report is the rate of hospitalization among people between the ages of 50 and 64. Over the course of the entire flu season, the cumulative hospitalization rate for these adults was 54.3 per 100,000 people. In the previous four years, that figure has been as low as 8.1 and it never topped 40.6.

The report noted one human case of a H3N2 virus that was first spotted in pigs in 2010 and was identified in a dozen people the following year. The new case was a child from Iowa who had direct contact with pigs. The patient fully recovered, apparently without spreading it to relatives or anyone else, according to the CDC.

The vaccine for the 2014-15 flu season will be based on the same four viruses, the CDC said.

Source: latimes.com

By KATE MURPHY

PITTSBURGH — Trauma patients arriving at an emergency room here after sustaining a gunshot or knife wound may find themselves enrolled in a startling medical experiment.

Surgeons will drain their blood and replace it with freezing saltwater. Without heartbeat and brain activity, the patients will be clinically dead.

And then the surgeons will try to save their lives.

Researchers at the University of Pittsburgh Medical Center have begun a clinical trial that pushes the boundaries of conventional surgery — and, some say, medical ethics.

By inducing hypothermia and slowing metabolism in dying patients, doctors hope to buy valuable time in which to mend the victims’ wounds.

But scientists have never tried anything like this in humans, and the unconscious patients will not be able to consent to the procedure. Indeed, the medical center has been providing free bracelets to be worn by skittish citizens here who do not want to participate should they somehow wind up in the E.R.

“This is ‘Star Wars’ stuff,” said Dr. Thomas M. Scalea, a trauma specialist at the University of Maryland. “If you told people we would be doing this a few years ago, they’d tell you to stop smoking whatever you’re smoking, because you’ve clearly lost your mind.”

At normal body temperatures, surgeons have less than five minutes to restore blood flow before brain damage occurs. CreditUniversity of Pittsburgh Medical Center

Submerged in a frozen lake or stowed away in the wheel well of a jumbo jet at 38,000 feet, people can survive for hours with little or no oxygen if their bodies are kept cold. In the 1960s, surgeons in Siberia began putting babies in snow banks before heart surgery to improve their chances of survival.

Patients are routinely cooled before surgical procedures that involve stopping the heart. But so-called therapeutic hypothermia has never been tried in patients in which a penetrative wound has already occurred, and until now doctors have never tried to replace a patient’s blood entirely with cold saltwater.

In their trial, funded by the Department of Defense, doctors at the University of Pittsburgh Medical Center will be performing the procedure only on patients who arrive at the E.R. with “catastrophic penetrating trauma” and who have lost so much blood that they have gone into cardiac arrest.

At normal body temperatures, surgeons typically have less than five minutes to restore blood flow before brain damage occurs.

“In these situations, less than one in 10 survive,” said Dr. Samuel A. Tisherman, the lead researcher of the study. “We want to give people better odds.”

Dr. Tisherman and his team will insert a tube called a cannula into the patient’s aorta, flushing the circulatory system with a cold saline solution until body temperature falls to 50 degrees Fahrenheit. As the patient enters a sort of suspended animation, without vital signs, the surgeons will have perhaps one hour to repair the injuries before brain damage occurs.

After the operation, the team will use a heart-lung bypass machine with a heat exchanger to return blood to the patient. The blood will warm the body gradually, which should circumvent injuries that can happen when tissue is suddenly subjected to oxygen after a period of deprivation.

Dr. Tisherman and his colleagues plan to try the technique on 10 subjects, then review the data, consider changes in their approach, and enroll another 10. For every patient who has the operation, there will be a control subject for comparison.

The experiment officially began in April and the surgeons predict they will see about one qualifying patient a month.

It may take a couple of years to complete the study. Citing the preliminary nature of the research, Dr. Tisherman declined to say whether he and his colleagues had already operated on a patient.

Each time they do, they will be stepping into a scientific void. Ethicists say it’s reasonable to presume most people would want to undergo the experimental procedure when the alternative is almost certain death. But no one can be sure of the outcome.

“If this works, what they’ve done is suspended people when they are dead and then brought them back to life,” said Dr. Arthur L. Caplan, a medical ethicist at New York University. “There’s a grave risk that they won’t bring the person back to cognitive life but in a vegetative state.”

But researchers at a number of institutions say they have perfected the technique, known as Emergency Preservation and Resuscitation, or E.P.R., in experimental surgeries on hundreds of dogs and pigs over the last decade.

As many as 90 percent of the animals have survived in recent studies, most without discernible cognitive impairment — after the procedure, the dogs and pigs remembered old tricks and were able to learn new ones.

“From a scientific standpoint, we now know the nuts and bolts and that it works,” said Dr. Hasan B. Alam, chief of general surgery at the University of Michigan Medical Center, who has helped perfect the technique in pigs.

“It’s a little unsettling if you think of all the what ifs, but it’s the same every time you push into new frontiers,” he added. “You have to look at risk and balance it against benefits.”

Trauma accounts for more years of life lost than cancer and heart disease combined, and it is the leading cause of death in people up to age 44, according to the Centers for Disease Control and Prevention. Surgeons are eager for new techniques that would help better the odds in emergency situations. Black males are disproportionately victims of homicide, especially gun violence, and most of the patients likely to fit the study criteria in Pittsburgh are African-American males, according to officials at the medical center.

In order to obtain an exemption to federal informed consent rules, the hospital held two town hall meetings on the university campus, placed advertisements on buses, and made sure the news got in newspapers catering to minority readers.

Officials posted information about the study on a website,acutecareresearch.org, and conducted a phone survey in the neighborhoods most at risk for “involuntary enrollment” in the trial. Still, a taxi driver, grocery clerk and security guard — all African-American men approached at random — said they had never heard of the trial, though they work within a couple of miles of the hospital.

They also did not object. “I don’t have a problem with it, if it saves lives,” said Charles Miller, a 52-year-old security guard.

Just 14 people have so far requested “No E.P.R.” bracelets, according to the medical center.

Nearly a half-dozen trauma hospitals may join the trial and begin testing the hypothermia procedure on dying patients, including the University of Maryland Medical Center in Baltimore.

Dr. Scalea, who will head the effort there, said he hoped to receive final regulatory approval by the end of the year.

He recalled a recent stabbing victim who died on his operating table.

“He might have lived if we could have cooled him down,” Dr. Scalea said.

Source: nytimes.com