DiversityNursing Blog

Honor Whiteman

Dogs are often referred to as "man's best friend," and a new study brings further strength to this term after revealing how a rescue dog called Frankie was able to detect the presence of thyroid cancer in human urine samples with almost 90% accuracy.

According to the research team, from the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Frankie - a male German Shepherd-mix - is the first dog that has been trained to differentiate benign thyroid disease and thyroid cancer by sniffing human urine samples.

Thyroid cancer is a cancer that begins in the thyroid gland, situated just below the thyroid cartilage in the front of the neck. Approximately 62,450 new cases of thyroid cancer will be diagnosed in the US this year, and around 1,950 Americans will die from the disease.

Unlike most other cancers, thyroid cancer is more common among younger adults, with almost 2 in 3 cases diagnosed in people under the age of 55.

Diagnostic techniques for thyroid cancer include fine-needle aspiration biopsy, which involves the patient having a thin needle inserted into the thyroid gland in order to obtain a tissue sample.

Senior investigator Dr. Donald Bodenner, chief of endocrine oncology at UAMS, says the diagnostic accuracy of canine scent detection is almost on par with that of fine-needle aspiration biopsy, but it would be an inexpensive and noninvasive alternative.

What is more, he notes many current methods for diagnosing thyroid cancer can be inaccurate, causing some patients to undergo needless surgery.

"Scent-trained canines could be used by physicians to detect the presence of thyroid cancer at an early stage and to avoid surgery when unwarranted," he adds.

Frankie trained to sniff out cancer in human urine samples

For their study, recently presented at The Endocrine Society's 97th Annual Meeting in San Diego, CA, Dr. Bodenner and colleagues obtained urine samples from 34 patients who attended the UAMS thyroid clinic.

All patients showed abnormalities in their thyroid nodules and went on to have biopsies and diagnostic surgery. Thyroid cancer was identified in 15 patients while 19 had benign thyroid disease.

Frankie - who the researchers say had been previously trained to recognize the smell of cancer in human thyroid tissue - was presented with the urine samples to sniff one at a time by a gloved dog handler.

While humans have around 5 million smell receptors, or olfactory cells, dogs possess around 200 million, making their sense of smell around a thousand times stronger than that of humans. 

Frankie alerted the handler to a cancer-positive urine sample by lying down, while turning away from the urine sample alerted the handler to a benign status. 

The authors note that the cancer status of each urine sample was unknown to both the dog handler and the study coordinator.

The handler also presented Frankie with urine samples with a known cancer status in between the study samples so the dog could be rewarded for achieving a correct answer.

30 out of 34 samples correctly identified with canine scent detection

On comparing Frankie's results with those of the final surgical pathology report for the samples, the team found the dog correctly identified the status of 30 out of 34 samples.

The sensitivity, or true-positive rate, of the canine scent detection came in at 86.7%, while specificity, or true-negative rate, was 89.5%. This means Frankie correctly identified a benign sample almost 9 in every 10 times.

The team notes that canine scent detection led to two false-negative and two false-positive results. The researchers now plan to expand their research by teaming up with Auburn University College of Veterinary Medicine, AL, who have agreed to assign two of its bomb-sniffing dogs to thyroid cancer detection training.

This is not the first time Medical News Today have reported on the cancer-detection talent of dogs. In May 2014, a study by Italian researchers revealed how specially trained dogs were able to detect prostate cancer in urine samples with 98% accuracy.

Source: www.medicalnewstoday.com

Liberia released its last Ebola patient, a 58-year old English teacher, from a treatment center in the capital Thursday, beginning its countdown to being Ebola-free.

"I am one of the happiest human beings today on earth because it was not easy going through this situation and coming out alive," Beatrice Yardolo said after her release.

She says she became infected while caring for a sick child.

"I was bathing her. I used to carry her from the bathroom alone because nobody wanted to take any risk. That is how I got in contact," she said.

Yardolo, a mother of five, said she had been admitted to the Chinese-run Ebola treatment center in Monrovia on Feb. 18.

"I am so overwhelmed because my family has been through a very difficult period from January to now. And to know that it's all coming to an end is a very delightful news. I'm so happy," Yardolo's son, Joel Yardolo, told reporters.

Tolbert Nyenswah, assistant health minister and head of the country's Ebola response, says there are no other confirmed cases of Ebola.

"For the past 13 days the entire Republic of Liberia has gone without a confirmed Ebola virus disease," Nyenswah told reporters. "This doesn't mean that Ebola is all over in Liberia."

After a 42-day countdown - two full incubation periods for the virus to cause an infection - the country can be declared Ebola-free. Officials are monitoring 102 people who have been in recent contact with an Ebola patient.

Since the epidemic started a year ago, Liberia has recorded 9,265 cases of Ebola, with 4,057 deaths. But the World Health Organization says there are almost certainly more cases than that. WHO says close to 24,000 cases have been recorded, and close to 10,000 deaths, in the entire West African epidemic.

-- The Associated Press and Reuters contributed to this story

Source: www.nbcnews.com

ELIZA MURPHY

It’s a battle they never thought they’d face, let alone at the same time.

Missy and Brooke Shatley, a mother and daughter from Prairie Farm, Wisconsin, both have cancer. They were diagnosed only 13 days apart.

“It’s that unbelief,” Missy, 38, told ABC News of her reaction when they learned the devastating news. “You feel numb like this can’t really be happening. This is happening to somebody else, it could never be you.”

Missy was diagnosed with stage 2 cervical cancer on December 26, the day after Christmas.

“I went in for my annual physical and that was the result of it,” she explained.

Then on January 8, Brooke, Missy and her husband Jason’s oldest child, was diagnosed with stage 3 ovarian cancer.

“Why us? Why?,” Missy asked. “Is it something in our water? Is it genetic? Why both of us in such a short time frame? The doctor said it’s not the water, it’s not the environment, it’s just a freak act of nature.”

Before Missy’s diagnosis, Brooke, 14, had been experiencing severe abdominal pain that went undiagnosed for several weeks.

“The doctors told us she had a baseball-sized hemorrhagic disc and it would go away on its own and we should just wait,” Missy explained. “We waited for a few weeks and thought, ‘This is ridiculous,’ and we sought a second opinion.”

The Shatley’s then took Brooke to see the same specialist that had just diagnosed her mom days earlier. The devastating news was that Brooke’s tumor was larger than they originally suspected and needed to be operated on immediately.

“It was a four-and-a-half hour surgery,” Missy recalled. “It was a football-sized tumor. It had intertwined in her abdomen. You couldn’t tell by looking at her belly, but it was football-sized.”

The brave mother-daughter duo began undergoing intense treatments at the same time in Marshfield, Wisconsin, about two hours from their home--understandably weighing heavily on husband and father Jason, a dairy farmer, who was traveling back and forth to take care of them while also tending to their other two children and maintaining their farm.

“It’s hard,” Missy said. “Just to even think, ‘That’s my wife and daughter,’ how does anybody deal with that? Plus we have two other kids at home so he’s trying to be a husband, father, keep up with the farm, he’s being pulled in so many directions, how do you even begin?”

This week has been better for the family, however. Both Missy and Brooke are back home, resting and enjoying their time, although possibly brief, out of the hospital.

Missy just completed her final round of radiation and chemotherapy on March 2. She now must wait eight to 12 weeks before they can tell how effective the treatment was on her cancer.

Brooke still has one more round of chemo to complete, tentatively scheduled to begin on March 9.

Although their simultaneous diagnosis has been difficult, Missy says, in a way, it’s been nice to have that newfound bond with her daughter.

“You don’t want to experience it with anybody, but if you have to, doing it as a mother-daughter is helpful,” she said. “You’re bonding over raw emotions. It’s definitely a connection that you form.”

On March 28 their community is holding a benefit for the resilient pair, which Missy says is just one of the generous things they’ve done to help throughout this process.

“Not in a million years could I imagine the outreach we’ve had,” she said. “The surrounding communities have been phenomenal. We have a dairy farm so we’ve had people volunteer to do chores, saw wood, make meals, provide transportation for the other kids when we need it--anything and everything they’ve offered up.”

Most importantly, she added, “Prayers, lots of prayers.”

Source: http://abcnews.go.com

Markus MacGill

As part of its campaign against "too much medicine" The BMJ has published reviews that question the value of screening for breast cancer in women and aneurysm in men - asking whether the harm of "over-diagnosis" outweighs the benefit of detecting and treating real cases of disease.

In the case of breast cancer, the analysis of the history of screening for the disease, written by a public health expert, calls for "urgent agreement" in the debate and controversy that exists between scientists.

For abdominal aortic aneurysm, the review about screening men who do not have symptoms suggests that the ratio of harm to benefit of carrying out these programs has worsened over the years.

This, they say, is thanks to a reduction in risk factors such as smoking, which has reduced the chance that screening will succeed in finding actual cases.

And a third paper looks at the results of surveys that gauged the level of over-diagnosis people would accept from screening programs aiming to detect different cancers - finding a wide range of attitudes to the harm or benefit of screening.

In the research on abdominal aortic aneurysm (a swelling in the main artery from the heart, which can lead to death when it ruptures), the authors estimate that 176 of every 10,000 men invited to screening are over-diagnosed. 

This means smaller aneurysms being picked up - and perhaps being repaired in preventive surgery - even though they might have swelled little and presented a low risk of rupturing. 

The researchers describe the real-life consequences of the programs, which, in the UK, invite all men over the age of 65 for screening, and in the US, only those who have smoked (a risk factor that greatly increases the likelihood of an aneurysm). They explain:

"These men are unnecessarily turned into patients and may experience appreciable anxiety throughout their remaining lives."

"Moreover," the authors continue, "37 of these men [out of every 10,000 screened] unnecessarily have preventive surgery and 1.6 of them die as a consequence." 

The authors quote men who have had abdominal aortic aneurysms detected by screening - they "report existential thoughts about frailty and mortality after diagnosis." One man describes his diagnosis as "a ticking bomb inside your stomach."

In addition to such risks of psychological burden, the authors cite the surgical risks for those who undergo a preventive operation, and the public health implications over cost-effectiveness.

"When health authorities invite asymptomatic men to screening, there should be no doubt that benefits clearly outweigh harms," the authors conclude. "We cannot judge whether this is true of abdominal aortic aneurysm screening: the harms have not been adequately investigated, as is true for cancer screening."

Value of breast cancer screening 'can be improved'

On the question of how good the harm-to-benefit ratio is for breast cancer screening, Prof. Alexandra Barratt, from the School of Public Health at the University of Sydney in Australia, gives an overview of the history of screening programs, and offers a list of ways to improve their benefit.

Writing her review for The BMJ's "too much medicine" campaign, Prof. Barratt believes "agreement between experts about over-diagnosis in breast cancer screening is urgently needed so that women can be better informed." She presses for the following measures, too:

• Do better research to quantify the true amount of over-diagnosis - by developing "internationally agreed standards" for studies that monitor the problem created by screening programs
• Investigate less aggressive treatment options for screen-detected breast cancers
• Be more wary of new technology - for example, digital mammography has increased cancer detection without reducing death rates, so three-dimensional mammography (tomosynthesis), which "promises a 30-50% increase in detection of breast cancers" should not be implemented without more research on "whether it alters the balance of benefit and harm"
• Provide quality information to women. "Many women continue to be 'prescribed' or encouraged to undergo screening rather than being supported to make an informed choice," says Prof. Barratt, yet "information is an intervention that may have both positive and detrimental effects"
• Think twice before extending screening programs - "extending screening to women in their 70s has been shown to significantly increase the incidence of early-stage breast cancer, and this could have detrimental effects for older women."

Prof. Barrett says lessons have been learned in breast cancer screening that should inform programs for other cancers. Breast cancer has "led the way in developing awareness" about the potential for screening to over-diagnose and treat people who have no symptoms, and this is also needed for "the early detection of lung and thyroid cancers, as well as breast and prostate cancers."

This neatly leads to the subject of the third paper, on cancer screening more generally, which analyzes people's risk attitudes in relation to the early detection of different cancers and varying levels of benefit.

Over-detection is acceptable to patients

Dr. Ann Van den Bruel - a senior clinical research fellow at the University of Oxford's Nuffield department of primary care health sciences in the UK - conducted a survey with colleagues "to describe the level of over-detection people would find acceptable in screening for breast, prostate and bowel cancer."

Her "striking" findings, from asking people in the UK's general population, were that more people would accept a screening program that created over-detection "in the entire population" being tested than would accept "no over-detection at all."

People aged 50 or older accepted less over-detection, however, and there was a wide overall variation in the risks of over-diagnosis that people would accept from cancer screening.

The average levels of "acceptability" ranged from 113 cases of over-detection in every 1,000 people screened, to 313 cases.

People were significantly less happy to accept the risk of being over-diagnosed with bowel cancer than they were of this happening with breast or prostate cancer - the latter, in other words, being more worthwhile screening for in terms of perceived benefit versus risk.

The following results from the study highlight the two extremes expressed for attitudes to screening:

• 4-7% of respondents indicated they would tolerate no amount of over-detection at all from a screening program
• 7-14% considered it would be acceptable for the entire screened population to be over-detected - that is, doing the screening would be worthwhile even if it resulted in all 1,000 people tested being unnecessarily diagnosed.

The survey asked questions about three different types of cancer screening: breast cancer for women, prostate cancer for men, and bowel cancer for both.

For each type, the researchers presented the absolute number of cases there were each year in the UK, plus a description of the treatment, including adverse effects. They then presented two scenarios of screening effectiveness: a 10% reduction in deaths from the specific cancer, or a 50% cut.

Dr. Van den Bruel says:

"People accepted more over-detection when they perceived a higher benefit from cancer screening, so from a 10% mortality reduction to 50% mortality reduction, median acceptability increased significantly, with a maximum of 313 cases per 1,000 people screened for breast cancer."

Source: www.medicalnewstoday.com

 

 

DONALD G. McNEIL Jr.

A major study testing whether Americans would take their H.I.V. drugs every day if they were paid to do so has essentially failed, the scientists running it announced Tuesday at an AIDS conference here.

Paying patients in the Bronx and in Washington — where infection rates are high among poor blacks and Hispanics — up to $280 a year to take their pills daily improved overall adherence rates very little, the study’s authors said.

The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.

Paying patients $25 to take H.I.V. tests, and then $100 to return for the results and meet a doctor, also failed, the study found.

“We did not see a significant effect of financial incentives,” said Dr. Wafaa M. El-Sadr, an AIDS expert at Columbia University and the lead investigator. But, she said, there is “promise for using such incentives in a targeted manner.”

Cash payments might still work for some patients and some poor-performing clinics, she said.

Other H.I.V.-prevention research released here Tuesday offered good news for gay men but disappointing results for African women.

Two studies — both of gay men, one in Britain and the other in France — confirmed earlier research showing that pills to prevent infection can be extremely effective if taken daily or before and after sex. Both were stopped early because they were working so well that it would have been unethical to let them continue with men in control groups who were not given the medicine.

But a large trial involving African women of a vaginal gel containing an antiviral drug failed — apparently because 87 percent of the women in the trial were unable to use the gel regularly.

The failure of the cash-incentives trial was a surprise and a disappointment to scientists and advocates. It had paid out $2.8 million to 9,000 patients in 39 clinics over three years, but the clinics where money was distributed did only 5 percent better than those that did not — a statistically insignificant difference.

Some small clinics and those where patients had been doing poorly at the start of the study did improve as much as 13 percent, however.

People in other countries have been successfully paid to stop smoking while pregnant and to get their children to school. In Africa, paying poor teenage girls to attend school lowered their H.I.V. rates; scientists concluded that it eased the pressure on them to succumb to “sugar daddies” — older men who gave them money for food, clothes and school fees in return for sex.

One study presented here at the annual Conference on Retroviruses and Opportunistic Infections estimated that every prevented H.I.V. infection saved $230,000 to $338,000. Much of that cost is borne by taxpayers.

Mathematical modeling suggested that paying people up to $5,000 a year could be cost effective, Dr. El-Sadr said, but $280 was settled on after a long, difficult debate.

Paying more than $280 at some clinics was not an option, she said; achieving statistical relevance would have meant signing up even more clinics. The study had already involved almost every H.I.V. patient in the Bronx and Washington.

“I don’t think anyone has an answer to what amount would be sufficient without being excessive,” Dr. El-Sadr said.

One advocate suggested that more money could work — in the right setting.

“In South Africa, $280 is a lot of money,” said Mitchell Warren, the executive director of AVAC, an organization that lobbies for AIDS prevention. “For that much, you’d definitely get some behavior change.”

The two studies among gay men looked at different ways to take pills. A 2010 American study, known as iPrEx, showed that taking Truvada — a combination of two antiretroviral drugs — worked if taken daily.

The British study, known as PROUD, used that dosing schedule, and men who took the pill daily were protected 86 percent of the time.

In the French trial, known as Ipergay, men were advised to take two pills in the two days before they anticipated having sex and two in the 24 hours afterward.

Those who took them correctly also got 86 percent protection.

“The problem,” Dr. Susan P. Buchbinder, director of H.I.V. prevention research for the San Francisco health department, said in a speech here commenting on the study, “is that studies have shown that men are very good at predicting when they will not have sex and not good at predicting when they will.”

The African study, known as FACTS 001, was a follow-up to the smaller trial from 2010, which showed that South African women who used a vaginal gel containing tenofovir, an antiviral drug, before and after sex were 39 percent better protected than women who did not.

But it also found that many women failed to use the gel because it was messy or inconvenient or because partners objected.

In this trial, there was virtually no effect.

One problem, said Dr. Helen Rees, the chief investigator, was that the women were very young — the median age was 23, and most lived with their parents or siblings.

“They had no privacy for sex,” she said. “They had to go outside to use the product.”

Mr. Warren, of AVAC, said: “The women wanted a product they could use. But this particular product didn’t fit into the realities of their daily lives.”

The development means that advocates are hoping even more that other interventions for women now in trials will work. They include long-lasting injections of antiretroviral drugs and vaginal rings that can be inserted once a month and leach the drugs slowly into the vaginal wall.

Another trial in Africa, the Partners Demonstration Project, conducted among couples in which one partner had H.I.V. and the other did not, found it was extremely effective to simultaneously offer treatment to the infected partner and preventive drugs to the uninfected one until the other’s drugs took full effect.

In the group getting the treatment, there were zero infections that could be traced to partners who were in the study.

Source: www.nytimes.com

JESSICA FIRGER

Have you ever wondered what happens during a heart transplant operation? The surgical team at Baylor University Medical Center (@BaylorHealth) in Dallas understands the curiosity. On Monday night, the hospital offered the public an intimate look at the process of one patient's heart transplant journey using the hashtag #HeartTXLive and also #heartTX.

While hospitals have tweeted about organ transplant surgeries before, this is believed to be the first one to be tweeted in real time. The hospital says they chose to tell the story from the patient's point of view, and also documented the surgery with photos and video. 

Dr. Gonzo Gonzalez (@HRTTRNSPLNTMD), chief of cardiac surgery and heart transplant and mechanical circulatory support at Baylor University Medical Center assisted with the live tweets, while Dr. Juan MacHannaford performed the surgery. 

To protect the patient's identity, the hospital used pseudonyms for the patient and her husband, referring to them as Jane and John in the tweets. Jane was born with cardiomyopathy, which causes an enlargement of the heart muscle and structural problems. In Jane's case, she was born with an abnormal left ventricle, and had a bacterial infection at 3 months old that caused her to go into cardiac arrest. 

The live tweets paint a picture of the stress that comes with performing such a high-profile and high-risk surgery -- from waiting for the donor organ's arrival to the complex process of removing the patient's heart, implanting the new one and ensuring it's beating and circulating the patient's blood inside her body. Here are some highlights:

Dr. Juan MacHannaford is performing Jane's #hearttx tonight. #heartTXlive pic.twitter.com/5LOFirFIg8

— Baylor Health Care (@BaylorHealth) February 17, 2015

Jane's new heart arrived back in Dallas just moments ago. #HeartTXLive pic.twitter.com/3dGWX1uaTc

— Baylor Health Care (@BaylorHealth) February 17, 2015

Dr. Raj Malyala entering the operating room with Jane's new heart. #HeartTXLive pic.twitter.com/Tnrivzl07h

— Baylor Health Care (@BaylorHealth) February 17, 2015

The heart-lung machine keeps Jane alive while her heart is out of her body #HeartTXLive pic.twitter.com/lsh4sNkwJc

— Baylor Health Care (@BaylorHealth) February 17, 2015

VIDEO: Jane's old heart is removed, moments before donor heart is implanted. #HeartTXLive pic.twitter.com/OCj9frOJSu

— Baylor Health Care (@BaylorHealth) February 17, 2015

Jane's new heart crosses w/old heart on the way in. (Donor's heart at top, Jane's old heart below). #HeartTXLivepic.twitter.com/kay7BmNICL

— Baylor Health Care (@BaylorHealth) February 17, 2015

The fourth connection is completed and Jane's new heart kickstarts immediately as seen on the EKG. #HeartTXLivepic.twitter.com/Pknn58Y0Li

— Baylor Health Care (@BaylorHealth) February 17, 2015

Source: www.cbsnews.com

JESSICA FIRGER

Scientists have discovered a highly aggressive new strain of HIV in Cuba that develops into full-blown AIDS three times faster than more common strains of the virus. This finding could have serious public health implications for efforts to contain and reduce incidences of the virus worldwide.

Researchers at the University of Leuven in Belgium say the HIV strain CRF19 can progress to full blown AIDS within two to three years of exposure to virus. Typically, HIV takes approximately 10 years to develop into AIDS. Patients with CRF19 may start getting sick before they even know they've been infected, which ultimately means there's a significantly shorter time span to stop the disease's progression. 

The scientists began studying the cases in Cuba when reports began coming in that a growing number of HIV-infected patients were developing AIDS just three years after diagnosis with the virus. The findings of their study were published in the journal EBioMedicine.

Having unprotected sex with multiple partners can expose a person to numerous strains of the HIV virus. Research has found that when this occurs, the different strains can combine and form a new variant of the virus.

When HIV first enters the human body it latches on to anchor points of a certain protein, known as CCR5 on the cell membranes, which then allows it to enter human cells. Eventually the virus then latches onto another protein of the cell membrane, known as CXCR4. This marks the point when asymptomatic HIV becomes AIDS. In CRF19, the virus makes this move much sooner. 

For the study, the researchers analyzed blood samples of 73 recently infected patients. Among the group, 52 already had full-blown AIDS, while the remaining 21 were HIV-positive but the virus had not yet progressed. The researchers compared their findings to blood samples of 22 AIDS patients who had more common strains of the virus. 

The researchers found that patients with CRF19 had higher levels of the virus in their blood compared with those who had more common strains. 

They also had higher levels of the immune response molecules known as RANTES, which bond to CCR5 proteins in early stages of the virus. The abnormally high level of RANTES in patients infected with the new strain indicates that the virus runs out of CCR5 anchor points much earlier and moves directly to CXCR4 anchor points.

Thanks to advances in medical treatment and the development of highly effective antiretroviral drugs, HIV/AIDS is no longer a death sentence. But the researchers caution that patients with the new strain of the virus are more likely to be diagnosed when they already have full-blown AIDS and when damage from the disease has taken a toll.

The researchers suspect that this aggressive form of HIV occurs when fragments of other subsets of the virus cling to each other through an enzyme that makes the virus more powerful and easily replicated in the body.

There are currently 35 million people worldwide living with HIV/AIDS, according to the most recent data from the World Health Organization. Scientists have identified more than 60 different strains of the HIV 1 virus, with each type typically found predominantly in a specific region of the world.

Source: www.cbsnews.com

Jana Kasperkevic

Far from offering patients pennies for their thoughts, mental health therapists often end up billing them hundreds of dollars per month.

The cost is a growing burden as depression among US adolescents and adults rises. The US is suffering a mental health crisis, with a San Diego State University study in October finding that one in 10 Americans is depressed – and more report symptoms of depression.

More Americans are seeking help, and that help can come at a financial sacrifice of thousands of dollars a year. Aside from the cost of often-weekly visits to psychologists – which may or may not be defrayed by insurance – there can be additional costs for psychiatrists and any medicine they prescribe.

The cost of therapy is especially acute for young Americans, many of whom are underemployed and burdened with college debt. This year, a record number of college freshmen reported being depressed. And while many campuses provide free mental health care, affordable help is often harder to find after students leave school.

The Guardian interviewed seven young professionals about their experiences to find out how young Americans manage to pay for therapy – and if they think it’s worth it. To protect their identities, we have kept their surnames anonymous.

Click on the titles below to read their stories: 

‘I just can’t afford to go’

– AK, 27

‘Why do I need to pay someone to listen to me?’

– Matt, 23

Therapy was ‘the best chance I had of feeling OK’

– JE, 29

‘I needed someone to help me find courage to leave [my job]’

– Eve, 33

‘At its best, it’s paying for a friend’

- John, 27

‘Therapy is not a magic wand’

-Jenn, 26 

‘I’d rather be sad’

– Alex, 27

Source: www.theguardian.com

By MICHAEL TOMSIC

In Medical Park Hospital in Winston-Salem, N.C., Angela Koons is still a little loopy and uncomfortable after wrist surgery. Nurse Suzanne Cammer gently jokes with her. When Koons says she's itchy under her cast, Cammer warns, "Do not stick anything down there to scratch it!" Koons smiles and says, "I know."

Koons tells me Cammer's kind attention and enthusiasm for nursing has helped make the hospital stay more comfortable.

"They've been really nice, very efficient, gave me plenty of blankets because it's really cold in this place," Koons says. Koons and her stepfather, Raymond Zwack agree they'd give Medical Park a perfect 10 on the satisfaction scale.

My poll of the family is informal, but Medicare's been taking actual surveys of patient satisfaction, and hospitals are paying strict attention. The Affordable Care Act ties a portion of the payments Medicare makes to hospitals to how patients rate the facilities.

Medical Park, for example, recently received a $22,000 bonus from Medicare in part because of its sterling results on patient satisfaction surveys.

Novant Health is Medical Park's parent company, and none of its dozen or so other hospitals even come close to rating that high on patient satisfaction. Figuring out why Medical Park does so well is complicated.

First, says Scott Berger, a staff surgeon, this isn't your typical hospital.

"It kind of feels, almost like a mom-and-pop shop," he says.

Medical Park is really small, only two floors. Doctors just do surgeries, like fixing shoulders and removing prostates, and most of their patients have insurance.

Another key is that no one at Medical Park was rushed to the hospital in an ambulance, or waited a long time in the emergency room. In fact, the hospital doesn't even have an emergency room.

The hospital doesn't tend to do emergency surgeries, says Chief Operating Officer Chad Setliff. These procedures are all elective, scheduled in advance. "So they're choosing to come here," he says. "They're choosing their physician."

These are the built-in advantages that small, specialty hospitals have in terms of patient satisfaction, says Chas Roades, chief research officer with Advisory Board Company, a global health care consulting firm.

"A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals]," Roades says.

This is the third year hospitals can get bonuses or pay cuts from Medicare (partly determined by those scores) that can add up to hundreds of thousands of dollars.

More typical hospitals that handle many more patients – often massive, noisy, hectic places – are more likely to get penalized, Roades says.

"In particular, the big teaching hospitals, urban trauma centers — those kind of facilities don't tend to do as well in patient satisfaction," he says. Not only are they busy and crowded, but they have many more caregivers interacting with each patient.

Still, Roades says, although patient surveys aren't perfect, they are fair.

"In any other part of the economy," he points out, "if you and I were getting bad service somewhere – if we weren't happy with our auto mechanic or we weren't happy with where we went to get our haircut – we'd go somewhere else." In health care, though, patients rarely have that choice. So Roades thinks the evaluation of any hospital's quality should include a measurement of what patients think.

Medical Park executives say there are ways big hospitals can seem smaller — and raise their scores. Sometimes it starts with communication – long before the patient shows up for treatment.

On my recent visit, Gennie Tedde, a nurse at Medical Park, is giving Jeremy Silkstone an idea of what to expect after his scheduled surgery – which is still a week or two away. The hospital sees these conversations as a chance to connect with patients, allay fears, and prepare them for what can be a painful process.

"It's very important that you have realistic expectations about pain after surgery," Tedde explains to Silkstone. "It's realistic to expect some versus none."

Medical Park now handles this part of surgery prep for some of the bigger hospitals in its network. Silkstone, for example, will have surgery at the huge hospital right across the street — Forsyth Medical Center.

Carol Smith, the director of Medical Park's nursing staff, says that after she and her colleagues took over these pre-surgical briefings, "Forsyth's outpatient surgical scores increased by 10 percent."

But some doctors and patients who have been to both hospitals agree that the smaller one is destined to have higher scores. It is just warmer and fuzzier, one patient says.

Source: www.npr.org

While debate about recreational marijuana use continues, researchers are investigating the effectiveness of cannabis for treating pain, spasticity, and a host of other medical problems. In a symposium organized by the McGill University Health Centre (MUHC) as part of the 2015 American Association for the Advancement of Science Annual Meeting held this week in San Jose, California,  experts from North America and the U.K. share their perspectives on the therapeutic potential of medical cannabis and explore the emerging science behind it.

"We need to advance our understanding of the role of cannabinoids in health and disease through research and education for patients, physicians and policy-makers," says Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit at the MUHC, in Canada.

As a pain specialist Dr. Ware regularly sees patients with severe chronic pain at his clinic in Montreal, and for some of them, marijuana appears to be a credible option. "I don't think that every physician should prescribe medical cannabis, or that every patient can benefit but it's time to enhance our scientific knowledge base and have informed discussions with patients."

Increasing numbers of jurisdictions worldwide are allowing access to herbal cannabis, and a range of policy initiatives are emerging to regulate its production, distribution, and authorization. It is widely believed that there is little evidence to support the consideration of cannabis as a therapeutic agent. However, several medicines based on tetrahydrocannabinol (THC), the psychoactive ingredient of cannabis, have been approved as pharmaceutical drugs.

Leading British cannabis researcher Professor Roger Pertwee, who co-discovered the presence of tetrahydrocannabivarin (THCV) in cannabis in the 70's, recently published with collaborators some findings of potential therapeutic relevance in the British Journal of Pharmacology. "We observed that THCV, the non-psychoactive component of cannabis, produces anti-schizophrenic effects in a preclinical model of schizophrenia," says Pertwee, professor of Neuropharmacology at Aberdeen University. "This finding has revealed a new potential therapeutic use for this compound."

Neuropsychiatrist and Director of the Center for Medicinal Cannabis Research (CMCR) at the University of California, San Diego Dr. Igor Grant is interested in the short and long-term neuropsychiatric effects of marijuana use. The CMCR has overseen some of the most extensive research on the therapeutic effects of medical marijuana in the U.S. "Despite a commonly held view that cannabis use results in brain damage, meta analyses of extensive neurocognitive studies fail to demonstrate meaningful cognitive declines among recreational users," says Dr. Grant. "Bain imaging has produced variable results, with the best designed studies showing null findings."

Dr. Grant adds that while it is plausible to hypothesize that cannabis exposure in children and adolescents could impair brain development or predispose to mental illness, data from properly designed prospective studies is lacking.

Source: www.sciencedaily.com