DiversityNursing Blog

www.sciencedaily.com

Pushing new frontiers in dementia research, Nanyang Technological University, Singapore (NTU Singapore) scientists have found a new way to treat dementia by sending electrical impulses to specific areas of the brain to enhance the growth of new brain cells.

Known as deep brain stimulation, it is a therapeutic procedure that is already used in some parts of the world to treat various neurological conditions such as tremors or Dystonia, which is characterised by involuntary muscle contractions and spasms.

NTU scientists have discovered that deep brain stimulation could also be used to enhance the growth of brain cells which mitigates the harmful effects of dementia-related conditions and improves short and long-term memory.

Their research has shown that new brain cells, or neurons, can be formed by stimulating the front part of the brain which is involved in memory retention using minute amounts of electricity.

The increase in brain cells reduces anxiety and depression, and promotes improved learning, and boosts overall memory formation and retention.

The research findings open new opportunities for developing novel treatment solutions for patients suffering from memory loss due to dementia-related conditions such as Alzheimer's and even Parkinson's disease.

This discovery was published in eLife, a peer-reviewed open-access scientific journal published by the Howard Hughes Medical Institute, the Max Planck Society and the Wellcome Trust.

Assistant Professor Ajai Vyas from NTU's School of Biological Sciences said, "The findings from the research clearly show the potential of enhancing the growth of brain cells using deep brain stimulation.

"Around 60 per cent of patients do not respond to regular anti-depressant treatments and our research opens new doors for more effective treatment options."

Dr Lim Lee Wei, an associate professor at Sunway University, Malaysia, who worked on the research project while he was a Lee Kuan Yew Research Fellow at NTU, said that deep brain stimulation brings multiple benefits.

"No negative effects have been reported in such prefrontal cortex stimulation in humans and studies have shown that stimulation also produces anti-depression effects and reduces anxiety.

"Memory loss in older people is not only a serious and widespread problem, but signifies a key symptom of dementia. At least one in 10 people aged 60 and above in Singapore suffer from dementia and this breakthrough could pave the way towards improved treatments for patients."

Growing new brain cells

For decades, scientists have been finding ways to generate brain cells to boost memory and learning, but more importantly, to also treat brain trauma and injury, and age-related diseases such as dementia.

As part of a natural cycle, brain cells constantly die and get replaced by new ones. The area of the brain responsible for generating new brain cells is known as the hippocampus, which is also involved in memory forming, organising and retention.

By stimulating the front part of the brain known as the prefrontal cortex, new brain cells are formed in the hippocampus although it had not been directly stimulated.

The research was conducted using middle-aged rats, where electrodes which sends out minute micro-electrical impulses were implanted in the brains. The rats underwent a few memory tests before and after stimulation, and displayed positive results in memory retention, even after 24 hours.

"Extensive studies have shown that rats' brains and memory systems are very similar to humans," said Prof Ajai who is a recipient of NTU's prestigious Nanyang Assistant Professorship award.

"The electrodes are harmless to the rats, as they go on to live normally and fulfil their regular (adult) lifespan of around 22 months."

The research was funded by the Lee Kuan Yew Research Fellowship which supports and promotes young and outstanding researchers in their respective areas of specialisation.

By SYDNEY LUPKIN

abcnews.go.com

The Easter Bunny has some sweet competition in the form of two therapy rabbits at NYU Langone Medical Center in Manhattan.

Nutmeg and Clovis, both 5 years old, live on the 13th floor of the hospital, and this week, they visited patients for Bunny Day, the hospital's nondenominational springtime celebration. They wore rabbit ears (yes, really), a bonnet, and sat on a basket of eggs.

"The bunny cart is decorated to the hilt, and then we'll go and see patients and work with patients," said Gwenn Fried, manager of horticultural therapy services at NYU Langone. "The patients adore it."

As she travels the hospital with one rabbit at a time (Rabbits need breaks, too!), she said she hands patients a plastic Easter egg, and it contains either a sticker or a bunny treat.

"The bunny is very excited about the bunny treat," she laughed.

The bunnies visited 15 patients on Thursday and will visit more today and tomorrow, Fried said.

The rabbits are part of a therapy program that's been at the hospital for about 13 years. Sometimes, doctors recommend the bunny therapy, and sometimes patients request it, but Fried said she's seen them work magic on children and adults alike.

"One dad just said, 'I really think Clovis changed our lives,'" Fried told ABC News last year. "He's the most patient animal I've ever seen in my life."

By Michelle Matthews

Source: www.al.com

Shortly before their baby, Eli, was born, Brandi McGlathery and Troy Thompson talked about the physical qualities they hoped he would possess.

"I said I wanted him to have blond hair," Brandi said. "And Troy said, 'I hope he doesn't get my nose.'"

At the time, it was just a joke between two parents anxiously awaiting their baby's arrival. After Eli was born, though, it became the kind of memory that now makes them wince at its irony.

When Eli was born at South Baldwin Hospital on March 4, weighing 6 pounds, 8 ounces, Dr. Craig Brown immediately placed him on Brandi's chest. As the doctor helped Troy cut the cord, Brandi looked at Eli for the first time.

"I pulled back and said, 'Something's wrong!' And the doctor said, 'No, he's perfectly fine.' Then I shouted, 'He doesn't have a nose!'"

The doctor whisked Eli away, and for about 10 minutes Brandi was left alone in the delivery room thinking surely she hadn't seen what she thought she saw - or didn't see.

When Dr. Brown returned, he put his arm on her bed and took a deep breath. "He had the most apologetic look," she said. She knew something was wrong with her baby. She started to cry before he said a word.

She looked to Troy, who, she said, never cries. He had tears in his eyes.

She'd been right. Eli didn't have a nose.

Meanwhile, he had started breathing through his mouth right away. She remembers that he was wearing a tiny oxygen mask. Not having a nose "didn't faze him at all," she said.

"I was the first person to see it," she said. "Even when they took him away, my family still didn't know something was wrong, due to being caught up in the excitement of his arrival. It wasn't until they opened the blinds of the nursery that everyone else saw."

Before she knew it, Eli was taken to USA Children's and Women's Hospital in Mobile. Throughout the night, Brandi called the number they'd given her every 45 minutes or so to check on her baby. She wasn't sure he would make it through the night -- but he did.

And her "sweet pea," her "miracle baby," has been surprising his parents and others who love him, as well as the medical staff who have cared for him, ever since.

Nothing unusual

The next day, her doctor checked her out of the hospital in Foley so she could be with her baby in Mobile. The doctor had also had a sleepless night, she said. "He said he'd gone back over every test and every ultrasound," but he couldn't find anything unusual in her records.

There were a few aspects of her pregnancy that were different from her first pregnancy with her 4-year-old son, Brysen.

Right after she found out he was a boy, at around 17 weeks, she said, she lost 10 pounds in eight days because she was so severely nauseated. Her doctor prescribed a medication that helped her gain the weight back and keep her food down. She continued to take the medication throughout her pregnancy, she said.

On a 3D ultrasound, she and Troy even commented on Eli's cute nose. The imaging shows bone, not tissue, she said - and he has a raised bit of bone beneath the skin where his nose should be.

After going into early labor three times, Brandi delivered Eli at 37 weeks. At 35 weeks, her doctor told her that the next two weeks would be critical to the development of the baby's lungs and respiratory system. "He said, 'Let's try to keep him in as long as we can,'" she remembered.

Happy, healthy baby

For the first few days of his life, Eli was in one of the "pods" in USA Children's and Women's Hospital's neonatal intensive care unit. At five days old, he had a tracheotomy. "He has done wonderfully since then," Brandi said. "He's been a much happier baby."

Because of the trach, he doesn't make noise when he cries anymore, so Brandi has to watch him all the time. She has been going back and forth between the Ronald McDonald House and Eli's room during his stay.

"Between the nurses here and Ronald McDonald House, everyone has gone above and beyond," she said. "The nurse from the pod comes to check on her 'boyfriend.' She got attached to him."

Besides not having an external nose, he doesn't have a nasal cavity or olfactory system. (Despite that fact, she said, he sneezes. "The first time he did it, we looked at each other and said, 'You heard that, right?'")

Eli Thompson has an extremely rare condition known as complete congenital arhinia, said Brandi, adding that there are only about 37 cases worldwide like his. The chance of being born with congenital arhinia is one in 197 million, she said.

Even at USA Children's and Women's Hospital, Eli's case has baffled the NICU. "Everyone has used the same words," Brandi said. As soon as they found out he was on his way, she said, the staff started doing research. They only found three very brief articles on the condition. Now, his doctors are writing a case study on him in case they ever encounter another baby like Eli.

After he got the trach, Brandi wanted to start breastfeeding. The lactation consultant encouraged her, and together they searched the Internet for more information. Brandi became the first mother ever to breastfeed a baby with a trach at the hospital, she said - and now the lactation consultant "is actually using him to put an article together about breastfeeding with a trach to encourage mothers of other trach babies to attempt it."

Thanks to her Internet research, Brandi found a mother in Ireland, Gráinne Evans, who writes a blog about her daughter, Tessa, who has the same condition as Eli. She also found a 23-year-old Louisiana native who lives in Auburn, Ala., and a 16-year-old in North Carolina, she said. With every case she found, Brandi started to feel better and more convinced that Eli could not only survive his babyhood, but that he'll grow to adulthood.

Communicating with Tessa's mother in Ireland has been especially gratifying for Brandi. She knows she and Eli are not in this alone.

'He's perfect'

While it would seem easy enough for a plastic surgeon to build a nose for Eli, it's not that simple, Brandi said. "His palate didn't form all the way, so his brain is lower," she said. "It's a wait-and-see game."

His condition affects his pituitary gland, she said. He'll have to be past puberty before his nasal passageways can be built. Until then, she'd like to spare him any unnecessary facial surgeries.

"We think he's perfect the way he is," she says, nodding toward the sweet, sleeping baby in his crib. "Until the day he wants to have a nose, we don't want to touch him. We have to take it day by day."

Within a month after Eli goes back home to Summerdale, he will have to travel to the Shriners Hospital for Children in Houston and Galveston, Texas, to meet with craniofacial specialists. "They will work with him for the rest of his life," she said. "Every three to six months, we'll be going back for scans and checkups for at least the next ten years."

Brandi said that, of the people she's found online, some are opting to have noses and nasal passageways built (including Tessa), while others haven't.

"We're going to do our best to make sure he's happy," she said. "The rest of him is so cute, sometimes you don't realize he doesn't have a nose."

Brandi's older son, Brysen, and Troy's four-year-old daughter, Ava, are too young to interact with Eli in the hospital. Brandi was grateful to one of the nurses who unhooked him and let the kids see him. "Ava asked me, 'When you were little, did you have a nose?'" Brandi said. "She said, 'I think he's cute.'"

Brysen pressed his hands against the window separating him from his baby half-brother and said, "He's perfect!"

'Facebook famous'

Brandi, who got pregnant with Brysen when she was a senior in high school, had planned to start going to school to become an LPN like Troy's sister and his mother. "That's all on the back burner now," she said. Because of her experience at USA Children's and Women's, she said she now wants to be a NICU nurse.

Her best friend, Crystal Weaver, logged onto Brandi's Facebook account and created the Eli's Story page to let friends and family members know what was going on. "It's easier that way to update everyone at once rather than to call everyone individually," Brandi said. "It's overwhelming. It's all on my shoulders." Within a day, she said, Eli's Story had 2,000 likes (it now has around 4,500). "People I didn't know were sending messages," she said.

Crystal also started a Go Fund Me account, which has raised about $4,300. "We've got years and years of surgeries and doctor's appointments nowhere close to us," said Brandi, who returned to her job as a bartender this past weekend. She plans to keep working two nights a week for a while. Being around her work family, she said, helps her maintain a sense of normalcy.

A fish fry is planned as a fundraiser for Eli's medical fund on April 11 at Elberta Park in Elberta, with raffles for prizes including a weekend stay at a condo in Gulf Shores and a charter fishing trip.

"It makes me feel really good that I have a support system," Brandi said. "Everybody's been awesome."

Updating Eli's page, adding photos and reading the positive, encouraging comments from hundreds of people, as well as reaching out to others who have been through what she's going through "keeps me sane," Brandi said.

Recently, Brandi posted a video of Eli waking up from a nap. From Ireland, Gráinne Evans commented: "I've actually watched this more times than I could admit!"

Eli is "100 percent healthy," she said. "He just doesn't have a nose. He has a few hormone deficiencies, but other than that he's healthy."

Brandi seems wise beyond her years. She is already worried about "the day he comes home and someone has made fun of his nose," she said. "We don't want anyone to pity him. We never want anyone to say they feel sorry for him. If other people express that, he'll feel that way about himself."

She jokes that Eli is "Facebook famous" now. "I can't hide him," said Brandi, who is a singer. "Eli's gotten more publicity in the past two weeks than I have in my whole life!"

She's been putting together a "journey book" full of medical records and mementoes to give Eil one day. "I'm excited to show him one day, 'Look, from the moment you were born people were infatuated with you.'"

'I'm doing something right'

In his short time on earth so far, Eli has brought his family together, Brandi said. She and Troy had been engaged, then called off the wedding and were "iffy," and then they broke up. A week later, she found out she was pregnant.

"Eli has made Troy my best friend," she said. "He has brought us closer than when we were engaged. To see Troy with him is really awesome."

Troy has been her rock, reassuring her since Eli was born, she said. "He tells me, 'Brandi, it's OK. It will end up happening the way it's supposed to be."

Last Thursday, Brandi posted on the Eli's Story page that Eli had passed his car seat trial and newborn hearing screening. "He now weighs 7 pounds, and we'll be meeting with home health to learn how to use all of his equipment so we can go home Monday."

Everyone in their family has taken CPR classes, and Brandi and Troy have learned how to care for Eli's trach. The couple has extended family nearby, and Troy's father and stepmother plan to move to Baldwin County from Mobile to be closer to Eli.

As she prepared to take her baby home from the hospital on Monday morning, almost four weeks since he came into the world, Brandi was excited to take care of him for the first time in the comfort of her own home, and to finally introduce him to his big brother and sister.

Though Brandi said her heart melts when Eli's little hand wraps around her finger, he's the one who already has her wrapped completely around his. He recognizes his parents' voices, and seems comforted by them. "As soon as he hears us, he looks around for us, finds us, then stares at us smiling," she said. "It makes me feel like I'm doing something right, that through the ten to twelve other women, the nurses who have been caring for him for the past month, he still knows who Mommy is!"

By MATTHEW FAHR

Barber chairs moved like turnstiles as people from all around the area came to the Romeo Lions Field House to show their support for those fighting cancer.

Volunteer event organizer Michael Fiscus said the Romeo event broke its own record, and is currently ranked fifth nationally for funds raised during the St. Baldrick’s Foundation event.

“It was more crowded than it has been since we began in Romeo,” said Fiscus. “We had wall-to-wall people from 1:30 to 4 p.m.”

In a show of support for children who are enduring the struggle of dealing with cancer and its body-ravaging effects, St. Baldrick’s asks people to show their solidarity with those young souls by shaving their heads.

They came out in force to Romeo with the event currently tallying $317,000 raised to date.

Fiscus said he expects that number to rise as people donate after the fact, pledging donations to those who took part in the event.

Last year, the event raised $302,000, with another $30,000 being donated in the days and weeks afterward.

“In the next few weeks we will be collecting cash that was donated and collecting sponsor matching funds, as well as new donations after people see what their friends and family did for St. Baldrick’s,” Fiscus said.

When the event began six years ago, 18 people shaved their heads and Fiscus raised just more than $14,000 to donate to the foundation, which is dedicated to raising money for life-saving childhood cancer research, and it funds more in childhood cancer grants than any organization except for the U.S. government.

Last year, 525 people shaved their heads.

Fiscus said this year more than 500 people sat down in barber chairs to change their image by shaving their heads, but he said donations went up even with the dip in “shavees,” as he calls them.

He said 16 people were also “knighted” for being involved for seven consecutive years.

“The number of folks returning was high this year,” said Fiscus. “The word is out there, and those who started with us and helped bring in others are back themselves for a good cause.”

With 25 barber chairs and an average of 10 minutes per haircut -- which may have felt like a lifetime for some first-timers -- the Lions Field House did steady business through the day and brought people into downtown Romeo at night as haircuts were done upstairs at Younger’s Tavern until well into the night.

“I think by the time I packed up and was heading out of town, it must have been 11:30 p.m.” Fiscus said. “A lot of people had a good time.”

Fiscus took time out of his chaotic day to look around at those making such a sacrifice for a loved one or friend.

“It can be so moving to see someone commit to something like that,” he said. “You can tell who the people are who are doing this for the first time and the look on their face, but afterward they are proud of what they did.”

He said 90 percent of donations this year for the Romeo event were done online, and donations will continue to be taken all year online at www.stbaldricks.org/events/romeo/

Romeo currently ranks fifth nationwide in event donations, a goal Fiscus was aiming for at the start of this year.

“That is the achievement I am most proud of,” he said. “We are still in fifth today and I don’t know how long we will be there, but being there right now is such an honor.”

Source: www.macombdaily.com

BY JENNIFER WALKER

In a Johns Hopkins Outpatient Center exam room, medical interpreter Julie Barshinger is working with a Spanish patient, a woman in her early 40s with a stocky build and a dark ponytail, who is concerned about complications related to her recent nose surgery.

But first, the woman must complete a medical history form. “¿Qué significa vertigo?” (“What is vertigo?”) she asks, as Barshinger goes through the list of symptoms on the form, verbally interpreting them from English to Spanish. Then later, “No sé qué es un soplo cardiac … ” Barshinger interprets the question — “I don’t know what a heart murmur is” — for the nurse who is preparing a nasal spray for the patient that will allow the doctor to look inside her nose.

“If it doesn’t apply to her, don’t answer it,” the nurse says kindly.

“I just want you to know that I have to interpret everything she says,” explains Barshinger, who is one of 18 full-time interpreters in Johns Hopkins Medicine International’s Language Access Services office. Part of Barshinger’s job is educating providers about her role. 

Later, the nurse starts to leave the room to see another patient before the woman has completed her medical history form. “I can’t continue if you’re not in the room with me,” Barshinger says. The patient is consistently giving additional information about her symptoms: She doesn’t see well since her operation; she has some nasal bleeding; she sees the room spinning when she lies down. It’s crucial for Barshinger to communicate these potentially important details to the nurse, who stays in the room, answering questions when needed, until the form is complete.

Throughout the interaction, Barshinger knows little about the full scope of the patient’s health history. But she doesn’t need to know. “I’m not in charge of her care,” she says. “I’m only her voice. I want to make sure her voice is being heard by the right people. I’m also the voice of the provider, so she can communicate the very necessary and important information that she has to the patient.”

While Johns Hopkins, like other hospitals that receive federal funding, has been providing interpretation services for 50 years — since passage of the Civil Rights Act of 1964, which prohibits discrimination based on national origin — requests for interpreters at The Johns Hopkins Hospital have grown dramatically since 2010, jumping from 23,000 to more than 50,000 annually.

This is due in part to the slightly rising limited English proficiency population in Baltimore City, which grew by about 4,000 people between 2000 and 2012, according to the U.S. Census. Today, the hospital also serves more refugees, about 2,500 of whom settled in Baltimore City between 2008 and 2012.

But Susana Velarde, administrator for Language Access Services at Johns Hopkins Medicine International, says the increase in requests is also due to the growing understanding among health care providers that they can do a better job treating their patients with limited English proficiency with the help of interpreters. 

Because they prevent communication errors, certified interpreters improve patient safety. A 2012 study in the Journal of General Internal Medicine found that patients with limited English proficiency who did not have access to interpreters during admission and discharge had to stay in the hospital between 0.75 and 1.47 days longer than patients who had an interpreter on both days. Moreover, when the interpreter has 100 hours of medical interpretation training — a qualification that researchers have found is more important than years of experience — they made two-thirds fewer errors than their counterparts with less training, according to a 2012 Annals of Emergency Medicine study.

The Language Access Services office’s full-time interpreters—who speak Spanish, Chinese-Mandarin, Korean, Russian, Arabic and Nepali — participate in an extensive two-year training program, which includes classes, tests and shadowing. Fifty percent of the team is certified; the rest are working toward certification, if available in their language. The office also has 45 medical interpreter floaters, and interpretation services are available 24/7 in person, over the phone or through a video monitor for patients with limited English proficiency who live in the Baltimore area and international residents who come to Johns Hopkins for treatment.

“We are the conduit, but also the clarifier,” says Spanish interpreter Rosa Ryan. “We are not simply repeating words but making sure the message is understood.”

For example, at the end of her visit on the otolaryngology floor, Barshinger walks to the front desk with the ponytailed Spanish woman to help her make a follow-up appointment. With Barshinger interpreting, the woman learns that she must get a Letter of Medical Necessity from her current insurer or change insurance companies before coming back to Johns Hopkins. When the administrator walks away, Barshinger checks in with the woman to make sure she understands the instructions.

“The patient might nod, but the information might not be registering,’” she says. “I try to check for clarification if I sense there is a disconnect.”  

Interpreters are also cultural brokers. Yinghong Huang, a Chinese-Mandarin interpreter, remembers when a nurse in labor and delivery tried to give a Chinese patient a cup of ice water. “In China, for a woman who has just delivered a baby, we don’t want her to touch anything cold, let alone ice,” Huang explains. This is one of the many rules that Chinese women abide by for a month to help the body recover from childbirth. With Huang present, providers knew to give the patient hot water with her medicine instead.

Despite the increasing demand for interpreters, their expertise too often goes untapped, says Lisa DeCamp, assistant professor of pediatrics at the school of medicine. She is the lead author of a 2013 Pediatrics study that found that 57 percent of pediatricians who completed national surveys in 2010 still reported using family members as interpreters.

This is a bad practice for many reasons, she says. For one thing, family members often don’t have specialized knowledge of medical terminology. Moreover, both patients and family members may censor information. “If you’re talking about something that is intimate or personal and your son is translating for you, you might not want to disclose something about your sexual activity, your drug use or anything else sensitive that could be contributing to your problem,” says DeCamp, who is also a pediatrician at Johns Hopkins Bayview Medical Center.

Even physicians with basic skills in a particular language should use an interpreter to prevent misunderstandings. “I [know] some high school Spanish, but I’m nowhere near fluent, so I need an interpreter,” says Cynthia Argani, director of labor and delivery at Hopkins Bayview, where about 70 percent of her department’s patient population speaks Spanish. “It’s not fair to the patient not to use one. The message can get skewed.”

DeCamp, who has passed a test certifying her as a bilingual physician, offers a real-life example from the literature that shows how this can happen. A pediatrician with limited Spanish language skills instructed parents to use an antibiotic to treat their child’s ear infection. In Spanish, “if you use the preposition, it really means, ‘put in the ear,’” she says. “So the family was putting the specified amount of amoxicillin that should be taken by mouth in the ear. That child is not going to die from an ear infection, but he’s having pain and a fever, and the family doesn’t have clear instructions on how to provide medication.”

On Barshinger’s rounds, after her otolaryngology visit, she walks at an impressively fast pace to The Charlotte R. Bloomberg Children’s Center, where a mother recognizes her and asks her to be her interpreter. The provider who requested Barshinger’s services is not ready yet, so she has time to help.

A doctor carrying a sheaf of papers joins them in a busy hallway. She points to a long list of care instructions translated into Spanish, then begins to explain them to the mother. Because the doctor is verbally giving the instructions, Barshinger interprets. The mother needs to buy an extra-strength, over-the-counter medication and give her daughter a second medication three times a day, which she will need to “swish and spit,” the doctor says. A third medication will be applied to the daughter’s face two times a day, and a special shampoo is needed to wash her hair. Before an upcoming dentist appointment, she’ll also need to give her daughter three amoxicillin. When the doctor steps away, the mother asks Barshinger a question about her daughter’s dental visit, which Barshinger interprets when the doctor returns.

While interpreting, Barshinger stands to the side of the patient’s mother, allowing the doctor and the mother to face each other and communicate directly with one another. This simple tactic encourages providers to develop a rapport with their patients with limited English proficiency.

The goal? “To make the patient feel like the appointment is with him and not with the interpreter,” says Velarde. “The interpreter is just the voice. We want providers to have a bond with their patients, like they do when everyone is speaking English.” 

Bonding Moments

Tapping the expertise of interpreters doesn’t have to complicate things for physicians, says Lisa DeCamp, a bilingual physician at Johns Hopkins Bayview Medical Center. Her advice for colleagues:

• Educate the interpreter about what you’re doing so they’re not going in blind. Say a patient has severe abdominal pain. Providers can quickly explain to the interpreter that the first job is to rule out appendicitis.

• Sit across from the patient, with the interpreter standing at the patient’s side, and talk directly to the patient. The goal is for the provider and the patient to feel like they have a relationship with each other despite language barriers. When possible, use short phrases to help the interpreter keep up with the conversation. 

Found In Translation

Arabic translator Lina Zibdeh remembers the first time she saw the recommendation in a patient education document that leftover medications should be discarded in used cat litter or coffee grounds.

There isn’t a direct translation for this concept in Arabic, a language that is spoken in different dialects by 22 countries but written in one common form. “It can take hours and extensive research to make sure a concept like this is translated correctly,” says Zibdeh, who translates written materials, such as informed consent forms, welcome packets, care instructions, brochures, video scripts and more. In this case, Zibdeh had to add an additional sentence to explain that medications should be disposed of in this way so they are not enticing to children and pets. 

While translation programs like Google Translate are readily available and easy to use, they often produce inaccurate translations, which can confuse patients and lead to poor health outcomes. This is because words in sentences can be organized in different ways from one language to another. Thus, when online programs translate those sentences from, say, English to Chinese, they can change the meaning, says Chinese-Mandarin interpreter and translator Yinghong Huang. Some English words, such as discharge, also have multiple meanings. “It’s very rare for a program to get the right meaning,” Huang says. Even Huang has to use tools, such as her cellphone and an online dictionary, to produce accurate translations.

Along with improving health outcomes, documents that are available in a patient’s own language can make him or her feel more comfortable and secure, says Zibdeh, who organized the American Translators Association’s first webinar for the Arabic Division on Arabic Medical Translation in early 2014. “It helps that patient feel closer to home,” she adds.

Source: www.hopkinsmedicine.org

A Dutch organization called "Ambulance Wens" (Ambulance Wish) fulfills the last wishes of terminally ill patients free of charge thanks to its 200 medical volunteers.

The company says, "There are still too many patients who die without getting to close everything. One of those reasons is the inability to achieve certain desires because the patient is no longer mobile and other existing facilities are inadequate for this purpose."

Special ambulances and stretchers help transport the patients safely and comfortably. Typical excursions include a visit to the beach, a visit to a neighbor who is also no longer mobile, and various places where the patient has special memories.

This woman's final wish was to visit the Rijksmuseum in Amsterdam.

Another woman enjoys the view from her favorite vacation destination in Tuscany.

This gentleman asked for one last view from the Euromast observation tower.

And this man asked to see the mills in Kinderdijk one last time.

Amsterdam is not the only place doing such wonderful things. A hospice outside Seattle made an old forest ranger's dying wish come true.

"Ed expressed one last hope to the hospice chaplain: He wanted to commune with nature one more time."

As the hospice wrote on its Facebook page, "People sometimes think that working in hospice care is depressing. This story ... demonstrates the depths of the rewards that caring for the dying can bring."

Source: www.sunnyskyz.com

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

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