Sunday, July 29, 2012

New Classification of Genes May Help Prevent Seizures

Discovery of a new classification of genes have the potential to change medication that can prevent seizures.

IRISH RESEARCHERS HAVE identified a new gene class which they say could potentially provide new treatment that would prevent epileptic seizures.

Researchers at the Royal College of Surgeons in Ireland, clinicians at Beaumount Hospital, and experts from Madrid’s Cajal Institute say that the new class of gene, called MicroRNA, is instrumental in the control of protein production inside cells. They found much higher levels of one particular type of this gene (microRNA-13) in the part of the brain that causes epileptic seizures.

The journal Nature Medicine has published the team’s paper, which outlines how scientists used a new type of drug-like molecule called antagomir which seems to lock onto the microRNA-13 gene and remove it from the brain cell – and, by doing so, prevent epileptic seizures.

“We have been looking to find what goes wrong inside brain cells to trigger epilepsy. Our research has discovered a completely new gene linked to epilepsy and it shows how we can target this gene using drug-like molecules to reduce the brain’s susceptibility to seizures and the frequency in which they occur,” said the senior author of the paper Prof DavidC Henshall,of the Department of Physiology and Medical Physics at the RCSI.

Approximately 37,000 people in Ireland are affected by epilepsy and, of those, one in three continue to experience seizures despite being prescribed medication.

Read more here

New Machine is Most Accurate in Locating Brain Electrical Activity

Finland produces a new machine that combines MEG and MRI technology that will provide the most accuracy in locating brain electrical activity.

Researchers at Aalto University in Finland have developed the world's first device designed for mapping the human brain that combines whole-head magnetoencephalography (MEG) and magnetic resonance imaging (MRI) technology. MEG measures the electrical function and MRI visualizes the structure of the brain. The merging of these two technologies will produce unprecedented accuracy in locating brain electrical activity non-invasively.

"We expect that the new technology will improve the accuracy of brain mapping of patients with epilepsy. It may also improve the diagnosis of cancer patients because the improved image contrast may facilitate the characterization of cancer tissue," says Academy Professor Risto Ilmoniemi.

"The innovative MEG-MRI device will allow brain imaging for new patients, such as those with metal implants. Also, the silent and open device will not scare children or make people feel claustrophobic. In the future, this development can also reduce costs as images can be obtained in one session rather than two," Ilmoniemi states.

The problem with MEG is that when the technique is used separately, the image accuracy can be compromised because of the movement of the brain. Also, the image it provides may not be accurate enough for precise brain surgery. In the past, it was not possible to combine high-field MRI and MEG because their magnetic fields interfered with one another. Extremely sensitive magnetic field sensors have now been developed, so scientists can now use the new low-field MRI with a magnetic field strength of only a few hundred-thousandths of that of the high-field MRI device. Fusing these two technologies produces localization accuracy that was not possible with MRI or MEG alone.

The project is coordinated by Aalto University in Finland and it includes 13 research groups from five different countries. The research project is part of the European Commission Seventh Framework Program.

Read more here

Animals can also have sleep disorders

Interesting information about animals and the sleep issues they can face.

Sometimes people ask if animals dream or have sleep disorders like them. The answer is yes! Just watch a sleeping dog for a few minutes and you will see their eyes moving from side to side, just as human's do during REM sleep.

Dogs and cats have many of the same sleep disorders as humans including sleep terrors, nocturnal seizures, narcolepsy, cataplexy and limb movements.1

Narcolepsy is known to occur more frequently in certain breeds of dogs, including Doberman pinschers, poodles, Labrador retrievers, beagles and dachshunds. Horses can also be affected. This disorder is usually inherited from the parents. Animals with narcolepsy also tend to have cataplexy when they are excited, for example when the feeding bowl arrives. It is treated much as it is in humans, with stimulants and anti-depressants.

It appears that most mammals and birds have REM sleep. It is questionable as to whether reptiles have REM sleep based on one study with turtles.2 Brain structures are different than in mammals and birds, so it is difficult to say absolutely.

You may be wondering, which mammal has the most REM sleep per day. The platypus ranks number first, getting about eight hours of REM sleep.3 The ferret, armadillo and possum also have high amounts of REM sleep daily. The giraffe and horse have the least at about 0.5 hours.

I hope you've found this information fun and interesting. The next time a patient complains of sleep difficulties, tell them they are not alone. They have only to look around their home to see how sleep affects their pets.

Sharon M. O'Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.


    1. Schenck, Carlos. Sleep: A Groundbreaking Guide to the Mysteries, the Problems, and the Solutions. New York: Penguin Group. 2007. pp. 258-263.
    2. Zepelin, Harold. Siegel, Jerome. Tobler, Irene. Chapter 8. "Mammalian Sleep". Principles and Practice of Sleep Medicine Fourth Edition Philadelphia: Elsevier Saunders, 2005. pp. 91-100.
    3. Siegel, Jerome. Chapter 10. "REM Sleep". Principles and Practice of Sleep Medicine Fourth EditionPhiladelphia: Elsevier Saunders, 2005. pp. 120-135.

Read more here

New Technology: Tiny Microchip that can Detect an Epileptic Seizure

A new microchip is being developed that could result in epileptic patients staying in the hospital less. It would be especially useful for children.

A hi-tech medical patch being developed in Abu Dhabi should soon help epileptics avoid long stays in hospital.

The 50fil adhesive microchip, the work of a researcher at the Masdar Institute, monitors epileptic seizures.

It will allow doctors to keep a close eye on patients for up to two weeks without the need for them to stay in hospital attached to a cumbersome and uncomfortable electroencephalograph (EEG) machine.

It would be applied to the forehead and is expected to be smaller in size than three grains of rice.

Currently, doctors often have to rely on patients' own descriptions of their seizures. But their recollections of events under such circumstances are notoriously unreliable.

The chip, which detects rapid eye movements - the early sign of an epileptic seizure - will give doctors a far more accurate picture of what happened, from the length of an attack to its severity.

The patch is the work of Dr Jerald Yoo, a circuit designer at the Masdar Institute, jointly funded by the Massachusetts Institute of Technology in the United States.

About 50 million people worldwide suffer from epilepsy. While no exact figure exists for the UAE, it is believed to be about 2 to 3 per cent of the population - more than 100,000 people.

Dr Yoo said the patch would be especially useful for children or babies, who cannot express what they have suffered.

The chip can also record seizures while asleep, of which patients might not even be aware.

"Doctors need to see raw information and data with their own eyes so they can make the right decisions, diagnoses and treatments.

"You need to learn the patient's seizure traits as they usually have one or two, which allows a more thorough diagnosis and treatment."

The Taiwan Semiconductor Manufacturing Company and the Abu Dhabi-owned Mubadala - which owns most of the chipmaker, Global Foundries - are looking to start making the chip by the end of this year.

Dr Sarmad Al Shamma, a neurologist at the Neuro Spinal Hospital in Dubai, said home monitoring would be good for doctors and patients alike.

"In addition to the discomfort of being in a hospital for more than 24 hours, there is a reduced possibility of an attack in the hospital because patients are lying in bed the entire time," he said.

"This often means they have to stay in the hospital for an even longer time. By monitoring them outside the hospital, we can learn what is triggering the attacks."

Epileptic seizures can be triggered in different patients by lack of sleep, stress, low blood sugar and flashing lights.

Dr Taoufik Al Sadi, the head of neurology at Sheikh Khalifa Medical City, said the chip could help fill "gaps in knowledge" about the condition.

"If this proves to be scientifically solid it would be an excellent addition to better understand the frequency and severity of the seizures, their duration," he said.

"It will allow better options for treatment based on solid, objective data, rather than relying on a patient's history and recollection."

He added that the chip could help reduce the stigma associated with epilepsy.

"Many sufferers feel deprived from basic privileges, such as driving a car and in some cases, going to school," said Dr Al Sadi.

"They find it difficult to be in social situations because they never know when they're going to have the next attack.

"But what they need to know is that after six months of treatment they can drive and resume their normal life."

Read more here

States are finding it difficult to enact concussion laws

This article discusses why states, such as Ohio, are having so much trouble passing concussion legislation.

Ohio state Reps. Michael Stinziano and Sean O'Brien thought they had a bill that would pass with no more than token opposition. It was a youth safety bill - a piece of legislation protecting young athletes who suffered head injuries on the playing field. Other states had taken similar action. The sponsors didn't expect a backlash. But a backlash is what they got.

It took multiple hearings and 10 rewrites to get the anti-concussion bill through the Ohio House. And it still faces an uncertain future in the state Senate. The reason has to do with the concerns of some doctors and the slippery problem of "return to play" decisions.

The bill aims to reduce the number of kids who suffer repeated concussions by requiring a coach to remove athletes from play if they show concussion symptoms and mandating that a health care professional sign off on their return to play. But which professionals are authorized to make that call? Some are bound to be excluded. Many legislators, says Stinziano, have an optometrist or a physical therapist in their district who is concerned about being cut out as an authorized concussion expert who could return a kid to play. Rural representatives argue that for their constituents, getting an athlete to a doctor or hospital for an evaluation can be too time-consuming to be practical.

The Ohio House reached a compromise and passed the bill by allowing each school district or governing authority of a chartered or private school to authorize which licensed health care providers can make return-to-play decisions. Stinziano acknowledges that while the doctors don't love it, it's what was needed to move the legislation. "This issue is not necessarily resolved," Stinziano says, "and we have our work cut out for us in the Senate."

The debate in Ohio follows a series of state youth concussion safety laws enacted since 2009, when Washington became the first state to create a law codifying the procedures for returning a young athlete to a game after sustaining a concussion. The Washington legislature was spurred to action by a serious injury to a middle school football player, Zackery Lystedt, who in 2006 was returned to a game after sustaining a concussion and suffered serious brain damage following a second hit.

Lystedt and his family lobbied the Washington legislature, and since then, the National Football League, which routinely sends its own players to testify in statehouses on concussion legislation, has been a key force behind the changes in 38 states. The urgency of the legislation has also been influenced by new research showing that repeated concussions can have life-altering repercussions, such as early-onset Alzheimer's disease, dementia, and increased risks of suicide. At least 2,000 former NFL players recently filed a lawsuit against the NFL claiming that the league deliberately misled them about the health risks of concussions. In an effort to make sure that youth stay safe from these dangers, at least eight states enacted concussion laws that went into effect this year.

Each state's law is slightly different. For instance, in New York and Minnesota, where, as in Ohio, debates surrounding access to care threatened the legislation's success, the laws do not specify which health care professionals can return a youth to play after sustaining a concussion. The NFL has not weighed in on the issue; it has specifically left it up to states to decide which doctors are qualified to make the decision.

There's a balance that must be struck, says Dawn Comstock, professor at Ohio State University'sCenter for Injury Research and Policy, between who really has the knowledge to evaluate a concussion and the level of access to those people. "Maybe a neurologist might be the best person to make the decision," says Comstock, "but how many neurologists are out there? In reality, if the kid can't access whoever is allowed to make the return-to-play decision, they're going to be more likely to hide the fact that they have a concussion."

According to data collected by the Centers for Disease Control, the number of emergency room visits by youth suffering from concussions or other traumatic brain injury sustained while playing sports increased by 62 percent from 2001-2009. While the rise is significant, says Julie Gilchrist, medical epidemiologist at the CDC, the increase is likely due to a heightened awareness of concussions, not to the fact that sports are more dangerous. "It's sad to see in one way," Gilchrist says, "but it's good that people are seeking care."

Boys' high school football had the highest rate of overall concussion at 6.94 per 10,000 athletes participating in school-sponsored practice or competition from 2008-2011, according to data from Ohio State University, followed by boys' ice hockey at 6.11, boys' lacrosse at 4.21 and girls' soccer at 3.83.

And while states are legislating protocols for what to do after a concussion is sustained, many sports associations are taking actions to prevent the injuries from happening in the first place. Minnesota Hockey, which governs more than 50,000 hockey players from ages 5 to adult, recently increased penalties for checking from behind, the practice of skating up from behind a player and pushing him before he has a chance to defend himself. After a Minnesota high school hockey player, Jack Jablonski, was paralyzed by getting checked from behind in January, the state's governing body for youth and amateur hockey decided to impose a minimum five-minute major penalty for checking from behind, up from a two-minute penalty.

Scott Gray, vice president for publicity and promotion for Minnesota Hockey, says that the change is aimed at preventing concussions and other serious injuries. "Most of the feedback that I've heard has been fairly positive," says Gray, who is also a parent of a hockey player. "My son is a junior in high school and it's hard to sit in the stands as a parent and watch your kid get blasted."

USA Hockey, the parent organization to Minnesota Hockey, last year banned all checking for players at the pee-wee level, younger than age 12, citing new research that showed the serious injury rate was four times higher for checking vs. non-checking pee-wee leagues. Pop Warner, an organization which manages hundreds of youth football teams nationwide, just last month limited contact in practices and banned full-speed, head-on blocking and tackling drills where players line up more than three yards apart.

But so far, none of the legislative efforts has addressed prevention, and Comstock says prevention isn't much of a research focus either. "All of the research has been going into diagnosing concussion and managing it, but hardly anything has gone into primary prevention. Not a single piece of any of these laws is going to keep a kid from getting a concussion in the first place."

That being said, any focus on concussion legislation is encouraging to many in the sports community. "People are fervent about their sport," says Gray, the

Minnesota Hockey dad, "and somewhere in there you have to pack in safety, development, costs ... but safety has become job number one as far as we're concerned. It's going to be a better sport because of it."

Read more here

Read more here:

Recognizing symptoms of concussions is necessary for coaches and parents

USA Football discusses the importance of parents and coaches knowing and recognizing concussions.

The Giants teamed up with USA Football on the Protection Tour on Tuesday at MetLife Stadium for a program designed to educate parents, players and coaches about signs and symptoms of concussions, and the importance of proper equipment and tackling techniques.
"I wanted to come and learn as much as I could," said Angelo Pira, a parent from Westwood who brought his son Dominic, 8, to the event. "My wife and I are worried about concussions. Some of the things I learned were shocking."
During a 25-minute seminar conducted by Dr. Pat Kersey, USA Football’s medical director, he described a concussion as similar to when a yolk shakes within an egg shell, the yolk being the brain and the shell being the skull.
Kersey then outlined a series of indicators parents and coaches should be looking for when it comes to concussions. Headaches, nausea, memory problems and blurry vision all are common signs, but the biggest sign is if the kids are not feeling like themselves.
"A lot of the signs of concussions are not visible," Kersey said. "So I think parents should really trust their instinct if they notice their child is not acting like themselves.
"Physically they can be fine, they can move arms and legs and can jump and run, but if they’re emotionally different or their personality changes, they should be checked out. That’s why it’s important to educate parents."
Kersey’s words hit home for Pira when he recalled that Dominic came home from wrestling practice a few years ago, and was not acting like himself.
"It made me think back that maybe he had a concussion," said Pira, who volunteers as a Westwoodfootball youth coach.
The statistics for concussion rates in youth sports are alarming. It’s estimated that anywhere from 1.6 million to 3.8 million kids suffer concussions every year. Once athletes suffers a concussion, they become three to six times more likely to suffer another.
In 2011, the National Federation of State High School Associations reported that 15 percent of all sports-related injuries are concussions. Sports and recreational activities contribute to about 21 percent of all traumatic brain injuries among American children.
"The numbers are quite staggering, and that’s the number of reported cases," said David Egazarian ofOradell, who brought his son Steven, 7, to the event. "Think of all the unreported cases. It’s important to be aware of all the information about concussions."
And it’s not just limited to football. Soccer, basketball, baseball, lacrosse and cheerleading also have high rates of concussions. Soccer has the highest rate worldwide and football is the highest in the U.S.
And it’s not just sports. Kids can suffer concussions anywhere from falling off their bikes to falling out of bed.
"The thing I learned was that I thought you got a concussion [only] when you blacked out, but that’s not the case," said Kim Mehandzic of Westwood, who brought her son Nik, 8, to the event.
"I think it’s important to know that concussions do heal if they’re treated properly. So I would let my son keep playing sports. They learn valuable life lessons through team sports. Parents have to trust their instincts."
Read more here

Saturday, July 28, 2012

Botox, Children and Fear-Mongering in Journalism

See this article that got my attention here. So obviously, its interesting that people in their 20's are getting cosmetic botox. But, I draw the line at increasing fear in parents with children who need treatment for illness. JR

Dear Sensationalist Journalists,

I am writing a letter to you as journalist who increases the hysteria around pediatric treatments with reckless concern for journalistic integrity. In your article on botulinum toxin treatments, you write about public health warnings about the safety of botox for children. These claims go unchallenged in your article.

Botulinum toxin injections are indicated for the treatment of spasticity based on CLASS A evidence. This level of medical evidence is the highest standard possible and is the type of evidence that also supports antibiotics for pneumonia and other basic medical treatments

The fact is that the weight of medical literature indicates that the use of botulinum toxins in children is safe and without major risk.

Is there risk in life? Of course. Are rare side effects possible? I warmly welcome advisories of such rare side effects. 

Keep in mind that in the US the risk of a fatal car accident in is 1.5 in 10,000 per year. Are the risks of botulinum toxin injections worse than those of the car ride to get them?

Imagine having a child with cerebral palsy. They may have trouble with movement or theri care due to spasticity. Spasticity is disabling, painful and can end in immobilizing, fixed contractures.

How would you treat your own child after reading your article? For spasticity, the options are surgeries, implanted devices and medications. All have higher risks with more unpredictable outcomes.

In the end, parents read your article and those like it and make decisions about the care for their children. Your fear-mongering, built on poor journalistic practices,  creates a barrier to children getting care.

I have included links to peer-reviewed article in major medical journals for your reference

I think a follow up article on the use and safety of this treatment is on order.

Dr. Rotenberg
Child Neurologist
Houston TX

NoƩmi Dahan-Oliel, Bahar Kasaai, Kathleen Montpetit, Reggie Hamdy
Int J Pediatr. 2012; 2012: 898924. Published online 2012 April 5. doi: 10.1155/2012/898924
Guy Molenaers, Anja Van Campenhout, Katrien Fagard, Jos De Cat, Kaat Desloovere
J Child Orthop. 2010 June; 4(3): 183–195. Published online 2010 March 18. doi: 10.1007/s11832-010-0246-x
M R. Delgado, D Hirtz, M Aisen, S Ashwal, D L. Fehlings, J McLaughlin, L A. Morrison, M W. Shrader, A Tilton, J Vargus-Adams
Neurology. 2010 January 26; 74(4): 336–343. doi: 10.1212/WNL.0b013e3181cbcd2f
Kristie Bjornson, Ross Hays, Cathy Graubert, Robert Price, Francine Won, John F. McLaughlin, Morty Cohen
Pediatrics. Author manuscript; available in PMC 2007 July 16.
Published in final edited form as: Pediatrics. 2007 July; 120(1): 49–58. doi: 10.1542/peds.2007-0016

See this  quote on Adverse Events

A total of 56 adverse events potentially having any relationship to treatment (injection of BTX-A or saline) were reported during the 6-month study period for both treatment groups. The frequency of adverse events by treatment group (30 = BTX, 26 = placebo) was not significantly different between the groups (p= 0.22). Six of these events required ibuprofen for muscle soreness at injection site (three per treatment group) and three decreased their activity level for 24 hours post injection.

Thursday, July 26, 2012

Pediatric Shortages, Long Wait Times Reinforce Need for Improved Access to Health Care for Children

Its worse in Texas!!!

Be vocal and advocate for your child to see a pediatric specialist! One way to reduce health care costs is to restrict access.

If you have an access issue, speak to your primary care, your HR department at your employer, your insurance representative and/or a case manager! JR

Children's Health

Pediatric Shortages, Long Wait Times Reinforce Need for Improved Access to Health Care for Children
Jul 23, 2012 - 10:43:10 AM

( - Alexandria, VA – As the fight around the constitutionality of the Affordable Care Act settles, new data indicate that the battle to ensure timely access to health care for America’s child patients is far from over. Today, the Children’s Hospital Association unveils results of a national survey that shows severe physician shortages and long wait times are a harsh reality for many kids seeking health care in the United States. The Association releases these findings as part of its Family Advocacy Day, July 23-25, an annual, national event that enables children’s hospital patients and their families to share their health care stories and make their voices heard on Capitol Hill.

“Although significant progress has been made to support children’s health care in recent years, children still face barriers when accessing pediatric care,” says Mark Wietecha, president and CEO of the Children’s Hospital Association. “Children deserve better. More needs to be done to ensure they’re getting the care they need, when they need it and in the right care setting.”

The survey analysis of nearly 70 children’s hospitals across the country reveals ongoing vacancies of 12 months or longer among key pediatric specialties – such as neurology (39 percent of hospitals surveyed), general surgery (30 percent) and developmental-behavioral medicine (28 percent) – that are impacting hospitals’ ability to provide timely medical care to kids. These findings are reinforced by American Board of Pediatrics Workforce Data 2011-2012, which show restricted access to certified specialists in several areas of the country.[i]

In fact, 3 out of 4 hospitals say the shortages have caused delayed appointments. By the time a child is able to get in for an appointment, he or she may be waiting up to seven times longer when compared to the ideal two-week appointment wait time that hospitals strive for. In the most affected specialties, children can wait nearly 15-weeks for appointments in developmental-behavioral medicine and nine weeks in neurology. Overall, children’s hospitals say the shortages most affecting their ability to deliver care lie in neurology (15 percent of hospitals surveyed), developmental-behavioral medicine (8 percent), gastroenterology (7 percent), pediatric surgery (7 percent), and neurosurgery (5 percent).

Experts agree that without federal funding for critical child health care programs, children’s access to care could be jeopardized even further. The Children’s Hospitals Graduate Medical Education (CHGME), a national program solely devoted to helping children’s hospitals train pediatricians and pediatric specialists, supports the training and development of half of all pediatricians and pediatric specialists practicing in the U.S. Unfortunately, CHGME funding has been rolled back by more than $50 million since FY 2010 and is far below the support needed to close the gap between demand for care and the supply of these specialized caregivers. While CHGME has been successful and has helped increase the number of pediatric providers trained annually, more is still needed. Without sufficient funding for CHGME, as illustrated through the new data, a national shortage of pediatric specialists will persist.

CHGME is not the only national child-focused health care program at risk. Federal budget proposals would slash funding to Medicaid, the federal-state program that provides health coverage to 1 in 3 children, further restricting children’s access to health care. Today, there are numerous proposals to cut Medicaid by billions over the next 10 years. These proposals are on top of the billions in cuts that states have already implemented over the past few years as a means to balance their budgets. (A $1 cut at the state level produces a federal savings of $0.57.)

No one understands the impact of the pediatric specialty shortages quite like the families who have experienced it firsthand. Joining the Children’s Hospital Association in Washington this week to discuss the impact of pediatric shortages is the Johnston family of Minneapolis, MN. Mike Johnston, age 14, suffered from debilitating headaches for over a year until he was diagnosed with a cancerous brain tumor in April 2011. Long waits were an unfortunate reality for Johnston, who attempted to get appointments with psychologists and neurologists before the discovery of the tumor. He was admitted to the emergency room before either of the appointments arrived.

“Had we visited the neurology department earlier, I’m confident they would have seen the mass forming,” explains his dad John Johnston. “And while the treatment likely would have been the same, Mike would have suffered far less. He was lucky, and thanks to specialized care, he’s now cancer free. Sadly, for millions of other children waiting for care, the outcome may be very different.”

The Johnston family is joined in Washington this week by nearly 30 other child patients, from 19 states and the District of Columbia, to bring to life the importance of timely, quality pediatric care for kids, and encourage legislators to take action to protect and improve care for children.

“As the data confirm, and the patient stories illustrate, many children wait far too long to get needed services to diagnose, treat and manage all kinds of diseases,” notes Wietecha. “When children don’t get timely care, they miss school; they can fall behind; their parents miss work, creating more family stress. A domino effect can occur when children don’t have timely access to specialized pediatric care.”

While shortages in neurology and behavioral-developmental care rise to the top of the Association’s list of shortages, the data show the overall impact of shortages is widespread, with children waiting for care in other key areas, including genetics (11 weeks), rheumatology (8 weeks), dermatology (8 weeks), child and adolescent psychiatry (7.5 weeks), and endocrinology (7 weeks).

As a result of difficulties recruiting pediatric specialists, children’s hospitals also report increased recruitment costs (67 percent of hospitals surveyed); lost referrals - where children are referred to other providers who are adult clinicians (64 percent); decreased staff morale (56 percent); increased salaries (55 percent); delayed and/or lost surgeries and reduction in level of service (52 percent).

# # #

About the Children’s Hospitals Pediatric Specialist Workforce Survey
Fielded by the Children’s Hospital Association during the month of May 2012, 69 member hospitals of the Association completed the survey.

Methodology: Surveys were sent to all medical directors (or their designees) in hospitals that are members of the Children’s Hospital Association. The survey, consisting of seven questions, was sent in an Adobe PDF format via email, and respondents were asked to email or fax their completed survey back to the Association. In total, 69 hospitals responded (approximately a 30 percent response rate) including many of the largest children’s teaching hospitals in the nation. Analysis was completed using SPSS Statistics 20.0.

Limitations: Responses came from a variety of hospitals: acute care to specialty care, large hospitals to small hospitals. Not every hospital provided a wait time for every specialty, due to the fact that some hospitals do not offer all services or do not collect data on all of services.

About the Children’s Hospital Association
The Children’s Hospital Association advances child health through innovation in the quality, cost and delivery of care. Representing more than 220 children’s hospitals, the Association is the voice of children’s hospitals nationally. The Association advances public policy enabling hospitals to better serve children, and is the premier resource for pediatric data and analytics driving improved clinical and operational performance of member hospitals. Formed in 2011, the Association brings together the strengths and talents of three organizations: Child Health Corporation of America (CHCA), National Association of Children’s Hospitals and Related Institutions (NACHRI) and National Association of Children’s Hospitals (N.A.C.H.).

For more information on Family Advocacy Day, visit, or follow the families on Facebook at or Twitter, @speaknowforkids, #FAD12.

[i] American Board of Pediatrics, 2011:

Tuesday, July 24, 2012

Pen-like tool might effectively stop seizures

New pen, similar to an epi-pen, is being developed to help stop seizures. This could be a huge advancement for emergency medical services when responding to calls about seizures.

Would it come as a surprise to learn that every two minutes someone dies from a neurological emergency? Or that seizures are the most common reason for ambulance calls? Witnessing someone having a seizure can be frightening – especially if you don’t know what to do.

First of all, what is a seizure? Seizures are a symptom of a commonly known condition: Epilepsy. A seizure results from a disturbance in the normal electrical functions of the brain. These intermittent, intense bursts of energy often affect a person’s consciousness, bodily movements or sensations for a short time. Epilepsy affects approximately three million Americans and 50 million people worldwide; it is the third most common neurological disorder in the U.S. after Alzheimer’s disease and stroke. It is estimated that about one in 10 people will experience a seizure at some point in their lives.

Typically, epilepsy patients can decrease the frequency and intensity of their seizures or even become seizure-free by using an anti-epileptic medication. Other treatment options include the removal of the part of the brain that causes the seizure – only if it doesn’t interfere with vital functions, including speech, language or hearing. Another option is vagus nerve stimulation – a therapy involving the implantation of a device under the skin of your chest, which delivers short bursts of energy to your brain through your vagus nerve.

One condition, termed status epilepticus, is of particular concern, as it causes 55,000 deaths each year. This type of seizure is one that lasts more than five minutes. The usual treatment for status epilepticus is the IV delivery of anticonvulsant drugs (e.g. lorazepam). As one might imagine, it can be very difficult to place an IV into someone having a seizure, thus wasting valuable time. Fortunately, new research has developed a pen-like mechanism – similar to an EpiPen for allergic reaction – which delivers anti-seizure medicine directly into the muscle, rather than through an IV.

A new trial, the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART), is the first randomized clinical trial to investigate whether intramuscular delivery of midazolam is as effective as IV-delivered lorazepam, the current standard of care. In this study, paramedics compared how well delivery by each method (IV vs. intramuscular) stopped patients’ seizures by the time the ambulance arrived at the emergency department.

Upon arrival at the hospital, 73 percent of patients were seizure-free (with intramuscular injection) whereas only 63 percent were seizure-free (with IV injection). Patients treated with midazolam (intramuscular injection) were also less likely to require hospitalization than the IV injection group. Among those admitted to the hospital, however, both groups had similarly low rates of recurrent seizures.

This development provides a promising future for those who suffer from seizures or epilepsy. Thus far, IV delivery has only been researched and utilized by paramedics. More research is needed to ascertain the ease of usage among epilepsy patients and their care givers.

In the meantime, if you do witness someone having a seizure, the best actions you can take are to: protect the person from injury by removing any harmful objects, cushion their head and call 911, especially if it lasts more than five minutes. Do NOT try to restrain the person’s movements, move them or put anything in their mouth.

Read more here

Police need sleep for health and adequate performance

One study looks into reasons why police specifically need enough sleep.

Forget bad guys and gunfire: Being a police officer can be hazardous to your health in other ways.

Researchers at the University of Iowa have found that police officers who sleep fewer than six hours per night are more susceptible to chronic fatigue and health problems, such as being overweight or obese, and contracting diabetes or heart disease. The study found that officers working the evening or night shifts were 14 times more likely to get less restful sleep than day-shift officers, and also were subjected to more back-to-back shifts, exacerbating their sleep deficit.

The study is the first peer-reviewed look at differences in duration and quality of sleep in the context of shift work and health risks in the police force, the authors noted.

"This study further confirmed the impact of shift work on law enforcement officers and the importance of sleep as a modifiable risk factor for police," wrote Sandra Ramey, assistant professor in the College of Nursing at the UI and the lead author on the paper published inWorkplace Health & Safety. "The good news is this is correctable. There are approaches we can take to break the cascade of poor sleep for police officers."

The research is important because getting fewer than six hours of sleep could affect officers' ability to do their jobs, which could affect public safety. It also boosts the risk for health problems, which could affect staffing and could lead to higher health costs borne by taxpayers.

The researchers recommend putting practices in place to ensure officers get proper sleep. For example, 83 percent of police on the evening or night shift reported having to report to duty early the next morning at least occasionally. One idea from the UI team is to change the morning time that evening or night-shift officers may need to appear in court, to ensure that they get full rest. They also recommend that law enforcement and nurses partner more closely, to encourage officers to get 7-8 hours of sleep per night.

The researchers surveyed 85 male police officers ranging in age from 22 to 63 years old from three police departments in eastern Iowa. The respondents were equally divided between those who worked the day shift and those who worked the evening or night shifts. The officers, who worked on average 46 hours per week, were queried on their levels of stress and fatigue, while their height, weight, and C-reactive protein levels (marks inflammation levels in the blood) were measured.

While officers working the evening or night shifts were more likely to get fewer than six hours of sleep, the researchers also found that police who slept fewer than six hours were twice as likely to sleep poorly. That finding is important, because poor sleep can lead to "vital exhaustion," or chronic fatigue, the authors noted, which can trigger additional health problems.

The UI study builds on other studies that show a possible link between sleep deprivation and ill health and chronic fatigue in police officers. "This finding is supported by other studies that suggested poor sleep and short sleep (with resultant fatigue) may be related to psychological stress," they wrote.

Somewhat surprisingly, the researchers did not find a strong tie between lack of sleep and the onset of health complications, although they said a larger statistical sample may be needed to more fully understand the relationship.

The study, titled "The effect of work shift and sleep duration on various aspects of police officers' health," was published in the May edition of the journal. M. Kathleen Clark, Yelena Perhounkova, and Hui-Chen Tseng from the UI College of Nursing are co-authors on the study. Laura Budde, from Mercy Hospital in Iowa City, and Mikyung Moon, from Keimyung University in South Korea, are contributing authors on the paper.

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Poor sleep may age your brain more quickly

Many studies conclude that negative impacts of poor sleep now include your brain aging more quickly.

Evidence is building that poor sleep patterns may do more than make you cranky: The amount and quality of shuteye you get could be linked to mental deterioration and Alzheimer's disease, four new studies suggest.

Too little or too much sleep was equated with two years' brain aging in one study. A separate study concluded that people with sleep apnea -- disrupted breathing during sleep -- were more than twice as likely to develop mild thinking problems or dementia compared to problem-free sleepers. Yet another suggests excessive daytime sleepiness may predict diminished memory and thinking skills, known as cognitive decline, in older people.

"Whether sleep changes, such as sleep apnea or disturbances, are signs of a decline to come or the cause of decline is something we don't know, but these four studies . . . shed further light that this is an area we need to look into more," said Heather Snyder, senior associate director of medical and scientific relations for the Alzheimer's Association in Chicago, who was not involved in the studies.

The studies are scheduled for presentation Monday at the Alzheimer's Association annual meeting in Vancouver.

The largest of the studies, which examined data on more than 15,000 women in the U.S. Nurses' Health Study, suggested that those who slept five hours a day or less, or nine hours a day or more, had lower average mental functioning than participants who slept seven hours per day. Too much or too little sleep was cognitively equivalent to aging by two years, according to the research, which followed the women over 14 years beginning in middle age.

The study also observed that women whose sleep duration changed by two hours or more a day from mid- to later life had worse brain function than participants with no change in sleep duration -- a finding that held true regardless of how long they usually slept at the beginning of the study.

"We went in with the hypothesis that extreme changes in sleep duration might be worse for cognitive function because they disrupt the circadian rhythm, so these results line up nicely," said study author Elizabeth Devore, an associate epidemiologist at Brigham and Women's Hospital in Boston. "I think this gives us data to think about sleep- and circadian-based interventions being a route to address cognitive function." Circadian rhythm is the term for the physical, mental and behavioral changes that follow a 24-hour cycle.

The other new research that associates sleep and brain function follows:

  • Scientists from University of California, San Francisco measured the sleep quality of more than 1,300 women over age 75 using sensor units and recordings of physical changes during sleep. They found that participants with sleep-disordered breathing or sleep apnea had more than twice the odds of developing mild cognitive impairment or dementia over five years than those without those conditions. Those with greater nighttime wakefulness were more likely to score worse on tests of verbal fluency and global cognition.
  • In France, nearly 5,000 mentally healthy French people over age 65 were evaluated four times over eight years. Researchers looked at different aspects of insomnia and found that excessive daytime sleepiness -- which was reported by 18 percent of participants -- increased the risk of mental decline. Difficulty in staying asleep did not.
  • Scientists from Washington University School of Medicine in St. Louis obtained samples of blood and cerebrospinal fluid from three groups of volunteers -- those with dementia, a healthy age-matched set and a younger set -- over 36 hours and found that daily sleep patterns were linked to levels of amyloid proteins. These proteins are recognized as an indicator of Alzheimer's disease.

While Snyder and Devore agreed that much more research is needed, the studies potentially pave the way for sleep interventions that could stave off mental deterioration.

"We may be able to help those individuals," Snyder said. "If you're having problems with sleep, you may want to follow up with your health care provider."

Because research presented at scientific conferences has not been peer-reviewed and published in a medical journal, results are considered preliminary.

Also, if you suffer from insomnia, don't worry that you're doomed to develop dementia. Although the studies report an association between sleep disturbances and mental decline, they do not show a cause-and-effect relationship.

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Study claims sleep deprivation lowers risk of post-traumatic stress disorder

If I was in colorado, I would advise modest sleep restriction for anyone traumatized by last weeks shooting. JR

A new study claims that a lack of sleep after a traumatic event reduces the risk of PTSD. This can help reduce the negative effects resulting from a traumatic event.

Sleep deprivation in the first few hours after exposure to a significantly stressful threat actually reduces the risk of Post-Traumatic Stress Disorder (PTSD), a new study has revealed.
The study revealed in a series of experiments that sleep deprivation of approximately six hours immediately after exposure to a traumatic event reduces the development of post trauma-like behavioural responses.
As a result, sleep deprivation the first hours after stress exposure might represent a simple, yet effective, intervention for PTSD.
Approximately 20 percent of people exposed to a severe traumatic event, such as a car or work accident, terrorist attack or war, cannot normally carry on their lives.
These people retain the memory of the event for many years. It causes considerable difficulties in the person’s functioning in daily life and, in extreme cases, may render the individual completely dysfunctional.
“Often those close to someone exposed to a traumatic event, including medical teams, seek to relieve the distress and assume that it would be best if they could rest and “sleep on it,” Prof. Prof. Hagit Cohen, director of the Anxiety and Stress Research Unit at BGU’s Faculty of Health Sciences, said.
“Since memory is a significant component in the development of post-traumatic symptoms, we decided to examine the various effects of sleep deprivation immediately after exposure to trauma,” Cohen said.
In the experiments, rats that underwent sleep deprivation after exposure to trauma, later did not exhibit behaviour indicating memory of the event, while a control group of rats that was allowed to sleep after the stress exposure did remember, as shown by their post trauma-like behaviour.
“As is the case for human populations exposed to severe stress, 15 to 20 percent of the animals develop long-term disruptions in their behaviour,” Cohen said.
“Our research method for this study is, we believe, a breakthrough in biomedical research,” Cohen added.
The new study was published in the international scientific journal, Neuropsychopharmacology
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