Thursday, October 24, 2019

Life at 32

Of course to me her eyes are the most beautiful and her face the most pleasing. However, outside observers would find that her eyes at first glance are nothing special. They are a normal shade of brown, just like the eyes of several other billion people alive today. And of course, it goes without saying that she has black pupils like I do. Her eyelids are average, even with those tattoos that serve as permanent eyeliner. People would say that she has a normal amount of moisture to her eyes, and when she blinks, it’s at an average rate. By all measures, you’d have to conclude that her eyes are identical to probably half of the entire population, maybe more. 

Her face is mostly symmetric, with smooth skin and the occasional freckle. Her skin color is an ordinary shade of Caucasian. Her teeth are unexceptional, being normal ivory colored and mostly straight. They are not that glaring white that is so prevalent among celebrities nowadays. Overall, people say that she has a common appearance to her face. In fact, so common that strangers frequently come up to her and say, “don’t I know you from somewhere?” or “didn't we go to school together?” or “aren’t we related somehow?”  

Some would say average, common, ordinary, normal, unexceptional. But it all changes when you look deeper.

To see beyond her eyes, beyond her face, beyond her outer appearance, that is where her remarkable and unique beauty lies. That is where you find greater beauty than the Mona Lisa, greater beauty than Marilyn Monroe standing over a subway grate, greater beauty than the Sistine Chapel. Think of the most gorgeous day you’ve ever experienced, or the most breathtaking sunset you’ve seen. Multiply that by infinity and you’ll know what I’m talking about. This is real beauty, the kind that not only touches your soul, but strengthens it. 

For her beauty comes from her confident love, unique in its depth and more solid than the bedrock that supports the tallest skyscrapers. It’s unshakable, unbreakable. You’ll find that she believes in you, not just a little bit, but without reservation. Although never approving of actions that hurt others, her gaze and her words let you know that she sees in you an inner goodness. She inspires you to be and do your very best, in a relaxed and joyous manner. She is confident in you. She knows you can do incredible things that will make the world a better place. She knows these things, and nothing you say, any doubts you may have, will change her confidence in you.

For my part, what have I ever done to deserve being with her? Even on our days apart, I become stronger, more complete, more full of optimism and love because of her. Pleasing to look at, yes, but I also get to experience the full essence of who she is. I experience an inner tranquility that doesn’t come from within myself, but rather is something she gives me. Every day. 

Now, at 32 years of marriage, I know what beautiful is. It’s her. 



Tuesday, October 22, 2019

Assessment of a Targeted Electronic Health Record Intervention to Reduce Telemetry Duration: A Cluster-Randomized Clinical Trial.

Should "alarm fatigue" be treated by the ostrich method, i.e. simply stop monitoring patients? How about learning how to identify false alarms better? - TFH



Assessment of a Targeted Electronic Health Record Intervention to Reduce Telemetry Duration: A Cluster-Randomized Clinical Trial.:

Icon for Silverchair Information Systems Related Articles
Assessment of a Targeted Electronic Health Record Intervention to Reduce Telemetry Duration: A Cluster-Randomized Clinical Trial.

JAMA Intern Med. 2019 01 01;179(1):11-15

Authors: Najafi N, Cucina R, Pierre B, Khanna R

Abstract

Importance: Physicians frequently use cardiac monitoring, or telemetry, beyond the duration recommended by published practice standards, resulting in "alarm fatigue" and excess cost. Prior studies have demonstrated an association between multicomponent quality improvement interventions and safe reduction of telemetry duration.

Objective: To determine if a single-component intervention, a targeted electronic health record (EHR) alert, could achieve similar gains to multicomponent interventions and safely reduce unnecessary monitoring.

Design, Setting, and Participants: This cluster-randomized clinical trial was conducted between November 2016 and May 2017 on the general medicine service of the Division of Hospital Medicine at the University of California, San Francisco Medical Center and included physicians of 12 inpatient medical teams (6 intervention, 6 control).

Interventions: The EHR alert was randomized to half of the teams on the general medicine service. The alert displayed during daytime hours when physicians attempted to place an order for patients not in the intensive care unit whose telemetry order duration exceeded the recommended duration for a given indication.

Main Outcomes and Measures: The primary outcome was telemetry monitoring hours per hospitalization, which was measured using time-stamped orders data from the EHR database. Physician responses to the alert were collected using EHR reporting tools. The potential adverse outcomes of rapid-response calls and medical emergency events were measured by counting the notes documenting these events in the EHR.

Results: Of the 1021 patients included in this study, in the intervention arm, there was a mean (SD) age of 64.5 (18.9) and 215 (45%) were women; in the control arm, there was a mean (SD) age of 63.8 (19.1) and 249 (46%) were women. The 12 teams were stratified to 8 house-staff teams and 4 hospitalist teams, with 499 hospitalizations analyzed in the intervention arm and 567 hospitalizations analyzed in the control arm. The alert prompted a significant reduction in telemetry monitoring duration (-8.7 hours per hospitalization; 95% CI, -14.1 to -3.5 hours; P = .001) with no significant change in rapid-response calls or medical emergency events. The most common physician response to the alert was to discontinue telemetry monitoring (62% of 200 alerts).

Conclusions and Relevance: A targeted EHR alert can safely and successfully reduce cardiac monitoring by prompting discontinuation when appropriate. This single-component electronic intervention is less resource intensive than typical multicomponent interventions that include human resources.

Trial Registration: ClinicalTrials.gov identifier: NCT02529176.

PMID: 30535345 [PubMed - indexed for MEDLINE]

A systematic overview of the scientific literature on the association between Mediterranean Diet and the Stroke prevention.

The Mediterranean Diet works great at disease prevention! - TFH



A systematic overview of the scientific literature on the association between Mediterranean Diet and the Stroke prevention.:

Related Articles
A systematic overview of the scientific literature on the association between Mediterranean Diet and the Stroke prevention.

Clin Ter. 2019 Sep-Oct;170(5):e396-e408

Authors: Saulle R, Lia L, De Giusti M, La Torre G

Abstract

BACKGROUND: Stroke is the most common cardiovascular disorder after heart disease and one of the major causes of death and disability. Mediterranean diet has proven to be an effective means to prevent cardiovascular diseases and may contribute to the prevention of stroke. This overview aims to analyze all reviews that examine the association between Mediterranean diet pattern and stroke.

METHODS: We conducted a literature search on PubMed and Scopus databases, using the keywords "Mediterranean diet" and "Stroke". All studies were selected evaluating the association between the Mediterranean diet and the prevention of stroke and only systematic reviews, meta-analysis and narrative reviews were included.

RESULT: 25 eligible articles were included (16 narrative reviews, 9 systematic reviews, 6 systematic reviews with meta-analyses). The authors stated that Mediterranean diet may be a useful means of preventing stroke, especially the 6 meta-analyses highlighted that high adherence to Mediterranean diet was protective against stroke, with a relative risk ranging from 0,64 (95% CI 0,48-0,88) to 0,90 (95% CI 0,87-0,93). Moderate adherence has not shown significant results.

CONCLUSION: A high adherence to the Mediterranean diet is inversely associated with stroke risk, and can modify the costs of its management, therefore the prevention policies should implement adherence to this healthy diet.

PMID: 31612199 [PubMed - in process]

The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study.

This study found that aspirin use decreased in-hospital mortality. - TFH



The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study.:

Icon for Nature Publishing Group Icon for PubMed Central Related Articles
The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study.

NPJ Prim Care Respir Med. 2018 02 21;28(1):7

Authors: Goto T, Faridi MK, Camargo CA, Hasegawa K

Abstract

Little is known about the effect of long-term aspirin use on acute severity of COPD. We hypothesized that, in patients hospitalized for acute exacerbation of COPD (AECOPD), long-term aspirin use is associated with lower risks of disease severity (in-hospital death, mechanical ventilation use, and hospital length-of-stay). We conducted a retrospective cohort study using large population-based data from 2012 through 2013. Among 206,686 patients (aged ≥40 years) hospitalized for AECOPD, aspirin users had lower in-hospital mortality (1.0 vs. 1.4%; OR 0.60 [95% CI 0.50-0.72]; P < 0.001) and lower risk of invasive mechanical ventilation use (1.7 vs. 2.6%; OR 0.64 [95% CI 0.55-0.73]; P < 0.001) compared to non-users, while there was no significant difference in risks of non-invasive positive pressure ventilation use. Length-of-stay was shorter in aspirin users compared to non-users (P < 0.001). In sum, in patients with AECOPD, aspirin use was associated with lower rates of in-hospital mortality and invasive mechanical ventilation use, and shorter length-of-stay.

PMID: 29467461 [PubMed - indexed for MEDLINE]

Clinical Guideline Highlights for the Hospitalist: Initial Management of Acute Pancreatitis in the Hospitalized Adult.

a couple of interesting recommendations are to start a PO diet as tolerated at 24h and also to us IV fluids on a case-by-case basis instead of giving lots of IV fluid to all patients.- TFH



Clinical Guideline Highlights for the Hospitalist: Initial Management of Acute Pancreatitis in the Hospitalized Adult.:

Related Articles
Clinical Guideline Highlights for the Hospitalist: Initial Management of Acute Pancreatitis in the Hospitalized Adult.

J Hosp Med. 2019 Oct 23;14:E1-E2

Authors: Jenkins A, Shapiro J

Abstract

GUIDELINE TITLE: 2018 American Gastroenterological Association (AGA) Institute Guideline on Initial Management of Acute Pancreatitis RELEASE DATE: March 2018 PRIOR VERSION: Not applicable DEVELOPER: AGA Clinical Practice Guideline Committee FUNDING SOURCE: AGA Institute TARGET POPULATION: Patients within first 48-72 hours of admission with acute pancreatitis (AP).

PMID: 31634105 [PubMed - as supplied by publisher]

Thursday, October 3, 2019

5 Ways To Accept You’ve Got A Chronic Illness

Good comments from a psychiatrist... - TFH



5 Ways To Accept You’ve Got A Chronic Illness:

Nobody wants to hear that their health problems are chronic, i.e., that the symptoms you’re dealing with are never really going to go away. If you’ve got anxiety, however, it’s not just unpleasant to hear that you’ve got a chronic illness–it can be downright impossible. Your brain is wired to obsess, so it’s natural to keep searching for a solvable problem instead of accepting the one you’ve got. Instead of fruitlessly fixating on ways to fix yourself, here are five ways to force yourself to accept you’ve got a chronic illness.

1) Resist Revisiting the Diagnosis

Don’t believe your feelings when they tell you that if you could just find a better doctor/hospital/health care system then you’d be able to find someone who knows how to help. Bad news often makes people feel that way, but searching for better news is a good way to make the inevitable disappointment even more painful. Your job isn’t to find a cure or just the right doctor to deliver it, but to look for treatments that might help and figure out how much risk they pose to your health and finances.

2) Get A Civilian Second Opinion

Find a friend, relative, or therapist who can help you figure out your options, focus your questions and keep them realistic. Don’t look for blanket reassurance and emotional support, which won’t protect you from listening to every charismatic quack you find or embracing a never-ending series of unlikely and dangerous treatments. Ask your trusted guide to help you interpret what your doctor says and ask yourself and your doctor whether you’ve gotten all the necessary tests, what any possible risks or side effects are to a suggested treatment, and whether you’ve tapped into all the expertise available.

3) Confusion Isn’t Failure

When the first round of tests don’t offer a cure or explanation, don’t let helplessness or fear convince you that you’ve failed to find the right help. Remind yourself that it’s important to know the conditions you don’t have; otherwise, you wouldn’t know what treatments won’t help you and aren’t worth pursuing. Then get a second medical opinion to help you figure out whether there are other tests worth doing or treatments worth trying. Either way, trial and error is what chronic illnesses are all about, so don’t get discouraged quickly if you get negative results or don’t see immediate improvement.

4) Dictate Your Own Direction

Don’t blindly ask your doctors to tell you what to do. Instead, gather as much information as you can and ask them why they think a particular diagnosis isn’t worth pursuing or treatment isn’t worth doing. Without letting your anxiety push you into an endless quest for the answer you desire, use it to gain expertise in your actual, undesirable situation so you gain confidence in your decision making. Having learned all you can, you will develop your own opinions about how you wish to manage your symptoms; knowledge may not lead you to a cure, but it will make you feel less helpless and doomed.

5) Get New Goals

Once your research into your illness has persuaded you to accept that a cure is unrealistic, assign yourself a new set of management goals. They should include seeking advice and gathering knowledge from other people with your illness who have been successful at living with their symptoms and deciding whether there are management techniques or medical treatments worth trying. You must also select clinicians who have the expertise to provide treatment, advice, and coaching over the long term. Most importantly, don’t let your diagnosis consume you; don’t focus so much on your illness that you forget the other important things in your life, like your relationships, work and values. Just because you’re not a healthy person doesn’t mean you can’t still be a good one.

The post 5 Ways To Accept You’ve Got A Chronic Illness appeared first on fxckfeelings.com.

Effects of Aspirin or Clopidogrel on Colorectal Cancer Chemoprevention in Patients with Type 2 Diabetes Mellitus.

Aspirin was associated in this study with a lower incidence rate of colorectal cancer. - TFH



Effects of Aspirin or Clopidogrel on Colorectal Cancer Chemoprevention in Patients with Type 2 Diabetes Mellitus.:

Effects of Aspirin or Clopidogrel on Colorectal Cancer Chemoprevention in Patients with Type 2 Diabetes Mellitus.

Cancers (Basel). 2019 Sep 29;11(10):

Authors: Kuan YC, Huang KW, Lin CL, Luo JC, Kao CH

Abstract

Background: The effect of clopidogrel, whose mechanism of action differs from that of aspirin, on CRC risk remains unknown. We investigated the effects of clopidogrel and aspirin, either as monotherapy or combined, on colorectal cancer (CRC) risk in patients with Type 2 diabetes mellitus (T2DM). Methods: We conducted a cohort study using Taiwan National Health Insurance Research Database. Four groups comprising 218,903 patients using aspirin monotherapy, 20,158 patients using clopidogrel monotherapy, 42,779 patients using dual antiplatelet therapy, and 281,840 nonuser matched controls were created using propensity score matching. Cox proportional hazards regression was used to evaluate the CRC risk during follow-up. Results: During the 13-year follow-up period, we found 9431 cases of CRC over 3,409,522 person-years. The overall incidence rates of CRC were 2.04, 3.45, 1.55, and 3.52 per 1000 person-years in the aspirin, clopidogrel, dual antiplatelet, and nonuser cohorts, respectively. The adjusted hazard ratios (aHRs) were 0.59 (95% confidence interval [CI], 0.56-0.61), 0.77 (95% CI, 0.68-0.87), and 0.37 (95% CI, 0.33-0.40) for the aspirin, clopidogrel, and dual antiplatelet cohorts, respectively. Dose- and duration-dependent chemopreventive effects were observed in the three cohorts.

PMID: 31569587 [PubMed]

Is Academic Medicine Ready for Term Limits?

This is a good idea.... - TFH



Is Academic Medicine Ready for Term Limits?:

Related Articles
Is Academic Medicine Ready for Term Limits?

Acad Med. 2019 Oct 01;:

Authors: Austin JP

Abstract

The use of term limits in politics and business has been proposed as a means to refresh leadership, encourage innovation, and decrease gender and racial disparities in positions of power. Many U.S. states and the executive boards of businesses have incorporated them into their constitutions and bylaws; however, studies in politics and business have shown that implementing term limits has mixed results. Specifically, research in politics has shown that terms limits have had a minimal effect on the number of women and minorities elected to office, while research in business indicates term limits do increase innovation. Additionally, term limits may have unintended negative consequences, including inhibiting individuals from developing deep expertise in a specific area of interest and destabilizing institutions that endure frequent turnover in leaders. Given this conflicting information, it is not surprising that AMCs in the United States have not widely incorporated term limits for those holding positions of power, including deans, presidents, provosts and department heads. Notably, a few academic medical centers (AMCs) have incorporated such limits for some positions, and faculty have viewed these positively for their ability to shape a more egalitarian and collaborative culture. Drawing on studies from academic medicine, politics, and business, the author examines arguments both for and against instituting term limits at AMCs. The author concludes that despite strong arguments against term limits, they deserve attention in academic medicine, especially given their potential to help address gender and racial disparities and to encourage innovation.

PMID: 31577584 [PubMed - as supplied by publisher]

Tuesday, October 1, 2019

Risk of myocardial infarction among new users of calcium supplements alone or combined with vitamin d: a population-based case-control study.

Calcium with vitamin D supplementation may decrease cardiovascular risk - TFH



Risk of myocardial infarction among new users of calcium supplements alone or combined with vitamin d: a population-based case-control study.:

Clin Pharmacol Ther. 2019 Sep 27;:
Authors: Rodríguez-Martín S, González-Bermejo D, Rodríguez-Miguel A, Barreira D, García-Lledó A, Gil M, de Abajo FJ

Abstract

A population-based case-control study was conducted to evaluate the risk of acute myocardial infarction among new users of calcium supplements, alone (CaM) or in combination with vitamin D (CaD). A total of 23025 cases and 114851 controls randomly sampled from the underlying cohort and matched with cases by age, sex and index date were included. New users of CaM and CaD were categorized as current-, recent-, past- and non-users. We computed adjusted odds ratios (AOR) and their 95%CI among current users as compared to non-users through a conditional logistic regression. No increased risk was associated with CaM overall (59 cases (0.26%) and 273 controls (0.24%); AOR=0.80;0.59-1.09), nor was it found in any of the conditions examined. Instead, the use of CaD was associated with a decreased risk (275 cases (1.19%) and 1160 controls (1.45%); AOR=0.78;0.67-0.90), dose and duration-dependent, and particularly evident in patients with a high cardiovascular risk (AOR=0.59;0.43-0.81).

PMID: 31560413 [PubMed - as supplied by publisher]

Air pollution: A systematic review of its psychological, economic, and social effects.

We need to transition from fossil fuels to nuclear energy in order to effectively combat this. Solar, wind, and hydro power are not sufficiently robust and reliable to power large cities such as New York, Tokyo, or London. Energy from biomass (i.e. burning wood and similar) creates even more air pollution and carbon production. Only nuclear will provide carbon-free, reliable 24/7 energy without polluting the air, and 4th generation nuclear plants even use up what was considered nuclear waste. Nuclear now is exceedingly safe and clean. Plus, from a health standpoint, it is the safest form of energy production we have, much safer than biomass or our obsession with fossil fuels. Don't let irrational fear prevent development of this clear energy source which powers most of France and has even safely powered submarines for decades! - TFH



Air pollution: A systematic review of its psychological, economic, and social effects.:

Curr Opin Psychol. 2019 Jul 08;32:52-65

Authors: Lu JG

Abstract

This review (178 published articles) is the first to systematically examine the psychological (affective, cognitive, behavioral), economic, and social effects of air pollution beyond its physiological and environmental effects. Affectively, air pollution decreases happiness and life satisfaction, and increases annoyance, anxiety, mental disorders, self-harm, and suicide. Cognitively, it impairs cognitive functioning and decision making. Behaviorally, air pollution triggers avoidance behavior, defensive expenditure, and migration as coping strategies. Economically, it hurts work productivity and stock markets. Socially, it exacerbates criminal activities and worsens perception of the government. Importantly, both actual and perceived air pollution levels matter. Limitations of past research and future directions are discussed.

PMID: 31557706 [PubMed - as supplied by publisher]

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.

This study found no benefit of tamsulosin for ureteral stones. - TFH



Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.

JAMA Intern Med. 2018 08 01;178(8):1051-1057

Authors: Meltzer AC, Burrows PK, Wolfson AB, Hollander JE, Kurz M, Kirkali Z, Kusek JW, Mufarrij P, Jackman SV, Brown J

Abstract

Importance: Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage.

Objective: To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.

Design, Setting, and Participants: We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase). Participants were followed for 90 days. The first phase was conducted at a single US emergency department; the second phase was conducted at 6 US emergency departments. Adult patients were eligible to participate if they presented with a symptomatic urinary stone in the ureter less than 9 mm in diameter, as demonstrated on computed tomography.

Interventions: Participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days.

Main Outcomes and Measures: The primary outcome was stone passage based on visualization or capture by the study participant by day 28. Secondary outcomes included crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention, and repeated emergency department visit for urinary stones.

Results: The mean age of 512 participants randomized to tamsulosin or placebo was 40.6 years (range, 18-74 years), 139 (27.1%) were female, and 110 (22.8%) were nonwhite. The mean (SD) diameter of the urinary stones was 3.8 (1.4) mm. Four hundred ninety-seven patients were evaluated for the primary outcome. Stone passage rates were 50% in the tamsulosin group and 47% in the placebo group (relative risk, 1.05; 95.8% CI, 0.87-1.27; P = .60), a nonsignificant difference. None of the secondary outcomes were significantly different. All analyses were performed according to the intention-to-treat principle, although patients lost to follow-up before stone passage were excluded from the analysis of final outcome.

Conclusions and Relevance: Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised.

Trial Registration: ClinicalTrials.gov Identifier: NCT00382265.

PMID: 29913020 [PubMed - indexed for MEDLINE]

Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease.

Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease.:

Icon for Masson (France) Related Articles
Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease.

Rev Neurol (Paris). 2019 Sep 11;:

Authors: Román GC, Jackson RE, Gadhia R, Román AN, Reis J

Abstract

The mechanisms of action of the dietary components of the Mediterranean diet are reviewed in prevention of cardiovascular disease, stroke, age-associated cognitive decline and Alzheimer disease. A companion article provides a comprehensive review of extra-virgin olive oil. The benefits of consumption of long-chain ω-3 fatty acids are described. Fresh fish provides eicosapentaenoic acid while α-linolenic acid is found in canola and soybean oils, purslane and nuts. These ω-3 fatty acids interact metabolically with ω-6 fatty acids mainly linoleic acid from corn oil, sunflower oil and peanut oil. Diets rich in ω-6 fatty acids inhibit the formation of healthier ω-3 fatty acids. The deleterious effects on lipid metabolism of excessive intake of carbohydrates, in particular high-fructose corn syrup and artificial sweeteners, are explained. The critical role of the ω-3 fatty acid docosahexaenoic acid in the developing and aging brain and in Alzheimer disease is addressed. Nutritional epidemiology studies, prospective population-based surveys, and clinical trials confirm the salutary effects of fish consumption on prevention of coronary artery disease, stroke and dementia. Recent recommendations on fish consumption by pregnant women and potential mercury toxicity are reviewed. The polyphenols and flavonoids of plant origin play a critical role in the Mediterranean diet, because of their antioxidant and anti-inflammatory properties of benefit in type-2 diabetes mellitus, cardiovascular disease, stroke and cancer prevention. Polyphenols from fruits and vegetables modulate tau hyperphosphorylation and beta amyloid aggregation in animal models of Alzheimer disease. From the public health viewpoint worldwide the daily consumption of fruits and vegetables has become the main tool for prevention of cardiovascular disease and stroke. We review the important dietary role of cereal grains in prevention of coronary disease and stroke. Polyphenols from grapes, wine and alcoholic beverages are discussed, in particular their effects on coagulation. The mechanisms of action of probiotics and vitamins are also included.

PMID: 31521398 [PubMed - as supplied by publisher]

Extra-virgin olive oil for potential prevention of Alzheimer disease.

More evidence that the Mediterranean Diet may help prevent or delay dementia. - TFH



Extra-virgin olive oil for potential prevention of Alzheimer disease.:

Rev Neurol (Paris). 2019 Sep 11;:

Authors: Román GC, Jackson RE, Reis J, Román AN, Toledo JB, Toledo E

Abstract

Observational epidemiological studies provide valuable information regarding naturally occurring protective factors observed in populations with very low prevalences of vascular disease. Between 1935 and 1965, the Italian-American inhabitants of Roseto (Pennsylvania, USA) observed a traditional Italian diet and maintained half the mortality rates from myocardial infarction compared with neighboring cities. In the Seven Countries Study, during 40years (1960-2000) Crete maintained the lowest overall mortality rates and coronary heart disease fatalities, which was attributed to strict adherence to the Mediterranean diet. In the French Three-City Study, a ten-year follow-up (2000-2010) showed that higher consumption of olive oil was associated with lower risk of death, as well as protection from cognitive decline and stroke. A large number of population-based studies and intervention trials have demonstrated that the Mediterranean diet is associated with lower prevalence of vascular disease, obesity, arthritis, cancer, and age-associated cognitive decline. Many of these effects are the result of consumption of fruits, seeds, legumes and vegetables but olive oil is the chief dietary fat in Mediterranean countries and the main source of monounsaturated fatty acids, as well as an important source of beneficial polyphenols and other antioxidants. Considering the critical role of vascular factors in the pathogenesis of late-onset Alzheimer disease it seems appropriate to focus on disease modification through proven dietary therapy. The authors base their hypothesis on meta-analyses of epidemiological data, numerous experimental studies, and a comprehensive review of the mechanisms of action of extra-virgin olive oil and its components in the prevention of vascular disease. In addition, extra-virgin olive oil has had positive effects on experimental animal models of Alzheimer disease. We therefore propose that extra-virgin olive oil is a promising tool for mitigating the effects of adverse vascular factors and may be utilized for potential prevention of late-onset Alzheimer disease.

PMID: 31521394 [PubMed - as supplied by publisher]

Nutrients in the Prevention of Alzheimer's Disease.

This is an important area of research as the world's population ages. The mediterranean diet remains as solid intervention to help preserve brain health. Intermittent fasting may also be of benefit. Although lots of advocates exist, the scientific data regarding keto diets remain slim and unproven regarding long-term brain health. Anecdotal stories aren't sufficient evidence.  - TFH



Nutrients in the Prevention of Alzheimer's Disease.

Oxid Med Cell Longev. 2019;2019:9874159

Authors: Cremonini AL, Caffa I, Cea M, Nencioni A, Odetti P, Monacelli F

Abstract

Alzheimer's disease (AD) is a disease caused by the complex interaction of multiple mechanisms, some of which are still not fully understood. To date, pharmacological treatments and supplementation of individual nutrients have been poorly effective in terms of the prevention and treatment of AD, while alternative strategies based on multimodal approaches (diet, exercise, and cognitive training) seem to be more promising. In this context, the focus on dietary patterns rather than on single food components could be more useful in preventing or counteracting the pathological processes typical of AD, thanks to the potential synergistic effects of various nutrients (neuronutrients). The aim of this narrative review is to summarize the currently existing preclinical and clinical evidence regarding the Mediterranean diet (MeDi), the Dietary Approaches to Stop Hypertension (DASH) diet, and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, which are three dietary patterns with well-known anti-inflammatory and antioxidant properties. Recently, they have been related to brain protection and AD prevention, perhaps thanks to their high content of neuroprotective bioactive compounds. Similarly, intermittent fasting (IF) or calorie restriction (CR) is emerging as interesting approaches that seem to promote hippocampal neurogenesis, activate adaptive stress response systems, and enhance neuronal plasticity, thus leading to motor and cognitive improvements in animal models of AD and hopefully also in human beings.

PMID: 31565158 [PubMed - in process]

Blockchain in Healthcare: A Patient-Centered Model.

Blockchain in Healthcare: A Patient-Centered Model.:

Related Articles
Blockchain in Healthcare: A Patient-Centered Model.

Biomed J Sci Tech Res. 2019;20(3):15017-15022

Authors: Chen HS, Jarrell JT, Carpenter KA, Cohen DS, Huang X

Abstract

A blockchain is a system for storing and sharing information that is secure because of its transparency. Each block in the chain is both its own independent unit containing its own information, and a dependent link in the collective chain, and this duality creates a network regulated by participants who store and share the information, rather than a third party. Blockchain has many applications in healthcare, and can improve mobile health applications, monitoring devices, sharing and storing of electronic medical records, clinical trial data, and insurance information storage. Research about blockchain and healthcare is currently limited, but blockchain is on the brink of transforming the healthcare system; through its decentralized principles, blockchain can improve accessibility and security of patient information, and can therefore overturn the healthcare hierarchy and build a new system in which patients manage their own care.

PMID: 31565696 [PubMed]

Electronic health records in a Blockchain: A systematic review.

Electronic health records in a Blockchain: A systematic review.:

Electronic health records in a Blockchain: A systematic review.

Health Informatics J. 2019 Sep 30;:1460458219866350

Authors: Mayer AH, da Costa CA, Righi RDR

Abstract

Blockchain could reinvent the way patient's electronic health records are shared and stored by providing safer mechanisms for health information exchange of medical data in the healthcare industry, by securing it over a decentralized peer-to-peer network. Intending to support and ease the understanding of this distributed ledger technology, a solid Systematic Literature Review was conducted, aiming to explore the recent literature on Blockchain and healthcare domain and identify existing challenges and open questions, guided by the raise of research questions regarding EHR in a Blockchain. More than 300 scientific studies published in the last ten years were surveyed, resulting in an up-to-date taxonomy creation, challenges and open questions identified, and the most significant approaches, data types, standards and architectures regarding the use of Blockchain for EHR were assessed and discussed.

PMID: 31566472 [PubMed - as supplied by publisher]

Consumers Would Use Blockchain-based Tokens to Control EHR Access

I would use a blockchain token to lock my EHR as well, since when I'm not being treated there is no reason for my health records to be unlocked. Blockchain tokens would allow you to lock your electronic health record. In an emergency, they could be opened by a surrogate (e.g. spouse) or possibly a bio-encoded key such as a retina scan, fingerprint, or facial recognition, just like smartphones use. - TFH

Consumers Would Use Blockchain-based Tokens to Control EHR Access: Other potential healthcare applications of blockchain include physician credentialing, patient identification, and doctor insurance affiliation tracking, ...


Study: Splashes From Shallow Hospital Sinks Are Spreading Infections

Interesting finding, that if confirmed has important implications for hospitals. Most hospitals nowadays use disposable foam antiseptics, not soap and water, but we still need soap and water for some patients such as those with c.diff. - TFH



Study: Splashes From Shallow Hospital Sinks Are Spreading Infections:

Doctors washing their hands in hospital sink
PHILADELPHIA — Who knew that hospital employees washing their hands may actually help spread infections? As hospital personnel of all levels know, hand hygiene is of paramount importance. However, a study by researchers at the University of Michigan Health System finds that shallow hospital sinks can cause contaminants from dirty faucets to splash out and infect…

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Regularly Including Onions, Garlic In Diet May Lower Breast Cancer Risk Significantly

Makes sense, plus makes your diet more flavorful! - TFH



Regularly Including Onions, Garlic In Diet May Lower Breast Cancer Risk Significantly:

Onions and garlic
BUFFALO, N.Y. — Onions and garlic are integral ingredients to countless recipes, including sofrito, a classic Puerto Rican condiment. Now, after examining the relationship between onion and garlic consumption and breast cancer rates in Puerto Rico, a new study has concluded that these two flavorful vegetables may reduce the risk of developing breast cancer. Researchers from…

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Three Studies Link Air Pollution In U.S. To Serious Mental Health Issues In Children

There are so many deaths and health problems caused by air pollution every year, typically from energy production (fossil fuels primarily). Yet "green energy" advocates are pushing for more biomass energy production because it is renewable. This means burning wood and similar products for energy production. This results in intentionally polluting the air just like a forest fire does. Stop the insanity! It's time to take clean nuclear energy seriously, the one energy source that has killed or harmed the fewest people per unit of energy produced. Time to look at the facts. 4th gen nuclear generators even can use up what was once considered nuclear "waste." - TFH





Three Studies Link Air Pollution In U.S. To Serious Mental Health Issues In Children:

Smog, air pollution in Los Angeles
Research “first to show association between daily outdoor air pollution, increased symptoms of psychiatric disorders” among kids. ‘Smog-induced feelings of anxiety and suicidal thoughts’ more prevalent in children living in poorer neighborhoods. CINCINNATI — Exposure to polluted air, or smog, can result in a number of physical health problems. There have also been numerous studies associating…

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A Nation Divided: U.S. Politics Taking Physical, Emotional Toll On Americans

This is why I decided almost a year ago to stop watching cable news which typically features highly partisan, unhappy, and angry talking heads. Should hospitals restrict the TV stations offerred to patient rooms, and not allow cable news? This would certainly lead to less stress! - TFH





A Nation Divided: U.S. Politics Taking Physical, Emotional Toll On Americans:

Cracked, split American flag indicates divided country
Survey reveals about two in five Americans are stressed out by the political climate, and one in five say they’re even losing sleep. Nearly a third of those surveyed feel views expressed on cable news channels are driving them “crazy.” Study author believes problem is akin to a public health crisis in the country. LINCOLN,…

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Green Tea May Be Essential To Conquering Antibiotic-Resistant Bacteria

This study found that combining an antibiotic for pseudomonas aeruginosa (aztreonam) with an agent found in green tea (epigallocatechin) was more effective than either agent alone. Should doctors prescribe green tea to patients with pneumonia? The answer possibly could be yes! - TFH





Green Tea May Be Essential To Conquering Antibiotic-Resistant Bacteria:

Green tea in bowls, spoons
GUILDFORD, England — Antibiotic-resistant bacteria have become a greater focus among doctors and health-focused scientists in recent years. However, researchers at the University of Surrey in England may have found a secret weapon in the fight against these persistent microbes: green tea. According to their new study, epigallocatechin (EGCG), a natural antioxidant commonly found in green tea,…

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Find the Joy

Lyrics I don’t know why it happened. Where it’s going, a mystery. Somewhere there’s an answer, But the hurt is still inside. And time just k...