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For the very sickest patients in an intensive care unit (ICU), being assigned to a room that can’t easily be seen from the central nursing station might lower the chances of survival.

“Very sick patients require close monitoring by healthcare professionals,” Dr. Phillip H. Factor from Beth Israel Hospital, New York, told Reuters Health by email. “Relying on electronic monitors is not sufficient in the sickest of the sick; these patients require direct observation.”

Factor was the senior researcher on a study of 664 patients in a medical ICU (as opposed to a surgical ICU). Roughly two-thirds of the patients were assigned to rooms with unimpeded visibility from the central nursing station. The remaining third were in corner rooms that couldn’t be seen clearly from the nurses’ station.

In the journal Chest, Factor and his coauthors report that overall, there was no difference in survival rates between patients in the rooms with good visibility and those that couldn’t be seen as easily.

The researchers also considered whether the severity of patients’ illnesses affected their risk in the different rooms. They used a standard tool known as the APACHE II score to judge how sick the patients were.

They found that the very sickest individuals – those with APACHE II scores above 30 – had a higher likelihood of dying while in the ICU, or while still in the hospital, if they were assigned to a low-visibility ICU room. This was true no matter what disease they were hospitalized for.

Why more deaths occurred among severely ill patients in the low-visibility rooms isn’t clear yet. “Whether they are due to late identification of…deterioration or less time spent by healthcare providers at the bedside or other undiscovered variables is unknown and requires additional study,” the authors wrote.

In a phone call with Reuters Health, the lead author, Dr. David Leaf from Columbia University College of Physicians and Surgeons in New York City emphasized, “This is the first article that addresses this issue, so the results should be interpreted cautiously.”

But, Leaf continued, “It’s both intuitive and now supported by some evidence that corner rooms with low visibility may be associated with poorer outcomes and therefore should be avoided whenever possible in the case of extremely sick patients.”

His colleague Dr. Factor pointed out that some ICUs may have special routines in place to improve the care of patients in lower-visibility rooms, such as increased nurse-to-patient ratios.

Even so, Leaf said, in the case of extremely sick patients, “if there is an empty room closer to the nurses’ station, it wouldn’t be unreasonable to ask to have the patient moved.”

SOURCE: Chest

The term “overuse injuries” may bring to mind tennis elbow and jogger’s knee, but the sole of the foot is also at risk of injury due to overuse, doctors warn.

The condition, plantar fasciitis, or inflamed tissue and swelling of the sole of the foot, can become chronic if steps aren’t taken to relieve it, according to Dr. Benedict DiGiovanni, an associate professor of orthopaedics at the University of Rochester Medical Center.

Weight gain or spending lots of time walking or standing can bring on the condition. The first signs of plantar fasciitis are typically heel pain when stepping out of bed, according to information in a news release from the American Orthopaedic Foot & Ankle Society.

If not dealt with, the pain of plantar fasciitis can worsen and possibly lead to problems with the foot, knee, hip and back due to gait changes. Plantar fasciitis can even impact pro athletes. Last fall, New York Giants quarterback Eli Manning struggled with the condition and a subsequent stress reaction in his foot for most of the season.

It’s hard, of course, to stay off your feet when you have things to do. So, to treat plantar fasciitis, DiGiovanni recommends taking it easy until the initial inflammation subsides, icing the sore area for 20 minutes, three or four times a day, and performing exercises to stretch the Achilles tendon in the back of the lower leg and plantar fascia, or the connective tissue that supports the arch of the foot.

The stretches should be performed before stepping out of bed in the morning and before taking a first step after being inactive for awhile. The stretches should be repeated four or five times per day for the first month, and then as needed, DiGiovanni explained. Also stretch the Achilles tendon twice a day, morning and evening.

Other options include over-the-counter anti-inflammatory medicine, over-the-counter soft arch supports, supportive shoes with shock-absorbing soles or taping the foot to support the arch.

By taking these steps, about 90 percent of people with plantar fasciitis see significant improvements within two months, DiGiovanni said.

If the pain continues or gets worse, orthopedic surgeons often suggest heel injections with steroidal anti-inflammatory medications, walking casts or positional splints.

A concussion is a brain injury caused by a bump or blow to the head that can change the way your brain normally works. Even what seems to be a mild bump or blow to the head can be serious.

To help ensure the health and safety of young athletes, CDC developed the Heads Up: Concussion in Youth Sports initiative to offer information about concussions—a type of traumatic brain injury—to coaches, parents, and athletes involved in youth sports. The “Heads Up” initiative provides important information on preventing, recognizing, and responding to a concussion.

CDC wants to equip coaches, parents, and young athletes across the country with the “Heads Up: Concussion in Youth Sports” tool kit, which contains a:
Fact sheet for coaches on concussion
Fact sheet for athletes on concussion
Fact sheet for parents on concussion
Clipboard with concussion facts for coaches
Magnet with concussion facts for coaches and parents
Poster with concussion facts for coaches and sports administrators
Quiz for coaches, athletes, and parents to test their concussion knowledge

Weak muscles may be the cause of the painful and debilitating condition known as “runner’s knee,” new research suggests.

People who develop the condition tend to have “weaker quads and hamstrings,” study co-author Darin Padua, said in a news release. “As a result, they don’t bend their knees as much when doing tasks, such as running or jumping. That means the contact area between the kneecap and the femur is smaller, so pressure is focused and pinpointed on a smaller area.”

That, in turn, leads to runner’s knee, also known as patellofemoral pain syndrome, said Padua, an associate professor of exercise and sport science at the University of North Carolina at Chapel Hill. Runner’s knee, which affects an estimated one in four people who are physically active, can lead to osteoarthritis.

The research appears to be the first of its kind to study athletes both before and after they develop runner’s knee, Padua said.

The researchers studied nearly 1,600 midshipmen from the U.S. Naval Academy. Of those, 40 people — 24 women and 16 men — developed runner’s knee over several years.

The study authors noted that those with weaker hamstring and quadriceps muscles, a larger “navicular drop” (flattening of arches in the foot) and less flexible knees were several times more likely to develop the condition.

People who wake up during the night to urinate shouldn’t automatically blame a urological problem. Sleep apnea, a breathing-related sleep disorder, could be the cause.

A new study suggests that nighttime urination, or nocturia, is comparable to loud snoring as a marker for obstructive sleep apnea, a disorder in which soft tissue in the throat blocks the flow of air into the lungs, disrupting sleep.

Previous studies established a link between nocturia and sleep apnea, a potentially serious condition that affects about 25 percent of U.S. men and 10 percent of U.S. women, the researchers said. But they believe this is among the first to show that screening for nocturia could help doctors identify patients with apnea.

The study also suggests that a common treatment for sleep apnea — positive airway pressure (PAP) therapy — can reduce symptoms of nocturia, thereby improving sleep and preventing debilitating falls among elderly people who get out of bed at night to use the bathroom.

PAP involves wearing a pressurized air mask while sleeping.

Typically, doctors screen for apnea by assessing patients’ weight (the condition is associated with overweight/obesity) and asking if they snore heavily, notice breathing problems at night or feel tired during the day (because of interrupted sleep). But because many patients, especially those who sleep alone, are unaware that they snore, apnea often goes undiagnosed.

“When you ask people about symptoms like snoring and gasping, they tend to say, ‘No, I don’t have them’,” said study author Edward Romero, research coordinator at the Sleep & Human Health Institute in Albuquerque, N.M. “But it’s very easy for them to realize that they wake up at night to go to the bathroom.”

One of Romero’s co-authors, institute director Dr. Barry Krakow, said doctors and patients are quick to blame nocturia on diabetes, prostate enlargement and other medical conditions with which it is associated. “I see patients all the time who think they’re waking up to urinate because they have prostate trouble or a small bladder,” Krakow said. “About 80 percent of the time we discover that apnea is the cause of their problem.”

Besides nocturia and snoring, symptoms of sleep apnea include daytime drowsiness, memory problems and depression. Untreated sleep apnea can lead to high blood pressure, blood clots and heart disease.

For the study, published online recently in Sleep and Breathing, the researchers reviewed data on 1,007 adults treated at two sleep clinics in New Mexico between 2005 and 2007. Of the participants, 797 were diagnosed with sleep apnea, 777 reported snoring and 839 reported nocturia. Neither snoring nor nocturia was proof of apnea, but the two symptoms were similar in their power to predict it: snoring was reported by 82.6 percent of apnea sufferers, and 84.8 percent of apnea sufferers reported nocturia.

The authors propose further research be conducted to confirm the effectiveness of nocturia as an apnea screening tool.

Mary Umlauf, a professor at the University of Alabama Capstone College of Nursing in Tuscaloosa and a noted nocturia researcher, said the study could play an important role in dispelling “old wives’ tales” about nocturia.

“Many health-care providers and ordinary people think of nocturia as a urological or gynecological problem,” she said. “They don’t understand that sleep apnea can cause the body to produce too much urine at night.

“People who wake up to urinate shouldn’t assume that it’s my prostate, or ‘I’m just old’,” she said.

When babies are teething, they’re generally miserable from the pain, swelling and tenderness in their gums.

Here are suggestions from the Nemours Foundation to help comfort little ones who are teething:
Use a warm, wet cloth to wipe down baby’s face and remove any drool. This may help prevent a rash.
Offer baby something soothing, such as a teething ring or a wet washcloth that’s been chilled in the freezer for about 30 minutes. Be sure to wash the cloth after each use.
Treat baby to a gentle gum massage, making sure to use a clean finger.
Ask your doctor if it’s safe to give baby acetaminophen. Make sure your doctor approves a specific dose and frequency.

Never tie a teething ring to baby, especially around the neck, as it could cause strangulation.

A number of adverse effects can result if you don’t take a medication as directed.

The American Academy of Family Physicians offers this list of possibilities:
Side effects, such as dizziness or nausea.
An interaction with another drug.
An interaction with a food or beverage.
An allergic reaction.
A sensitivity that results from use of the drug, such as sensitivity to the sun.

A potentially deadly intestinal infection is on the rise outside of hospital settings, especially among the elderly, researchers warn.

The germ that causes the condition, known as Clostridium difficile, can create serious symptoms, including diarrhea and an inflammation of the colon, that can be fatal. The infection can be difficult to treat because the bacteria have become immune to some drugs.

The bacteria have been found mostly in hospitals, nursing homes and similar facilities.

“Recent reports have shown increasing incidence and severity of C. difficile infection, especially in the older population,” Dr. Darrell Pardi, a Mayo Clinic gastroenterologist and senior author of a study on the situation, said in a Mayo news release. “Our study examines why the cases are on the rise and who is getting the infection.”

The findings were presented recently at the American College of Gastroenterology annual meeting, in San Diego.

The researchers examined 385 cases of disease caused by the germ from 1991 to 2005 to see if more were being acquired in places other than a hospital.

They found that people who got sick outside of a hospital were younger — a median of 50 years old versus 72 — and had less severe cases.

“The growing incidence of C. difficile infection in both inpatient and outpatient settings could be linked to the increasing usage of antibiotics and to the possibility that C. difficile may be getting resistant to some of our newer antibiotics,” Pardi said.

Health experts have gotten better at spotting the bacteria in hospitals and nursing homes, he said, but “now doctors and patients need to be more aware that you can get this infection as an outpatient and that a case of diarrhea or abdominal cramps at home could become serious.”

The germ kills an estimated 5,000 people in the United States each year, according to the U.S. Centers for Disease Control and Prevention.

The federal government’s push to control health costs through comparative effectiveness research could threaten strides in personalized medicine, in which medicines are tailored to an individual’s genetic makeup, the chief of the National Institutes of Health said on Monday.

“There is a potential collision here,” Dr. Francis Collins, director of the National Institutes of Health said at a forum sponsored by the American Association for the Advancement of Science.

Collins, a genetics pioneer tapped by President Barack Obama in July to head the NIH, said studies that lump together large groups of people to test the effectiveness of treatment A versus treatment B run the risk of overlooking clusters of people for whom a drug might have a dramatic effect.

“That’s going to get lost in the wash by considering everybody equivalent, which we know they are not,” said Collins, who helped lead the Human Genome Project that in 2003 produced a sequence of all the DNA in people.

“The antidote to that is pretty straightforward,” said Collins, saying that studies need to include genetic information that allows researchers to find such responses.

Backers of comparative effectiveness research, who include insurers and large employers, see the government-funded studies as a way to learn which treatments work best. But Collins said the studies should be well crafted.

“We need to be mindful of the goal of comparative effectiveness research and not lose all that we have gained in understanding how individuals differ and how that could be factored into better diagnostics and preventive strategies,” Collins told the meeting, which was broadcast on the Internet.

COST-CUTTING POTENTIAL

There is already evidence that personalized medicine can help reduce health costs, Collins said, pointing to Genomic Health’s Oncotype DX, a genetic test that can predict the recurrence of breast cancer.

“This test allows those individuals at low risk for recurrence to know they are at low risk and make a decision about whether to forgo chemotherapy, with all of its adverse consequences, based on that information,” Collins said.

He said the test costs $3,500, and most women who get tested and discover they are at low risk decide to forego chemotherapy, saving an average of $2,000 per patient in additional costs from chemotherapy treatment.

“In 2009, roughly 50,000 women are going through this process, predicting we will therefore save the healthcare system $100 million this year based on the availability of this kind of personalized medical test,” Collins said.

Dr. Margaret Hamburg, commissioner of the U.S. Food and Drug Administration, told the meeting that many clinical trials are structured to determine if a drug is safe and effective in a large group of patients, but the drugs often leave out the why — why certain patients benefit while others do not.

The FDA increasingly is approving drugs with companion diagnostic tests using biomarkers — such as specific proteins or genes — that improve the odds that a new, high-cost biotechnology drug will work.

She said studies that look at the genetic profile of patients and its role in how drugs work could strengthen a drug’s application, lending more scientific certainty about why a new drug works.

“Perhaps then we could see more new drug applications in the pipeline that are more likely to succeed,” she said.