Researchers figure out how to use MRI technique on children

It is not necessary for radiologists to sedate or anesthetize pediatric patients who undergo magnetic resonance imaging (MRI) through the BLADE technique, according to new research. The results of this study could help clinicians acquire clear pictures of children’s central nervous systems and other tissues.

Device manufacturer Siemens describes the BLADE technique as being capable of imaging uncooperative patients because of its ability to reduce motion artifacts.

Although MRI’s lack of radiation exposure makes it an advantageous imaging modality, some healthcare providers are hesitant to use it on children either because young patients have difficulty staying still, or clinicians do not want to go through the trouble of admitting children to the hospital in order to be sedated.

This is where BLADE may come in handy.

In the new study, researchers from Ruhr-University Bochum examined 326 pediatric patients using the BLADE technique. The subjects underwent age appropriate preparation, toured the scanner room, took a stuffed toy into the scanner and had their parents present in the room.

Results showed that the researchers obtained successful data from 41 percent, 91 percent and 98 percent of patients aged 3 years, 4 years and 5 years, respectively. None of these individuals had to be sedated.

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Lasers can treat ear infections in dogs

Ear infections can be just as painful and stressful for dogs as they can be for humans. It is important for veterinarians to use the most effective treatments available. In a recent article published by Veterinary Practice News, one expert discusses the use of Class IV laser therapy.

Signs of a canine ear infection include red ears, head shaking and foul odors around the organ, wrote Phil Harrington, DC, CMLSO. Owners may also seek attention if their dogs are scratching, develop scabby or crusty skin on the ear flap, lose hair around the ear, experience problems with balance, walk in circles, ooze a discharge or demonstrate hearing loss, according to the ASPCA. Dogs that have allergies, floppy ears or hair inside the inner ear canals may be especially prone to these problems.

Class IV laser therapy can be useful for cases of ear infection that are caused by bacteria. The reason for this is that many bacterial species tend to be anaerobic, and because lasers tend to stimulate circulation and oxygen intake, the pathogens may be less likely to thrive.

This regimen can be used in addition to topical and oral medications.

“Treatment would be administered to the external ear, targeting the vertical and horizontal canals, to the bulla and down the auditory tube. Internal treatment can be accomplished by lifting the pinna. A typical treatment plan is for six treatments over a three-week period,” Harrington wrote.

Additionally, laser therapy can be applied to surgical resections of the ear.

Veterinary practices who decide to use Class IV laser therapy need to be mindful of safety. Technicians must use protective eyewear that is designed for the wavelength of energy used. Furthermore, doctors must also protect the eyes of the dogs they treat. This can be done with special glasses, a black cloth or the help of an assistant to keep the animal steady. Training is usually the responsibility of the device company.

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Surgical technique less painful than traditional laparoscopy for kidney tumors

Patients who need to undergo kidney tumor removal may benefit more from laparo-endoscopic single-site surgery (LESS) than traditional laparoscopy, according to researchers from the University of California, San Diego School of Medicine.

This conclusion is based on a study of 74 individuals who needed either all or part of a kidney removed because of cancer. While some subjects underwent LESS, others had the conventional operation. Compared to the latter procedure, which may need between four and six incisions, LESS only requires one incision through the umbilicus.

Following surgery, the study participants answered questions about their experience of pain.

“We found that patients rated the LESS surgery as 40 percent less painful than traditional laparoscopic surgery, while requiring approximately 50 percent less narcotic pain medication,” said researcher Ithaar Derweesh, M.D. “This is an excellent sign that the LESS technique may further improve the quality of life of appropriate patients undergoing major cancer surgery.”

This study is published in the journal Urology.

Nearly 65,000 individuals in the U.S. will be newly diagnosed with kidney cancer in 2012, as projected by the National Cancer Institute. More than 13,000 patients will die from the disease during the same year.

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HIMSS pushes for progress on patient identification

The Healthcare Information and Management Systems Society (HIMSS) has requested that lawmakers take another look at patient identification issues.

In the past, most have not been inclined to support the idea of assigning a national patient identifier. HIMSS’ request did not specifically mention such an identifier, Modern Healthcare notes, though it may refer to one by implication. The organization asked Congress to consider reviewing state and federal laws regarding health information privacy and ensuring that they do not conflict, which could place health organizations in an untenable position and lead to compliance problems in the industry.

“One of the largest unresolved issues in the safe and secure electronic exchange of health information is the need for a nationwide patient data-matching strategy to ensure the accurate, timely and efficient matching of patients with their healthcare data across different systems and settings of care,” HIMSS said in a two-page policy statement.

While the spread of electronic medical records and other healthcare information technologies can help doctors, insurers and other stakeholders store and transfer information more efficiently, those systems must be able to interact. Without compatibility, their advantages are lost, or at least diminished. That may apply to software, but also to the way information is recorded and matched with the proper patient. Organizations which identify patients in different ways might have trouble comparing the right histories and records, impeding proper diagnosis and treatment.

Likely future developments

Privacy issues have complicated and prevented past efforts to establish consistent patient identification methods, the news source notes. The desire to protect privacy and keep information secure conflicts with the ability to share it effectively between concerned parties in this regard. If lawmakers follow their past pattern, they are unlikely to allow much progress in implementing patient identifiers, much less support such a change.

Until and unless such a proposal includes clear and sufficient measures to protect privacy, to the satisfaction of Congress, it will likely remain a practical impossibility. At the same time, HIMSS and many involved in healthcare IT may be motivated to continue their efforts. Physicians should keep apprised of any new developments in this regard, though, and recognize that concerns for privacy may have other effects on healthcare IT implementation.

This is likely a long-term issue, rather than a pressing one. If lawmakers do decide to follow up on the review of state and federal privacy laws, however, changes could result at either level of government. That might affect practices significantly, and more immediately.

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Transoral robotic surgery can be a good option for throat cancers

Researchers from the Ohio State University Comprehensive Cancer Center demonstrated that robotic surgery is a safe option for the removal of tumors in the throat or on the voice box. The availability of this approach can be less invasive for patients, therefore improving recovery outcomes.

A team of scientists conducted a prospective study to evaluate the use of transoral robotic surgery on 126 patients who underwent the procedure between 2008 and 2011. A subset of 13 subjects were head and neck cancer patients who had tumors in the supraglottic region.

An analysis of the transoral robotic procedures conducted on these individuals, which removed their tumors through the mouth, revealed that the average time for an operation was 25 minutes. The mean amount of blood loss was 15.4 milliliters per patient, and 11 out of 13 study participants were able to eat within one day of surgery. The researchers recorded no complications.

By comparison, open surgical procedures for the same condition could last four hours and hospitalize an individual for up to 10 days. In addition, a patient may need a stomach tube and a tracheostomy tube.

“The transoral robotic technique means shorter surgery, less time under anesthesia, a lower risk of complications and shorter hospital stays for these patients,” said lead researcher Enver Ozer. “It also means no external surgical incisions for the patient and better 3-D visualization of the tumor for the surgeon.”

In the U.S., more than 12,000 individuals will be newly diagnosed with laryngeal cancer in 2012, while another 13,000 will have pharyngeal cancer, as projected by the National Cancer Institute. Additionally, about 3,700 and 2,300 patients will die from these diseases, respectively, during the same time period.

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Hacking attempt underscores importance of health information security

A successful hacking attempt recently affected the Utah Health Exchange, which has been a work in progress since before healthcare reform legally mandated that each state begin to construct its own exchange.

The website had distorted words and headlines and some individual pages were offline, with the Salt Lake Tribune reporting that the site was down for about 10 days. Sensitive information was apparently not affected, because it is maintained on a separate website. With the push to implement exchanges and electronic record systems, many have voiced concerns about data security.

Partly because of these concerns, and the breadth of personal health information that state exchanges are expected to end up holding, they must meet certain security and privacy provisions to secure the approval of the U.S. Department of Health and Human Services.

The need to develop and implement effective data security measures will likely slow the progress of exchanges and healthcare information technologies to some extent. Smaller organizations and practices, while they may seem less attractive targets for hackers, should still be vigilant and ensure their measures are strong enough to secure data both physically and online.

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Next-generation gene sequencers may help diagnose type of thyroid cancer

Researchers from the University of Pittsburgh Medical Center concluded that next-generation gene sequencers may be valuable in the diagnosis and treatment of follicular papillary thyroid cancer.

More than 56,000 individuals in the U.S. will be diagnosed with thyroid cancer in 2012, as projected by the National Cancer Institute. Around another 1,800 patients will die.

According to the researchers, papillary thyroid cancer is the most common form of malignancy to affect the organ. Incidence of the condition is growing rapidly, mostly because of the follicular form of the disease.

In order to find better tools for doctors, the scientists conducted a study in which they analyzed about 500 papillary thyroid carcinomas samples. Next-generation gene sequencers revealed that 73 percent of samples were positive for known mutations, while 27 percent were negative but contained novel mutations. Within the latter group, the majority of samples were the follicular form of the disease.

“A lack of understanding of molecular drivers of the follicular variant of papillary thyroid carcinoma greatly limits the ability to investigate reasons behind its increased incidence and hampers the development of more individualized management of patients,” said Elizabeth Pearce, M.D., program co-chair of the 82nd annual American Thyroid Association Meeting, where these findings were presented.

She added that the new study supports use of newer technologies.

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Ultrasound may improve diagnosis and treatment in critical care

In order for patients to receive the best medical care, doctors need to diagnose them correctly. One new study published in the journal Anesthesiology suggests that within the context of critical care, ultrasound tests may provide useful guidance for clinicians.

This conclusion is based on a study conducted by researchers at Maria Vittoria Hospital in Italy. The scientists reviewed the medical data on 125 consecutive individuals who were admitted to the general intensive care unit. As required by protocol, the patients underwent bedside ultrasound scans of the thorax, heart, abdomen and other anatomic structures.

According to the researchers, ultrasound results modified the diagnoses of 26 percent of patients, and confirmed diagnoses in 58 percent of study participants. Furthermore, these tests led to changes in treatment for 18 percent of patients, as well as new invasive procedures for 22 percent of subjects.

“The findings support the use of ultrasound in critical care patients,” said researcher Emilpaolo Manno, M.D. “Systematic ultrasound examinations upon admission are beneficial for not only establishing accurate diagnosis, but providing appropriate and effective treatment.”

Ultrasound tests were especially effective in differentiating various conditions affecting the respiratory system.

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Children with neuroblastoma may benefit from whole-genome scans

According to a new study published in the British Journal of Cancer, whole-genome scans may be beneficial for all pediatric neuroblastoma patients because the technology can guide their treatment.

“These gene tests would help doctors provide a more accurate prognosis and decide the best treatment for their patients, which could potentially save more lives and spare other children the risk of serious side-effects,” said senior study author Andy Pearson.

This conclusion is based on a study that included about 8,800 neuroblastoma patients from around the world. Results showed various associations between survival rates and several large-scale genetic faults, suggesting that it may not be enough to screen patients for individual defective genes.

Previously, the same team of researchers completed a study that classified neuroblastoma according to 13 genetic characteristics. This latest research provides a significant update to that classification system, and promotes the idea of using whole-genome scans as standard treatment for neuroblastoma patients.

This could be important, considering how treatable this malignant disease of the nervous system is. According to the National Cancer Institute, the five-year survival rate of patients younger than 1 year is 87 percent, and 65 percent for those aged 1 to 14 years.

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New rule serves as step toward wireless device use

The Federal Communications Commission (FCC) has announced a decision to broaden the wireless spectrum available for uses involving medical devices.

This should allow professionals to use wireless medical body area network (MBAN) devices to monitor patients and record their health information more conveniently. MBAN technology uses wireless sensors worn by the patient to relay data through a nearby hub for professionals to access it. The FCC rule indicates that the agency expects MBAN technology will enhance patient care and improve healthcare industry efficiency, potentially helping to lower total care costs.

“As the numbers and types of medical radio devices continue to expand, these technologies offer tremendous power to improve the state of healthcare in the U.S.,” stated the FCC’s final rule.

The agency noted that current technologies, which rely on wired devices, reduce patient mobility and make it harder for professionals to transport or even reposition patients if it is necessary, occupying patients’ and professionals’ time. Wireless devices should make care and monitoring more convenient and enable both patients and professionals to spend their time more productively. The rule takes effect on October 11.

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