Monthly Archives: February 2013

Obama Seeks to Map the Human Brain

Obama Seeks to Map the Human Brain The Obama administration is seeking $3 billion from Congress to launch a major scientific initiative- mapping the human brain to better understand how it functions and malfunctions. The initiative, dubbed the “Brain Activity Map“, could be similar to the Human Genome Project, which is considered one of the greatest medical advances of the century.

The Brain Activity Map would involve teams of neuroscientists and nanoscietnists, private organizations, and federal agencies like the National Science Foundation and the National Institute of Health.

Scientists hope that mapping the brain’s activity could advance our understanding of the billions of neurons in our brains leading to better insight into our perceptions, actions, and consciousness. The decade-long project could improve therapies for a number of mental illnesses as well as Alzheimer’s and Parkinson’s diseases. The administration could unveil its plans for the project as early as March, according to The New York Times.

But whether or not Congress will jump on board with funding the initiative remains to be seen as they work up to the last minute to avoid across-the-board spending cuts scheduled for March 1st.

Better Roads Cut Cycling Crash Rates

Better Roads Cut Cycling Crash RatesGetting more people to commute with a bicycle could lead to widespread improvements in public health and environmental sustainability. Despite these benefits, most Americans stick to driving over cycling, unlike in other developed countries like the Netherlands, which has the highest per capita bicycle to person ratio the world.

A new literature review suggests that the differences could lie in the perceived safety of cycling. Most developed countries with higher rates of cycling have designated cycling lanes on roadways, making people feel more comfortable. But do these cycle tracks actually lower the rate of injury due to road collisions?

After analyzing the available research on the safety of cycling lanes, the authors concluded that cycle lanes do indeed reduce cyclists crashes. They also found that one-way lanes are safer than two-way lanes, and that modifying intersections with raised cycle crossing lowers the risk of severe injury.

Over the past decade, the number of cycling-related head injuries has been cut in half in Australia, thanks to stricter helmet laws and better road infrastructure.

The Role of Beliefs in Brain Injury Testing

The Role of Beliefs in Brain Injury Testing Do a patient’s beliefs about their brain injury affect their diagnosis?

Earlier research supported the concept of the “diagnostic threat” that argued that a patient’s negative beliefs about their brain injury significantly altered their performance on cognitive tests. Now, new research from Queensland University in Australia has called this concept into question.

To test the concept of the diagnostic threat, researchers randomly assigned a group of university students into three groups:

  • In one group, physicians told the students that TBI patients often perform poorly on cognitive tests
  • In another group the doctors told students that TBI patients can perform well on the tests.
  • The last group received neutral instructions.

After the students took the cognitive tests, the researchers analyzed their performance to see whether expectations influenced test results. Although there were some differences in tests that measured working memory and attention, no other significant differences were found among the three groups. The researchers pointed out that their findings echo the results of other more recent studies on the diagnostic threat. They concluded,

“Taken together with these more recent findings, the results of this study suggest that it is timely to reconsider the role of diagnosis threat as a contributor to poor mTBI outcome.”

These results add to idea that cognitive tests provide an objective method to assess cognitive deficits in patients with mild traumatic brain injuries.

However, scientists are still searching for objective, biological methods of diagnosing brain injuries.

Treating PTSD in Whiplash Patients

Treating PTSD in Whiplash Patients Whiplash-associated disorders (WAD) are common conditions involving both physical and psychological components. Often, trauma such as a motor vehicle crash results in both whiplash and posttraumatic stress disorder, resulting in substantial disability. However, there are currently no treatment guidelines for targeting this comorbidity.

Research has found posttraumatic stress disorder (PTSD) is associated with poorer physical recovery following whiplash injuries. While cognitive-behavioral therapy (CBT) has been shown to be effective for other chronic pain conditions, there have been no clinical trials to examine the effectiveness of CBT on whiplash patients.

A recent study adds to this understanding by reporting on the effectiveness of CBT in patients with chronic WAD and PTSD. The study involved 26 people who were randomly assigned to either CBT or a waitlist. The treatment consisted of ten weekly sessions of individually delivered cognitive-behavioral therapy. The effects of treatment were evaluated at posttreatment and a six-month follow-up using clinical interviews, self-report questionnaires, and measures of sensory pain thresholds.

The researchers found clinically significant reductions in PTSD symptoms in the group receiving cognitive-behavioral therapy. The treatment was also associated with clinically significant improvements in neck disability, physiological reactivity to trauma cues, and physical, emotional, and social functioning. This study provides support for the use of cognitive-behavioral therapy to target PTSD symptoms in patients with chronic whiplash.

Reference

Dunne RL, Kenardy J, Sterling M. A randomized controlled trial of cognitive-behavioral therapy for the treatment of PTSD in the context of chronic whiplash. Clinical Journal of Pain; 28(9): 755-65.

Concussion Rates Higher in Schools with Athletic Trainers

Concussion Rates Higher in Schools with Athletic TrainersAccording to a recent study, high-school athletes at schools with athletic trainers experience more diagnosed concussions, but fewer overall injuries, than athletes at schools without trainers. The study, “A Comparative Analysis of Injury Rates and Patterns Among Girls’ Soccer and Basketball Players,” was presented at the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans last fall.

The researchers reviewed national data on sports injuries in girls’ high-school basketball and soccer programs with athletic trainers, and compared it to data on a sample of Chicago public high-school programs without athletic trainers for the same sports.

Overall injury rates were found to be 1.22 times higher among basketball players and 1.73 times higher among soccer players in schools without athletic trainers. Recurrent injury rates were 2.97 times higher in basketball and 5.7 times higher in soccer. This data suggests that athletic trainers facilitate treatment and monitor recovery, preventing athletes from returning to play prematurely.

In schools with athletic trainers, concussion diagnosis rates were 8.05 times higher in soccer players and 4.5 times higher in basketball players. It is believed that this increase reflects more accurate diagnosis, rather than more frequent concussions.

Lead researcher Dr. Cynthia LaBella commented, “This data shows the valuable role that [athletic trainers] can play in preventing, diagnosing and managing concussions and other injuries.” Athletes with concussions are more likely to be identified in schools with athletic trainers, and therefore more likely to receive prompt, proper treatment.

Studies show that that rates of concussion in girls’ soccer and boys’ football is on the rise. Improving treatment for sports-related concussions could help these athletes avoid the long-term effects of brain injuries.

Reference

LaBella C, et al. A comparative analysis of injury rates and patterns among girls’ soccer and basketball players at schools with and without athletic trainers from 2006/07-2008/09.  AAP 2012.

Outcome of Kids’ Brain Injuries Difficult to Predict

 Outcome of Kids' Brain Injuries Difficult to Predict It is difficult to identify children most likely to experience persistent neurological symptoms after suffering a concussion, though doing so would have important clinical applications.

A systematic literature review recently examined 15 studies that attempted to find predictive factors for persistent symptoms. The review, conducted by Roger Zemek, MD, of Children’s Hospital of Eastern Ontario and colleagues, found no consistent pattern in the results. The study authors wrote:

“Minimal, and at times contradictory evidence exists to associate clinically available factors with eventual development of persistent concussion symptoms in children.”

Due to this lack of a method to predict which children will recover rapidly and which will experience long-term symptoms, doctors must continue to recommend conservative management, followed by a gradual return to normal activity level, for all children with concussion. They suggest that a “multicenter prospective study” should be conducted to determine potential factors that could identify children at high risk of prolonged symptoms.

Zemek and colleagues found that existing studies on childhood concussion recovery were heterogeneous, making meta-analysis difficult. Of 561 published studies, all but 15 were thrown out of the systematic literature review for failing to provide data on all of the following clinical factors: age, medical history, comorbidities, pre-existing medication use, mechanism of injury, and initial presence and severity of symptoms. Zemek and colleagues also noted the large array of instruments used for measuring symptoms—in the 15 studies included in the review, ten different assessment tools were used.

Despite these issues, Zemek and colleagues suggest that some clues to potential predictors can be found. Two of the larger prospective studies concluded that “the risk for developing persistent concussion symptoms was increased in older children with a history of loss of consciousness and either headache or nausea/vomiting.” Several smaller studies also noted that initial dizziness could be predictive of prolonged recovery. The researchers concluded that no “clear conclusions” could be reached on factors potentially associated with safely resuming normal activities such as sports and school.

Despite these findings, scientists continue to search for a tool for predicting prognosis of pediatric brain injuries.

Reference

Zemek R, et al. Prognosticators of persistent symptoms following pediatric concussion: a systematic review. JAMA Pediatrics 2013; 10(1001): 216.

Brain Can Protect Itself from Damage, Stroke Study Shows

Brain Can Protect Itself from Damage, Stroke Study Shows Scientists have discovered how the brain works to protect itself after a stroke, reported Medical News Today. New research from the University of Oxford demonstrates, for the first time, that the brain has its own mechanisms for keeping cells alive after a stroke.

During a stroke, the blood supply to a part of the brain is stops, depriving the cells of oxygen and nutrients. This glucose and oxygen deprivation causes brain cells die, leading to brain damage. This can happen immediately after the stroke begins which is why treating strokes is a race against the clock. For years scientists have been searching for neuroprotectants, or medications that buy time for the neurons to cope with damage. Now the Oxford researchers have identified endogenous neuroprotection.

When designing their study, the researchers recalled evidence showing that some neurons in the hippocampus can survive the oxygen deprivation during a stroke. They wanted to discover why these cells are resistant.

In a series of animal experiments, researchers found that a type of protein called hamartin protects rats’ brain cells from dying. Additionally, the neurons were more likely to survive if hamartin production was stimulated.

Understanding these natural biological mechanisms could help scientists create medications that mimic the effect of hamartin, researchers pointed out. And it’s not just stroke victims that could benefit from this research. Neuroprotective drugs could help patients with other brain conditions like Alzheimer’s and motor neurone disease, they wrote.

Meanwhile, scientists are continuing to search for drugs that could prevent the Alzheimer’s disease.

Gov. Regulators Hiding Auto Safety Concerns

Gov. Regulators Hiding Auto Safety Concerns A new report from USA Today reveals that government safety regulators frequently hide investigations behind a wall of secrecy that protects automakers.

Although the National Highway Traffic Safety Administration (NHTSA) has a number of safety reports widely available on its website, the agency often conducts informal investigations outside of the public eye.

That could affect consumers who may not discover that a car they were considering may actually have safety concerns covertly raised among automakers and NHTSA. Jayne O’Donnell of USA Today found many examples of these informal investigations occurring months before a formal investigating or recall.

For instance, in 2011, the NHSTA launched a formal investigation of Chevorlet Volts—despite that it had been secretly testing Volts for several weeks after some caught fire in a crash tests. And in 2008, the NHTSA and Evenflo recalled one million Discovery child car seats; what consumers didn’t know was that the agency had been testing the seats for a year before the recall after they performed poorly in crash tests.

Much of this information is difficult to access or can only be obtained through FOIA requests.

The NHTSA claims that these secret investigations are merely a part of the screening process before a formal investigation or recall. But consumer advocates say these investigation resemble formal ones, and that the information needs to be readily available to the public. Not doing so could only put more people in danger.

Laser Surgery Malpractice Lawsuits On the Rise

Laser Surgery Malpractice Lawsuits On the RiseMore patients injured during laser surgery are taking their doctors to court, a new study shows. Researchers examined records on medical malpractice lawsuits related to laser surgery filed over the past twenty-five years.

They discovered that the number of such lawsuits has increased, with a peak in incidence in 2010. The most common procedure leading to injury and litigation was laser hair removal, involving in 36% of cases, followed by skin rejuvenation (25%), and treating vascular lesions and leg veins ( 8% each).

While negligence was the most common accusation, other allegations included failure to adequately train and supervise staff and inadequate provision of informed consent ( when patients were not fully notified of potential hazards).

In several of the cases, the physicians being sued did not actually perform the procedure but were responsible for managing those who did. Under the legal concept of respondeat superior, plaintiffs’ attorneys typically sued  insured parties who could satisfy successful judgment.

Among the 120 cases that had final dispositions available, 32 cases were in favor of the patient, 59 were in favor of the doctor, and 29 were settled out of court.

The damages awarded to patients ranged from $5,000 to $2 million, with an average compensation of $380,700.

Kids with Brain Injuries: Drugs May Not Help Behavioral Problems

Kids with Brain Injuries: Drugs May Not Help Behavioral ProblemsAfter a concussion, many kids experience behavioral problems like responsiveness issues and agitation. Although doctors frequently prescribe medications to help manage these symptoms, a new study suggests that there is insufficient evidence to support this treatment.

Researchers from John Hopkins University School of Medicine analyzed the available data on pharmaceutical interventions for children with behavioral problems after a TBI. They found that several small studies point to potential benefits of dopaminergic agents for improving responsiveness in kids with TBIs, but the evidence was limited due to the size of the studies and lack of multi-center collaborations. The literature on using medications to treat agitation is even more sparse. The authors suggested that this insufficient data highlights the need for additional research on pharmaceutical interventions for kids with TBI.

In addition to suffering from behavioral problems after a concussion,  research shows that children can show signs of cognitive deficits for up to two years after the injury.