Monthly Archives: May 2013

Texting Behind the Wheel Now Biggest Killer Among Teen Drivers

Texting Behind the Wheel Now Biggest Killer Among Teen Drivers
Photo by Intel Free Press

Texting while driving has officially surpassed drinking and driving as the leading cause of death from motor vehicle collisions among teenagers.

The number of teen deaths and injuries as a result of texting and driving crashes has reached new highs as more and more young people use mobile devices.

According to researchers at Cohen Children’s Medical Center and the Centers for Disease Control and Prevention, the estimated number of teen deaths from texting and driving is 3,000 per year, compared to around 2,700 who die after driving drunk. The number of injuries is also greater among those texting compared to those drinking, with 300,000 texting-and-driving injuries and 282,000 drinking-and-driving injuries.

In addition to the increased numbers of phone users, the data is also a result of a dramatic decline in drunk driving among adolescents. Additionally, drinking is typically a behavior that most teens engage in only occasionally, while texting is a daily activity.

A team of researchers at Cohen Children’s Medical Center also found about 49% of boys and 45% of girls aged 15 to 18 admitted to texting while driving. They also discovered that older teens were more likely to engage in the risky behavior, with 58% of 18-year-olds acknowledging that they do it regularly.

Typing and engaging in texted conversation is especially dangerous compared to other distracted driving habits. The activity involves manual, visual, and mental distractions, all at the same time.

Adolescents aren’t the only drivers endangering themselves and others with mobile devices. Other research has found that up to one-third of adult drivers aged 30 to 64 admitted to sending text messages while driving.

Another recent study revealed the ineffectiveness of laws prohibiting texting and driving among adolescent drivers. Comparing states with laws to states without them, researchers found an insignificant difference in the numbers of teens taking the risk.

Reference

Ricks D. Study: Texting while driving now leading cause of death for teen drivers. Newsday May 8, 2013. www.newsday.com.

New Study Reveals Brain Can Rewire Itself After TBI

New Study Reveals Brain Can Rewire Itself After TBINew research has uncovered more about how the brain compensates after a head injury or trauma. Scientists are hopeful that the new findings may result in advancements in treating a variety of health problems.

Many brain scientists have followed the thinking that when a brain injury occurs, other areas of the brain may compensate for the damaged parts. However, until this study, it was not understood how this happens.

In a UCLA news release about the discovery, the team of scientists further discussed what they found, and what it might mean for the future of neuroscience.

The group has identified the section of the brain that takes over function when the hippocampus is damaged. The hippocampus is the “learning center” of the brain, and some types of brain injury may result in a disability in this region. According to this new research, when that happens, other brain parts in the prefrontal cortex have the ability to take over the function of the hippocampus.

The researchers at UCLA labeled their findings as a “breakthrough discovery,” saying that the new knowledge could help develop new treatments for Alzheimer’s disease, stroke, and other types of brain injury.

The study involved laboratory rats with injury to the hippocampus region of their brains. Although they needed additional training compared to uninjured rats, the lab rats with brain damage were able to learn new problem-solving tasks. While this kind of success was once believed to be a result of the brain’s hippocampus repairing itself to a degree, with studies revolving around how to stimulate this repair, this new research revealed that other regions of the brain were actually responsible.

In studying the brains of the rats, the scientists were able to identify changes that took place in the prefrontal cortex. They observed that new brain circuits were created to compensate for the brain injuries. The brains actually rewired themselves.

UCLA’s Michael Fanselow, who led the research team, explained more about the process in the May 15 news release. “The brain is heavily interconnected — you can get from any neuron in the brain to any other neuron via about six synaptic connections,” he said. “So there are many alternate pathways the brain can use, but it normally doesn’t use them unless it’s forced to. Once we understand how the brain makes these decisions, then we’re in a position to encourage pathways to take over when they need to, especially in the case of brain damage.”

This could mean major advancements in treatment for brain injury involving learning or memory issues.

Reference

Fanselow M, Zelikowsky M, Vissel B, et al. Prefrontal microcircuit underlies contextual learning after hippocampal loss. Proceedings of the National Academy of Sciences of the Untied States of America. Published online before print May 15, 2013. doi: 10.1073/pnas.1301691110.

Heather A. Brain rewires itself after damage or injury, life scientists discover. UCLA Newsroom. Online May 15, 2013.

 

Increasing Seat Belt Use for Teen Drivers

Increasing Seat Belt Use for Teen Drivers
Photo courtesy of State Farm

Motor vehicle crashes remain the leading cause of adolescent death in the United States. Teens have higher collision rates and a decreased likelihood of using seat belts compared to older, more experienced drivers.

In a new study published in the journal Accident Analysis & Prevention, researchers tested the effectiveness of a service-learning program in teaching teens better seat belt habits. The educational intervention was conducted in eleven high schools across the U.S. in the 2011-2012 school year.

Direct observation of students wearing seat belts both before and after school was used during the fall semester to create a baseline of seat belt use. After the service-learning intervention, seat belt use was again observed in the spring semester for comparison.

After the service-learning program, seat belt use increased 12.8%, from 70.4% usage in the fall to 83.2% usage in the spring. The increase in using seat belts was noted among white, black, and Hispanic teen drivers. However, researchers found that black and Hispanic teens were still less likely to use seat belts compared to white drivers.

The study found that female teen drivers were significantly more likely to be influenced by service-learning and use seat belts than their male counterparts. It was also discovered that the teens who drove with passengers in their vehicle had an increased likelihood of seat belt use.

The authors of the study concluded that a service-learning intervention can be effective for increasing the use of seat belts. They recommended that high schools utilize curricula continuously incorporating service-learning about safety and seat belts.

Additional research has sought areas of needed improvement for teen safety in motor vehicles. One such study revealed the prevalence of risky driving behaviors among teens. Another found that almost 43% of adolescents admit to the dangerous habit of texting and driving.

Education about safe driving shouldn’t stop at drivers’ training courses. Parents can help their teens make safe choices behind the wheel by communicating and revisiting the topic often.

Reference

Godzweig I, Levine R, et al. Improving seat belt use among teen drivers: findings from a service-learning approach. Accident Analysis & Prevention 2013 May 21 (online only). doi: 10.1016/j.aap.2013.04.032.

Whiplash Causes Driving Difficulties After Injury

Whiplash Causes Driving Difficulties After InjuryPeople with chronic whiplash-associated disorder (WAD) often report that they have difficulty driving after the collision that left them injured. Among other problems caused by WAD, the result can be inconvenience and a decreased quality of life. Driving is one of the tasks that most adults take for granted. But WAD-victims may not have that luxury.

To explore the reasons that contribute to driving difficulty after whiplash, researchers recently analyzed the physical, cognitive, and psychological factors that may contribute to troubles with driving.

The study involved 40 patients with chronic WAD. Participants self-reported their driving difficulty, using a measurement tool to indicate the magnitude of difficulty and pinpoint the contributions associated with the trouble driving. Researchers adjusted the results to measure factors other than the obvious ones: neck pain and dizziness. Their goal was to discover if other variables came into play to keep WAD- victims from getting behind the steering wheel. Their list of possibilities included reduced speed of head rotation, gaze instability, eye-head coordination, cognitive symptoms like fatigue, and psychological problems like traumatic stress, depression, fear of neck movement, and fear of driving.

The study found that chronic WAD resulted in both physical and cognitive impairments that can possibly harm a patient’s driving ability and enjoyment. Researchers concluded that self-reported driving difficulty goes beyond neck pain and dizziness for WAD victims.

These results are consistent with other research tying psychosocial factors to whiplash symptoms and recovery. In one recent study, scientists discovered that a positive attitude could have a more favorable outcome for whiplash recovery than a negative one. Additionally, research has shown that post traumatic stress disorder often accompanies chronic whiplash-associated disorder and discovered that cognitive-behavioral therapy significantly improved symptoms of PTSD as well as whiplash neck disability.

Whether struggling to drive a car or being forced to quit working, chronic WAD can harm a person’s quality of life, all too often with long-term results.

Reference

Takasaki H, Treleaven J, Johnston V, Jull G. Contributions of physical and cognitive impairments to self-reported driving difficulty in chronic whiplash-associated disorders. Spine 2013 May 21. [Epub ahead of print].

 

 

Robotic Surgery Company Wins Wrongful Death Case

FDA Investigating Safety of Robotic Surgery Amidst Malpractice Claims
Doctors showing the da Vinci robot system in tour of Ft. Belvoir Community Hospital; Photo by Sgt. Bernardo Fuller, Courtesy of US Army Medicine

Bad news for robotic surgery claims: Intuitive Inc. was considered not guilty of negligence in a recent wrongful death claim involving the company’s da Vinci robot.

The verdict was made after a five-week trial in Port Orchard, Washington, and was the first case in at least 26 lawsuits against Intuitive Inc. who manufactures the da Vinci Robot device.

The da Vinci Robot and related products cost upwards of $2.5 million each, and were the primary source of Intuitive Inc.’s $2.2 billion revenue in 2012. The use of robotic-assisted surgery has proliferated in recent years, with nearly 400,000 surgeries conducted with da Vinci products last year alone. But now the manufacturer is under growing scrutiny from the FDA, who recently launched an investigation into the safety of the da Vinci robot. A spokesperson for the FDA says the administration has received an increasing number of reports of freak accidents and deaths tied to the device.

This latest case involved a Port Orchard man, Fred Taylor, who received a robotic-assisted prostatectomy. Taylor’s doctor, a urologist named Scott Bildsten, had previously performed 100 successful prostatectomies without a robot, but this was his first surgery using the da Vinci. Bildsten and his surgical team were forced to switch to emergency care and traditional surgery after seven difficult hours of operating with the da Vincia device that resulted in a rectal laceration. Last year, Taylor died after suffering from multiple complications related to his surgery.

Taylor’s family accused Intuitive Inc. of failing to properly train Dr. Bildsten for using the da Vinci. The company’s “best practices” recommendation for training includes just just a one-day session at the company’s headquarters in Sunnyvale, California. The recommendation was developed by Gene Nagel, an executive who was a former wine salesman with no prior training medicine or medical devices, pointed out the plantiff’s attorney, Richard Friedman.

However Intuitive Inc.’s lawyer said that Dr.Bildsten failed to adhere to the company’s specific instructions that doctors perform simple operations with the da Vinci device first, before moving on to more complex surgeries. The company also recommended doctors first perform operations with patients who have a low BMI index, unlike Taylor, who was morbidly obese.

The case is Estate of Fred E. Taylor v. Intuitive Surgical Inc., 09-2-03136-5, Superior Court, State of Washington, Kitsap County (Port Orchard).

 

Multiple Brain Injuries = Greater Suicide Risk

Multiple Brain Injuries = Greater Suicide Risk People with a history of multiple concussions have greater risk of suicidal thoughts than people with only one or no concussions, according to a new study.

The study showed that soldiers who had multiple traumatic brain injuries were three times more likely to have suicidal thoughts compared to soldiers who had only a single TBI.

Suicide is now the second most common cause of death in the military. In 2008, there were 16 suicides per 100,000 service members. That represented a 50% increase in suicides since 2001, according a study from the RAND corporation.

Traumatic brain injuries are likely behind the rising suicide rates as more soldiers suffer from the signature wound of war, the researchers explained in the study published in the journal JAMA Psychiatry. Although TBIs have been linked to suicide, it was unclear whether having cumulative concussions lead to greater risks, according to lead author Craig Bryan, PsyD, of the University of Utah National Center for Veterans’ Studies.

Bryan and his colleagues studied 157 service members and 4 contractors who were treated at a military hospital in Iraq for suspected brain injuries. Eighteen soldiers said they’d never been diagnosed with a TBI in the past, 58 had been diagnosed with one TBI previously, and 85 had experienced multiple brain injuries in their lifetime. Most TBIs were mild.

Patients without a history of previous concussions did report having suicidal thoughts. In soldiers who had a single previous concussion, 6.9% reported having suicidal thoughts at some point in their life, and 3.4% had such thoughts in the past year. The numbers were much greater for soldiers with cumulative concussions: 21.7% reported lifetime suicidal thoughts and 12% reported having suicidal thoughts in the previous year. The more concussions a solider had, the greater their risk was for suicidal thoughts, even after adjusting for depression, PTSD, and injury severity.

Although the study was limited to soldiers, Bryan said their results may have implications for other groups at risk of multiple concussions, like athletes. Brain injuries in football and other contact sports have received increasing attention in the past few years, as more athletes suffer from depression and cognitive deficits associated with multiple TBIs.

However, the study doesn’t imply that concussions cause suicidal thoughts, Bryan explained to the Chicago Tribune. The majority of soldiers with TBI didn’t report suicidal thoughts in his study. Furthermore having suicidal thoughts doesn’t necessarily mean someone will commit suicide, especially if adequate treatments are available.

Growing suicide rates in soldiers led 53 congressmembers to send a letter to Defense Secretary Chuck Hagel and Veterans Affairs Secretary Eric Shinseki, asking them to investigate the link between IED-blast brain injuries and suicides.

“As we prepare to bring 34,000 troops home from Afghanistan this year and the entirety of the 66,000 members strong force by the end of 2014, we must gain a better understanding of the psychological impact of injuries from IEDs,” they wrote.

Reference

Bryan C, et al. Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel. JAMA Psychiatry 2013; 1-6. doi:10.1001/jamapsychiatry.2013.1093.

Saving Children’s Lives with Booster Seat Laws

Saving Children's Lives with Booster Seat Laws
Photo by V Kanaya, Creative Commons

At a national conference, the American Academy of Pediatrics (AAP) presented compelling research in support of mandating booster seat use in all states. It was discovered that state laws requiring booster seats at least until age eight were associated with fewer fatalities and severe injuries in motor vehicle collisions. Presenters argued that standardizing the law throughout the country would help protect many more children.

The AAP recommends that parents use booster seats to secure their children in vehicles, optimizing the proper positioning of the seat belt. The suggestions have changed through the years, with both the size and the age of recommended use increasing. Currently, the AAP recommends a booster seat for children under four feet, nine inches tall, which is usually reached between eight and 12 years old.

Right now, it is up to each state to write booster seat law. Some have laws that reflect the AAP recommendations, but others set age allowances, only requiring a booster seat until the age of six or seven. Still other states do not have any booster seat laws in place.

The study referenced at the AAP conference was published last year in the journal Pediatrics and included data collected between 1999 and 2009, comparing fatality and serious injury rates in states before and after booster-seat litigation. There were nearly 10,000 fatalities and incapacitating injuries in children aged four to eight during the study period. The children between four and six years old were 20% more likely and children between seven and eight were 33% more likely to die or be incapacitated in an auto collision if they lived in a state without booster laws.

The children in the study who were only restrained by a seat belt had drastically increased odds of fatality or severe injury.

The study authors, in addition to the American Academy of Pediatrics, now recommend legislation to standardize booster seat regulations and to extend the current laws to older children to optimally protect them while riding in motor vehicles.

References

Boston Children’s Hospital. Standardized booster seat laws could save lives of children. Science Daily 5 Nov 2012. www.sciencedaily.com.

Mannix R, Fleegler E, et al. Booster seat laws and fatalities in children 4 to 7 years of age. Pediatrics 2012; 130(6): 996-1002.

Study Finds Gender Bias in Severe Injury Care

Study Finds Gender Bias in Severe Injury Care New research points to a gender bias in the treatment of severe injuries in trauma care centers. A study from Canada found that women were significantly less likely than men to receive treatment at trauma centers following a fall or auto accident.

Previous studies have demonstrated gender bias in the medical treatment of severely-injured patients, and researchers sought to advance these earlier findings, according to Andrea Hill, MSc, PhD, a postdoctoral fellow at Sunnybrook Health Science Centre and the University of Toronto.

Hill and colleagues analyzed a national database that included 98,000 adults with severe injuries who sought treatment at acute care hospitals in Canada during an eight-year period. They looked at whether patients were referred from acute centers to trauma care centers, and whether patients received treatment when admitted to trauma facilities.

Centers focusing on trauma care are considered to provide the best treatment for severe injuries, and have been shown to lower mortality and morbidity, Hill explained. However emerging research suggests that access to such facilities are affected by factors like age and gender.

When referred to trauma centers,  49.6% of women received treatment compared to 63.2% of men. In patients older than 65 years, 37.5% of women were treated compared to 49.6% of men. These age and gender disparities are significant, Hill said in a presentation at the annual conference of the American Thoracic Society.

Overall women had a 22% lower odds of treatment in trauma centers, and this difference remained constant even after adjusting for age, injury severity, body site of injury, and geographic location.

It’s still unclear why this gender gap in care occurs. Some data suggests that women prefer treatment nearby their home, and some evidence suggests that women may fare better after a severe injuries which may influence the decision making in transferring them to different facilitates. Patient preferences and perceived patient preferences from surrogates speaking on behalf of patients may also play a role in the decision making, pointed out Mark Mikkelsen, MD, who commented on the study for MedPage Today. Mikkelson wondered what was the biggest factor affecting the gender gap: actual patient preferences, perceived patient preferences, or health-care provider assumptions?

Whether or not this gender gap in trauma care is the result of bias is unclear, but other research has pointed to a gender disparities in the treatment of chronic pain conditions. A 2011 study from the Institute of Medicine found that women with chronic pain are more likely to be dismissed, according to The New York Times. Another study called “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” showed that female patients tend to receive less aggressive treatment and are more likely to have their symptoms categorized as “emotional” or “not real.”

If the gender gap in severe-injury treatment is indeed related to gender biases, how would this impact the prognosis of auto injuries in women?

 

References

Hill A, et al “Access to trauma centre care following severe injury: Are women at a disadvantage?” ATS 2013.

Susman, Ed. Trauma center not care site for most women. Medpage Today. May 22, 2013. Accessed May 22, 2013.

Whiplash Causes Hypersensitivity to Pain

Whiplash Causes Hypersensitivity to PainChronic whiplash-associated disorder can cause patients a host of problems in addition to neck pain and disability.

A recent study has demonstrated that whiplash victims are also more susceptible to widespread pain and sensitivity to pain stimuli on other body parts far from the original pain source.

Researchers used leg and arm cuffs that were inflated to increase pressure to the deep tissues of the muscles, testing the pain intensity and tolerance for the patients throughout ten minutes of wearing the cuffs. The subjects were women, 25 of whom had whiplash associated disorder, and ten controls who did not.

Patients with whiplash had lower pain thresholds than the control group. The sensitivity to pain was experienced in both the arms and legs of the whiplash victims, extremities far from the neck.

In addition, participants were given a saline injection in their tibialis anterior muscles. The researchers discovered that the whiplash group experienced more pain intensity after the injection than the control group.

Researchers concluded that chronic whiplash-associated disorder led to widespread hyperalgesia, or sensitivity to pain. They suggested that central sensitization may be to blame.

Central sensitization occurs when a trauma such an auto injury starts a chain reaction in a patient’s body. Muscle damage and inflammation from the injury sends pain signals to the brain, and the brain reacts by telling the central nervous system that something is wrong. The injured muscles then contract to prevent further injury. The pain centers in the patient’s brain become over-stimulated and the patient’s entire body can become overly sensitive to pain. The resulting widespread, chronic pain will often affect an auto-injury victim in the arms, legs, hands, and feet, sources spread far away from the original source of the injury. Central sensitization can harm an auto injury-victim’s quality of life and ability to work.

Reference

Lemming D, et al. Widespread pain hypersensitivity and facilitated temporal summation of deep tissue pain in whiplash associated disorder: an explorative study of women. Journal of Rehabilitation Medicine 2012; 44(8): 648-57. doi: 10.2340/16501977-1006.

 

Diagnosis Mistakes Most Costly, Common, and Dangerous

Diagnosis Mistakes Most Costly, Common, and Dangerous Diagnostic errors are the most common, costly, and dangerous medical mistakes made in the US, according to a new study. Incorrect or delayed diagnosis could result in 160,000 deaths or permanent injuries in the US annually, the study found.

Researchers from John Hopkins Medicine analyzed 350,706 medical malpractice claims made over 25 years. They discovered that diagnostic errors — not surgical mistakes or medication overdoses — are the leading reason behind malpractice claims, accounting for 29.6% of cases and 35.2% of payments. Between 1986 and 2010, diagnostic-related payments totaled $38.8 billion.

Co-author of the study, David E. Newman-Toker, M.D., PhD, said that diagnostic errors have been historically “underappreciated and under-recognized” since there’s often a gap in time between when the mistake is made and when it’s detected. These errors are also harder to recognize than other medical or surgical mistakes.

The findings are based on an analysis of data from the National Practitioner Data Bank, an electronic repository of all medical malpractice payments made in the US since 1986.

The number of fatal diagnostic errors was roughly equal to the number of errors causing permanent damage. This suggests that that public health impact of diagnostic errors is much greater than previously imagined since earlier estimates were based on autopsy data, Newman-Toker explained.

Every year billions of dollars are spent on “defensive medicine” in effort to protect physicians from being sued and prevent against such medical mistakes. But more testing doesn’t always improve detection since thousands of diagnoses are missed every year, Newman-Tokwer pointed out. He suggested a multifaceted solution for minimizing these medical mistakes like better monitoring and reporting of the errors and diagnostic checklists.

While diagnostic errors are the number one medical mistakes, another new study from the John Hopkins Medicine found that medical “never events” are also much more common than previously thought.

 

References

Saber, AS. 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf, 22 April 2013 DOI: 10.1136/bmjqs-2012-001550.