All posts by Barbara Payne

Patient satisfaction surveys barking up the wrong tree?

Trying to achieve perfect customer satisfaction is not only nearly impossible in most businesses, but is often found to be, including in the case of medical care, completely the wrong approach to improving quality. Quality measurement is more readily applied to easily tracked process measures, like using checklists and giving discharge instructions. But improvements here don’t necessarily lead to improvements in patient outcomes, according to a recent Modern Healthcare article.

Getting medical staff to complete checklists of action items doesn’t focus on the real goals–lower mortality and lower readmission rates–and can lead to unintended consequences like acceding to a patient’s demand for medically unnecessary care.

Someone wrote once that traditional businesses ought to have a dissatisfaction rate of at least ten percent. If not, they were focusing too much on trying to please everyone, rather than doing the best possible job for the greatest number of customers. iSixSigma writes here about the pitfalls of relying too heavily on customer satisfaction surveys.

“The squeaky wheel gets the grease,” and other such aphorisms may apply just as well for medical care issues as they do for other businesses.

New microneedle biosensor detects nitric oxide during cancer diagnosis

"Cancer - Early Diagnosis Would Save 50,0...
“Cancer – Early Diagnosis Would Save 50,000 Lives Every Year” – NARA – 514027 (Photo credit: Wikipedia)

Nitric oxide NO) plays a variety of complex roles in the genesis, growth and death of cancer cells/tumors. As it does in so many physiological processes, it exhibits both pro- and anti-tumor activities, and researchers are still discussing the implications of these data on the use of NO as a therapeutic agent for the treatment of cancer.

A recent study takes advantage of NO activity to make diagnosing cancer more certain. A novel microneedle biosensor electrically detects NO emissions from cancer tissues in real-time for in situ cancer diagnosis during endomicroscopy. Researchers showed that using this as a dual diagnostic system yields high resolution imaging and provides a new way to easily, quickly and accurately diagnose cancers.

Nitric oxide once again takes a starring role in science’s efforts to understand how the human body works.

Plant-based nanofibers don’t harm lungs – unlike carbon nanotubes

nanofiber
nanofiber (Photo credit: Wikipedia)

Plant-based cellulose nanofibers, as opposed to carbon nanotubes suitable for similar purposes, don’t pose a short-term danger to human lungs, particularly when the fibers are very short. So says a study done as part of National Research Programme “Opportunities and Risks of Nanomaterials” (NRP 64).

Rather than experimenting on animals, researchers used human lung tissue in test tubes to develop a simulated 3D lung system that mimics human lungs. They found short nanofibers were fairly easily eliminated, but lung cells were less efficient at getting rid of longer fibers, as is true of humans inhaling asbestos fibers.

The study issues a recommendation that, in order to best protect technicians working with nanomaterials, manufacturers should develop and use soft, pliable, short, plant-based nanofibers rather than longer, rigid tubes. Thankfully, some specific safety guidelines for workers in this burgeoning field of bioscience.

Dormant mouse heart tissue made to regenerate

English: Medical X-rays Congestive heart failure
English: Medical X-rays Congestive heart failure (Photo credit: Wikipedia)

Heart attack and heart failure are major causes of death and disability around the world. And although when we are brand new babies, our hearts can regenerate themselves–just like our blood and skin do throughout our lives–but once we’re past infancy, this ability to automatically regenerate new heart cells disappears. That’s why the only “cure” for advanced heart failure is a heart transplant.

Now a team of Australian and Israeli researchers at the Sydney Victor Change Cardiac Research Institute and the Weizmann Institute of Science has proven a method of getting murine (mouse) heart cells (cardiomyocytes) to recharge their ability to regrow. Invoking the neonatal process, researchers developed a strategy for administering Neuregulin-1 (NRG1) and inducing co-receptor ERGG2 expression, thereby encouraging hypertrophy, then dedifferentiation and growth of the mouse heart cells. Although it’s still early days and much more research is needed, this study is extremely promising for future sufferers of heart attack and heart failure.

If they can get mice hearts to regrow their damaged cells, it’s highly likely that one day they’ll be able to get ours to do the same. Too bad most of us won’t be around for it.

Stem cells made to produce new neurons

English: Complete neuron cell diagram. Neurons...
English: Complete neuron cell diagram. Neurons (also known as neurones and nerve cells) are electrically excitable cells in the nervous system that process and transmit information. In vertebrate animals, neurons are the core components of the brain, spinal cord and peripheral nerves. (Photo credit: Wikipedia)

Our bodies are born with X number of neurons, which are the parts of the nervous system that carry chemical and electrical messages between the brain and other body parts. Up until now, no one has found neurons reproducing like regular cells do.

Now scientists have found a way to manipulate an RNA molecule called Pnky in such a way that neural stem cells will actually produce new neurons. It’s a complex process that takes a lot of explaining, so read more at BioScienceTechnology.com. And while you’re at it, read some clear layperson’s explanations about the many functions neurons perform in our bodies and brains on Psychology.About.com.

They’ve only done this in mice so far. But it’s clear this discovery constitutes a breakthrough in understanding a whole set of long, non-coding RNA molecules that researchers have heretofore assumed were just there–with no known function. One scientist called these the “dark matter” of the human genome, meaning there’s a lot more of this stuff than there is of the DNA we’ve already explored and named.

Another whole new world of knowledge is just beginning to crack open.

Can shrimp shells solve our huge plastic waste problem?

English: A heap of Pandalus borealis shrimp. O...
English: A heap of Pandalus borealis shrimp. Originally from en.wikipedia; description page is/was here. 2005-03-09 (original upload date) Original uploader was Stemonitis at en.wikipedia (Photo credit: Wikipedia)

Imagine a moldable, sturdy, biodegradable substitute for the billions of pounds of plastics we dump into our oceans and rivers and on the ground. Scientists at the Wyss Institute at Harvard University have been working on developing just such a substance.

Their search may be yielding results. They report being able to do what they imagined with a substance called “chitosan, a form of chitin…a powerful player in the world of natural polymers and the second most abundant organic material on Earth. Chitin is a long-chain polysaccharide that is responsible for the hardy shells of shrimps and other crustaceans, armor-like insect cuticles, tough fungal cell walls — and flexible butterfly wings.”

They’ve been combining the chitosan with a protein from silk to make a pliable material that can be molded without breaking or shrinking. What’s more, it biodegrades in about two weeks, while also adding nutrients to the soil and helping plants – like the Institute’s black-eyed peas – grow in the enriched soil.

Fabulous news: recycling the Earth’s own resources to do what human civilization wants to accomplish – and not leaving more deadly waste. Can’t wait til they get this going.

Promising: Nanoparticles reverse bone loss in mice

Three osteoblast visible at 400x in developing...
Three osteoblast visible at 400x in developing bone (Photo credit: Wikipedia)

It started out in test tubes. Scientists introduced engineered 50?nm spherical silica nanoparticles into an artificial environment with a view to seeing whether they might help osteoblasts differentiate and promote bone building while also suppressing the re-absorption of osteoclasts. It worked well.

Next they found that could get the nanoparticles to help build bone in young living mice. Now in a new study they tried to get these nanoparticles to reverse bone loss in aged mice in a model of osteoporosis in elderly humans. Weekly injections of nanoparticles resulted in a significant increase in BMD, bone volume, and biochemical markers of bone formation.”

What’s even better, they couldn’t identify any abnormalities resulting from the treatment. Further studies will be conducted to see if this ability to halt and even repair age-associated bone loss might also work in humans.

As of now, broken hips in elderly women tend to lead to death within a year for many. Imagine being able to treat people before they develop a life-threatening broken hip–thus extending their lives with the greater independence that is the hallmark of higher quality of life. Read further evidence on that in the doctor’s treatise on end-of-life issues, Being Mortal. Highly recommended if you care or may have to care for elders or are getting there yourself.

 

Stem cells help more than drugs to slow MS

A bone marrow harvest.
A bone marrow harvest. (Photo credit: Wikipedia)

A small study recently showed that multiple sclerosis patients who received injections of stem cells taken from their own bone marrow had 80% fewer areas of brain damage over the next few years than those who were given the usual immune-system-suppressing drug, mitoxantrone. Researchers feel the study indicates that stem cell treatment may actually re-set the immune system and thus may profoundly influence progress of the disease. Results of the limited study–only 21 patients–were published in a recent online issue of Neurology.

Considered the most common disabling neurologic disease of young people, MS afflicts approximately a quarter of a million Americans. The symptoms of MS result from recurrent attacks of inflammation in the central nervous system. The disease is typically characterized by progressive loss of motor control and often leads to paralysis and is considered incurable so far.

More demonstration of the incredible promise of stem cell treatments. Nature’ way.

Blueberries lower BP and raise nitric oxide levels

English: A pack of blueberries from a organic ...
English: A pack of blueberries from a organic farm co-op program. (Photo credit: Wikipedia)

News about blueberries. A small study—48 post-menopausal women who were pre- or stage 1 hypertensive—showed that participants who took 22 grams (that’s .77 of an ounce for those of us who are gram-challenged) of freeze-dried blueberry powder (equivalent to one cup of the fresh fruit) every day for a month lowered their blood pressure and limbered up their arteries compared to those who took a placebo. And they lost 10 pounds!

No. Just kidding on that last one.

But they did lower their systolic (top number) blood pressure by 5% and their diastolic (bottom number) BP by 6%, raised their nitric oxide (NO) levels by a whopping 68.5% and decreased arterial stiffness by 6.5%, as reported in a paper by Sarah A. Johnson and several other exercise and nutrition professors. Johnson is assistant director of the Center for Advancing Exercise and Nutrition Research on Aging (CAENRA) and postdoctoral fellow in the Department of Nutrition, Food and Exercise Sciences at Florida State University.

Previous studies had shown impressive benefits for blueberries, but most involved consuming huge quantities (13 cups per day in one study).

My calculations say you’d have to spend between $58.50 and $78 a month for the cup-a-day dose – and none of that would be covered by insurance.

The cost of blood pressure medication (angiotensin receptor blocker ARB) varies wildly, depending on the type prescribed and the place you buy it. One site gives ARB prices ranging from a discounted $9 to a top price of $183 for a 30-day supply.

A caveat: The study was paid for by the U.S. Highbush Blueberry Council. The Council is industry-funded and is in the business of marketing blueberries. But at least the USDA’s Agricultural Marketing Service monitors their operations.

Another study done at University of California Davis states that consuming freeze-dried blueberry powder in smoothies every day can increase insulin sensitivity—and is thus very good for anyone at risk of developing type II diabetes, a risk that increases for Baby Boomers as they age. Note: Participants had to cut back 500 calories on other foods to accommodate the calories in the two smoothies each day.

So it looks like freeze-dried blueberry powder is a nutritionally equivalent substitute for the fresh fruit at a similar price—plus it keeps longer and is easier to store.And while the fruit will never replace your blood pressure meds, it still might be a worthwhile investment to get some o’ that blueberry powder.

 

Nanoparticle exposure linked to heart problems

Asbestos fibres - a single fibre is believed t...
Asbestos fibres – a single fibre is believed to cause mesothelioma (Photo credit: Wikipedia)

Asbestos was hailed, even many centuries ago, as a material that could be used to create “miraculous” solutions to multiple problems – it was fireproof, it was flexible, it had tremendous insulating properties, it was easy to manipulate, etc. But it had a powerful, long-unacknowledged dark side. It gradually disabled and then killed people who ingested or inhaled the minute fibers.

Nanoparticles are even smaller than asbestos fibers. They’re used to make things stronger, to deliver drugs directly into tumors – on and on. Yet even as the world watches with wonder and awe the exciting developments in nanoparticle research, some have been tracking its dark side. Now a team of Israeli scientists has established that exposure to nanoparticles (NPs) of silicon dioxide (SiO2) can lead directly to developing cardiovascular diseases.

Silicon dioxide powder (silica fume), 130m²/g ...
Silicon dioxide powder (silica fume), 130m²/g surface area, placed on the scanner under a blue book, scanned in at 1600dpi. (Photo credit: Wikipedia)

The exposure must be such that the nanoparticles cross the body’s natural tissue and cellular barriers and find their way into the circulatory system. That is precisely the type of environmental exposure that happens consistently to people who work in research or production and thus use, handle or dispose of nanoparticles.

When the doctor sends a drug into your body that rides inside a nanoparticle, we just want him to make sure the cure isn’t bringing its own death threat.