Living Well: Health and Wellness Tips

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Indiana University experts discuss how the right nutrition at the right time can give athletes an edge, gender differences in self-handicapping, and steps to take when considering a career change.

GIVE YOUR TRAINING OR WORKOUT SOME OOMPH -- WITH THE RIGHT NUTRITION AT THE RIGHT TIME

What you eat or don't eat immediately after a workout could be just as important as what you do on the field, in the pool or in the gym. Properly refueling spent muscles can help athletes feel less fatigue and perform better at the next workout, particularly athletes who work out twice daily. The benefits are not lost on recreational athletes, either, after demanding workouts.

Timing is everything, however. Indiana University researchers say a 4:1 ratio of carbohydrates to protein is key and it must be eaten or drunk within 45 minutes of the workout for the maximum benefit.

"Muscle cells actually become relatively resistant to absorbing nutrients after two hours," said Joel Stager, professor in the Department of Kinesiology at IU Bloomington School of Health, Physical Education, and Recreation.

Stager's research team discovered a few years ago that chocolate milk makes an excellent exercise recovery beverage in part because of its carb-to-protein ratio and because it helps rehydrate the body. Carbs and protein can be ingested in many forms, however, including drinks, gels and good ol' peanut butter and jelly sandwiches.

"Eating right on a daily basis and proper exercise recovery nutrition should be considered part of an athlete's training," Stager said. "Athletes who eat and drink within that 45-minute window following practice have an edge over competitors who do not."

Stager is director of the Counsilman Center for the Science of Swimming, a national champion in U.S. Masters Swimming and a coach. He and his colleague Alice Lindeman, associate professor in HPER's Department of Applied Health Science and a registered dietitian, offer these nutritional suggestions for recovering after exercise:

* Not just once. The initial snack should be eaten or drunk within 45 minutes of the physical activity. For the serious athlete, additional snacks with the same 4:1 carb-to-protein ration should be ingested every hour for four to six hours.

* What to choose. It is best to make the food as easy to digest and absorb as possible. Beverages help rehydrate and can be easier on the stomach. Options include juices, sodas (avoid too much caffeine), sports beverages, sports bars, gels or even Kool-Aid. Some commercial products are designed to provide the 4:1 ration. Here are two examples of homemade combos: 12 ounces low-fat chocolate milk and half a jam sandwich equals 60 grams of carbs and 15 grams of protein; 12 ounces of lemonade and a peanut butter and jelly sandwich equal 87 grams of carbs and 19 grams of protein.

* Skip the diet sodas. Because of the caffeine and lack of carbs, even water would be a better choice.

* How much. This formula can be used to figure out how much to eat: Divide your body weight by two or three and use the number to represent the amount of grams of carbs that you should eat. If you weigh 150 pounds, you would eat from 50 to 75 grams of carbs during your refueling snacks. Divide your weight further by four to determine how much protein to eat -- 12-19 grams in this example.

* Carbs, protein, antioxidants? Foods containing antioxidants can help reduce inflammation and oxidative processes that naturally occur in muscles after prolonged exercise. Bright colored fruits and vegetables or their juices and dark chocolate contain antioxidants. Cans of vegetable juice and dried berries can make good snacks.

* What does Stager do? When training hard, he follows his workout with a large serving of chocolate milk and a 3-ounce can of tuna.


WOMEN SAY, "SAVE THE EXCUSES"

Self-handicapping expert Edward R. Hirt has found that men are more likely to engage in self-handicapping than women and are more forgiving of others who are quick with the excuses.

Self-handicapping is when a person creates an excuse for failure before the situation even occurs. Being late, blowing off studying, excessive drinking and inadequate sleep are examples of self-handicapping.

"Self-handicappers make excuses ahead of time so they are covered if they do poorly and appear like over-achievers if they do well," said Hirt, associate professor in Indiana University Bloomington's Department of Psychological and Brain Sciences.

Hirt's recent research on self-handicapping focuses on gender differences. While neither sex is immune to making excuses, men are more likely to actually sabotage their chances for success by withdrawing effort -- or failing to do the practice or preparation that they know will increase their chances for success.

"Women are less likely to self-handicap in this way and respond more negatively to others who fail to expend effort at important tasks," Hirt said. "Men will actually engage in self-sabotage and are more lenient and understanding of others who do."

He said women and men place different personal value on effort, with women placing more importance than men on putting forth effort.

Hirt said he strongly believes that people can change. For people who self-handicap, this requires them to change their perspective on performance issues. He suggests the following:

* Focus on success. Hirt said focusing on success rather than worrying about potential failures appears to help self-handicappers. Self-handicappers constantly worry about the possibility that "I could fail," instead of focusing on what they can do to maximize their chances for success and getting the necessary task done.

* Recognize self-handicapping. Poor nutrition, tardiness, inadequate sleep, excessive drinking, blowing off studying or practice, poor preparation and stress are examples of self-handicapping.

* Quit complaining. Most self-handicappers complain after the situation has occurred and talk about "what could have been" rather than what actually happened.

* Put yourself to the test. The next time you have an exam or presentation at work, prepare for it. Continue to challenge yourself.

THINKING ABOUT A NEW JOB?

Boredom. Anxiety. Restlessness. A sense of dread. If these terms describe your feelings at work, don't be afraid to make a change, said Amy Gregor, coordinator of career services at the Indiana University Alumni Association.

"Career change is a natural life progression. Most studies show that the average job seeker will change careers -- not just jobs -- several times over the course of his or her lifetime," said Gregor, who regularly communicates with alumni who are making career changes.

But before you turn in your pink slip, take some time to carefully assess the situation. It is very difficult to find satisfaction if you don't know what you need. Do you need a radical leap or just a tweak? Gregor offers the following suggestions:

* Take a hard look. Start with a self-assessment of likes and dislikes about your current position. Are there certain aspects that you do enjoy? Get specific about your list of grievances. Are the hours too long? Are you bored? Is the pay too low? Do you wish you had a healthier balance between work and family life? Does your job match your values? You might find that some of the negatives can be addressed within your current position. "It is possible that your boss has no idea you are unhappy and would be perfectly willing to change things if you propose a new plan," Gregor said.

* Bad habits? Certain habits tend to make people unhappy at their jobs regardless of the circumstances. "If you never take a lunch, have poor time management skills, and never use your vacation time, most people will burn out. If you bring that approach to another job or career you may continue to have the same levels of dissatisfaction," Gregor said.

* Don't put it off. Once you're certain you need to leave, start taking steps to transition as soon as possible, Gregor said. "Don't wait until you are at the point where you are so frustrated you're willing to burn bridges," she said.

* Rediscover your passion. Think of times when you felt most successful. Ask yourself what you really love to do. What's the best thing about your profession? What do you do for fun? If you didn't care about what anyone thought, what would be your highest aspiration? Answering these questions can help you get a sense of what career path to pursue.

* Still not sure? "If you've analyzed your likes and dislikes, but you're still not sure what career path to take, consider taking a career assessment. The key is investing in the time to rediscover yourself, and using your self-assessment to steer your new career search," Gregor said.

* "You're never starting from scratch." Once you have discovered your passion, be sure to take the time to assess the skills you already possess. You may be surprised to see that you already hold many skills -- and well-earned experiential knowledge -- that will directly apply to your new career. In some cases it may help to pursue further education, but many career changes are possible without going back to school, Gregor said. "You are never starting from scratch," she said. "Try to stop identifying yourself as a job title like 'accountant' or 'programmer' and learn to talk proudly about your skills and strengths that can apply in any situation. For example, you could say, 'I am good at problem-solving and presentations.' You have worked, gained experiences, earned a degree, and you have success stories to tell. So many talents are transferable across career fields." Some positions may require more education, but don't assume the requirements listed in job postings are always set in stone, Gregor said. "The truth is that employers want to hire the right candidate, so do not underestimate yourself. If you have the knowledge, skills, and experience you may consider contacting the employer." she said.

* Network. Don't just dive into the help wanted ads, Gregor said. Test the waters by talking with people who work in various career fields. "Most individuals are happy to chat and describe their typical workday," Gregor said. College or university alumni associations are a great place to start looking for contacts or mentors, Gregor said. The Indiana University Alumni Association, for example, offers many networking resources, including an alumni online directory, an alumni-to-alumni mentoring program and more than 100 alumni chapters worldwide.

* Talk about your dreams. "During this time it may be helpful to talk about your plan with the people you trust most, such as your family, friends, alumni contacts, pastor, trusted counselor, financial advisors, and maybe even your doctor," Gregor said. "It will be important to gain support during any times of transition." (Newswise)

Botulinum Toxin Type A May Do More than Make You Look Younger, May Make Your Joints Feel Younger Too

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A single injection of intra-articular botulinum toxin Type A may significantly decrease pain and improve shoulder function in osteoarthritis sufferers, according to researches presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.



A single injection of intra-articular botulinum toxin Type A may significantly decrease pain and improve shoulder function in osteoarthritis sufferers, according to researches presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.

Osteoarthritis is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage—the slippery material at the end of long bones—and causes changes in the structures around the joint. These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.

Injection of botulinum neurotoxin (commonly referred to by the brand name Botox) into joints is a promising new approach for treating sustained shoulder pain brought on by arthritis. An injection of neurotoxin in the joint may work by decreasing the release of certain proteins from the nerves in the joints—thereby decreasing the pain sensation in the joint.

Researchers recently studied the effectiveness of intra-articular botulinum neurotoxin versus placebo in patients with chronic shoulder pain, due to osteoarthritis or rheumatoid arthritis, who did not respond to corticosteroids or pain medication. These patients also were not candidates for shoulder arthroplasty.

Forty-three patients with moderate to severe arthritis pain (categorized as greater than 4.5 on a scale of zero to 10 with zero as no pain and 10 as the worst pain) were randomly placed in two groups and assessed at one, three and six months. The first group received intra-articular neurotoxin and lidocaine, while the second group received saline and lidocaine.

By comparing pain levels before beginning treatment to pain levels 28 days after the treatment, researchers found that pain levels were significantly lower in the patients receiving neurotoxin compared to placebo. Thirty-eight percent of patients receiving the injection of botulinum neurotoxin into the joint had at least a 30 percent reduction in pain score compared to only nine percent of patients in the placebo group. There was a trend toward a greater improvement in shoulder function in the botulinum toxin group, as compared to the placebo group at 28 days.

“This study provides the initial ‘proof of concept’ of effectiveness of botulinum toxin injection for relief of shoulder joint pain,” says investigator in the study, Jasvinder Singh, MBBS, MPH; staff physician, Minneapolis VA Medical Center; assistant professor of medicine, University of Minnesota; visiting scientist and K -12 scholar, Mayo Clinic School of Medicine. “A more sophisticated, larger, multicenter, randomized study is needed to assess efficacy, safety, mode of action, optimal dose and frequency of this novel treatment option.”

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see http://www.rheumatology.org/annual.

Editor’s Notes: Dr. Singh will present this research during the ACR Annual Scientific Meeting at the Boston Convention and Exhibition Center from 9:00 – 11:00 am ET on Friday, November 9, 2007, in the Exhibit Hall.


Presentation Number: L4

Intra-articular Botulinum Toxin Type A (IA-BoNT/A) Significantly Decreases Shoulder Pain in Patients with Refractory Shoulder Pain due to Osteoarthritis: A Randomized Double-Blind Placebo-Controlled Trial

Jasvinder A. Singh, Maren L. Mahowald, Siamak Noorbaloochi. Minneapolis VA Medical center, Minneapolis, MN

Persistent shoulder pain is very common problem affecting over 5% of adult Americans each year. IA Neurotoxin injection for sustained analgesia is a promising new approach to persistent joint pain (J Neurotox Res: 2006;9:179-88), which may act by inhibiting vesicle release of neuropeptides such as Substance P and CGRP and disrupting nociceptor function to decrease pain.

Purpose: To report the efficacy data from the Double-blinded RCT of IA-BoNT/A vs. IA-placebo in patients with chronic, shoulder osteoarthritis (OA) pain refractory to intra-articular corticosteroids and oral analgesics, who were not candidates for shoulder arthroplasty.

Methods: 43 patients with moderate to severe OA pain (>4.5 on 0-10 numeric rating scale (NRS)) were randomized to two groups and assessed at baseline, 1-, 3- and 6-months: (1) 100 units IA-BoNT/A + lidocaine (BoNT/A group); or (2) saline + lidocaine (Placebo group). The Primary Efficacy outcome measures of pain severity at 1 month were: Visual Analog Scale (VAS, 0-10 cm); day pain on 0-10 NRS and Shoulder Pain and Disability Index (SPADI) pain subscale score (0-100 mm, higher score=worse). Secondary outcomes included validated measures: SPADI Disability index (0-100 mm scale; higher score=worse) and proportion of patients achieving >=30% pain relief (=clinically meaningful pain relief). We compared baseline to day 28 changes by using paired student’s t-tests for continuous and chi-square for categorical outcomes.

Results: 43 shoulder joint in 37M (5 with bilateral shoulder joint injections) and 1F with mean age (Standard deviation) of 71±10 yrs were randomized: 21 BoNT/A, 22 Placebo. Both groups were comparable with regards to demographic and outcome variables at baseline.

[Figure 1, Outcomes at Day 28 post-shoulder joint injection, available on request]

Primary Outcome Measure: At day 28, pain as measured by VAS pain, day pain on NRS and SPADI pain score were all significantly lower in the BoNT/A vs. placebo group (Table).

Secondary Outcome Measures: SPADI disability score was better at Day 28 in BoNT/A vs. placebo group with trend towards significance. 38% patients in BoNT/A vs. 9% in placebo group had >=30% reduction in SPADI pain score. A detailed analysis of adverse effects and duration of effects is in progress.

Conclusion: A single injection of IA-BoNT/A produced statistically significant and clinically meaningful decrease in moderate/severe refractory OA shoulder pain and tended to improve shoulder function. These data are very promising and provide further evidence supporting the efficacy of this novel neurotoxin therapy. A multi-center RCT is needed to confirm these findings. (Newswise)

Women Who Receive DXA Scans Should Request a Copy of Their Bone Density Results

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Sending bone density results directly to patients increases the likelihood that they will seek treatment and is a preferred method of physicians for communicating results, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.



Sending bone density results directly to patients increases the likelihood that they will seek treatment and is a preferred method of physicians for communicating results, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.

DXA scans, commonly called bone density tests, are a way of determining if a patient has low bone mass, and is at increased risk for fracture. Bone density tests are often used for diagnosis and following the progression of osteoporosis, a disease that weakens the bones and makes them prone to fracture.

Osteoporosis affects an estimated eight million women and two million men in the Untied States. Studies show that many patients who are diagnosed with osteoporosis never receive treatment, and some are not even notified of their DXA scan results.

Researchers followed 370 women as a part of a four-year study. The participants were divided into two groups. The first group received a copy of their bone density results and information about osteoporosis prevention directly from the testing facility, while the second group received a letter asking them to follow up with their physicians.

In addition to following the participants, a survey was sent to 308 physicians who ordered at least four DXA scans to obtain feedback regarding the delivery of test results.

At the three to six-month follow-up, of those women identified by their bone density studies as having osteoporosis, 13 out of 14 who received their bone scan results directly from the testing center were taking prescription medication for osteoporosis. Only 8 out of 14 of those who received a letter requesting them to follow up with their physicians were taking prescription medication to treat osteoporosis.

Of the physicians who responded to the survey regarding test results delivery, ninety-six percent agreed that sending results directly to patients would increase the likelihood of patients seeking treatment. Eighty-five percent said patients would be more likely to discuss their test results with their physician if they received them directly.

“This study indicates that patients who are sent the results of tests are more likely to communicate with their providers and start appropriate therapy, said researchers Edward S. Leib, MD; professor, University of Vermont College of Medicine; director, The Osteoporosis Center, Fletcher Allen Health Care Ambulatory Care Center 5E and Teresa Fama, MD, MS; fellow, rheumatology, University of Vermont College of Medicine. “Despite concerns that patients who receive such results might misinterpret the findings, this study demonstrates that physicians did not object to findings being sent directly to patients and, that by having this done, it would likely encourage better communication with patients.”

This study may have wider implications than just for bone density studies and this method of sending results directly to patients might be useful and acceptable for other types of testing results.

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see http://www.rheumatology.org/annual.

Benefits of Reporting Bone Density Results Directly to Patients

Teresa A. Fama1, Priscilla Carr1, Edward Leib2. 1Central Vermont Medical Center, Berlin, VT; 2University of Vermont, Burlington, VT

Purpose: Studies show that many patients who are diagnosed with osteoporosis never receive treatment, and some are not even notified of their DXA scan results. We performed an IRB-approved two-part study to evaluate whether sending DXA results directly to patients influences subsequent osteoporosis treatment, and to assess referring providers’ opinions of this DXA reporting process.

Methods: Women presenting to our osteoporosis center for their first DXA were eligible to enroll in the study. BMD was measured on a GELunar Prodigy densitometer (GELunar, Madison, WI). Following their DXA, women were randomized to receive either: (1) a copy of their results and additional information about osteoporosis prevention (Group 1); or, (2) a letter stating they should contact their referring provider for results (Group 2).

A total of 616 providers ordered DXA scans through our center over a four-year period. For the referring provider portion of the study, a survey was sent to the 308 providers who ordered at least 4 scans (median number). We received 96 surveys for a response rate of 31%.

Results: 370 women were equally and randomly enrolled in Groups 1 and 2. The majority was college-educated and almost all had health insurance. Baseline characteristics of the two groups were similar. At 3 to 6-month follow-up, 13 of 15 women in Group 1 with a T-score ≤ -2.5 were taking prescription medication for osteoporosis, while only 8 of 15 women in Group 2 with a T-score of ≤ -2.5 were taking prescription medication (p=0.029). Over half the women in Groups 1 and 2 were consuming dairy or calcium and vitamin D supplements prior to testing, and there was no difference in calcium and vitamin D intake between the two groups after DXA testing.

Of the 96 referring provider respondents, three-quarters practiced primary care (43% family practice and 28% general internal medicine), 59% were women, and the average number of years in practice was 16. 96% of responders agreed with sending DXA results directly to patients. Only 6% of responders would rather have notified patients themselves of the results. Moreover, 85% of responders thought that it was more likely for patients to discuss DXA results if their patients received results directly from the testing center.

Conclusions: Directly sending patients their DXA results increased the likelihood that prescription medication was started to treat osteoporosis. Direct contact did not seem to have an appreciable effect on the use of calcium and vitamin D supplements, perhaps because a large percentage of patients were already taking supplements prior to the DXA. Almost all (96%) responders to the provider survey agreed with sending results directly to patients, and most thought that this process increased the likelihood of discussing osteoporosis treatment with their patients at follow-up appointments. (Newswise)

Disclosure Block: T.A. Fama, None; P. Carr, None; E. Leib, None.

High Blood Pressure, Chest Pains Speed Up Progression of Alzheimer’s Disease

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People with Alzheimer’s disease who have high blood pressure, chest pains or an irregular heartbeat may lose their memories faster than others with Alzheimer’s disease, according to a study of the American Academy of Neurology.


The study involved 135 elderly people with newly diagnosed Alzheimer’s disease who had annual cognitive tests for an average of three years. At the beginning of the study, 62 percent of the participants reported one or more of the following vascular factors: irregular heartbeat, high blood pressure, chest pains, coronary artery bypass surgery, heart attack, diabetes, use of medications to treat high blood pressure, and stroke.

The study found those people who reported high blood pressure at the time of the Alzheimer’s diagnosis saw their rate of cognitive decline accelerate twice as fast as those Alzheimer’s patients who did not have high blood pressure. Irregular heartbeats and chest pains due to a lack of blood supply in the heart were also associated with a more rapid decline on cognitive tests.

“The good news is that vascular factors can be modified, so these results may suggest strategies for slowing the progression of Alzheimer’s,” said study author Michelle Mielke, PhD, with The Johns Hopkins University School of Medicine in Baltimore, MD. “Many studies suggest that vascular factors are associated with an increased risk of developing Alzheimer’s disease; these findings suggest that vascular factors also affect rate of cognitive and functional decline after a diagnosis and further research is clearly warranted.”

The study also found Alzheimer’s patients who have a history of heart bypass surgery, diabetes, or taking medications to treat high blood pressure had a slower rate of cognitive decline.

“Our findings further suggest that medications used to treat high blood pressure may be important in slowing the progression of Alzheimer’s once a person is diagnosed,” said Mielke. “However, the findings that show heart bypass surgery and diabetes are associated with a slower rate of cognitive decline are counterintuitive and more research is clearly needed before recommendations can be made.”

The study was supported by grants from the National Institute on Aging.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as multiple sclerosis, restless legs syndrome, Alzheimer’s disease, narcolepsy, and stroke. (newswise)

Over-the-Counter Pain Medications May Reduce Risk of Parkinson’s Disease

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Over-the-counter pain medications known as non-steroidal anti-inflammatory drugs (NSAIDs) may reduce a person’s risk of Parkinson’s disease, according to a study.



Over-the-counter pain medications known as non-steroidal anti-inflammatory drugs (NSAIDs) may reduce a person’s risk of Parkinson’s disease.

“Given our results and the growing burden of Parkinson’s disease as people age, there’s a pressing need for further studies explaining why these drugs may play a protective role,” said study author Angelika D. Wahner, PhD, with the UCLA School of Public Health in Los Angeles.

The study involved 579 men and women, half of whom had Parkinson’s disease. The participants were asked if they had taken aspirin and if they had taken non-aspirin NSAIDs, such as ibuprofen, once a week or more at any point in their life for at least a month.

Participants were considered regular users of aspirin or non-aspirin NSAIDs if they took two or more pills a week for at least one month. Non-regular users were those who took fewer pills.

The study found regular users of non-aspirin NSAIDs reduced their risk of Parkinson’s disease by as much as 60 percent compared to non-regular users and non-users. Women who were regular users of aspirin reduced their risk of Parkinson’s disease by 40 percent, especially among those who regularly used aspirin for more than two years.

“Our findings suggest NSAIDs are protective against Parkinson’s disease, with a particularly strong protective effect among regular users of non-aspirin NSAIDs, especially those who reported two or more years of use,” said Wahner. “Interestingly, aspirin only benefited women. It may be that men are taking lower doses of aspirin for heart problems, while women may be using higher doses for arthritis or headaches.”

“It’s possible the anti-inflammatory agent in NSAIDs may contribute to the observed protective effect of the drugs, but the exact mechanism isn’t clear and further research is needed,” said the study’s principal investigator Beate Ritz, MD, PhD, with UCLA School of Public Health.

The study was supported by grants from the National Institutes of Health, the National Institute of Environmental Health Sciences and the American Parkinson Disease Association.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Parkinson’s disease, ALS (Lou Gehrig’s disease), dementia, West Nile virus, and ataxia. (Newswise)

Source : American Academy of Neurology.

Cardiac Resynchronization Therapy produced no improvement in peak oxygen uptake

Study Puts Brakes on Extending Indications for Cardiac Resynchronization Therapy
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A randomized, controlled, multi-center trial has found that cardiac resynchronization therapy produced no improvement in peak oxygen uptake during exercise testing, the trial's primary endpoint, in patients with Class III heart failure, including mechanical problems that disrupt the heart's normal rhythm and a moderately prolonged QRS complex as demonstrated on EKG.

The Resynchronization Therapy in Narrow QRS (RethinQ) trial was designed to determine whether cardiac resynchronization therapy (CRT), which currently benefits about 10 to 15 percent of patients with moderate to severe heart failure, could be extended to a much larger group of heart failure patients, about 40 to 50 percent of the 550,000 new cases diagnosed each year.

Although patients in the trial reported increased activity levels and decreased discomfort, the study's results -- presented Nov. 6, 2007, at a late-breaking clinical trial session of the American Heart Association’s Scientific Sessions in Orlando, Florida -- showed that CRT produced no improvement for this population in any of the other objective parameters and endpoints. These parameters included performance on a six-minute walk test, echocardiographic improvement in left-ventricular remodeling, and the secondary endpoint of quality-of-life score.

"While cardiac resynchronization therapy has helped thousands of patients with heart failure caused by electrical dyssynchrony, we did not see that same benefit in patients with mechanical dyssynchrony as determined by echocardiography," said study lead author John F. Beshai, MD, director of pacemaker and defibrillator services at the University of Chicago Medical Center. "This is a valuable therapy for carefully selected patients," he said, "but further research will be necessary to determine which additional groups might benefit from CRT."

CRT devices are surgically implanted in the upper chest with leads to the right and left ventricles. The device delivers electrical impulses to each ventricle simultaneously, which stimulates synchronous contraction. This synchronous contraction improves the heart's pumping efficiency, which improves patients' symptoms.

Current guidelines support the use of CRT in patients with moderate to severe heart failure, an ejection fraction less than or equal to 35 percent, and a prolonged QRS duration, greater than 120 milliseconds, what physicians refer to as a "wide QRS."

The RethinQ investigators followed 172 patients with advanced heart failure, mechanical dyssynchrony (when the heart's main pumping chambers, the ventricles, do not contract together efficiently) and a QRS duration of less than 130 milliseconds, for six months. Eighty-five patients were randomly selected to receive treatment with CRT. The other 87 were followed as controls.

The sub-group of patients with the longest QRS duration, between 120 and 130 milliseconds, did show improvement from CRT, as measured by peak oxygen uptake during exercise testing. This sub-group already is indicated for CRT, said Beshai, and this finding "supports previous research on this patient sub-group." Patients with a QRS duration of less than 120 milliseconds, however, did not show improvement.

"While there may be a group of patients with a narrow QRS who can benefit from CRT therapy, the measures of dyssynchrony used in the RethinQ study did not identify them," Beshai said. "These new data are helpful for all heart failure physicians as we continue to determine the best criteria for assessing who will most benefit from CRT therapy."

Heart failure, one of the leading causes of death in the U. S., is a progressive condition in which the heart weakens and loses its ability to pump an adequate supply of blood to the body. About 5 million Americans suffer from heart failure, with 550,000 new cases diagnosed each year.

This investigator-initiated study was funded by St Jude Medical, makers of the CRT device. Additional authors include Richard Grimm and Patrick Tchou of the Cleveland Clinic Foundation; Sherif Nagueh of the Methodist Hospital, Houston; James Baker of St Thomas Hospital, Nashville; Scott Beau of Arkansas Heart Hospital, Little Rock; Steven Greenberg of St. Francis Hospital, Roslyn, NY; and Luis Pires of St. John Hospital and Medical Center, Detroit.(Newswise)

Diabetic Innovator Announces New Injection Aid

SOUTHAMPTON, Mass., Nov. 2, 2007 -- When faced with the certainty of daily insulin injections, innovator Chris Hillios knew he had to design a device that would help him overcome his injection anxiety. Through his determination and innovative spirit, Confidisc was developed.

Confidisc is an aid for injecting, by syringe or pen, insulin or like medications. It can be used by the patient or by a caregiver. "It is truly amazing that a simple device like Confidisc can make such a huge difference in one's life. Our testing has shown that Confidisc not only reduced pain perception, it clearly reduced injection anxiety," said Chris Hillios. "Users focus on the disk rather than the needle." With Confidisc's help, patients' lab results are now better than ever.

Confidisc enables users access to a larger range of injection sites, allowing better injection rotation. It provides added stability in both filling the syringe and during injection. Its simple form is easy to use, convenient and cost-effective. Confidisc may be manufactured as a reusable attachment product and/or as a permanently fixed part of a hypodermic syringe. As a new hypodermic syringe, Confidisc also helps to deter illegal intravenous drug use.

More than 18 million Americans are living with type 2 diabetes. Many suffer from injection anxiety. Fear of injection can lead to improper treatment and poor control. "Having first-hand knowledge of the problems associated with home injections, it is our belief that this product will be of enormous benefit to the ever-growing diabetic population. Confidisc provides the confidence I need. I will no longer inject without it," said Hillios.

Confidisc was well-received by a review of Endocrinologist, Diabetic Educators and Nurse Practitioners. They look forward to having it available for their patients. It is sure to be a beneficial, simple, and affordable product for everyone facing daily injections. "Diabetes was our primary concern. However, we can now see that as the self-injectable market grows, the uses for Confidisc also grow," said Hillios.

New Guideline Recommends When to Use CT Scans in ER for Seizures

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A guideline developed by the American Academy of Neurology recommends immediate brain CT scans to screen certain emergency room patients with seizures. Evidence shows such scans can help doctors select the right treatment option. The guideline is published in the October 30, 2007, issue of Neurology, the medical journal of the American Academy of Neurology.



A guideline developed by the American Academy of Neurology recommends immediate brain CT scans to screen certain emergency room patients with seizures. Evidence shows such scans can help doctors select the right treatment option. The guideline is published in the October 30, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology.

To develop the guideline, the authors analyzed all available scientific studies on the topic.

“Our analysis found immediate CT scans are a useful screening procedure because the results can help doctors decide how to care for the patient, especially after the first seizure, and for very young children and people with AIDS,” said the guideline’s lead author Cynthia L. Harden, MD, with Weill Cornell Medical College in New York and member of the American Academy of Neurology.

The strongest evidence shows that imaging in the emergency room with a head CT scan is particularly useful for seizure patients with a predisposing history, focal seizure onset, an abnormal neurologic exam, a history of AIDS, or who are younger than six months old.

“Infants under six months old with seizure may have brain abnormalities on their CT scans 50 percent of the time,” said Harden. “In addition, evidence shows people with AIDS who are treated in the emergency room for their first seizure have high rates of brain abnormalities. Central nervous system toxoplasmosis, an infectious disease caused by a parasite, is also frequently found in AIDS patients.”

The guideline suggests physicians consider an emergency CT scan in adults and children with a first seizure because evidence shows the results will change how these people are treated in up to 17 percent of adult cases and up to eight percent of cases involving children.

Abnormalities found on CT scans that would lead to a change in treatment include: tumors, traumatic brain injury with skull fracture, and stroke including bleeding in the brain.

Harden says future research should address the use of brain MRI in the emergency room to screen people with seizures because there isn’t sufficient data available to make recommendations regarding its use.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as epilepsy, dystonia, migraine, Huntington’s disease, and dementia. (Newswise)