A Typical Communication Pattern of People with Alzheimer’s

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Dementia, in any form, is a heartbreaking disease that can take away one’s thinking and judgement abilities before they pass. To save face, people with dementia often pretend to know answers to questions, even if they really don’t. This often hides the severity of the disease and exasperates the fears and frustrations of the people who care for them. 

The act of pretending to know answers to keep up appearances is referred to as “saving appearance responses” (SARs), and a research group from Kumamoto University in Japan has performed the first statistical analysis of SARs in patients with various forms of dementia. Their findings revealed that those face-saving responses are particularly common in people with Alzheimer’s disease (AD), leading the researchers to recommend that doctors and caregivers should develop a more respectful attitude toward dementia patients who exhibit SARs because SARs imply conflicted feelings about questions that patients cannot answer correctly.

“SARs are a patient’s effort to show that they have no cognitive problems, but it seems that there are various psychological conflicts involved,” said Kumamoto University’s Dr. Masateru Matsushita of the Center for Medical Education and Research, leader of the study. “The reason more SARs are seen in AD may be because even though the memory function of the brain is in decline, thinking and judgment abilities are barely compromised. Attention to SARs might be helpful for more accurate dementia diagnosis. We expect that a better understanding of the characteristics of SARs, particularly in AD, will lead to earlier detection and better medical care for people suffering from dementia.”


Declines in Hospital-Acquired Conditions Save 8,000 Lives and $2.9 Billion in Costs

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Data released today by the Agency for Healthcare Research and Quality (AHRQ) show continued progress in improving patient safety, a signal that initiatives led by the Centers for Medicare & Medicaid Services (CMS) are helping to make care safer. National efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls, helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to the report.

The AHRQ National Scorecard on Hospital-Acquired Conditionsestimates that 350,000 hospital-acquired conditions were avoided and the rate was reduced by 8 percent from 2014 to 2016. Federal experts note that the gains in safety among hospital patients echoed earlier successes, including 2.1 million hospital-acquired conditions avoided between 2010 and 2014.

CMS has set a goal of reducing hospital-acquired conditions by 20 percent from 2014 through 2019. Through the work of the Hospital Improvement Innovation Networks (HIINs), CMS drives this aim through intensive, focused quality improvement assistance to more than 4,000 of the nation’s 5,000 hospitals by spreading best practices in harm reduction. The HIINs, together with federal agencies, private partners, and patient advocacy organizations, work collaboratively to make hospital care safer. Once the 20 percent reduction goal is met, AHRQ projects that during 2015 through 2019 there would be 1.8 million fewer patients with hospital-acquired conditions, resulting in 53,000 fewer deaths and saving $19.1 billion in hospital costs from 2015 through 2019.

Examples of hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central-line associated bloodstream infections, pressure injuries, and surgical site infections, among others.

Woman Cured of Advanced Breast Cancer With New Treatment

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A woman’s advanced stage breast cancer that metastasized throughout her body was completely eradicated with her own immune cells, marking the first time immunotherapy has successfully treated late-stage breast cancer. 

According to The Guardian, Florida engineer Judy Perkins, 49, was selected to undergo the radical therapy after rounds of chemo failed to cure her breast cancer. She’d been given just three years to live. The immunotherapy used Perkins’ “own immune cells to find and destroy cancer cells that have formed in the body,” and doctors at the U.S. National Cancer Institute say she’s now been cancer-free for two years. 

“It feels miraculous, and I am beyond amazed that I have now been free of cancer for two years,” Perkins said. Doctors call her recovery a sign that science is at the “cusp of a major revolution” in figuring out how to treat cancer through all of its mutations. They caution that the treatment must still go through clinical trials and may not work for all cases.

Is there a link between GERD and fatigue?

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Fatigue is different from feeling tired. A tired person who has not slept well may struggle the next day and want to do less than they normally would.

In contrast, fatigue can have a significant impact on day-to-day life.

A person experiencing fatigue will feel that they do not have the energy to complete everyday tasks, and this feeling will continue over an extended period.

While a person can usually identify why they feel tired, fatigue is often a symptom of an underlying health condition that needs to be investigated. A doctor will need to make a diagnosis before the person can be treated.

GERD is one condition that can interfere with sleep patterns and cause fatigue. It occurs when stomach acid flows upward into the food pipe, which is called the esophagus, rather than staying in the stomach and aiding digestion.

There are different reasons why a person with GERD may experience fatigue.

When a person is walking or standing upright, gravity helps to keep stomach contents, including acid, where they belong.

However, when a person lies down, the position prevents stomach contents from moving through the body efficiently and allows stomach acid to rise into the food pipe.

When a person is lying down and trying to sleep, symptoms such as heartburn and coughing may worsen to become painful and disruptive. Heightened symptoms can prevent a person from sleeping properly and may eventually lead to fatigue.

Also, fibromyalgia sometimes occurs alongside GERD, and one symptom is fatigue. Fibromyalgia is a painful condition that can affect every area of the body.

Feeling permanently exhausted and lacking the energy to complete simple tasks is a sign that something is wrong.

Fatigue can be a symptom of various underlying conditions, and it is important to see a doctor, who can rule out unrelated issues.

Anyone experiencing fatigue should make a note of other symptoms.

This will help the doctor make a more quick and accurate diagnosis.

Other conditions that can cause fatigue include:

If GERD symptoms, such as heartburn and coughing, are interrupting a person's sleep, they should seek advice from a medical professional. Treatments a can ease symptoms and help a person to get a better night's rest.

Colonoscopies lead to many more infections than previously thought

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"Though patients are routinely told that common endoscopic procedures are safe, we found that post-endoscopic infections are more common than we thought, and that they vary widely from one ASC facility to another," says lead researcher Susan Hutfless of Johns Hopkins University.

Colonoscopy is one of six options suggested by the American Cancer Society for colon cancer screening. The traditional recommendation is that patients be regularly screened starting at 50, but the ACS recently reduced its recommended age to 45.

Upper-GI endoscopies, known as EGDs, can be used to diagnose a number of problems in the upper digestive tract, including heartburn, swallowing issues, and abdominal pain.

Each year in the United States, there are more than 15 million colonoscopies and 7 million EGDs. Both procedures are performed with an endoscope, a reusable optical instrument that gives doctors a view of a patient's gastrointestinal tract. Besides screening and diagnosis, they can be used for procedures such as removing polyps without invasive surgery.

Researchers examined data from six states—California, Florida, Georgia, Nebraska, New York, and Vermont—to track infection-related emergency room visits and unplanned inpatient admissions within seven and 30 days after a colonoscopy or EGD.

Post-endoscopic infection rates were previously believed to be in the neighborhood of one in a million, Hutfless says. The new study found a rate of infection seven or fewer days after a procedure was slightly higher than one in 1,000 for screening colonoscopies and about 1.6 per 1,000 for non-screening colonoscopies. Rates for EGDs within that time were more than three per 1,000.

Patients who had been hospitalized before undergoing one of the procedures were at even greater risk of infection. Since many ASCs lack an electronic medical record system connected to hospital emergency departments, those ASCs are unlikely to learn of their patients' infections, Hutfless says.

"If they don't know their patients are developing these serious infections, they're not motivated to improve their infection control."

Ten tips to help you communicate with a person with dementia and sight loss

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There are six sight loss guides in the top tips series. This is the fifth guide of six.

The advice given here will help you feel confident about talking to a person with dementia and sight loss:

  1. Gain an understanding of the effects of the eye condition(s) and position yourself to minimise their impact
  2. Ensure the 3 C’s - correct, clean, and current glasses are worn
  3. Minimise “visual noise” by wearing block colours and minimal accessories
  4. Gain the person’s attention by saying their name first and/or by a gentle touch on the arm
  5. Introduce yourself and what you do
  6. Tell the person when you are moving away from them or leaving the room
  7. Speak clearly using simple, short sentences, giving only one idea, question or instruction at a time
  8. Follow the OWL principle - Observe, Wait and Listen for responses
  9. Ask if guidance or support is required and provide in a consistent manner
  10. Provide information in an alternative/accessible way such as audio, large print or braille.

Download the Ten tips to help you communicate with a person with dementia and sight loss  as an accessible PDF.

Drug-Free Remission a Possibility in Early SpA

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More than half of patients had sustained remission after induction with golimumab.

Patients with very early peripheral spondyloarthritis (SpA) who underwent induction treatment with golimumab (Simponi) had high rates of sustained clinical remission, and more than half were able to achieve drug-free remission, a pilot study found.

In a cohort of 60 patients whose mean symptom duration was approximately 5 weeks, 82% achieved sustained clinical remission, with most reaching this goal by week 24, according to Filip Van den Bosch, MD, PhD, and colleagues from Ghent University in Belgium.

And with at least 18 months of follow-up after stopping the golimumab, 53% remained in drug-free remission, they reported in Arthritis & Rheumatology.

Peripheral SpA is a subtype of spondyloarthritis that includes psoriatic arthritis and non-psoriatic peripheral SpA and is characterized by arthritis, dactylitis, and enthesitis. Therapeutic options in the past were limited, but biologic therapies have dramatically improved outcomes. The tumor necrosis factor (TNF) inhibitors have shown efficacy across the entire spectrum of SpA, including ankylosing spondylitis and psoriatic arthritis.

In addition, in previous studies of axial and nonradiographic SpA, better efficacy has been seen when treatment is introduced early rather than when the disease is established, and ongoing trials are exploring the possibility of treatment withdrawal in axial SpA once remission is achieved. Evidence has been growing in support of an early "window of opportunity" for optimal treatment outcomes in various other inflammatory diseases such as rheumatoid arthritis.

Leaky gut: What is it, and what does it mean for you?

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The expression “leaky gut” is getting a lot of attention in medical blogs and social media lately, but don’t be surprised if your doctor does not recognize this term. Leaky gut, also called increased intestinal permeability, is somewhat new and most of the research occurs in basic sciences. However, there is growing interest to develop medications that may be used in patients to combat the effects of this problem.

What exactly is leaky gut?

Inside our bellies, we have an extensive intestinal lining covering more than 4,000 square feet of surface area. When working properly, it forms a tight barrier that controls what gets absorbed into the bloodstream. An unhealthy gut lining may have large cracks or holes, allowing partially digested food, toxins, and bugs to penetrate the tissues beneath it. This may trigger inflammation and changes in the gut flora (normal bacteria) that could lead to problems within the digestive tract and beyond. The research world is booming today with studies showing that modifications in the intestinal bacteria and inflammation may play a role in the development of several common chronic diseases.

Who gets a leaky gut (and why)?

We all have some degree of leaky gut, as this barrier is not completely impenetrable (and isn’t supposed to be!). Some of us may have a genetic predisposition and may be more sensitive to changes in the digestive system, but our DNA is not the only one to blame. Modern life may actually be the main driver of gut inflammation. There is emerging evidence that the standard American diet, which is low in fiber and high in sugar and saturated fats, may initiate this process. Heavy alcohol use and stress also seem to disrupt this balance.

We already know that increased intestinal permeability plays a role in certain gastrointestinal conditions such as celiac disease, Crohn’s disease, and irritable bowel syndrome. The biggest question is whether or not a leaky gut may cause problems elsewhere in the body. Some studies show that leaky gut may be associated with other autoimmune diseases (lupus, type 1 diabetes, multiple sclerosis), chronic fatigue syndrome, fibromyalgia, arthritis, allergies, asthma, acne, obesity, and even mental illness. However, we do not yet have clinical studies in humans showing such a cause and effect.

A path toward a healthier gut

A common initial step some practitioners take is to remove foods that can be inflammatory and could promote changes in the gut flora. Among the most common are alcohol, processed foods, certain medications, and any foods that may cause allergies or sensitivities. In my practice, I often see patients improve significantly when they start eating a healthier diet.


America’s graying population in 3 maps

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The U.S. population has changed substantially in the last half century, growing by nearly 63 percent.

Perhaps the two most prominent demographic changes over the past 50 years relate to age. In 1968, the baby boom had just ended, and the oldest members of its cohort were only 22 years old.

As baby boomers age, the nation has substantially aged as well. In 1970, the median age in the U.S. was 28.1. In 2016, it was 37.9.

Demographers and geographers like myself have watched as this aging cohort transformed the U.S., from young children in the 1950s and 1960s to senior citizens today. This graying of America has left a distinctive geographical fingerprint.

Where older Americans live

Unsurprisingly, popular retirement states like Florida and Arizona have high concentrations of older Americans.

What may be more of a surprise is the broad swaths of elderly running through the Midwest and the Appalachians. These regions have aged significantly, as many younger residents headed toward the coasts.

Younger people have also moved out of New England, primarily in search of jobs. Maine, New Hampshire, Vermont and Connecticut are among the seven states with a median age of over 40 in 2010; Pennsylvania, West Virginia and Florida are the others.

Not only is the U.S. aging, but the number of deaths is rising. This trend will accelerate over the next few decades.

Meanwhile, the number of births has declined since 2007. In fact, in 2013, over 30 percent of all U.S. counties experienced a phenomenon known as “natural decrease,” due the greater number of deaths than births. Natural decrease is now most prominent in Maine, the Appalachian region, the Great Plains and the Midwest.

Demographers expect this phenomenon to expand geographically over the coming years, as the general population continues to age.

The country has also become more urban. The percentage of the population living in urban areas increased by about 7 percentage points between 1970 and 2010. Urbanization increased in all states except Oklahoma and Maine.

Despite this trend, many cities are now shrinking – particularly cities in the Northeast and Midwest. More people, particularly young adults, are leaving these places for economic opportunity than are coming in. The percentage of the population living in large cities has declined since 2013, while the percentage living in smaller cities increased from 17.9 to 20.1 percent.

Could Lawn Weed Prevent COPD Exacerbations?

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An oral extract of the speedwell (also known as veronica) plant appeared to reduce some symptoms of chronic obstructive pulmonary disease (COPD), researchers reported here.

The peak expiratory flow increased in patients on YPL-001 by about 10%, while the increase in the placebo patients was less than 3%, according to Nathaniel Marchetti, DO, of the Lewis Katz School of Medicine at Temple University in Philadelphia, and colleagues.

"YPL-001 is an oral formulation of an extract from the aerial part of the plant speedwell used in traditional Asian medicine to treat respiratory inflammatory diseases including ... COPD," they explained in a presentation at the American Thoracic Society (ATS) annual meeting.

The phase IIa study was initiated to determine the safety and tolerability of YPL-001, so the trend toward efficacy was encouraging, Marchetti said.

"We found that the treatment with the drug was very well tolerated," he noted. "There were very few side effects other than those commonly seen among COPD patients including exacerbations."

"This is a medication, a herbal product, that has been used for millennia in Asia to treat inflammatory respiratory diseases," he added. "What Yungjin Pharm of Korea is trying to do is to take this herbal, and make it more standardized, so that everyone gets the same dose, and also to figure how not only whether it works, but how it works, so we can use it to treat people in a more systematic way."

Speedwell/veronica is commonly found in the U.S. as well. Plants are sold in garden shops and are also a frequent lawn weed problem.