It’s a matter of time

            NEW ORLEANS - MedPage Today reported the age of patients, how they ride to the emergency department, and how busy it is on arrival factor in to whether those with pneumonia get antibiotics within the recommended four hours. So say physicians from Mount Sinai Medical Center in New York, who found older patients, those transported by emergency medical services, and those who spent the least time waiting to be seen were most likely to receive antibiotics within the four-hour window. "As measured in our study, the patient length of stay is significantly associated with a delay to delivery of antibiotics, indicating that crowding has some impact on the timeliness of pneumonia care," wrote Dr. Phillip Andrus and colleagues at the American College of Emergency Physicians meeting. Although their data suggest patients most at risk from pneumonia - the acutely ill elderly - are receiving appropriate antibiotic therapy in a timely fashion, more attention needs to be paid to ensure all patients received necessary treatment within guidelines, authors suggested. "To improve timeliness of pneumonia care, emergency departments should focus their performance improvement efforts on walk-in, non-elder patients with lower acuity of illness at presentation" they wrote. "More validated measures of crowding are needed to better delineate the effects of crowding on the timeliness and quality of care." Getting drugs to pneumonia patients faster requires a coordinated, multi-system approach, Dr. Andrus said.

            BIRMINGHAM, AL - Newswise noted the U.S. healthcare system is one of the most highly-advanced in the world, yet many Americans suffer unequal access to high-quality care, a problem that carries a high cost for individuals, communities, and society. A special section of the Southern Medical Journal (SMJ) of the Southern Medical Association (SMA), focused on U.S. healthcare disparities. "As a physician member association, we are pledging a five-year commitment to this issue to make a difference in this country by using our areas of influence to bring recognition and change," said Dr. Braxter P. Irby, SMA president. "Discrepancies in healthcare encompass factors such as race, age, gender, socioeconomic status, geography, and culture," says Dr. Ronald C. Hamdy, SMJ editor. "Southern Medical Journal is planning a series of articles on healthcare disparities to make our readers more aware of this inequality in the hopes that appropriate changes may be implemented." The papers in the section draw attention to some of the difficult and complex issues involved: the "Katrina Clinic" to meet the medical needs of hurricane victims evacuated to the Houston Astrodome/Reliant Center Complex; Black children in an impoverished rural Mississippi community get only half the amount of health services as white children in the same area.

            WASHINGTON - Newswise disclosed scientists identified a common gene variant that more than doubles the risk of Autism. Research, led by investigators at Vanderbilt University ’s Kennedy Center for Research on Human Development, provides new insights into the genetic basis of the complex disorder. In an online edition of the Proceedings of the National Academy of Sciences, an international team of scientists led by research fellow Drs. Daniel Campbell and Pat Levitt report a genetic variant tied to the MET gene is common in children with Autism and appears more frequently in families that have more than one affected child. Although both environmental and genetic factors are likely involved in Autism, mounting evidence suggests genes play an important role in an individual’s susceptibility to the disorder. “Autism is recognized as the most highly heritable neuropsychiatric disorder,” said Dr. Levitt, professor of pharmacology and director of the Vanderbilt Kennedy Center . “In identical twins, the concordance is 70-90%, meaning that if one twin has Autism, the other twin is at very high risk of having the disorder.” While the search for Autism vulnerability genes has intensified in recent years, most studies have identified only linkage peaks, or areas on specific chromosomes where such genes might lie. While doing research on genes involved in brain development in mice, Dr. Levitt’s team found the MET gene - a gene typically associated with cancer - was involved in the development of certain circuits within the cerebral cortex, a brain region whose development is disrupted in Autism.

            BOSTON - MedPage Today stated that compared with cardiovascular benefits of finfish and shellfish, fears of mercury and polychlorinated biphenyls (PCBs) should be considered dead in the water, a review of the evidence found. The coronary heart disease benefit was hundreds to a thousand times greater for salmon than the lifetime cancer risk from contaminants in the fish for adults, said Dr. Dariush Mozaffarian, and Dr. Eric B. Rimm, both of Brigham and Women's Hospital and Harvard Medical School , in the Journal of the American Medical Association. "The public is faced with seemingly conflicting reports on the risks and benefits of fish intake," investigators wrote, "resulting in controversy and confusion over the role of fish consumption in a healthy diet." However, "based on strength of evidence and potential magnitudes of effect, the benefits of modest fish consumption - one to two servings per week - outweigh the risks among adults and, excepting a few selected fish species, among women of childbearing age," they concluded on the basis of a systematic review. The researchers found the cardiovascular benefit to be 100- to 370-fold greater than cancer risk for farmed salmon and 300- to more than 1,000-fold greater than the cancer risk for wild salmon.

            MEMPHIS , TN - Clinicians at St. Jude Children’s Research Hospital demonstrated successfully an improved technique for blood stem cell transplantations in children that shows promise for those most likely to fail standard treatment for leukemia. The technique allows blood stem cells to come from parents or unmatched adult siblings and avoids aggressive, toxic treatments that usually must accompany the transplant. This allows the majority of patients with leukemia or non-cancerous blood disorders to get a transplant, said Dr. Gregory Hale, St. Jude Bone Marrow Transplantation Division interim chief. A report appeared in the prepublication edition of the British Journal of Haematology. A clinical trial of this technique demonstrated it accelerated recovery of the immune system in recipients and shortened the duration of immune deficiency during the early post-transplant period, cutting the risk of infections. “The overall success of this procedure suggests it holds promise for children who are likely to fail standard treatment for leukemia because they have treatment-resistant disease and no matched donor,” Dr. Hale said. The key to the St. Jude strategy - reduced intensity conditioning regimen (RICR) - is it avoids the total-body irradiation routinely used to kill the recipient’s own stem cells to make way for the transplantation.