The U.S. Department of Health and Human Services (HHS) has issued a statement setting up a five-year plan to prevent infections caused by the health care industry. Most of these infections can be avoided by implementing better procedures for in-care hospital treatment and surgical practices. Known as health care-associated infections, or HAIs, the plan outlines a variety of different areas that should be looked at as part of the prevention techniques for example, infections acquired from a surgical site.
In The Action Plan to Prevent Health Care-Associated Infections, is a compiled list of programs and agencies nationwide supported by the HHS who are collaborating to reduce the death toll from HAIs and to alleviate some of the cost involved in health care as a result of inaccurate treatments or procedures that can initiate HAIs. The Centers for Disease Control and Prevention’s (CDC) recent statistics from 2002 estimate about 1.7 million HAIs were reported throughout hospitals in the United States and were affiliated with over 99,000 deaths. The CDC also reports that HAIs are also estimated to be causing up to 20 billion dollars a year in the health industry.
A common infection found in hospitals, Methicillin-resistant Staphylococcus aureus (MRSA) is one that might have been on the news in the past year for the fight over whether or not a universal screening should be used on all patients. However, while screening for the infection may be costly, statistics show that MRSA infections since the year 2000 have more than tripled, partially due to HAIs.
By proposing a universal plan including state and local organizations, the HHS might have greater results by enabling everyone to work together toward the same uniformed goal.
HHS Secretary Mike Leavitt says in a statement, “This plan will serve as our roadmap on how the department addresses this important public health and patient safety issue….This collaborative interagency plan will help the nation build a safer, more affordable health care system.”
Accounting for 75 percent of the active HAIs, there are four types of infections to be aware of while staying in or visiting a hospital. The first category is surgical site infections (SSIs), followed by central line-associated bloodstream infections, pneumonia related to use of a ventilator, and urinary tract infections from catheter-insertions. MRSA comes in close behind on that list with a smaller number of infections contracted.
In order to control and eventually try to eradicate the occurrence of HAIs, the HHS came up with a five-point draft strategy for starting their plan. The first point is to establish a steering committee for HAI prevention to further a plan of action. Point two is to prioritize the science and research components among the 1,200 clinical practices in order to facilitate a widespread healthcare implementation. The third point is to investigate the policy options of the recommended practices and oversights in order to start a hospital-wide compliance assistance program. Point four is working towards a better consistency of HAI data by using a standard form of definitions. The fifth and final point to ensuring the plan’s progress is to continue to build on the principle of patient support and choice to come up with more motivation for healthcare providers and organizations to give the best care possible.
With HAIs as a leading cause of death in the United States, it makes sense that the HHS would make these specific infections a high priority for 2009. The five-year prevention plan largely relies on the cooperation of all healthcare organizations and an agreement on the guidelines associated with patient care and prevention of HAIs as a universal standard. Remember HAIs can occur in many different settings whether on the surgical floor of a hospital, within a typical outpatient procedure room, or in long-term facilities like assisted-living or rehabilitation centers.
HHS will update the plan after public response starts to come in and they will be holding meetings throughout the spring where the public can share their comments, concerns, and ideas for regulating implementation. With lives at stake and insurmountable debt a possibility for many people and organizations because of errors involved with spreading HAIs, the HHS seems to be starting the New Year with a great resolution.
For a complete medical description of The Action Plan to Prevent Health Care-Associated Infections from the Introduction to the Appendix, including the index of abbreviation codes to understand it all go to he Department of Health and Human Services website.
Sunday, March 15, 2009
Health and Human Services Announces 5-Year Plan for Infection Prevention
National Brain Injury Month
March inevitably brings everyone closer to the arrival of spring and away from the dreariness of winter but our third month also hosts a widespread awareness of many disorders and conditions. Among them is National Brain Injury Month, the goal of which is to maintain awareness of brain deterioration and cases of sudden diagnosis across the nation.
In 2008, Capitol Hill hosted the “Brain Crane Project” at the Congressional Brain Injury Awareness Fair asking for patients or family members of someone who has suffered a brain injury to make a crane to display on Capitol Hill. Hundreds of colored cranes lined the exhibit increasing the participants’ awareness of these traumatic brain injuries (TBI) by sharing their personal stories with all of America. This year we look towards the future by saving children by focusing awareness on youth sports.
The theme for the Brain Injury Association of America’s (BIAA) 2009 awareness month is Sports and Concussions. The BIAA estimates that there are over 5.3 million Americans living with a disability caused by an injury to the brain and that the costs of such injuries maintained over a lifetime exceeded $60 billion according to the totals from the year 2000.
It has been said that a TBI occurs every 23 seconds and that almost 1.5 million Americans will endure one over the next year. The 2009 theme is focusing primarily on youth sports because many adolescents sustain concussions without realizing it and an untreated concussion is dangerous and can cause severe neurological damage. By bringing awareness to schools, after-school sports programs, and intramural leagues, the BIAA, as well as parents, teachers, and coaches, can only hope to prevent some of the traumatic brain injuries in children this year.
The Centers for Disease Control and Prevention (CDC) estimate that each year between 1.6 and 3.8 million concussions happen as a result of recreation and sports related incidents. As concussions are the most common type of injury to the brain during activity, one can occur after a severe blow or hit to the head.
Symptoms of a concussion can vary and may not appear for hours, days or weeks after the initial contact. Some concussions can happen when a direct hit to another body part causes the impact to go right to the brain. Signs of a concussion are usually any combination of the following: headache, nausea, dizziness or a problem standing or walking, blurred or double vision, general feelings of sluggishness, sensitivity to any noise or lights, a lingering groggy feeling, confusion, and trouble remembering things or focusing on one thing.
Doctors advise parents, teachers, supervisors, and coaches to never ignore a blow to the head. If there is a visible bump, take the victim out of the game or activity immediately and watch them for the symptoms of a concussion. If symptoms are visible take the player to see a doctor right away and only return to the game with consent from a health care provider.
Remember to remind your children/students to always tell an adult if he or she hits their head because a concussion is serious. Also remember to tell your child that the main myth about concussions is that people blackout or lose consciousness, however only in rare and very extreme cases does this actually happen.
The most common activities in which children ages 5 to 18 often receive concussions are: playground structure activities, bicycling, basketball, soccer, and football.
To learn more about the local events related to brain injury awareness in your area this month, look at the BIA-chartered website for your state.
For the month of March (and every month after) stay aware of traumatic brain injuries and teach your sports fanatics, rambunctious neighborhood kids, and professional athletes-in-training about the dangers and signs of a concussion while keeping them safe.
Optic neuritis
Optic neuritis (optical neuritis, visual neuritis) is the sharp disease, shown an inflammation of an optic nerve. It often meets in a combination to the neurologic illnesses described demyeliniation. Demyeliniation is a loss of an external fatty layer of a nervous fibre which provides fast conductivity of a nervous impulse. More often neuritis an optic nerve it is combined with a multiple sclerosis - slowly progressing disease of the nervous system shown just this most demyeliniation. The inflammation of an optic nerve is frequent is a debut of a multiple sclerosis or precedes development of a multiple sclerosis for some years. Sometimes the reason of development neuritis an optic nerve remains to the unknown person.
The majority of patients with neuritis of an optic nerve test sharp deterioration of sight in a combination to a pain arising at movement by a sick eye. This disease is usually shown on one eye and can periodically give relapses, as for example often happens at a combination to a multiple sclerosis.
Attributes (symptoms)
Following symptoms of an optic nuritis do not meet in all cases, but they happen more often.
- Pain at movement by an eye (in 90 % of cases)
- Pain in an eye without movement
- Reduction of visual acuity
- Sight as in darkness
- The lowered perception of color
- Narrowing of a peripheral field of vision
- Blind spot in the center
- Fever
- Headache
- Nausea
- Decrease in sight after physical activities, baths, a hot shower or a bath (at rise of a body temperature)
Diagnostics
The doctor considers some factors at diagnostics an optic neuritis. Disease not always finds verification at survey of a disk of an optic nerve on eye day by means of ophthalmoscope. A pain at movement by an eye - the characteristic complaint for this disease. The doctor can check up reaction of pupils to light and appoint electrophysiological research of an optic nerve, research of fields of vision, colour perception and a computer tomography or a Magnetic resonance tomography of a brain.
Treatment
Treatment of this disease in overwhelming majority of cases is spent by purpose of steroid hormones and not steroid anti-inflammatory preparations in drops, ointments, tablets and injections. Also antibiotics are applied also. Very seldom resort to surgical operation at neuritis an optic nerve. It refers to decompression environments of an optic nerve and consists in its opening for pressure decrease in an optic nerve which at this disease is inevitably raised owing to an inflammatory hypostasis.
From long-term research of treatment an optic neuritis (Optic Neuritis Treatment Trial) doctors have learned, that purpose of steroid hormones in a vein (instead of in tablets) reduces risk of progress of a multiple sclerosis in the future. This find is of great importance, as at half of patients with neuritis an optic nerve in the future the multiple sclerosis develops. Though this treatment has the minimal influence on vision, it is important for the general health of the patient.
Pneumonia
It is considered pneumonia to be artful illness. At a seeming simplicity of process (a bacterial inflammation of a fabric of a lung) it is rather diverse in the displays. Frequently the pneumonia is shown in such a manner that to suspect a pathology from lungs not too simply. Such feature of this illness is connected by that a huge role play age and conditions in which the pneumonia develops. The activators (bacteria) causing a pneumonia at the baby, the ill house, and at the elderly person who has ill during stay in hospital, essentially different, accordingly both displays, and treatment, and the forecast at these patients cardinally differ.
In most cases it is necessary to collide with a pneumonia which is complication SARS or with a pneumonia which begins at once, without any previous colds.
In this case the circle of microbes which doctors cause a pneumonia, and is known, selecting an antibiotic for treatment, are guided by this list of potentially possible activators. Necessity to consider what microbe has caused an inflammation, is dictated to what not all antibiotics act on all microbes. The choice of an antibiotic depends on that, how much concrete bacterium is sensitive to action of an antibacterial preparation.
The pneumonia is characterized, as was already spoken, varied symptoms.
Sudden rise of temperature up to 40 degrees, accompanied all over again dry cough, extremely bad state of health, a short wind (that is any physical activity, even minimal, causes the speeded up heavy breath). Thus there can be pains in the breasts amplifying at cough and deep breath. The pain can give to a stomach or is simple the stomach can hurt only. At a deep breath the fit of coughing is possible. Sometimes there is a reddening one cheek (from that side where the pain is marked). All this conforms so-called croupous to a pneumonia at which the inflammation covers the most part of a lung. Not all from the described symptoms are present necessarily, but the temperature, cough and sharp weakness meet practically constantly.
Illness begins as usual SARS: a cold, cough, temperature. After a while the temperature falls, and then again raises and does not decrease any more. It too a variant of current of a pneumonia.
The temperature does not rise above 38 degrees, but keeps almost constantly at this level, is accompanied by cough, weakness. It also can be a pneumonia.
At children criteria which should guard concerning possible presence of a pneumonia, the following are: duration of temperature above 38 degrees within three and more days; a short wind (the speeded up breath); sharp slackness, drowsiness.
The final diagnosis can be put only on the basis of x-ray of a thorax.
Friday, March 13, 2009
Parkinson's disease
Parkinson's disease (vorum tremens) is the chronic progressing disease of a brain for the first time was described in 1817 by J. Parkinson. Patients who has Parkinson's disease often suffer from involuntary trembling finitenesses (tremor), muscular rigidity, infringements of coordination and speech, and also experience difficulties with movement. These symptoms usually occurs after 60 years though cases of Parkinson's disease are known in the age of 50 years are more younger.
Parkinson's disease is a progressing disease, i.e. its symptoms and appearance eventually become aggravated and worsen. However, in spite of the fact that finally Parkinson's disease leads to physical inability and loss of capacity, disease progresses slowly, and even after statement of the diagnosis the majority of patients as early as long years can conduct a high-grade life.
Moreover, unlike other serious neurological diseases, Parkinson's disease gives in to treatment. Often resort to medicamentous treatment, or implant in a brain the special device stimulating brain activity. In extreme cases resort to surgical intervention - operations on a brain a method stereotaxis which essence consists in destruction of a small zone in subcrustal structures of a brain. Searches of effective means of treatment of Parkinson's disease now proceed.
Symptoms of Parkinson's disease
The first symptoms of Parkinson's disease is difficult to notice, as, for example, an immovability of hands at walking, an easy tremor in fingers of one hand or insignificant infringements of speech. Patients feel a devastation, a breakdown, depressions are subject or suffer from a sleeplessness. Besides habitual employment (a shower, shaving, cooking, etc.) require major efforts and borrow more time.
Other symptoms of Parkinson's disease
* Tremor. The tremor often begins with easy trembling hands or even separate fingers. Sometimes the tremor of hands is accompanied by the non-uniform movement of the big and average fingers reminding overrolling of invisible pills (so-called «a syndrome of driving of pills»). Sometimes there is also a tremor of the bottom finitenesses. These symptoms can be more expressed on one party of a body or be shown symmetrically and to be combined with other symptoms of defeat of nervous system. the Tremor is especially shown by infringements of coordination, sensitivity, when the patient is in a condition of stress. Though the tremor of finitenesses causes significant inconveniences, it does not lead to loss of capacity and disappears only when the patient sleeps. Many patients with Parkinson's disease suffer only from an insignificant tremor.
* Slowness of movement (bradykinesia). In due course Parkinson's disease "acquires" new symptoms, among which slowness and awkwardness of movements, as well as infringement of coordination. Rigidity of muscles of legs can complicate movement, gait is broken. It especially annoyingly as complicates performance of the elementary actions.
* Rigidity of muscles. Often there is a rigidity of muscles of neck and finitenesses. In some cases rigidity even holds down movements and hurts.
* Loss of balance. Parkinson's disease, especially in a heavy condition, it is often accompanied by inability to keep balance. For many years this problem remains insignificant and does not cause discomfort.
* Loss of automatism of movements. Blinking, occurrence of a smile and flourish hands at walking - automatic actions of a normal organism which are carried out at a subconscious level and even besides our desire. At patients with Parkinson's disease this automatism of movements often vanishes, and and sometimes and disappears absolutely. In some cases on the person of patients expression of the steadfast and intense attention, a unblinking sight is fixed. At some patients, except for a mimicry, ability to gesticulation vanishes also.
* Infringement of an articulation. Many patients also suffer from infringement of speech - it can become slightly modulated, illegible. The voice loses intonations and becomes monotonous and silent. For older people it represents a special problem, as badly hearing elderly co-habitants can simply not hear them.
* Infringement of swallowing and salivation. This symptom appears at late stages of development of illness, but, with rare exception, patients with this symptom nevertheless are capable to accept food independently.
* Dementia. The insignificant percent of patients suffers from dementia - inability to think, understand and remember. This symptom also appears at recent stages of disease. Though dementia consider as display of Alzheimer's disease is more often, it can accompany and other serious diseases, including Parkinson's disease. In this case delay of thought processes and inability attests to the beginning of dementia to concentrate.
Reasons of occurrence of Parkinson's disease
For those 200 years that have passed from the moment of opening Parkinson's disease, scientists were possible to understand some aspects and processes of this most complicated disease.
Today it is known, that many symptoms and displays of Parkinson's disease develop owing to damage or destruction of the certain nervous terminations, located in black substance of a brain. In a normal condition these nervous cells develop dopamine. Function of dopamine consists in smooth transfer of impulses for maintenance of normal movements. At Parkinson's disease production of dopamine decreases, normal transfer of nervous impulses is broken and there are basic symptoms of Parkinson's disease.
During ageing all people lose some part developing of dopamine neutrons. But patients with Parkinson's disease lose more than half of the neutrons located in black substance. Though there is a degeneration and other cells of a brain, the cells developing of dopamine, are necessary for movement, therefore their loss is catastrophic. The reasons of damage or destruction of these cells till now is object of many researches. In opinion of scientists, Parkinson's disease can develop owing to an adverse combination of genetic and external factors. The certain medicines, illnesses and toxic substances also can create a clinical picture, characteristic for Parkinson's disease.
Brain edema
Brain edema - the pathological condition, described accumulation of a liquid in a fabric of a brain and intracranial hypertensia clinically shown by a syndrome.
There are 4 basic kinds of brain edema:
- cellulotoxic
- vasogenic
- interstitial
- osmotic.
They differ by etiology, time of development, localization and methods of preventive maintenance and treatment
Cellulotoxic edema appears because of swelling glia, neurocyte and endotheliocyte and begins in some minutes after damage of a brain, for example hypoxia. As a result of decrease in a metabolism activity Na+, K+-AT phases a cellular membrane is broken. Sodium collects in a cell, and on a gradient of osmotic pressure in a cell water starts to act. Cellulotoxic edema is localized basically in grey substance of a brain.
Vasogenic edema is the most frequent version of a hypostasis of a brain. It develops because of increase of permeability of capillaries. Through a wall of capillaries in extracellular space there are fibers, and after them - water. vasogenic edema is localized basically in white substance of a brain.
Interstitial edema develops at a hydrocephaly because of difficulty of outflow pressure inside ventricle of a brain raises. Under the action of this pressure there is a strengthened filtration of water and low-molecular substances in the fabric of a brain surrounding ventricles.
The ischemia of a brain leads all over again to cellulotoxic, and then - to vasogenic edema. Thus, the pathophysiological picture is so usual that some people suggest to use the term "an ischemic edema". In the first minutes of an ischemia develops cellulotoxic edema mentioning mainly astrocytes which are located around of capillaries. If blood supply is quickly restored, these changes happen to be backwards. Otherwise because of swelling of astrocytes and endothelial cells the gleam of capillaries is narrowed so, even after restoration of blood supply blood can not act in capillaries. It aggravates an ischemia and necrosis.
In a phase vasogenic edema permeability of a wall of capillaries raises. It is shown, that it occurs cause of pinocytosis increases and as a result of infringement of dense contacts between cells of endothelium. After restoration of a blood-groove permeability of blood-brain barrier increases even more. As well as at other forms of vasogenic edema.
Simultaneously with cellulotoxic and vasogenic edema necrosis develops. Glia and neurocyte in a greater degree are subject of necrosis in comparison with endothelium. In process of their destruction in intercellular substance of a brain osmotically active substances that leads to an even greater output of water from capillaries collect.
The ischemic hypostasis reaches a maximum on 2-4-ะต day after a heart attack and decreases by the end of the second week. Further in the field of necrosis inflammatory reaction, including phagocytosis develops. Within several day or weeks necrotic weights resolve, and the hypostasis disappears. Believe, that the hypostasis can cause an ischemia and by that to increase a zone of a heart attack.
Thursday, March 12, 2009
What is epilepsy?
Epilepsy is a condition when post convulsive attacks are repeated. However, the diagnosis of epilepsy is set up only in case if the person have had at least two attacks and if no any other illness causing attacks is proved. Epilepsy is not infectious and is not mental disease.
How often it occurs?
This illness is observed approximately at 7 of 1000 children in the age of under 16 years; and at 1 from 200 of adults.
When it occurs?
Attacks often occurs at newborns and children with diseases of a heat. It does not mean, that at the child will develop in the subsequent epilepsy.
Epilepsy can develop at any person at any age, but begins at children and teenagers is more often: at 75 % of people with the epilepsy the diagnosis is put in the age under 20 years. At more recent age the reason of occurrence of epilepsy can become craniocereberal traumas, insults, tumors of a brain. The number of such cases of epilepsy sharply increases among people older 60 years.
What are the reasons of occurrence?
There is no unified reason of occurrence of epilepsy. The majority of forms of epilepsy is not inherited, but can occur a little bit more often in some families. About 40 % of patients with epilepsy have close relatives with this disease. There is a set of various types of post convulsive attacks with a various degree of weight. The attack which begins from one certain site of a brain, refers to fractional or focal. If the attack covers at once all brain from the beginning it is generalized. Some attacks can begin from one site, and then extend on all brain and become generalized. Organic infringements of a structure of a brain (a tumor, scars from traumas, an insult) detect at people with fractional by attacks is more often. In 70 % of cases the reason of epilepsy is unknown.
The most popular reasons of occurrence are:
- A craniocereberal trauma
- An insult
- Tumors of a brain
- Lack of oxygen and blood supply at a birth
- Infringements of a structure of a brain
- A meningitis, virus and parasitic diseases, an abscess of a brain
- Hereditary factors
What are necessary inspections?
To set the correct diagnosis, the doctor in details finds out all symptoms of an attack, sequence of their development, frequency and their stereotype. As illnesses of the patient and its relatives for revealing disease which can cause development of an attack are studied all.
The further inspection depends on of this type attack, age of the patient, results of the analysis of its case record and clinical survey. Often statement of the diagnosis is helped by the description of an attack the witness of its progress (the person who has transferred an attack, as a rule, of it does not remember).
In addition to clinical survey it is necessarily to check the electroencephalography. This painless procedure represents record of bio electric activity of a brain. Carrying out of a resonant tomography or a computer tomography.
What are consequences?
People with epilepsy often collide that their attacks strongly frighten associates. Children cannot participate in some sports and other kinds of activity, schoolmates can avoid them. Despite of correct selection anti epileptic therapies occurrence of hyperactive behavior and difficulties in training is possible.
Restriction of some kinds of activity, for example, driving of the car, can lower mood, cause alarm. Treatment of people with heavy uncontrollable forms of epilepsy should include discussion of social, emotional and personal changes which can accompany with disease.
How it is treated?
Modern treatment completely prevents progress of attacks, and patients with the epilepsy can conduct a normal way of life. Objective of treatment is full elimination of attacks with the minimal by-effects.
Now the most widespread way of prevention of development of attacks is daily reception antiepileptic preparations there is a wide range of them. Some of them operate only at the certain types of epilepsy. By-effects in case of their occurrence absolutely differently proceed at various patients. In this connection very important precisely to follow instructions of the attending physician. With the epilepsy medical consultation up to and during pregnancy is necessary for women. At pregnancy it is not necessary to interrupt sharply reception anti epileptic medicines at all.
If medicinal treatment does not allow to supervise attacks, probably to remove the damaged site of a brain surgical by. To define, whether it is necessary to be treated in a similar way, the inspection including record of an attack with use of video and electroencephalography of the equipment is necessary highly specially.
