New Research : Treadmill may help tots with neuromotor delays (such as cerebral palsy) walk

While the study group was a small one (15), researchers at the University of Michigan’s School of Kinesiology have reported supervised treadmill walking may help children with neuromotor delays.   This study was reported yesterday in an article published in The Hindu.

Rosa Angulo-Barroso, Associate Professor of movement science  at the School, and her colleagues followed 15 infants at risk for neuromotor delays over a period of two years.  They tested the changes in physical activity and treadmill-stepping performed with parental supervision in the children’s  homes.   Six of these children had been diagnosed with cerebral palsy.

“We found that in those with neuromotor delays, the pattern of development through time was parallel (but less) than normal kids.” said Angulo-Barroso. “We also found less toe-walking, so foot placement improved.” Angulo-Barroso added. The study also suggests a critical intervention window. Both children without a diagnosis and kids with cerebral palsy improved the most between 10 months and 18 months.

As The Hindu article notes, “The study, “Treadmill Responses and Physical Activity Levels of Infants at Risk for Neuromotor Delay” appears in the journal Pediatric Physical Therapy.

It would be most interesting to see if a larger, multi-center, double-blind  study could produce the same or similar results.  I haven’t personally seen the ‘tot’ version of a treadmill, but a quick search on Google images does show some interesting devices (see picture on left).  As researchers in the etiology and treatment of cerebral palsy keep working, the efforts of others such as reported here will potentially provide a wonderful interim measure toward helping these kids with special needs.  We’ll try to keep an eye on this story and will report should more information become available.

The Unexpected Killers: Hospital-Acquired Infections

According to an article published by NPR, a recent study found that as many as 48,000 people die each year in the U.S. from hospital-acquired infections. Researchers say that this is the first truly national study of its kind, involving 69 million cases of hospital-acquired infections in 40 states.

This study, unlike its predecessors, specifically isolated cases of hospital-acquired infections from cases involving patients  with possible existing infections at the time of admission. In part, this was accomplished by focusing on patients admitted to undergo elective surgery.

The researchers found the death toll from avoidable pneumonia and sepsis is bigger than from traffic fatalities. It’s more than three times higher than that for AIDS, and roughly twice as much as annual deaths from firearms.

Examples of hospital-acquired infections include: pneumonia, sepsis (infection of the blood), urinary tract infections, gastroenteritis, clostridium difficile (c-diff), tuberculosis, and staphylococcus-related infections.

Most hospital-acquired infections can be effectively treated with the proper choice of antibiotics.  There is simply no justification for such an incredibly high mortality rate  to be associated with a series of preventable and treatable medical conditions. For this reason, the results of the study are truly disturbing.

Contributing author: Jon Stefanuca

AMERICAN ACADEMY OF PEDIATRICS Policy Statement: Prevention of Choking Among Children

Hot Dogs…we love to eat them.  Many would argue eating hot dogs is an American Tradition.  Now, the American Academy of Pediatrics (AAP) is issuing a warning that hot dogs are a food choking hazard in small children.  Yesterday, February 22nd, the AAP published a Policy Statement regarding such choking hazards, through the AAP’s Committee on Injury, Violence, and Poison Prevention.  The AAP has already made some broad-sweeping recommendations in regard to preventive measures and warnings.  Some of their recommendations are quoted below from their Policy Statement:

The US Consumer Product Safety Commission (CPSC) should increase efforts to ensure that toys that are sold in retail store bins, vending machines, or on the Internet have appropriate choking-hazard warnings; work with manufacturers to improve the effectiveness of recalls of products that pose a choking risk to children; and increase efforts to prevent the resale of these recalled products via online auction sites. Current gaps in choking-prevention standards for children’s toys should be reevaluated and addressed, as appropriate, via revisions to the standards established under the Child Safety Protection Act, the Consumer Product Safety Improvement Act, or regulation by the CPSC.

The existing National Electronic Injury Surveillance System–All Injury Program of the CPSC should be modified to conduct surveillance  of choking on food among children. Food manufacturers should design new foods and redesign existing foods to avoid shapes, sizes, textures, and other characteristics that increase choking risk to children, to the extent possible. Pediatricians, dentists, and other infant and child health care providers should provide choking-prevention counseling to parents as an integral part of anticipatory guidance activities.

Many children lose their life every year from choking on food.  The Associated Press published an article yesterday citing the horrifying statistics:

Choking kills more than 100 U.S. children 14 years or younger each year and thousands more – 15,000 in 2001 – are treated in emergency rooms. Food, including candy and gum, is among the leading culprits, along with items like coins and balloons. Of the 141 choking deaths in kids in 2006, 61 were food-related.

The article also mentions the tragic death of 4 year old Eric Stavros Adler, who died from choking on a hot dog.

The AP article cites the following as some recommendations:

Doctors say high-risk foods, including hot dogs, raw carrots, grapes and apples – should be cut into pea-sized pieces for small children to reduce chances of choking. Some say other risky foods, including hard candies, popcorn, peanuts and marshmallows, shouldn’t be given to young children at all.

Something as simple as making lollipops flat like a silver dollar instead of round like a pingpong ball can make a big difference, said Bruce Silverglade, legal affairs director at the Center for Science in the Public Interest, which also has lobbied for more attention to choking prevention.

Please, please, please…make sure your children are ‘eating safely’.  Supervise your children when they are eating.  Our precious little ones are irreplaceable.  Don’t allow the shape and/or size of food to pose a life and death situation for you and your loved ones.

Announcement: Newborn Possibilities Program underway in AZ – stem cell research related to cerebral palsy

A posting yesterday in PRNewswire tells of a collaborative research effort called “Newborn Possibilities Program” in Tuscon, Arizona, for preservation of cord blood stem cells “so that if a child is diagnosed with the condition, he or she may be eligible to receive a new treatment being researched under approval from the FDA using the child’s own cord blood stem cells.”

This research initiative is being done as a collaborative effort by the Cord Blood Registry, the world’s largest stem cell bank; Save the Cord Foundation, a nonprofit advocacy organization based in Tucson; Tucson Medical Center, the region’s leading birthing hospital; and Watching Over Mothers and Babies Foundation (WOMB), a local non-profit research foundation.

A statement by the CEO of the Cord Blood Registry, Tom Moore, best describes the goal of this new program:

This program is a way for us to provide a safety net to children at-risk for cerebral palsy and other forms of neonatal brain injury while helping to advance the science of regenerative medicine.  CBR and our collaborators in this unique program share a commitment to advance cord blood stem cell research, expand education about the value of cord blood banking, and improve outcomes for children with neurological disabilities.

In a statement by the founders of one of the program’s collaborating members, Save the Cord Foundation, Anne Sarabia and Charis Ober,  we are provided further insight into the present and future goals of the program:

We believe that cord blood will play a very important role in future medicine and will benefit so many children in our community at risk for cerebral palsy.   Our dream is that this program will inspire other medical institutions to follow and make preserving cord blood the standard of care for all newborns.

Dr. Hugh Miller, head of WOMB and a specialist in Maternal-Fetal Medicine, who will be the program’s director at Tuscon Medical Center, said in the interview:  

The Newborn Possibilities Program is laying the groundwork for potential new treatment options for cerebral palsy and neurological disorders by connecting patients who may be at risk for these conditions and who have access to their cord blood stem cells with FDA-approved research studies. We believe this program will be instrumental in accelerating the pace of research and potentially helping many children.

As those of you who follow our blog postings and/or the recent news concerning stem cell research relating to cerebral palsy are aware, the Food and Drug Administration recently approved  a human clinical trial evaluating the safety and efficacy of using a child’s own newborn blood stem cells to treat cerebral palsy.

Having been involved in handling cases of children with cerebral palsy for many years, I have seen the issues of preservation of tissue, blood and medical records (i.e. fetal monitor strips) go the full gamut.  For years, placental pathologists were begging medical institutions to preserve placentas for further research into perinatal  birth injuries (among other concerns).  There was a time when one institution, which shall remain nameless, had a suspected policy of discarding fetal monitor strips (gee – wonder why that was!) and so on and so on.  It is really heartening to see that this new collaborative program is putting the interests of science, children’s health and knowledge far ahead of any conjured concerns relating to fear of litigation.    Hopefully, this program, in conjunction with all the other research regarding cerebral palsy now going on, will get to the bottom of this horrible disorder and provide new meaningful care options for at least some of the victims of cerebral palsy.

Women With Migraine Headaches At Higher Risk For Developing Multiple Sclerosis (MS)

A recent article published by Reuters Health indicates that there might be a positive correlation between migraine headaches and the incidence of Multiple Sclerosis (MS) in women.

Multiple Sclerosis (MS) is a disease in which the nerves of the central nervous system (brain and spinal cord) degenerate. Myelin, which provides a covering or insulation for nerves, improves the conduction of impulses along the nerves and also is important for maintaining the health of the nerves. In multiple sclerosis, inflammation causes the myelin to eventually disappear. Consequently, the electrical impulses that travel along the nerves decelerate, that is, become slower. In addition, the nerves themselves are damaged. As more and more nerves are affected, a patient experiences a progressive interference with functions that are controlled by the nervous system such as vision, speech, walking, writing, and memory.

The study involved 116,000 participants who were examined over the course of 16 years. Researchers found that women diagnosed with migraine headaches at the beginning of the study were 47 % more likely to develop MS than women who did not suffer from migraines.

Although the research seems to indicate a correlation between migraines and MS, it remains unclear whether migraines contribute to the development of MS. Dr. Illya Kister, the research investigator noted:

Over 99% of migraineurs will not develop MS, since MS is a rare disease, while migraines are quite common; about one in 5 women in the U.S. will have a migraine over the course of a year.

Researchers called for closer scrutiny of the relationship between migraines and MS.  It is worth noting that,  despite extensive research,  the causes of MS are not well-understood.  In this regard, further research of migraines in MS patients could be illuminating.

Contributing Author: Jon Stefanuca

Product Recalls: Granola bars – Trader Joe’s Chocolate Chip Chewy Granola Bars

I suspect that many of you love to grab that ‘healthy’ and ‘quick fix’ granola bar.  Well before you do, you may want to   check which one it is you are getting ready to bite into.  This notification just in from the FDA of a voluntary recall by Trader Joe’s on it’s product – Chocolate Chip Chewy Coated Granola Bars –Product Recalls: Granola bars.

[I]t has the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

The FDA’s press release advises that there have been “no illnesses . . . reported to date in connection with this product.” Forewarned is a good policy – so be  forewarned!

For details on contact information on the product’s recall, see the FDA announcement.

Consumer Product Safety Commission vows to crack down on defective cribs – washingtonpost.com

An announcement last week by the Consumer Product Safety Commission (CPSC) will hopefully prevent future catastrophic injuries and deaths of infants from crib defects, through tougher federal legislation regarding cribs.  The chairman of the organization, Inez Tenenbaum, made a powerful statement in a recent Washington Post Article in this regard:

While we are on the subject of cribs, I have a message for manufacturers, a message that actually applies to makers of any consumer product,” Tenenbaum said. “I say no more to the tired tactic of blaming parents in the press when CPSC announces a recall that involves a death. Take responsibility and show respect to the grieving family, yes, even if they are pursuing litigation. Those who tread into this arena when CPSC has found your product to be defective will be called out.

The article also details the number and type of crib recalls to date by the CPSC:  

The CPSC has recalled more than 6 million cribs since September 2007, many due to failures related to drop sides, hardware and wooden slats. Consumer advocates and health professionals have long complained that federal safety requirements governing cribs do not address the durability of drop-sides on cribs and related hardware, as well as wood strength and quality and other issues.

Let’s hope that these actions send a powerful message to crib manufacturers and retailers alike, to put safety first, especially when it comes to our little ones.  What could be more important?  We will monitor developments within this and other related recalls.

Contributor: Rodd Santomauro

TBI (Traumatic Brain Injury) research underway at 17 centers – progesterone therapy – might it be the answer?

In an article posted online by Medical News Today, we learn of new research spear-headed by Emory University and  funded by NIH for a Phase III trial using the hormone progesterone to treat patients with traumatic brain injury (TBI).

The article cites some startling statistics from the Centers for Disease Control and Prevention:  

Every 15 seconds, someone in the United States sustains a significant traumatic brain injury. Approximately 2 million adults and children in the United States suffer from traumatic brain injuries each year – leading to 50,000 deaths and 80,000 new cases of long-term disability, according to the Centers for Disease Control and Prevention. Despite the enormity of the problem, scientists have failed to identify effective medications to improve outcomes following a traumatic brain injury.

As the term TBI denotes, when a person sustains a brain injury as a result of an outside traumatic force (e.g. a fall, car accident, being struck in the head, etc.), they are said to have sustained a TBI.

Apparently, notwithstanding the enormous numbers of deaths and disabilities associated with such injuries, there has been no approved new treatment for severe TBI in over 30 years.

Why the hormone progesterone?

Progesterone is naturally present in small but measurable amounts in the brains of males and females. Human brain tissue is loaded with progesterone receptors. Laboratory studies suggest that progesterone is critical for the normal development of neurons in the brain and exerts protective effects on damaged brain tissue.

According to today’s report, “The treatment is part of a randomized, double-blind Phase III clinical trial that will enroll approximately 1,140 people over a three- to six-year period beginning in March, 2010.”

Credit-Card Fees: the New Traps – WSJ.com

CONSUMER ALERT:  read this report from The Wall Street Journal – Credit-Card Fees: the New Traps – WSJ.com.

It goes into effect tomorrow – Monday, February 22, 2010.  Here it is in essence:

The law made some important changes. Card companies must now tell customers how long it would take to pay off the balance if they only make the minimum monthly payment. Customers can only exceed their credit limit if they agree ahead of time to pay a penalty fee. And unless a cardholder misses payments for more than 60 days, interest-rate increases will affect only new purchases, not existing balances.

Now for the reality of what’s ahead:      

Banning these and other profitable tactics is expected to cost the card industry at least $12 billion a year in lost revenue, according to law firm Morrison & Foerster. This has sent the industry scrambling to find new sources of revenue. So get ready for higher annual fees, higher balance-transfer charges, and growing charges for overseas transactions.

Just be aware of what’s new and what’s probably coming when you get that new credit card statement.

Tort Reform – Tennessee Style: ER doctors back bill ‘redefining’ malpractice – NO KIDDING!

As I was going through the listings and hashtags on my TweetDeck yesterday, I came across this tweet from a report in a Tennessee online publication – Emergency doctors back bill redefining malpractice | tennessean.com | The Tennessean. While I don’t practice in Tennessee, any trend in legislative changes affecting a patient’s right of access to the legal system is on my watch list.  

Here’s the essence of the proposed legislation according to this article:

Under the bill filed last month, the definition of medical malpractice would be changed from “negligence” to “gross negligence,” which would raise the bar for mistakes that could trigger a lawsuit.

To put this in context, Maryland and the District of Columbia, where I am licensed to practice, have many times defined “gross negligence.”  Those definitions are precisely what caused a chill to run up and down my spine when I saw the proposed change to Tennessee’s malpractice law.

In Maryland there is legislation called the Good Samaritan Act and the Fire and Rescue Company Act, which essentially provides in relevant part that in an emergency setting, only extraordinary or outrageous conduct by a person giving assistance or medical care in an emergency, or by a member of a fire company or rescue company, can be termed “gross negligence.”  For the lawyers among you, see, e.g. McCoy v Hatmaker, 763 A2d 1233 (2000).

In the District of Columbia, one case that gives multiple but somewhat common definitions for  ‘gross negligence is D.C. v Walker, 689 A2d 40 (D.C. 1997):

[Gross negligence is] [t]he failure to exercise even slight care,” and “such negligence as would shock fair-minded men.”Shea v. Fridley, 123 A.2d 358, 363 (D.C.1956).  Similarly, the United States Court of Appeals for this circuit has stated that “gross negligence implies an ‘extreme departure from the ordinary standard of care.’ ” Wager v. Pro, 195 U.S.App. D.C. 423, 428, 603 F.2d 1005, 1010 (1979).  We have applied Maryland law to define gross negligence in the driving context as “a wanton or reckless disregard for human life or for the rights of others,” and “indifference to the consequences … [which] implies malice and evil intention.” Hall v. Hague, 257 A.2d 221, 223 (D.C.1969).  * * * And our federal court of appeals, applying what it apparently perceived to be District law, has said that, “[t]o constitute willful or wanton negligence, the police actions must involve ‘such reckless disregard of security and right as to imply bad faith.’ ”      

And just what is the alleged justification for this ‘gross negligence’ in ER’s standard being proposed?  Well here you go:

“In my personal practice, if I knew that I couldn’t be sued except for things that I truly believe I should get sued over, I could eliminate half of my lab tests, two-thirds of my X-rays and 90 percent of my CT scans because all of those tests are done for my protection, not the patient’s,” said Dr. Andy Walker, a local emergency physician and vice president of the Tennessee chapter of the American Academy of Emergency Medicine. “For TennCare patients, of course, the Tennessee taxpayer is paying for that.”

Yeah – that’s my emphasis added to the above quote.  Is this doctor kidding?  He does twice the number of labs, three times the number of x-rays and ninety percent of the CT scans he orders – to protect himself, not the patient?  And his litmus test for getting sued is what?  – “… things that I truly believe I should get sued over.”  Maybe when the Senate Committee is done investigating the ‘stents controversy’ at St. Joseph Medical Center in Maryland, they can take a look at what’s going on in Tennessee!

Using this wonderful test – “I should only get sued for what I believe is malpractice” – I am pretty confident that  there won’t be much medical malpractice litigation concerning ER care in the state of Tennessee should this wonderful piece of legislation go through.

Perhaps I should also make you aware that there is also pending in the legislature of this state a cap on non-economic damages.   If you are wondering at what amount they want such damages capped – it’s $1,000,000.  Apparently, however, the lobbyists for the medical profession really would like to see such damages capped at $300,000 since they believe such a low figure would “take away the profit motive of trial lawyers.”

I wonder if this double-pronged legislative initiative isn’t a variant on the old shell game.  Throw enough legislation out there and negotiate to get at least one of them passed.

Tell you what – I won’t be moving our firm to Tennessee any time soon.