Thursday, April 19, 2012
ROCHESTER, Minn. — Forced body cooling known as therapeutic hypothermia has reduced in-hospital deaths among sudden cardiac arrest patients nearly 12 percent between 2001 and 2009, according to a Mayo Clinic study being presented at the upcoming American Academy of Neurology 2012 Annual Meeting in New Orleans. The research is among several Mayo abstracts that will be discussed at the conference.
The goal of therapeutic cooling is slowing the body's metabolism and preventing brain damage or death. It is believed that mild therapeutic hypothermia suppresses harmful chemical reactions in the brain and preserves cells. Two key studies published in 2002 found therapeutic hypothermia more effective for sudden cardiac arrest patients than traditional therapies. Mayo researchers analyzed a database covering more than 1 million patients and found mortality rates among in-hospital sudden cardiac arrest patients dropped from 69.6 percent in 2001 — the year before the studies appeared — to 57.8 percent in 2009, the most recent data available.
"Because we reviewed such a large number of cases, we are confident that the reduction in mortality among in-hospital sudden cardiac arrest patients is significant and sustained," says co-author Alejandro Rabinstein, M.D., a Mayo Clinic neurologist. "We continue to seek answers to the questions: Why did this trend develop, and how can we accelerate it," says co-author Jennifer Fugate, D.O.
These measures are important because disease accumulates in the cortex over time, and inflammation in the cortex is a sign the disease has progressed.
Other studies being presented at AAN include:
Structured resident sign-out during shift changes improves patient care: In the study, junior residents in Mayo Clinic's General Neurology, Stroke and Neurologic Intensive Care Units spent the first half of their rotations using unstructured sign-out approaches and transitioned to a structured system for the second half. The residents reported that the standardized sign-out improved communication substantially, including information on pertinent past medical history, pending lab tests, recommendations on how to handle nursing and pharmacy calls, and up-to-date code status. Residents using standardized sign-out were also more likely to share test results with patients and their families prior to shift changes. This led to a significant increase in overall satisfaction with the sign-out process.
"This study is particularly timely now, when residency programs are adjusting to new duty-hour restrictions established in 2010," says lead author Brian Moseley, M.D., a Mayo Clinic neurology resident and Assistant Professor of Neurology. "When you have hand-offs because of the duty restrictions, unless the communication is good, there is a lot of opportunity for error," says Jeffrey Britton, M.D., a Mayo Clinic neurologist and study co-author. "This structured method seems to both prevent the error, but also make the patient and their family feel comfortable that this important communication is happening," says Dr. Britton.
Medical costs rise significantly as patients move from normal cognition through mild cognitive impairment to full-blown dementia: Researchers studied 3,591 patients ages 70 to 89 categorized into four groups: normal, mild cognitive impairment, newly discovered dementia and prevalent dementia. Mean medical care costs rose from $6,042 for people in the normal group to $11,678 per year for those with prevalent dementia. Compared to normal persons, annual costs were an average of $859 higher for persons with mild cognitive impairment; and compared to persons with mild cognitive impairment were an average $4,457 higher for persons with dementia.
"Data about medical costs across the full range of cognitive decline are essential for identifying cost-effective strategies to postpone and prevent the onset of Alzheimer's disease," says co-author Cynthia Leibson, Ph.D., a Mayo Clinic epidemiologist. "Building on these data, we next will consider nursing home costs associated with dementia and identify the risk factors that underlie the differences between individual patients and among cognitive categories."
Stroke prevention program helps patients reduce risk factors: Patients in a stroke prevention program were likelier to follow a prescribed diet and exercise than those receiving traditional care, Mayo researchers found in a study supported by the American Heart Association. Sixty-one percent of patients in the physician-directed, nurse-based program reduced at least one major risk factor after one year, such as high blood pressure, diabetes, smoking or high blood cholesterol. Just 33 percent of patients receiving more traditional care improved over the same period. The patients studied had suffered an atherosclerotis stroke — a stroke caused by a blocked blood vessel leading to or within the brain — and were at high risk for a second stroke.
"The study shows that relatively modest changes to a traditional care model for chronic disease can make a major difference in the continued health of stroke patients," says co-author Kelly Flemming, M.D., a Mayo Clinic neurologist.
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