Doctors raise blood pressure in patients

Doctors routinely record blood pressure levels that are significantly higher than levels recorded by nurses, the first thorough analysis of scientific data has revealed.A systematic review led by the University of Exeter Medical School, and supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care in the South West Peninsula (NIHR PenCLAHRC), has discovered that recordings taken by doctors are significantly higher (by 7/4mmHg) than when the same patients are tested by nurses.Dr Christopher Clark, of the University of Exeter Medical School, said the findings, published in the British Journal of General Practice, should lead to changes in clinical practice. “Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome. The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side-effects. Some patients may be erroneously asked to continue to monitor their own blood pressure at home, which can build anxiety. These inappropriate measures could all be avoided by the simple measure of someone other than a doctor taking the blood pressure recording.””Researchers should also think carefully about how to account for this effect in studies that compare treatment by doctors and nurses. Some studies have concluded that nurses are better at treating hypertension, when in fact those findings could be down to this recording bias.”The phenomenon of doctors recording higher blood pressure is known as the “white coat effect,” and is thought to result from the patient’s physical response to being assessed by a doctor. It has previously been noted in a number of studies, but Dr Clark’s research is the first comprehensive analysis of available data to quantify this effect.The team examined the blood pressure levels of 1,019 individuals whose measurements had been taken by both doctors and nurses at the same visit. Dr Clark said: “Our results were pooled from different settings across ten countries, so we can be confident that they can be generalised to any healthcare environment where blood pressure is being measured. These results were all from research trials — our next task will be to examine data from GP surgeries.”Professor John Campbell, Professor of General Practice and Primary Care at the University of Exeter Medical School and a co-author on the study said: “This interesting study forms part of our portfolio of primary care research examining factors which might need to be considered when doctors and other healthcare professionals undertake assessments of patient’s risk of cardiovascular disease. Increasing doctor’s awareness of factors which might affect the accurate assessment of blood pressure is of great importance since this is one of the commonest clinical assessments undertaken, and one where important decisions regarding a patient health and well-being may follow.”The University of Exeter Primary Care Research Group is part of the Medical School’s Institute of Health Research. …

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New therapy improves life span in melanoma patients with brain metastases

July 31, 2013 — In a retrospective study, Saint Louis University researchers have found that patients with melanoma brain metastases can be treated with large doses of interleukin-2 (HD IL-2), a therapy that triggers the body’s own immune system to destroy the cancer cells.The study that was recently published in Chemotherapy Research and Practice, reviews cases of eight patients who underwent this therapy at Saint Louis University.John Richart, M.D., associate professor of internal medicine at SLU and principal investigator of the study, first treated a patient with the disease using the HD IL-2 treatment in 1999.”Traditionally, melanoma patients with brain metastases have not been considered for HD IL-2 because treatment was thought to be futile,” Richart said. “Our study shows that having this condition does not exclude a patient from getting this treatment and can in fact improve the length of their life.”Melanoma is the most dangerous form of skin cancer that begins in the melanin-producing cells called melanocytes. In some melanoma patients, the cancer spreads to the brain, causing multiple tumors that are difficult to treat. According to the CDC, melanoma is the third most common cancer causing brain metastases in the U.S. Richart said the median overall survival of patients with melanoma brain metastases is approximately four months whereas in the study, the median overall survival for patients was 8.7 months.During the treatment, patients are given an IV medication — a chemical the body naturally makes that stimulates the immune system to recognize and destroy melanoma cells — for a period of six days while they are admitted to the hospital and are closely monitored by doctors and nurses. A patient requires four such six-day admission cycles in order to complete the course of the treatment.To be eligible for HD IL-2 treatment, melanoma patients with brain metastases have to be in healthy shape with good brain function — that is they cannot have brain lesions that are growing rapidly or show any symptoms of brain lesions. In the past, melanoma patients with brain metastases have been considered ineligible for this treatment because doctors thought that the treatment would cause life-threatening cerebral edema, a complication that causes excess accumulation of fluids in the brain, and neurotoxicity, or irreversible damage to the brain or the nervous system.”In this review, we found that there were no episodes of treatment-related mortality. Our findings demonstrate that HD IL-2 can be considered as an option for patients with melanoma brain metastases,” said Melinda Chu, M.D., a first year dermatology resident at SLU and first author of the study. SLU is the only medical center in the region that provides this treatment.”We need a highly skilled nursing staff for the HD-IL-2 program to be successful,” Richart said. “Our nursing team at SLU is with each patient every step of the way, 24 hours a day. …

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A 20-minute bout of yoga stimulates brain function immediately after

June 5, 2013 — Researchers report that a single, 20-minute session of Hatha yoga significantly improved participants’ speed and accuracy on tests of working memory and inhibitory control, two measures of brain function associated with the ability to maintain focus and take in, retain and use new information. Participants performed significantly better immediately after the yoga practice than after moderate to vigorous aerobic exercise for the same amount of time.The 30 study subjects were young, female, undergraduate students. The new findings appear in the Journal of Physical Activity and Health.”Yoga is an ancient Indian science and way of life that includes not only physical movements and postures but also regulated breathing and meditation,” said Neha Gothe, who led the study while a graduate student at the University of Illinois at Urbana-Champaign. Gothe now is a professor of kinesiology, health and sport studies at Wayne State University in Detroit. “The practice involves an active attentional or mindfulness component but its potential benefits have not been thoroughly explored.””Yoga is becoming an increasingly popular form of exercise in the U.S. and it is imperative to systematically examine its health benefits, especially the mental health benefits that this unique mind-body form of activity may offer,” said Illinois kinesiology and community health professor Edward McAuley, who directs the Exercise Psychology Laboratory where the study was conducted.The yoga intervention involved a 20-minute progression of seated, standing and supine yoga postures that included isometric contraction and relaxation of different muscle groups and regulated breathing. The session concluded with a meditative posture and deep breathing.Participants also completed an aerobic exercise session where they walked or jogged on a treadmill for 20 minutes. Each subject worked out at a suitable speed and incline of the treadmill, with the goal of maintaining 60 to 70 percent of her maximum heart rate throughout the exercise session.”This range was chosen to replicate previous findings that have shown improved cognitive performance in response to this intensity,” the researchers reported.Gothe and her colleagues were surprised to see that participants showed more improvement in their reaction times and accuracy on cognitive tasks after yoga practice than after the aerobic exercise session, which showed no significant improvements on the working memory and inhibitory control scores.”It appears that following yoga practice, the participants were better able to focus their mental resources, process information quickly, more accurately and also learn, hold and update pieces of information more effectively than after performing an aerobic exercise bout,” Gothe said. “The breathing and meditative exercises aim at calming the mind and body and keeping distracting thoughts away while you focus on your body, posture or breath. Maybe these processes translate beyond yoga practice when you try to perform mental tasks or day-to-day activities.”Many factors could explain the results, Gothe said. …

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