By Sally Robertson, B.Sc.Jan 29 2019Reviewed by Kate Anderton, B.Sc. (Editor)A study conducted in Denmark has shown that patients with breast cancer may be at an increased risk of developing the heart condition atrial fibrillation (AF).sfam_photo | Shutterstock”This study was the first to show that women with recent breast cancer had an increased risk of developing AF,” said lead investigator Maria D’Souza from the cardiology department Herlev and Gentofte Hospital in Hellerup.D’Souza and colleagues suggest that the reason this patient group may be more prone to AF is that breast cancer induces inflammation, a well-known risk factor for the condition.The findings have recently been published in the journal HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society.In a retrospective analysis of nationwide registries in Denmark, the researchers found that women with breast cancer were at an increased risk of developing AF within three years following their diagnosis, compared with female counterparts of the same age in the general population.D’Souza says that modern treatment regimens ensure that about 80% of breast cancer patients become long-term survivors. However, long-term complications arising from both the cancer and associated treatments can threaten survival.In particular, an increased incidence of heart disease, especially ischemic heart disease and heart failure have been observed in this patient group.The team therefore hypothesized that women with breast cancer may be more susceptible to developing AF as a result of inflammation.After identifying breast cancer patients diagnosed between 1998 and 2015 and matching 74,155 female patients with 222,465 age- and sex-matched controls form the general population, the researchers used cumulative incidence curves and multivariate Cox regression models to estimate the long-term incidence of AF.They found that breast cancer was associated with a greater risk of AF, in a manner that was dependent on current age and the time since diagnosis.Patients younger than 60 were at more than twice the risk in the first six months following their diagnosis and an 80% greater risk between six months to three years following diagnosis.Those older than 60 were at a similar risk to the general population during the first six months but were at a 14% greater risk during the six month- to three-year time frame. Our findings should encourage doctors to focus on the risk of AF in patients with recent breast cancer in order to diagnose and treat as early as possible, and researchers to search for increased risk of AF looking at the cancer itself, treatment, genetic predisposition, and shared life style risk factors.Maria D’Souza, Lead Investigator Source:Do women with breast cancer have a higher risk of atrial fibrillation? “Ultimately, earlier treatment may result in better stroke prevention.”
Reviewed by Kate Anderton, B.Sc. (Editor)May 24 2019Currently available evidence does not support the recent “Hour-1 Bundle” recommendation to perform five initial treatment steps within the first hour in patients with sepsis. That’s the position of the European Society of Emergency Medicine (EUSEM), published in the May/June issue of the European Journal of Emergency Medicine, official journal of EUSEM. The journal is published in the Lippincott portfolio by Wolters Kluwer.While acknowledging the importance of early recognition and treatment of sepsis, “The EUSEM wishes to express its concerns regarding the low level of evidence that underlies these guidances, and potential implication from an emergency physician point of view,” according to the position paper by a panel of leading European emergency medicine specialists. The lead author is Prof. Yonathan Freund of Sorbonne Université and Hôpital Pitié-Salpêtrière, Paris.Concerns about ‘unexpected harm’ from updated sepsis recommendationsIn 2018, the Surviving Sepsis Campaign (SSC) issued an updated set of recommendations for initial treatment of sepsis and septic shock. The SSC is a global cooperative effort to improve treatment and reduce the risk of death from sepsis. Sepsis is a common and potentially life-threatening condition, occurring when the immune system mounts an overwhelming inflammatory response to infection.The 2018 update introduced an “Hour-1 Bundle” of steps that healthcare professionals should begin as soon as time of triage: measuring blood lactate level, performing blood cultures, and starting treatment with antibiotics, intravenous fluids, and vasopressors if indicated.The recommendation to perform these five steps within the first hour represents an acceleration of treatment, compared to the 3-hour target recommended in the 2016 SSC guidelines. Even the definition of “time zero” moved forward: from the time of sepsis recognition to the time of triage in the emergency department.The new EUSEM position paper is an “expression of concern” over the updated recommendations. Noting the prominent role of emergency physicians in initial recognition and care of patients with sepsis, the EUSEM position paper highlights the low to moderate quality of evidence supporting the Hour-1 Bundle. “The empirical basis for the reduced timeframe of the sepsis bundle is too weak to be mandatory,” Prof. Freund and coauthors write.Related StoriesAPPG report highlights need to improve identification and treatment of sepsisResearchers discover biochemical agent responsible for blood pressure drop in sepsisResearchers find lower ER triage scores are linked to delayed antibiotics for sepsis patientsThe authors note deficiencies in other recommendations as well, raising questions about the benefits of early lactate measurement and intravenous fluids. Rather, they conclude, starting antibiotics as soon as the likely diagnosis of sepsis is made seems to be the key factor responsible for the improvement in outcomes with early treatment.The EUSEM statement questions whether it is practical to start all elements of the sepsis bundle within the first hour – especially since up to one in five patients initially diagnosed with sepsis are ultimately found to have a noninfectious diagnosis. Prof. Freund and colleagues also express concern about possible unintended consequences of setting the “Hour-1 Bundle” as the standard of care. They write, “In emergency medicine, unrealistic time targets taken as quality indicators may cause unexpected harm.” Completion of the sepsis bundle within one hour after triage is not evidence based and may even be potentially harmful. Therefore, EUSEM cannot support the new SSC guidance, but emphasizes the early recognition of sepsis and timely administration of antibiotics in appropriately selected patients within 1 hour of triage.”Prof. Yonathan Freund and coauthors Source:Wolters KluwerJournal reference:Freund, Y. et al. (2019) European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign. European Journal of Emergency Medicine. doi.org/10.1097/MEJ.0000000000000603.
Reviewed by James Ives, M.Psych. (Editor)Jul 17 2019Death rates from sepsis fell faster in New York than expected and faster than in peer states following the introduction of the nation’s first state-mandated sepsis regulation, according to an analysis led by University of Pittsburgh researchers and published today in JAMA. The policy requires all New York hospitals to quickly implement certain protocols when the deadly condition is suspected.The finding is good news for the nearly dozen other states in varying stages of adopting similar policies to reduce deaths from sepsis, the leading cause of death in hospitalized patients. Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Rory’s Regulations were issued by the New York State Department of Health in 2013 after 12-year-old Rory Staunton died of undiagnosed sepsis. The regulations require that hospitals in New York follow protocols for sepsis that include giving antibiotics within three hours and intravenous fluids within six hours of hospitalization. The hospitals also are required to regularly train staff in the protocols and to report adherence and clinical outcomes to the state.Kahn and his team analyzed records of more than a million sepsis admissions in 509 hospitals in New York and four control states without a sepsis regulation: Florida, Maryland, Massachusetts and New Jersey. The team looked at dates from two years before Rory’s Regulations were adopted, and two years after.Related StoriesResearchers find lower ER triage scores are linked to delayed antibiotics for sepsis patientsDoctors urge hospitals to reconsider the type of fluids used to treat children with sepsisScientists identify mechanism that makes babies more likely than adults to die from sepsisIn the years before the regulations went into place, 26.3% of the people diagnosed with sepsis in New York died while hospitalized, compared to a rate of 22% in the control states. Following the regulations, New York’s sepsis mortality rate dropped 4.3% to 22%, but the death rate only fell 2.9% to 19.1% in the control states.After accounting for patient and hospital characteristics, as well as pre-existing sepsis trends in the states, New York’s sepsis death rate was 3.2% lower following the regulation than would have been expected, relative to the control states. This comparison was crucial to estimating the improvement and sets this study apart from prior work. Sepsis outcomes are known to improve over time-;a study just looking in New York would not be able to differentiate the effects of the regulations from underlying trends. Because these improvements occurred more quickly in New York compared to other states, the researchers are more confident that the regulations are the source of the improvement.”Sepsis is a tremendous global health burden, so developing proven ways to quickly recognize and treat people who have it is a top public health priority,” said senior author Derek Angus, M.D., M.P.H., professor and chair of Pitt’s Department of Critical Care Medicine and director of Pitt’s Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center. “While every state should consider their specific population and needs when developing regulations, our analysis reveals that policies enforcing evidence-based clinical protocols for the timely recognition and treatment of sepsis saves lives.” Source:Health Sciences at the University of Pittsburgh Rarely in the U.S. do we force hospitals to implement specific clinical protocols. Typically, quality improvement is achieved through financial incentives and public reporting. For the first time, state officials are enshrining in regulations that hospitals must follow certain evidence-based protocols when it comes to sepsis. And our study finds that, at least in New York, it seemed to work.”Lead author Jeremy Kahn, M.D., M.S., professor in the Department of Critical Care Medicine at Pitt’s School of Medicine and the Department of Health Policy and Management at Pitt’s Graduate School of Public Health
In this Feb. 4, 2015, file photo, Tesla product specialist Kat Brand explains the control panel on the electric car at a dealership for the vehicle in Seattle. Washington state’s sales tax exemption for electric vehicles is expected to end sometime this summer after efforts to extend the tax break stalled during the recent legislative session. (AP Photo/Elaine Thompson, File) Citation: Washington state’s electric vehicle sales tax break to end (2018, March 21) retrieved 18 July 2019 from https://phys.org/news/2018-03-washington-state-electric-vehicle-sales.html The current exemption expires in June 2019 or once 7,500 electric vehicles have been registered with the state—whichever comes first. That number hit 6,843 as of last week, according to the state department of licensing.There were a number of bills that tried to extend the existing sales tax exemption.The current tax break applies to up to $32,000 of an eligible new electric passenger car, light duty truck or medium-duty passenger vehicle that uses a clean alternative fuel such as electricity, propane or natural gas. Sales tax differs in each county so the overall savings varies.One measure sponsored by Rep. Jake Fey, a Democrat from Tacoma, easily cleared the House in February with bipartisan support, but it didn’t make it out of the Senate before the short 60-day session ended March 8.That bill would have extended the exemption end date to June 30, 2021, and removed the 7,500 vehicle cap.”It’s quite unfortunate, given the vote in the House,” Fey said. He said the exemption provided an incentive to switch from petroleum-related products to electricity and had benefits for the environment and reducing greenhouse gas emissions.General Motors, Tesla, Ford and other automakers and the Association of Washington Business testified in support of the bill. Supporters say the tax break has helped grow the electric vehicle market in the state and provided economic as well as environmental benefits.Gov. Jay Inslee supported the exemption as a way to help the state meet its goal to put 50,000 electric or other clean vehicles on the road by 2020. There are about 25,000 such electric vehicles already on the road now.The Sierra Club, Washington Bikes, Transportation Choices and other transit groups said they supported the policy but objected to the funding source.They told lawmakers earlier this month that money for the sales tax incentives should not come from the state’s multi-modal transportation account that pays for a range of projects, including pedestrian safety, buses and bikes. Some said that there isn’t enough money in that account to pay for much needed projects. Washington state’s sales tax exemption for electric vehicles is expected to end sometime this summer after efforts to extend it stalled during the recent legislative session. © 2018 The Associated Press. All rights reserved. Nissan to invest $9.5 billion in China to drive sales Explore further This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.