For Some, Deep Brain Stimulation Brings Lasting Improvement in Neuropathic Pain

Posted on February 13, 2013

Large Study Shows Continued Improvement with Longer Follow-up, Reports Neurosurgery

Philadelphia, Pa. (February 13, 2013) – For many patients with difficult-to-treat neuropathic pain, deep brain stimulation (DBS) can lead to long-term improvement in pain scores and other outcomes, according to a study in the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

About two-thirds of eligible patients who undergo DBS achieve significant and lasting benefits in terms of pain, quality of life, and overall health, according to the report by Sandra G.J. Boccard, PhD, and colleagues of University of Oxford, led by Tipu Aziz FMedSci and Alex Green, MD. Some outcomes show continued improvement after the first year, according to the new report, which is one of the largest studies of DBS for neuropathic pain performed to date.

Most Patients Benefit from DBS for Neuropathic Pain

The authors reviewed their 12-year experience with DBS for neuropathic pain. Neuropathic pain is a common and difficult-to-treat type of pain caused by nerve damage, seen in patients with trauma, diabetes, and other conditions. Phantom limb pain after amputation is an example of neuropathic pain.

In DBS, a small electrode is surgically placed in a precise location in the brain. A mild electrical current is delivered to stimulate that area of the brain, with the goal of interrupting abnormal activity. Deep brain stimulation has become a standard and effective treatment for movement disorders such as Parkinson’s disease. Although DBS has also been used to treat various types of chronic pain, its role in patients with neuropathic pain remains unclear.

Between 1999 and 2011, that authors’ program evaluated 197 patients with chronic neuropathic pain for eligibility for DBS. Of these, 85 patients proceeded to DBS treatment. The remaining patients did not receive DBS—most commonly because they were unable to secure funding from the U.K. National Health Service or decided not to undergo electrode placement surgery.

The patients who underwent DBS were 60 men and 25 women, average age 52 years. Stroke was the most common cause of neuropathic pain, followed by head and face pain, spinal disease, amputation, and injury to nerves from the upper spinal cord (brachial plexus).

In 74 patients, a trial of DBS produced sufficient pain relief to proceed with implantation of an electrical pulse generator. Of 59 patients with sufficient follow-up data, 39 had significant improvement in their overall health status up to four years later. Thus, 66 percent of patients “gained benefit and efficacy” by undergoing DBS.

Benefits Vary by Cause; Some Outcomes Improve with Time

The benefits of DBS varied for patients with different causes of neuropathic pain. Treatment was beneficial for 89 percent for patients with amputation and 70 percent of those with stroke, compared to 50 percent of those with brachial plexus injury.

On average, scores on a 10-point pain scale (with 10 indicating the most severe pain) decreased from about 8 to 4 within the first three months, remaining about the same with longer follow-up. Continued follow-up in a small number of patients suggested further improvement in other outcomes, including quality-of-life scores.

Deep brain stimulation has long been regarded as potentially useful for patients with severe neuropathic pain that is not relieved by other treatments. However, because of the difficulties of performing studies of this highly specialized treatment, there has been relatively little research to confirm its benefits; only about 1,500 patients have been treated worldwide. The new study—accounting for about five percent of all reported patients—used up-to-date DBS technologies, imaging, and surgical techniques.

Dr. Boccard and coauthors acknowledge some important limitations of their study—especially the lack of complete patient follow-up. However, they believe their experience is sufficiently encouraging to warrant additional studies, especially with continued advances in stimulation approaches and technology. The researchers conclude, “Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Publications, Surgery, Surgery - Neurosurgery | Leave a comment

The Journal of Craniofacial Surgery Honors Dr. Joseph E. Murray

Posted on February 12, 2013

Tribute to Nobel Prize Winner and ‘Master of Plastic Surgery’ Leads off January Issue

Philadelphia, Pa. (February 12, 2013) – The field of surgery lost a giant last year with the death of Joseph E. Murray, MD, Nobel laureate in medicine and biology and a pioneer in both transplantation and craniofacial surgery. A special tribute to Dr. Murray appears in the January issue of The Journal of Craniofacial Surgery, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Mutaz Habal, MD, Editor-in-Chief of The Journal of Craniofacial Surgery, shares an editorial celebrating the career and contributions of Dr. Murray as a mentor, colleague, and friend. Dr. Habal’s is one of several tributes included in the special January issue, which also features updates on new research developments and clinical problems of interest to plastic, reconstructive, and craniofacial surgeons.

Memories of Dr. Murray by a Colleague and Friend

Dr. Murray died last November at age 93. His place in history is assured as the surgeon who performed the first successful human kidney transplant, between a pair of identical twins, in 1954. Dr. Murray went on to perform groundbreaking research in transplantation biology and tissue and organ rejection.

Dr. Murray was also instrumental in developing immunosuppressive drugs that led to the development of modern organ transplantation. In 1990, he shared the shared the Nobel Prize in Physiology or Medicine with Dr. E. Donnall Thomas “for their discoveries concerning organ and cell transplantation in the treatment of human disease.” (Dr. Thomas, a pioneer in bone marrow transplantation, also died last year.)

At a time when transplantation surgery is a specialty in its own right, it may be surprising to learn that Dr Murray’s specialty was plastic surgery. His interest in transplantation developed from his experience with skin grafting as a military surgeon treating seriously burned patients.

In his editorial, Dr. Habal recalls his first encounter Dr. Murray during a lecture question-and-answer period more than four decades ago. Dr. Habal went on to train with Dr. Murray in the Department of Plastic Surgery at Harvard University and Brigham and Women’s Hospital. It was a time of groundbreaking contributions to craniofacial surgery—including the first mid-face advancement surgery, and the correction of hypertelorism. Dr. Murray inspired all the young surgeons who became the spear head of the development of the field of craniofacial surgery with his work on composite transplantation with Dr. John Woods, which was the grounds for the development of face transplant at the same medical institution. This was well discussed as the new frontier in plastic surgery.

“This special issue of the journal should serve as an inspiration to the young and newcomers of the specialty as a model for the advancement of their careers,” Dr. Habal writes. “Dr. Murray taught us all that the patient comes first, and self-promotion is out of the formula of patient care.”

New Research on Wound Healing, and Two Unusual Injuries

The special issue includes a number of other tributes to Dr. Murray—including one by Elof Eriksson, MD, PhD, who succeeded Dr. Murray as Chief of Plastic Surgery at Brigham and Women’s Hospital. Along with his colleagues Johan P.E. Junker, PhD, and E.-J. Caterson, MD, PhD, Dr. Eriksson is coauthor of an update on the microenvironment of wound healing. They report on recent research showing that a “wet, incubator-like environment provides the fastest healing with fewest aberrations and least scar formation.”

The researchers have created a “wound chamber” that creates a wet environment, promoting survival and proliferation of transplanted cells and tissues. Dr. Eriksson and colleagues conclude, “With the addition of various active molecules and cells, it also provides a platform technology for regeneration in vivo.”

The special issue also present brief reports on unusual wounds of special interest to plastic, reconstructive, and craniofacial surgeons. One report describes “conductive contact burns” as a serious injury caused by overexposure to Korean-style hot dry saunas. Another suggests that titanium miniplates used in reconstructive surgery may be a risk factor for osteonecrosis in elderly patients taking bisphosphonate drugs for osteoporosis.

Dr. Habal comments, “We believe the tributes to Dr. Murray, along with the cutting-edge research and practical clinical information presented in our special issue, are a fitting memorial to a surgeon-scientist who contributed so much to the fields of plastic, transplantation, and craniofacial surgery—thus affecting the lives of countless patients, now and in the future.”

About The Journal of Craniofacial Surgery

The Journal of Craniofacial Surgery, under the guidance of Editor-in-Chief Mutaz B. Habal, MD, serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Media, Publications, Surgery, Surgery - Plastic and Reconstructive | Leave a comment

Subcortical Damage Is ‘Primary Cause’ of Neurological Deficits after ‘Awake Craniotomy’

Posted on February 7, 2013

Even with Brain Mapping, Damage to Inner Brain Structures Can Occur during Conscious Brain Surgery, Reports Neurosurgery

Philadelphia, Pa. (February 7, 2013) – Injury to the subcortical structures of the inner brain is a major contributor to worsening neurological abnormalities after “awake craniotomy” for brain tumors, reports a study in the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

During a procedure intended to protect critical functional areas in the outer brain (cortex), damage to subcortical areas—which may be detectable on MRI scans—is a major risk factor for persistent neurological deficits. “Our ability to identify and preserve cortical areas of function can still result in significant neurological decline postoperatively as a result of subcortical injury,” write Dr. Victoria T. Trinh and colleagues of The University of Texas MD Anderson Cancer Center, Houston.

Risk Factors for Neurological Deficits after Awake Craniotomy

The researchers analyzed factors associated with worsening neurological function after awake craniotomy for brain tumor surgery. In awake craniotomy, the patient is sedated but conscious so as to be able to communicate with the surgeon during the operation.

The patient is asked to perform visual and verbal tasks while specific areas of the cortex are stimulated, generating a functional map of the brain surface. This helps the surgeon navigate safely to the tumor without damaging the “eloquent cortex”—critical areas of the brain involved in language or movement.

The study included 241 patients who underwent awake craniotomy with functional brain mapping from 2005 through 2010. Of these, 40 patients developed new neurological abnormalities. Dr. Trinh and colleagues examined potential predictive factors—including changes on a type of MRI scan called diffusion-weighted imaging (DWI).

Of the 40 cases with new neurological deficits, 36 developed while the surgeon was operating in the subcortical areas of the brain. These are the inner structures of the brain, located beneath the outer, folded brain cortex. Just one abnormality developed while the surgeon was operating in the cortex only.

MRI Changes May Reflect Subcortical Damage

Neurological abnormalities developing while the surgeon was operating in the subcortex were likely to remain after surgery, and to persist at three months’ follow-up evaluation. Dr. Trinh and coauthors write, “Patients with intraoperative deficits during subcortical dissection were over six times more likely to have persistently worsened neurological function at three-month follow-up.”

In these patients, MRI scans showing more severe changes in the DWI pattern in the subcortex also predicted lasting neurological abnormalities. Of patients who had neurological deficits immediately after surgery and significant DWI changes, 69 percent had persistent deficits three months after surgery.

Patients who had “positive” cortical mapping—that is, in whom eloquent cortex was located during functional mapping—were somewhat more likely to have neurological abnormalities immediately after surgery. However, the risk of lasting abnormalities was not significantly higher compared to patients with negative cortical mapping.

Awake craniotomy with brain stimulation produces a “real-time functional map” of the brain surface that is invaluable to the neurosurgeon in deciding how best to approach the tumor. The new results suggest that, even when the eloquent cortex is not located on cortical mapping, subcortical areas near the tumor can still be injured during surgery. “Subcortical injury is the primary cause of neurological deficits following awake craniotomy procedures,” Dr. Trinh and colleagues write.

The researchers add, “Preserving subcortical areas during tumor resections may reduce the severity of both immediate and late neurological sequelae.” Based on their findings, they believe subcortical mapping techniques may play an important role in avoiding complications after awake craniotomy.

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Publications, Surgery - Neurosurgery | Leave a comment

No Increase in Brain Aneurysm Rupture Risk during Pregnancy and Delivery

Posted on February 7, 2013

Study in Neurosurgery Questions High Rate of Cesarean Deliveries in Women with Aneurysms

Philadelphia, Pa. (February 7, 2013) – For women with aneurysms involving the brain blood vessels, pregnancy and delivery don’t appear to increase the risk of aneurysm rupture, reports a paper in the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study also finds that women with known, unruptured aneurysms have a very high rate of cesarean delivery—which isn’t supported by evidence and “may not be necessary,” according to Dr. Brian L. Hoh of University of Florida, Gainesville, and colleagues.

Pregnancy Doesn’t Increase Risk of Aneurysm Rupture

The researchers used a national hospital database (the Nationwide Inpatient Sample) to estimate the risk of brain aneurysm rupture during pregnancy and delivery. An aneurysm is a weakened spot in a blood vessel wall. If the aneurysm enlarges or ruptures (breaks), it can cause life-threatening bleeding in the brain.

The database identified 714 women hospitalized for ruptured aneurysm during pregnancy and 172 during delivery between 1988 and 2009. Based on an estimated rate of 1.8 percent among women of childbearing age, Dr. Hoh and colleagues calculated that, across the United States, approximately 49,000 women with unruptured aneurysms were hospitalized during pregnancy and 312,000 during delivery.

Using these figures, the researchers estimated a 1.4 percent risk of aneurysm rupture during pregnancy and 0.05 percent during delivery. Based on previous studies, these rates were “comparable with the risk of aneurysm rupture in the general population,” Dr. Hoh and coauthors write.

Women with ruptured aneurysms were at high risk of poor outcomes—including maternal mortality rates of 9.5 percent for those with rupture during pregnancy and 18 percent with rupture during delivery. The risk of poor outcomes appeared lower for women who underwent treatment for ruptured aneurysms: either surgical clipping or less-invasive, endovascular “coiling.” However, because of the relatively small number of patients, these differences were not statistically significant.

High Rate of Cesarean Section May Be Unnecessary

The researchers also identified 218 deliveries in women with known unruptured aneurysms. Approximately 70 percent of these were cesarean deliveries—much higher than the 25 percent rate in women without aneurysms. However, there was no evidence that cesarean delivery improved outcomes for either the mother or baby, compared to “closely supervised vaginal delivery,” Dr. Hoh and colleagues note. “Therefore, the method of delivery in patients with intracranial unruptured aneurysm should be based on obstetric considerations.”

Aneurysms of the brain blood vessels are rarely detected in pregnant women. However, ruptured aneurysm during pregnancy and delivery is an unpredictable complication with a substantial risk of death for both the mother and infant. With MRI and other advanced brain imaging studies, more brain aneurysms are being detected before rupture or other problems occur.

In the absence of data on how pregnancy or delivery affects the risk of aneurysm rupture, the optimal management of unruptured aneurysms in pregnant women has been unclear. “We were not able to find an increased association between pregnancy or delivery and the risk of rupture of cerebral aneurysms,” Dr. Hoh and colleagues conclude. “Once ruptured, however, prompt aneurysmal obliteration (either surgical clipping or endovascular coiling) should be helpful in decreasing the rate of poor outcomes.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Publications, Surgery - Neurosurgery | Leave a comment

Nursing2013 Symposium to Inspire Transformation and Promote Nursing Innovation in Clinical Excellence

Posted on February 6, 2013

March 19 – 22, 2013 • Paris Hotel & Casino • Las Vegas, NV

Philadelphia, PA (February 6, 2013) – Elevating the nursing practice and promoting innovation in quality of patient care is the goal of Nursing2013 Symposium: The Conference for Clinical Excellence, which will be held March 19-22, 2013, at the Paris Hotel & Casino in Las Vegas, NV. The conference is sponsored by Lippincott Williams & Wilkins, publisher of Nursing2013, and part of Wolters Kluwer Health.

The meeting is designed for nurses in direct care positions as well as aspiring new leaders. Nurses will attend a sweeping variety of sessions taught by the country’s premier experts on such topics as heart failure, trauma, pain management, diabetes, and healthy work environments.  

Symposium attendees will also earn contact hours, network with colleagues, and meet with vendors and industry representatives in the exhibit hall.

“We’ve designed a program that includes everything from core content to the latest healthcare innovations,” said Nursing2013 Editor-in-Chief Linda Laskowski-Jones, RN, MS, ACNS-BC, CEN, FAWM. “There’s been a wave of major changes in health care, so we want each nurse to leave the Symposium feeling energized and prepared to meet the challenges.”

For complete program and registration information, visit the Nursing2013 Symposium Web site at Nursing2013 Symposium.

Program Highlights

The Symposium launches on Tuesday, March 19, with four preconference workshops including the Med-Surg Certification Review Course, Pharmacology: Simplified, Not Mystified, 12-Lead ECG Interpretation, and Adult Physical Assessment. Later that day, Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC, Vice President and CNO of Mary Immaculate Hospital, delivers the Opening Address, “Leading from Where You Are: Creating a Culture that Inspires.”

Wednesday, March 20, will begin with the ‘Nurse of the Year Award’ presentation, followed by keynote speaker Charles Denham, MD, Founder and Chairman, Texas Medical Institute of Technology. Dr. Denham will explore high performance leadership in his session, “A Lifesaver for Lifesavers: How to Survive the Rough Seas of Patient Safety and Value-Based Purchasing Demands.”

Breakout sessions follow and will continue through Thursday, March 21. Topics include patient safety, kidney failure, sleep apnea, caring for the oncology patient, writing for professional publications, workplace conflict, and much more. Experts will also present general sessions on patient advocacy, achieving a healthy lifestyle, and end-of-life issues.

On Friday, March 22, Laskowski-Jones will deliver the closing session on “Developing the Leader in You: A Plan for Success.”

Registration Information

Complete information and online registration is available at www.nursingsymposium.com. For additional information, contact Wolters Kluwer Health at 1-800-346-7844, ext. 7798 or 7793.

Continuing Nursing Education

Lippincott Williams & Wilkins (LWW), publisher of Nursing2013, will award a maximum of 25 contact hours for this continuing nursing education activity.

LWW is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 25 contact hours. LWW is also an approved provider by the District of Columbia and Florida #50-1223. Certificates are is valid in all states.

The ANCC’s accreditation status of Lippincott Williams & Wilkins Department of Continuing Education refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product.

Members of the press are invited to attend the conference and interview speakers and exhibitors. A complimentary one-day pass will be granted and an editorial production timeline will be requested. For more information about Nursing2013 Symposium, contact Karyn Cousart at (800) 346-7844, ext. 7750 or email at karyn.cousart@wolterskluwer.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health and pharmacy. Major brands include traditional publishers of medical and drug reference tools, journals, and textbooks, such as Lippincott Williams & Wilkins; and electronic information providers, such as Ovid®, UpToDate®, Medi-Span®, Facts & Comparisons® and ProVation® Medical.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company focused on professionals with annual revenues (2009) of €3.4 billion ($4.8 billion), approximately 19,300 employees worldwide and operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America. Visit our website, YouTube or follow @Wolters_Kluwer on Twitter for more information about our market positions, customers, brands, and organization.

About Anthony J. Jannetti, Inc.

Conference management services are provided by Anthony J. Jannetti, Inc., a health care management, marketing, and publishing corporation located in Pitman, NJ (www.ajj.com).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Media, Nursing, Publications | Leave a comment

In Combat Vets and Others, High Rate of Vision Problems after Traumatic Brain Injury TCG6VMVXE8WX

Posted on February 4, 2013

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Comprehensive Visual Evaluation Needed after Any TBI, Suggests Study in Optometry and Vision Science

Philadelphia, Pa. (February 4, 2013) – Visual symptoms and abnormalities occur at high rates in people with traumatic brain injury (TBI)—including Iraq and Afghanistan War veterans with blast-related TBI, reports a study, “Mechanisms of TBI and Visual Consequences in Military and Veteran Populations,” in the February issue of Optometry and Vision Science, official journal of the American Academy of Optometry.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Vision problems are similar for military and civilian patients with TBI, and are common even after relatively mild brain injury, according to the report by Gregory L. Goodrich, PhD, of the VA Palo Alto (Calif.) Health Care System and colleagues.  “Comprehensive eye examinations are recommended following even mild traumatic brain injury,” comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science.

High Rate of Vision Problems in after TBI…

The researchers analyzed rates and types of vision problems in 50 Iraq and Afghanistan War veterans with blast-related TBI.  Blast-related TBI is a unique type of injury, with brain trauma caused by proximity to a blast or explosion, such as from an improvised explosive device.  “There is understandably a great deal of interest in the impact of war injuries on veterans and the eyes are among the most impacted of injuries to the body,” says Dr Adams.

The findings were compared to those of 50 patients, mainly civilians, with non-blast-related TBI—most commonly occurring in motor vehicle crashes.  (About one-third of the veterans with blast-related TBI also had direct head trauma, caused by events surrounding the blast.)

The results showed high rates of vision problems in both groups.  More than 65 percent had vision-related symptoms, including difficulty reading in about half of patients.  Patients with blast-related TBI were more likely to complain of light sensitivity—67 versus 77 percent.

On examination, patients with non-blast-related TBI were more likely to have problems related to eye movement (saccadic dysfunction)—85 versus 58 percent.  Other types of problems were similar between groups, including blurred vision caused by focusing problems (accommodative dysfunction) and problems moving the eyes together to focus on near objects (convergence insufficiency).  Visual field defects (blind spots) were less common.

The high rate of visual problems occurred even though most patients had normal visual acuity.  In both the blast-related and non-blast-related TBI groups, visual problems were similar after mild versus moderate to severe TBI.

…With Similar Rates Regardless of TBI Cause or Severity

Traumatic brain injury is a common problem, affecting an average of 1.7 million Americans each year.  “TBI can take place in any setting and can happen to anyone,” according to Dr Goodrich and coauthors.  Visual problems, especially oculomotor (eye movement) difficulties, are common after TBI.   The new study is one of the first to examine the rates and types of visual problems among military personnel with blast-related TBI.

The results show high rates of visual symptoms and abnormalities after blast-related TBI, similar to those found in non-blast-related TBI.  The similarities are despite the differing mechanisms of injury.  The higher rate of light sensitivity in the military group is consistent with previous studies reporting increased sensitivity to light and noise in patients with blast-related TBI.

Dr Goodrich and colleagues call for further studies to understand “the pathophysiologic and neurologic changes that occur in all types of acquired brain injury.”  Meanwhile, considering the high rates of vision problems after even mild TBI, they conclude, “[A] comprehensive vision examination should be conducted following brain injury, regardless of injury type or severity.”

To read the article “Mechanism of TBI and Visual Consequences in Military & Veteran Populations”, please visit http://journals.lww.com/optvissci/Fulltext/2013/02000/Mechanisms_of_TBI_and_Visual_Consequences_in.3.aspx

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning.  All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Lippincott Williams & Wilkins
 
Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Optometry, Publications | Leave a comment

The Nurse Practitioner Marks 25th Annual Legislative Update

Posted on January 22, 2013

Comprehensive Review of Laws and Regulations Affecting APRNs’ Practice in Every State

Philadelphia, Pa. (January 22, 2013) –  The most comprehensive review of new legal and regulatory issues affecting advanced nursing practice across the United States is now available in the “25th Annual Legislative Update,” presented exclusively by The Nurse Practitioner: The American Journal of Primary Healthcare.  The Nurse Practitioner is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Compiled by Susanne J. Phillips, MSN, FNP-BC, the annual supplement presents a comprehensive review of the legislative proceedings, bills, and laws pertaining to advanced practice registered nursing (APRN) practice in every state.  The 25th Annual Legislative Update is now freely available on the journal website

Progress in Evidence-Based Reforms Improving Access to APRN Care

The 25th Annual Legislative Update incorporates current information provided by state nursing boards and APRN associations about the “hot topics” affecting APRN practice in their states.  “Despite attempts by medical boards to limit current practice authority, APRNs succeeded in improving access to APRN care in several states,” writes Phillips. 

The special edition provides an essential update on recent legislative and regulatory activity promoting access to APRN care, prompted by decades of peer-reviewed research demonstrating the quality and safety of APRN practice.  Efforts are ongoing to standardize laws and regulations governing APRN practice across states, and to establish effective consumer protections.

Yet legislation continues to be “vehemently opposed” in many states, according to Phillips.  She discusses steps APRNs can take to “empower legislators to move beyond the outdated, evidence-lacking arguments that APRNs are not educated enough, safe enough, or credentialed enough to care for the nation’s residents.”

This year’s update presents a rundown of the latest developments in the areas of legal authority, reimbursement, and prescriptive authority for all 50 states.  It also includes a table summarizing practice authority for nurse practitioners in every state and the District of Columbia, along with updated statistics and the total number of APRNs reported by state boards of nursing.

Nurses Encouraged to Work Together to Meet Challenges

The past year has seen several important improvements in legal authorization of APRN practice, including passage of legislation and promulgation of regulations in 17 states.  In addition, eight states reported statutory or regulatory activity leading to improvements in prescriptive authority.

But challenges remain, including reports of defeated bills and unsuccessful regulatory reform efforts in five states.  In addition, two states—Kentucky and Missouri—passed legislation limiting APRN practice in specific ways.   Phillips urges APRNs and others interested in ensuring access to evidence-based healthcare to support state APRN organizations.

Nurses are also encouraged to check out the Future of Nursing Campaign for Action, supported by the Robert Wood Johnson Foundation and AARP, to see what steps are being taken and participate in efforts to improve nursing practice.  Phillips adds, “This is a great way for all of the APRN organizations to work together to implement the recommendations and improve practice in your state.”

About The Nurse Practitioner

The Nurse Practitioner: The American Journal of Primary Healthcare is the leading monthly source for clinical, practical, cutting-edge information for advanced practice nurses and other primary care clinicians. Each issue presents peer-reviewed articles that range from clinical topics and research to political and practice issues. In addition, The Nurse Practitioner provides regular features, columns, continuing education and pharmacology credits, staff development education, and more.  Its mission is to meet the needs of the nurse practitioner (and other advanced practice nurses and clinicians) by providing practical, cutting-edge clinical and professional information.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals, and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence, and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Media, Nursing, Nursing - Administration Management & Leadership, Nursing - Practioner and Advanced Practice, Publications | Leave a comment

New Research on Military Traumatic Brain Injury— Journal of Head Trauma Rehabilitation Presents Update

Posted on January 22, 2013

Studies in Iraq/Afghanistan Veterans Show That Even Mild TBI Can Have Lasting Impact

Philadelphia, Pa. (January 22, 2013) – Researchers are making new strides in understanding the health consequences  and treatment and rehabilitation needs of combat veterans and other service members affected by traumatic brain injury (TBI).  The January-February issue of The Journal of Head Trauma Rehabilitation, official journal of the Brain Injury Association of America, is a special issue devoted to new research in military TBI.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“For the second consecutive year, we’ve expedited publication of new papers related to diagnosis, management, and rehabilitation of the many thousands of military personnel affected by TBI,” comments John D. Corrigan, PhD, ABPP, Editor-in-Chief of JHTR.  Contributed by leading U.S. experts in brain injury and rehabilitation, the eight papers in the special issue address a wide range of aspects of military TBI—from combat to peacetime, and from active duty to many years after trauma.

Important Updates on Brain Injury in Military Personnel

There’s a pressing need for new research on military TBI—a problem with lasting consequences on the lives of thousands of Iraq and Afghanistan war veterans.  It has been estimated that 19 percent of military personnel will sustain a TBI during combat deployment.  Although most of these injuries are mild, some of those service members who incur a mild TBI will go on to develop a “post-concussive” syndrome, consisting of chronic cognitive, behavioral, and psychological problems.

Several papers in the special issue address associations of mild TBI with post-concussive symptoms and other co-occurring problems, including posttraumatic stress disorder (PTSD), depression, suicidal thoughts and behavior, and pain. Dr Corrigan comments, “The interplay of TBI, post-concussive symptoms, PTSD, depression, suicidality, pain, and substance abuse is the most challenging problem facing the Department of Defense and VA when treating service members with TBI.”

Highlighted topics include:

  • Research by Dr Jeffrey J. Bazarian of the University of Rochester, linking PTSD to structural brain damage seen on diffusion tensor imaging—even in service members with no reported history of mild TBI.  Blast-related trauma may have subclinical effects—not experienced at the time of injury, or not recalled—that are associated with PTSD. “Some of the effects of blast exposure may be below the threshold of symptom experience, including a predisposition to PTSD,” Dr Corrigan comments. “If so, this would offer additional support for the policy of event-based screening for 24-hour removal from combat in Afghanistan, recently introduced by the Army and Marine Corps.”
  • A study by Kelly J. Miller, MPH, and colleagues of the Defense and Veterans Brain Injury Center, reporting that service members with previous TBIs had more symptoms in the first three months after a subsequent injury, compared to those with their first TBI.  ”These findings underscore the growing appreciation that in addition to severity of TBI, prior experience of TBI is also an important determinant of consequences both short- and long-term,” says Dr Corrigan.
  • A study by Andrew J. MacGregor, PhD, MPH, and colleagues of the Naval Health Research Center, San Diego, which found that service members with mild TBI were more likely to report health symptoms, such as headache, back pain, ringing in the ears, dizziness and memory problems.  Those with dizziness and memory problems were at particularly high risk of declining health after mild TBI.

Other topics in the special issue include important associations of loss of consciousness, altered consciousness, or amnesia with the outcomes of TBI; factors associated with use of health care services by veterans with TBI; and the high rate of TBI among veterans seeking mental health services.  The editors have also announced that a collection of the most popular articles on military TBI published in JHTR over the past three years has been made available free on the journal website.  Dr Corrigan adds, “We hope these papers will help to increase awareness of TBI and its consequences among returning veterans, and spur further research into the most effective approaches to treatment and rehabilitation.” 

About The Journal of Head Trauma Rehabilitation

The Journal of Head Trauma Rehabilitation (JHTR) is a bimonthly journal s a peer-reviewed journal that provides information on clinical management and rehabilitation of persons with head injuries for the practicing professional. It is the official journal of the Brain Injury Association of America.

About the Brain Injury Association of America

The Brain Injury Association of America (BIAA) is the country’s oldest and largest nationwide brain injury advocacy organization.   Its mission is advance brain injury prevention, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, the BIAA brings help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Publications | Leave a comment

Robot Allows ‘Remote Presence’ in Programming Brain and Spine Stimulators

Posted on January 16, 2013

Technology Can Help Increase Access to Experts as Use of Neuromodulation Grows, Suggests Neurosurgery

Philadelphia, Pa. (January 16, 2013) – With the rapidly expanding use of brain and spinal cord stimulation therapy (neuromodulation), new “remote presence” technologies may help to meet the demand for experts to perform stimulator programming, reports a study in the January issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The preliminary study by Dr. Ivar Mendez of Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, Canada, supports the feasibility and safety of using a remote presence robot—called the “RP-7″—to increase access to specialists qualified to program the brain and spine stimulators used in neuromodulation.

Robot Lets Experts Guide Nurses in Programming Stimulators

Dr. Mendez and his group developed the RP-7 as a way of allowing experts to “telementor” nonexpert nurses in programming stimulator devices. Already widely used for Parkinson’s disease and severe chronic pain, neuromodulation is being explored for use in other conditions, such as epilepsy, severe depression, and obsessive-compulsive disorder.

In this form of therapy, a small electrode is surgically placed in a precise location in the brain or spine. A mild electrical current is delivered to stimulate that area, with the goal of interrupting abnormal activity.  As more patients undergo brain and spine stimulation therapy, there’s a growing demand for experts to program the stimulators that generate the electrical current.

The RP-7 is a mobile, battery-powered robot that can be controlled using a laptop computer. It is equipped with digital cameras and microphones, allowing the expert, nurse, and patient to communicate. The robot’s “head” consists of a flat-screen monitor that displays the face of the expert operator.

The RP-7 also has an “arm” equipped with a touch-screen programmer, which the nurse can use to program the stimulator. The expert can “telestrate” to indicate to the nurse the correct buttons to push on the programming device.

Access to Specialists in the Next Room—or Miles Away

In the preliminary study, patients with neuromodulation devices were randomly assigned to conventional programming, with the expert in the room; or remote programming, with the expert using the RP-7 to guide a nurse in programming the stimulator. For the study, the expert operators were simply in another room of the same building. However, since the RP-7 operates over a conventional wireless connection, the expert can be anyplace that has Internet access.

On analysis of 20 patients (10 in each group), there was no significant difference in the accuracy or clinical outcomes of remote-presence versus conventional programming. No adverse events occurred with either type of session.

The remote-presence sessions took a little more time: 33 versus 26 minutes, on average. Patients, experts, and nonexpert nurses all gave high satisfaction scores for the programming experience.

“This study demonstrated that remote presence can be used for point-of-care programming of neuromodulation devices,” Dr. Mendez and coauthors write. The study provides “proof of principle” that the RP-7 or similar devices can help to meet the need for experts needed to serve the rapidly expanding number of patients with neuromodulation therapies.

The researchers have also started a pilot study using a new mobile device, called the RP-Xpress. About the size of a small suitcase, the RP-Xpress is being used to perform long-distance home visits for patients living hundreds of miles away, using existing local cell phone networks. Dr. Mendez and colleagues conclude, “We envision a time, in the near future, when patients with implanted neuromodulation devices will have real-time access to an expert clinician from the comfort of their own home.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Publications, Surgery, Surgery - Neurosurgery, Technology | Leave a comment

New Biomarker May Help in Detecting Gliomas, Reports Neurosurgery

Posted on January 16, 2013

Marker Called ELTD1 Reflects New Blood Vessel Formation Associated with Brain Cancers

Philadelphia, Pa. (January 16, 2013) – Researchers using sophisticated genetic testing techniques have identified a promising new biomarker for diagnosis of glioma—the most common type of malignant brain tumor, reports the January issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The biomarker ELTD1 “may serve as an additional biomarker for gliomas in preclinical and clinical diagnosis of gliomas,” according to the study by Rheal A. Towner of Oklahoma Medical Research Foundation, Oklahoma City.

Biomarker Reflects Rapid Blood Vessel Development

Dr. Towner and colleagues used advanced “data mining and bioinformatic” techniques to evaluate genes and gene products potentially associated with gliomas. Glioma is a general term referring to tumors originating in the glial cells of the brain and spinal cord. Gliomas make up about 40 percent of all brain tumors and 80 percent of central nervous system cancers. Especially for advanced (high-grade) gliomas such as glioblastoma multiforme (GBM), expected survival is very poor.

Out of nearly 200 possible markers analyzed, ELTD1 was identified as the strongest candidate for a significant association with glioma. There’s special interest in ELTD1 because it is linked to development of new blood vessels, or angiogenesis—a characteristic of rapidly growing cancers. (ELTD1 stands for “epidermal growth factor, latrophilin and seven transmembrane domain-containing protein 1.”)

Studies in human patients suggested that ELTD1 was strongly associated with gliomas. ELTD1 was more highly expressed in specimens from 50 patients with high-grade gliomas, compared to 21 patients with lower-grade gliomas.

Higher levels of ELDT1 expression were associated with a higher grade of glioma, and with lower survival. ELTD1 compared well with other known markers of glioma, such as vascular endothelial growth factor. It also appeared to be associated with one specific subtype of GBM (mesenchymal GBM).

In further experiments, the researchers transplanted glioma cells into the brains of rats. As the tumors developed, they showed elevated levels of ELTD1, compared to normal brain tissue. The rat studies included evaluation of a “molecular MRI technique” for measuring ELDT1 levels in the living brain.

A Helpful Marker for Glioma Diagnosis?

Even with modern treatments, GBM and other malignant gliomas are devastating cancers. In recent years, advances in research have led to the identification of biomarkers associated with glioma. Dr. Towner and colleagues write, “Validation of more biomarkers for GBM could be beneficial in the diagnosis and therapeutic intervention of this disease.”

With further study, ELTD1 could become a useful new marker of glioma, including GBM. Gliomas show increased expression of ELTD1, and higher levels of ELTD1 expression are associated with higher tumor grade and a worse prognosis. “Any increase in ELTD1 will more than likely be associated with increased angiogenesis or neovascularization [new blood vessel development] in gliomas,” the researchers write.

Although the findings are only preliminary, Dr. Towner and coauthors suggest that ELTD1 could be useful in detecting the presence and grade of gliomas—particularly high-grade gliomas such as GBM. They conclude, “[T]his biomarker may play an important diagnostic role in addition to currently used markers for gliomas, particularly as a histological marker for identifying vascular proliferation.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in Neurology, Publications, Surgery, Surgery - Neurosurgery, Technology | Leave a comment