Deadly flu season has likely peaked, CDC says

The worst flu season in years has likely peaked, the CDC said Friday. But the illness still remains widespread in every state, except for Hawaii and Oregon.

From: http://www.cbsnews.com/video/deadly-flu-season-has-likely-peaked-cdc-says/

A Conversation with Crystal Jackson and Dr. Fran Cogen: Part 1

Recently, our Safe at School Director, Crystal Jackson, got the chance to chat with Fran Cogen, MD, CDE, Director of Diabetes Services and Interim Co-Chief of Pediatric Endocrinology at Children’s Hospital. Dr. Cogen’s practice serves approximately 1,800 patients in the DC/Maryland/Virginia metro area, with 85 percent of those patients living with type 1 diabetes. Dr. Cogen has been working with diabetes patients since 2002 and is also a member of the ADA’s Safe at School Working Group. Crystal and Dr. Cogen spoke about the Safe at School program, diabetes management in schools and how parents can work with schools as a team—check out part one of this interview series that will be helpful to parents, diabetes providers and school staff.

Dr. Fran Cogen

Crystal Jackson: Most of [your patients] are school age. What are some common school diabetes care complaints that you hear from parents?

Fran Cogen, MD, CDE: Let’s start with insulin—sometimes, private schools may refuse to give insulin at school (but that’s happening less and less). Another concern is independence of the student. Many school nurses insist that students go to the clinic to check blood glucose or to receive other diabetes care. Students then often miss class time. That also goes for insulin pumps—some of the nurses feel that the students are not capable of bolusing on their own. In addition, some schools refuse to give glucagon…even if (in some cases) a child is seizing, they call 911 and give glucose gel. Other schools insist that every time the healthcare provider OR the parent/caregiver makes an insulin dose adjustment, we have to send new orders, which is impractical and can result in delaying an insulin dose and the child being able to eat lunch with classmates. Many school nurses take the position that they will not accept parental permission for insulin dose adjustment and require written orders from the student’s provider. This is unnecessary. Parents and self-managing students adjust insulin doses all of the time without input from the child’s provider.

CJ: What is your feeling about the need for provider authorization to make changes? What do you base that change on; for example, do you know what the child has been up to that day?

FC: I don’t personally know the latest insulin adjustments made by the family, but what we do (at least on the Maryland school form) is give permission to adjust the insulin-to-carb ratio at a certain range, and we give them permission to adjust the correction factor to a certain range…a responsible parent is best positioned to make these adjustments.

CJ: Going back to insulin, you mentioned that some of the private schools don’t have anybody to give insulin?

FC: Some schools don’t have nurses. [In those cases,] We ask that they delegate and train a school employee to give insulin—we haven’t seen many problems with that as of late. Of course, with some day care situations, that may be an issue.

CJ: What about public schools in the D.C. area?

FC: I haven’t heard any issues with the public schools in the area giving shots or using pens—what I am hearing are issues with the insulin pumps. They’re not comfortable letting the children manage them. For example, I recently got a call from one family whose child is perfectly capable of adjusting pump settings, and the child was low and knew what to do, but the nurse was trying to change the basal rates which she had no experienced in how to change. The father was very angry and ended up meeting with the principal.

CJ: What do you think could help to address a situation like that?

FC: It is my personal belief that we want someone trained and experienced to handle insulin pumps. Many school nurses—unless they’re insulin pump nurses—usually do not have that experience. I can understand if there’s a problem and [the school] wants to go over it with the parents on the phone, but I don’t feel it’s appropriate for a nurse to be changing pump basal rates, or changing infusion sites if they fall out in school unless they have training, experience and are comfortable with doing so. I don’t want someone who has little experience changing basal rates and replacing infusion sets basal rates in school, especially with the back-up option of giving insulin injections by pen or syringe.

---

Interested in learning more about our Safe at School program? Check out our resources here.

From: American Diabetes Association http://diabetesstopshere.org/2018/02/23/a-conversation-with-crystal-jackson-and-dr-fran-cogen-part-1/

Nasty flu season finally starts to wane

The CDC says this year's deadly flu season finally seems to be getting better instead of worse, although it won't be over for many more weeks. CBS News' Kenneth Craig reports.

From: http://www.cbsnews.com/video/nasty-flu-season-finally-starts-to-wane/

Nasty flu season showing signs of winding down

The CDC is cautious about saying flu season has peaked, but called a decline in doctor visits encouraging

From: http://www.cbsnews.com/news/nasty-flu-season-showing-signs-of-winding-down-in-us/

New research debunks medical marijuana myths

Two common beliefs about legalizing the medical use of pot do not hold up under scrutiny, researchers say

From: http://www.cbsnews.com/news/medical-marijuana-myths-debunked-in-new-study/

Women's Heart Attacks Can Have Hidden Causes

Women who complain of chest pain often are told they haven't had a heart attack if their arteries aren't blocked, the researchers said.

From: https://www.webmd.com/heart-disease/news/20180223/womens-heart-attacks-can-have-hidden-causes?src=RSS_PUBLIC

Eating disorders awareness week set for Feb. 26-March 4

National Eating Disorders Awareness Week is set for Feb. 26-March 4.

From: https://www.ada.org/en/publications/ada-news/2018-archive/february/eating-disorders-in-spotlight-feb-26-march-4

Mayo Clinic Minute: Do you practice good sleep hygiene?

From: Mayo Clinic https://www.youtube.com/watch?v=k7_Fi0G5GsM

The Role of Setons – IBD in the News

From: Mayo Clinic https://www.youtube.com/watch?v=OG9NUknNwY4

Early Type 2 Diabetes Diagnosis Bad for Your Heart

One thing that's clear is that type 2 diabetes is on the rise, especially among younger people across the developed world.

From: https://www.webmd.com/diabetes/news/20180223/early-type-2-diabetes-diagnosis-bad-for-your-heart?src=RSS_PUBLIC

Poorer Kids May Fare Worse After Heart Surgery

The disparities between affluent and poor children persisted even though all were treated at the same major hospitals, the researchers said.

From: https://www.webmd.com/children/news/20180223/poorer-kids-may-fare-worse-after-heart-surgery?src=RSS_PUBLIC

FDA raises death count from kratom, a natural opioid

It now attributes 44 U.S. fatalities to the herb, and it launched a major recall of dietary supplements containing it

From: http://www.cbsnews.com/news/fda-raises-death-count-from-kratom-a-natural-opioid/

Why mental illness is only a part of preventing gun violence

President Trump is making mental health a focus of his efforts to curb gun violence. While experts welcome more resources and attention, some say the solutions are more complicated. Psychologist and CBS News contributor Lisa Damour joins "CBS This Morning" to discuss the importance of looking at factors beyond mental health when trying to prevent violent behavior and the gaps in America's mental health services.

From: http://www.cbsnews.com/video/why-mental-illness-is-only-a-part-of-preventing-gun-violence/

Former Ulta Beauty manager says she felt pressured to resell used products

A popular personal products chain is accused of repacking and reselling used products as if they're new. Ulta Beauty has more than 1,000 stores in 48 states, but is now facing two class-action lawsuits after a social media post. Anna Werner reports.

From: http://www.cbsnews.com/video/former-ulta-beauty-manager-says-she-felt-pressured-to-resell-used-products/

Clues to Parkinson's May Be Shed in Tears

When people shed tears, certain proteins are released. Levels of those proteins are different in people with Parkinson's compared to those without the disease, according to a preliminary study.

From: https://www.webmd.com/parkinsons-disease/news/20180222/clues-to-parkinsons-may-be-shed-in-tears?src=RSS_PUBLIC

Transcranial magnetic stimulation (TMS): Hope for stubborn depression

Depression is the leading cause of disability in the United States among people ages 15 to 44. While there are many effective treatments for depression, first-line approaches such as antidepressants and psychotherapy do not work for everyone. In fact, approximately two-thirds of people with depression don’t get adequate relief from the first antidepressant they try. After 2 months of treatment, at least some symptoms will remain for these individuals, and each subsequent medication tried is actually less likely to help than the one prior.

What can people with depression do when they do not respond to first-line treatments? For several decades, electroconvulsive therapy (ECT or “shock therapy”) was the gold standard for treatment-resistant depression. In fact, ECT is still considered to be the most potent and effective treatment for this condition, and it continues to be used regularly across the country. For many people with depression, however, ECT can be too difficult to tolerate due to side effects on memory and cognition. For those individuals and the many others who have had an inadequate response to medications and therapy alone, there is a newer treatment option called transcranial magnetic stimulation (TMS).

What is transcranial magnetic stimulation?

Transcranial magnetic stimulation, or TMS, is a noninvasive form of brain stimulation. TMS devices operate completely outside of the body and affect central nervous system activity by applying powerful magnetic fields to specific areas of the brain that we know are involved in depression. TMS doesn’t require anesthesia and it is generally exceptionally well tolerated as compared to the side effects often seen with medications and ECT. The most common side effect is headache during or after treatment. A rare but serious side effect is seizures, and TMS may not be appropriate for people at high risk such as those with epilepsy, a history of head injury, or other serious neurologic issues.

Does TMS work?

Approximately 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS. About one-third of these individuals experience a full remission, meaning that their symptoms go away completely. It is important to acknowledge that these results, while encouraging, are not permanent. Like most other treatments for mood disorders, there is a high recurrence rate. However, most TMS patients feel better for many months after treatment stops, with the average length of response being a little more than a year. Some will opt to come back for subsequent rounds of treatment. For individuals who do not respond to TMS, ECT may still be effective and is often worth considering.

What is TMS therapy like?

TMS therapy is an intensive treatment option requiring sessions that occur 5 days a week for several weeks. Each session may last anywhere from 20 to 50 minutes, depending on the device and clinical protocol being used. When patients arrive, they may briefly check in with a technician or doctor and then begin the stimulation process. The technician will determine the ideal stimulation intensity and anatomical target by taking advantage of a “landmark” in the brain called the motor cortex. By first targeting this part of the brain, the team can determine where best to locate the stimulation coil as it relates to that individual’s brain and how intensely it must “fire” in order to achieve adequate stimulation. Calculations are then applied to translate this data toward finding the dorsolateral prefrontal cortex, the brain target with the greatest evidence of clinical effectiveness and an area known to be involved in depression. Though one session may be enough to change the brain’s level of excitability, relief isn’t usually noticeable until the third, fourth, fifth, or even sixth week of treatment.

Can TMS help with other conditions?

TMS is being studied extensively across disorders and even disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatry. There are currently large clinical trials looking at the effectiveness of TMS in conditions such as pediatric depression, bipolar disorder, obsessive-compulsive disorder, smoking cessation, and post-traumatic stress disorder. While promising avenues for research, TMS for these conditions is not yet approved and would be considered “off-label.”

The post Transcranial magnetic stimulation (TMS): Hope for stubborn depression appeared first on Harvard Health Blog.

From: Adam P. Stern, MD https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335