As a complement to traditional pain relief tools like medication, listening to music may lessen acute or chronic pain related to cancer and other conditions, according to a new review.

“We have seen and observed this effect in multiple clinical settings such as medical hospitals and hospice-care facilities,” said author Jin Hyung Lee of Ewha Womans University in Seoul, South Korea.

“In addition to all the clinical trials investigating the effects of music interventions on pain, we are seeing an increase in the number of music therapists who work in the medical and hospice care settings,” Lee told Reuters Health by email. “Of course, these professionals work on a variety of clinical goals in addition to pain management, but it definitely is one of the major goals.”

Lee reviewed 97 randomized controlled trials conducted between 1995 and 2014 that included a total of 9,147 participants. Most trials involved music therapy, which typically involves interactions with a music therapist, while a handful of trials looked at music medicine, which mainly involves exposure to “prerecorded music experiences” selected for their effects, Lee writes in the Journal of Music Therapy.

The trials examined those effects on participants’ self-reported pain intensity, emotional distress from pain, vital signs and amount of pain relief medication taken.

Many studies let participants choose the type of music they wanted to listen to, often including classical, easy listening, new age, slow jazz and soft rock. A quarter of the trials used music selected by researchers. On average, participants listened to about 38 minutes of music during the experiments.

Overall, people getting the music intervention in their trial rated their pain intensity about one point lower on a zero to 10 scale after music sessions compared to groups that got no music. But the results were not consistent among all studies, Lee notes.

Seven of the studies found a significant decrease in anesthetic use in music groups compared to non-music groups. There were similar small but significant differences in studies examining use of opioid and non-opioid painkillers, but there was no difference in sedative use.

Heart rate, blood pressure and respiration rate were all found to be lower among participants in music groups in some studies.

Music stimulates additional senses other than pain receptors, which attracts patients’ attention, and relieves stress and anxiety with its soothing quality, Lee said.

“In addition, music therapists provide various music experiences with specific clinical intent to promote a sense of hope and control, to actively re-direct patients’ attention, and to support patients to actively cope with their illness,” he said.

“Music medicine and music therapy are not meant to be alternative forms of therapy, rather they are provided as a complementary treatment to existing care,” he said.

Music may distract and relax patients, said Dr. John Marshall of the University of Missouri School of Medicine in Columbia, Missouri, who was not part of Lee’s review.

“When we did our music study in colonoscopy patients many years ago, we were giving patients light sedation,” Marshall said. “The patients were awake during their procedures. The music seemed to be a helpful adjunct to improving the patient experience.”

Today, most colonoscopy patients are moderately to heavily sedated, so music during the procedure may not matter as much, though pleasant background music prior to the procedure makes sense.

“There are many things to consider when devising a music program for patients, so I would recommend consulting a music therapist when establishing a music medicine program,” Lee said.

source: Reuters Health
http://www.reuters.com/article/us-health-pain-music-therapy-idUSKBN12Z2MH

An immunotherapy drug has been described as a potential "game changer" in promising results presented at the European Cancer Congress, according to a report in the BBC Saturday.

In a study of head and neck cancer, more patients taking nivolumab survived for longer compared with those who were treated with chemotherapy.

In another study, combining nivolumab with another drug shrank tumours in advanced kidney cancer patients.

Immunotherapy works by harnessing the immune system to destroy cancer cells.

Advanced head and neck cancer has very poor survival rates.

In a trial of more than 350 patients, published in the New England Journal of Medicine, 36% treated with the immunotherapy drug nivolumab were alive after one year compared with 17% who received chemotherapy.

Patients also experienced fewer side effects from immunotherapy.

The benefits were more pronounced in patients whose tumours had tested positive for HPV (human papillomavirus). These patients survived an average of 9.1 months with nivolumab and 4.4 months with chemotherapy, the BBC reported.Normally, this group of patients are expected to live less than six months, it added.

Early data from a study of 94 patients with advanced kidney cancer showed that the double hit of nivolumab and ipilimumab resulted in a significant reduction in the size of tumours in 40% of patients.

Of these patients, one in 10 had no sign of cancer remaining.

This compares with 5% of patients showing tumour reduction after standard therapy.

As yet, nivolumab has only been approved for treating skin cancer and in June it became one of the fastest medicines ever approved for NHS use, in combination with ipilimumab, for the same cancer.

Nivolumab and ipilimumab both work by interrupting the chemical signals that cancers use to convince the immune system they are healthy tissue.

In an interview with BBC, Prof Kevin Harrington of the Institute of Cancer Research and consultant at the Royal Marsden Hospital in London, who led the head and neck cancer trial, said nivolumab could be a real "game changer" for patients with advanced head and neck cancer.

"This trial found that it can greatly extend life among a group of patients who have no existing treatment options, without worsening quality of life.

"Once it has relapsed or spread, head and neck cancer is extremely difficult to treat. So it's great news that these results indicate we now have a new treatment that can significantly extend life, and I'm keen to see it enter the clinic as soon as possible."

Prof Paul Workman, chief executive of The Institute of Cancer Research, told BBC nivolumab was one of a new wave of immunotherapies that were beginning to have an impact across cancer treatment.

source: Philippine Star
Health & Medicine

Going to the right hospital for heart attack care could add a year to your life, a new study suggests.

Using Medicare records, researchers found that roughly 17 years after a heart attack, average life expectancy was 9 to 14 months longer for patients who had been treated at hospitals that do best on widely used quality measures than for those treated at low-rated ones.

“Where you go really does matter,” not just for surviving the heart attack but also long-term, said Dr. Emily Bucholz, a study leader and researcher at Boston Children’s Hospital.

A year of life from high-quality care is a big deal; consider that some cancer drugs won approval for adding a few months or weeks. But if you’re having possible heart attack symptoms, don’t delay getting help because you’re worried about which hospital to go to, said another study leader, Yale cardiologist Dr. Harlan Krumholz.

Too many people wait at home too long," and any delay means more risk of permanent heart damage, he said.

The study was funded by the National Institutes of Health. Results were published Wednesday by the New England Journal of Medicine.

Hospitals often are rated based on their heart attack death rates at 30 days, taking into account how sick their patients were, such as how many had diabetes. 

But it’s not known whether doing well in the short term translates to a lasting benefit.

The new study finds it does. Researchers compared life expectancy for 120,000 Medicare patients treated between 1994 and 1996 at roughly 1,800 hospitals.

The difference in life expectancy at top and low performing hospitals emerged at 30 days and remained over time.

“This is really an important study,” said an independent expert, Dr. Ralph Brindis, a University of California at San Francisco cardiologist and former president of the American College of Cardiology.

“Delivering better care not only saves lives, but that the gain persists over 17 years, independent of how sick the patients were initially.”Heart attack care has improved a lot since the 1990s, but more recent comparisons of short-term hospital mortality rates show that big differences still exist.Where the good hospitals in your community are is worth knowing,” Bucholz said.

And they’re not necessarily the ones that advertise on TV. Medicare has a website that lets you check how they do in your area.

Heart attack symptoms can be sudden, but many start slowly, with mild pain or discomfort, according to the American Heart Association.

Signs can include pressure, squeezing or pain in the chest, one or both arms, the back, neck, jaw or stomach; shortness of breath; breaking out in a cold sweat; nausea, or lightheadedness.

source: Philippine Star
Health & Medicine

If the previous occupant of a hospital bed received antibiotics, the next patient who uses that bed may be at higher risk for a severe form of infectious diarrhea, according to a new study.

Clostridium difficile (C. diff) diarrhea causes 27,000 deaths each year in the U.S. Hospital patients taking antibiotics are particularly at risk for it, say the authors of the study. Antibiotics disturb the normal healthy bacteria of the gut so a C. diff infection can take hold.

The new study shows that “antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk” for C. diff infection, the researchers wrote in JAMA Internal Medicine.

“Other studies have also demonstrated that antibiotics can have a ‘herd’ effect - in other words, that antibiotics can affect people who do not themselves receive the antibiotics,” said lead author Dr. Daniel Freedberg of Columbia University Medical Center in New York.

Freedberg and his colleagues studied more than 100,000 pairs of patients who sequentially occupied a given hospital bed in four institutions between 2010 and 2015, not including those who had recent C. diff infection or whose prior bed occupant was in the bed for less than 24 hours.

More than 500 patients, or less than 1 percent of the total group, developed a C. diff infection as the second bed occupant.

The infections were 22 percent more likely when then previous occupant had received antibiotics.

Other factors about the previous bed occupant were not associated with C. diff risk.

People can be carrying C. diff organisms without having any symptoms, Freedberg told Reuters Health by email. When these colonized patients receive antibiotics, C. diff may expand within their gut microbiome and start shedding more spores, which means more spores on the bed, the bedside table, the floor, and other areas, he said.

“The next patient who enters the room is thus more likely to be exposed to C. diff spores,” he said. “It’s not easy to sterilize the room/bed between patients because C. diff spores are extremely hardy. To be killed, they need to be soaked in a bleach-containing cleaning agent for an adequate amount of time.”

About half of patients in acute care facilities take antibiotics on any given day, said Kevin Brown of the University of Toronto Dalla Lana School of Public Health, who was not part of the new study.

“That’s a huge portion of patients that could be involved in spreading the infection,” Brown told Reuters Health by email.

But the increased risk is modest, Freedberg added.

“There was a 22 percent relative increase in risk for C. diff with the prior patient’s antibiotics but there was a four-fold increase in risk related to the antibiotics received by the patient him- or herself,” he said.

Other patients, such as other antibiotic user patients within the ward, could have contributed increased risk as well, Brown said.

“Doctors (and patients) should avoid antibiotics in situations where they are not necessary,” Freedberg said. “Too often, antibiotics are prescribed without clear indications.”

“I think this evidence needs to be taken just as an association that needs further exploration,” said Jack A. Gilbert of Argonne National Laboratory in Argonne, Illinois, who was not part of the new study. “While it would be tempting to use these results to change policy, there are so many uncertainties here that such a move would not be advisable.”

source: Reuters Health
http://www.reuters.com/article/us-health-infections-hospital-beds-idUSKCN12A1VY