Local food advocates and confirmed “locavores” are quick to claim that local food is more nutritious. But is it really? While this seems like a simple straightforward question, it is anything but! The answer, like many having to do with food and nutrition, is a definite, “It depends.”By the time fruits and vegetables reach your kitchen counter – whether from a stall at a local farmers market, or the supermarket produce department – several factors determine their nutritional quality: the specific variety chosen, the growing methods used, ripeness when harvested, post harvest handling, storage, extent and type of processing, and distance transported. The vitamin and mineral content of fruits and vegetables depends on decisions and practices all along the food system – from seed to table – whether or not that system is local or global.
But before concluding there is no nutritional justification for eating locally, let’s take a closer look at this system.
Variety. Most varieties of fruits and vegetables found in supermarkets today were chosen first and foremost for yield (how many pounds, pecks, bushels, etc. are harvested per acre), growth rate, and ability to withstand long-distance transport. Unfortunately, these traits which benefit national and international produce distribution often come at a cost: nutritional quality. Fruit and vegetable varieties differ in appearance and taste, as well as their vitamin, mineral, and phytochemical content. Farmers producing for a local and direct market (farmers’ market, community supported agriculture (CSA) members, or a local restaurant or grocer, for example), are more likely to prioritize taste and nutritional quality over durability when making varietal decisions.
Production Method. Production methods that improve the health of the soil – such as the use of cover crops and composted manure for fertilizers – tend to yield crops with higher nutritional content. The roots of crops grown organically or in some Integrated Pest Management systems are healthier and grow deeper allowing them to more efficiently take up nutrients. Composted manures and other organic fertilizers release nutrients more slowly and over longer periods than synthetic chemical alternatives, which also enhances nutrient uptake by the plants.
Ripeness. When produce is ready for harvest varies from one fruit and vegetable to another and depends on whether it is “climacteric” not. Climacteric fruits – such as apples, nectarines, melons, apricots, peaches, and tomatoes – are capable of generating the ripening hormone ethylene, after being detached from the mother plant. Non-climacteric crops – for example, peppers and citrus – reach commercial maturity on the plant only. Being somewhat autonomous, from the ripening point of view, climacteric fruits will change in taste, aroma, color and texture as they reach and pass a transitory respiratory peak related to ethylene production. Climacteric produce such as tomatoes reach full red color even when harvested green while non-climacteric vegetables, such as bell peppers, will not. As a general rule, the more mature the product, the shorter its post-harvest life. So, if destined for distant markets, climacteric fruits are often harvested as early as possible, after reaching their physiological maturity, in order to withstand mechanical harvesting and long-distance transport without damage.
While full color may be achieved after harvest, nutritional quality may not. Total vitamin C content of red peppers, tomatoes, apricots, peaches and papayas has been shown to be higher when these crops are picked ripe from the plant which, in the case of tomatoes, is attributable to increased sun exposure while attached to the mother plant. While the vitamin C content of tomatoes, for example, will increase to some degree after picking, it will not reach levels found in those allowed to vine ripen. Because tomatoes make up nearly a quarter of total US vegetable consumption, following production and harvest practices that maximize their nutritional content is particularly important to public health of Americans.
Post-harvest Handling. Maintaining nutritional quality after fruits and vegetables are harvested requires careful handling. This means, chilling (to remove the “field heat”) immediately, preventing bruising, and maintaining specific temperature, and humidity during storage and distribution. Careful handling preserves plant integrity and quality and careless handling chemically alters plant structure, often diminishing nutritional quality. Further, nutrients differ in how they are affected by various farming and post-harvest practices.
Bruising from handling is one of the most common problems. Mechanical harvesting methods like those used in mass production have the potential to be most damaging and can result in accelerated nutrient losses. Bulk handling involving forklifts or trucks after picking significantly contributes to crop injury particularly with apples. Delicate items like berries and tomatoes are also easily affected. In tomatoes, there has even been evidence of abnormal ripening following impact bruising.
Processing and Packaging. Fruits and vegetables are increasingly found on supermarket shelves pre-cut in open containers or in various types of packaging. These items are considered “fresh cut” or “lightly or minimally processed products” and have increased in sales in the US in billions of dollars since the mid-1990s. These products are highly perishable, as they have already experienced stress and are left without intact skin for protection and prevention of nutrient loss. Minimal processing – cutting, slicing, chopping, peeling, etc. – while tremendously useful from a food service standpoint, causes injuries to the plant tissues and initiates enzymatic changes, such as ethylene production, respiration, accumulation of secondary metabolites and water loss from tissues. This increases susceptibility to microbial spoilage, which not only compromises food safety, but alters chemical make-up and promotes loss of nutrients. The effect of processing on antioxidants and phytonutrients vary.
To preserve moisture and humidity as well as protect fresh-cut products, films and coatings are used. Packaging can help preserve some nutrients in fresh-cut products, particularly if done at the right time and under appropriate conditions, mainly because it delays ripening and deterioration. Other techniques such as irradiation, chemical preservation (dips in ascorbic acid, calcium chloride, and/or citric acid), modification of pH, and reduction of water activity (with sugars/salts) are also used to control deterioration of processed products.
Storage. Due to continued respiration and enzymatic activity, minimally processed fruits and vegetables suffer changes in nutritional value and sensory quality including loss of texture, appearance and flavor during storage,18 especially if factors such as temperature, atmosphere, relative humidity and sanitation are not well regulated.16 Fresh-cut produce must be maintained at lower temperatures than whole fruits and vegetables, as they tend to have higher respiration rates, which increase as temperature rises. Temperature maintenance is considered most deficient factor in post-harvest handling of minimally processed foods, which is why contained, modified atmospheres are important.
Transportation. The advent of refrigerated trucks and rail cars has made it possible to eat fresh California or Mexico produce in the Northeast. But even when temperature and humidity are optimal from harvest to supermarket, there is some nutrient loss during days-long trip. If temperature control is faulty, losses accelerate. Bruising damage, with subsequent decrease in nutrition quality, is likely when transported at high speeds on bumpy roads. The longer the trip, the more potential for damage.
The Bottom Line
While all of the factors affecting nutritional quality of fruits and vegetables – crop variety, production method, post-harvest handling, storage, and processing and packaging – apply equally to produce that is produced locally or on farms across the country, relying on local sources for your produce needs has some distinct advantages. First, even when the highest post-harvest handling standards are met, foods grown far away that spend significant time on the road, and therefore have more time to loss nutrients before reaching the marketplace.17,18 Second, farmers growing for a local (and especially a direct) market favor taste, nutrition and diversity over shipability when choosing varieties. Greater crop diversity from the farmer means greater nutritional diversity for the eater. Third, in direct and local marketing strategies, produce is usually sold within 24 hour after harvest, at its peak freshness and ripeness, making consuming them a more attractive prospect. Fourth, during this short time and distance, produce is likely handled by fewer people, decreasing potential for damage, and typically not harvested with industrial machinery. Minimizing transportation and processing can ensure maximum freshness and flavor, and nutrient retention.
This may seem like an overly simplistic explanation of why local fruits and vegetables are more healthful than those from our conventional long haul agricultural system. In the Northeast, diets based on foods available locally can be nutritionally adequate year-round. Concerns over nutritional adequacy usually arise because people are unaware of what is available. Fortunately, this guide can provide you with information regarding the delicious seasonal items of the Northeast and Mid-Atlantic, and how to prepare and store them.
“Locavore”, the 2007 New Oxford American Dictionary Word of the Year, refers to a person whose diet focuses on foods grown and produced nearby, typically 100 miles. The term reflects a growing trend of using locally grown ingredients, taking advantage of seasonally available foodstuffs that can be bought and prepared without the need for extra preservatives. The “locavore” movement encourages consumers to buy from farmers’ markets or even to grow or pick their own food, arguing that fresh, local products.
1.) Halweil B. Still No Free Lunch: Nutrient levels in U.S. food supply eroded by pursuit of high yields. Critical Issues Report. The Organic Center. September 2007.
2.) Howard LR, Pandijaitan N, Morelock T, Gil MI. Antioxidant capacity and phenolic content of spinach as affected by genetics and growing season. J Agric Food Chem. 2002; 50: 5891–5896.
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4.) Kopsell DA, Kopsell DE. Accumulation and bioavailability of dietary carotenoids in vegetable crops. Trends Plant Sci. 2001; 11(10): 499–507.
5.) López Camelo A F. Manual for the preparation and sale of fruits and vegetables: From field to market. Food and Agriculture Organization (FAO) Services Bulletin 151. ISSN 1010-1365. August, 2002
6.) Lee, SK, Kader, AA. Preharvest and postharvest factors influencing vitamin C content of horticultural crops.Postharvest Biol Technol. 2000; 20: 207 –220.
7.) Dumas Y, Dadomo M, Di Lucca G, Grolier P. Review. Effects of environmental factors and agricultural techniques on antioxidant content of tomatoes. J Sci Food Agric. 2003; 83: 369–382.
8.) Harris RS, Karmas E ed. Nutritional Evaluation of Food Processing. 3rd ed. New York: Van Nostrand Reinhold Company, Inc; 1988.
9.) US Environmental Protection Agency, Office of Pesticide Programs and US Department of Agriculture, Agricultural Research Service. 2000b. Document files – Section 2: “Essential Information in Food Commodity Intake Database (FCID).”. Version 2.1 (CD-ROM computer file). National Technical Information Service, Springfield, VA.
10.) Dobrzañski B, Rabcewicz J, Rybczyñski R. Handling of Apple. 1st ed. Lublin: B Dobrzañski Institute of Agrophysics, Polish Academy of Sciences; 2006.
11.) Jeffrey EH, Brown AF, Kurilich AC, Keck AS, Matusheski N, Klein BP, Juvik JA. Variation in content of bioactive components in broccoli. J Food Comp Anal. 2003; 16 (3): 323–330.
12.) Moretti CL, Sargent SA, Huber D, Calbo AG, Puschmann R. Chemical composition and physical properties of pericarp, locule, and placental tissues of tomatoes with internal bruising. J Am Soc Hortic Sci. 1998; 123: 656–660.
13.) Watada AF, Ko WP, Minott DA. Factors affecting quality of fresh-cut horticultural products. Postharvest Bio Technol. 1996; 9: 115–125.
14.) Shah NS, Nath N. Minimally processed fruits and vegetables – Freshness with convenience. J Food Sci Tech. 2006; 43 (6): 561–570.
15.) Goldman IL, Kader AA, Heintz C. Influence of production, handling, and storage on phytonutrient content of food. Nutr Rev. 1999; S46–S52.
16.) Cantwell, M. Postharvest handling systems: minimally processed fruits and vegetables. UC Vegetable Research and Information Center. Available at: http://vric.ucdavis.edu/selectnewtopic.minproc.htm. Accessed January 20, 2007.
17.) Heaton S. Organic Farming, Food Quality and Human Health. A Review. Soil Association, 2001.
18.) Worthington V. Nutritional quality of organic versus conventional fruits, vegetables, and grains. J Altern Complement Med. 2001; 7(2): 161–173.
19.) Wilkins JL, Gussow JD. Regional dietary guidance: is the northeast nutritionally complete? In: Lockeretz W, ed. Agricultural production and nutrition. Proceedings of an international conference, Boston, March 19-21, 1997. Medford, MA Tufts University School of Nutrition Science and Public Policy, September 1997.
- Danielle Nierenberg: The Nutritional and Economic Potential of Vegetables (huffingtonpost.com)
- Q & A: Is Ripeness All? (nytimes.com)
- Organic food ‘is of little benefit’ (mirror.co.uk)
- Can neutraceuticals save us from junk food? (theglobeandmail.com)
- Marcus Samuelsson: The Politics of Food: U.S. Policy Impacts Farmers Worldwide (huffingtonpost.com)
- Organic Veggies Not More Nutritious (news.discovery.com)
- Compelling Reasons To Grow Your Own Organic Vegetables (glenns-garden.com)
- Carol Howard Merritt: How Your Church Can Support Local Food Movements (huffingtonpost.com)
Most ‘locked-in syndrome’ patients say they are happy
A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority
Most “locked-in syndrome” patients say they are happy, and many of the factors reported by those who say they are unhappy can be improved, suggest the results of the largest survey of its kind, published in the launch issue of the new online journal BMJ Open.***
The findings are likely to challenge the perception that these patients can no longer enjoy quality of life and are candidates for euthanasia or assisted suicide, say the authors.
The research team quizzed 168 members of the French Association for Locked in Syndrome on their medical history and emotional state, and their views on end of life issues, using validated questionnaires.
Locked-in syndrome describes a condition in which a person is fully conscious, but cannot move or communicate, save through eye movements or blinking. The syndrome is caused by brain stem injury, and those affected can survive for decades.
In all, 91 people replied, giving a response rate of 54%. Around two thirds had a partner and lived at home, and most (70%) had religious beliefs.
There were no obvious differences between those who expressed happiness or unhappiness, but not unexpectedly, depression, suicidal thoughts, and a desire not to be resuscitated, should the need arise, or for euthanasia were more common among those who said they were unhappy.
Over half the respondents acknowledged severe restrictions on their ability to reintegrate back into the community and lead a normal life. Only one in five were able to partake in everyday activities they considered important.
Nevertheless, most (72%) said they were happy.
Only four of the 59 people (7%) who responded to the question asking whether they wanted to opt for euthanasia, said they wished to do so.
Among the 28% who said they were unhappy, difficulties getting around, restrictions on recreational/social activities, and coping with life events were the sources of their unhappiness.
But a shorter period in the syndrome – under a year – feeling anxious, and not recovering speech were also associated with unhappiness.
A greater focus on rehabilitation and more aggressive treatment of anxiety could therefore make a big difference, say the authors, who emphasise that it can take these patients a year or more to adapt to this huge change in their circumstances.
“Our data show that, whatever the physical devastation and mental distress of [these] patients during the acute phase of the condition, optimal life sustaining care and revalidation can have major long term benefit,” they write. “We suggest that patients recently struck by [the syndrome] should be informed that, given proper care, they have a considerable chance of regaining a happy life,” they add.
And they conclude: “In our view, shortening of life requests … are valid only when the patients have been give a chance to attain a steady state of subjective wellbeing.”
***BMJ Open ” is an online-only, open access general medical journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or potentially low-impact studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.
BMJ Open aims to promote transparency in the publication process by publishing reviewer reports and previous versions of manuscripts as pre-publication histories. Authors are asked to pay article-processing charges on acceptance; the ability to pay does not influence editorial decisions.”
New research in the FASEB Journal suggests that a gene called CMAH has been lost during the course of recent evolution, and may lead to an increased risk of Type 2 diabetes in humans
From the February 25 2011 Eureka news alert
As if the recent prediction that half of all Americans will have diabetes or pre-diabetes by the year 2020 isn’t alarming enough, a new genetic discovery published online in the FASEB Journal. *** provides a disturbing explanation as to why: we took an evolutionary “wrong turn.” In the research report, scientists show that human evolution leading to the loss of function in a gene called “CMAH” may make humans more prone to obesity and diabetes than other mammals.
“Diabetes is estimated to affect over 25 million individuals in the U.S., and 285 million people worldwide,” said Jane J. Kim, M.D., a researcher involved in the work from the Department of Pediatrics at the University of California, San Diego in La Jolla, CA. “Our study for the first time links human-specific sialic acid changes to insulin and glucose metabolism and therefore opens up a new perspective in understanding the causes of diabetes.”
In this study, which is the first to examine the effect of a human-specific CMAH genetic mutation in obesity-related metabolism and diabetes, Kim and colleagues show that the loss of CMAH’s function contributes to the failure of the insulin-producing pancreatic beta cells in overweight humans, which is known to be a key factor in the development of type 2 diabetes. This gene encodes for an enzyme present in all mammalian species except for humans and adds a single oxygen atom to sialic acids, which are sugars that coat the cell surface.
To make their discovery, the researchers used two groups of mice. The first group had the same mutant CMAH gene found in humans. These mice demonstrated that the CMAH enzyme was inactive and could not produce a sialic acid type called NeuSGc at the cell surface. The second group had a normal CMAH gene. When exposed to a high fat diet, both sets of mice developed insulin resistance as a result of their obesity. Pancreatic beta cell failure, however, occurred only in the CMAH mutant mice that lacked NeuSGc, resulting in a decreased insulin production, which then further impaired blood glucose level control. This discovery may enhance scientific understanding of why humans may be particularly prone to develop type 2 diabetes. Results may also suggest that conventional animal models may not accurately mirror the human situation.
“The diabetes discovery is an important advance in its own right. It tells us a lot about what goes wrong in diabetes, and where to aim with new treatments,” said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal, “but its implications for human evolution are even greater. If this enzyme is unique to humans, it must also have given us a survival advantage over earlier species. Now the challenge is to find the function of CMAH in defending us against microbes or environmental stress or both. This evolutionary science explains how we can win some and lose some, to keep our species ahead of the extinction curve.”
Related articles and Web sites
- Food Processing and Obesity (education.com)
- How Can an Unhealthy Diet Cause Diabetes? (brighthub.com)
- Diabetes (MedlinePlus) has links to overviews, basic information, health check tools, research findings, reference materials, and more
Washington, DC — The U.S. Food and Drug Administration and Georgetown University Medical Center (GUMC) today announced a new partnership to stimulate innovation in regulatory science, ethics, education, and training. The partnership enhances the capabilities of both institutions to meet their common goal of improving public health.
“We are excited about this new partnership and the unique opportunities for supporting our goal of translating basic research discoveries into real world products that benefit patients and public health,” said Jesse Goodman, M.D., the FDA’s Chief Scientist and Deputy Commissioner for Science and Public Health. “By fostering interactions between FDA scientists and GUMC researchers, we believe that we can make major strides in achieving this goal. The FDA and GUMC share complementary expertise and a fundamental commitment to applying innovation to improving health in the U.S. and globally.”
Terms of the partnership are spelled out in a Memorandum of Understanding, signed earlier today, that supports a range of new activities including:
- Joint research and public health activities in areas such as novel technologies, public health preparedness, ethics, and bioinformatics
- Joint mentorship of doctoral and post-doctoral students in collaborative research relevant to FDA’s mission
- Scientific staff exchanges and professional development opportunities, including selected FDA staff serving as adjunct faculty in teaching and clinical activities at GUMC and selected GUMC staff participating in research and other activities with FDA
- Shared access to and development of important training and continuing education activities.
“Georgetown University Medical Center’s partnership with the FDA is backed by an outstanding cadre of scientists who all share a common goal of improving the lives of people around the world through robust research and its application,” said Howard Federoff, M.D., Ph.D., GUMC’s Executive Vice President of Health Sciences and Executive Dean of its School of Medicine. “It is at the heart of our mission to share our knowledge and expertise, and we welcome the many opportunities this new collaboration will deliver.”
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Georgetown Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO). In fiscal year 2009-2010, GUMC accounted for 79 percent of Georgetown University’s extramural research funding.
Study uses fMRI scans to attempt communication with severely brain-injured patients, suggests cognitive functioning may not be recognized at bedside
[Editors note: My great uncle was in a coma for 10 years. His wife insisted that he was aware of his surroundings to some degree and could hear her.
We all just smiled and yes, Aunt Jenny…even though we agreed amongst ourselves that she was mistaken..Now I think she was probably right to a great degree]
NEW YORK (Feb. 25, 2011) — Using a sophisticated imaging test to probe for higher-level cognitive functioning in severely brain-injured patients provides a window into consciousness — but the view it presents is one that is blurred in fascinating ways, say researchers at Weill Cornell Medical College in the Feb. 25 online edition of the journal Brain.
In a novel study of six patients ranging in their function from minimally conscious state to the locked-in syndrome (normal cognitive function with severe motor impairment), the researchers looked at how the brains of these patients respond to a set of commands and questions while being scanned with functional magnetic resonance imaging (fMRI).
They found there was a wide, and largely unpredictable, variation in the ability of patients to respond to a simple command (such as “imagine swimming — now stop”) and then using that same command to answer simple yes/no or multiple-choice questions. This variation was apparent when compared with their ability to interact at the bedside using voice or gesture.
Some patients unable to communicate by gestures or voice were unable to do the mental tests, while others unable to communicate by gestures or voice were intermittently able to answer the researchers’ questions using mental imagery. And, intriguingly, some patients with the ability to communicate through gestures or voice were unable to do the mental tasks.
The researchers say these findings suggest that no exam yet exists that can accurately assess the higher-level functioning that may be, and certainly seems to be, occurring in a number of severely brain-injured patients — but that progress is being made. [editors emphasis]
“We have to abandon the idea that we can rely on a bedside exam in our assessment of some severe brain injuries. These results demonstrate that patients who show very limited responses at the bedside may have higher cognitive function revealed through fMRI,” says the study’s corresponding author, Dr. Nicholas D. Schiff, professor of neurology and neuroscience and professor of public health at Weill Cornell Medical College and a neurologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
While progress has been made in elucidating the range of brain function in those who are severely injured, Dr. Schiff urges caution. “Although everyone wants to use a tool like this, fMRI is not yet capable of making clear measurements of cognitive performance. There will be a range of possible responses reflecting different capabilities in these patients that we have to further explore and understand,” he says.
The new study tested three levels of communication in steps that required increasing cognitive capacity, says Dr. Henning Voss, who is the study’s senior investigator and associate professor of physics in radiology at Weill Cornell Medical College. “While we could not unambiguously establish communication in these brain-injured patients, our research is helping us identifying problems specific to this patient population,” Dr. Voss says. “We got a clear picture about where and how to look for this kind of brain activity in response to certain commands.”
“Thousands of people suffer debilitating brain injuries every year, and there is a clear ethical imperative to learn as much as possible about their ability to communicate,” says the study’s lead author, Jonathan Bardin, a third-year neuroscience graduate student at Weill Cornell Medical College.
“These findings caution us against giving too much weight to negative results and open our eyes to the diversity of responses one might expect from the wide-ranging group of severely brain-injured people,” he says.
The potential implications of these kinds of consciousness studies are significant, says co-author Dr. Joseph Fins, the E. William Davis, Jr., M.D. Professor of Medical Ethics, chief of the Division of Medical Ethics, and professor of medicine, professor of public health, and professor of medicine in psychiatry at Weill Cornell Medical College. “Beyond facilitating communication with these patients, these studies should communicate to society at large this population is worthy of our collective attention.
“A vast majority of severely brain injured patients around the country are receiving substandard care because they are improperly diagnosed, not given adequate rehabilitation, and often end up in nursing homes. We all want this to change,” adds Dr. Fins, who is also director of medical ethics and chairman of the ethics committee at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
fMRI Reveals Consciousness’s Complexity
The Weill Cornell study is a continuation of research into how fMRI can establish a line of communication with brain-injured patients in order to understand if they can benefit from rehabilitation, and to gauge their level of pain and other clinical parameters that would improve care and quality of life.
Research collaborators in Cambridge, England, and Liege, Belgium, published earlier demonstrations in 2006 and 2010 that severely brain-injured patients could respond to commands or questions. The present studies extend the earlier findings and represent an important confirmation of such measurements by independent scientists.
In the current study, the dissociations observed and the wide range of communication capacities in the patient subjects studied provide unique insights. In the first step, the six patients, as well as 14 control participants, were asked a command that formed the basis for further communication. The control volunteers were asked to imagine performing their favorite sports, the patients to imagine themselves swimming.
Then, in the three patients who could do this, and in all of the controls, the researchers asked them to use the same imagined activity to respond to one or two options in a simple two-part question. In the third multiple-choice task, they were shown a face card from a deck of playing cards, then asked to respond when either the face or suit of the card was named.
The scans showed a number of “dissociations” in these patients — “surprising instances in which patients’ imaging responses diverged from their behavior,” Bardin says.
One patient could generate the mental imagery but not use it to answer questions — although he could communicate accurately with gestures. Another patient, who can speak, could not carry out the mental imagery task. A third patient who could imagine swimming on command showed dramatically varied brain response patterns when tested over time.
“The patients participating in this study often have multiple or widespread brain injuries affecting not only local brain areas but the whole brain network on a wide scale,” Dr. Voss says. “Even if we knew precisely all the injuries involved in a subject, our still-limited understanding of the brain networks involved in communication makes it impossible to accurately predict remaining cognitive and communicative skills in many cases. If there is no normal communication possible, fMRI can reveal cognitive capacities on several levels.”
“This is a reality check, in essence, because there is a wide range of cognitive abilities in these patients, and the implications on the extreme ends of the spectrum are important,” Dr. Schiff says. “There are people whose personal autonomy is abridged because they don’t have a good motor channel to express themselves despite their clear mind and opinions and desires about themselves and the world. And there are people who are without cognitive capacity, but because there is a misinterpretation of what is possible, there is a willingness to hold out hope.
“Not all minimally conscious patients are the same, and not all patients with locked-in syndrome are the same,” Dr. Schiff says.
Going forward, the research group, along with others in the field, is planning a major multicenter trial of fMRI along with European and Canadian colleagues supported by The James S. McDonnell Foundation to better understand both its promise and limitation in gauging cognitive abilities in severely brain-injured patients.
Adverse drug events costly to health care system: Vancouver Coastal Health-UBC research
Emergency department physicians call for screening tools
Patients who suffer an adverse medical event arising from the use or misuse of medications are more costly to the health care system than other emergency department (ED) patients, say physicians and research scientists at Vancouver General Hospital and UBC. Their research, the first to examine the health outcomes and cost of patient care for patients presenting to the ED with adverse drug events, is published today in the Annals of Emergency Medicine.***
The research team, led by Dr. Corinne Hohl, emergency physician at Vancouver General Hospital and research scientist with the Centre for Clinical Epidemiology and Evaluation at Vancouver Coastal Health and the University of British Columbia, studied the health outcomes of patients who had presented to the emergency department with an adverse drug event and compared them to patients who presented for other reasons.
An adverse drug event is an unwanted and unintended medical event related to the use of medications.
After adjustment for baseline differences between patient groups, researchers found no difference in the mortality rate of the patients they studied, but those presenting with an adverse drug event had a 50% greater risk of spending additional days in hospital, as well as a 20 % higher rate of outpatient health care needs. The team followed 1,000 emergency department patients from Vancouver General Hospital for six months.
This new research builds on a 2008 study, published in the Canadian Medical Journal, which showed more than one in nine emergency department visits are due to medication-related problems.
“What we are finding is that these incidents are common and costly, both in terms of patient health and utilization of health care dollars,” says Dr. Corinne Hohl. “We also know that these events are hard for physicians to recognize, and that nearly 70 percent of these incidents are preventable.”
In BC alone, hospital emergency departments treat an estimated 210,000 patients each year for adverse drug events. The most common reasons for them are adverse drug reactions or side effects to medication, non adherence, and the wrong or suboptimal use of medication. The research team estimates that the cost of treating these patients is 90% greater than the cost of treating other patients after adjustment for differences in baseline characteristics. The added cost could be as much as $49 million annually.
The research team has been developing screening tools to better assist health care providers in the emergency department in recognizing patients at high risk for adverse drug events, as well as developing an evaluation platform that will help inform prescribing practices for physicians in the community
“We anticipate the development of a screening tool will be able to increase the recognition rate of these adverse drug events from 60 to over 90 percent, and we will be able to treat the patient effectively and rapidly, improving his or her care,” says Dr. Hohl.
“Right now we spend a lot of time trying to diagnose what is wrong with the patient, yet often miss the fact that there is a medication-related problem. This means that patients often go home still on a medication which may be causing harm.” We are also using the data from this research project to help develop a new drug evaluation platform to inform prescribing practices for physicians in the community. The hope is to prevent many of these adverse events from even taking place.”###
Funding support for this research is through Vancouver Coastal Health Research Institute, the Michael Smith Foundation for Health Research, and the Department of Surgery at the University of British Columbia.
**Not at Web Site as of this posting
- Enhancing medication safety with computerized alerts (physorg.com)
- Americans and Canadians get different drug information online: UBC study (eurekalert.org)