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April 16, 2014

In Research

Like hand-washing, blood transfusions linked to infections

blood bags

Blood transfusions are among the most common treatments for hospitalized patients nationwide, but doing them less often reduces infection rates by nearly 20 percent, according to a study in the Journal of the American Medical Association coauthored by Neil Blumberg, professor of pathology and laboratory medicine at the School of Medicine and Dentistry.

As director of transfusion medicine and the blood bank at UR Medicine, Blumberg for more than 25 years has been investigating how to make blood transfusions safer. The latest study is the first to show conclusively, through a study of 18 randomized clinical trials involving 8,735 patients, that fewer transfusions save lives, he says.

He compared the sea change that’s occurring in transfusion medicine to the 19th- and 20th-century recognition that hand-washing reduces infections.

“Many people are beginning to accept that we can make a difference—despite being taught in medical school that blood transfusions ‘might help and can’t hurt,’” Blumberg says. “What we’ve found is actually the opposite, that it can hurt and it rarely helps.”

Prior studies suggest that when donor blood is introduced into a patient’s body, it suppresses certain immune functions, particularly the cells that fight infection. However, the exact mechanism of action is not clear, Blumberg says. Read more at www.urmc.rochester.edu/news.

Study: Device saves lives in heart failure patients

A new study shows for the first time that cardiac resynchronization therapy with defibrillator (CRT-D therapy) saves the lives of mild heart failure patients over the long term.

The study was presented at the American College of Cardiology’s 63rd Annual Scientific Session in Washington, D.C., and published simultaneously in the New England Journal of Medicine. It found, after seven years, that the likelihood of death was 18 percent among patients with mild heart failure and a common condition called left bundle branch block who received CRT-D therapy. Among patients with the same condition who received a defibrillator only, the likelihood of death was close to 30 percent. Left bundle branch block results in disorganized electrical activity throughout the heart. 

The finding translates into a 40 percent reduction in the risk of death long-term among patients who received CRT-D therapy.

The study is a follow-up to the MADIT-CRT trial, which showed that early intervention with CRT-D therapy in mild heart failure patients with left bundle branch block led to a significant reduction in heart failure, such as being hospitalized with heart failure symptoms, for more than two and a half years. Study authors believe that the decrease helped patients live longer during long-term follow-up.

“With cardiac resynchronization therapy we have the ability to slow the progression of heart failure, reduce death, and increase the life span of patients,” says Arthur Moss, professor of cardiology at the School of Medicine and Dentistry. Moss has led the MADIT (Multicenter Automatic Defibrillator Implantation Trial) series of studies since 1990. Read more at https://www.urmc.rochester.edu/m/news/story.cfm?id=4038.

Improving outcomes for urban teens with asthma

n article published in February’s Journal of Asthma, authored by Susan Blaakman, associate professor of clinical nursing, has identified some potential ways to improve the outcomes of city teens with asthma by taking a novel approach—asking the teens themselves.

“Urban minority teens face one of the highest risks of being hospitalized and dying from asthma,” says Blaakman. “We need to gain a deeper understanding of the reasons why, so that we can more effectively help them control it and prolong their lives. It seems like common sense, but there are very few studies that explore this issue purely from the perspective of students.

Blaakman’s article, “Asthma Medication Adherence Among Urban Teens,” analyzes student responses that were collected during a 2009–10 pilot study at four Rochester city high schools. Jill Halterman, co-vice chair for research in the Department of Pediatrics, was principal investigator on the study. School of Medicine and Dentistry student Alyssa Cohen also collaborated and conducted the qualitative data analysis.

Even though persistent asthma can be successfully controlled through the routine use of a corticosteroid inhaler at home or under the supervision of a school nurse, there are many reasons why urban teens might neglect to take their medications before or during a busy school day, says Blaakman.

In the study, some described difficulty getting to the nurse’s office at their scheduled time because they didn’t want to fall behind in their classwork or miss a favorite class, or they simply felt too busy in their school day. Difficulty obtaining hall passes, competing social pressures, and lengthy distances to the nurse’s office were other challenges that teens noted, she says. Read more at https://www.urmc.rochester.edu/news/story/index.cfm?id=4044.

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