Active surveillance is safe for prostate cancer at low risk

Active surveillance is safe for prostate cancer at low risk - Active surveillance is becoming a widely adopted alternative for some men with prostate cancer.  

Instead of immediate treatment, men on active surveillance are monitored with periodic biopsies, physical examination and specific tests for prostate antigen (PSA) prostate. Treatment begins only when the cancer shows signs of progression.

But it is safe to wait until then? A new study adds to the growing evidence that the answer is yes, but only for men whose cancers are divided into favorable risk categories.

The study is based on data collected at Johns Hopkins Hospital in Baltimore, Maryland, the site of an active long-term monitoring program. The authors studied nearly 1,300 men who were enrolled in active surveillance between 1995 and 2014.  

Most of the men had "very low-risk cancer," which means their PSA levels were too high at diagnosis and only small amounts of low-grade cancer was found in a maximum of 2 nuclei in a standard 12-core biopsy. The rest was a category of "low risk", which means that the low-grade cancer was detected in no more than 5 cores.

The men averaged 66 years old at diagnosis. At the time of analysis, 49 men were dead was complete, but only two of them for prostate cancer. The rates of specific cancers in the categories of both low-risk and low-risk combined survival exceeded 99% in both 10 and 15 years of follow up, and the predominant cause of death was by far heart disease.

"These results confirm that men with a favorable risk of cancer should be encouraged to consider active surveillance instead of treatment given the low probability of damage diagnosis," said Dr. Jonathan I. Epstein, professor of pathology, Urology and Oncology, Johns Hopkins Hospital, who led the study.

It is important to note that prostate cancer may worsen active surveillance. During this study, 22% of very low risk men and 31% of low-risk people may need treatment within 15 years. But the processing time began, men were under active surveillance for an average of 8.5 years.

"The very low risk men clearly are the best candidates for active surveillance," said Epstein. "But in the case of cancer, and even low-intermediate risk, health problems and other seniors can increase eligibility."

Epstein added that some men may feel strongly that they do not want to live with cancer, which can lead to opt for active surveillance in favor of treatment. "We try to think of strategies to help these men stay on track," he said.

"The study adds important information about the growing practice of active monitoring of certain populations of men," said Dr. Marc Garnick, Gorman Brothers professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center and Editor Chief of the Harvard Knowledge.org prostate. "

But we must also keep in mind that we have no evidence of survival benefit with treatment pro men at risk, or when they are diagnosed or when cancers progress through active surveillance. The benefits of treatment are difficult to not prove the risk of prostate cancer is generally favorable life threatening over the expected life of a man. "
By: Charlie Schmidt 

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Healing through Music

Healing through Music - The last time I had a mammogram, I have a big surprise - and it was good.  

A string quartet played just outside the gates of breast imaging center, and immediately changed my thoughts "What will they find mammography?" A "Do Schubert or Beethoven?" For when my name was called, he had almost forgotten why I'm here.

The concert was an unexpected work Chartrand and Holly Lorrie Kubicek, therapists and co-coordinator of the Environmental Music in Massachusetts General Hospital. But bring music into hospital rooms is a complementary activity for music therapists. Most of his time is devoted to the use of music to help patients to achieve specific objectives, such as the recovery of their speech after a stroke and reduce the stress of chemotherapy.

Chartrand is a singer and a graduate of the Berklee College of Music. He decided to become a therapist to music when he realized he could use music to help others as he had supported all his life. "The favorite part of my job is to see how big an impact music can have on someone who is not feeling well," she said.

What is music therapy?

Music therapy is a growing field. These certificates are therapists are accomplished musicians who have a deep understanding of how music can evoke emotional responses to relax or stimulate people, or help them heal. Combine this knowledge with his familiarity with a wide variety of musical styles to find the specific type that you can get through a difficult physical rehabilitation session or will guide you in meditation. And they can find their favorite music style, or electro pop and grand opera.

Music therapists know few limits. They can play music for you or with you, or even teach you how to play an instrument. On any given day, the tank can Chartrand carrying a drum, a ukulele or iPad and speakers in the room of a patient. "Technology gives us both access to all types of music that can find and read almost any type of music you like," she said.

Proof of music therapy

A growing body of research shows that music therapy is most appreciated. It can improve the performance and quality of life health in a variety of ways. Here is an example:

Improved invasive procedures. In controlled clinical trials of people with colonoscopies, cardiac angiography and knee surgery, listening to music before your procedure had reduced anxiety and a reduced need for sedatives. Those who listened to music in the operating room reported less discomfort during the procedure. Listening to music in the recovery room under the use of opioid analgesics.

Restore lost his speech. Music therapy can help people who are recovering from a stroke or head trauma that damaged the left area of ​​the brain responsible for speech. Because singing ability comes from the right side of the brain, people can avoid the injury on the left side of his brain thought of singing first and then gradually release the melody.  

Former Congresswoman Gabby Giffords uses this technique so that you can testify before a congressional committee two years after a gunshot wound in his brain destroyed his ability to speak.

Reducing side effects of cancer therapy. Music reduces anxiety associated with chemotherapy and radiotherapy. You can also relieve nausea and vomiting in patients receiving chemotherapy.

AIDS pain relief. Music therapy has been tested on patients from those suffering from severe acute pain in people with chronic pain of arthritis. In general, music therapy reduces the perception of pain, reduces the amount of necessary drugs against pain, helps relieve depression, and gives people a greater sense of control over their pain. 

Improving the quality of life for dementia patients. Because of the ability to interact with the music it remains intact until the disease process, music therapy can help you remember the memories, reduce agitation, communication aid, and improve physical coordination.
 
How to find a music therapist

If you face a procedure or disease, or just want relief from stress of everyday life and helps to stick to an exercise program of a music therapist may be able to help. You can find one on the website of the American Music Therapy Association. 
By: Beverly Merz 
 

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Cognitive behavioral therapy online: The latest trend in mental health care

Cognitive behavioral therapy online: The latest trend in mental health care - What if you can get it offers without seeing a psychologist? Many people appreciate the warm relationship, the care provided by a doctor of mental health, but others simply want to improve.  

Many people prefer not open to someone about your problems - at least not in person. Also, see a mental health doctor can be embarrassing and expensive - and it might even be closer.

One of the new frontiers of psychotherapy is the use of the Internet to provide cognitive behavioral therapy (CBT) for depression, anxiety and other mental health problems in a way that reduces - or sometimes eliminates - the amount of time spent with physicians in person.  

This delivery method allows new treatments that have been traditionally offered one-on-one to be extended so they can reach many more people. After all, no matter if it is a good treatment if people can not access them.

What are these therapies online?

The field is new, so that data on these online programs are rare - but a team of British researchers recently conducted a review of the available literature. For the review, which toured the medical journals for studies "John Henry" - that is, by comparing the actual software therapy or cognitive behavioral websites that provide treatment for anxiety or depression.

What did the researchers find? They used a rigorous scientific bar and found only five mental health interventions were online compared directly with doctors live offer the same treatment to adults of working age. Two interventions were from Australia and three were Swedish, and all were for social anxiety or panic disorder.

Most online interventions studied by the researchers were divided into sessions, reflecting how CBT delivered in person on a weekly basis. All treatment therapies offered online through written content, also known as "bibliotherapy." This was combined with communication with a mental health clinician, usually a psychologist, on e-mail or mail systems. 

In one study, psychologists were limited to spending only 10 minutes a week to each participant. Some programs add text messages and discussion forums, and most include tasks - things that made participants between sessions - in person as CBT involves practices between sessions.

All treatment groups, in person and online CBT significantly improved symptoms. One study showed better results for online processing, and similar results were found between the two types. Online treatments takes time and much less clinical, making them more profitable.

Does the floor? Any line treatment of participants needed to do a lot of reading, which can be a limiting factor for some people. In addition, written with a psychologist or other clinician interaction of any intervention he was online in this review.  

This means that, to a certain extent, the efficiency of the operation still depends on the physician at the other end. In addition, require physicians to participate at all creates a barrier to the expansion of treatment to achieve a massive number of people.

The latest innovations in a very new area

New programs online and mobile applications emerge that minimize the amount of reading, video and audio use to provide treatment and do not require clinical intervention at all. These simulate live TCC, but can be delivered to a large number of people.  

Direct comparisons of these new programs with traditional therapy (the type of comparison that meet the criteria of the British team) has not yet been published. So stay tuned for the evolution of this new generation of the administration of treatment.
By:  James Cartreine, PhD.

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Complementary therapies for neck pain

Complementary therapies for neck pain - May have escaped, but the neck is an amazing thing. At the top, which has a cage-hard rock - the cervical vertebrae, which contains and protects the top of the spinal cord, which connects the brain to the rest of your body.  

Nevertheless, the neck is completely mobile, allowing you to turn the corner and nods. Then there are the blood vessels, the esophagus, trachea, thyroid, and (among other structures). And, of course, day after day, neck worn around the equivalent of a bowling ball - 11 pounds skull and its contents. It is no wonder, then, that sometimes the neck becomes painful.

Business Neck Pain  

For many people with neck pain, it is much more than a "pain in the neck." It is the leading cause of doctor visits and disability. The improvement may be slow. In many cases, there is no single treatment uniformly successful. (Long term) Chronic neck pain is a painful condition for millions of people worldwide.

Many causes pain

Neck pain is not a disease. It is a symptom, and a number of conditions that can cause. Some of the most common causes are:

       *  muscle strain or spasms
       *  discopatía
       *  arthritis
       *  a wound

In many cases, however, the precise reason for neck pain can not be identified. Add to this the fact that the treatments do not always work well, and work fast, and can be a very frustrating problem.

That is why the results of a new study are so encouraging - and potentially important.

Complementary therapies for neck pain 
Research published in the latest issue of the Annals of Internal Medicine compared two alternative approaches to the treatment of chronic neck pain with the results of standard care. The researchers randomly divided the patients with neck pain into three treatment groups:

    *  "The usual treatment." This includes treatments commonly recommended by doctors in primary care, such as medication and referral to a physiotherapist.

    *  Acupuncture. These patients received usual care, more than 12 acupuncture sessions over five months.

    *  Alexander Technique. The usual care group received 20 training sessions over one by one toward the Alexander technique, a self-care approach that emphasizes "self-observation and subtle behavior change" of to monitor response to pain and improve how daily activities are performed life.

Of course, there are warnings 
Before declaring victory over neck pain, it is worth mentioning some important limitations of this research. They understand:

     *  More than half of patients with neck pain originally considered for the study were excluded. The most common reasons for exclusion were the presence of only a slight pain, neck pain causes "serious" (such as rheumatoid arthritis), or previous surgery

     *  Differences in the degree of improvement between the three groups was rather modest. For example, with respect to symptoms initially, there was a 32% improvement in pain score with acupuncture, 31% with the Alexander technique, and 23% for usual care.

     *  These study subjects were highly motivated to enroll in a clinical trial that requires a good amount of time and commitment.

     *  These treatments require not only a large time commitment, but outside of clinical trials can be expensive.

     *  We do not know whether the benefits go beyond a year.

What the results for people suffering from neck pain mean? 
Even with the encouraging results of this study, we need better treatments for neck pain and why they work. For example, observed improvements in acupuncture and Alexander Technique groups could be due to the placebo effect. Many chronic pain significantly improve with lots of personal contact between patients and professionals and an expectation of improvement, which are both key acupuncture and Alexander technique throughout. 

If only these two features - unlike the actual interventions - could explain the findings of this study, which means that we must find ways to exploit this effect so that more people can benefit. Finally, future research may yet prove better results with a combination of acupuncture, Alexander Technique lessons, and other non-pharmacological approaches.

Given the amount of stress we put on our necks is neck pain may never be completely eliminated. Therefore, we must be open to any new approach is safer and better than what we already have.
By: Robert Shmerling, M.D. 
 

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Incredible and true: the placebo effect

Incredible and true: the placebo effect - The placebo effect is a mysterious thing. I have always been fascinated by the idea that something so inert and harmless as a sugar pill can ease the pain of a person or speed recovery with only the hope that it would.

Studies using placebo - an inactive treatment such as a sugar pill - in an attempt to understand the true impact of the active substance.

Comparing what happens to a group of patients taking the active drug with the results of those taking a placebo may help researchers understand how good is the active drug.

The word "placebo" comes from Latin and means "I will please." And "please" did. In study after study, many people taking a placebo improved program in your symptoms or condition.

The placebo effect is real

Recent research on the placebo effect only confirms how powerful it can be. - And the benefits of treatment with placebo are not just "in your head" measurable physiological changes can be observed in those who received placebo, similar to those seen in people who take drugs effective. in particular, blood pressure, heart rate, and blood test results were shown to improve subsets of research subjects who responded to placebo.

Of course, not everyone has a therapeutic response to a placebo. If that were the case, we would not need medication at all. Instead, we just could exercise the power of suggestion. Understanding why some people improve with placebo treatment and others are not the "holy grail" of research placebo.Nocebo: Placebo evil twinThe power of suggestion is a double edged sword. If you plan a treatment to help you, they are more likely to do so. And if you expect to prejudicial treatment, it is more likely to feel the negative effects. This is called "nocebo effect" (Latin for "I will harm").  

For example, if you tell someone that a headache is a common side effect of a particular drug, that person is more likely to report headaches, even if they are actually taking a placebo. The power of expectation is great and probably plays an important role in the benefits and side effects of commonly prescribed drugs.

It is the power of the placebo effect increases?

A new fascinating study examined the impact of the placebo effect in 84 trials for treatment of nerve pain that occurred over the last 23 years. The researchers found that the placebo effect has become much stronger, but this observation was seen in US studies.  

What for? One theory is that the flow of direct to consumer advertising of drugs in the United States (which is banned in most other countries) raises expectations of a drug to help patients. Stronger and expectations of a drug can lead to a greater placebo effect efficiency.

Another theory links the increased effectiveness of placebos to test their own research: the largest, most expensive and most elaborate judgment, plus expectations of study participants. Analyses of this type tend to be more common in the US than elsewhere.

Whatever the reason, there is a downside to this trend. A powerful placebo effect makes it more difficult for the researchers show that a new drug works. The stronger the placebo effect, it becomes more difficult to show a significant difference between the placebo and active drug - even if the active drug is quite good. Consequently, some effective drugs can "fail" in clinical trials. And that could lead researchers to spend their education outside of the US

What future?

Research on the pros cons of the placebo effect has changed the number of people think about this phenomenon. We used to think that the placebo effect is limited to those influenced disease-free "real"; Now we know better. But there is much that remains a mystery. We do not know how to predict who will respond to a placebo or how to reliably operate their power.  

And it is important to note that while "feeling better" is important, they do not always come with genuine health benefits. For example, some study subjects who took a placebo for asthma reported improvement of their symptoms but their lung function measures are not really better.

Yet the day will come when a better understanding of the placebo effect and, in appropriate circumstances, which are used effectively in clinical practice. Like many people either do not respond to standard medications or have unpleasant side effects, that day can not come soon enough.
By: Robert Shmerling, M.D.

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Challenge your mind and body to hone their thinking skills

Challenge your mind and body to hone their thinking skills - My friend Betty is one of the most impressive elders that I met him. At 88, her voice is strong and his heart is young, and it seems to have so much energy and enthusiasm as he did in 1982 when I met her. It exercises, friends, gardens, to pay their own bills, follow the news, and is constantly reading and ask questions. How do you stay so strong? "I guess I'm just a curious person, boy," he laughs.

But living there how Betty - always learn new things, and keep busy with friends and favorite activities - is exactly what experts say can help keep our skills sharp thinking. "Cognitive and social commitment demonstrated a protective effect against cognitive decline, while the loss, depression and social isolation of hearing is associated with cognitive impairment," says Dr. Kathryn Papp, a neuropsychologist and professor of neurology at Harvard Medical School.

How it works?
Dr. Papp said he does not know the exact reasons for the mental and social engagement, protecting our thinking abilities, but we have some ideas. "Until the 1990s, we thought that people are born with however many brain cells die with now know that new cell growth. - A process called neurogenesis - occurs throughout life, even in Does old age, "says.

It turns out that the human brain has great potential for something called neuroplasticity, or in other words, being very malleable. It seems to challenge our brain - for example, by learning a new skill - leading to real changes in the adult brain. "You can create new connections between brain cells by altering the balance of neurotransmitters available and change how to make connections," says Dr. Papp.

Being socially engaged can help repel social isolation and depression, both of which have been linked to decreased cognitive functioning in the future. Having good social support also reduces stress, another thing that we know that this has a negative impact on thinking skills.

Other factors 
A healthy lifestyle is also associated with neurogenesis, including getting enough sleep, avoid overeating, and the big boss of all: exercise. "The researchers found that physical exercise leads to the release of cellular growth factors that are important to neurogenesis," says Dr. Papp.And this combination of growth and new brain cells factors that come from a healthy, stimulating the brain, and stay connected socially in a meaningful way can actually help protect the brain and keep it more resistant to changes that cause dementia.

Start your engine 
What is the best way to speed up your thinking skills? Start with mini-challenges for the brain:

 *   Brush your teeth with the hand not commonly used.
 *   Take a different route or shop work.
 *   Eat a piece or two dinner with eyes closed.
 *   Listen to a new type of music.
 *   Do jumps 60 seconds (or any physical activity).
 *   Sit in a different place in your home or at a favorite restaurant."This requires the brain to do a job because it clashes with something you have not experienced before," says Dr. Papp.

You can also search for activities that integrate brain stimulation, physical activity, and social commitment, such as:

*   learn to play a sport or game (tennis, table tennis, golf)
*   learn to dance (try the cha-cha, rumba and merengue)
*   take a class by planting flowers or vegetables
*   learning tai chi, which has been shown to increase thinking skills.

If physical activity is not possible, consider taking a class in

*   painting (watercolors start, then switch to oils)
*   piano, flute, guitar or
*   write stories (or memories)
*   Computers
*   flower arrangement
*   hosiery (useful for Christmas presents!)
*   a new language.

Or you can participate in any new activities that you find interesting, such as:

 *   Volunteer at a local charity
 *    explore a new city
 *    join a book club
 *    try a new restaurant or new types of foods
 *    become a museum of education
 *    helping at a local school or daycare
 *    join a club collector (Dolls, stamps, souvenirs). 

"The best activities are those that are nice," says Dr. Papp. And just as it is important to stick to a diet medications or exercise, should take a model to always learn, as my friend Betty, to reap the benefits. "I like to ask questions and hear the stories of people," he said. "I never want to stop learning."

She would have made a great reporter, that one. But I'm glad I can be the one to share the news flash here, which is that staying mentally sharp decline in the use of your brain and your body, whatever your age.
By: Heidi Godman

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