Homing instinct applied to stem cells show cells ‘home’ to cardiac tissue

In a world first, scientists have found a new way to direct stem cells to heart tissue. The findings, led by researchers at the University of Bristol and published in Chemical Science, could radically improve the treatment for cardiovascular disease, which causes more than a quarter of all deaths in the UK.

To date, trials using stem cells, which are taken and grown from the patient or donor and injected into the patient’s heart to regenerate damaged tissue, have produced promising results.

However, while these next generation cell therapies are on the horizon, significant challenges associated with the distribution of the stem cells have remained. High blood flow in the heart combined with various ’tissue sinks’, that circulating cells come into contact with, means the majority of the stem cells end up in the lungs and spleen.

Now, researchers from Bristol’s School of Cellular and Molecular Medicine have found a way to overcome this by modifying stem cells with a special protein so they ‘home’ to heart tissue.

Dr Adam Perriman, the study’s lead author, Associate Professor in Biomaterials, UKRI Future Leaders Fellow and founder of the cell therapy technology company CytoSeek, explained: “With regenerative cell therapies, where you are trying to treat someone after a heart attack, the cells rarely go to where you want them to go. Our aim is to use this technology to re-engineer the membrane of cells, so that when they’re injected, they’ll home to specific tissues of our choice.

“We know that some bacterial cells contain properties that enable them to detect and ‘home’ to diseased tissue. For example, the oral bacterial found in our mouths can occasionally cause strep throat. If it enters the blood stream it can ‘home’ to damaged tissue in the heart causing infective endocarditis. Our aim was to replicate the homing ability of bacteria cells and apply it to stem cells.”

The team developed the technology by looking at how bacterial cells use a protein called an adhesin to ‘home’ to heart tissue. Using this theory, the researchers were able to produce an artificial cell membrane binding version of the adhesin that could be ‘painted’ on the outside of the stem cells. In an animal model, the team were able to demonstrate that this new cell modification technique worked by directing stem cells to the heart in a mouse.

Dr Perriman added: “Our findings demonstrate that the cardiac homing properties of infectious bacteria can be transferred to human stem cells. Significantly, we show in a mouse model that the designer adhesin protein spontaneously inserts into the plasma membrane of the stem cells with no cytotoxity, and then directs the modified cells to the heart after transplant. To our knowledge, this is the first time that the targeting properties of infectious bacteria have been transferred to mammalian cells.

“This new technique carries enormous potential for the seven million people currently living with heart disease in the UK.”

Dr Perriman’s UKRI Future Leaders fellowship is based on research funded by the Elizabeth Blackwell Institute-funded Catalyst project. He is also a member of the University’s BrisSynBio, a multi-disciplinary research centre part of the Bristol BioDesign Institute, that focuses on the biomolecular design and engineering aspects of synthetic biology.

Dr Perriman is well-known for his pioneering research on the construction and study of novel synthetic biomolecular systems for regenerative engineering.

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Story Source:

Materials provided by University of Bristol. Note: Content may be edited for style and length.

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Journal Reference:

1. Wenjin Xiao, Thomas I. P. Green, Xiaowen Liang, Rosalia Cuahtecontzi Delint, Guillaume Perry, Michael S. Roberts, Kristian Le Vay, Catherine R. Back, Raimomdo Ascione, Haolu Wang, Paul R. Race, Adam W. Perriman. Designer artificial membrane binding proteins to direct stem cells to the myocardium. Chemical Science, 2019; DOI: 10.1039/C9SC02650A

https://www.sciencedaily.com/releases/2019/07/190703121425.htm

4 surprising ways to get a sunburn, and 6 ways to treat it

When University of Alberta dermatologist Robert Gniadecki was growing up in Denmark, getting a sunburn was part of every family holiday.

“The first day at the seaside you would go out in the sunshine, and the next day you would have a bonfire, peel your skin off and throw it in the fire,” he said.

“It’s so disgusting, when you think about it today, but 40 years ago this was a normal thing.”

Gniadecki said these days most of us know that even a tan is a sign of skin cell damage, but sunburn still sneaks up on us from time to time. He shared four surprising ways people can get burned:

Foods that increase your UV sensitivity

Turns out “margarita sunburn” isn’t just a reference to what happens when snowbirds roast on Mexican beaches. There’s a naturally occurring chemical called furocoumarin in limes, some kinds of carrots, celery, dill and other plants that, when ingested, causes your skin to become more sensitive to the sun’s harmful rays.

“And of course people often fall asleep after having a couple of drinks, which doesn’t help either,” said Gniadecki. “A simple thing like sleeping in the sun is terribly dangerous.”

Unexpected weather changes

It even happens to dermatologists.

“I was on a rainy winter hike in the mountains,” Gniadecki said. “Then the clouds cleared and I was left on a snow patch with no protection.”

More UV than you realized

Most of us realize the sun’s rays are stronger at the equator than in our own backyard, and weaker at sunset than at high noon—it’s all about the angle of the sun. What we may not realize is how ultraviolet light is concentrated when we are on water, sand or even snow.

“People often think that in winter, because it’s cold and you don’t feel the warmth of the sun, you will never get a sunburn or you can tolerate more sun,” Gniadecki said. “You can actually tolerate less sun during the winter because of the reflection from the snow.”

He said that sun exposure is almost doubled in the snow, compared with being on grass, while sand reflects 15 to 20 percent more and seawater reflects 25 percent more UV than grass.

Sunscreen spread too thinly

Gniadecki said you need to apply enough sunscreen to create a sheen all over your skin. If you’re using sunscreen that contains titanium or zinc oxide, a white hue should be visible. Be sure to use a product with a sun protection factor (SPF) of at least 20, which lets through just 1/20th of the sun’s harmful rays. That means that if you would normally start to burn in 10 minutes, you can stay out in the sun for 200 minutes. But be realistic about how long your exposure will be, and reapply your sunscreen if you get wet.

“If you sweat a lot, some will wash away, and you can get a sunburn,” said Gniadecki.

He recommended avoiding sunscreens that contain oxybenzone, a common ingredient that was recently shown to be absorbed through the skin into the bloodstream. Gniadecki suggested using other products until the health effects of oxybenzone are better known.

Treating a sunburn

Gniadecki recommends staying away from household remedies—such as applying cooking oil or yogurt, or the Danish prescription of putting lemon slices on your skin—which are not only ineffective, but could also be harmful. He suggests the following steps instead:

1. Cool the skin with a damp cloth.
2. Apply a fragrance-free moisturizer or even an over-the-counter hydrocortisone cream.
3. Take oral ibuprofen. (Don’t use topical painkillers such as those branded with “caine.”)
4. Rehydrate by drinking lots of water.
5. If you have small blisters, apply a topical antibiotic to prevent infection.
6. See a doctor if you are vomiting or if large blisters develop a crust and are visibly infected.

“The short-term effects of sunburn are trivial and you can usually manage them at home,” said Gniadecki, who is also a member of the Cancer Research Institute of Northern Alberta. “But the long-term effects are serious.”

Sunburn, especially in childhood, causes permanent and irreparable damage to the skin that can develop into cancer 20 or 30 years later.

“The skin will remember forever,” said Gniadecki.

https://medicalxpress.com/news/2019-07-ways-sunburn.html

Sleep training for your kids

or thousands of years, mothers have sung lullabies to help their babies and children fall asleep. In more recent times, gadgets and devices have been invented and marketed to help the tired child – and weary parent.
One of these devices has been linked in recent years to the tragic deaths of 32 babies. Fisher Price recently recalled its Rock ‘n Play Sleeper after the deaths.
The popularity of the device and others shows the widespread desire for help getting babies and children to sleep. Consider that nearly 30% of young children experience sleep problems that warrant clinical attention.
As behavioral sleep medicine specialists, we completed postdoctoral training in assessment and treatment of behavioral sleep problems in children and teens. Our knowledge of pediatric sleep research suggests children won’t outgrow sleep problems, and sleep problems may even worsen over time. Yet children with sleep problems are not destined to be sleep deprived forever. There are sleep training methods for babies and young children that can work.

Sleep, my child … so I can, too

A mother rocks her baby to sleep. FamVeld/Shutterstock.com

We sleep doctors have seen that sleep problems correlate with a host of daytime problems, such as overactivity and attentional impairments, poor school performance, and excessive moodiness and irritability. As many as 20% of adults experience persistent insomnia, and many can trace their sleep problems to childhood.
The most common sleep problems in young children are difficulties falling asleep at bedtime, disruptive nighttime awakenings, or needing special conditions to fall asleep, such as the presence of a parent. These problems, in turn, are likely to cause parental stress and next-day impairments for the entire family.
People often equate sleep with “tiredness” and “fatigue.” In fact, sleep is its own process. It is an interaction of sleep-promoting brain chemicals and consistent daily rhythms of wake and sleep produced by bright light exposure in the morning. The bright light signals suppression of the sleep-promoting hormone melatonin.
Darkness, on the other hand, signals the brain via direct connection from receptors in the eye: “Produce melatonin; Go to sleep.” At the end of the day, there is nothing parents can do safely to make their children sleep. But there are many things parents can do to teach their children the skills necessary for good sleep.
Insomnia responds well to a number of behavioral treatment interventions.

From crying it out to teaching a skill

Timed checks on a baby can be more effective than constantly watching him or her. Elnur/Shutterstock.com

Many families have heard of the conventional “cry it out” approach – formally known as unmodified extinction. Although research supports the effectiveness of this method with infants and young toddlers, it is our clinical experience that few parents find this approach bearable. Furthermore, “cry it out” is not intended for use with older toddlers or preschool-aged children.
Instead, a method called graduated extinction is the mainstay of current behavioral intervention for bedtime resistance and sleep association problems. There are several approaches, used from toddlerhood through middle childhood, consisting of techniques such as timed checks, or the “walking chair.”
In timed checks, parents enter and exit the bedroom on a strictly timed schedule. This breaks the connection between problem child behavior, such as crying and calling out, and parental response.
The walking chair method involves the parent moving further and further from the child’s bed until outside the bedroom door and, eventually, back to the parent’s own bed. Our clinical experience is that sometimes a combination of these methods is needed.
Although these procedures emphasize the importance of limiting attention to problem behavior, they differ from unmodified extinction by providing attention for positive sleep behaviors, such as lying quietly in bed.
Consider a child who has a longstanding history of needing parental presence to fall asleep. The child can be said to have a skill deficit of being unable to fall asleep on her own. Learning to fall asleep can be likened to learning to ride a bike, first with training wheels, then without, and then without the parent steadying the handlebar. Little by little, the parent takes away her hand, and the child learns balance and eventually pedals away on her own.
With sleep training, the parent teaches the child to practice behaviors that are compatible with sleep, such as lying still and quiet in bed with their head on the pillow. When the parent enters the room every five minutes to say, “Good job staying in bed and lying so still” and offers a quick kiss and pat on the back, the child knows exactly what is pleasing to the parent. Once the child learns to lie quiet and still in bed, sleep physiology takes over.

Healthy sleep now, healthy sleep in adulthood

Many parents may incorrectly believe that sleep training is damaging to the parent-child relationship or attachment bond. In fact, we argue that healthy attachment bonds are formed by high rates of reinforcing parent-child interaction such as those used to teach behavior that is compatible with sleep.
Sleep training at younger ages may protect against more serious sleep problems later in life. For instance, at the onset of puberty, most teens experience a natural biological shift that causes them to prefer later bedtime and later wake time.
For most, this preference does not subside until young adulthood. If this natural shift in bedtime and wake time is paired with already problematic sleep habits learned in childhood, the results can be serious. Kids can get behind at school because they fall asleep in class, or they may become truant. Furthermore, when teens attempt to self-correct problem sleep schedules, they often find themselves unable to fall asleep easily at an appropriate bedtime. Many end up spending excessive time awake in bed, placing them at risk for chronic insomnia that could persist well into middle age.
So, that conversation that you are thinking about having with your child’s pediatrician: Have it. Your pediatrician also can help you decide when it might be time to seek specialty care with a behavioral sleep specialist or sleep medicine physician.
If your child doesn’t sleep, don’t lose hope. Change is possible. You already have taught and will continue to teach your child many important lessons in life. With persistence, good information and willingness to try new things, healthy sleep habits and a good night’s sleep are within reach.
https://theconversation.com/sleep-training-for-your-kids-why-and-how-it-works-117638

FDA thinks an Xbox game can stop kids smoking

Ninja / Twitter

The FDA is behind a horror video game designed to teach teens about the dangers of smoking. Inspired by the statistic that three out of every four high school students who start smoking continue on to adulthood, One Leaves sets players in a cell with three other teens. The free PC and Xbox One game’s objective is to escape the cell, but only one of the players will succeed. The game is being released as part of the FDA’s “The Real Cost” youth tobacco prevention campaign, which is aimed at youth who are 12 to 17 years of age.

The game’s heavy-handedness won’t be lost among its Gen-Z players. As you play the game, you encounter challenges that are also faced by smokers. You can run from the cell, but only in short bursts since your lungs are damaged by smoking. The smoke obscures your vision. The game is structured like a maze, which is meant to be a metaphor for quitting smoking. Much like in the game, quitters often fail and can end up right back where they started.

Anti-smoking and anti-drug campaigns targeting teenagers inspired a lot of eyerolls, and studies suggest they don’t always work and sometimes can have the opposite effect. The FDA is taking a more creative route with the grisly horror imagery of One Leaves, but it’s hard to believe that today’s teenagers are any less jaded than the ones of the past. And unlike yesterday’s youth, today’s teens face a new temptation in the form of e-cigarettes. According to the CDC, the number of high school students using tobacco increased by 38 percent in 2018, due to vaping.

But even if the game doesn’t convince players to drop smoking, One Leaves may still be a compelling distraction. The fact that film director Darren Aronofsky created the trailer doesn’t hurt. The FDA even scored the endorsement of popular Fortnite star Ninja, who tweeted out a playthrough of the game. With that kind of star power, maybe One Leaves will be better-regarded than most anti-smoking PSAs.

 YouTube ‎@YouTube

Ninja

@Ninja

Watch my playthrough of a NEW game called One Leaves! I swear it wasn’t scary at all…  https://youtu.be/3XK_SrgA8N0@KnowTheRealCost #OneLeavesGame #ad

1,074

2:08 PM – Mar 19, 2019

https://www.engadget.com/2019/03/20/fda-xbox-anti-smoking-game-one-leaves/

Netflix says its originals will kick their smoking habit

Future Netflix original shows rated TV-14 or lower and movies rated PG-13 or below will no longer include depictions of smoking or e-cigarette use, except in cases of historical or factual accuracy. The service will also avoid showing smoking or e-cigarette use in more adult-orientated projects “unless it’s essential to the creative vision of the artist or because it’s character-defining (historically or culturally important),” it told Variety.

“Netflix strongly supports artistic expression,” a Netflix spokesman said. “We also recognize that smoking is harmful and when portrayed positively on screen can adversely influence young people.” As part of its clampdown, Netflix will also reveal details about smoking in its ratings.

The move follows a report from anti-smoking group Truth Initiative, which states season 2 of Stranger Things had 262 depictions of smoking, up from 182 in the first season. To date, smoking has featured in every episode, the watchdog said. The report, coincidentally or not, dropped a few daysbefore Stranger Things season 3 starts streaming.

Truth Initiative claimed there was an uptick in smoking instances in recent seasons of some other Netflix originals that are popular among folks aged 15-24. Between seasons 2 and 3 of Unbreakable Kimmy Schmidt, depictions of smoking rose to 292 from nine. They jumped from 45 to 233 between seasons 4 and 5 of Orange is the New Black, the group claimed.

It also said 12 of the 13 overall most popular TV shows among that age group prominently feature smoking. Those include Amazon Prime Video’s The Marvelous Mrs. Maisel and Hulu’s Gap Year. Truth Initiative ranked the most popular shows among 15 to 24-year-olds based on 750 survey responses from people in that age group.

https://www.engadget.com/2019/07/03/netflix-originals-smoking-stranger-things-orange-is-the-new-black/

Can Stem Cells be Used to Treat Epilepsy?

Epilepsy is a neurological condition characterised by recurrent episodes of seizures. Most cases of epilepsy do not have a clear known cause, apart from susceptible genetic factors.
The primary pathogenesis of genetic forms of epilepsy is an abnormal expression of certain receptors in the brain that lead to an enhanced excitation and reduced inhibition. Some cases occur following oxygenation deprivation during birth.
Other later-life forms of epilepsy may be attributed to damage to the brain e.g. stroke, brain tumours, traumatic brain injury, drug misuse or a brain infection.
To date, there are several key treatment strategies to help people have fewer seizures. Predominantly, anti-epileptic drugs are used to treat the frequency and severity of epilepsy. However, these have to be taken routinely, and are not a long-term solution. They also have many undesired side-effects. However, anti-epileptic drugs may not work for everyone, therefore other treatments are used, including surgery and dietary modifications (e.g. keto-diet). Therefore, the need to find effective long-term solutions is needed to treat epilepsy.

 

What are Stem Cells?

Stem cells are cells that have the ability to develop into different specialised cell types of the body. Most cells in the body are post-mitotic, meaning they are unable to divide and grow into new types of tissues. However, stem cells are able to divide after periods of no apparent activity and are able to transform into different body cell types, including muscle cells, nerve cells and blood cells.

 

Stem cells therefore have the potential to be used in the treatment of many disorders where the normal body cells are dysfunctional or abnormal. This includes conditions where the body’s own cells begin to degenerate e.g. stroke, heart attacks, spinal cord injury and macular degeneration.
Traditionally, stem cells were only able to be isolated from embryos (animal and human) and some adult somatic stem cells, such as those found in e.g. bone marrow. However, due to advances in science and technology, adult cells taken from tissues such as e.g. skin, are now able to be reprogrammed into stem-cell like cells called induced pluripotent stem cells (iPSCs). These iPSCs may be able to function in very similar ways to those previously only obtainable through embryo donation.
iPSCs can be genetically manipulated to form a variety of different body cells e.g. neurons and muscle cells. However, much more work is needed before iPSCs can be used to replace dysfunctional cells within the body, though many advances have been made, especially in animal studies, including successful replacement of damaged heart cells with lab grown heart cells from the animals.

Can Stem Cells be Used to Treat Epilepsy?

As most cases of epilepsy can be attributed to receptor expression differences within the brain (due to mutations), correcting these may in theory reduce the likelihood of electrical seizures developing in the brain.
In addition, during status epilepticus, the excitation overload sometimes kills neurons, especially within the hippocampus. This can actually worsen the condition over time and lead to the development of temporal lobe epilepsy (TLE). Whilst anti-epileptic medication may treat the seizures, the damage caused to the temporal lobe is often irreversible and permanent, and current therapies do not address this.
As previously discussed, the reduction in inhibition in the brain, primarily due to loss of GABA-ergic interneurons, coupled with increased excitation of neurons, is key in the development of epilepsy including TLE.
Scientists therefore have speculated that enhancing inhibition by GABA-neurons may alleviate status epilepticus due to renewed inhibitory balance.
A study by Upadhya and colleagues (published in 2019 in PNAS); aimed to investigate whether iPSCs grafted into the brain of rats could reduce seizures and reverse damage in the hippocampus. They found that medial ganglionic eminence (MGE) cells derived from human-derived iPSCs, grafted into the hippocampus successfully reduced the frequency of seizures and reduced GABA-ergic neuronal loss.
Furthermore, there was an improvement to cognition and mood. Although this study was performed in rats, the implications of this research has far reaching potential to be used clinically.
Another study, a Phase I clinical trial in 22 patients, using autologous mesenchymal stem cells in epilepsy patients was shown to reduce overall seizure frequency (published in Advances in Medical Sciences by Hlebokazov and colleagues in 2017). Stem cells were obtained from patients’ own bone marrow, and administered intravenously and through a single injection into the spinal cord. After 1 year, 3 out of 10 patients achieved complete remission (no seizures) and another 5 patients that previously did not respond to drugs began to respond favourably. No side effects were observed in any of the patients.
This study is promising and showed a good safety profile for the patients. It appears that stem cells were associated with  alleviation of pathological hallmarks as well as the symptoms of epilepsy. Though this was only a Phase I trial with a very small cohort, additional controlled trials with placebos are needed in a larger cohort to make any definitive conclusions on the efficacy and safety.
In summary, stem cell based therapies, show promising results in the treatment of diseases including epilepsy. Animal and clinical studies have shown the remarkable efficacy of stem cells’ regenerative properties. However, larger clinical trials are needed before stem cell therapy can become routine. It is also expensive with therapies starting at around $5,000-$8,000 per treatment, though they can be as expensive as $25,000. In the UK, the NHS does not offer stem cell therapy routinely, only for a very small number of people in designated centres for diseases such as MS.
In the United States, the only type of stem cell therapy that has been extensively studied and approved for human treatment involves use of hematopoietic stem cells for patients with certain types of cancer.

Sources:

1. NHS.uk, 2019. Epilepsy. https://www.nhs.uk/conditions/epilepsy/
2. NIH.gov, 2019. Stem Cell Information. https://stemcells.nih.gov/info/basics/1.htm
3. Upadhya et al, 2019. Human induced pluripotent stem cell-derived MGE cell grafting after status epilepticus attenuates chronic epilepsy and comorbidities via synaptic integration. PNAS. 116(1):287-96. https://www.pnas.org/content/116/1/287.short?rss=1
4. Hlebokazov et al, 2017. Treatment of refractory epilepsy patients with autologous mesenchymal stem cells reduces seizure frequency: An open label study. Adv Med Sci. 62(2):273-279. https://www.ncbi.nlm.nih.gov/pubmed/28500900

https://www.news-medical.net/health/Can-Stem-Cells-be-Used-to-Treat-Epilepsy.aspx

Cutting opioid prescriptions by stopping pain before it starts

Doctors today are reducing their patients’ need for strong opioid medications after surgery by pre-treating patients with other pain relievers before they even enter the operating room.

While opioids relieve patients‘ pain and suffering, between 8% and 12% of those who take these drugs develop an opioid use disorder. At Keck Medicine of USC, health professionalsare part of a national mobilization effort to tackle the crisis at one of its sources: the doctors who prescribe the drugs.

How? By reducing the need for narcotics among patients undergoing operations.

“Our goal is to fight the opioid epidemic by decreasing the pain so patients need less opioids after surgery,” says Keck Medicine anesthesiologist Michael Kim. “After all, the best way to reduce opioid misuse is to avoid using them in the first place.”

Kim—an assistant professor of anesthesiology with the Keck School of Medicine of USC—and his colleagues lead Keck Medicine’s Enhanced Recovery After Surgery (ERAS) program. ERAS is a slate of nationally recognized practices that help patients recover well while simultaneously reducing the need for opioid medication. And the results are striking: Some surgical groups at Keck Medicine have slashed their opioid usage by 50 to 80% over the past year through ERAS.

Step 1: Start with Non-opioid Pain Medication

A growing body of research suggests that following a non-opioid pain medication protocol improves patient outcomes and speeds up recovery.

Carol Peden, professor of anesthesiology with the Keck School of Medicine, says, “prior to the current systemwide approach with ERAS, we had pockets of excellence with Keck Medicine surgeons using these techniques. Now we are systematically embedding this approach across service lines, so more patients benefit.”

When Peden saw her first patient treated with an ERAS approach, she couldn’t believe her eyes. “I walked in the morning after he had a major bowel resection, and he was sitting out of bed, alert and smiling,” says Peden, who has international experience with ERAS. The strategy is effective, in part, because the care starts before surgery: The patient and family are prepared and working with their health care team to meet common goals.

Here’s how it works:

Pre-treat the Pain Before Surgery

Research confirms that patients do better when they know what to expect, especially when pain is involved. Keck Medicine physicians develop a roadmap of patients’ health care from pre-op through recovery.

“Before they ever set foot in an operating room, patients know their projected length of hospital stay, their expected level of pain and how long it will take to get back to their usual activities,” Kim says. When surgeons make their first incision, the body reacts to the injury, initiating a reflex stress response. But under ERAS, doctors blunt that response by “pre-loading” patients with non-narcotic pain relievers, such as acetaminophen (Tylenol), gabapentin and non-steroidal anti-inflammatory drugs like ibuprofen, for up to three days before surgery.

They also educate patients to drink sufficient fluids, eat a healthy diet, exercise and avoid alcohol and smoking before surgery.

Fewer Medications During Surgery

Since patients receive some pain-relieving medication prior to surgery, doctors are able to use fewer medications during the procedure. In many cases, doctors also use local pain blocks to minimize pain during and after surgery to help relieve pain without making the patient feel groggy.

Guided Recovery After Surgery

Patients begin a regimen of non-opioid pain medication around the clock to help them meet targeted milestones after surgery. “Each patient gets a goal sheet with specific guidelines for when they should drink, eat and start moving,” says Kim. “The goals are designed to help them get well quickly and send them home without exposure to potentially addictive medications.”

Patients Feel Better

Traditionally, patients came out of surgery sleepy and needing strong painkillers. With ERAS, patients are alert, awake, comfortable and moving around within a few hours of surgery. Since rolling out ERAS in April 2018, Kim and his colleagues have seen these benefits:

• Significantly reduced opioid use

• Reduced rate of postoperative complications and readmissions

• Reduced average hospital stays by up to 21%

• Reduced variance in care

• Improved patient satisfaction

“The impact has been so dramatic it gives me chills just thinking about it,” Kim says. Cardiothoracic surgery patients are going home with minimal narcotics. Ear, nose and throat patients are spending less time in intensive care. And urology patients are getting their bladder catheters out two days earlier, he adds.

Who Practices ERAS at Keck Medicine?

ERAS is only effective when every person who has contact with patients knows the protocol, including schedulers, nurses, pharmacists, physical and occupational therapists, and nutritionists.

“This has been an incredible systemwide effort to give the patient the best experience possible,” Peden says. “We even have nurses who are coming in at 4 in the morning to ensure the night shift staff know the protocol.”

At USC, seven surgical groups currently follow the ERAS practices: cardiovascular, thoracic, colorectal and spine surgery; gynecologic oncology; otolaryngology; and urology. In the pipeline for 2019-20 are vascular surgery, orthopedic oncology, plastic surgery, bariatric surgery and liver/kidney transplant surgery. Within a few years, Kim projects that 60 to 70% of Keck Medicine operations will follow an ERAS protocol.

“The program is successful because health care professionals have come together as a team to deliver this incredible care. The team sees visible improvement in their patients. They are much more alert and comfortable, and they get out of the hospital more quickly,” Kim says. “We’re enhancing recovery for patients, and in the process, actively fighting the opioid epidemic from the front end by decreasing the patients’ need for narcotics.”

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Opioid use down with ‘enhanced recovery after surgery’ program

https://medicalxpress.com/news/2019-07-theyre-opioid-prescriptions-pain.html