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Vol. LX, No. 22
October 31, 2008

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Shown at Harvard University
Whether to stop life support measures all at once or discontinue them one at a time can affect how surviving family members rate care in the intensive care unit.

Timing Key for Families in Life-Support Decisions

Whether to stop life support measures all at once or discontinue them one at a time can affect how surviving family members rate care in the intensive care unit, according to a paper in the Oct. 15 issue of the American Journal of Respiratory and Critical Care Medicine. ICU clinicians often care for patients who are on several life-support measures at once. When such patients are dying and the decision is reached to withdraw life support, these clinicians must balance the complex needs of the patient and the patient’s family. A study funded by NINR found sequential withdrawal may have a varying impact on the family’s satisfaction with ICU care. Researchers looked at the life-support withdrawal process for 584 patients who died in the ICU. Family members were asked their perceptions of the care provided. Included in the study were such life-support measures as mechanical ventilation, tube feedings and dialysis. Family members of patients who had a short ICU stay reported lower satisfaction with the ICU care if the withdrawal process was extended over more than 1 day. However, for family members of patients who had a long ICU stay (8 days or more), satisfaction with care increased with a more extended withdrawal. Investigators had theorized extending the process would lower satisfaction among all families: drawing out the process is unlikely to help the patient, because it prolongs non-beneficial and sometimes painful therapies.

Paralyzed Limbs Move via Artificial Brain-Muscle Connections

Researchers with funding from NINDS and NCRR have shown for the first time that a direct artificial connection from the brain to muscles can restore voluntary movement in monkeys whose arms have been temporarily anesthetized. The results, published online Oct. 15 in Nature, may hold promise for people affected by spinal cord injuries and paralyzing neurological diseases, although clinical applications are years away. In the study, investigators trained monkeys to control the activity of single nerve cells in the motor cortex, an area of the brain responsible for voluntary movements. Neuronal activity was detected using a type of brain-computer interface. In this case, electrodes implanted in the motor cortex were connected via external circuitry to a computer. The neural activity led to movements of a cursor as monkeys played a target- practice game. After each monkey mastered control of the cursor, researchers temporarily paralyzed the monkey’s wrist muscles using a local anesthetic to block nerve conduction. Next, scientists converted the activity in the monkey’s brain to electrical stimulation delivered to the paralyzed wrist muscles. The monkeys continued to play the game—only now cursor movements were driven by actual wrist movements—demonstrating they had regained the ability to control the otherwise paralyzed wrist.

More Effective Treatment Identified for Common Childhood Vision Disorder

Scientists have found a more effective treatment for a common childhood eye muscle coordination problem called convergence insufficiency (CI). For words on a page to appear in focus, a child’s eyes must turn inward, or converge. In CI, the eyes do not converge easily and as a result additional muscular effort must be used to make the eyes turn in. While the majority of eye care professionals treat children diagnosed with CI using some form of home-based therapy, a new study concludes that office-based treatment by a trained therapist along with at-home reinforcement is more effective. The research, reported in the Oct. 13 issue of Archives of Ophthalmology, was funded by NEI. The 12-week study found that approximately 75 percent of those who received in-office therapy by a trained therapist plus at-home treatment reported fewer and less-severe symptoms related to reading and other near work.

New Genes Linked to Gout

Researchers have identified two new genes—and confirmed the role of a third gene—associated with increased risk of higher levels of uric acid in the blood, which can lead to gout, a common, painful form of arthritis. Combined, the three genetic variations were associated with up to a 40-fold increased risk in developing gout. The findings suggest that genetic testing could one day be used to identify individuals at risk for gout before symptoms develop, as well as determine who might benefit from medications to prevent gout’s development. Published Sept. 30 online in The Lancet, the study was supported by NHLBI, NCRR and the NIH Roadmap for Medical Research.—

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