CHICAGO—Even though the recommended interval for repeat screening flexible sigmoidoscopy (FSG) after a negative examination is five years, new research shows that a repeat FSG at three years will detect some advanced colon polyps and colon cancer, according to an article in the July 2 issue of The Journal of the American Medical Association (JAMA).

Robert E. Schoen, M.D., M.P.H., of the University of Pittsburgh Cancer Institute, University of Pittsburgh, and colleagues examined the number of adenomas and cancerous lesions in the distal colon (the lower portion of the colon) found by repeat FSG 3 years after a negative examination. Most adenomas, also known as polyps, are small, benign tumors. However, adenomas can be advanced, large, or have changes in cellular makeup and give rise to colorectal cancers.

Participants for the study were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a randomized, controlled community-based study of cancer screening. The average age was 65.7 years at study entry (1993-1995) and 61.6 percent were men. Individuals underwent screening FSG at baseline and at 3 years. Of 11,583 eligible for repeat screening FSG 3 years after an initial negative examination, 9,317 (80.4 percent) returned.

The researchers found that a total of 1,292 returning participants (13.9 percent) had a polyp or mass detected by FSG 3 years after the initial examination. "In the distal colon, 3.1 percent (292/9,317) were found to have an adenoma or cancer. The incidence of advanced adenoma (n = 72) or cancer (n = 6) in the distal colon was 78 (0.8 percent) of 9,317. Of individuals with advanced distal adenomas detected at the year 3 examination, 80.6 percent (58/72) had lesions found in a portion of the colon that had been adequately examined at the initial sigmoidoscopy," the authors write.

CHICAGO—The use of feeding tubes among nursing home residents with severe cognitive impairment is common and is associated with patient characteristics as well as nursing home-related factors, according to a study in the July 2 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, "A growing proportion of the approximately four million older U.S. adults with Alzheimer disease or other dementias are now surviving to the advanced stages of their illnesses. Eating and swallowing problems typically develop during the terminal stages of dementias. … The widespread use of feeding tubes among older persons with advanced cognitive impairment in the United States is concerning amid growing empirical data and expert opinion indicating that feeding tube use has no demonstrable health benefits in this population and may be associated with increased risks and discomfort," the authors write.

Susan L. Mitchell, M.D., M.P.H., from Beth Israel Deaconess Medical Center, Boston, and colleagues examined how patient factors and facility characteristics are associated with feeding tube use among severely cognitively impaired older persons in U.S. nursing homes. The authors analyzed data from 186,835 individuals with advanced cognitive impairment who resided in Medicare- or Medicaid-certified U.S. nursing homes in 1999.

"Thirty-four percent of residents with advanced cognitive impairment had feeding tubes (n = 63,101)," the authors report. "Resident characteristics associated with a greater likelihood of feeding tube use included younger age, nonwhite race, male sex, divorced marital status, lack of advanced directives, a recent decline in functional status, and no diagnosis of Alzheimer disease."

The authors continue, "Controlling for these patient factors, residents living in facilities that were for profit, located in an urban area, having more than 100 beds and lacking a special dementia care unit had a higher likelihood of having a feeding tube. Additionally, feeding tube use was more likely among residents living in facilities that had a smaller proportion of residents with do-not-resuscitate orders, had a higher prevalence of non-white residents, and lacked a nurse practitioner or physician assistant on staff."

CHICAGO—Patients with diabetes and heart failure are commonly treated with the antihyperglycemic drugs metformin and thiazolidinediones, even though the FDA warns against this practice, according to an article in the July 2 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, although diabetes and heart failure commonly coexist, the treatment of diabetes in patients with both conditions is complicated because some of the drugs known as "oral insulin sensitizers" are not recommended for treatment of patients with moderate-to-severe heart failure. According to package inserts, one of these drugs, metformin, is contraindicated in diabetic patients receiving drug treatment for heart failure therapy, and another class of these drugs, thiazolidinediones, are not recommended in diabetic patients with symptoms of advanced heart failure. Little is known about patterns of use of these drugs in diabetic patients with heart failure.

Frederick A. Masoudi, M.D., M.S.P.H., of the Denver Health Medical Center, Denver, and colleagues conducted a study to determine the proportions of patients hospitalized with heart failure and diabetes who were treated with metformin or thiazolidinediones. Data were extracted from medical records from nongovernmental acute care hospitals in the United States. It included two nationally representative samples of Medicare beneficiaries hospitalized with the primary diagnosis of heart failure and diabetes between April 1998 and March 1999 and between July 2000 and June 2001.

The researchers found: "In the 1998-1999 sample (n=12,505), 7.1 percent of patients were discharged with a prescription for metformin, 7.2 percent with a prescription for a thiazolidinedione, and 13.5 percent with a prescription for either drug. In the 2000-2001 sample (n=13,158), metformin use increased to 11.2 percent, thiazolidinedione use to 16.1 percent, and use of either drug to 24.4 percent. Similar increases were seen among patients of all age groups, all races, and both sexes."

"In this study of nationally representative samples of hospitalized heart failure patients with diabetes, the use of antihyperglycemic agents not recommended in the package insert in this setting was widespread. This practice nearly doubled between 1998-1999 and 2000-2001, reflecting increasing popularity and familiarity with these agents by prescribing physicians," the authors write. "Use of these drugs in patient populations at particularly high risk for adverse events (i.e., metformin with renal dysfunction or thiazolidinediones with insulin) also increased."

SIGMOIDOSCOPY MAY BE MORE EFFECTIVE AT PREVENTING COLON CANCER IF DONE MORE OFTEN THAN CURRENTLY RECOMMENDED