JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, October 18, 2005)
JAMA NEWS RELEASES
RISK OF DEATH FROM BARIATRIC SURGERY AMONG MEDICARE PATIENTS HIGHER THAN PREVIOUSLY ESTIMATED
BARIATRIC SURGICAL PROCEDURES INCREASE SUBSTANTIALLY
PATIENTS HAVE INCREASED HOSPITALIZATION RATE AFTER GASTRIC BYPASS SURGERY
HIGH-RISK AFRICAN AMERICAN WOMEN MAY BENEFIT FROM GENETIC TESTING FOR BREAST CANCER
ATYPICAL ANTIPSYCHOTIC DRUGS FOR DEMENTIA MAY BE ASSOCIATED WITH SMALL INCREASED RISK OF DEATH
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
DEATH RATES AFTER BARIATRIC SURGERY HIGHER THAN PREVIOUSLY THOUGHT IN ELDERLY AND ILL PATIENTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on the risk of death among Medicare patients undergoing bariatric surgery. The release will be fed Tuesday, October 18, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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Embargoed for Release: 3 p.m. CT, Tuesday, October 18, 2005
Media Advisory: To contact David R. Flum, M.D., M.P.H., call Pam Sowers at 206-685-4232.
To contact editorial co-author Bruce M. Wolfe, M.D., call Tamara Hargens at 503-494-8231.
RISK OF DEATH FROM BARIATRIC SURGERY AMONG MEDICARE PATIENTS HIGHER THAN PREVIOUSLY ESTIMATED
CHICAGO—Medicare patients have a substantially higher risk of early death following bariatric surgery than previously suggested, and the risk of death is higher among men, older patients, and patients of surgeons who perform lower numbers of bariatric procedures, according to a study in the October 19 issue of JAMA.
In the United States, most adults are overweight or obese, and obesity is soon to become the leading cause of death, according to background information in the article. Bariatric surgical procedures (surgery on the stomach and/or intestines designed to promote weight loss) are the only interventions that consistently help patients achieve significant and sustained weight loss and improvements with co-existing medical conditions. As a result, there has been dramatic growth in bariatric surgery over the last decade. Balanced against these beneficial effects, however, are the risks of perioperative death and short-term adverse outcomes, which have been poorly defined in the community at large.
David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to determine the risk of all-cause early postsurgical death among Medicare beneficiaries undergoing open bariatric surgery. The study examined early (30-day, 90-day, and 1-year) death figures for all U.S. fee-for-service Medicare beneficiaries who underwent bariatric procedures from 1997-2002.
A total of 16,155 patients underwent bariatric surgical procedures (average age, 48 years; 75.8 percent women, with 90.6 percent younger than 65 years). A total of 61.2 percent of cases were claims for the bariatric surgical procedure Roux-en-y gastroenterostomy (RYGB) and 19.9 percent were for RYGB with small intestine reconstruction to limit absorption. There was more than a 3-fold increase in the number of procedures performed from 1997 (n=1,464) to 2002 (n=4,814).
The researchers found that among all patients, the rates of 30-day, 90-day, and 1-year death were 2.0 percent, 2.8 percent, and 4.6 percent, respectively. Advancing age and male sex were associated with early death after bariatric surgery, with the highest rates of early death among older men. Overall, men were more likely to die after bariatric surgery than women (3.7 percent vs. 1.5 percent, 4.8 percent vs. 2.1 percent, and 7.5 percent vs. 3.7 percent for men and women at 30 days, 90 days, and 1 year, respectively). Death rates were greater for those aged 65 years or older (n=1,517) compared with younger patients (4.8 percent vs. 1.7 percent, 6.9 percent vs. 2.3 percent, and 11.1 percent vs. 3.9 percent at 30 days, 90 days, and 1 year, respectively).
After adjustment for sex and co-existing illness index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged 75 years or older; n=136) than for those aged 65 to 74 years (n=1,381). The odds of death at 90 days were 1.6 times higher for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and co-existing illness index.
"There may be several reasons for these findings. Older patients do not tolerate surgical stress as well as younger patients and may also have less benefit after surgery than younger patients because much of the impact of obesity on organ systems, such as the heart, may have occurred by the time of the operation. It also remains to be seen if surgical weight loss in older patients decreases utilization of health care resources, improves functional status and quality of life, or extends survival as has been suggested in studies of younger patients," the authors write.
"In conclusion, this study found that the risk of early postsurgical death among Medicare beneficiaries undergoing bariatric surgery was considerably higher than prior case series have suggested and was strongly associated with advancing age, male sex, and lower surgeon volume. Those considering the role of bariatric procedures in older patients should balance this population-level risk of adverse outcomes against the anticipated benefits of the procedure. Directing care of older patients to surgeons who perform higher volume of bariatric procedures in Medicare beneficiaries might be expected to improve outcomes in this high-risk population," the researchers write.
(JAMA. 2005;294:1903-1908. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was funded in part by grants from the National Institute of Diabetes and Digestive and Kidney Diseases.
EDITORIAL: WEIGHING IN ON BARIATRIC SURGERY - PROCEDURE USE, READMISSION RATES, AND MORTALITY
In an accompanying editorial, Bruce M. Wolfe, M.D., of Oregon Health & Science University, Portland, and John M. Morton, M.D., M.P.H., of Stanford University, Stanford, Calif., comment on the studies in this week's JAMA on bariatric surgery.
"These studies contribute important information regarding morbid obesity and its treatment. Morbid obesity is a significant health concern and bariatric surgery offers a potentially effective and enduring treatment for weight reduction. Bariatric surgery results in long-term weight loss, helps resolve comorbidities, provides a survival benefit, and has increased substantially as a direct consequence of its success in treating morbid obesity. These studies demonstrate that there are vulnerable patient populations and potential additional costs associated with surgery but suggest that surgical volume helps mitigate these risks and costs. Bariatric surgery may be a potentially life-saving intervention in the right patients and in the right surgeons' hands. The studies presented in this issue indicate that experience and technique count."
"Given that obesity is a societal concern, there must be societal solutions and perspective. Prevention initiatives, medical alternatives, and new technologies may emerge in the future to help combat obesity. However, bariatric surgery today remains a fundamental therapy for morbidly obese patients. The studies by Santry et al, Zingmond et al, and Flum et al must be seen as opportunities for improvement in bariatric surgery, not as support for exclusionary practices by payors for patients in dire need. Instead, bariatric surgeons must meet the challenge of safely and efficiently providing this essential therapy for the most imperiled patients," the authors write.
(JAMA. 2005;294:1960-1963. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, October 18, 2005
Media Advisory: To contact Heena P. Santry, M.D., call John Easton at 773-702-6241.
BARIATRIC SURGICAL PROCEDURES INCREASE SUBSTANTIALLY
CHICAGO—The number of bariatric surgical procedures performed in the U.S. from 1998 to 2003 increased considerably, according to a study in the October 19 issue of JAMA.
Morbid obesity is an increasing health problem in the United States, according to background information in the article. In 2002, 5.1 percent of U.S. adults had a body mass index (BMI) higher than 40. The prevalence of individuals with a BMI higher than 40 quadrupled from 1:200 in 1986 to 1:50 in 2000; the prevalence of individuals with a BMI higher than 50 quintupled from 1:2000 to 1:400. The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity.
Heena P. Santry, M.D., of the University of Chicago, and colleagues examined recent national population-based trends in bariatric surgical procedures, patient characteristics, and in-hospital complications to determine trends in newer techniques, in sociodemographic disparities, in co-existing illnesses, and in surgical complications due to these procedural and patient population changes. The researchers used the Nationwide Inpatient Sample to identify U.S. bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states for 2003).
The researchers found that the estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002. Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102,794 in 2003. Gastric bypass procedures accounted for more than 80 percent of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81 percent to 84 percent), privately insured patients (75 percent to 83 percent), patients from ZIP code areas with highest annual household income (32 percent to 60 percent), and patients aged 50 to 64 years (15 percent to 24 percent). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002. The adjusted in-hospital death rate ranged from 0.1 percent to 0.2 percent. The rates of unexpected reoperations for surgical complications ranged from 6 percent to 9 percent and pulmonary complications ranged from 4 percent to 7 percent. Rates of other in-hospital complications were low.
"If our observed rate of growth continues, there will be approximately 130,000 bariatric procedures in 2005 and as many as 218,000 in 2010. The cost to the U.S. health care system will be substantial. However, in the absence of a nonsurgical option for morbid obesity, our findings regarding in-hospital safety of bariatric surgery are promising while our findings regarding worsening sociodemographic disparities are worrisome," the authors write.
"Disproportionate sociocultural pressures to be thin may explain the imbalance between men and women undergoing an elective procedure for weight loss. Type of insurance coverage also may play a role in socioeconomic disparities," the researchers write. "Other sources of disparities include the possibility that cultural attitudes toward morbid obesity may differ by socioeconomic status, that primary care physicians may be less likely to refer patients of lower socioeconomic status for bariatric surgery, or that hospitals providing bariatric surgery may be less accessible to lower socioeconomic groups."
The researchers add that public health campaigns focusing on the health dangers of obesity may help shift thinking about obesity from a cosmetic concern of women to a health concern for both sexes.
"With increased knowledge of bariatric surgery indications, risks, and benefits among health care professionals, bariatric surgery is likely to become the standard of care for morbidly obese individuals. Together, these changes should lead to more morbidly obese patients of both sexes and all socioeconomic groups seeking surgery. Although preventing obesity should remain the focus of U.S. health care, efforts must be made to ensure equal access to bariatric surgery irrespective of sex and socioeconomic status for those who are morbidly obese, have an indication for surgical intervention, and wish to undergo an elective surgical procedure to improve health, longevity, and quality of life," the authors conclude.
(JAMA. 2005;294:1909-1917. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Santry was supported by a fellowship from the Robert Wood Johnson Clinical Scholars Program and a pilot project grant from the National Institute on Aging to the Center on Aging at the University of Chicago, and the Dr. Paul Jordan Research Fund in Surgery at the University of Chicago.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, October 18, 2005
Media Advisory: To contact David S. Zingmond, M.D., Ph.D., call Rachel Champeau at 310-794-2270.
PATIENTS HAVE INCREASED HOSPITALIZATION RATE AFTER GASTRIC BYPASS SURGERY
CHICAGO—Patients who have gastric bypass surgery have double the rate of hospitalization in the year following the operation than in the year preceding surgery, according to a study in the October 19 issue of JAMA.
Bariatric surgical procedures are an increasingly common treatment for morbid obesity, according to background information in the article. More than 100,000 Roux-en-Y gastric bypasses (RYGB)-the primary bariatric procedure now done-are performed annually in the United States. A recent systematic review and meta-analysis of bariatric procedures determined that the average percentage of excess weight loss after operation was 61 percent, with rates of resolution or improvement for the following co-existing illnesses: diabetes 86 percent, hyperlipidemia 70 percent, hypertension 79 percent, and obstructive sleep apnea 84 percent. Utilization of inpatient services after RYGB is not well understood.
David S. Zingmond, M.D., Ph.D., of the University of California, Los Angeles, and colleagues assessed the impact of RYGB on use of inpatient care by examining rates of inpatient hospitalization before and after RYGB performed in California between 1995 and 2004.
In California from 1995-2004, a total of 60,077 California residents underwent RYGB for obesity, with 11,659 in 2004. The average age was 42.2 years, 84 percent of patients were women, and 88 percent were privately insured or self-pay. Average length of stay was 3.5 days. For patients with a year of follow-up (1995-2003), 19.3 percent were readmitted within the first year after RYGB surgery compared with 7.9 percent being admitted in the year before surgery. In a subset analysis of all patients (24,678) who underwent RYGB with complete 3-year follow-up, the average percentage of patients admitted in the year prior to RYGB was 8.4 percent. In each of the 3 years following RYGB, the rates of hospitalization remained increased, with 20.2 percent of patients readmitted in the first year after RYGB, 18.4 percent in the second year after, and 14.9 percent in the third year after. The cumulative admission rate for the 3-year period prior to RYGB was 20.2 percent compared with the cumulative 3-year admission rate after RYGB of 40.4 percent.
For persons with 3 years of follow-up, average hospital charges were $33,672 for RYGB, $4,970 for hospitalizations in the 3 years before RYGB, and $20,651 for hospitalizations in the 3 years after RYGB. In the subset of patients with full 5 years of follow-up (1995-1999), postoperative admission rates remained elevated (average 13.3 percent) in the fifth year after operation.
The most common reasons for admission prior to RYGB were obesity related problems (e.g., osteoarthritis, lower extremity cellulitis), and elective operation (e.g., hysterectomy), while the most common reasons for admission after RYGB were complications often thought to be procedure related, such as ventral hernia repair and gastric revision.
"A working hypothesis in our study was that use of health care services should likewise improve, namely that inpatient care should decrease after RYGB. However, we found significant and sustained increases in the rates of hospital admission for morbidly obese patients after RYGB. Annual rates of hospital admission after RYGB are double than prior to operation and are sustained beyond a year in this population-based study," the authors write.
"Our findings may have implications for payers and purchasers of health care. Rather than expecting a decrease in inpatient health care utilization after RYGB, the costs associated with inpatient hospitalization may remain elevated for as many as 5 years following RYGB. Analysis of 3-year charges before and after RYGB suggest that costs of post-RYGB-related procedures and complications may be 40 percent to 60 percent of the costs of RYGB itself."
"The potential of RYGB for yielding long-term weight reduction and alleviation of obesity-related comorbid illnesses has significantly increased the rates of RYGB over the past decade. Despite these potential benefits, the current study demonstrates that the rates of hospitalization doubles in the years after operation and that many of these admissions are directly attributable to this procedure," the researchers conclude.
(JAMA. 2005;294:1918-1924. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Zingmond is funded by a Mentored Clinical Scientist Award from the National Institute on Aging. Co-author Dr. McGory is funded by the Robert Wood Johnson Clinical Scholars Program at the University of California Los Angeles.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, October 18, 2005
Media Advisory: To contact corresponding author Olufunmilayo I. Olopade, M.D., call John Easton at 773-702-6241.
HIGH-RISK AFRICAN AMERICAN WOMEN MAY BENEFIT FROM GENETIC TESTING FOR BREAST CANCER
CHICAGO—African American women at high-risk of breast cancer have genetic mutations that would make genetic testing feasible, according to a study in the October 19 issue of JAMA.
Because of recent advances in the understanding of breast cancer risk factors and the promise of prevention, women from high-risk families are encouraged to consider genetic testing to quantify their risk, according to background information in the article. An estimated 5 percent to 10 percent of breast cancer cases occur in individuals with inherited mutations in breast cancer susceptibility genes. Germline mutations in BRCA1 and BRCA2 are by far the most common and account for 80 percent to 90 percent of families containing multiple cases of breast and ovarian cancer. The proportion of breast cancer attributed to mutations in BRCA1 or BRCA2 has varied widely among different studies and different ethnic groups. Of note, one of the largest ethnic minorities in the United States, the African American population, remains understudied, despite having a proportionately higher incidence of early-onset breast cancer. Many of the risk-assessment tools used in cancer risk clinics, such as the BRCAPRO statistical model, were developed based on mutation rates observed primarily in Ashkenazi Jewish and other white women of European descent.
Rita Nanda, M.D., of the University of Chicago Medical Center, Chicago, and colleagues conducted a study to characterize the clinical predictors of BRCA1 and BRCA2 mutations among high-risk individuals of European and African ancestry, highlighting the similarities and differences.
The study included a comparative analysis of families (white, Ashkenazi Jewish, African American, Hispanic, Asian) with 2 or more cases of breast and/or ovarian cancer among first- and second-degree relatives. Families were identified at U.S. sites between February 1992 and May 2003; in each family, the individual with the highest probability of being a mutation carrier was genetically tested.
The researchers found that the mutation spectrum was vastly different between families of African and European ancestry. Compared with non-Hispanic, non-Jewish whites, African Americans had a lower rate of deleterious BRCA1 and BRCA2 mutations but a higher rate of sequence variations (27.9 percent vs. 46.2 percent and 44.2 percent vs. 11.5 percent). Deleterious mutations in BRCA1 and BRCA2 were highest for Ashkenazi Jewish families (69.0 percent). Early age at diagnosis of breast cancer and number of first- and second-degree relatives with breast and ovarian cancer were significantly associated with an increased likelihood of carrying a BRCA1 or BRCA2 mutation. In discriminating between mutation carriers, BRCAPRO performed as well in African American families as it did in white and Jewish families.
"BRCA1 and BRCA2 mutations do occur with appreciable frequency in high-risk families of African ancestry, with 28 percent testing positive for a deleterious mutation in 1 of these genes, a rate consistent with other clinic-based studies in the United States," the authors write.
"Our data support the use of personal and family history of breast cancer, ovarian cancer, or both in making clinical decisions and identifying individuals who are likely to benefit from genetic counseling. Certain family characteristics-most notably the number of breast cancer cases among first- and second-degree relatives and the mean age at diagnosis of breast cancer-are associated with the likelihood of carrying a deleterious mutation among African Americans, as has previously been observed in white and Ashkenazi Jewish families," the researchers write.
"Our observations underscore the need for large, collaborative studies to systematically validate the role of genetic testing, the use of risk prediction models, and the role of risk-reducing strategies in improving health outcomes for individuals of African ancestry," the authors conclude.
(JAMA. 2005;294:1925-1933. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, October 18, 2005
Media Advisory: To contact Lon S. Schneider, M.D., M.S., call Jon Weiner at 323-442-2823.
To contact editorial co-author Constantine G. Lyketsos, M.D., M.H.S., call Eric Vohr at 410-955-8665.
ATYPICAL ANTIPSYCHOTIC DRUGS FOR DEMENTIA MAY BE ASSOCIATED WITH SMALL INCREASED RISK OF DEATH
CHICAGO—Patients with dementia who took atypical antipsychotic drugs had a slightly increased risk of death compared to patients who took placebo, according to a meta-analysis published in the October 19 issue of JAMA.
A majority of elderly patients with dementia develop aggression, delusions, and other neuropsychiatric symptoms during their illness, according to background information in the article. Antipsychotic medications are commonly used to treat these behaviors, along with psychosocial and environmental interventions. During the last decade, newer atypical antipsychotic drugs (i.e., risperidone, olanzapine, quetiapine, and aripiprazole, in order of introduction) have largely replaced the older conventional or first generation antipsychotic drugs (e.g., haloperidol and thioridazine) and have been considered preferred treatments for these behavioral disturbances associated with dementia. However, concerns have arisen about possibly increased risks for cerebrovascular adverse events, rapid cognitive decline, and death with their use.
Lon S. Schneider, M.D., M.S., and colleagues at the University of Southern California, Los Angeles, conducted a meta-analysis of atypical antipsychotic drug trials to assess the evidence for death associated with their use in elderly patients with dementia. After a search of databases and meeting presentations, the researchers selected 15 trials (9 unpublished) that met criteria, generally 10 to 12 weeks in duration, including 16 contrasts of atypical antipsychotic drugs with placebo (aripiprazole [n = 3], olanzapine [n = 5], quetiapine [n = 3], risperidone [n = 5]). A total of 3,353 patients were randomized to study drug and 1,757 were randomized to placebo. Outcomes were assessed using standard methods to calculate odds ratios (ORs) and risk differences based on patients randomized and relative risks based on total exposure to treatment. There were no differences in dropouts.
The researchers found that death occurred more often among patients randomized to drugs (118 [3.5 percent] vs. 40 [2.3 percent]; OR, 1.54), indicating a significantly increased risk. Sensitivity analyses did not show evidence for differential risks for individual drugs, severity, sample selection, or diagnosis.
"These findings emphasize the need to consider certain changes in some clinical practices. Antipsychotic drugs have been dispensed fairly frequently to patients with dementia and used for long periods. The established risks for cerebrovascular adverse events together with the present observations suggest that antipsychotic drugs should be used with care in these patients. The fact that excess deaths and cerebrovascular adverse events can be observed within 10 to 12 weeks of initiating medication, coupled with observations from individual clinical trials results that there is substantial improvement in both drug and placebo groups during the first 1 to 4 weeks of treatment, lead to the consideration that antipsychotic drugs should be prescribed and dosage adjusted with the expectation of clinical improvement within that time. If improvement is not observed, the medication could be discontinued," the authors write.
"As a meta-analysis, our results should be taken as hypothesis-generating for an increased risk for deaths in patients with dementia receiving atypical antipsychotic drugs. … No drug is individually responsible for the effect, but rather each contributes to the overall effect. This effect may not be limited to atypical drugs as a class and may be associated with haloperidol and other drugs that have not been subjected to efficacy trials in elderly patients with dementia," the researchers conclude
(JAMA. 2005;294:1934-1943. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information and financial disclosures, please see the JAMA article.
EDITORIAL: ANTIPSYCHOTIC DRUGS IN DEMENTIA - WHAT SHOULD BE MADE OF THE RISKS?
In an accompanying editorial, Peter V. Rabins, M.D., M.P.H., and Constantine G. Lyketsos, M.D., M.H.S., of Johns Hopkins Medical Institutions, Baltimore, examine the results of the meta-analysis by Schneider et al.
"So what should a clinician do when caring for a patient with dementia who develops psychotic symptoms or aggression? First, etiologies other than dementia need to be considered. Delirium, untreated or undertreated medical illnesses, overmedication, environmental triggers, lack of engaging activities, and misinterpretation of disease symptoms are among the potential etiologies of such behaviors and symptoms. Because all have specific therapies, they should be considered when such symptoms first develop. Second, clinicians should consider the risk/benefit ratio for each patient. For example, patients with hallucinations and delusions that are neither distressing nor placing them or others at risk or harm should not be treated with antipsychotic drugs. Third, once antipsychotic drugs have been prescribed, careful assessment and documentation of the need for continued care is necessary. The Omnibus Budget Reconciliation Act (OBRA) regulations of 1987 require such a reassessment in long-term care, but the need for medication continuation should be regularly reassessed and justified for all individuals. Given the high rates of dementia in assisted living homes, similar practices should be instituted in those settings as well."
(JAMA. 2005;294:1963-1965. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information and financial disclosures, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
DEATH RATES AFTER BARIATRIC SURGERY HIGHER THAN PREVIOUSLY THOUGHT IN ELDERLY AND ILL PATIENTS
VIDEO:
B-ROLL
Photo of Julia weighing 400 pounds
AUDIO:
THIS WAS 44-YEAR OLD JULIA HILL WHEN SHE WEIGHED FOUR-HUNDRED POUNDS, AND HER DIABETES WAS OUT OF CONTROL.
VIDEO:
NAT SOT UP FULL FOR :03
Julia Hill playing outside with grandkids
AUDIO:
"Sounds of kids playing"
VIDEO:
B-ROLL
Julia playing outside with grandkids
AUDIO:
TODAY, SHE’S HEALTHIER, AND CAN EVEN PLAY WITH HER GRANDKIDS.
VIDEO:
SOT/FULL
@ :11
Super: Julia Hill
Had bariatric surgery
Runs :03
AUDIO:
"I’ve lost a total of like, 76 pounds."
VIDEO:
B-ROLL
Bite runs long until "since"
Surgery video –wide of surgery
Internal surgery video – "egg" being made
Full screen illustration of new stomach and intestine
AUDIO:
AND SHE LOST IT IN JUST FOUR MONTHS, SINCE HAVING BARIATRIC SURGERY. THAT’S WHEN SURGEONS MAKE A NEW, SMALL STOMACH, ABOUT THE SIZE OF AN EGG, AND MAKE A SHORT-CUT WITH THE INTESTINE, SO LESS FOOD GOES INTO, AND IS USED BY, THE BODY.
VIDEO:
SOT/FULL
@ :28
Super: David Flum, M.D., M.P.H.
University of Washington
Runs :07
AUDIO:
"The operation provides patients with the opportunity to lose tremendous amounts of weight in a very short period of time."
VIDEO:
B-ROLL
Surgery -wide
Dr. Flum looking at MRI with colleague
Julia outside with grandkids
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BUT IT’S A MAJOR SURGERY, AND DR. DAVID FLUM AND COLLEAGUES AT UNIVERSITY OF WASHINGTON WANTED TO KNOW ABOUT THE RISK OF DEATH FOR PATIENTS ON MEDICARE. THAT IS, PATIENTS OVER AGE 65, OR YOUNGER PATIENTS LIKE JULIA, WHO RECEIVE MEDICARE BECAUSE OF HEALTH DISABILITY.
VIDEO:
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David Flum, M.D., M.P.H.
University of Washington
Runs :11
AUDIO:
"While people are told the risk, the risk of death is anywhere between one in 500 to one in a thousand, in reality, for people on Medicare, the risk of death is more like one in 50."
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B-ROLL
Surgery - wide
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AND FOR ELDERLY PEOPLE, THE RISK OF DEATH IS EVEN HIGHER.
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David Flum, M.D., M.P.H.
University of Washington
Runs :07
AUDIO:
"For people over age 65, obesity surgery is much higher than the risk of other operations like open heart surgery."
VIDEO:
B-ROLL
GFX/JAMA COVER
Surgery/surgeon in action
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THESE FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. THE STUDY ALSO FOUND THAT EXPERIENCE COUNTS.
VIDEO:
SOT/FULL
David Flum, M.D., M.P.H.
University of Washington
Runs :09
AUDIO:
"The best results come when patients go to surgeons who have done many of these operations in such high-risk groups, such as people who are over the age of 65."
VIDEO:
B-ROLL
Julia with grandkids
AUDIO:
AND, HE AGREES WITH JULIA ABOUT WEIGHING THE RISKS AND BENEFITS OF BARIATRIC SURGERY.
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SOT/FULL
Julia Hill
Had bariatric surgery
Runs :14 few seconds covered with b-roll
AUDIO:
"If you have illness from your weight like your heart problems and diabetes and everything like that, you know you’re going to die anyway, so you know, I would think it would be worth the chance to lose the weight and to live your life out."
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Julia with grandkids
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THIS IS MAVIS PRALL WITH THE JAMA REPORT.
