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 25, 2005)
JAMA NEWS RELEASES
PATIENTS RECEIVING SUPPLEMENTAL OXYGEN DURING SURGERY HAVE REDUCED RISK OF WOUND INFECTION
PREVENTING PNEUMONIA IN CHILDREN HELPS PREVENT PNEUMONIA IN OLDER ADULTS
MEASURING CERTAIN ENZYME ACTIVITY IN URINE SHOWS PROMISE FOR DETECTION OF BLADDER CANCER
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
VACCINATING CHILDREN AGAINST PNEUMOCOCCAL DISEASE LINKED TO 55% REDUCTION IN SERIOUS PNEUMOCOCCAL ILLNESSES IN THE ELDERLY
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TV Note: This week's JAMA video news release is on the link between vaccinating children for pneumonia and a lower incidence of pneumonia among adults. The release will be fed Tuesday, October 25, 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 25, 2005
Media Advisory: To contact F. Javier Belda, M.D., Ph.D., email: fjbelda{at}uv.es. To contact editorial author E. Patchen Dellinger, M.D., call Clare Hagerty at 206-685-1323
PATIENTS RECEIVING SUPPLEMENTAL OXYGEN DURING SURGERY HAVE REDUCED RISK OF WOUND INFECTION
CHICAGO—Patients who received a higher concentration of supplemental oxygen during colorectal surgery had a significantly reduced risk of wound infection, according to a study in the October 26 issue of JAMA.
Surgical wound infections prolong hospitalization by an average of 1 week and substantially increase the cost of care, according to background information in the article. These infections are possibly the most common serious complication of surgery and anesthesia. Supplemental oxygen during and after surgery has been variously reported to halve or double the risk of surgical wound infection.
F. Javier Belda, M.D., Ph.D., of the Hospital Clínico Universitario de Valencia, Spain, and colleagues conducted a study to determine whether supplemental perioperative (performed at or around the time of an operation) oxygen reduces the risk of wound infection. The double-blind, randomized controlled trial included 300 patients aged 18 to 80 years who underwent elective colorectal surgery in 14 Spanish hospitals from March 1, 2003, to October 31, 2004. Baseline patient characteristics, anesthetic treatment, and potential confounding factors were recorded. Patients were randomly assigned to an oxygen/air mixture with a fraction (concentration) of inspired oxygen (Fio2) of 30 percent or 80 percent intraoperatively and for 6 hours after surgery.
A total of 143 patients received 30 percent perioperative oxygen and 148 received 80 percent perioperative oxygen. Surgical site infection (SSI) occurred in 35 patients (24.4 percent) administered 30 percent Fio2, and in 22 patients (14.9 percent) administered 80 percent Fio2.
" … we found that 80 percent supplemental oxygen reduced the risk of SSI by 39 percent. When controlling for multiple contributing factors, the reduction in SSI risk associated with 80 percent Fio2 was nearly 54 percent. Patients with infections had significantly longer hospital stays and delays to ambulation," the researchers write.
"This result is consistent with most available in vitro data and 1 other appropriately designed randomized controlled trial. Supplemental oxygen appears to confer few risks to the patient, has little associated cost, and should be considered part of ongoing quality improvement activities related to surgical care," the authors conclude.
(JAMA. 2005;294:2035-2042. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
EDITORIAL: INCREASING INSPIRED OXYGEN TO DECREASE SURGICAL SITE INFECTION
In an accompanying editorial, E. Patchen Dellinger, M.D., of the University of Washington School of Medicine, Seattle, comments on the topic of preventing wound infection.
"… a large number of other factors and interventions are known to influence risk for SSI in operative patients. For many of these interventions, there is essentially no controversy, and yet they are not being consistently delivered to patients. Recent surveys of actual practice in the United States show that proper choice of prophylactic antibiotic, timing of antibiotic delivery, avoidance of shaving the surgical site, keeping the patient warm in the operating department, and maintaining normoglycemia are not achieved in 10 percent to 55 percent of patients. Recent quality improvement SSI surveillance data from 1 hospital has demonstrated that when an SSI does occur, in more than 70 percent of the cases, known preventive measures, such as antibiotic delivery and maintenance of normothermia [normal body temperature], were not achieved. A focused effort to change these conditions can result in a dramatic reduction in SSI."
"Surgeons and members of surgical teams should all be working in these areas until more definitive information about oxygen concentrations in the operating department becomes available. Surgeons should encourage the broader use of higher oxygen tensions for their patients undergoing major abdominal procedures and be more involved in quality improvement initiatives aimed at reducing SSI," Dr. Dellinger concludes.
(JAMA. 2005;294:2091-2092. 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 25, 2005
Media Advisory: To contact Catherine A. Lexau, Ph.D., M.P.H., call Doug Schultz at 651-201-4993.
PREVENTING PNEUMONIA IN CHILDREN HELPS PREVENT PNEUMONIA IN OLDER ADULTS
CHICAGO—The incidence of pneumonia among older adults has decreased substantially, linked to the introduction of a pneumonia vaccine for children in 2000, according to a study in the October 26 issue of JAMA.
The pneumococcal conjugate vaccine (PCV-7) was licensed for use in infants and young children in March 2000, according to background information in the article. Use of PCV-7 in children can affect pneumonia transmission in the community. Pneumonia causes substantial illness and death among older adults. Consistent with the ability of PCV-7 to interrupt transmission, declines in invasive pneumococcal disease incidence among older adults were observed in 2001, the year after PCV-7 introduction.
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).
Catherine A. Lexau, Ph.D., M.P.H., of the Minnesota Department of Health, St. Paul, Minn., and colleagues conducted a study to determine whether the observed early decline among adults aged 50 years and older has continued over the 4 years since pneumococcal conjugate vaccine licensure, whether disease characteristics have changed, and whether the spectrum of patients acquiring invasive pneumococcal disease has changed. The study included population-based surveillance data of invasive pneumococcal disease in 8 U.S. geographic areas (total population, 18,813,000), 1998-2003.
The researchers found that the incidence of invasive pneumococcal disease among adults aged 50 years or older declined 28 percent, from 40.8 cases/100,000 in 1998-1999 to 29.4 in 2002-2003. During 2002 and 2003, the overall rate of invasive disease among persons aged 65 years or older (41.7 cases/100,000) was lower than the Healthy People 2010 goal of 42 cases/100,000. Among adults aged 50 years or older, incidence of disease caused by the 7 conjugate vaccine serotypes declined 55 percent from 22.4 to 10.2 cases/100,000.
In contrast, disease caused by any of the 16 serotypes only in polysaccharide vaccine did not change, and disease caused by serotypes not in either vaccine increased somewhat, from 6.0 to 6.8 cases/100,000. Between 1998-1999 and 2002-2003, the proportion of case-patients with human immunodeficiency virus infection increased from 1.7 percent (47/2,737) to 5.6 percent (124/2,231), and those with any co-existing illness that is an indication for pneumococcal polysaccharide vaccination increased from 62.3 percent (1,842/2,955) to 72.0 percent (1,721/2,390).
The researchers estimate that 12,500 fewer cases and 1,100 fewer deaths occurred among older Americans in 2002 and 2003, compared with the numbers of cases and deaths occurring before the vaccine was available.
"Several factors support the hypothesis that the declines in invasive disease reported here likely occurred because of decreased community transmission of vaccine-type pneumococci from young children, many of whom have received PCV-7. Studies of pneumococcal carriage indicate that conjugate vaccines reduce carriage of vaccine-type pneumococci in vaccinated children. Likewise, unvaccinated children in close contact with vaccinated children or living in communities in which the vaccine is being used also have experienced reductions in pneumococcal carriage and disease caused by PCV-7 serotypes. In this analysis, the overall decline in invasive disease incidence was mainly due to a decrease in disease caused by PCV-7 serotypes, suggesting a specific conjugate vaccine effect. In addition, the timing of the changes among older adults coincided with uptake of vaccine in children; incidence first declined in 2001, following initial use of PCV-7 among young children in the last half of 2000, and then dropped further in 2002-2003 as vaccine coverage in children increased," the authors write.
"We have documented a consistent decrease in incidence of invasive pneumococcal disease in an age group at high risk for serious disease and death from these illnesses. Policy makers elsewhere who are considering whether to incorporate PCV-7 into their routine infant immunization programs and who are weighing its cost-effectiveness should consider the benefits seen in older adults. However, it is unknown whether this herd effect will be similar in all settings and population subsets. The size of the effect may differ in populations with different serotype distributions or with a higher or lower prevalence of chronic conditions among older adults. We look forward to results from other populations to see if similar effects will occur. In the U.S. population, use of PCV-7 for children has been an effective means of preventing disease in older adults," the researchers conclude.
(JAMA. 2005;294:2043-2051. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial support for this project was provided in part by the CDC Emerging Infections Program.
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 25, 2005
Media Advisory: To contact the corresponding author Daniele Calistri, Ph.D., email: biomolec{at}ausl.fo.it.
MEASURING CERTAIN ENZYME ACTIVITY IN URINE SHOWS PROMISE FOR DETECTION OF BLADDER CANCER
CHICAGO—Measurement of an enzyme level (telomerase activity) in urine appears useful for detection of bladder cancer in men, according to a study in the October 26 issue of JAMA.
The incidence of human bladder cancer has greatly increased over the last few decades, with more than 60,000 new cases diagnosed each year in the United States alone, and now represents the 4th most common malignancy in men and the 10th most common in women, according to background information in the article. At present, about 20 percent of patients die each year, but when the disease is diagnosed and treated in the early stage, the chances of survival are good, indicating the importance of a timely and accurate diagnosis.
Established approaches for detecting bladder cancer are either invasive and costly or have limited sensitivity, highlighting the need for the development of a noninvasive, reliable, and simple test to increase the rate of detection of bladder cancer. Among the markers investigated for this purpose has been telomerase (a certain enzyme) activity in urine.
Maria Aurora Sanchini, M.Sc., of Morgagni-Pierantoni Hospital, Forlì, Italy, and colleagues conducted a study to define the diagnostic accuracy of different telomerase activity cutoff values in terms of sensitivity and specificity. The study included 218 men (84 healthy individuals and 134 patients at first diagnosis of histologically confirmed bladder cancer), recruited between March 2003 and November 2004 in Italy. Urine telomerase activity was determined using a highly sensitive telomeric repeat amplification protocol (TRAP) assay. Urine samples were processed for cytological (cell) diagnosis and TRAP assay. The diagnosis of bladder cancer was based on bioptic and cystoscopic examinations (direct visual examination of the urinary tract). The performance of the TRAP assay to detect urine telomerase activity was compared to urine cytology as an aid to early cancer detection.
Using a 50 arbitrary enzymatic unit (AEU) cutoff value, in the overall series, there was 90 percent sensitivity and 88 percent specificity. Specificity increased to 94 percent for individuals aged 75 years or younger. The same predictive capacity of telomerase activity levels was observed for patients with low-grade tumors or with negative cytology results. The sensitivity of urine telomerase activity in detecting bladder tumors was similar in the subgroups of patients with different tumor grades at all AEU cutoff values. In particular, at 50 AEUs the sensitivity was 93 percent, 87 percent, and 89 percent for grades 1, 2, and 3, respectively.
"The test we developed requires a small amount of urine; is noninvasive, inexpensive, and easy to perform; and permits a quantitative evaluation of telomerase activity in cellular extracts from urine. Furthermore, it is objective, reproducible, and specific and is not reliant on the expertise of the cytopathologist. Indeed, one important advantage of this test is its proven ability to also identify low-grade tumors, which often escape detection, thus largely contributing to false-negatives in cytologic examination," the researchers write.
"However, notwithstanding the validated optimal diagnostic accuracy of the test, it is not recommended for use in routine screening programs because of the low incidence of bladder cancer, and should be aimed at high-risk subgroups. Specifically, smokers have about a 3-fold increased risk of developing bladder cancer compared with nonsmokers," the authors add.
"In conclusion, we believe that our telomerase activity urine assay, with the reliability verified in pilot and confirmatory studies, represents a promising and potentially important contribution to the early diagnosis of bladder carcinoma, in particular for high-risk subgroups. Further prospective studies on larger patient populations are needed to assess the promising diagnostic role of urinary telomerase and to define the ability of this assay to detect low-grade tumors and disease recurrence before it becomes clinically evident, which is especially important in a tumor characterized by a high relapse rate."
(JAMA. 2005;294:2052-2056. 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
VACCINATING CHILDREN AGAINST PNEUMOCOCCAL DISEASE LINKED TO 55% REDUCTION IN SERIOUS PNEUMOCOCCAL ILLNESSES IN THE ELDERLY
VIDEO:
B-ROLL
C/u preschoolers
Preschoolers painting at table with elderly women
AUDIO:
THESE PRE-SCHOOLERS HAVE BEEN VACCINATED AGAINST PNEUMOCOCCAL DISEASE, PROTECTING THEM FROM MOST EAR INFECTIONS, PNEUMONIA, AND MENINGITIS. BUT THEIR VACCINATIONS AREN’T ONLY PROTECTING "THEM."
VIDEO:
SOT/FULL
@ :11
Super: Catherine Lexau, Ph.D., M.P.H.
Minnesota Department of Health
Runs :14
AUDIO:
"What’s really exciting about this new children’s vaccine is that it’s reducing serious infections for young children. But then in addition, we’re seeing these major reductions in serious pneumococcal infections in older adults."
VIDEO:
B-ROLL
Infant receiving vaccine
Dr. Lexau at microscope in lab with colleague
GFX/JAMA COVER
AUDIO:
CHILDREN STARTED GETTING THE VACCINE IN THE YEAR 2000. TO SEE IF THIS HAD ANY AFFECT ON ADULT HEALTH, DR. CATHERINE LEXAU (lex-oh) AND COLLEAGUES AT THE MINNESOTA DEPARTMENT OF HEALTH, THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION, AND SEVERAL UNIVERSITIES, COMPARED DISEASE RATES IN OLDER ADULTS BETWEEN 1998 AND 2003. THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Catherine Lexau, Ph.D., M.P.H.
Minnesota Department of Health
Runs :09
AUDIO:
"We were surprised about how dramatically the rates of serious pneumococcal infections declined among older adults and how quickly these declines occurred."
VIDEO:
B-ROLL
Close up on vial of Pneumococcal Conjugate Vaccine
Vials on assembling line in factory
Elderly men and women having lunch at tables
Infant receiving vaccine
Preschoolers painting with elderly women
AUDIO:
THE PNEUMOCOCCAL VACCINE FOR CHILDREN PROTECTS AGAINST CERTAIN TYPES OF DISEASE. IT’S THOSE EXACT TYPES OF DISEASE THAT DECLINED BY MORE THAN HALF IN PEOPLE OVER AGE 50, EVEN THOUGH ADULTS DON’T RECEIVE THIS VACCINE. ADULT DEATH RATES FROM THESE ILLNESSES ALSO WENT DOWN, ALMOST TWENTY PERCENT. THIS MAY BE BECAUSE VACCINATED CHILDREN WERE CARRYING, AND SPREADING, FEWER PNEUMOCOCCAL GERMS.
VIDEO:
SOT/FULL
Catherine Lexau, Ph.D., M.P.H.
Minnesota Department of Health
Runs :14
AUDIO:
"We think that once there were fewer carriers in the population, that older and elderly adults who are more susceptible to these infections were exposed less frequently and then had fewer infections."
VIDEO:
B-ROLL
Preschoolers painting with elderly women
AUDIO:
SINCE THE VACCINE REDUCED ILLNESS IN CHILDREN BY ABOUT 75 PERCENT, THE FACT THAT IT ALSO INDIRECTLY PROTECTS OLDER PEOPLE IS MORE GOOD NEWS TO THIS MOM.
VIDEO:
SOT/FULL
@ : 1:42
Super: Kathryn Sabetti
Mom
Runs :10
AUDIO:
"My kids are in contact with their grandparents all the time and it’s wonderful to know that me providing immunization for my kids is also a benefit to my parents."
VIDEO:
B-ROLL
Preschooler sitting on elderly woman’s lap looking at book
AUDIO:
SHE WOULD CALL THAT A "WIN-WIN." THIS IS MAVIS PRALL WITH THE JAMA REPORT.
