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 of 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 CONTENTS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 15, 2007)
LEARNING WITH A PARTNER IMPROVES SKIN CANCER SELF-EXAMINATION PRACTICES
ONE-TIME MELANOMA SCREENING OF OLDER ADULTS APPEARS TO BE COST-EFFECTIVE
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 15, 2007)
STUDY PROFILES RURAL INDIVIDUALS MOST LIKELY TO HAVE RECURRENT TRAUMA CENTER ADMISSIONS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 15, 2007)
OUTCOMES COMPARABLE FOR YOUNGER AND OLDER CHILDREN WITH SURGICALLY IMPLANTED HEARING AIDS
COMMON BLOOD TEST CAN HELP DISTINGUISH BETWEEN MONONUCLEOSIS AND TONSILLITIS
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 15, 2007)
SOME PATIENTS DISSATISFIED FOLLOWING CLOSED REDUCTION OF NASAL FRACTURES
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 15, 2007
Media Advisory: To contact June K. Robinson, M.D., call Marla Paul at 312-503-8928.
LEARNING WITH A PARTNER IMPROVES SKIN CANCER SELF-EXAMINATION PRACTICES
CHICAGO—Individuals who received instruction on skin self-examination with their partners may be more likely to engage in this cancer prevention behavior, according to a report in the January issue of Archives of Dermatology, one of the JAMA/Archives journals.
Skin self-examination can help detect the skin cancer melanoma early, decreasing death rates and the physical and emotional burdens associated with the disease, according to background information in the article. “Persons who perform skin self-examination present for care at an earlier stage in the disease process and have 50 percent less advanced melanoma and markedly lower mortality from melanoma,” the authors write. “Skin self-examination can be learned by those who recognize that they are at risk of developing melanoma, including the elderly,” who are more likely to both develop melanoma and to die from it than younger individuals.
June K. Robinson, M.D., Northwestern University Feinberg School of Medicine, Chicago, and colleagues performed a trial of a skin self-examination instruction program with 130 participants who had previously had melanoma. Sixty-five of the participants were randomly assigned to undergo the instruction alone and the other 65 to receive the instruction with their live-in partners. During the instruction session, a trained research assistant explained the ABCDE rule for examining moles (asymmetry of shape, border irregularity, color variegation, diameter of 6 millimeters or more and evolution or changing of the lesion, all of which can indicate the presence of melanoma). All of the participants took a skills quiz and a written assessment of skin self-examination performance immediately after the session and again four months later.
“At the four-month follow-up visits, paired-learning individuals (treatment) showed significantly stronger intentions to perform skin self-examinations on the face and skin in general than the solo-learning individuals (controls),” the authors write. “Significantly more solo learners than dyadic [paired] learners did not check their skin at the long-term follow-up visit (45 vs. 23), whereas significantly more dyadic learners checked their skin one time (19 vs. 9) and several times (13 vs. 4).”
Because about half of melanomas are initially discovered by the patients themselves, skin self-examination may be the best opportunity for early detection among those at risk, they continue. “The present study confirms that dyadic learning of skin self-examination enhances the perceived importance of skin self-examination, self-efficacy [belief in one’s ability] in performing skin self-examination, and performance of skin self-examination,” the authors conclude. “Attitude and belief in the ability to perform skin self-examination are fostered when the partners learn about melanoma recognition and skills training together. Partners may provide social reinforcement for skin self-examination and in checking locations that are difficult for the patient to see, for example the scalp, back, ears and back of legs.”
(Arch Dermatol. 2007;143:37-41. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from the National Cancer Institute, Bethesda, Md. Dr. Robinson, who is chief editor of the Archives, was not involved in the editorial evaluation or editorial decision to accept this work for publication. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 15, 2007
Media Advisory: To contact Elena Losina, Ph.D., call Lisa Brown at 617-414-1401. To contact editorialist Howard K. Koh, M.D., M.P.H., call Todd Datz at 617-432-3952.
ONE-TIME MELANOMA SCREENING OF OLDER ADULTS APPEARS TO BE COST-EFFECTIVE
CHICAGO—One-time melanoma screening of adults age 50 or older appears to be as cost-effective as other nationally recommended cancer screening programs, according to an article in the January issue of Archives of Dermatology, one of the JAMA/Archives journals.
Melanoma is the only cancer for which incidence and death rates continue to increase in the United States, while screening continues to be underused, according to background information in the article. Treating melanoma costs more than $740 million each year in the United States. Older patients and those who have immediate relatives with melanoma are at higher risk. Knowledge regarding risk factors and the availability of treatment has spurred greater interest in screening; however, the lack of a large randomized trial proving screening efficacy has been cited as an obstacle preventing its widespread implementation.
Elena Losina, Ph.D., Boston University School of Public Health, and colleagues constructed a mathematical model to simulate the melanoma events that occur in a population, including disease occurrence, progression, detection with and without a screening program, treatment and death. The authors projected the additional costs of screening and the additional survival attributable to earlier detection. They then assessed the cost in dollars for every extra year of life gained (the cost-effectiveness) from melanoma screening by a dermatologist.
“We considered the following four screening strategies: background screening only; that is, skin examination at a routine non-dermatologist physician visit, followed by referral to a dermatologist, on average, once every five years; and one-time, every two years and annual screening by a dermatologist, all beginning at age 50 years,” the authors write.
In the model analysis, the cost-effectiveness of screening was about $10,100 per quality-adjusted life year gained for one-time screening compared with current practice. In other words, for every $10,100 in costs associated with one-time screening, one individual would have one additional year of life because of the screening. In addition, costs totaled $80,700 per quality-adjusted life year gained for screening every two years compared with one-time screening, and $586,800 per quality-adjusted life year gained for annual screening compared with screening every two years. Among siblings of patients with melanoma, one-time screening cost $4,000 per quality-adjusted life year gained compared with current practice, screening every two years cost an additional $35,500 per quality-adjusted life year gained, and annual screening cost an additional $257,800 per quality-adjusted life year gained.
Cost-effectiveness analyses are typically used when large randomized trials of screening procedures cannot be done for either logistical or ethical reasons, the authors write. “Using this method, interventions in the United States are generally considered cost-effective at less than $50,000 per quality-adjusted life year gained or less than $100,000 per quality-adjusted life year gained,” they continue.
“This study suggests that one-time screening of the general U.S. population at age 50 years for malignant melanoma is very cost-effective and that screening every two years of siblings of patients with melanoma may also be cost-effective, depending on disease progression rates,” according to the authors. “Either screening programs should be expanded or efforts to perform a definitive efficacy trial should be initiated.”
(Arch Dermatol. 2007;143:21-28. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Cancer Institute and grants from the National Institute of Allergy and Infectious Diseases. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: STUDY PROVIDES VALUABLE INFORMATION FOR DIFFICULT SCREENING DECISION
Although screening strategies are necessary to save lives that would otherwise be lost to cancer, controversies abound when decisions about screening recommendations are discussed, writes Howard K. Koh, M.D., M.P.H., Harvard School of Public Health, Boston, in an accompanying editorial.
Such recommendations are ideally based on large, randomized clinical trials of screening methods. “For melanoma, however, no randomized prospective clinical screening trial exists worldwide. Furthermore, none appears to be forthcoming,” Dr. Koh writes. “In this context, the new mathematical simulation model published by Losina et al in this issue of the Archives adds focus and another layer of sophistication.”
“The cost-effectiveness ratios generated were comparable to those seen for other types of cancer screening, such as for breast cancer and colorectal cancer,” he concludes. “This new quantitative analysis not only reinforces consideration of one-time screening for melanoma but also resurrects hopes for a definitive randomized trial using this strategy.”
(Arch Dermatol. 2007;143:101-103. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 15, 2007
Media Advisory: To contact Eric A. Toschlog, M.D., call Doug Boyd at 252-744-2482.
STUDY PROFILES RURAL INDIVIDUALS MOST LIKELY TO HAVE RECURRENT TRAUMA CENTER ADMISSIONS
CHICAGO—About 3.4 percent of patients treated in rural trauma centers appear to be recidivists, meaning that they have visited the facility more than once for separate injuries, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. Substance abuse appears to be the common feature among urban and rural recurrent trauma patients.
Trauma is the leading cause of death and disability for individuals age 40 and younger, according to background information in the article. Historically, trauma centers have focused on reducing death and disability following injury; however, it is now recognized that like other diseases, trauma affects certain individuals in high-risk groups. “Correspondingly, the primary prevention of injury has become implicit in the development of integrated trauma systems,” the authors write. “The identification of individuals at risk for injury has led to the development of preventative measures to reduce predisposing behavior.” Recurrent injury, or trauma recidivism, has been recognized as a behavior that is costly and leads to additional illness in trauma centers.
Eric A. Toschlog, M.D., and colleagues at The Brody School of Medicine at East Carolina University and University Health Systems of Eastern North Carolina, Greenville, assessed 15,370 consecutive patients admitted to one rural, university, level I trauma center between 1994 and 2002. A national trauma registry was used to identify patients who were admitted for distinct injuries two, three, four and five times during the study period. Demographic and clinical information, including blood alcohol levels and toxicology results, were obtained from the same database.
A total of 528 patients (3.4 percent) were admitted to the trauma center a second time for a different injury; the total cost for these admissions was more than $7 million. Compared with patients admitted only once, patients with recurrent admissions for trauma (recidivists):
- Were older (55.9 years vs. 39.7 years)
- Were disproportionately white (65.2 percent vs. 56.5 percent)
- Were more often female (49.1 percent vs. 37.3 percent)
- Had a higher percentage of positive blood alcohol screening results (58.7 percent vs. 39.9 percent)
- Had higher average blood ethanol levels (132.1 milligrams per deciliter vs. 69.5 milligrams per deciliter)
- Had higher rates of cocaine use (6.4 percent vs. 4.1 percent)
- Were more likely to be injured in a fall (63.8 percent of those admitted three to five times and 47.2 percent of those admitted twice vs. 24.4 percent of those admitted only once)
- Were less likely to be injured in a vehicle accident (10.3 percent of those admitted three to five times and 28.4 of those admitted twice vs. 48.1 percent of non-recidivists)
The rate of recurrent injury was lower than that in urban trauma centers (which range from 6.4 percent to 52 percent), and many of these characteristics differ from those found in studies of trauma recidivists in urban populations, who tend to be young, male and injured by violent means, the authors write. “The common feature seems to be substance abuse,” they conclude. “Correspondingly, prevention strategies for recidivism must be considerably different among rural and urban populations.”
(Arch Surg. 2007;142:77-81. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 15, 2007
Media Advisory: To contact corresponding author Blake C. Papsin, M.D., M.Sc., call Lisa Lipkin at 416- 813-6380.
OUTCOMES COMPARABLE FOR YOUNGER AND OLDER CHILDREN WITH SURGICALLY IMPLANTED HEARING AIDS
CHICAGO—Outcomes following surgically implanted hearing aids that are anchored to bone appear comparable for children younger than 5 years and those older than 5 years, according to a report in the January issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Early and consistent stimulation of the part of the inner ear known as the cochlea is critical to a child’s development of speech and language, according to background information in the article. Bone-anchored hearing aids, structures that are surgically attached to the skull’s temporal bone, treat hearing loss by directly stimulating the cochlea and conducting sound through the bone. Medical literature suggests that the optimal age for implanting these hearing aids is 2 to 4 years, the authors write, but this is not common practice. For example, the U.S. Food and Drug Administration has approved the devices for use in only children older than 5 years.
Taryn Davids, M.D., and colleagues at The Hospital for Sick Children, Toronto, reviewed surgical data from children receiving bone-anchored hearing aids over a 10-year period between 1996 and 2006. Twenty children 5 years or younger (average age 3.21) constituted the study group and were compared with 20 older children (average age 7.63). The devices were implanted using a one- or two-stage procedure, depending on the thickness of the child’s bone. In the two-stage procedure, the hearing aid’s titanium fixture was implanted first and the rest of the device installed later. Hearing tests were performed on all the children before and after implantation, and physicians assessed the stability of the implant and condition of the skin at the surgical site at each follow-up visit (which occurred one week after stage 2 of the implant, every three months for nine months afterward, and then every two years).
All of the younger children and 18 of the older children underwent a two-stage procedure. The average interval between the first and second stages was significantly longer in younger children (7.72 months vs. 4.41 months). Two of the younger children and four of the older children experienced traumatic fixture loss, meaning the components loosened or detached from the skull and required general anesthesia to repair. Three of the younger children required skin site revision, additional surgery due to poor hygiene or inadequate care at the surgical site. All of the children continue to wear their bone-anchored hearing aids, and all experienced hearing improvement.
“In conclusion, two-stage bone-anchored hearing aid implantation yields surgical success in younger children that is comparable in audiologic outcomes and traumatic device failures and/or revisions with that achieved in older children when there is an appropriate (i.e., lengthened) delay between surgical stages to allow for osseointegration,” or fusion to the bone, the authors write.
“Earlier implantation of bone-anchored hearing aids allows the younger children who receive them to benefit from earlier speech and language habilitation,” they conclude.
(Arch Otolaryngol Head Neck Surg. 2007;133:51-55. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported in part by the Ingolia-Nalli Family Fund at The Hospital for Sick Children. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 15, 2007
Media Advisory: To contact Dennis M. Wolf, B.Sc., D.O.-H.N.S., M.R.C.S., e-mail: dennis.wolf{at}gmail.com.
COMMON BLOOD TEST CAN HELP DISTINGUISH BETWEEN MONONUCLEOSIS AND TONSILLITIS
CHICAGO—Measuring a patient’s ratio of white blood cell types may help physicians accurately distinguish between the similar conditions infectious mononucleosis and bacterial tonsillitis, potentially guiding treatment decisions, according to an article in the January issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Acute tonsillitis (inflammation of the tonsils) and infectious mononucleosis (caused by the Epstein-Barr virus) are both common ear, nose and throat conditions with similar symptoms, according to background information in the article. These symptoms include sore throat, fever, painful swallowing, white plaque on the tonsils and redness of the throat and tonsils. “The importance in differentiating patients with tonsillitis from those with glandular fever [mononucleosis] is the prevention of spontaneous rupture of the spleen and acute intra-abdominal hemorrhage,” potential complications of mononucleosis, the authors write. Currently, distinguishing between them requires an expensive mononucleosis spot test.
Dennis M. Wolf, B.Sc., D.O.-H.N.S., M.R.C.S., and colleagues at St. George’s Hospital, London, retrospectively analyzed laboratory tests from 120 patients with infectious mononucleosis and 100 patients with bacterial tonsillitis treated at their facility. All patients were given the spot test for mononucleosis and additional blood tests were performed to determine the number of lymphocytes (a particular type of white blood cell involved in the body’s immune response) and overall white blood cell count.
Total white blood cell count was significantly increased in the tonsillitis group compared with the mononucleosis group (16,560 cells per microliter vs. 11,400 cells per microliter), but the lymphocyte count was higher in the mononucleosis group (6,490 cells per microliter vs. 1,590 cells per microliter). The ratio of lymphocyte/white blood cell count ratio averaged .54 in the mononucleosis group and .10 in the tonsillitis group.
Based on this data, the researchers determined that a ratio higher than .35 would have a sensitivity of 90 percent and a specificity of 100 percent for the detection of mononucleosis, meaning that an individual with a ratio this high would be correctly diagnosed with mononucleosis 90 percent of the time and an individual with a ratio of .35 or lower would be correctly diagnosed as not having mononucleosis 100 percent of the time. “The specificity and sensitivity of this test seem to be better than the mononucleosis spot test itself,” the authors write.
“In conclusion, we recommend that the lymphocyte–white blood cell count ratio should be used as an indicator to decide whether mononucleosis spot tests are required,” they continue. “Results from our retrospective pilot study suggest that the lymphocyte–white blood cell count ratio could be a quickly available alternative test for the detection of glandular fever [mononucleosis].”
(Arch Otolaryngol Head Neck Surg. 2007;133:61-64. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 15, 2007
Media Advisory: To contact Terry Hung, M.B.Chir., F.R.C.S., e-mail: terryhung{at}surgery.cuhk.edu.hk.
SOME PATIENTS DISSATISFIED FOLLOWING CLOSED REDUCTION OF NASAL FRACTURES
CHICAGO—In a small series of patients who underwent closed reduction, the standard procedure to repair a broken nose, nearly one-third reported dissatisfaction with the outcome and about one-third said they would consider further surgery to correct their nasal deformities, according to a report in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
Closed reduction involves repositioning nasal bones without an open surgical incision. It is typically performed within seven days of nasal fracture for children and within 10 days for adults, according to background information in the article. “This method, although simple, fails to address deformities of the cartilaginous framework and the nasal septum caused by the injury,” the authors write. “Increasing evidence shows that patients have persistent aesthetic concerns about the outcome and obstructive symptoms after closed reductions.”
Terry Hung, M.B.Chir., F.R.C.S., and colleagues at The Chinese University of Hong Kong, Prince of Wales Hospital, interviewed 62 patients who underwent a closed reduction between July 1, 2002, and June 30, 2005. The interviews assessed patients’ satisfaction and the severity of their deformity aesthetically and functionally both before and after the procedure. Satisfaction and severity were assessed on a scale from one to five, with one being very satisfied or least severe and five being very dissatisfied and most severe.
Fifty patients (81 percent) were male and 12 (19 percent) were female, and they had an average age of 27.7 years. Forty-five percent of nasal fractures were caused by sports injuries, 23 percent by physical altercations or assaults and 10 percent by motor vehicle crashes. The average score for nasal deformity was 3.08 before surgery and 1.62 after surgery, the average score for aesthetic concern was 2.97 before surgery and 1.54 following, and the average score for nasal obstruction was 2.03 before surgery and 1.36 after surgery. Following the closed reduction, eight patients (13 percent) reported dissatisfaction with their nasal deformity, seven (11 percent) were dissatisfied with the aesthetic appearance as a result of nasal deformities and 13 (21 percent) were dissatisfied because of nasal obstruction.
“Eighteen patients (29 percent) indicated that they would like revision surgery to correct an aesthetic and/or nasal airway problem,” the authors write. “Of those who requested revision surgery, four (24 percent) wanted surgery for both cosmetic and functional reasons, six (35 percent) wanted surgery for nasal obstruction alone and eight (47 percent) wanted surgery for aesthetic reasons alone.”
Although many of the patients reported improvements in nasal structure and function following surgery, the large number of dissatisfied patients suggests that alternative procedures might work better for some, the authors continue. “A stringent preoperative assessment is paramount, before patients are advised to undergo a closed reduction of a nasal fracture,” they conclude. “A septorhinoplasty may be offered as a definitive and/or elective procedure when the post-injury assessment suggests that a closed reduction of the nasal fracture may be inadequate to address all the deformities.”
(Arch Facial Plast Surg. 2007;9:40-43. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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