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 INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 12, 2007)
LONG-TERM BETA CAROTENE SUPPLEMENTATION MAY HELP PREVENT COGNITIVE DECLINE
PROGRAM OF EXERCISE AND EDUCATION IMPROVES FUNCTION AND SYMPTOMS IN WOMEN WITH FIBROMYALGIA
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 12, 2007)
SURGICAL ERRORS RARE BUT SERIOUS IN OPHTHALMIC PROCEDURES
CORRECTING POOR VISION IN NURSING HOME RESIDENTS MAY IMPROVE QUALITY OF LIFE AND DECREASE SYMPTOMS OF DEPRESSION
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 12, 2007)
REPORTS OF SEIZURE FREQUENCY MAY BE INACCURATE IN PATIENTS WITH FOCAL EPILEPSY
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, November 12, 2007
Media Advisory: To contact Francine Grodstein, Sc.D., call Jessica Podlaski at BWH at 617-534-1603. To contact editorialist Kristine Yaffe, M.D., call Corinna Kaarlela at 415-476-2557.
LONG-TERM BETA CAROTENE SUPPLEMENTATION MAY HELP PREVENT COGNITIVE DECLINE
CHICAGO—Men who take beta carotene supplements for 15 years or longer may have less cognitive decline, according to a report in the November 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Decreases in cognitive ability—thinking, learning and memory skills—strongly predict dementia, a growing public health issue, according to background information in the article. Long-term cellular damage from “oxidative stress” may be a major factor in cognitive decline. Some evidence suggests that antioxidant supplements may help preserve cognition, although previous studies have been inconclusive, the authors note.
Francine Grodstein, Sc.D., of Brigham and Women’s Hospital (BWH) and Harvard Medical School, Boston, and colleagues studied the antioxidant beta carotene and its effect on cognitive ability in two groups of men. The long-term group included 4,052 men who in 1982 had been randomly assigned to take placebo or 50 milligrams of beta carotene every other day. Between 1998 and 2001, an additional 1,904 men were randomly assigned to one of the two groups. Both groups were followed through 2003, completing yearly follow-up questionnaires with information about their health and their compliance with taking the pills. The men were assessed by telephone for cognitive function at least once between 1998 and 2002.
The long-term participants were treated for an average of 18 years and the short-term participants for an average of one year. Men in the short-term group displayed no differences in cognition regardless of whether they took beta carotene or placebo, but men in the long-term group who took beta carotene had significantly higher scores on several of the cognitive tests compared with men who took placebo.
“In this generally healthy population, the extent of protection conferred by long-term treatment appeared modest; nonetheless, studies have established that very modest differences in cognition, especially verbal memory, predict substantial differences in eventual risk of dementia; thus, the public health impact of long-term beta carotene use could be large,” the authors write.
Beta carotene is not without risks—for example, it may increase the risk of lung cancer in smokers, the authors note. However, its benefits against dementia surpassed those of other medications tested in healthy older people. “Thus, the public health value of beta carotene supplementation merits careful evaluation,” the authors conclude. “Moreover, as these data support the possibility of successful interventions at early stages of brain aging in well-functioning subjects, investigations of additional agents that might also provide such neuroprotection should be initiated.”
(Arch Intern Med. 2007;167(20):2184-2190. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institutes of Health and from BASF Corporation (Florham Park, N.J.), Wyeth (New Jersey) and DMS (New Jersey). Dr. Grodstein was partially supported by a New Scholars in Aging award from the Ellison Medical Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: MORE STUDIES ON COGNITION AND AGING NEEDED
Though the results are plausible, other potential explanations exist for beta carotene’s neuroprotective effects, writes Kristine Yaffe, M.D., of the University of California, San Francisco, in an accompanying editorial. For example, men who take pills as assigned for 18 years may have certain characteristics that make them less likely to lose cognitive abilities.
“For the clinician, there is no convincing justification to recommend the use of antioxidant dietary supplements to maintain cognitive performance in cognitively normal adults or in those with mild cognitive impairment,” Dr. Yaffe writes. “Furthermore, there is new concern that high-dose antioxidant supplementation, including beta carotene, may have adverse health consequences including mortality.”
Additional studies are needed to identify preventive measures against cognitive decline, and the strategy of adding a cognitive component to other long-term studies of supplements and aging should be encouraged, she concludes.
(Arch Intern Med. 2007;167(20):2167-2168. 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, November 12, 2007
Media Advisory: To contact Daniel S. Rooks, Sc.D., call Jeff Lockwood at 617-871-7026.
PROGRAM OF EXERCISE AND EDUCATION IMPROVES FUNCTION AND SYMPTOMS IN WOMEN WITH FIBROMYALGIA
CHICAGO—An exercise program that incorporates walking, strength training and stretching may improve daily function and alleviate symptoms in women with fibromyalgia, according to a report in the November 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. These benefits appear to be enhanced when exercise is combined with education about managing the disease.
Fibromyalgia affects approximately 3.4 percent of women and 0.5 percent of men in the United States, according to background information in the article. Patients with fibromyalgia experience chronic pain throughout their bodies for at least three months, along with specific sites of tenderness. Causes and mechanisms are poorly understood. “Even with the recent approval of pregabalin by the Food and Drug Administration to treat fibromyalgia symptoms, pharmacotherapy is often insufficient to resolve persistent symptoms or improve functional limitations and quality of life,” the authors write.
Daniel S. Rooks, Sc.D., from Brigham & Women’s Hospital and Harvard Medical School, Boston, and now with Novartis Institutes for Biomedical Research, Inc., Cambridge, Mass., and colleagues recruited 207 women taking medication for fibromyalgia between 2002 and 2004. For 16 weeks, the women were randomly assigned to four groups: 51 performed aerobic and flexibility exercises only; 51 added in strength training; 50 received a self-help course on managing fibromyalgia; and 55 participated in all the exercises and the education course. The exercise groups met twice weekly, gradually increasing the length and intensity of their workouts, with instructions to perform a third day of exercise on their own.
A total of 135 women completed the study and underwent a six-month follow-up assessment. As measured by two self-assessment questionnaires and one performance test, women who participated in all forms of exercise improved their physical function, an effect that was larger in the combined education and exercise group. “Social function, mental health, fatigue, depression and self-efficacy also improved,” the authors write. “The beneficial effect on physical function of exercise alone and in combination with education persisted at six months.”
“The present study suggests that progressive walking, simple strength training movements and stretching activities are effective at improving physical, emotional and social function, key symptoms and self-efficacy in women with fibromyalgia who are being actively treated with medication,” the authors write. “Furthermore, the benefits of exercise are enhanced when combined with targeted self-management education, and improvements in physical function continue for six months after completion of the intervention. Our findings suggest the need for inclusion of appropriate exercise and patient education in the treatment of individuals with fibromyalgia.”
(Arch Intern Med. 2007;167(20):2192-2200. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This research was supported by an Arthritis Foundation Investigator Award (Dr. Rooks) and National Institutes of Health grants. 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, November 12, 2007
Media Advisory: To contact John W. Simon, M.D., call Sue Ford at 518-262-3421.
SURGICAL ERRORS RARE BUT SERIOUS IN OPHTHALMIC PROCEDURES
CHICAGO—Surgical confusions—for instance, operations involving the wrong site, the wrong patient or the wrong procedure—occur infrequently in eye surgery procedures, according to a report in the November issue of Archives of Ophthalmology, one of the JAMA/Archives journals. Although most surgical confusions cause little or no permanent injury, they may involve serious consequences for the patient, physician and profession, yet could often be prevented.
“Surgical confusions (i.e., wrong patient, wrong site, wrong procedure) are an increasingly recognized cause of morbidity, recently representing the most common category of reportable medical error,” the authors write as background information in the article. “In July 2004, the Joint Commission on Accreditation of Healthcare Organizations, in concert with many professional organizations, including the American Academy of Ophthalmology, promulgated the Universal Protocol in an effort to prevent such confusions in all surgical procedures. This protocol includes consistent preoperative verification, site marking and a time-out immediately before incision.”
John W. Simon, M.D., of the Lions Eye Institute, Albany Medical College, N.Y., and colleagues retrospectively analyzed 106 cases of surgical confusions involving eye operations that occurred between 1982 and 2005. This included 42 cases from the Ophthalmic Mutual Insurance Company and 64 from the New York State Health Department.
Their analysis found that:
- The most common confusion was wrong lens implants, which occurred in 67 of 106 cases (63 percent) and most often happened because lens specifications were not checked properly before implantation.
- The wrong eye was injected with anesthesia in 14 cases (13 percent) and operated on in 15 cases (14 percent).
- In eight cases, confusions involved the wrong patient or the wrong procedure.
- The wrong tissue was transplanted in two cases.
- Confusions involving the wrong implant or transplant more often caused severe injuries than those involving the wrong eye, patient or procedure.
- The Universal Protocol, if implemented, would have prevented 85 percent of the confusions.
The authors estimate that these data suggest a rate of 69 surgical confusions for every 1 million eye operations.
“The causes of these confusions were faulty systems, processes and conditions that led people to make mistakes, more often than an individual’s recklessness,” the authors write. “The traditional response to medical error, ‘blame, shame and train,’ therefore misses the point. Humiliating or otherwise disciplining caregivers tends to perpetuate a culture of secrecy that impedes effective root-cause analysis and future improvement. A more enlightened approach is entirely non-punitive, drawing on methods of crew resource management adapted from the airlines and the defense department.”
(Arch Ophthalmol. 2007;125(11):1515-1522. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a grant from the Sight Society of Northeastern New York, Inc. 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, November 12, 2007
Media Advisory: To contact Cynthia Owsley, Ph.D., M.S.P.H., call Bob Shepard at 205-934-8934.
CORRECTING POOR VISION IN NURSING HOME RESIDENTS MAY IMPROVE QUALITY OF LIFE AND DECREASE SYMPTOMS OF DEPRESSION
CHICAGO—Nursing home residents who received eyeglasses for uncorrected refractive error were found to have improved quality of life and decreased symptoms of depression when compared to those with refractive error who had not received eyeglasses, according to a report in the November issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Refractive error occurs when the proper degree of light does not reach the back of the eye, resulting in blurred vision. “Nursing home residents in the United States and other industrialized countries have high rates of vision impairment, with estimates ranging from three to 15 times higher than corresponding rates for community-dwelling older adults,” according to background information in the article. “Studies suggest that vision impairment in about one-third of nursing home residents could largely be reversed by treatment of uncorrected refractive error (myopia [nearsightedness], hyperopia [farsightedness], presbyopia [loss of focus]).”
Cynthia Owsley, Ph.D., M.S.P.H., and colleagues at the University of Alabama at Birmingham conducted a trial in which 142 nursing home residents age 55 or older were assigned to a group that would receive eyeglasses one week after check-up (78 residents) or a group that would receive eyeglasses at follow-up two months after check-up (64 residents). Vision-related quality-of-life and depressive symptoms were measured at baseline and at two months.
At baseline, both groups had similar demographic and medical characteristics and had similar visual acuity and refractive error uncorrected by eyeglasses. After two months, distance and near visual acuity for the right and left eye improved in the group that received eyeglasses, while the group that had not received eyeglasses had no change in visual acuity.
At the two-month follow-up, the group that received eyeglasses reported higher scores for general vision, reading, activities and hobbies and social interaction as well as fewer depressive symptoms.
“This study implies that there are significant, short-term quality-of-life and psychological benefits to providing the most basic of eye care services—namely, spectacle correction—to older adults residing in nursing homes,” the authors conclude. “These findings underscore the need for a systematic evaluation of the factors underlying the pervasive unavailability of eye care to nursing home residents in the United States so that steps can be taken to improve service delivery and eye care utilization.”
(Arch Ophthalmol. 2007;125(11):1471-1477. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by the Retirement Research Foundation, the EyeSight Foundation of Alabama, the Pearle Vision Foundation, a National Institutes of Health grant and Research to Prevent Blindness, Inc. 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, November 12, 2007
Media Advisory: To contact Christian Hoppe, Ph.D., e-mail: christian.hoppe{at}ukb.uni-bonn.de. To contact corresponding editorialist James A. Ferrendelli, M.D., call Deborah Mann Lake at 713-500-3030.
REPORTS OF SEIZURE FREQUENCY MAY BE INACCURATE IN PATIENTS WITH FOCAL EPILEPSY
CHICAGO—Asking patients with focal epilepsy (also known as partial seizures, which usually involve focal areas of the body and altered consciousness) how often they have seizures does not appear to provide an accurate count, according to a report in the November issue of Archives of Neurology, one of the JAMA/Archives journals. Reminding patients to record their seizures in a diary may not help, because patients may be unaware of some seizures.
“Seizures are the main symptom of epilepsy and the major target of its treatment,” the authors write as background information in the article. “Accordingly, seizure frequency is the primary outcome measure for individual treatment and for clinical trials.” Seizures can be detected objectively using video-electroencephalographic (EEG) monitoring; however, because this method is expensive, it is used only in certain patients for short time periods. Physicians most often ask patients to maintain seizure diaries.
Christian Hoppe, Ph.D., and colleagues at the University of Bonn Medical Centre, Bonn, Germany, studied 91 consecutive adult patients with focal epilepsy who were admitted to a video-EEG monitoring unit between Oct. 1, 2004, and July 31, 2005. The patients were outfitted with electrodes and monitored by video for an average of 4.5 days. All were asked to keep a seizure diary and to push a warning button summoning a nurse when they felt a seizure coming. About half (42) were randomly assigned to receive daily reminders about documenting all seizures during the monitoring period. Patients with generalized epilepsy or a history of pseudoseizures were excluded from the study.
Patients experienced a total of 582 partial seizures during monitoring but did not report 323 of them. Patients’ level of consciousness before the seizure appeared to affect their reporting rate—85.8 percent of all seizures that occurred during sleep were unreported, compared with 32 percent of seizures that occurred when patients were awake. Of the seizures recorded by video-EEG, 43.6 percent occurred during sleep, while only 13.9 percent of seizures reported by patients occurred during sleep.
“Patients activated the push-button alarm ahead of 51 seizures (8.8 percent) but failed to document 17 (33.3 percent) of these seizures,” the authors write.
Reporting also varied by seizure type. Fifty-one percent of patients did not document any complex partial seizures, which arise from a single brain region and impair consciousness; a total of 73.2 percent of these types of seizures went unreported. This compares with 26.2 percent of simple partial seizures—which do not affect awareness or memory—that were not reported.
“The accuracy of seizure documentation was not correlated with neuropsychological performance, including verbal or non-verbal memory, verbal fluency and intelligence level, nor was it correlated with academic achievement,” the authors write. “However, in a group comparison, perfect seizure documenters had better verbal memory performance and higher school education than did non-perfect documenters.” Patients who were reminded to report seizures did not document them at a higher rate than patients who were not.
“In conclusion, patient seizure counts are not valid and reports of complete seizure freedom may need objective evaluation (e.g., regarding a driver’s license),” the authors write.
(Arch Neurol. 2007;64(11):1595-1599.
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.
EDITORIAL: PATIENT SEIZURE COUNTS STILL USEFUL IF PROPERLY INTERPRETED
The data from this study “starkly prove that, on average, patients report fewer than half of all their seizures,” write Giridhar P. Kalamangalam, M.D., D.Phil., of the University of Texas Health Science Center, Houston, and colleagues in an accompanying editorial. “Further, exhorting patients to keep an accurate tally with seizure diaries and reminders is fruitless.”
“Does all of this demolish the epileptologist’s main interrogative tool, the question, ‘How many seizures have you had over the past few weeks?’” they write. “No, we maintain. The authors’ data themselves suggest how the question may be resurrected.” Based on the percentages of unreported nighttime and daytime seizures in the study, average frequency based on patient reports can be calculated.
“For the individual practitioner, the main lesson is acknowledging the pitfalls of routine clinical questioning of patients with seizures, especially those with complex partial seizures,” they conclude.
(Arch Neurol. 2007;64(11):1565-1566.
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.
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