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 SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 17, 2007)
MASSAGE MAY HELP EASE PAIN AND ANXIETY AFTER SURGERY
VIDEOCONFERENCING CAN HELP SURGEONS MAKE THEIR ROUNDS FROM A DISTANCE
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 17, 2007)
SEVERE PSORIASIS ASSOCIATED WITH INCREASED RISK OF DEATH
CLASSIFYING INDOOR TANNING BEHAVIORS CAN HELP PHYSICIANS TAILOR PREVENTION MESSAGES
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 17, 2007)
STUDY EXAMINES FACTORS ASSOCIATED WITH SURVIVAL IN ADVANCED LARYNGEAL CANCER
ROBOTIC DEVICE APPEARS USEFUL FOR SURGICAL REMOVAL OF CANCER INVOLVING THE TONSILS
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, December 17, 2007
Media Advisory: To contact corresponding author Daniel B. Hinshaw, M.D., call the VA Ann Arbor Healthcare System Office of Public Affairs at 734-845-3403.
MASSAGE MAY HELP EASE PAIN AND ANXIETY AFTER SURGERY
CHICAGO—A 20-minute evening back massage may help relieve pain and reduce anxiety following major surgery when given in addition to pain medications, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
Many patients still experience pain following major surgery despite the availability of pain-relieving medications, according to background information in the article. Pain may be under-treated because patients fear becoming dependent on medications, are concerned about side effects, believe that they should endure pain without complaining or worry about bothering nurses. Physicians and nurses may administer ineffective doses of pain relievers because of personal biases, cultural attitudes or a lack of knowledge.
Allison R. Mitchinson, M.P.H., N.C.T.M.B., of the Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Mich., and colleagues conducted a randomized controlled trial involving 605 veterans (average age 64) undergoing major surgery (chest or abdominal operations) between 2003 and 2005. Patients were randomly assigned to one of three groups for the five days following surgery: 203 received routine care; 200 received a daily 20-minute back massage; and 202 received 20 minutes of individual attention each day from a massage therapist, but no massage. “The purpose of this group was to assess the effect of emotional support independent of massage,” the authors write. Patients were asked daily to rate the intensity and unpleasantness of their pain, plus their level of anxiety, on scales of one to 10.
“Compared with the control group, patients in the massage group experienced short-term (preintervention vs. postintervention) decreases in pain intensity, pain unpleasantness and anxiety,” the authors write. “In addition, patients in the massage group experienced a faster rate of decrease in pain intensity and unpleasantness during the first four postoperative days compared with the control group.” There were no differences in long-term anxiety, length of hospital stay or the amount of pain-relieving medications used among the three groups.
“The effectiveness of massage in reducing both the intensity and unpleasantness of pain suggests that it may act through more than one mechanism,” the authors write. “Massage may ameliorate suffering by helping to relieve the anxiety that so effectively synergizes with pain to create distress.” It could also generate mood-boosting endorphins or create a competing sensation that blocks pain, they note.
“Historically, massage was a common experience for postsurgical patients,” the authors write. “As health care systems have become more complex and administrative demands on nursing time have increased, the tradition of nurse-administered massage has been largely lost. With the recent emphasis on assessing pain as the fifth vital sign tempered by renewed concerns for patient safety, it is time to reintegrate the use of effective and less dangerous approaches to relieve patient distress.”
(Arch Surg. 2007;142(12):1158-1167. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the Department of Veterans Affairs Health Services Research and Development. 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, December 17, 2007
Media Advisory: To contact Lars M. Ellison, M.D., call Christopher Burke at 207-594-6715.
VIDEOCONFERENCING CAN HELP SURGEONS MAKE THEIR ROUNDS FROM A DISTANCE
CHICAGO—Using robotic teleconferencing to monitor patients after urologic surgery appears to result in similar patient outcomes and satisfaction as traditional bedside rounds, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
“The defining image of inpatient care is that of the physician conducting bedside rounds,” the authors write as background information in the article. “This bedside interaction has come to be a measure of physician compassion. The reality for elective surgical patients is that established critical pathways define postoperative care. To be sure, these require timely physician oversight, but the value of the bedside visit may be secondary to objective vital signs and laboratory data.”
Lars M. Ellison, M.D., then of the University of California, Davis, Sacramento, and now at Penobscot Bay Medical Center, Rockport, Maine, and colleagues conducted a randomized controlled trial involving 270 adults. Participants were all undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours. The patients were randomly assigned to receive either traditional bedside rounds (136 patients) or robotic telerounds (134 patients) daily during their time in the hospital. “The telerounding robot is a 60-inch–tall wheel-driven device,” the authors write. “The robot consists of the motor base unit, a central processing unit, a high-definition digital camera, a flat-screen monitor and a microphone. Data to and from the robot is transferred over a high-speed wireless network and is integrated with proprietary software. The physician connects remotely to the robot via a base station.”
Both types of visits followed a set script and included reviewing objective data, including vital signs and laboratory results, as well as a discussion regarding treatment goals for the day.
Telerounding did not appear to lengthen hospital stays—both groups stayed an average of 2.8 days—or increase the complication rate. Sixteen percent of the patients in the standard round group and 13 percent in the teleround group developed complications, similar to the expected rate of complications for these types of procedures (16 percent). There were no instances in which detection of complications appeared to be delayed by telerounding.
Patient satisfaction was equally high in both groups. Most of those who received telerounds rated the audio and video quality as very good or excellent, 86 percent believed they could communicate easily via the telerounding device and two-thirds agreed they would rather see their own physician remotely than another physician in person.
“Economic realities and staff shortages have placed increasing burdens on physicians’ time,” the authors write. “Telerounding with hospitalized patients has the ability to ease time constraints through elimination of travel time. Videoconferencing systems give physicians the potential to directly assess their own patient’s situation. This is optimal compared with current practices where partners or other health care professionals with little previous patient knowledge are called on to make assessments based purely on pathways rather than firsthand operative events.”
(Arch Surg. 2007;142(12):1177-1181. 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, December 17, 2007
Media Advisory: To contact Joel M. Gelfand, M.D., M.S.C.E., call Marc Kaplan at 215-662-2560.
SEVERE PSORIASIS ASSOCIATED WITH INCREASED RISK OF DEATH
CHICAGO—Patients with severe psoriasis appear to have an increased risk of death compared with patients without the skin condition, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis is a common inflammatory disorder that affects the skin and joints, according to background information in the article. The condition has been associated with various other factors, including smoking, alcohol use and diseases such as obesity, cardiovascular disease and some cancers. “In addition, certain systemic therapies for psoriasis may rarely be associated with mortality [death] due to chronic cumulative drug toxicity or idiosyncratic reactions, and the disease itself may lead to death in rare instances,” the authors write.
Joel M. Gelfand, M.D., M.S.C.E., and colleagues at the University of Pennsylvania School of Medicine, Philadelphia, analyzed records from a database of patients who visited general practitioners in the United Kingdom between 1987 and 2002. They identified 133,568 patients with mild psoriasis, defined as having a diagnosis of psoriasis but no history of treatment for the condition, and 3,951 patients with severe psoriasis, who did receive medications or other therapies. These patients were matched with up to five control patients who visited the same practice at around the same time but did not have psoriasis, including 560,358 matched to those with mild psoriasis and 15,075 matched to those with severe psoriasis.
During the study period, patients with severe psoriasis had a 50 percent increased risk of death compared with patients who did not have psoriasis (21.3 deaths per 1,000 individuals per year vs. 12 deaths per 1,000 individuals per year, respectively). Mild psoriasis was not associated with increased risk of death. Men with severe psoriasis died an average of 3.5 years younger than men without the condition, while women with severe psoriasis died 4.4 years earlier than women without psoriasis.
“Further studies are necessary to determine the cause of excess mortality in patients with severe psoriasis, how the extent of skin disease affects mortality risk and whether the risk of mortality in patients with severe psoriasis is altered by various systemic therapies,” the authors conclude. “Patients with severe psoriasis should receive comprehensive health assessments to enhance preventive health practices, improve overall health and decrease the risk of mortality.”
(Arch Dermatol. 2007;143(12):1493-1499. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by an unrestricted grant to the Trustees of the University of Pennsylvania from Centocor and a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. 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, December 17, 2007
Media Advisory: To contact Joel Hillhouse, Ph.D., call Joe Smith at 423-439-4317.
CLASSIFYING INDOOR TANNING BEHAVIORS CAN HELP PHYSICIANS TAILOR PREVENTION MESSAGES
CHICAGO—Identifying indoor tanning behavior patterns can help physicians tailor prevention messages, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals.
“Nearly 2 million Americans tan indoors each day, with the number of individual users in the United States having doubled to nearly 30 million in the past decade,” according to background information in the article. “Evidence that indoor tanning poses a serious public health risk is increasing.” Recent studies have shown that sunlamp and sun bed exposure increases the risk for melanoma and non-melanoma skin cancers.
Joel Hillhouse, Ph.D., at the East Tennessee State University, Johnson City, and colleagues studied the indoor tanning behaviors of 168 women (average age 20.2) at a southeastern university from January 2006 to April 2006. The women were asked to complete questionnaires on indoor tanning to determine behavioral patterns, intentions, attitudes and perceptions about indoor tanning, descriptive indoor tanning norms, perceived subjective norms, indoor tanning predictors and tanning dependence.
Four types of tanners were identified: special event (tan numerous times over a short period associated with a special event, followed by extended periods of no tanning); spontaneous or mood (non-regular tanners with spontaneous patterns strongly influenced by mood); regular year-round (tan weekly or biweekly) and mixed (have both regular tanning periods and shorter periods associated with special events). Researchers compared demographic, behavioral and psychosocial information for each of these groups.
“Event tanners [53.6 percent] tanned the least, started tanning the latest and scored lowest on measures of attitudes, social norms and tanning dependence measures,” the authors write. “Regular year-round tanners [11.9 percent] started the earliest, tanned at the highest levels and scored the highest on the attitude, social norms and tanning dependence measures. Spontaneous or mood tanners [6 percent] were similar to event tanners but with a mood component to their tanning.” Mixed tanners (28.6 percent) displayed a mixture of behaviors of regular and event tanning types.
“The results of this study emphasize the fact that ‘one size fits all’ does not apply when it comes to indoor tanning,” the authors conclude. “By labeling tanners by behavioral type and adjusting our interactions based on those types, we will have a more accurate picture of our patients and be more effective in our health care messages.”
(Arch Dermatol. 2007;143(12):1530-1535. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported in part by a grant from the American Cancer Society and a grant from the National Cancer Institute to East Tennessee State University. 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, December 17, 2007
Media Advisory: To contact Amy Y. Chen, M.D., M.P.H., e-mail David Sampson at David.Sampson{at}cancer.org.
STUDY EXAMINES FACTORS ASSOCIATED WITH SURVIVAL IN ADVANCED LARYNGEAL CANCER
CHICAGO—Type of treatment, sex, race and insurance status are associated with survival rates among patients with advanced laryngeal cancer, according to a report in the December issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
About 10,000 U.S. men and women each year are diagnosed with cancer of the larynx, or voice box, according to background information in the article. For many years, total removal of the larynx (laryngectomy) followed by radiation therapy was the standard treatment. “Unfortunately, patients treated with total laryngectomy experience a complete loss of voice and may also experience impairment of swallowing function, leading to decreased quality of life in many aspects, including nutrition, social functioning and personal hygiene.” Following additional clinical trials, some patients began receiving chemotherapy followed by radiation therapy as a larynx-preserving treatment.
Amy Y. Chen, M.D., M.P.H., of Emory University and the American Cancer Society, Atlanta, and Michael Halpern, M.D., Ph.D., also of the American Cancer Society, analyzed data from a national cancer registry containing 7,019 patients diagnosed with advanced laryngeal cancer between 1995 and 1998. Of these, 53.6 percent underwent total laryngectomy, 30.6 percent radiation therapy (radiotherapy) alone and 15.8 percent combined chemotherapy and radiotherapy.
“Controlling for the other included factors, the radiotherapy and chemo-radiotherapy groups had lower odds of survival than did the total laryngectomy group,” the authors write. “The increased risk associated with death is approximately 30 percent for the chemo-radiotherapy group and 60 percent for the radiotherapy group.”
In addition, men were less likely to survive than women, those with stage IV disease were less likely to survive than those at stage III, black patients were more likely to die than white patients and uninsured patients and those with Medicaid, Medicare or other government health plan coverage were more likely to die than those with private insurance. “We do not believe that insurance status in this analysis represents differential treatment or quality of care for patients with advanced laryngeal cancer,” the authors write. “Rather, insurance status is likely a proxy for multiple medical care issues, including usual source of medical care, participation in screening and preventive care activities and exposure to related risk factors, including alcohol and/or tobacco use and poor diet, all of which can influence overall survival.”
“In conclusion, this analysis demonstrates that total laryngectomy yields the highest likelihood of survival for patients with advanced laryngeal cancer,” the authors write. “These results differ from those of previous analyses comparing total laryngectomy and chemo-radiotherapy, suggesting that caution is needed when applying clinical trial findings to broader medical care settings and populations.”
(Arch Otolaryngol Head Neck Surg. 2007;133(12):1270-1276. 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, December 17, 2007
Media Advisory: To contact Gregory S. Weinstein, M.D., call Marc Kaplan at 215-662-2560.
ROBOTIC DEVICE APPEARS USEFUL FOR SURGICAL REMOVAL OF CANCER INVOLVING THE TONSILS
CHICAGO—A new robotic surgery technique appears promising for the removal of cancer involving the tonsil region, according to a report in the December issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Typically, surgeons trying to remove tonsils of patients with cancer through the mouth have limited access to the area, according to background information in the article. If the cancer has spread to any of the surrounding tissues, an open approach involving cutting through the skin is needed. These procedures take a long time, can cause long-term difficulty swallowing and usually require the placement of a tracheotomy tube.
Gregory S. Weinstein, M.D., and colleagues at the University of Pennsylvania, Philadelphia, evaluated the feasibility of a new surgical technique—transoral robotic surgery (TORS)—on 27 participants undergoing radical tonsillectomy for cancer between May 2005 and April 2007. The surgical system consists of a console, where the surgeon sits at a distance from the patient; a surgical cart; three instrument-holding arms and a central arm with an endoscope. This lighted optical instrument with two video cameras offers a three-dimensional view of the inside of the body. The surgical arms are controlled by the surgeon’s movement of handles in the console. In TORS, the mouth is held open and incisions are made in the gums, soft palate, tongue and throat muscles to reach and remove the tonsils and any surrounding cancerous tissue.
“The surgeons successfully performed TORS in all cases,” the authors write. “All robotic arms functioned optimally during the procedures, and no interference between robotic arms was noted.” In 25 patients (93 percent), surgeons were able to remove all cancerous tissues. The average length of surgery was one hour and 43 minutes. Following the procedure, 26 out of the 27 patients were swallowing without the use of a stomach tube.
No deaths occurred, and although complications occurred in five of the 27 patients (19 percent), most were resolved without significant consequences. “The early complication rate is comparable to the rates reported for the alternative therapies of non-robotic transoral surgery, open surgical resection and concurrent chemoradiation treatments,” the authors write. Complications—including death, pneumonia or fistula (an opening or passage in the skin or organs)—that are usually reported during these other types of procedures did not occur in the TORS patients.
“Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity,” or complications, they conclude. “Future reports will focus on long-term oncologic and functional outcomes.”
(Arch Otolaryngol Head Neck Surg. 2007;133(12):1220-1226. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Co-authors Drs. Weinstein and O’Malley received a one-time compensation from Intuitive Surgical Inc. for time, materials and teaching a TORS workshop on Oct. 28, 2007. 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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