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 OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 21, 2008)
SALINE NASAL WASH HELPS IMPROVE CHILDREN’S COLD SYMPTOMS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 21, 2008)
CHANGE IN TRAUMA LEVEL DESIGNATION ASSOCIATED WITH IMPROVED PATIENT SURVIVAL
SURGICAL SITE INFECTIONS MORE COMMON THAN EXPECTED FOLLOWING BREAST PROCEDURES
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 21, 2008)
MELANOMAS MAY APPEAR NOTICEABLY DIFFERENT THAN OTHER MOLES
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 21, 2008)
DIVIDING LIP ZONES TO BE INJECTED FOR AUGMENTATION MAY HELP INCREASE PATIENT SATISFACTION
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 21, 2008
Media Advisory: To contact corresponding author Jana Skoupá, M.D., e-mail Jana.skoupa{at}iol.cz.
SALINE NASAL WASH HELPS IMPROVE CHILDREN’S COLD SYMPTOMS
CHICAGO—A saline nasal wash solution made from processed seawater appears to improve nasal symptoms and may help prevent the recurrence of respiratory infections when used by children with the common cold, according to a report in the January issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Infections of the upper respiratory tract and sinus infections are common among children, according to background information in the article. “Nasal irrigation with isotonic [balanced] saline solutions seems effective in such health conditions and is often used in a variety of indications as an adjunctive treatment,” the authors write as background information in the article. “Although saline nasal wash is currently mentioned in several guidelines, scientific evidence of its efficacy is rather poor.”
Ivo Šlapak, M.D., of Teaching Hospital Brno, Brno, Czech Republic, and colleagues randomly assigned 401 children age 6 to 10 with cold or flu to two treatment groups, one receiving standard medication and the other also receiving a nasal wash with a modified processed seawater solution. “Patients were observed for a total of 12 weeks, from January to April 2006, during which health status, symptoms and medication use were assessed at four visits over the course of the trial,” the authors write. “Acute illness was evaluated during the first two visits (up to three weeks), prevention during the following two visits (up to 12 weeks). The third visit, scheduled for week eight after study entry, could be conducted over the telephone.”
For children in the nasal wash group, the formula was administered six times per day during the first phase and three times per day during the prevention phase, in one of three strengths: medium jet flow (9 milliliters per nostril), fine spray (3 milliliters per nostril) and a dual eye/nose formula with fine spray (3 millimeters per nostril).
A total of 390 children completed the study. By the second visit, the noses of patients using saline were less stuffy and runny. During the prevention phase, eight weeks after the study began, those in the saline group had significantly less severe sore throats, coughs, nasal obstructions and secretions than those in the standard treatment group.
In addition, during the prevention phase, fewer children in the saline group were using fever-reducing drugs (9 percent vs. 33 percent), nasal decongestants (5 percent vs. 47 percent), mucus-dissolving medications (10 percent vs. 37 percent) or antibiotics (6 percent vs. 21 percent). During the same period, children using saline had fewer days of illness, missed school days or complications.
The nasal wash was well tolerated, although participants reported less discomfort using the fine spray formulations. “We did not hear substantial complaints about compliance, and good compliance seemed to be confirmed by the weight of returned empty bottles,” the authors write.
Saline washes may work by reducing the production of inflammatory compounds or by creating a favorable environment for cilia, tiny hairs in the respiratory system, to sweep away mucus and particles. “It is not clear whether the effect is predominately mechanical, based on clearing mucus, or whether salts and trace elements in seawater solutions play a significant role,” the authors write.
(Arch Otolaryngol Head Neck Surg. 2008;134[1]:67-74. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by Goemar Laboratoires La Madeleine, Avenue du Général Patron, France. 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 21, 2008
Media Advisory: To contact corresponding author David Bar-Or, M.D., call Julie Lonborg at 303-826-7170.
CHANGE IN TRAUMA LEVEL DESIGNATION ASSOCIATED WITH IMPROVED PATIENT SURVIVAL
CHICAGO—Death rates among patients admitted to a Colorado trauma center appeared to decrease after the center’s designation was upgraded, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
Trauma centers are accredited through the American College of Surgeons, according to background information in the article. Level designations are based on factors such as surgeon and nurse availability, protocols and research. Level 1 is the highest level of trauma center and most studies report improvements in survival and outcomes for patients admitted to these centers as compared with lower-level centers and non-trauma centers, although some have found no difference between level 1 and level 2 centers.
The trauma center at Swedish Medical Center—a community hospital in Englewood, Colo.—was upgraded from level 2 to level 1 in 2002. Kristin Scarborough, B.S., and colleagues at the hospital studied all 17,413 trauma patients consecutively admitted to the trauma center between 1998 and 2007. The researchers compared death rates of the 9,511 patients admitted when the center was designated level 2 (Jan. 1, 1998, to Dec. 31, 2002) to those of the 7,902 patients admitted after the upgrade to level 1 (Jan. 1, 2003, to March 31, 2007).
After adjusting for several other factors—including age, sex, injury severity, low blood pressure on hospital admission, breathing rate and co-occurring illnesses—3.48 percent of patients admitted during level 2 designation died, compared with 2.5 percent of those admitted during level 1 designation. Among severely injured patients, 14.11 percent of those admitted during the level 2 designation died, compared with 8.99 percent of those admitted during level 1 designation.
“Patients admitted during a level 1 designation with a severe head, chest or abdominal or pelvic injury diagnosis had a significant decrease in mortality [death] (9.96 percent vs. 14.51 percent, 7.14 percent vs. 11.27 percent, and 6.76 percent vs. 17.05 percent, respectively), as did patients who developed acute respiratory distress syndrome during their hospital stay (9.51 percent vs. 26.87 percent),” the authors write.
The results suggest that modifying protocols to send trauma patients to the appropriate trauma facility may improve survival, the authors note. “The number of patients needed to be treated at a level 1 trauma center over a level 2 trauma center to save one life is as follows: overall, 70 patients; injury severity score of 15 or more [severely injured], 22 patients; head injury, 17 patients; chest injury, 20 patients; and abdominal or pelvic injury, eight patients,” they write. “In addition, every fourth patient who developed acute respiratory distress syndrome may have been saved had the patient been triaged to a level 1 trauma center.”
(Arch Surg. 2008;143[1]:22-28. 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 21, 2008
Media Advisory: To contact Margaret A. Olsen, Ph.D., M.P.H., call Caroline Arbanas at 314-286-0109.
SURGICAL SITE INFECTIONS MORE COMMON THAN EXPECTED FOLLOWING BREAST PROCEDURES
CHICAGO—Infections at the incision site occurred in more than 5 percent of patients following breast surgery and cost them more than $4,000 each in hospital-related expenses, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
Reported surgical site infection rates following mastectomy (surgical removal of the breast) and other breast procedures range from 1 percent to 28 percent, according to background information in the article. “Given the state of fiscal constraints within the U.S. health care system, it is important to calculate the cost-effectiveness of infection control interventions to justify their use from an economic perspective,” the authors write. “Cost-effectiveness analyses require accurate estimates for the attributable costs of hospital-acquired infections, which are lacking for surgical site infections.”
Margaret A. Olsen, Ph.D., M.P.H., of the Washington University School of Medicine, St. Louis, and colleagues studied 949 hospital admissions for mastectomy or breast reconstruction procedures at a university-affiliated hospital between 1999 and 2002. Surgical site infections were identified in an electronic hospital database and verified by review of medical records. Costs were taken from the hospital accounting database and included those from the original admission to the hospital for surgery as well as any readmissions within one year of surgery.
Surgical site infections were identified in 50 women within one year of surgery (5.3 percent). Infections were more common in patients undergoing cancer-related procedures, and occurred following 12.4 percent of mastectomies with immediate breast reconstruction using an implant; 6.2 percent of mastectomies with immediate breast reconstruction using abdominal tissue; 4.4 percent of mastectomies only and 1.1 percent of breast reduction surgeries. The average time between surgery and infection diagnosis was 46.6 days.
“Patients with surgical site infections had significantly higher hospital costs associated with surgery and during the one-year period after surgery compared with uninfected patients, and they had a significantly longer total length of hospital stay,” the authors write. After adjusting for the type of surgical procedure performed, breast cancer stage and other variables that influence cost, the cost of surgical site infections was $4,091 per patient.
“Potential interventions to reduce the incidence of surgical site infections in this patient population include strategies to optimize the timing and dosage of prophylactic antibiotics administered before the surgical incision, glucose control in diabetic patients, promotion of meticulous hand hygiene and strategies to promote timely removal of drains, among others,” the authors conclude. “Interventions to reduce the incidence of surgical site infections following breast cancer surgical procedures are essential to reduce not only morbidity in these patient populations but also costs to the individuals and to society.”
(Arch Surg. 2008;143[1]53-60. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by an Epicenter Prevention Program Cooperative Agreement from the Centers for Disease Control and Prevention. 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 21, 2008
Media Advisory: To contact corresponding author Ashfaq A. Marghoob, M.D., call Jeanne D’Agostino at 646-227-3573.
MELANOMAS MAY APPEAR NOTICEABLY DIFFERENT THAN OTHER MOLES
CHICAGO—A preliminary study suggests that melanomas have a different appearance than other irregular skin moles (i.e., are “ugly ducklings”), according to a report in the January issue of Archives of Dermatology, one of the JAMA/Archives journals.
Rates of malignant melanoma continue to increase, and early identification allows surgeons to treat the disease by removing the tumor, according to background information in the article. The disease is more common in individuals with many moles or other skin marks, especially if the marks are atypical in color, shape or size. “The challenge for clinicians who diagnose and treat pigmented skin lesions is to distinguish between malignant melanoma and benign simulants,” the authors write.
Alon Scope, M.D., of the Memorial Sloan-Kettering Cancer Center, New York, and colleagues obtained images of the backs of 12 patients from a database of standardized patient images. All of the patients had at least eight atypical moles, and five patients had one lesion that had been confirmed as a melanoma. Thirty-four study participants—including eight pigmented lesion experts, 13 general dermatologists, five dermatology nurses and eight non-clinical medical staff—were asked to evaluate the images and identify lesions that looked different from all other atypical moles.
All five melanomas and only three of 140 benign lesions (2.1 percent) were generally apparent as different, meaning that two-thirds of the participants identified them as “ugly ducklings.” “The malignant melanomas were apparent as being different to at least 85 percent of participants, whereas the agreement rate on the benign lesions perceived as being different was 76 percent at most,” the authors write. “Four lesions were generally apparent as completely different, all four being malignant melanomas.”
For all participants, the test had a sensitivity of 90 percent, meaning 90 percent of the melanomas were identified as different. Sensitivity was 100 percent for the pigmented lesion experts, 89 percent for general dermatologists, 88 percent for nurses and 85 percent for non-clinicians.
“Although the sensitivity and specificity and diagnostic accuracy of the ugly duckling sign depended on clinical expertise, the values for these parameters were good in all subgroups of participants,” the authors write. “These preliminary findings suggest that the ugly duckling sign may prove to be a useful screening strategy for primary health care providers and even for skin self-examination.”
(Arch Dermatol. 2008;144[1]:58-64. 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, September 17, 2008
Media Advisory: To contact Andrew A. Jacono, M.D., call 516-773-4646 or e-mail: drjacono{at}newyorkfacialplasticsurgery.com.
DIVIDING LIP ZONES TO BE INJECTED FOR AUGMENTATION MAY HELP INCREASE PATIENT SATISFACTION
CHICAGO—Dividing the lips into zones based on structure may help cosmetic surgeons perform enhancement procedures with high patient satisfaction and few adverse effects, according to a report in the January issue of Archives of Facial Plastic Surgery.
“The lips are an essential component of facial symmetry and aesthetics,” according to background information in the article. Studies have found that wider and fuller lips are a mark of female attractiveness with a trend in fuller lips in models featured in magazines over the past century. “There has been a dramatic increase in cosmetic surgery in Western culture in the past few decades, with an increasing focus on achieving aesthetic ideals and maintaining a youthful appearance.”
Andrew A. Jacono, M.D., of The North Shore University Hospital, Manhasset, New York, performed 137 lip augmentation treatments on 66 patients from Jan. 1, 2004 to Jan. 1, 2006. The investigator used a new classification of 15 lip zones to direct the placement of non-animal-sourced stabilized hyaluronic acid (Restylane) injectable gel fillers used for lip enhancement. The average amount of time before lips returned to their original appearance and adverse effects were recorded. Patient satisfaction was measured on a scale of one to five.
“A total of 137 treatments were performed on lips of 66 patients [62 women and 4 men],” the author writes. The average age for treatment was 45.8 years with patients ranging in age from 20 to 76. Of those who underwent treatment, 53 patients (who had received 118 treatments in total) filled out a follow-up questionnaire to measure satisfaction with their procedures. The average score was 4.5, with 5 signifying the most satisfaction. The average amount of time it took for lips to return to their original state was 4.9 months, which is similar to that seen in other studies.
Using this new classification of lip zones to direct injection increased the “ability to better control lip shape and size in lip augmentation,” according to the author. “This technique was met with high patient satisfaction and no adverse effects.”
(Arch Facial Plast Surg. 2008;10[1]:25-29. 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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