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, April 21, 2008)
DEATH RATES DECLINE FOLLOWING CORONARY BYPASS SURGERY REGARDLESS OF HOSPITAL VOLUME
U.S. SEES DECLINE IN NUMBER OF GENERAL SURGEONS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 21, 2008)
SURVIVAL RATES APPEAR LOWER FOR SCALP AND NECK MELANOMA THAN FOR OTHER SITES
LARGER SKIN LESIONS APPEAR MORE LIKELY TO BE MELANOMAS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 21, 2008)
NASAL SURGERY ASSOCIATED WITH IMPROVEMENTS IN QUALITY OF LIFE FOR THOSE WITH SLEEP APNEA
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, April 21, 2008
Media Advisory: To contact Rocco Ricciardi, M.D., M.P.H., call Amy Yelin at 781-744-3981.
DEATH RATES DECLINE FOLLOWING CORONARY BYPASS SURGERY REGARDLESS OF HOSPITAL VOLUME
CHICAGO—Rates of death following coronary artery bypass graft (CABG) surgery have declined since 1997 while the number of procedures performed has decreased, according to a report in the April issue of Archives of Surgery, one of the JAMA/Archives journals. This suggests that the volume of CABG procedures performed at a given facility may not be a reliable predictor of how patients will fare following the surgery.
“The relationship between increased hospital CABG volume and lower mortality has been consistently observed in the clinical literature,” the authors write as background information in the article. “The robustness of this association has led some investigators to suggest that postsurgical morbidity [illness] and mortality [death] could be reduced substantially if hospitals with little working experience in cardiac techniques stopped performing procedures such as CABG.”
Rocco Ricciardi, M.D., M.P.H., then of the University of Minnesota, Minneapolis, and now of Lahey Clinic, Tufts University, Burlington, Mass., and colleagues analyzed hospital discharge data from a random sample of 108,087,386 patients admitted to U.S. hospitals between 1988 and 2003. A total of 1,082,218 (1 percent) underwent CABG, while 186,483 received heart valve replacement and repair and 1,589,942 received percutaneous transluminal coronary intervention, another procedure used to treat coronary artery disease. “During our 16-year study period, the rate of CABG increased from 7.2 cases per 1,000 discharges in 1988 to 12.2 cases in 1997 but then decreased to 9.1 cases in 2003, while the rate of percutaneous interventions tripled,” the authors write.
“For CABG, the proportion of high-volume hospitals declined from 32.5 percent in 1997 to 15.5 percent in 2003,” they continue. Despite this shift, the in-hospital death rate following CABG decreased from 5.4 percent in 1988 to 3.3 percent in 2003. Hospitals performing the fewest CABG procedures experienced the largest decreases in death rates.
The findings suggest that improved quality practices may have disseminated to all facilities performing CABG, the authors note. In addition, lower death rates may have remained constant at previously high-volume hospitals that began performing fewer CABG procedures.
“Our data indicate that in-hospital mortality rates and, possibly, quality care practices are improving everywhere independent of CABG volume,” the authors write. “This finding should challenge the setting of any arbitrary volume cut point: positive effects on patient outcome are multifactorial and are inadequately described by procedure volume. In addition, the in-hospital mortality rate after CABG may have diminished to such low levels that it is no longer a useful marker of quality.”
(Arch Surg. 2008;143[4]:338-344. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study and Dr. Ricciardi were supported by the University of Minnesota Academic Health Center’s Clinical Scholars Research Grant. 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, April 21, 2008
Media Advisory: To contact Dana Christian Lynge, M.D., call Clare Hagerty at 206-685-1323.
U.S. SEES DECLINE IN NUMBER OF GENERAL SURGEONS
CHICAGO—The number of general surgeons per 100,000 Americans has declined by more than 25 percent during the past 25 years, according to a report in the April issue of Archives of Surgery, one of the JAMA/Archives journals.
“General surgeons play a pivotal role in the health care systems of the United States,” according to background information in the article. Rural general surgeons provide surgical backup to primary care physicians and help keep small rural hospitals financially viable, while urban general surgeons provide important surgical services, including emergency and trauma care that some surgical subspecialists may not offer. “There is some question as to whether there will be an adequate number of general surgeons to care for an increasingly elderly population, with its attendant increased demand for surgical care.”
Dana Christian Lynge, M.D., and colleagues at the University of Washington, Seattle, analyzed the number of general surgeons per 100,000 population using the American Medical Association’s Physician Masterfiles from 1981, 1991, 2001 and 2005. Surgeon’s age, sex and locale were also noted.
The number of active general surgeons fluctuated from 17,394 in 1981 to 17,922 in 2001 to 16,662 in 2005. The ratio of general surgeons to the population declined from 7.68 surgeons per 100,000 people in 1981 to 5.69 surgeons per 100,000 people in 2005. With the U.S. population increasing from 226 million to 292 million, the national general surgeon to population ratio declined by 25.91 percent during those 25 years, with a greater decrease in urban areas (27.24 percent) and a 21.07 percent decline in rural areas.
The number of women general surgeons increased substantially from 1981 to 2005, but they were disproportionately concentrated in urban areas. The average age of rural surgeons increased compared with surgeons practicing in urban areas.
Although other medical practitioners and health care clinicians can help the U.S. medical system adjust to the decline in general surgeons, they cannot completely fill the role of general surgeons, the authors note. Ways to address this decline should be considered by surgeons, their professional organizations and organizations that control the number of general surgeons trained annually. “These might include increased funding of residency positions, and exploring and addressing the issues surrounding training, remuneration and lifestyle that seem to have made general surgery less attractive than other specialties to medical students, especially women,” the authors conclude. Medical schools and surgical residencies should also “ensure that general surgical residents are sufficiently exposed to rural surgical practice through rural training tracks and rural-based residencies.”
“A growing and aging population, especially in rural areas, will continue to require a workforce of well-trained general surgeons who can provide a wide spectrum of surgical services.”
(Arch Surg. 2008;143[4]:345-350. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Washington-Wyoming-Alaska-Montana-Idaho Rural Health Research Center in the School of Medicine at the University of Washington. 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, April 21, 2008
Media Advisory: To contact corresponding author Nancy E. Thomas, M.D., Ph.D., call Leslie H. Lang at 919-843-9687.
SURVIVAL RATES APPEAR LOWER FOR SCALP AND NECK MELANOMA THAN FOR OTHER SITES
CHICAGO—Individuals with melanoma on their scalp or neck appear less likely to survive for five or 10 years than those with melanoma at other sites, according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals.
Melanoma rates continue to increase while rates for most other cancers decline, according to background information in the article. The significance of tumor location in determining cancer prognosis has been debated for decades, the authors note. “Understanding the role of anatomic site in melanoma survival is important for public health messages on skin awareness and sun protection,” they write. “Moreover, because the role of screening in melanoma is considered important for early detection, it is useful to clarify those characteristics with prognostic significance.”
Anne M. Lachiewicz, M.P.H., of the University of North Carolina School of Medicine, Chapel Hill, and colleagues analyzed data from U.S. cancer registries for 51,704 individuals first diagnosed with melanoma between 1992 and 2003. Of those, 43 percent had melanomas on their arms or legs, 34 percent on the trunk, 12 percent on the face or ears, 6 percent on the scalp or neck and 4 percent at an unspecified site.
Survival rates were lower among those with scalp and neck melanoma than among those with melanoma at other sites both five years (83.1 percent vs. 92.1 percent) and 10 years (76.2 percent vs. 88.7 percent) after diagnosis. “Fourteen percent of those with scalp/neck melanoma and 44 percent of those with melanomas at unknown sites died compared with only 6 percent of those with extremity [arm or leg] melanoma, 8 percent with trunk melanomas and 6 percent with face/ear melanomas,” the authors write. After controlling for other factors—including age, tumor thickness and sex—patients with melanoma on their neck or scalp died at 1.84 times the rate of those with melanoma on their arms or legs.
“The reason for worse survival among patients with scalp/neck melanomas is unclear,” the authors write. The blood supply and lymphatic drainage systems serving these areas are rich and complex, which may make it easier for melanoma cells to penetrate and circulate. In addition, such patients are more likely to have cancer that spreads into their brain than those with melanoma on their arms, legs or trunk. Finally, the skin lesions may be hidden by hair and therefore diagnosed later than those at other sites.
“The recognition that scalp/neck location is associated with poorer melanoma survival has implications for screening and public health recommendations,” the authors conclude. “We suggest that all full-skin examinations and future screening studies include a careful inspection of the scalp/neck.”
(Arch Dermatol. 2008;144[4]:515-521. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded in part by National Cancer Institute grants. Ms. Lachiewicz is supported by the Holderness Medical Foundation Fellowship Program at the University of North Carolina. 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, April 21, 2008
Media Advisory: To contact corresponding author David Polsky, M.D., Ph.D., call Pamela McDonnell at 212-404-3555.
LARGER SKIN LESIONS APPEAR MORE LIKELY TO BE MELANOMAS
CHICAGO—Skin lesions larger than 6 millimeters in diameter appear more likely to be melanomas than smaller lesions, according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals. The findings suggest that the diameter guidelines currently used by dermatologists to screen for melanoma are useful.
Many clinicians use the ABCDE method to screen for melanoma, according to background information in the article. The criteria are evidence-based guidelines that remind physicians of the features characteristic of melanoma—asymmetry, border irregularity, color variegation, diameter larger than 6 millimeters and evolution, or changes in the lesion. However, some researchers argue that strict adherence to the diameter guideline will cause physicians to miss smaller melanomas.
Naheed R. Abbasi, M.P.H., M.D., of the New York University School of Medicine, New York, and colleagues studied 1,323 patients undergoing biopsies of 1,657 pigmented skin lesions or markings suggestive of melanoma. The maximum diameter of each lesion was calculated before biopsy using a computerized skin imaging system.
Of the lesions, 804 (48.5 percent) were larger than 6 millimeters in diameter and 138 (8.3 percent) were diagnosed as melanoma. Invasive melanoma, which has penetrated deeper into the skin, was diagnosed in 13 of 853 lesions (1.5 percent) that were 6 millimeters or smaller in diameter and in 41 of 804 (5.1 percent) lesions that were larger than 6 millimeters in diameter. In situ melanomas, which remain in the skin’s outer layers, were diagnosed in 22 of 853 (2.6 percent) lesions 6 millimeters or smaller in diameter and in 62 of 804 (7.7 percent) lesions larger than 6 millimeters in diameter.
“Within each 1-millimeter diameter range from 2.01 to 6 millimeters, the proportion of melanomas did not vary significantly, remaining stable at 3.6 percent to 4.5 percent,” the authors write. “However, we observed a nearly 100-percent increase in the proportion of melanomas when comparing the 5.01- to 6-millimeter category (4.3 percent) to the 6.01- to 7-millimeter category (8.3 percent).”
“We recommend that a diameter criterion of larger than 6 millimeters remain a part of the ABCDE criteria,” the authors conclude. “We do not recommend downward revision of the D criterion at this time. In the United States, rates of melanoma and nonmelanoma skin cancers have markedly increased, and skin biopsy rates have more than doubled in 20 years. In an era that demands greater data to support clinical decision making, the ABCDE criteria are valuable evidence-based guidelines to aid physicians in decisions regarding the biopsy of pigmented lesions of the skin.”
(Arch Dermatol. 2008;144[4]:469-474. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Co-author Dr. Gutkowicz-Krusin is an employee of Electro-Optical Science Inc. (EOS); Drs. Mihm, Googe, King and Prieto are dermatopathologists for the MelaFind Study, sponsored by EOS; Dr. Friedman is a consultant for and shareholder in EOS; Dr. Rigel is a consultant for EOS; Drs. Kopf and Polsky are investigators for the MelaFind Study sponsored by EOS; and Dr. Polsky is a consultant for EOS. 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, April 21, 2008
Media Advisory: To contact corresponding author Pa-Chung Wang, M.D., M.Sc., e-mail: drtony{at}tpts4.seed.net.tw.
NASAL SURGERY ASSOCIATED WITH IMPROVEMENTS IN QUALITY OF LIFE FOR THOSE WITH SLEEP APNEA
CHICAGO—Nasal surgery to remove obstructions from the airway is associated with improvements in quality of life for patients with obstructive sleep apnea and symptoms of nasal blockages, according to a report in the April issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Obstructive sleep apnea (OSA) is characterized by episodes of partial or complete blockage of the airway during sleep, leading to snoring and daytime sleepiness, according to background information in the article. Blockage of the nasal passages also is common in OSA patients, causing fragmented sleep and leading to daytime tiredness and poor quality of life.
Hsueh-Yu Li, M.D., of Chang Gung Memorial Hospital, Taipei, Taiwan, and colleagues assessed 51 consecutive patients with OSA (50 men and one woman, average age 39) and symptoms of nasal obstruction who underwent nasal surgery as initial treatment. Patients completed questionnaires assessing their symptoms, sleepiness, snoring and overall quality of life before and three months after the procedure.
Following surgery, symptoms of nasal obstruction improved significantly, and marked improvement was apparent on scales measuring snoring and sleepiness. A slight improvement also was seen in overall health status.
“The degrees of quality of life improvement, compared with the preoperative generic health status, were 30.4 percent for role-emotional [problems with work or daily activities caused by emotional difficulties], 20.7 percent for role-physical, 18.9 percent for vitality, 14.8 percent for mental health, 11.4 percent for generic health, 7.4 percent for social functioning, 1.6 percent for physical functioning and 1 percent for bodily pain,” the authors write. “These results suggest that, when nasal obstruction in OSA patients was relieved, their generic health improved and that the effects were especially remarkable in reducing role limitations caused by physical or emotional problems.”
“Our findings substantiate the role of nasal surgery in treating nasal obstruction among OSA patients,” they conclude.
(Arch Otolaryngol Head Neck Surg. 2008;134[4]:429-433. 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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