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, August 18, 2008)
EMERGENCY CARE PERSONNEL APPEAR LESS LIKELY TO TRANSPORT ELDERLY PATIENTS TO TRAUMA CENTERS THAN YOUNGER PATIENTS
SURVEY COMPARES VIEWS OF TRAUMA PROFESSIONALS, THE PUBLIC ON DYING FROM INJURIES
CHEWING GUM ASSOCIATED WITH ENHANCED BOWEL RECOVERY AFTER COLON SURGERY
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 18, 2008)
STUDY EXAMINES ASSOCIATION OF SMOKING WITH HEMORRHAGE AFTER THROAT SURGERY
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 18, 2008)
STUDY OUTLINES TEENS’ PREFERENCES AND TRADEOFFS FOR FREEDOM FROM ACNE
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, August 18, 2008
Media Advisory: To contact David C. Chang, Ph.D., M.P.H., M.B.A., call Eric A. Vohr at 410-955-8665.
EMERGENCY CARE PERSONNEL APPEAR LESS LIKELY TO TRANSPORT ELDERLY PATIENTS TO TRAUMA CENTERS THAN YOUNGER PATIENTS
CHICAGO—Elderly trauma patients appear to be less likely than younger patients to be transported to a trauma center, possibly because of unconscious age bias among emergency medical services personnel, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
An estimated 39 percent of all trauma patients will be age 65 years or older by the year 2050, according to background information in the article. “Evidence-based clinical practice guidelines strongly recommend that elderly trauma patients be treated as aggressively as non-elderly patients,” the authors write. “However, some studies have suggested that age bias may still exist in trauma care, even in the prehospital phase of that care.”
David C. Chang, Ph.D., M.P.H., M.B.A., of Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues analyzed 10 years of data from the statewide Maryland Ambulance Information System. They also surveyed emergency medical services (EMS) and trauma center personnel after presenting them with the registry findings at EMS conferences and grand rounds between 2004 and 2006. The registry identified 26,565 trauma patients, defined as those who met criteria set by the American College of Surgeons (ACS) and were declared level I status (critically ill or injured and requiring immediate attention) by EMS personnel.
More patients older than 65 were undertriaged, or not taken to a state-designated trauma center, than were younger patients (49.9 percent vs. 17.8 percent). After adjusting for other related factors, the researchers found that being 65 years or older was associated with a 52 percent reduction in likelihood of being transported to a trauma center. This decrease in transports was found to start at age 50 years, with another decrease at age 70.
A total of 166 individuals, including 127 EMS personnel and 32 medical personnel (14 attending physicians, four residents, six medical students and eight nurses), responded to the follow-up surveys. When asked about the most likely reasons for not transporting elderly patients to trauma centers, participants cited inadequate training for managing elderly patients (25.3 percent), unfamiliarity with protocol (12 percent) and possible age bias (13.4 percent) as the top three factors.
“The problem of age bias raised in this study may negate efforts to improve clinical care for elderly trauma patients within trauma centers if the system as a whole does not function properly and deliver patients appropriately to needed resources,” the authors write.
“However, it may be difficult to change attitudes of age bias and may require a broad societal campaign. Nevertheless, it may be possible to address this problem without directly addressing age bias. A focus on retraining the providers about triage protocols may be sufficient,” the authors conclude. “Additionally, it may be helpful to highlight the literature that now suggests that elderly trauma patients do, in fact, return to productive lives after their injury, which can eliminate the perception of futility of care that may be used consciously or subconsciously to justify age bias.”
(Arch Surg. 2008;143[8]:776-781. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Dr. Chang was supported by an Individual National Research Service Award from the National Institute of General Medical Sciences for a portion of this study and was awarded the Maryland EMS-Geriatrics Award by the governor of Maryland in 2005. 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, August 18, 2008
Media Advisory: To contact Lenworth M. Jacobs, M.D., M.P.H., call Michaela O. Donnelly at 860-545-4658.
SURVEY COMPARES VIEWS OF TRAUMA PROFESSIONALS, THE PUBLIC ON DYING FROM INJURIES
CHICAGO—Most trauma professionals and members of the general public say they would prefer palliative care following a severe injury if physicians determined aggressive critical care would not save their lives, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals. However, trauma care professionals and other individuals differ in their opinions regarding patients’ rights to demand care and the role of divine intervention in recovery from an injury.
Trauma has been the third or fourth leading cause of death in the United States for the past 17 years, according to background information in the article. “Trauma poses unique issues to clinicians,” the authors write. “Victims are unknown to them prior to the injury event and the clinicians frequently need to make rapid life and death decisions with little time to determine victims’ values and preferences for care.”
Lenworth M. Jacobs, M.D., M.P.H., of Hartford Hospital, Hartford, and the University of Connecticut School of Medicine, Farmington, and colleagues analyzed the results of two surveys conducted in 2005. One was a telephone survey of 1,006 members of the general public age 18 and older, and the other was a written survey mailed to medical directors at trauma centers, trauma nurses and emergency medical services personnel.
The researchers found that:
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Similar percentages of the general public (46.2 percent) and trauma professionals (47.4 percent) had received emergency medical care in the past 10 years
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51.9 percent of the public and 62.7 percent of the professionals would prefer to be in the emergency department treatment area while an injured loved one was resuscitated
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Most of the public (72.4 percent) and less than half (44.3 percent) of the professionals believe trauma patients have a right to demand care not ordered by a physician; however, most of both groups trust a physician’s decision to withdraw treatment when it would be futile
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Professionals were more likely to be organ donors than the general public (78.9 percent vs. 50.6 percent), and slightly more professionals report having a living will (40.4 percent vs. 35.7 percent)
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Religious beliefs would be important to 41 percent of the public and 30.6 percent of the professionals when making decisions about their own medical care; more of the public (61.3 percent) than the professionals (20.2 percent) believe that a person in a persistent vegetative state could be saved by a miracle or that divine intervention could save a person when physicians believe treatment is futile (57.4 percent vs. 19.5 percent)
“The findings of the surveys pose challenges for trauma professionals, hospital administrators, insurers and society as a whole,” the authors conclude. “Issues need to be discussed in the clinical and public arenas and within the curricula of health professional education. Rich and sensitive dialogue is needed so that all dying trauma patients and their families receive quality end-of-life care.”
(Arch Surg. 2008;143[8]:730-735. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The survey of the public was supported by funds from the Aetna Foundation. 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, August 18, 2008
Media Advisory: To contact corresponding author Paris P. Tekkis, M.D., F.R.C.S., e-mail p.tekkis{at}imperial.ac.uk.
CHEWING GUM ASSOCIATED WITH ENHANCED BOWEL RECOVERY AFTER COLON SURGERY
CHICAGO—Chewing gum is associated with enhanced recovery of intestinal function following surgery to remove all or part of the colon, according to an analysis of previously published studies in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
“Postoperative ileus [inability of the intestines to pass contents] is regarded as an inevitable response to the trauma of abdominal surgery and is a major contributing factor to postoperative pain and discomfort associated with abdominal distension, nausea, vomiting and cramping pain,” the authors write as background information in the article. The problem is estimated to cost approximately $1 billion in U.S. health care expenditures.
Sanjay Purkayastha, B.Sc., M.R.C.S., and colleagues at St. Mary’s Hospital, London, analyzed data from five trials published in or before July 2006 and involving 158 patients. In each trial, a group of patients chewed sugarless gum three times per day following surgery for a period of five to 45 minutes and were compared with patients who did not chew gum.
When the trial results were combined, patients who chewed gum took an average of .66 fewer days to pass flatus (gas) and an average of 1.10 fewer days to have a bowel movement, both signs of returning intestinal function. “Postoperative length of hospital stay was assessed in four trials comprising 134 patients,” the authors write. “This was also reduced in the chewing gum group by longer than one day; however, this result was not statistically significant.”
Gum chewing is thought to act as a kind of “sham feeding,” stimulating nerves in the digestive system, triggering the release of gastrointestinal hormones and increasing the production of saliva and secretions from the pancreas, the authors note.
“In conclusion, we feel that the current evidence suggests that gum chewing following abdominal surgery offers significant benefits in reducing the time to resolution of ileus; however, the studies are insufficiently powered to identify a significant benefit in length of stay,” they write. “The potential benefits to individual patients, in health economics terms, are such that a well-designed, large-scale, blinded, randomized, controlled trial with a placebo arm is warranted to answer the question of whether gum chewing can significantly reduce the length of stay after abdominal surgery or whether it merely represents a placebo effect.”
(Arch Surg. 2008;143[8]:788-793. 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, August 18, 2008
Media Advisory: To contact Sean M. Demars, M.D., call the Bassett Army Community Hospital Public Affairs Office at 907-361-5206.
STUDY EXAMINES ASSOCIATION OF SMOKING WITH HEMORRHAGE AFTER THROAT SURGERY
CHICAGO—Smoking appears to be associated with an increased rate of hemorrhage (bleeding) in patients who undergo uvulopalatopharyngoplasty (UPPP, a surgical procedure used to remove excess tissue from the throat) with tonsillectomy (a surgical procedure in which the tonsils are removed), but not in those who undergo tonsillectomy alone, according to a report in the August issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Although indications for tonsillectomy have changed over the years, it remains a common surgical procedure with a substantial risk for complications, the greatest of which is post-operative hemorrage, according to background information in the article.
Sean M. Demars, M.D., then of Madigan Army Medical Center, Tacoma, Wash., and now of Bassett Army Community Hospital, Fort Wainwright, Alaska, colleagues evaluated the rate of post-operative bleeding in 1,010 tonsillectomy patients from 2000 to 2005. Age, sex and smoking status were also noted.
The total bleeding rate for all patients was 6.7 percent. When divided into smokers and non-smokers, the bleeding rate for patients was 10.2 percent and 5.4 percent, respectively. The large difference was found “to be attributable to a marked increase in post-operative hemorrhage in the patients who underwent UPPP [10.9 percent in smokers vs. 3.3 percent in non-smokers],” the authors write. In addition, “men who underwent tonsillectomy alone bled significantly more than women (11.2 percent and 5.4 percent, respectively).”
Awareness of the association between smoking and post-operative hemorrhage “may help clinicians further counsel their patients before surgery,” the authors conclude. “Further investigation of this relationship is needed, with stratification of patients by the number of cigarettes smoked and attention to the length of time before and/or after surgery that patients refrain from smoking.”
(Arch Otolaryngol Head Neck Surg. 2008;134[8]:811-814. 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, August 18, 2008
Media Advisory: To contact corresponding author Lee T. Zane, M.D., M.A.S., e-mail lzane{at}anacor.com. To contact editorialist Marta J. VanBeek, M.D., M.P.H., call Tom Moore at 319-356-3945.
STUDY OUTLINES TEENS’ PREFERENCES AND TRADEOFFS FOR FREEDOM FROM ACNE
CHICAGO—Teens report that they would pay about $275 to have never had acne, and are willing to pay considerably more to be acne-free than to have 50 percent clearance of their acne or to have clear skin with acne scars, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.
Acne vulgaris affects almost all adolescents and has been associated with anxiety, depression, embarrassment and social dysfunction, according to background information in the article. “Reducing the psychosocial impact of acne is considered one of the guiding principles for its clinical management and it is important to measure and evaluate this impact,” the authors write.
Cynthia L. Chen, M.D., and colleagues at the University of California, San Francisco, studied 266 teen volunteers with acne from four public high schools in San Francisco. The participants completed written surveys regarding how much of their lifetime they would give up or how much money they would pay to have never had acne, to be 100-percent acne-free from then on, to have 100-percent acne clearance but with visible scarring or to have 50-percent acne clearance. They and their parents also were asked about acne history and severity, and parents were asked about their willingness to pay since they typically bear the cost of their children’s acne treatment.
The researchers’ used teens’ responses to the time trade-off question to calculate their current acne state utility score. This was done by dividing the participants’ reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average score for the current acne state was 0.961; 100-percent clearance received a higher score (0.978) than 50-percent clearance (0.967) and 100-percent clearance with scarring (0.965).
On the willingness-to-pay analysis, the teens reported they would pay a median (midpoint) of $275 to have never had acne, $100 to be 100-percent cleared of acne, $10 for 50-percent clearance and zero for 100-percent clearance with scarring. Parents said they would pay a median of $250 for their child to never have had acne, $100 for 100-percent clearance, $100 for 50-percent clearance and zero for 100-percent clearance with scarring.
Adolescents who rated their acne as more severe reported a willingness to trade more time and money for acne clearance than those with less severe acne.
“Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients’ expectations of therapy,” the authors write. “Randomized, blinded, placebo-controlled trials have shown that three to four months of conventional acne therapy, including topical benzoyl peroxide, topical retinoids and oral antibiotics, typically produces reductions in lesion counts in the 40 percent to 60 percent range.”
“It has also been suggested that the incidence of scarring from facial acne approaches 95 percent,” they continue. “Thus, adolescents’ marked preference for total clearance over partial (50 percent) clearance or clearance with scarring suggests that physicians must weigh high patient expectations against these clinical data regarding efficacy and risk of sequelae.”
(Arch Dermatol. 2008;144[8]:988-994. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Dr. Zane has participated on advisory boards for Connetics Corp., Stiefel Laboratories Inc., Medicis Pharmaceutical Corp. and QLT Inc., and is now an employee of Anacor Pharmaceuticals Inc. This study was supported in part by the Mount Zion Health Fund of the Jewish Community Endowment Fund. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PREFERENCE-BASED UTILITY QUESTIONNAIRES HELP IMPROVE PATIENT CARE
“Dermatologists are keenly aware of the ways skin diseases may have a substantial impact on a patient’s overall quality of life,” writes Marta J. VanBeek, M.D., M.P.H., of the University of Iowa Hospitals and Clinics, in an accompanying editorial. “However, in an environment in which health expenditures are allocated by non-physicians, it is critical to demonstrate the burden of skin disease relative to non-dermatologic disease to funding sources, government agencies and the lay public.”
“In terms of social value, preference-weighted questionnaires are instrumental in evaluating the extent to which increased health care expenditures lead to patient benefits because they incorporate a summary description of health status, social values and life expectancy,” Dr. VanBeek writes. “Fundamentally, utilities measure true patient preferences, uninhibited by physician assumptions. Such measurement refocuses physicians on the primary goal of our profession: improving the care of our patients.”
(Arch Dermatol. 2008;144[8]:1037-1041. 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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