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 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, February 12, 2008)
JAMA NEWS RELEASES
EXPENDITURES RISING FOR BACK AND NECK PROBLEMS, BUT HEALTH OUTCOMES DO NOT APPEAR TO BE IMPROVING
NEW STUDY EXAMINES VENTILATOR TREATMENT STRATEGIES FOR PATIENTS WITH SEVERE RESPIRATORY DISORDERS
GAPS EXIST FOR ADOPTING CONFLICTS OF INTEREST POLICIES AMONG MEDICAL SCHOOLS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
COST OF TREATING SPINE PROBLEMS INCREASES BUT PATIENTS ON AVERAGE DO NOT REPORT FEELING BETTER
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the expenditures and health outcomes for adults with back and neck problems. The report will be fed Tuesday, February 12, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, February 12, 2008
Media Advisory: To contact Brook I. Martin, M.P.H., call Clare Hagerty at 206-685-1323.
EXPENDITURES RISING FOR BACK AND NECK PROBLEMS, BUT HEALTH OUTCOMES DO NOT APPEAR TO BE IMPROVING
CHICAGO—Although expenses related to back and neck problems have increased substantially in the last decade, outcomes such as functional disability and work limitations do not appear to be improving, according to a study in the February 13 issue of JAMA.
Back and neck problems are among the symptoms most commonly encountered in clinical practice. In a 2002 survey of U.S. adults, 26 percent reported low back pain and 14 percent reported neck pain in the previous three months, according to background information in the article. Rates of imaging and therapy for back and neck (spine) problems have increased substantially in the last decade, but it is not clear how this has effected expenditures or health outcomes for individuals with these problems.
Brook I. Martin, M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to examine changes in expenditures and health status related to spine problems. The researchers analyzed 1997 – 2005 data from the nationally representative Medical Expenditure Panel Survey (MEPS). A total of 23,045 respondents (U.S. adults older than 17 years) were sampled in 1997, including 3,139 who reported spine problems. In 2005, the sample included 22,258 respondents, including 3,187 who reported spine problems.
The researchers found that expenditures were higher in each year for those with spine problems than for those without. In 1997,the average age- and sex-adjusted medical costs for respondents with spine problems was $4,695, compared with $2,731 among those without spine problems (inflation adjusted to 2005 dollars). In 2005, the average age- and sex-adjusted medical expenditures among respondents with spine problems was $6,096, compared with $3,516 among those without spine problems. From 1997 to 2005, these trends resulted in an estimated 65 percent inflation-adjusted increase in the total national expenditure of adults with spine problems, a more rapid increase than overall health expenditures.
Most of the difference observed in inflation-adjusted expenditures between those with and without spine problems in 2005 was accounted for by outpatient services (36 percent) and inpatient services (28 percent). Smaller proportions were accounted for by prescription medications (23 percent); emergency department visits (3 percent); and home health, dental and other expenses (10 percent).
The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7 percent to 24.7 percent from 1997 to 2005. Adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997.
"These data suggest that spine problems are expensive, due both to large numbers of affected persons and to high costs per person. We did not observe improvements in health outcomes commensurate with the increasing costs over time. Spine problems may offer opportunities to reduce expenditures without associated worsening of clinical outcomes," the authors conclude.
(JAMA. 2008;299[6]:656-664. Available pre-embargo to the media 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, February 12, 2008
Media Advisory: To contact Maureen O. Meade, M.D., M.Sc., call Veronica McGuire at 905-525-9140, ext. 22169. To contact Alain Mercat, M.D., email: almercat{at}chu-angers.fr. To contact editorial co-author Luciano Gattinoni, M.D., F.R.C.P., email: gattinon{at}policlinico.mi.it. To contact editorial co-author Jean-Daniel Chiche, M.D., email: jean-daniel.chiche{at}cch.aphp.fr.
NEW STUDY EXAMINES VENTILATOR TREATMENT STRATEGIES FOR PATIENTS WITH SEVERE RESPIRATORY DISORDERS
CHICAGO—A comparison of treatment methods for patients with severe lung disorders treated with ventilators found no significant difference in reducing the risk of death, but did result in lower rates of severe persistent low oxygen levels and reduced the need for additional "rescue" therapy, according to a study in the February 13 issue of JAMA.
Acute lung injury (ALI; such as from severe pneumonia) and acute respiratory distress syndrome (ARDS; the most serious form of acute lung injury), are potentially devastating complications of critical illness, according to background information in the article. Although mechanical ventilation provides essential life support, it can worsen lung injury. Low-tidal volume (volume of air that is drawn in or expelled) ventilation reduces the risk of death in critically ill patients with acute lung injury and ARDS. Adding therapies to open collapsed lung segments may further reduce the risk of death, the authors write.
Maureen O. Meade, M.D., M.Sc., of McMaster University, Hamilton, Ontario, Canada and colleagues examined the effect on death of an experimental "lung open ventilation" (LOV) strategy combining low tidal volumes, recruitment maneuvers (periodic hyperinflation [expansion]) and high levels of positive end-expiratory pressure (PEEP; a technique used to increase airway pressure) compared with an established low-tidal-volume strategy (control group) in 983 patients with moderate and severe lung injury. The randomized LOV trial was conducted between August 2000 and March 2006 in 30 intensive care units in Canada, Australia and Saudi Arabia.
All-cause hospital death rates were 36.4 percent in the experimental group and 40.4 percent in the control group. Barotrauma rates (injury to the lung caused by the pressure of the ventilator) were 11.2 percent and 9.1 percent, respectively.
"...for patients with acute lung injury and ARDS, we found similar mortality in patients with a multi-faceted protocolized lung-protective ventilation strategy designed to open the lung compared with an established low-tidal-volume protocolized ventilation strategy. We found no evidence of significant harm or increased risk of barotrauma despite the use of higher PEEP. In addition, the ‘open-lung’ strategy appeared to improve oxygenation, with fewer hypoxemia-related deaths and a lower use of rescue therapies by the treating clinicians. Our results, in combination with the two other major trials, justify use of higher PEEP levels as an alternative to the established low-PEEP, low-tidal-volume strategy," the authors write.
(JAMA. 2008;299[6]:637-645. Available pre-embargo to the media 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.
TREATMENT APPROACH MAY HAVE SOME BENEFITS, BUT DOES NOT SIGNIFICANTLY REDUCE RISK OF DEATH FOR PATIENTS ON VENTILATORS
A therapy designed to set PEEP at a certain level did not significantly lower the rate of death for patients on mechanical ventilation, but did improve lung function and reduce the duration of organ failure, according to a study in the February 13 issue of JAMA.
Alain Mercat, M.D., of CHU d’Angers, Angers, France, and colleagues compared a strategy for setting PEEP aimed at increasing alveolar (pertaining to the air sacs in the lungs) recruitment while limiting hyperinflation to one aimed at minimizing alveolar distension (stretching) in 767 patients with ALI. The randomized trial (the Express study) was conducted in 37 intensive care units in France from September 2002 to December 2005.
The researchers found that the 28-day death rate in the minimal distension group was 31.2 percent (n = 119) vs. 27.8 percent (n = 107) in the increased recruitment group. The hospital mortality rates in these two groups were 39.0 vs. 35.4 percent, respectively. The increased recruitment group had a higher median number of ventilator-free days (7 vs. 3) and organ failure-free days (6 vs. 2) compared with the minimal distension group. This strategy also was associated with higher compliance values, better oxygenation, less use of additional therapies and larger fluid requirements.
(JAMA. 2008;299[6]:646-655. Available pre-embargo to the media 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: REFINING VENTILATORY TREATMENT FOR ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME
In an accompanying editorial, Luciano Gattinoni, M.D., F.R.C.P., and Pietro Caironi, M.D., of the Universita degli Studi di Milana, Milan, Italy, comment on the studies in this week’s JAMA for treating acute lung injury and ARDS.
"The LOV study and the Express study not only should conclude the era of comparing PEEP levels in unselected populations with ALI and ARDS, but also underscore the need for a new definition of ARDS aimed at identifying patients with greater lung edema [accumulation of fluid in the tissue] and larger recruitability. Higher and lower levels of PEEP should be tested in this more selective population to obtain a definitive answer. In the meantime, the data from these two studies favor the use of higher levels of PEEP in the early phase of ALI and ARDS."
(JAMA. 2008;299[6]:691-693. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
EDITORIAL: TESTING PROTOCOLS IN THE INTENSIVE CARE UNIT
Jean-Daniel Chiche, M.D., of the University Rene Descartes, Paris, and Derek C. Angus, M.D., M.P.H., of the University of Pittsburgh, and Contributing Editor, JAMA, write concerning the challenges of complex interventions in critically ill patients in an editorial in this week’s JAMA.
"...both the Lung Open Ventilation Study and the Express Study demonstrated that is was possible to convert the physiologic principles on which experts base their care into a set of reproducible instructions and then test these instructions in a broad multicenter environment. Although neither study demonstrated a significant improvement in mortality, their findings appear to have implications for future practice. Finally, these studies made important steps toward increasingly rigorous assessment of increasingly sophisticated protocols for the best care of critically ill patients."
(JAMA. 2008;299[6]:693-695. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, February 12, 2008
Media Advisory: To contact Susan H. Ehringhaus, J.D., call Retha Sherrod at 202-828-0975. To contact editorial author David J. Rothman, Ph.D., call Susan Craig at 212-305-3900.
GAPS EXIST FOR ADOPTING CONFLICTS OF INTEREST POLICIES AMONG MEDICAL SCHOOLS
CHICAGO—A minority of U.S. medical schools surveyed have adopted policies on conflicts of interest regarding financial interests held by the institutions, while at least two-thirds have policies applying to financial interests of institutional officials, according to a study in the February 13 issue of JAMA.
Institutional academic-industry relationships exist when academic institutions or their senior officials have a financial relationship with or a financial interest in a public or private company. "Institutional conflicts of interest (ICOI) occur when these financial interests affect or reasonably appear to affect institutional processes. These potential conflicts are a matter of concern because they severely compromise the integrity of the institution and the public’s confidence in that integrity," the authors write. They add that these conflicts may also affect research results. The Association of American Universities (AAU) and the Association of American Medical Colleges (AAMC) have recommended policies regarding ICOI.
Susan H. Ehringhaus, J.D., of the Association of American Medical Colleges, Washington, D.C., and colleagues assessed the extent to which U.S. medical schools have adopted ICOI policies. The authors conducted a national survey of deans of all 125 accredited allopathic medical schools in the U.S., administered between February 2006 and December 2006, and received responses from 86 (69 percent).
The researchers found that 38 percent (30) of survey respondents have adopted an ICOI policy covering financial interests held by the institution, 37 percent (29) are working on adopting an ICOI policy covering financial interests held by the institution, and 25 percent (20) are not working on adopting such a policy or do not know.
"Much higher numbers are reflected for ICOI policies that cover the individual financial interests of officials: with adoption of policies for senior officials (55 [71 percent]), midlevel officials (55 [69 percent]), institutional review board (IRB) members (62 [81 percent]), and governing board members (51 [66 percent]); and with adoption of policies being worked on for senior officials (9 [12 percent]), midlevel officials (12 [15 percent]), IRB members (6 [8 percent]), and governing board members (2 [3 percent])," the authors write.
Most institutions treat as potential ICOI the financial interests held by an institutional research official for a research sponsor (43 [78 percent]) or for a product that is the subject of research (43 [78 percent]). The majority of institutions have adopted organizational structures that separate research responsibility from investment management and from technology transfer responsibility. The researchers add that gaps exist in institutions informing their IRBs of potential ICOI in research projects under review.
"While acknowledging that adoption of ICOI policies is not a simple task and is dependent on, among other factors, highly interactive institutional databases and the active involvement of faculty, administrative officials, and the institution’s governing board(s), it is problematic that more schools do not have more comprehensive policies in place," the authors write.
"The gaps in coverage suggest the need for continuing attention by the academic medical community to more consistently and comprehensively address the challenges presented by ICOI."
(JAMA. 2008;299[6]:665-671. Available pre-embargo to the media 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: ACADEMIC MEDICAL CENTERS AND FINANCIAL CONFLICTS OF INTEREST
In an accompanying editorial, David J. Rothman, Ph.D., of Columbia University, New York, comments on the findings of Ehringhaus and colleagues.
"It is fair to ask whether it is naive to trust institutions to monitor and discipline their own financial activities, particularly when the financial returns can be substantial. Licensing agreements on patents generate close to $2 billion per year for academic research centers … At a time when federal research funding is declining and competition for philanthropic gifts is intensifying, universities may not be eager to promulgate policies that would restrict their freedom to maneuver."
"Will government regulation step in to fill the vacuum? Current federal and state interests in industry-academy relationships provide reason to believe so. Congressional hearings are addressing the implications of industry support for continuing medical education, gifts to clinicians, the sale of physician-prescribing data, and pharmaceutical company efforts to intimidate researchers critical of their product(s). Currently, 8 states and the District of Columbia have laws or resolutions affecting marketing of pharmaceuticals," Dr. Rothman writes.
(JAMA. 2008;299[6]:695-697. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
COST OF TREATING SPINE PROBLEMS INCREASES BUT PATIENTS ON AVERAGE DO NOT REPORT FEELING BETTER
INTRO:
Healthcare costs are a major concern for many patients, especially when it means paying money out of your own pocket. When it comes to treating your back and neck, a new study finds costs are skyrocketing in the United States and on average, patients are not feeling any better. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
Patient working on car
Shot of his back
AUDIO:
BRUCE WILSON LOVES RESTORING OLD CARS BUT PERSISTENT PAIN FROM A RUPTURED DISK IN HIS BACK AND DEGENERATIVE JOINT DISEASE MAKE IT DIFFICULT TO ENJOY HIS HOBBY.
VIDEO:
SOT/FULL
@ :12
Super: Bruce Wilson
Spine Patient
Runs :07
AUDIO:
"I just can’t sit, stand or walk for any kind of extended period of time."
VIDEO:
B-ROLL
Walks into office
Patient working at desk
AUDIO:
AFTER 5 SURGERIES AND NEARLY 270 THOUSAND DOLLARS IN MEDICAL BILLS BRUCE CAN NO LONGER WORK AND IS STILL IN PAIN TODAY. NEW RESEARCH SUGGESTS HE’S NOT ALONE.
VIDEO:
SOT/FULL
@ :30
Super: Brook Martin, MPH
University of Washington
Runs :11
AUDIO:
"We’re spending a lot more money as a society on treatment and diagnosis of back problems but we’re not getting clear cut results from it."
VIDEO:
B-ROLL
Two researchers
Study papers on desk
Full screen graphic
Treating Spine Problems in U.S.
1997- 2005
Costs (up arrow) 65%
$85.9 Billion Dollars in 2005
Physical Limitations: (up arrow) from 21% to 25%
AUDIO:
RESEARCHER BROOK MARTIN AND HIS COLLEAGUES AT THE UNIVERSITY OF WASHINGTON ANALYZED DATA FROM NATIONAL HEALTHCARE SURVEYS FROM 1997 THROUGH 2005. THEY FOUND COSTS FOR TREATING SPINE PROBLEMS HAD INCREASED ROUGHLY 65 PERCENT. AMERICANS SPENT AN ESTIMATED 85.9 BILLION DOLLARS ON SPINE CARE IN 2005 AND THE PROPORTION OF ADULTS REPORTING LIMITATIONS IN PHYSICAL FUNCTION INCREASED FROM 21 PERCENT IN 1997 TO 25 PERCENT IN 2005.
VIDEO:
SOT/FULL
@1:11
Sohail Mirza, M.D.
Orthopaedic Surgeon
Runs :10
AUDIO:
"We need to look more carefully at newer technologies and newer procedures that cost more and see if they really make a meaningful difference for patients"
VIDEO:
Patient getting MRI
Drug video
GFX/JAMA COVER
AUDIO:
OUTPATIENT VISITS AND EXPENSIVE PRESCRIPTION DRUGS CONTRIBUTED TO THE INCREASE IN COST. THE FINDINGS APPEAR THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Brook Martin, MPH
University of Washington
Runs: 07
AUDIO:
"That’s alarming that we may be over prescribing, over utilizing and over treating people with back problems."
VIDEO:
SOT/FULL
Bruce Wilson
Spine Patient
Runs: 05
AUDIO:
"I used to be able to do so much."
VIDEO:
B-ROLL
Patient in home at desk
Researcher looks at spine on computer
Tight of spine x-ray
Patient walking away down the stairs
AUDIO:
BRUCE WILSON DID NOT HAVE THE OUTCOME HE EXPECTED. WHILE THAT IS NOT THE CASE FOR EVERYONE, RESEARCHERS HOPE THE FINDINGS WILL PROMPT PATIENTS TO ASK MORE QUESTIONS IN ORDER TO MAKE THE MOST INFORMED DECISION POSSIBLE. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers say it’s important to remember the latest technology does not always guarantee improvement or pain relief for you the patient. Surveys used for this study were conducted annually by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. For more information, visit www.jama.com.
