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THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, March 11, 2008)
JAMA NEWS RELEASES
MONTHLY CONTACT WITH COUNSELOR PROVIDES SOME BENEFIT FOR MAINTAINING WEIGHT LOSS
SCREENING FOR MRSA AT HOSPITAL ADMISSION NOT ASSOCIATED WITH REDUCED RATES OF INFECTION IN SURGICAL PATIENTS
NEW RESUSCITATION APPROACH FOR OUT-OF-HOSPITAL CARDIAC ARREST ASSOCIATED WITH INCREASED SURVIVAL
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY SHOWS CHANGE IN LIFESYTLE HABITS HELPS MAINTAIN WEIGHT LOSS
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Embargoed for Release: 3:00 p.m. CT, Tuesday, March 11, 2008
Media Advisory: To contact Laura P. Svetkey, M.D., call Debbe Geiger at 919-660-9461.
MONTHLY CONTACT WITH COUNSELOR PROVIDES SOME BENEFIT FOR MAINTAINING WEIGHT LOSS
CHICAGO—Weight-loss program participants who had a brief, monthly personal contact intervention – most often a 10-15 minute phone conversation – regained less weight than participants who were in a Web-based intervention or self-directed program, according to a study in the March 12 issue of JAMA.
“Nearly two-thirds of U.S. adults are overweight or obese. Together overweight and obesity are the second leading cause of preventable death, primarily through effects on cardiovascular disease (CVD) risk factors (hypertension, dyslipidemia [abnormal amounts of lipids and lipoproteins in the blood], and type 2 diabetes). Weight loss improves these risk factors, and evidence suggests that benefits persist as long as weight loss is maintained,” the authors write.
Relatively short-term (4-6 months) behavioral interventions for adults can result in clinically significant weight loss, but regaining weight is common. “Given the vast scope of the overweight and obesity epidemic, there is a critical need for practical, affordable, and scalable intervention strategies that effectively maintain weight loss,” they write. “Despite the potential for health benefits of weight loss maintenance, there is little evidence, particularly from clinical trials, on how to accomplish this objective.”
Laura P. Svetkey, M.D., of Duke University Medical Center, Durham, N.C., and colleagues conducted the Weight Loss Maintenance (WLM) trial, a comparison of strategies for maintaining weight loss for 30 months following initial weight loss in a large, diverse, adult population at high risk for CVD. The two-phase trial included 1,032 overweight or obese adults (38 percent African American, 63 percent women) with hypertension, dyslipidemia, or both who had lost at least 8.8 lbs. during a 6-month weight loss program (phase 1) and were randomized to a weight-loss maintenance intervention (phase 2).
The interventions included monthly personal contact, unlimited access to an interactive technology–based intervention, or a self-directed control, in which participants received minimal intervention. Monthly personal contact consisted of a case management approach with monthly person-to-person guidance and support. Participants had telephone contact with an interventionist for 5 to 15 minutes each month, except for every 4th month when they had a 45- to 60-minute individual face-to-face contact. The interactive technology–based intervention included unlimited access to a Web site designed to support weight loss maintenance, with interactive features allowing participants to set personal goals and action plans for the next week and to graph personal data over time.
Average weight at entry in the study was 213 lbs. During the initial 6-month program, average weight loss was 18.7 lbs. All groups regained weight after randomization by an average of 12.1 lbs. in the self-directed, 11.5 lbs. in the interactive technology–based, and 8.8 lbs. in the personal-contact group. The average weight at 30 months remained lower in each group than average weight at entry into the study.
At 30 months after randomization, on average those in the personal-contact group regained 3.3 lbs. less weight than those in the self-directed group, whereas those in the interactive technology–based group regained only .7 lbs. less than those in the self-directed group. Those in the personal-contact group regained an average of 2.6 lbs. less than those in the interactive technology–based group. Overall, 41.8 percent of participants maintained at least 8.8 lbs. of weight loss compared with entry weight, with no significant differences between treatment groups; 70.9 percent remained at or below their entry weight.
“Although weight regain with the personal-contact intervention was statistically less than weight regain in the self-directed control group, the [average] effect was a modest 1.5 kg [3.3 lbs.] at the end of the study. However, even modest weight loss can improve cardiovascular risk factors. Each kilogram [2.2 lbs.] of weight loss is associated with an average decrease in systolic blood pressure of 1.0 to 2.4 mm Hg and a reduction in incident diabetes of 16 percent,” the author write. “At the end of the study, more than 45 percent of those in the personal-contact intervention were still maintaining at least [8.8 lbs.] of weight loss, an amount with clear clinical benefits.”
“Future research should focus on longer intervention and follow-up, understanding predictors of successful maintenance and further refinement of both personal-contact and interactive technology–based interventions,” the researchers conclude.
(JAMA. 2008;299[10]:1139-1148. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, March 11, 2008
Media Advisory: To contact Stephan Harbarth, M.D., M.S., email: stephan.harbarth{at}hcuge.ch. To contact editorial co-author Michael Climo, M.D., call Darlene Edwards at 804-675-5242.
SCREENING FOR MRSA AT HOSPITAL ADMISSION NOT ASSOCIATED WITH REDUCED RATES OF INFECTION IN SURGICAL PATIENTS
CHICAGO—New findings do not support the recommendation for universal screening on hospital admission for methicillin-resistant Staphylococcus aureus (MRSA) to reduce the rate of hospital-acquired infections in surgical patients, according to a study in the March 12 issue of JAMA.
Individuals who carry antimicrobial-resistant disease-producing agents such as MRSA places patients at high risk of infection. Early identification of patients with MRSA and subsequent prevention of patient-to-patient spread through infection control measures are believed to be important interventions to control MRSA. “Experts and policy makers, nationally and internationally, recommend universal admission screening as a means to control MRSA. However, no controlled trial has tested the hypothesis that rapid MRSA screening may improve patient outcome by decreasing MRSA cross-transmission and increasing the adequacy of pre-operative prophylaxis [disease prevention],” the authors write.
Stephan Harbarth, M.D., M.S., and colleagues with the University of Geneva Hospitals and Medical School, Geneva, Switzerland, conducted a study to evaluate the effect of a early MRSA detection strategy on MRSA infections acquired in a hospital (nosocomial ) among 21,754 surgical patients at a Swiss teaching hospital. There were two MRSA control strategies: rapid screening on admission plus standard infection control measures vs. standard infection control alone.
Twelve surgical wards including different surgical specialties were enrolled according to a pre-specified protocol, assigned to either the control (n = 10,910) or intervention (n = 10,844) group for a 9-month period, then switched to the other group for another 9 months. During the screening intervention periods, patients admitted to the intervention wards for more than 24 hours were screened before or on admission by a molecular technique for rapid, early detection of MRSA. Overall, 10,193 (94 percent) of the intervention group patients were screened with the rapid test during the intervention periods. Median (midpoint) time from admission screening to notification of test results was 22.5 hours.
Admission screening during the intervention periods identified a total of 515 MRSA-positive patients among the screened patients (5.1 percent). The majority of patients (n = 337 [65 percent]) had not been previously identified as MRSA carriers and would have been missed without systematic screening on admission. The authors estimate that to detect 1 previously unidentified MRSA carrier on admission, 30 patients would have to be screened.
A total of 93 patients (1.11 per 1,000 patient-days) developed nosocomial MRSA infection in the intervention periods compared with 76 patients (0.91 per 1,000 patient-days) in the control periods. The rate of MRSA surgical site infection and nosocomial MRSA acquisition did not change significantly. Fifty-three of 93 infected patients (57 percent) in the intervention wards were MRSA-free on admission and developed MRSA infection during hospitalization.
“Overall, our real-life trial did not show an added benefit for widespread rapid screening on admission compared with standard MRSA control alone in preventing nosocomial MRSA infections in a large surgical department. To increase effectiveness, MRSA screening could be targeted to surgical patients who undergo elective procedures with a high risk of MRSA infection. In such cases, earlier identification would allow sufficient time for optimal preoperative handling, including preoperative decontamination and adjustment of surgical prophylaxis. Finally, we suggest that surgical services and infection control teams should carefully assess their local MRSA epidemiology and patient profiles before introducing a universal screening policy,” the authors conclude.
(JAMA. 2008;299[10]:1149-1157. 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: PREVENTING MRSA INFECTIONS — FINDING IT IS NOT ENOUGH
In an accompanying editorial, Daniel J. Diekema, M.D., of the University of Iowa Carver College of Medicine and Iowa City Veterans Affairs Medical Center, Iowa City, and Michael Climo, M.D., of the Virginia Commonwealth University Medical Center and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va., write that more research is required regarding controlling MRSA infections.
“While awaiting more and better data, what should clinicians do to control MRSA in hospitals? The first part of a tiered approach should include careful assessment of MRSA within the local health care environment. Hospitals should first adhere to established infection control principles and pursue patient safety initiatives known to reduce morbidity and mortality from all health care–associated infectious pathogens. Despite the attention rightly focused on MRSA, this pathogen causes only 8 percent of hospital-acquired infections in the United States, according to the most recent data from the National Healthcare Safety Network.”
“Interventions that will address those 8 percent plus the other 92 percent of hospital infections include intensive and multifaceted hand hygiene programs; ‘bundled’ interventions to reduce central venous catheter–related bloodstream infections, ventilator-associated pneumonia, and surgical site infections; and ‘source control’ in the form of chlorhexidine [an antiseptic] bathing of intensive care unit patients. These interventions are simple and cost-effective and have the benefit of reducing all infections, including those due to MRSA. If health care–associated infections can be reduced to near zero with bundled interventions, MRSA infection rates should fall concordantly.”
(JAMA. 2008;299[10]:1190-1192. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, March 11, 2008
Media Advisory: To contact Bentley J. Bobrow, M.D., call Lynn Closway at 480-301-4337. To contact editorial co-author Mary Ann Peberdy, M.D., call Joe Kuttenkuler at 804-828-6607.
NEW RESUSCITATION APPROACH FOR OUT-OF-HOSPITAL CARDIAC ARREST ASSOCIATED WITH INCREASED SURVIVAL
CHICAGO—Patients who had cardiac arrests outside of the hospital setting and were treated with a resuscitation approach designed to limit interruption of chest compressions, termed minimally interrupted cardiac resuscitation (MICR), were more likely to survive than those patients who received standard treatments, according to a study in the March 12 issue of JAMA.
“Out-of-hospital cardiac arrest is a major public health problem and a leading cause of death,” the authors write. “Although early defibrillation with automated external defibrillators improves survival, early defibrillation is rare and few patients with out-of-hospital cardiac arrest survive. In 2004, the average survival of patients with out-of-hospital cardiac arrest was 3 percent in the state of Arizona.”
MICR, previously referred to as cardiocerebral resuscitation, is a new approach to out-of-hospital cardiac arrest for emergency medical services (EMS) personnel. MICR focuses on maximizing blood flow to the heart and brain through a series of coordinated interventions, and includes an initial series of 200 uninterrupted chest compressions, rhythm analysis with a single shock, 200 immediate post-shock chest compressions before pulse check or rhythm re-analysis, early administration of epinephrine (adrenaline, used to stimulate the heart), and delayed endotracheal intubation (placement of a flexible plastic tube into the trachea for the purpose of ventilating the lungs).
Bentley J. Bobrow, M.D., of Mayo Clinic, Scottsdale, Ariz., and colleagues investigated whether MICR would improve survival from out-of-hospital cardiac arrest. Patients with out-of-hospital cardiac arrests in two metropolitan cities in Arizona before and after MICR training of fire department emergency medical personnel were assessed. In a second analysis of protocol compliance, patients from the two metropolitan cities and 60 additional fire departments in Arizona who actually received MICR were compared with patients who did not receive MICR but received standard advanced life support.
Among the 886 patients with cardiac arrest in the two metropolitan cities, survival-to-hospital discharge increased from 4 of 218 patients (1.8 percent) in the before MICR training group to 36 of 668 patients (5.4 percent) in the after MICR training group. In the subgroup of 174 patients with a witnessed cardiac arrest and ventricular fibrillation (chaotic, irregular heart rhythm that results in little or no circulation but that may respond to defibrillation), survival increased from 2 of 43 patients (4.7 percent) in the before MICR training group to 23 of 131 patients (17.6 percent) in the after MICR training group.
For the protocol compliance analysis, overall survival-to-hospital discharge occurred in 69 of 1,799 patients (3.8 percent) who did not receive MICR and in 60 of 661 (9.1 percent) who received MICR. Survival with witnessed ventricular fibrillation and cardiac arrest occurred in 46 of 387 patients (11.9 percent) who did not receive MICR and in 40 of 141 patients (28.4 percent) who received MICR.
“Why should MICR be associated with improved outcomes after out-of-hospital cardiac arrest? One major contributor to the poor survival rates of patients with out-of-hospital cardiac arrest is prolonged inadequate myocardial and cerebral perfusion. During resuscitation efforts, the forward blood flow produced by chest compressions is so marginal that any interruption of chest compressions is extremely [harmful], especially for favorable neurological outcomes. Excessive interruptions of chest compressions by pre-hospital personnel are common. Therefore, MICR emphasizes uninterrupted chest compressions,” the authors write.
“In this study, survival-to-hospital discharge of patients with an out-of-hospital cardiac arrest improved significantly after implementation of MICR as an alternate EMS protocol. These findings require confirmation in randomized trials.”
(JAMA. 2008;299[10]:1158-1165. 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: PROGRESS IN RESUSCITATION — AN EVOLUTION, NOT A REVOLUTION
In an accompanying editorial, Mary Ann Peberdy, M.D., and Joseph P. Ornato, M.D., of Virginia Commonwealth University, Richmond, comment on the findings of Bobrow and colleagues.
“Although the concept of MICR needs further scientific evaluation, perhaps in the form of a randomized, controlled, clinical trial with precise documentation of protocol compliance, these details are likely not important factors to the numerous additional survivors who are back home with their families after the implementation of this new protocol. Progress in improving survival after cardiac arrest is most commonly made by a gradual evolution of science and its translation into clinical medicine rather than single, earth-shattering revolutions. This study ... represents confirmation that the quality of CPR, particularly the need for minimally interrupted chest compression and the lesser importance of positive pressure ventilation [receiving oxygen under pressure by a mechanical respirator], is a meaningful development in the evolution of resuscitation science.”
(JAMA. 2008;299[10]:1188-1190. 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.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
STUDY SHOWS CHANGE IN LIFESYTLE HABITS HELPS MAINTAIN WEIGHT LOSS
INTRO:
Nearly two thirds of adults in the U.S. are overweight or obese, a condition that often leads to high blood pressure and diabetes. Losing weight can be challenging. Now a new study indicates certain lifestyle changes are helping some people lose pounds and keep the weight off. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
NAT OPEN
“I’m never going back to two hundred and forty-four pounds and I am never going to gain this weight back.”
B-ROLL
Robert being weighed
Walking on track
AUDIO:
ROBERT SANDERS HAS BATTLED A WEIGHT PROBLEM FOR YEARS. HE RECENTLY ENROLLED IN THE LARGEST STUDY OF ITS KIND ANALYZING HOW TO LOSE WEIGHT AND MORE IMPORTANTLY HOW TO KEEP IT OFF.
VIDEO:
SOT/FULL
Super @ :15
Laura Svetkey, M.D.
Duke University Medical Center
Runs :06
AUDIO:
“We talked about making changes in your lifestyle that you could sustain for your life.”
VIDEO:
B-ROLL
Doctor walks down hall
Overweight man on treadmill
More exercising here –
Cook preparing healthy food
People eating
Shots of food
Lady makes call to participant
Computer showing inter-active website
AUDIO:
DR. LAURA SVETKEY WITH DUKE UNIVERSITY MEDICAL CENTER IS PART OF A TEAM OF RESEARCHERS WHO STUDIED ABOUT A THOUSAND OVERWEIGHT AND OBESE ADULTS. PARTICIPANTS WERE TAUGHT LIFESTYLE CHANGES SUCH AS REDUCING DAILY CALORIES, INCREASING MODERATE EXERCISE, EATING A WELL BALANCED DIET AND KEEPING TRACK OF CALORIES AND ACTIVITY. SOME RECEIVED MONTHLY MOTIVATIONAL CALLS DURING THE MAINTENANCE PHASE, OTHERS WERE ASKED TO LOG ON TO THIS INTER-ACTIVE WEBSITE WHERE THEY RECEIVED SIMILAR SUPPORT.
VIDEO:
SOT/FULL
Laura Svetkey, M.D.
Duke University Medical Center
Runs :08
AUDIO:
“After two and a half years of this maintenance phase about seventy percent weighed less than they had at the very beginning of the study and that percent was higher for the group who had got the personal counseling.”
VIDEO:
SOT/FULL
Robert Sanders
Study Participant
Runs: 04
AUDIO:
“That person was my motivator, my cheerleader.”
VIDEO:
B-ROLL
Lady on rowing machine
Man lifting weights
Cook puts lettuce into pita
Eating/preparing healthy foods
AUDIO:
WHILE THE INTERVENTION DID OFFER SOME HELP IN KEEPING WEIGHT OFF, THE EFFECT WAS MODEST. RESEARCHERS FOUND THOSE WHO WERE MOST SUCCESSFUL WERE THE PEOPLE WHO KEPT GOING BACK TO THE LIFESTYLE CHANGES INTRODUCED AT THE BEGINNING OF THE STUDY.
VIDEO:
SOT/FULL
Laura Svetkey
Duke University Medical Center
Runs:04
AUDIO:
“That’s the way to approach weight loss. Change your lifestyle don’t go on a diet.”
VIDEO:
BROLL
GFX/JAMA COVER
Robert eating
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. ROBERT SAYS AFTER TRYING SEVERAL DIETS AND ALWAYS GAINING THE WEIGHT BACK HE FINALLY GETS IT.
VIDEO:
SOT/FULL
Super@ 1:32
Robert Sanders
Study Participant
Runs :11
AUDIO:
“My lifestyle change has really, has enabled me to sustain this weight and I’m never going back. I will never gain the weight back I had before.”
VIDEO:
B-ROLL
Doctor weighing Robert
Feet on walking track
People on machines working out
AUDIO:
ROBERT LOST TWENTY-FIVE POUNDS IN ABOUT SIX MONTHS AND HAS ONLY GAINED ONE POUND BACK. BUT RESEARCHERS POINT OUT EVEN SMALL AMOUNTS OF WEIGHT LOSS CAN OFFER HEALTH BENEFITS SUCH AS LOWERING BLOOD PRESSURE, CHOLESTEROL LEVELS AND HELPING PREVENT DIABETES. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers say by eating healthy, keeping calories under control and incorporating daily moderate exercise all participants in the study were able to lose about twenty pounds during the initial six month weight loss program. If they stuck with those lifestyle changes, most were able to maintain much of their weight loss. The study was funded by the National Heart, Lung and Blood Institute. For more information visit www.jama.com.
