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, May 20, 2008)
JAMA NEWS RELEASES
TEEN BLOOD DONORS HAVE HIGHER RISK OF DONATION-RELATED COMPLICATIONS
HIGHER OXIDIZED LDL LEVELS ASSOCIATED WITH INCREASED RISK OF METABOLIC SYNDROME
SEPSIS GUIDELINE COMPLIANCE IMPROVES, RATE OF DEATH DECLINES AFTER EDUCATIONAL EFFORT
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
TEENAGERS WHO DONATE BLOOD MAY EXPERIENCE AN ADVERSE REACTION
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TV Note: This week's JAMA Video News Report is on complications from donating blood by 16- and 17- year-olds. The report will be fed Tuesday, May 20, 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, May 20, 2008
Media Advisory: To contact Anne F. Eder M.D., Ph.D., call Stephanie Millian at 202-303-4488.
TEEN BLOOD DONORS HAVE HIGHER RISK OF DONATION-RELATED COMPLICATIONS
CHICAGO—Sixteen- and 17-year olds who donate blood are significantly more likely to experience donation-related complications such as fainting and bruising than older blood donors, according to a study in the May 21 issue of JAMA.
“The unremitting need and increasing demand for blood components constantly challenges blood centers to maintain a safe and adequate blood supply from a decreasing pool of eligible donors that is now estimated at only 38 percent of the U.S. adult population,” the authors write. Blood centers have taken a number of steps to recruit more eligible donors, including advocating for state legislation to collect blood from 16- and 17- year-old high school students in states where it is not allowed. In the American Red Cross system between 1996 and 2005, blood collection from donors age 16 to 19 years increased and now accounts for 14.5 percent of annual donations, whereas blood donation by older individuals declined, according to background information in the article. Some data suggest that complications from donations are highest among young donors.
Anne F. Eder M.D., Ph.D., of the American Red Cross, Washington, D.C., and colleagues evaluated adverse reactions to blood donation by 16- and 17-year-olds compared with older donors. Data were from nine American Red Cross blood centers that routinely collect blood donations from 16- and 17-year-olds, a population that provides approximately 80 percent of its donations at high school blood drives. In 2006, nine American Red Cross regions collected 145,678 whole blood donations from 16- and 17-year-olds, 113,307 from 18- and 19-year-olds, and 1,517,460 from donors age 20 years or older.
Complications (such as loss of consciousness, bruising) occurred after 10.7 percent of donations by 16- and 17-year-olds, 8.3 percent of donations by 18- and 19-year-olds, and 2.8 percent by donors age 20 years or older. Sixteen- and 17-year-olds were significantly more likely to experience any loss of consciousness and major complications than 18- and 19-year-old donors or donors age 20 years or older. Injuries related to fainting were uncommon (86 events among 16- and 17-year-old donors, 5.9 events per 10,000 blood collections), but were 2.5 times more common among 16- and 17-year-old donors compared with 18- and 19-year-olds, and 14 times more likely compared with donors age 20 years or older. Almost half of all injuries occurred in 16- and 17- year-old donors; and many episodes (such as those involving concussion, laceration requiring stitches, dental injuries, broken jaw) were severe enough to require outside medical care.
Sixteen-year-old donors who experienced even a minor complication were 60 percent less likely to return to donate within 12 months than 16-year-olds who experienced uncomplicated donations (52 percent vs. 73 percent return rate). “Consequently, any negative experience diminishes the likelihood of return blood donation, and increases the possibility that a short-term yield in donations incurs the ultimate expense of deterring future blood donation by young donors. These findings are particularly pertinent at a time when blood centers are becoming increasingly reliant on young donors to maintain an adequate blood supply,” the researchers write.
“These data on common and infrequent complications of blood donation should be considered when age limits are deliberated by state authorities. The relatively comparable reaction rates in 16- and 17-year-old donors, and their increased complication rates compared with young adults and adults, suggest the need for a consistent approach. Blood centers have an obligation to constantly monitor risks of blood donation and to make a concerted and committed effort to achieve the lowest possible rate of complications. Although zero risk may not be attainable even in adults, the rate of complications in minors calls for ongoing attention to a sustained operational effort that is continually focused on donation safety,” the authors conclude.
(JAMA. 2008;299[19]:2279-2286. 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, May 20, 2008
Media Advisory: To contact corresponding author David R. Jacobs, Jr., Ph.D., call Nick Hanson at 612-624-2449.
HIGHER OXIDIZED LDL LEVELS ASSOCIATED WITH INCREASED RISK OF METABOLIC SYNDROME
CHICAGO—Higher concentrations of low-density lipoprotein (LDL) that has been modified by oxidation is associated with an increased incidence of abdominal obesity, high fasting glucose levels and high triglyceride levels and the metabolic syndrome, which includes a combination of these conditions, according to a study in the May 21 issue of JAMA.
Studies in cellular and animal models have suggested that oxidized LDL (small fraction of LDL, the so called “bad” cholesterol, that has undergone oxidation) contributes to processes that lead to the incidence of the metabolic syndrome. However, this association has not been tested in humans, according to background information in the article. Oxidized LDL is only a minor fraction of LDL, ranging from 0.001 percent in healthy individuals to approximately 5 percent in patients with acute coronary events.
Paul Holvoet, Ph.D., of Katholieke Universiteit Leuven, Belgium, and colleagues conducted a study to determine the association between the concentration of oxidized LDL and the incidence 5 years later of metabolic syndrome and its components. The study included 1,889 participants (41 percent African American; 56 percent women) who were between the ages of 18 and 30 years at the time of recruitment in 1985 and 1986 and were seen both at year 15 (2000-2001, ages 33-45 years) and year 20 examinations (2005-2006), when oxidized LDL was measured.
The researchers found that oxidized LDL showed a graded relation to incident metabolic syndrome, with participants in the group (i.e., the 20 percent of the study population) with the highest levels being 3.5 times more likely to develop the metabolic syndrome than participants in the group (i.e., the 20 percent of the study population) with the lowest levels. A similar relationship was found for components of metabolic syndrome, with those with the highest oxidized LDL levels having about twice the risk for abdominal obesity and high fasting glucose and triglyceride measurements.
“A novel finding of this study is that oxidized LDL was associated with incident metabolic syndrome. As yet, it is not possible to conclude whether oxidized LDL is a marker related to mechanistic underlying factors on the pathway to the development of metabolic syndrome, or whether it is by itself a functional intermediary in this pathway. However, the strong association of oxidized LDL with the incidence of metabolic syndrome is consistent with a causal role,” the authors write.
(JAMA. 2008;299[19]:2287-2293. 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, May 20, 2008
Media Advisory: To contact Ricard Ferrer, M.D., email: rferrer{at}tauli.cat. To contact co-author Mitchell M. Levy, M.D., F.C.C.M., call Wendy Lawton at 401-863-1862. To contact editorial co-author David W. Bates, M.D., M.Sc., call Kevin Myron at 617-534-1605.
SEPSIS GUIDELINE COMPLIANCE IMPROVES, RATE OF DEATH DECLINES AFTER EDUCATIONAL EFFORT
CHICAGO—A national educational effort in Spain to promote appropriate care for severe sepsis and septic shock was associated with a lower rate of sepsis deaths in hospitals and improved guideline adherence, although the improvement in compliance with some resuscitation procedures diminished after one year, according to a study in the May 21 issue of JAMA.
“Sepsis [a bloodstream infection] is one of the most prevalent diseases and one of the main causes of death among hospitalized patients. Severe sepsis accounts for 1 in 5 admissions to intensive care units (ICUs) and is a leading cause of death in noncardiac ICUs,” the authors write. In the United States, the mortality rate of severe sepsis is 28.6 percent, which represents 215,000 deaths annually.
The Surviving Sepsis Campaign (SSC) guidelines were developed as part of a plan to reduce severe sepsis mortality. For improving sepsis care, the SSC and the Institute for Healthcare Improvement recommend implementing a 6-hour resuscitation bundle (a number of procedures and treatments) as well as a first 24-hour management bundle. Concern exists that current guidelines are not consistently followed, possibly due to a lack of adequate education.
Ricard Ferrer, M.D., of the Universidad Autónoma de Barcelona, Spain and colleagues conducted a study to determine whether a national educational program based on the SSC guidelines could improve compliance with recommended processes of care in severe sepsis at 59 Spanish ICUs. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the pre-intervention period (November-December 2005), 1,465 patients during the post-intervention period (March-June 2006), and 247 patients during the long-term follow-up period one year later (November-December 2006).
The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in two bundles: a resuscitation bundle (six tasks to begin immediately and be accomplished within six hours) and a management bundle (four tasks to be completed within 24 hours).
Patients in the post-intervention group had a statistically significant lower risk of hospital mortality (44.0 percent vs. 39.7 percent) and 28-day mortality (36.4 percent vs. 31.1 percent) compared with the pre-intervention group. Compliance with the process-of-care variables improved after the intervention in the sepsis resuscitation bundle (5.3 percent vs. 10.0 percent) and in the sepsis management bundle (10.9 percent vs. 15.7 percent). The percentage of patients in whom care complied with all resuscitation and all management measures improved significantly after the educational program. During follow-up at one year, compliance with the resuscitation bundle returned to baseline but compliance with the management bundle and mortality remained stable with respect to the post-intervention period.
At the beginning of the study, only three process-of-care measurements had compliance rates higher than 50 percent. Compliance rates remained relatively low at the follow-up period. Hospital and ICU length of stay did not change after the intervention.
“The decreased mortality observed in our study and other studies might derive from better identification of patients with severe sepsis or from improved compliance with quality indicators, including earlier administration of antibiotics, or both,” the authors write.
(JAMA. 2008;299[19]:2294-2303. 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: IMPROVING SEPSIS CARE—THE ROAD AHEAD
In an accompanying editorial, Jeremy M. Kahn, M.D., M.Sc., of the University of Pennsylvania, Philadelphia, and David W. Bates, M.D., M.Sc., of Brigham and Women’s Hospital and the Harvard School of Public Health, Boston, comment on the findings of this study regarding sepsis care.
“Ferrer and colleagues supply powerful evidence that broad-based quality improvement in sepsis care is feasible on a national scale. The data also suggest that delivering a bundle of care effectively for patients with sepsis may be as or even more important than developing new therapies. Indeed, the absolute risk reduction in hospital mortality observed in this study would translate to an impressive number of lives saved if this type of intervention were successfully implemented on an international scale. The science of quality improvement must include not only development of effective measures, but also evaluation of what techniques for spreading and maintaining them are most effective.”
“Furthermore, this study should be a wake-up call to policy makers, a challenge to the leaders of professional societies, and a road map for the path ahead. No longer is it acceptable to simply publish practice guidelines and hope that quality improvement happens at the local level. Development of these guidelines should be followed by rigorous testing, and, when results are positive, by dedicated regional, national, and even international implementation efforts. Such broad-based efforts are needed to achieve population-level benefits from interventions known to be effective.”
(JAMA. 2008;299[19]:2322-2323. 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
TEENAGERS WHO DONATE BLOOD MAY EXPERIENCE AN ADVERSE REACTION
INTRO:
Teenagers are beginning to make up more of the eligible blood donor pool in the United States. In most states you have to be seventeen to donate blood but in twenty-two states including New York, California and Illinois you only have to be sixteen. While complications are rare, a new study indicates that these youngest donors are most likely to experience some type of adverse reaction. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Teens walking
Map of U.S.
AUDIO:
TEENAGE BLOOD DONATION IS INCREASING ACROSS THE UNITED STATES. TEENS AS YOUNG AS SIXTEEN ARE NOW ALLOWED TO DONATE BLOOD IN THESE TWENTY-TWO STATES. MOST REQUIRE PARENTAL CONSENT. KANSAS AND OREGON DO NOT.
VIDEO:
SOT/FULL
Anne Eder, M.D., Ph.D.
American Red Cross
Runs: 03
AUDIO:
“The blood supply depends on the commitment of our volunteer donors.”
VIDEO:
Doctor at table
Girl donating blood
AUDIO:
DOCTOR ANNE EDER (ED-ur) IS THE EXECUTIVE MEDICAL OFFICER AT THE AMERICAN RED CROSS. SHE SAYS TEENS ARE ENTHUSIASTIC DONORS AND THEY ARE ALSO MORE LIKELY THAN ADULTS TO EXPERIENCE ADVERSE REACTIONS.
VIDEO:
SOT/FULL
Super @ :30
Anne Eder, M.D., Ph.D.
American Red Cross
Runs: 12
AUDIO:
“In sixteen and seventeen year olds eleven percent will experience a reaction compared to eight percent of eighteen and nineteen year olds and about three percent of donors older than twenty years.”
VIDEO:
B-ROLL
People donating blood
Tech with bags of blood
Graphic:
“Lightheadedness”
“Dizziness”
Second page:
“Fainting”
“Lose consciousness”
Teenagers walking
AUDIO:
RESEARCHERS AT THE NATIONAL HEADQUARTERS OF THE AMERICAN RED CROSS ANALYZED ABOUT ONE HUNDRED AND FORTY-FIVE THOUSAND TEENAGE DONATIONS FROM NINE OF THEIR REGIONAL BLOOD CENTERS IN 2006. THEY FOUND THE MAJORITY OF ADVERSE REACTIONS IN SIXTEEN AND SEVENTEEN YEAR OLDS ARE MILD INCLUDING LIGHTHEADEDNESS, AND DIZZINESS. BUT A SMALL PERCENT WILL ALSO EXPERIENCE FAINTING OR MAY LOSE CONSCIOUSNESS. A HANDFUL MAY BECOME PHYSICALLY INJURED DUE TO A FALL.
VIDEO:
SOT/FULL
Anne Eder, M.D., Ph.D.
American Red Cross
Runs: 12
AUDIO:
“We believe this study indicates a need for awareness and preparedness especially on high school blood drives.”
VIDEO:
GFX/ JAMA COVER
Tight shots of donating blood
Person on chair donating
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. INJURIES TO YOUNG DONORS USUALLY OCCUR AFTER DONATION IN THE REFRESHMENT AREA OF THE BLOOD DRIVE OR IN A RESTROOM OR ANOTHER AREA OF THE SCHOOL.
VIDEO:
SOT/FULL
Anne Eder, M.D., Ph.D.
American Red Cross
Runs: 19
AUDIO:
“It is important to have well trained staff to recognize and treat reactions. We collect this data so that we can understand what’s going on and so that we can evaluate the steps that we take hopefully to improve safety.”
VIDEO:
B-ROLL
Teenagers walking
Person giving blood
AUDIO:
IT’S NOT ENTIRELY CLEAR WHY YOUNG BLOOD DONORS ARE MORE LIKELY TO EXPERIENCE THESE REACTIONS. RESEARCHERS BELIEVE THE WAY TEENS RESPOND TO EMOTIONAL AND PHYSICAL STRESS MAY ACCOUNT FOR PART OF THE REASON. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers say drinking water and making sure you eat something prior to donating can be helpful. The study revealed that first time donors and female donors are also more likely than others to experience adverse reactions after donating. For more information about this study you can log on to www.jama.com.
