|
|
|
|
|
| ||
|
August 17, 2009JAMA 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 DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 17, 2009)
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 17, 2009)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, August 17, 2009)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website 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
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 17, 2009
Antioxidants Not Associated With Increased Melanoma Risk
CHICAGO—Antioxidant supplements do not appear to be associated with an increased risk of melanoma, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals. A recent randomized trial of antioxidants for cancer prevention found that daily supplementation with nutritionally appropriate doses of vitamins C and E, beta carotene, selenium and zinc appeared to increase the risk of melanoma in women four-fold, according to background information in the article. Because an estimated 48 percent to 55 percent of U.S. adults use vitamin or mineral supplements regularly, the potential harmful effects of these nutrients is alarming, the authors note. Maryam M. Asgari, M.D., M.P.H., of Kaiser Permanente Northern California, Oakland, and colleagues examined the association between antioxidants and melanoma among 69,671 women and men who were participating in the Vitamins and Lifestyle (VITAL) study, designed to examine supplement use and cancer risk. At the beginning of the study, between 2000 and 2002, participants completed a 24-page questionnaire about lifestyle factors, health history, diet, supplement use and other cancer risk factors. Intake of multivitamins and supplements during the previous 10 years, including selenium and beta carotene, was not associated with melanoma risk in either women or men. The researchers also examined the risk of melanoma associated with long-term use of supplemental beta carotene and selenium at doses comparable to the previous study and found no association.
"Consistent with the present results, case-control studies examining serologic [blood] levels of beta carotene, vitamin E and selenium did not find any association with subsequent risk of melanoma," the authors write. "Moreover, the Nurses' Health Study reported no association between intake of vitamins A, C and E and melanoma risk in 162,000 women during more than 1.6 million person-years of follow-up."
Editor's Note: This study was supported in part by a grant from the National Institute of Arthritis Musculoskeletal and Skin Diseases and by grants from the National Cancer Institute. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 17, 2009
Dermatologist Skin Examinations Detect More, Thinner Skin Cancers Than Patients Identify Themselves
CHICAGO—Most melanomas detected in a general-practice dermatology clinic were found by dermatologists during full-body skin examinations of patients who had come to the clinic for different complaints, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals. In addition, cancers detected by dermatologists were thinner and more likely to be in situ (only on the outer layer of skin) than were cancers detected by patients. "Early melanoma detection is the cornerstone of effective treatment, but guidelines remain sparse regarding appropriate screening procedures for both the general population as well as high-risk patients," the authors write as background information in the article. "While it is known that screening identifies melanomas at an earlier stage than would be found otherwise and that physicians detect melanomas with less tumor thickness, the U.S. Preventive Services Task Force states that current evidence is insufficient to recommend for or against routine screening. The population seen in skin cancer screenings differs markedly from that seen in a dermatology practice with a high-risk patient population." Jonathan Kantor, M.D., M.S.C.E., and Deborah E. Kantor, M.S.N., C.R.N.P., of North Florida Dermatology Associates, Jacksonville, analyzed 126 cases of melanoma diagnosed at the practice between July 2005 and October 2008. Of these, 51 cases were invasive (had spread to deeper layers of the skin) and 75 were in situ. Overall, 56.3 percent of all melanomas and 60 percent of melanomas in situ were detected by the dermatologists and were not among the reasons the patient had visited the clinic. "A greater proportion of melanomas in the physician-detected group (mean [average], 63.4 percent) than in the patient-detected group (mean, 54.5 percent) were in situ," the authors write. Dermatologist detection was also associated with thinner melanomas. "Including only invasive melanomas, the median [midpoint] melanoma depth for the physician-detected group was 0.33 millimeters, and for the patient-detected group the median depth was 0.55 millimeters," they continue. Patients whose melanoma was detected by a clinician were significantly more likely to have cancers thinner than 1 millimeter. "These data suggest that minimizing the substantial public health and financial impact of melanoma may be aided by a full-body skin examination. While self-examination plays a critical role in early detection, prior studies have suggested that physicians, and dermatologists in particular, may be better able to detect melanomas with lesser tumor thickness. Because increasing tumor thickness is closely correlated with decreasing survival, it follows that complete examination plays an important role, particularly in high-risk populations," the authors write.
"Further research in this area, and in the cost-effectiveness of screening, may lead to important changes in practice that could potentially reduce melanoma mortality and improve patient outcomes," they conclude.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Findings Add to Body of Evidence for Screenings
"In this issue of the Archives, Kantor and Kantor provide new data on the topic of melanoma screening," write Daniel G. Federman, M.D., of VA Connecticut Health Care, West Haven, and colleagues in an accompanying editorial. "Does this report, along with similar reports, provide convincing evidence that screening with full-body skin examination decreases melanoma-related mortality? The results, although provocative, are not definitive."
"At this time, we see the metaphorical glass with respect to screening for skin cancer as 'half full'," the editorial authors conclude. "Findings from suitable reports, such as the article by Kantor and Kantor, contribute information that adds incrementally to our understanding of the issues involved. Perhaps we can sip from the glass (i.e., consider full-body skin examination to be a reasonable approach), assuming that future studies will eventually fill the remaining half with fine wine."
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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 17, 2009
Distressed Personality Type Associated With Risk of Death Among Individuals With Peripheral Artery Disease
CHICAGO—A preliminary study suggests that a negative, inhibited personality type (type D personality) appears to predict an increased risk of death over four years among patients with peripheral arterial disease (PAD), according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals. Peripheral arterial disease occurs when plaque builds up in arteries that supply body areas other than the heart and brain, such as the extremities. However, patients with PAD also have an increased risk of secondary events such as stroke, heart attack and death, according to background information in the article. "Preliminary evidence suggests that personality traits such as hostility may also be associated with the severity and progression of atherosclerosis [plaque buildup] in patients with PAD," the authors write. "Another potential individual risk factor in this context is the distressed personality type (type D). Type D refers to the joint tendency to experience negative emotions and to inhibit self-expression in social interaction." Annelies E. Aquarius, Ph.D., of Tilburg University, Tilburg, the Netherlands, and colleagues studied 184 patients (average age 64.8) with peripheral arterial disease. The participants completed a personality questionnaire when they enrolled in the study, between 2001 and 2004. On the questionnaire, patients rated certain statements (such as 'I often find myself worrying about something' or 'I would rather keep people at a distance') as true or false on a scale of zero to four to assess their negativity and social inhibition. During four years of follow-up, 16 patients (8.7 percent) died, including seven who died of cancer and six of cardiovascular disease. After adjusting for age, sex, diabetes and kidney disease, patients with type D personality had an increased odds of death. Several physical and behavioral pathways may link type D personality and risk of adverse health outcomes, the authors note. The personality type has been associated with increased activation of the immune system and changes in the body's stress response system. In addition, "inadequate self-management of chronic disease is a potential behavioral mechanism that may explain the relation between type D personality and poor prognosis in cardiovascular disease," the authors write.
"Although patients with peripheral arterial disease typically have multiple cardiovascular risk factors that put them at high risk for cardiovascular events, research shows that patients with peripheral arterial disease receive suboptimal secondary prevention," they conclude. "In addition to improving awareness of the traditional medical risk factors in peripheral arterial disease, attention should be given to psychological factors that may have an adverse effect on the clinical course of peripheral arterial disease. The present findings show that screening for type D personality may be especially important in this context."
Editor's Note: This study was supported by the Netherlands Organization for Scientific Research. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 17, 2009
Surgeon Experience Not Associated With Survival Among Trauma Patients in a Structured Trauma Program
CHICAGO—Within a structured trauma program, trauma patients are equally likely to survive if they are treated by a novice surgeon or by the experienced trauma director, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals. "Trauma care in the United States is provided by surgeons with vastly different training and experience," the authors write as background information in the article. "It is assumed that after general surgery residency training, surgeons are competent to provide trauma care. Trauma fellowships exist for additional training in trauma surgery but are not a prerequisite at most medical centers." One trauma facility—The Johns Hopkins Hospital in Baltimore—recruited a fellowship-trained, seasoned (more than 10 additional years of experience) trauma surgeon to serve as the trauma program director. Previously, trauma surgery was principally the responsibility of junior first-year surgical attending surgeons. Elliott R. Haut, M.D., of The Johns Hopkins University School of Medicine, and colleagues studied trauma deaths among 13,894 patients over a 10-year period, before and after the director was hired and implemented structural changes, such as the use of evidence-based guidelines and the addition of a dedicated trauma admitting unit. In the early period (July 1, 1994, to Dec. 31, 1997), 4,499 patients were treated by novice surgeons; of the 9,395 patients in the late period (Jan. 1, 1998, to June 30, 2004), novice surgeons treated 5,783 patients and the experienced surgeon treated 3,612 patients. Overall, in the late period, concurrent comparison of patients treated by novice vs. experienced trauma surgeons demonstrated no differences in death rates between the two groups. In the group treated by novice surgeons, trauma patients were 44 percent less likely to die after the structural changes were made than in the early period (odds ratio 0.56 in the later period vs. in the earlier period). Patients managed by novice surgeons in the later period were less likely to die than were those in the early period.
"Together, these data support the belief that in a structured trauma program, surgeons with vastly different levels of training can safely provide care and obtain equivalent outcomes," the authors conclude. "System effects outweigh any potential benefits of individual surgeon experience in the care of trauma patients. The implementation of an organized trauma program with evidence-based protocols and senior surgical guidance may have a greater effect on mortality than individual surgeon experience alone."
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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 17, 2009
Corticosteroid Injections May Be Helpful to Manage Vocal Fold Polyps Without Surgery
CHICAGO—Corticosteroid injections appear to offer an alternative to surgery for treating polyps on the vocal cords, according to a report in the August issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Vocal fold polyps are benign growths often found in hoarse patients, according to background information in the article. These polyps are typically caused by vocal overuse or misuse. "Although some small vocal fold polyps may resolve with conservative treatment, typically, these polyps do not change in size in response to voice therapy," the authors write. "Surgical removal with direct microlaryngoscopic technique under general anesthesia is considered standard treatment and is recommended in most cases." However, surgery requires specialized instruments, carries the risks involved in general anesthesia and may result in vocal fold scarring or stiffness if it is performed multiple times. Yen-Bin Hsu, M.D., of National Yang-Ming University and Taipei Veterans General Hospital, Taipei, Taiwan, and colleagues reported on the applicability of an alternative to surgery, injection of corticosteroids through the skin and into the vocal folds. Twenty-four patients with vocal fold polyps received this treatment between March 1 and Dec. 31, 2007. They were followed up at one and three months afterward, and every three months thereafter. The procedure was completed smoothly in 22 of the 24 patients (92 percent), with no complications and typically within 20 minutes, the authors note. The unsuccessful procedures were due to thick, soft neck tissue or to the patient having an overly sensitive gag reflex. When examined by stroboscopy-using high-speed flashes of light to examine the patient's vocal cord vibrations-the overall response rate was 91 percent (20 of 22). "The polyps disappeared in five patients (23 percent) at one month after the percutaneous [through the skin] corticosteroid injection and in 13 (59 percent) after a three-month follow-up period," the authors write. "No further improvement was noted at six months." Two patients experienced recurrence of their vocal fold polyps at six and nine months after the injection. Corticosteroids suppress inflammation, reduce swelling and inhibit the production of collagen and fibroblasts (the cells that form collagen), mechanisms which contribute to their effectiveness in treating vocal fold polyps, the authors note.
"In contrast to traditional microlaryngoscopic surgery, percutaneous corticosteroid injection avoids possible scar formation and a second injection can be considered if necessary. In addition, this technique avoids the need for direct microlaryngoscopic instruments and the expense and risk of general anesthesia," they continue. "In conclusion, percutaneous corticosteroid injection is a practical procedure with low invasiveness and minimal morbidity."
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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 17, 2009
Post-Treatment Pain in Head and Neck Cancer Patients May Be Associated With Recurrence, Lower Survival Rate
CHICAGO—Patients with head and neck cancer who experience a higher level of post-treatment pain appear to have a lower survival rate than those who experience little or no post-treatment pain, according to a report in the August issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. "Pain is an important but infrequently analyzed symptom in head and neck cancer and may play a predictive role in recurrence and survivorship outcomes," according to background information in the article. "Failure to investigate substantial changes in pain symptoms or new-onset pain that develops following treatment may potentially delay the diagnosis of recurrent disease." Joseph Scharpf, M.D., and colleagues at the University of Iowa College, Iowa City, examined results from 339 patients who participated in the Department of Otolaryngology's Outcomes Assessment Project, conducted between 1998 and 2001. Participants provided information about their health and quality of life at diagnosis and three, six, nine and 12 months later. Participants also rated their post-treatment pain at follow-up. Of the 339 patients, 233 were men (68.7 percent) with an average age of 60.8. "Most had primary disease (84.4 percent), advanced-stage disease (59.9 percent) and oral cavity (42.2 percent) or laryngeal (23.3 percent) tumors. Most received surgical treatment alone (37.2 percent) or combined with radiotherapy," the authors write. "Pain was associated with age, general physical and mental health conditions, depressive symptoms, survival rate and recurrence within the first year," the authors note. "The five-year survival rate was 81.8 percent for patients with low post-treatment pain and 65.1 percent for those with high pain. Post-treatment pain and tumor site were independent predictors of recurrence. Pain level, age and treatment modality were independent predictors of five-year survival."
"The prevalence of post-treatment pain within the first year after diagnosis of head and neck cancer suggests that physicians are not adequately addressing this issue, even though pain is associated with health-related quality of life and recurrent disease," the authors conclude. "Appropriate monitoring can be accomplished through the routine collection of pain as the fifth vital sign. Proper treatment, including an initial workup for recurrent disease, should be provided using a comprehensive, multidisciplinary approach."
Editor's Note:This work was supported in part by a grant from the National Institutes of Health, Office of Cancer Survivorship. 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. |
|
|
