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September 21, 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 SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 21, 2009)
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 21, 2009)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, September 21, 2009)
ARCHIVES OF FACIAL PLASTIC SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, September 21, 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, September 21, 2009
Alcohol in Bloodstream Associated With Lower Risk of Death from Head Injury
CHICAGO—Individuals with ethanol in their bloodstreams appear less likely to die following a moderate to severe head injury, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals. Each year, 2 million Americans sustain traumatic brain injuries and 56,000 die as a result, according to background information in the article. Alcohol use had been implicated as a risk factor for all types of trauma, and up to half of hospitalized trauma patients are intoxicated when they are injured. "Despite these associations between alcohol and trauma, very little is known regarding the pathophysiologic implications of ethanol on traumatic brain injury," the authors write. "Experimental animal studies suggest that ethanol may have a neuroprotective effect, though results are conflicting." Ali Salim, M.D., of Cedars-Sinai Medical Center, Los Angeles, and colleagues analyzed data from 38,019 patients with moderate to severe traumatic brain injuries whose blood ethanol levels were tested on admission to the hospital between 2000 and 2005. Of these, about 38 percent (14,419) tested positive for ethanol. Those who did tended to be younger (37.7 years vs. 44.1 years), have less severe injuries and spend less time on a ventilator or in the intensive care unit than those with no alcohol in their bloodstreams. About 9 percent of the patients died in the hospital, including 7.7 percent of those with alcohol in their bloodstreams and 9.7 percent of those without. "The decrease in mortality was tempered by an apparent increase in complications for patients with positive serum ethanol levels, a finding consistently reported in the literature," the authors write. How ethanol might be associated with a reduced risk of death in patients with brain injuries is unknown, the authors note. "Several traumatic brain injury animal studies demonstrated improved mortality, reduced cognitive impairments, decreased contusion volume and improved motor performance with the preinjury administration of low doses of ethanol compared with placebo," they write. "These beneficial effects are apparently lost at higher doses." Other animal studies, however, indicate an association between ethanol and decreased survival.
"The sociologic implications are important and have been raised previously," the authors write. "It is important to note that we examined in-hospital mortality as our outcome measure. It is well established that alcohol contributes to nearly 40 percent of traffic fatalities and the risk of dying is obviously increased while driving under the influence. However, the finding of reduced mortality in traumatic brain injury patients with pre-injury ethanol raises the intriguing possibility that administering ethanol to patients with brain injuries may improve outcome." Further studies are needed to investigate the mechanisms behind this association and potential therapeutic implications.
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, September 21, 2009
Study of Hospital Relocation Provides Insights to Aid in Disaster Planning
CHICAGO—Restricting elective surgeries, limiting incoming transfers and enhancing the efficiency of the discharge process helped one major hospital reduce capacity before a relocation without interrupting emergency or trauma services, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals. Similar principles could help hospitals absorb patients in the aftermath of a disaster, the authors observe. Planning to respond to natural or manmade disasters has become a priority for health care facilities around the world, according to background information in the article. "Thorough preparation requires a coordinated effort to determine the appropriate allocation of hospital resources to accommodate an acute influx of patients with needs for various services, including operative and other procedures," the authors write. Surge capacity is the term used to describe this ability to accommodate a sudden arrival of patients. "Surge capacity is rarely tested, as most disaster drills terminate after triage and immediate treatment in the emergency department and operating rooms." UCLA Medical Center relocated to the new Ronald Reagan UCLA Medical Center site in June 2008, providing a unique opportunity to examine surge capacity issues. Howard C. Jen, M.D., and colleagues at the David Geffen School of Medicine, UCLA, analyzed hospital operations for one-week periods beginning two weeks and one week prior to move day. The researchers also analyzed regional hospital and emergency department capacity. The medical center had an average daily census (point-in-time number of patients) of 525 patients before relocation planning began, and set a target of 350 patients for move day. "There were three components to our census management strategy," the authors write. "First, the elective surgery schedule was restricted beginning one week prior to move day, and operative volume was reduced by 45 percent. Second, incoming transfers were limited, leading to a reduction in both urgent and emergent admissions to medical and surgical services without limitation of trauma and emergency department admissions. Finally, a centralized multidisciplinary discharge team was used to enhance the efficiency of the discharge process." Through these strategies, hospital census was reduced 36 percent, from 537 two weeks before move day to 345 on move day, with no change in rate of death among patients. Surgical services were reduced more than non-surgical services (46 percent vs. 30 percent); the number of elective operations decreased significantly while the number of emergency operations did not change. Hospital admissions decreased by 42 percent and discharges per occupied bed increased by 8 percent. "The majority of our strategies required three to four days to achieve significant census gains and would be particularly useful during disasters, such as hurricanes or illness epidemics, with longer lead times," the authors write. "When lead times are brief, such as earthquakes, urban bombings or other mass casualty incidents, strategies to bolster emergency department and trauma center preparedness are the first priority. Inpatient capacity for continued hospital care of injured patients must also be generated simultaneously, and our model provides useful tools for this purpose."
The findings are particularly important given results of the analysis of regional capacity, which found that during a period in which the southern California population increased 8.5 percent, the number of acute care beds decreased by 3.3 percent. In addition, Los Angeles County emergency departments experienced a 13 percent diversion rate due to overcrowding. "Hospitals should create an internal plan using these principles of census management with modifications to reflect local characteristics," the authors conclude. "Finally, as many hospitals are currently operating at capacity, a regional and integrated systems approach to surge capacity creation is needed."
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, September 21, 2009
Nationwide Study Examines Youth Access to Indoor Tanning
CHICAGO—Many indoor tanning businesses require parental consent for teenagers to use their facilities, but most would allow young tanners more than the government-recommended amount of exposure during the first week, according to a report in the September issue of Archives of Dermatology, one of the JAMA/Archives journals. Facilities with specific state laws regarding parental consent or accompaniment were more likely to require these steps. "Exposure to UV radiation from indoor tanning lamps has been linked with both melanoma and squamous cell cancer, and first exposure before age 35 years may increase melanoma risk by as much as 75 percent," the authors write as background information in the article. Indoor tanning is especially popular among adolescent girls in the United States, which may contribute to the recently reported increase in melanoma rates among U.S. women ages 15 to 39. As of 2005, 28 states had laws regulating indoor tanning, including 21 with youth access restrictions. Latrice C. Pichon, Ph.D., M.P.H., of San Diego State University/University of California, San Diego, and colleagues assessed indoor tanning practices at 3,647 facilities in 116 cities representing all 50 states. Data collectors phoned tanning salons posing as fair-skinned, 15-year-old female potential customers who had never tanned before. They asked whether the facility required a parent's consent or accompaniment, in addition to how frequently they would be allowed to tan during the first week. The U.S. Food and Drug Administration recommends but does not require or enforce a maximum of three exposures during the first week of tanning. Approximately 87 percent of the facilities required teens to get parental consent, about 14 percent required a parent to accompany the tanner and 5 percent would not allow a 15-year-old to tan at all. "State law and youth access law each were significantly related to parental consent and parental accompaniment, with facilities in states with a law more likely to require these than facilities in states without such a law," the authors write. For example, 1,966 of 2,118 facilities (92.8 percent) required parental consent when mandated by state law, compared with 1,042 of 1,345 (77.5 percent) of facilities in states without consent laws. Only around 11 percent of the facilities limited teens to the FDA-recommended three or fewer sessions the first week. The average number of sessions allowed the first week was 6.02, and about 71 percent of facilities reportedly indicated they would allow a teen to tan seven days a week. "Our data indicated that having any youth access law was associated with significantly higher rates of requiring parental consent and parental accompaniment, and facilities in states with laws specific to these practices had considerably higher rates than facilities in states without comparable law content," the authors write. "However, given the relatively high rates of indoor tanning by adolescent girls, as well as the potentially important gatekeeping function of parents, apparently many parents are allowing their teens to tan and are providing written consent or accompaniment."
More states should consider adopting complete bans on indoor tanning for minors, similar to existing laws in Wisconsin and pending in Ohio, the authors note. "Bans such as these may both reduce youth access in a direct way and more forcefully educate parents about the real dangers of indoor tanning," they conclude.
Editor's Note: This study was supported by National Cancer Institute grants. 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, September 21, 2009
Tanning May Be Associated With Moles in Very-Light-Skinned Children
CHICAGO—Very-light-skinned children without red hair who tan appear to develop more nevi (birthmarks, moles or other colored spots on the skin) than children who do not tan, according to a report in the September issue of Archives of Dermatology, one of the JAMA/Archives journals. Cutaneous melanoma ranks sixth in incidence of all cancers among men and women in the United States, according to background information in the article. The presence of numerous benign or atypical nevi are the strongest risk factors for melanoma development. "The number and size of nevi are often used for determining the risk of developing melanoma," the authors write. "The risk factors for melanoma and factors associated with higher nevus counts are the same: lighter hair color, eye color and skin color; greater UV exposure; higher frequency and severity of sunburns; male sex; and freckling." Although previous studies on tanning exposure and nevus development in the white population have been conducted, none have investigated the relationship between tanning and nevi in those with the lightest skin. Jenny Aalborg, M.P.H., of the Colorado School of Public Health, University of Colorado, Denver, and colleagues conducted skin exams in 2004, 2005 and 2006 to determine full-body counts of nevi in 131 very-light-skinned white children without red hair and 444 darker-skinned white children without red hair born in Colorado in 1998. Participants' skin color, tanning measurements and hair and eye color were also noted. Redheads were excluded because numerous previous studies suggest that individuals with red hair report fewer nevi than all other hair colors in the white population. "Among very-light-skinned white children, geometric mean [average] numbers of nevi for minimally tanned children were 14.8 at age 6 years; 18.8 at 7 years and 22.3 at age 8 years. Mean numbers of nevi for tanned children were 21.2 at age 6 years; 27.9 at age 7 years and 31.9 at age 8 years," the authors write. "Differences in nevus counts between untanned and tanned children were statistically significant at all ages. The relationship between tanning and number of nevi was independent of the child's hair and eye color, parent-reported sun exposure and skin phototype." There was no correlation between tanning and nevi among darker-skinned white children.
"In conclusion, UV tanning promotes nevus development in non-redhead children with the lightest skin pigmentation," the authors write. "Whether nevus development is directly in the pathway for melanoma development or a surrogate marker for UV-induced skin damage and/or genetic susceptibility to melanoma, our results suggest that tanning avoidance should be considered as a measure for the reduction of melanoma risk in this population."
Editor's Note: This study was supported in part by a grant 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, September 21, 2009
Incomplete Radiation Therapy Common Among Medicare Recipients With Head and Neck Cancer
CHICAGO—Medicare recipients with head and neck cancer commonly do not complete radiation therapy without interruptions or at all, according to a report in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Patients who have surgery before radiation treatment appear more likely to complete therapy, whereas those who have other illnesses or who have chemotherapy first may be more likely to experience interruptions or discontinuation in radiation treatment. Head and neck cancers are a complex group of tumors that involve the sinuses, lips, mouth, pharynx and larynx, according to background information in the article. "Radiotherapy [radiation therapy] alone or as an adjuvant to surgery and/or chemotherapy has been shown to be curative in patients with local or regional head and neck cancers," the authors write. "Clinical evidence suggests that the radiation dose and duration of treatment is correlated with tumor control and survival. Breaks in radiotherapy have been associated with inferior tumor control in the larynx, pharynx and oral cavity." Megan Dann Fesinmeyer, Ph.D., M.P.H., of Fred Hutchinson Cancer Research Center, Seattle, and colleagues used cancer registries linked to Medicare data to identify 5,086 patients diagnosed with head and neck cancer between 1997 and 2003. They then calculated the timing and duration of radiotherapy using Medicare claims data, and performed analyses to estimate the association between tumor and clinical characteristics and any interruptions or discontinuation of therapy. A substantial percentage of patients (39.8 percent) had interruptions in radiation therapy or failed to complete the course of therapy. Patients who had surgery at any tumor site were more likely to complete radiotherapy with no interruptions (70.4 percent, vs. 52 percent of those who did not have surgery). However, patients with co-occurring illnesses, those who underwent chemotherapy and those whose disease had spread to surrounding lymph nodes were less likely to do so. "Surgical patients may be more likely to complete radiotherapy for several reasons. First, characteristics that make patients good candidates for surgery may also make them more likely to complete radiotherapy. Because comorbidities are known to decrease survival in patients with head and neck cancer, healthier patients may be chosen by surgeons to complete more rigorous treatments (e.g., surgery in addition to radiotherapy)," the authors write. "In addition, patients who are willing to undergo major surgery to treat their disease may also be more motivated to complete a full course of uninterrupted radiation therapy, despite any toxic effects of treatment that may occur."
Further research is needed to understand the factors associated with interruptions or failure to complete radiation therapy among patients who do not have surgery, the authors conclude. "Because chemotherapy appears to reduce the likelihood of completing radiotherapy, future research is needed to identify specific agents, doses and schedules that specifically reduce the likelihood of completing treatment in community settings," they write.
Editor's Note: This study was supported by an unrestricted research grant from Amgen, Inc. Dr. Fesinmeyer reports ownership interest in Amgen, Inc. Co-author Dr. Mehta reports having served as a consultant for Amgen, Inc. 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, September 21, 2009
Study Examines Treatment and Outcomes for Nasal Fractures
CHICAGO—Both minimally invasive and traditional open approaches can successfully repair nasal fractures, provided the procedure is matched to the individual fracture, according to a report in the September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. A treatment algorithm based on factors such as fracture type and degree of septal deviation (displacement of the bone and cartilage separating nostrils) may help surgeons choose the appropriate treatment. Nasal fractures are common, but treatment of these injuries remains controversial among surgeons, according to background information in the article. Some recommend no intervention at all, whereas others favor extensive open surgery using rhinoplasty techniques. Treatment is typically divided into closed reduction (minimally invasive repair) or open reduction techniques. "Closed reduction is a relatively simple procedure, at times producing acceptable outcomes," the authors write. "However, advocates of open reduction purport better cosmetic results and a high likelihood that closed reductions will eventually need a second operation using an open reduction technique." "Deciding which technique to use for a given nasal fracture can be challenging. Not all fractures can be treated using closed techniques and, conversely, not all fractures require the time and expense of an open reduction," they continue. Michael P. Ondik, M.D., and colleagues at Penn State Hershey Medical Center, Hershey, Pa., studied 86 patients who received treatment for nasal fractures (41 who had closed treatments and 45 who had open treatments) at the facility between 1997 and 2007. Fractures were classified as one of five types, revision rates were calculated for each group, pre- and post-operative photographs were rated and available patients were interviewed about aesthetic, functional and quality of life issues. The revision rate for all fractures was 6 percent, including 2 percent for closed treatment and 9 percent for open treatment. Many closed treatment cases were classified as type II fractures, or simple fractures that included septal deviation, whereas most open treatment cases were classified as type IV fractures (severely deviated nasal and septal fractures). "There was no statistical difference in revision rate, patient satisfaction or surgeon photographic evaluation scores between the closed and open treatment groups when fractures were treated in the recommended fashion," the authors write. A treatment algorithm that considers fracture type, whether the fracture is impacted (in which bone fragments are wedged together) or incomplete, the degree of septal deviation and whether previous treatments have failed could help surgeons determine the best approach to each individual fracture, the authors note.
"A successful management algorithm should provide each patient with an aesthetically and functionally superior repair, leaving the most invasive repairs for only those patients who require it and allowing simple fractures to be managed relatively conservatively. Our results validate this approach and effectively 'even out' the outcomes between the open and closed groups," they conclude. "We believe that our classification system and management algorithm represent a new paradigm in nasal fracture management."
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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